Disability Assessment Services

Leaving the Eu: Fishing – in Westminster Hall at 4:27 pm on 13th March 2019.

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Photo of Gillian Keegan Gillian Keegan Conservative, Chichester 4:27 pm, 13th March 2019

I beg to move,

That this House
has considered improvements to disability assessment services.

It is an honour to serve under your chairmanship, Sir Christopher. I am grateful to have the opportunity to debate this important topic. People with disabilities and ill health are often confronted with barriers at every turn. I believe it is the role of Government to remove these barriers as often as possible. Everyone deserves the same opportunities to achieve their potential, and I am proud that we are ensuring that the issue is high on the Government’s agenda. The support available through the benefits system is there to take some of the strain off people who are living through often unimaginable day-to-day challenges. However, I am sure that, like me, colleagues have heard from constituents at times when they have needed help and found it difficult to navigate the system.

A very dear friend of mine and colleague from the business world, Andrew Knowlman, sadly lost his courageous fight with motor neurone disease late last year. He used his time and experience of the disease to campaign to ensure that I clearly understood the physical challenges it brought him, and the challenges he faced in trying to access the support available through the Department for Work and Pensions. One of the most significant issues that he brought to my attention was the repeated requests he received to attend work capability assessments.

This point is echoed by my constituent Lee Millard, who has been diagnosed with the same condition. Lee and his wife Jean have been campaigning to make a difference for those affected by the disease. When we met, Lee explained how stressful the reassessment process can be for claimants of the employment and support allowance, which is now moving across to universal credit, and personal independence payments—particularly when we consider that conditions such as motor neurone disease are degenerative, and the person who is affected is all too aware that they will not improve. He said that the whole process can feel very much like a “waste of precious time.”

Photo of Andrea Jenkyns Andrea Jenkyns Conservative, Morley and Outwood

Does my hon. Friend agree that disability assessors should rely more on the opinion of medical experts, particularly when judging mental health and invisible disabilities?

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

Yes, that is absolutely vital. One of the learnings from the system is that it needs to make sure that those assessments are available in time. I will go on to talk about that.

In a bid to tackle this problem, the Department stopped requiring people with the most severe and lifelong conditions to undertake assessments from September 2017. However, some of my constituents told me that that is not their experience, and that they are still being asked to go for assessments. The Minister kindly clarified that for those receiving ESA and universal credit before 29 September 2017, the severe conditions criteria will take effect at their next work capability assessment, so it could be that my constituents had one after that date, but will not have another.

I welcome the move, which is being encouraged, to enable decisions to be made without face-to-face assessments, through health questionnaires and evidence collected from GPs and specialist health professionals. On a similar note, I am pleased that people receiving the highest level of PIP will receive an ongoing award, with only a light-touch review after 10 years. That is another progressive step to ensure that those who most need support receive it hassle-free.

Photo of Vicky Ford Vicky Ford Conservative, Chelmsford

Some of my constituents have found the PIP assessment process and the work capability assessment deeply traumatic and very flustering, and they often get confused. Does my hon. Friend agree that allowing assessments to be recorded—especially video-recorded—will give people confidence that they are getting a fair assessment, and that the assessors are being monitored and must come up to a high standard?

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

Yes, I do. Technology in general is enabling us to put better processes in place. Recording will not be appropriate for some people, but it is important to use technology in the right circumstances.

Photo of Jamie Stone Jamie Stone Liberal Democrat Spokesperson (Armed Forces)

I declare an interest: my wife is disabled. I am interested in the assessment that takes place when somebody moves from the disability living allowance to PIP. From my constituency surgeries, I have noticed that that the mobility element for DLA is somewhat lower than for PIP. Does the hon. Lady think that that pattern is more widespread throughout the UK? Is there something here that is not right? Leaving out my wife, I have dealt with cases of people who have lost out on the initial assessment. The sentiment about continuing assessment is absolutely correct, and I support that.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

I am not in a position to see an overall pattern—perhaps the Minister does, because she sees what is going on across the country—but many of us have heard about issues relating to mobility and Motability.

Last week, the Secretary of State announced that people over state pension age will no longer have to go through PIP reassessments. That is part of her ambition to ensure that disabled claimants do not feel like they are on trial. These changes have been rightly welcomed in the press and, I am sure, by many Members in this Chamber.

These improvements are good news for claimants. However, one of the most common times when I receive a request for help from a constituent claiming disability benefits is when they do not agree with the outcome of their assessment. Recent figures from my area—Chichester—show that the overturn rates at tribunal are 71% and 81% for ESA and PIP respectively. It is my understanding that that is largely due to medical evidence not being available in good time, and being available only at tribunal. Those levels are clearly unacceptable. It is very stressful for people to go through the initial assessments, the reassessments and a tribunal. I would be grateful if the Minister could let us know what more work is being done to improve the system. Are there any plans to consider the timescales within which we ask GPs and medical professionals to give information about claimants, to ensure it is in time for assessments?

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour)

We have all seen that the appeal rates are unusually high. What, in the hon. Lady’s experience, is the time it takes to get to an appeal? In my part of the world, it is 40-plus weeks, which for some of these people is a ridiculous amount of time to wait.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

Yes, it can be quite a long time. We have heard that people can wait for three or four months. That uncertainty means that it is very difficult for a person to plan, as they do not know how much support they will receive.

Photo of Ruth George Ruth George Labour, High Peak

The hon. Lady is making an excellent speech and is putting into words what a lot of us experience in our constituencies. In my area, it takes 48 weeks for an appeal to be heard, and people usually have to sign on for universal credit, rather than ESA. They have to undergo conditionality, even though in 71% or 72% of cases in my area, at the end of the process it is found that they are not able to work. They are being pushed into that by a system that does not take into account their disability. Does the hon. Lady agree that that desperately needs looking at? People have to wait a year or more to get assessed properly.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

Yes, I do, but we need to solve the root cause of the problem, so that we do not have these high tribunal rates. If we do not have them, we will not have the waiting times. That is the best way to ensure that the system has a low failure rate.

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

I am very grateful to the hon. Lady for giving way. She is being very generous with her time. Is she as concerned as me about a report in the GP journal Pulse last week that said that the transformation of the new health assessment system could lead to unfettered access to medical records via the GP? We should surely speak up against that. Medical records are personal data; that is an absolute human right.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

Yes, although we need to balance that with having enough medical data to make the assessments in the first place. I have not seen that report. I do not know whether the Minister has, and whether she can take that into account in her speech.

I am glad to hear that, following the recent Government announcements, we are moving our benefits system into the 20th century by integrating multiple data sets into one system, although I take the hon. Lady’s point that we must ensure that they are very well protected. That will streamline the assessment process and make submitting a claim much more user-friendly, particularly for people transitioning between benefits. Plans to test a single health assessment for all disability benefits will mean less form-filling, and will reduce face-to-face assessments, cutting red tape and the inconvenience it causes. My constituents who need support often have highly complex needs, so I hope the changes will save them time and stress. It is important that we listen to our constituents and put them in the driving seat of reforms. I hope the Department will do that.

An issue that has been highlighted to me is people’s reluctance to attend assessments. We must do more to ensure people feel comfortable with and trust the process. It is key that we ensure that people know that in every case they are being assessed by a qualified doctor, nurse or healthcare professional—often somebody who works in the NHS—who has undergone additional training to carry out assessments. I did not realise that every single assessment is carried out by a qualified medical assessor. Many members of the public do not realise that. They think it is some third-party company, but often nurses work for those companies. We need to do more to make sure that people are aware of that, so they feel more comfort and trust.

Photo of Kirstene Hair Kirstene Hair Conservative, Angus

Does my hon. Friend agree that we must ensure that the questions in the assessment process are not too intrusive, so people do not feel that their integrity or dignity has been taken away from them? They should feel comfortable taking part in the process.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester

Yes, absolutely. We should not only look at who is carrying out the assessments, but open up where they can take place. Perhaps we can have a wider range of premises where assessments can be carried out, including places that are more familiar to and convenient for claimants, such as local authority buildings, NHS sites or even jobcentres. I would be interested to hear whether the Minister has any plans to do that.

In recent years, disability employment has risen, and now over half of disabled people are in work. Nine per cent. more disabled women and over 6% more disabled men are in work than in 2013. That is testament to the programmes that support people with disabilities into the workplace. I am pleased to hear that the Secretary of State outlined her ambition to build on that record, as every person with a disability or learning difficulty deserves the same opportunities to go to work and build a career. Programmes such as the personal support package have been crucial to that; they provide tailored employment support that recognises the individuality of people’s conditions. Much of that work is done through the jobcentre. In Chichester, we have a great team with some real success stories because of the support available through the programme.

Our Jobcentre Plus makes good use of the community partners and small employment advisers. Chichester has a low unemployment rate of 1.7%, so local businesses look to use all the available talent and need more local people in the workplace. I am glad that the small employment advisers are able to bring people with long-term health conditions and disabilities together with businesses to help them find a decent job.

Work coaches and disability employment advisers use all the tools at their disposal to help build skills, and to help disabled claimants prepare for the workplace. They do that not only through national programmes, such as the Work and Health programme, but local initiatives, such as WorkAid, which is run by the Aldingbourne Trust. It is great to hear the success stories of constituents who have managed to move into work, and that is made possible by the tireless effort of the jobcentre staff, who make those initiatives a success on the ground. I am sure that we all have many examples of that.

Getting a good job has a powerful impact. Last year, I met a constituent whose son is on the autism spectrum—there is a big problem getting people with autism into the workplace; much more needs to be done on that. She told me that he rarely utters a word and is uncomfortable around people. She is determined to help her son, and managed to get him work experience at a games software development firm. That was transformative; for the first time in a long time, he began to speak.

Getting a foot on the career ladder is challenging irrespective of disability; sometimes, extra-special effort must be made to find opportunities, particularly for work experience. I am very pleased that the jobcentre is offering careers advice to disabled students in schools, because building confidence in disabled kids as early as when they are 12 is critical to making them feel that they have all the opportunities that everybody else has. This is just the start; there are exciting pilots up and down the country, such as Tri-Work, which offers work experience to children in years 10 and 11, and programmes that support internships for school-leavers. I want every disabled child to be excited and have a wide range of options in the workplace, so we need to ensure that such initiatives are available throughout the country. The schemes are empowering young children, but they must to be available to all who need them.

The Disability Confident scheme is another successful programme, which now has almost 10,000 signatories. One participating employer is Chichester District Council, which works hard to make sure that its work environment is accessible, and has made workplace adjustments—for example, providing ramps, lifts, and an emergency evacuation chair. Perhaps more importantly, on top of that, the council has a welcoming workplace culture, actively helps applicants to apply, and will always interview disabled applicants when they have fulfilled the basic role requirements. That additional support removes the barriers to the workplace for disabled people and gives them confidence to start their journeys into new jobs.

We all know from our constituents that the system is not perfect, but I am pleased that the Government and the Secretary of State are listening to constituents’ voices and reforming it. There needs to be less stress, wasted time, and red tape all round; we need a more welcoming environment that makes people feel that they can trust the system, not that they are on trial.

I am proud of this Government’s record in supporting disabled people into work. There is still a long road ahead to ensure that all disabled people who can and want to work get the support that they need and the opportunities that they deserve.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour) 4:44 pm, 13th March 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate Gillian Keegan on securing the debate. Like many other Members, I am sure, I felt compelled to speak because of the number of constituents who have come to me with harrowing stories of their experiences, and with a clear message that improvements to disability assessment services are very much needed.

In my constituency, we have seen a variety of issues recently, including cases of incorrect information being recorded; there have been statements saying that physical assessments were carried out when they were not, and that a constituent could go out alone when the assessor was actually told in the interview that they could not. In one case, the information was so incorrect that it was assumed that the assessment report had been mixed up with that for another case. My constituent Amy was recorded as walking despite being wheelchair-bound, which must surely have been apparent at the assessment. When a complaint was raised, the DWP noted that that could be a “misleading statement”, but worryingly, Capita, which has consistently failed to meet its target for an acceptable standard of assessment, responded that there was no evidence that the statement made by the assessor had been misreported. I find that unbelievable.

Last-minute cancellations are a problem. We have heard from constituents whose assessments were cancelled on the day that they were due to take place. Even worse, in some cases, the constituents were actually at the assessment centre when their appointment was cancelled. Yet perversely, if a constituent is unable to attend their assessment, they are penalised. When one of my constituents rang up two days before her assessment to give notice that she would not be well enough to attend, she was told that it was too late for the assessment to be rescheduled, and that she would be recorded as a no-show. Those are double standards of the highest order.

Constituents who have attended assessments have raised with me the concern that their assessor carried out the assessment very quickly, and did not listen to their answers. Others were concerned that the assessment was not carried out safely. For example, a constituent with a slipped disk was asked to complete the physical part of the assessment without anything to support her, despite informing the assessor that she would need to hold on to something. Why are my constituents being put at risk in that way?

Another major concern is the refusal to conduct home assessments, despite medical evidence that they are necessary. That is a concern shared by organisations such as Macmillan Cancer Support, which has found that home visits can often be difficult to obtain, and that the option of a home visit is not widely communicated.

Photo of Jamie Stone Jamie Stone Liberal Democrat Spokesperson (Armed Forces)

The hon. Gentleman makes an excellent point about home visits. Does he agree that the problem is compounded by the fact that some people have to travel very large distances for those assessments? That is an issue facing some of my constituents. It would be so much easier if they could be done at home.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour)

Absolutely. The hon. Gentleman’s constituency must be rather more rural than mine, but for anyone who has a disability, travelling distances of any order is challenge. Home assessments need to be much more widely promoted.

Photo of Andrea Jenkyns Andrea Jenkyns Conservative, Morley and Outwood

I was recently contacted by a constituent who won her battle against cancer. That should have been a moment of celebration, but she is worried about her impending disability assessment. Does the hon. Gentleman agree that the parity of esteem between mental and physical health should be reflected in disability assessments?

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care), Shadow Minister (Business, Energy and Industrial Strategy) (Labour)

I agree; I will address that shortly. I will not take any more interventions, because a number of hon. Members wish to speak.

My constituents feel let down by the complaints process. They do not feel that it is fit for purpose. Many of their legitimate complaints are just passed back to the DWP, so those undertaking the assessments face little accountability. Does the Minister monitor the number of complaints against particular providers, and if so, can she tell us who the worst offenders are and what will be done about them?

As Andrea Jenkyns mentioned, another common issue is that assessments do not take into account the effect of mental health conditions, or acknowledge that many physical conditions can fluctuate daily. Certainly, the assessments that I have seen have focused on what people say about their good days—or moments—as the baseline for a typical day. There appears to be an almost institutional incapability of appreciating that just because people with fluctuating conditions have times when they are doing better, that does not mean that that is their condition all the time. There are occasions when they do need real assistance.

I am sorry to say that some private providers show no prospect of making any real improvements to disability assessment services, which are inaccurate, ineffective and unfair, and need to be brought back in house. It is a damning indictment of the system’s failings that the DWP does not even bother to turn up to about 80% of the appeal hearings against the assessments.

The message that I bring from my constituents to those who undertake the assessments—perhaps the Minister can consider this—is that they should be carried out with the idea that we should treat others as we wish to be treated. Show respect, show empathy and show compassion. That is what our constituents deserve.

Photo of Derek Thomas Derek Thomas Conservative, St Ives 4:49 pm, 13th March 2019

I am grateful for the opportunity to speak in this debate, Sir Christopher, and I congratulate my hon. Friend Gillian Keegan on securing it. I know that the Minister, who is almost a constituency neighbour, is fully engaged in the issue, and we should be in no doubt about how committed she is to finding a way through.

Photo of Vicky Ford Vicky Ford Conservative, Chelmsford

Would my hon. Friend like to take this opportunity to put firmly on the record what a brilliant Minister and champion for disabled people she is?

Photo of Derek Thomas Derek Thomas Conservative, St Ives

I am sorry that I did not make it quite as plain as my hon. Friend did, but that was the point that I was trying to make.

I am fortunate that in my office I have a member of staff who used to work in the DWP, before I pinched him. He has taken this issue seriously, and we work hard and often successfully to support people who find themselves challenging, and struggling because of, PIP decisions. My office has seen numerous cases of the DWP accepting a poor medical report containing obvious errors and incorrect recommendations from medical services. If those reports had been returned at an earlier stage, decisions would have been overturned immediately.

