Mental Health: Assessment — [Joan Ryan in the Chair]

– in Westminster Hall at 11:28 am on 22nd January 2019.

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[Joan Ryan in the Chair]

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities) 2:30 pm, 22nd January 2019

I beg to move,

That this House
has considered mental health and the benefits assessment process.

It is a pleasure to serve under your chairship, Ms Ryan. I thank the hundreds of people who wrote to me via the call for evidence on the House of Commons Facebook page, as well as the digital support team at Parliament.

Many of the stories shared by people from across the country were harrowing and difficult to read, simply because of how badly they felt they had been treated. I cannot do justice to the subject without reading out some of the words that they used. The main themes that came out of the online contributions were that the process seemed to be making mental health issues worse; that people did not think that the assessors were qualified; that the amount of money awarded was simply not enough to live on; that the process was inappropriate and poorly conceived; and that people were often declared ineligible despite having mental health diagnoses, as well as support and evidence from their doctor.

One woman specifically said that she thought the process was “confrontational, intimidating and unsupportive”, and that

“frankly it is outright cruelty and very distressing.”

Another said that it was “degrading, embarrassing and exhausting”. She said:

“My assessment left me in tears and feeling suicidal because I’d spent all week getting ready, and not a single questions was asked about my mental health.”

Another person said that they did not have enough to live on and were

“trying to have one meal every two days.”

They could not afford a new suit to go to a job interview and the money that they were receiving was only enough to pay the rent, the electricity and their phone bill.

Another person said that as someone who had suffered from suicidal ideation, they did not know why the assessors thought that asking them about that would somehow transform or change the experience. They said it was “barbaric, pointless and unnecessary.” Many people said that charities helped them the most, not the jobcentre or even the NHS. It was local charities, which in many cases were funded by the EU, that were able to give them the support they needed. That is just some of the feedback from the online contributions.

Photo of Gloria De Piero Gloria De Piero Shadow Minister (Justice)

A young man from Ashfield—it is relevant that he is young—had severe anxiety and his doctor wrote to support his case. On the day that he was supposed to have his face-to-face interview at his house, the assessor did not turn up. The young man was so anxious about it that he suffered a heart attack. Is this not a disgraceful and sick way of treating people who are in need?

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

Absolutely, and I am sorry to hear about that constituent’s experience. It is harrowing. The assessment process has a detrimental impact on the lives of people who are already vulnerable and already not in control of their circumstances in many regards. For them to be put through a harrowing process and feel that way is simply unacceptable.

Photo of Andrea Jenkyns Andrea Jenkyns Conservative, Morley and Outwood

Does the hon. Lady agree that the number of forms that people suffering with mental health conditions have to complete is a real problem? It can cause unnecessary stress during difficult times, especially when many of the forms are duplicated.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I could not agree more. During last week’s debate on fibromyalgia, she explained how the process and the application forms simply do not pay respect to mental health conditions. I champion her calls to the Government to change that process.

I urge the Minister to look through the comments, to get an idea of how the policies really impact people and to understand what they have gone through. Standing here and reading out the comments does them no justice; it is only by reading them that she will get an understanding of their point of view.

Photo of Laura Pidcock Laura Pidcock Shadow Minister (Business, Energy and Industrial Strategy) (Labour)

The hon. Lady’s stories are a perfect depiction of the fact that the process is not adequately designed to assess mental health and wellbeing. Instead, it is a functionality test that lacks understanding of the nuances and fluctuation of mental health. If anything, the process actually exacerbates mental illness, meaning that people drop out of the cruel system to avoid and end acute worry. Let us hope that the Minister will not try to individualise the problems by saying, “Come and see us about these cases,” and that she will acknowledge the systemic failure of the assessment process.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I completely agree. I know that the Minister is always receptive and keen to understand and learn more. I am not going to harp on and give her a hard time about this. I am simply trying to change a process that I think we all want to see improved.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I would like to make some progress first.

I am grateful to everyone who contacted me and took the time to comment, both on Facebook and through email, especially those who were brave enough to come forward and share their story. It is vital, given the needs of people with mental health issues, that the Government take time to listen to them.

Over the past few years there have been a great many public understanding and national awareness campaigns on mental health. Where mental health was once kept a secret from family, friends and colleagues, more and more people feel able to come forward and openly discuss their experiences of mental illness and get the necessary help. That recognition is largely due to the tireless work of national campaigns such as the Scottish Association for Mental Health, Mind and many others.

On 10 October last year, the Prime Minister held a reception to celebrate World Mental Health Day and to make a policy announcement, which included the creation of a Minister for suicide prevention. The Prime Minister said,

“we are not looking after our health if we are not looking after our mental health...we need that true parity between physical and mental health, not just in our health systems but elsewhere as well—in our classrooms, our workplaces, in our communities too.”

I agree with all of those points, but I would add that one of biggest and most positive changes would be parity of esteem between mental and physical health in Government Departments themselves. That would be the place to start.

The highest number of people who seek my support are those who have been denied access or assistance by the Department for Work and Pensions. A common theme of the complaints I hear is that the constituent’s mental health needs have been ignored during work capability assessments for universal credit, employment support allowance and the personal independence payment. Most of those people have a genuine claim and have been incorrectly assessed. That is because the majority of decisions brought to me are ultimately overturned at the mandatory reconsideration and appeals stage.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

I congratulate the hon. Lady on securing this important debate. On Friday night I met a number of people with mental health problems. Their issue is that the doctor says that they are not fit to work, but the benefits assessor says that they are, which leaves them in limbo. It is also a problem that employers do not always recognise mental illness. Does the hon. Lady agree that the Minister should do something about that?

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I thank the hon. Gentleman for his intervention and I am sorry that I did not take it earlier. Each and every day, our constituency offices deal with situations where there has been an issue with the Department for Work and Pensions. It is our staff who work day in, day out to get those decisions overturned. If we have to do that, and if decisions are being repeatedly overturned, there is obviously a flaw in the system.

Several hon. Members:

rose—

Photo of Paul Blomfield Paul Blomfield Shadow Minister (Exiting the European Union)

I thank the hon. Lady for giving way. Clearly, there is competition for interventions because this is such an important issue. On the question of process, a constituent of mine scored zero on an employment and support allowance assessment despite having numerous and well-documented physical and mental health problems. The decision was overturned on appeal. The appeal was a gruelling process to go through but the decision was readily overturned, because there was a basic factual error in the first stage. Does the hon. Lady agree that the process would be much more effective if claimants had the option of their assessments being recorded, as recommended by Paul Gray, the independent reviewer? Does she share my hope that the Minister will update us on the pilot announced last June and confirm that her Department will go ahead with the recording of interviews?

Photo of Ged Killen Ged Killen Labour/Co-operative, Rutherglen and Hamilton West

I congratulate the hon. Lady on securing this debate. She will have seen, as I have, the number of people who visit constituency surgeries after having had an initial assessment for a physical health problem but then ending up with a mental health issue as a result of how they were treated and having their support incorrectly withdrawn. Does she agree that that needs to be looked at very seriously?

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I wholeheartedly agree, and hat is the point of this debate. If the system worked well and we did not have any complaints about it, we would not be here today, but the fact is that the system is not working as it should, nor as it was probably intended to work in its initial design or concept. It is simply not working in practice. If we were to amend that system and make it work better, we would probably spend less time going through administrative appeals and mandatory reconsiderations, which should incentivise the Government to get it right the first time.

Returning to my earlier point, it is my staff who deal with constituents’ cases every day, and I would like to say thank you to each and every one of them. Rhona, Josh, David, John, Mary-Jane, Carmen and, of course, Georgia—I have quite a few staff and think I have covered them all—work hard every day to have those cases overturned, because they can see the constituent before them and can see that person who is crying out for help and needs support.

