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Clause 69 : Ending of discretionary payments
Moved by Baroness Lister of Burtersett
50ZA: Clause 69, page 54, line 8, at end insert-
"( ) Where amounts are re-allocated to local authorities as described in subsection (5), the Secretary of State must publish the following information annually for five years following the first re-allocation-
(a) the amount of money which has been re-allocated from the Consolidated Fund in each local authority; and
(b) an annual report accounting for the expenditure of these amounts in each local authority area."
My Lords, in order to be of assistance to the noble Baroness, who is seeking to move a very important amendment, may I suggest that those leaving the Chamber do not pass in front of speakers? That is not the habit of this House. May they please leave the chamber by another route, so that we may hear from the noble Baroness?
The amendment is about accountability. Considerable concern was raised in Grand Committee about the accountability of local authorities for the moneys devolved to them when the discretionary Social Fund is abolished. The amendment has been drafted with the help of Family Action, to which I am grateful, so as to put into effect the recommendation of the Communities and Local Government Committee report Localisation issues in welfare reform. While the CLG Committee accepted the Government's case against ring-fencing the money, its report said that this,
"may carry some risks at a time of difficult financial circumstances for councils".
The committee therefore recommended that,
"central government identifies clearly the amounts that are being allocated to local authorities, and collects information about their use, until the new arrangements have bedded in-we suggest a period of five years. ... This would provide some reassurance about the effectiveness of the new system in helping those in need".
Ministers have been giving out mixed messages on this issue. I hope that means that they are genuinely trying to find a way of answering the concerns about lack of accountability that have been raised in a number of quarters. One ministerial response has been to rely on the ballot box, even though the people affected are those least likely to vote, and also to contend that it is sufficient to set out the purpose of the funding in a settlement letter.
However, a chink of light emerged in the Government's response to the call for evidence, when they said that the settlement letter, mentioned last week by the Minister, the noble Lord, Lord De Mauley,
"may be supplemented with a requirement to report on how the funding has been used".
The CLG Committee observed:
"This would fall some way short of the accountability mechanisms suggested by some stakeholders".
Nevertheless, if the Minister now committed the Government to imposing such a requirement, we would be satisfied.
Last week, the noble Lord, Lord De Mauley, spoke about supplementing the planned review of a cross-section of local authorities in order to collect more information on how the money is spent. While I welcome the spirit in which this very small concession was offered, I fear that it falls short, not just of what we believe is necessary but of what the Government themselves hinted at in their response to the committee's evidence.
We are still awaiting an answer to some astute questioning in Grand Committee from the noble Lord, Lord German, about how the Government will meet their obligations of stewardship for the money allocated to local authorities in England. As the noble Lord stated very powerfully, this is a question of accountability to Parliament. How can such accountability be ensured if local authorities are not required to report on how they spend the money allocated to them?
The purpose of Amendment 50ZB is to allay the fears voiced by voluntary organisations such as Family Action, Women's Aid and Platform 51 that local authorities might impose a local or residence condition as a way of rationing assistance when allocating social housing. Again, I am grateful to Family Action for help with drafting this amendment. Given the pressures on local authorities, it is quite conceivable that some at least might seek to impose a local connection test-that is, confine help to people who already have a local connection with the area. In Committee, I tabled a general amendment to prevent such a test. This amendment is drafted more tightly to ensure that such a test is not applied to people fleeing domestic violence-or, more accurately, people who have fled domestic violence-young people leaving local authority care, people who are homeless or who have been homeless within the previous 12 months and people leaving institutional residential care such as a hospital, prison or a young offenders' institution. In other words, this amendment is designed to safeguard the interests of groups who are likely not to have a local connection.
As the voluntary sector consortium headed by Family Action points out,
"These groups of people are much less likely than others to be able to demonstrate local connection. Without crucial assistance from a Community Care Grant to buy essential items such as cooking equipment and bedding, they may struggle to set up and maintain a home. This puts them at risk of reoffending or moving back into temporary or institutional accommodation, which is far more costly and means they lose their newly-found independence".
The consortium is particularly concerned that, without a clear legal prohibition on requiring a local residence connection, women who have experienced domestic violence will be discouraged from moving elsewhere to flee their violent partner, or will return to their partner because they are unable to provide basic household items such as a cooker to prepare cheap healthy food for themselves and their children. The consortium's concerns were echoed in the impact report published last week by the Office of the Children's Commissioner for England, which looked at the impact of the legislation in relation to children's rights. When questioned on this matter in the House of Commons, the Secretary of State assured Members that local authorities had a moral duty. Welcome as this recognition is, I fear that if a woman who has fled domestic violence or an ex-prisoner cites a moral duty to their local authority they will not get very far. Surely if the Government believe that a moral duty holds, they should translate it into a statutory duty.
The Minister, the noble Lord, Lord Freud, did not address these issues in Committee but kindly wrote to me afterwards. However, he simply set out in his letter the local connection provisions on homelessness contained in the Housing Act 1996. I shall not spell those out now, but they protect a person from being denied any assistance anywhere because of a lack of local connection. If the Minister is saying that the same rule will apply here, then I welcome it, but does it not need to be written into the legislation? As I understand it, the Housing Act 1996 does not apply to the legislation we are discussing here. If the Minister were to offer to bring forward his own amendment at Third Reading to give effect to the Housing Act provisions on local connection, I would happily withdraw the amendment as unnecessary. As an absolute minimum, can the Minister assure the House that the settlement letter will spell out that local authorities should follow the same provisions as in the housing legislation?
It seems to me that the aims of these two amendments are not that far from what the Government themselves wish to achieve. I hope therefore that the Minister might be willing either to accept them or to agree to bring forward his own amendments at Third Reading. I beg to move.
My Lords, I will speak briefly to Amendment 50ZA and will refer to Amendment 50ZC. I very much applaud the aims of the noble Baroness, Lady Lister, in seeking to have publication of information about the allocations of money to local authorities for the purposes envisaged. She presented her case very powerfully as always.
I want to thank the Bill team for a most helpful conversation. I understand that the £36 million allocated for crisis loans could be spent by local authorities on grants or payments in kind as well as loans. I find that very encouraging. I for one am very suspicious of loans for people attempting to live on the breadline-they can build up even greater problems for the future-other than when provided for budgeting purposes, which I know is very much what the Minister has in mind. If, for example, households receive half their monthly income half way through the month as a loan only to be repaid at the end of the month, that would go some way to ameliorate what would otherwise, for me anyway, be a highly risky set of proposals.
Amendment 50ZA, tabled by the noble Baroness, Lady Lister, would provide information on whether the funds had been spent by local authorities on the purposes for which the Government are allocating them-we all understand that is what they are being allocated for. I have some concerns that, even if the Minister concedes this amendment, it remains true that there is no statutory requirement for local authorities to provide some form of assistance to households in crisis. Many Social Fund crisis loans are sought because mothers, often single mothers, have no cash for the electricity meter-apparently, this is really the dominant issue confronting people who seek these loans-with several days to go before getting any more benefit and, of course, the children are cold and the mother cannot even make a hot meal for them without some form of electricity. I understand that the idea of the settlement letter is to spell out the purposes for which the £36 million should be used. I applaud that. I also understand that the DWP plans to follow up a representative sample of local authorities after one year to find out how they have spent the money.
My concern is that over time the settlement letter might be redrafted-heaven forbid that Ministers even change from time to time-and, if local authorities report after one year that unfortunately the £36 million had to be spent on other matters, it seems to me that there is no way of ensuring that these households in crisis actually have funds allocated to those needs. That is actually my concern. We need to know that there will continue to be a system for dealing with these household crises, particularly for families with children. We do not want these children disadvantaged.
I understand the logic of making the £178 million for community care grants and crisis payments available to local authorities, which are no doubt closely involved with many of these families-certainly, if they are not involved, they should be. The aim, as I understand it, is that these funds need to be brought together with other forms of assistance for these families in order to generate greater value for money. At the moment, the Social Fund is a national system that operates at arm's length from other services. I recognise that this has some disadvantages. The concern is that every local authority is likely to respond differently to this challenge. How can we be sure that households in crisis will have somewhere to go for help, as I have already said? The Government are already committed to the settlement letter and review after 12 months, again as I have already alluded to. I welcome those commitments very strongly. They are a start, but they are a weak provision in this very important area of policy.
I hope that the Minister will take seriously the need for a more robust system to underwrite what I understand to be the Government's intentions. The amendment tabled by the noble Baroness, Lady Lister, is one option, but whether or not the Minister accepts Amendment 50ZA, perhaps he will consider incorporating in regulations the requirement that the funds envisaged for resolving household crises are indeed allocated to that purpose. I understand that how local authorities want to do that is a matter for them, but I think that ensuring that the funds are focused on that issue merits a sentence in the regulations. That would certainly make a much stronger support for the provision and give an assurance to the House that we have not lost it.
I would be very grateful for the Minister's serious consideration of the amendment. I should mention that I will not move Amendment 50ZC at this stage.
My Lords, I make a brief intervention to support the amendments, as I did in Committee. Clause 69 is very important for a relatively small but very vulnerable group of people. The discretionary Social Fund has been part of the furniture, if you like, of social security for a long time, and during the period that it has been deployed, people have been able to take advantage of it to save the public purse considerable sums. One of the main purposes behind the discretionary Social Fund is to prevent people being institutionalised in various ways, and it has done that very successfully. There is cross-party agreement that reform of the Social Fund is long overdue, but to abolish or decentralise it like this raises many questions, which remain unanswered. I hope that the Minister will take the opportunity to try to assuage the concerns that some of us continue to have.
First, the process that will now unfold is less than clear to me. Reading the penultimate subsection of Clause 69, I think that an affirmative resolution will be required to give effect to the power that the Government are seeking in the clause, but I should like reassurance about our ability to have ongoing discussion about how the Social Fund Commissioner's assets and the apparatus that we have in place at the moment will be dismantled in a way that makes sense, and that the allocation formula for the disbursement of these moneys is carefully considered and consulted on, because the discretionary Social Fund spend obviously has a very spatial dimension to it because some communities need it much more than others. We need to be careful about how we make that decision in the first instance. That is another reason why Parliament, by virtue of affirmative resolution or statutory instrument, must be continuously approached for advice and reassurance. The sample of local authorities being lined up for the welcome review process needs to be carefully considered because of the point I have just made: the decentralisation process will affect some dramatically differently from others.
I still have serious misgivings about this. If we are going to do this, we need to be really careful that we are getting it correct in the first instance and that the client group who have relied on discretionary payments from the Social Fund in crisis situations are not left wanting, completely abandoned and without access to liquid cash in circumstances where they find it difficult to survive.
My Lords, I wish to raise briefly the question of whether to centralise payments to people in extreme difficulty or whether to leave that to the discretion of local authorities or, as was originally suggested prior to the First World War, friendly societies, or others. That idea has subsisted for at least 100 years and I think it will continue. I am generally supportive of the localism agenda and I can see material benefits in devolving this opportunity to local authorities. However, the amendments raise two issues that need a little reflection.
The wider question, which has been touched on by a number of noble Lords, is whether this money, which was intended for people in severe difficulties, will continue, albeit with local administration, to be applied to such people in general. I think that on the whole the Government are facing in the right direction here, but I look forward to the Minister's assurances on it.
The specific twist that I want to add was prompted by something that the noble Baroness, Lady Lister, said about whether there should be a local connection. Clearly there is the subtext that there could be some discrimination in favour of the local boy or girl against someone from outside, someone who was felt to be in some sense the architect of their own distress or someone in some way morally unworthy. I do not want to go on about that now, but we can see the argument developing.
I should like the Minister to consider-and it may be helpful to him to do so-the fact that since the passage of the Housing Act some 16 years ago, we have had all the equality duties, including the public sector equality duty. Certainly local authorities, in exercising the discretion being offered them, will have to operate within the framework of that duty. I wonder whether that is indeed helpful in obtaining the assurances that I think we want with regard to making sure not only that the money goes where it is intended to go but that it goes to the people who need it most within that category of difficulty, rather than being siphoned off to people who are more acceptable or who come more within the interest of the local authority concerned.
My Lords, I want to speak in favour of all these amendments and to ask a question about Amendment 50ZB. When we discussed the Social Fund on our previous day on Report, I raised the fact that the Office of the Children's Commissioner had published the Child Rights Impact Assessment of the Welfare Reform Bill. I understand that at that point the Minister had not had the opportunity to read the assessment in any detail, but I wonder whether he has had the chance to read it since then and, if so, whether he can assure the House about the line that says:
"In failing to guarantee that crisis support is available for children fleeing an abusive home with their parent/carer, the clauses abolishing the Social Fund fail to take all appropriate legislative measures to protect children from domestic abuse and we therefore believe they are in breach of Article 19", of the UN Convention on the Rights of the Child. That goes to the heart of the point which the noble Lord, Lord Boswell, has just raised. People might have a very good reason to cross boundaries. If one were fleeing domestic violence, that would be a good reason not to move to the neighbouring street, as I am sure the noble Lord would accept. How can the Government guarantee that local authorities will give appropriate support to children and families in that circumstance, and how can they prove that the UK will discharge its responsibilities under this convention?
My Lords, I speak as a heretic who is even now probably having his burning at the stake prepared by the Secretary of State for Local Government, my right honourable friend Eric Pickles, because I believe in ring-fencing. I have always thought it daft that Governments make available for a specific purpose money that is then spent by other people on something else. The Government get the blame for not having provided the money and everyone else gets the credit when anything good happens. I do not think that is sensible. However, it is a brick wall against which I do not propose to bang my head this afternoon.
The suggestion of the noble Baroness, Lady Lister-that if local authorities are going to have this money, they should at least be required to account for it-is a good one. I am slightly scarred by my experience as chairman-although I am no longer-of Help the Hospices; the previous Government allegedly made £50 million available but no one ever found it. It disappeared into thin air. I do not want to see that happen here. I do not want to see it spent on swimming pools, or campaigns, or many other good causes, when it is intended for people with severe disabilities.
There is an irony here which the noble Baroness, Lady Lister, will appreciate. Nearly 25 years ago, when we were introducing the Social Fund, I was the villain. She pursued me up hill and down dale. Now I am the hero whose achievement is to be safeguarded. I hope she may reflect on that.
This transfer is probably sensible. The needs of very seriously disabled people require a discretionary, judgmental element in the help that is provided. This cannot be met by benefit rates, which are inevitably restricted and generalised, so I am not opposed to this. The noble Baroness knows that I declined to sign her earlier amendment on the basis that all such money intended for disabled people-not just the Social Fund money-should be, if not ring-fenced, then protected to some extent. I cleave to that view.
It is sensible to have at least this requirement for local authorities to say what their allocation has been and what they have done with it, in line with whatever protestations Ministers have made. It does not cost the Government anything significant. It does not blow a further hole in the finances. It is reasonable, sensible, proportionate and justified, and I hope we shall get a positive response.
My Lords, like other speakers I support Amendment 50ZB. Very few police officers have not come across the fleeing mother with her children. There is no more desperate person imaginable. However, that is not the point I want to make. My point relates to a longer-term issue, and is about making sure that this funding goes towards the long-term prevention of crime. The connection between criminality and having been in care, between criminality and homelessness, and between criminality and having been already in prison is so clear that money spent here and accounted for by the local authorities, as the noble Lord, Lord Newton, has just said, is money well spent. This money should be spent on this, and to have it spent on other things would be a great shame.
My Lords, to concur with the noble Lord's last sentence, this is a matter of accountability. I refer to Amendment 50ZA, which applies only to England. Members of the House of Lords will be very familiar with the fact that other parts of the United Kingdom will receive this money, and I would like some confirmation from the Minister on the arrangements that are to be made for Scotland and Wales. If, as I understand it, this money is to be transferred by means of the Barnett formula, the amendment will apply only to England. I wonder how it is possible to seek accountability for money that has been given by this Parliament for the services that are so vital for people within the current arrangements for the Social Fund. This is not an anti-devolution to local government statement, but the lines of accountability here do need to be judged. If we are devolving the power for that accountability to the Welsh and Scottish Governments, we need to state that now, and noble Lords need to understand that this is a further devolution of responsibility. Many noble Lords may accept this, or like it, or find it an attractive proposition, but the Government's intention in this respect is as yet unclear to me.
My Lords, I am not sure whether the noble Lord, Lord German, is for or against the amendment, but all the other speakers have clearly supported these amendments. This is quite sensible, because the amendments all set out to ensure that vulnerable people can continue to access support once the Social Fund has been devolved, to whomsoever.
The first amendment in the group implements a recommendation of the Select Committee in another place. It would provide some reassurance about the effectiveness of the new system of helping those in need, and clearer information to local voters about whether their local authority is choosing to spend less than the allocated amount. It does nothing to restrict local discretion in how to implement the Social Fund replacement scheme; it merely places a requirement on the local authority, as has been said, to account for it. I think that all noble Lords who spoke would support that, and I feel sure that this is an aim that the Minister, similarly, will support.
The second amendment in the group, as was spelled out, would ensure that the use of local connection rules cannot prevent, for example, care leavers, the homeless, those fleeing domestic violence-the noble Lord, Lord Blair, spoke about them-and those leaving institutional residential care accessing Social Fund-type support. It is true that it ties the hands of local authorities a little, but only to ensure that groups that might be very much in need of support are not left with nowhere else to turn. As we heard, for many women fleeing domestic violence, community care grants are vital in helping them to set up a new home and perhaps buy a cot, a bed or a cooker. Given that many women need to enter refuges or other homes away from their former partners, they will often be unable to meet local connection rules.
We know that, among people who use the discretionary Social Fund, one in eight is leaving some sort of institutional care; nearly one in 10 is leaving prison; and one in five has at some time experienced homelessness. I work in Camden with people who have alcohol problems. There are a lot of train stations in Camden, so a lot of people arrive on our doorstep. At the time we help them with their drink problem, they will not be in the same area where they have lived and worked for perhaps 30 years.
