John
Robertson: I have listened intently to the hon. Gentleman
and I have great sympathy with what he says. Does he agree, however,
that part of the problem is not just the amount of assessment but the
people who are doing the assessing and that we can have three different
assessments with three different outcomes? It is not the people who are
being assessed who are the problem, but the people doing the
assessment.
Danny
Alexander: I agree with the point that has been made and I
would like to table further amendments that I hope we will be debating
later today in relation to training for the people who carry out the
assessments. With regard to some mental health conditions in
particular, lack of training and lack of awareness are a real barrier
to getting accurate assessments of the conditions and barriers to work
that people face when they have certain conditions or
impairments. I would
like to hear from the Minister whether he thinks it is possible to
combine these core assessments. I raised this issue with
representatives of Atos Origin, which carries out the assessments on
behalf of the Government, when I had a very useful visit to its testing
centre in Inverness in August. I got the impression that having to make
different assessments for different benefits, often for the same
people, is sometimes a source of frustration for them as well. This may
simply be due to the fact that they have to make different appointments
with the same person over a period of weeks. It would be easier for the
individual concerned if someone only had to come into the office once,
even if they had to undergo a slightly longer
assessment.
Mr.
David Ruffley (Bury St. Edmunds) (Con): Does the hon.
Gentleman agree that the hon. Gentleman the Member for Glasgow,
North-West (John Robertson) raised a key point when he said that
different assessments could give rise to a large number of appeals? The
complexity of this new regime is not just bad for the claimant, but
could result in many more
appeals.
Danny
Alexander: I certainly agree with that point and we may
wish to debate this later as we go through this clause and clause 9, as
I am particularly concerned about the way in which the Government
propose to test the new personal capability assessment, which relates
particularly to clause 8 on limited capability for work. My
understanding is that the testing proposal is simply that the new
assessment should be run in parallel with the old assessment. There
should be some medical assessors looking at how it works and there
should be a study of the outcomes of the two different assessments.
Unless the Minister
can clarify this point, I think there that there will be serious
questions about whether the criteria that will be used are better. If
we consider whether the outcomes are the same—the point that the
hon. Members for Bury St. Edmunds (Mr. Ruffley) and
for Glasgow, North-West (John Robertson) made in relation to the outcome
of assessments and appeals—we see that, in many cases, the
current assessments do not work very well as they result in numerous
mistaken assessments that result in many appeals, many of which are
successful. If all we are doing is seeking a new assessment that is as
good as that, our ambitions are very low indeed. I would like to see a much
longer period of study for the proposed new personal capability
assessment to make sure that it works properly, and I would like that
to be carried out by an independent body. Having the company that is
responsible for the assessments making the judgment as to whether the
new one works better or not is not
desirable.
Natascha
Engel: To return to our investigations at the Select
Committee, one of the dramatic differences between the personal
capability assessment that is now proposed and the medical assessments
that are carried out today is the massive cultural shift away from
assessing someone’s incapability to do something to considering
someone’s capacity to do something. That cultural shift from
incapacity to capability will make an enormous difference in the way
that people are assessed and will give a far more holistic approach to
the way the medical profession view someone who is to be
assessed.
Danny
Alexander: I should have made it clear that, having
studied the documentation in relation to the transformation of the
personal capability assessment, it seems to me that a great deal of
progress has been made in rethinking the way the assessment works. My
point is not that the thinking that has gone into it is not good or
that progress has not been made, but rather that the evaluation of this
new assessment should be more robust and more independently led than
the fairly brief assessment that the Government are
proposing. Given that
the Bill is proposing two separate assessments, one for limited
capability for work and one for limited capability for work-related
activity, which on the face of it seem to be quite similar even though
they are intended to reach different decisions, what are the
Government’s intentions as to how these two assessments should
be carried out? What will be the claimant’s experience? Do the
Government intend a claimant to be invited for an assessment for
limited capability for work to determine whether they are entitled to
ESA and then, once that decision has been made, for another, separate
assessment to determine their limited capability for work-related
activity? That second assessment would determine whether the
person was entitled to the support component or the
work-related activity component. How will the claimant experience those
two different assessments in practice?
Mr.