We have also seen numerous cases in which the mandatory reconsideration has rubber-stamped the original decision, failing to reflect in any detail what the constituent has said or to refer to any new evidence provided, and in which the DWP has failed to send new medical evidence for a medical opinion—I mentioned that earlier—to contact the constituent to find out more, or to consider further evidence when it is provided. Therefore, once a mandatory reconsideration is done, it must go to appeal. I know that is often very much the responsibility of work coaches and individual jobcentres, but there is a need for leadership in addressing the problem.

Resolving any disputes without the need for an appeal will help to ensure that people receive the right decision earlier in the process. Avoiding a tribunal saves money and time for everyone concerned. I am reluctant to mention the Minister’s constituency and county, but the tribunal statistics for the Truro tribunal centre in this financial year show that 351 PIP appeals have been cleared, with the DWP’s decision upheld on only 32 occasions. We have heard other tribunal statistics this afternoon, but in Cornwall 90% of tribunal appeals are won. That must be addressed; we need to look at what is going on in Cornwall.

A constituent of mine was awarded no PIP at all, but on appeal was awarded higher mobility and daily living components within minutes of attending the tribunal. I dropped off my member of staff as I went to another meeting on the way up to London, and he texted me within 15 minutes to say we had won—it was almost immediate, because the minute the tribunal started my constituent was awarded the higher allowance.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Like the hon. Gentleman and his office, we have had cases—in particular those related to PIP and other benefits—where it has been questionable whether people will get their benefits through examination. I know that the Secretary of State is looking at that, but it also strikes me that the companies who do the assessments are not well managed and, more importantly, their staff are not trained properly. Does the hon. Gentleman agree?

Photo of Derek Thomas Derek Thomas Conservative, St Ives

That is fair. I sit on the Select Committee on Work and Pensions with other colleagues in the Chamber, and we hear such examples all the time.

I met the individual I am talking about and I could see clearly that he should have been getting the higher mobility component. An assessor who had asked the right questions and inquired after the person’s clear and obvious physical difficulties would have discovered their whole life was adapted to be independent, and a tribunal would absolutely have been avoided.

On a few occasions, medical services for PIP assessments have stated that tribunals are not as “restricted as we are”, when justifying the fact that tribunals are often successful for the claimant. Our understanding, however, is that they all follow the same legislation and the same medical handbook, so it can only be down to poor information gathering, poor questioning and poor decision making.

The Minister knows about what I will mention now, and I am sure that she shares my concern. If the DWP did not rubber-stamp mandatory reconsiderations, as it does, people in Cornwall would not be left in desperation, causing them to turn to organisations such as Benefit Resolutions, which charges clients £100 before it even looks at the cases. Then, from some of our most vulnerable people, it takes 15% of tribunal winnings in commission. It no longer attends tribunals, and it uses aggressive tactics with the DWP, other offices and its clients. Going by the results claimed on its website, Benefit Resolutions has taken almost £200,000 from the most vulnerable people in Cornwall over the past four years. There have been numerous complaints about its conduct throughout Cornwall, and the previous charity related to it, which was called Bufferzone, was closed down following an investigation by the Charity Commission.

I take the opportunity to remind people that the many free-to-use services include Citizens Advice, Counselling and Benefit Support, disAbility Cornwall and MPs’ offices. I have serious questions about the work and moral justification of companies such as Benefit Resolutions. I would always encourage people to make contact with the organisations that I have referred to. However, the truth remains that Benefit Resolutions and companies like it exist only as a result of incompetent and poor service provided by the system.

To conclude, I will read from a letter that has been submitted as a formal complaint to the DUP, I mean the DWP—probably not the DUP, though they might do a better job—which clearly sets out the case being made this afternoon:

“Last week I had a PIP assessment which lasted an hour and a half. They ask you really hard questions like do you think about committing suicide, and you have to go over again and again how your disability or illness has affected your life.

I understand they have to assess people and I am grateful there is somewhere that we can ask for help in this country, but the system is failing and more importantly it is hurting people…This was my third assessment in three years. It was gruelling and left me completely distraught afterwards. Having to face how much my life has changed and how little I can do now in comparison to before is very difficult. Watching the person who is sitting in on your assessment with you get visibly upset by the process is heart-breaking.

I have probably over 20 supporting letters from doctors, neurologists, colorectal surgeons and healthcare professionals. These letters state that I am not going to get better. That things are likely to deteriorate for me. Not fun reading. I hand them all over willingly.

A week later I got a phone call saying that I would have to be reassessed again. The healthcare professional had not gathered enough evidence. They were at my house for an hour and a half asking me question after question. I have support from all my doctors. How could they not have enough evidence? They could not answer that question. My father asked for management to call back the next day. They did not, and have not fulfilled that request. Instead I was booked in the next day for another assessment. Not just a few extra questions. I have to go through the whole thing again.”

Thank you, Sir Christopher.

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

I will call the wind-ups at 10 past 5 o’clock, which means that we have about 12 minutes and four or five people wanting to speak.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer Affairs) 4:58 pm, 13th March 2019

Thank you, Sir Christopher. I will be as brief as possible.

Support for those living with a disability is a mark of a civilised society but, as we have heard, the process that too many seeking support have to go through is often found to be daunting. That is certainly the case in my constituency. The rate of successful mandatory reconsiderations and appeals demonstrates that the process is fundamentally flawed. Evidence-based reviews conducted on behalf of the DWP have identified a pervasive culture of mistrust around PIP and ESA processes. That is simply not good enough.

There is no place in a welfare system for private companies, because that immediately introduces the profit motive. Looking after and supporting our sick and disabled should not be influenced by how much profit a private contractor can make. The Scottish Government will therefore remove the use of private companies for assessments.

We all have cases of constituents who have had an unfavourable decision made about them because information on them has been inaccurately recorded. Unbelievably, for example, someone with a heart condition has been assessed by a mental health professional, or vice versa. How does that promote faith in the assessment system? We need an overhaul of the system, a true recognition of the fact that life costs more for someone who lives with a disability. That is not a matter of opinion; it is a matter of fact. For that reason, in Scotland the bedroom tax has been fully mitigated by the SNP Scottish Government, because we know that people who live with a disability are disproportionately affected by the tax.

The PIP evidence-gathering process should be streamlined—that is the way forward. The stress and bureaucracy that claimants are put through, which I see every day in my constituency, are unacceptable. They cause real harm to people who are already struggling every day with serious and debilitating conditions. The system must take more account of the often very vulnerable people with whom it deals, and be redesigned accordingly. Otherwise, when our constituents need support, they will continue to face cruel and unnecessary barriers. Scotland is building a social security system that is fair to all. I urge the Minister to look critically at the system in place and do what she can to improve it for the people who use it.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock 5:00 pm, 13th March 2019

I thank Gillian Keegan for securing this debate. As MPs, we have all handled cases where errors have been made with disability assessments; that was the case before the introduction of universal credit and the personal independence payment. Sadly, no doubt it will continue to be the case as the system is further refined and improved. I do not say that to lessen the impact of the distressing cases we have all assisted with or read about, but to illustrate that individual mistakes do not alone indicate a fundamentally flawed system, just that the system has to improve.

I certainly had concerns previously that there was a lack of common sense and flexibility in the assessment process for those with longer-term disabilities. I know many in this House felt the same. Health conditions can change and hopefully improve over time, so there will always be a need for occasional assessments to establish the correct level of support, but one must recognise that for some conditions sadly there is no improvement or recovery. However, I am pleased that of late there has been a greater focus on flexibility in the assessment process, whereby those with the most serious conditions can now have their evidence reviewed by a DWP case manager without the need for a face-to-face and repeated assessment. I very much welcome that change.

The help to claim service in tandem with Citizens Advice, which was mentioned earlier, is free to the user and is to be launched next month. It is designed to help the most vulnerable claimants with their applications, whether through a home visit, over the telephone or online. It will assist universal credit claimants with their award until the first accurate full payment is received. I very much welcome the Government’s recent improvements to the PIP process and the measured approach with which the universal credit system itself is being implemented nationally. However, there is no room for complacency. I hope the Minister and the Department will develop a policy of continuous improvement, ensuring that client trust is established—particularly with clients with a disability.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:02 pm, 13th March 2019

I congratulate Gillian Keegan on bringing forward this debate. It is an important issue; I told her I would make it my business to be here at the right time.

I have made my reputation as a councillor, a Member of the Legislative Assembly and an MP based on my constituency work, which I am very proud of. I used to fill out the disability living allowance application forms myself, and attend appeals for constituents. I do not have the time do that now because I am over here most of the time, but also because the number of applications and the help needed have increased so much. I have a full-time staff member who is allocated to PIPs and benefits, although I still carry out that work whenever I can when I am at home.

Benefits is the biggest issue in my office, but the question is not why so many people are claiming—I have always had large numbers in my area who are disabled and who claim. People are so desperate for help and they deserve help and attention. The Minister is always very responsive to anything I ask her—I thank her for that. I have seen people with serious illnesses being turned down for PIP.

I have a constituent with a long list of ailments who is at pains always to be dressed well, be washed and look the part. That is only possible because his ex-wife comes every day to make sure he gets out of bed and is washed and dressed. He was turned down. Like the example Derek Thomas gave, he went to an appeal and was not even called in, because the panel looked at the notes and said, “You know something? This man should get it,” and he got it in 15 minutes. Why did that happen? When someone goes out to assess someone and looks at their circumstances, they will say, “He looks terribly well,” or, “She’s dressed well and her hair is combed. She’s okay, she has no illness.” But they need help.

I have said this to the Minister in correspondence and I will underline it: one must question how much a physiotherapist knows about the intricacies of ulcerative colitis and the side effects of the medicine. How much does a paramedic know about the restriction on the movement of someone with multiple sclerosis? Someone with expertise needs to assess the circumstances, and GP notes should follow that up. Four out of 10 PIP candidates do not appeal as they cannot handle the stress. Do we really believe that half of the people who are claiming do not deserve it? I do not. As far as I am concerned, those people are telling the truth and they should not be looked upon as liars.

There must be a written review. We must start again for the sake of those people who are living beneath the poverty line, because they do not possess the mental fortitude to fight for what they are entitled to. Today, other hon. Members and I fight on their behalf and ask for fairness, a level playing field and an assumption that not all people are telling lies.

Photo of Paul Masterton Paul Masterton Conservative, East Renfrewshire 5:05 pm, 13th March 2019

I congratulate my hon. Friend Gillian Keegan on securing this debate.

I welcome the Secretary of State’s recent announcement of the change in the assessment process. Face-to-face assessments cause anxiety and distress among our constituents. It is paramount to safeguard the most vulnerable in society from undergoing assessment when their conditions are unlikely to have changed from their previous visit. As a constituency MP, I am often able to obtain the agreement of the DWP for paper-based reports that remove the need for face-to-face assessments, or at least the agreement to a home consultation, but it can be a real uphill battle to do so.

Those suffering from conditions such as MS, myalgic encephalomyelitis, severe autism and Asperger’s, agoraphobia and a range of mental health health disorders should not be required to submit a new claim every two years. Those suffering from mental health conditions do not find it easy to obtain the required evidence, particularly if that person has no engagement with medical professionals due to their condition. The recent announcement will alleviate those concerns for some claimants. I quickly draw hon. Members’ attention to the great report by the Scottish Association for Mental Health, which is the Scottish equivalent of the charity Mind. It is a sensible report that states clearly that the assessment process does not adequately gauge the impact of mental health or other fluctuating conditions, because it focuses primarily on physical impairment.

