Atos Healthcare

– in Westminster Hall at 11:00 am on 4th September 2012.

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Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy) 11:00 am, 4th September 2012

It is a pleasure to serve under your chairmanship, Mrs Riordan.

I am pleased that the Minister of State, Department for Work and Pensions (Chris Grayling) is here. I am not sure whether this will be his valedictory performance in that role, but I saw pictures of him going into Downing street earlier, and if he has been promoted to the post of Secretary of State for Justice, I would like to be the first to congratulate him. I remind him, however, that in that post he will be responsible for the tribunals service, which deals with appeals relating to the work capability assessment, so he will not completely escape responsibility for some issues that will be raised this morning.

I am conscious of the number of people present for this debate, which highlights the fact that although hon. Members may be consumed by events in and around Downing street today, many people outside are concerned about aspects of the work capability assessment and employment support allowance. I am sure that hon. Members will want to reflect those views and with that in mind, I shall endeavour to be brief. I shall take only a few interventions, in order to allow more Members to contribute.

There are three points on which we probably all agree: first, there are benefits in working. I have seen many of my constituents—although it is harder to do so now than it was a few years ago—return to work after long periods of unemployment. As well as any material benefits, the positive impact on their health and well-being is obvious. We should all encourage as many people as possible to work and get back into work if they have not worked for some time. Secondly, as most of us would acknowledge, helping and supporting those who have not worked for a long time can be difficult and time-consuming. It needs to be done sensitively, so that people feel helped and not as though they are being punished. Thirdly, although not everybody completely accepts this point, many feel that an assessment for those who rely on sickness and disability benefit is useful and appropriate. That was the envisaged purpose of ESA: to support those who can work into work, as well as those who sadly will never be able to work again.

Six months ago, I was fortunate enough to secure a debate on this issue. At that time, the Minister confidently predicted that the performance and situation would massively improve and some changes that had been made had not yet fed through. Six months later, I suggest to the Minister that the number of people present today indicates that very real concerns and problems remain, many of which are sure to be reflected during the debate.

In our previous debate, I focused on the experiences of constituents who had undergone the assessment. I told the story of a constituent trapped in the system who went through an assessment, a successful appeal, a reassessment, followed by another successful appeal and then another reassessment. For too many people, that remains the experience across the country. The Minister and whoever his successor will be need to look carefully at that issue and address it. I have spoken with many constituents who would love to go out to work, but it is not possible to do so because they suffer from a disability or a chronic condition, and I am sure that many Members in the Chamber will want to speak up for such people.

Photo of Jack Dromey Jack Dromey Shadow Minister (Housing)

I congratulate my hon. Friend on securing this debate on a vital public concern. He has spoken of his own constituents. In my constituency, Paul Turner, a manager and proud family man, contracted a serious heart disease. He was off work and although desperate to work, could not do so. However, he was told that he was fit for work and was denied benefit. As his wife says, he went into serious decline and died only weeks later. In the work capability assessment, his heart was not tested: does that not demonstrate how fundamentally flawed the assessment process and its conduct by Atos are? Does my hon. Friend not agree that it is absolutely wrong in a case such as that for the Minister to refuse to refer it to the serious case review, so that profound lessons can be learned? Never again should anyone be treated in the way that Mr Turner was.

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

My hon. Friend makes a powerful point. A number of cases could be cited that indicate the lack of comprehensiveness in the assessment process and the failure sometimes to incorporate other evidence to ensure that not as many people are wrongly assessed.

I want to concentrate on some contractual issues this morning, and I am sure that others, like my hon. Friend, will make comments about individual cases in order to illustrate those points. The work capability assessment must be tailored in the interests of both the individual and the taxpayer. Unfortunately, both are getting a raw deal from the current system. It is true that the work capability assessment was introduced under the previous Government, which is a point that Government Members frequently make, as I am sure that they will today. It is also the case, however, that in late 2010 the contract with Atos Healthcare was amended, extending it to 2015, beyond its original conclusion date of 2012. The work capability assessment was rolled out to millions of people on incapacity benefit under this Government, despite pilot projects in Aberdeen and Burnley highlighting serious concerns. The Minister said, during our previous debate—I paraphrase him slightly—that in his judgment, the Government should get on with that process and try to work on the basis of the expert reviews as they were going on, rather than fixing it in the first place.

Photo of Kevin Brennan Kevin Brennan Shadow Minister (Education)

My hon. Friend is right to point out that the work capability assessment has been around for some time. For many years, I have been helping my constituent, Mr Robert Shafer, who was the victim of a poor assessment. Is my hon. Friend as concerned as I am that the chief medical officer of Atos is now Professor Michael O’Donnell? He was previously employed as chief medical officer by the American insurance company, Unum, which was described by the insurance commissioner for California, John Garamendi, as an “outlaw company” that has operated in an unlawful fashion for many years, running claims denial factories. Is that the kind of person that the Government should allow to be in charge of a work capability assessment system?

