Clause 8 — Limited capability for work
Orders of the Day
Alan Haselhurst (Deputy Speaker)
With this it will be convenient to discuss the following amendments:
No. 80, in page 6, line 37, leave out 'a medical examination' and insert 'an assessment'.
No. 81, in clause 9, page 7, line 30, leave out from 'medical examination' and insert 'assessment'.
No. 82, in page 7, line 38, leave out 'a medical examination' and insert 'an assessment'.
No. 89, in clause 10, page 8, line 7, leave out 'health-related'.
No. 90, in page 8, line 12, leave out 'health-related'.
No. 91, in page 8, line 15, leave out 'health-related'.
No. 92, in page 8, line 22, leave out 'health-related'.
No. 93, in page 8, line 44, leave out 'health-related'.
No. 94, in page 9, line 2, leave out 'health-related'.
No. 95, in page 9, line 8, leave out 'health-related'.
No. 96, in page 9, line 11, leave out 'health-related'.
No. 83, in page 9, line 12, leave out 'health care'.
No. 72, in page 9, line 16, leave out 'his physical or mental condition' and insert
'factors that limit his capability to work'.
No. 84, in page 9, line 20, leave out 'health care'.
No. 85, in page 9, line 23, at end insert
'or is concerned with the employment of such individuals'.
Roger Berry (Kingswood, Labour)
All 16 amendments are in my name and the names of my hon. Friends; that is, I suppose, the parliamentary equivalent of getting a full house. I do not intend to dwell on each of them in detail, but I wish to explain what they have in common and where the differences lie. In essence, the amendments are an attempt to move the Bill, strong though it is, closer to a social model of disability and to make it less obviously focused on issues of medical assessment and health-related matters.
Let me illustrate my point by discussing the first sub-group. Amendments Nos. 79 to 82 would amend clauses 8 and 9, which concern assessments relating to limited capability for work and limited capability for work-related activity. As the Bill is currently drafted, regulations may make provision for such medical examinations as regulations may require. The purpose of the amendments is to remove the commitment that regulations must be limited to defining capability for work or work-related activity according to a medical examination.
The point that I am making is similar to that made by Mr. Hunt in his first contribution to the debate; he did not say that he was articulating the social model of disability, but of course he was. Gone are the days of 12 years ago when finding a Conservative MP who understood the social model of disability was a bit like winning on the pools. Now we are all into the social model of disability, which I welcome. I am being serious, not sarcastic, and I know that the hon. Member for South-West Surrey was not in the House 12 years ago. My serious point is that the whole House seems to have moved towards an understanding that the problems faced by disabled people and those with long-term illnesses in trying to secure employment are not just a medical issue. Medical matters are important, of course, but the whole issue is more important than that.
The first four amendments are designed to extend the ability of regulations to include other factors and other types of assessment that may not be medically related. Perhaps I can give a simple example. Let us consider someone with a sight impairment. Assessing such a person's capability for work-related activity may matter little as far as a medical examination is concerned. A medical examination may not tell us anything at all that we do not already know; it may be of no value in making a serious assessment of whether such an individual is capable of work-related activity. If one talks about assistive technology for people with sight impairments, one is probably getting closer to the nub of the problem. A whole range of circumstances and other factors—in addition to the specific sight impairment—may affect a person's capability of undertaking work-related activity. I have already referred to assistive technology, but education, skills, training or environmental factors such as access to the workplace may also be relevant, as may other factors within the purview of the employer. Financial support from the Government and whether funding is available for reasonable adjustments are further factors.
The main point is quite simple: changing the wording in clauses 8 and 9 to include "assessment" rather than "medical examination" leaves open the possibility that regulations can investigate and address the relevant factors. If we do not change the wording, we will close off the possibility of taking into account issues that are, in my view, essential to determining whether people have a limited capability for work or for engaging in work-related activity.
John Robertson (PPS (Dr Kim Howells, Minister of State), Foreign & Commonwealth Office; Glasgow North West, Labour)
Is my hon. Friend saying that in changing the words from "health assessment" to just "assessment", he means that there has to be an ability for more than one person's assessment of the client or customer to be taken into consideration? Does he mean that a physiotherapist or perhaps a social worker who understands the client's problems should be involved? Is he saying that someone needs to look at the bigger picture rather than take account only of ordinary health matters?
Roger Berry (Kingswood, Labour)
Yes, indeed; I am saying precisely that. I will come in a few moments to the amendments that deal particularly with assessments. I am concerned that parts of the Bill refer only to assessments by health professionals, because when we consider the factors that restrict people's ability to engage in work-related activity, not only the health professional's assessment matters. It is the assessment of professionals who understand the workplace that matters.
Michael Weir (Spokesperson (Energy; Work and Pensions; Trade & Industry); Angus, Scottish National Party)
I very much agree with the hon. Gentleman and his amendments seem sensible, but given that his examples relate to new technology or perhaps involve adaptations to the workplace, considerable costs may be incurred. We have already heard concerns about funding the roll-out of pathways to work, so has he made any investigations into the potential cost of the changes that he wants?
