Mrs.
McGuire: I shall deal first with the Northern Ireland
issue. The hon. Gentleman may have helped the whole Committee by
raising this point, because it can be confusing when we talk about
Great Britain, the United Kingdom and Northern Ireland. He makes the
point that we are a country of union, and that Northern Ireland,
Scotland, Wales and England are all part of the United Kingdom. I
thought, however, that he realised that for some significant years,
Northern Ireland has had its own social security system, which often
mirrors—if not exactly mirrors—the provisions of our own
social security system. However, the actual powers have resided in
Northern Ireland. I think that I am right in saying that we have a
reciprocal agreement. I know that that sounds like peculiar terminology
in the context of the United Kingdom, but that is just the way it is.
We have had that agreement since 1976, so it is not something new or
innovative that we are imposing in the Bill to link in with the current
situation. I hope that that addresses some of the issues raised. It is
long held in legislation that Northern Ireland has a slight
separation, but the situation often mirrors, and may well exactly
mirror—I do not want to be caught out on a
technicality—the social security system in the rest of the
UK.
Mr.
Boswell: I am grateful to the Under-Secretaryfor
that explanation. I suspected that it might be something along those
lines, but the amendment is intended to maintain the entitlement to a
benefit, not the actual payment of it, for the comparatively short
period of six weeks, not least for administrative reasons. She has been
slightly unclear as to what would happen if, perhaps for no more reason
than taking a therapeutic holiday or staying with a sister in Northern
Ireland, a claimant was to move over there. Would the benefit be
maintained or lost? What would happen for the weeks spent in Northern
Ireland? Would the claim not fall and be replaced with a Northern
Ireland claim? We do not seek to trap the Under-Secretary, but she
might like to reflect on that at length or at her
leisure.
Mrs.
McGuire: I reassure the hon. Gentleman that, because of
the agreement between the social security system in Northern Ireland
and that of the other parts of the UK, which I called a reciprocal
agreement, people moving from one jurisdiction to the other do not lose
out on any non-means-tested benefit. The situation is, in a peculiar
way, unified in terms of the individual’s right to be
protected. Amendment
agreed
to. Amendment
made: No. 54, in clause 17, page 15,line 2, at end
insert— ‘( ) Except where
regulations otherwise provide, a person shall be disqualified for
receiving a contributory allowance for any period during which he
is— (a) absent from
Great Britain, or (b)
undergoing imprisonment or detention in legal
custody.’.—[Mrs.
McGuire.] Question
proposed, That the clause, as amended, stand part of the
Bill.
Danny
Alexander: I shall not detain the Committee long, but
there are important questions to be answered about a number of the
provisions of the clause. It is worth noting in passing that, under
previous clauses, we have discussed a number of different rules.
Failure to follow them will mean that people can have their benefit
sanctioned. This clause makes provision for circumstances in which
someone can be disqualified from receiving benefit at all. It mentions
the power to disqualify someone from receiving employment and support
allowance on the grounds of
misconduct, “the failure
without good cause to follow medical
advice”, which is loose
phrasing, or the failure without good
cause “to observe any
prescribed rules of
behaviour.” That means
that someone who has gone through the assessment process and been
identified as having limited capability for work, and is therefore
entitled to receive the employment and support allowance, could
nonetheless be disqualified from receiving it and therefore receive no
benefit at all for up to six weeks. That could happen to someone who
had become of limited capability for work or who remained in that
category, through their own misconduct.
The Under-Secretary has rightly
made the point that provisions to disqualify someone from benefits
already exist in incapacity benefit legislation. She said that the
Government were seeking to repeat those provisions in the context of
the Bill. I do not wish to be thought of as a pedant, but I should
point out that under IB rules someone can be disqualified
where “he fails without
good cause to attend for or submit himself to such medical or other
treatment as may be required in accordance with the
regulations”. Clause
17 replaces that fuller wording with the term “medical
advice”. Will the Under-Secretary spell out what is meant by
“medical advice”? Does it mean that someone who has had a
work-focused health-related assessment and refused to follow the
suggestion to seek further medical help or condition management, or
advice from their GP to go for a counselling session, could be
disqualified for ESA?
The term “prescribed
rules of behaviour” is also worryingly vague. What do the
Government envisage by it? The matter was brought up in an earlier
amendment. I hope that, in applying the clause, the Under-Secretary and
the Government will take into account the possible effect of such rules
on those with behavioural problems or other mental health conditions
that might affect their behaviour. Any prescriptive sense that certain
forms of behaviour are required in order to qualify for benefits could
have worrying implications for people in those categories. I would
welcome any further information that she could provide on that
point. There is a
further question on the point about medical advice. If someone is to be
disqualified for benefit for a failure without good cause to follow
medical advice, to use the Bill’s language, what is likely to
count as “good cause”? Who will provide the evidence that
someone has failed to follow medical advice? Will it be their GP, or
the doctor or other medical practitioner who is required to carry out
the medical
assessment?
Mr.
Boswell: Would the hon. Gentleman not also like to reflect
on the difficulty of what happens if the person’s GP and the
doctor examining on behalf of the Department take a different view
about the appropriate course of medical
action?
Danny
Alexander: The hon. Gentleman makes a pertinent point.
There might be a disagreement about medical advice. We know from our
earlier discussions about the clause on work-focused health-related
assessments that the attendance at such an assessment could be subject
to a sanction—in other words, someone’s failure to turn
up could lead to their benefit being sanctioned.
It was made clear by the
Secretary of State in a letter to me, and by other Ministers, that any
particular course of medical action or treatment is not subject to a
sanction, yet the Bill provides that simply failing to follow medical
advice will potentially be grounds for disqualification from benefit
altogether. We are not simply talking about someone having their
work-related activity premium sanctioned, but about their being
disqualified from benefit overall.
I am sure that the Government do
not intend to reverse the undertaking given on work-focused
health-related assessments in the context of this clause.None
the less, the rather vague language used about the severe penalty of
disqualification from benefit warrants a little more of the
Committee’s attention, so I look forward to the
Under-Secretary’s
response. 5.45
pm
Mr.
Boswell: I think that the
Under-Secretary will probably shortly be telling us that the clause is
again about delinquency or a wilful refusal to follow the rules. In
that, we can be sympathetic to the Government’s position.
Equally, I find my notes on the clause in sympathy with the comments by
the hon. Member for Inverness, Nairn, Badenoch and Strathspey. I
suppose that the answer to both is that we need to strike the right
balance with the right kind of consultation to ensure that the rules
work. I, too, have
some points that I would like to emphasise. First, we should check the
coverage because it appears that the disqualification rules are not
confined to those on the employment component and could apply also to
those on the support allowance. I think that Ministers might need to
reflect on that because once somebody has limited capacity for work,
they are within the frame, and if they are unable to participate in
work-related activities, they would move on to the support component. I
cannot see how that sensitive route is excluded by the
clause. My second
concern relates to serial disqualification. The Minister has made it
perfectly clear that the intention is to deal with a short-term
situation, but as far as I can see, there is nothing in the clause to
stop an officer taking the view that somebody should be disqualified
and then disqualified again, as it were, indefinitely. Will she respond
to that
point? Following on
from that, I am concerned about the definition of misconduct,
particularly if relations with the claimant are bad or, to be honest,
if the official has a bee in their bonnet. It would be arguable,
although I would think not in this Committee, that somebody with a
condition induced by smoking or the misuse of drugs such as cannabis
might well have a psychotic condition that has resulted in their
limited capacity for work. We can all take different views about the
balance between deploring or even trying to sanction such behaviour and
being understanding, but the general spirit of the Committee is to try
and take people as they are and to work with them to get them back into
the labour market. I
am genuinely concerned that somebody might within the rubric of the
clause be able to say, “It is your own fault that you have got
yourself into this position of being unable to work”. Let us
take obesity: “You are a very fat slob and should not be in that
position, but now you cannot work.” I do not think that that is
what the Under-Secretary is targeting in the clauses, but I would like
her assurance that that is the
case. I shall move on
to the underlying concerns of the hon. Member for Inverness, Nairn,
Badenoch and Strathspey, which I too have flagged up. Let us consider
people with conditions that are somewhere between the medical and the
social. I am thinking about addictions, whether to alcohol or drugs,
or—I make a distinction
between these—mental health conditions that might well fluctuate.
