Atos Healthcare

11 am

Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op): It is a pleasure to serve under your chairmanship, Mrs Riordan.

I am pleased that the Minister of State, Department for Work and Pensions (Chris Grayling) is here. I am not sure whether this will be his valedictory performance in that role, but I saw pictures of him going into Downing street earlier, and if he has been promoted to the post of Secretary of State for Justice, I would like to be the first to congratulate him. I remind him, however, that in that post he will be responsible for the tribunals service, which deals with appeals relating to the work capability assessment, so he will not completely escape responsibility for some issues that will be raised this morning.

I am conscious of the number of people present for this debate, which highlights the fact that although hon. Members may be consumed by events in and around Downing street today, many people outside are concerned about aspects of the work capability assessment and employment support allowance. I am sure that hon. Members will want to reflect those views and with that in mind, I shall endeavour to be brief. I shall take only a few interventions, in order to allow more Members to contribute.

There are three points on which we probably all agree: first, there are benefits in working. I have seen many of my constituents—although it is harder to do so now than it was a few years ago—return to work after long periods of unemployment. As well as any material benefits, the positive impact on their health and well-being is obvious. We should all encourage as many people as possible to work and get back into work if they have not worked for some time. Secondly, as most of us would acknowledge, helping and supporting those who have not worked for a long time can be difficult and time-consuming. It needs to be done sensitively, so that people feel helped and not as though they are being punished. Thirdly, although not everybody completely accepts this point, many feel that an assessment for those who rely on sickness and disability benefit is useful and appropriate. That was the envisaged purpose of ESA: to support those who can work into work, as well as those who sadly will never be able to work again.

Six months ago, I was fortunate enough to secure a debate on this issue. At that time, the Minister confidently predicted that the performance and situation would massively improve and some changes that had been made had not yet fed through. Six months later, I suggest to the Minister that the number of people present today indicates that very real concerns and problems remain, many of which are sure to be reflected during the debate.

In our previous debate, I focused on the experiences of constituents who had undergone the assessment. I told the story of a constituent trapped in the system who went through an assessment, a successful appeal, a reassessment, followed by another successful appeal and then another reassessment. For too many people, that remains the experience across the country. The Minister and whoever his successor will be need to look carefully at that issue and address it. I have spoken with

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many constituents who would love to go out to work, but it is not possible to do so because they suffer from a disability or a chronic condition, and I am sure that many Members in the Chamber will want to speak up for such people.

Jack Dromey (Birmingham, Erdington) (Lab): I congratulate my hon. Friend on securing this debate on a vital public concern. He has spoken of his own constituents. In my constituency, Paul Turner, a manager and proud family man, contracted a serious heart disease. He was off work and although desperate to work, could not do so. However, he was told that he was fit for work and was denied benefit. As his wife says, he went into serious decline and died only weeks later. In the work capability assessment, his heart was not tested: does that not demonstrate how fundamentally flawed the assessment process and its conduct by Atos are? Does my hon. Friend not agree that it is absolutely wrong in a case such as that for the Minister to refuse to refer it to the serious case review, so that profound lessons can be learned? Never again should anyone be treated in the way that Mr Turner was.

Tom Greatrex: My hon. Friend makes a powerful point. A number of cases could be cited that indicate the lack of comprehensiveness in the assessment process and the failure sometimes to incorporate other evidence to ensure that not as many people are wrongly assessed.

I want to concentrate on some contractual issues this morning, and I am sure that others, like my hon. Friend, will make comments about individual cases in order to illustrate those points. The work capability assessment must be tailored in the interests of both the individual and the taxpayer. Unfortunately, both are getting a raw deal from the current system. It is true that the work capability assessment was introduced under the previous Government, which is a point that Government Members frequently make, as I am sure that they will today. It is also the case, however, that in late 2010 the contract with Atos Healthcare was amended, extending it to 2015, beyond its original conclusion date of 2012. The work capability assessment was rolled out to millions of people on incapacity benefit under this Government, despite pilot projects in Aberdeen and Burnley highlighting serious concerns. The Minister said, during our previous debate—I paraphrase him slightly—that in his judgment, the Government should get on with that process and try to work on the basis of the expert reviews as they were going on, rather than fixing it in the first place.

Kevin Brennan (Cardiff West) (Lab): My hon. Friend is right to point out that the work capability assessment has been around for some time. For many years, I have been helping my constituent, Mr Robert Shafer, who was the victim of a poor assessment. Is my hon. Friend as concerned as I am that the chief medical officer of Atos is now Professor Michael O’Donnell? He was previously employed as chief medical officer by the American insurance company, Unum, which was described by the insurance commissioner for California, John Garamendi, as an “outlaw company” that has operated in an unlawful fashion for many years, running claims denial factories. Is that the kind of person that the Government should allow to be in charge of a work capability assessment system?

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Tom Greatrex: My hon. Friend makes an important point about the organisation of the company contracted to undertake that work on behalf of the Department for Work and Pensions. I shall go on to make points relating to other legitimate concerns about Atos Healthcare that need to be addressed. In many respects, given that the cost of appeals has more than doubled in two years, from £25 million in 2009-10 to £60 million in 2011-12, the performance by Atos Healthcare has, in many ways, been extraordinarily poor.

Wayne David (Caerphilly) (Lab): On appeals, does the fact that nearly 40% of the people who are initially unsuccessful are then successful on appeal not demonstrate a fundamental flaw in the work capability assessment process?

Tom Greatrex: The level of appeals and successful appeals indicates that, although no process is 100% accurate all the time, many decisions are wrong and need to be corrected through the tribunals service. No one should forget, however, that that process can take six to nine months because of the backlog of appeals. During that time, people suffer from severe anxiety and concern about their fate, so my hon. Friend makes an important point.

Joan Walley (Stoke-on-Trent North) (Lab): This issue affects us all, in all our constituencies. The whole test is deeply flawed. Does my hon. Friend agree that in the short term, we can advise our constituents that when they are undergoing the test, they can request that it is videoed, which would at least assist with further appeals? has just pointed out how much the appeals cost the taxpayer, so the Government are paying twice over for what is essentially a flawed capacity assessment.

Tom Greatrex: I thank my hon. Friend for her intervention. I am not unaware of what Atos says to people who seek to video their assessment, because cases have been highlighted to me in which people have asked for their assessments to be recorded. In the previous debate, the Minister said that if anyone wanted to have their assessment recorded, they could have them recorded, but that has not been the case in many instances and people are refused permission to record the assessment themselves. I would be interested to hear the Minister’s response to that point.

Richard Burden (Birmingham, Northfield) (Lab): I am grateful to my hon. Friend for giving way again; he is very generous. He has hit on an important point about the interface between the appeal problems and Atos’s work. Is it not true that there is a weird revolving door now? People get an assessment, question it and wait ages for the appeal. They may or may not win the appeal, but by the time the appeal comes up, they have had another assessment and therefore they go through a revolving door of losing benefits. Something is fundamentally wrong and unfair.

Tom Greatrex: My hon. Friend touches on a very important point. When I raised it with the Minister at recent DWP questions, he indicated that, finally, some of the information coming back from the tribunals service would go to DWP decision makers, so that they were better informed. I will make this point now, so that 

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the Minister can, I hope, respond to it. That started to happen in July. I want to raise the issue of the status of those reports and what impact they will have on people being called for further assessments. In particular, some tribunals now have a section at the end of that information that suggests that that particular applicant should not be reassessed within 12 months or 24 months. Is that something that the DWP is taking into account and appreciating before it calls people back? I ask that because my hon. Friend the Member for Birmingham, Northfield (Richard Burden) is exactly right: there are many cases of people who have been caught in this process, which is no good for their health and no good for taxpayers, because we end up paying again and again over time.

Several hon. Members rose —

Tom Greatrex: I will take one more intervention. I apologise to everyone else, but I want to leave time for other hon. Members to make contributions. I give way to my hon. Friend the Member for Airdrie and Shotts (Pamela Nash).

Pamela Nash (Airdrie and Shotts) (Lab): On the point about recording assessments, a constituent of mine was told recently that they could record the assessment, but only if they paid for a private, independent company to come in and do it. Obviously, someone who is living on benefits cannot afford that. I wrote to the Minister at the time about the issue. I wonder whether he can deal with the recording of assessments in his closing remarks.

Tom Greatrex: I thank my hon. Friend for her intervention. She has made a point to which I hope the Minister will be able to respond.

I will attempt to move on. Back in February, I wrote to the National Audit Office to outline concerns about the contract between Atos Healthcare and the DWP. The correspondence centred on two issues: first, a lack of efficiency in the use of public funds, to which I have referred, and secondly, a lack of accountability inherent in the disbursement of those public funds. As the recent House of Commons Library note and many of the figures that I have received as answers to parliamentary questions over the past 18 months or so have confirmed, and as my hon. Friend the Member for Caerphilly (Wayne David) reflected, 41% of those found fit for work appeal the decision and 38% have their appeal upheld. For those who seek the advice and support of professional advocacy groups such as Citizens Advice, the appeal success rate is closer to 70%. Just last week, Kent’s largest citizens advice bureau indicated an appeal success rate of 95%.

The impact of what is happening is twofold. First, too many sick and disabled people are being found fit for work when they are not. They become entangled in a lengthy appeal process that, as I said, can occupy up to nine months of their time. In many cases, even when the appeal is successful, the individual is placed in the work-related activity group and then they have to begin the whole process anew.

Ann McKechin (Glasgow North) (Lab): Will my hon. Friend give way?

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Tom Greatrex: I will not, because I need to make progress. I apologise to my hon. Friend.

The second impact of the high appeal success rate is cost. The cost to the public purse from appeals relating to the WCA was £60 million in 2011-12. As I said, that figure has more than doubled since 2009-10. It is almost 50% of the total yearly value of the Government’s contract with Atos Healthcare to carry out the assessments in the first place. In effect, taxpayers are paying for the process not to work, and then to correct it. Given the unprecedented pressures on the public purse, it beggars belief that the Government are apparently content to sit back and do very little to rectify that situation.

In oral evidence to the Work and Pensions Committee in June 2011, the Minister claimed that if the migration of those on incapacity benefit to ESA was successful, it would save money. He said that the aim is not a

“savings measure—it is not a financially based exercise, although clearly if we succeed it will save money”.

The Minister appeared to accept that an indicator of success was saving money, so does he accept that the significant increase in costs associated with the number of decisions being appealed—and being successfully appealed—shows that, on that measure, the Government have failed?

One measure that I and many others have been questioning is the imposition of financial penalties on Atos Healthcare to compensate for poor performance. In February, in response to my written question on whether the Government had considered imposing such sanctions, the Minister appeared to absolve Atos of the blame for the number of decisions overturned on appeal by saying:

“it would not be appropriate to impose financial penalties on Atos to reflect the number of work capability assessments which are overturned on appeal.”—[Official Report, 22 February 2012; Vol. 540, c. 852W.]

I tried again in July by asking for a note of when penalties had been imposed and what their total value was, but that time, rather than absolving Atos of blame, he decided to protect the company’s commercial interests, replying with the frequent defence of “commercial sensitivity” as the reason for withholding that information. I find it difficult to understand how commercial sensitivity comes into play when we are talking about a single company that is paid from the public purse to carry out an exclusively public function on behalf of a Government Department. Transparency would help to ensure that there could be confidence in the system and to highlight where performance was not being properly managed. It is important that the Minister seeks to address that.

It was not until the NAO responded to me last month that some light was shed on the issue. It said:

“We do not consider that the current contractual targets are sufficiently challenging, and in our view this allows the contractor to deliver a significant number of assessments before financial penalties become due.”

It continued:

“Our review also concluded that the Department has not sought adequate financial redress for contractor underperformance.”

One of the most concerning revelations from the NAO was that in only 10% of the cases in which financial penalties could have been imposed did the Government do so. That is astonishing. Given that the Government and the Minister quite frequently comment on the 

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importance of value for money for the taxpayer—in some respects, I agree with that—it beggars belief that when there are opportunities to put that into practice, the Government have done so in only one in 10 cases.

I quote:

“In these times of tight budgets, we need to make sure the money we do spend is better spent. If we don’t we are failing disabled people and their families.”

Those were the words of the Prime Minister in 2009 at a conference on autism. In that same speech, the then Leader of the Opposition cited a NAO report that examined value for taxpayer money in relation to autism. I am sure that, even given his elevation today, the irony is not lost on the Minister.

There are many questions that the Minister must answer to account for the failure properly to manage the contract with Atos Healthcare. Why did he impose financial penalties on only 10% of the occasions on which they could have been triggered? What was the total value of compensation clawed back from Atos Healthcare to reflect that poor performance, and what was that as a percentage of the cost to the public purse for the original contract and appeals? Does he agree with the NAO that current targets that trigger financial penalties are not sufficiently challenging? What are the key performance indicators that the NAO described as insufficiently challenging? That is a particularly important issue.

On a number of occasions, I have attempted to gain clarity on what is expected of Atos in relation to customer service, the number of assessments conducted, the number of people found fit for work, targets, statistical norms and many other issues. The Minister has refused to be fully transparent, releasing a very limited excerpt from the medical services agreement with Atos that relates only to waiting times. As I said, maximum transparency is important to enable people here to hold the Government properly to account, and to hold Atos Healthcare, through the Department for Work and Pensions, properly to account for the work that it is undertaking in a very important area.

The NAO was also scathing about the Government’s failure properly to monitor the performance of Atos. According to the NAO, there is

“Limited routine validation of information provided by Atos Healthcare”.

It went on to recommend that

“the Department develop processes to validate key performance information supplied by Atos Healthcare.”

Back in February, in the previous debate on the issue, the Minister stated, with a certain degree of confidence:

“On capacity issues, as we stand here today, the incapacity benefit reassessment is on time. New claims for ESA have fallen a bit behind, mostly because of the introduction of the personalised statement…We discovered in the first few weeks that it took health care professionals…longer to complete the statement than expected, so the number of completed assessments dropped. That has changed. They have caught up again, and we are chasing through to clear the backlog, as we are doing with the appeals backlog”.—[Official Report, 1 February 2012; Vol. 539, c. 292WH.]

Unfortunately, the evidence does not bear out that assessment.

The target waiting time from when the ESA50 form is issued to the claimant to when Atos Healthcare completes the work capability assessment and hands the case back to the DWP is 35 working days—seven actual weeks. 

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Between September 2009 and August 2010, the target was met with a clearance rate of 33 days, yet in the space of less than two years, not only has the target not been met by an astonishing margin, but the length of time sick and disabled people have to wait for their assessment has risen by 85% to 61 working days, or more than 12 full weeks.

More than 20,000 people are waiting more than 13 weeks for a work capability assessment. The reason the Minister gave was:

“Atos Healthcare’s ability to deliver a service within the AACT was also impacted by the service volumes for this period which were significantly above departmental forecasts; in addition Atos had recruitment demands/challenges. These issues…resulted in an increase in the AACT.”—[Official Report, 9 July 2012; Vol. 548, c. 51W.]

Atos Healthcare receives more than £110 million a year to deliver a contract, but is unable to meet its recruitment needs to deliver it properly. That, at best, is an example of the underperformance and the level of failure due to which the Government should ensure that financial penalties are brought against Atos Healthcare. Such contractual failure feeds directly into the experiences that I am sure we will hear about in the remainder of the debate. Many people across the country have found themselves waiting an excessive time for their assessment. They are under pressure and feel hounded, and they may well wait a significant period for the appeal to follow. A degree of the chaos in the system is caused by the Government’s decisions and the failure to hold Atos properly to account.

This is not the first time that recruitment challenges at Atos have been highlighted as reason for failure. In December 2011, the Minister advised that a key Harrington recommendation would not be implemented beyond the pilot stage due to capacity pressures at Atos. In less than a year, the Government have twice cited the failure of Atos to recruit enough staff as the reason why those undergoing the WCA are being short changed, which gives rise to a question: if the Government are content to blame Atos, why has the Minister spectacularly failed to do anything about it? Why, on the one hand, in his answer to written questions, does he lambast Atos when waiting times increase, and yet, on the other hand, sit on his hands when it comes to making the company pay financially for its underperformance?

In 2010, the average WCA customer journey was 36 working days. That rose to 44 working days in the first half of 2011, and increased still further to 53 working days in the second half of 2011. Unfortunately, 2012 brought more misery for ESA claimants, as between January and May, the average customer journey increased to 64 working days, or just under 13 weeks. The Minister inherited 36 working days and transformed it into 64—an increase of 78%. It might seem that I am talking about the dry detail of contractual issues, but we see the defects at the heart of the process—the failure of the management of the DWP and the failure of delivery at Atos—reflected in the experiences of many people we represent.

I want to say a few words about the award of the £400 million contract for the personal independence payment in many parts of the UK to Atos Healthcare. 

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A further criticism in the NAO review, which interestingly enough was dated the same day as the announcement of the PIP framework agreement, was about medical services contracting. The NAO stated specifically in relation to the PIP procurement process:

“Our review of existing arrangements concluded that the Department needed to make changes to secure effective leverage over future medical services contracts…we have recommended that the Department focus on reducing the barriers for new suppliers to making a sustainable entry to the medical services market, in particular addressing the current risk that a single incumbent supplier has significant cost advantage which makes delivery of a level playing field in the market more challenging”.

The NAO went on to lament the DWP’s

“dependence on a sole national supplier”

that has

“limited opportunities for routine assessment of value for money, for exercising contractual leverage and for wider market development.”

Like many Members in the Chamber who represent constituencies within the areas for which Atos Healthcare will undertake the PIP assessment process, I received a letter from Atos confirming that it had been successful in securing the contract. It included the chilling phrase that it had won the contract on the basis of its record delivering assessments for the Government over a period of years. This is a serious point, because as the PIP process is established, it is vital that some of the problems encountered in the WCA are not simply repeated. There is concern that there is an increasing risk that that will be exactly the case, given the chosen contractor.

Contractual arrangements, performance measures, penalty clauses, and monitoring and delivery failures are technical, dry and dull matters, especially when contrasted with the sometimes heartbreaking and tragic cases that I have heard about, not only from my constituents, but from many of those who have contacted me prior to the debate. Many of those experiences are due to the flawed delivery of the WCA and the record of Atos Healthcare.

Whoever is the responsible DWP Minister tomorrow afternoon, we need a process that works in the interests of taxpayers, and of individual claimants and applicants. We need a process that is comprehensive enough to encompass complex conditions and that recognises that it is a waste of time and money to keep reassessing people with progressive and incurable conditions, while also recognising the fluctuating nature of many other conditions—that people have good days and bad days. We need a process that appreciates the very difficult challenges of assessing mental health needs and that takes account of expert medical evidence much more fully than the current process, particularly in some of the cases we have heard about. We need a process that does not make blanket assumptions about the time it takes to recover from very serious illnesses, such as cancer, nor imposes blanket conditions as a result. We need a process that helps people who can work and does not hound those who cannot.

Several hon. Members rose —

Mrs Linda Riordan (in the Chair): Order. With the permission of the Chairman of Ways and Means, and due to the number of Members wishing to speak, I will limit speeches to three minutes. When you hear the bell, you have one minute left. I remind Members that 

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interventions should be short and remind those in the Public Gallery that they should listen in silence and not interrupt the debate. I call Duncan Hames.

Duncan Hames (Chippenham) (LD): Given the number of Members wishing to speak, I am happy to forego the opportunity. Thank you for calling me, Mrs Riordan, but I would prefer to listen to other speakers who are clearly keen to take part in the debate.

11.28 am

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): I will take the opportunity to speak, but for the reasons the hon. Member for Chippenham (Duncan Hames) gave—the number of Members who want to speak—I shall be brief. I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate, but more importantly on the work that he has done over almost a year in highlighting the problems of Atos and the work capability assessment. Like many Members, I came to the debate today with a dossier of cases from my constituency of people who had suffered in the process, and not only that which involves Atos. Let us be clear, not only Atos is at issue, but how the system operates, how it is being put into effect and how Atos is asked to carry out its work. There are certainly major deficiencies in the organisation, but it is not only Atos with which we need to be concerned.

Given the time, I will make just a few points. Many applicants find the experience of going through the WCA process terrifying. There is plenty of evidence, especially in the cases of those with mental health issues, that the process does not take account of the particular circumstances of those who suffer from conditions that may vary from day to day, as my hon. Friend made clear. Inevitably, any process, under any system, will lead to stress and tension for many people, but what makes it worse is that the process is felt by many applicants to take away from their dignity as human beings. It does not lead to proper consideration of their personal circumstances and they believe, notwithstanding what the Government and the contracts say, that it is a method of keeping down the cost of benefits. I know that that is not in the policy or the contracts in any sense, but in a climate where there is a feeling that the Government are trying to drive down costs at any expense, it is inevitable that many of those who apply for benefit will feel that way. Those subjective feelings are borne out by the high rate of successful appeals.

The high rate of successful appeals, which hon. Members have pointed out, leads one to conclude that there must be people who do not appeal or even apply for benefit who would have been successful or been entitled had they done so. It is essential that the process is right first time. That is partly the responsibility of Atos; it is also the responsibility of Government. What must be ensured is that all available evidence is used at the earliest possible stage in the process. We are all familiar with cases in which the medical evidence from GPs and consultants is overwhelming and yet the applications are unsuccessful. It is only at appeal that such people receive the right decision. It is also important to reduce unnecessary reassessments, as there have been cases where it is overwhelmingly obvious that a reassessment should not be carried out. I would like to know what the Minister is doing about that.

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I make this final comment to the Minister. He may be leaving his current post today, but I seriously hope that in his new role he will ensure that the backlog of appeals is dealt with speedily. That is important for individual applicants and for the system. Until that backlog is dealt with we will not get out of this vicious circle in which new applications are put in at the end of the appeal process and the whole process starts again. That should be a priority for the Minister to address in his new role.

11.31 am

Katy Clark (North Ayrshire and Arran) (Lab): I am delighted to have the opportunity to contribute to the debate, because many constituents have contacted me about this issue over the past few weeks. For a number of years many constituents have been in touch with my office with concerns about Atos. The publicity over recent weeks has meant that many people not directly connected with the process are now aware of the problems. I ask that the Minister listen not just to what is said today but to the concerns raised over a long period.

