I beg to move,
That this House
has considered the matter of Atos work capability assessments.
I warmly thank the Backbench Business Committee for enabling me and cross-party colleagues to introduce this debate on Atos work capability assessments. There is enormous concern about the issue both in the country and in this House, as witnessed by the fact that more than 30 Members wish to speak on a Thursday. To try to ensure that they can all do so, I propose to speak for no more than 10 to 15 minutes. I hope that colleagues will accept that, for reasons of pressure on time, I do not propose to take interventions.
As knowledge of the debate has spread, I have been sent nearly 300 case histories, many of which make heart-rending reading. I cannot begin to do justice to their feelings of distress, indignation, fear, helplessness and, indeed, widespread anger at the way they have been treated. Nor can I easily contain my own feelings at the slowness, rigidity and insensitivity with which Atos and the Department for Work and Pensions have responded—or very often not responded—to the cries of pain that they have heard repeatedly. I have time to cite briefly only three examples which show how extreme is the dysfunction and malfunctioning of the Atos assessments.
The first example concerns a constituent of mine who was epileptic almost from birth and was subject to grand mal seizures. At the age of 24, he was called in by Atos, classified as fit for work and had his benefit cut by £70 a week. He appealed, but became agitated and depressed and lost weight, fearing that he could not pay his rent or buy food. Three months later, he had a major seizure that killed him. A month after he died, the DWP rang his parents to say that it had made a mistake and his benefit was being restored.
The second example, also from the Oldham area, concerns a middle-aged woman who was registered blind and in an advanced stage of retinitis pigmentosa. She was assessed at 9 points—well short of the 15 that are needed—and her incapacity benefit was withdrawn. On review by a tribunal, the Atos rating of 9 points was increased to 24.
The third case—I could have chosen from hundreds of others—also comes from the north-west and concerns an insulin-dependent diabetic with squamous cell cancer, Hughes syndrome, which involves a failed immune system, peripheral neuropathy, which meant that he had no feeling in his feet or legs, heart disease, depression and anxiety. Despite his life-threatening condition, he was placed in the work-related activity group.
Those and myriad other examples illustrate incontrovertibly that Atos’s current work capability assessment system is drastically flawed, and for several reasons. First, Atos is an IT firm and it uses the so-called Logic Integrated Medical Assessment, which is often described as “rigid” and “tick-box” because computer-based systems make it difficult for health professionals to exercise their professional judgment. Because such a mechanistic system has little or no regard for the complexity of the needs of severely disabled or sick persons, the British Medical Association and others have condemned the current WCA as “not fit for purpose”.
Despite my hon. Friend being my colleague in Oldham, I really must keep strictly to what I said, but I very much hope that she will be called.
Secondly, assessed persons regularly felt that the opinion of their own doctor or of other specialist medical personnel who were treating them was either ignored or overridden. That is all the more serious when Atos’s practices simply do not adhere to the guidance for doctors set down by the General Medical Council.
Thirdly, because of the failure of so many initial assessments, the appeal procedure is grossly overloaded and hugely expensive. No less than 41% of decisions are appealed, of which 38% are won. At £60 million in a single year, the appeals have cost the taxpayer more than half of the £110 million that was spent on the original assessments. Moreover, the National Audit Office has castigated the Department for failing to penalise Atos for what it politely calls its “underperformance” and for not setting “sufficiently challenging” targets.
Fourthly, there are concerns about the responsibility for work capability assessments, in particular that of the Atos chief medical officer. Professor Michael O’Donnell joined Atos from the American company, Unum, formerly UnumProvident, which had a very poor reputation in the US, where it was described as an “outlaw company” by the US authorities, partly because it was regarded as a “disability denial factory”. In that situation, the responsibilities of the Minister and the Secretary of State need to be established clearly.
Against that background, it is frankly not good enough for the Minister to respond to the debate by saying that there have been three Harrington reviews, and that the Department is doing the best it can to improve procedures. The fundamental issue is this: how can pursuing with such insensitive rigour 1.6 million claimants on incapacity benefit, at a rate of 11,000 assessments every week, be justified when it has led, according to the Government’s own figures, to 1,300 persons dying after being put into the work-related activity group, 2,200 people dying before their assessment is complete, and 7,100 people dying after being put into the support group? Is it reasonable to pressurise seriously disabled persons into work so ruthlessly when there are 2.5 million unemployed, and when on average eight persons chase every vacancy, unless they are provided with the active and extensive support they obviously need to get and hold down work, which is certainly not the case currently?
I therefore want to conclude by asking the Minister five specific questions to which I want a specific answer before the end of the debate. First, it is true that Harrington has produced minor adjustments—implemented at a glacial place—but the underlying system remains largely undisturbed. The BMA and the NAO have therefore called for a thorough, rigorous and transparently independent assessment of the suitability of the work capability assessment. Will the Minister now implement that?
Secondly, will the Minister accept that the current criteria and descriptors do not sufficiently—or even at all—take into account fluctuating conditions, especially episodic mental health problems? How will he rectify that?
Thirdly, will the Minister provide full and transparent details of the Atos contract? They should not be hidden by specious claims of commercial confidentiality when Atos is the sole provider of what is clearly a public service. Better still, given that Atos has failed so dramatically, why does he not in-source the work back into the NHS?
Fourthly, how will the Minister ensure that the medical expertise of disabled persons’ doctors and related professionals is fully taken into account before assessments are completed?
Lastly, I want to provide a full dossier to the Secretary of State so that he fully understands what is being done today in his name, and to bring a small delegation to see him from some of the excellent organisations of disabled people who have heroically battled to highlight and tackle the distress and pain caused by Atos. Can I please be assured that the Secretary of State will see such a delegation?
I repeat that I am sincerely grateful for this debate, for the co-operation of colleagues from all parties, and for the detailed responses I have received from so many hundreds of victims of Atos, but I assure the Minister of this: the debate is important, but it will certainly not be the end of the matter.
Order. If everybody could resume their seats, I just want to inform the House that there are 28 Members who wish to participate in this relatively short debate. My responsibility is to protect Back Benchers’ time and get as many Back Benchers in as I possibly can. While we are starting at six minutes, you should start to think in terms of a four-minute contribution if you possibly can, so that as many Members as possible can get in.
I offer my hearty congratulations to Mr Meacher. He has long been known as a champion in this area. I listened carefully to what he had to say and I am afraid that my experience, and that of the people I have been talking to, mirrors much of what he is saying.
I would like to address the debate from the perspective of people with autism. There is a great deal of concern on both sides of the House, and among our constituents, about the way this process handles people with autism. The National Autistic Society, which provides advice to so many of us in this House and on which we rely a great deal, believes that the work capability assessment should be delivered differently so that it is fair and appropriate for claimants with autism.
More than 2,000 people have signed a National Autistic Society petition to Atos, which was launched following the “Dispatches” and “Panorama” investigations, with which many of us are familiar, into the company last year. The programme claimed that Atos was working to internal targets on the numbers of people being put into the work-related activity group, the support group or as being fit for work. Atos has indicated that it is open to working with the National Autistic Society and other charities, including in the context of this petition, but I have a specific question for the Minister. Will the Minister provide assurances that no such targets are in place?
There have been key concerns with the face-to-face assessment process. The work capability assessment model can certainly prove to be challenging in the context of claimants with autism. Most people with autism have difficulties with social interaction, and some will also lack insight into their difficulties. They may also have difficulty understanding the questions being asked and with communicating a response. Even travelling to the assessment centre and engaging with the process may be difficult to understand and create great anxiety. Therefore, face-to-face assessments may not always result in a fair and accurate assessment of claimants’ ability to work. The NAS has had a lot of inquiries relating to the quality and appropriateness of the WCA for claimants with autism, and that feeds into a broader picture of widespread concern.
There is also concern about the awareness of, and training for, assessors. In the cases of claimants with autism, including high-functioning autism and Asperger’s syndrome, difficulties in the workplace may not be obvious and may not become apparent in the course of a face-to-face assessment. That could be due to the hidden nature of the disability and a desire to appear more able than they really are to an assessor, or to other difficulties with this form of communication associated with the condition. It is therefore a strongly held view that it is vital that claimants with autism are assessed by professionals who have received autism-specific training. That would ensure that assessors have a better understanding of autism and routinely make reasonable adjustments as part of their assessment.
If the hon. Lady will forgive me, I have only a short time to speak.
I think people are pleased that the Government have committed to having mental and cognitive champions, but I believe that people are concerned at the number of champions, their level of training and their expertise in autism. Our understanding is that there about 60 across the UK and it remains unclear what, if any, expertise they have in autism.
On collecting evidence, the NAS has consistently called for a tiered approach to assessment, both in terms of the WCA and the assessment process, for the personal independence payment under the new benefits system. I hope that the Minister, who has met recently with the NAS, Mind and other organisations, has listened carefully, and I am looking for reassurance in his response that all these points will be taken onboard.
In summary, I have a few questions for the Minister. What steps will the Government take to ensure that Atos collects existing evidence relating to a claimant’s capability to work, which would create a more cost-effective and streamlined system? Do WCA assessors receive autism-specific training? If so, of what does it consist?
How many of the mental and cognitive champions currently operating at Atos assessment centres have specific autism training? How will he monitor the effectiveness of the introduction of those mental and cognitive champions?
I am sorry I could not give way to Meg Hillier, because I know she has a great track record and a special interest in this matter, but I hope that she will make her own speech. I hope that I have reflected in my contribution the widely held concern about this process among those least able to speak for themselves, and I hope that the Minister will respond positively.
I pay tribute to my right hon. Friend Mr Meacher and thank him for bringing this debate to the Backbench Business Committee. We were delighted to schedule it, and the number of Members present from both sides of the House demonstrates the importance of this issue mainly from a constituency perspective. I, like all other Members, have received a huge amount of correspondence about awful, tragic cases of individuals who have been badly treated by Atos during their work capability assessments.
The fault lies not with Atos, but with its employer, which, in this case, is the Department for Work and Pensions. When we look at the other employers for which Atos works, such as Royal Mail and the NHS, we see numerous cases of people who have been signed off work—not just their current work, but for any work ever again, with a recommendation that they be retired from all kinds of work—going back to Atos, but this time when it is employed by the DWP, and being assessed as entirely fit for work. They get no points and are deemed fit for work. As my right hon. Friend said, the number of people who are not just not fit for work but who die after being assessed as fit for work, is a reflection not of Atos but of the DWP. That is where the questions need to be asked.
I am sure that my hon. Friend will not be surprised to learn that in Gateshead, of the 1,400 cases taken to appeal by the citizens advice bureau, more than 1,200 were successful. I am worried about the CAB’s lack of capacity to deal with other cases that it could have taken but which have been unsuccessful because they were not advocated at tribunal.
I am glad that my hon. Friend has made that point as I want to come to that.
The proportion of original Atos decisions that are overturned is shocking—it is about 30% or 40%. I would be grateful if the Minister replied to that point. Precisely how many people deemed fit for work by Atos have their decisions overturned on appeal and are signed off work? I have asked about that in the past. The number is very high, but I would like to have the precise figure.
The welfare rights organisations dealing with the people who are being deemed fit for work—for instance, the unemployed workers centre in Derbyshire and the CAB—are swamped at the same time as they are having their funding cut. Not only are they swamped with work, but volunteers are leaving in droves because they cannot cope with the amount of work and the stress of seeing all these cases.
How many people deemed fit for work who do not take their cases to appeal then find work? As has been said, the employment situation, especially the further north we go in the country, gets worse and worse. In my constituency, there are 15 people applying for every job. Is it really for the best to sign people as fit for work when there are no jobs to be had? I would like answers to those specific questions.
We all want people to go back to work if they can, but the welfare state is there to protect those who cannot. People who are not fit for work would love to work if they could, but they cannot. The jobs are not there, but they are being signed fit for work. How many of them are getting a job, and how many of them are just being signed over to destitution?
As Natascha Engel said, we need to separate two things. The first is the principle of assessing those on out-of-work benefits to establish whether they can rejoin the workplace. As everyone in the House accepts, that must happen if we are to be responsible guardians of the public purse and if we are to help people who can work to get back into work. The second is the need to look in detail at the practice of how the assessments are being conducted.
I am grateful to my hon. Friend for giving way so quickly. A number of people who have been assessed reasonably recently had their incapacity benefits stopped but then reintroduced on appeal are now being reassessed and found fit for work once again. Surely people who have recently been assessed and won on appeal should not be being recalled by Atos.
I absolutely agree with my hon. Friend and what he says goes to the nub of the points I wish to make. This debate should focus on the practice of how these assessments are being conducted. He, like me and probably every Member, will have had scores, if not hundreds, of constituents experience a similar problem as they go through the system.
There is a consensus in the House on the principle of making assessments. The last Administration set up the WCA and the Atos contract in 2008, and it was right that in 2007 Liberal Democrat Members pressed for and secured the annual review of how the WCA was being implemented. Over the last few years, as every hon. Member will know, these reviews have revealed a catalogue of errors, and, to their credit, the coalition Government have taken action: there has been increased flexibility for assessors to take additional evidence, not least from consultants; there has been better communication with people undergoing assessment; and new standards have been implemented for descriptors. All that is having results. The numbers going into the ESA support group have risen to 26%—from 11% under the last Administration —so fewer people are now being found fit for work.
None of us can underestimate or undervalue the human effect that some of these assessments are having. I would like to read into the record an e-mail I received from a constituent. It is probably similar to e-mails that all hon. Members have received. It reads:
“They never asked about the amount of pain I have to contend with or how tired I get from coping with it. After the interview I was told I was to be disallowed ESA benefit. I could probably go down the route of appeal but I really don’t feel like fighting for a benefit that I have already been made to feel that I do not deserve, neither do I have the energy” to appeal. If we in this House cannot give voice to these people, who are some of the most vulnerable in our society, I really do not know what we are for.