Although I understand that the noble Baroness, Lady Meacher, will not press her amendment, I urge the Minister to consider it. We know that although universal credit budgeting loans could be available for rent in advance, crisis loans will be abolished before the introduction of universal credit, and it could be some time before the new system is set up and reliable. We know from our experience of many new IT systems that even the best laid plans occasionally go wrong. We have had many assurances from the noble Lord, Lord Freud, about the robust nature of the system being put in place, but it would be prudent to ensure that a national safety net remains while we wait for him-we hope-to be proved right on this occasion. I said "prudent" but it is probably vital that we continue to guarantee national access to community care loans and crisis loans until the universal credit system is set up. Once national systems have been devolved, the accountability that my noble friend spoke of, as well as the local connection rules, will be an essential part of helping these vulnerable groups. We are happy to support all three amendments in this group.
My Lords, when we discussed the Social Fund last week, I hope I was able to offer reassurance in two key areas. First, I informed noble Lords that we would extend the 2014-15 review of a cross-section of local authorities to include information about the way they have used their funding for the new local provision. Perhaps I may return to that in a moment.
I was also able to assure your Lordships that the settlement letter that noble Lords referred to today that will accompany the funding will set out what the funding is to be used for and will describe the outcome that must be achieved-although, for reasons I explained, not the method that should be used to achieve the outcome. After further consideration of the issue, and following questions from noble Lords, I am able to explain what the settlement letter will contain. The letter will set out what the funding is to be used for, the underlying principles, and describe the outcome that must be achieved. It will say that the funding is to concentrate resources on those facing greatest difficulty in managing their income, and to enable a more flexible response to unavoidable need. The letter will make explicit that the funding is to provide a replacement provision for community care grants and general living expenses crisis loans.
The letter will go on to explain that community care grants were awarded for a range of expenses, including household equipment, and were intended to support vulnerable people to return to or remain in the community or to ease exceptional pressure on families. They were also intended to assist with certain travel expenses. It will also explain that crisis loans were made to meet immediate short-term needs in an emergency or as a consequence of a disaster when a person had insufficient resources to prevent a serious risk to the health and safety of themselves or their family. As I said in our discussion of Amendment 50 last week, I assure your Lordships that we are equally committed to ensuring that this funding goes to help the most vulnerable.
Amendment 50ZA would require the Secretary of State to publish information on the amount of money given annually to each local authority. I can assure your Lordships that we already plan to publish this information on the DWP website. On community care grant budgets, noble Lords might like to be aware that work has been done since Committee to make the funding distribution fairer by changing the funding allocation methodology.
It is each local authority's responsibility to decide what type of support it provides with these funds. We have already been made aware of a variety of innovative ways in which local authorities plan to use this money, such as furniture re-use schemes, working with credit unions, investing in existing projects or joining up with other organisations in the area. For example, the fieldwork undertaken by the department shows that rural local authorities had very different ideas from those of urban authorities, and would embrace the freedom to design and establish local provision that suits the particular challenges they face.
Some benefit recipients cannot even afford the delivery of free goods from support schemes. During the fieldwork, the department was made aware of the fact that a local authority in Yorkshire is considering using some of the new funding to pay the delivery fees charged by an existing provider for the delivery of free goods to benefit recipients and other low income groups. This demonstrates the benefit of tailoring support to the local area. This initiative is particularly useful in a rural area, as it would have been far more expensive for people to arrange their own deliveries than in an urban area. This service would help people on the lowest incomes to receive free household goods that they might otherwise be simply unable to access.
Another example of innovative thinking came from a local authority in the Greater Manchester area, which said that it would use the funding to expand the local credit union, as this already provides household goods to people on low incomes. Expanding the scheme would increase access to affordable credit for those on low incomes and reduce the reliance on high-cost and illegal lenders. Yet another different approach to the new provision is that of a local authority in the south-west, which has been looking at how commissioning services would boost the local economy, providing new skills and routes back into employment and out of poverty.
As I hope is evident from these examples, giving local authorities the responsibility for deciding what the new local provision will look like allows for innovative new schemes that are tailored to the local area.
These examples are very helpful, as is the further fleshing-out of the content of the letter to local authorities, but what is the arbitration process, supposing local authorities deliberately and in bad faith pay no attention to the contents of the letter that the Minister is proposing to send?
Perhaps I might come to that as I proceed. Amendment 50ZA would also require the Secretary of State to publish an annual report accounting for the expenditure of this funding. As each local authority will be delivering different types of support, requiring the Secretary of State to report on a large number and variety of schemes-some of which, as I have explained, would be combined with existing services-would, I suggest, be impractical as well as costly. It would lead to expenditure on administration when local authorities will, in any event, be required to account to their communities for their spending and services.
There will be a large variety in the size of awards to local authorities, as the amount of funding each will receive will be based on the equivalent Social Fund spend at the point of transition. Therefore, while some local authorities will receive large amounts, others will receive less than £10,000. It would be far too onerous to require these authorities to report in detail on how the funding is spent. It would make no sense to enforce the same reporting requirements on such a wide range of local authorities receiving such differing amounts. However, as I said in the debate on Amendment 50, the department will conduct a review in 2014-15, obtaining appropriate information from a representative cross-section of local authorities, in order to help inform future funding levels. I am not talking about a small sample. An analogous exercise conducted last year covered 50 local authorities, so we are talking about quite a substantial exercise. Following the helpful contributions of noble Lords in Committee, I have made a commitment that this exercise will be extended to provide more information about the way in which local authorities have used the funding.
Amendment 50ZB seeks to ensure that certain particularly vulnerable groups of people are not rendered ineligible for support on the basis of a test of local residence or connections. We have discussed this issue with local authorities, which are, of course, as noble Lords will be well aware, already very familiar with the issue. In fact, it is not really a Social Fund-specific issue at all because local authorities already deal with boundary issues in the delivery of other services, such as housing and homelessness. Local authorities already have many duties to provide assistance to vulnerable people under existing legislation and frequently co-operate with other local authorities in doing so. We believe that local authorities should be given the freedom to set their own eligibility criteria to enable them to tailor the new provision to their local area.
Furthermore, we will encourage local authorities to link support across boundaries. Indeed, several authorities have mentioned to us in discussions that they were already planning to establish collaborative working relationships. Wandsworth, Hammersmith and Fulham and Kensington and Chelsea, for example, already work together to provide some joint services and have said that they will look to see how they can join up for this new local provision. Bristol is also looking at working with neighbouring authorities. Each of the groups referred to in Amendment 50ZB already receives assistance from local authorities and the Government. As my noble friend Lord Boswell mentioned, local authorities already have a number of existing responsibilities in relation to the provision of emergency and longer-term accommodation. They have particular responsibilities in respect of those with a priority need, such as those who are vulnerable because of age, mental illness or disability and those with dependent children.
The noble Baroness, Lady Lister, referred to Section 199 of the Housing Act 1996, which sets out what constitutes a local connection in relation to people who are homeless. There is also statutory guidance for local authorities from the Department for Communities and Local Government to which local authorities must have regard. The effect is that those with no local connection receive help from the local authority to which they apply; those with a local connection to a particular area receive help from the authority responsible for that area unless they are at risk of violence if they return there. A local authority housing a vulnerable person would be in a good position to provide help through the new local provision-for example, by providing furnishing for the accommodation it arranges. This is a more holistic approach for local authorities to adopt and such an approach would also be beneficial for local authorities delivering support to those fleeing domestic violence. Local authorities can use the new local provision alongside existing support.
The noble Baroness, Lady Lister, challenged me as to how the other groups in the amendment are covered by duties and responsibilities. Local authorities already have a duty to house someone fleeing from domestic violence. They will be able to use the new provision to continue to provide support further down the line-for example, helping to furnish new accommodation that has been provided to someone who has fled domestic violence. As regards young people leaving local authority care, local authorities have a duty to safeguard and promote the welfare of a child who has been a looked-after child, including providing maintenance, and have such duties until the child is 21. Local authorities also already have duties to support disabled people or those who are destitute. They must make arrangements for promoting the welfare of those with a disability or mental disorder, including assessing the welfare needs of a person leaving hospital having received in-patient treatment for a mental disorder.
The National Health Service and Community Care Act 1990 requires local authorities to prepare a plan for the provision of community care services in consultation with relevant bodies and to assess the needs of people who may be in need of these services. Local authorities are already required by multiple legislative duties to provide support to the most vulnerable people in their area and they have a great deal of experience of doing so. They will be able to use this experience to deliver the new local provision in a way that will best suit the people in their local area. Therefore, I suggest that there is no specific need for local connection eligibility rules to be published.
The noble Baroness, Lady Sherlock, asked about the Children's Commissioner's report. I have read the report, published last week, which suggests that certain changes made by the Bill could lead to breach of the UN Convention on the Rights of the Child. The Government are satisfied that the Bill is compatible with their human rights obligations, including those under the UN Convention on the Rights of the Child.
The safeguards to which I have referred will ensure that the money intended for vulnerable people goes to vulnerable people. The most discretionary support will be better tailored to people's needs when it is delivered locally. The new local provision and the national provision of payments on account will complement each other and, taken as a whole, they will provide more effective and better targeted support. For these reasons, I urge noble Lords not to press their amendments.
Does the Minister intend to respond to the point raised by the noble Lord, Lord German, with regard to the interplay with devolved authorities? It is a material question that was raised in Committee. My understanding in Committee was different from the understanding of the noble Lord, Lord German. If the Minister cannot respond now, perhaps he will write to interested parties in order to provide clarity on the matter.
Can the Minister also respond to the point raised by the noble Lord, Lord Kirkwood, which I also raised, on the real assurance-the teeth, if you like-that the Government will need in emergencies to make sure, without specifying how it is spent, that the money is spent on those in greatest need? I would be grateful for a response from the Minister.
My Lords, I hoped that I had emphasised that point. A great deal of work has been done with local authorities explaining the proposal and the intentions behind it. We have encountered considerable enthusiasm for the principle. We have put a lot of effort into helping and educating local authorities which will be making the decisions. I hoped that I had emphasised the importance of that point. I am agreeing with the noble Baroness but I do not think that I can go very much further than I have gone.
My Lords, I thank all noble Lords who have contributed to the debate. They have added some powerful arguments and questioning. In response to the noble Lord, Lord Newton, I should say that it is better to go from zero to hero than the other way round.
I thank the Minister who, I feel, is inching gradually in the direction that we have been trying to push him. He has again reassured us that the Government share the concern across the House that the money that is allocated to local authorities should be used for the purposes intended. It was helpful to have more information about what will be in the settlement letter. However, I have heard nothing today to reassure me that the money will necessarily be spent on what is intended. We should think of the context. Local authorities are under huge pressure. Apart from anything else, they will have to be responsible for council tax benefit, with a cut of 10 per cent in the money available for it. How tempting it might be for them to say, "Oh, let us use a bit of the Social Fund money to top up council tax benefit".
How can the noble Lord say with such assurance that the money will not be used on a swimming pool, a road or anything else? Without the information that this amendment would provide, I am afraid that the Government simply cannot give that assurance. I am very disappointed that the noble Lord has not felt able to go further in meeting the spirit of these amendments even if not the letter of them. I do not think that he has dealt adequately with the questions and comments made by noble Lords.
We have the example of the supporting people budget. When the ring-fence was removed, immediately many local authorities started spending the money on other things. That was with an existing budget. This is a new budget, which will be even more tempting for local authorities. I hope that the Government will reflect further on this issue. We will certainly reflect further but, for the moment, I beg leave to withdraw the amendment.
Amendment 50ZA withdrawn.
Amendments 50ZB and 50ZC not moved.
Clause 74 : State pension credit: capital limit
Amendment 50ZD not moved.
Clause 76 : Personal independence payment
Tabled by Baroness Campbell of Surbiton
50ZE: Clause 76, page 56, line 8, leave out "personal independence payment" and insert "personal disability costs payment"
My Lords, the noble Baroness, Lady Campbell of Surbiton, is unfortunately unwell today. Currently, she is watching the Report stage of the Welfare Reform Bill from her hospital bed. She has asked that Amendment 50ZE is not moved and I would ask your Lordships' House to agree to this request. I am sure that your Lordships' House would also want to send best wishes to the noble Baroness for a speedy return to the Chamber.
Amendment 50ZE not moved.
Amendments 50ZF and 50ZG not moved.
Moved by Baroness Meacher
50ZGA: Clause 76, page 56, line 17, at end insert-
"(4) A person is not entitled to personal independence payment unless the person is aged 18 or over."
My Lords, in moving Amendment 50ZGA, I shall speak also to Amendment 56ZC, the purpose of which is to allow disabled children aged 16 and 17 to continue to qualify for DLA for children instead of PIP until they reach the age of 18. It would mean that they would not have to go through the PIP assessment process until they reach an adult age. It would also simplify the benefits system by aligning PIP with universal credit.
I thank the Minister for sparing time to discuss this amendment at the end of a long day, which was at the end of a long week. I should offer him my apologies because last week I was jetlagged, tired and not very well, and I did not always get all my little ducks in a row. But I understand that 16 and 17 year-olds applying for PIP would not have to go through an income assessment. However, they would have to undertake a capability assessment. The point of this amendment is to sort out some issues of principle and consistency in relation to 16 and 17 year-olds. When I met the Minister, we did not touch on these issues and I should be interested to know his response today.
I understand that this amendment would bring the Bill into line with the United Nations Convention on the Rights of the Child, which defines a child as,
"every human being below the age of eighteen years".
More particularly-in my view more importantly-this amendment would deal with the adverse consequences of these clauses for the young people affected. In other words, if disabled 16 and 17 year-olds would benefit from being treated as adults, frankly, that would be good enough for me but the fact is that they will not.
In terms of consistency, the Government plan to raise the age of participation in education or training to 17 in 2012 and 18 in 2015, but the introduction of PIP from 2013 will treat 16 and 17 year-olds as working-age adults. Does it make any sense to treat these young people as children with respect to education and as adults when it comes to claiming benefits?
Another important point is that Clause 4 of the Welfare Reform Bill sets out the basic conditions of entitlement to universal credit, one of which is that the person will be,
"at least 18 years old".
I understand that regulations will provide for some exceptions for that. I also understand that some children aged 16 and 17 may claim ESA and thus universal credit. But the basic assumption of the new universal credit system will be that children will be treated as dependents of their parents, and therefore not generally expected to claim universal credit in their own right, until they reach the age of 18.
In our discussion, the Minister defended the decision to transfer 16 and 17 year-olds to PIP on the grounds that they would only need to undertake the capability assessment and not the income assessment. That is fine. My question to the Minister is: why is it necessary to create this anomaly between the age limit for universal credit and the age limit for PIP? I look forward to hearing his explanation. In my experience, the Minister always has very good explanations for everything that the Government do, but I have difficulty imagining what the explanation for this one is, unless it is a straight conflict between the Treasury's determination to cut £18 billion from the welfare and benefits bill and the DWP's aspiration to create a much simpler system-an aspiration which noble Lords across this House support.
The treatment of 16 and 17 year-olds under the PIP system rather than the DLA system will also impact upon their entitlement to disability additions. As noble Lords will know, universal credit includes disability additions to provide extra help for both children and adults with disabilities. However, the gateways to this additional support differ for the two groups. Children aged 16 and 17 will, other than in some exceptional circumstances, count as part of their parents' household. The disability additions for children who are part of their parents' household will be based upon DLA. Even if these 16 and 17 year-olds are part of their parents' household, along with younger children-and in almost every case 16 and 17 year-old disabled children will be a part of their parents' household-they will not be treated as such. Again, is there any logic behind this provision?
A separate point is that the PIP assessment tool envisaged for 16 and 17 year-olds is not appropriate for children, albeit that the PIP assessment tool is more sensitive to mental health disabilities than the DLA assessment-I will return to that point, which is an important one. The Children's Society points out that children and young people need a system designed to take into account their developmental needs and circumstances, including the importance of social networks and friendships. PIP questions are narrower than those for the DLA assessment. The DLA assessment itself includes reference to reasonable amounts of social activity and the support needed to take part in that. There is no question that friendship and the ability to get out and about are essential for children and perhaps even more essential for 16 and 17 year-olds than for any other age group whatever.
Despite concerns about the applicability of the PIP assessment tool to 16 and 17 year-olds, disabled children will be one of the first groups to trial the new assessment system when they turn 16. Is this not likely to lead to large numbers of unfair or inappropriate decisions? I understand from the CAB service that the numbers affected will be some 50,000 16 and 17 year-olds currently receiving DLA, plus the flow of future youngsters into that age group. I hope that the Minister will take this point seriously.
On mental health issues, the Minister is well aware of the concerns about the efficacy of face-to-face assessments for adults. Some improvements have undoubtedly been made, but those involved in the improvements recognise that there is still a long way to go to achieve an adequate level of reliability. Mind reinforces the point, stating that,
"although we recognise that there is a more explicit reference to mental health in the criteria for PIP than DLA, we are very concerned that many people currently receiving DLA for mental health problems will struggle to access the new benefit".
Although a smaller proportion of mentally disabled people will lose benefit as a result of the shift from DLA to PIP, considerable numbers of both physically and mentally disabled people will lose out, as the Minister will be aware.
Before concluding these comments, I applaud the Minister's commitment to improving assessments for people with mental health problems. He has been dedicated to that task and very real improvements have been, and are being, made. I think that this House will want to recognise that.
The amendment would achieve three things: it would align universal credit with PIP and the Government's plans in other parts of the system to treat 16 and 17 year-olds as still being part of their parents' household; secondly, it would safeguard young people from being assessed using an inappropriate tool, albeit that more explicit reference is made to mental health in the criteria; and, thirdly, it would further simplify the system. I look forward to the Minister's response to these points. I beg to move.
My Lords, the noble Lord, Lord Patel, and I have amendments in this group. Our noble friend Lady Meacher has spoken most eloquently to the specific problems for these age groups. This is Report stage, and we are well aware that there has already been much debate about young people who have to transition between children's services and those for adults. However, I remind the Minister that, coming from a medical background, we have tabled our amendment because of the specific problems for those who fall ill suddenly or who are severely ill. As they transition for all their care in the medical sense, they transition also for all their life events and social interactions. They struggle to move to a degree of independent adulthood and are faced with a whole range of problems that those who are more settled either in the security of childhood or, later on, in an adult framework might not encounter so acutely. For that reason, we ask the Government to allow them to be considered separately should it be appropriate.
My Lords, we have strong sympathy with these amendments, spoken to so effectively by the noble Baronesses, Lady Meacher and Lady Finlay. We had a bit of a canter around this issue in Committee, focusing particularly on 16 to 24 year-olds. I took from that debate, and the Minister may take the opportunity to confirm or deny it, that there is potentially scope within the Bill for a regulation not to require 16 year-olds inevitably to move towards PIP. If that is not the case, it is important that we clarify it, because it impacts on how we approach the amendment.