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

My hon. Friend makes an important point about the organisation of the company contracted to undertake that work on behalf of the Department for Work and Pensions. I shall go on to make points relating to other legitimate concerns about Atos Healthcare that need to be addressed. In many respects, given that the cost of appeals has more than doubled in two years, from £25 million in 2009-10 to £60 million in 2011-12, the performance by Atos Healthcare has, in many ways, been extraordinarily poor.

Photo of Wayne David Wayne David Shadow Minister (Justice) (Political and Constitutional Reform)

On appeals, does the fact that nearly 40% of the people who are initially unsuccessful are then successful on appeal not demonstrate a fundamental flaw in the work capability assessment process?

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

The level of appeals and successful appeals indicates that, although no process is 100% accurate all the time, many decisions are wrong and need to be corrected through the tribunals service. No one should forget, however, that that process can take six to nine months because of the backlog of appeals. During that time, people suffer from severe anxiety and concern about their fate, so my hon. Friend makes an important point.

Photo of Joan Walley Joan Walley Chair, Environmental Audit Committee, Chair, Environmental Audit Committee

This issue affects us all, in all our constituencies. The whole test is deeply flawed. Does my hon. Friend agree that in the short term, we can advise our constituents that when they are undergoing the test, they can request that it is videoed, which would at least assist with further appeals? has just pointed out how much the appeals cost the taxpayer, so the Government are paying twice over for what is essentially a flawed capacity assessment.

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

I thank my hon. Friend for her intervention. I am not unaware of what Atos says to people who seek to video their assessment, because cases have been highlighted to me in which people have asked for their assessments to be recorded. In the previous debate, the Minister said that if anyone wanted to have their assessment recorded, they could have them recorded, but that has not been the case in many instances and people are refused permission to record the assessment themselves. I would be interested to hear the Minister’s response to that point.

Photo of Richard Burden Richard Burden Labour, Birmingham, Northfield

I am grateful to my hon. Friend for giving way again; he is very generous. He has hit on an important point about the interface between the appeal problems and Atos’s work. Is it not true that there is a weird revolving door now? People get an assessment, question it and wait ages for the appeal. They may or may not win the appeal, but by the time the appeal comes up, they have had another assessment and therefore they go through a revolving door of losing benefits. Something is fundamentally wrong and unfair.

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

My hon. Friend touches on a very important point. When I raised it with the Minister at recent DWP questions, he indicated that, finally, some of the information coming back from the tribunals service would go to DWP decision makers, so that they were better informed. I will make this point now, so that the Minister can, I hope, respond to it. That started to happen in July. I want to raise the issue of the status of those reports and what impact they will have on people being called for further assessments. In particular, some tribunals now have a section at the end of that information that suggests that that particular applicant should not be reassessed within 12 months or 24 months. Is that something that the DWP is taking into account and appreciating before it calls people back? I ask that because my hon. Friend Richard Burden is exactly right: there are many cases of people who have been caught in this process, which is no good for their health and no good for taxpayers, because we end up paying again and again over time.

Several hon. Members:

rose —

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

I will take one more intervention. I apologise to everyone else, but I want to leave time for other hon. Members to make contributions. I give way to my hon. Friend Pamela Nash.

Photo of Pamela Nash Pamela Nash Labour, Airdrie and Shotts

On the point about recording assessments, a constituent of mine was told recently that they could record the assessment, but only if they paid for a private, independent company to come in and do it. Obviously, someone who is living on benefits cannot afford that. I wrote to the Minister at the time about the issue. I wonder whether he can deal with the recording of assessments in his closing remarks.

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

I thank my hon. Friend for her intervention. She has made a point to which I hope the Minister will be able to respond.

I will attempt to move on. Back in February, I wrote to the National Audit Office to outline concerns about the contract between Atos Healthcare and the DWP. The correspondence centred on two issues: first, a lack of efficiency in the use of public funds, to which I have referred, and secondly, a lack of accountability inherent in the disbursement of those public funds. As the recent House of Commons Library note and many of the figures that I have received as answers to parliamentary questions over the past 18 months or so have confirmed, and as my hon. Friend Wayne David reflected, 41% of those found fit for work appeal the decision and 38% have their appeal upheld. For those who seek the advice and support of professional advocacy groups such as Citizens Advice, the appeal success rate is closer to 70%. Just last week, Kent’s largest citizens advice bureau indicated an appeal success rate of 95%.

The impact of what is happening is twofold. First, too many sick and disabled people are being found fit for work when they are not. They become entangled in a lengthy appeal process that, as I said, can occupy up to nine months of their time. In many cases, even when the appeal is successful, the individual is placed in the work-related activity group and then they have to begin the whole process anew.

Photo of Tom Greatrex Tom Greatrex Shadow Minister (Energy)

I will not, because I need to make progress. I apologise to my hon. Friend.

The second impact of the high appeal success rate is cost. The cost to the public purse from appeals relating to the WCA was £60 million in 2011-12. As I said, that figure has more than doubled since 2009-10. It is almost 50% of the total yearly value of the Government’s contract with Atos Healthcare to carry out the assessments in the first place. In effect, taxpayers are paying for the process not to work, and then to correct it. Given the unprecedented pressures on the public purse, it beggars belief that the Government are apparently content to sit back and do very little to rectify that situation.