Perhaps the assessors are just not getting that full picture of someone, and perhaps we are being unfair to all the staff who work at DWP, but there is a flaw in the process, which I will turn to now. The assessments are carried out by contractors of Maximus and Atos according to guidelines set by the Department for Work and Pensions. I know there have been changes and adaptations, but ultimately they are still not working. Turning to the administrative process administered by DWP, those assessment reports are then filtered into descriptors set by the policies of this Government. I do not believe that the assessors are given the correct level of training or resources to deal with mental health issues. I have written to the Department about that on a number of occasions and I have been assured that assessors are getting adequate training, but if that is not the experience on the ground, there is obviously a flaw or an issue there.

I do not believe that the criteria for assessments give enough credence to the crippling effects that mental ill health can have on people’s lives. As Ged Killen has outlined, that turns into a detrimental effect on people’s mental health, even if it did not start out that way. Indeed, many of my constituents complained that their mental health problems do not fit neatly into the assessment forms because the form is not designed to assess disability resulting from mental ill health, a point that Andrea Jenkyns also covered.

One of my constituents from Hamilton, whose daughter has bipolar disorder and was denied personal independence payments, said,

“we see mental health brought up everywhere—in adverts, in TV soaps—and the advice is to speak out. But if you tell the DWP, they ignore you and do nothing to help, they have fallen behind the times and are not keeping up to the standard.”

In the assessment reports, indicators of mental ill health bear little relation to the advice of mental health charities and are at best unhelpful for diagnosis. The assessors will make wide-reaching assertions based on outdated ideas of mental health and often irrelevant judgments on the person’s appearance: “Was the person rocking in a chair? Were they trembling? Were they sweating? What was the person wearing? Had they washed or were they wearing make-up?” That is institutional stereotyping of people suffering from poor mental health. The fact that someone turned out that day and made the effort, even if it perhaps took them hours and days to prepare themselves for that experience, only to then have it marked against them, seems arbitrary and frankly ridiculous.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I am sympathetic to a number of the points the hon. Lady makes, although, for an experienced medical professional, one component of assessing somebody who is unwell is looking at how they appear, because that may be a symptom of distress, self-neglect or other issues, notwithstanding the points she has made. One of the challenges she raised is that of those patients with fluctuating conditions such as bipolar disorder, who can be well for periods and then become quite unwell. Does she agree that the system does not have adequate assessments in place to allow for patients who can become very rapidly unwell, and that those patients in particular can become distressed by the system and how it is put into practice by assessors?

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I agree with the second part of the hon. Gentleman’s intervention, but I return to my original point, which is that we are talking about a tick-box exercise that does not recognise the fluctuating nature of mental ill health—I think that is the point he is trying to make. Why should someone have the fact that they put make-up on that day, or made the effort to turn up and be there for the assessment, marked against them? It seems completely arbitrary and unnecessary.

The constituent I mentioned earlier has a nervous compulsion and, as a result, she picks at her nails. She has chosen to wear acrylic nails so that she will not unconsciously pick at her hands due to her nervous disposition. That was taken by the healthcare professional as an indicator that she was well kept and therefore mentally stable. It did not seem to matter that it was a form of self-harming and that she had had suicidal thoughts, which she outlined to the person. Those are Victorian and antiquated measures through which to identify someone with mental ill health, and they come up time and again. My constituent Donna from Carluke recently had a personal independence assessment. She acknowledged that she had two options: she could present as someone who had a mental illness and

“Present as they expect someone who has a mental illness to i.e and I quote here from your own assessment documentation ‘rock, shake, sweat, unkempt, poor eye contact and look unwell and troubled’”, or she could present as she was on the day,

“which was apparently none of the above.”

That does not negate the fact that she has a mental health condition; it simply does not tick the markers on that sheet. The DWP tick-box system does not seem to account for that at all, nor for people who live with long-term chronic health conditions that fluctuate between good days, bad days and unimaginable days.

Donna has faced an extremely difficult few years trying to cope with severe depression. She has outlined that on one day she can be great and on another she is simply not. I take the point that Dr Poulter made; I know it comes from a position of experience, and I greatly appreciate his expertise, but the fact is that Donna has been working in the mental health sector, so she has huge insight into her condition. She knew the only way she would get better would be by taking time and allowing herself to heal, which has taken longer than she had hoped, but now that she has returned to work, she has to fight to keep her personal independence payment, which has allowed her to stabilise her life.

I mentioned this case in a debate last week. Donna recently went back to work on very reduced hours, and through the personal independence payment, she was able to effectively self-manage her condition, meaning that she can lead a meaningful and purposeful life, return to work and provide for her family. Given the presence of her symptoms, that is only possible through the personal independence payment, which she is now being denied because the fact that she returned to work has been held against her. She exactly fits the purpose of those benefits and the criteria set out, but her claim was reassessed and, as a direct result of returning to work, she is no longer entitled to them.

It seems that all the valuable support Donna received over the last three years, combined with her self-determination, is now in jeopardy because, on the day of her PIP assessment, she was:

“well kempt, behaved normally, maintained eye contact and had good insight into my illness”.

Those are the assessor’s marks. They have decided against the criteria that she is no longer eligible for a personal independence payment, despite the fact that, as I am outlining, she relies on it and it has helped her to get back to work, which I believe is ultimately what the Government want. It is counter-intuitive. Healthcare professionals appear to be carrying out assessments without prior knowledge of how mental ill health works.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

My hon. Friend is making some extremely valid and excellent points, and I thank her for securing the debate. Does she agree that there is a real issue for people whose mental ill health, and perhaps some of the symptoms of it, such as paranoia or severe depression, mean that it is extremely difficult for them to even go to an assessment, because they feel the system might be against them, or they are just not well enough to get there? They are then penalised, and have their benefits taken away when they are very much in need of them, and have been very ill for a long time.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I could not agree more with my hon. Friend, and with the comments from Gloria De Piero about the individual who prepared themselves for an assessment, only for the assessor to not turn up. These assessments are really distressing, and they do not take into account the condition that the person being assessed has, or the impact that the assessment might have. Another of my constituents, Denise from Hamilton, was denied assistance for bipolar disorder because, as the report repeatedly stated, she is not manic all the time or on most days. How does one assessor even know that?

The idea of requiring assistance during periods of mania completely misses the point about the problems that Denise faces. The report ignores the depressive cycles that follow, and her struggles to find a measure of stability. That is a reckless approach, as she would be sent into a manic state if she were not supported, or if she tried to live the way many of us without a disability take for granted. Some of the things that have triggered a manic state in my constituent over the years would wash over most of us without her condition, but that is why the condition is extremely harrowing and distressing for those who have it. Simple things such as preparing for Christmas or a family wedding, stressful news events such as the Grenfell Tower incident, wider health issues such as the menopause, and changes to Denise’s medication for bipolar disorder are all things that have exacerbated her condition. Additionally, she has sometimes entered into mania for no apparent reason. In other words, the condition is out of her control.

