Mr.
Boswell: This possibly answers or anticipates the
Minister’s answer to my specific question about what might be
termed the legal cover for this exercise. Should a possible model be
that the assessment process—it will be a process rather than a
spot event in many cases—is monitored or signed off by a medical
practitioner, drawing on information that others, who might not be
formally qualified but who are appropriately trained, bring to that
assessment?
Mr.
Murphy: On the point made by the hon. Member for Bury St.
Edmunds, the issue is to continue that conversation to find out the
most appropriate way to support people with mental health experience. I
am happy to have that conversation with him and others.
On the specific point made by
the hon. Member for Daventry, through the PCA and the revised PCA a
medical health practitioner would carry out the assessments, so
technically they would sign off the assessment. It is important to put
that on the record. However, they would not make the decision. They
would make the assessment, but the decision maker would make the
decision. Hopefully that reassures the hon. Gentleman that a medical
professional would be involved in the
assessment.
Mr.
Boswell: I am grateful to the Minister for that assurance.
Does he not also agree with something that I have gleaned from my
experience from Jobcentre Plus: when the decision maker considers the
report of the medical practitioner in a PCA case even now, it is not so
much that they hold up their hands and say, “The whole thing is
wrong medically” but that they refer it back? There is then a
dialogue, or expression of views, which enables the process to be
refined and cross-checked.
Mr.
Murphy: The hon. Gentleman raises, for the first time in
our proceedings, this important point: a decision maker is not in place
to second-guess the medical assessment of Atos Origin. The decision
maker is a legal necessity, as the legal responsibility lies with them.
The decision maker, when looking at the paperwork, might say,
“Two contrary boxes have been ticked. This does not make sense.
A procedure has not been followed,” after which they would go
back to the
assessor and ask more questions to probe further. The decision maker is
in place to ensure that processes have been followed and that there is
a robustness to the journey for the customer. They will then make their
decision based on
that. It is important
to say clearly that the decision maker has a legal responsibility, and
that they have a responsibility to ensure that processes have been
followed. They are not in place to overrule, in a medical sense, the
recommendations from those who carry out the
assessments.
Kali
Mountford: My hon. Friend has just made an important
point, but it brings into question what happens when two medical
opinions directly contradict each other, particularly where conditions
are more rare or less well understood. This might be a difficult area,
although possibly a small one. Where a contradiction of opinion exists,
how can it be properly ironed out to the satisfaction of the person who
is being assessed?
Mr.
Murphy: That is another important point. On the revised
PCA, the individual carrying out the assessment would ultimately make
the judgment. You would not thank us for going through the whole
customer journey again, Mr. Amess. Jobcentre Plus would
initially ascertain whether it thought it was appropriate for the
person to go for an assessment or whether they could immediately be
admitted to the support group based on paper evidence. We would prefer
that to be the route for most entering the support group. Ultimately,
the decision as to the impact of that illness, ailment or condition on
a person’s ability to undertake work-related activity or to work
at all will be a decision of the person carrying out the assessment.
All the evidence provided in writing and in the face-to-face interview
would be taken into account. Ultimately, the person doing the
assessment is the arbiter of all the different evidence. They will
reach a conclusion and make a recommendation that will go to the
decision maker. The customer, who will also increasingly have the right
of reconsideration, will then have the right of appeal. Additional
medical evidence—perhaps from their GP—will be heard on
appeal. As my hon.
Friend acknowledges, it is important to make a distinction between the
different medical views: a GP is there primarily to diagnose, rather
than to assess the impact of the relevant condition on the
customer’s ability to work. There will be two different medical
practitioners for two different purposes. On appeal, the issue about
which my hon. Friend is concerned could be raised.
We had a one-minute
conversation about why the amendment is not technically necessary:
because in our process there is a flexible power to amend training as
is necessary. I encourage the hon. Member for Inverness, Nairn,
Badenoch and Strathspey, who has been offered additional reassurance,
to withdraw his
amendment.
Danny
Alexander: I am grateful for that detailed response. I
take on board the Minister’s points about the legality of the
amendments. However, I press him
for clarity on three further points. Not wishing to try the
Committee’s patience, I shall do so briefly. Some of what he
said at the end of his remarks was important and needs to be teased
out. The Minister
finished by discussing the role of the decision maker, an issue that
could be brought up under a number of clauses. It may as well be dealt
with now. During our last sitting, we discussed the process by which
someone went from their assessment for limited capability to work to
their assessment for limited capability for work-related activity and
then, potentially, on to their work-focused health-related assessment.