In oral evidence to the Work and Pensions Committee in June 2011, the Minister claimed that if the migration of those on incapacity benefit to ESA was successful, it would save money. He said that the aim is not a

“savings measure—it is not a financially based exercise, although clearly if we succeed it will save money”.

The Minister appeared to accept that an indicator of success was saving money, so does he accept that the significant increase in costs associated with the number of decisions being appealed—and being successfully appealed—shows that, on that measure, the Government have failed?

One measure that I and many others have been questioning is the imposition of financial penalties on Atos Healthcare to compensate for poor performance. In February, in response to my written question on whether the Government had considered imposing such sanctions, the Minister appeared to absolve Atos of the blame for the number of decisions overturned on appeal by saying:

“it would not be appropriate to impose financial penalties on Atos to reflect the number of work capability assessments which are overturned on appeal.”—[Hansard, 22 February 2012; Vol. 540, c. 852W.]

I tried again in July by asking for a note of when penalties had been imposed and what their total value was, but that time, rather than absolving Atos of blame, he decided to protect the company’s commercial interests, replying with the frequent defence of “commercial sensitivity” as the reason for withholding that information. I find it difficult to understand how commercial sensitivity comes into play when we are talking about a single company that is paid from the public purse to carry out an exclusively public function on behalf of a Government Department. Transparency would help to ensure that there could be confidence in the system and to highlight where performance was not being properly managed. It is important that the Minister seeks to address that.

It was not until the NAO responded to me last month that some light was shed on the issue. It said:

“We do not consider that the current contractual targets are sufficiently challenging, and in our view this allows the contractor to deliver a significant number of assessments before financial penalties become due.”

It continued:

“Our review also concluded that the Department has not sought adequate financial redress for contractor underperformance.”

One of the most concerning revelations from the NAO was that in only 10% of the cases in which financial penalties could have been imposed did the Government do so. That is astonishing. Given that the Government and the Minister quite frequently comment on the importance of value for money for the taxpayer—in some respects, I agree with that—it beggars belief that when there are opportunities to put that into practice, the Government have done so in only one in 10 cases.

I quote:

“In these times of tight budgets, we need to make sure the money we do spend is better spent. If we don’t we are failing disabled people and their families.”

Those were the words of the Prime Minister in 2009 at a conference on autism. In that same speech, the then Leader of the Opposition cited a NAO report that examined value for taxpayer money in relation to autism. I am sure that, even given his elevation today, the irony is not lost on the Minister.

There are many questions that the Minister must answer to account for the failure properly to manage the contract with Atos Healthcare. Why did he impose financial penalties on only 10% of the occasions on which they could have been triggered? What was the total value of compensation clawed back from Atos Healthcare to reflect that poor performance, and what was that as a percentage of the cost to the public purse for the original contract and appeals? Does he agree with the NAO that current targets that trigger financial penalties are not sufficiently challenging? What are the key performance indicators that the NAO described as insufficiently challenging? That is a particularly important issue.

On a number of occasions, I have attempted to gain clarity on what is expected of Atos in relation to customer service, the number of assessments conducted, the number of people found fit for work, targets, statistical norms and many other issues. The Minister has refused to be fully transparent, releasing a very limited excerpt from the medical services agreement with Atos that relates only to waiting times. As I said, maximum transparency is important to enable people here to hold the Government properly to account, and to hold Atos Healthcare, through the Department for Work and Pensions, properly to account for the work that it is undertaking in a very important area.

The NAO was also scathing about the Government’s failure properly to monitor the performance of Atos. According to the NAO, there is

“Limited routine validation of information provided by Atos Healthcare”.

It went on to recommend that

“the Department develop processes to validate key performance information supplied by Atos Healthcare.”

Back in February, in the previous debate on the issue, the Minister stated, with a certain degree of confidence:

“On capacity issues, as we stand here today, the incapacity benefit reassessment is on time. New claims for ESA have fallen a bit behind, mostly because of the introduction of the personalised statement…We discovered in the first few weeks that it took health care professionals…longer to complete the statement than expected, so the number of completed assessments dropped. That has changed. They have caught up again, and we are chasing through to clear the backlog, as we are doing with the appeals backlog”.—[Hansard, 1 February 2012; Vol. 539, c. 292WH.]

Unfortunately, the evidence does not bear out that assessment.

The target waiting time from when the ESA50 form is issued to the claimant to when Atos Healthcare completes the work capability assessment and hands the case back to the DWP is 35 working days—seven actual weeks.

Between September 2009 and August 2010, the target was met with a clearance rate of 33 days, yet in the space of less than two years, not only has the target not been met by an astonishing margin, but the length of time sick and disabled people have to wait for their assessment has risen by 85% to 61 working days, or more than 12 full weeks.

More than 20,000 people are waiting more than 13 weeks for a work capability assessment. The reason the Minister gave was:

“Atos Healthcare’s ability to deliver a service within the AACT was also impacted by the service volumes for this period which were significantly above departmental forecasts; in addition Atos had recruitment demands/challenges. These issues…resulted in an increase in the AACT.”—[Hansard, 9 July 2012; Vol. 548, c. 51W.]