I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate and on all his work on the issue. It is not just MPs who are expressing concern. All of those involved, whether in representing claimants—organisations such as Mind—or the professionals involved in the process, such as the PCS trade union or the British Medical Association, are expressing concerns and taking the view that the process is fundamentally flawed. I also ask the Minister to recognise the anger that Atos is sponsoring the Paralympics. Many feel that is an insult to the people going through this process.

A year or more ago, many of the constituents contacting my constituency office were doing so about new employment and support allowance claims. The problems seemed to come largely from the Atos medical assessments. As has been said, constituents who get in touch with their MPs are almost invariably successful, either at the initial reconsideration or the appeal stage. When constituents approach MPs with a credible claim, invariably that person is successful at appeal. However, there has been a change and the constituents now getting in touch are mostly those transferring from incapacity benefit and being put on the work-related activity scheme. That basically means they get only contributions-based benefit for one year rather than the permanent help they would get if they were put in the support group.

That is quite different from the previous situation. Apart from the financial implications of being means-tested after a year, it involves reassessments, attending interviews and the requirement to look for a job. Most of us are aware of many constituents in extremely difficult medical situations who are being caused a huge amount of stress. I ask the Minister to listen to what is said today and make serious changes to the current position.

11.34 am

Jim Shannon (Strangford) (DUP): I congratulate the hon. Member for Rutherglen and Hamilton West (Tom Greatrex) on bringing this matter to the House. The issue affects us all as MPs. With benefits changing now and in the future, the impact on our constituents is greater than ever.

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I want to focus on one thing, as I am conscious of the time. I will give an example of how the Atos system does not work when it comes to basic knowledge of the interaction between the applicant who is appealing against the decision to refuse incapacity benefit or ESA to those who are wheelchair-bound and have severe mobility problems. They are asked to attend the appeal on the third floor of a building in the centre of town. The first question the receptionist will ask is, “Can you leave this building on your own if there is a fire?” That is a very important question but the fact is they could not do so, so they have been asked to attend an appeal tribunal that cannot take place. They go home and join the back of the queue once again, having to wait perhaps another six or eight months. They are then asked to attend an appeal that takes place about 45 to 60 minutes away by car, through traffic, pain and other problems in order to get where they want to be.

There are clear problems in the basic knowledge of the scheme. Whenever an elected representative makes a complaint about that to the relevant bodies, whether Atos or the Minister responsible in Northern Ireland, they take it on board and seem to respond. That is great, because one thinks one has won the battle for the constituent and the system in future. However, it does not work that way. Guess what happens? Next time, someone else in a wheelchair with severe mobility difficulties encounters the same problem. I want to illustrate that with an example, because we have a system that has failed my constituents again and again.

There has to be a grassroots change in how the system works. That is what the hon. Member for Rutherglen and Hamilton West is saying and why we are all here today. There are many people who fall into the category. It is assumed that if someone is not able to walk they can sit and do a job. That is unfair for many people because the problems they have with their back or severe mobility problems they have means they cannot stand or sit on a regular basis. I am very conscious of these issues and want to raise them. I hope the Minister will give a positive response. We need change or accountability—either one or the other, or indeed both.

11.37 am

Dame Anne Begg (Aberdeen South) (Lab): Congratulations to my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing this important debate. This is my first time speaking after my extended absence and therefore a good subject.

The Minister of State, Department for Work and Pensions (Chris Grayling): On behalf of everybody in the room and in the House, I welcome the hon. Lady back to the House. We are delighted to see her in such good shape. We were sad to hear of the difficulties in the long period of recovery she has had to go through. She is very welcome back.

Dame Anne Begg: I thank the Minister for being gracious. He may not be quite so gracious by the time he has heard what I have to say. I do not think that the Government have grasped how disastrous the ESA assessment system is. It is not something that can be fixed by a few tweaks here and there; we tried that with 

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the Harrington review. What we have heard today in the Chamber—and in the “Dispatches” and “Panorama” programmes filmed in June this year—suggests that not much has changed. The people complaining are not just the usual suspects, not just the radical crips, the workshy or those who want money without being assessed. They are ordinary people, most of whom worked hard all their lives until the sky fell in and they lost their job because of an illness or an acquired disability.

It is not enough for Government to say that the genuine claimant has nothing to fear. In too many cases, genuine claimants are not scoring any points in their initial assessment. There is something fundamentally wrong with the system and the contract that Atos is delivering. When the British Medical Association votes at its conference to say that the work capability assessment is not fit for purpose there is something wrong with the system. When GPs are reporting an increased workload, not just as a result of providing reports but as a result of treating patients whose condition has worsened as a result of their WCA experience, there is something wrong with the system.

When my constituent, who has lost his job because he has motor neurone disease, scores zero on his WCA and is found fully fit for work, there is something wrong with the system. When that same constituent appears in front of a tribunal and in less than five minutes is awarded 15 points, there is something wrong with the system. When people with rapidly progressive illnesses are not automatically put in the support group, there is something wrong with the system. When some people would rather do without the money to which they are absolutely entitled rather than submit to the stress of a WCA, there is something wrong with the system. When someone with a severe illness has to fight for a year through an appeal to get the correct benefit, only to be called in almost immediately for another assessment, there is something wrong with the system. When the recall and assessment happen the following year, and the following year, there is something wrong with the system. When people feel so persecuted, there is something wrong with the system. To top it all, they lose their contributory ESA after only a year if they are in the WRAG group.

When up to 40% of appeals are successful and there is no penalty for the company carrying out the assessments, there is something wrong with the contract. When so many appeals result in an award of ESA support group status when the original assessment was no points, there is something wrong with the contract. When there is no penalty for a high percentage of wrong decisions, there is something wrong with the contract. When there is no incentive for assessors to get the assessment correct first time, there is something wrong with the contract. It is time for the Government to act, because there is something fundamentally wrong with the whole system.

11.41 am

Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op): I am pleased to be called in this debate. I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate and on giving a superb speech. I wish to add my voice to those concerned about the operation of the WCA by Atos, and to highlight specific concerns in relation to people with autism.

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I accept that we have a problem in the UK with the number of people who are not in the labour market owing to illness or disability. I asked the Library for a comparative analysis of the levels across the EU. Although it is hard to make such an analysis given the differences in scope, eligibility and recording of information, the European labour force survey clearly shows that the UK has a much higher proportion of the population aged 20 to 64 outside the work force owing to illness or disability. It is 6.1% in the UK, against an average of 4.3% in the rest of the EU. I think we know why that is. From the Thatcher Government onwards, people were put on the incapacity benefit rolls to hide the true scale of unemployment. There are people who were dumped there in the 1980s who have been there ever since. That is why I do not have a problem with the principle of a medical assessment; otherwise the Government can too easily push people into inappropriate benefits to massage the unemployment figures. Equally, I do not have a problem with three classifications: fit for work; unfit for work; and the possibility of work, but not in the short term, because someone has been out of the labour market for so long.