In a previous sitting, the Minister stated that a claimant is
potentially sanctionable if they do not turn up for the work-focused
health-related assessment and that the Government intended the claimant
to take part in that assessment immediately after their assessments for
limited capability for work and for work-related activity. That hangs
crucially on the question of when the decision is taken and the
decision about entitlement to the benefit support component, or
whatever, is taken. If someone attending a first work-focused
health-related assessment immediately after the other two assessments
can be sanctioned at that point, that implies that the decision is
taken when the Atos Origin doctor decides, not when the information
goes to the decision maker to confirm, as the Minister said, that the
process has been gone through properly and so
on. My point is
important legally. Someone could be sanctioned following their decision
not to participate in a work-focused health-related assessment because
they believed that the decision as to whether they were entitled to the
support component was wrong and they wished to appeal. I should be
grateful for the Minister’s clarification on that
point.
Mr.
Boswell: I understand the sensitivity of the hon.
Gentleman’s point. Having reflected on the process at the
weekend, I thought that it must be open to any claimant or customer, at
any stage, to abort the process—or rather not allow the process
to advance beyond the stage under consideration—unless and until
a decision had formally been taken. In other words, if this is a test
on limited capability for work, it would be open to the Department to
say, “Without prejudice to this test and the formal decision on
it, would you like to be considered for limited capacity for
work-related activity?” However, it would be open to the
individual to say, if they wished, “No, I want the issue out of
the way. Then we can come back and consider any subsequent issues under
later
provisions”.
Danny
Alexander: I am grateful for that intervention, with which
I partly agree. I was convinced by the Minister’s previous
remarks that it made sense for the assessments for the limited
capability for work and for work-focused activity to take place at the
same time, and that the break that the hon. Member for Daventry wants
the claimant to have could legitimately take place after the assessment
for limited capability for work benefit, and before the work-focused
health-related assessment. The question whether one is entitled to the
benefit is one of the criteria that is considered before a sanction can
be applied. If someone has a work-focused health-related assessment
immediately following that, but before a decision maker has taken the
decision, that decision not to attend should not be sanctionable. I
apologise for going into this matter now, but as we are following on
from the Minister’s remarks about decision makers, I thought it
was worth pursuing. I
have a couple of other quick points. The Minister gave a comprehensive
list of training that Atos Origin doctors are required to undergo,
which I found very encouraging. One thing that he did not mention was
training on when it would be appropriate to bring in outside advice, in
other words training on making decisions about whether to bring someone
else in when the person making the assessment does not realise that he
has reached the limit of his expertise. It is important that doctors
can make that decision and that the decision maker, when looking at the
file, can say that perhaps someone else should have been brought in and
perhaps the procedure was not followed properly in that case.
An earlier point about the
opportunity to bring these matters forward with Atos Origin concerned
revisions of its contract. Will the Minister tell us whether that
contract is being revised anyway in the context of the Disability
Discrimination Act 1995? If so, does that provide an opportunity to
make some of the points that we have been discussing in this important
debate
clearer?
Mr.
Boswell: In order to pave the way for the
Minister’s response, does the hon. Gentleman agree that the
Minister owes the Committee a moment of time on the use of logic-driven
protocols as part of the process as against the by and large
assessments which have perhaps applied in the
past?
Danny
Alexander: I am grateful for that intervention. The hon.
Gentleman, with his usual degree of foresight, predicts the third point
that I wish the Minister to address. The personal capability assessment
works through logic-driven protocols and the logic-integrated medical
assessment system. Some of the disability organisations and others who
are involved in the consultative groups for the redesign of the
personal capability assessment have been given only limited information
about the LiMA computer system that is used to administer the
assessment. It is therefore important to consider how it
works. Answers are
prompted by questions about a person’s typical day, for example.
That is a good way to have the conversation. I can fully accept that.
Answers are inputted into the system using, wherever possible,
pre-coded responses. When one asks about a typical day and certain
responses come up the doctor is asked to fit the response into a
pre-coded response. The pre-coded responses themselves are then linked
tothe descriptors which are described in some detail in the
documentation about the revised PCA. That link between the pre-coded
responses and the descriptors is where the question about protocols is
particularly important.