Atos Healthcare receives more than £110 million a year to deliver a contract, but is unable to meet its recruitment needs to deliver it properly. That, at best, is an example of the underperformance and the level of failure due to which the Government should ensure that financial penalties are brought against Atos Healthcare. Such contractual failure feeds directly into the experiences that I am sure we will hear about in the remainder of the debate. Many people across the country have found themselves waiting an excessive time for their assessment. They are under pressure and feel hounded, and they may well wait a significant period for the appeal to follow. A degree of the chaos in the system is caused by the Government’s decisions and the failure to hold Atos properly to account.

This is not the first time that recruitment challenges at Atos have been highlighted as reason for failure. In December 2011, the Minister advised that a key Harrington recommendation would not be implemented beyond the pilot stage due to capacity pressures at Atos. In less than a year, the Government have twice cited the failure of Atos to recruit enough staff as the reason why those undergoing the WCA are being short changed, which gives rise to a question: if the Government are content to blame Atos, why has the Minister spectacularly failed to do anything about it? Why, on the one hand, in his answer to written questions, does he lambast Atos when waiting times increase, and yet, on the other hand, sit on his hands when it comes to making the company pay financially for its underperformance?

In 2010, the average WCA customer journey was 36 working days. That rose to 44 working days in the first half of 2011, and increased still further to 53 working days in the second half of 2011. Unfortunately, 2012 brought more misery for ESA claimants, as between January and May, the average customer journey increased to 64 working days, or just under 13 weeks. The Minister inherited 36 working days and transformed it into 64—an increase of 78%. It might seem that I am talking about the dry detail of contractual issues, but we see the defects at the heart of the process—the failure of the management of the DWP and the failure of delivery at Atos—reflected in the experiences of many people we represent.

I want to say a few words about the award of the £400 million contract for the personal independence payment in many parts of the UK to Atos Healthcare.

A further criticism in the NAO review, which interestingly enough was dated the same day as the announcement of the PIP framework agreement, was about medical services contracting. The NAO stated specifically in relation to the PIP procurement process:

“Our review of existing arrangements concluded that the Department needed to make changes to secure effective leverage over future medical services contracts...we have recommended that the Department focus on reducing the barriers for new suppliers to making a sustainable entry to the medical services market, in particular addressing the current risk that a single incumbent supplier has significant cost advantage which makes delivery of a level playing field in the market more challenging”.

The NAO went on to lament the DWP’s

“dependence on a sole national supplier” that has

“limited opportunities for routine assessment of value for money, for exercising contractual leverage and for wider market development.”

Like many Members in the Chamber who represent constituencies within the areas for which Atos Healthcare will undertake the PIP assessment process, I received a letter from Atos confirming that it had been successful in securing the contract. It included the chilling phrase that it had won the contract on the basis of its record delivering assessments for the Government over a period of years. This is a serious point, because as the PIP process is established, it is vital that some of the problems encountered in the WCA are not simply repeated. There is concern that there is an increasing risk that that will be exactly the case, given the chosen contractor.

Contractual arrangements, performance measures, penalty clauses, and monitoring and delivery failures are technical, dry and dull matters, especially when contrasted with the sometimes heartbreaking and tragic cases that I have heard about, not only from my constituents, but from many of those who have contacted me prior to the debate. Many of those experiences are due to the flawed delivery of the WCA and the record of Atos Healthcare.

Whoever is the responsible DWP Minister tomorrow afternoon, we need a process that works in the interests of taxpayers, and of individual claimants and applicants. We need a process that is comprehensive enough to encompass complex conditions and that recognises that it is a waste of time and money to keep reassessing people with progressive and incurable conditions, while also recognising the fluctuating nature of many other conditions—that people have good days and bad days. We need a process that appreciates the very difficult challenges of assessing mental health needs and that takes account of expert medical evidence much more fully than the current process, particularly in some of the cases we have heard about. We need a process that does not make blanket assumptions about the time it takes to recover from very serious illnesses, such as cancer, nor imposes blanket conditions as a result. We need a process that helps people who can work and does not hound those who cannot.

Several hon. Members:

rose —

Photo of Linda Riordan Linda Riordan Labour, Halifax

Order. With the permission of the Chairman of Ways and Means, and due to the number of Members wishing to speak, I will limit speeches to three minutes. When you hear the bell, you have one minute left. I remind Members that interventions should be short and remind those in the Public Gallery that they should listen in silence and not interrupt the debate. I call Duncan Hames.

Photo of Duncan Hames Duncan Hames Liberal Democrat, Chippenham

Given the number of Members wishing to speak, I am happy to forego the opportunity. Thank you for calling me, Mrs Riordan, but I would prefer to listen to other speakers who are clearly keen to take part in the debate.