A number of questions have been posed which I should like to emphasise. The first is whether the Minister contends that the PIP assessment as currently constructed is fit. Does he believe that it would be appropriate for most 16 year-olds? The assertion is that it is not. Another issue is the extent to which there is alignment of ages for a range of things-the UN convention certainly, but care generally and education and training. Would it not be better if that alignment were brought into effect also for the purposes of the PIP and the DLA cut-off?
When somebody aged 15 is about to become 16, that is the point at which things change on the DLA journey and we move into a somewhat different regime. If somebody reaches that once PIP is up and running, do they inevitably have to apply and go through the PIP process at that point, or is there an opportunity for them to remain within DLA or perhaps migrate at a subsequent point? Otherwise, there is a real risk that these young people will the first to test the new PIP arrangements. What is the technical position there? Does somebody who wishes to make their first claim after the age of 16 have the route only to PIP and not to DLA? Would somebody currently claiming DLA necessarily be denied the opportunity to continue with that until, perhaps, the migration plan has run its course? I thought part of the noble Lord's response to our Committee debates was that you could deal with this in part by the way people in the DLA system migrated towards PIP. One way of dealing with some of the issues that have been very validly raised in this amendment would be to use that flexibility, if it exists. If not, it seems doubly important to lock into the 18 year-old cut-off point, which is being pressed.
My Lords, I welcome these amendments tabled by the noble Baroness, Lady Meacher, and the noble Lord, Lord Patel. They allow me just to go through how the Government intend to introduce PIP successfully for young disabled people from the age of 16. Clearly, the central question is whether 16 or 18 is the right age. In one sense, all ages are a little arbitrary here. Adulthood is defined at different ages in different contexts. The key to the decision to start PIP at 16 was based around the assessment criteria and at what stage people fit in with those, in terms of the activities that they can undergo and how we can look at them. When we looked at it with a range of experts, we concluded that you would normally expect individuals without disabilities to be able to carry out these activities independently from the age of 16. For example, you would expect a 16 year-old to be able to wash and dress themselves, to communicate with others, to plan, and to follow and make a journey. It is the age at which, currently, you expect individuals to be able to be employed full-time. There is a general expectation that they have the capabilities of adults.
The group looked at whether you would expect even younger people-I had better use that word now, rather than adults or children-to fit this assessment. They concluded that children go through several developmental stages under the age of 16, and they do that at uneven speeds. So, there was a cut-off in developmental terms between the two stages, for the purposes of this test, at 16. The other way of looking at this is that it is about trying to move people into adulthood and independence. A lot of these youngsters are living in their households but need to move to independence. Having their own independent help and their own funding in PIP at that age matches their aspirations to move into adulthood, and allows them to make their own decisions about aspects of their lives.
This is an area where, as we described in our policy document, we have set out our intentions and outlined the key principles that we have debated and agreed with stakeholders. We have set up a subgroup of the PIP implementation development group specifically to help and inform the design and testing of the new system in relation to disabled young adults. Together with the focus group work and the interviews that we have held with disabled young people, their appointees and representatives, this is the process that we have under way to get the system right. One of the most important areas where we are using the development group is around the question of how we look at the process of moving people into the 16 category and how we signpost, communicate and get awareness of the changes and then join up the support for disabled young adults and their families.
Clearly, this is not the only testing that disabled youngsters undergo in this phase of their lives. There are a number of assessments as they move from childhood to adulthood. We will ensure that all young people claiming PIP or moving on to it at age 16 have the appropriate support to allow them fully to express their needs. We know it is important that they have a parent, an advocate or a friend to accompany them to that face-to-face consultation. We are not changing anything in terms of DLA in this area. We are changing a lot of things by moving DLA to PIP, and we will be discussing some of them, but in this area we are sticking with the same age as the existing DLA arrangements.
There was an anomaly that the noble Baroness, Lady Meacher, tried to pin me down on and defied me to find a good explanation for. I have been challenged and I shall do my best. On the point about the difference between the universal credit at 18 and PIP at 16, the blunt answer is that these are different benefits for different purposes. It is important that we do not think of PIP as an income supplement; that is not what it is, and nor is it for someone who is out of work. PIP is a payment to people who are disabled who will always need extra money to live because their costs of living are higher, and we will pay it regardless of whether people are in work or out of work. That is why it is a different argument. By giving PIP earlier, we are giving youngsters their independent funding to run their own lives from that point-not from the point when they are meant to be in the workforce and fully independent-when, if they do not have a job, they will need an income supplement. That is the difference. I hope that I have risen to the challenge; I am sure that the noble Baroness will say that I have not, but I have done my best.
We are working closely with the Department for Education to explore evidence gathered so that we can have a single assessment for an education, health and care plan that can be used to support a personal independence payment claim. We are trying to get rid of all the multiple assessments.
Does the Minister accept that there are a lot of people who are very worried about this shift? The reality is that many of them who might have been entitled to DLA will not be entitled to PIP and will therefore lose out. They will also lose out on the disability additions. There is quite a big financial consequence here.
I accept that there are concerns but one has to stand back. We are spending £12 billion on PIP in real terms, which is the same as the spending in 2009-10. The talk about a big cut refers to a big cut of a projection-the 20 per cent. I want to reinforce that point. In this House we should not get carried away with the simplicity of the big cut. It is not a big cut. With PIP we are trying to direct scarce resources, at a very difficult time, to the people who need them most. That is the purpose of it.
One of the other things that is happening-and is probably the biggest difference in emphasis between DLA and PIP-is that PIP is trying to take account of people with mental health problems in a way that DLA finds much harder. That is why the assessments and activities that are looked at are very different. Therefore, PIP is different and there are changes. Some people will lose out but they are the people who need the money less. That is the point of making the adjustment. However, the overall sum remains that £12 billion.
To pick up the point of the noble Lord, Lord McKenzie, we have the power and flexibility to treat 16 year-olds differently. This includes different assessment processes during the migration period. We are working actively now with children's groups to make sure that we have the right migration strategy for youngsters and to finalise it. We will publish that approach. It is not a settled matter, which was, I think, the noble Lord's real question. We are working very hard to get it right.
Let me deal with some of the amendments. Amendments 57, 58, 50ZGA and 56ZC would prevent our abolishing DLA for those aged 18, and potentially limit our flexibility by imposing statutory duties that would be less able to respond to change, especially as we refine and improve processes as a result of feedback and our experiences. It is very important that we have that flexibility. One of the things that we will discuss later this evening is feedback and the amount of research that we will carry out on a continuous basis. Clearly we want to incorporate that into how we apply PIP, particularly for youngsters.
This is very technical but I need to make it clear that the Government consider Amendment 56ZC to be consequential on Amendment 50ZGA; and, separately, Amendment 58 to be directly consequential on Amendment 57. I do not want any misunderstandings later, although the noble Baroness, Lady Hollis, is not in her seat at the moment to give me a piece of her mind. Given the reassurances that I have given the noble Baroness, and the technical limitations that the amendments of the noble Baroness, Lady Finlay, would impose, I hope she will withdraw her amendment.
If the amendments which the noble Lord, Lord Patel, and I have tabled would be more restrictive, does the Minister now have more powers to make regulations to exercise discretion in relation to people of different ages? Does this discretion remain wider by not including our amendments where an age group is highlighted?
This is a framework Bill. There is a lot of potential flexibility as we set up the regulations, particularly in this migration period, as we move into them. This flexibility would be denied by these amendments.
I thank the noble Baroness, Lady Finlay, and the noble Lord, Lord McKenzie, for contributing to this short debate. This amendment was tabled very late and others have not had a chance to catch up with the thrust of the argument. I thank the Minister for his reply, although I doubt that the considerable number of people who will be losing out as a result of this provision will be very reassured by his response. I do, of course, understand-at least in general terms-the thrust of the Government's commitment to focus resources on those most severely disabled. I beg leave to withdraw the amendment.
Amendment 50ZGA withdrawn.
Clause 77 : Daily Living Component
Moved by Baroness Grey-Thompson
50ZGB: Clause 77, page 56, line 18, at end insert-
"( ) A person is entitled to the daily living component at the basic rate if-
(a) the person's ability to carry out daily living activities is limited by the person's physical or mental condition; and
(b) the person meets the required period condition."
My Lords, the amendment is designed to complement broader plans for social care and links to the Dilnot review of care funding. The Dilnot review examined care costs and how best to manage our demographic change. It concluded that universal disability benefits for people of all ages should continue as now. Dilnot was referring to DLA. The rationale for his recommendation was that DLA helps many disabled people avoid formal social services. It acts as a form of low-level needs management. However, Government plans include abolishing the low-rate care DLA payments of £19.55 per week, which 652,000 disabled people aged 16 to 64 currently receive.
Despite ignoring the Dilnot recommendation, the DWP has not provided a cost-benefit analysis of what this abolition could mean for care services. Charities and individual disabled people have, however, indicated that reduced access to DLA will increase dependency on social care services funded by councils. About one in eight of the disabled people who completed a Disability Alliance survey suggested they would be more likely to need a council-funded care home placement as, without DLA, families would no longer be able to manage needs. This leaves councils funding a much more expensive service. The lack of information being provided on this issue, despite the clear recommendation of the Dilnot review, can leave us with no choice but to assume it has not yet been fully analysed.
The Minister has suggested that providing a basic level of help is unaffordable, but we must also take into account the further costs of the two million medical notes from the NHS which disabled people who are forced to undergo the new assessment process will have to provide. This is not a cost-free policy. What about the analysis of the cost of potentially avoidable NHS use following the abolition of low-rate care payments? Disability and ill health do not just disappear, and the costs and needs of disabled people will be exacerbated. I suspect that there is an unfortunate silo approach being operated. Disabled people will suffer first and then their families, followed quickly by the NHS and councils.
The DWP has been pressed on these issues since plans emerged in 2010. It is unacceptable that these legitimate questions on the policy costs remain unanswered. I also believe the amendment is essential to help mitigate the risks of the current government proposals to disabled people, their families, the NHS and councils.
Figures published just yesterday suggest that of the 652,000 disabled people receiving low-rate care, about a quarter of a million may be able to access daily living payments under PIP. The statistics suggest an increase of 166,000 in the numbers receiving enhanced daily living payments, compared to DLA high-rate care, and an increase of 89,000 in standard daily living payments, compared to middle-rate care DLA. However, this means that 400,000 disabled people will lose support.
My amendment aims to secure basic support for just some of those 400,000 disabled people. The amendment will not simply carry over the same people and the same rules. I realise that the Government need to ensure a new approach. The amendment allows them to retain the right to establish the level of basic need at which disabled people would be entitled to support, as well as levels of payments. The DWP has not yet published the payment levels that disabled people can expect under PIP, but it could examine different payment levels. I beg to move.
My Lords, I strongly support the amendment, which has the support of many disability organisations and thousands of disabled people and their families who face losing help under the Government's plans.
The noble Baroness, Lady Grey-Thompson, has already outlined the numbers of people affected by the Government's proposals. These people are not fakers and scroungers. Of current low-rate care claimants, DWP statistics show that 20,000 are blind, 57,000 have learning disabilities, 94,000 have arthritis, and more than 100,000 experience psychosis or psychoneurosis. These are some of the people affected, and these conditions are clearly not fake. These are the people who the Government suggest should lose support.
Disabled people have told the Government exactly what losing low-rate care could mean. Examples include people who categorically state the clear health and social care consequences of cutting DLA, as the noble Baroness, Lady Grey-Thompson, outlined. I shall cite examples of people who have commented. One said:
"If DLA was reduced or removed then I would be unable to attend doctors and hospital appointments due to the cost of getting to and from them, and my health would be severely put at risk due to not having enough money to either keep myself warm and/or fed".
"We would be in crisis-end of story ... my son would start self-harming again", and that even,
"prescriptions would be out of the question".
The amendment could help prevent an explosion of avoidable NHS and social care needs, as the noble Baroness said. Will those needs of the disabled people who are losing help be met elsewhere? I fear that no support may be available from any other public service for many of the 400,000 who will lose all their DLA. The past decade has seen a shrinking of council social care service provision through the tightening of eligibility criteria. More than 80 per cent of councils in England now only help people with critical or substantial needs. The people losing DLA may very well not be able to access care services until crises develop. This leaves families, friends and neighbours to care for them. We already have one of the highest economic inactivity rates due to informal care provision. By not accepting this amendment the Government risk ignoring the impact on carers-especially on women aged between 46 and 64 who are more likely to have to take up caring responsibilities in lieu of formal services or benefit provision.
In proposing to abolish low-rate care provision, the department appears to fail to understand or, worse, to wilfully ignore the genuine needs of disabled people and carers. The amendment would help the Government ensure that they did not simply end the lifeline of DLA for disabled people and families who are unable to access alternative help until they receive expensive NHS treatment or residential care. Accepting the amendment and devising a fairer way to share the burden of the proposed dramatic cut in DLA resources would also help the Government ensure that they do not permanently undermine disabled people and the trust and confidence of carers. I hope that the Government really mean what they have said-that we are all in this together.
My Lords, I will speak just briefly on this. It seems to me that the importance of this amendment has been heightened by the documentation we got just yesterday from the DWP, which emphasised that half a million people are going to miss out under the new system compared with the current arrangements. In passing, I might say that it would have been more helpful had we had that documentation a little earlier so we could have studied it in more detail, although clearly the noble Baroness, Lady Grey-Thompson, has delved into it more deeply than I have had the chance to do.
There must be an onus on the Government to undertake some sort of assessment of the consequences for those half a million people who are not going to be able to benefit under the new system. Some of the consequences have been spelt out, such as extra pressure on social services and the health service. We know there will be loss of income tax and national insurance because DLA helps many people to stay in work or to work longer than they otherwise would. All those consequences are quite apart from the worst feature which is the human cost for people who are going to miss out who had been able to rely on funding and not just at the lower rate. It may be that most of those who fall out of the system are currently on the lower rate of DLA, but that certainly is not the case for all of them.
It seems to me that this approach reinforces the perception that is too prevalent that if you claim these benefits then somehow you are not worthy and you do not really deserve them. Half a million people will come out of the system under these proposals. What are the consequences for them? What assessment have the Government undertaken of their needs as a consequence of falling out of the system? Have they or will they look at the sort of proposal that this amendment covers so that there is some basis for bringing some redress for those people who, on any analysis, are bound to suffer as a result of these proposed changes?
My Lords, before the Minister gets up-I am sorry I did not get in before the noble Lord on the Opposition Front Bench, who beat me to it-I want to say a few words in support of Amendment 50ZGB moved by the noble Baroness, Lady Grey-Thompson. It provides a basic rate of daily-living payment to minimise the number of disabled people who might otherwise be totally deprived of such focused help. Listening to Radio 4 this morning and hearing the Minister from the House of Commons acknowledging that 500,000 people could be hit by these changes really brought home to everyone the significance of what we are talking about. The ending of lower-rate DLA will leave people with needs arising from their disability but without the means to pay for them.
The point was made earlier by the Minister-and I understand his point-that the day-to-day costs of living are covered separately from the additional costs of disability. The implication is that people who would be in the lower group do not have additional costs of disability, but we all know from experience that they do and they are going to be losing out as a direct result. If the Government's intention is that so many people who have previously been recognised and acknowledged as having needs will no longer be helped to meet those needs, let them say so. I think it is a very retrograde step.
My Lords, I had also meant to rise to speak a bit earlier. I, too, very much support what has been said about those amendments. We have all been absolutely flooded with e-mails about the situation of many of the people with disabilities we are talking about, who are fearful about their future and about how they are going to be affected. What has really impressed me is the details they give of their own lives and just what they need the extra money for-things that you and I would not even think about. It is not just support to get out of the house and to get to the shops or extra money for a car because there is no other way of getting about, but support for very basic extra things to make it possible to use saucepans and things like that.
I appreciate the actions that have already been taken, but I hope that serious thought will be given to those half a million people who will still suffer as a result. I am sure that the Minister will do everything he can to ensure that those in real need are approached with a flexible mind, but, nevertheless, some will fall between the new systems that are being devised, so I support the amendment and hope that serious consideration will be given to it.
My Lords, I start by picking up the point that the lower rate is being thrown out so everyone on the lower rate will no longer get DLA or PIP. That is absolutely not the structure of what is happening. We are looking at the needs of people from the ground up and designing a support mechanism in PIP to look after people who have disability needs. Clearly, anyone who needs support, on the grounds of a rigorous and consistent assessment, will get it. Many of those people will get more. In fact, we think that the proportion of people who will be in the group with the greatest need, in the highest group, will rise under PIP compared to those in the standard group.
The difference between PIP and DLA is that we are trying to strip out the complexity of all the different rates and boil it back down to eight rates-by the time you take the two components on the two different rate levels. The amendment replicates the complexity of the structure of DLA and moves it back up from eight to 11 components, making it more difficult to administer coherently.
I pick up the specific point made by the noble Baroness, Lady Grey-Thompson, on the Dilnot review, and reassure her that the DLA reform proposals published in April 2011 were shared with Andrew Dilnot's review of long-term care funding, which was published a couple of months later in July. Andrew Dilnot said that universal disability benefits should continue, based on need and not on means. We are doing PIP exactly on those grounds-it is not means-tested but based on needs. He did not say that that benefit should go on unreformed.
We have designed the PIP assessment criteria to take broader account of the impact of disabilities than simply care and mobility, which are still of course very important factors. In our most recent draft of the assessment criteria-I remind noble Lords that we are still consulting on this process; this is work in progress and we are still listening very hard to the responses that we are getting-care and support needs feature very strongly. If someone needs attention with things such as washing, bathing, going to the toilet, dealing with medication, cooking food and eating, that is taken into account. We have amended the draft assessment criteria so that they now include supervision, whereas before they just considered whether someone needed assistance and prompting.
Finally, I should make it clear that the constituent parts of the current DLA cooking test have, in effect, been retained in the first activity relating to preparing food and drink. Therefore, again, individuals' needs in relation to this are taken into account.
It is clear that by moving to a two-tier structure we are not withdrawing support from those who require levels of support which we would expect to be covered by the criteria for entitlement to the lowest-rate care component of DLA. We are moving to fairer, more transparent and more objective criteria against which to assess people.