Roger Berry (Kingswood, Labour)
The hon. Gentleman will know that I have raised the issue of resourcing this programme both in the Chamber and elsewhere, and I am sure that discussions between the Minister and the Treasury are ongoing. Clearly, the important point is that the more people are empowered to go back to work, the more the Exchequer saves a substantial sum of money: the recycling possibilities are enormous.
Let me move on briefly to amendment No. 89 and amendments Nos. 90 to 96, which relate to the work-focused health-related assessments. They are designed essentially to remove reference to "work-focused health-related assessments" and to replace that phrase simply with "work-focused assessments" for precisely the reason that I do not see why we cannot talk about work-focused assessments in the round. I have already made the point, but let me provide another example.
Someone who has been a wheelchair user from childhood or, like one of my constituents, is a wheelchair user as a result of an accident, may subsequently be far healthier than someone who is not disabled. The problem is not the health assessment of a wheelchair user, but assessing that person's capacity to engage in work-related activity and, ultimately, to work. That can have a lot to do with access to the workplace, as the building may require ramps, lifts and so forth.
I genuinely do not understand why, when we are talking about work-focused assessments, which are crucial to the Government's strategy, we have to tag on the "health-related" provision. Someone somewhere, it seems to me, has a bit of the old medical model in the system and I am urging whoever it is to relax a little and look more broadly at the obstacles that people face, because they are not always entirely health-related.
Amendments Nos. 83 to 85 are designed to amend clause 10. As drafted, subsection (7) states that
"'work-focused health-related assessment' means an assessment by a health care professional"—
a point that has been made already. I reiterate that work-focused assessments should not be restricted to health matters, so those who make the assessments should not be restricted to health professionals: that follows as night follows day.
Time is limited, so I shall move quickly to amendment No. 72, which also relates to clause 10. Subsection(7)(c) refers to assessing
"such other matters relating to his"
or her "physical or mental condition". Again, instead of referring to matters confined to that condition, why do we not make provision for factors that limit people's "capability to work"?
In summary, all 16 of my amendments are designed to recognise that capability for work or work-related activity is not solely a health matter and cannot be solved only by medical or health professionals. The Government obviously subscribe to the social model of disability—hence the whole package of measures introduced over the past 10 years that have been all about empowering disabled people to remove the barriers that they face in work and elsewhere. That is what motivates the strategy. Clearly, the Opposition—and I mean both parties—subscribe to the social model of disability, so I feel sure that they will strongly support the sentiments that I have expressed.
To conclude, the danger of not seeking to deal with the concerns that I have expressed through the amendments is that the Government will deny themselves the possibility of framing regulations that adopt a broader approach to meeting individual need. If they are not careful, they will be less successful in achieving the objectives that we all share.
Jeremy Hunt (Shadow Minister (the Disabled), Work & Pensions; South West Surrey, Conservative)
It is a pleasure and privilege to follow Roger Berry, who is extremely well known for his commitment to dealing with disability issues. I am sorry that listening to one of my speeches is no longer like winning the pools, as it might have been 12 years ago. I believe that there is indeed considerable understanding of the social model of disability in the Conservative party.
As the hon. Gentleman rightly said, his amendments are intended to promote the social as opposed to the medical model of disability. Some hon. Members might be tempted to think that this is all a matter of semantics, but if they did, they would be greatly mistaken. The social model is essentially a recognition that, if we are to move towards including disabled people in the mainstream of society, we have to move beyond seeing disability as a purely medical condition. We must also accept the importance of removing the barriers faced by disabled people in society at large—whether they be practical barriers, such as problems with physical access to buildings or public transport, or psychological barriers caused by the attitudes and prejudices of others.
One of the disappointments of the Bill is that it says nothing about the responsibilities of the wider community to help disabled people achieve engagement in the world of work. There is plenty of talk about what might be called the supply side of the problem—that is, about getting people ready for work—but very little about the demand side of ensuring that opportunities are not stifled by outdated or prejudiced attitudes among employers or society at large. That is where the social model is very important.
In Committee, we had substantial discussions about the appropriate use of language. A number of amendments suggested using the phrase "labour market disadvantage" instead of "limited capability for work" at the beginning of the process. The Minister rejected that option, and he may be tempted to use the same arguments again today, but today's amendments are nothing like as strong, as they would simply replace the words "medical examination" with the word "assessment". Omitting the word "medical" would not mean that no medical examination would take place, but it would make it possible for the medical examination currently planned to be expanded to cover a wider remit, as and when the Government consider that to be appropriate. The Minister may argue, as he did in Committee, that it is vital that the tests be objective. My response is that that objectivity is not confined to medical tests: when a person faces a barrier to employment that is linked to a disability, can that not also be looked at objectively?
Conservative Members accept that an objective assessment of a person's impairment must be the starting point. That means, at a bare minimum, that the phrase "medical examination" in clauses 8 and 9 should be changed to "health and disability examination". The phrase "medical examination" strongly suggests an examination of a person's health, but it is clear from the PCA, the regulations and the 48 descriptors used to assess a person's limited capability for work-related activity that the medical examination will look at issues to do with that person's health and disability.