I have heard many reports of assessors using very inappropriate language during assessments for people with mental health problems. Several people, including constituents I have mentioned, have told me that when discussing suicidal thoughts, they have been asked bluntly, “Why didn’t you kill yourself?” I do not know what that adds to the assessment, or what it does to a person to be asked that, but this point has been repeated by many of my constituents. When they have discussed suicidal ideation, they have been asked by the assessor, “Well, why didn’t you kill yourself?” I cannot say why they have been asked that.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I thank the hon. Lady for giving way; she is being very kind. In relation to getting a full picture of suicidality, there are sometimes protective factors that stop people wanting to take their own life. For example, they may have children. There may be other factors in their life that mean that they would not want to go through with the act of ending their life, even though they are having fleeting suicidal thoughts. It is relevant to a clinical examination or history of a person to work out what protective factors there may be, and why it was that, even though they were feeling very bad, very low, and having those thoughts, they did not want to follow them through. I just wanted to make that clinical point to the hon. Lady; it may be helpful for her constituents.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

That would be absolutely fine if the assessor had that level of medical qualification and experience. The point is that they do not. It is fine for a doctor to say that they would ask those questions, and of course any doctor reasonably would, but that is not how this has been delivered. It has not been asked by a trusted medical professional such as a doctor, psychologist, psychiatrist or other professional with the correct experience and understanding of how to handle the situation, the follow-up aftercare or anything that comes with it. The assessor is an individual sitting with a form; it is not the same experience, so I appreciate the hon. Gentleman’s point, but that is just not how it works in reality.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

The hon. Lady is making a very powerful speech. Are not DLA and its successor, PIP, meant to be about supporting disabled people with the extra costs that they face, which are about £560 a month? This system fails to recognise the real injustice that disabled people are experiencing, and unfortunately the Government are just not addressing that.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

I completely agree. The point is that mental illness is a disability—that is what we have argued in previous debates—and should be recognised as such and handled appropriately. I am grateful for the point made by the hon. Member for Central Suffolk and North Ipswich, but we are not having this debate because there is an issue with the healthcare system; I am arguing that there is an issue with the practitioners in the Department for Work and Pensions.

The question to which I have referred has been asked without any follow-up, without any understanding and without the qualification and experience to handle it appropriately. I just cannot understand how it is appropriate or why it is necessary for the assessor to ask that. The ultimate fact is that it can be devastating for people with suicidal depression to have to justify such a dark thought; it can shake the foundations of their wellbeing and make them question their worth. It is not uncommon to hear from people that their personal independence payment or work capability assessments have made them feel worthless. It is not uncommon to hear that from my constituents; indeed, it is all too regular. That is why I am raising this matter with the Minister.

Since 2011, assessors are meant to have had, as part of the assessment process, access to a mental function champion or mental health champion for support and training. I am not sure whether that is working in practice, which is why I urge the Minister to look at it. In not one of the cases that I have dealt with regarding mental health problems has a mental function champion been used. That prompts the question: if the training and capacity are there, why is that not being used by the local DWP jobcentre staff? Why is it not being used to assess people appropriately? Why are assessors not using the support that is available to them if it is in fact there, provided by the Department for Work and Pensions?

I have made challenges in a number of cases in which some support for the assessor on mental health issues would have been appropriate, yet such an intervention has never been used. I have had trouble trying to find concrete figures for how many mental function champions there are across the service and what their role is. I would be grateful if the Minister could enlighten us on exactly what the mental function champions are supposed to do, what role they are supposed to play in the assessments, and how their effectiveness is being measured, because ultimately I was unable to get relevant or accurate statistics from the Department outlining how well that function is being used. If it is there and not being used, it seems that assessors are doing a disservice to the individuals who come face to face with them every day.

When someone is found fit for work but in fact is not, they need to go through the arduous process of appeals. For people with a depressive or other mental illness, that process is extremely difficult and can exacerbate their symptoms. For some, the process is too daunting and they will simply go without the support that they need. I can only imagine the number, because we will not have accurate statistics for how many people go without as they are unwilling to go through that process. I do not believe that that is the right approach to mental illness—or to public expenditure; it would save the Government time and money if assessments were correct, and the correct benefits were awarded at the first stage, in the first instance. The fact that people are having to go through the appeals process and decisions are being overturned at the mandatory reconsideration stage tells us that there is something wrong with the system that could be fixed.

Not only is this a waste of resources for the Department for Work and Pensions and our courts system, but it depletes the mental resources of people who do not have the energy to spare to go through the process. I believe that, ultimately, discrimination against mentally ill people is built into the whole culture of this system. If people disagree with that, they can just ask the High Court. The Government were found in 2018 to have discriminated against mentally ill people in the High Court ruling on regulations that meant that people who were unable to travel for reasons of psychological distress were debarred from the enhanced rate of the mobility component of personal independence payment.

I do not even know where to start with that. If someone has identified under the previous, legacy system that they are unable to travel or have limitations, and then that is undermined in the new system, that seems counter-intuitive. There is surely a better way of operating. The transition from DLA to personal independence payment has been anything but smooth; in fact, there are still flaws and errors in the system. That is all that I am trying to get to here. I really want the system to work better for people, because ultimately I would rather not have to deal with individuals having this horrible experience every day. They should not have to come to me to get things improved; the system should just work better.

The regulation to which I referred was introduced in March 2017 without any stakeholder consultation. I urge the Minister to reconsider that. There are mental health charities and experts outside the House who would be able to provide the relevant and necessary information to the Minister, if she were willing to hear it. That civic engagement would get things correct for those who have used the service and had an adverse experience; it could only enhance and improve the experience.

The High Court ruling represents just a small part of the benefits system, but I think that it represents well the Government’s approach to people with mental health problems. The personal independence payment system, contrary to the Government rhetoric, was designed so that fewer people would be eligible for it than were for the legacy benefit of DLA. If the entire concept and design of a system is to get more people out of the system, it is not really doing what it was designed for, which was to help people. It just seems ridiculous that we are working to these arbitrary targets; that is the only way I can understand this. If we are trying to reduce the number of people on the benefit, even if there is no reduction in the number of people who need the support, ultimately we are just letting people fall through the net. That is a dereliction of our duty of care to the people we serve.

One quarter of people claiming DLA for mental health conditions do not qualify for PIP when reassessed, so they lose the support that they need.

Photo of Andrea Jenkyns Andrea Jenkyns Conservative, Morley and Outwood

I welcome a lot of the comments that the hon. Lady has made. I do feel that, as a society and as a Government, we still have a long way to go. However, does she acknowledge that mental health funding has reached record levels? We are talking about £12 billion of funding. Does she at least welcome the fact that the Government have now made big commitments to mental health funding?

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities)

On the one hand, I wholeheartedly agree that any additional funding for mental health will always be welcomed, because we are more aware of the condition and its lifelong effects, but ultimately why are we throwing money against the wall, when at the other end of the process people have to undergo a horrible and unnecessary experience? Join the dots: to improve the health service, improve the service in another Department that gives people the financial support they need. If improvements can be made through one Department, that should be done for another. I have spoken for longer than I intended, and a lot of other hon. Members want to speak, so I will press on.

The Government need to rethink their approach to the needs of people making benefit claims. They must be cognisant of the effect of mental health. Assessments must be more in line with best practice on mental health, so I ask the Minister to meet charities and organisations calling for reform of the benefits system.

I do not know how else to convey to the Government how much I just want to make the system better. I am not trying to make political points for the sake of it. There are flaws in the system, and I would like to improve it. I would like to give as many hon. Members a chance to speak as possible, so I end by quoting from the film “I, Daniel Blake”, because I think it captures this issue perfectly.

“I am not a client, a customer, nor a service user… I demand my rights. I demand you treat me with respect… I…am a citizen, nothing more, nothing less.”

In this day and age, and in this process, it is easy to refer to people as constituents, clients, service users or customers, but we forget that they are just people who ultimately rely on our support. Most people would not chose to rely on that support, especially under the arbitrary measures of the system, which are completely off-putting and attempt to reduce their reliance. People do not tend to want to rely on the state. Every day, my constituents are left feeling demoralised, degraded and ignored. These people elected us to represent them, and we must do more and do better, because at the moment it is simply not good enough. I want to do the best I can for my constituents, and I would not be doing that if I did not call on the Minister to improve this service.

