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Again, I am grateful for the comments from the noble Baroness, Lady Afshar, who has been supportive of and has engaged in these provisions. We are grateful for that.
With that, I ask for support for the government amendments and ask the noble Lord, Lord Northbourne, not to press his amendments.
Lord Northbourne: My Lords, I do not think that the Minister really explained why the non-availability of childcare, whether family care or outside care, was not a better criterion than a parent simply happening to be a lone parent. Is it just that Gingerbread is persuasive or is there some real argument for this particular prejudice in favour of lone mothers when many couple mothers also have problems? Having said that, I shall not press my amendments.
8: Clause 2, page 4, line 23, after “support” insert “, and
(b) is not a lone parent of a child under the age of 3,”
Lord McKenzie of Luton: I beg to move.
Amendment 9, as an amendment to Amendment 8, not moved.
10: Clause 2, page 5, line 41, at end insert—
“(7A) Regulations under this section must include provision for securing that lone parents are entitled (subject to meeting any prescribed conditions) to restrict the times at which they are required to undertake work-related activity.”
Lord McKenzie of Luton: I beg to move.
Amendment 11, as an amendment to Amendment 10, not moved.
12: Clause 2, page 5, line 44, at end insert—
“(aa) “lone parent” means a person who—
(i) is not a member of a couple, and
(ii) is responsible for, and a member of the same household as, a child;”
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13: Clause 2, page 6, line 8, at end insert—
“(8A) For the purposes of this section regulations may make provision—
(a) as to circumstances in which one person is to be treated as responsible or not responsible for another;
(b) as to circumstances in which persons are to be treated as being or not being members of the same household.”
14: Clause 2, page 6, line 30, at end insert “provided that such particulars shall not include taking any surgical or medical treatment”
Baroness Meacher: My Lords, I shall speak also to Amendments 23 and 35. These amendments complement the Government’s amendment to Clause 8, which ensures that a direction by the Secretary of State may not specify medical or surgical treatment as the only activity which is regarded as work-related activity in an individual case. The government amendment reflects the Government’s agreement that medical treatment cannot be regarded as an activity, which, if the claimant fails to accept it, is subject to sanctions. In other words, compulsory treatment under the threat of benefit sanctions does not belong in this or in any other government legislation. I am not suggesting that the Government are saying that compulsory treatment does not belong in any other legislation—those are my words—but their amendment on this issue shows their commitment, at least, in relation to this piece of legislation.
I have tabled these three amendments because I believe that the government amendment on its own leaves a loophole. If a claimant agrees to include medical treatment in their action plan, perhaps under duress—none of us can be sure about that—and if they fail to undertake that part of their action plan they may be subject to benefit sanctions. We know that some 50 per cent of claimants are failing the test which could qualify them for employment support allowance. Therefore, they are placed on jobseeker’s allowance, as I understand it, even if they have mental or physical disabilities as long as those are not assessed as preventing them taking a job. It is therefore important that the clarification that medical treatment will not be a sanctionable work-related activity is included within the Bill in relation to the various benefits covered by the Bill.
These three amendments do just that. There is an issue here. For many people, psychological treatment or a rehabilitation programme may be very important in preparing them for a return to work. It would therefore make sense to include those treatments within an action plan. My point is that these treatments must not be sanctionable. If someone does not feel able to enter treatment for some reason at a particular time, they should not be forced to do so.
There are four powerful reasons for that. First, treatment without consent is a breach of civil liberties and a potential breach of the European Convention on Human Rights. Secondly, such treatment is not efficacious. Any treatment, but most particularly
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I shall not go into detail on that. Suffice it to say that someone can be given treatment without his consent only with the most rigorous safeguards under the 2007 Act. For example, if somebody has a severe mental illness and two senior clinicians and a nurse or social worker have signed to say that he has such an illness and that that illness might result in him being a threat to his own life or somebody else’s, he may be detained in hospital and, for a period of three months, given treatment without his consent. None of that is reflected in this Bill, and I do not think any Government could justify that inconsistency between the rigours of the Mental Health Act 2007 and the apparent relaxation in relation to treatment without consent that one is confronted with in the Bill. I understand that the Government accept these arguments.
I propose that any medical treatment needed by a claimant should be included in an annexe to the action plan that would not be sanctionable. I do not want the idea that psychological help, which may be very important to the claimant, should not be included in any way in an action plan. That would be unhelpful. I wait with interest to hear the Minister’s response.
An important related point is that under the Mental Health Act regulations and guidance, it is made abundantly clear that the term “medical treatment” includes habilitation and rehabilitation and, most particularly, includes psychological treatment. I ask the Minister to assure the House today that the regulations to be issued with respect to the Welfare Reform Bill will use the same definition of medical treatment as that used in the regulations and guidance under the Mental Health Act. I beg to move.