The amendments would remove the language problem. Removing the word "medical" and calling the process an "assessment" would allow the process to be defined much more broadly. It would also allow it to be defined nationally and consistently. The Minister made clear in Committee his legitimate concern that widening the assessment to take account of other, non-health related factors would be unworkable in practice, but I repeat that the amendments would not commit the Government to widening the scope of the assessment in a specific way that would make it unworkable. They would merely change the language used to allow for a possible widening of the scope of the assessment at a later stage.
If the Government accepted the proposals, they would be signalling that they really understand that achieving the Bill's objectives involves tackling the wider barriers that disabled people face, as well their individual impairments. Therefore, I hope that the Government will give the amendments careful consideration.
Danny Alexander (Shadow Minister and Disability Spokesperson, Work & Pensions; Inverness, Nairn, Badenoch and Strathspey, Liberal Democrat)
I shall be very brief, as I know that the Minister wants to respond to the debate. The amendments so eloquently explained by Roger Berry touch the conceptual basis of the Bill, and are profoundly important. He was right to say that all parties subscribe, to a greater or lesser degree, to the social model of disability. They agree that a disability is not merely a health condition or impairment, but has to do with the barriers that society puts in the way of people who are disabled. It is important that the Bill reflect that conceptual agreement, and the amendments draw attention to the language that is used in the Bill.
Mr. Hunt said that we debated amendments in Committee that would have used the term "labour market disadvantage" in relation to disability or impairment. I believe that that would capture much more accurately what the assessment procedure would determine, and today's amendments would allow the same thing to happen. They would not in every case lead to huge changes in how the assessment process works—although they might do so in respect of the work-focused health-related assessment—but they would send the clear signal that the Bill makes real the Government's acceptance of the reality of the social model of disability. For that reason, I commend the amendments to the House.
Charles Walker (Broxbourne, Conservative)
I am sorry that I was not present for the whole debate, but I congratulate Roger Berry on these amendments.
I believe that the vast majority of people not currently in the labour force want to work. I have been a Member of Parliament for 18 months, and most of the people with disabilities whom I have met in that time have been desperate to re-enter the work force. I understand the arguments underpinning the amendments—that the words "medical assessment" attach a pejorative meaning to a condition that many people have come to terms with.
People with serious disabilities try to overcome them, and very often succeed—to the extent that when one meets them on the street and asks how they are they respond by saying that they are feeling extremely well. They say that because they have moved on from their disability, and that is why the hon. Member for Kingswood is right to say that the word "assessment" is much to be preferred.
With this Bill, we are trying to help people re-enter the labour market. We are not burdening them with a medical condition, but are trying to find a route that eases them back into work. We are also trying to put in place the support systems that allow them to re-enter the labour force with the mechanisms that they need to be productive and have successful and fulfilling careers.
Many of the people whom I have met feel excluded from the labour market because they believe that there is a lack of understanding of, or concern about, what they need to make the transition back into work. I know that my party supports these amendments, so my support for them will not upset anyone. People with disabilities face the stigma that they have a medical condition. If the amendments get rid of that, that is another excellent reason to support them.
Jim Murphy (Minister of State (Work), Department for Work and Pensions; East Renfrewshire, Labour)
I am pleased to have the opportunity to respond briefly to this important debate on the 16 amendments tabled by my hon. Friends the Members for Kingswood (Roger Berry), for Bradford, North (Mr. Rooney) and for Hayes and Harlington (John McDonnell).
My hon. Friend the Member for Kingswood was right to say that the Government have taken the social model approach to civil rights and the rights of people who are disabled, in relation to the labour market but in other aspects of public policy too. The Disability Discrimination Act 1995 was followed by the establishment of the Disability Rights Commission and other strengthening of disabled people's civil rights. Although these amendments differ from the proposals discussed in Committee, for technical reasons I cannot accept them. If I have time, I shall explain why the wording used prevents that, but I assure my hon. Friend that I am happy to expand on the specifics in the regulations that are put forward.
In the minute and a half that I have left, I want to assure the House that the work-focused health-related assessment and the medical examination process will not look only at medical issues. Non-medical barriers will not be ignored; they will also be taken into account in the draft regulations based on these clauses that we will table for consideration. They will be specific and detailed in their approach, and will examine more than just the medical barriers faced by people with disabilities who want to re-enter the labour market.
The reason why we are using the phrase "medical examination" is that the word "assessment" is a catch-all that captures all three parts of the process—gathering the evidence is part of an assessment; the medical examination is part of an assessment; and the work-focused health-related assessment is also part of a wider assessment. In clause 8 and in regulations we use the word "assessment" to relate to the whole process.
Although I accept the way in which my hon. Friend has tabled his amendments, technically we think that they are confusing.
It being Eight o'clock, Mr. Deputy Speaker put forthwith the Question already proposed from the Chair, pursuant to Order [this day].
Alan Haselhurst (Deputy Speaker)
I apologise to the hon. Gentleman; he was not called during the time allotted by the programme motion, so I must now put the question. If the House so wishes, it can be negatived.
Mr. Deputy Speaker then proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour.