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Welfare Reform Bill
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Publications on the internet
Welfare Reform Bill
Welfare Reform Bill
The Committee consisted of the following Members:
James Rhys, Committee Clerk
† attended the Committee
‘(d) allowing a suitable person, as defined under regulations, to participate with or on behalf of the claimant in a consultation to determine the questions mentioned in subsections (1) and (2).’.—(Jenny Willott.)
The Parliamentary Under-Secretary of State for Work and Pensions (Maria Miller): I will continue with my comments on the amendment. As I was saying before we adjourned, I was not sure whether it was the intention of my hon. Friend the Member for Cardiff Central to table an amendment that would allow an individual to have another individual attend an assessment in their place, but that is what the amendment would do.
The face-to-face consultation will play a pivotal role in the assessment as a whole, allowing the nuance of how a health condition or impairment affects the individual specifically to be explored in a two-way discussion. It also provides an opportunity to observe an individual, consider their mental state and directly assess any physical impairment, if relevant. As such, it is critical that the individual themselves be part of the process wherever possible.
We recognise the importance of ensuring that the assessment process is appropriate to an individual’s circumstances and appreciate that face-to-face consultations may not be appropriate in absolutely every case—for example, when there is sufficient evidence on which to make an assessment for those individuals with the most severe impairments or those who are terminally ill.
My hon. Friend raised concerns about the work capability assessment and the role of advocates within the system. I assure her that individuals are encouraged to bring someone along for support if they feel that it would be useful. Atos Healthcare, the organisation that provides the work capability assessment, ensures that training includes guidance on how to work effectively with advocates.
Jenny Willott (Cardiff Central) (LD): From my experience and that of other hon. Members, I understand that there are instances in which people have not been allowed to take the advocate into the assessment with them, and other times when an advocate has been allowed to go in but not to say anything, participate in any way or even assist in the assessment. What will the
Maria Miller: Although I do not want to stray too far into the work capability assessment, I assure my hon. Friend that we very much believe that advocate supporters have an important role, and we certainly see them playing an important role within the personal independence payment scheme and the work capability assessment. There could be circumstances in which advocates might not have a positive role within an assessment process, but I am sure that such cases will be few and far between.
It is important to us that advocates have a role, whether in the PIP scheme or the work capability assessment. If there were instances in which that was not happening and my hon. Friend brought it to my attention or the attention of my right hon. Friend the Member for Epsom and Ewell, the Minister, I am sure that we would be interested in looking into the matter further.
It is, of course, essential to get the PIP processes right. No conclusions have been reached yet on the delivery model for the new assessment, and we are therefore keen to work with disabled people and disability organisations to develop appropriate processes that reflect and cater for individuals. I hope that with those reassurances, my hon. Friend feels that it is appropriate to withdraw her amendment and feels encouraged that we are very much in the same place on this issue.
Jenny Willott: I am reassured that the Minister sees the role of an advocate as important in the process and that the Department is “encouraging” their involvement. “Encouraging” is a good word; it is positive and proactive, and I am reassured that it reflects the Department’s attitude. There are problems with how the work capability assessment will be rolled out across the country. Given that the Minister has highlighted her belief that advocates will play an important role in PIP assessments, I hope that the Department will take on board some of the issues with work capability assessment advocates when PIP assessments are rolled out.
I am reassured by the Minister’s words, however, and I appreciate that the wording of the amendment has some unintended consequences. I clearly did not mean that someone should be able to attend an assessment in place of someone else. Given that the wording is dubious, I beg to ask leave to withdraw the amendment.
‘(d) exempting certain groups from a requirement to participate in a consultation to determine the questions mentioned in subsection, (1) and (2).’.
‘(9) Regulations shall exempt people with prescribed medical conditions from the requirement in subsection (4)(c), including in prescribed circumstances where the individual is—
(i) severely mentally impaired;
(ii) a double amputee;
(iv) undergoing haemodialysis;
(v) severely visually impaired; and/or
(vi) meets the requirements of special rules set out in Clause 80.’.
Jenny Willott: The amendment is about exempting some people from the initial assessment. The Minister mentioned in her comments on the previous amendment that the Government see that some people should be exempt—those with terminal conditions, in particular. She mentioned some other exemptions as well, so I will be brief, and grateful for more detail.
As the principle has already been accepted, the amendment is for teasing out a little more what the Government are thinking. I appreciate that the proposal does not need to be in the Bill, but it is a good opportunity to raise some of the issues. Until now, some cases have been exempt from regular assessments; a selection is set out in amendment 218. I was trying to be less prescriptive about some cases, but others are laid out clearly. Some disabilities are so serious—people are born with certain conditions—that they will never change. Assessing those in the most severe categories seems a waste of time and money.
For some groups, in particular those with various mental health conditions, assessment worsens their condition. I have examples from casework, as I am sure other Members have. In a work capability assessment, a GP may in effect sign people off, by stating that it would not be appropriate for them to go to regular reassessments for the purposes of continuing their employment and support allowance, on the basis of the detrimental effect on mental health. How that works involves a number of issues, and it applies to a very small number of people, but through the amendment I hope to explore whether there can be a similar mechanism for PIP assessments.
Some of the disability organisations have suggested a tiered approach to assessment, so that we start with the paper evidence in the self-assessment and from medical professionals. If the evidence justifying a PIP is already there, so be it; if more evidence is needed, that person can go to a face-to-face assessment. That would mean that not everyone needs to go on to that second stage and some cases could be decided earlier, on the paperwork.
The amendment need not be included in the Bill, but it provides an opportunity for the Minister to clarify the circumstances and possibly to expand a little on the types of cases in which people will be exempt from the initial assessment. I hope that the Government will be generous about whom they consider to be in that category.
Margaret Curran (Glasgow East) (Lab): I will speak to amendment 218. I thank the hon. Member for Cardiff Central for some interesting points. My points are similar, but my emphasis in this amendment and some
Amendment 218 would secure automatic entitlement to the personal independence payment for the severely disabled. The emphasis that is different is that those conditions would be the same as for those who already automatically receive DLA because of the consistency argument and the message around that. I hope that my argument will become clear as I progress through my points.
I remind the Committee that the categories are: severely mentally impaired; double amputee; deaf-blind; undergoing haemodialysis; severely visually impaired; and terminally ill, which is already covered by clause 80. I understand the argument that I am sure the Minister will make—she has already done so this morning: some people believe that there should not be automatic entitlement because the issue goes to the heart of the principle of what is trying to be achieved. It is not about defining people by their disability, and it is not about an impairment-linked disability benefit. I understand those arguments, but my limited proposal would not undermine the principle. I have had some interesting discussions with groups and individuals about the matter.
My amendment would improve part 4 of the Bill in two major ways. First, it would greatly reduce anxiety among severely disabled people who fear having a test to prove their disability, and would have to have one again and again. It would provide a cost and administration saving on the needless assessment. It is important to appreciate that the amendment would give automatic entitlement for only six conditions. At the moment, around 41,500 severely disabled people of working age automatically receive DLA. In the grand scheme of reform, which will affect 1.8 million people of working age on DLA, the change would be small, but would make a massive difference to those who are incredibly anxious about going through a face-to-face assessment.
To put the matter into context, I had asked the Minister how many new claimants of working age for PIP payment could be identified year on year, so that we had some sense of the scale. She could not say; I got that answer on Monday. However, if the number is 1.8 million overall, around 600,000 will have to be reassessed per annum, which is around 11,500 every week or around 2,300 every day. That is a monumental exercise, so my amendment to exempt 41,000 is a small matter. Given the circumstances in which the people involved live, it is also reasonable.
The Minister will know that there is widespread support within the disability movement for an amendment to retain automatic entitlement for those with severe disabilities that will clearly not change during their lifetimes. Many organisations understand the social mobility model and the arguments about people not being defined by their impairment, and they argue their case strongly. The Disability Benefits Consortium says:
“PIP will not have any ‘automatic entitlements’. However, if it is clear that certain impairments will always meet the criteria for PIP then PIP should include automatic entitlements in these cases, as they provide an easy way of awarding benefit to people who are certain to qualify and mean money is not wasted on assessments that could be spent on supporting disabled people. PIP should include automatic entitlements for those cases where an individual’s impairment means they will always meet the criteria for the benefit”
“a retrograde step which would not only introduce uncertainty for claimants, but would remove an administratively straightforward process from a small number of well-defined groups. This runs counter to wider efforts to streamline benefit administration.”
“The case for the deaf blind and severe visual impairment higher mobility provision is very strong. The numbers of visually impaired people getting DLA (where visual impairment is the ‘main disabling condition’) are broadly the same as the numbers registered, so automatic entitlement based on registration and certification evidence would be accurate, objective, administratively simple, cost-effective and easy for claimants to understand. Existing experience of DLA, where an assessment is carried out by a non-specialist, is that the assessment is often inaccurate or clear medical evidence is misinterpreted”.
We must address the stress and anxiety of face-to-face assessments for those who clearly need help. Wholesale reform of DLA will have massive implications for millions of disabled people, as I have already said. We cannot underestimate or brush aside the level of anxiety that many people feel about that. The prospect of going through a face-to-face assessment and having ultimately to prove their disability to receive help is incredibly stressful and worrying for many, many disabled people.
“My other general concern - as someone with no sight at all and who is registered deaf blind - is the withdrawal of automatic entitlement. I can’t really see the point. Certification as vision impaired is done by an eye consultant with whom one usually has a long-term relationship and who knows your case history and the impact of your sight loss intimately. I cannot see how a so called ‘objective’ assessment can replace this.”
Wherever possible, we should do anything to try to ensure that the transition to PIP is as smooth and calm as possible. Surely protecting the severely disabled from facing an assessment is one way in which we can do that. We know that the Government plan on spending £675 million on the establishment and administration of PIP. That is a huge amount of public money and I am sure that we will continue to talk about it. However, just a small amount could surely go some way towards dealing with my concerns.
I shall refer to some of the points made in the briefing paper that the Minister issued last week, which picks up some of the matters raised by the hon. Member for Cardiff Central. The briefing note published by the DWP last Friday suggests that some people may not be subject to face-to-face assessments. It states that assessments will be carried out with a trained assessor but, in some cases, a paper-based assessment may be more suitable. Just to repeat the comments made by the hon. Lady, I would be grateful if the Minister said what that will actually mean. Although a paper-based assessment is better than a face-to-face assessment, it is still an assessment and it means that we are taking away that automatic entitlement and guarantee. The use of such an assessment does not fundamentally address my points.
The briefing note has also produced some draft indicators that are beginning to shape our understanding of the Government’s direction in relation to the assessment
One set of draft indicators that are causing concern are those that affect the severely visually impaired. Of course, that is relevant to the discussion on clause 78, as the severely visually impaired are one of the groups that the amendment seeks to cover with regard to automatic entitlement. I presume that Committee members know that the previous Labour Government worked very hard and successfully with disabled people and their organisations to campaign for those with severe visual impairments to be automatically entitled to receive the higher rate of DLA mobility. Under the current proposals, some 25,000 severely visually impaired people stand possibly to lose out as a result of the decision to discard a hard-fought-for and much-agreed-upon policy development.
What is more, according to the draft indicators before us today, it is becoming increasingly apparent that the Government plan not only to stop thousands of severely visually impaired people from automatically receiving PIP, but to go a step further and separate claimants into two specific groups: those who have adapted to their visual impairment and those who have not. That raises ambiguity and questions about what aids and adaptations will be taken into account. I ask the Minister for clarity on that because a lack of clarity raises alarms and concerns.
I am obliged to note that the Minister supported automatic entitlement for severely visually impaired people no later than June 2010, when she indicated that she was: “committed to making sure that help gets to the people who need it.”
The core point that I am trying to make is about the guarantee of the entitlement, so that people know they will receive it, rather than their needlessly having to go through an assessment that everyone knows they will probably pass, with the administration costs that go with it. It is important that we look at those issues and see whether we can amend the Bill appropriately.
This is an important amendment. It seeks to avoid needless assessment that will both cost the taxpayer money and put unnecessary stress on the disabled person who must now prove that they have a severe disability before they are given support. Does the Minister think that people with the conditions listed in the amendment, such as severe mental impairment and those I have already described, should always have to undergo an assessment? Currently the Bill automatically gives PIP to only one group of people—those who are terminally ill. While we agree with that decision and welcome it, we urge the Government to go one step further. The issue matters fundamentally to the people in this category
Maria Miller: We have reached an important point in the debate. We have found an important point of difference between the Government’s approach to the reform of DLA and the Opposition’s approach. One of the firm, underlying principles of what we are doing is to recognise each and every disabled person as an individual. That is important. For too long, disabled people have been labelled by their disability rather than considered as individuals. Blanket assumptions have been made about what people can and cannot do simply because of their conditions. We do not feel that that is an appropriate way forward and the responses to our consultation would tend to suggest that many others would agree with that stance.
We recognise that people live varied and complicated lives and do not fit neatly into boxes. Many people will have multiple conditions. The hon. Member for Glasgow East referred to individuals who are deaf-blind. That is a condition that deteriorates over time. There is a risk in simply saying that an individual does not require some sort of touch point with the Department to make sure that their needs are being met. Individuals who are looking for support from various benefits should be able to make sure that they are in receipt of the right level of support for their conditions.
Sheila Gilmore (Edinburgh East) (Lab): If the person is already receiving the highest rate of benefit, what is the purpose of further assessment at that stage? Is the Department putting itself in the role of a key worker for that individual to access other forms of support and is that something the Minister envisages the Department doing?
Maria Miller: The hon. Lady mentions individuals who are in receipt of the highest support. I am not sure which conditions she is thinking of. Those conditions might change over time. It is impossible to say that one would just exempt people from having a reassessment simply because they were in receipt of the highest support. I should like to assure the Committee that, in some situations, individuals might not need to come forward for face-to-face assessments. We could assess them through a paper application process, with supporting evidence that they did not need a face-to-face assessment.
I have been in discussions about various other opportunities as well, particularly for people with serious mental or cognitive impairments where it would be difficult for them to go to an unfamiliar place. We are already exploring opportunities for the potential of home visits or assessments in more familiar places. The previous Government created this principle so that lone parents could go to interviews while they were in receipt of income support. They would go to Sure Start centres for assessments—an extremely good way to ensure that individuals regularly attended the interviews, being mindful of the restrictions that might affect them.
Lilian Greenwood (Nottingham South) (Lab): I want to pick up two points. First, my hon. Friend the Member for Edinburgh East said that, under the current rules, those who are deaf, blind or severely visually impaired
Secondly, the Minister seemed to imply that the Opposition did not seek to treat disabled people as individuals. The point about automatic entitlement is made in a joint submission for the visual impairment sector, which speaks on behalf of a number of people dealing with visual impairment and deaf-blindness. I do not feel that we are out of kilter with the views of the disabled people whom we seek to represent.
Maria Miller: I apologise if I misunderstood the hon. Member for Edinburgh East. I did not realise that she was particularly focusing on those groups. When an individual is in ongoing receipt of the highest benefit, there may always be ways in which we can assist people to look for new ways to try to support them with their impairment. PIP might have a role not in removing the support that is there, but in ensuring that they get access to the right level of support.
The hon. Member for Nottingham South mentioned briefings that she received from various groups. She may be aware that there is a difference of opinion between groups on whether it is appropriate to look at an individual’s impairment and passport them through as a result of a specific impairment. That is a debate for another day. It is an important principle that we look at the people first and foremost and at the effect that the condition has on their ability to participate in daily life.
Kate Green (Stretford and Urmston) (Lab): I want specifically to ask the Minister about the point she made a moment ago about the possibility of assessment in people’s own homes. Of course that would be welcome and appropriate in a number of cases. However, many people cope better in their own homes than when they are out and about. Will the Minister assure us that the individualised approach that she talks about will properly reflect whether people can function, not just in their homes, but in the wider community?
Maria Miller: The hon. Lady makes an extremely important point. We are in no way suggesting that the proposal is an attempt to reduce or identify inaccurately the support that an individual needs. As we move forward, it is right to explore different ways to assess individuals. The hon. Lady might be aware that we already undertake some home visits where appropriate—this is not a completely new idea—but she is right to caution and to want to ensure that the assessment is accurate.
A number of hon. Members referred to the DLA blind measure recently put in place. It is important that the Committee knows why the Government decided to proceed with that. The previous Administration worked on that important measure for a number of years, because of DLA’s failure to tackle or accurately assess the needs of individuals who are blind. Our decision to proceed with the measure underlines the DLA’s shortcomings. Its assessment criteria simply do not accurately pick up the needs of individuals who are blind. We talked earlier about mobility and the fact that because someone could not walk, they will be deemed as in need of further mobility support. The current
Margaret Curran: May I ask the Minister to clarify what she has just said? She seemed to be arguing that the Government extended a benefit that they did not agree with because it was not structured or organised properly and it had fundamental flaws. Why did the Government agree to extend a benefit that they fundamentally disagreed with?
Maria Miller: We agreed to implement the DLA blind measure because we want to ensure that support is there for people who need it. As the previous Administration had identified, DLA was not supporting people who were blind. They proposed a measure that took an extremely long time to introduce. The legislative structure of DLA meant that the allowance was not easy to amend. Such provisions are mainly defined not in regulations but in primary legislation. In a nutshell, the reason why we have introduced this measure is that we want blind people to get the support that they need and, at the moment, DLA fails to give them that.
Lilian Greenwood: Will the Minister clarify how many blind people are missing out on the opportunity to get extra help with the costs of their disability? How many extra people will be able to claim PIP and how much will it all cost?
Maria Miller: If the hon. Lady had been following the earlier part of the debate more closely, she would know that we cannot define that yet because we are in the process of finalising the assessment. We will produce more detailed figures in the future.
At the risk of us all incurring the wrath of Mr Gray, we should perhaps go back to the issue at hand in amendments 202 and 218. For most people, a face-to-face consultation with a trained independent assessor will play a key role in creating a much fairer, more objective and more transparent assessment process. Such a consultation will also provide individuals with the opportunity to put across their own views on how their health conditions or impairments impact on their everyday lives. We recognise the importance of having a system that is flexible to meet each individual’s needs. As I have outlined, we will have those flexibilities inbuilt in our system.
In proposing these amendments, my hon. Friend the Member for Cardiff Central mentioned individuals who are born with disabilities and conditions that do not change. She said that they could benefit from an assessment exemption. At this stage, we do not propose that the new PIP would apply immediately to children. We want to take time to learn from the initial implementation of PIP and then look at how we can simplify the assessment process for children as we move forward, working in consultation with our colleagues in the Department for Education and the Department of Health.
I take issue with my hon. Friend’s key point. It is important that we help people as their conditions change and evolve over time and that we have a real understanding of the multiple conditions that they face. The way in which conditions change can be variable. Blanket treatment of individuals opposes one of the key and underlying principles of PIP, which is that of treating each person as an individual.
The broad condition types are listed in amendment 218, which was tabled by the hon. Member for Glasgow East. They do not necessarily say much about need and the impact that the impairment has on the individual. We may not need to see some people with such conditions on a face-to-face basis, but that may be the only way in which we can truly understand the support that other people need.
Exempting individuals with prescribed conditions would fail to reflect any co-existing condition that an individual may have. Such conditions could have a far greater impact on the individual, but that may not be identified simply because they are defined by the principal condition. It is precisely for those reasons that, although we accept and appreciate that face-to-face consultations are important for the majority of people, we will have exemptions, but we will not state them in the Bill.
Maria Miller: As I said earlier, there will be situations where a face-to-face consultation may not be required because of paper-based evidence. There may well also be cases where such a consultation may not be required in a prescribed place because of a serious mental or cognitive impairment, and we could then provide home visits. As my hon. Friend the Member for Cardiff Central said, the important thing is that we ensure that the way that we assess individuals is as flexible as it can be. We have also made it clear that we will continue the special rules for terminally ill people, and we do not plan to ask them to attend face-to-face consultations. I hope that those comments reassure my hon. Friend and the hon. Member for Glasgow East and that my hon. Friend will feel able to withdraw the amendment.
The Chair: Order. I am conscious that it is rather warm in the Committee Room, and therefore hon. Gentlemen may, if they wish, take their jackets off. That is contrary to my normal practice; I will not be doing so, but hon. Members may.
Jenny Willott: We have had an interesting debate about exactly how the proposal will work. I am aware that we have strayed into the territory of the next group of amendments, so I am sure that the debate on them will be quick. I am glad that the Government will consider paper assessment to be appropriate for some people.
Stephen Timms (East Ham) (Lab): I think that I understand where the hon. Lady is heading with her remarks, but I urge her to stick to her guns with the amendment. From the Opposition’s point of view, she made a telling case in introducing her amendment, which was expanded further by my hon. Friend the Member for Glasgow East, and we have had a vague
I am glad that the Government accept that it is not appropriate for everyone to have a face-to-face assessment. That principle is quite important. I am also glad that they are exploring alternative ways of doing an assessment, because those of us who have been Members for a while are always coming up against cases where people have not been treated appropriately for their disability. Taking that into account and doing assessments in different places might make the system simpler for people to participate in. Our recent debate on advocates is a crucial example of why we need them to be encouraged to be part of the system and for them to be accepted as part of it. If we assess a broad range of people, it will be hard for many of them to get a fair hearing without support and advocates working with them during the assessment.
Kate Green: Does the hon. Lady share my puzzlement at what the Government are assessing in respect of the people whom she encompasses within her amendment? Their conditions are severe and unchanging, and it is clear that even paper evidence will simply reinforce evidence that was received two, four, six and eight years ago.
Jenny Willott: Amendment 202 actually relates to the initial assessment only, and the next amendment that I tabled is about the ongoing reassessment of people. I agree with the hon. Lady that an assessment is not necessary for some people who should be entitled to PIP. I understand where the Minister is coming from when she says that she wants everyone to be assessed at the beginning of the system, but I have some issues. Some people should be exempt, but the Minister has made it clear that there will be some exemptions, and we have to see, in time, who the Government include in those exemptions.
I hope that the Government will keep an open mind and see how the system works in practice, because there is a whole world of difference between the theory—the way that legislation and guidance are put together—and how it is implemented. An awful lot of the cases that we have seen as Members of Parliament, where people have had difficulty with the structures currently in place, were never foreseen, or the difficulty was caused by the way that something was implemented, rather than the bare bones of the structure. It will be important to see how the system is actually implemented on the ground. A lot of that will involve working with Atos and how it implements the system. The Department can have various policies in place, but if they are not implemented by Atos, we have a whole load of problems.
Maria Miller: I absolutely endorse what the hon. Lady says. This is an iterative process and we will always learn along the way, but may I gently remind her that Atos has not been chosen to implement this programme? Any assignment of that contract will be done through the usual procurement processes.
Jenny Willott: I am glad to hear that, and I hope that the Government keep an open mind about who they might consider for running the assessments as well. I hope that, in keeping that open mind and learning from how the system works in practice, the Minister will consider, over time, adding categories and conditions to the list that would be exempt from initial face-to-face assessments. She referred to flexibility. I hope that the Government will consider extending that flexibility as we learn and possibly include other people in the exempt category, so that we learn from the experience as PIP is rolled out. Given that there are already exemptions and that the Government intend to make them, it seems clear that the amendment is not needed; it is already possible to make exemptions.
Stephen Timms: Does not the hon. Lady accept that the Minister has plainly refused to give her the reassurances that she is seeking? I accept that there is another mechanism by which such things might be done, but the Minister has given absolutely no assurance that that will happen.
Jenny Willott: It is clear that the amendment is not necessary. We do not need to amend the Bill for such things to happen. I might not completely agree with the Minister on how many people are exempt, who is exempt and how that operates, but it seems clear to me that the amendment is not needed for that to happen.
Maria Miller: Perhaps the right hon. Member for East Ham is not clear about what I said, so perhaps I should make it absolutely plain that, where we have sufficient evidence to make an assessment for someone with the most severe impairments, we would not expect to undertake a face-to-face consultation.
Jenny Willott: We are discussing how many people are considered exempt—the categories and conditions for which the Government would consider an exemption from the initial assessment. Clearly, the legislation does not need to change for that to happen. There is now a debate about who is considered in that category and what process there is for considering more people.
Kate Green: The hon. Lady talks about categories being deemed exempt from face-to-face assessment, but my understanding is that the Minister is saying that individuals will not be required to go for face-to-face assessment. Does the hon. Lady accept that that is rather different from the assurance that she seems to think that she has heard?
Stephen Timms: Several Committee members find themselves in a slightly difficult position. We agree with the case that the hon. Lady has put to the Committee and disagree with the response that the Minister has given. We would like the opportunity to vote in favour of the amendment that the hon. Lady has moved and support the argument she has put to us. I hope that she will give us that opportunity.
Jenny Willott: I am sorry to disappoint the right hon. Gentleman, but I do not intend to push the amendment to a vote. It is quite clear that we do not need such a measure in the Bill. There is going to be a lot debate in future about which categories and individuals should be exempt, but we do not need the amendment in the Bill for that to happen and for people to be exempt. I beg to ask leave to withdraw the amendment.
‘(d) exempting certain categories of people from any requirement to participate in an assessment (or repeated assessments) where their diagnosis, or available medical and other expert evidence, is deemed sufficient to determine the questions measured in subsections (1) and (2).’.
This should be a brief debate, because we strayed into this territory in the debate on the previous amendment. The amendment is designed to make it possible for some people not to have to go for reassessment, so that, after the initial assessment, they do not have to be reassessed regularly. In some cases, it is a waste of resources to do that when people have a condition that we know will not change, or will certainly not get any better. Reassessments were raised with me by a constituent whom I mentioned earlier and whose 29-year-old son has Down’s syndrome and a mental age of less than six. That condition is never going to change—it probably will not get much worse, but it certainly will not get better. His condition will be constant throughout his life. Reassessments seem to me to be a waste of time and money, and it causes stress for him and his family to go through them regularly.
That point applies to a range of different conditions; there are degenerative conditions such as Parkinson’s, motor neurone disease and multiple sclerosis, where there will not be an improvement, and someone will only get worse over time. I appreciate that the Government in effect want to keep tabs on how somebody’s condition is progressing, and I hope that the Minister can confirm today that they will consider paper assessments in circumstances where people’s conditions will not improve and they will not be taken out of eligibility for PIPs.
We have already discussed necessary exemptions for the initial assessment, but slightly different criteria apply to regular reassessments. There is probably a fairly limited group of conditions and a limited number of people involved, and it should be possible to do an assessment using a medical assessment, prognosis, GPs, consultants and so on, rather than requiring people to come regularly for reassessment. Given that we have had a lengthy debate about this issue, that is all I will add, but I hope that the Minister can reassure us on those matters.
Margaret Curran: I want to make a few points. Although similar arguments were made about an earlier amendment, there are a few points of principle wrapped up in this amendment too, and I wish to draw attention to them. I take the point that this is about reassessment, and perhaps we cannot cover the principle of assessment itself. However, enshrined in the amendment is the notion of categories of people, not individuals, and that is not in step with what the Minister has said, so I think that we need to resolve that issue. I support what the hon. Member for Cardiff Central said, as it is reasonable to look at categories. We are talking about a very limited number of people, which will not undermine in any way the general thrust of the Bill.
The hon. Lady also discussed the Government’s intentions. The implicit purpose of looking at individuals, rather than categories, is to keep tabs on people with such conditions. I have not yet heard a satisfactory argument about why it is necessary to keep tabs on certain people, or what the purpose is of doing so. If it is to ensure that people receive a range of support to assist them with their conditions, I would accept that argument, but I do not regard that as a function of the Department for Work and Pensions. It is more likely to be the function of the health service, or social care support. If it is to be the function of the DWP, that is a very significant development, which should be clarified this afternoon. It is very important to try to understand
Maria Miller: I do not want to repeat the points that I made on the previous amendment, but I will summarise our view for my hon. Friend the Member for Cardiff Central and reiterate some points that I have made. Although we think that face-to-face consultations are an important part of the process for most people, we accept that it will not be appropriate in every case. In particular, where we have strong enough evidence to make a decision on entitlement, a face-to-face consultation may not add very much value, and in such cases, a paper-based assessment of an individual may well be more appropriate. All individuals should be assessed, but we want the process to be tailored to individual circumstances and, most importantly, to be carried out sensitively, as emphasised in Professor Harrington’s review.
Lilian Greenwood: I am trying to understand the Minister. She seems to be saying that there will be a reassessment, albeit a paper one. If people are in receipt of the higher rate of PIP and they have a lifelong or degenerative condition, the purpose of the reassessment process is not clear. For example, if they are deafblind or have multiple amputations and are in receipt of the higher level, why do they need to be reassessed at all?
As the Committee knows, we are indeed considering the detail and the likely operational processes of the new personal independence payment. We recognise the importance of getting it right, which is why we are working with disabled people and their organisations as we develop such matters, ensuring that we can cater for individuals and individual circumstances.
If we should decide—for example, as a result of testing the assessment or in the light of operational experience—that we need to deem certain individuals exempt, we already have the powers to do so in clause 78(3)(a). For that reason, I cannot accept the amendment of my hon. Friend the Member for Cardiff Central, because it would duplicate an existing power in the Bill. However, perhaps the hon. Members who participated in the debate can, in summary, accept that it is our overwhelming desire to treat every person who applies for or is in receipt of a PIP as an individual. That is the main premise of this benefit.
We fully understand the issues raised in the consultation and in today’s debate. For some individuals, the standard approach is not an appropriate way forward. We have already made provision in the Bill to consider the matter further. In all cases, it is right to have a tailored and flexible approach so that we can, wherever possible, accommodate the needs of disabled people, in the way in which we would accommodate the needs of every other person in this country, not simply labelling them by their condition.
As I have said, the Bill includes clear provisions on terminally ill people. Those separate provisions, in clause 80, allow people to be dealt with quickly. It is remarkable
Jenny Willott: I appreciate the fact that the Government are considering different and less intrusive ways of reassessment. I hope that they make progress, because the process of reassessment can be extremely stressful, generating significant anxiety for many people, in particular those with mental health problems. For those with lifelong, unchanging conditions, facing yet another reassessment seems more of a drag. I am glad the Government are considering less intrusive reassessment.
Margaret Curran: I urge the hon. Lady to press the amendment to a vote. I take the point that the Government are addressing some of the concerns that have been expressed, but we need to take the opportunity to make provision in the Bill and to resolve some of what we are beginning to hear as contradictions, otherwise the people whom she is describing and whose cause she has advocate will not get the anticipated outcome. The best way to achieve that is to stick with it and to press the amendment to a Division.
Jenny Willott: First, the Minister has clarified the fact that the issue is dealt with in the Bill. Secondly, if Opposition Members wanted to press the matter to a vote, they should have tabled their own amendment. They did not table any amendments on the matter, although it was entirely in their hands to do so.
I am sure that it will become clear as the process continues that there are people whom it is simply not worth reassessing—it is not worth if from their perspective and it is not worth it from the Government’s perspective. I am reassured that the Minister clarified the fact that the Government will look at that in future and that the power is already in the Bill to take that into account. As the power is there already, the process will need to adapt with time. Strong views are clearly held across the House and by members of the public that there are people whom it is not worth reassessing and who should be exempt from the initial assessment. Given that the Government have accepted both those principles and the power is in the Bill, I beg to ask leave to withdraw the amendment.
‘(7) The Secretary of State must consult with appropriate organisations prior to drafting regulations made under sections 78(3), 78(4) and 78(5).’.
This is a less controversial issue. The amendment is linked to the previous amendments that I have tabled. It is about the importance of consulting disability organisations and individuals with disabilities. I am sure that the Minister agrees that it is important to consult at an early stage to avoid the mistakes made by the previous Government in designing the work capability assessment. If we can make the system better right from the start—particularly for things such as fluctuating conditions, which are a perennial problem in the assessment process—we can make life much easier for the people who are undergoing assessment.
I appreciate that the process is different from the WCA and that the system is entirely new. The fact that it is an entirely new type of assessment and a totally different benefit means that it makes sense to involve disability organisations and individuals from the start to try to get it right. I know that the Government consult constantly. In discussing an earlier amendment, the Minister mentioned the consultation that has already taken place with organisations representing disabled people. I would be grateful if she were to reassure us that the Government will consult both organisations and individuals, because they have an important voice that needs to be heard. We should ensure that we do not make the mistakes of the past, and that we design a system that needs fewer changes once it has been put in place.
Kate Green: I am pleased that the amendment has been tabled, for the reason highlighted by the hon. Member for Cardiff Central. It is clearly important that we improve the process from the outset, rather than having to catch up later by putting right badly designed provisions.
Will the Minister outline how the consultation process will be carried out? Will there be written consultation, with an invitation for people to put in written submissions? Will there be an opportunity for proper detailed work to be carried out with disability organisations and disabled people to design the detail of what the assessment will look like, and not just a high-level and generalist consultation in which those organisations and people express concerns? The lessons that I learned from the early stages of attempting to design the WCA were that that there were initial attempts to do that round table detailed design work with disability partners. After a time, that process became more difficult, and ultimately
Maria Miller: I assure my hon. Friend the Member for Cardiff Central and the hon. Member for Stretford and Urmston that consultation is at the heart of this programme of work, right from the start. The latter asked for an assurance that this is not only about high-level consultation. It is easy to reassure her on that, because we have been working with a group of specialist advisers of disabled people, representatives of organisations and health care professionals on the development of the assessment criteria, and we will continue to work with them on testing the criteria to ensure that the criteria are working in the way in which we want. As we move forward this summer, we will be doing grass-roots consultation and testing, and we will be talking to disabled people about our assessment and asking people to take part in testing the criteria. That will provide the rich feedback that hon. Members have discussed today to ensure that we get the new PIP assessment right from the start.
We will continue to work with disabled people and their organisations. We are planning to involve them in a number of ways as we design the operational processes—the way in which the assessment will be carried out. We have set up a dedicated PIP implementation consultation group specifically for that purpose. Membership has been drawn from a wide range of national and grass-roots user-led organisations. My officials and I have met many of them already, and we look forward to the work they are going to be doing with us on this most important part of the process. Many of them are people who have expressed an interest in working with us on the operational processes, and I look forward to progress as we move forward.
We will ask the group to look at the practical way in which operational issues will be developed. The initial list of issues will be discussed at the group’s first meeting on 16 May. I hope that that reassures the Committee that consultation and co-production are at the heart of the development of PIP. I stress that our approach is not only about meeting legislative requirements. The development of PIP will be, as the WCA has been, an iterative process in which we actively seek out opportunities to learn from our experience to ensure that we make the changes necessary to make it the success that we all want it to be. That is why we have already published initial draft assessment criteria, which are available on our website. Members of the public can access them now and e-mail or write in with their comments on the assessment criteria. We are being open and transparent about how the new support is being developed. We intend to publish a second draft of the assessment criteria in the autumn, building on the comments that have been made. I assure Committee members that we view this as an ongoing process and we will continue to work with disabled people and their organisations on the criteria after that point, as we work towards finalising draft regulations to submit for parliamentary scrutiny.
We are absolutely committed to transparency and engagement with disabled people. I hope that what I have outlined today will show that consultation is not at a very high level—to use the phrase of the hon. Member
Jenny Willott: I am reassured by what the Minister has said; clearly, a lot of work is already going on and will be ongoing. I appreciate that the work capability assessment is very different from the PIP assessment, but I hope that we can learn lessons from it when designing the PIP assessment—how it was implemented and what changes have been needed since then—and in particular incorporate the recommendations made by Professor Harrington. I am glad that so much consultation is going on. Piloting is a really important way of ensuring that the problems are ironed out before the regime is implemented, rather than testing it on people and finding out that it does not work when it has already been brought in.
Jenny Willott: I apologise for the wrong use of “pilot”; I meant “testing”. It is crucial to the credibility of the new assessment, as well as to having a system that works, that it is well tested and worked through with individuals with disabilities and the organisations representing them. If it does not have credibility and is not seen to be fair, it will not work. It is important to ensure that people are involved at an early stage and throughout the process, so that they feel that their voices are listened to and so where it does not work, the problems are identified and changes are made. Clearly, those things are already happening.
‘(7) The Secretary of State shall ensure that any assessment carried out under this section is performed by an individual who has access to sufficient skills and expertise appropriate to the impairment type of the claimant, as defined in regulations.
(8) The Secretary of State shall issue clear guidance outlining the needs of different impairment groups for the use of professionals assessing people under this section.’.
The amendment has two main purposes, both of which relate to the individuals who will carry out assessments. The amendment’s first aim is to require assessors to have access to sufficient skills and expertise about the impairment type of the claimant whose application is being assessed. The second half of the amendment fulfils our second aim by requiring the Secretary of State to issue clear guidance about the needs of different impairment groups, which will be used by those who carry out the assessment process.
As my hon. Friend the Member for Glasgow East has explained, we recognise that it is right to reform the DLA and accept that it is perfectly sensible to use a medical test as the basis for assessment, but we need to
“It is essential both for the applicants, and for the integrity of the benefit, that the assessments are carried out fairly and effectively. Studies have shown that various groups have been disadvantaged in the past due to assessors not understanding certain conditions. This causes distress to the applicant and their family; and can lead to a tribunal process which is costly to the state and often ends in the initial decision being overturned.”
The amendment applies to all types of impairment, but we are particularly concerned about two particular types, with which we are becoming familiar in Committee. The first is fluctuating conditions and how they will be assessed—the hon. Member for Redcar raised the point earlier today—because they may appear less severe than they typically are on the day of the assessment, and there are plenty of examples of erroneous assessments. If the person conducting the assessment has access to expertise and guidance for dealing with the impairment, there is a much better chance of being able to make a correct assessment when it is carried out.
The second group, which we discussed during earlier debates, is people with mental health impairment. We have been reminded that in his independent review of the WCA, Professor Harrington found evidence that some mental health conditions may be being inappropriately assessed at present. The briefing notes circulated by the Government on PIP, which we all received on Friday, strike me as muddled on what we can learn from the WCA about the assessment for PIP. The Minister has touched on that a couple of times today. The notes state:
“Employment and Support Allowance and Personal Independence Payment are different benefits paid for very different reasons. Any direct comparison between the Work Capability Assessment…and the new assessment for Personal Independence Payment is not therefore possible or helpful.”
It is an odd turn of phrase to say that it is not possible, and then to say that it is not helpful. Those couple of sentences from paragraph 8 on page 8 of the briefing note at least make the position clear. The Government believe that lessons cannot be learned and that a direct comparison cannot be drawn between the two.
I do not agree with the statement, but it is at least clear about the position. Although the benefits are different, there is no doubt that the WCA and the new assessment for PIP, given what we received from the Government at the end of last week, have striking similarities, at least in how they look. But the Government’s briefing is clear, and having told us that the direct comparison is not possible or helpful, it states:
“'We are, however, seeking to learn from the experience of the WCA. As part of this we are looking closely at the findings of the first independent review of the WCA carried out by Professor Malcolm Harrington in order to inform the design of the Personal Independence Payment claiming and assessment processes.”
Let me declare my position. I agree with the second part of that paragraph, which says that there are lessons that we can learn, and disagree with the first part, which says that it is neither possible nor helpful. It is important that the design of the PIP assessment process responds to the recommendations that the Harrington review identified and set out for the WCA.
“Mind supports the call for clear guidance for DWP staff carrying out the new PIP assessment We know from our experience of the Work Capability Assessment that DWP staff do not always have adequate knowledge and understanding of the ways in which mental health problems impact upon people’s lives, and their ability to participate in society. Nor do they always carry out the assessments in a supportive or suitable way, as the following quotes from Mind’s website demonstrate.”
“The assessors can hugely influence the answers by how they word the questions or how much they bother to probe to get the full truth. People with mental health problems feel ashamed of how bad things are and are unlikely to easily tell a stranger about their intimate difficulties unless that person bothers to ask in a way that is not judgmental and not many assessors are bothered.”
It is clear that for people with mental health impairments, there is a great deal of scope for getting things wrong. This amendment is intended to minimise the likelihood of mistakes by ensuring that the assessor has access to appropriate expertise and guidance.
I am not proposing that the person conducting the assessment must necessarily themselves have that expertise. Given the very large number of people who will be assessed—my hon. Friend the Member for Glasgow East has talked about the number of people going through this process—it may not be possible or practical for everyone carrying out the assessment to have that expertise. None the less, those conducting assessments should have ready access to somebody who can guide and advise them on how to make an accurate assessment of the various types of impairment that they will need to deal with. The precise details of what would constitute access to or sufficient expertise would be set out in regulations under this proposed new subsection.
Proposed new subsection (8) specifies that the Secretary of State must issue clear guidance outlining the needs of different impairment groups for the use of professionals assessing people under this section, which is important for several reasons. First, it ensures that every person
“In its 23rd report the Committee noted evidence that 40% of appeals against a decision that an individual is capable of work are currently upheld, so the quality of the guidance material provided to staff and the consistency of their decision making will be crucial to the scheme operating as intended.”
That seems to be an example of a case where the lessons learned from the WCA should also be learned for the assessment process for PIP. I hope that the Minister can welcome the intention of our amendment.
Kate Green: I share with my right hon. Friend a wish to draw on at least some of the lessons that we have learned from the experience of the introduction of the work capability assessment. As the Minister has comfortingly acknowledged, we are discussing a test with a very different purpose this afternoon. None the less, there are some interesting points that we can draw on when we look at where some of the discrediting of the WCA in the eyes of disabled people and those who work with them has occurred. They perceive that the independent assessors, the Atos assessors in the case of the work capability assessment, are not suitably qualified or do not have a suitable appreciation of or suitable expertise to assess the condition of the person in front of them.
We have heard repeated reports from disabled people who have been through the work capability assessment that it felt like a tick-box exercise, that it was routine and that it was not focused on their particular circumstances and condition. It is really important that for the gateway assessment for the PIP we have professional, expert people who can temper what will presumably be the structured approach to making the assessment with their own expertise and experience in making judgments and interpretations in relation to the answers and information that they receive.
This is not just a matter of technical expertise. It is not just a matter of having, for example, someone who assesses someone with MS being a specialist in MS, or someone who assesses someone with a visual impairment having a long-term specialism in blindness. Although that might be useful, it is unlikely to be sufficient if the person making the assessment lacks what in the business context are often called soft skills. Those are the skills around empathy and the ability to interpret and to communicate. Two-way communication was mentioned earlier today, and it means that the way in which the disabled person offers a response to a question or an
It is important that the assessor recognises that the setting in which they meet the disabled people for the assessment is not necessarily the only setting in which that disabled person will want to operate. We talked earlier about assessing people in their homes. That could be useful and appropriate, but it will only give the assessor a picture of the way the disabled person works in that setting. The person carrying out the assessment will need to be sufficiently expert and experienced to translate what they can see in front of them in the home setting to the wider social setting in which the disabled person may need to operate.
When I met Atos, the provider of the work capability assessment a few weeks ago, I was interested to learn that it uses a whole range of professionals to carry out the assessments. Those professionals could be GPs or medical professionals with full medical degrees. They could be nurses with a particular specialism, generalist nurses or occupational therapists in some cases. The explanation that was offered to us was that these people had had additional training by the company providing the test, which in a sense rendered their initial professional qualifications, as Atos saw it, as a matter of secondary importance.
That is all very well if the training that the people carrying out the assessments receive is good enough for them properly to carry out the tests and to deal with a whole range of conditions that they may come across. If it is not clear that the people carrying out the assessments are trusted to understand and appreciate the conditions that they meet and seek to assess, there will a real credibility problem—Ministers might want to think about that at an early stage. Will the Minister say something about the sort of standards that will be put into contracts for the assessment process to ensure that credibility in terms of the expertise, qualifications and skills provided by the assessors is both perceived and real?
On who might be given the contract to carry out such assessments, what discussions has the Minister had so far about the specific levels of staff training and qualification required, and the areas and issues that such training should cover? What monitoring and quality assurance processes does she expect the DWP to put in place to ensure that assessments are carried out by appropriately qualified experts and skilled professionals? Will those processes be kept under regular review, and can she assure us that feedback from disabled people who have been through the assessments will form part of that procedure?
Maria Miller: I thank the right hon. Member for East Ham and the hon. Member for Stretford and Urmston for their contributions. I fully agree with the right hon. Gentleman that the skills of assessors and the training and support available will be critical to the success of the reforms. The hon. Lady put her finger on the issue when she said that if we are to engender trust, we must have a group of people who are appropriate and have the right skill sets. We are giving a great deal of thought
In his opening remarks, the right hon. Gentleman described PIP as a medical assessment. It is not a medical assessment; it is more of an objective assessment, and that is important. The hon. Member for Stretford and Urmston said something similar on Second Reading, and it is an important point because that is one of the things that marks out PIP from other assessments. Now that we have a first draft of the assessment criteria, we will look at the matter in more detail and link it to our work on testing the criteria.
Early thoughts suggest that PIP will not necessarily be administered by doctors, and that a broader range of individuals may have more appropriate skill sets and be better able to carry out the assessments. Those include, for example, allied health professionals such as occupational therapists or physiotherapists. We are exploring that suggestion in our testing, and talking about it to disabled people. It is an important part of building the trust referred to by the hon. Lady.
Regardless of who is chosen, I assure the Committee that the assessments, including face-to-face consultations, will be carried out by fully trained independent and approved assessors. Assessments for ESA and the DLA are currently carried out only by health care professionals who have been approved by the Department’s chief medical adviser on behalf of the Secretary of State. Those doctors, nurses and physiotherapists have passed strict training and experience criteria and have received additional tailored training approved by the Department. Similar arrangements will apply for PIP and will include broad training in disability analysis as well as training on specific impairments. As I said at the start of today’s debate, disability is one word but it has many thousands of different meanings. It is important to get the training of health professionals in that area right, and we have learned from the work capability assessment, which I will come to in a moment.
Stephen Timms: I can well see how the use of physiotherapists adds choice of a kind. What sorts of skills would the Minister expect an assessor to have in the case of people with mental health impairments? Can she envisage a counterpart to a physiotherapist, for example, who could carry out the assessment when the impairment is a problem of mental health?
Maria Miller: I thank the right hon. Gentleman for his question. The very fact that we are assessing such a wide range of different disabilities means that we need a range of people available to assess. Many people who have a more physical disability might have allied mental-health problems, so I am not sure that one would necessarily want to say that one set of individuals has one type of assessor and that another set has another type of assessor.
If the right hon. Gentleman will forgive me, he is still falling into the trap of simply pigeonholing people based on their assessment. Many disabled people will have a physical impairment, a sensory impairment and perhaps even a mental-health impairment. I do not think that we can go down the route that he is suggesting.
Stephen Timms: I presume that the Minister would not argue that a physiotherapist would be an appropriate person to make an assessment of an individual when a mental-health problem was being assessed. What kind of people would be appropriate in that case?
Maria Miller: People who have access to trained individuals who have specialisations in mental health could well be how that problem would be dealt with. This is one of the many lessons that we are learning. Perhaps I can use the Harrington review as an example; the right hon. Gentleman highlighted that he felt somewhat confused about some of the information put out by the Department on Friday about the policy documents that we have issued around the assessment criteria. To clarify that for him, I should say that we are learning and will always learn from what we are doing with the WCA. The policy document that he was referring to discussed the assessment criteria. It would not be helpful to try to learn from the assessment criteria of the WCA in particular, because those criteria are to do with work, not everyday living, which is what PIP will be looking at in future. We can learn from the development process of the WCA and from its implementation.
We can particularly learn from the issue that the right hon. Gentleman raises about the professional skill set of the people undertaking the assessment. That is probably one of the biggest things that we have learned from the whole Harrington process. Harrington clearly said in his report that there is a need to ensure that those undertaking assessments have good qualifications and access to the sort of expert advice that the right hon. Gentleman mentioned. We are considering, therefore, the use of mental, intellectual and cognitive champions to support the assessment process for PIP in much the way that Professor Harrington discussed developments in how we ensure that we have the right assessment skills in place for the WCA.
Kate Green: Will the Minister say whether she has any plans to make use of the expertise of specialist disability organisations in offering training, particularly awareness training, to potential assessors? For example, I know that the National Autistic Society has offered to provide such training to the DWP and its contractors in the past, but it feels that, from time to time, its offer has fallen on deaf ears.
Maria Miller: There are two responses to that. One is “absolutely.” Drawing on the experience of the WCA and the role of some of the mental-health charities in supporting development in that area, we will be looking to work closely with specialist organisations in the training that is put forward. I would, however, take that one step further and say that we also need to look at the important role that user-led organisations can have in helping disabled people in this whole process.
The hon. Lady may be aware of an announcement that I have already made about a £3 million pot of money to help develop the role of such organisations throughout the country. In some areas, such as Norfolk and Essex, we have strong user-led organisations, but we do not in other areas. It is that sort of user-led organisation that can provide a great deal of support for disabled people through this process, and that will be extremely important as well.
There is a great deal to be learned from Harrington, and I hope that the right hon. Gentleman can understand where the mix-up has come in terms of his interpretation of the policy document. Ensuring that an individual who has been assessed has the opportunity to feed in properly and that their voice is heard; that evidence is gathered from the right people; that assessments are conducted by people with the necessary skills and training; and that those assessors have access to expert support where it is needed—we have learnt all those things very clearly from the Harrington process, and we will take them forward to the assessment and PIP.
On the other aspects raised by the right hon. Gentleman, I should say that fluctuating conditions have come up consistently. All hon. Members would expect that; it is very much to the fore of all our minds. It clearly exemplifies why we need individuals who have the right sort of training, but also have access to experts in other areas of disability to ensure that they are able to identify accurately when somebody is dealing with the realities of a fluctuation condition. We have designed the draft criteria to take account of physical, sensory, mental, intellectual and cognitive impairments, and it is essential that this assessment also deals effectively with variable and fluctuating conditions.
The assessment will not—I repeat, not—be a snapshot of one day, but will consider an individual’s ability to carry out activities over a period of time; we are suggesting a year. We will consider impacts where they apply for the majority of the time. The expertise of the assessor in looking at that on an individual case basis will be an important part of getting the implementation of this new assessment right. That is why we will continue to look at the skill sets of assessors, with disabled people and their organisations, to ensure that we get the balance right and that we have in place the sort of expert training that the hon. Member for Stretford and Urmston talked about.
Finally, I would like to turn my attention to the requirement to issue clear guidance. As expected, we will shortly begin the commercial process to identify who will be responsible for undertaking the personal independence payment assessment on a national basis. I assure the Committee that, whoever is successful in this process, clear guidance on how specific health conditions or impairments should be assessed will be available to staff undertaking the assessment. That guidance will also be made available to the public.
We will also ensure that there are clear monitoring and quality assessment and assurance processes in place, in much the same way as we spoke about earlier today in the debate about the provision of Welsh language access. It is that sort of quality assurance process that can help to ensure that we give every person who applies for the personal independence payment the sort of quality assessment and experience that we expect.
Given those assurances, I hope that the right hon. Gentleman will feel that we have a shared agenda. Given my clarification on what was included within the policy papers that were issued on Friday, I hope that he is assured that we will be learning very much from our experiences of the WCA, some of which were as a result of the work that he did when he was a Minister in this Department. I hope, therefore, that he will withdraw his amendment.
The Minister’s suggestion that physiotherapists might be used in future to assess people with mental health impairments could cause some concern. A lot of work would be required to assure people that those individuals can make accurate assessments. I am not ruling out the possibility of such people being used, but a lot of work will need to be done. I am grateful to her for recognising that much hangs on this measure and that a lot of work will have to be done to ensure that it is an effective process. As I do not intend to push my amendment to a vote, I beg to ask leave to withdraw it.
‘(10) The assessment process specified in Regulations under subsection (3) shall, prior to its national implementation, be the subject of a pilot, which—
(a) shall operate in one or more specified areas; and
(b) shall assess the impact on specific groups of people, including those with fluctuating conditions and mental health conditions; and
(c) shall receive a formal response from the Secretary of State.’.
The amendment intends to insert in the Bill a requirement that the medical assessment to ascertain eligibility for PIPs should be the subject of a pilot before its national implementation. It specifies three characteristics of the pilot. First, it should operate in one or more specified areas. Secondly, it should assess the impact on specific groups of people. Thirdly, it should be the subject of a formal response from the Secretary of State. Although it is a relatively modest amendment in its scope, establishing a proper pilot is important for ensuring that the transition to PIP is not fraught with problems. We debated some of the reasons for that when we considered the previous amendment.
My hon. Friend the Member for Glasgow East has already made it clear that we do not oppose the establishment of an objective test to assess eligibility for PIP, and we firmly supported the reform of the gateway. None the less, the Government need to tread very carefully. We have already heard some sensible suggestions, including those from the Liberal Democrat members of the Committee. The hon. Member for Cardiff Central, who is not in her place at the moment, was rebuked by the Minister earlier for talking about a pilot when she should have referred to testing. I am much more persuaded by the suggestion of the hon. Member for Cardiff Central here. I am not quite sure what the distinction is between piloting and testing. Perhaps the Minister can clarify that in her answer. Perhaps the difference is in the scale and the seriousness of the exercise that is envisaged, with piloting being a step higher than testing. If that is the case, I feel that piloting is the appropriate action.
It is worth reminding the Committee again of the huge scale of the operation that will be required to assess people for PIP. My hon. Friend has already referred to this. Some 1.8 million working-age people who currently receive DLA will have to go through the new assessment by the end of 2015 and beginning of 2016. On top of that, there will be a steady stream of new applicants and a fair number of appeals. We are considering a very large number of people having to be assessed for PIP over a rather short time. If the Government get this wrong, or the process starts to go wrong, the implications could be very far-reaching and there would not be much time to put things right.
Harriett Baldwin (West Worcestershire) (Con): I wonder whether the right hon. Gentleman has read section 7 on page 12 of the briefing notes. It goes into the timetable in great detail. It outlines how the process might be tested and refined and then tested again. I just want to understand his distinction between testing and piloting.
Stephen Timms: The pilot for which I am arguing has the characteristics set out in the amendment. However, as I said, it should be in one or more specified areas, not just in one place or a particular centre. The pilot should assess the impact on specific, identified groups of people, including those with fluctuating conditions and mental health conditions. After the pilot has taken place, the Secretary of State should produce a written response—an assessment—of the experience of it. If one could have a test with all those characteristics, I would be perfectly happy to say, “That’s fine and will do.” At the moment, I do not know whether it does. Perhaps the Minister will set out for us in a moment whether the test that she envisages will meet those three criteria.
There are several specific reasons for needing to be cautious about the matter. First, and probably most importantly, we need to ensure that the process assesses people’s circumstances properly. As we have already discussed, we need to learn that lesson from the establishment of the WCA. The Minister made the point that the process is likely to be iterative. I hope that most of the iteration will take place in the piloting before we start applying the assessment to people who currently receive DLA. If we are still trying to modify the system once we are in the large-scale process of putting existing benefit recipients through the new assessment, that could be a recipe for serious problems. I suspect that that point is likely to be made at the rally and event tomorrow.
There are certainly lessons to be learned from the WCA. Obviously, as the Minister says, I was involved in setting up the employment and support allowance and therefore in setting up the WCA. However, the Harrington review pointed out that the process still needed further refinement. For instance, Professor Harrington found evidence that some mental health conditions might currently be inadequately assessed. It is probably unrealistic to expect any new assessment process to be entirely without fault at the beginning. That is why we need to do everything possible to iron out the difficulties as early as possible in a pilot phase, rather than once the assessment is being used in earnest.
It is of the utmost importance that we identify and address as many problems as possible before the assessment process is implemented across the country. A proper
Stephen Timms: We did and, of course, the big difference with the work capability assessment is that that has not as yet been applied to existing recipients of incapacity benefit. It shortly will be. By the time it is and the Government have set out their proposals for doing so, we will have had a number of years’ experience of how it works for new applicants. The difference here is that the new assessment will be applied from the start to people who are dependent on disability living allowance.
Stephen Timms: Once the ESA was introduced in September 2008, if I remember rightly, it went nationwide —but, as I said, for new applicants only. My concern is that what we are discussing will be rather different.
Kate Green: We learned considerably from the experience of the work capability assessment and, in particular, difficulties were uncovered when it was being piloted for roll-out nationally. Does my right hon. Friend agree with the suggestion in our amendment not only that there should be piloting but that full implementation should not take place until the consequences of the pilot and the learning from it have been taken on board and implemented?
Stephen Timms: My hon. Friend makes an important point. We have a later amendment suggesting a period in which the new assessment should be applied to new applicants before being applied to those currently receiving DLA—but we shall come to that debate later.
A second reason is that, regardless of how effective the PIP assessment process turns out to be, it will be valuable for those affected to have the greatest possible confidence in it. All of us have received correspondence from groups who represent disabled people expressing deep concern about the replacement of the DLA with the PIP. The Government need to recognise that a substantial number of disabled people currently receiving and financially dependent on DLA are terrified at the prospect of the changes proposed.
I am not saying that the Government should back off or not proceed, but they must recognise that a lot of people are very anxious. For a large number of people, the planned new tests will cause a great deal of anxiety,
Those individuals, whose circumstances we do not know much about, might well go through the assessment process and find themselves completely protected, so that they do not lose out at all. However, a lot of people do not feel confident in that. A proper pilot process would help disabled people to feel confident that the new system will be clear, fair and transparent.
Many stringent criticisms have been levelled against the work capability assessment, and Professor Harrington’s recommendations on how it can be improved have been accepted. We have the opportunity to avoid such negative perceptions when the PIP is introduced. While I am talking about what outside organisations have said, I refer to a point made by Mind on the lessons to be learned from the work capability assessment:
“In order to avoid the significant problems that have arisen with the WCA, it is vital that the new PIP assessment is piloted extensively to ensure that it is working fairly and effectively before it is extended to all DLA claimants...it was only when the assessment was independently reviewed by Professor Harrington that the DWP would recognise the flaws in the process. It is of fundamental importance that an assessment of this kind is both valid and reliable, and that any issues flagged-up by such a pilot are properly addressed before moving forwards with full reassessment.”
Stephen Timms: No. What it points to is that the work capability assessment has needed significant modification and refinement since it was introduced for new applicants in October 2008. We have had two and half years’ of experience now, and in the light of that we are able to make some changes to it. I am suggesting that there needs to be something comparable to that with the assessment process for the personal independence payment. Otherwise there will be serious problems when severely disabled people have the new assessment applied to them and it is not quite right.
Charlie Elphicke: I am loth to pay tribute, but it seems that the work capability assessment was an inspired piece of work by an inspirational Minister. I put it to the right hon. Gentleman, while I am blowing sunshine around the Committee room, that many of the lessons learned from the work capability assessment should in principle be transferable. Is it not the case that many of those things can be learned and taken on board from the improvements that have been made in the past two and half years?
Stephen Timms: I am grateful to the hon. Gentleman for his kind remarks. I think that it is probably either my right hon. Friend the Member for East Renfrewshire (Mr Murphy) or my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), the former Secretary of State, who deserves his generous tribute.
I agree with the hon. Gentleman—I am glad that the Minister has accepted it as well—that we do need to learn lessons from the WCA process for the one we are embarking on. It seems that the stakes are a lot bigger here, because many people who are financially dependent on DLA feel a good deal of uncertainty about their position once they have been through the new assessment for PIP. Some extra work to reassure them at this stage would be well worth doing. That is the aim of the amendment.
Now that the hon. Member for Cardiff Central is with us again, I will repeat the point that I made earlier, that I agree with her about piloting; I am less convinced by what the Minister said about testing. I think she was right to use the word “piloting”, although it may be that we mean the same thing. I look forward to the Minister’s explanation of the testing she has in mind. This needs to be a serious exercise because of how much is at stake. The case is strengthened by the fact that on paper the new gateway looks very like the work capability assessment. I have some sympathy with the assumption made by the hon. Member for Cardiff Central that Atos would apply. She was rebuked by the Minister, because of course there has to be a tendering process. It is difficult to understand who might do it, other than Atos in practice. That is certainly the view of the disability organisations, too. I can understand why the hon. Lady made that assumption.
Another reason why the case for piloting is even stronger is the scale of the exercise—the 1.8 million people to whom it will be applied from the outset. Right from the beginning, the intention is that existing DLA recipients will have this assessment applied to them, not just new applicants. We have a later amendment on schedule 10, suggesting that that will be ill-advised. I will not run through the arguments now. However, that also highlights why the case for piloting is so important. The stakes are very high indeed. If there are any doubts in Committee today, they are likely to be vanquished by the rally and the representations that all of us will receive tomorrow.
There are also financial considerations to be aware of. There is a great deal of concern from people with disabilities that the Government’s approach to PIP is being dictated essentially by a cuts target. The Government have decided that they need to make 20% cuts, and the finer points of how they do that are a secondary consideration. That is the worry for organisations that represent people with disabilities. The truth is that too much is at stake for too many people. The Minister assured us that her approach is principled, and I welcome that, but it was not clear during the debate on ESA. I am pleased that she has been able to affirm that, on this issue, the Government’s starting point is principled, and that the budget consequences must be worked out second, and not be determined up front, which is a worry because that would be the wrong way of going about reform.
There is a danger of rushing ahead too quickly, before the assessment has been properly worked through, and the difficulties identified and removed. There is no point putting people through a flawed assessment process, only for it to be necessary to assess them again, perhaps through an appeal mechanism when the problems have been ironed out. If the Government proceed too rapidly without the necessary safeguards in place, they may waste a lot of money instead of saving it, as well as causing a lot of unnecessary anxiety. The three compelling reasons for proceeding carefully and starting with a proper pilot are to ensure that people’s circumstances are assessed accurately and fairly, to allow disabled people to have full confidence in the process, and to ensure that we do not end up wasting money by implementing a flawed assessment.
The amendment proposes that the pilot should show three characteristics. The first is that it should operate in one or more specified areas. In that way, it should be possible to ensure that the pilot covers a reasonable cross-section of the population demographics and the different circumstances in different parts of the UK. That should be possible by choosing areas.
Secondly, the amendment proposes that the pilot should assess the impact of the assessment process on people with specific types of medical impairment or disability. This is a radical overhaul of access to disability benefit, and there could be types of impairment that are not assessed adequately at the first attempt. The amendment draws attention to two that we have already discussed: fluctuating conditions and mental health impairment. It is right to spend a fair amount of time and effort to ensure that the assessment process works well.
The third characteristic of the pilot is that it should be the subject of a formal response by the Secretary of State. If the pilot is to be effective, there should be a statutory requirement on the Government at least to respond to its findings, and to put them in the public domain. That would help to ensure that the lessons of the pilot were learned and applied instead of being ignored. Perhaps more important, it would help to give confidence to existing DLA recipients and others who will apply for PIP in future that their concerns will be properly addressed.
There is a strong case for a pilot of PIP, given the scale of the proposed changes and the number of people who will go through the assessment. The case for it is very strong and, like so much in the Bill, the effects of precisely what the Government are going to do will hang on the detail. I hope that the Minister recognises that the amendment would take us in the right direction.
Sheila Gilmore: It is important to look not only at a test—the criteria against which people will be measured—but at the whole assessment process. Some of the discussion has been about the independent test in which people must show how they cope with certain day-to-day activities, whatever they might be. I fully understand that we need to get that correct—deciding what ought to be measured and how to do so—but we must also look at the assessment process, almost from start to finish, to see how it works in practice. A pilot would enable that to be done.
Although the test is different, some of the process could be similar to that of the ESA. The first Harrington report told us about severe flaws not only in the kind of
If we want to get this right, we ought to have the opportunity to see how it works in practice. I suspect that looking at certain small bits and consulting on others will not reveal some of those flaws. Many aspects of the ESA probably looked okay or viable until the new applicants became a pilot. I am not convinced that that was the right thing to do. However, what gave rise to considerable concern among those who experienced the process, the organisations supporting them and many of us who met constituents and dealt with such issues was the fact that, so often, the people who appealed were successful in those appeals, thus suggesting —endorsed by Harrington, I think—that a symptom of something flawed in the process. We sometimes talk too narrowly about that part of the process which is the independent test.
We do not need to get precious, necessarily, about who did what and whether it was right before. When I first encountered people having difficulties with the ESA process, I agreed that we had to take action to reach a situation in which people were not pushed into a siding for a long time, on a benefit perhaps because it was more convenient for them. However, when I recognised that individuals had serious difficulties with the process that they were being put through and that their lives were being made very difficult indeed, I realised that there is a huge difference between having an idea—a good idea—and the practice and implementation.
If we have the opportunity and time to carry out a pilot, it would be a means of avoiding some of the unnecessary mistakes and expense. The expense of the appeal process that might result from a flawed assessment process could be avoided if the work was done in advance. I hope the Minister is prepared to consider the amendment.
Maria Miller: This is another turning point in our debate. I was pleased to hear the right hon. Member for East Ham say that we had reassured him on taking a principled approach, which is first and foremost in our minds. I am glad that he understands the need for an objective test and for the reform of the gateway. I hope that, in this debate, I can also reassure him about our approach to testing. We all have the same objective: we want the assessment and the process by which it is administered to be effective for disabled people from day one.
At the risk of being pedantic—I hope I did not rebuke my hon. Friend the Member for Cardiff Central, but if I did I apologise profusely; it was not my intention to do so—I simply drew attention to the fact that “pilot” and “testing” apparently do not mean exactly the same thing. My background is in marketing, and I
If we piloted PIP, we would have to take legal powers to reassess entitlement to disability living allowance and assess entitlement to PIP by taking an approach termed “testing” as opposed to “piloting”. We could therefore examine the impact of the new assessment on recipients of DLA without withdrawing their entitlement to their current benefits. That is important because, as the right hon. Gentleman drew out very well in his contribution, we are trying to introduce an assessment that will enjoy the confidence of disabled people and not in any way put them in a position of feeling anxious about the support that they will receive.
One of my concerns about taking the right hon. Gentleman’s approach, given the legal implications of a pilot versus a test, is about what would happen to individuals who were reassessed in the period during which we were reporting on the pilot. If we set aside the word “pilot” and consider the content of what he suggested, he might find that there is little difference between our approaches other than that slightly legalistic term. I think that that is the case, and I am sure that he will let me know if it is not.
Our approach to testing clearly meets the right hon. Gentleman’s first two criteria of being able to operate in one or more specified areas and evaluating the impact of the new assessment on specific groups, including people with fluctuating conditions. On the third—to receive a formal response from the Secretary of State—we will publish a report and provide an update to draft regulations in time for that to be discussed in the other place, as I mentioned earlier. We have similar objectives for the next set of activities; perhaps we are just calling them slightly different names.
Stephen Timms: I am encouraged by what the Minister has said about the clause. Is she saying that some of the testing will have been carried out by the time it is debated in the other place? I am anxious to establish that after the test or pilot, whichever it is—I, too, thought that they meant the same, but I stand corrected by her explanation—a report should be written about the lessons learned from it. Will that document be available in time for the debate in the other place, because that implies that the testing is imminent and will have to be brief?
Maria Miller: As I have said, in the summer, we want to move forward to testing the draft criteria on current recipients of DLA, and we will consider our findings from that before the Bill reaches the Lords. We anticipate producing information about that testing in advance of the debate there.
It might perhaps help the right hon. Gentleman if I go through exactly what we intend to do in more detail. Drawing very much on the findings of the WCA, our approach will give us far more flexibility than the sort of mass-scale pilot that was done in the past. This week, as he will know, we published an initial draft of the assessment criteria, but that is absolutely not the end of our development work. We will continue to refine those initial draft criteria as we move forward, working with disabled people and their organisations to ensure that the criteria work as they need to.
We will then test the criteria over the summer, to ensure that they accurately and consistently assess individuals, and consider the impact of the assessment. As part of that testing, we will consider the impact of the assessment on specific impairment groups, such as those with mental health conditions, learning disabilities and sensory impairments. The exercise will provide a vital opportunity to learn, early on and without affecting customers’ current benefit claims, how the new assessment criteria will work on the ground. It will be a safe environment in which we can understand how the new assessment will work.
Testing and our work with disabled people’s organisations will inform the next draft of regulations to be published in the autumn and the Bill’s final stages in the other place. We will also consider further testing afterwards along similar lines if we think it necessary. The resulting regulations will, of course, be subject to full parliamentary scrutiny, including debate under the affirmative procedure.
Maria Miller: It would be almost impossible not to consider fluctuating conditions when considering individuals with mental health problems or, indeed, many of the other impairments that I outlined. I can absolutely and fully assure the right hon. Gentleman that my right hon. Friends the Secretary of State for Work and Pensions and the Minister of State and I will consider the issue closely. We want to get it right from the start, and we will do everything that we can to ensure that.
Ian Swales: On fluctuating conditions, we talked earlier today about advocacy. To what extent will the process take account of relevant medical information? I am thinking of conditions such as ME. Medical records for sufferers would be very relevant to the assessment. Will they be available to the assessors?
Maria Miller: The hon. Gentleman brings up an important part of the testing process, which will involve ensuring that the right information is available. He will recall from earlier debates today that the Government want to take a flexible approach to what information is taken into account when an assessment is made. Other members of the Committee will consider that issue, particularly as we go through our testing processes.
Alongside that, it is important to pick up on another point, as the right hon. Member for East Ham did in his remarks. This is not just about the assessment; it is about the operational post-processes as well. We are already involving disabled people and their organisations in the development of the benefit’s administration, including the assessment process. We are setting up a dedicated personal independence payment implementation consultation group, as I mentioned, which will draw on a wide number of national and grass-roots, user-led organisations. The first meeting will be held next week. We want to ensure that we involve disabled people at all stages of the operational design. It is no good getting the assessment right if the operation does not work in practice for disabled people.
The group will form part of our development and testing process. That approach is important and has been well thought through as a way of working actively together with disabled people to refine both the assessment and the operational processes with hands-on involvement, instead of simply putting an assessment into a pilot area and then walking away from it for six months and seeing what happens. We will work with people on an iterative and hands-on basis to obtain solutions to the problems that arise, instead of simply walking away and waiting for a report to be written. I think that that is the right approach.
Of course, we are seeking to learn from our experience of the WCA, and as part of that we are looking closely at the processes used in ESA, particularly the pilots around Aberdeen and Burnley. We are also drawing further on Professor Harrington’s report to see how we can ensure that we have maximised PIP’s design beforehand.
Maria Miller: As the right hon. Gentleman will expect, I need assurance that our testing is robust and will provide the sort of evidence that the Government can have confidence in. I will write to him with more details, but I anticipate that it will involve many hundreds of people—several hundreds, I am told. He may be aware that we have done some initial probing work with DLA recipients already, as part of the initial criteria development phase. This is something that we are putting at the heart of our work.
I want to drive home the point that we are undertaking a more holistic, end-to-end test of the process. Picking up on the points made by the hon. Member for Edinburgh East, we are ensuring that we know how the process will work end-to-end before it is introduced in April 2013, again reflecting some of the lessons learned from the Harrington review and involving co-production with disabled people.
In addition to those assurances, the Bill requires the Secretary of State to commission an independent report on the operation of the assessment when it has been implemented and to lay that report before Parliament. That thorough and fully independent review will allow us properly to decide how the assessment is working and its impact, thus allowing us to refine it if necessary. In contrast with DLA, providing the assessment criteria in regulations will enable us quickly to change things as and when we believe it would be prudent to do so. That is an important innovation that PIP offers.
I hope that my comments reassure the right hon. Gentleman that, although we do not intend to pilot, we intend to achieve the objectives that he set out in his amendment before we implement PIP, utilising the experience of disabled people, and to evaluate its impact after implementation. Adding formal pilots would delay these important reforms and the important benefits that they will bring for disabled people. On that basis, I hope that the right hon. Gentleman will find it appropriate to withdraw his amendment, but I will listen to his comments.
Stephen Timms: I do not agree with the Minister’s final point. It is so important that the assessments are right that if the price is a bit of delay that is well worth having, because proceeding with a flawed assessment would do so much damage. Nevertheless, the Minister has made some helpful points and provided some information that I was not aware of. I should like to reflect on what she said. I do not know whether she will write to me, but if she does, perhaps she will reflect on that information as well and consider whether the proposals that she has set out this afternoon are sufficient for the job that needs to be done. For that reason, I will not press the amendment to a vote and beg to ask leave to withdraw it.
Stephen Timms: I have a question for the Minister. The clause is about the ability to carry out daily living activities or mobility activities. The note that we were sent at the end of last week explains that the proposal is to focus, under the daily living heading, on key everyday activities essential to enabling participation and independence. We have been told in the briefing that there are nine such activities: planning, buying food and drink, preparing and cooking food, taking nutrition and so on.
The Disability Benefits Consortium, which I think only saw that note yesterday when it was made more widely available, is—as the Minister will know—critical of that approach and has described it as a “tick-box approach.” It has made it clear that it would prefer what it describes as a more holistic approach. However, it says that given the Government’s commitment to a set list of criteria, it has proposed an alternative set of eight criteria, which it argues assess the wider range of activities necessary to leading an independent life. They provide a more accurate measure of the costs faced by disabled people. Those eight criteria are, first, maintaining a clean and safe living environment; secondly, preparing for the start or the end of the day; thirdly, social participation; fourthly, communicating with others; fifthly, preparing and consuming food and drink; sixthly, maintaining health and condition management; seventhly, dealing with utilities, such as gas and electricity; and eighthly, adaptations.
Looking at the consortium’s list of eight there clearly is not surprisingly some overlap with the Government’s list. However, it is clear that the consortium’s list is wider in scope than that of the Government. It could be argued that the consortium’s list contains a more rounded appreciation of what is involved in securing independence and is perhaps a fuller list of the things that ought to be considered when dealing with what the Minister has said she wants the assessment to take into account. The Government’s list, which was sent around at the end of last week, by contrast, is rather narrower. The consortium’s list is a more rounded set.
Is the Minister in a position to comment on why the Government’s list of nine is better than the consortium’s list of eight? I could ask a similar question about the mobility assessment—where the Government have two
Maria Miller: I thank the right hon. Gentleman for initiating this stand part debate and for giving us the opportunity to talk a bit more broadly about such matters, although I will focus my remarks on the issues he has raised about the activities that are included in the assessment criteria. The assessment criteria that we have put forward have been developed by an independent group of specialists in health and social care and disability. That group includes a wide-range of professionals who have looked at what they feel are the most important proxies for assessing somebody’s care and mobility needs. The activities that they have chosen—and I emphasise that they have chosen them, because we wanted that sort of independent advice on this—provide a more holistic assessment of the impact of disability than the existing DLA criteria, considering the impact of the full range of impairment types. For example, the introduction of communication, as has been mentioned, is a significant departure.
I have only just seen the Disability Benefits Consortium submission, but we welcome the active involvement of such groups in the discussion that we will have on the assessment criteria. I welcome the time that the consortium took to look carefully at our proposals to see whether there are other areas that might need to be addressed. I can assure the right hon. Gentleman that we take all such submissions very seriously, and we are looking carefully at whether there are other ways that we can hone and shine our assessment criteria to ensure that they are the best that they can be. I underline, however, that we are not trying to be able to take into account every aspect of an individual’s life, and I am sure that the right hon. Gentleman would agree that that would be unmanageable. We are looking for a reasonable set of proxies to assess the abilities of an individual to participate in everyday life.
Stephen Timms: I appreciate that the consortium list is new—of course, I think that the consortium did not see the Government list until yesterday. The consortium list contains communicating with others, which is also in the Government list, but separately, its list contains “social participation”. It struck me, looking through the other items on the Government list, that there is not really anything that addresses that, apart from the point about communicating. I think that one can see the reasons why one might want to consider the ability for people to participate socially in a broader way, and I wonder whether the Minister thinks that there may be some merit in that.
Maria Miller: Behind some of our thinking on communication is the very issue that he raised—the ability for an individual to communicate with people who they know well, and those who they know less well. Some innovations that we have been discussing on mobility will also have a beneficial effect on people’s ability to be part of their community. An important part of that is being able to have that social interaction, and, because the DLA does not adequately take into
I absolutely want to look carefully at all submissions on the assessment criteria that we have put forward, whether they are from disabled people’s organisations or from disabled people themselves, and we would want to do that anyway, even if the right hon. Gentleman had not raised that point in the stand part debate. As I have underlined throughout this debate, it is about getting this right. I believe that the invaluable help that we have had from the group of independent experts in developing the new assessment criteria has been extraordinarily useful, and I hope that they will be able to work with us further on looking at suggestions such as those that the right hon. Gentleman has cited in the debate today.
Margaret Curran: The amendment would retain the three-month waiting period that claimants must wait before they are eligible to receive the personal independence payment. However, the proposals would go on to extend the period that the claimant must show that they will be with that disability to nine months, rather than six months, which is currently the case with the disability living allowance.
We agree with the extension to a year. We are just arguing for a different balance within that year, because we believe that this is a question of fairness and balance in reform and I will explain why, hopefully quite briefly.
I repeat the point that this change is a part of the reform process that we support. There is a clear case for reforming the gateway to the personal independence payment, to ensure that the new benefit goes to those who need it. I think that we all agree on that. Unlike the Government, however, we do not believe that the right way to do that is to make disabled people wait for six months before they are given the support that they clearly need to help them to meet the extra costs associated with living with a disability. We do not think that that is the right way to go about reform.
We believe that it would be better to keep the initial three-month waiting period before people can apply for PIP and instead extend the time after they receive the benefit during which they must show they have the
To be clear, we would also extend the required period condition that currently exists around DLA, extending it from nine months to a year under the PIP. However, we would extend the provision after the receipt of the benefit rather than at the beginning. That is the fundamental point, because we believe that extending the waiting period at the beginning unfairly penalises those disabled people who need extra help to cope with their disability early on in their treatment. Ultimately, the change that we are proposing could lead to a reduction in costs. If we move in quickly to help people and give them the support they need, that can stop their condition deteriorating. If their condition deteriorates, that would sometimes require other expenditure from other parts of the state, as it were.
Margaret Curran: I thank the hon. Gentleman for putting that question. I was feeling very neglected by him. He had not intervened on me once and I was feeling very disappointed about that. I am glad that I attracted his attention sufficiently for him to ask a question.
Of course, the hon. Gentleman is raising a very serious point and in preparing the amendment we have of course given some serious thought to the associated costs. There are two points that I want to raise with him. First, I pursued the Minister and the Department to try to get some figures about the cost of these measures but the cost is quite hard to determine, because we cannot actually determine the costs. If someone claims the benefit at three months, how would we then assess the costs? What would the journey be to six months? That information is quite hard to extract. What we have tried to do is to balance the fact of earlier application and earlier eligibility by extending the period after an application to nine months. I will go on to say that a number of the organisations in the sector substantially agree that we can save money if we intervene early. That is prevention. Sometimes, if we do not intervene early, a person’s condition deteriorates and we might have to provide substantially more support, particularly social care support. So there is a complex argument about costs that the Government, a number of organisations and I myself are involved in.
Secondly, many charities are deeply concerned by the Government’s decision to make disabled people wait for six months before they can apply to receive help. The Centre for Mental Health, Mind, Rethink, the Royal College of Psychiatrists and the Scottish Association for Mental Health issued a joint statement, which said:
“We are concerned that this will unfairly disadvantage people with sudden-onset needs who will have to wait an additional three months to get the vital funds to help them manage their condition,
That quote from the Multiple Sclerosis Society makes it clear that this issue is not just about ensuring that people get the help they need when they need it. There is also an argument for preserving the preventive mechanism, to ensure that the impairment of a disabled person is not allowed to worsen as they sit and wait for half a year before the Government take note and help them. It is not only an issue of cost but a health issue, in terms of assisting disabled people.
One particular group who are deeply worried—I am sure that the Minister is aware and has had representations as we have had on this side of the House—are cancer charities. In an open letter to the Secretary of State, a group of cancer charities highlighted why the change is especially problematic for cancer patients:
“Firstly, we are very concerned by the proposal that people with cancer will have to wait six months before they claim the new Personal Independence Payment (PIP), which will replace DLA. We know that even the existing three-month wait for DLA is extremely problematic for people with cancer. Cancer treatment often starts very quickly following diagnosis and the needs associated with cancer can escalate rapidly. In the first six months following diagnosis, people with cancer face dramatically increased outgoings to cover expenses such as travel and parking for hospital appointments and extra fuel costs. Without support for these costs as soon as need arises, people with cancer will face increasing levels of hardship and some will get further into debt.”
The briefing note from the Department has released further details about that and about the required period condition. I think that the Minister will argue that they will go some way to address the point I have just made about up-front costs, particularly for people with hospital appointments. The Government acknowledge that there are extra costs at the start, particularly in cases of a serious illness such as cancer, or indeed a disability. The briefing note goes on to say:
“While we acknowledge that some impairments or conditions may appear long-term at their outset, and that additional costs may arise as a result, this may not always be the case. Where disability-related costs do arise early on, for instance as a result of having to make frequent hospital visits for treatment, additional support mechanisms provide an element of coverage before the qualifying period is satisfied, for example through the NHS travel costs scheme or other social security benefits.”
Of course, other interventions are there through the NHS and through other benefits and such like, and we recognise that. The cancer charities, however, will tell us that that is a particularly narrow example and a very limited definition, which shows a very limited understanding of the costs involved when people experience cancer, sadly. They particularly emphasise issues such as new clothes, extra fuel costs, aid adaptations and things like wigs, shoes and special diets, which, if someone is experiencing cancer and having to pay those costs without much money, really do matter. I ask the Minister for her thoughts on that.
The Minister and the Government argue that this is a proper recommendation because it aligns DLA with the waiting period for attendance allowance. I have to ask whether it is right to apply that to people who are working, many of whom face sudden onsets of conditions that no one was expecting. I do not know whether that parallel is quite as sound as the Government suggest. Many we know would argue that it should be the other way around—that the attendance allowance should be aligned to the three-month period, rather than doing it the other way around. I am sure that the Government and the Minister are aware of that.
Elsewhere in the briefing note it states that, in practice, most people will have completed some or all the qualifying period of the required period condition when their claim is submitted. I am not quite sure what is meant by that. Is that the six months, or the three months? I presume that that is the three months, but even if it is, I think that adding another few months to that exacerbates some of the conditions that many people face. Throughout the briefing note and, as I said earlier, throughout many Government submissions on the introduction of PIP, the emphasis is on those with the greatest need. If the Government intend to shift the goalposts with DLA eligibility fundamentally, they must move the supporting structures that go with that, and shifting the waiting time from three to six months does not do that and, in fact, could undermine and counteract the proposal for people with the greatest need, because sometimes those with the greatest need are captured within that three-month period.
Essentially, we recognise the overall framework that the Government are introducing within the year. I think that some of the charities recognise that shift. We would be willing to go with that shift, but there is a question of balance. It is that critical period of three months. We will lose many, many people. Many people will go into debt. Many people will face enormous difficulty at a time when they are already facing difficulty in terms of disability and ill health. I do not think that there is a proper balance and that underlines yet again the deep concern people have about the scale and pace of change. The amendment asks the Government to reconsider.
Yvonne Fovargue (Makerfield) (Lab): I want to reinforce my hon. Friend’s remarks. Often, for people who experience a sudden catastrophic event, the costs come up front in the first three months. I will give an example of someone who is personally known to me who was mugged and dragged in front of a car. She suffered a serious brain injury. Not only did she have to cope with the costs of dealing with that and adapting her house, but her mother had to give up work to look after her. They waited three months, the qualifying period, before her mother could claim carer’s allowance for looking after her. To wait six months would have meant an incredible and catastrophic drop in their income.
The qualifying benefits that people get from carer’s allowance and from local authorities are important in that time, and the loss of income by anyone who suffers an illness can be very detrimental. Citizens Advice has said that one fifth of people who get into debt, and such serious debt that they end up in court with mortgage arrears, do so because of an illness. To extend the qualifying time to six months at a time when there are extra expenses and when extra emotional and physical
Maria Miller: We have reached one of the difficult points in our debate on disability living allowance and the new personal independence payment. We are dealing with difficult issues, as the hon. Member for Makerfield pointed out. I will outline the Government’s intention on clause 79 regarding the amendments, and I hope to provide some clear and genuine reassurance to the hon. Ladies who have spoken.
The measure to increase the existing qualifying period from three to six months is not meant to be a punitive one, denying disabled people access to support. It is our view that support in the short term should be met by existing, albeit mainly means-tested, support mechanisms, with PIP kicking in at a stage when additional costs become burdensome to all regardless of income. It is about balancing the needs of those who can be reasonably expected to meet some of their needs in the short term with the needs of people who cannot.
Maria Miller: I will be honest and open with my answer. I would like to reassure the hon. Lady and my hon. Friend the Member for Dover that the principal aim of extending the qualifying period from three to six months is not about savings. We do not expect the measure to provide any significant savings. It is a principled measure to bring PIP in line with the common definition of disability used in the Equality Act 2010, to provide an appropriate measure of long-term disability that can be robustly assessed, and to align with the qualifying period for attendance allowance. The hon. Member for Glasgow East asked in the beginning what I have learned from the consultation. What we learned was that people appreciated and welcomed the simplification of the definitions, which is important for the Committee to note.
I should thank Macmillan Cancer Support and Disability Alliance for their immense work in providing briefings for hon. Members who are participating in the debate. I would like to thank them for actively doing that. I would also like to thank the hon. Member for Glasgow East, in tabling the amendment, for so explicitly accepting the principle that PIP is to be paid to people who have long-term conditions. PIP cannot be all things to all people. It is there to provide support for people who have long-term conditions and who are facing some additional costs associated with that, and PIP will go some way to try to ameliorate that situation.
With disability living allowance, people must satisfy a three-month qualifying period, as the hon. Lady pointed out, and a six-month prospective test. Those rules were put in as something of compromise when the old attendance and mobility allowances were merged in 1992, and, as the hon. Lady pointed out, attendance allowance continues to apply a six-month qualifying period to this day. While those rules have operated for nearly 20 years—much longer in the case of attendance allowance—we must consider what an appropriate measure of long-term disability is in the 21st century, which should form part
I want to take the opportunity to stress that most people will not have to wait six months before they start to receive PIP. That is because the six-month qualifying period starts at the point when somebody is first entitled to PIP, regardless of whether a claim has been received. Perhaps I can provide a practical example of how that works by using the case of somebody who suffers a serious stroke. From the point of the stroke onwards, they could be meeting the conditions of entitlement for PIP and would theoretically pass the assessment conditions. In my example, the person has had a stroke, but does not submit their claim form until they have completed extensive in-patient hospital treatment and rehabilitation, which may take five months. That would mean that five months of the qualifying period have already elapsed at the point that they make their claim, and they would be in receipt of the benefit soon after. It is an important point, and one that is often misunderstood, that most people will not be submitting a claim on the day that they become entitled to that benefit. In fact, the research that we have suggests that few people currently make a claim for DLA before the existing three-month qualifying period has been met, and many put their claim in long after that. We would expect the same sort of pattern of behaviour with PIP.
As we have heard today, there have been examples of how those rules already affect many disabled people, and I appreciate that, in some instances, there may be immediate costs that people incur in the early months when a disabling condition or impairment begins to have effect. Clearly, that is something that we need to take into account, because, as I said at the outset, it is our view that support in the short term for people who have sudden-onset conditions can and should be met from existing means-tested support, leaving PIP to do the job that it was designed for, which is to ensure that the financial support is in place when those costs become too burdensome for somebody to deal with.
After having set our thinking out, I hope that I can provide the hon. Lady with the reassurance that this is an absolutely clear way to pull PIP and attendance allowance into alignment with the Equality Act 2010, which was enacted under her party’s Government. That provides some consistency, which is unfortunately not always the case in this area.
Sheila Gilmore: There have been a number of occasions when fairness and equalities have been prayed in aid of certain changes. It would be equally reasonable to equalise things in a different way. Just because attendance allowance has a six-month period, why is that being equalised to six months rather than attendance allowance being equalised to three months? Has the Minister also considered the concern of cancer charities that there are considerable additional expenses that are not met by other sources?
Maria Miller: I understand the hon. Lady’s point. The definition of long-term disability in the Equality Act is consistent with our approach. We are taking our lead from the pretty fundamental pointer in the way that Parliament has chosen to define disability in the past. The hon. Lady may not agree with the Equality Act—I do not think she was in Parliament when we debated it in detail before the general election—but that is certainly the principle that we are following. I hope she will think that is an appropriate thing for us to do.
Another point that I should clarify, as it is something that the hon. Lady picked up on, concerns people who have to reapply for PIP, which is particularly pertinent for individuals whose condition may deteriorate following a period of remission. An individual in that situation will not have to fulfil the qualifying period again. Hon. Members may be aware of that but I want to make it absolutely clear. I hope that with that set of comments the hon. Lady will feel it appropriate to withdraw her amendment.
Margaret Curran: I thank the Minister for the many points of clarification that she offered this afternoon. I pay tribute to her good manners. I should also thank all the organisations for their briefings. The Opposition do not enjoy the same level of support as the Minister does from her officials, so those briefings are greatly appreciated. That is evident today from the way we have used them. May I also thank the Minister for clarifying the point about savings? This is a debate about how we manage the reform. There is some disagreement between us on that, but I appreciate her clarification that this is not a drive to save money and that essentially we are having a different discussion about that.
I am not broadly persuaded by what the Government are doing. With the greatest respect to the Minister, I do not think that she realises the scale of concern that organisations have about the measure and the personal impact it will have on a number of people who have had experiences in this area. My hon. Friend the Member for Makerfield made a significant point and gave a graphic illustration quoting the evidence from Citizens Advice about the reality that people face. The Government should be guided by that reality.
Perhaps the argument is about what is short term and what is long term. It seems to me reasonable to stay with three months and balance it out by nine months. As I understand it, we would be consonant with the requirements of the Equality Act if we went for three months and nine months, rather than six and six as the Government propose. The Minister made my argument for me in some ways with her example of a stroke victim. I have not heard anything to convince me that it is reasonable for a stroke victim to wait six months rather than three months. If someone has the full impact of a stroke and it has incapacitated them, it is reasonable for us to continue to set their eligibility at three months.
Yvonne Fovargue: Does my hon. Friend agree that when the argument about aligning through attendance allowance is examined more fully it does not hold up? People who claim PIP are more likely to be earning, and more likely to be in work and to lose that income, than people who claim attendance allowance, who tend to be
Maria Miller: I am sorry to interrupt the hon. Lady, but I want to make it clear that PIP is not an income replacement. If an individual loses earnings, they will be able to apply for the appropriate out of work benefits. I wanted to make that clear because there is so much confusion about the role of DLA, and I do not want that confusion to roll over into PIP.
Kate Green: Does my hon. Friend share my puzzlement at that remark from the Minister? DLA and PIP are not means-tested, as the Minister said, yet she implied in her remarks earlier this afternoon that need in the first three months will be met by means-tested support. I am not sure what she is talking about.
Margaret Curran: That question of other support is why I am so troubled by the Minister’s contribution. It is clear to me—it is a hard reality that we were obliged to address in government—that many people in that three to six-month period will have no other support available. That is what the cancer charities have laid out in graphic detail. Some support might be available, such as NHS support for travel costs, but substantial support is not. The charities tell us directly that if we take away that benefit, restrict it even more or change the period from three months to six months, people will be in substantial need and will fail to have that need addressed.
The Minister said that the measure is not about savings and that there is no drive to make the Government do it. I cannot see that there is any strong rationale for the measure other than tidying up, which seems to be the argument that she is making. Given that, I do not think that we should take this step. It would have such a negative impact on the circumstances of people in particularly difficult need.
Lilian Greenwood: I want to pick up on the point about consistency with the Equality Act. Is it not the case that conditions including HIV, cancer and multiple sclerosis are automatically included in the definition of disability under the Act from the point of diagnosis, with no waiting period of three, six or 12 months?
Margaret Curran: Yes. That reinforces the point that I was about to make in conclusion. The measures are a significant part of the Bill and have raised considerable concerns, as the Minister recognised in her introduction. Disabled people will be looking closely at what we decide today. On that basis, I will push my amendment to a vote.
The Chair: Order. Before we come to amendment 199, we have decided to press on this evening. If that is all right with the Committee, perhaps Members could be brief and to the point. I will try to keep them absolutely in order, if that is all right all round.
(c) for persons who experience a sudden onset physical or mental condition, whether, as respects every time in the next 12 months, it is likely that if the relevant ability were to be assessed at that time that ability would be determined to be limited or (as the case may be) severely limited by the person’s physical or mental condition.
‘(11A) Regulations must make provisions as to—
(a) what conditions are to be considered “a sudden onset physical or mental condition”;
(b) the amount or rate of payment which can be made under subsection (1)(c) above.’.
I will be brief. The amendment looks specifically at people with a sudden onset condition, such as a cancer diagnosis, a car accident or a stroke. As has been discussed, there is a clear start to the condition rather than a slow build-up. It is already hard for people with sudden onset of a disability to have to wait three months to get disability living allowance. Only a small number of people are affected, but I want to read briefly an account by Karen, who has been diagnosed with cancer, which was passed to me by Macmillan. It clearly explains the issues:
“When you are diagnosed with cancer the last thing you need is money worries. You need to focus on getting better, but cancer is expensive. I had to leave my job when I started chemotherapy and immediately the costs started to mount up. I was paying to travel to and from hospital to get treatment and had higher energy bills because I was at home more. Before long I was really struggling to pay my bills and was getting into more and more debt. Despite needing help straight away, I had to wait three months before I could get my DLA. Eventually I got my DLA and it made a massive difference. As well as the DLA I was able to qualify for the disability premium on tax credits and got more council tax benefit and housing benefit. If I had had to wait six months there is no way I would have been able to cope financially. I would have got further in debt.”
For many people with a sudden onset condition, the first six months is when the costs are greatest. That is why there is concern about the proposal. For example, cancer patients have to pay for travel and parking at
There are also the other costs associated with having a disability. However, for people with a sudden onset condition, items such as special adaptations come all at once and at the beginning. They have a very heavy up-front loading of the costs associated with their condition and disability. Such costs—travel, extra heating bills and adaptations—are exactly the sort that PIP is designed for. We have just had a discussion about whether PIP is an income replacement, which clearly it is not. The considerations I am talking about are the things that PIP is designed to cover.
The Government said in their consultation on PIP, and the Minister has repeated today, that there are other sources to pay for those additional costs in the first six months, such as NHS travel costs, employment and support allowance, social services support and so on. However, they are either means-tested or are not available for people who are in work or on statutory sick pay. It often takes a long time to get through the assessment process for social services support from local authorities. Extra support at the beginning would not be there through those methods either.
The amendment is only one way forward; I accept that there other ways. I also accept that the wording is probably not perfect. I found it difficult to express in a helpful way. It is not the wording one would want to see in the Bill.
Jane Ellison (Battersea) (Con): My hon. Friend makes a point that has been made to many of us in representations. Although it is welcome that the Government are consulting separately on DLA for under-16s, it has been highlighted to me that for those in the 16 to 18-year-old bracket, all the things described by my hon. Friend can affect a whole family. Most 16 to 18-year-olds are, in reality, children living at home; particularly if they have a sudden onset illness, they would be treated in that way.
Jenny Willott: My hon. Friend is right. There are many issues that go alongside, not just the cost, particularly when children or young people are affected. The financial and emotional implications for the family as a whole are significant. The amendment would require the Government to define a sudden onset condition, which I suspect is easier said than done. If a claimant fits those criteria and can show that they are likely to have the disability for the following 12 months, they would become eligible for PIP immediately. The amendment would retain the requirement to show that the disability will remain for 12 months, but it enables people to claim PIP up front.
The Minister has said that cost is not an issue, but it might be, particularly if people are given the benefit up front, as an extra six months would have to be paid. The amendment would leave open the possibility to vary payments over that time. Payments could be reduced later on, for example, so that they were cost-neutral.
I appreciate that this is a difficult issue. As I have said, I am not sure that the wording of the amendment is the right vehicle, but I want to raise the issue. Many people have concerns about this group of people. It is a small group, but they are in a particularly difficult predicament. I would be grateful to the Minister if she told us what discussions she has had with the relevant organisations, which are concerned about this. Are the Government looking at alternative ways of taking such circumstances into account and doing something for those people?
Maria Miller: I thank my hon. Friend for the amendment. Unlike the previous one, this amendment seeks to vary the required period conditions, so that people who experience a sudden onset condition can access PIP immediately without having to satisfy the six-month criteria.
My hon. Friend knows this, but PIP is not about children at this point. I will look at the issues that she has raised when we consider how PIP affects children in future. Officials and I have had good discussions with the various cancer support groups and other organisations that have expressed opinions on this issue, and we will continue to do so. Such discussions are an important part of the Bill’s progress.
I am aware that for some people with sudden onset conditions, such as those described by my hon. Friend, there may be immediate costs associated with their condition, but, equally, there may not. That gets to the heart of the issue. As she heard me say earlier, PIP views people as individuals, rather than labelling them by their condition.
We are getting to some tough decisions. Achieving the consistency that I am looking for requires us to take some tough decisions. I want to stay true not to labelling disabled people by their conditions, but to treating them as individuals. This is a case in point.
Sheila Gilmore: I am now puzzled by the nature of those tough decisions. The Minister indicated earlier that cost is not the reason for this provision. Is consistency a tough decision? Is consistency always to be favoured over fairness or humanity?
Maria Miller: I am sure the hon. Lady would expect the Government to try to be consistent. We are trying to make it easier for people to understand the premise from which we start. I understand the point she is making, but, equally, I hope that she understands that we have to operate within a framework. That is what I am discussing today.
I do not want to labour the arguments that have already been made, but many of them are similar, as my hon. Friend the Member for Cardiff Central has said. As with the previous amendment, the key here is that neither the existence of a condition nor a diagnosis tells
I do not want to detain the Committee any longer with my explanation, but in winding up, I want to reiterate that the required period condition is a necessary, proportionate and pragmatic measure to distinguish between short-term and long-term need. PIP is not, with the exception of the rules for terminally ill people, designed to meet needs over the short term, even where they can be assumed to be long term eventually. Our view is that the existing support mechanisms to meet shorter-term needs provide adequate and focused support for the vast majority of individuals. I urge my hon. Friend to consider withdrawing her amendment.
Jenny Willott: I thank the Minister and appreciate what she is saying about the varying impact of different conditions on individuals. I am slightly disappointed in the response, although I understand where she is coming from. I hope that she will look at whether anything can be done to help such individuals. There is a bit of a gap here. In the past, everyone had to wait for three months before they were eligible to apply, but the gap between three and six months can be significant. I do not have any wish to press the amendment to a vote; I am not convinced that the wording is the way forward. I am glad that the Minister is talking to organisations that are concerned about these issues.
Maria Miller: Given the expediency of time, I did not go into some of the problems around the wording of the hon. Lady’s amendment. I thank her for clarifying it with the Department. As she knows, it is defective, so it would be difficult to incorporate it into the Bill anyway.
Jenny Willott: I absolutely accept that; I was endeavouring to open the issue up to debate, so that we could discuss the concerns that people have raised. I hope that the Government will continue to look at the issue and discuss it with the organisations that are working on it. It is an area that could do with some further development. With that, I beg to ask leave to withdraw the amendment.
‘otherwise than by virtue of an award made before he attains that age.’.
Hon. Members will be glad to know that I shall be mercifully brief on the amendment, which I hope is straightforward. It would include in the Bill a commitment that the personal independence payment would continue
The Minister can probably guess what I am going to say, because she has heard me say this before, and I can guess what she will say in return. As the clause stands, a person will not be entitled to the daily living or mobility component for any period after they reach pensionable age, unless specified in subsequent regulations. Will she put that in the Bill?
“we intend in regulations to allow individuals already in receipt of personal independence payment when they reach state pension age to continue to receive the benefit, subject to the entitlement conditions continuing to be satisfied.”—[Official Report, 31 March 2011; Vol. 526, c. 447W.]
I have moved the amendment merely to offer the people who have concerns about losing their benefit the clarification that we will be rock solid on the measure. I suggest that the Minister put the proposal in the Bill.
Maria Miller: I am happy to respond to the hon. Lady’s amendment and to set the record straight. We plan to make regulations that allow people who are already in receipt of PIP and who have reached the upper age limit to continue receiving their award into retirement, which I think is exactly what she is looking for. As with DLA, we envisage having linking rules that will allow individuals who have a short break in their claim after pensionable age to claim PIP, provided their claim is made within a given period.
Subsection (3) will enable regulations to be made to specify such provisions. As the hon. Lady will understand, such things are best dealt with by regulation to give us the sort of flexibility that we need with those provisions. With that clear assurance, I hope that she will feel that it is appropriate to withdraw the amendment.
The Chair: In a change to the published selection list, I intend to select amendment 247. The reason why I have decided to do so is that, although amendment 247 has not been tabled with the notice that I would ordinarily require for selection, I am satisfied that the amendment represents a revision of amendments 225 and 226, which were tabled with adequate notice. In this instance, unusually and for that reason, I am therefore prepared to select this starred amendment.
Margaret Curran: Thank you, Mr Gray, for that ruling, which is much appreciated. I am sure that we are all feeling a bit weary, but this part of the Bill will certainly wake us up, because it is the most controversial element and the one that has received by far the most attention.
There are no surprises in what the Opposition will say this afternoon. The Government are well aware that we do not believe that the DLA mobility component should be removed from those in residential care homes. We believe that the Bill fails the compassion test because it contains this clause, which will remove the mobility component of DLA for people in residential care homes and put nothing appropriate in its place. We support sensible, careful and compassionate reform to DLA, but this measure will leave many disabled people trapped in their own homes.
There have been various developments in the story of the DLA mobility component cut, so it might be helpful to the Committee if I provide a brief summary of how we got here and try to clarify exactly where we are now. Originally, the Government stated that 60,000 people would be affected by the decision to remove DLA mobility from those in residential care homes:
The Government have since updated that estimate, and they are now on record as stating that the change will affect about 80,000 people, at a cost saving to the Exchequer of £160 million. I am sure that people are familiar with that figure. On 23 March, the Prime Minister told the House that the Government would not remove the mobility component of DLA. When pressed by the Leader of the Opposition—
The Budget Red Book, which I know that Members have here today, flatly contradicts the Prime Minister’s statement on two key points. It confirms that the Government plan to remove the mobility component of DLA from claimants in residential care, with £475 million taken from people in residential care by 2015-16 and a cut of £150 million more from the mobility component of DLA than originally forecast in the comprehensive spending review last year—of course that reflects the 20,000 extra people who will lose the mobility component.
Following widespread condemnation of the decision to take the mobility component away from those in residential care homes, the Government once again
For the record, I asked the Minister when she expected the results of the review to be published; whether people living in state-funded residential care will be eligible to receive payment of the mobility component of PIP; what plans she has to engage disabled people, groups and organisations in her Department’s review of the proposal and what the terms of reference were for the review. I tabled those questions some time ago, and I received a reply today—perhaps in good time for the Committee. My right hon. Friend the Member for East Ham has had similar experiences.
“announced in the spending review, to withdraw the mobility component of disability living allowance (DLA) from people in residential care homes…In response to the concerns raised by individuals and organisations, we announced that we would not remove the DLA mobility component from people in residential care from October 2012 and that we would review the existing evidence and gather more to enable us to determine the extent to which there are overlaps in provision for mobility needs of people in residential care homes.
The work is being carried out by civil servants in the Department for Work and Pensions and has included, among other things, discussions with individuals and groups of disabled people as well as with organisations which represent them.”
Charlie Elphicke: I am listening with great care to the case the hon. Lady is putting forward. Does she think that, in principle, it is right or wrong that people receive the mobility component in a residential care home when they are not mobile nor will be mobile or able to go anywhere whatever? Should such people receive or not receive a mobility component?
Margaret Curran: I thank the hon. Gentleman for his contribution. He always makes for a lively debate. I heard a colleague say, “That is not the issue”. It is indeed not the issue. In fact, we dealt earlier, under a different part of the Bill, with people in those circumstances. We are saying categorically that those who are eligible for the mobility component if they live in residential homes should be treated exactly the same as anyone else who is eligible for the mobility component.
Margaret Curran: Can the hon. Gentleman bear with me, as he might want to come back again as I refer to certain criteria? I was just about to finish reading the response I received from the Minister about the review. She continued:
That was a very disappointing response, given that she knows about the parliamentary as well as the public interest in the review. The fact that the review, the outcomes of which are so monumental to so many people and have stirred up such controversy, will not be published really begs many questions. Today, we are calling for full disclosure of the review, much of which will be shaped on what the Minister actually says in response to the amendment. I am assuming that the Government will go ahead, as they planned, although there are many inconsistencies. However, perhaps the hon. Lady can explain why we have had to fight for such things.
Let me put on the record the Opposition’s resistance to the cut. I have been asked to do so, and feel obliged to do so on behalf of many charities that have campaigned against it. Charities are campaigning against the changes, warning that they are fundamentally unfair, target the most vulnerable people in the country and will mean people becoming
“The government position has varied massively and this leads to fear and anxiety in the minds of disabled people and their families. If the Prime Minister’s comments mean that the government is going to withdraw that clause, that would be very welcome, but DWP have confirmed that that is not the government’s intention.
“of the mobility component of Disability Living Allowance (DLA) for people living in residential care, which will simply increase dependency and mean many people will literally become prisoners in their own homes.”
“The removal of the DLA mobility component and the squeezing of local authority budgets, which help fund residential care homes, is a double blow for people with a learning disability. They rely on this money to access the community and live a fulfilled life. Through this cut the government is targeting some of society’s most vulnerable people who cannot always fight for their rights themselves. It also suggests that the government does not believe that people in residential care who receive DLA are entitled to live independently.”
“This cut will take us back to the days when people were left in care homes with just four walls for company and will undo decades of progress. Mencap is calling for the government to urgently review this proposal and prevent this devastating blow to some of the UK’s most vulnerable people.”
In its submission to the consultation on reform to DLA, the Social Security Advisory Committee argued that the proposal to remove the mobility component should not go ahead, arguing that it would substantially reduce the independence of disabled people who are being cared for in residential accommodation. It stated:
“We consider that the proposal to remove the mobility component from people in residential care should not go ahead. This measure will substantially reduce the independence of disabled people who are being cared for in residential accommodation, which goes against the stated aim of the reform of DLA to support disabled people to lead independent and active lives.”
The Minister will know that a large group of influential charities from the disability and social care sector have produced a report on the Government’s proposal to scrap the DLA mobility component. The report highlights the fact that at different times the Government have used eight different arguments, which have shifted to justify this one cut. The report outlines why each argument is deeply flawed:
One person has given substantial, powerful evidence, which I wanted to quote in full, Mr Gray, but I will not because he has asked us not to go into it in depth. It is a substantial part of the argument, so I will briefly quote the end, if I may. I will not go through the substance of it, but may I state for the record that the gentleman’s name is Vincent Greenwood? His memorandum on behalf of his son stated:
“The evidence given…shows how important the mobility allowance is to my son’s life and the ability of his care home to give all residents as full and independent a life as possible. I also believe most care homes have alternative but equally effective arrangements. I hope I am mistaken but my fear is that the Government are in danger of confusing complexity with disorder and believing a problem to exist where it does not. Therefore I urge the Committee to ensure that the Bill and associated Regulations do not have the effect of removing the mobility component of PIP from severely disabled people in care homes.”
I have a few comments from the Liberal Democrat spring conference. My intended targets for those comments are not with us this afternoon, but I will read them out for the record, because they do in some way aid our understanding of the strength of feeling. At their spring conference earlier this year, the Liberal Democrats tabled a motion to highlight their strong opposition to cut DLA mobility from those in residential care homes. I will shorten the quotes, Mr Gray, in line with your instruction.
“Conference regrets the recent decision to remove the mobility component of the new Personal Independence Payment…from people in residential care and from children in residential schools with effect from October 2012…The outcome of the cut for adults is not in accord with the principle of fairness because it affects the poorest recipients and allows those people who pay for their own care to retain the Mobility Component.”
In conclusion, this element of the Government’s proposals has been subject to great controversy and has been heavily criticised. The goalposts have changed significantly over the past four months: first, there was the issue of double funding; then there was overlap and chaos, and everything we heard in the oral evidence sessions showed that there was no shred of evidence for that; and then there was the review and the real concerns about how it has been conducted.
In fact, some people would have us believe that no cut is taking place at all. If that is so, why are we having to deal with this provision in the Bill and why is that saving still flagged up in the Red Book? Unless the Minister makes another announcement today, which would stretch credibility a bit far, that is my understanding. If there is no cut, supporting the amendment to make that clear should not pose any difficulty. I have heard Committee members welcome the review in the sense that there will no longer be a cut and that the benefit will still be protected for disabled people. If they believe that to be the case, they should categorically support the amendment, which would send a strong signal. The removal of the clause from the Bill would also have the advantage of reassuring people such as Mr Greenwood, who are so worried.
If there are inconsistencies, the Government should sort them out with the proper authorities—the care homes and local authorities—but they should not make disabled people the victims of those inconsistencies and of any overlaps in the system. If we care about the evidence that we have all received, the only option is to support the amendment. It would categorically protect the interests of those living in residential homes and ensure that they receive the benefits to which they are entitled, because they receive precious few benefits and they need them.
Sheila Gilmore: This issue has been running for several months. Even before the consultation and the discussion about the need to reform DLA, it appeared to be a one-off issue. Without a doubt, the proposal appeared to be a savings measure. No less a person than the Prime Minister repeatedly stated that the reason for it was to equalise the position with people in hospital, whose situation is said to be equivalent. That was either an example of equalising downward, to which I referred earlier, or it was a misconception about what it means to be in residential care and in hospital.
The intervention made by the hon. Member for Dover suggests that he still labours under the same misconception that people in residential care are like people in what I describe as nursing homes—they are so ill that they are nursed in bed. It takes a long time for DLA to be removed. People in hospital, usually for a relatively short period, clearly suffer from an illness that is over and above their usual disability, which is why they are there. The days have long gone when people spent long periods in hospitals that were equivalent to what are now residential homes.
What became clear during the discussion was that we are talking about not only elderly people, whom some folk think should not go out too much and need not be
Charlie Elphicke: Far from being a luddite, I am clear-sighted and focused about the nature of elderly residential care, having had personal experience of it. The hon. Lady makes a fair point, however, about younger people’s residential care, providing there is no double counting. Older people’s residential care is my concern, because if the allowance is not used to get out and about, how can it be properly targeted?
Sheila Gilmore: People have to apply for benefit under both the DLA system and the proposed PIP, so it is not simply handed out, with people saying, “Here you are, in residential care—here’s your mobility allowance.” I understand that people will still have to make an individual application and they will doubtless have to demonstrate that they meet the criteria. My hon. Friend the Member for Glasgow East referred to one of those criteria, which is in a separate section that deals with people who are unable to make use of a mobility payment.
Under the measure, people will have to meet the criteria to enable them to participate in society. We have heard much about what personal independence payment is meant to be about. It is to enable people to have the freedoms that the rest of us have. That might be to meet friends and participate in clubs on a social basis, to volunteer, or—especially for some of the younger, working-age people in that situation—to hold down a job or undertake training. Any concerns about people not needing benefit are addressed by the fact that they have to apply for it, which they will have to do under the personal independence payment, and as we have heard, there will be tests in that process.
The suggestion of ruling out a group from the benefit does not sit well with what we have heard in our discussions. Even this very afternoon, we have been told how important it is not to categorise people by group or allow them to have automatic entitlement to a benefit by group, because we must look at people as individuals. It seems strange, therefore, that the proposal suggests that someone should not receive the benefit because of their group category—because they are in a residential care facility. I argue that individuals in that situation should be considered individually. Saying that someone clearly does not meet the requirement or cannot make use of it is very different from saying that anyone in that situation should not be covered.
It was unclear what was meant by the review. The proposal has its own savings category, which is quite separate from any other financial savings that some people might feel will be made from this reform; it comes as a distinct line in the Budget. I was left unclear some weeks ago about whether there would be a review of the specific proposal or whether the proposal was being put into the mix to be considered as part of PIP.
If there is double payment, and the evidence from many people is that there is not, the only way to establish that would be for the Department for Work and Pensions to contact local authorities up and down the country to ascertain what people pay for and do not pay for, and what their contracts with care homes cover. If there is an ongoing process to ascertain whether there really is an overlap and a duplication of payments, it is not clear that it is happening. It is not clear that requests for information are going to local authorities. Many allegations of double payment have been made, although little evidence has been adduced. I cannot see an easy way of gathering it without making contact with local authorities, though that will be an expensive process, putting a lot of people to a lot of effort.
Having been in politics as a local councillor, I know that proposals can be made that on the face of it sound like a good idea. However, when examined further, it is realised that the proposal is inherently bad. There are times when it is true that, “If you are in a hole, stop digging.” This is one of them.
Kate Green: I strongly endorse the comments of my hon. Friends. I also want the Minister to be crystal clear about the Government’s attitude to proposals affecting people entitled to the mobility component or disability living allowance in residential care homes. Like my hon. Friends, I am confused about what we are reviewing, and why the savings identified by the Government remain in the Budget Red Book.
I want to add a few remarks about the reasons why this particular Government proposal has excited so much concern across so many organisations and families, and across all parties. I have been struck by the depth of concern across the House about the matter, as I am sure the Minister has. There are a few points about which we need to be crystal clear, to understand why my hon. Friends tabled the amendment.
First, we are looking at the position of care homes. Many care homes receive their funding from local authorities in block form. It is not necessarily broken down by the items of expenditure purchased, or by the individuals and the items bought for them. Even if there is some funding by local authorities of mobility for individuals in some residential care settings, it is often extremely difficult to identify. It is not the usual way that the funding package is constructed for care homes. We are looking at a very murky and confusing picture, if we start to read that kind of financial support into the existing contracts.
However, many residential care homes expect to receive people in receipt of DLA as a precondition of taking them on. They know that they come with that source of funding, to enable them to access their own mobility needs and requirements. To be able to provide the quality of care that they want, it is important for care homes to know that they have residents who will be mobile because they have access to the DLA mobility component. That becomes, in some instances at least, a precondition of the acceptance of a disabled person to the residential care setting.
It is important to realise what could happen if those care homes no longer receive those residents and the payments made for them by local authorities. The overall financial impact on residential care homes could be very damaging. It has been suggested that many of them would be forced to reduce wages to care workers. We all know that poor wages lead to poor care, which none of us wants to see for our most disabled individuals.
As my hon. Friends have said, it has not been possible to uncover any specific evidence of duplication of payments. All the witnesses who gave us evidence on this matter, while accepting that it might exist, had never seen it, despite their extensive experience in the disability field. The Disability Alliance has made clear that, if the Government were suggesting that there is a statutory obligation on local authorities to fund mobility needs for residents in care homes, it is completely unclear where such statutory obligation sits.
We know that people in residential care settings are living in what is their home. As my hon. Friends have rightly pointed out, a benefit to assist mobility should not operate differently because of the nature of the home setting. I remind the hon. Member for Dover that we must not confuse profound disability with immobility. People may experience severe levels of need and disability, but it does not mean that they should not be entitled to move around in the community as part of their daily life.
Let me tell the Committee about Hamza, the profoundly disabled adult son of my constituent Mrs Khan-Sindhu. He is in his early 20s and, as a result of brain damage at birth, he is a wheelchair user. He is doubly incontinent and has profound learning difficulties, but he loves being able to go home to visit his extended family at the weekends. Without the mobility component of disability living allowance, which enables his family to afford specially adapted transport, he would not have that pleasure. I am sure that no hon. Member would want people such as Hamza to be unable to enjoy such quality of life.
Charlie Elphicke: The hon. Lady makes a powerful point about targeting, but let me give her another case based on my personal experience. I had to look after my father for the last 10 years of his life. He had Alzheimer’s and was in an elderly people’s residential home. Holding his power of attorney, I was fiducially obliged to claim on his behalf the highest amount that I could. That meant the mobility component, but I did not want him to go anywhere. If he went out for more than five minutes, he would forget who he was and where he was and would become lost. That was the nature of his condition. It is a serious issue. Surely the mobility component should be targeted at need and utilisation, rather than being handed out to everyone who wants to claim it.
Kate Green: The problem with the Government’s position is that it is a blanket withdrawal of the benefit from predominantly working-age adults. People have to be of working age to make an initial claim, although the payment may continue beyond retirement. We are talking about predominantly working-age people, younger middle-aged people. For many such people it may be right, in terms of their quality of life and access to social and other activities, that they receive the personal independence payment or the mobility component of DLA.
Whatever the merits of the hon. Gentleman’s argument for targeting to avoid some of the money potentially going to people at the very end of their life and who could in no sense benefit from mobility support, the assessment process should be capable of determining whether there is an entitlement to mobility payments, as my hon. Friends have pointed out. It is utterly wrong to remove such payments wholesale from everyone simply by dint of their being in residential care.
I am interested in what the hon. Gentleman said about the circumstances in which it might be wrong for people to move out of their residential care setting. Conversely, the National Autistic Society has pointed out the damaging effects of people being confined to their home and being unable to go out and undertake social activities. That can have an extremely harmful effect on their behaviour and well-being.
My hon. Friends pointed out that some people in residential care homes, none the less, leave their homes to access education or training. Some are leaving their homes to access employment. The mobility component can be used, for example, to assist them in acquiring a Motability car. Removing the mobility component, which will remove their ability to pay for transport, such as special taxi services or the acquisition of specially adapted cars to drive themselves, will remove them from paid employment. Not many people are in that situation, but surely we do not want to remove from profoundly disabled people who are able to take paid work the financial support that enables them to do so.
I look forward to the Minister’s clarification of the Government’s intentions. If we are to assume that everything Ministers have said in recent weeks can be taken in the upmost good faith, then, as my hon. Friend says, there should be no difficulty for any Member in supporting the amendment. It is probably our last chance to offer real reassurance to profoundly disabled people and their families that there will be proper recognition of their serious concerns. I look forward to the Minister’s response.
Maria Miller: I welcome your decision to accept the late amendment 247, Mr Gray, to ensure that we have a full debate on the issue tonight, because it is important not only for members of the Committee but for those listening to the debate. I hope I can provide Members with some assurance and clarity on this issue, because it is an important one that has, as the hon. Ladies have said, prompted a great deal of discussion, debate and comment.
First, I want to turn to another aspect of the amendments that the hon. Member for Glasgow East tabled on her party’s behalf. Currently, payment of the care component of DLA stops when a person is in a care home, and payment of the care and mobility components stops when a person is a hospital in-patient. That ensures that there is no double payment for the same need. However, any mobility component of DLA continues to be paid to people in residential care. Clause 83 replicates the existing rules for the daily living component for people in residential care, and for both the daily living and mobility components for people in hospital. In addition, the clause provides for the extension of the non-payment of the mobility component for people in residential care if there is an overlap of provision.
I am somewhat surprised that the hon. Lady has taken the approach she has with the amendments, particularly given that it would reverse provisions that the previous Government had formally supported—on ceasing to pay the daily living component to people in publicly funded residential care. I remind hon. Members that successive Governments have accepted that the care needs of residents in care homes are met through local authority funding, and that is why the care component of DLA currently stops when a person is in a care home. Under the amendment, the cost to the taxpayer last year would have been an additional £235 million. It cannot be Opposition Members’ intention to introduce an amendment that would result in the taxpayer paying twice for the same need.
Maria Miller: Obviously, I am speaking to the three amendments on the amendment paper. An amendment was tabled late, which we are happy to debate in addition; but I presumed that, because the others had been selected by you, Mr Gray, and submitted by Opposition Members, those are subject to debate.
The Chair: Order. The position is quite contrary to normal practice. Owing to amendment 247’s late submission, we would normally have debated amendments 225 and 226 only. However, because amendment 247 seemed quite plainly to be amending amendments 225 and 226, it seemed reasonable to accept that late amendment, and, in informal discussions with both sides of the Committee, everyone seemed to agree that that was a sensible thing to do. If we are discussing amendment 247 grouped with amendments 225 and 226, it is therefore perfectly in order to discuss all those amendments.
Maria Miller: I thank you for that clarification, Mr Gray. It may not have been Opposition Members’ intention to have submitted that amendment in this way. However, it is clear that these amendments, if proceeded with, would make some substantial changes to the provision of support for people living in residential care homes and in those paid for by the NHS. In doing so, they would also entail quite an additional cost.
Stephen Timms: The Minister is perhaps unnecessarily detaining the Committee on this issue. Our intention was to substitute amendment 247 for amendments 225 and 226. You have helpfully indicated, Mr Gray, that to facilitate debate on this matter tonight, which the Government want and are perfectly entitled to have,
The Chair: Order. It is simply not possible to withdraw amendments that have previously been selected and are therefore on the selection list. We are entering into a debate on this issue, and the Minister is indicating that, had amendments 225 and 226, which it is perfectly in order for the Committee to discuss, been moved by the right hon. Gentleman, there would have been certain consequences. As the Minister will understand, the Opposition’s intention was to replace amendments 225 and 226 with amendment 247, but that is not what occurred, and it could not occur under our procedure. All three amendments, therefore, are on the Order Paper, and all three are being debated. It is perfectly in order for the Minister to comment on amendments 225 and 226, but she should bear it in mind, particularly given the late hour, that the intention behind amendment 247 is to replace amendments 225 and 226.
Maria Miller: Thank you for that clarification, Mr Gray, and I am pleased to hear that the Opposition will not be pressing the relevant amendments and will think again about them. I say to the right hon. Gentleman that I would never wish to mislead the Committee—I am sure he would not want to imply that I would—and I was simply responding to the amendments he had tabled, which, obviously, is my role.
I want to send a very clear message to both sides of the Committee about the new power in clause 83. We have already announced that we will not remove the mobility component of DLA from people in residential care from October 2012, as was originally planned, and we have said clearly that we will review the needs of care home residents alongside all other recipients of DLA, either current or future, and not separately. That is entirely consistent with what the Prime Minister said and what I said previously. Let me be absolutely clear: we will not remove disabled people’s mobility. We will only remove overlaps.
A couple of hon. Members questioned whether our approach has been consistent, to which I assert that we have been absolutely consistent from the start. Our contention is that this proposal is about reducing overlaps in provision—something I am sure all hon. Members would want to see. In a time of fiscal problems for our country, we do not want to pay unnecessarily for the same provision twice, and that applies not only in this area but in many other areas of government. All hon. Members want that, as do our constituents and all disabled people: they want to ensure that we are spending every penny piece most effectively in their interests.
This is not about reducing the mobility of care home residents. We have considered this issue thoroughly, particularly in light of evidence provided by a number
Sheila Gilmore: I want to press the Minister further on this point. Earlier, I asked whether this was a review of the proposal. The initial proposal, without a doubt, involved the blanket removal of the mobility component of DLA from people in residential care. I asked whether the intention was to review that proposal or to include the recipients within the overall transition from DLA to PIP. I now understand the Minister to be saying that she intends that individual cases will be looked at as and when people are moved from DLA to PIP. People will have the opportunity to have their cases reviewed. If there is overlap, the benefit will be removed; otherwise, it will not be. However, surely the financial saving relating to this blanket proposal remains within the Government’s budget, so is the Minister saying that that proposal has now been withdrawn in its entirety, with the financial consequences?
Maria Miller: The hon. Lady probably was not listening to what I was saying earlier. I have made it clear that care home residents’ needs will be reviewed at exactly the same time as everybody else’s, not separately and not before. So in as much as that is a change, it is one that has been agreed to. It is important that we get this right for everybody.
Maria Miller: Perhaps the hon. Lady could allow me to respond fully to her point before she intervenes again. Regarding the finances in the Red Book, it is clear that we have to make those savings. How we make them will be down to the way the assessment is put together. Care home residents will be part of that whole process, as we have discussed for the last few hours. We still have a great deal of work to do on how those assessment criteria will work, and care home residents will form part of that. That provides the clarity that Committee members need on this issue.
Kate Green: Is the Minister suggesting that the savings in the Red Book will arise entirely because double funding will be identified, and DLA and PIP payments will not therefore be made for those individuals where double funding is in existence? Or is she suggesting that some of those individuals will cease to qualify as a result of the assessment? What she is not suggesting, I think, is that the mere fact they are in residential care homes will, of itself, disqualify them in future.
Maria Miller: If Opposition Members will allow me to continue, they may be reassured by what I am saying. Because of the extensive work being done in this area, several Opposition Members have asked about the review we have been carrying out. This is an important part of our decision-making process.
Stephen Timms: I do not understand the argument. According to my reading of clause 83, unamended, people in residential care will not get the mobility component. The Minister says that she does not intend to take the mobility component away from those people. Does that mean that the Government will amend the Bill?
Maria Miller: What I am saying very clearly is that the way we decide to support individuals in care homes will be looked at alongside the support for other recipients of DLA. We will not remove mobility support from people if additional support is not in place.
When looking at this issue, we have discovered a number of things that need addressing concerning the local provision of mobility support, and I am not willing to walk away from some of the problems that we have identified. There is clearly uncertainty about how mobility support works in practice. My hon. Friend the Member for Aberconwy has graphically described some of the work he has been doing by talking to care homes in his constituency, and the different ways that individual care homes identify and meet the mobility needs of their residents. There are a wide range of different duties and contractual obligations to meet those needs, and service providers and residents—and their families—are sometimes very unclear about where the responsibility lies for mobility funding. The issue might be difficult and add complications to the debate, but it is an important part of unpicking the problem. If we are to address the fundamental issue of ensuring certainty about the provision and funding of mobility support for some of the most vulnerable members of our community, we must acknowledge that the system is far from perfect and requires some intervention and remedial work.
Families and disabled people across the board have been concerned about the lack of clarity, and to me that is unacceptable given that we are dealing with some of
I welcome the commitment made by the Minister responsible for social care, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), to personalised services for all disabled people, and I hope that that will move towards clarifying and reducing some of the confusion and opacity currently in the system. Those charities that have been vocal about the issue have pointed out that current provision is patchy at best and may not always work in the best interests of disabled people. I do not find that situation acceptable and I give the Committee a clear undertaking that we will not remove the ability of severely disabled people to get out and about. We will always strive to remove overlaps, and as we move towards introducing the PIP in April 2013, I will make sure that disabled people are treated fairly, regardless of their place of residence. I hope that with those reassurances, hon. Members will find it appropriate to withdraw their amendments.
Margaret Curran: I am speechless: whatever way one describes this measure, it certainly is not clear—no wonder people are confused. I am not at all clear where the Government are coming from on this matter, and as the evidence I gave in my opening speech shows, Labour Members are not the only people who think that. This is not part of a political agenda; the entire disability movement will agree with us. My speech was based on evidence from the disability movement, and the Minister has provided no evidence to support what I believe is her argument.
The Minister says that she does not want us to get bogged down in detail, but I repeat: we have no answers to fundamental questions on this provision. What is the purpose of clause 83? Who does it address and whose circumstances will change as a result?
Maria Miller: I am sorry to detain the Committee, but which bit of not wanting to remove the ability of severely disabled people to get out and about, and wanting to focus only on overlaps, is unclear?
Maria Miller: Does the hon. Lady agree with the remarks I have just made, namely that it is important for the Government to have made clear that it is not our intention to remove the ability of severely disabled people to get out and about, and that we are focusing on overlaps? Does she agree that that is a good objective, and does she support us in that objective?
I refer the Minister to the Red Book, because the column in the Red Book specifically refers to the mobility component in residential care. She cannot argue that this is a general, overall saving, which is a general part of the PIP assessment.
Charlie Elphicke: First, clause 83 states that regulations “may” provide, so it is conditional and, therefore, it can be fine-tuned. That is as clear as day. Secondly, paragraph 2.63 on page 55 of the Red Book contains a clear explanation of what is going on and makes it clear that it will not happen before October 2012. It states:
Margaret Curran: We obviously have different definitions of the word clarity. Every time I engage in this debate—believe me, I have done so over a period of months—a different argument is posed to me. Research that has been undertaken by credible disability organisations has provided clear evidence to support the facts that I have outlined. No matter what assertions hon. Members hear tonight, no credible argument has ever been put forward to challenge that evidence.
The hon. Member for Dover has said that it is a “may” now. We do not want a “may”; we want to abolish it altogether. Let us be abundantly clear about that. The hon. Gentleman has referred to the Red Book, but—this goes to the heart of what I am trying to clarify tonight—although we are now told that a review will be conducted and perhaps there will not be a saving, the Red Book already contains a saving, which has a number and a column attached. Can the Committee not see the inconsistency in that?
Charlie Elphicke: Paragraph 2.63 cross refers to AI in table 2.2, which makes it clear that the savings in relation to the DLA mobility component and the gateway reform as a whole are cross referred and brought together. That is the essence of the review; the Government are not quite clear in which direction they are going, because, presumably, they are listening carefully to the concerns of disabled people and looking carefully at double charging, which we would expect them to do.
Margaret Curran: That reflects a debate that was held in the Chamber, in which the Financial Secretary to the Treasury got himself into exactly the same argument. I think that he was referring to page 55 of the Budget report, but Labour Members were referring to page 44, if my memory serves me correctly, which indicates that the saving is there.
I am grateful to the hon. Member for Dover for making the real problem clear, namely that the Government do not know what direction they are going in. We know the direction in which we are going. We are saying categorically that people who live in residential homes—as a category, which completely contradicts everything that the Minister has said this afternoon—should not have their mobility component taken away because they live in residential care. That is what the Government plan to do, and that is what the amendment is about.
Sarah Newton (Truro and Falmouth) (Con): The hon. Lady has welcomed the commitment from the Government to make a principled decision. Does she agree that it is not possible to make a principled decision about a gateway into assessing the level of need and support that somebody needs, as a firm budget saving?
It is reasonable that the Government have identified, in the round, an estimation of the savings with these reforms. Those savings cannot be as precise as the hon. Lady is intimating, because it is a principled decision.
Margaret Curran: With the greatest respect, if it were that, I would welcome it. I do not think that it is a principled decision, however. That is not what the Government are saying. Maybe the hon. Lady heard this, but I am asking again whether the savings estimated in the Budget—perhaps they are an estimate, although that is not what the Chancellor said, and perhaps you know the facts better than I do, but that is not what the document states—
Margaret Curran: I am sorry, Mr Gray. I will behave myself. I am sure you are well acquainted with the Chancellor too, Mr Gray. Maybe the hon. Member for Truro and Falmouth can answer some of these questions, because so far the Minister has not. What is the purpose of clause 83? Will some, or all, of those who currently receive the benefit lose it as a result of this change and the budget cut? Will some, or all, lose it is as a result of the review? Will some, or all, lose it as a result of overlap? Is the plan for savings a general review?
Margaret Curran: If the Minister will bear with me, I will make my argument. Is the plan a general review, or are we specifically looking at people in residential care homes? It is unavoidable that the Government are saying that we need to look at people in residential care homes and reassess their entitlement to a mobility component. My amendment says that that is wrong, that should not be done and that the Government have gone about it in completely the wrong way.
Maria Miller: The hon. Lady is asking questions about the assessment criteria, which have not yet been finalised. It is not possible to answer her questions. I am still perplexed as to why the hon. Lady is not hearing my clear assurances that we are not removing severely
Margaret Curran: I am astonished at that. The Minister has not given any answers that would allow me to withdraw the amendment. If she had, then, as with other amendments, I would be willing to do that. She has not managed to answer our questions. She has not explained the purpose of the clause. If the Government are saying, “We originally came forward with a proposal that categorically said that, as a group, we do not think that those in residential homes should get a mobility component”, she could have drawn the comparison, as the Prime Minister did, with people in hospitals. There was a huge reaction to that comparison. The Government reasonably said, “That was not what we meant. We understand that it is a different case and that there are differences. We need to look at this again.”
If the Government said to us, “We are looking at this again and we are undertaking a review; we will come back to you. We are not sure which direction we are going in”, I would understand that. That would be a perfectly reasonable approach. I probably would have disagreed with it, if I am being honest, but it would have been a reasonable, consistent and clear approach. That is not what the Minister has said. We will all go back through Hansard, as will a number of organisations, and find that that is not what the Minister or the Government have said. They have said that they are keeping clause 83 in the Bill, that they are undertaking a review and that they are looking at overlap, but they cannot tell us who that will apply to, what the criteria and the terms of reference are for the review or who they will be speaking to. With the greatest respect, it would a dereliction of our duty if we withdrew this amendment, given what we have heard today.
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