My concerns and objections relate to the way in which the Government are allowing Atos to conduct the test. Like other colleagues, my observations are heavily based on the experiences of constituents who have come to see me. It is not sensible, prudent or fair to have a test in which 40% of appeals against decisions are successful. It is a waste of money and it causes unnecessary distress. The Government need to hold Atos to account for an assessment that is clearly not working as it should. Atos is not coping with the complexity of the cases that are seen, and it is clearly struggling to deal with people with complex conditions, particularly those with less visible symptoms. Some specific problems are particularly evident: the Royal National Institute of Blind People has reported that the descriptors against which blind and partially sighted people can score points are primarily those based on navigation and communication, with no account taken of other barriers that blind and partially sighted people might face in obtaining work.

I am one of the vice-chairs of the all-party group on autism, and I remind the House of my existing declaration of interest in relation to my son. For people with autism, such face-to-face assessment can often be extremely problematic. People with autism face problems with communication that other people would not see. They may misunderstand questions that are asked, find it hard to answer questions, and fail to pick up on inference and assumption. For example, when asked, “Can you travel to work on a bus?”, they may say yes, but not explain that they can use only one bus route, planned with the help of a support worker, provided that the bus is not late or a different colour from usual, or that no other factors have arisen.

In addition, the testing of some people is too frequent. I have a constituent with a degenerative disease who passed one assessment, but failed another one within a year. As his condition was degenerative, it was surely medically impossible that he had got better. It does not make sense. At the extreme end, I have heard accounts of people in the support group being tested again after as little as three months. The worry that that causes is 

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exacerbated by the freak results that an assessment can produce. I have another constituent who was deemed fit for work despite having a broken back.

The Government need to listen to the feedback that is coming in across the country about the very real problems in the operation of the WCA. Crucially, they must begin to hold to account private companies with important Government contracts when they do not deliver for the taxpayer. The quality of life of thousands of people depends on getting this right, and it will soon be even more the case given that Atos has won the contract for the personal independence payment assessment. Let us not get into the usual party political rhetoric and stereotypes that tend to mark welfare debates. Let us focus on meaningful changes that will improve many people’s lives.

11.45 am

Nick de Bois (Enfield North) (Con): I have a small contribution to make to the debate. All MPs watch closely and listen carefully to charities, as I do in my constituency. I meet charities regularly and I am always seeking to handle cases in which it appears that odd decisions have been made, and with which I am uncomfortable. I will always pursue such cases, like any good MP, if someone feels that the system is not working correctly.

I rose to speak today to make a point. In all my time and in all my dealings I have never lost sight of what is fundamentally driving the WCA. We are asking what people can do and encouraging and helping people who have been ignored by the system. We seek to find what they can do and not what they cannot do. Many people in this Chamber will agree with that premise.

However, I will turn specifically to the statistics. If we look only at the statistics, it is easy to get a distorted picture. It is recorded that for 55% of new claimants who have been found fit for work, that is a good thing. I accept that appeal levels appear somewhat high. When we hear that 40% of those who are found fit for work appeal, we have to remember that 38% of them have a decision overturned. To put that in perspective, of all the claimants, overall we are talking about 15% fit for work decisions being overturned. I am not saying that that is satisfactory or that that is a good thing. However, I am determined to make a point.

Anne Marie Morris (Newton Abbot) (Con): Although it is a good idea to help people who can work, we need to look at providing a more flexible work opportunity. At the moment, there are permanent job opportunities, but there is nothing flexible such as working from home for those who have mental health problems, which would help to achieve what the Government want. To make the system work better and to save taxpayers’ money, the people who will never be able to work again—people who have very serious problems with blindness or mental health problems—ought to be in an exclusion category so that they do not get reviewed.

Nick de Bois: My hon. Friend is absolutely right. My point—my argument—is that if we stick to the headline statistics, we start to get into a debate that dwells on statistics. If we are going to do that, I am keen that we dig down and analyse them correctly before we make sweeping judgments.

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I am pleased that the Government, along with the specialists, the occupational therapists and Professor Harrington, have not sat back since coming to power, and have not failed to review the process. They have reviewed it twice, and Professor Harrington has been asked to review it a third time. That is right, but it should not detract from the overriding principle that the hon. Member for Rutherglen and Hamilton West (Tom Greatrex) highlighted. It is right that we should encourage and help people back to work where possible. After all, they were not assessed for a long time and it would be wrong to ignore them, because many have returned to work and will continue to do so. [ Interruption. ]

Mrs Linda Riordan (in the Chair): Order. May I remind Members and those in the Gallery that other Members must be heard?

11.49 am

Alison Seabeck (Plymouth, Moor View) (Lab): I thank my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) for securing this debate, which has not come a moment too soon for many of my constituents. The principle that people should be supported into employment when they can work is the right principle. The problem is that the system is not achieving that. It is causing untold grief and serious concern to many vulnerable people. There are several issues. Will the Minister explain why there is still confusion between ESA and JSA? Cases have been brought to my attention of constituents being passed back and forth, with both the relevant Departments feeling that the benefit is not the right one. A constituent of mine was claiming JSA and was notified by her hospital that she had to have an operation on her wrist. She was told by the jobcentre adviser to claim ESA instead of JSA, because no one would employ her for five or six weeks. She was then refused ESA, because she scored no points, and was left in limbo, with no money. That is not acceptable.

That incident occurred over a relatively short period, but some of my constituents have had to wait up to 18 months for a tribunal decision. When they sought updates on progress one was told that no update was available, because there was no one in the area to hear her case. Consequently, other benefits to which people are entitled are not given to them. A constituent applied for cold weather payments and was told that because her position had not been resolved she could not claim them. She might have frozen to death in the meantime, during the bad weather, while a decision was reached.

There are many incidents of poor claim handling by Atos. I am sure that every hon. Member in the Chamber has dealt with tens of them. A constituent recently came off contribution-based ESA. He was assessed by an Atos nurse who advised him that he needed a wheelchair but at the same time assessed him with no points. Another constituent had a major cancer operation. The GP’s report said that she was

“currently in wheelchair, not fit for travel”,

but it took three goes to get a home visit for her. Eventually, she was given a wheelchair, received DLA and had home adaptations. Then Atos said it wanted to see her, and insisted she should come, with the threat 

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that if she did not her money would be stopped. She had to cancel a hospital appointment to do so. That is not acceptable.

I ask the Minister whether independent assessments can be considered at the front of the process, not the back. That would, I am sure, save untold numbers of appeals in due course, as well as saving my constituents untold misery. They feel—particularly those with multiple issues, including mental health issues—that the medical advisers who are asked to assess them do not fully understand their cases. The Government should be ashamed of the slump in Atos’s performance that my hon. Friend the Member for Rutherglen and Hamilton West has highlighted. It has had an unacceptable impact on disabled people, particularly in my constituency.

11.52 am

Hywel Williams (Arfon) (PC): I, too, congratulate the hon. Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate, because there can hardly be an MP who has not had a constituency case involving Atos and the work capability assessment. The Members present in the Chamber are only a small sample of the people who have had to work with that system.

From my casework I find that the faults in the system fall into clear categories. First, as to the form of the assessment, there is insufficient information. It is a particular problem for decision makers, who are trying to take reasonable decisions without enough information. Information is also lost or disregarded. There are persistent complaints that Atos is working to targets to fail people, and about continual reassessments. Missed appointments are another issue. A couple of weeks ago, a constituent of mine stayed in all day, and the doctor did not turn up. I turned up, by the way, and wasted a couple of hours of my time. My constituent will not complain, because he is scared to do so. He does not want the attentions of the Atos doctor again, thank you very much.

As to the content of assessments, to give a snapshot of something we have already heard about, it is unsubtle—it consists of ticking boxes; and it does not work well with intermittent conditions. There are questions about the competence of Atos staff to assess mental illness, for example. In another constituency case, apparently the doctor involved was not allowed by the medical authorities to work with patients or perform any form of medical intervention, apart from undertaking Atos assessments.