The decision to integrate assessment services into one body is welcome news; it will streamline services and allow those applying for ESA, universal credit and PIP to undergo just one assessment rather than two. Although the benefits assess two different matters, the information obtained from one assessment can be used to determine both benefit outcomes.

Like all hon. Members, I have met several constituents who have stressed their anxiety at undergoing assessments because they do not trust the system. Many constituents have been reassessed for ESA and PIP every couple of years and do not get the time to focus on improving their well-being without the threat looming over them of going back for another assessment and potentially losing some or all their benefit. Ultimately, as many Members have stressed, the issue is a lack of trust and faith in the system. Is it any wonder, given the number of low or nil awards given incorrectly, not properly picking up hidden and non-physical disabilities and forcing people to battle the system that should be supporting them?

Like many MPs, my office offers full advocacy support for welfare claimants, from the initial application and accompanying to the assessment centre, to doing appeals and representation at tribunals. Our record of success is well over 80%, which is partly due to my amazing caseworker, Jamie. But that is ridiculous, because we should be getting those decisions right first time, to increase the faith and trust of vulnerable people in the assessment process. By introducing the changes the Government have outlined, we are taking a huge step to begin to rebuild that trust with those living with disabilities.

Photo of Ruth George Ruth George Labour, High Peak 5:08 pm, 13th March 2019

I echo much of what has been said across the House. I am glad that Members on the Government side are taking an interest. I would love for some of them to take up the vacancies on the Work and Pensions Committee, where we look in detail at these issues.

I have met and heard from many constituents, particularly those with mental health problems, who suffer from the whole round of assessments. They are often on both ESA and PIP, so they have assessments roughly every year. Once they get a letter about an assessment, they have to fill in a form and seek medical letters to substantiate their claim. Many medical professionals are refusing to write those letters, because the DWP ask for such detailed information and they cannot possibly give the time to provide that. If they do, they charge for the letters—often £25 or £30.

As Members across the House have said, there is great reluctance to perform home visits—particularly in my very rural area where they can take longer, but also where it takes much longer for constituents to travel to appointments. Often, they simply cannot. One constituent told me about dragging her disabled daughter, who was ill and in pain, out of bed to go to her assessment because she was told she had to. Another’s GP refused to give evidence for any more assessments about home visits.

Yes, people get their taxi fare paid for them, but they have to pay up front. That often costs £100, which some people simply cannot afford. The Minister promised the Work and Pensions Committee that work capability assessments would be video-recorded, but now people are being asked to provide their own recording equipment. Again, that is an issue of affordability.

As Paul Masterton said, the process has an impact on claimants’ mental health. They go to an assessment; they wait for the result; they put in for a mandatory reconsideration, which often is turned down point-blank, and they then have to wait for an appeal. That is an incredibly stressful process, during which the claimant has to sign on for universal credit and go through the process of being assessed for work and claimant conditionality, under threat of sanctions.

I spoke to the Minister last week about a constituent of mine who died on his first day back at work. I spoke to his wife, who was absolutely clear that her husband had been forced into returning to work by DWP’s refusal to take doctors’ evidence. It said it knew best because he had passed a work capability assessment. That should no longer happen. Doctors should not receive letters saying they must not give people fit notes because they have passed a work capability assessment. That sends people further into mental health despair and, in some cases, towards suicide. I really hope the Minister looks at this issue.

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) 5:11 pm, 13th March 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I appreciate that we only had an hour for this debate; I am only sorry that some hon. Members who made a number of interventions were not able to stay to hear the Minister sum up. I am grateful for the opportunity to follow Ruth George, whom I commend for her work on the Work and Pensions Committee. I thank Gillian Keegan for securing the debate. I share her belief that we need a system that works better for everyone, especially those with disabilities.

The process for claiming personal independence payment or employment and support allowance is not easy or straightforward. As we have heard, claimants fill in extensive forms detailing how their condition affects their daily life and send them off to the Department for Work and Pensions. For some people, that, along with medical evidence, is enough to merit an award. However, more often than not, people are required to attend a face-to-face assessment carried out by one of three contracted assessment providers. The healthcare professional employed by the contractor reports back to the Department, and a decision maker makes a decision about the claimant’s entitlement.

Last Friday, I was invited to witness a personal independence payment assessment, which was conducted by an actor and a health professional. It took an hour and a half. I imagine that was the gold standard for conducting such an assessment. I am sure everyone in the Chamber would agree that the experience of most of our constituents—granted, we see the worst examples—is that assessments are never conducted quite as efficiently or in as gold-standard a way, so I think that exercise was slightly contrived. It was worthwhile to see how the process should operate, but we have all argued time and again how it should operate; the reality is that it does not operate in that way. In reality, assessments are stressful, and many people are forced to go through the mandatory reconsideration process and the conclusions of a decision maker, which ultimately is unfair.

I only have a few minutes to sum up, but I pay credit to the hon. Member for Chichester for rightly highlighting the experience of her constituents, and to my hon. Friend Patricia Gibson and the hon. Members for Ellesmere Port and Neston (Justin Madders), for St Ives (Derek Thomas), for Ayr, Carrick and Cumnock (Bill Grant), for Strangford (Jim Shannon) and for East Renfrewshire (Paul Masterton). I agree with the hon. Gentleman about the work of the Scottish Association for Mental Health. The Government have to do more to recognise mental health in the assessment process.

