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Session 2005 - 06 Publications on the internet Standing Committee Debates Parliamentary Debates |
Welfare Reform Bill |
The Committee consisted of the following Members:John
Benger, Chris Shaw, Committee
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attended the Committee Standing Committee ATuesday 24 October 2006(Morning)[Mr. David Amess in the Chair]Welfare Reform BillClause 8Limited
capability for
work 10.30
am Danny
Alexander (Inverness, Nairn, Badenoch and Strathspey)
(LD): I beg to move amendment No. 171, in
page 7, line 6, at end
add— ‘(7) A person
authorised to exercise the functions in subsections (2) and (3) may be
required to undergo such training in relation to claimants with
particular impairments and health conditions as the Secretary of State
may by regulation
require.’. It
is a pleasure to serve under your chairmanship once again,
Mr. Amess, and I am looking forward to continuing these
debates in the positive spirit in which they have been conducted so
far, especially, if I may say so, from the Government Benches, from
whom the only party political remarks we have heard have
come.
Danny
Alexander: I notice that the hon. Gentleman on the Tory
Front Bench, from a sedentary position, seems also to be engaged in a
pilot scheme of being nice—he is managing reasonably well so
far. No doubt, however, we shall be able to get some more rancour into
the debate as the week goes
on. Amendment No. 171
would allow the Secretary of State to require those carrying out
assessments of claimants with particular impairments or health
conditions, in relation to limited capability for work, to be trained.
The amendment probes the Government’s intentions in that area.
Given the range and complexity of disabilities, impairments and health
conditions that might be encountered in the assessment process, as
described in previous debates, it is important to ensure that assessors
have the required degree of training, knowledge and understanding of
the full range of those conditions or
impairments. It is
interesting to note that in some cases specialist nurses are used
already for assessments in relation to disability living allowance,
specifically to ensure that specialist knowledge is brought to the
assessment. By contrast, however, personal capability assessments so
far have relied exclusively on general practitioners, but it is widely
believed, particularly by disability lobby groups, that GPs’
knowledge of some conditions or impairments might not be sufficient to
make a reliable
assessment. The amendment would empower the Secretary of State to order
such training as might be necessary to bring them up to
speed. Currently there
are no statutory obligations for training for medical assessors in
relation to certain disabilities, particularly in relation to mental
health conditions, learning disabilities and so on. A higher level of
understanding of those non-physical conditions would help to reduce the
current high level of appeals and their high success rate. For example,
in 2003 nearly 48 per cent. of appeals against the refusal of
incapacity benefit were successful; indeed, 68 per cent. were
successful when a citizens advice bureau or other adviser with
expertise in the appellant’s condition attended the appeal. In
many cases, the lack of knowledge of the nature of the condition or
impairment at the initial PCA is cited by appellants as a reason why
they think that the first decision was wrong. The amendment aims to
bring more specialist knowledge to the
PCA. Mr.
Tim Boswell (Daventry) (Con): The hon. Gentleman will not
be surprised to hear that I am very much sympathetic to the lines of
his argument; they are entirely congruent with what we have heard from
disability and other organisations over the
years. Would the hon.
Gentleman accept that there are two practical problems with his
amendment? First, in relation to multiple conditions, is it possible
for any one examiner to have the sufficient range of knowledge to be
able to embrace all the difficulties and their interaction? Secondly,
in order to produce the full range of expertise it might be necessary
to have a panel of people examining simultaneously, which could be
extremely daunting for the
claimant.
Danny
Alexander: The hon. Gentleman makes two very good points.
Of course, it might be asking a lot for the same doctor to have
expertise in every single potential condition, impairment or
disability. That is a valid point, and if the answer was to have a
panel of people who a claimant might appeal to, that too might be
intimidating. It could also reinforce some of the biggest problems with
the assessment process at the moment.