Ruffley: On that point, is it the hon. Gentleman’s
understanding—it is my understanding, although this is not dealt
with in the Bill—that the two assessments will be done at the
same time, by the same person, in the same room and on the same
day?
Danny
Alexander: Although it is not in the Bill, that is my
understanding. A claimant would go to the medical assessment office,
sit down and have their assessments for limited capability for work and
work-related activity. At the end of those assessments, the person
would leave the room and a decision would be taken about whether they
were entitled to the support component or the work-related activity
component. Depending on that decision, the person might or might not be
invited back into the room for a further, work-related, health-focused
assessment to determine the work-related activity to which they were
entitled. If the
Government are proposing that the two separate assessments described in
clauses 8 and 9 take place seamlessly—at the same time, in the
same room and with the same person—I fail to see why they should
be subject to two separate sets of regulations. In practice, that could
allow a future, perhaps less well-intentioned Government to separate
the two assessments and invite someone back to the room on a subsequent
day or in a subsequent week or subsequent month for a different
assessment to do the same thing. I would be grateful if the Minister
could clarify that point and I look forward to his
response.
Mr.
Ruffley: We all look forward to the Minister’s
considered reply, and I should like to hear his response on one final
point. Although the issue is not dealt with in the Bill, we understand
that the two assessments will be done at the same time or sequentially,
within an hour or so of each other, by the same assessor and probably
in the same room. Does the Minister agree, however, that there could be
a potential conflict in what the assessor teases out from the claimant?
A claimant will try to demonstrate that they are unwell enough not to
be able to work and that they are eligible for the employment and
support allowance, and they know that the first assessment will test
their level of unwellness. However, in a very real sense, the next
assessment will test something at the other end of the spectrum: what
the person can do—their capability.
There seems to be an in-built
tension in that arrangement. The first assessment shows unwellness, and
the claimant will want to show that they are unwell, because they will
want and need the allowance. However, a few minutes later, they will,
given that they will be acting in good faith, have to demonstrate some
level of functionality, if they have it. That will determine whether
they are eligible for the support component or whether they have to go
on to the work-related activity component. In the mind of the claimant,
that will compromise their responses. I thought about this when I first
saw the Bill and it has been confirmed by what some disability and
support groups have told me. Claimants will think that if they show too
much “capability” in the second assessment, it might
compromise their eligibility under the first test about whether or not
they get the
allowance.
10.15
am I do not, in
any way, say that this is slack drafting or that having two assessments
is a ridiculous proposition, because I know that officials and
Ministers have put a lot of thought into this during a fairly serious
period of consultation since January and the Green Paper.
We must make that clear and I must put it on record. There are questions
to be asked. We will get to the issue of how much work has gone in, and
will go in, to get the new testing regime right, and we will have a
debate about piloting. Let us put all that to one side, because it is
for another day. Much
thought has gone into the clauses, but I should sum this up again
because I feel strongly about it: someone who is asked to show
capability in the second test might think, and get worried, that it
will compromise what has been decided on the first assessment about
whether they get the allowance.
Kali
Mountford (Colne Valley) (Lab): It is dangerous to try to
put ourselves in the mind of another. My experience is contrary to that
mentioned. The people I see making claims for current benefits do the
opposite of what the hon. Gentleman is saying. They usually
underestimate the difficulties and challenges that they face. They
generally put forward the best case of the best day. They do not say,
“This is the worst day” and give a proper assessment of
their own capacity and incapacity. Perhaps it is time to examine in a
more holistic way how an individual operates, not just on a specific
day but over a period of
time.
Mr.