I read recently that the Department for Work and Pensions will introduce a further step in the appeals process called the continuous online resolution system, which will involve an online review by a tribunal panel. If my understanding is correct, that means people will have to endure a claim, potentially a mandatory reconsideration, and an online text-box tribunal before they can get an oral appeal. The success rate for written appeals is dramatically lower than that for oral hearings, so does the Minister accept that that step may serve only to introduce another needless level of bureaucracy to claimants’ appeals, and that it may not achieve the ends she hopes it might?

The high number of mandatory reconsiderations and the fact that, as the hon. Member for Chichester outlined, 71% of decisions are overturned shows that there are already flaws in the system. I would like the Minister to do more to address those current flaws before taking on the process of streamlining and bringing all these benefits together. I genuinely worry that that would cause many of those who need financial support—particularly those who are disabled—not to get that support, and that such an integrated assessment service would penalise disabled people who need the full range of benefits. I would hate to see that happen.

It is not right or fair for any individual, whether they are disabled or suffering from mental ill health or a long-term debilitating health condition, to be put through such an arduous process. These people are not criminals—they are people who demand and need support from the social security system, which was designed to support them. I hope the Minister takes the time to answer my questions.

Photo of Marsha de Cordova Marsha de Cordova Shadow Minister (Work and Pensions) (Disabled People) 5:15 pm, 13th March 2019

It is an honour to serve under your chairmanship, Sir Christopher. I congratulate Gillian Keegan on bringing forward this debate. She made some really valid points. She is absolutely right that it is up to the Government to remove of some of the barriers that disabled people face to ensure that they can live independently and participate fully in society. I welcome the move to stop assessments for personal independence payment for pensioners, but we need to go further to ensure that those who do not need reassessment do not have to continue to go through the arduous assessment process.

We heard from Members across the Chamber about the fundamental flaws in the assessment framework for disabled people. We heard about the time that many ill and disabled people have to wait for an assessment. Indeed, my hon. Friend Ruth George highlighted that in her area people have to wait up to 48 weeks before they get to an appeal. We heard countless accounts of what happens at assessments and of poor decision making. My hon. Friend Justin Madders shared his constituent’s experience of being given two days’ notice but still being recorded as a no-show, yet assessment providers can cancel at the last minute. We need to eliminate such double standards. Derek Thomas pointed out some of the poor decision making that happens after assessments and highlighted the rubber stamping of decisions at mandatory reconsideration stage. That step was put in place to ensure that we got decisions right earlier, so it is really important that that issue is picked up.

Since 2013, more than 700,000 ill and disabled people have been forced to challenge decisions at appeal following poor decision making after their assessment. Last week, the Secretary of State for Work and Pensions admitted that disabled people feel “put on trial” by these assessments. By her own admission, we need not just small-scale improvements of the assessment framework, but a wholesale overhaul of the system, which has created a hostile environment for disabled people.

Every week, I hear from constituents and from disabled people across the country who have been pushed to despair as a result of the failing assessment framework. I was contacted by a lady called Susan, who has Crohn’s disease. She is on DLA and has a Motability vehicle. Following her assessment, in which she did not score any points for her mobility, she lost her car, which she described as her one bit of independence. I share her experience with the House because it is not isolated; I hear these heart-wrenching accounts all the time.

Some 72% of PIP decisions are overturned at appeal, and more than 100,000 disabled people have been wrongly deprived of PIP. We heard that more than 4,500 disabled people were wrongly denied PIP when they transferred from DLA. Most shockingly, 17,000 people died before their PIP decision was reached. In the last three months, nearly three quarters of people who appealed their work capability assessment decision were successful.

We know the system is flawed and is not working. That is why it is worrying that we are looking at combining all these assessments. We cannot combine them when we know there is bad decision making and the assessment framework is flawed, so I ask the Minister: why not listen to people like Susan, and look at conducting a wholesale review and overhaul of the system?

Photo of Marsha de Cordova Marsha de Cordova Shadow Minister (Work and Pensions) (Disabled People)

I will not; I do not have time, frankly.

The Government announced last week that they would extend the contract of the Centre for Health and Disability Assessments, better known as Maximus, to carry out work capability assessments. Nothing could be worse for any disabled person to hear. Since 2014, an estimated £595 million has been paid to Maximus to carry out assessments and in total £1 billion has been paid out to private contractors. These companies have repeatedly failed the DWP’s standards, so does the Minister agree that rather than extending the contract, it is time to bring these assessments back in-house? Will she confirm that the details of the new contract will be made available to Members?

It appears that I have only 20 seconds left, which is shocking, so let me be clear: we need a radical overhaul of the assessment framework before any moves are taken to combine the assessments. We need an assessment framework that will take into account disabled people’s lived experiences and treat all disabled people with the dignity and respect they deserve.

Photo of Sarah Newton Sarah Newton The Minister of State, Department for Work and Pensions 5:20 pm, 13th March 2019

It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful for the number of Members from across the House and all parts of the country who have come together for the debate. There is a compelling debate going on in the main Chamber, yet many Members chose to prioritise this debate, which is to the great credit of everybody who has participated.

I pay particular tribute to my hon. Friend Gillian Keegan for her passionate, eloquent and well-informed contribution. She was joined by many colleagues who shared examples of the poor treatment that their constituents had faced in going through the assessment services. That is exactly why we made the announcements last week about the transformation of the way that we undertake assessments.