With regard to disability
living allowance, specialist nurses can be called upon where someone
with a particular condition is presenting. Bearing in mind that in the
application for employment and support allowance the applicant has to
spell out their reasons, it should be possible to predict with a large
degree of accuracy the cases in which some form of specialist input
might be useful. That could mean either ensuring that the doctor who is
carrying out the assessment has the requisite skills, knowledge or
understanding or,if they do not and if no one in that
particular locality has those skills and experience, making sure that
another specialist doctor or a specialist nurse could be brought
in. I am not seeking
to create an unnecessarily burdensome or intimidating assessment
procedure. What I am seeking to probe is the extent to which the
Government consider it important that specific knowledge of health
conditions or disabilities is included in the assessment process to
ensure that it is
accurate. This is also important in relation to fluctuating conditions,
particularly those, such as MS, where specialist knowledge of the
condition may be useful in carrying out an assessment.
Particular representations have
been made to me in relation to people with autism or autistic spectrum
disorders. According to the National Autistic Society, 40 per cent of
GPs do not have enough information to make informed assessments in
relation to disorders on the autistic spectrum. It is worth noting that
only 6 per cent of people who are autistic in some way are in
employment. That is an incredibly low figure compared with 49 per cent
for disabled people as a whole. This may, therefore, be an area where
having a degree of specialist knowledge throughout the assessment
process would really help to add value at all stages. I shall be
grateful if the Minister will address that point specifically in his
response.
John
Robertson (Glasgow, North-West) (Lab): The training for
assessors has been brought up in the past and I know that
Mr. Hood said that we would not have any stand part debate
on this clause, so I feel that this is a good point to raise
it. Training in
general terms is a concern of many bodies that represent people with
disabilities; the fear is that a general practitioner would be given a
job as an assessor with absolutely no knowledge of some of the problems
suffered by the people that they would be assessing.
Can my hon. Friend the Minister
allay my fears on that, and maybe go into some detail on the training
for assessors? Can he also clarify the point on collation of
information? I mentioned that when we debated an earlier amendment. It
is important that he reiterates the fact that we would pull in all
information and, if all the information were not available, we could go
back over it a second time to gather any missing information.
The hon. Member for Inverness,
Nairn, Badenoch and Strathspey (Danny Alexander) makes good points
about the fact that it may be necessary to bring in more than one
expert for discussion. I would like to know what sort of liaison is
carried out in relation to talking to the medical experts, whether they
are, for example, experts on injuries or on mental
health.
Mr.
Ruffley: Welcome to the Chair, Mr. Amess, on
this grey morning—not as cheerful as the other days when you
have been in the Chair.
I would like to tease out from
the Minister a couple of points which bear on what the hon. Member for
Glasgow, North-West (John Robertson) has just said. On the question of
the types of people who would be doing the assessing, the Secretary of
State in evidence to the Select Committee in the Spring this year
said, “my understanding
is that people agree that we should involve the skills and expertise of
a wider relevant range of healthcare professionals to help us do
this.”
“Wider” implies wider than
is the case under the current regime. He went on to
say: “There
will be a list of people, I am sure, occupational therapists and
physiotherapists and others, but who actually is involved in individual
assessments I think is going to have to be something we discuss with
people over the next few months.”
That is fair enough; the Secretary of
State says that a wider range of specialists and professionals will be
involved. I think I know which group polices and executes the
conditions under the current regime, but it would be extremely useful,
given that the Secretary of State was generous in saying that he would
consult on involving a wider range, if the Minister could give us some
information on that.
That brings me to my second
point. Does it trouble me? I do not know—it niggles a bit at the
back ofmy mind. In evidence to the Select
Committee,Dr. Boardman of the Royal College of Psychiatrists,
who gave a lot of evidence for the excellent Select Committee report on
the pathways programme, set a hare running—certainly in my mind,
if a hare can be set running in a person’s mind, and I think
other people were also worried—on the question whether there
would be enough people to carry out the wider assessments. Obviously,
there will be more varied assessments under provisions in these clauses
than under the current regime; we all know that.