I apologise to the noble Lord, Lord McKenzie, if I did not give him enough time regarding the thresholds. In future, I shall try to make information available a bit earlier, as I know that there is much to absorb. This is a huge Bill and there is a great deal of information on it, so I acknowledge that getting that information out on a timely basis is important. On the assessment of the thresholds, we have now launched a further formal consultation to gather views from disabled people and their organisations, particularly on the weightings and the entitlement thresholds. This consultation will run for 15 weeks, during which time we aim to get all the information we can, and it will end on
Of course I understand the noble Baroness's concerns, but these amendments would not restore the DLA status quo and they fail to address the more fundamental questions of how, and for whom, support is prioritised. I repeat that we are trying to make sure that the scarce resources that we have go to the people who need them most. We know that under these changes there will be shifts in provision. Some people will receive less support-
I am sorry to interrupt my noble friend. On the point about scarce resources, I think we all understand the financial situation and the imperative to reduce the deficit. However, if people who are currently on the lower rate of DLA lose it-a point made earlier in the debate-they will not just carry on with life as it is. If we accept that these people do not claim DLA without a need for it, then we accept that they have a genuine disability and that the lower rate of DLA is factored into their weekly budget. If it is then decided that their case is not as important as someone else's and that that person might need the DLA, that is going to have an impact. Earlier, the point was made that if you take away the lower rate of DLA from a lot of people with a wide range of disabilities, there will be consequences for their health and well-being, which will translate into a financial cost on the public sector. Will my noble friend consider undertaking a cost-benefit analysis of that consequence?
My Lords, I have two answers to that question. The first is that people who need the support because of a disability may happen to be on the lower rate of DLA today but that does not mean that they will not be entitled to the standard rate in the future. My noble friend gave an example of people who are really dependent on that funding. I would expect in those circumstances that it would continue. Indeed, I would regard PIP to be a failure if it did not do that. Secondly, we will be monitoring that really closely. As I have discussed, later this evening I will present an amendment to make sure that we properly monitor what happens in this area and make sure that PIP does what it should be doing, which is to stop people ending up in the situation that my noble friend is so concerned about.
I must point out that if we move to a three-tier system on the daily living component, the implications are that the caseload would be larger-possibly larger than that under DLA-and spending would increase rather than decrease against the original and revised forecast under the personal independence payment. We cannot possibly quantify such expenditure implications, mainly because we have not yet set the rates at which benefit is paid, but the implications are there. I want the House to be under no illusions that they would be anything but significant.
Before I ask the noble Baroness to withdraw her amendments, I would like to confirm that the Government see Amendments 50ZGH and 50ZJA as directly consequential upon Amendment 50ZGB. On that note, I beg the noble Baroness to withdraw these amendments.
My Lords, I thank the Minister for his response. I have to say that I am disappointed. I am also concerned and gravely worried for a huge number of disabled people. The tiny spark I take out of his comment is that he says he is listening. That is positive. However, there are lots of ways in which spending will increase if we push disabled people into poverty or do not give them the right support they need. We will be making massive, long-term mistakes, for the rest of those disabled people's lives. It is not a small number of people. It could be up to 500,000 disabled people-half a million disabled people could be affected by this.
I am keen to keep pressing the Minister to ensure that the outcomes of disabled people losing the lower rate of care will be monitored throughout the rollout of the PIP assessment because, whatever way you look at the maths, there will be people who lose out. It is a big mistake to see this as a deadweight expenditure. You only have to look at our postboxes or e-mail inboxes -in the past two days, I have had nearly 600 emails from different disabled people saying they are terrified of the changes that are going to happen.
It is really important that the assessment process properly records whether losing DLA has a negative impact on the health of disabled people or their ability to work. We have a long way to go on this. Very reluctantly, I beg leave to withdraw the amendment.
Amendment 50ZGB withdrawn.
Amendment 50ZGH not moved.
Moved by Baroness Grey-Thompson
50ZH: Clause 77, page 56, line 21, after "condition" insert "and the social, practical and environmental barriers they face as a disabled person living with that condition"
My Lords, the issue of the social model of disability was discussed at some great length in Committee and the noble Baroness, Lady Campbell, spoke very eloquently on it. Despite the Government's commitment to the social model of disability, their other commitment on this issue-to provide an objective assessment-works in opposition to this aim.
The idea of an objective assessment is to ensure that people with the same functionality receive the same level of PIP. This looks only at the person's functionality, and not at the barriers faced by that person within society. A benefit which was based on the social model of disability would look at the barriers that individuals faced, not just at their functionality. Despite their stated intention to bring in a more active and enabling benefit that supports disabled people to overcome the barriers they face to lead full and independent lives, it actually takes less account of the individual barriers people face-because different people face different barriers.
The DLA has been criticised and no one would argue that it could not be improved on. However, DLA takes into account to some extent an individual's circumstances and uses-again to some extent-the social model of disability. It is claimed that, by making the criteria simpler, PIP will use the social model. However, it seems to rely much more on the medical model and appears to be going backwards in terms of taking into account someone's costs in surmounting their barriers. The charity Scope has made it clear that it considers that the Government are introducing a tick-box style medical assessment that will not help them achieve the aims they have set out to achieve.
The stated aim is to provide a more active and enabling benefit that supports disabled people to overcome the barriers they face to leading a full and independent life, yet nowhere in the assessment process is there any space for looking at the barriers that an individual faces. Disabled people face a multitude of barriers to participation and independence, many of which come as a direct result of social, practical and environmental factors. Making the test more objective and simpler will inevitably lead to a greater focus on the medical model, which will work against the stated aims and purpose.
Richard Hawkes, chief executive of the disability charity Scope, said:
"We recognise that Disability Living Allowance needs reforming and we fully support the government's ambitions to create a more active and enabling benefit. However, we are concerned that the new assessment the government is planning to use is flawed because it doesn't take into consideration all the barriers that disabled people face in daily life. Without understanding the extent of barriers people face, the government has no hope to overcome them and genuinely enable people to take part in daily life".
At a time of limited resources, it is crucial to ensure that support is targeted as effectively and accurately as possible. This will not happen using the proposed assessment. To ensure effective targeting, the assessment process for PIP claimants must accurately measure the extra costs that individuals incur, based on an understanding of the variables that affect those costs. I beg to move.
My Lords, this is the first time I have contributed on Report. I declare my interest as vice-president of the National Autistic Society, patron of Research Autism and as the named carer of an autistic adult man in receipt of DLA. I am concerned about this part of the Bill and support the amendment and the detail with which it outlines what I believe are shortcomings, despite my noble friend's best efforts to identify how the assessment will affect people on the autistic spectrum.
In 1990, the House of Commons sent to this Chamber the Autism Bill, which became an Act of Parliament. It was passed as a result of a Private Member's Bill introduced by the right honourable Cheryl Gillan MP. It was supported by all parties in both Houses and was enacted in 2010 by the coalition Government. I tabled a Question for Written Answer just before Christmas asking whether the Welfare Reform Bill that is before us was compliant with the Autism Act. It is worth remembering that no other Act of Parliament has been passed that is specific to a condition. Certain medical conditions are mentioned in other Acts, but the reason for both Houses agreeing to pass the Autism Act, which is now on the statute book, was that autism is different. I make no apology-I know I bang on about it quite a lot-for drawing the attention of the House to the fact that an Act of Parliament was needed because autism is so different.
There are many aspects to the Bill, including the amendment we are now debating, which have a specific read-across to the autistic spectrum. Some years ago in another place I introduced the first debate in Parliament on Asperger's syndrome. It was not well understood then. It is far better understood now, which is a great relief to me and many others. Even so, parents and people with Asperger's syndrome still struggle to get access to services, benefits and independent living, and to take their place in society as they would wish. The Autism Act was passed in recognition of that. I have to say to my noble friend that I was very disappointed when the reply to my Question for Written Answer in relation to this piece of legislation said that this was a matter for the relevant services by local authorities and NHS bodies and was not the subject matter of the Welfare Reform Bill.
Under the Autism Act, there is now a statutory responsibility on health and social services to implement the autism strategy which will require them to work with partners; for example, local authority housing departments. The Health Minister will be in a strong position to call to account local authorities and health authorities that do not implement this strategy. I know it is not the subject of this clause but if you are going to say that people under 35 will have restrictions placed on them as to where and with whom they live, that is a total contravention of what local authorities are being asked to do to implement the Autism Act. Equally, in the assessments for people on the autism spectrum, Asperger's syndrome is not "autism-lite".
Some years ago the National Autistic Society produced a report on autism called Ignored or Ineligible?. It is a 10 year-old report but sadly a lot of it is still relevant today, especially for those trying to get support for people on the autism spectrum, particularly those at the end of the spectrum who are more able-people with higher than average IQs. The anomaly about this condition is that you can have people with Masters degrees who cannot cope with some of the day-to-day detail of looking after themselves. The House has put on the statute book the Autism Act because autism is so different. The amendment before us picks up on some of those defects in the assessment.
I had time to read the case study-unfortunately it was number 13-in the information that my noble friend published yesterday, which related to a young man with autism and how his assessment had been carried out. Yes, he scored highly and one would take a lot of comfort from that. But I want to bring my noble friend back to the situation of what is sometimes regarded as quirky behaviour-sometimes threatening or challenging behaviour-but in the main non-threatening behaviour; odd behaviour, yes, with the inability to do certain things sometimes but able to do much more difficult things at other times. It is a very strange and complex condition. Therefore, in an assessment process, it is absolutely essential that people are viewed as individuals in the way in which their condition affects their day-to-day lives, whether it is their medical condition, the way they live socially or their housing conditions. It is that sort of complex condition. It is sometimes associated with other things such as learning disabilities and/or mental health issues as well, which makes it much more specialised in terms of understanding the behaviour that is presented.
I do not want to focus on my own situation but, as I am sure noble Lords can imagine, as a mum I am pretty worried. I want to take this opportunity to say on behalf of other mums-if I do not say it, who is going to say it for them?-that when you have a child who is born with a lifelong disability and you know they are going to die with that disability, as a parent your relationship with that child is very different from your relationship with other children you may have. When they are little children, you agonise about things like education. As they get older, life skills and whether they can cope for themselves become far more important to you than whether they ever got a GCSE. As they and you get older, your waking moments are haunted by how they will cope when you are no longer there to support and help them. I think that most parents of disabled children-whatever the nature of their disability -would understand that. Therefore, when you feel after many years that you have them in what I would describe as a stable situation-and how important, particularly for autism, stability is-it is so worrying when you suddenly look into the future and find that actually it is not stable at all. It is not stable for you-as you are growing older with goodness knows how many years left-and you see that it is not stable for them.
I have every respect for the amount of time my noble friend has put into autism. I am totally in favour of what he is trying to do to get more autistic people into work, because there are many who could work if they were given the right support and back-up to do it. I fully support that. But Asperger's syndrome and those people on one end of the spectrum of autistic spectrum disorders are not "autism-lite". I mentioned the report Ignored or Ineligible?. It showed that for people between 20 and 30 the suicide rate was 8 per cent. The reason it was 8 per cent was that the people on that spectrum try like mad to be part of society and try to be like everybody else. However, there comes a point at which, for many of them, they give up that struggle. I am very concerned that if they are not assessed as individuals, with all the quirkiness and strangeness of this very complex condition, we will go back to people on the more able end of the autistic spectrum being either ignored or ineligible, with all that that means. That is why I support the amendment tonight.
My Lords, that was a most moving contribution from the noble Baroness. I think we were all very touched by it. I declare an interest at this point, as I receive DLA.
There is a real fear among so many disabled people who have contacted us that the migration to PIP is going to be like a horrid game of musical chairs, because they all know that the Government want a 20 per cent cut, wherever that comes. They all think that when the music stops, they will be the one without a chair. They also know that DLA, for all its faults, has the lowest incidence of fraud, and many of them say they feel demonised in the press for being scroungers. Would it not be nice if some of the screaming headlines in tabloid newspapers were about the way in which many people receiving DLA are able to live independently, contributing hugely to society in many different ways, rather than the other way around?
On the low level of DLA fraud, we have to acknowledge that my noble friend, coming to this whole subject with a fresh eye, reckons not that the wrong people are claiming the benefit but perhaps that the net has so small a mesh that it tends to pick up everyone who has any level of disability rather than picking up only those with the greatest need. Therefore, his argument goes, you do not have to resort to fraud in order to get DLA; it is so loosely drawn that almost anyone can get it if they know how to fill in a long and complex form in the right way. Taxpayers are entitled at this point to ask why medical reports are looked at in only around half the cases, which I for one find quite inexplicable, but we will come to that in our debate on a later amendment.
However, it is the phrase "those with the greatest need" that is most worrying. It could mean many things and is most closely associated with those who are entitled to means-tested benefits, which we know is not the case for PIP, and long may this last. Among the arguments that the Minister deployed when he rejected this amendment in Grand Committee were that it was too widely drawn; would be too expensive; would lead to too long an assessment, which would be too intrusive; and too complex. The noble Baroness, Lady Campbell, countered this by saying that the proposed points-based tick box descriptors approach will not capture enough information about the barriers and costs faced by disabled people on a daily basis. Both are right, which is why this issue is so difficult. It would be almost impossible to translate this amendment into a points-based assessment in a meaningful way, although in an ideal world that is exactly what is required.
I wonder whether there is any way in which the sense of this admirable amendment, or elements of it, could somehow be incorporated into the assessment process. I shall be most interested in my noble friend's reply.
My Lords, I support the amendment, which seeks to ensure that the assessment for the new entitlement is fit for purpose and fulfils the Government's commitment to the social model of disability. As has already been noted, DLA occupies a unique space in the welfare benefits system as it recognises that disabled people face a plethora of extra, often prohibitive, costs as a result of living in our society with a condition or impairment.
We should all warmly welcome the Government's repeated commitment to the social model of disability, for which, as many of your Lordships know, disabled people have fought long and hard. At the heart of the social model is the recognition that it is our society, not just their bodies, that disables people with health conditions and impairments. However, I fear that the proposed assessment for the new entitlement does not reflect this commitment. Despite the Government's assurances in Grand Committee, the Minister admitted that the proposed test,
"is not a full social model assessment; it is not intended to be".-[Official Report, 14/11/11; col. GC 199.]
I ask the Minister in his response to clarify to the House and disabled people why such a commitment was ever made in the first place.
The second draft of the PIP assessment criteria includes some small improvements from the first. However, it does not go nearly far enough. By assuming that a medical assessment will capture social and environmental barriers to independence, the Government risk homogenising the diverse difficulties that disabled people face in their everyday lives. The new threshold document makes many mentions of extra costs and barriers, but only a few of these will be captured by an assessment that looks exclusively at impairment.
It is with this in mind that I support the amendment of the noble Baroness, Lady Grey-Thompson. The assessment for the new entitlement must consider the real social, practical and environmental barriers faced by disable people with impairments living in our society. I, along with disability charities such as Scope, disabled people's organisations and disabled people across the country, voice great concern that the Government are reneging on their commitment to the social model of disability. Doing so would undo decades of campaigning for and progress towards a better and more equal society.
My Lords, I thank the noble Baroness, Lady Browning, for her honest and enlightening contribution. I speak as a doctor and as a mother; I have two adult children who are in receipt of disability living allowance.
I wish to talk about the medical approach to disability. As a doctor, I have often been accused of being a very medical model, usually by disabled people. The medical model to disability is reductionist. Many doctors and other health professionals do not understand the social model; they do not understand the social, practical and environmental barriers that people with physical and mental impairments face. I support the amendment, but it would require skilled and sensitive assessments to be available and they would need to be delivered by people who understand the social model.
My Lords, I, too, support the noble Baroness, Lady Grey-Thompson, in her amendment. I read the whole of the information sent to us yesterday and I was pleased to see that ME/CFS, in which I am interested, was raised in two examples, and that the difference between the two conditions was shown. I am concerned not just for people with ME but for those who can almost function normally and will not meet the criteria for getting DLA. For example, there are those who, because they have an endocrine problem, cannot cope with the cold. They need extra heating and clothes. If they are working, they are probably on a minimum salary because they are not very well. Therefore, they need extra money. They might also need extra clothing.
If they are incontinent, they may need to be able to change their clothing regularly. They may need incontinence pads, which-as everyone knows from questions in the House-are extremely difficult to get from the National Health Service. My mother-in-law, who died a few years ago, could not go out of the house because she was worried about wetting herself in public. If she could have afforded incontinence pads, she would have been fine. She was not going to tell her children or her daughter-in-law about her problem and we had to extricate the information from her to find out why she was not going out. Such people get confined to their homes and become desocialised, and it is very difficult to get them back into society. We must take all these things into consideration-not just whether they can cook or wash themselves-when we think about what they need to keep functioning on a relatively normal basis.
My Lords, I shall speak briefly on this amendment. The comments of the noble Baroness, Lady Browning, about her personal experience of the whole range of autism reminded me just how this range has developed over the years. When I first got involved with the autistic movement many years ago, it really was just one thing; but since then, many different branches and forms of behaviour have been identified. The fact that all these extra aspects have to be borne in mind re-emphasises the whole question of whether the clause is fit for purpose. In particular, the Asperger's syndrome comment was very apt. I hope the Minister will be able to persuade us that there will be a thorough method of assessment by people who understand the range of problems that we are talking about as well as-as my noble friend Lady Mar said-the detailed and different ways in which extra help is used and needed for such people to have a basic ability to lead a normal life.
My Lords, let me start by referring to the moving speech made by my noble friend Lady Browning. I confess to a real concern about autism generally and I am very proud that my maiden speech was on the Autism Bill. I have undertaken a number of initiatives in the autism area because we do not look after people with autism and Asperger's properly. I also strongly believe that it would not take a huge effort to make sure that we look after those people much better. As my noble friend knows, there is currently a major initiative to try to ramp up the number of such people who have and keep jobs. Currently only around 15 per cent have jobs, which is ludicrous, and I am determined to double that figure.
As part of that concern for this particular group, we wish to make sure that this assessment takes people with autism and with Asperger's properly into account. I am hopeful that PIP will do a better job than DLA, and, furthermore, that we will make sure that we have the right processes in place to look after this group. As we refine processes during the next consultation period, which we are running until the end of April, one of the things that I want to make absolutely sure of is that we have the right measures in place for autism. I know that everyone in this Chamber feels similarly on this issue, and feels very strongly that we should get this right for that particular group.