Our approach has been one of wholesale continuous improvement—to the personal independence payment since it was introduced, but also to the work capability assessment, since it was introduced by the Labour Government back in 2008. There have been numerous independent reviews, the Select Committee did an excellent inquiry and the Department has embraced and implemented a great number of recommendations. We are committed to continuous improvement, as Justin Madders asked us to be. I thoroughly agree with him and want to reiterate what he said: we should treat others as we would like to be treated. Everyone should be treated with respect and dignity, and I can assure him and my hon. Friend the Member for Chichester, who also raised that point, that there is no complacency at all; there is an utter commitment to improvement.

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

I will not; I have little time, and I was asked many questions. If I do not manage to cover all the questions that Members asked, I will of course write to them. It is great that we often have debates in this Chamber on this subject. I am sure there will be other opportunities to ask questions, perhaps in oral questions to the DWP on Monday.

My hon. Friend the Member for Chichester asked some questions that I particularly want to answer. She made a good point about how people feel when they go to an assessment, as well as about the location, how people look and what clothes they wear. People forget that the assessors are fully qualified healthcare professionals; they are the same people they might see if they went to A&E on a Saturday night. As part of our transformed service, we are looking carefully at where we can co-locate services. That could be in NHS or local authority facilities, but they need to be in a place where people will feel more comfortable.

We are seriously looking at how the people undertaking the assessments appear, and at ensuring that their certificates showing that they are fully qualified healthcare professionals are available, so that people have the same confidence when going to their assessment as they do when going to see their GP. Most people have a high degree of trust in their GP, and that is helpful, because that is the point that I want to get to. Repeatedly, GPs and healthcare professionals have told us that they do not want to be the gatekeepers of the benefits system, as that would get in the way of their patient-doctor, or patient-healthcare professional, relationship. We will need to have healthcare professionals undertake assessments, but they need to be separate from NHS services.

We are working closely with the medical profession to make sure that we have as close a relationship as possible, and to obtain information as swiftly as possible. I want to offer reassurance to Debbie Abrahams about how we will go about getting medical information in our new transformed service. It will be with patient consent. We will not break into NHS or GP computer systems and extract data somehow. The information will be obtained with the consent of the patient.

I want to reiterate a commitment that I made at the Dispatch Box, when I answered the urgent question about the new transformed service. I want to make sure that disabled people co-design the service with us. We are starting soon on stakeholder engagement to enable that. We will work with the medical professionals—as I said, we will do a lot of work with them over the summer on this—stakeholders and disabled people. We want to improve people’s confidence and trust in the system, and make it properly accessible.

There were a whole range of really good points raised by the hon. Members for Strangford (Jim Shannon), for High Peak (Ruth George), for North Ayrshire and Arran (Patricia Gibson) and for Lanark and Hamilton East (Angela Crawley), and my hon. Friend Derek Thomas, pointing to changes that they would like to see in the training of the healthcare professionals undertaking the assessments. I reassure hon. Members that a whole series of stakeholders—charities or people who work alongside those with particular health conditions—have met those undertaking health assessments to ensure that the guidance given to them is up to date and properly takes into consideration variability in conditions, and to ensure that those assessing people with rare conditions that we do not often come across are aware of that condition and its impact on a person’s ability to live their daily life in the way that we would like them to.

I assure all hon. Members that we give physical and mental health parity of esteem. Many of our healthcare assessors, as well as our frontline staff in the DWP, are undergoing good mental health awareness training, and they all have access to specialists whom they can call on. Through lots of small improvement to assessments, we are beginning to see real changes.

We spend a lot of time working with our colleagues in the Ministry of Justice to ensure that people can access tribunals in a more timely way. The delays are unacceptable. There has been recruitment of a lot of staff, and there is a new online resolution service for PIP, which was piloted and received good feedback from claimants. It will not replace people’s opportunity to have a face-to-face tribunal service, but some people might choose to go that way.

We are looking at improving our mandatory reconsideration process. It is not fair to say that it is a rubber-stamping process—around 20% of decisions are changed at mandatory reconsideration—but we are learning from the work we are doing with Her Majesty’s Courts and Tribunals Service to ensure that we can get more information, including medical information, from the claimant at the mandatory reconsideration stage, so that more decisions can be changed then, without having to go on to appeals.

However, the most important thing is to get more decisions right the first time, and to enable conversation, so that people are confident enough to give us all the information we need when we need it, and that we get that. We are working on that at pace.

In terms of the transformed service, it has been necessary to extend the existing contracts for both PIP and the work capability assessment, so that we have a secure and stable way of assessing the benefits. Developing the new transformed service will take a huge amount of work. We are creating a new digital platform, which we will co-design with disabled people. It will take this year to get that right; only then can we start to introduce the new service.

In the short time I have left, I return to the good point that my hon. Friend the Member for St Ives made about organisations such as the Benefits Resolutions service, formerly known as Bufferzone. I would love to work with him on what we can do to regulate those offering support to people going through the tribunal service. I agree with him; what he described is totally unacceptable. I would also like to work with my hon. Friend Paul Masterton and look at the report he mentioned to see what we can do to ensure that improvements are made.

I thank all hon. Members very much indeed; I am absolutely determined, as they all are, to improve these services and ensure that they are the best they can be.

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester 5:29 pm, 13th March 2019

I thank the Minister very much, mostly for listening and taking into account all the points raised today. I thank you, Chair, for your excellent chairmanship, which got us through this debate in an hour, and I thank all hon. Members for their participation. It is clear that we all have similar desires and concerns: we want to ensure that the system continuously improves, treats people with respect and in the way that we would all like to be treated, and, perhaps most importantly, helps people to live a fulfilling life, so that they can make the most of their many talents. I thank everyone for participating, and I look forward to seeing the transformation of the service.

Question put and agreed to.

Resolved,

That this House
has considered improvements to disability assessment services.

Sitting adjourned.