Photo of Peter Grant Peter Grant Shadow SNP Spokesperson (Europe), Shadow SNP Spokesperson (Exiting the European Union) 3:02 pm, 22nd January 2019

I am grateful for the chance to contribute to this debate. I commend my hon. Friend Angela Crawley on securing this debate, on her excellent speech, and on the tireless work she is doing on behalf of her constituents and many others.

In my constituency office, we have the equivalent of a full-time employee doing nothing but fixing mistakes made by the DWP in assessments. I have no reason to believe it is any better in other constituencies. We could be talking about an army of people funded by the taxpayer just to sort out the mess created by a Government Department. During my three and a half years in this place, one significant area that has generated a lot of work has been the appalling treatment of constituents if they have assessments based on mental problems or a combination of physical disability and mental health problems.

In theory and in principle, I agree with what the Government claim to be trying to do through the benefits system. In practice, what they are really doing is completely wrong and I cannot support it at all. Having said that, I will not hear one word of criticism against the people who work in my local jobcentres, because they are fantastic. They do everything possible to help people, but they are trammelled by the regulations that they have to work under. They are clearly restricted as civil servants, in that sometimes they cannot say publicly what they appear to feel privately. The support they tried to give to every constituent we have contacted them about has been outstanding, so I want to place on record the fact that the people in our local jobcentres are doing a great job, but they cannot do the job they want to do, because the rules will not let them.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

The hon. Gentleman is addressing the nature and complexity of the changes. Many of us support the long-term objective. However, the number of times issues have been delayed and roll-outs have been put back, and the number of changes, amendments and adjustments all indicate a fundamental flaw at the heart of the concept. Does he agree that we need to address that, rather than tinker at the edges?

Photo of Peter Grant Peter Grant Shadow SNP Spokesperson (Europe), Shadow SNP Spokesperson (Exiting the European Union)

My view is that the fundamental flaw was built into the system from day one, when the entire review started from the bottom line of financial saving and everything else was built on top of that. A benefits system cannot be built on a price tag, especially a price tag significantly lower than the current cost of the benefits system. That will guarantee that a significant number of people will be left a lot worse off than they were. A system has never been invented that ensures that the tiny minority of people who play the system are called to account and those who need to benefit are protected. Far too often, the system hits the easy targets rather than the ones who should be stopped from abusing the system.

What are the assessments for people with mental health problems in the benefits system supposed to do? They are supposed to give additional support to anyone living with a disability that makes it dearer for them to have the basic essentials of life. They are supposed to provide financial support for people who cannot get into work and help those who will be able to get into work to get there. We must recognise that some people will never be able to carry out enough work to support themselves financially. For those facing that reality, the system is supposed to help.

Instead, our system makes the situation worse for somebody with mental health problems that prevent them from working. We are talking about things that on their own might not seem that severe, such as anxiety, which can be made worse if they keep getting knocked back or psychologically beaten about. These people struggle just to carry on the usual social contact that some of us take for granted and lack the simple social skills that are essential to survive in the workplace.

For people struggling with those problems due to mental illness, which can be exacerbated by the way they are being treated, the worst thing we can do is force them through a system that makes them feel even less worthwhile than before they went in, even worse about themselves and even more anxious about their next assessment.

We would not assess a blind person with a paper form and we would not assess a deaf person over the phone, unless there was somebody at the other end to interpret for them. Why should it be any different when assessing somebody whose difficulties are related to severe anxiety and the inability to cope with going out the door and taking a bus on their own? They are told to go to an address they have never heard of, in a place they have never been to, to find their way there by a bus that they do not know exists, by a time set by the assessors, and to pay their own way there. By the time they get there, if they are lucky, an assessor will carry out the interview, but if the assessor does not turn up, that is okay. However, if the claimant does not turn up, they get their benefit stopped. Then we wonder why people think the system is rigged against them.

The whole work capability assessment is lengthy and demeaning. It treats people as numbers—as statistics. Sometimes it treats people as problems, instead of as human beings who need the support of a caring and civilised society. For example, most of my constituents are quite surprised, if not astonished, when they discover that it is not routine for the DWP to ask for a report from their GP or community psychiatric nurse, if they have been getting support from a nurse. They will sometimes ask for it, if the claimant themselves insists on them asking for it, but why do they not do it routinely? Surely the person’s own GP and the health professionals—those with qualifications in psychology or psychiatry—who have worked with this person, sometimes for years, have something important to say about their ability to work now and the realistic prospects of them getting back into work in the future.

Tomorrow, it will be exactly a year since I asked an urgent question in the Chamber about changes to personal independence payment assessment criteria. That followed a Government defeat in a case in the High Court where, in essence, the court ruled that the assessment process the Government had put in place was illegal, because it discriminated between people with mental health problems and people with physical disabilities. On 23 November last year we received an update on that case: 140,000 cases had had to be reviewed and £4.5 million in benefits had been paid back to 1,000 people. I know that the succession of Ministers we have had in the DWP like to quote statistics about the percentage of people who like the result and the percentage of people who do not. In that case, 1,000 people were owed the money, which they needed just to have a decent standard of life. This Government had unlawfully withheld that money from them. We still do not know how many more people are due to get money back once the full review has been carried out. These are not the actions of a caring society.

Some of my constituents have turned up at assessments that were difficult and stressful to get to and found that the assessment had been cancelled. They had paid the cost of getting there, sometimes borrowing money to pay the bus fare, and the assessment was cancelled. At other times they have turned up and the paperwork had been lost or the person who had read the paperwork had phoned in sick. A different assessor had no idea who the person coming in to be assessed was. It is no wonder it creates the impression that, “The system really does not care about me. It does not see me as a human being. It sees me as a problem instead of as a human being with intrinsic value and the same rights to be treated properly as anyone else in our society.”

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

The hon. Gentleman is making a powerful speech. Is he as concerned as I am about the York University report that came out today, which states that people with mental health conditions are two and a half to three and a half times more likely to have their PIP claim reduced or stopped than people with physical health conditions? Does he share the view of the Royal College of Psychiatrists that if there is parity of esteem for mental health and physical health conditions in the health service, there should also be parity of esteem in social security?

Photo of Peter Grant Peter Grant Shadow SNP Spokesperson (Europe), Shadow SNP Spokesperson (Exiting the European Union)

I am grateful for the hon. Lady’s comments. I have not seen the report, but my impression has been that people with significant mental health problems do not always help themselves and act in their own best interest. As a society, we have not got a balance about how far we allow someone to be who they want to be and live their own life. At what point do we step in and say, “You are not doing yourself any favours”? I have met far too many people whose initial problem started with a letter saying they had to go for an assessment, but, because they were scared of an assessment, they did not go, and from then on the problems multiplied.

I had one recent case of a constituent whose behaviour admittedly sometimes was completely unacceptable. One of the ways that he responds to the fact that he cannot cope is by getting aggressive. In at least one instance, he caused damage in a DWP office. I cannot condone that, but it turned out that one of things he was annoyed about was the fact that his benefit had been substantially reduced. He did not think he had seen a letter telling him why it had been reduced, and we could not find anything, either. It turned out the DWP had decided that because he might react badly to being told that, it cut his benefit, but decided not to tell him what it had done. So that information was kept in a part of the system that assessors could see, but he could not. The assessor was supposed to try to help him get back into the workplace. The DWP thinks he is capable of doing some work, so it thinks he is capable of all the stresses and strains and upsets that go with going out to work in the morning, or in the afternoon, but he cannot be trusted with information about his own claim in case he reacts to it in the wrong way.

I do not think anybody here would like to sit down and design the perfect benefits system from scratch. I do not suggest that I have all the answers, and there will always be difficult judgments to be made. There will always be cases when someone has to decide, “Is this somebody who knows how to work the system and is chancing it, or is this somebody who really needs help?” I would much rather the system was biased a little more towards accepting that a tiny minority of people can play the system in order to make sure that nobody who needs the support of the system is left behind, but the experience of my constituents is that it is very much loaded in the opposite direction. In numerous cases that I have raised with various Secretaries of State for Work and Pensions—more than six since I was elected—after a few months, the answer has come back that the person has abandoned their appeal and is not going through with the latest stage in the process. Some in the DWP see it as a success every time someone does not carry through an appeal, because that means they have accepted the result. They do not think it means they have given up because they simply cannot win against a system that they feel, and sometimes I feel, is designed to stop people getting what they are entitled to get.

If we look at what has been happening since some of the benefits system was devolved to the Scottish Government, they were criticised for not moving quicker, but the first thing they did was to embark on a major consultation and engagement process not only with the usual suspects, but with people who had been through previous processes. They went out and actively looked for people who had either got successful claims or had lost out under the previous system to find out from them what they thought the system should be like.

The Scottish Government have given an assurance that any benefits assessments they are responsible for will not be carried out by private companies, so any suspicion that there is something in it for the private assessor who says no instead of yes is immediately taken out. The DWP will always say that that is not the case, but if a private company hopes to get the contract in a few years’ time, there will always be that suspicion, especially in the minds of those who do not get the result that they want.

We need to go back to the basics of what people are entitled to get either from the benefits system or from any other part of the state. The Scottish Government have said from day one that their system will be based on fairness, dignity and respect. Every one of our citizens deserves that, whether they are dealing with a benefits application to the DWP or in any other interaction with the Government. At the moment, far too many of my constituents do not feel they are being treated fairly. They do not feel they are being respected as human beings and they definitely do not feel that they come out of the process with the dignity that each and every one of us is entitled to. Until that changes, I cannot support the system. I want to see it fundamentally changed or scrapped altogether so that we go back and start again.

Photo of Joan Ryan Joan Ryan Labour, Enfield North

We have two more Back-Bench speeches. I intend to move to the Front Bench at 1530, so I suggest the two Members wishing to speak help each other and take about seven minutes each.

Photo of David Linden David Linden SNP Whip 3:16 pm, 22nd January 2019

It is a great pleasure to serve under your chairmanship, Ms Ryan. I warmly congratulate my hon. Friend Angela Crawley on securing the debate. It is also good to see the Minister in her place. She knows how much I respect and value the close working relationship that we have, particularly given my constituency caseload. I therefore hope that my remarks today, based on that constituency casework experience, are reflected upon in the Department for Work and Pensions and that action can be taken to build a social security system that is truly underpinned by respect, dignity and human rights.

At the weekend, and in anticipation of today’s debate, I asked constituents to share their thoughts with me. Indra from Tollcross said:

“I asked if they”— the assessor—

“knew anything about my genetic condition—they didn’t but said it didn’t matter. I asked if they had worked in mental health treatment and again was dismissed.”

Indra went on to say:

“I left feeling worse off, and totally demoralised instead of supported.”

I guess that brings me to the first concern that I have about the assessment process, which was something I highlighted during my own debate on work capability assessments back in December 2017. It is a source of great regret that we are back today discussing the same issue a year or so on.

There is a concern, which is echoed by the Rethink Mental Illness report, that staff who perform assessments have an incredibly poor understanding of mental health. To illustrate the point, during the December 2017 debate I told the House how my constituent was asked if her son still had autism. That was an absolutely shocking thing to learn. The fact that that is something we can hear from a constituent should send an alarm signal to us. We have also seen examples where assessments have been carried out by physiotherapists for those with a mental health condition. That is like asking a chef to do the work of a car mechanic.

The second issue relates to vulnerable constituents who might have anxiety. Too often we ask people who struggle with the most basic tasks to complete long, convoluted forms riddled with jargon and difficult questions, a point made eloquently by Andrea Jenkyns. Just yesterday morning, while meeting the manager of Easterhouse CAB, I heard the story of a man who had started filling out his universal credit application over Christmas but found it so overwhelming that he did not complete it. The mess that that has caused the citizens advice bureau, which is now having to clear it up, is considerable.

We also know from experience that constituents who perhaps fail at the initial assessment and submit their mandatory reconsideration are left for weeks on end, worrying about the outcome of the appeal. That is simply not helpful for people with poor mental health.

Photo of Hugh Gaffney Hugh Gaffney Labour, Coatbridge, Chryston and Bellshill

Does the hon. Gentleman feel, as I do, that some of those people are being tested and tried before being given their benefits? That brings on anxiety. Last week’s Demos report is important in reviewing the issue. People should not be tested to get some money.

Photo of David Linden David Linden SNP Whip

I agree. The hon. Gentleman will have seen that in his constituency caseload and in surgeries. I am sure that all Members see it in surgeries.

I want to mention fibromyalgia. I attended the recent debate on the subject, as did my hon. Friend Angela Crawley and Andrea Jenkyns. Fibro campaigners raise the legitimate concern that the DWP does not recognise the significance of mental health in fibromyalgia, which spans anxiety and depression. What work is under way in the Minister’s Department to explore what further training and support can be given in that area, including to work coaches?

There is much more to be done to ensure that the most vulnerable people can go about their lives in the knowledge that the process of assessing them for benefits will be underpinned by dignity, respect and human rights. The current system does not get that right, with the result that the British Government are failing the most vulnerable in society. I think we would all agree that we can and must do better.

Because of the respect I have for the Minister, I believe she is the Minister who can take the matter forward. We look to her for encouragement when she replies. There is strong cross-party consensus that we want to work together to protect our most vulnerable constituents. I look forward to supporting the Minister as she takes the matter forward.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 3:21 pm, 22nd January 2019

It is a pleasure to speak in the debate, and to follow those who set the scene. Angela Crawley made a significant contribution, as did my colleagues and friends left and right. We may not agree on the constitutional position of Northern Ireland or the United Kingdom, or Scotland and Wales, but we agree on the important issue we are debating.

The Minister attending this debate is one who responds. Her comments to me in the Chamber, and whenever we meet, are soft-spoken words, which are always taken in the light in which they are meant. I thank her for her help and the interest she shows in the issues I bring to her attention. My comments today are not meant to be aggressive or harsh, but they are factual. Before I go on with those comments, I want to say how much I appreciate the Minister’s compassion and her interest in a job that she does extremely well.

We set up this social state to enable those in genuine difficulty to live, and not simply survive in poorhouses and the like. We determined that it was fair to ask those who could to help others, through tax and national insurance contributions. That has set us apart from many countries. I believe we are here to help the ill and the most vulnerable in society. Those suffering from mental health issues are more in need of our help today than ever before. Peter Grant mentioned staff, and I have staff in my office who work on nothing but benefits—reviews, appeals, applications and advice. They work on those issues full time, to give the correct advice and assistance that it is our job to give as elected representatives. All my other staff are trained and, in fairness, the Government have set up training classes for our staff so that they can be versed in universal credit issues. I thank the Minister for that. We take advantage of it, and make sure our staff are trained.

In the UK, 20.3 million families receive a form of benefit, and 8.7 million of those are pensioners, which is about 30% of the population. For some families, the benefits they receive make up more than half their income. If an individual suffers with a mental health condition that has a long-term effect on their normal day-to-day life, it is considered a disability as defined under the Equality Act 2010. People with mental health conditions are less likely to receive any form of universal credit.