To illustrate one of those cases, I shall cite a letter I received from a constituent, Janine, in Liverpool. Her dad was thrown off sickness benefit in November after an Atos work capability assessment and was declared fit for work despite suffering from chronic obstructive pulmonary disease. Six weeks later, on Christmas day, Janine’s father died. Does the hon. Gentleman agree that this example clearly highlights the fact that the work capability assessment, run by the DWP, is fundamental flawed?
As I have said, and as I am sure the hon. Gentleman would acknowledge, the point is not the principle of conducting assessments but the practice—how they are rolled out and how millions of our constituents experience them. Constituents have told me that they find the process dehumanising and degrading and that they are often seen by people who are unqualified to make an assessment of their condition. We have to get the assessment process right. That is right for the individuals concerned, but it is also the decent, moral and humane thing to do.
I am particularly concerned about those with fluctuating conditions such as ME—myalgic encephalomyelitis, or chronic fatigue syndrome—and those with lifelong degenerative conditions, who will never recover from the illness from which they are suffering but who continue to be called in for repeated assessments. The principle is the right one; the practice, however, is failing many millions of the most vulnerable people across the country. Although the coalition has made welcome efforts to get right a system that it inherited from the last Government, much more still needs to be done to ensure that we are doing things in a humane way.
Does my hon. Friend agree that most people were extremely pleased that Professor Harrington convened his working group to look at the descriptors for fluctuating conditions? However, whatever has happened has not solved the problem for people with ME, multiple sclerosis or mental health conditions. It is therefore imperative that the DWP get on with this and make the system work for those people.
I could not have put it better. This is not about the principle of assessments; it is about how they are conducted in practice. We owe it to some of the most vulnerable people across our country to ensure that we get this right.
Nothing has shocked me more as the Member of Parliament for Airdrie and Shotts than the sheer scale of anxiety and hardship caused by the flawed work capability assessments, which is apparent in the number of people visiting my office every week. I am sure that that experience is replicated across the House and that we will hear many such stories today. I have had a frail lady sitting in my office who had only recently finished chemotherapy but had been told she was fit for work. I have had a lady who suffered 90% burns to her body—she spends every day in severe pain—and was told that she was now ready to join the Work programme. I could list hundreds of others—sadly, these are very familiar stories. These people are having their lives ruined by a system that was designed to support them.
Last year the whole country came together to celebrate the Paralympic games. I have to say that the vast majority of the country joined those booing in the Olympic park when the Chancellor took the spotlight, but he was not the only unpopular person at the games. Atos’s sponsorship was also widely condemned, leading to protests throughout the country, including by our very own Team GB. Unfortunately, the Scottish Government have not listened to the Scottish people on this. In fact, our Deputy First Minister has welcomed Atos’s sponsorship of the Commonwealth games next year. She has tried to wriggle out of it by saying that Atos is only carrying out the will of the UK Government. However, the Scottish people disagree not only with the structure of these work capability assessments but with the incompetence with which they are being carried out.
As I have such limited time today, I will restrict the rest of my comments to the recording of work capability assessments, which I have raised before on the Floor of the House. I know that there has been a pilot of recording work capability assessments as a result of Harrington review. The result was that the majority of those being assessed do not wish to have their assessments recorded. However, recording should continue to be offered to everyone being assessed, and the reason for doing this—the huge number of assessments whose results are overruled when they go to appeal—should also be explained to every claimant.
The hon. Lady is making a powerful case. Does she agree that the Atos assessment process is not only humiliating and demeaning for those involved—and often plain wrong—but counter-productive, in the sense that it adds to the stress they are under, making sick people even sicker?
I thank the hon. Lady for that contribution. I am sure she has had the experience, as I have, of seeing people who have claimed employment and support allowance as a result of a physical disability or illness ending up with mental health problems owing to the stress of going through the system.
Does my hon. Friend agree that it says a great deal about the nature of the work capability assessment that not only do many people win their appeals but that so many are appealing that this can lead to delays of up to 25 weeks for them to be heard?
I completely agree with my hon. Friend. We have heard that one in six of those claiming ESA ends up eventually winning their appeal, but in North Lanarkshire—the local authority area that I live in—60% of appeals are being won by those lodging them.
“should make recording available on a voluntary basis”.—[Hansard, 4 September 2012; Vol. 549, c. 42WH.]
However, not a single constituent of mine who has come to see me about work capability assessments has told me that they have been offered the prospect of having it recorded. In fact, one constituent told me that she had asked for her assessment to be filmed, following her previous assessment, which resulted in a report that bore little resemblance to that assessment. On that occasion she was found fit for work, but she subsequently won her appeal. She was informed that recording would indeed be possible, but that she would have to pay for a private, independent company to come in to record her assessment. Equipment was not made available to her. She had hoped to take a family member in to film the assessment, but was told that this would not be allowed or appropriate. How on earth is a person living on benefits—living on the breadline—supposed to be able to afford to pay a private company to record their assessment?
The Minister’s predecessor also stated in that debate that additional audio recording machines had been ordered for work capability assessments. I hope that the Minister can today update the House on the progress made on that and on whether visual recording equipment is being purchased for that purpose. I would also like clarification on the right of the claimant to request a recording. If claimants have that right, will the Minister make it clear whether Atos is obliged to provide a recording? Will Atos reschedule an assessment date if the person concerned is told that equipment is not available on the original date? In the event that a claimant refused to go through with an assessment without a recording, would they be sanctioned in terms of their benefits?
This is an important issue to raise in the House today. Not only does it affect those going through the assessments directly, but there is a huge cost for the taxpayer, as my right hon. Friend Mr Meacher, who has brought this matter to the House today, illustrated in his speech. This process has cost £60 million in the last tax year, which is more than half the original cost of the contract with Atos to perform the work capability assessments.
Briefly, I want to make three points. Britain is rightly generous to its disabled people. That is a good thing and something that unites the whole House. That said, there have always been problems with Atos. As a major contractor, it has repeatedly failed to inspire confidence and needs shaking up. Thirdly, whatever the party politics, we must clear our minds of hyperbole and focus on the evidence and the facts. People are always fearful of change. Whatever our differences on this issue, we must focus on the politics of fairness, not the politics of fear. It was suggested in the other place that disabled people were facing “ghettoisation”. I think that is a trivialisation of the real evil of the holocaust, which is why I say that how we use our language and the facts that we set out are so important.
Like many Members here today, I feel very strongly about this issue on behalf of the hundreds of constituents who have come to see me with heart-rending cases and told me about the dehumanising process that they have been put through. Why does the hon. Gentleman think the Department for Work and Pensions and Atos have been unable to accept the recommendations of the British Medical Association and the Royal Colleges for more specific diagnostic tests that would make the assessments more appropriate?
I am here today because I care about this issue as much as the hon. Lady does. The fact remains, however, that it was the previous Government who signed the contract with Atos that led to all the problems and started the work capability assessment. This Government have accepted in full the recommendations of the Harrington review.
The disability living allowance was first introduced by John Major’s Conservative Government in 1992 as a way of helping people with the cost of their care and mobility needs. It is partly because of that reform that we now spend £50 billion a year on support for disabled people, which is one fifth higher than the EU average. I am glad that the coalition has rapidly expanded the access to work budgets, helping more than 30,000 people to retain and enter work. By this April, the disabled worker element of the working tax credit will have risen by £285 a year since the Secretary of State started in his job in 2010. The element for the severely disabled will have risen by an extra £125 a year on top of that. The Minister has said before that Britain is acknowledged as a world leader in its support and care for disabled people, and that that is something we should all be proud of.
I have initiated and signed early-day motions on these matters, and hon. Members will know that I have been an outspoken critic of the French multinational Atos in this House since November 2010, because of its treatment of a number of my constituents in Harlow, and I will go on to talk about that in a moment. I want to emphasise that this Government are expanding on what subsequent Labour Governments did after 1997.
I want to carry on for a moment.
The Labour Government were right to introduce the work capability assessment in the last 18 months before the 2010 election. Mrs McGuire, the shadow Minister for disabled people, was also right at the Labour conference to defend the idea of testing in the personal independence payment, when she said:
“The principle of an arm’s-length assessment is not wrong.”
Whatever party politics might be involved, there is consensus on the principles and on what our aims should be, and that is welcome.
The hon. Gentleman is correct in saying that the first contract with Atos was introduced by the previous Government, but why did the present Government renew and extend that contract even though they knew about all the problems that he and others have raised in the House?
I have given way twice; I need to carry on.
As I have said, Atos has not covered itself in glory. It was the main contractor when the coalition came to power, but the problems are significant. For example, the Atos benefit assessment centre for my constituents in Harlow is in Romford, 20 miles away, and it has been a source of complaints and genuine disappointment to many. I have met Ministers several times to make these points and, to be fair, they have listened to and acknowledged them. I have also made a trip to an Atos centre in London to try to understand what occurs there.
I welcome the changes that have been made by putting in place champions with expertise in mental, cognitive and intellectual conditions, but the objections from many Harlow people are not about the principle of testing, but about how it is done. We have to remember that whenever a disabled person goes for a test, that creates an enormous amount of fear inside them, because they worry that something that they rely on might be taken away. Their objections are simple ones, but the problems have massive implications for ordinary people.
The problems include centres that are inaccessible, and a long distance away. It can be difficult to travel to them, and there might be no parking there. There are sometimes no rails on the walls. People might have to lose a whole day’s earnings to attend, or use up a day’s annual leave. Some centres are on the second floor, with no proper lift. The testing centres can be hard for people in wheelchairs to get into. Some of my constituents tell me that they have been tested by doctors who do not even speak English properly. All of that is totally unacceptable, especially when people are going to those centres in fear and apprehension that that their benefit will be taken away.
I accept that, because of the contractual history, it is difficult to unwind the arrangement. What matters, however, is that we should learn lessons from what has happened to people who have been tested by Atos and use that information for the future. It is essential that those people who are tested for the new personal independence payment should go to a local centre and not have to travel far. I can understand why people should not be tested by their own doctor, but I do not understand why they cannot go to another surgery in their area to be tested. It is unacceptable that they have to travel so far, as those journeys take up an enormous amount of time. I urge the Government to look at radical localisation, and to consider the use of spare rooms in local buildings, including jobcentres.
The people who bring their complaints to me do not have an axe to grind. They just expect a public service to be as good and professional as the private sector. Given the experience of my constituents, it seems that the system that Atos has set up is still not good enough.
My caseworker, like those of many Members, is inundated with cases that are tragic and heart-rending. The telephone line to my office is often clogged with crying people. They often ring several times a day, as they are unable to cope with the stress that they are facing. Many have mental health problems, and are unable to cope with the paperwork. They are unsure what to do with it, and they ring me to ask for help in the most tragic and personal way.
My hon. Friend raises the issue of people with mental health problems. Does she agree that that is an area of great concern, along with other conditions that can fluctuate, such as HIV and AIDS? Such conditions are difficult to assess in a 15-minute interview. Does she also agree that it is the framework of the assessment that is at fault, and that Atos might have something to answer for as well?
It is absolutely clear that the framework of the assessment is unable to clarify realistically whether someone is able to work. The assessment is not valid for the purpose for which it was set up, unless that purpose was deliberately to deny people access to benefits.
The head of Atos was recruited from Unum in the United States. Is it not disturbing that the lieutenant governor of California has stated that Unum was operating “claims denial factories” for working men’s compensation? Does not that disturb my hon. Friend?
It disturbs me a great deal. Quite honestly, the lieutenant governor was right to say that, because that is what we have found in this country too.
I want briefly to describe some of the cases that I have been dealing with. I shall start with 53-year-old Mrs E, who was employed as an accounts officer. She was a very able and capable woman. She suffered a vicious sexual attack, and was diagnosed with post-traumatic stress disorder. Her health problems caused her difficulties with working, and she was forced to take redundancy. She started claiming employment and support allowance, and attended her Atos assessment. The doctor who saw her is well known to me. I have received many complaints about him. I regularly receive complaints about his rudeness, arrogance and total lack of compassion towards the people whom he is assessing. He made unprofessional remarks to Mrs E, and bluntly told her carer to shut up, saying that he did not want to hear from him.
An official complaint was made, but Mrs E was found fit for work. An appeal judge overturned the decision maker’s decision and she was placed in the support group. Three months later, she faced another Atos medical, and it was decided that she would be fit for work in six months. She was then placed in the work-related activity group. A month later, because of the stress, her mental and physical condition had deteriorated, and medical advisers told her to apply for disability living allowance. DLA was refused because of the original Atos report. When it was pointed out that the report was negative, but had been overturned on appeal, a reconsideration was requested. The DWP insisted that the information from the first Atos assessment was sound and that the only option was to appeal to the first-tier tribunal.
My constituent then faced two tribunals. We should remember that this is a lady with post-traumatic stress disorder. She faced two appeals. The first was for DLA. The decision to award the lower rate for mobility and care was backdated. Since then, another DLA application has raised the mobility and care components to the higher rate. The second appeal tribunal was for the employment and support allowance. She was placed in a support group and her benefit was backdated.
That was not the end of this lady’s trauma. Her mental health had deteriorated to the extent that she attempted to take her own life. Her carer has to remain constantly vigilant. A few months later, she received a letter saying she had been transferred back to the ESA work-related activity group from the support group. Payment for the ESA support component was stopped. Following some investigation, the DWP apologised and said that that was a random “administrative error”, but it affected the lady very badly and her mental state became even more fragile.
Despite that, incredibly, on Christmas eve last year the same “administrative error” occurred. My office was contacted, and I have to say that we were extremely angry. The additional stress was placing this lady in a suicidal position again. The application process started again, and yet again there has been an apology for an “administrative error”. This lady is being hounded by the state: there is no other way of describing it. There is no excuse for this behaviour. This is a company that is not playing fair by this country’s most vulnerable people.
I am afraid I cannot; I have only a short time.