Lord McKenzie of Luton: My Lords, I completely concur with the noble Baroness’s view that benefit recipients should never be directed to undertake medical or surgical treatment to fulfil their conditionality, and I agree that we should have consistency across the legislation in this area. That has always been our policy intention. Nevertheless, we have listened to the invaluable debates that we have had in this House and we have decided to move this safeguard into the Bill. That is the purpose of our Amendments 16, 28, 36, 42, 43, 49 and 50.
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Amendment 16 amends Clause 2F, which covers income support customers, to ensure that a direction cannot specify a medical or surgical treatment as the only activity that in any person’s case is to be regarded as being work-related activity. Amendment 28 to Schedule 1 ensures that this extends to customers on modified JSA. Amendment 36 is to Clause 8 and extends this safeguard to ESA customers. Amendments 42 and 43 are to Schedule 3 and extend this safeguard to problem drug users on JSA. Amendments 49 and 50 are to Schedule 3 and extend this safeguard to problem drug users on ESA.
Where individuals have a health condition that in itself is a barrier to them returning to work, we believe that they should receive appropriate help and support to make a return to work possible, such as counselling or physiotherapy, if that is something they think is appropriate for themselves. The effect of the government amendments is such that it will remain permissible for customers to undertake such medical or surgical treatment to meet their work-related activity requirement voluntarily and with informed consent. However, under the noble Baroness’s amendment, that would be impossible. Whether it were in an annex or in the agreement itself, it would amount to the same thing. This would prohibit an adviser from entering such activities on the action plan—activities that the customer might want to undertake and which might be very beneficial for that person. We will ensure that customers are not penalised, if they changed their mind about this voluntary decision, by allowing them to fulfil their requirement to undertake work-related activity by completing another activity on their action plan.
3.30 pm
We have deliberately not defined medical or surgical treatment in the Bill, but we will produce detailed guidance for advisers on what are and are not appropriate activities to direct customers into. We would never, for example, direct customers into treatments such as physiotherapy, psychotherapy, a condition-management programme, or a diet or exercise regime. We are also confident that healthcare professionals will not deliver anything that constitutes treatment against a customer’s will. This would be against medical ethics and codes of practice.
I hope that our government amendments will allay the concerns that noble Lords have expressed about this issue in previous debates, and will demonstrate in primary legislation our determination to ensure that people cannot be coerced into medical treatment—the same concerns that the noble Baroness has sought to address through her amendments. I commend Amendments 16, 28, 36, 42, 44, 49 and 50 to the House, and I ask the noble Baroness to withdraw her amendment.
Lord Freud: My Lords, we welcome the Minister’s clarification of whether the claimants of the ESA might have to undergo medical treatment under the guise of work-related activity with the obvious result that they would be penalised if they failed to comply. We are pleased that he has clarified that that will not happen.
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Lord Rix: My Lords, in this debate on government Amendment 36, on work-related activity for claimants of the employment and support allowance, I bring to noble Lords’ attention the importance of the monitoring-by-impairment group. The Minister and the Bill team have been very helpful in improving the Bill, although I fear that their help has not extended as far as the monitoring-by-impairment group as I would have wished. However, I live in hope.
Amendment 36 is specific to Clause 8, on the power to direct the claimant to undertake specific work-related activity, and relates in particular to employment and support allowance claimants and to Pathways to Work provision. My point, however, relates to other provisions such as the new Work Choice employment programme, the flexible new deal, and the “work for your benefit” scheme, which is to be piloted for long-term jobseekers.
Given the scope of the changes that are proposed in the Bill, inevitably there is significant uncertainty about what will follow for people with a learning disability. This uncertainty would be acknowledged if appropriate safeguards were put in place by the monitoring-by-impairment group, thereby addressing many people’s concerns about some aspects of the Bill. There are, for example, multiple barriers to employment faced by people with a learning disability, and I am concerned about the apparent failure to take their specific needs into account and that a disproportionate number of them could be moved towards “work for your benefit” schemes.
I am concerned that such workfare measures could be introduced as a consequence of factors outside the control of the individual, such as a failure by the flexible new deal provider to give them appropriate support. Indeed, the Department for Work and Pensions’ very own impact assessment states that “the policy proposal”—the “work for your benefits” scheme—
- “is expected to have a greater impact on people with a disability as they are more likely to reach the end of Flexible New Deal without having moved into employment”.