I shall now turn to the more technical aspects of this issue-that is, looking at what we are doing with the PIP and its assessment. Is it a medical assessment, as the noble Baroness suggested? It absolutely is not. In fact, as I said in Committee, our approach is-and this is rather a mouthful-akin to the biopsychosocial model. I shall try to draw this out a bit-I do not mean in time: I shall try to draw the themes out. A medical assessment would be something like the industrial injuries disablement benefit, where there is a direct correlation between the injury sustained and its severity and the amount of benefit or compensation received. Nor will the PIP assessment focus on the functional limitations of the individual in the way that the work capability assessment does. Instead, it will assess how the individual's health condition or impairment impacts on his or her everyday life by looking at their ability to carry out a series of key and holistic activities, all of which are essential for participation and independent living. In such an approach, the type of condition or impairment an individual has is of limited relevance.
It is not, however, a full social model assessment. I accept that. That is something that many noble Lords and disability organisations would like, but I have to point out that it was not our intention to develop it in this way. As a department, we do support the social model. As the noble Baroness, Lady Wilkins, said, we are on record as supporting it. While we want to ensure that the PIP assessment better reflects it than previous assessments, that does not mean that the full social model is relevant for assessment, although it is relevant for some things. I sent round a rather interesting piece of analysis to many noble Lords in the Committee, called Models of Sickness and Disability, which showed the differences between the models, explaining the medical model, the reaction of the social model against the pure medical model and the synthesis of the biopsychosocial model. The summary of the biopsychosocial model in the analysis is that:
"Sickness and disability are best overcome by an appropriate combination of healthcare, rehabilitation, personal effort and social/work adjustments".
There is a coherent theory behind this assessment.
Will my noble friend confirm whether, when people on the autistic spectrum are assessed, there will be somebody present as part of that assessment who is expert in cognitive specialisms?
People will be able to bring anyone with them to the assessment, whether it is a parent, adviser or anyone else. For the WCA, the person doing the assessment can call in that support where they need it. We are now entering the consultation phase on the PIP assessment. Wrapping in that support will be one of the elements that we will look at. I accept that the assessor needs to understand how those factors reduce the ability of the person in front of them to run their lives.
It has been suggested-I hope that this is an opportunity for my noble friend to put this straight-that the assessor will be able to call somebody on the telephone in making the cognitive assessment. I hope that he is able to assure me tonight that that is not the case.
Clearly, the system will be elaborated and developed, and we are at an early stage. Although the WCA is a very different test from the PIP assessment, one of the useful lessons that we have drawn from Professor Harrington's recommendations for it is that mental health champions are available on site for assessors. That is the way in which that test has developed, and there are some valuable lessons there for when we look at how we elaborate the PIP assessment.
If we were to go with the full social model assessment along the lines suggested by Scope, looking at the full range of factors that potentially cause barriers and cost, it would require a very long, intrusive and costly assessment, putting significant cost burdens on the state and, more importantly, very large burdens on the individuals involved. They would also inevitably require much more regular assessment, as the social factors that would be taken into consideration would change more regularly than the impact of a health condition or impairment. You might, for instance, get to the ludicrous position where every time a local bus service changed, you would have to do a reassessment on that model. In meeting after meeting with noble Lords, I have been left under no illusion that having too many reassessments is one of the things that they dislike the most. We will try to provide later on some reassurance that there will be decent gaps wherever possible between reassessments.
The situation could go very dramatically the other way and lead inevitably to inconsistency, with factors considered varying from person to person and affected by local factors or service provision. With PIP, we are looking at something that is universal and where entitlement is based on the same criteria wherever individuals are and whatever their circumstances. This discussion carries echoes of our ring-fencing debate earlier today in relation to the Social Fund. If we move to a kind of local needs-testing, which is what the amendment implies, it would be at odds with how we deliver a national benefit. Clearly, we could do something else. We could localise it as a benefit, but then it would be a very different benefit. I suspect that many noble Lords would be very concerned about moving in that direction.
Most importantly, we think that a social-model approach would be more subjective. Benefit entitlement needs to be based on clearly defined and transparent criteria which we need to be able to set down in legislation and apply to individuals consistently, whatever their circumstances and wherever they are in the country. If you cannot do that there would be a level of unfairness and uncertainty, high levels of appeals and a system in disrepute. Under the type of assessment proposed, it would be harder to define the criteria that individuals would be assessed against and less clear whether they had met the thresholds for entitlement.
Finally, we do not think that an assessment along these lines would allow us to control expenditure and keep that benefit spend sustainable, making sure that it goes where it is needed most. I do not think that I can really reach a figure on how much it might cost, but our estimate is that it would be very substantial.
Although the social-model approach is superficially attractive-and I emphasise that we support it in many ways-we have decided that it is not the right way to go with this assessment. We have not gone for the medical model; we have gone for the biopsychosocial model. That model has now garnered very significant academic support, as those noble Lords to whom I sent that very interesting piece of research will recognise. It recognises the diverse range of biological, psychological and social factors that impact upon an individual and cause variation in need. We think that approach-of looking at activities and outcomes-matches the requirement.
My Lords, I wonder whether the Minister can answer a question for me. I made a particular point about people having very special needs such as extra heating and incontinence pads, for example. If they are leading a fairly normal life but would be restricted to their homes because they cannot pay for things, will this be taken into account in the PIP assessment? I could not see it anywhere when I read the details. How are these facts going to be elicited when the person is being assessed? People do not fit into boxes-everyone is an individual. It seems that the noble Lord is trying to make people fit into boxes when they do not.
We are very much trying not to make people fit into boxes. We are not saying, "Because you have that condition, that's your relevant position". We are trying to look at people as individuals. Clearly, you go through all these criteria very carefully and reach a judgment. It is almost impossible for me to say whether a particular person would hit the assessment criteria or not. You just have to go through it and see. However, we clearly expect someone to get a payment who has genuine needs for coping with life because of their disability. That is what it is designed for. I cannot answer the specific question, but I can tell the noble Baroness the principle-where that person needs that support as a result of their disability, they should get it.
When we develop an assessment for PIP, we have to balance a range of factors. A complete model should include all the perspectives and important interactions between an individual, their health and the environment. That is what the bio-psychosocial model does. There are limitations in considering only a single perspective, and this is a much more holistic approach.
I do not accept the criticism that our proposals do not truly reflect the extra costs faced by disabled people. As I have tried to explain, it would not be feasible to assess the actual costs without something hugely intrusive to disabled people and very complicated. We therefore have to assess other factors as a proxy for these costs. We are using "care" and "mobility" in DLA, which we do not think are broad enough. So, in our draft assessment criteria we have a range of everyday activities for PIP that we believe are a good proxy for the impact of impairments, the overall level of disabled people's needs and the extra disability-related costs. We will go on refining those; we will not just stop when we finish the consultation in April.
The proposals have taken into account many of the key drivers of cost that Scope and others are obviously concerned about. For example, individuals who have difficulty getting out are likely to have higher utility bills, while those who need support planning a journey and moving about are likely to have higher transport costs. The proxies and associated criteria should therefore allow us to prioritise spend on those who face the greatest challenge and expense. In answer to my noble friend Lady Thomas's point on the tick-box assessment, the proposals, which have been around since May, are very much not a tick-box approach; they are trying to look at people's functional capability.
We have changed the assessment very considerably as a result of the enormous amount of engagement that we have with disabled people and their organisations. We will go on doing that. However, if we had fundamentally to revisit our approach in the way in which the amendment would require, we would have to go back to the drawing broad, spend more time developing and testing, and have greater consultation. It would push back the start of PIP by at least a year and reduce savings over the reassessment period by £1.4 billion. This is, I think, the priciest amendment yet.
This is about doing the right thing for people and focusing money on them; it is not about playing silly games-by which I mean that we are not playing silly games here and we are determined to get this right. We are consulting widely and know that we have the right approach with the model that we are using. I understand the noble Baroness's position, but we do not think that the Bill should specify that the assessment should consider social and environmental factors. That approach would be inappropriate and unworkable, because we need the assessment to be straightforward, objective and consistent. We would lose £1.4 billion of savings. For that combination of reasons, these amendments are not acceptable to the Government. Just for the avoidance of any doubt whatever, I confirm that the Government see Amendments 50ZJ to 50ZQ and Amendments 51A and 52A as directly consequential upon Amendment 50ZH. On that basis, I urge the noble Baroness to withdraw her amendment.
I thank the Minister for his response. It is nice to know that, even for a short time, I might hold a record in your Lordships' Chamber for tabling the priciest amendments. I also thank the noble Baronesses, who have brought much personal and moving experience to this debate.
I apologise to your Lordships; in introducing the amendment, I did not declare that I am a recipient of DLA, although I am fairly unlikely to be on PIP. I realise that to many the social model turns into a philosophical debate but I felt that it was important to raise it again, as-
My Lords, I feel that I should interrupt. I think that when the noble Baroness looks at the PIP assessment, she will find that she is on PIP-without doing an assessment myself.
I thank the Minister and accept that I did not just go through an assessment process.
I feel that it is important to raise this issue again as a gentle reminder that the social model is written by disabled people using their experience. The noble Countess, Lady Mar, made the important point that you cannot fit disabled people into boxes. I tend to think that we are a little more like Venn diagrams. It is obvious to me that if the Minister were truly committed to helping disabled people, the full social model would be used. I recognise that there is a balance between costs and how far we want to go to help disabled people.
I share the Minister's view on autism but I would like to widen the issue and hope that we will take all disabled people's experiences into account. I look forward to seeing the refined process that he mentioned.
There is one point on which I agree with the Minister: the bio-psycho model is interesting. However, that is as far as I can go. If we looked at the definition of "interesting", he and I would probably differ considerably. Perhaps we could save that exciting debate for another time. I beg leave to withdraw the amendment.
Amendment 50ZH withdrawn.
Amendments 50ZJ to 50ZJA not moved.
Clause 78 : Mobility component
Amendments 50ZK and 50ZL not moved.
Clause 79 : Ability to carry out daily living activities or mobility activities
Amendments 50ZM to 50ZQ not moved.
Moved by Baroness Grey-Thompson
50ZR: Clause 79, page 58, line 4, at end insert "including a requirement for the decision maker to collect evidence from the claimant's own health care professionals as a part of the decision making process"
My Lords, there is a great deal of evidence that decisions are frequently inaccurate when made on the basis of reports from face-to-face assessments on their own without being informed by evidence from the claimants and healthcare professionals. The purpose of the amendment is to ensure that in all cases, as a part of the decision-making process to decide eligibility to PIP, evidence is collected by the DWP from the claimants' own healthcare and other care professionals. If sufficient evidence is collected to decide entitlement to PIP, it should not be necessary to have a face-to-face assessment.
There have been ongoing problems with the assessments for ESA. Recent figures published by DWP show that nearly one-third-29 per cent-of those in the work-related group were originally found fit for work and had to appeal to be placed in the right group. Even more worrying, a staggering 60 per cent of those who won their appeal had been awarded no points at all in their initial face-to-face assessment, and at least 15 points are needed to be awarded ESA. These are not borderline decisions.
Why are so many decisions going wrong? The assessment reports frequently contain a partial or inaccurate account of what the claimant has said. The reports done by the healthcare professional are meant to record accurately what the claimant says about the effect of their condition. The second half of the report is where, on the basis of what the claimant has said and their observations, the healthcare professional comes to their own decision about the level of the claimant's functionality. However, welfare rights workers have consistently reported over the years that many of the reports contain a partial or inaccurate account of what the claimant has consistently reported is the impact of their impairment on their everyday life. Regular feedback from welfare rights workers, who are dealing with these reports every day, is that although there have been some improvements, such as in the reconsideration process, there are still considerable problems with the accuracy of these reports. It has not been solved and will not be while relying on these assessments on their own.
The healthcare professional doing the assessment sees the claimant for only a relatively short time on one day, which may well be a good day. They are unlikely to be a specialist in the condition and know the likely effects or how they vary, and will not have access to all the medical records and the tests that have been done establishing the level of seriousness of that condition. DWP and Atos now recognise the value of medical evidence from the claimants' own doctors-this is a really valid point-which was acknowledged by Dr Crawford, clinical director of Atos, in evidence to the Work and Pensions Select Committee. Healthcare professionals working for Atos also acknowledged that when a sample group was interviewed in a survey for DWP.
The following is an extract from that DWP report, and it demonstrates that Atos healthcare professionals themselves believe that medical evidence from the claimants' own healthcare professionals should make the assessment process more accurate:
"GPs' reports were particularly well received because they tended to know the claimant so well. Some HCPs felt that would help to contextualise what they observed on a single appointment ... In addition, it was felt that greater access to medical evidence ahead of the face-to-face WCA might improve the quality of decision-making by providing a more rounded picture of the customer's condition than was really possible in a one-off assessment: 'It can be very difficult sometimes when you're assessing somebody in a short space of time as to whether what they're telling you and whether all your examination findings, whether they all tie together. It can be very difficult, and I think if you had some supporting evidence from a health practitioner, it would make your decision making a lot more robust'".
So Atos healthcare professionals themselves are saying that their decisions about the level of functionality would be more robust if medical evidence were collected, yet the DWP collects evidence for ESA only when it is likely that there will be no assessment.
Unsurprisingly, in view of all this, the deciding factor in tribunals overturning decisions is frequently evidence from the claimant's own doctor or healthcare professional. The Government say that they are committed to getting the right decision first time, yet the following is an extract from guidance sent to GPs:
"DWP may ask you to complete a factual ESA113 report on your patient. You can complete this form from your medial records ... DWP will only ask you to complete an ESA113 if it could result in us confirming your patient's benefit on claim evidence alone, without need for a face to face assessment".
Despite evidence from all sides-welfare rights workers and claimants, the tribunal service and the Atos healthcare professionals themselves-that decision-making in the assessment would be much more likely to be right first time if medical evidence were collected, the only concession is to encourage claimants to send in their own medical evidence. Not getting it right first time will cost money as well as create stress for the claimant. The numbers of ESA appeals are mounting, as are their costs. We do not want PIP appeals to follow a similar trajectory. It clearly makes sense to get this right.
In addition to the costs of appeal, people are too often called in for face-to-face assessments when they should not be. One claimant had recently had a spinal operation. The HCP was shocked that she had been called in for an assessment; he sent her back home immediately and commented that she should not have been asked to leave her house. The stress for the claimant was obviously dreadful but the cost of that face-to-face assessment was also wasted.
The Government estimate that the cost of implementing the changes to DLA, including implementing the new assessment regime, will total £675 million, yet a large number of people receiving DLA could be placed on to the new benefit by a combination of their own evidence in their application together with evidence from their own healthcare professionals, without recourse to a face-to-face consultation or assessment. This is particularly true for those with a lifelong condition or with long-term degenerative conditions, and for those currently receiving the higher rates of benefit.
If there is recognition that medical evidence from claimants' own healthcare professionals is needed to make the assessment process more accurate, the onus must not be placed on the claimant to collect that evidence. Claimants are often charged for medical reports, and while advisers are sometimes able to negotiate with the doctor to drop the charge where a claimant is going to tribunal, doctors who charge will not make that concession in the case of every claim. The charge is often £30 or £35 and sometimes more. Citizens Advice reported one case where the consultant initially wanted to charge £200 an hour. If someone is living on the basic ESA of £67 a week, or even on the ESA main rate of £94, they cannot afford to pay this amount of money to claim PIP. It must be DWP's responsibility to collect the evidence that is needed for an accurate assessment.
It is vital that the assessment process for PIP includes a requirement for the decision-maker to collect evidence from the claimant's own healthcare professionals as a core part of the decision-making process. Without that requirement, there is a danger that there will be a two-tier system, with the poorest and most vulnerable claimants unable to afford to pay for the evidence themselves and, as a result, at risk of receiving a less reliable decision. I beg to move.
My Lords, the importance of this amendment, and of collecting evidence from a person's healthcare professionals, cannot be overstated. Some of us are shocked that not all medical reports are looked at present under DLA; I think only around half are.
Turning to the assessments, I, too, was very interested in the finding by Citizens Advice that welfare rights workers report that the WCAs often present a distorted picture of what a claimant has said. In case noble Lords have forgotten that report, it said that 37 clients were asked to examine their reports and establish how accurately they reflected what they had said and done in their assessments. Sixteen were found to be very inaccurate. We know from experience that if you hear two people speaking to each other and one of them tells you afterwards what they said all over again, it often does not match your recollection of what they said at all. I note that in relation to PIP we are told:
"Individuals or professionals who support the customer on a regular basis will be able to provide evidence to support their claim".
Who will ask these people to provide evidence? Will it be written evidence? If it is not from a healthcare professional, who else might it be from? The finding of Citizens Advice in connection with the WCA alarms me a great deal about the quality of some of the Atos healthcare professionals who are currently carrying out the assessments. I fervently hope that those doing the PIP assessments will be of a higher calibre altogether.
My Lords, I support Amendment 50ZR, tabled by the noble Baroness, Lady Grey-Thompson, and to which I have added my name. The noble Baroness has made the case comprehensively so I will be brief. She referred to the alarming error rate in benefits decisions. At the same time, I am aware that steps are being taken to improve the accuracy of those decisions.
Here I want to make sure that we do not forget the particular problems of people with learning difficulties and mental health problems, who may not adequately convey their limitations in a face-to-face assessment. These groups have to spend their lives concealing their symptoms. They are embarrassed by them, and the last thing they want to do is to spell them out. They are acutely aware of the stigma associated with those symptoms. The Government are ensuring that claimants can take someone along to their assessment. There is not doubt that that will help and in some cases lead to appropriate outcomes. However, for many having a companion simply will not be enough. The companion cannot conduct the interview and the pressure on these individuals to conceal their problems is very difficult to overcome in one of these one-off assessment interviews.
There are also people for whom the very idea of one of these assessments is completely unacceptable. The obvious example is of people with agoraphobia, for whom just going out of the house can present real problems, as can getting on a bus or whatever it is. It is a real problem for this particular group. These people would benefit massively from having a psychiatric assessment at the start of the process, which would eliminate the need for them to go through all the distress of having to do something that they find completely intolerable. It is very fashionable to knock medical assessments but, having worked in mental health for a quarter of a century, in my experience psychiatric assessments are bio-psycho-social assessments. I think that was the term that the Minister used. They do look at the biological, the social, the genetic and every other aspect of someone's functioning.