Atos received £112.8 million in 2010-11 for its DWP services. About 60% of all claims are judged fit to work; 41% of those people appeal, and 38% of those appeals are successful. Last year, appeals cost £54 million.
How can that be seen as value for money? How can this be seen as evidence of a supportive and caring Government in action?
Here are my questions to the Minister. We are told that specific support staff for mental health will be provided. Are they in place? Are they aware of the trauma of post-traumatic stress disorder? Is sensitivity training available, because it has certainly not been made available to the ex-GP who works as an Atos assessor in my area? Has the DWP looked at the cost—to Members, to citizens advice bureaux and to welfare rights organisations—of fighting this iniquitous system?
I rise to make just a few comments, particularly on fluctuating conditions. I have received many representations from people with mental health conditions, as have other Members. Some of the individual cases and stories that sometimes come from mothers with adult daughters about what has happened during the assessment process have been absolutely heartbreaking.
Let me read out a few comments from one of my constituents, who says:
“I do not believe that the WCA is working for people with mental health problems. Too many people are found fit for work when they are not, and are becoming trapped in a distressing and expensive cycle of appeals and reassessments. Too much of the decision making is inaccurate and too often the WCA and related processes worsen people’s mental health.”
Does the hon. Lady agree that, given that everyone in the House knows that Atos is not fit for purpose and given that we know the Government have taken no action on it, we can believe only that the Government are supporting Atos as long as lots of people are getting signed off and put back into work?
I think we are here today to point out that there certainly are problems, and I await to hear the Minister’s response to them. We need to remember that a great deal of improvements to the system have been made since the Labour Government set it up in the first place. That does not mean, however, that the situation cannot be improved. I think it is right and proper for us to point out where we feel improvements should be made.
I have visited my local Atos and have sat in on an appeal at the local tribunal, but I do not share the universal condemnation of Atos that I have heard in this House. Does my hon. Friend acknowledge that Professor Harrington reviewed the system three times with particular reference to mental health and that he concluded that the improvements were starting to have an impact so that, in his view, no fundamental reforms were needed to the current work capability assessment?
I thank my hon. Friend for her intervention, and reiterate that it was a positive move by the coalition to ask Professor Harrington to do this work.
I would like to refer briefly to the issue of ME—myalgic encephalomyelitis. I understand that although the discussions on ME were very productive, the changes that we all want are not coming through individually. What we are looking for today is a means of unlocking some of the frictions that are causing the individual problems.
I am chair of the all-party parliamentary group on ME, so I have obviously received many representations on this matter. I would like to draw the Minister’s attention to a survey on the work capability assessment carried out by the charity, Action for ME. It had 203 responses. I commend the report to the Minister and hope he will read all the conclusions. I shall refer only to several of them as I do not want to take up too much time.
The conclusions included one to the effect that
“all face-to-face interviewees should be automatically given a copy of the Atos medical report”, which I understand is not always happening. That is an area where the Minister could intervene to make sure that it does happen. Another conclusion was that
“more efficient communication is needed between the DWP and Atos”— and that is almost certainly true. I believe we can have a positive and constructive debate when we look at those sorts of points. One further conclusion was:
“Atos healthcare professionals who carry out the face-to-face assessment should receive specialist training about fluctuating conditions, developed in consultation with organisations that support people with M.E. Training needs to be as frequent as the staff turnover at Atos requires”.
Those are really important points to which I would like the Minister to pay some attention.
We had a meeting in the House this week, but it was not possible to get a Minister to attend it. I would like to request that the offices of the all-party group be used for a meeting to talk about ME, the work capability assessment and fears about the personal independence payment in the future.
It is always a pleasure to follow Annette Brooke. I also pay tribute to my right hon. Friend Mr Meacher and Dan Rogerson for initiating the debate, and to the Backbench Business Committee for agreeing to it.
We are all here today because constituents have come to us and told us their stories. Constituents have come to me in their wheelchairs with their carers because they have wanted me to know about the difficulties that they are experiencing. They cannot understand why, in the face of overwhelming medical evidence, they are still being called in for interviews. Some cannot understand why they have been told “If you make it to this interview, you must be fit for work.”
Does my hon. Friend share my utter despair at the sheer amount of money that is wasted on calling in people whose well-documented histories clearly show that they suffer from conditions which, sadly, will not improve in any way, rather than being spent on trying to find ways of helping those who are in a better position to go back to work?
I agree with my hon. Friend.
My constituents cannot understand why, although 40% of appeals are upheld, the Minister’s predecessor said that the system works. When I asked him, in a written question, how many people in Walsall South had been declared “not fit to work”, his response was:
“Please note that constituency information on the work capability assessment process is not available.”
It is no wonder that the Government have no idea why my constituents are suffering, but I will tell them now.
SD has cancer and is undergoing radiotherapy; she has been declared fit for work. SH suffered seven strokes, and also suffers from type 2 diabetes and a liver condition; she has had to appeal against a decision. KH was placed in a work-related group; she has incontinence of bowel and bladder as well as diabetes, and is partially sighted. CS has received zero points despite having a spinal disc prolapse. SA suffered a stroke and is blind, but has still been declared fit for work. LM has arthritis of the spine, and has had to appeal against a decision. Stephen Nye was so angry that he came to see me on behalf of his father, and said “I want to let you know what is going on. Sick people are being persecuted: the assessment system is flawed, and they are being harassed by the jobcentre.”
I entirely agree, and I do not subscribe to the “strivers and shirkers” nomenclature.
MD came to see me with her husband, who is blind and deaf. They told me that the work capability assessment did not take account of the issues faced by blind and partially sighted people. I wrote to the Minister’s predecessor, who replied that Professor Harrington had had considerable engagement with the Royal National Institute of Blind People, Sense, and Action on Hearing Loss. However, that was only at the time of the professor’s third review—it should have happened before the assessments had even been devised—and only at the time of his second review did he suggest the introduction of sensory descriptors and an additional descriptor addressing the impact of generalised pain and/or fatigue.
I am pleased to say that, at their annual conference, GPs called for the scrapping of the computer-based work capability assessment. They should know: they make the medical assessments every day, and they see the sick and the vulnerable every day. There is no common sense in these assessments, and there is no humanity or dignity for the most vulnerable members of society. I urge the Minister to listen to those who have to undergo these assessments, and to instruct Atos to start again.
I congratulate Mr Meacher on securing the debate, and the Backbench Business Committee on enabling it to take place. I am pleased that the Minister is present, because I entirely agree with his statement last year that there must be
“continuous improvements to the process to get the right outcomes for claimants”.—[Hansard, 5 September 2012; Vol. 549, c. 136WH.]
I want to mention a few improvements that I should like to see implemented immediately—I am glad that the Minister is listening to this—all of which were brought to my attention by constituents. The first relates to the frequency of recall for people with long-term medical conditions. Last year the Minister wrote to me:
“A claimant for whom a return to work is considered unlikely within two years will be reassessed after two years.”
I want to be sure that these decisions are being monitored, and that people are not being recalled more frequently even than the DWP has suggested.
Secondly, as we heard earlier from my hon. Friend Mr Leech, there are cases in which people have had to wait for up to a year before winning appeals and then immediately face another work capability assessment, so the whole process starts again. Why cannot such people be given at least a considerable period of grace? Surely that would be possible.
My right hon. Friend is absolutely right.
Thirdly, there is a category of people who are being considered fit for work although they have had, for instance, a severe stroke or are awaiting a back operation. One constituent was told that if people could move an empty cardboard box, they could go to work. Do the health care professionals employed by Atos always take account of the fact that people have to get to work in the first place, or that, while they may be able to perform an action once, they may not be able to perform it repeatedly when it causes severe pain?
Does my hon. Friend share my fear that the reputation of Atos may be so damaged that it can never really be effective? Perhaps the time has been reached when we need to park Atos and move on in a different direction.
The Minister has definitely heard what my hon. Friend has said. I would only add that even if that is not the case, Atos is in the last chance saloon.
Fourthly, as the right hon. Member for Oldham West and Royton pointed out in his excellent opening speech, there are people whose conditions fluctuate. They may be all right on one day, but completely incapable on the next. At least two of my constituents have made that point.
Fifthly, there is the disregarding of expert medical opinion. I understand that there are marginal cases, but I have seen cases—as, I am sure, have all Members—that bear absolutely no relation to the WCA reports. Because I always make a point of visiting constituents at home if they have a problem with Atos, I see for myself that in some cases the reports bear no relation to the reality. I believe that appeal tribunals that overturn such reports should highlight blatant instances of that, because it clearly constitutes a misuse of public money when the reports are written so badly.
Finally, there are people who are not considered fit for work—for instance, those who are awaiting operations with no idea of the time scale—and who are put into the work-related activity group although they cannot work. That strikes me as a contradiction in terms.
I hope that the hon. Gentleman will forgive me if I do not. I am about to end my speech, and I know that others are waiting to speak.
I know from past experience that the Minister certainly listens. I welcome his willingness to make those
“continuous improvements to the process to get the right outcome for claimants”, and I urge him to do so.
Atos and the work capability assessment should be seen in the broader context of the UK Government’s assault on, and demonisation of, disabled people. We have seen first the reduction in the disability living allowance and then its replacement by the personal independence payment, about whose workability we have grave concerns.
Many disabled people’s groups say that the reductions in benefits have had a catastrophic effect on recipients, and there have been a number of reports of suicides and untimely deaths brought on by immense distress. In my surgeries, I have heard several harrowing and very sad accounts from constituents who have been subjected to impersonal and inhumane work capability assessments by Atos. One has been diagnosed with an aggressive brain tumour, which cannot be completely removed because that would leave her paralysed. In August and September of last year she had radiotherapy to slow down the growth of the tumour, but in October she was told that it would grow back even more quickly, and that she would have to have further radiotherapy or she would die. I should add that this lady also has polyarthritis and asthma. Why has this lady been placed in the work-related activity group? Her doctors and consultants have specified that she should be placed in the support group as she is fighting for her life. Her only concern should be winning that battle.
I was speaking about my constituents’ experiences, and I think I should concentrate on that in the limited time available to me.
Another constituent contacted me who had been ill for two years and was eventually diagnosed with cancer following a serious bout of pneumonia. Prior to her illness, she had an unblemished employment record. She was certified as unable to work by her GP and had attended many DWP hearings about the employment and support allowance, with the final one being in April 2012. She won her tribunal hearing against the Atos decision. She had not received a single penny in state benefits from before April 2012 until she died at the end of November. She faced immense distress and was denied any financial assistance at a time when she was vulnerable and in desperate need of assistance.
As with a lot of current UK Government policy, this is a matter of completing the job left by the last UK Government; it is another example of the Labour-Tory tag team in action. Labour introduced WCAs in 2008 and signed up Atos. As a Welsh nationalist and a socialist, I believe an independent Wales would choose a different path, where Governments do not offer contracts to private companies to make profits from inflicting misery and suffering on the most vulnerable people in our society. We would treat people who need support with the dignity and respect they deserve.
I pay tribute to Mr Meacher for leading the effort to secure this debate. I was happy to accompany him and Robert Halfon when they appeared before the Backbench Business Committee, and I am grateful to the Committee for having found time, in what is a busy schedule, for a debate on this issue. It is of great concern to many Members and, more importantly, to those who have been assessed under the WCA system and those who work to support them and are inundating us with case studies.
We have heard a lot about the history of this issue, so I will not rehearse what has been said on that. I am pleased that an annual review of the system is in place and that it is highlighting the concerns, which we are then able to address in this House. The coalition Government have moved to tackle some of the concerns, but they need to do more, such as by addressing the issues raised by Professor Harrington.
I remember a case that arose during the last Parliament—when this system was introduced—involving a constituent of mine from one of the north-coast villages. He was told he had to attend an assessment, and printed information on how to travel to the assessment venue by public transport was sent to him. The suggested journey involved an overnight stay on a railway platform. It was hardly helpful to send such a suggestion to someone who was travelling to attend a WCA.
We have moved on a little since then. As we have heard, however, people attending WCAs are often nervous and fail to get across all the points they want to make, and they frequently feel that, as a result of the process, they are railroaded into responding in a certain way. As we heard from Mrs Moon, the people who accompany them are sometimes shut out of the process, too, even though they can perform the valuable role of giving their companion the confidence to represent themselves thoroughly.
Pamela Nash raised the important point that the process is recorded. As we all know, telephone calls to many organisations are routinely recorded and people, including those undergoing WCAs, should realise that the recording of proceedings is for their benefit as well as that of the organisation concerned. Those undergoing WCAs can get a copy of that recording, too. That point was raised with me by a woman whose son had to wait for seven months to get his assessment, which serves to highlight that we must also speed up the process. Work needs to be done to help Atos understand the problems that might be leading to those delays.
Does my hon. Friend agree that we must make Atos understand that in remote rural constituencies such as those we both represent some people have to travel long distances? That problem is leading to a lot of no-shows at the Truro Atos centre, which in turn is leading to lots of delays in assessments, thereby causing a great deal of anxiety.
That is also a common problem in respect of visiting district general hospitals. I have repeatedly asked hospitals to make sure that people travelling long distances are seen in the middle of the day, rather than early in the morning. Sensible decisions like that would help.
A constituent who would rather I did not reveal her name also raised the issues of delays and recordings, and others have mentioned the lack of expertise. If Atos has practitioners with different areas of expertise—some in physical disability, others in mental health issues, for instance—it should arrange assessments in such a way as to utilise that.
The language that is used and how people are treated are also important issues—some Members of this House could probably moderate the language they use in discussing this subject.
We are, in effect, trying to put a sticking plaster on a gaping wound. Atos and the WCA are not fit for purpose. Does the hon. Gentleman agree that we should bin them both, and start again with the idea of looking after disabled people, rather than the opposite?