Between October 2013 and October 2016, 193,000 people with mental health conditions were reassessed, and of those 39% were awarded more money. However, 14% were given the same amount, 22% were awarded less money and 25% no longer received the benefits they once had. I say it very gently, but the benefits assessment process needs to be amended, as it is clearly not fitting for those who suffer with serious mental health problems that result in an inability to work. There was a debate in the Chamber on Thursday about mental health first aid in the workplace, with a good level of participation. In Northern Ireland, the legacy of the troubles is a considerably higher frequency of mental health problems than here on the mainland. The figures are extreme: 25% higher than on the mainland. That is the legacy of a 30-year terrorist campaign that affects not just those involved but the families—wives, daughters, sons, mums and dads.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

The hon. Gentleman is making an excellent speech. Will he join me in commending the excellent work of psychologists in Northern Ireland who hosted a successful international trauma conference last year that is putting Northern Ireland on the map as a leader in international expertise on trauma?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Lady for that intervention, and congratulate her on all she does, and on her interest in the issue.

Mental health issues have caused 300,000 people to lose their jobs because they cannot cope with the stress of their career. In Northern Ireland, one in five adults show signs of mental illnesses in their lifetime. We can see clearly that more funding needs to go towards helping those who cannot work because of mental health problems. People who cannot hold down a job owing to such problems must be treated with compassion and understanding. I have had several meetings with Capita. As the hon. Member for Glenrothes said, the staff are excellent and work hard. Frances, the manageress of the social security office in Newtownards, is extremely supportive and helpful, as are all the staff when anyone phones about an issue. However, that does not stop the problems that we are having. In my meeting with Capita, I outlined some cases where benefits were withdrawn, but in conjunction with its staff, we were able to overturn the decisions. I was glad that those constituents had come to see me and my staff, and that we could use medical evidence, supplied by doctors, to persuade Capita of the adverse effect on their mental health, wellbeing and, at times, physical safety. Things must change.

Photo of Paul Girvan Paul Girvan Shadow DUP Spokesperson (Education), Liberal Democrat Lords Spokesperson (Transport), Shadow DUP Spokesperson (Transport)

The point that my hon. Friend is making relates to the fact that some people are so depressed that they do not want to contact anyone who could help them. They fall through the gaps. When people are willing to go forward, we have a high success rate for overturning decisions on appeal, but unfortunately some of the neediest bury their heads in the sand, as they do not have the will or drive to go ahead, or the support behind them.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I agree wholeheartedly. What my hon. Friend described is the reason why we are charged, as elected representatives, with delivering our views, in debates such as this and in offices.

People suffering long-term mental health issues should be supported financially because of the challenges that they bring in their career. Those with severe and enduring mental illnesses are exposed to premature mortality of up to 15 to 20 years; the situation affects their health, wellbeing and the length of time they will be in this world. Those people need support. We should not assume their health will improve over time, as it will improve only with rest and coping mechanisms, and the ability to work in a place where there is understanding of the needs of people with mental health issues, and a preparedness to work with them. Such jobs are few and far between. The question is how to achieve that, which is why the debate has been brought forward today.

Changes are needed in society, and I do not think anyone in the House would deny that. However, they must begin with a recognition that mental health issues are not an excuse not to work. They are a tunnel of darkness. What my hon. Friend Paul Girvan and Dr Cameron said about this is very relevant, for each and every one of us here. We are here because we have a passion for our people and want to put that over in the debate.

That tunnel of darkness is brightened only by the light of love and compassion, and I believe that governmental dealings with those in need of help must change in a compassionate way. We ask the Minister to do that, first because we know that she appreciates, understands and has an interest in these issues, and also on behalf of our people, who beseech her to make those changes.

Several hon. Members:

rose—

Photo of Joan Ryan Joan Ryan Labour, Enfield North

Order. If Front-Bench speakers could limit themselves to nine minutes, that will allow Angela Crawley to wind-up the debate.

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment) 3:30 pm, 22nd January 2019

It is a pleasure to see you in the Chair, Ms Ryan, and I join others in paying tribute to the tour de force that we heard at the beginning of the debate from my hon. Friend Angela Crawley. She was right to start by mentioning staff members, because one of her staff members—Mary Jane Douglas—is also one of mine, and she contacted me to make sure that I mentioned her name. I also wish to mention other members of the casework team: Dominique Ucbas, Tony McCue, and my office manager, the great Roza Salih. They all deal with the benefits and assessment system and have delivered some success. Interestingly, when I interviewed recently for a caseworker, one of the successful candidates I mentioned today, and other candidates, explained how they had helped family members, and others acting on behalf of relatives, who were trying to navigate their way through the benefits process.

The UK Government’s tick-box exercises for disability assessment are woefully inadequate when it comes to mental health conditions. The Work and Pensions Committee, on which I sit, considered a report from last year that contained a damning indictment of the Government’s assessments for the personal independence payment and employment and support allowance. It highlighted that assessments can be emotionally draining for people, and that is doubly awful for those who have mental health conditions. Indeed, such conditions can sometimes be exacerbated by the process and the stress of undergoing an assessment, or by a feeling that the health professional making the assessment is not accurately recording the impact of a condition.

The Government’s follow-up on the report’s criticisms were described by the Committee as “regrettably slow”. One example of their attitude was the contempt that they showed towards people with psychological conditions who require additional support under PIP. As has been said, in 2016 the Government introduced regulations that specifically excluded people with psychological conditions from receiving higher points in their disability assessment for PIP, until the Department was defeated in the courts for what was described as “blatantly discriminatory” legislation. That shows that the Government have absolutely no regard for the impact of psychological conditions, and it completely flies in the face of the commitment made by the Prime Minister on the steps of No.10 to create parity between physical and mental health conditions. We urgently need a complete overhaul of the PIP and ESA assessment process, to ensure that individuals with mental health conditions are treated with respect and dignity.

A huge amount of evidence from both claimants and stakeholder groups suggests that the system of disability assessment is failing people with mental health conditions. The Committee pointed out that there was an “unprecedented response” from claimants to its inquiry into PIP and ESA assessments. Rethink Mental Illness has said that many assessors do not have the necessary expertise in mental health conditions to carry out assessments, and that is exacerbated by the fact that ESA and PIP assessments are not designed to take account of the full impact of someone’s condition on their day-to-day life.

Mencap is

“concerned that assessors often do not have a full understanding of learning disability as exemplified in the stories we hear from individuals and their families.”

Mind and the Scottish Association for Mental Health have said that they hear

“frequently from people with mental health problems who have been assessed by healthcare professionals who lack a basic understanding of mental health. Often in these cases the problem is not that assessors lack specific clinical knowledge, but that they do not have good understanding of what it’s like to have a mental health problem or do not ask sensitive questions about how someone’s mental health affects them.”

That point came across clearly in the inquiry. We asked the contractors Atos and Capita how many qualified doctors they had in their organisations to carry out assessments. Atos said that it had two, as did Capita, and they described the rest of their assessors as “occupational health practitioners”.

I remember specifically asking a senior figure from Atos—this became one of those videos that are widely shared within minutes on social media—who someone with multiple sclerosis and depression would see in their organisation, and I was advised that they would see an occupational health practitioner. When I asked that senior figure whether he understood why people are cynical about the process, he nodded his head.

One recommendation in the Committee’s report was for audio and visual recording, because around 80% of successful appeals are based on verbal information that was provided at the original assessment. Will the Minister update Members on that recommendation?

