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My Lords, the Government have ambitious aspirations to halve the disability employment gap, to achieve parity of esteem for mental and physical health conditions, and to improve children’s life chances. My remarks will be particularly relevant to Clauses 1 and 13, and are intended to highlight some risks in the Bill and to propose some changes and different approaches.
Clause 1 obliges the Secretary of State to report on progress made towards full employment, but this full employment reporting obligation does not include a breakdown to show whether any progress is being made towards halving the disability employment gap. Such a breakdown would maintain focus on the Government’s welcome manifesto commitment. Does the Minister agree that the reporting duty in the Bill would be strengthened if it included progress towards their wished-for reduction in the disability gap?
The employment rate for people in all disability groups between July and September this year was 47.6%. The gap between unemployment for disabled people and the rest of the population has remained stagnant at 30% for a decade, although it seems to be beginning to grow. People with certain specific disabilities are further underrepresented in the workplace. For example, just 15% of adults with autism are in full-time paid employment.
I have an interest and expertise in learning disability. There are 1.5 million people with a learning disability in the UK. As my noble friend Lord Rix mentioned earlier, fewer than one in 10 adults with a learning disability is in work. Supporting people with a learning disability back to work requires specialist skills. A number of approaches are known to help people with learning disabilities into work. These include skills development; buddying schemes and mentoring; improved access to apprenticeship schemes, especially traineeships and supported internships; and breaking down the structural and societal barriers that prevent people with learning disabilities entering or returning to work. Dr Knight, a psychiatrist colleague and researcher who has helped me with this speech, recently saw three patients with a learning disability. Each of them wanted to work and had experience as a volunteer. None of them, however, has been able to progress to paid employment. The workplace is where efforts should be focused to get people with learning disabilities into work. A good example of that is the recent announcement by NHS England that NHS employers will become model employers of people with learning disabilities. I shall watch that with interest.
The Work and Pensions Committee report Welfare to Work highlighted the ineffectiveness of the current work programme in supporting disabled people into work. It called for a separate, specialist employment programme for disabled people. Scope has produced a range of proposals for what specialist employment support for disabled people could look like. Will the Minister commit to developing detailed plans on specialist employment support for disabled people? The Government have committed an additional £100 million to support people into work by the end of this Parliament, and I join my noble friend Lord Rix in hoping that the Minister will pledge a proportion of the money to getting people with learning disabilities into work.
Clauses 13 and 14 propose to cut the money that new claimants receive within the employment and support allowance work-related activity group, to encourage them to seek work. This group includes more than 490,000 disabled people, the largest group of them having serious mental illness, learning disabilities or autism. Being in this group means that they are not currently fit for work. This might be because of frequent and uncontrollable episodes of aggression or disinhibition; an inability to travel independently outside their home; an inability to learn anything beyond a simple task, such as setting an alarm clock, or an inability to cope with a minor planned change.
The Royal College of Psychiatrists has pointed out that only 8% of people with mental health problems have been helped into work, compared to 24% of those who do not have a health problem. Furthermore, a survey by Rethink found that 78% of respondents said that they would require more support from their GP, community health services or in-patient mental health services if their benefits were cut. A survey by the Disability Rights Coalition found that almost seven in 10 disabled people say that cuts to employment support allowance will cause their health to suffer. Between 2010 and 2013, just over 1 million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist, the work capability assessment.
Although reviews of the functioning of the work capability assessment have led to changes in the way that mental disability is assessed, the reviews have not looked at the mental health effects of such reassessments. Doctors and disability rights organisations continue to raise concerns that they have had an adverse effect on the mental health of claimants, but until now there has been no population-level study exploring the health effects of this policy. However, a new study by Dr Barr at Liverpool University was published online yesterday in the Journal of Epidemiology and Community Health. The researchers adjusted for factors known to influence mental ill-health and for baseline conditions. They looked for any association between the reassessments conducted and changes in local rates of suicide, self-reported mental health problems and anti-depressant prescribing rates, in 149 local authorities in England. The researchers found that for each additional 10,000 people who were reassessed there were an additional six suicides, 2,700 cases of reported mental health problems and 7,020 anti-depressant prescriptions, all in working-age adults, and this trend has continued after the economic recovery.
A report of this study in the Guardian today quoted a DWP spokesperson as saying that the researchers did not know how many of the suicides were by people who had had an assessment. This seems to me, however, to miss the point. It is, in the first place, a population-level study—a large epidemiological study. The whole system, however, puts additional mental stress on an already disabled and vulnerable group, and the anticipation of reassessments may be too much for some. The researchers concluded:
“This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits”.
These important new findings add weight to the demands from a number of disability charities that Clause 13 should be left out of the Bill altogether. Does the DWP intend to link benefit data to mental health data, including suicide, and how and when will such information be made public? I also agree with the noble Lord, Lord Layard, that being assigned to the ESA WRAG group should trigger referral to IAPT for psychological therapy.
The Bill in its current form has missed a number of opportunities. A focus on welfare rather than help to get back into work misses the opportunity to deliver on the commitment to halve the disability employment gap. There is a missed chance to design proper support to get the 250,000 people with mental health problems who are out of work back into employment. In his eloquent maiden speech the noble Lord, Lord Lansley, suggested that critics of legislative proposals should suggest alternative ways to achieve their goals. I suggest that specialist employment support for disabled people would be more cost-effective than the non-evidence-based so-called financial incentives proposed in this Bill.