The problem with that suggestion is that all the people who have been through the process and have won appeals will have to go back to square one. I am therefore in favour of improving the current system. Every time we renew a system, we go back to square one. Those who have been through an assessment and an appeal and have finally got the right result should not be sent back to square one. The hon. Gentleman articulates the anger that is felt, and there are clearly problems with the process, but I do not think scrapping it and going back to square one is the best way to proceed. Professor Harrington has not suggested that course of action, either. What he has said is that there are problems that need to be resolved.
No, I want to conclude so that others can have a chance to speak.
There are certainly questions to be asked about the company operating this process. Jeremy Lefroy said it was drinking in the last-chance saloon. We have heard in other contexts that people can remain in that saloon for a long time, however, and this debate serves to show the Government that we are taking this issue very seriously.
There is another issue, too. Those who are found capable of work even after an appeal should be supported into work. We must do that properly. I hope we will address that issue on another day, as it is the second part of this process and there are problems to be solved.
I congratulate my right hon. Friend Mr Meacher on securing this important debate. There is a huge groundswell of discontent about Atos and the work capability assessment. It is deplorable that our sick and disabled constituents are experiencing immense hardship after being deprived of benefits having endured an Atos WCA. We all recall last year’s television programmes exposing the way people are treated across the country by Atos, and I have heard from a number of my constituents who have been badly treated—treated without care, compassion or understanding.
I am sure that, as a Scot, my hon. Friend will share my concern about the fact that Atos will now be carrying out the personal independence payment assessments as well. The Government have already determined the outcome of those assessments. The Minister for disabled people, Esther McVey, told this House that by October 2015 560,000 claimants will have had their assessments, and 160,000 will get a reduced award, 170,000 will get no award, and 230,000 will get the same support. How can we know the assessments are valid when we have had such a prediction?
I could not agree with my hon. Friend more. The accuracy of assessments is essential, as I will go on to discuss later.
Let me outline briefly some of the cases that have been brought to my surgeries, on the back of a recurring issue now being referred to by my constituents as the “Lazarus letter”. This is a letter they receive instructing them to make their way to Glasgow for assessment and containing many connotations about what will befall their benefits. A constituent who suffers from severe cerebral palsy and could not travel was refused a home visit and told to go to Glasgow to be tested. Another constituent who was recovering after being seriously injured in an accident was advised to attend an Atos assessment in Glasgow. Both those constituents could not possibly travel because they were in so much pain, and I had to get involved and ask for a home assessment for them. It does not end there because they then had their benefits cut or stopped because Atos sent the assessment forms to the wrong address. If it cannot get the address right, what chance does it have with assessments?
Clearly many of my constituents have not been treated with the fairness and decency they deserve. Although I realise that we need to see whether people can work, we need a system that is humane and fair, not one that causes fear and loathing. It is time the Government realised that they are driving many sick and disabled people into poverty. What does the Minister think of Citizens Advice’s detailed year-long study “Right first time?” on the controversial work capability assessment run by Atos, which has revealed evidence of widespread inaccuracies in the medical reports that help to determine whether individuals are eligible for sickness benefits? Citizens Advice also tracked a group of people through the process of claiming employment and support allowance and looked at how their claims were handled. The report’s conclusions are stark: 37 individuals were tracked and had their reports examined, with serious levels of inaccuracy revealed in up to 43% of the reports. That level is significant enough to have an impact on the claimant’s eligibility for benefits—surely our sick and disabled deserve better than this.
The low rate of accuracy is worrying because the reports are used in deciding entitlement to other benefits. Is it not better to have an accurate, fair and just system of medical assessment, one that claimants know will treat them fairly and with the humanity they deserve, rather than a system that is, frankly, unfit for purpose and that uses a company, Atos, that instils fear and loathing in people, resulting in a system where people are continually appealing against decisions? We have already heard that the success rate against the decisions is about 60%.
Although the Department has made much of the fact that Atos does not actually make the decisions, with that being done by decision makers in the job centres, I have never seen evidence of the decision makers taking account of any evidence apart from the Atos assessment and the questionnaire, unless the case goes through appeal or reconsideration. Does my hon. Friend agree that decision makers should in every assessment be seeking the opinion of the person’s GP and of other professionals who are offering the person care at that time?
I thoroughly agree with my hon. Friend on that point. It is ridiculous to have people making an assessment based on a tick-list that looks like it should be used for an MOT on a car.
We need to ensure that the people who are going through the system are treated well, justly and fairly. The British Medical Association has called for the work capability assessment to end immediately and be replaced with a system that does not cause harm to some of the most vulnerable people in society. I call on the Government to change course and look again at this process.
It is an honour to follow a thoughtful contribution from Mr McKenzie. It is fair to say that the mark of a civilised society is how it treats the most vulnerable people who live within it, so it is important that we have this type of debate in order to review how we are treating vulnerable people. I add my congratulations to Mr Meacher on securing the debate and to the other hon. Members who have contributed so far.
In 2006, I was serving on the Greater London assembly and we carried out a report and review on the huge number of people consigned to permanent disability—they were written off by the previous Government as not being capable of working. The one key issue is the sensitivity in determining whether someone is capable of work and therefore should be employed or seeking employment, or is clearly not able to work and is therefore in need of the maximum support.
It is important that we acknowledge that we now have to look at how this test is working. After all, it is not good enough for us just to trade insults and say that the previous Government left people to rot, because the system was actually introduced by the previous Tory Government. We could therefore pass these comments backwards and forwards, but the important thing is to ensure that if we are going to test people, we get it right.
My constituency has a relatively low unemployment rate, but I have received a succession of complaints from constituents who have been put through the work capability assessments and clearly believe they have been treated unfairly—I agree with many of them. My hon. Friend Jeremy Lefroy described how he visited his constituents at home, and I have had a similar opportunity to visit some of my constituents at home to see the position they are in and the lives they lead. These people are and should be entitled to full disability benefits, yet they have been denied them.
I want to discuss one specific example, that of a constituent who came to see me in late 2011 to make a complaint against her employer. She suffered from a degenerative spinal condition and struggled to stand for long periods of time. She had asked her employer to split her two eight-hour shifts into three four-hour shifts so that she would be able to continue to work. After some discussion, her employer eventually consented to changing her shift pattern. The point is that this woman was committed to work for as long possible and in a job that she could clearly do. After receiving higher rate mobility allowance and lower rate care allowance for several years, my constituent had her claim reviewed as part of these reforms. Following an Atos work capability test, all her benefits were suspended and she spent the following year appealing the decision. She got full support from me and my office, and I am delighted to say that after the appeal process and a successful tribunal she had her benefits fully restored. Of course, the pain and suffering for a full year was outrageous.
It is worth pointing out some of the medical conditions from which my constituent suffered. She has had a disc removed from her spine, and I understand that its removal caused a mid-posterior annular tear. Those conditions have brought a lifetime of mobility problems and associated side effects, amounting to a debilitating spinal injury. When we add that information to my previous comments about her keenness to work, we see that this is not someone who seeks fraudulently to claim benefits; she seeks only what she is entitled to. At the original work capability assessment my constituent was assessed by a physiotherapist. I have no doubt that the physiotherapist was reputable and qualified, but as an assessor they were clearly not sufficiently qualified to understand the complex medical needs of my constituent. Having had the opportunity to review some of the cases brought to me, I can say that it is clear that Atos and its employees do not have the required expertise.
I totally agree with the hon. Gentleman. We have a situation where the likes of physiotherapists are assessing people with acute mental health problems. Does he agree that that is wholly unacceptable?
I agree. One reform we could quite reasonably ask the Minister and Atos to introduce would involve ensuring that the assessor was qualified to assess the type of problem from which the individual suffers. That could take the form of a referral by the Atos assessor to a proper medical professional in a given field where there was expertise. That would save the individuals from the trauma of the appeals process and would save money as it would mean that the medical professionals could properly undertake an appropriate assessment. I urge the Minister to consider that as a way of improving the system.
It appears to me that there is a tick-box mentality among the Atos assessors. I could refer to a stream of cases in which people have conditions that come and go and have good days and bad days. When Atos assessors make the assessments, those people can often be having a good day and the tick boxes do not allow the right decision to be made.
I will not, because I have given way twice and I want to conclude.
The clear point is that there needs to be a fundamental reform of the process. It is right that we should assess people to see whether they are capable of work, but the people subjected to horrendous trials and tribulations as a result need further support and deserve to have the whole process reconsidered so that it can be improved for the benefit of all.
The number of MPs who want to speak today and the passion that has been shown are testimony to the fact that the system has not worked, is not working and ought to be scrapped. I hope that the Minister is listening, because that is clearly a strong concern on both sides of the House.
The key weakness of the system is the perfunctory, mechanical, inhuman and rushed process of assessment. I have to point out to the Minister that as the system has been handed to the private sector, the more perfunctory the process of assessment, the greater the profit made by Atos and the assessors.
Other Members have raised the issue that Atos is a private company. I am sure that my hon. Friend will agree that it would be helpful if the Minister could reveal the profit margin, as this is public money being spent by a private company, which one would expect to make a profit. Would it not also be useful if the Minister could tell us whether there has been any change in the profit in the years for which Atos has been doing the assessments?
I am grateful to my hon. Friend for that intervention. That was one of my concerns as a member of the Public Accounts Committee and it was to have been part of my passionate penultimate ringing declaration when I intended to ask the Government to tell us how much profit has been made, but I can now omit that from my speech.
The system is perfunctory and totally inadequate. I will not repeat the cases that have come to my surgery after the assessment—that has been done brilliantly by some of my colleagues—but it is clear that the assessment fails patients with mental health conditions, particularly schizophrenia, which are very difficult to assess and treat. It fails when conditions are intermittent and emerge one day only to fade away the next. It fails on degenerative conditions, too. The system of assessment does not take into account any of its own inadequacies in those areas.
In the Public Accounts Committee, I was able to voice a suspicion that there was a quota for the number of disabled people that should be shaken out in what appears to be an enormous attempt to do that rather than to provide them with the support and help that they need and with encouragement to go back to work. The process is more concerned with shaking them off benefit than with treating their cases properly. We were assured by Atos and the Department that there was no quota, but I think we can guarantee that any medical assessor for Atos who finds that the total or a high proportion of the number of people he is examining are not fit for work will not advance his career in assessment, his career in Atos or his contact with the Department. Inevitably, there are those pressures on the assessors.
As our Committee was told, 38% of the cases that go to appeal—I advise all my cases to go to appeal—are successful in reversing the verdict. That demonstrates its inadequacy and the enormous cost in the reassessment process at appeal, a cost that is not taken into account in the Government’s estimates of the savings produced by the system. Those reassessments are usually done with the help of the patient’s own doctor, so I do not see why their doctor’s view cannot be invoked and used at an earlier stage in the process. After all, the Government are giving more power to the doctors and claiming that they represent the patients. The doctors know the long-term conditions—they are treating the patient—so why are their views not taken into account by Atos at the start?
Our PAC report on the system was pretty damning—one of the most damning we have done. Our concerns included the rate of profit, as my hon. Friend Meg Hillier has mentioned. The Minister should tell us the rate of profit made by Atos and what efforts the Department is making to reduce that and to ensure a more efficient service and more efficient assessment processes. We were concerned, too, that this is a monopoly contract with no great risk to Atos. The monopoly is continuously reinstated and Atos is put back in power. Monopoly processes go slack, and if such tasks are going to go to the private sector—I do not think that they should—the companies should be subject to competition and to more regular reviews. The weakness of the assessment system shows that Atos is not working effectively. There should not be a long-term monopoly in this area.
If the Minister reads Twitter at all, as I do avidly—normally to see people abuse me—he will see the widespread concerns about people’s treatment by Atos. If he listens to this debate, he will hear the same. If he listens to the disablement groups, he will hear the same. Instead of backing an inhumane system and refusing to change it or tighten the terms and conditions under which Atos operates, it is time that the Minister showed some concern and changed the system.
I was not expecting to be called to speak, Mr Deputy Speaker, but I shall say a few words.
The debate has been very valuable and there has been cross-party consensus, which shows that there is a great deal of concern about how Atos is performing against its contract. That is not to say that all the language used today is acceptable, and I feel that some of the constructive changes that have been implemented have been ignored. For example, when I was on the Welfare Reform Bill Committee, one of the key issues of concern for me was how the work capability assessments would deal with cancer patients. It is a fact that more cancer patients now qualify for unconditional support than ever before, yet we have had no mention of that. In the midst of making constructive and, in many cases, justified criticisms of Atos, it is important that Members are careful not to frighten people listening to this debate who might be cancer patients and might feel that they have no hope whatever of a fair hearing from Atos. I also want to highlight the fact that more people—double the number from two years ago—now qualify for unconditional support.
Those two points—about cancer patients and the number of people getting unconditional support—are important reasons why the proposal made by some Opposition Members that we should simply throw the whole system out and start again is dangerous. It does not take into account some of the constructive changes that have been implemented.
I do not deny that there have been some improvements—although one speaker said that they had happened at a glacial pace, which was probably a fair comment—but we must bear it in mind that the unconditional support is not available without the person being re-subjected to an assessment. One complaint is about the frequency of reassessment, even for people whose conditions are so serious that they have been put in the support group but who sometimes, a year later, still have to come back and go through the whole process again.
The hon. Lady’s point is important, because although we all subscribe to the principle of a review, when a condition has been assessed as demanding unconditional long-term support there is a question about whether an annual review is justified. That is an issue that a constituency MP who takes case work seriously would not ignore, so I take her point on board.
There are a couple of aspects that I welcome, but about which I still have concerns. One is the way in which the system deals with patients who suffer from mental health problems. Mental health services are often the Cinderella service of the NHS, but when it comes to people who have difficulty accessing work and feeling confident to do so, the way that Atos deals with such patients has been less than acceptable. I understand that the Department and Atos are putting in 60 champions, but given the number of issues that I have seen in my own constituency, I question whether 60 will be sufficient for the whole of the United Kingdom. The way in which we deal with people with mental health problems is not acceptable in the health service and it is not acceptable at this point in time in Atos, even though the problem has been recognised and work is being done to try to deal with it.