There has, I concede, been some improvement since the Harrington review. However, it is interesting to consider the nature of the mistakes that the system produces. For example, I was told by my local citizens advice bureau that since April it has launched 62 appeals, of which it has won three and lost two; the rest are still pending. That is a common experience for MPs. Incidentally, as a Welsh MP, I have been told that appeals in Welsh are taking longer, and I would like some response on that issue.

Atos should be put into special measures. It should report frequently—monthly, perhaps—on the number and percentage of cases that lead to appeal and to a change in the decision, and also on the number and percentage of revolving-door appeals. Most importantly for the public debate, we should have some qualitative information about people’s experiences. I think that that would influence the public debate on disability and 

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benefits in a positive way, given the current climate fostered by some newspapers and commentators, and by the Government’s policy.

11.55 am

John McDonnell (Hayes and Harlington) (Lab): Yesterday, I met constituents who have gone through the system. They call themselves victims of Atos, and I promised them that I would briefly set out the experience that they described. The assessment was exactly as others have said. Applicants are often met by an assessor with no expertise or specialist knowledge of their condition; it is a tick-box exercise—my constituents completely agree with the BMA about that. Despite the Harrington recommendations for improvements, the test bears no relationship to the real-world challenges that people with disabilities face. There is no recognition of fluctuating conditions, as has been said—particularly in connection with mental health. The procedure largely ignores the assessments and advice of applicants’ own GPs.

[Mr Philip Hollobone in the Chair]

In addition, the process even ignores previous Atos assessments. A constituent of mine was employed by Royal Mail, which used Atos to assess capability for work, and was assessed as not being capable. My constituent then retired and applied for benefits, and following another Atos assessment was found capable of being re-employed in the same type of work.

The fly-on-the-wall exposés by television programmes have exposed the pressure exerted on assessors to fail people. If people are assessed as capable of working correctly, they are then regularly harassed with challenges that they are unable to cope with, and they lose their benefit as a result. If they succeed at the assessments, they are harassed with reassessment after reassessment. We have heard the appeal statistics, but most of my constituents must wait six months or longer for an appeal. Those who have support—and I do support them; I represent people now at appeals—win. However, there is a lack of support, because of cuts in local government support for advice centres, and Government cuts; so many people are not supported.

The result? To be frank, it is financial hardship. People are living in poverty because they lose their benefits. In addition, there is emotional stress, breakdowns, and, as Mind points out in its briefing, self-harm and suicide. Why do the Government defend the company? Why have they awarded it the personal independence payments process?

I share the disgust of many disability groups about Atos being allowed to sponsor the Olympics. It is a disgrace. I support Disabled People Against Cuts, and the Black Triangle campaign, which organised the protest against Atos sponsorship. I am calling for an inquiry into violence against people with disabilities who protested last week at the Department for Work and Pensions, and elsewhere. A few months ago, I tabled an early-day motion calling for Atos’s contract to be withdrawn, and for the establishment of a new system; 103 hon. Members have signed that early-day motion. Surely after that, and following debate after debate and the protests on the streets, the Government must reassess the role of Atos, and establish a new system based, as my hon. 

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Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) suggested, on reputable, fair and equitable criteria.

Several hon. Members rose —

Mr Philip Hollobone (in the Chair): Order. Ladies and gentlemen, please take your seats. To be frank, there are more people standing than we shall have time to hear from in the debate. The Opposition spokesman has said he requires eight minutes. I suspect that, because of interventions and so on, Members will want the Minister to have slightly longer. I propose that we begin the winding-up speeches just after five past, so we probably have time for two more speeches before then. I have a list given to me by the previous Chairman, and I shall take speakers in that order.

11.59 am

Yvonne Fovargue (Makerfield) (Lab): I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing the debate. It is worth reminding people that behind the statistics we have talked about are people who have wrongly been denied the money they need to live on and the support they need.

Like many hon. Members, I have dealt with innumerable cases, and I want to return to the issue of recording. A constituent who came to me wanted his Atos assessment to be recorded, because he had heard of problems in the past. He was told that there were 10 working sets of recording equipment for 140 centres, and that he would have to attend an assessment that could not be recorded, although I believe that it is his right to have it recorded.

Recording might have helped another constituent who came to me, who had been suffering from depression and anxiety, and who had an assessment. She does not cook; in fact, she has not got a cooker, because her lack of concentration means that it would be unsafe. She could barely communicate with me, but the Atos assessment said that her communication was good. She forgot to mention that she lives with her sister—she had to be reminded by her mother—so that was never mentioned in the assessment.

Those clients are appealing with the help of advice agencies, but I fear that when legal aid goes in 2013, there will be a drop in the number of appeals. That drop will not be because Atos is getting it right first time; it will be because people have nowhere else to go for an appeal and will be living without the benefit to which they are entitled. In particular, Atos needs to request medical evidence, which costs money—I have known doctors’ reports to cost anything from £35 to £200—and people eligible for legal aid can get those reports paid for, if they go to an advice agency. What will happen when that system stops?

Lastly, in the short time we have left in this debate, I want clarification on the compulsory reconsideration phase that will come in from April 2013. Will claimants still receive employment and support allowance during that period, as is vital? As we have already heard, 35% of appeals are successful, which means that those people were not fit for work—the decisions were wrong—and if they are not fit for work, they cannot meet the work search requirements. It is therefore essential that ESA continues during that period, and I want clarification about that in relation to all the groups.

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Several hon. Members rose —

Mr Philip Hollobone (in the Chair): Order. If there are no interventions, we can hear from two more speakers before hearing from the Front Benchers. On the list provided to me, those speakers are Julie Hilling and Bill Esterson.

12.2 pm

Julie Hilling (Bolton West) (Lab): I am so grateful to have been called, Mr Hollobone. I congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing this important debate, because there is no doubt that Atos work capability assessments are not working. When campaign groups adopt the slogan, “Atos kills for profit”, something is deeply, deeply wrong. Any organisation that is proved wrong on 40% of its decisions is failing, and it certainly came as a real surprise to us all when Atos was given the contract for the personal independence payment. Of course, we want to help into work disabled people who are able to work, but removing benefit from those who cannot work is heartless, cruel and just plain wrong. Assessments should take notice of medical reports, whether from GPs or specialists, and of prognosis and treatment programmes, and they must take better account of fluctuating conditions and mental health issues. I want to ask the Minister two questions: how many people have died between being rejected for ESA and their appeal, and how many people have actually committed suicide?

Time is short, so I shall give only two examples. Aaron, who came to me last week, was injured in a bomb blast in Afghanistan in 2009. The explosion broke virtually every bone in his body, and he suffered a crushed-leg injury. Despite immediate medical care, his injury resulted in a partial leg amputation—below the knee—in 2010, and he has had several other surgical procedures. He originally received disability living allowance, but after his Army discharge, his benefit was stopped. He was reassessed for benefit in November 2011 and was told that, as his walking had improved, he would no longer get it. That was a bit of a surprise to him, because he is still struggling with his transition to having a prosthetic leg as his stump is regularly infected, he has required other surgical procedures, and he is still waiting for an operation this autumn. I have a second question relating to Aaron. It is not only the Department for Work and Pensions that has failed him; what about the Prime Minister’s assurances earlier this summer guaranteeing welfare support for ex-servicemen and women injured in military conflicts?