Photo of David Linden David Linden SNP Whip

My hon. Friend is spot on. Does he, like me, believe that this issue is such a problem partly because it has been contracted out to private companies that cut corners in all ways, meaning that our constituents get such a bad service? It comes down to the issue of privatisation; that is why the service is so poor.

Photo of Chris Stephens Chris Stephens Shadow SNP Spokesperson (Fair Work and Employment)

My hon. Friend makes an excellent point. My next question to the Minister is about acceptable reports. The contractors have never hit Government targets for acceptable reports. If any other contractor were to conduct its business in such a way and failed to meet Government targets, it would no longer have its contract. How are the contractors now performing with regards to acceptable reports?

Will the Minister explain the mandatory reconsideration process, and confirm the rule that eight out of 10 mandatory reconsiderations—80% of them—should result in failure? That instruction was given to staff. I think the Government said it was guidance, but some of us believe it was an instruction. Will the Minister say whether it has been rescinded, so that mandatory reconsiderations can be dealt with in a fairer way? Will she provide statistics on the number of successful appeals made by those with mental health conditions? I recently wrote to her about people who are blind or have a visual impairment, as that issue has had some press scrutiny in Scotland, but can she provide similar figures for individuals with mental health conditions?

The removal of implied consent under universal credit will have a particularly detrimental impact on those with psychological disorders or learning difficulties. Under the legacy system, implied consent allowed family members, support services and benefits advisers easily to represent claimants when making claims to the DWP. That seems to be changing under universal credit, because a claimant now has to give explicit consent for such representation. For claimants who are severely sick or disabled, and especially those with mental health conditions or learning difficulties, the ability to rely on implied consent was important. The stress and pressure of having to interact with the benefits system and provide explicit consent is a real concern, as it may force claimants to jump through new hoops to get support in making their claim or resolving any problems with it.

I will conclude with the Scottish Government’s approach to the social security system. The Scottish Government will have some devolved power over the PIP process, and they are building the necessary infrastructure to deliver that. Disability benefit assessments will be carried out not by the private sector, but by Scotland’s public sector healthcare professionals. The approach taken by the Scottish Government will mean that the system is evidence-based and uses healthcare professionals, and that important step has been welcomed by many third-sector organisations in Scotland. It is vital to put the needs of the individual at the centre of the social security system by providing choice, flexibility and control. I thank you, Ms Ryan, and I look forward to the Minister’s response.

Photo of Marsha de Cordova Marsha de Cordova Shadow Minister (Work and Pensions) (Disabled People) 3:39 pm, 22nd January 2019

It is a pleasure to serve under your chairmanship, Ms Ryan.

I start by congratulating Angela Crawley on securing this debate and on making a truly powerful speech, in which she shared some of the evidence that she has received as a result of the call she put out for accounts of people’s harrowing experiences of their mental distress and of accessing the social security system. She highlighted that it was actually down to a number of voluntary sector organisations—charities and other bodies—to help those individuals through the claim process, and many of those organisations rely on funding they receive from the European Union.

The hon. Lady said that what is lacking in the whole process is adequate training of the healthcare professionals involved. It is vital that they be trained adequately. We know that there are meant to be mental distress champions, but ultimately their influence is not being felt by those going through the assessment.

Many Members, in speeches or interventions, spoke about the appeals process. It is recognised that there is concern about it, as there is such a high success rate for appeals, which I will come to later.

The hon. Lady absolutely hit the nail on the head when she talked about the change from the disability living allowance to the personal independent payment, and the impact that change has had on so many claimants. My hon. Friend Debbie Abrahams highlighted in an intervention the report published today by York University, which shows that people with psychological conditions were 2.4 times more likely than claimants without such a condition to have their DLA award stopped when they were being assessed for PIP, so there is clearly a problem. Many people assume that the policy intention behind PIP was to reduce the number of people in receipt of such support. There should be parity of esteem for those with physical conditions and those with mental health conditions, because PIP is there to contribute towards the extra costs of living with such an illness or condition.

We know that disabled people, particularly those who experience mental distress, have been let down by the assessment framework. Many people would say that the framework is innately flawed. As of May 2017, half of those claiming ESA and a third of those claiming PIP were described as having “mental or behavioural disorders”.

The Department for Work and Pensions has spent more than £1 billion on outsourcing the assessments for these benefits to providers such as Capita and Atos. However, those providers are falling woefully short of the DWP’s own performance standards. More than half of the assessment reports by Capita have been graded as unacceptable, so we know that there are clear problems with the way that the assessment framework is being used by these providers, which has obviously had a great impact on those experiencing mental distress.

Many Members have today shared—as Members have done constantly throughout their time in Parliament—the heart-wrenching accounts of constituents whose assessment left them in deep despair and distress. If anyone has not heard such accounts, they should think back to February last year, when the Work and Pensions Committee received an unprecedented amount of evidence from individuals sharing their experiences of the PIP and ESA assessment and framework, and of the distress that they caused them.

There have even been reports of people who have admitted being suicidal being asked why they had not killed themselves yet. Like the hon. Member for Lanark and Hamilton, I do not know how an assessor could ask somebody that. I would like to think that the Minister will ensure that that does not happen again; it really should not.

There have been reports of assessors overlooking someone’s mental distress, and asking inappropriate and offensive questions. I will give just one example. An individual diagnosed with borderline personality disorder, depression and anxiety lost his job and had a mental-health breakdown, so he applied for PIP twice, but was turned down twice. Obviously, the process began with his filling out the claim form, collecting all the medical evidence requested of him, and finally having to endure the humiliating face-to-face assessment. The process of trying to claim PIP caused that individual—David—great anxiety. He spiralled out of control into self-harm, and eventually overdosed on drugs.

No assessment for essential social security support should lead to anyone spiralling toward self-harm. The Minister will agree that we have to consider whether it is right for the burden of providing medical evidence to fall on the claimant. Will she commit to removing the burden of collecting medical evidence from the person claiming PIP and ESA?

When David went to a tribunal, he was awarded PIP, based on the same evidence that the DWP had previously deemed insufficient. However, we know that David’s story is not a one-off; it is all too common. Since 2013, 71% of PIP decisions have been overturned on appeal, which is a clear indication that there is inaccuracy and poor decision-making in the assessment process. Denying more than 100,000 disabled people PIP will obviously have a negative impact on whether people can go on and live independently. The DWP spent over £100 million in administering reviews and appeals between 2016 and 2018. Much of the evidence would have been “inadmissible” in a normal court of law; that was said by a senior judge.

The Minister must consider all recommendations, particularly those of the Social Security Advisory Committee around mandatory reconsiderations, decision making, and ensuring that assessments are recorded. The High Court last year ruled that the negative changes regarding those who experience psychological distress were unlawfully discriminatory. Obviously, that has led to the review of 1.6 million PIP awards.

When does the Minister anticipate that the reviews of the system will be completed, and has a timetable for them been published, so we can see that they are completed? It will be important to know that all those people have got their back payment in a timely fashion.

The DWP is undergoing seven reviews of disabled people who are wrongly being deprived of social security. Five of those reviews are of flawed PIP and ESA assessments. So it is really important that the DWP gets this right. The failings of the assessment framework go way beyond discrimination; they contribute to, or even cause, individuals’ mental distress. In the words of one person,

“Going through the WCA process is the biggest source of worry in my life”.

That is how we are treating some of our most vulnerable people in society.

Labour recognises that there needs to be a radical overhaul of the assessment framework. It was labelled “superficial” and “dismissive” by the UN special rapporteur on extreme poverty. It should be replaced by a holistic, personalised and tailored single assessment, which would treat all disabled people, whether they have a physical or mental health condition, with the dignity and respect that they so desperately deserve.