The other matter, which has been touched on by several hon. Members, is the issue of people with chronic long-term illnesses. The problem that I have seen in my constituency surgeries is that quite often somebody may turn up at an assessment centre and on that particular day would be capable of a certain type of work, but the situation could be completely different the following day. The problem with the system that we have put together is that it does not take into account those long-term chronic conditions that could result in somebody occasionally being able to take on work, but not on a long-term basis. That is another weakness in the system.
Does the hon. Gentleman agree that people with HIV/AIDS, where the side-effects can cause many day-to-day problems, are not properly assessed in the work capability assessment?
I entirely accept that point. The same is applicable to cancer patients, for example. However, there is a counter-argument that often people who suffer from HIV/AIDS or who are dealing with cancer would enjoy the opportunity of working. My father, who passed away owing to lung cancer, was working until three weeks before he died, and there is no doubt that being able to work for such a long period was a contributory factor to the way in which he fought the disease. We need to make sure that we do not categorise everybody who has a long-term chronic illness as incapable of any type of work.
On a specifically Welsh issue, despite the promises made by Ministers in the Welfare Reform Bill Committee when I tabled an amendment to allow assessments through the medium of Welsh, I have encountered numerous examples where assessments have been requested through the medium of Welsh but that service has not been provided. An excellent example was that of a young woman in my constituency who had a stroke at the age of 42, I believe. As a result, she largely lost the ability to communicate through the medium of English. Despite numerous requests for the service to be provided in accordance with the promises made by the Department, as yet we have not been able to ensure that she has that service through the medium of Welsh, which is her right under the Welsh Language Act 1993.
I subscribe to the general views expressed in the debate that the system is not performing as it should and that there are real concerns about the way that Atos is performing. However, I believe that what the Government are trying to do is right, as it is important that we recognise that we have a higher number of long-term unemployed in the United Kingdom than any comparable western state in Europe, and we need to question why that is so.
I do not think it is necessarily wrong, harsh or unreasonable to say that people who could work should be supported into work, but we need to do that in a way which recognises the dignity of individuals going through the system. Despite my support for the welfare changes that this Government are making, the examples that
I have seen in my own constituency surgery leave a lot to be desired. We should not throw out the baby with the bathwater, but we need to make sure that the recommendations that have been made time after time are implemented as soon as possible. We owe that to the constituents we represent.
Today we have heard a litany of problems with the work capability assessment, not least the problem that it persistently reaches the wrong outcomes in assessing people’s ability to work.
Aberdeenshire was part of the pilot scheme for the work capability assessment, so ever since I was elected, I have faced a steady stream of sick and disabled constituents, distraught, worried and in some cases angry about the process that they have had to endure. These are not anecdotal or isolated instances. The citizens advice bureau has kept close track of the issues brought by clients over many years, and it has documented the sharp increase in demand for advice and help on matters related to work capability assessments. In the past year alone the Turriff citizens advice bureau in my constituency has seen a 60% increase in this type of case, on top of a sharp increase last year. I suspect that we are seeing only the tip of the iceberg.
In spite of three reviews by Professor Harrington, the work capability assessment still is not working well enough. Too many decisions are being appealed, and 38% of those appeals are successful, rising to a 70% success rate when people are supported by the CAB and other advocacy groups. That system failure is costly not only in financial terms, but in human terms.
One of the things that has disturbed me most over the past couple of years is the way in which disabled people have found the process an assault on their dignity. I am also disturbed by the failure of the Government to take remedial action and manage the contract with Atos more effectively. Public money is being spent on these assessments. There is a substantial body of evidence to show that they are failing to deliver, yet the Government continue to hide behind commercial confidentiality in declining to make public the details of their relationship with Atos. That lack of accountability is not good enough.
As an MP, I am dealing with increasing numbers of constituents who are distressed and desperate because they have been told that they are fit for work when they manifestly are not. The very first constituent who came to me for help and who had been found fit for work was a man who could not climb the stairs in his own house to go to the toilet. He came to one of my surgeries which had disabled access, but he needed help from relatives to do so and it was quite an ordeal. His GP rather euphemistically told me that the man had “a poor prognosis”, and the man has absolutely no prospect of getting back into the labour market. He successfully appealed against the decision, but it emerged in that process that no account had been taken of his GP’s documentation or of the evidence supplied by his hospital consultant.
I have encountered incontinent patients being asked to make four-hour round trips on public transport. I have also encountered constituents who have had to make very long journeys by public transport only to find that their appointment is not double-booked, but triple-booked. My biggest ongoing worry, though, is about people who have found themselves placed in the work-related activity group with very little realistic prospect of finding a job. I think of one constituent, disabled since birth, who has wanted nothing more than a job since she left her special school. Now in her 30s, she has been on endless training courses. She has enthusiastically embraced work placements but she has never had a mainstream job, despite her efforts. Possibly, she could work, with the right support in place.
In Aberdeenshire we enjoy levels of employment much higher than the average. It is probably easier to find a job there than anywhere else in Scotland, but jobs still do not grow on trees. Many of the jobs that new entrants to the labour market might have a chance of getting are physically demanding. They require strength, dexterity, co-ordination and a degree of endurance. My constituent could not stand on a food production line. She does not have the balance or the motor skills to work in a retail outlet. Her speech impairment would make telecommunications work difficult. She can type, but not nearly fast enough for a modern office. She will lose her benefit in a few months, even though she has always sought work, and is just looking for someone to give her a chance.
I worry that, instead of becoming independent, my constituent is going to become even more dependent on her ageing parents, who are themselves in failing health. They are not a wealthy family. Bringing up a disabled child often impairs a family’s wealth and erodes their assets and their ability to cope with setbacks. I am worried about the impact of increased caring on her family and on their health and financial well-being.
Finally, I want to say a quick word about the situation facing people with serious mental health problems and long-term fluctuating conditions. There is a world of difference between being potentially fit for work, given the right support, and being an attractive prospect to a potential employer. The elephant in the Chamber today is the fact that many employers will think very long and hard before taking on a member of staff with a serious long-term or fluctuating health condition. Anyone with a chequered work history knows that they are perceived as a risk to prospective employers. Many employers will admit this in private but will not come out and say it publicly. I do not think the Government are being realistic enough about the stigma attached, for example, to degenerative conditions or mental illness. These hurdles are not insurmountable, but we must admit that they exist if we are to challenge them. I hope that today’s debate will inject a dose of realism into the Government and that they will stop hounding and persecuting disabled and sick people for their disabilities.
I apologise for not being in the Chamber for the beginning of the debate, owing to another commitment. Mr Speaker kindly put my name towards the end of the list for today’s speeches.
Interestingly, the scheme has worked relatively well in South Derbyshire. We have quite a high level of returners-to-work as a result, but equally, issues have come to my surgery and I have had occasion to write to the Minister and his predecessor. I welcome the Backbench Business Committee’s decision to hold the debate.
I have had conversations not only with my local citizens advice bureau but my jobcentre, which has highlighted a few points that I hope the Minister will take on board. I hope that he will answer them in his winding-up speech. I heard about a number of harrowing cases—not from the CAB, interestingly, but from the jobcentre, whose staff see people coming back into training and what have you after the assessment. Those staff are incredulous at times at the cavalier approach of Atos to people’s health conditions.
Long-term disabled people have come back into the work arena; unbelievably, within three months of being told that they are perfectly fit for work, they have dropped down dead. I would not like that on my conscience, and I find it surprising. I am sure that such cases are relatively rare, but when do they happen? If the Minister does not know the answer, perhaps he will be kind enough to write to me.
Does anybody go back through the files to check on what happened with Atos? There needs to be a review. Folk in the Chamber know that I used to be the leader of a district council. Our job was to put out contracts and make procurements, but we always had penalty clauses, clawback arrangements and the ultimate option of getting rid of a firm if it was not performing.
One of my early letters to a previous Minister asked about the point when we say that the system is not working; frankly, I have not had an adequate reply. When someone drops down dead within three months of being assessed as being perfectly capable of going back to work, what is the review process for Atos?
We have heard about the Harrington report and the need for mental health champions. Only last week, a constituent, who, frankly, did not know what time of day it was, went through the process. Not only were they not allowed to have their carer with them, but no mental health champion was there.
I am sorry, but I do not think the hon. Lady understands the notion of mental health champions. They are not for the clients but to advise the health care professionals doing the assessment.
I do get that point; I am saying that the champions ought to be there when the interviews are taking place. I find the juxtaposition astonishing—according to Professor Harrington’s report, people need that extra bit of care. I find it interesting that we have just heard that there will be 60 champions in the country. Patently obviously, that is not enough. Perhaps the Minister will advise us that that number represents a pilot and, notwithstanding what we are saying in this debate, it will be increased in short order.
I am sure the Minister has heard every word that the hon. Lady said.
I finish on two final points because time is short and many people want to speak. People have mentioned the tick-box nature of the interview; my constituents find it hugely frustrating that they cannot expand on an answer. After all this time, perhaps the interview process could be tweaked to allow that. My last point is about the absolute frustration of GPs and consultants who feel that no account whatever is taken of the fact that they take their time to write the letters. That is desperately frustrating and a huge waste of public money.
I thank the Minister for putting that on the record. I will gladly go back to my GPs and consultants and say that they will be taken into account if they please return the forms on time.
I will finish now, because many hon. Members want to get in. I am delighted that we are having this debate because I genuinely feel that there is an opportunity to get the issue right. The people deserve it.
Someone said that what we are debating is a party political issue. Let me be clear: I opposed the system when it was introduced by the last Government and I oppose it now—for the same reason. I see it as a brutal attack on the weakest and most vulnerable individuals in our society and an exercise by private companies to profiteer at those individuals’ expense.
I started raising the issue in Parliament early on. My first constituency involvement was like that of many other hon. Members: it involved someone who was mentally ill, went for the assessment and had a nervous breakdown. That had an impact on the whole family—the mother, in particular.
I was then contacted by a range of organisations, which came together and produced the Spartacus report. I urge Members to read it. In the last debate on this issue, in Westminster Hall, we read some of its case studies into the record. They are horrendous examples of human suffering and what can only be described as abuse by the system itself.
I also refer Members to Calum’s List, which has a website. It is a list of people who have died, including by suicide, as a result of, or where there has been a contribution from, the loss of benefits. The first example on the list was that of Paul Reekie. Some Members may have known Paul, an award-winning writer and poet in Leith, Scotland. He did not leave a suicide note, just two letters on the table beside him. One was about his loss of housing benefit and the other was about his loss of incapacity benefit. He died.
The other example is that of Mark and Helen Mullins from Bedworth. They could not access their benefits. They were walking 10 miles a day to a Salvation Army soup kitchen. They committed suicide together because they could not access their benefits. Read Calum’s List, which has example after example of the brutal effect of the system.
This is at least the sixth debate that we have had on the issue. The concern expressed by Members about an issue of public administration in all those is unprecedented in recent decades. There is example after example of human suffering on a scale unacceptable in a civilised society. That is why 117 Members of Parliament have so far signed our early-day motion calling for the scrapping of the system.
I have read Mind’s briefing for today’s debate and I urge other Members to do the same. It has put forward what is wrong with the system. Yes, it has recommended improvements, but one of the key factors coming out of its survey of people facing the work capability assessment process was that 51% of them said it made them have suicidal thoughts. Any system involving that level of risk is irretrievable and unreformable. That is why I believe it should be scrapped and why the British Medical Association has said it should be scrapped.
I say the following, and I do not say it lightly: we now know that the system does not work. We know the human suffering that is occurring. The responsibility is now on us to do something about it. We will be to blame for every injury, harm, suicide and other death as a result of the system if we do not scrap it now and bring in something that is fair and based on proper medical knowledge—assessment by a person’s own GP, reinforced by expertise. We need something that gives advice and emotional support for people when they go through the system, not something that leaves them at risk.
If my hon. Friend does not mind, I shall not give way as other hon. Members want to speak.
I conclude by saying that we all have a responsibility to say, “Let’s end the system now, start again and make something fair.” We will be to blame for all the injury and harm if we do not.
The system is not working for those suffering from mental health conditions. My hon. Friend the Member for Hayes and Harlington has just mentioned the Mind survey. Some 87% of those surveyed said that the system caused distress and 75% said that it had worsened their mental health condition. As my hon. Friend rightly pointed out, 51% said that they had suicidal thoughts as a result of it.
My right hon. Friend the Member for Oldham West and Royton referred to the deaths of people who have been through the Atos system. Through a freedom of information request, I understand that the DWP keeps a figure for the number of people who have died but does not record the causes and how they died. It has been asked to record the suicide cases, for example, but has not done so. As my hon. Friend the Member for Hayes and Harlington eloquently demonstrated, there are a number of well-publicised cases where people have taken their own lives because of this system. It is not too putting it too strongly to say that this coalition Government have blood on their hands for the deaths of those individuals.
Like my hon. Friend Mrs Moon, a lot of constituents come to see me at my surgery about this, and I should like to give an example. I also referred to several cases in the mental health debate on
Much has been made of the Harrington reviews, and we have heard a lot about the mental health champions, but they are there not to help applicants but to give advice to the health care practitioners. There are only 60 of them, and there are some 140 assessment centres throughout the country. Paul Farmer, the chief executive of Mind, who was on the scrutiny panel, resigned because the system was clearly failing people with mental health conditions. The Minister’s predecessor then tried to rubbish him by saying that he had been asked to resign because Mind had a conflict of interest in a legal case, but it did not. Mind is very clear that the system is failing.