Photo of Mark Lazarowicz Mark Lazarowicz Labour, Edinburgh North and Leith 11:28 am, 4th September 2012

I will take the opportunity to speak, but for the reasons Duncan Hames gave—the number of Members who want to speak—I shall be brief. I congratulate my hon. Friend Tom Greatrex on securing the debate, but more importantly on the work that he has done over almost a year in highlighting the problems of Atos and the work capability assessment. Like many Members, I came to the debate today with a dossier of cases from my constituency of people who had suffered in the process, and not only that which involves Atos. Let us be clear, not only Atos is at issue, but how the system operates, how it is being put into effect and how Atos is asked to carry out its work. There are certainly major deficiencies in the organisation, but it is not only Atos with which we need to be concerned.

Given the time, I will make just a few points. Many applicants find the experience of going through the WCA process terrifying. There is plenty of evidence, especially in the cases of those with mental health issues, that the process does not take account of the particular circumstances of those who suffer from conditions that may vary from day to day, as my hon. Friend made clear. Inevitably, any process, under any system, will lead to stress and tension for many people, but what makes it worse is that the process is felt by many applicants to take away from their dignity as human beings. It does not lead to proper consideration of their personal circumstances and they believe, notwithstanding what the Government and the contracts say, that it is a method of keeping down the cost of benefits. I know that that is not in the policy or the contracts in any sense, but in a climate where there is a feeling that the Government are trying to drive down costs at any expense, it is inevitable that many of those who apply for benefit will feel that way. Those subjective feelings are borne out by the high rate of successful appeals.

The high rate of successful appeals, which hon. Members have pointed out, leads one to conclude that there must be people who do not appeal or even apply for benefit who would have been successful or been entitled had they done so. It is essential that the process is right first time. That is partly the responsibility of Atos; it is also the responsibility of Government. What must be ensured is that all available evidence is used at the earliest possible stage in the process. We are all familiar with cases in which the medical evidence from GPs and consultants is overwhelming and yet the applications are unsuccessful. It is only at appeal that such people receive the right decision. It is also important to reduce unnecessary reassessments, as there have been cases where it is overwhelmingly obvious that a reassessment should not be carried out. I would like to know what the Minister is doing about that.

I make this final comment to the Minister. He may be leaving his current post today, but I seriously hope that in his new role he will ensure that the backlog of appeals is dealt with speedily. That is important for individual applicants and for the system. Until that backlog is dealt with we will not get out of this vicious circle in which new applications are put in at the end of the appeal process and the whole process starts again. That should be a priority for the Minister to address in his new role.

Photo of Katy Clark Katy Clark Labour, North Ayrshire and Arran 11:31 am, 4th September 2012

I am delighted to have the opportunity to contribute to the debate, because many constituents have contacted me about this issue over the past few weeks. For a number of years many constituents have been in touch with my office with concerns about Atos. The publicity over recent weeks has meant that many people not directly connected with the process are now aware of the problems. I ask that the Minister listen not just to what is said today but to the concerns raised over a long period.

I congratulate my hon. Friend Tom Greatrex on securing the debate and on all his work on the issue. It is not just MPs who are expressing concern. All of those involved, whether in representing claimants—organisations such as Mind—or the professionals involved in the process, such as the PCS trade union or the British Medical Association, are expressing concerns and taking the view that the process is fundamentally flawed. I also ask the Minister to recognise the anger that Atos is sponsoring the Paralympics. Many feel that is an insult to the people going through this process.

A year or more ago, many of the constituents contacting my constituency office were doing so about new employment and support allowance claims. The problems seemed to come largely from the Atos medical assessments. As has been said, constituents who get in touch with their MPs are almost invariably successful, either at the initial reconsideration or the appeal stage. When constituents approach MPs with a credible claim, invariably that person is successful at appeal. However, there has been a change and the constituents now getting in touch are mostly those transferring from incapacity benefit and being put on the work-related activity scheme. That basically means they get only contributions-based benefit for one year rather than the permanent help they would get if they were put in the support group.

That is quite different from the previous situation. Apart from the financial implications of being means-tested after a year, it involves reassessments, attending interviews and the requirement to look for a job. Most of us are aware of many constituents in extremely difficult medical situations who are being caused a huge amount of stress. I ask the Minister to listen to what is said today and make serious changes to the current position.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights) 11:34 am, 4th September 2012

I congratulate Tom Greatrex on bringing this matter to the House. The issue affects us all as MPs. With benefits changing now and in the future, the impact on our constituents is greater than ever.

I want to focus on one thing, as I am conscious of the time. I will give an example of how the Atos system does not work when it comes to basic knowledge of the interaction between the applicant who is appealing against the decision to refuse incapacity benefit or ESA to those who are wheelchair-bound and have severe mobility problems. They are asked to attend the appeal on the third floor of a building in the centre of town. The first question the receptionist will ask is, “Can you leave this building on your own if there is a fire?” That is a very important question but the fact is they could not do so, so they have been asked to attend an appeal tribunal that cannot take place. They go home and join the back of the queue once again, having to wait perhaps another six or eight months. They are then asked to attend an appeal that takes place about 45 to 60 minutes away by car, through traffic, pain and other problems in order to get where they want to be.