I have been visited by the mother of someone whom I will call Tony. Tony lives alone and is struggling to have as normal a life as possible, despite the world appearing to be very difficult for him. His mother was desperately worried about him, because he has just scored zero in his Atos assessment, despite the fact that he is bipolar and has obsessive compulsive disorder and Asperger’s. Tony has really wanted to work and has tried several jobs. He tried a job as a postman, but because of his OCD he could never get out the door—he would sort the letters by address and would then have to re-sort them by size and colour. Although he has been supported by a number of employers, he found that he was unable to work. In the end, he had a breakdown and ended up 

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in hospital. His consultant has said that he cannot work, and his family is now terrified about his suicide risk.

Mr Philip Hollobone (in the Chair): Order. I call the last speaker: Bill Esterson.

12.5 pm

Bill Esterson (Sefton Central) (Lab): More than 40 people have approached me with cases of being denied benefit following a WCA, or about their fear of that happening. The Member who mentioned the culture of fear among that group of people is absolutely right. A number of them have described being afraid to appeal, because the experience that people they know have had of Atos staff members has been so terrifying that they are scared to proceed with the appeal. That is why some appeals do not take place, and it is artificially depressing the level of appeals.

I want to describe a few of those 40 cases. One involved a lady who had a serious operation because of cancer—what operation is not serious, following cancer?—and it took her more than a year to get her backdated pay after her claim was denied. In a second case, it took four months for a decision to be overturned after someone’s ESA claim was rejected following their heart-bypass surgery.

Colleagues have mentioned the work-related activity group; I will talk in detail about what happened to my constituent, George Mullen. Mr Mullen had one leg amputated at the age of 18, after an accident as an apprentice joiner. Despite that, he continued to work full time for more than 35 years. A solicitor told him that he would be a fool to try to get back to work, but he ended up as a successful clerk in a small business, even though he was in considerable pain. To aid his mobility for work, he did not use a wheelchair, but got about either on a false leg or on crutches. He suffered with chronic infections and abscesses at the amputation site, and he developed arthritis in his neck, shoulders and back, and in the knee and foot of his remaining leg. In spite of all that, he continued to work until he was told that he was being retired on health grounds, because there was absolutely no way his health would allow him to continue performing his job. He is on 24-hour blood-pressure monitoring, because stress pushes his blood pressure to a dangerously high level.

Mr Mullen applied for ESA as an absolute last resort. When he attended the WCA with his wife, the questions he was asked included: “Are you married? How did you travel here? How long have you been married?” There was not one question about his physical or mental condition, and no physical examination was carried out. Mr Mullen insists that he tried to offer information about his condition, but he was ignored. He was placed in the work-related activity group, but at no point was it explained that that lasts only for a year, and that ESA is then means-tested, or that if he felt he ought to be in the support group he had to appeal within a month. It came as a complete shock to have his ESA stopped when the year was up. He has applied again, and he awaits his assessment. He has had to attend counselling, because the situation has caused him so much stress. There was no explanation that, in the work-related activity group, ESA stops after a year—that is the reality that faces the 

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real people who are affected. As someone said earlier, this is not about figures; it is about real, vulnerable and at-risk people in our society.

12.8 pm

Stephen Timms (East Ham) (Lab): I, too, congratulate my hon. Friend the Member for Rutherglen and Hamilton West (Tom Greatrex) on securing this debate about a matter of huge importance to hundreds of thousands of people, as well as on the work that he has done to highlight the problems that people face. I give the Minister my hearty congratulations on his appointment as Secretary of State for Justice and thank him for turning up to discharge his final responsibility in his old job. I am also very pleased that my right hon. Friend the Member for Stirling (Mrs McGuire) is in the Chamber because she and I have had a close interest in this issue for a long time.

The previous Government introduced the work capability assessment and employment and support allowance to provide support for people who are out of work for health reasons, but who are able to plan for a return to work. The current Government chose to take a drastic short cut by curtailing the bedding down period for the new benefit and rolling out the assessment without any improvement, even though by that stage improvements had been identified and proposed. The predictable result of that has been severe problems. Ministers are failing in their task of managing the contract with Atos, of ensuring that people who claim employment and support allowance are treated as they should be, and of reviewing and reforming the test so that it works as it should. The test needs major improvement. Two of Professor Malcolm Harrington’s reviews have reported so far—the hon. Member for Enfield North (Nick de Bois) was right—and while the Government say that they have accepted most of the recommendations, they simply have not implemented them, and that is the heart of the problem.

One simple example that shows the muddle that the Minister has got into has been raised several times in the debate. The year one Harrington review recommended that Atos should pilot the audio recording of work capability assessments, and a pilot of 500 claimants followed. Atos said that it was a good idea, but we have heard what has happened in practice from my hon. Friends the Members for Makerfield (Yvonne Fovargue), for Stoke-on-Trent North (Joan Walley) and for Airdrie and Shotts (Pamela Nash).

In a previous debate secured by my hon. Friend the Member for Rutherglen and Hamilton West, the Minister made a commitment that

“we will offer everyone who wants it the opportunity to have their session recorded”.—[Official Report, 1 February 2012; Vol. 539, c. 291WH.]

He has not delivered on that pledge, and it turns out that the problem is a shortage of tape recorders. I was contacted by someone who struggled for weeks to get her assessment recorded. Eventually, Atos wrote to tell her that she could not have a recording or a rescheduled appointment. I wrote to the Minister about that and reminded him of the commitment that he had made. He said that he thought it would be unreasonable to delay the assessment indefinitely for such a reason, but that was not the commitment he gave to the House in February. I am afraid that this mess and shambles shows all we need to know about the Minister’s management 

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of this process. The Government need to get a grip on Atos. I wish the Minister great success in his new job, but I wish he had put a bit more effort into this aspect of his old one.

We have also had a series of mishaps. For example, the Minister made rather farcical efforts to suppress a YouTube video giving advice to people who were claiming against their work capability assessment. It turned out that the subversives who were responsible for this pernicious video were his colleagues at the Ministry of Justice.

Perhaps the most harmful thing to the credibility of the work capability assessment has been the delay in making the changes needed so that the test can work. Professor Harrington’s first review in 2010 asked Mind, Mencap and the National Autistic Society to propose better descriptors for people with mental health conditions. They produced recommendations in November 2010, and Professor Harrington commended them to the Department in April 2011. Further recommendations went to the Department in November 2011 about changes to the descriptors for fluctuating conditions.

Mr Kevan Jones (North Durham) (Lab): Several announcements that have been made, including about having mental health champions, have not been rolled out to assessment centres. Atos is still being inconsistent about allowing support workers or friends to assist those with mental health illnesses who are going to assessments.

Stephen Timms: I agree that commitments have not been delivered, and my hon. Friend cites a good example.

The work capability assessment must not be a snapshot of someone’s condition on the day they attend the medical assessment. By definition, that is likely to be a good day, because otherwise they would not be able to show up. The assessment needs to take account of the frequency with which they can do work-related tasks and that with which they suffer the ill effects of their condition. The alternative descriptors proposed do just that. They are now in the public domain thanks to the Grass Roots disability blog, without which we would not have known what they were, and they look like a real step in the right direction.

The Department has had the recommendations on mental health descriptors for 17 months and those on fluctuating conditions descriptors for nine months, but hardly any progress has been made in that time. On 25 June, in a written answer, the Minister said:

“we have been carefully considering how to build an appropriate evidence base around the proposed new descriptors…Terms of reference have been agreed and we aim to publish a report of the Evidence Based Review in the spring of 2013.”—[Official Report, 25 June 2012; Vol. 19, c. 54W.]