The system is also costing the taxpayer money, not only through the additional health care provision for those with mental health conditions but through the extra work load on GPs, the tribunal system, which is at breaking point, and the reassessment system. The other week a 60-year-old nurse with osteoporosis, who has spent 38 years in the NHS, came to see me. She failed the work capability test. She is 61 in April and is now being told that she will be retrained for a new career until she is 62, when she gets her pension. What on earth is the point in wasting money on individuals like that? There are also cases such as the 21-year-old young lady who ended up in the local psychiatric hospital because she failed the Atos interview. What is the cost of that to the NHS?
I raise serious questions about the capability of the individuals who are doing the Atos assessments. We see from today’s very welcome briefing from the BMA that it is concerned about the turnover of GPs. Let me tell people—I do know a bit about mental health—that GPs are not experts on mental health. It is wrong to get someone who has no training in mental health to assess these cases. We need a new start for people with mental health conditions. We need to take them out of the system and we need a separate work stream for dealing with them. They should be assessed by people who are qualified psychiatrists and people who understand mental health. If we do not do that, we will continue to have the torture—I will use that word—that people are going through in this system and the deaths to which my hon. Friend the Member for Hayes and Harlington referred. If the Minister can have that on his conscience, so be it; I do not think that I could if I were in his shoes.
I congratulate my right hon. Friend Mr Meacher on securing this very important debate.
Over 5,000 of my constituents are on incapacity benefit or employment and support allowance and they are facing this terrible system. I should like to give a few examples. Mr H, a double-leg amputee, was told to undertake an 80-mile round trip for his work capability assessment. Mr W, who has serious mental health problems, had a panic attack and was physically sick during his WCA but was told he was fit for work. His wife believes that he is being victimised by Atos. Mrs D, a district nurse who broke her back at work, was told that she is fit for work. Mrs M, who was treated for cancer in July 2010, was deemed fit for work before the results of the operation came through. Her appeal will not take place until next month. Mr E, who is one of the people the RNIB is worried about, had been completely blind for 16 years and forced to give up work, but was told by Atos that he was fit for work.
As the shadow Secretary of State, my right hon. Friend Mr Byrne has said, we need fundamental reform of the system, including the descriptors. There are problems with the descriptors not only for mental health but for physical health, in every category. I will read out the conditions that have a score of 9, which means that people with all these conditions are deemed capable of going to work. A person who
“Cannot mount or descend two steps unaided by another person even with the support of a handrail” is deemed fit for work; a person who
“Cannot, for the majority of the time, remain at a work station, either…standing unassisted by another person…or…sitting…for more than 30 minutes, before needing to move away in order to avoid significant discomfort or exhaustion”
—fit for work; a person who
“Cannot pick up and move a one litre carton full of liquid”
—fit for work; a person who
“Cannot use a pencil or pen to make a meaningful mark”
—fit for work; a person who
“cannot use a suitable keyboard or mouse”
—fit for work; a person
“Unable to navigate around unfamiliar surrounding, without being accompanied by another person, due to sensory impairment”
—fit for work; a person
“At risk of loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder, sufficient to require cleaning and a change in clothing, not able to reach a toilet quickly”
—fit for work. And only scoring 6, a person who
“At least once a month, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration”
—also fit for work. As the RNIB points out, it is possible for a person to have an epileptic fit once a fortnight and be deemed fit for work. As it happens, Mr Deputy Speaker, my husband suffers from epilepsy, and last time he had an epileptic fit he had the headache and the hangover for several days, so the notion that anybody can do a job if they experience this once a fortnight is completely absurd.
Also supposedly fit for work is someone who
“Cannot learn anything beyond a simple task, such as setting an alarm clock”, or whose
“Reduced awareness of everyday hazards leads to a significant risk of…injury to self or others; or…damage to property or possessions such that they frequently require supervision”.
The situation is not even safe for their colleagues, but somehow they are deemed fit for work. The same applies to someone who
“Cannot cope with minor planned change”, such as a change to lunchtime, or a person who
“Is unable to get to a specified place with which they are familiar, without being accompanied by another person.”
A person in the following category is also deemed fit for work if:
“Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the individual.”
This is a cynical exercise and Ministers know it. In the current situation, none of those people are ever going to find work. It is a cruel and demeaning system and it should be changed now.
Like my hon. Friend the Member for Bishop Auckland, I want to demonstrate to the House, through a series of examples from my case load, the crass, degrading and unprofessional way in which my constituents are being treated. A constituent of mine—let us call her Mrs J—is 51-years-old and suffers from diverticular disease. This leads to a compacting of her bowels, which means that she soils herself on a daily basis, requiring a change of clothes. Often she requires hospital treatment because when her bowels are heavily compacted she is unable to deal with the matter without medical intervention. She was on contribution-based ESA, but was allowed to be on it for only 365 days, and that period expired in 2012. She asked to be reassessed on the basis of her condition, and her assessment stated that she was fit for work. She appealed against this decision, but the appeal was declined. She had to go down the tribunal route but, as she told me in an e-mail last September:
“So I’m now faced having to go to a tribunal which I was told today will take months. I’ve got no representation. I’m unable to go to the CAB as when I attempted to do this I’d soiled myself on route so ended up going home in tears. What can I do? I’ve not got a penny to my name. I’ve borrowed just to survive since April…I’m now faced with another 3-4 months with a tribunal decision again without money…I don’t know what to do and cannot carry on like this. Surely this isn’t how you expect people who legitimately cannot work. And the likelihood is I’ve failed my appeal just because I’ve not worded my appeal correctly when clearly my medical records and specialist have stated otherwise. Please, please help before I end up on the streets.”
A gentleman in my constituency—let us call him Mr D—served in the forces for many years and is now in his late 50s. In the past 18 months, he has undergone extensive surgery to the brain, following a tumour, and in November 2011 he was informed that he required further surgery, this time to his neck, to remove the growing tumour. At the same time—in precisely the same month—Atos assessed Mr D as being fit for work. That assessment was undertaken by someone who was not trained as a doctor at a time when Mr D was going to assessments with a gaping wound in his head and still undergoing treatment. Does it not make an entire mockery of the whole process if that is allowed to happen? Does it not cast real doubt on the effectiveness and accuracy of the whole system? Most ominously, does it not reveal the system’s true intention?
Several of my constituents—far too many to be isolated incidents—have told me that they were asked by the person carrying out the assessment whether they just sat around all day watching Jeremy Kyle. I expect uninformed, unprofessional and crass comments from the likes of the Chancellor of the Exchequer, but not from medical professionals with the serious task of determining whether a person is fit for work in, presumably, an objective and non-prejudicial manner.
Another woman in my constituency—let us call her Mrs M—left school at 16 and worked diligently for 33 years. She paid her taxes. She was made redundant a couple of years ago at just the time that she was starting to suffer from ill health. Mrs M suffers from Crohn’s disease, which has led to severe diarrhoea, incontinence and abdominal pain. She has had surgery to remove a large section of her bowel, but the symptoms are getting worse. As Members may know, there is no cure for Crohn’s disease. Mrs M will not recover. There will be a gradual and irreversible increase in the severity and frequency of her symptoms. Mrs M is a proud and dignified woman who is embarrassed by her condition. She wants to do nothing more than work, but is unable to do so. She suffers from about two bouts of diarrhoea a day, for which she has no more than a second’s notice, and she cannot leave the house unaccompanied.
Mrs M was assessed as having 15 points with limited capability for work. Her assessment and appeal were degrading, insensitive and unprofessional. She was described throughout her appeal notes as a man. Incorrect dates and fictitious telephone calls were placed on her files—in other words, lies. Mrs M was told that she could wear a nappy for work. What sort of country have we become? What sort of ethical values do the Government have, if that is the degrading and crass way in which decent, law-abiding constituents of mine are being dealt with?
I believe that everybody who can work should be entitled to work and that the role of the state is to help achieve that, but all the evidence in my constituency demonstrates that the system is not working and the most vulnerable and ill constituents in Hartlepool are paying the price. The Government are treating my constituents like dirt and that needs to change.
Last week I held a meeting in my constituency for a number of disabled constituents, their carers and family members, and the organisations that support them. I want to highlight to the Minister two or three messages that build on some of the things that have been said this afternoon.
First, and most importantly, the Minister needs to understand how totally discredited this whole system has become. My constituents told me categorically last week that they believe that the whole system was deliberately designed and operated to trick them—to make them incriminate themselves and to catch them out. They firmly believe that the system is deliberately designed, not to assess and then help them into work if they are fit for it, but simply to stop paying benefits wherever possible. I regret that they continue to believe—I know that this is not the case—that Atos is paid to bring that about.
Whether or not the system is deliberately designed to trick them, it is clear that there are far too many instances of trickery and misleading people and of distorting what they have done, said and reported and drawing conclusions from that. That is happening far too often. It is an absolute disgrace that we should run a public assessment process in such a discredited way.
I will not, because others wish to make speeches.
The Minister has to either sort out the process or address the fundamental scepticism and mistrust of the system. Many Members have already said that we do not believe that that is possible unless the system is scrapped and we start all over again.
I say to the Minister—because I think I know what he will say in his response to the debate—that I understand that this is an occupational assessment, not a medical assessment. I understand why it is not just doctors, but other occupational health professionals who can carry out the test, but it is disgraceful when those professionals have no understanding of the underlying medical condition and can arrive at such distorted judgments on a person’s fitness for work.
I also want to report to the Minister that, of the couple of dozen constituents I met last week, about half of them had no idea that they could take a companion to the assessment process. They said that they had not been told. Of those who did know that they could take a companion and who had sometimes done so, that companion was not made to feel welcome and was not able to assist them. Someone who suffers from autism is likely to behave in a particular way when responding to the questions asked—by trying to please and to give the answer that they think is wanted, rather than accurate—so I am sure that the Minister will appreciate that a companion who can support them and, if necessary, intervene is very important indeed. This bit of the system is not working and the Minister needs to look at it very carefully.
When the work capability assessment was introduced, we knew that it would be difficult and that we were trying something new. We built in the review process that led to the appointment of Professor Malcolm Harrington and some of the early improvements, which I think we all welcomed. Today, however, we have to face up to the fact that it is no longer possible to make the kinds of improvements that would make the system viable.
I get the impression—perhaps the Minister will correct this—that the Government have moved from trying to improve the system to either defending it or, to be frank, washing their hands of it. I honestly do not believe that that is a good enough response. If the Minister intends to say that there is not a problem, that improvements can continue and that these are simply still early days teething troubles, I say to him that the extent of the reports from throughout the House and the country of repeated, systemic problems means that it is time to look again.
I am sure that the Minister and many Members will remember—I most certainly do—the last time we had such a failure, whatever the intentions, of public policy implementation: the Child Support Agency. It took us 20 years to realise that the design that had been put in place simply could not work. Please let us not wait 20 years to realise that this system cannot work and must be started again.
As a member of the Backbench Business Committee, I was delighted that we scheduled this topic for debate. I believe that it is an example of the exact reason why the Committee was set up on the insistence of people who were Members way before us. This is about Parliament doing business. It is not about petty, party political point scoring; it is about issues that face thousands of our people every day. Those issues might one day face some of us or our family members. The issue also impacts on this country’s taxpayers, who are not getting value for money. It is about a system that has failed.
“The test of a good society is how you protect the poorest, the most vulnerable, the elderly and the frail.”
I agree with the Prime Minister on very little, but I certainly agree with him on that. That is the test that should be held today.
People say that the jury is out on Atos, but it is not —it has been out and has come back in, and the evidence is that Atos is failing miserably. We have already heard that 40% of appeals are successful. Evidence published this week has shown that, when people are represented, 70% of appeals are successful. The system is broken. This is not just about the financial cost of appeals; the human cost and suffering of people waiting to go through appeals is drastic.
I will not go through individual cases. I want to draw the Minister’s attention to evidence from those who represent people. First, I ask the Minister whether he has read “The People’s Review of the Work Capability Assessment”, which was produced in November 2012? It contains 67 pages of indictments of the system. It was supported by people across this House and by professionals inside and outside the system.
I asked my caseworker, Sheila Stevenson, how the work capability assessment was affecting people in my constituency. She said, “How many people do you want me to tell you about?” I asked her to give me her view. This is a woman who for seven years was a legal officer for the Union of Construction, Allied Trades and Technicians and has worked for me for four years. She said that about every third call is about benefits—mainly about ESA and people being found fit for work. People are being found fit for work despite an NHS GP, a consultant or psychiatric reports saying that they are not. Atos does not seem to take medical reports into account when deciding on someone’s capability. About
90% of my work is now benefits-related, whereas two years ago the figure was about 20%. As the citizens advice bureaux and jobcentres cannot cope, they refer cases to their local MP.
Recently, the all-party parliamentary group on coalfield communities, which I chair, heard evidence from Keith Lamb from the Durham Colliery Mechanics Trust and Mick White who works for the Yorkshire miners about their experiences from decades of representing people at work. They have had a huge increase in their work load and a very low success rate in overturning these decisions. They talked about how people have been failed. Doctors have made a number of mistakes. Assessors have been used whose first language is not English, so they cannot discuss clearly with claimants what their problems are. Claimants have signed medical reports and doctors have filled them in afterwards, when they were not even present at the medical. Claimants have been told that they do not have a disease.
I will give a classic example of the last point which the Minister should know about because, like me, he comes from a part of world where diseases such as pneumoconiosis cripple people. The Americans call it “black lung”. It is where somebody has a lung full of coal dust. People who have pneumoconiosis never improve and there is no way of getting better. And yet, people who are inexperienced are saying that people with the disease are no longer suffering and are capable of work. That is utterly out of order.
I spoke last night to Dave Hopper, who is the general secretary of the Durham Miners Association, an organisation that has represented people in this country for almost 200 years. He said:
“The system is breaking down.”
He told me that decades of close, professional relationships that had been built up between the association and the examiners and the chairmen of the tribunals are being undermined by the aggressive attitude of the people from Atos. He said that claimants are in dread of examinations and many refuse to appeal because of their initial experience. Surely that has to be wrong.