There are clear problems in the basic knowledge of the scheme. Whenever an elected representative makes a complaint about that to the relevant bodies, whether Atos or the Minister responsible in Northern Ireland, they take it on board and seem to respond. That is great, because one thinks one has won the battle for the constituent and the system in future. However, it does not work that way. Guess what happens? Next time, someone else in a wheelchair with severe mobility difficulties encounters the same problem. I want to illustrate that with an example, because we have a system that has failed my constituents again and again.

There has to be a grassroots change in how the system works. That is what the hon. Member for Rutherglen and Hamilton West is saying and why we are all here today. There are many people who fall into the category. It is assumed that if someone is not able to walk they can sit and do a job. That is unfair for many people because the problems they have with their back or severe mobility problems they have means they cannot stand or sit on a regular basis. I am very conscious of these issues and want to raise them. I hope the Minister will give a positive response. We need change or accountability—either one or the other, or indeed both.

Photo of Anne Begg Anne Begg Chair, Work and Pensions Committee, Chair, Work and Pensions Committee 11:37 am, 4th September 2012

Congratulations to my hon. Friend Tom Greatrex on securing this important debate. This is my first time speaking after my extended absence and therefore a good subject.

Photo of Chris Grayling Chris Grayling The Minister of State, Department for Work and Pensions

On behalf of everybody in the room and in the House, I welcome the hon. Lady back to the House. We are delighted to see her in such good shape. We were sad to hear of the difficulties in the long period of recovery she has had to go through. She is very welcome back.

Photo of Anne Begg Anne Begg Chair, Work and Pensions Committee, Chair, Work and Pensions Committee

I thank the Minister for being gracious. He may not be quite so gracious by the time he has heard what I have to say. I do not think that the Government have grasped how disastrous the ESA assessment system is. It is not something that can be fixed by a few tweaks here and there; we tried that with the Harrington review. What we have heard today in the Chamber—and in the “Dispatches” and “Panorama” programmes filmed in June this year—suggests that not much has changed. The people complaining are not just the usual suspects, not just the radical crips, the workshy or those who want money without being assessed. They are ordinary people, most of whom worked hard all their lives until the sky fell in and they lost their job because of an illness or an acquired disability.

It is not enough for Government to say that the genuine claimant has nothing to fear. In too many cases, genuine claimants are not scoring any points in their initial assessment. There is something fundamentally wrong with the system and the contract that Atos is delivering. When the British Medical Association votes at its conference to say that the work capability assessment is not fit for purpose there is something wrong with the system. When GPs are reporting an increased workload, not just as a result of providing reports but as a result of treating patients whose condition has worsened as a result of their WCA experience, there is something wrong with the system.

When my constituent, who has lost his job because he has motor neurone disease, scores zero on his WCA and is found fully fit for work, there is something wrong with the system. When that same constituent appears in front of a tribunal and in less than five minutes is awarded 15 points, there is something wrong with the system. When people with rapidly progressive illnesses are not automatically put in the support group, there is something wrong with the system. When some people would rather do without the money to which they are absolutely entitled rather than submit to the stress of a WCA, there is something wrong with the system. When someone with a severe illness has to fight for a year through an appeal to get the correct benefit, only to be called in almost immediately for another assessment, there is something wrong with the system. When the recall and assessment happen the following year, and the following year, there is something wrong with the system. When people feel so persecuted, there is something wrong with the system. To top it all, they lose their contributory ESA after only a year if they are in the WRAG group.

When up to 40% of appeals are successful and there is no penalty for the company carrying out the assessments, there is something wrong with the contract. When so many appeals result in an award of ESA support group status when the original assessment was no points, there is something wrong with the contract. When there is no penalty for a high percentage of wrong decisions, there is something wrong with the contract. When there is no incentive for assessors to get the assessment correct first time, there is something wrong with the contract. It is time for the Government to act, because there is something fundamentally wrong with the whole system.

Photo of Jonathan Reynolds Jonathan Reynolds Labour, Stalybridge and Hyde 11:41 am, 4th September 2012

I am pleased to be called in this debate. I congratulate my hon. Friend Tom Greatrex on securing the debate and on giving a superb speech. I wish to add my voice to those concerned about the operation of the WCA by Atos, and to highlight specific concerns in relation to people with autism.

I accept that we have a problem in the UK with the number of people who are not in the labour market owing to illness or disability. I asked the Library for a comparative analysis of the levels across the EU. Although it is hard to make such an analysis given the differences in scope, eligibility and recording of information, the European labour force survey clearly shows that the UK has a much higher proportion of the population aged 20 to 64 outside the work force owing to illness or disability. It is 6.1% in the UK, against an average of 4.3% in the rest of the EU. I think we know why that is. From the Thatcher Government onwards, people were put on the incapacity benefit rolls to hide the true scale of unemployment. There are people who were dumped there in the 1980s who have been there ever since. That is why I do not have a problem with the principle of a medical assessment; otherwise the Government can too easily push people into inappropriate benefits to massage the unemployment figures. Equally, I do not have a problem with three classifications: fit for work; unfit for work; and the possibility of work, but not in the short term, because someone has been out of the labour market for so long.