Photo of Sarah Newton Sarah Newton The Minister of State, Department for Work and Pensions 3:48 pm, 22nd January 2019

It is a pleasure to serve under your chairmanship, Ms Ryan.

I begin by my adding my praise to that of other Members for Angela Crawley, both for securing this debate and for the way in which she addressed the House. She and others are absolutely right: I am utterly determined to make sure that we improve the system by which we assess people for employment and support allowance, the personal independence payment and of course universal credit. I am just as ambitious as everybody else in the room to ensure that we treat everyone in society with respect and dignity, and really promote their human rights.

On independent assessments, people who go on this journey—I do not want to call them claimants or customers; that was a good point well made by the hon. Lady—through the system give the approach that we have taken to both ESA and PIP a satisfaction rating in the high 80s. That is the vast majority of people applying for these benefits. This is not something we measure internally; it is properly independent research that we publish and is open to scrutiny. One poor experience is one too many. We are utterly determined to improve the experience at every stage of the journey, and really put the person at the centre.

PIP was introduced to ensure that mental and physical health conditions have parity of esteem. Many more people are benefiting from it than ever did from disability living allowance, and are getting the higher rates of support, for both their daily living and their mobility. Broadly, therefore, it is working, but as we have heard, there are some absolutely horrendous and terrible cases of unacceptable behaviour, where things are going wrong. I thank all hon. Members who have come along today. It is clear that everyone here wants to do the best they can for their people and to work with me to absolutely get this right, and I welcome that.

I want to answer questions, but I have been given very little time to respond; that is the nature of these debates. As always, I will write to hon. Members on any questions that I do not have time to address. I start with the invaluable work of the Work and Pensions Committee. It is great to have one of its members here speaking up for that. The Committee gathered a huge amount of evidence, and I looked through all the research findings and the Committee’s recommendations thoroughly. We have agreed to implement all those recommendations, and we are carefully working our way through every single one of them. I want to reassure hon. Members that I work very closely with SSAC. It is an invaluable body. Everyone in the Department always thoroughly considers its reports and recommendations, and whenever possible we seek to implement them.

A few hon. Members mentioned video recording, which, when I came from the Home Office to take up this position, I thought was a really good idea. One of the fundamental problems we face with people claiming benefits is a lack of trust. Unfortunately, too many people are worried. We have today heard eloquent contributions about people being really worried about having to go through the process. In spite of the fact that most people have a really good experience, most of them are worried before they enter the process. I obviously want to eliminate that, as does everyone in the Department.

I want people to fill in the forms confidently, and pick up the phone or go into their jobcentre thinking, “There will be compassionate people who will help me”. That is what we are all striving to achieve. I believe that video recording the assessments will play an incredibly important role in regaining people’s trust in the whole process. Hon. Members will know that audio recordings are already available, but they are not done with the most up-to-date equipment. It can be a clunky and difficult experience, and I want to make it as easy as possible.

Throughout the summer we did a lot of work both with people who are claiming benefits and with healthcare professionals. All assessments are undertaken by fully qualified healthcare professionals. They are mostly nurses, but they all have experience and they have additional training in how to undertake the functional assessments. They are highly motivated and trained individuals, and it was important to consider how they felt about the video recording, just as much as how people coming in to be assessed felt about it. Having taken all that into consideration, we have started a pilot, which is going well. It is voluntary, because we wanted to ensure that people felt really confident about having their assessments videoed.

The strength of the pilot will be that lots of people take up the opportunity. There is no point coming up with a videoing possibility if people are not prepared to say, “Yes, I would like my assessment to be videoed”. We have been working carefully on the pilot and will review the findings to see how and when we can roll the initiative out. There is an absolute determination and commitment to doing that, because it will build the trust and confidence in the system that we want.

We also been looking at every single stage of the process. I really want to assure hon. Members that I regularly meet our stakeholders—the large charities and disability rights organisations. We have a PIP forum and a stakeholder team working with us on improvements to the work capability assessment, and disabled people are really getting alongside us and working with us on improving the process. I have already commissioned an independent review of the PIP application process. We have been looking carefully and in detail at every single part of the claimant journey—the person’s journey—through the system to see what more we can do, right through to how we can improve our mandatory reconsideration process. At the same time, as I said, we have been implementing the very helpful findings of the Work and Pensions Committee.

Going back to comments about what happens in the assessment, we will make a decision based just on the application, without sending someone to a face-to-face assessment, if we can gather enough information from the person applying for the benefit, and if they provide information from healthcare professionals, whether they be consultants, GPs or community mental health nurses. We will use that information whenever possible. A lot of our work over the summer was engaging with healthcare professionals to try to understand the barriers to their providing us with information. Relatively small numbers of people go to appeal, and relatively small numbers have decisions overturned. Most often, decisions are overturned because more information has become available by the time of the appeal. I am determined to see what we can do to have the information provided up front by healthcare professionals, so that we can make more paper-based assessments, without the need for face-to-face ones.

Hon. Members will know that we have introduced a set of new criteria called the severe conditions criteria, for employment and support allowance and now for PIP. If people have severe mental or physical health conditions that, sadly, are not going to improve, we put them into a category where they do not have to be reassessed, apart from a very light-touch reassessment after 10 years, just to ensure that their circumstances have not changed. That means that fewer people will be reassessed, and I hope that everyone here can commend that.

On some of the other observations on face-to-face assessments, we have had quite a discussion about the mental health questions. The questions that the assessors use and the training they receive is all approved by the National Institute for Health and Care Excellence. I think hon. Members were referring to the mental state examination questions. As my hon. Friend Dr Poulter, who has left the room and is a doctor, said, this is the best practice of the medical profession. It is really important that the Department takes its duty of care very seriously—and we do. Right through from our job coaches in the Jobcentres Plus to people in our telephony services, we have a really good process to ensure that anyone expressing suicidal thoughts is supported. For example, everyone in our jobcentres is going through mental health training to ensure that they feel able to chat to someone with suicidal ideation and keep them safe and in front of them while their colleagues secure additional support from the NHS. We take that extremely seriously and are led by the best evidence—

Photo of Sarah Newton Sarah Newton The Minister of State, Department for Work and Pensions

I have so few minutes and so many questions to answer.

I want to reassure hon. Members that our work in this area is led by the best possible clinical input. The deputy chief medical officer, Professor Doctor Gina Radford, oversees all this work, because keeping people safe is just as important as treating everyone with respect and dignity and ensuring that their human rights are upheld.

I will conclude, so that I can give the hon. Member for Lanark and Hamilton East a few moments to wind up. I am absolutely determined to carry on our work on fibromyalgia and on all the issues she has mentioned. I have invited people into the Department for weekly meetings, so that together we can make the changes we want to see.

Photo of Angela Crawley Angela Crawley Shadow SNP Spokesperson (Disabilities), Shadow SNP Spokesperson (Pensions), Shadow SNP Spokesperson (Youth affairs), Shadow SNP Spokesperson (Children and Families), Shadow SNP Spokesperson (Equalities) 3:59 pm, 22nd January 2019

I thank the Minister for her kind and compassionate words. It always comes across as if she genuinely cares, and I believe she does, but what I say to her is this: do not be another Minister who passes through the Department and does not address these problems. They need to be dealt with. It is fine saying that on paper the stats look good and people are fine with them, but if one person goes through the process and does not get the support they need, it can be life-changing or life-ending for them and I want to see that it is life-changing, not life-ending.

Question put and agreed to.

Resolved,

That this House
has considered mental health and the benefits assessment process.