We are told in this House time and again that we need evidence-based policy. The Minister has today heard evidence from both sides of the House of where the system is breaking down. I suggest that he takes the evidence on board, listens to the people out there in the real world who are dealing with this matter day in and day out, gets them to sit around the table with Professor Harrington, and puts the system right. The system has failed, we need to put it right and we need to do so now.
There is so much to say and so little time. Let me start by congratulating my right hon. Friend Mr Meacher on securing this important debate.
The Government have many questions to answer about the way that work capability assessments are being carried out and about Atos. The way in which decisions are made on the ability of disabled people to work is nothing short of scandalous. The attack on people who are unable to work, in which they are labelled as skivers and scroungers, has demonised them in the eyes of the public. Yet fraud in disability benefits is very low—so low that it is not even under continuous review. Why are Atos and the Department for Work and Pensions cruelly finding people fit for work or putting them in the work-related activity group when they are clearly unable to work?
About 40% of appeals against the assessments are successful. Interestingly, the figure rises to 70% for claimants who are represented by a benefits expert. Of course, the success rate is only half the story because some people are too ill to appeal, others decide to resubmit their application from the start, and still others die before they get to the tribunal.
There are real questions about Atos and the Government. If I had a contract with anyone who failed in 40% of their decisions and cost me a lot of money, I would not continue to use them. However, the Government have just given Atos the contract for the personal independence payment, so they cannot be dissatisfied with its performance. There are questions to answer. Are the Government giving targets to Atos, either covertly or overtly? Have the Government discussed their expectation of reducing the number of people on benefits or is Atos doing that of its own accord? Everybody says officially that there are no targets, but workers report a different story.
When Dr Steve Bick went undercover for the “Dispatches” programme, he was told more than once that the process is meant to take people off benefit, and that if he did not find enough people fit to work, his assessments would be monitored. He was also told that if he found more than 12% or 13% of people unfit for work, he would be told that his rate was too high.
My surgery is full of people who have been cruelly treated by the DWP and Atos. I wish that I could tell all their stories, but I will tell just a few. I have changed their names. Sylvia’s husband came to see me because she was too ill to come. She had a subarachnoid haemorrhage four years ago, but aged 41, has now been found fit for work. She suffers blackouts, cannot dress herself, cannot self-medicate, cannot climb stairs by herself and cannot go out alone because she cannot remember where she lives or where she is going. Three to four times each month, she gets hemiplegic migraines, which last between two and six days, and mean that she becomes paralysed on her right side and loses her speech. Despite that, she has been found fit for work. The jobcentre, however, will not sign her on because it says that she is not fit for work. Needless to say, the stress sets off her migraines. One wonders what is the matter with her assessors.
Susan, a sufferer of fibromyalgia and hypermobility syndrome, told me that she felt like she was on trial for benefit fraud at her assessment. Bill, a former long-distance lorry driver, had chronic obstructive pulmonary disease, heart disease and diabetes. He thought the fact that he could not breathe would be reason enough to find him unfit for work, but of course he was wrong. He did not tell the assessors about his cerebral brain ascension, which means that he has terrible memory problems, because he is ashamed of having the condition. Of course, he has now had to tell them. He waited for nine months and then the decision was overturned.
There are many more people I could talk about, but I will finish with Clare, who has severe mental health issues and scoliosis. She scored 15 points and was placed in the work-related activity group, even though she will clearly never be able to work. She appealed the decision and had to wait for 12 months, which made her condition far worse. She was then put in the support group.
People being placed in the work-related activity group is the next scandal. When people score 15 points and are found not fit for work, but are put in the work-related activity group, they will lose their benefit after 365 days. Is that another way of saving money, but one that also puts disabled people into abject poverty and causes them terrible stress?
There are so many questions. Why do the assessors give more weight to work capability assessment descriptors than to professional medical assessments? Why do they reassess people who have just won their appeal? Why do they not record the number of people who die through illness or suicide when being rejected for disability benefit? Why do they not track people who have been found fit for work and people who no longer receive benefit? How much do all the botched assessments cost us?
We believe that we have a contract with the state. We work and pay our national insurance and tax in the belief that when we can no longer work, the state will look after us. The Government seem to have broken that contract. Surely the Minister cannot accept this cruel and heartless treatment of ill and disabled people. What is he going to do about it?
Like everybody else, I thank my right hon. Friend Mr Meacher for securing this debate and the Backbench Business Committee for agreeing to it. Clearly, we could have done with double the time or even more. Most of us could probably speak for at least an hour on these issues.
Getting the system right is hugely important for individuals. People have spoken about the effects on people’s mental state and their well-being, but I will mention some of the financial effects, which the last speaker began to touch on, for people who go into the work-related activity group. If that decision is not right, those people lose their contributory benefits after a year. The people who suffer the most from that are those who have a working partner—that partner may only work part time—and who have built up some savings, because they cease to get any benefit. If they want to get their national insurance credits, they still have to go through the assessment or they will not get the credits that will help them in the future with their pension. They may not be getting any money, but they are still going through the assessments.
Depending on the prognosis that is given in the recommendation—we are told it is not a “decision”—by Atos, many of the people in the work-related activity group will be mandated into the Work programme. That happens if the prognosis is that they might be fit within six months, but we are told that that will shortly be increased to twelve months. That means they could experience sanctions if things go wrong with the Work programme. If something goes wrong, perhaps because they have a learning disability or a mental health problem, and they do not turn up or are deemed not to be co-operating, they could be sanctioned. I have a constituent in that position who was sanctioned for six months for that reason. The people in that group are the ones who are most affected by having only a 1% increase in benefits for the next three years, although it must be said that people in the support group are in large part also affected, contrary to what has been said.
Getting it wrong can mean that people slip off benefits altogether. Research commissioned by the previous Government, which I understand is not being continued by this Government—the Minister might reassure us on that—found that 43% of those found fit for work were neither in work nor in receipt of an out-of-work benefit a year later. We must ask where they are. What is happening to them? We should know and we should care. It is not good enough for Minister to say, “We have reduced the number of people on out-of-work benefits,” and to imply that those people are happily in work when that is almost certainly not the case.
The Minister will probably say that things are improving, but the work on the descriptors shows that the pace is glacial. In November 2011, Professor Harrington suggested that new descriptors be tested. The Government said then that they would look at the suggestion in early 2012. The current position is that the testing has only recently begun, and we will be lucky if we get a full response and report on it by autumn 2013, which is nearly two years since Professor Harrison made that suggestion.
Another problem—this has already been touched on by others—is that some people are falling into a hidden trap. They are found fit for work, but are told that they cannot sign on for JSA, which is the only benefit for which they are eligible, because they are not fit for work and hold a medical certificate. Potentially, people in that situation get no benefit. I am not sure whether Ministers are even aware of that procedural issue.
On appeals, finally, after a lot of pushing, tribunal judges are giving limited information on their reasons, but it is not good enough—it is too general. But that information is being used by Ministers, and it was used by Atos in a briefing that I presume was sent to all MPs, to say that all is well, because it was found that Atos was found to be at fault in only 0.5% of cases. That is very misleading, because people are winning their appeals on the basis of new oral evidence.
It is a pleasure to follow so many passionate speeches this afternoon and to say a few words on behalf of some of the constituents who have contacted me. Like many hon. Members, I have held meetings in my constituency. I have also met Parkinson’s UK and the local branch of the Multiple Sclerosis Society, and received representations from many cancer patients. I hope the Minister can say something about their situations and about how descriptors affect cancer patients.
However, I want briefly to highlight other issues. There is a perception—notwithstanding what Atos or the Department for Work and Pensions says—that there are targets for placing numbers of people in the various groups. One constituent got in touch with me when he found out about this debate. He states:
“Getting a copy of the ESA85 report…to which everyone examined is entitled was like getting blood out of a stone.”
The man was found fit to work despite being on crutches and in constant pain at the time. He said:
“When I eventually received a copy I found that the examiner had stated clearly that I was found unfit for any kind of work and would remain so for at least two years.”
He tells me that when he tried to follow that up via the DWP, he was left with the distinct impression that staff had been advised, encouraged or instructed that everyone was to go into one of the employment support groups rather than be deemed completely unfit for work. I am sure the Minister will be able to comment on that.
Another issue that people frequently raise with me is about consultants. People who have seen consultants for medical conditions for a number of years feel that their consultant and general practitioner know their condition well, but they suddenly find that the Atos examiner takes a very different view. I have one example of a gentleman who was brought to my constituency office by a neighbour. He had had his third WCA in May 2012 and was zero rated. On the previous two occasions he appealed, and his appeals were upheld on the basis that the tribunal decided that he had reduced awareness of everyday hazards, leading to a significant risk of injury to him or others, and was therefore not fit for work.
That gentleman was brought to my office in August 2012 because he was awaiting his third appeal and was distressed by the process. Obviously, we gave him advice. On
I should briefly mention mental health, which was mentioned by a number of hon. Members, and again quote a constituent who contacted me this week. He says:
“I have been treated by my GP for over seven years for this illness, he is aware of the ups and downs, and the debilitating effects I am subject to. How can a registered nurse make a decision on my mental health in 41 minutes, most of which was asking questions about my physical health? This is what happened at my Atos WCA…There must be a change to the way people with mental health problems are dealt with by the system. I have spent the time since my WCA in June in misery, and the weeks leading up to the tribunal hearing in a mix of terror and stress. I was terrified at the tribunal itself.”
That is no way to treat people in a civilised society. The gentleman says that he is
“part of the last generation of ‘stiff upper lip’ and ‘put the best face on it’ people.”
He says that that “works against” him because he does not fit what he describes as the stereotype of someone with a mental health problem.
We need a system that is sophisticated enough to deal with those situations, but also one that is fair enough to ensure that people who are in the last weeks of their lives are not left in misery while they await tribunals.
We have a heard a large number—26, I believe—of extraordinarily powerful speeches in the debate. There is no doubt that the current WCA arrangements are causing immense problems and anxiety for people for whom all hon. Members want anxiety to be minimised.
In opening the debate, my right hon. Friend Mr Meacher mentioned the distress, indignation, fear and anger that have been caused. His assertion was amply supported by contributions from both sides of the House. We should not allow the system to continue. It needs fast and fundamental reform. I put it to the Minister—this struck me as I am sure it did him—that calls for such reform have come from both sides of the House, which does not often happen. It certainly happened today.
Part of the background to the debate is that a very small proportion of people who are placed by the WCA in the work-related activity group of ESA are getting into work. The invitation to tender for the Work programme said that the minimum performance standard would be that 5.5% of new applicants for ESA get into sustained job outcomes within one year, but the data published in November show that the proportion was 1%. The Work programme has performed terribly for the group of people we have spoken about in this debate.
What has gone wrong? The structure of the employment and support allowance is right. In the 1980s—my hon. Friend Sheila Gilmore was absolutely right to remind Bob Blackman of this—thousands of people were encouraged to move from unemployment benefit to invalidity benefit in order to reduce headline unemployment. People who worked in benefit offices at that time have explained to me how staff were given incentives to encourage people to make that shift. Once they had gone on to invalidity benefit, later incapacity benefit, that was it—they were abandoned. No further support beyond the cash benefit was provided. It was only in 1997 that that began to change. It was recognised that the vast majority of people in receipt of incapacity benefit would prefer to be in employment, if they could be. Starting with the new deal for disabled people and later with pathways to work, new ideas were developed. Nothing previously had been done to practically support people with serious health impairments into work. The approach can be summarised as: work for those who were in a position to work, and support for those who were not.
Out of that experience was drawn the design of the employment and support allowance. From that, the work capability assessment was designed to allocate people into the three groups: fit for work, work-related activity group, and support group. That is the right structure and architecture for the benefit, but it is the assessment—the topic of this debate—that is now in doubt. The key problem is that very soon after the election, the Government announced that they would reassess the entire incapacity benefit case load on a very fast timetable. At that time, the WCA had been introduced less than two years previously. Problems were still being ironed out and the organisation had not properly bedded down, yet on to this still developing system was placed the enormous burden of reassessment. Atos tells us it carried out 1 million work capability assessments last year. The load has just been too much, resulting in the problems that we have heard about, and which have been expressed so impressively in this debate.
They were laid before Parliament just before Christmas on
The Government have recognised that the WCA needs modification. However, as we have heard from a number of speakers, they have gone about the task in an extraordinarily leisurely way, which has been described as “glacial” by a number of Members. I hope that the Minister can encourage us and tell us that the Department will now get a move on. I want to put to him a number of specific points. When will the changes to the descriptors for fluctuating conditions and mental health conditions, which were recommended months ago by the disability organisations, be implemented? He answered a question that I tabled last week on this, and there still seems to be a terrible, lackadaisical approach. He said:
That was the first alarm signal, because his predecessor, in an answer on
In his reply to me last week, the Minister said:
“We have undertaken extensive work with these charities throughout the summer”— that was an answer last week, and the summer was the season before last. What happened in autumn?—
“to ensure that the ‘alternative’ WCA assessment combines recommendations from both the mental functioning and fluctuating conditions groups, and that the descriptors are suitable for testing.”—[Hansard, 7 January 2013; Vol. 556, c. 181-82W.]
The mental health descriptors were signed off by the charities in March last year. I really hope that the Minister will get the Department to get a move on and not just try these things out, which is what the evidence-based review—when it finally happens—will do, but introduce the changes that are clearly so urgently needed.
On progressive conditions, does it make sense to push everybody with a progressive condition, such as Parkinson’s disease, through regular reassessments when we all know that those conditions are only going to move in one direction and get worse. My hon. Friend Nia Griffith made that point in an intervention. The Minister answered a question from me recently about this. He said:
“Around 360 people with Parkinson’s disease in the Work Related Activity Group have undergone a repeat assessment following their initial assessment…Of these, around 20 people…were found Fit for Work at their first repeat assessment.”—[Hansard, 15 January 2013; Vol. 556, c. 725W.]