My concerns and objections relate to the way in which the Government are allowing Atos to conduct the test. Like other colleagues, my observations are heavily based on the experiences of constituents who have come to see me. It is not sensible, prudent or fair to have a test in which 40% of appeals against decisions are successful. It is a waste of money and it causes unnecessary distress. The Government need to hold Atos to account for an assessment that is clearly not working as it should. Atos is not coping with the complexity of the cases that are seen, and it is clearly struggling to deal with people with complex conditions, particularly those with less visible symptoms. Some specific problems are particularly evident: the Royal National Institute of Blind People has reported that the descriptors against which blind and partially sighted people can score points are primarily those based on navigation and communication, with no account taken of other barriers that blind and partially sighted people might face in obtaining work.

I am one of the vice-chairs of the all-party group on autism, and I remind the House of my existing declaration of interest in relation to my son. For people with autism, such face-to-face assessment can often be extremely problematic. People with autism face problems with communication that other people would not see. They may misunderstand questions that are asked, find it hard to answer questions, and fail to pick up on inference and assumption. For example, when asked, “Can you travel to work on a bus?”, they may say yes, but not explain that they can use only one bus route, planned with the help of a support worker, provided that the bus is not late or a different colour from usual, or that no other factors have arisen.

In addition, the testing of some people is too frequent. I have a constituent with a degenerative disease who passed one assessment, but failed another one within a year. As his condition was degenerative, it was surely medically impossible that he had got better. It does not make sense. At the extreme end, I have heard accounts of people in the support group being tested again after as little as three months. The worry that that causes is exacerbated by the freak results that an assessment can produce. I have another constituent who was deemed fit for work despite having a broken back.

The Government need to listen to the feedback that is coming in across the country about the very real problems in the operation of the WCA. Crucially, they must begin to hold to account private companies with important Government contracts when they do not deliver for the taxpayer. The quality of life of thousands of people depends on getting this right, and it will soon be even more the case given that Atos has won the contract for the personal independence payment assessment. Let us not get into the usual party political rhetoric and stereotypes that tend to mark welfare debates. Let us focus on meaningful changes that will improve many people’s lives.

Photo of Nick de Bois Nick de Bois Conservative, Enfield North 11:45 am, 4th September 2012

I have a small contribution to make to the debate. All MPs watch closely and listen carefully to charities, as I do in my constituency. I meet charities regularly and I am always seeking to handle cases in which it appears that odd decisions have been made, and with which I am uncomfortable. I will always pursue such cases, like any good MP, if someone feels that the system is not working correctly.

I rose to speak today to make a point. In all my time and in all my dealings I have never lost sight of what is fundamentally driving the WCA. We are asking what people can do and encouraging and helping people who have been ignored by the system. We seek to find what they can do and not what they cannot do. Many people in this Chamber will agree with that premise.

However, I will turn specifically to the statistics. If we look only at the statistics, it is easy to get a distorted picture. It is recorded that for 55% of new claimants who have been found fit for work, that is a good thing. I accept that appeal levels appear somewhat high. When we hear that 40% of those who are found fit for work appeal, we have to remember that 38% of them have a decision overturned. To put that in perspective, of all the claimants, overall we are talking about 15% fit for work decisions being overturned. I am not saying that that is satisfactory or that that is a good thing. However, I am determined to make a point.

Photo of Anne Marie Morris Anne Marie Morris Conservative, Newton Abbot

Although it is a good idea to help people who can work, we need to look at providing a more flexible work opportunity. At the moment, there are permanent job opportunities, but there is nothing flexible such as working from home for those who have mental health problems, which would help to achieve what the Government want. To make the system work better and to save taxpayers’ money, the people who will never be able to work again—people who have very serious problems with blindness or mental health problems—ought to be in an exclusion category so that they do not get reviewed.

Photo of Nick de Bois Nick de Bois Conservative, Enfield North

My hon. Friend is absolutely right. My point—my argument—is that if we stick to the headline statistics, we start to get into a debate that dwells on statistics. If we are going to do that, I am keen that we dig down and analyse them correctly before we make sweeping judgments.

I am pleased that the Government, along with the specialists, the occupational therapists and Professor Harrington, have not sat back since coming to power, and have not failed to review the process. They have reviewed it twice, and Professor Harrington has been asked to review it a third time. That is right, but it should not detract from the overriding principle that Tom Greatrex highlighted. It is right that we should encourage and help people back to work where possible. After all, they were not assessed for a long time and it would be wrong to ignore them, because many have returned to work and will continue to do so. [ Interruption. ]

Photo of Linda Riordan Linda Riordan Labour, Halifax

Order. May I remind Members and those in the Gallery that other Members must be heard?

Photo of Alison Seabeck Alison Seabeck Shadow Minister (Defence) 11:49 am, 4th September 2012

I thank my hon. Friend Tom Greatrex for securing this debate, which has not come a moment too soon for many of my constituents. The principle that people should be supported into employment when they can work is the right principle. The problem is that the system is not achieving that. It is causing untold grief and serious concern to many vulnerable people. There are several issues. Will the Minister explain why there is still confusion between ESA and JSA? Cases have been brought to my attention of constituents being passed back and forth, with both the relevant Departments feeling that the benefit is not the right one. A constituent of mine was claiming JSA and was notified by her hospital that she had to have an operation on her wrist. She was told by the jobcentre adviser to claim ESA instead of JSA, because no one would employ her for five or six weeks. She was then refused ESA, because she scored no points, and was left in limbo, with no money. That is not acceptable.