However, without adequate information from the monitoring-by-impairment group, we may not be aware of the extent of this or indeed other trends. Without the means to know the extent to which people with learning disabilities and others—I am aware that the Royal College of Psychiatrists has expressed similar concern about those with mental health conditions—how are we to judge the effectiveness of the Government’s proposals? How are we to assess whether people with learning disabilities are able to access genuine opportunities to employment? How are we to ascertain the extent, or otherwise, of the Government's success? As noble Lords will be aware, 1 have consistently championed moves to provide increased support for people with learning disabilities, and disabled people in general, to seek, gain and retain employment.
However, I have ongoing concerns as to how the reforms may work in practice for those individuals furthest from entering the labour market. There needs to be an acknowledgement that individuals’ disabilities can be vastly different and require significantly diverse types and levels of support. Without a clear analysis of those for whom the new reforms are reaching, and where, when and to what extent, I fear that the
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l believe that this Bill provides the Government with a valuable opportunity to meet their commitments as set out in Valuing Employment Now and ensure that more people with learning disabilities can access employment and not be denied the opportunities to which they are clearly entitled as they seek to enter the job market and gain full citizenship. What assurances can the Minister give me?
Baroness Meacher: My Lords, I want to thank the Minister sincerely for a most helpful response to my amendments, in particular the absolute clarification that in no circumstances would a claimant be subject to sanctions, even if they have a reference to some form of medical treatment or psychological therapy within their action plan, and subsequently change their mind for any reason and do not pursue that treatment. It is enormously important to have had that said in this House as a reference for anyone concerned.
The other important aspect of the Minister’s response was his clarification that medical treatment refers to all forms of treatment, including—we did not use the word “rehabilitation”—psychological treatment, to which the noble Lord referred, which makes the point. On the basis of those assurances, I am happy to withdraw my amendment.
15: Clause 2, page 6, line 40, at end insert—
“(6) In preparing any action plan, the Secretary of State must have regard (so far as practicable) to its impact on the well-being of any person under the age of 16 who may be affected by it.”
Lord McKenzie of Luton: Before I turn to Amendment 15 formally, perhaps I may thank the noble Lord, Lord Freud, for his support for the government amendments. I am pleased that we have been able to clarify the points that the noble Baroness, Lady Meacher, is appropriately concerned about and that we have a meeting of minds. I acknowledge that the noble Lord, Lord Rix, is a huge campaigner and has great expertise around the issue of people with learning difficulties. He is fundamentally absolutely right about the need for monitoring. Without that monitoring and data, it is difficult to determine the progress being made. I thank the noble Lord for giving me this opportunity to discuss that important issue before I explain what data we collect on our employment programmes.
Perhaps I may start by outlining the progress we have made since our debates in Committee. During the summer, departmental officials held a workshop with the Disability Benefits Consortium to discuss this issue. The discussion focused on the data that the department currently holds about a customer’s impairment type and how it could be used to enhance understanding
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For all IB and ESA customers, the department holds detailed information about a customer’s primary medical condition. This information uses the international classification of disease. Figures on the high-level medical condition of IB and ESA claimants are already published on the DWP website as part of our quarterly national statistics publication. This information will be collected on customers taking part in the welfare reform pilots and will be used to analyse the impact of these back-to-work programmes. Subject to sample size and data validity, we plan to use such data to analyse the impact of our programmes and to publish them as part of DWP’s evaluation and research.
For specialist disability employment programmes such as WORKSTEP, work preparation and Access to Work, the department collects high-level impairment information using a variety of classification systems. The Government intend to publish official statistics on the new Work Choice programme and we hope to include impairment information as part of this publication. I hope that this goes some way towards reassuring the noble Lord that we take this matter extremely seriously.
That leads me, if I may, to government Amendment 15 and the amendments grouped with it. Again, I thank the noble Lord, Lord Northbourne, for ensuring that during our discussions in Grand Committee, we did not lose sight of the impact that this Bill may have on children. Amendments 15, 24 and 60 ensure that the well-being of children is always taken into account when the personal adviser and the parent agree the steps the parent will take to prepare for and move into work when completing an action plan or a jobseeker’s agreement. We have drawn on the provisions in Section 7 of the Children and Young Person’s Act 2008 which state that it is the general duty of the Secretary of State to promote the well-being of children in England. The Act refers to a definition of “well-being” in Section 10(2) of the Children Act 2004 and requires the following to be taken into account: the child’s physical and mental health and emotional well-being; protection from harm and neglect; education, training and recreation; the contribution made by them to society, and their social and economic well-being. It is this definition that will be used when advisers and decision-makers make judgments on what is reasonable when they draw up an action plan or jobseeker’s agreement with a parent. This will require them to take into account all these important factors.
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