Also, any self-respecting psychiatrist will not do an assessment in a single sitting. They expect to assess someone over a period of time. They will bring in the views of social workers, nurses and others who have seen someone over a period. There is no way that a one-to-one assessment by someone who may be a nurse but not a psychiatric nurse-even if they call in someone who might be a psychiatric nurse but does not know the patient-can meet the need to make sure that someone is properly assessed, gets the benefits to which they are entitled and does not get benefits to which they are not entitled. It works both ways. This is an important issue.
Other examples include people with a psychosis whose symptoms are not controlled by medication. Many people's symptoms are controlled but some people's tragically, are not. Those people should be able to have a medical-a bio-psycho-social-assessment and, on the basis of that assessment showing that such a person may not be able to function at all, it should be sufficient. I would have thought that the Government would accept that view.
There are physical diagnoses to which the same sort of arguments would apply. For example, those undergoing treatment for cancer, who again have uncontrolled and uncontrollable symptoms, would fall into this category. I referred to this group in connection with an earlier set of amendments. An early medical certificate for those people would avoid enormous distress and the gross injustice of requiring them to do things that none of us would wish them to do if we saw them face-to-face.
I understand the issue of medical fees, which has been referred to. GPs will not tolerate an inundation of requests for medical assessments without a fee. One of my daughters is a GP. I discussed it with her and she was not impressed by the idea. I am also aware that the Government have introduced an important new element in that the claimant can seek a report from their favoured clinician, who could be anybody-it might not be a doctor. This is helpful but it raises the issue, which has already been raised, of a two-tier system. Some people may be able to afford such a thing; others may not. It is a great step forward and I wish to acknowledge that, but it does not detract from the importance of this amendment. I look forward to hearing the Minister's response.
My Lords, I am sorry to come in on Asperger's syndrome again. I know that the Government involved people on the autistic spectrum in some trials that they carried out over the summer. I just wanted to encourage my noble friend to take the feedback from some of the people who took part in that, in a mock PIP assessment. Because the spectrum, particularly at the more able end, includes people who may be very articulate, on a good day it may be quite difficult to see that this is a communication disorder. On the other hand, you could have an assessment in which, even with the benefit of someone in support in the same room, the person on the autistic spectrum may have some difficulty in answering any question themselves as they struggle to put the words together or to make eye contact with the assessor.
On this group of amendments, I would encourage my noble friend to be aware of the variation in how people can present. However confident they may appear, it will inevitably be a very stressful situation for them to be in a room, answering questions from someone they are unfamiliar with. However they present, there will be stress behind it. I just reiterate something that I asked my noble friend a little earlier. I ask him to make absolutely sure that the people doing these assessments have not just mugged up on what autism or any other disability is from some book, but really understand and have a working knowledge of the disciplines in which they are assessing people. I will leave it at that.
The amendment on which mine is the lead name also refers to the autistic spectrum. When the noble Baroness is in the Chamber with us, I always feel as though you are definitely on the end of the passing movement, as opposed to being the play-maker. The noble Baroness knows exactly what she is talking about. At my conference, someone who was talking in a meeting about autism said, "You must understand that autism is a three-dimensional spectrum". Does that phrase not start to explain why the diversity of people and their reactions are incredibly difficult to understand and always will be? I wish I had thought of that expression myself. The great diversity of needs and different types of behaviour mean that you must have some specific training.
When I was approached to put down this amendment, I had a conversation with the NAS. I want to use it as an example of the fact that you always need a certain degree of knowledge to make this type of assessment. I remember that, in years gone by, when the noble Baroness, Lady Hollis, spoke for the then Government, our exchanges on the subject of the initial interview process went on and on and developed almost into a ritual dance. "Can we have specific knowledge?", we would ask the Government. "No, but we will give them lots of training", they would reply. We have got better, because we always do, but it remains the case that unless you have someone who actually understands the condition which they are assessing and reporting on, they will make mistakes.
The noble Baroness, Lady Grey-Thompson, has already pointed out that mistakes cost "blood and gold" for everybody concerned. You burn up time; you burn up money; you cause suffering. Getting more expertise into assessment, either by taking a better history, or by making sure you have the right person there at the right time, will make life a lot easier and will probably save money in the long term or, indeed, in the medium term. The Minister has been moving forward, although he is pushing water uphill with certain concerns here. I stress that I am looking for clarification on where he is moving to and his thoughts on where this expertise is going to be dragged in. If you have a problem, empower people to say that there is a problem and that someone who understands it needs to be brought in. If you can do that, you will take huge steps forward. You will not get it right all the time but you will get it right more often.
If the Minister can give us some encouragement and some firm guidelines about what is going to happen to encourage people to get it right-not just to get the numbers through-I will be a very much happier man at the end of this.
My Lords, I do not intend to detain the House long, because Amendments 50B, 50C and 50D were debated at some length in Committee. I attempted to withdraw Amendment 50A yesterday, but the gremlins crept in and the only thing that has been withdrawn is my name-the amendment still appears on the Marshalled List.
With Amendment 50B, the noble Lord, Lord Addington, has once again made a very powerful case in support of the need for properly trained assessors. In particular, all assessors should have an understanding of and training in autism if they are to recognise and understand the complex cases they will have to deal with. It has been said a number of times-I make no apology for repeating it here, because it is important-that when you have seen one person with autism, you have seen one person with autism. This is why the training is so important. A knowledge of autism and possessing the right skills to assess the needs of an autistic person are essential in making any decision about the appropriate level of financial support that that person might need. I believe that the Minister accepts this point of view.
Following the Committee stage, a number of other noble Lords and I had a very useful meeting with the Minister and his colleague Maria Miller MP, and we are grateful for that opportunity to exchange views in a less formal situation. One point from that discussion, which was touched on today by the noble Baroness, Lady Browning, did concern me-the point about the qualifications of the person carrying out the initial assessment. One of the Minister's officials told us at that meeting that the initial assessments would be carried out by an occupational therapist. Will this be the case? That seems a very narrow skill base from which to draw the expertise for any kind of wider assessment, and it leaves me, for one, with the impression that the assessment is aimed primarily at getting people into work and not at trying to understand and support them if they are not able to work. Such a situation would fly in the face of the well-argued case that assessors should have specific training in all mental, intellectual and cognitive disorders, as advocated by the amendment. I hope the Minister can allay my fears.
I turn to Amendments 50C and 50D, in my name and that of my noble friends Lady Healy of Primrose Hill and Lord Wigley. The amendments concern face-to-face assessment and would, if accepted, exempt certain categories of people from the process of continuous reassessment where sufficient medical and other expert evidence existed to demonstrate that their condition would not improve. I return again to my concerns about people with autism. Autism can be summed up in this way: autism is for life. Any reassessment must accept this fact before progress can be made. The Minister made it clear, at Second Reading and in Committee, that the Government did not believe that a face-to-face assessment would be the right course to follow in all cases.
At our meeting, both the Minister and his colleague, Maria Miller MP, gave a strong impression that the Government would support a tiered approach to assessment in such cases, as advocated by the National Autistic Society and others. In practice, this tiered approach would allow for written assessment from professionals to be considered and a decision to be made, on that basis, about whether a face-to-face assessment was appropriate or necessary. I will not test the patience of the House any longer. I look forward to the Minister's response and hope he will have something positive to say about a tiered assessment.
This is an important debate because existing relevant medical evidence is absolutely essential to getting this test-and the whole process-delivered as accurately and as sweetly as it possibly can be. This is true in two separate directions. First, getting access to and active consideration of existing relevant medical evidence will make the examination-if an examination is needed-much more satisfactory for all concerned. As has already been said, it will reduce appeals-and it will minimise costs for that reason if for no other.
It has a second important function which I hope the Minister will be able to spend some time on. If the Minister could help us understand better how desktop assessments can obviate face-to-face assessments, he could diminish the fear factor that clearly exists, rightly or wrongly, about what will face people who might be invited to these face-to-face tests in future, and that would be enormously helpful. I am aware, having followed this for some time, that the DLA provisions which we put in the primary legislation in 1992 were, in some respects, too prescriptive. I understand perfectly that assurances can be made and put into regulations and put into medical contracts as well.
I am in the market for voting for this amendment if we do not get the kind of response that I hope for. However, there are ways of delivering the assurances that are being sought by our correspondents and the disability community. It would be helpful if the Minister could say a word about the contract. I understand that the contract is out to tender and it is too early to say who is interested, but people are drawing conclusions from the Atos Healthcare experience. I do not think that that experience would necessarily be repeated in the future if the terms of the contract are drawn sufficiently clearly. In that contract, if not in regulations or primary legislation, we should be saying clearly that on cause shown, if there is heavyweight medical evidence that can be addressed at a desktop level, those are circumstances where it should almost be a default that people will not be subjected-if that is the right verb-to these assessments.
I share a concern about the quality and experience of the assessors. I have a capacity issue as well as a quality issue about that. It does not matter if you get the best contract in the world and the most enthusiastic prime contractors who come in and promise, hand on heart, to do the best they can. The professionals with the right qualifications and experience to do this work may not be out there. If that is the case then we need to be very careful. There is not enough emphasis in the United Kingdom on this kind of medicine, and we should be promoting with our medical colleagues a far higher degree of interest in and development of the specialist skills that medical professionals need to do these jobs in order to make this process a success.
I have here a case history that caught my imagination. A 25 year-old young man is undergoing his first major reassessment of his problems as an adult. His assessments will involve MR scans, examination by neurologists, neurogeneticists, neurophysiotherapists and a specialised occupational therapist. He has scattered neuromotor difficulties. Although I trained as a pharmacist a long time ago, I could not even find on the internet what neuromotor difficulties actually amount to, but it is clearly a serious condition that is being addressed by experts at a tertiary, if not international, level by a centre of excellence in a region in the United Kingdom. The young man has written to say that he is now fearful that he will have to address the circumstances of these tests. It would be completely daft and stone mad that we cannot say something now that is clear. There may be technicalities with the legislation, and perhaps I could be persuaded that such provisions should not be in primary legislation, but we absolutely need some clear, copper-bottomed assurances from the Minister that a person in those circumstances would not face such difficulties.
I hope that the Minister will understand that this is an important amendment and that he will take as much time as he can to tell us as much as he knows about how these processes will work and where in the legislative process-whether by regulation or primary legislation-we can be assured that we will get some protection for the kind of young person to whom I alluded.
My Lords, I have difficulty with Amendment 50ZR. I fully endorse the fact that medical evidence is needed, but some people with ME have not seen a doctor in years, simply because there is no treatment for them. If the department is expected to depend a lot on medical evidence for corroboration of the illness, I do not know how people with ME are going to cope. That really disturbs me and the issue needs to be examined.
I fully support the amendment of the noble Lord, Lord Addington, on training. People with ME have cognitive difficulties as well as all their other problems, and these are not very well understood. I give him my heartfelt support, and I hope that the noble Lord will take on board the fact that some people cannot get current medical evidence to corroborate their illness.
My Lords, I shall speak briefly because time is pressing. We went into this issue in some detail in Committee and I warmly support the amendment of the noble Lord, Lord Addington, which was better than the one we originally considered. The noble Lord, Lord Touhig, referred to the tiered approach, and I very much hope that the Minister can confirm that the tiered approach that has been pressed upon him by those involved with autism will be central to this matter.
I also hope that he can take the main thrust of the amendment of the noble Lord, Lord Addington, whereby expertise needs to be brought on board. Earlier today, the Minister emphasised the need to make sure that those with greater disabilities get the support they need and that those with lesser disabilities get less. That approach is dependent upon knowing exactly what the conditions are. When we consider people in the spectrum associated with autism and Asperger's we need to know the individual challenges they have. If the wording of this amendment is inappropriate, so be it. However, there needs to be an approach that brings that expertise on board, otherwise we are failing to do what the Minister says he wants to do.
My Lords, I shall speak briefly in support of this amendment and Amendment 50B. I spoke at length in Committee in support of the requirement for the decision-maker to collect evidence from the claimant's own health professional, and I do not intend to repeat myself. However, I should like to make a specific point about the requirement in Amendment 50B that,
"persons approved by the Secretary of State to undertake assessments have specific training in all mental, intellectual and cognitive disorders".
This is because it is necessary to state that specialist skills are required in assessing someone with autism, learning disability or mental illness, and I know that it is intended that such expertise should be provided. However, most medical doctors do not have these skills. Indeed, Professor Steve Field, when writing about the NHS Future Forum in connection with the Health and Social Care Bill, pointed out in his most recent papers that it is of some sadness and regret that most doctors do not have training in these specialties, particularly those relating to learning disability and autism.
The other point I should make is that in psychiatry these are also specialist skills and not all psychiatrists have them. Some will be good at assessing mental illness, but not all will have expertise in assessing people with learning disability or autism. That requires additional or different specialist training. I wish just to draw that to the Minister's attention.
My Lords, these amendments would improve the assessment process for the new PIP and allay the fears of many people with disabilities that the poor experience of the ESA assessments, where around 40 per cent have been successfully appealed, is not replicated under the new benefits system.
Amendment 50B relates to the training of those undertaking face-to-face assessments to ensure that they have knowledge of mental, intellectual and cognitive disorders, clear guidance about when to access more specialist advice, and a guarantee that such advice will be available. In Committee, we received some encouragement from the Minister who stated:
"Assessors will be required to have a broad training in disability analysis as well as training on specific impairments ... we intend to ensure that they have sufficient training in mental, intellectual and cognitive impairments ... and will stipulate this in our contracts".-[Official Report, 16/11/11; col. GC 263.]
Perhaps the Minister could let us know what budget has been set aside for such training.
Amendments 50C and 50D would exempt certain people from a face-to-face assessment where sufficient evidence is available via other means. This would actually save money for the Government. I hope that the Treasury is listening. Implementing face-to-face assessments was to have cost about £675 million. The amendments would reduce the costs by removing from the process claimants for whom a face-to-face assessment is clearly unnecessary. This would help those with lifelong or degenerative conditions, for whom a face-to-face assessment could be stressful. For example, about half those with MS or Parkinson's are receiving the highest level of DLA. Putting them through an expensive and stressful face-to-face test seems unnecessary.
Again, we received some assurance in Committee. The Minister stated that,
"where there is already sufficient evidence on which to make a decision ... we completely agree ... a face-to-face consultation should not be required".
I hope that the flexibility would be there for that. However, he also argued that other than for those with a terminal illness,
"we do not agree that there should be different rules or processes for different groups of people ... on the basis of impairment type".-[Official Report, 16/11/11; col. GC 261.]
Yet, if the Minister is prepared to accept that those with a terminal illness should not be subject to unnecessary assessment, surely the same argument could be applied to those with degenerative conditions where there is no hope of improvement. We look forward to any assurances the Minister can give that unnecessary face-to-face assessments will not be necessary.
If he is not persuaded by me, perhaps he will be persuaded by someone of his own political background-the Mayor of London, Boris Johnson. I have never quoted from one of his speeches before. He writes:
"Evidence from the individuals GP and/or a consultant will provide an accurate assessment of need. It would be difficult for a healthcare professional in a one-off meeting to elicit a comprehensive response about the daily reality for each claimant. Face-to-face meetings ... could prove ... inappropriate for an individual who may have difficulty with social contacts, such as those with autism, or for those with an intellectual or mental health disability".
This brings me to the first amendment in this group which would ensure that the assessment process always takes account of evidence from the claimant's old healthcare professional. It builds on the experience of the work capability assessment for ESA and is to help the Government to avoid history repeating itself. Unfortunately, in this case, it would be as tragedy not farce. The problem with the current proposals is that they put the onus on the claimant to collect the medical evidence and also to have the knowledge that would be helpful to provide this. As we have seen with ESA assessments, it is exactly this that often leads to unnecessary duplication as a case is assessed and then reassessed in the light of the evidence from the GP or professional. The initial failure to consider such evidence has contributed to the very high and expensive success rates.
In Committee the Minister argued that while medical evidence could be of use, he felt that it was not necessary to gather evidence in every case. He said:
"In some cases what the claimant has already told us ... will be sufficient. In other cases, information ... might be likely to add only limited value".-[Official Report, 16/11/11; col. GC 261.]
Surely it would be better to err on the side of caution, given the widespread inaccuracy of the ESA assessments and the need to ensure that the personal independence payments do not follow the same route. Medical evidence is bound to assist the decision-maker in far more cases than those in which it proves unnecessary.
This is a modest amendment. It seeks to ensure that the introduction of personal independence payments proceeds smoothly and more importantly to ensure that the right benefit is paid to the right people. I hope the Minister will accept this. Certainly it would have our full support.
My Lords, I could summarise my speech in about three sentences. I am in agreement with virtually everything said in the Chamber. I hope that after my three sentences I will be able to provide assurances. My only point of real disagreement is that I do not want it to be mandatory-in primary legislation. This is in regard to the point made by my noble friend Lord Kirkwood that it reduces flexibility and we are much better off setting it up in regulations and guides and in the contracts. That is our proposed approach but fundamentally we are absorbing all the valuable points made on this group. I will try now with some speed to go through those assurances. I ask noble Lords to stop me with the precise assurance they want if I am not making the assurance well enough.
Amendment 50A was semi-withdrawn by the noble Lord, Lord Touhig, but I will try to deal with it because it is a building block. People being assessed can bring in someone with them-a relation, a friend or a professional-to help them. That is really important in the group we spent a lot of time on this afternoon relating to autism and Asperger's. When people are over-bright their relation can make the point about the reality and the over-anxiety of the person being assessed. That would be an active role in the process.
I turn now to Amendment 50B. Clearly, we need to make sure that assessors have all the appropriate training to interpret the evidence that they are provided with. I have to make the point that it is not a medical assessment PIP. It does not ask the assessor to diagnose a condition or to recommend treatment options. It is different. It looks at how the conditions or impairments affect individuals' everyday lives. That is a different skill set from that involved in treatment. There is not quite the same level of need for specialist skills but it is our intention that assessors will have a broad training in disability analysis as well as training in mental, intellectual and cognitive impairments. That level of training will be stipulated in our contracts with any providers and we will be responsible for signing off the training syllabuses. There will be occasions when assessors need more specialist support in the course of making these assessments. We will ensure that they have access to and support from individuals who have the in-depth knowledge that the noble Baroness, Lady Meacher, mentioned with regard to mental health conditions.