That incident occurred over a relatively short period, but some of my constituents have had to wait up to 18 months for a tribunal decision. When they sought updates on progress one was told that no update was available, because there was no one in the area to hear her case. Consequently, other benefits to which people are entitled are not given to them. A constituent applied for cold weather payments and was told that because her position had not been resolved she could not claim them. She might have frozen to death in the meantime, during the bad weather, while a decision was reached.

There are many incidents of poor claim handling by Atos. I am sure that every hon. Member in the Chamber has dealt with tens of them. A constituent recently came off contribution-based ESA. He was assessed by an Atos nurse who advised him that he needed a wheelchair but at the same time assessed him with no points. Another constituent had a major cancer operation. The GP’s report said that she was

“currently in wheelchair, not fit for travel”,

but it took three goes to get a home visit for her. Eventually, she was given a wheelchair, received DLA and had home adaptations. Then Atos said it wanted to see her, and insisted she should come, with the threat that if she did not her money would be stopped. She had to cancel a hospital appointment to do so. That is not acceptable.

I ask the Minister whether independent assessments can be considered at the front of the process, not the back. That would, I am sure, save untold numbers of appeals in due course, as well as saving my constituents untold misery. They feel—particularly those with multiple issues, including mental health issues—that the medical advisers who are asked to assess them do not fully understand their cases. The Government should be ashamed of the slump in Atos’s performance that my hon. Friend the Member for Rutherglen and Hamilton West has highlighted. It has had an unacceptable impact on disabled people, particularly in my constituency.

Photo of Hywel Williams Hywel Williams Shadow PC Spokesperson (Education), Shadow PC Spokesperson (Work and Pensions), Shadow PC Spokesperson (Health), Shadow Spokesperson (Cabinet Office), Shadow PC Spokesperson (International Development) 11:52 am, 4th September 2012

I, too, congratulate Tom Greatrex on securing the debate, because there can hardly be an MP who has not had a constituency case involving Atos and the work capability assessment. The Members present in the Chamber are only a small sample of the people who have had to work with that system.

From my casework I find that the faults in the system fall into clear categories. First, as to the form of the assessment, there is insufficient information. It is a particular problem for decision makers, who are trying to take reasonable decisions without enough information. Information is also lost or disregarded. There are persistent complaints that Atos is working to targets to fail people, and about continual reassessments. Missed appointments are another issue. A couple of weeks ago, a constituent of mine stayed in all day, and the doctor did not turn up. I turned up, by the way, and wasted a couple of hours of my time. My constituent will not complain, because he is scared to do so. He does not want the attentions of the Atos doctor again, thank you very much.

As to the content of assessments, to give a snapshot of something we have already heard about, it is unsubtle—it consists of ticking boxes; and it does not work well with intermittent conditions. There are questions about the competence of Atos staff to assess mental illness, for example. In another constituency case, apparently the doctor involved was not allowed by the medical authorities to work with patients or perform any form of medical intervention, apart from undertaking Atos assessments.

There has, I concede, been some improvement since the Harrington review. However, it is interesting to consider the nature of the mistakes that the system produces. For example, I was told by my local citizens advice bureau that since April it has launched 62 appeals, of which it has won three and lost two; the rest are still pending. That is a common experience for MPs. Incidentally, as a Welsh MP, I have been told that appeals in Welsh are taking longer, and I would like some response on that issue.

Atos should be put into special measures. It should report frequently—monthly, perhaps—on the number and percentage of cases that lead to appeal and to a change in the decision, and also on the number and percentage of revolving-door appeals. Most importantly for the public debate, we should have some qualitative information about people’s experiences. I think that that would influence the public debate on disability and benefits in a positive way, given the current climate fostered by some newspapers and commentators, and by the Government’s policy.

Photo of John Martin McDonnell John Martin McDonnell Labour, Hayes and Harlington 11:55 am, 4th September 2012

Yesterday, I met constituents who have gone through the system. They call themselves victims of Atos, and I promised them that I would briefly set out the experience that they described. The assessment was exactly as others have said. Applicants are often met by an assessor with no expertise or specialist knowledge of their condition; it is a tick-box exercise—my constituents completely agree with the BMA about that. Despite the Harrington recommendations for improvements, the test bears no relationship to the real-world challenges that people with disabilities face. There is no recognition of fluctuating conditions, as has been said—particularly in connection with mental health. The procedure largely ignores the assessments and advice of applicants’ own GPs.


The tick-box exercise mentioned is caused by the LIMA software produced, it seems to disadvantage the disabled person and award them 0 points, when they should get 15 or more.
All of this assessment procedure is deliberately designed by UNUM to disadvantage and refuse claimants who deperately need the help.
A disgraceful indictment on the government and it's management of the 'Common Purpose' led DWP.

Submitted by Jane Birkby