The idea was floated that lay
people could be trained to carry out the mental health assessments,
which is an interesting idea. The reason I want the Minister’s
view on that point is that Dr. Boardman is very distinguished and a bit
of a player in incapacity benefit reform. He said to the Select
Committee that “it is
quite possible, for example, to train anybody to do a perfectly good
interview with somebody with a mental health problem and come up with a
reliable judgment. This is used in research all the time. When we look
at the results, say, of the OPCS survey of Psychiatric Morbidity in
Great Britain, a national survey, this was all done by lay interviewers
using a particular form of structured interview.”
I do not know what is in the mind of
Ministers but that distinguished psychiatrist raised the possibility of
lay people carrying out mental health assessments. I do not have a
preconceived view, but I would be interested to know whether the new
regime will recruit lay assessors for the mental health component of
the tests that we are considering.
My final point relates to
observations fromSue Christoforou and Mind. I shall quote,
becausethe quotation raises powerfully the main issue of this
amendment and a theme that is a leitmotif of the whole Bill. We have
personal advisers under the pathways programme and we will have
personal advisers under the new regime, but do they and will they have
enough training? Later I hope to show that the advisers themselves do
not feel that they have enough of a skill set to be able to do the
extra things required of them under the new regime.
Mind
said: “The
majority of doctors who carry out
PCAs”— this is
under the current
regime— “will be
locums. Most will be GPs who have done a day’s work and will do
PCAs in addition.” This
is Mind’s view; I am not necessary impugning all those who work
with and for Atos Origin. I have seen a simulated version of Atos
Origin’s PCA in Woking and it seems to be a professional
company. “They
do get some condition-specific training but it is very limited. They
certainly do not have much in-depth knowledge of mental health problems
in the experience of our”—
Mind’s—
“advisers who work with people
with mental health
problems. I spoke
recently to one of our welfare rights advisers. She attended, I think,
50 PCAs with various clients and in only one case did she find the
person to have any understanding of what the issues were, to treat the
person with respect, and to conduct the assessment at a pace that could
give the person the opportunity to discuss as much as needed to be
discussed in order for the assessment to be thorough. So I think, given
that40 per cent. of people in receipt of incapacity benefit at
the moment have a primary diagnosis of mental health problems, not to
mention whatever per cent there is of the rest of the caseload who have
a secondary diagnosis, it has to be the case that the doctors
conducting PCAs have to have a thorough, possibly NVQ level three
mental health training at the very least, as indeed should decision
makers, in order to make proper
judgments.” 10.45
am We are talking
not about decision makers here, but about the cutting edge assessment
that is the subject of the clause and the amendment. I certainly know
from one of the Department for Work and Pensions reports on evaluation
of pathways that the NVQ level 2 was the average for incapacity benefit
personal assessments. An NVQ level 3 in mental health is being asked
for here. Those
observations may be partial. Perhaps Atos or Ministers will dispute
what Mind has said, but it is an interesting debating point which
relates to the amendment. I should be grateful if the Minister
responded to that point. I have no idea whetherDr.
Boardman’s suggestion that lay people can be trained to do
mental health assessment is sensible or not, but it would be useful to
hear the Minister’s views on that and on the point that the
Secretary of State raised in evidence to the Select
Committee.
Kali
Mountford (Colne Valley) (Lab): Good morning,
Mr. Amess. Earlier in our deliberations the Minister
outlined a process whereby, at the early stages of an assessment, a
paper sift would be possible. I have been looking at cases in my
constituency and at the level to which the NHS can now treat conditions
that hitherto were untreatable. I cite the case of a woman in my
constituency who was horrifically attacked. She was unfortunate to be
attacked but lucky to be alive, given the extent of her injuries. She
would like to work now but, unfortunately, the consultant vascular
surgeon who is treating the injuries to her brain says that she would
be ill advised to do so because he has been able to stabilise her only
enough to be at home, not to be able to go out to work.
Under the current system,
people looking at my constituent and answering the questions would
assess her as suitable to work because they would not look closely
enough at the consultant’s advice. I want the new process to
take account of such clear advice from a consultant that someone would
be harmed by going through the process, and that the injuries are such
that it could be a threat to their life if such a process were to
continue. We should all be assured that the almost daily advances of
medical science can catch up with the process that we are trying to
deliver for another part of someone’s
life.
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