I am sorry to interrupt again. Can my noble friend give us any hope that when an assessment is called there will be any publication of the qualifications and background of the assessors so that the people being assessed at least have some view of what their expertise actually is?
It is a nice idea. I do not think I will make an utter commitment to it here and now but it is a cute idea and maybe we should put it in the contract. I will take it away and think about it.
We do not think that we should prescribe this in the Bill or even in regulations because it is important that assessors have an understanding of the limits of their knowledge so they know when to bring in the expert advice. I think the noble Baroness, Lady Healy, got that absolutely right.
I will now go on to Amendments 50C, 50D and 50ZR. We know that individuals can have a wealth of material, knowledge and evidence that will help in the assessment process and we need to get the right material and evidence from them at the right time and we need to encourage that evidence to come forward. We will not create a two-tier system where the poorest and the most vulnerable have less chance of receiving benefit because they cannot afford to pay for the evidence. We are going to make sure that does not happen.
I want to pick up the very valuable point raised by the noble Countess, Lady Mar. If we have a mandatory process to involve the individual's health professionals it may very well be an entirely nugatory and expensive process in the many situations where the GP is not up to date with what is happening. That is the inflexibility of having something in the Bill which adds nothing except cost. If someone who has a learning disability has not visited a health professional for many years, why go through the expense of getting evidence? It would be unnecessary; it would slow the process down; and there may be someone else whom we would not have thought of including in the Bill who is much better placed to provide information and evidence for the assessor. We need to pull out the cumbersome implications of the mandatory process-the point made so precisely by my noble friend Lord Kirkwood.
We have made it clear that face-to-face consultation should form part of the claim process for most-but absolutely not for all-claimants. Ultimately, consultation will play a key role in creating a fairer and more objective assessment. It needs to be done sensitively and proportionately, but where sufficient evidence is available, we are in absolute agreement that there does not have to be face-to-face consultation. There will be many examples where that is unnecessary.
We are talking about something very close to, if not exactly, the tiered process recommended by the National Autistic Society. That is what we are planning to adopt. We have flexibility in the Bill to do that.
My Lords, I should have said this when I was making my initial speech. About 60,000 people with ME are either bedbound or housebound. To go to a face-to-face interview would cause enormous stress and probably exacerbate their symptoms. Will that be taken into account? They cannot provide medical evidence because there is no treatment; yet they cannot come out of their homes. How will the Minister deal with that?
My Lords, one thing I was trying to get over about trying not to have a two-tier process so that the rich can get their evidence and the poor cannot, is that we turn the burden on to the assessors, so that when someone cannot come out, that requires a house visit if we cannot use paper evidence. There will be examples where paper evidence will do the job; where it cannot, the onus is on the assessor to do the checking, rather than the other way round. That is how we will provide that protection.
I hope I have gone through all the specific issues and given assurances on all those important matters. We are planning to meet the concerns expressed around the House. All I am asking for is that we have the flexibility to go on running the system as things change, as they inevitably do, and that we do not lock it up in primary legislation so that if we need to make changes it takes years. That is really what we are talking about.
I apologise for interrupting the Minister. I just wanted to make a point about ME patients, who have the most awful time. I have direct personal experience of that-not myself but through people close to me. Does the Minister accept that Amendment 50ZR would enable someone bedridden with ME who has not seen a doctor for years to call their GP and have a proper assessment? They are bedridden; they cannot go to assessments. That would avoid getting into a benefit assessment straight off. That is the whole point of the amendment. There has been support around the House because of the many situations where tremendous distress can be avoided by an appropriate person-perhaps a nurse, perhaps a doctor-to do a full and careful assessment, rather than getting into the benefits system.
My Lords, I hope that I have made it absolutely clear that if we write into the Bill that it must be the GP, who may not be the right person, we are stuck. If you give us the flexibility, we are not stuck and in those circumstances we will go to the person's home to do the assessment, or take someone else's piece of paper on the tiered approach.
What we are planning will be better for people suffering from ME and other illnesses because we will be able to respond. I think that the market will change. My noble friend Lord Kirkwood said that there is not an adequate market in this area. Occupational health and support for people of working age is a Cinderella service. We will be building that. As things change, we can move the assessment. If you tie it up, we will be locked in to 1948 as the years go by. The only difference between us on this, I think, is how mandatory and prescriptive we want to be, and it would be most unusual to put it in the Bill.
Let me cover the technicalities. The Government consider that Amendment 50D is directly consequential on Amendment 50C; the others are separate, so I ask noble Lords not to press them to a vote and the noble Baroness to withdraw the amendment.
My Lords, I thank the Minister and everyone else who has taken part in the debate this afternoon. On a point of clarification to the noble Countess, Lady Mar, although the wording of the amendment was "relevant healthcare professionals", in her speech she mentioned doctors; it is much wider than that.
The amendment is a fundamental cornerstone of what is necessary in the move to PIP. I recognise that the Minister has moved a long way. I am still not comfortable with some part of his statement on the broad training for professionals. You do not know what you do not know. It is very difficult to instil that knowledge in people. I would like to know an awful lot more about the detail of how that training and education will take place.
There has been broad support around the House for my amendment, and I am grateful to noble Lords for that, but considering that the Minister has moved further than perhaps I expected, there is an awful lot to think about in what he has said. I beg leave to withdraw the amendment.
Amendment 50ZR withdrawn.
Moved by Baroness Thomas of Winchester
50AB: Clause 79, page 58, line 6, at end insert-
"(d) shall not take into account aids, appliances or adaptations used by the person."
My Lords, we had quite a debate about the use of aids, appliances and adaptations in Grand Committee, at the end of which I found myself more confused than ever about how the PIP assessment was going to take them into account. I have already declared one interest; I feel that I should declare another in having most of the aids and appliances known to mankind in my house.
My purpose in tabling the amendment is not so that we can have another debate about the detailed use of all kinds of aids-
My Lords, I am not going to have another debate here and now about the detail of all kinds of aids and appliances, but I want to signal my concern about the question and to ask the Minister whether he would consider hosting a meeting for interested Peers on this topic, together with the relevant officials from his department.
I quite appreciate that those who have been working on the second draft criteria for PIP have tried to do their best to incorporate the views of many organisations and people, including disabled people, but we must not forget that the Government want to cut the bill for DLA by bringing in PIP, which may mean that some of those who currently receive DLA will not receive PIP. If so, it is very important to make sure that some people do not fall through the net because their particular needs have not been met.
We have to keep in our minds at all times the purpose of PIP, which is to help a person to carry out daily living activities and mobility activities if that person is limited or severely limited by their physical or mental condition. The Minister has repeatedly made it clear-we heard it just now-that the Government are looking not just at the medical model of disability but at the biopsychosocial model, which tries to include part of the social model. The responses of disabled people and organisations to the first draft criteria were instructive. Many were keen to point out that taking the use of aids and appliances into account does not necessarily remove a barrier to participation. Those of us who have mobility problems can all testify that there are still a lot of buildings such as restaurants, shops and even hotels which are not accessible, as well as dropped kerbs which are positively dangerous and public transport which is not suitable. The mobility descriptors are, in my view, worryingly minimal, and here again the responses to the "Moving Around" section were useful. While moving outside, for example, no account is to be taken of the gradient or texture of the ground, or the weather, and there was no box for whether the physical support of another person was needed for those with poor balance.
I turn now to a very basic issue-managing toilet needs or incontinence. One response was that toilet needs outside the home should be considered. Most disabled people can manage in their own homes, many with aids, but going out is a different matter, as we heard from the noble Countess, Lady Mar, who is not in her place at the moment. This has not been included but it may make all the difference to whether someone can participate in society. If that is the criterion for receiving PIP, why is there no suitable box for it? Or perhaps there is and I have not been able to find it.
Before ending, I should like to raise one matter that has concerned me for some time but about which I may not have to worry-that is, the difference between using an aid or appliance for work capability and using the same aid or appliance for ordinary living purposes. For example, we know that a person in a manual wheelchair is no longer classified as having limited capability for work simply because of their use of a manual wheelchair, so they will not automatically get ESA rather than JSA. Although I am not happy with that state of affairs, that is the situation at the moment. However, if that person applies for PIP under the new regime, knowing that PIP will be an in-work as well as an out-of-work benefit, and because they might need extra help with daily living activities, then I can see no good reason why they should not receive it. Therefore, I hope that whether a person has "passed" or "failed" the work capability assessment will not be taken into account when they are being assessed for PIP. I think that this is why the noble Baroness, Lady Grey-Thompson, thought that she might be ineligible for PIP.
I understand that the aim for PIP is to take account of aids and appliances which are actively used by individuals and those which could reasonably be expected to be used to reduce barriers to participation. If the Government expect a person to buy and maintain aids, the least they can do is to help to pay for them.
The case studies that the Minister promised us I found extremely valuable, but they also beg a few questions. For example, the phrase "Needs to use an aid or appliance to bathe" means using a shower seat to take a shower, but what about those who can use a shower only if there are suitably placed grab-handles and the shower has the lowest step possible, or if the person has a wet room but has to use, say, a walker while using the shower?
In view of the very late appearance of the PIP thresholds and the case studies, I hope that the Minister will agree to an early meeting between concerned Peers and the relevant officials at the DWP to talk in more detail about how aids, appliances and adaptations are going to be used in the assessment. I beg to move.
My Lords, I have added my name to the amendment and I have here an eloquent speech in its support. However, I do not propose to deliver it because I am aware of even larger fish to fry a little way down the track, and I think it is important that we should reach those as soon as possible. However, I want to make it clear that that in no way reflects any lack of support for the amendment of the noble Baroness, Lady Thomas. I support and agree with every word that she has said, and I entirely agree with the approach that she has suggested of getting together with the Minister and his officials to see whether we can find a way through before Third Reading.
My Lords, I support the amendment. I have raised this issue with the Minister in private in the past. Many people on the existing benefit have used the money to increase their possibility of living normally by putting it towards aids or adaptations, and it would be very wrong if they were disadvantaged because of that.
My Lords, a fundamental principle of PIP is that support should be targeted at those who are most affected. I reassure my noble friend Lady Thomas that we will not be penalising people who use aids and appliances.
We know that many disabled people have a greater level of participation because of the help provided by aids, appliances and adaptations. If we were to disregard entirely the use of such aids, we would penalise individuals whose health condition or impairment could not be helped through their use. In those circumstances, the needs of those individuals would seem less of a priority, even though their levels of participation might be lower. Therefore, there is a balance to be struck here. I would be the first to admit that the use of aids, appliances and adaptations do not of themselves eliminate needs, barriers or costs. We accept and understand that, and that is why we are applying points in the assessment when such aids are in use. The number of points will vary depending on the aids in question and the levels of need.
With regard to the daily living component, the entitlement thresholds have been set at such a level that an individual who requires aids to carry out a number of activities may receive the component at the standard rate. I am pleased to reconfirm to the noble Baroness, Lady Grey-Thompson, that with the mobility component, individuals who use aids and appliances to move short distances can receive the standard rate, while someone who needs to use a wheelchair to do so-whether it is a manual or an electric one-will receive the enhanced rate. In that sense, it is a different assessment and it does things differently from the WCA for ESA. The valuable point has been made tonight that people do not understand that, so clearly we need to put across information about it.
As I informed noble Lords in Committee, the approach that we wish to adopt for PIP is the same in this area as that currently used within DLA. We take into account aids that are currently used by individuals as well as those which might reasonably be expected to be used. Let me be precise-I mean those that are easily and cheaply available. We will not, for example, say that an individual's needs would not be present if they simply bought themselves a wheelchair, a stairlift, or a walk-in shower. That would not be reasonable, and we will have guidance available to make sure that claimants are treated consistently.
I will, however, be delighted to host a meeting with my noble friend, and any group she wishes to bring. Clearly, there is a big consultation exercise going on in precisely this area. I know this is an area in which she has great interest, and I will be very pleased to host that meeting. I urge her to withdraw her amendment.
My Lords, I am very grateful to the Minister for agreeing to such a meeting, and for clarifying that there is a great difference between the assessment for the work capability assessment and PIP. With that, I beg leave to withdraw the amendment.
Amendment 50AB withdrawn.
Amendments 50ABA to 50D not moved.
Clause 80 : Required period condition: further provision
Moved by Baroness Grey-Thompson
50E: Clause 80, page 58, line 26, at end insert-
"( ) The Secretary of State must lay before Parliament an independent review of the plans for implementation of the assessments under section 79 before the provisions are brought into effect, and such plans must in particular provide for-
(a) a trial period before any assessment process is implemented fully for new applicants and those transferring from DLA;
(b) disabled persons organisations to be involved in formulating the assessment process."
My Lords, the purpose of the amendment is to ensure that there is an independent report on the plans for both the PIP assessment and its implementation before implementation starts, and a trial period before it is implemented in full.
We have spent much time today debating why disability benefits matter so much, but perhaps I may briefly point out that nearly one-quarter of individuals in families with at least one disabled member live in relative income poverty, and over 50 per cent of working-age disabled adults are not in paid employment. One-third of working age disabled people are estimated to live in poverty.
There is huge concern about the effect of DLA reform. The thresholds for the new benefit were announced only yesterday. The modelling suggests that the second draft will produce a 2015-16 caseload of 1.7 million people receiving PIP. Without introducing the new benefit, we would expect the number of 16 to 64 year-olds claiming DLA in 2015-16 to be 2.2 million. That is a reduction of half a million people who will not receive any help with the cost of disability, who would have been receiving DLA.
Just last week an analysis of organisations' responses to the original government consultation on DLA reform highlighted the amount of concern about the proposed changes. The extent of this concern was not clear from the DWP response to the consultation. Scope, in its report, The Future of PIP: A Social Model Based Approach, says:
"We remain very concerned that this decision is based purely on budgetary targets, rather than on robust evidence as to how the benefit is used and by whom".
I just do not believe that there has been time to analyse who will lose out. The Disability Benefits Consortium stated:
"We are very concerned that there has not been due consideration of the impact this reform will have both on those who lose all their entitlement and those who are left with a reduced award following reassessment".
The thresholds were published only yesterday, but without those thresholds it is impossible to look in detail at who will lose out. Without them, it is almost impossible to have an informed debate about this part of the Bill. The few examples in the consultation document, while helpful, cannot possible address this properly.
Why do we need an independent review and trial period? Some early analysis has suggested that one of the groups who might lose out are those with mental health conditions, who currently receive the lower rate of mobility. Many people with a mental health condition find it impossible to use public transport. They frequently use their DLA to pay for taxis. If they are unable to get out, it is likely to make them more socially excluded, and push them further from the job market. This is just one possible unintended consequence.
There needs to be careful scrutiny of who will be affected by these changes. Many more groups will emerge in the months and years ahead, together with some unintended consequences. I have a real concern that it could lead to a deterioration of people's health. Will it impact on the social care budgets? There are so many more things to consider in this. For such a major change as this, it is important to be much clearer on what the changes will be.
There is concern not just about the test or the thresholds but about the way that the benefit is assessed, and this is a much greater change than the move from IB to ESA. An independent report on the plans for both the PIP assessment and its implementation, before the implementation starts, would provide an appropriate level of scrutiny, given the huge impact this reform will have on disabled people.
The trial of the IB reassessment process in Burnley and Aberdeen threw up a number of important lessons which the DWP learnt from and implemented in the full rollout. It is so important that there is a trial of PIP in a similar way before the full rollout to either new or existing claimants. I beg to move.
My Lords, I declare my interest in these debates as a recipient of DLA. This amendment is every bit as important as those we passed last week. Noble Lords will know from their postbag that people are looking to us to ameliorate the worst excesses of this Welfare Reform Bill. Although the Bill has some very sensible and progressive things at its core, in the shape of universal credit, nevertheless it goes too far for most people's consciences in the way that it takes vital support away from some of the most needy in our society, in ways that have been movingly illustrated-far more eloquently than I could-in earlier debates.
Let me be clear about what the amendment does and does not do. It does not entail the Bill being paused, as happened with the Health and Social Care Bill, and as it has been portrayed outside. It merely states that the new assessment regime should not be commenced until Parliament can be given the benefit of an independent review-a common enough procedure regarding the introduction of particular statutory provisions.
It may be said that it is pointless to pass such an amendment, and that the Commons will only reverse it. However, there are two reasons for passing it, notwithstanding that. First, it sends a strong signal to the Government that they cannot be too cavalier in the way that they drive the juggernaut of reform over those who are weakest and most defenceless in our community. Secondly, as we have seen in the last week, it ensures that they cannot do this below the radar of public attention.
I support the amendment from my noble friend Lady Grey-Thompson because I think that this is all being rushed through far too quickly to meet Treasury targets, before it is ready. The latest consultation draft of the assessment criteria reached us only yesterday, as we have heard, which has left little time to carry out the necessary analysis, but enough to see that it is still very much work in progress. For instance, just one day before we were due to discuss the Government's plans for the future of DLA, the number of disabled people likely to lose help through the new assessment process was revised upwards to 500,000, as we have heard.
When the proposals were first announced in the June 2010 Budget we were told that a 20 per cent reduction in case load was likely. At that time this represented 360,000 disabled people, so the figure for the total of losers from the Government's proposal has risen by 140,000, to which we should probably add the 80,000 care home residents who will no longer receive their mobility payments.
The Treasury's target saving of 20 per cent was always arbitrary, being cost-driven rather than evidence-based. The Government themselves admit that the level of fraud is very low with DLA, at only 0.5 per cent. There are even suggestions that the increased figure for losers which we heard of yesterday will not achieve the Treasury's target, either. At all events, the DWP is giving the impression of making it up as it goes along, all in an effort to satisfy its Treasury masters.
Disabled people do not have confidence in this process, which all serves to underline the fundamental unfairness of taking needed support away from the most vulnerable simply to meet Treasury targets. Confidence is not enhanced by the experience disabled people have had of the work capability assessment for out-of-work benefits. This was trialled on new claimants and regionally piloted for 18 months before national implementation, and has been the subject of two independent reviews, yet still gives rise to considerable difficulty, with 40 per cent of appeals upheld. This is a massive waste of money. We need to be sure that we have got the system right for the personal independence payment before it is introduced. So far, the DWP has tested the proposed assessment for PIP on fewer than 1,000 people. A sample of fewer than 1,000 is simply not enough to get a proper handle on the complexity of the issues that will arise when the full DLA caseload of 2.2 million people is put through the reassessment process; it is not like saying whether you vote Labour or Conservative.