Ruffley: The hon. Lady makes a good point. I know that she
had much experience of these matters in her former life. I just want to
clarify something. I am not suggesting for a second—I know that
she was not putting these words in my mouth—that those who apply
for the new allowance will be looking to make a bad fist of it and to
exaggerate their illness. She makes the point that claimants will, in
good faith, say, “I am not well enough to work and I need the
support of this allowance—or incapacity benefit, as it is
now”. We all agree on that. She has given examples where
claimants will underestimate how unwell they are. That would be
assessed in the first test, which is the subject of the
clause. I have also
heard a contrary view, which might involve a minority of cases and the
hon. Lady might be referring to the majority of cases. I wonder whether
a minority of claimants might be stressed. We know that 40 per cent. of
claimants currently on incapacity benefit have mental or behavioural
conditions. It is at least likely that in a minority of cases there
might be an inbuilt tension between showing unwellness and then having
to show functionality and capability in the second assessment. People
might get a bit confused by that, for perfectly understandable
reasons. I am not
suggesting that this is driving a coach and horses through the
proposition that Ministers have put forward in this clause and the next
one. However, on the basis of both the evidence that I have been given
by outside groups and my intuitive reading of the way the clauses are
constructed, for what it is worth, it is at least worthy of a
response.
Mr.
Boswell: I shall not detain the Committee to prevent the
Minister from responding. I just want to say that the hon. Member for
North-East Derbyshire was on to a substantial and good point: we are
changing the whole conceptual basis to encourage people to emphasise
the positive rather than highlight
the negative. That must be welcome, and is across the Committee. We need
to be able to deliver it. My concerns are twofold and congruent with
what has been said, which I need not repeat.
My first concern is about
friction in the process. We must hammer home the point that those
people are non-expert, sometimes inarticulate, vulnerable, confused and
worried about their situation. Many people come to us as constituency
MPs with problems about medical assessments, and with stories that are
sometimes well founded, sometimes not. Undoubtedly, the process is
stressful, and the more it is simplified and made acceptable to them,
the better. One assessment is in principle better than two, and if it
is necessary to move from one phase of that assessment to the other,
that may be a reasonable compromise.
My second concern is with legal
friction, embedded in a clause that I drafted, new clause 6, which we
shall debate later. It is about the hat that the assessor wears at any
one time, about whether it is clear and fair to the claimant, and about
whether the assessors are properly trained. We have all heard stories
about doctors who have had an off day. That is not to subvert the
system of medical assessment, but to say that there are difficulties.
It applies legally, too. With that structure, carefully constructed
though it is, there may be huge evidential arguments about whether the
assessment was carried out under the terms of clause 8 or clause 9,
while the poor claimant says, “I don’t care. All I know
is that I went to my doctor, and I didn’t get my
benefit.” That is the human side and the legal side.
Finally, there is the
conceptual issue. Clauses 8 and 9 bear on the capability for work or
for work-related activity. They are not tests about whether work has
been carried out or whether work-related activity will be carried out,
but prospective tests about a person’s capacity for them. I find
it increasingly difficult as I reflect on the issue to see the logical
distinction between work and work-related activity. There may be some
functional differences, and the Minister will talk to them, but I
cannot see the essential difference. If that links into the operational
factors, the claimant’s concern, and the difficulty with
producing a harmonised and coherent structure whereby it is clear at
all times who is doing what to whom and whether the procedure is
appropriate, the Committee should at least reflect on whether we have
created an unnecessary complication in our effort to help
people.
Natascha
Engel I understand that the hon. Gentleman is to visit the
Derbyshire pathways to work programme in my constituency. It has been
fantastic. He will hear some stories that the Select Committee, and
myself as a constituency MP, have heard. The staggering part about the
individual human stories that he has discussed is the shift
from a tick-box medical assessment of what cannot be done to a
more employer-based, support and training-oriented capability
assessment. That is exactly what the Bill is about: to ensure that we
focus on the job that a person can do, get them job-ready through
condition-management programmes, and give them the skills that
employers need. The assessment is outside work, but it faces work. That
is the crucial difference.
Mr.
Boswell: The hon. Lady is eloquent. I am very much looking
forward to my visit to Derby, I have heard good reports, and I expect
to be able briefly to share them with the Committee when I return next
week. She is right, and our intentions are all the same. My only worry
in simple terms is with a familiar phrase that chills many of our
constituents. If one walks into a room and says, “I’m
from the Government. I’m here to
help you,” that is the danger. The intentions are good; no one
questions that. However, we must translate those intentions into a
system that achieves our shared objectives.
Debate
adjourned.—[Mr.
Heppell.] Adjourned
accordingly at twenty-four minutes past Ten o’clock, till this
day at half-past One
o’clock.
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