Will the Minister consider the
following point? The stakeholder groups—I assume that they will
continue to help manage the process of changing the
assessment—should continue to be involved not just
with the descriptors that are being used, but also with the operation of
LiMA and its effectiveness. If possible the external stakeholders
should be engaged in an ongoing basis in monitoring the effectiveness
of LiMA so that we make sure that the link between the pre-coded
responses and the descriptors continues to be valid and does not lead
to decisions being made which perhaps the Government or the Committee
would not intend to be
made. 11.45
am
Mr.
Murphy: In seeking three specific points of clarification,
the hon. Gentleman tempts us to reopen our entire debate. I will try to
respond to those three specific areas. The first area was when and how
the decision is formally taken and the relationship between that and
the Atos Origin assessment. As we discussed in a previous debate, if
someone attains the 15 points and is therefore entitled to
ESA—we can have another competition as to whether that amounts
to success or failure and that comes down to perceptions—and in
the same interview someone meets one of the 46 descriptors that we have
listed on page 18 of the draft regulations, then of course they would
be in the support group. There would be no conditionality and there
would be no requirement to undertake the work-focused health
assessment. If someone
at that point says, “I do not want to be written off. I know
that I have 15 points and I know that I meet one or two of the 46
descriptors but I still want to be in this system,” they would
get the support group level of benefit, so they would have the higher
rate of benefit. If they still wished to undertake the work-focused
health assessment at that point they could do so. Regardless of what
happens to them in that work-focused health assessment, if they do get
closer to the labour market, based on the assessment that was
undertaken by Atos Origin that they did have 15 points and did meet one
of the descriptors, they would continue to receive that higher rate of
benefit, as being part of the support
group. Where Atos
Origin says that a person has 15 points and meets one or more of the 46
descriptors, the Atos Origin medical expert could then defer the
work-focused health assessment. The decision maker would then examine
all the paperwork. He is not there to second-guess the medical
assessment of the medical expert from Atos Origin but simply to ensure
that all of the procedures have been followed and that everything has
been done within the laws that we agree on and the regulations that
will be decided at a later point.
If the customer is told that
they have the 15 points and are entitled to ESA but they do not meet
any of the 46 descriptors and therefore they are not in a support
group, they would be asked to undertakethe second interview
for the work-focused health assessment. If the customer decided not to
attend that interview there would be no sanction at that point. Any
sanction, if appropriate, would be enacted at the point where a
decision maker received the paperwork and the assessment took place.
The customer would, of course, have the right of appeal as they have
throughout this process on any decision that impacts on their level of
benefits. I hope that reassures the hon. Gentleman.
Atos Origin does an important
and technically difficult piece of work for us all and all of our
constituents. They know as well as we do that in the past there have
been problems with their systems and they have sought to resolve those.
The figure for the number of complaints about Atos Origin is down to
0.3 per cent. We can continue to find ways to reduce that 0.3 per cent
even further. With
regard to disability organisations getting access to LiMA, they are
happy to share that methodology and information with the disability
organisations and, if they wish, will be happy to organise
demonstrations of how the system works and dry run some cases to ensure
that there is greater understanding of the
system.
Mr.
Boswell: The Minister has been very helpful in giving
those assurances. May I take him back to something that he said a
moment ago about the decision-making process when he tied the main
function of the decision maker to ensuring that processes are correctly
carried out? Let me rehearse with him some wider concerns, which might
or might not apply to the decision maker. If, for example, there is an
examining doctor and there appears to be a pattern building up of
racial prejudice or a particular blind spot on some medical issue,
would it be in the powers of the decision maker to have a conversation
with the examining doctor about it? The conversation would not strictly
be about the paperwork or the process. A skewing of the conclusions
might give rise to concern, however, and it ought to be addressed or
examined.
Mr.
Murphy: The hon. Gentleman raises an important point, but
it is better if the management information systems rather than the
decision maker pick up on the issue. Work is under way to ensure that
the systems are designed to pick up on wide variations in outcomes that
are based on common character traits or the circumstances of the
individual customer. There are different ways of implementing and
assessing the 15 points or the 46 descriptors. If there are differences
at the extremes, whereby one medical assessor has a 95 per cent.
outcome for access to the support group and another has none, something
is happening, and it is for the management information systems to pick
up on. I do not agree with the hon. Gentleman about the way in which we
pick up on that important point, but it is important that we do
so.
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