No doubt some of them will have appealed and had their appeals upheld. Is it really worth putting 360 people with Parkinson’s disease through reassessments in order to find that perhaps 20 should be fit for work—although, as I say, a number of those would no doubt have been overturned? I also asked how much the reassessments were costing. As a number of Members pointed out, the Minister simply will simply not answer any questions about cost, on the grounds of commercial confidentiality. This is public money, and we need to know where this money is going and how it is being spent.
We need to make better provision for people to be able to supply their own supporting medical information in their assessment—a point made by my right hon. Friend the Member for Oldham West and Royton in opening the debate, and by Jeremy Lefroy and my hon. Friend Mrs Moon. The application form should be amended to invite people’s own supporting medical information, and Atos assessors need to be more open to being informed by that information.
Atos assessors should be told why previous assessments were overturned on appeal—a point raised with me by Atos itself some months ago. We have heard how often people have won their appeal, gone back to Atos and immediately been found fit for work again. Part of the problem is that Atos was never told why a person’s appeal was upheld. I believe that changes are in hand or perhaps have been introduced to assess that problem. My hon. Friend Pamela Nash, however, was among those who referred to the seriousness of this revolving door problem. It needs to be addressed. I was also troubled by what she said about the difficulties people had getting their assessments recorded. That was supposed to have been sorted out, but her comments, and those of others, suggest otherwise.
Is my right hon. Friend aware that although tribunal judges are giving brief statements of reasons, these are not enough to help the decision makers or Atos understand?
My hon. Friend makes a telling point. That information needs to be provided.
The architecture of ESA is sound, but the assessment system is clearly not up to the load it is being asked to bear. That is why we need fundamental and much faster reform, with a much greater sense of urgency than we have seen from Ministers so far.
I also congratulate Mr Meacher on securing this helpful debate. It gives me the opportunity to address some of the concerns expressed on both sides of the House about this process.
“For too long, too many long-term sick and disabled people have been written off by the welfare system to a life of dependency, entirely reliant on benefit and devoid of experience of the labour market.”—[Hansard, 9 January 2007; Vol. 455, c. 246.]
Welfare Reform Bill in January 2007. Helen Goodman was a DWP Minister at the tail end of the previous Government, so I am sure she made her concerns known at that time to her ministerial colleagues—or perhaps not. This measure was introduced by the previous Government. The argument of the right hon. Member for East Renfrewshire was right then, and it is right now.
I welcome the hon. Lady’s candour. It would be good if more of her colleagues expressed similar candour.
One aspect of the Welfare Reform Act 2007 that has been referred to frequently throughout the debate is the establishment of the independent annual review. The last three have been undertaken by Professor Harrington, a distinguished occupational physician. What evidence has he put forward? In his first report, he stated that he did
“not believe that the system is broken or beyond repair”.
In his second report, he noted that the WCA had
“noticeably changed for the better”, and in his third report, he said that
“real progress has been made” and stressed that things are beginning to change positively in the best interests of the individual.”
It is important not to lose sight of that.
I want to make a bit more progress, because a lot of detailed points were raised and I want to address as many of them as possible.
Despite the improvement, it is clear—today’s debate reinforces this—that the WCA continues to generate heartfelt and passionately held views, but some of the worry experienced by claimants is a result of adverse media coverage and risks being fuelled by incorrect anecdotal information and—indeed—total myth. We have heard some of those myths today, and I want to set the record straight. This is an opportunity to address the facts behind the process and to set out what is happening in the Atos process.
Several hon. Members suggested that Atos had targets for finding people fit for work or placing them in a particular group. Let me be absolutely clear—let nobody in or beyond the House be in any doubt—there are no such targets. There are no targets for who should be put into which group. Instead—hon. Members would want this—there are quality-control checks. We want the right decisions to be made for our constituents and we want to ensure consistency between physicians and practitioners, and assessment centres. That quality control —saying that we should all be familiar with things we do and come across in our daily life—is not the same as a target. Atos has no targets to recommend that people go in particular groups.
I am grateful for that assurance, because it is a matter of great concern. Will the Minister go a step further and say whether he is aware of any internal targets? Will he give us an assurance that there are no internal targets at Atos?
There is nothing in the contract with Atos to suggest that there should be any targets for whom they recommend gets placed in particular groups. I want to be absolutely clear: there no targets and it is absolutely right that there should be no targets, because what all of us want, whichever side of the debate we are on, is to ensure that we get the right people in the right groups for the right support. We cannot do that with targets. We have to treat everyone individually. That is the dignity that we should accord the people going through the process. They should know that they are going to be treated with dignity. There are no preconceived targets.
The question then is not whether the Government are putting targets in place, but whether the Minister is 100% convinced that Atos does not set targets for any of its work force in any way, because that does not seem to be the evidence coming out. Is he utterly convinced about that and if not, will he investigate whether that is the case?
We have these discussions; there are no targets in the system. Indeed, the proportion of people who have been placed in the support group has doubled. To my mind, that suggests that there are no targets—it is very clear evidence of that.
No, I am not going to give way. I want to make some more progress and the hon. Lady raised some questions that I want to address.
It has also been suggested that Atos health care professionals make decisions on benefit entitlement. They do not. Those decisions are made by DWP decision makers. They take the ESA50—the form people complete when making an ESA claim—any further medical evidence produced by a GP, consultant or health practitioner with whom the claimant is working, and the Atos assessment, but they look at all that evidence. The decision is made by DWP decision makers, not Atos. That is why there are a number of cases where the DWP decision maker’s decision has been different from any recommendation made by Atos. It is up to the DWP—the decision is made by the Department, not Atos—to decide who goes into which group.
Let me make a bit more progress.
People say that the number of appeals overturned at tribunal is evidence of poor Atos reports—a point raised by Sheila Gilmore. When we asked judges why they overturned DWP decisions, they said that an error in the Atos assessment was the primary reason for an overturn in only 0.3% of cases. However, although it happens very rarely, I agree with her on one point: I would like to get more information from the judges.
The hon. Gentleman says that I am a Minister, but the judges are independent—one of the strengths of our system. I hope that the judges have heard the comments that have been made—not only in this debate, but in other debates—about the need for more detail. To get the system right we need better feedback from the judges, but let us not forget that where we ask judges for the reason for an overturn, in a large proportion of cases they say it is the presentation of fresh evidence. They are very explicit in saying that the primary reason for overturn in only 0.3% of cases is the Atos assessment.
I am grateful to the Minister for giving way, because this is an important point, especially as it has been briefed on so often. What I want to know—the Minister has to ask this question too—is this. I suspect that the question of overturns is simply one of some fairly simple error in the form, but according to the same judges, in 40% of cases they made their decision because they disagreed with the presentation of the case. That still suggests something wrong with the initial assessments—whether because the people concerned did not present them well or because the Atos assessors rushed them through. In 40% of cases the judges came to a different decision.
Just because the statistics do not suit the hon. Lady’s argument does not mean that they are wrong. A lot of this debate is about constituency casework and experience. Sometimes we also need to look at the overall stats and figures behind this issue to put those cases in context, which is why I made the point about the overturn rate.
“However, it is not part of the GP’s role to provide any opinion…on the patient’s capability to work as part of this process. It is vital that these two roles are kept separate and that GPs are not asked to provide an opinion on their patient for the purpose of receiving the Employment and Support Allowance; doing so could damage the doctor-patient relationship.”
It has also been said that the work capability assessment does not take full account of mental health conditions. Let me say a bit about that important issue. We have sought to improve the process and the support for the health care professionals who are undertaking the assessments. All Atos health care professionals receive specific and additional training in assessing mental health conditions—
We do ensure that those professionals receive the support that they need to assess those conditions.
Following Professor Harrington’s recommendation, Atos has 60 mental health function champions in place to spread best practice. My right hon. Friend Mrs Gillan asked whether they had specific training in autism. I can assure her that that is the case. She also asked, as did other hon. Members, whether we could review the effectiveness of the mental health champions. It is not for me to dictate the work that Professor Harrington’s successor will undertake as part of the fourth review, but I think that that is a good suggestion. We need to look at the effectiveness of the recommendations that Professor Harrington has made.
I am going to make some progress, as I have only a few minutes left to speak before the next debate starts.
In March 2011, we also implemented the recommendations of a Department-led review of the work capability assessment, which included the expansion of the support group to cover more people with certain communication problems and severe disability due to mental health conditions.
Hon. Members have suggested that the assessment does not take account of fluctuating conditions, but that is not the case. It gives people with a fluctuating condition the opportunity to explain how their condition varies over time. It is not a tick-box assessment, as some have suggested. There is a discussion between the health care professional and the person making the claim for ESA to determine how their condition varies over time. The questionnaire that customers are sent has been redesigned for that purpose, and people are now asked to give more details about how their fluctuating condition affects them as an individual. If a person cannot carry out a function repeatedly and reliably, they will be treated as unable to carry out that function at all. We all recognise that the capacity of people with a fluctuating condition can change, and it is important that proper regard should be given to that fact.
I want to pick up on a point made by Stephen Timms. We have committed to a review of the descriptors for fluctuating conditions, and we are working closely with charities on that. We also need to ensure that any new descriptors are as good as, or better than, the existing ones, for the purpose of assessing someone’s condition. That work is going on at the moment.
I know that the right hon. Gentleman is keen to find out when that review will be published, but let me just say this. We want to make changes, if there is evidence to support such changes, and we need to ensure that that evidence is gathered and evaluated. I am as keen as he is to ensure that changes are made as quickly as possible, and that we make the right changes and the best changes to improve the process. I am not in any way seeking to delay the process—we want to ensure that it happens—but we have had to work quite hard to get the right descriptors that will provide the evidence on functional ability, and we are now assessing them.
I will not give way. I have only three or four minutes left and there is a bit more to say.
Some criticism has been made of Atos, with suggestions that—
I am, Mr Speaker. I am aiming to finish at 2.58 to allow the right hon. Gentleman his two minutes. I would quite happily continue for longer, but I know another debate is to follow in which hon. Members are also interested and another time limit applies.
I have only four minutes left and I want to address some more questions.
Let me deal with the issue of Atos’s capability. Atos deals with 100,000 cases every month and it consistency meets the quality thresholds. Only 3.6% of assessments are below standard compared with a threshold of 5%. It receives complaints about only 0.6% of assessments. DWP decision makers return to Atos assessments that are inadequate for reaching a decision in only 0.2% of cases.
Natascha Engel asked about the appeal rates. Let me be clear about the rate of successful appeals. Of all the fit-for-work decisions taken by the Department, only 15% are overturned on appeal. Only 15% of all the decisions we take, then, are overturned on appeal, which I think demonstrates that while we need to ensure that there is a proper appeals process, we should not be bandying around figures that misrepresent the level of successful appeals.
No. I have two minutes left and I want to make some more comments.
My hon. Friend Jeremy Lefroy talked about quality. The tribunal service can refer substandard reports back to Atos as an appeal for further action. It has exercised that right only 23 times in the past year. Rigorous checks are in place to ensure that quality applies.
Much has been said about employment and support allowance not working—that is untrue. What we are seeing is people coming off ESA and getting into work. The number of working-age people on ESA and incapacity benefit in February 2012 was 2.56 million—the lowest level since the introduction of IB in 1995. Early estimates to September 2012 suggest that overall numbers for this benefit are falling and will for the first time be below 2.5 million.
Finally, although there are many other myths, the last one I shall address today is the myth that the WSA is not fit for purpose. Professor Harrington has made it quite clear that the WSA, designed as a first positive step for work, is the right concept for assessing people who need our support. There is a need to improve it. No one doubts that, which is why we have implemented Professor Harrington’s recommendations. The assessment we inherited needed refinement. That is why we accepted and have largely implemented more than 40 of his recommendations over the past two years. That is why twice as many people have gone into the support group in comparison with when ESA was introduced.
Overall, the proportion of people with mental health conditions being awarded ESA has risen from 33% to 49%. We are seeing improvements and more will be introduced later this month on the categories of cancer treatment that allow people to go straight into the work-related activity group. These changes are happening. We should recognise that change is important and that it is happening. This is the right approach; demonising the work capability assessment does not help our constituents and does not address their concerns.
I cannot remember attending such a compelling and powerful debate, combining passion, analysis and a very powerful demand for radical reform. It is absolutely clear that the consensus of the whole House is that the current Atos system has failed irretrievably and needs to be replaced by a wholly new and fair system.
I have to say that the Minister’s response just now was extremely disappointing. He gave no assurance whatever that the present failed, mechanistic, tick-box system used by Atos will be replaced, or that the evidence of GPs and other medical personnel who know the disabled person will be taken into account. He could thus give no assurance that the original decisions will be made any more accurate or fairer. As a consequence, the appeals system, already overloaded, is going to remain choked.
My hon. Friend Natascha Engel, the Chair of the Backbench Business Committee, made the forceful point that when Atos works for another employer, such as the NHS or Royal Mail, it produces very different results in terms of fitness for work—which strongly suggests the very uncomfortable truth that perhaps the DWP is entirely prepared to accept the results that we all deplore if that is only way of getting hundreds of thousands of people off benefits.
That is not just the view of the Opposition. I think that the mood of the House was caught by one of the Minister’s very senior colleagues, who said—I noted it down at the time—that the reputation of Atos was so damaged that it was necessary to park it to one side and move off in a different direction. That is exactly what is needed.
This issue is a test of the Government’s accountability to the House. In my opinion, the incontrovertible message conveyed by today’s debate is that until the Government and the DWP listen to, and act on, the unanimous view that has been expressed today—I have never seen such unanimity across the Benches—and introduce a wholly different system, the House will not let the matter go.
Question put and agreed to.
That this House has considered the matter of Atos work capability assessments.