Those are certainly medically relevant conditions, but they concern the
person’s behaviour as well as medical condition. It would be
quite wrong to think about disqualifying, because of misconduct, people
who had a serious drink or drugs problem and whom one is trying to help
through pathways. The references to “medical advice” and
“without good cause” might make that easier, although it
is difficult to know how we tie that down or determine how far it is
being complied with. In all seriousness, the
Under-Secretary will be aware that many people who have got into such a
situation might lead pretty chaotic lives. In the great scheme of
things, it might be their fault, or they might have contributed to
their own difficulties. That might well be true and the origins or the
pattern of difficult behaviour might go a very long way back, but to
remove a benefit for six weeks because of misconduct might not be the
most fruitful thing to do, or the fairest.
I hope that the Under-Secretary
will reflect on that balance and respond to the concerns that have been
expressed. In no sense does anyone here wish to subvert the intention
to stop delinquency, but it is important that the provisions are tied
down to that and not to wider
considerations.
Mrs.
McGuire: I am pleased that the issues have been aired,
because that allows us to deal with some of the concerns that have been
raised. I hope that I can, once again, give some comfort to Committee
members. The
hon. Member for Daventry (Mr. Boswell) asked whether people
with mental health conditions would feel as though they were being
victimised by the clause. I reassure him, and other colleagues too,
that we will not disqualify any claimant without taking into account
all the relevant factors, such as the likely impact of an illness on
their ability to understand and comply with advice and evidence from
their own medical practitioner, or without giving them the opportunity
to explain their position. I must reiterate the words “good
cause”. Disqualification takes place where there is no
“good cause”. I hope that the hon. Gentleman will have
appreciated, as we have progressed through the Bill, that we recognise
the seriousness of people’s fluctuating mental health
conditions. Medical
advice and treatment has been a part of IB for many years. The IB
legislation contained the words “medical treatment” and
that has never caused any great concerns. I hope that hon. Members
recognise that we would not anticipate using this power in any
overwhelming way. I
think that the hon. Member for Daventry was backing up comments made by
the hon. Member for Inverness, Nairn, Badenoch and Strathspey about
whether people could be disqualified if they did not take advice to
give up smoking or lose weight. If that were so, a lot of Committee
members would not qualify for our jobs. No names, no pack drill. We are
not anticipating using the power in that way; we would use it only
where, for example, a claimant disregarded without good cause advice
from their general practitioner or hospital specialist regarding
generally accepted, reasonable and non-invasive treatment that
would significantly improve their condition. The GP will determine the
medical advice, although it will be an issue for Jobcentre Plus advisers
to decide about whether there is good cause to disregard that
advice. Danny
Alexander: I welcome that clarification. However, if
someone failed to follow medical advice offered by a GP or another
medical practitioner on a work-focused health related assessment, which
is considered reasonable as Ministers have described it, would their GP
then have to make an assessment? How would it work in those
circumstances?
Mrs.
McGuire: To a certain extent, perhaps we are talking at
cross purposes. The powers under the clause are intended specifically
to deal with those people who wilfully or intentionally try to get
round the regulations relating to the new employment and support
allowance by not following standard medical advice. For example,
someone may not take their medication to manage their condition, which
would put them in a worse medical condition than if they had followed
standard
advice.
Mr.
Boswell: The Under-Secretary of State has made it clear
that the basic responsibility for medical advice lies with the
claimant’s GP. As I understand it—she will disabuse me if
I am wrong—that advice is privileged between the GP and their
patient who is, for this purpose, the claimant. Therefore the personal
adviser, or the person who has conducted a work-related health-focused
assessment, has no locus in the matter. It would be an entirely private
matter if the GP said, “You should no longer take these drugs or
you should take more of these drugs,” and the person failed
todo it.
I fully
understand the Minister’s assurance that this may be a
precedence in IB and may never have given rise to any problems, but
there is the potential of a confidentiality problem. Of course, if
someone conducting an assessment on behalf of the Department sees an
acute medical condition, they have a professional duty to draw that to
the attention of any medical adviser in the patient/claimant’s
best interests. There is at least a sensitivity there. The Minister may
like to reflect on how this will be tied up and who best will carry it
out.
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