DWP research suggests that more than half of those receiving DLA have four or more health conditions or impairments. The process of reassessing everyone is set to cost £675 million, to say nothing of the cost to the NHS of providing 2 million medical reports. Is it really worth such a massive outlay in public expenditure -all of half the anticipated saving-when, with a much more modest overhaul of the system, the money could be used to maintain support for vulnerable disabled people, which the Prime Minister made a great play of pledging to do, rather than taking it away from them?
Particular issues have arisen with the work capability assessment for people with fluctuating conditions such as MS and ME, and also for people with mental health problems. I do not believe that the Government can yet demonstrate that these issues have been resolved for the new PIP assessment, which adopts a similar points-based approach. We all want an efficient, effective welfare system that delivers support only to those who need it, but I do not believe that the current assessment proposals will achieve this, and they could cost as much in long-term NHS social care and tribunal costs as they save, to say nothing of the distress and hardship that certainly will be caused to individuals. For these reasons, I urge the Government to pause the full implementation of this provision until a proper study has been undertaken of the testing system, of those affected and of the costs to individuals, families and the Government.
From the Government's point of view, this makes good sense if they want to avoid the kind of debacle we witnessed with Atos Healthcare's conduct of the work capability assessment. I simply do not believe that the new system will be ready to go by April 2013, when it is due to come into force. From where we are now, there must be a 15-week consultation period on the latest draft of the criteria, followed by a modicum of time for the Government to respond if the consultation is to be genuine. Regulations will have to be prepared and consulted on. The DWP states that the regulations will not be ready until the end of this year. After that, the details of the assessment will have to be finalised before contracts can be tendered for carrying it out. This cannot be rushed if the sort of problems that bedevilled Atos Healthcare, the company that carried out the work capability assessment, are to be avoided. Therefore, it is as much in the Government's interests as those of disabled people that we take the time needed to get this right.
My Lords, for the second time today I feel that I need to say something, however brief, because of my history. Just as I engaged in badinage earlier with the noble Baroness, Lady Lister, about the Social Fund, I now have to declare to the House-possibly as a proud boast-that as a Minister I was responsible for introducing the disability living allowance in the early 1990s. I was given huge help by someone who deserves a great deal of credit, namely my former and unhappily now late colleague, Nick Scott, whom some noble Lords in the House today will remember with respect and affection.
On that occasion, we cobbled together a slightly curious construction based on the existing benefits of mobility allowance and attendance allowance, using the maximum amount of money I could extract from the Treasury at the time, to extend help to various groups who had previously been excluded, including the mentally ill. Perhaps we did a better job than I thought at the time because it has not only stood the test of 20 years but has survived with people now seeking to defend it against all comers, in much the same way as they defend the Social Fund.
What I say to the House may be uncomfortable for the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Low, for whom I genuinely have huge respect. This is not flannel; they are immensely valuable Members of this House. However, I have been taken down a different path. If somebody had told me 20 years ago that that structure was to be seen as anything near a settled state for 20 years, I would have been surprised, because there were obvious ways in which it could have been developed and carried forward to build on what we had achieved at the time. That is what the Government now seek to do. I say to the noble Baroness that I am not sure that it is right now to try to slow down the process by yet another review after the many that we have had.
Only yesterday the Government published a revised review of the assessment process. I accept that neither I nor anybody else has had a chance to digest it. However, it makes it crystal clear-this picks up on the second half of the noble Baroness's amendment-that this will be worked through steadily and carefully, in conjunction with organisations representing disabled people. I assume that account will be taken of the results of that consultation. Of course I accept that it would be nicer in a perfect world if we had all the details now, and that there will need to be a good deal of tweaking-or perhaps more than tweaking-as the consultation proceeds. However, I also accept that we have a Minister who knows his stuff, who cares about the subject and who has shown himself to be willing to listen to those representations. We should let him get on with it.
I do not accept the tenor of the e-mails that jammed my system from yesterday through the early hours of the morning into today, which suggested that the Government had a dastardly plot to do down disabled people. It is not the case, and I would not say this if I believed that for a moment. It is clear to me, having glanced at some of the e-mails-I have not been able to read them-that a number of them came from people who will not only not lose but may well gain from the proposals that the Government made. I hope that the senders will reflect on that.
This is not the moment for the House to agree this amendment. If we want to agree amendments, I suggest that between now and Report both the Minister and the House might reflect on the desirability of some extra-affirmative procedure of the kind used in the Public Bodies Bill for affirmative resolutions-I hope that they will be affirmative-that will come forward as a result of all the consultation. That would be far more productive than trying to slow the whole thing down with another review.
I have other points to make but the hour is late and the House wants to get on, so I will conclude by saying that at the end of the day I speak only for myself when I say that this would certainly cause delay, and would almost certainly add to the cost of an already expensive government programme. There may be smaller issues later, including those espoused by my noble and learned friend Lord Mackay, on which I may take a different view; but this amendment is strategic, damaging and mistaken, and I hope that noble Lords in all quarters of the House will join me in opposing it if it is pressed to a Division.
In the context of this amendment and the ability of health and social services to carry out their statutory responsibilities under the Autism Act, will my noble friend agree to take a look the number of people who currently have DLA but are predicted to lose it? There is a read-across here, because small levels of support have been identified as having prevented people taking their place in society and gaining independent living.
As I mentioned previously, I am concerned that as regards those who will lose the allowance-some will and others who apply in the future will not get it-the measure is going to have an impact on the way in which we have required health and social services to implement the Autism Act. Does my noble friend agree that there will be some hardship for those who lose it and that we have to face up to that reality, and that the Government should have a clear and examined view of how they are going to square that with the new statutory responsibility?
My Lords, we support this amendment, moved so comprehensively by the noble Baroness, Lady Grey-Thompson, and spoken to so effectively by the noble Lord, Lord Low. I would say to the noble Lord, Lord Newton, that in doing so we are not motivated by a belief that this is all some dastardly plot, but a belief that we need to be assured that the system does not just need to be tweaked but that it is fit for purpose before this major change is introduced.
This amendment is aimed at helping the Government get right the process of transfer from DLA to the personal independence payment. It calls for an added layer of safeguards within the process of reform, with an independent review of the plans for operation of the assessments before they start and a trial period when the assessment process first comes into effect. Crucially, it calls for the full involvement of disabled people and their organisations in this process, ensuring that they have confidence that the assessment process for the new benefit will be fair. The need for safeguards in this area has been all too fully revealed with the experience of the employment and support allowance. The noble Lord, Lord Newton, told us that he was responsible for introducing DLA-which in Committee the noble Lord, Lord Low, called an "iconic" benefit-and he should be proud of that achievement. I have some responsibility for having introduced the employment and support allowance so I cannot claim any such accolade.
It is clear that the assessment process has not been working and has caused not only distress to too many disabled people but considerable headaches for the Government. We all know that 39 per cent of appeals have led to a decision about ESA being overturned in favour of the claimant, and the unreliability of the assessment procedure has also made it difficult for the Government accurately to budget for the cost of these reforms. The Office for Budget Responsibility's November economic and fiscal outlook states:
"ESA changes have resulted in an increase in expenditure of £1 billion by 2015-16", and the latest administrative data suggest that fewer people than previously assumed will be judged fit for work as a result of the initial ESA work capability assessment and the reassessment of incapacity benefit cases, and more will be placed in the support group. This accounts for around four-fifths of the increase. Other changes arise from a change in assumptions about the composition of the ESA caseload, which results in higher average benefit payments per person and higher inflows. The costs of getting this process wrong can therefore be high, and we know that the Government have benefited from the independent review of the ESA assessment process undertaken by Professor Harrington.
As other noble Lords have said, we received just yesterday the document providing further information about the second draft of the PIP assessment criteria, together with proposals on entitlement thresholds, impact modelling and case studies. While this technically fulfils the Minister's commitment that we should get it before the Report day, as we have previously noted, there has hardly been time for detailed study and analysis-although it is hard to miss the startling figure that some half a million disabled people will be excluded from the new benefit in comparison to existing DLA arrangements. Before causing this to happen, the Government should be called to account for the impact that this may have on the disabled people who are missing out.
The January document launches a 15-week formal consultation on the assessment criteria and this is welcomed as another opportunity for disabled people to input their views. However, this is no substitute for what this amendment calls for: that before these provisions are implemented, there is an independent review focused on implementation, with trial periods before the full rollout. There can be little doubt that proposals to abolish DLA for working-age claimants and substitute the personal independence payment have caused genuine consternation among disabled people. The representations we have received reflect that. What we have heard from our own colleagues, noble Lords in particular, who are powerful advocates for disabled people, in Committee and again today reinforces this.
We accept, as do many people, that DLA in its current form needs updating but the huge difference the benefit has made to the lives of millions requires the absolute maximum assurance to be provided before any replacement is implemented. That reassurance is made more difficult by the 20 per cent cut in the budget provision and in the context of some £18 billion of cuts from the coalition Government, which the IFS and others confirm are careless of the circumstances of the poor and disadvantaged. Whatever the Government's protestations, there is a strong belief that the changes are about securing cuts.
The Minister will argue that the proposed assessment process will be assessing different things in a different manner, but the parallels with the work capability assessment are clear. Most would accept the concept of the WCA, but implementation has been chaotic and the assessment process flawed. Improvements are under way but these were driven by the independent report of Professor Harrington. Indeed, it was the independent report of the noble Lord, Lord Low, which brought about the Government's change of heart, which we appreciate, on the mobility component and care homes.
The changes from DLA to PIP could cause a major upheaval in the lives of millions of people, many of them extremely vulnerable. We do not argue against change, but for a precautionary approach in introducing that change. This should include an independent report before the start of change, focused particularly on the assessment process, trials before general rollout and, above all, meaningful engagement with disabled people, because they deserve no less.
The noble Lord is an experienced hand and has made a very interesting speech, but it would help the House enormously if he could be tempted to give an assessment-if he was the Minister facing Amendment 50-of how long he thinks it would take to discharge the responsibilities contained in the amendment.
It is clear that the Government are going to have to do some of this anyway, but in terms of an overall time period it is clearly a matter of some months rather than weeks, but not a matter of years. It depends on the determination and effort that the Government bring to bear. They have the levers and the resources to cause this to happen quite quickly, I would suggest, but there has to be full engagement with disabled people for it to be meaningful. This does not mean endless delay in the introduction but it does mean a real level of reassurance before we embark upon this very significant change.
I will come to my conclusion first. Basically, we are doing a lot of trialling in this process and the way that this particular amendment is drawn would delay us very significantly. At the end of my speech, I will give the noble Lord the actual cost that we estimate the delays will represent.
I will spend a bit of time highlighting our approach to developing, testing and refining the assessment criteria that we already have. We have been developing those in collaboration with a group of independent experts, including disabled people and disability organisations. We had initial proposals on which we then carried out 16 weeks of consultation. We met 60 disability organisations; had 170 written responses; and carried out testing involving sample assessments of around 900 volunteers selected from current or recent DLA claimants. Both the testing and the consultation were very effective and allowed us to review, revise and improve the draft assessment criteria from that published in May. We provided a second draft in November in advance of discussing the PIP clauses in Grand Committee. Since publication, we sought the initial views of disabled people and the organisations that represent them in an informal way to listen to their thoughts. Yesterday, as promised, we published a further document detailing our initial thinking on entitlement thresholds for the rates and components of PIP. We have now commenced a formal consultation on the entire assessment criteria, including the weightings and entitlement thresholds which will last for 15 weeks.
That gives disabled people and disability representative groups the opportunity to tell us what they think the criteria will mean to them and their members and what amendments might be needed before we finalise the regulations. I can assure my noble friend Lord Newton that those regulations, which we will lay later this year, will be subject to the full affirmative procedure of both Houses. We are confident that we will be able to test the impact of these using the data we gathered during our earlier exercise. If for any reason this is insufficient, we will carry out additional testing to support our analysis. In response to a specific request from my noble friend Lady Browning, I will personally look at the impact of this on our autism obligations and I will make sure that that is done as a key part of this process.
There have been, and there remain, significant opportunities for involvement from disabled people and their organisations, and significant opportunities to influence our proposals to ensure we get them right. That, however, is not all. In terms of the delivery and operation of PIP, we intend to continue to develop a number of our operational processes in conjunction with disabled people and their representative groups through our implementation development group, which I talked about a little earlier this evening. This group has already played such an important role that it is our intention to retain its services after April 2013 in order to work with it to help evaluate the new delivery arrangements.
We have also created a number of customer research panels, made up of groups of disabled people who share similar characteristics, in order to understand, and gain an insight on, how the process impacts upon them. We will also test our operational processes in a model office environment, allowing us to see how they work without affecting individuals' benefit entitlement. The trouble with a formal trial, of course, is that it would change what people actually get even though we are trialling. Here, by doing it in a model office, we can do it in a way that does not actually affect what they receive, but we know exactly how it will work.
We want similar arrangements to be in place with regard to the processes of the eventual supplier of the assessments of the benefit. We will be making it clear to bidding organisations that we expect them to work with disability organisations on the design of their processes, to improve the customer experience. This will be before, during and post-implementation. This will be a clear requirement in the contracts.
As well as getting the whole development process right, I recognise the value in moving away from a big-bang approach to implementation which would see both new claims and reassessments beginning in April 2013. Since the Committee stage, a significant amount of work has been undertaken to investigate the options for ensuring a sensible implementation which allows us to learn from early experience. Therefore, I can inform the House that, in addition to the pre-implementation testing work that I have already mentioned, we will limit the number of new claims for personal independence payment to a few thousand per month for the first few months of implementation. This will allow us fully to trial all the processes in a truly live environment. We are still developing the details on how we can meet our claimant target over the first few months.
Once we are satisfied that the new processes are working as intended with this reduced number, we will allow all new claims for personal independence payment to enter into the process. We will continue monitoring and reviewing the processes to ensure they are working effectively and appropriately and to see how claimants are finding the experience. We will begin to reassess existing DLA claimants in a co-ordinated way six months after the initial implementation. Again, we will stagger this process. We expect the first stage of reassessment to start in the autumn of 2013, beginning with individuals on a DLA fixed award who will need to renew their claim and those claimants who report a change of circumstances on their existing DLA claims.
At the same time, we intend to conduct a pathfinder trial reassessing individuals who would not, in the ordinary course of events, come up for reassessment. We expect the pathfinder to run for around three months to ensure the processes for identifying and contacting people and taking them through the claim processes are working satisfactorily. Allowing a small number of existing DLA claimants to advance through the reassessment process ahead of full national implementation will enable us to be sure that our approach to engaging these customers into the claims process is working effectively ahead of widening the selection. Also very relevant here is the independent review and report on the assessment that we are legislating for in Clause 87.
During Committee, the noble Lord, Lord Rix, laid an amendment seeking to increase the number of independent reviews carried out. Noble Lords will remember that I promised to take this matter away and consider it further, and I have done that. Our revised proposal is that we legislate for two biennial independent reviews within the first four years of the implementation of PIP. The first would report within two years, beginning with the date on which the first assessment regulations come into force, and the second within four years of that date. Although it is only two reviews formally in legislation, we commit to undertake a third if the second review demonstrates ongoing issues with the operation of the assessment which need to be addressed in this manner. That is a firm commitment from me and my ministerial colleagues.
In reality, in the way that we are structuring this, we are trialling it in any real sense; we are doing it on a gradual basis. If we do it in this way, we will get the assessment and wider benefit processes right; we will involve disabled people and we will learn from the earlier delivery of the benefit. We do not think, therefore, that the formal trial proposal in this amendment is necessary. However, if we do it that way, the House should know that it would push back the implementation of the benefit. Our estimate is that the loss will be £1.4 billion of savings over the reassessment window. Clearly, that has to be found somewhere else. I know that noble Lords opposite think that is funny.
Could the noble Lord give us a bit more detail of that estimate? The figure of £1.4 billion seems to trip off the tongue as the cost of any amendment that we pursue.
That is an assessment based on the delays that we anticipate from this amendment, which is actually similar to the previous amendment where I used the same figure. It would have the same effect of delaying the whole process. That is the Government's position, having worked through the implications of the amendment.
I remind the House of where the Opposition have got to with their amendments. We estimate that as a result of the votes on amendments so far, over five years they have imposed £3.8 billion-worth of extra costs, and this amendment will take that figure to £5.2 billion.
I am sorry to see a Minister, whose integrity and respect for evidence has been apparent to the whole House, going back to the box-ticking, false assumption that there are no political choices available to this House. There are plenty of political choices if the Minister wishes to use them-for example, freezing council tax, increasing council tax bands, looking at some of the things that go on in pensions tax relief and so on. It is not clear to me that the economic growth of this country depends on taking away DLA from some of the most disabled people in the country.
My Lords, I do not want to debate where alternative cuts would be found by the Opposition if they were in government and needing to balance the budget. All I can tell you is that the effect of the amendments that the Opposition have supported comes to that figure. It is amazing how, given an amendment here and an amendment there, pretty soon you are talking serious billions. I am afraid that this is another amendment which involves a serious amount of money and, for that reason, it is not acceptable to the Government. I urge the noble Baroness to withdraw her amendment.
I thank the Minister for some of the reassurances that he has offered tonight. He has, once again, moved further than I expected, although it would have been wonderful to have heard some of it a little earlier. I thank the noble Lord, Lord Newton of Braintree, for his consistent honesty and for what he has done for DLA. Unfortunately, I am genuinely sorry that I do not agree with him tonight because we have to get this right.
The noble Lord, Lord Low, talked about confidence and, even with what the Minister has said today, there is such a lack of confidence among disabled people about where we are going with this that I am really concerned.
The Minister referred to costs, which are important, and huge financial sums are involved here. I would like to talk about cost-the social cost of what we are doing to the lives of disabled people. A number of disability organisations-I shall not go into how many-have contacted me and are telling me that we are not in the right place; disabled people are telling me that we are not in the right place; and my personal belief and conscience tells me that we are not in the right place. I wish to test the opinion of the House.