The Minister’s successor will need to get a grip on this. If that ambiguous deadline is even met—and that would be a first—it will be two years after expert guidance was received on how to improve the assessment for people with mental health conditions, and a year following the other recommendations.

Ann McKechin: Does my right hon. Friend agree that if a person suffers from cancer but does not require chemotherapy, they should still be deemed to be not 

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capable of working if they are in treatment? Why have the Government not changed that indicator when they could do so immediately?

Stephen Timms: My hon. Friend raises a good point that we discussed when we considered the Bill that became the Welfare Reform Act 2012. My understanding was that the Government had committed to make precisely that change, but it appears that that has not happened.

I want to ask the Minister two questions. First, on recording assessments—this might appear to be a minor issue, but it has been raised several times in the debate—will he stand by the commitment he made in Westminster Hall in February that people who want recordings will be able to have them? He seemed to have reneged on that commitment in the letter to me that was written by officials, but signed by him, about a case that I raised. Secondly, will he get these new descriptors evaluated quickly—he can urge his successor to get a move on—do so transparently, and make the changes quickly after the evaluation is completed?

12.16 pm

The Minister of State, Department for Work and Pensions (Chris Grayling): It is a pleasure to serve under your chairmanship, Mr Hollobone. I know that this is an issue of great concern to many Members, as it was always going to be. I totally accept that this is a long and difficult process, and I have always said that, both in this Chamber and in the House. I will not be able to respond to every individual point. One or two hon. Members have raised individual constituency cases, and if they write to the Department, I will ensure that it addresses their specific questions.

Let me make one point in relation to a comment made by the hon. Member for Hayes and Harlington (John McDonnell). He drove to the absolute heart of what we are trying to achieve, and this is an ambition that was and is shared by both the Opposition and the Government. If people can make a return to work, even if it is a different form of work from the one they did before their health issue arose—[ Interruption .]

Mr Philip Hollobone (in the Chair): Order—[ Interruption. ] Order. Parliamentary rules state that there should be no noise at all from the Gallery—[ Interruption. ] Madam, if you persist in carrying on talking and shouting, I will have no choice but to suspend the sitting and clear the Gallery—[ Interruption. ] This is your last chance. If there is any more noise from the Gallery, I will have no choice but to suspend the sitting, meaning that no one will hear from the Minister.

Chris Grayling: If people can make a return to work, even if it is a different form of work from what they were able to do before their health condition arose, that is better for them than spending the rest of their life on benefits. That is the principle that we are working towards.

Helen Goodman (Bishop Auckland) (Lab) rose—

Chris Grayling: I will briefly give way once, but that is all.

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Helen Goodman: If the Minister has read the current descriptors, will he explain what kind of work a person could do when their engaging in social contact with someone unfamiliar is always precluded due to difficulty relating to others? There are those who have reduced awareness of everyday hazards, which means that they face significant risk of injury to themselves or others, and those who are at risk of loss of control leading to extensive evacuation of their bowel and bladder. What work can these people do?

Chris Grayling: Let me pick up on that point straight off. It is all well and good for Opposition Members to stand up and rail about the system, but it is a system that was created by Labour four years ago when they were in government, and it is a system that we have consistently tried to improve.

Let me be absolutely clear. I put it on record that this is not a financial exercise. There are no targets attached to the reassessment of people on incapacity benefit—[ Interruption. ] The assessment that is in place for new claimants for employment and support allowance—

Mr Philip Hollobone (in the Chair): Order. If there is any more noise from the Public Gallery, I am afraid that, under the rules of Parliament, I have no choice but to suspend the sitting and clear the Gallery. I understand that people are very concerned about this issue—my constituents are concerned about it as well—but under the rules, I will have to clear the Gallery if there is any more noise. This is the last time that I will say it: if there is any more noise, I am afraid that I will have to suspend the sitting.

Chris Grayling: It is really important to emphasise that the reassessment of people on incapacity benefit is not a financial exercise and that there are no financial targets attached to it. It is about finding the right number of people who can make a return to work. It is not an exact science—it never was and never could be—but it is all about trying to help people back into the workplace if they can possibly return to it. That was the previous Government’s motivation when they established the work capability assessment. When we took office, we put in place the changes that they themselves had put in the pipeline through the internal review of the work capability assessment.

When we took office, I fully accepted that the whole process needed to be improved. That was why we brought in Malcolm Harrington and it is why I am absolutely clear that we have implemented his recommendations. I have regularly met and talked to Malcolm Harrington, and at no point has he said to me that the process is not fit for purpose. At no point has our independent adviser, who I believe has the confidence of most people in the charitable sector who are involved in this work, said to me that this is a system that has to stop or that is unfit for purpose. He has made suggestions about improvements, and we have followed his advice in that regard. Our objective is to do the right thing, but of course this is not an exact science. We will never create a system that is perfect, and that is why people have a right to appeal.

Stephen Lloyd (Eastbourne) (LD): Following the substantial improvements that the Government have made, does my right hon. Friend the Minister agree that the number of people who have been moved into the support set of the ESA has increased by 20%?

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Chris Grayling: It is a matter of record that since we have implemented changes as a result of the Harrington process and the internal review that we inherited from the previous Government, the number of people going into the support group, including the number of people with mental health conditions, has increased. That is a good thing and I am pleased that we made those changes.

The issue of cancer has been raised. It has taken us longer than I expected to address that, because of various issues that arose in our discussions with Macmillan Cancer Support, but I believe that we are now in the right place. We will be making a formal announcement very shortly, but I have said before that I believe that we should extend to those receiving oral chemotherapy the access to the support group that is offered to people receiving intravenous chemotherapy.

Stephen Timms: Will the Minister give way?

Chris Grayling: I will give way very briefly, but this is the last intervention that I will take.

Stephen Timms: The Minister will acknowledge, however, that the new descriptors that have been proposed for mental health conditions and for fluctuating conditions are nowhere near being implemented. When does he expect that they will be implemented?

Chris Grayling: I will make just one more point and then I will answer that question.

It is really important to put on record that Atos does not take decisions. In no circumstance does Atos take a decision about whether somebody receives a benefit or does not. A claimant will be asked to fill in a form that goes to Atos for consideration of whether they should be put to an assessment, or passported straight through to the benefit. Atos carries out the assessment, but the decision about benefits is taken by a Department for Work and Pensions decision maker in Jobcentre Plus. It is really important that people understand that Atos does not take decisions.

When we talk about Atos, we are talking about a team of perhaps 1,500 health care professionals, many of whom have trained in the NHS. Those professionals are carrying out an assessment that was designed by the DWP under the previous Government and that has been continued under the current Government. Atos does not take the decisions itself.

As a result of the Harrington recommendations, we have gone out of our way to address people much more directly. Rather than letters, they now receive phone calls, in which they are asked to bring forward additional evidence. A question was asked about the mandatory reconsideration phase. Effectively, that phase already happens. Every case in which the person says they are not happy will now involve a reconsideration within Jobcentre Plus. I am keen that we have that second opinion, because we will not always get things right and I want to try to see if we can bring forward further evidence that would enable us to make the right decision before a case ever reaches the tribunal service. Effort is being put in to make that happen.

The right hon. Member for East Ham (Stephen Timms) asked about recordings. Let me be clear that Harrington recommended that we carried out a pilot to test recordings. 

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I was keen that we just did it, but Harrington said to me, “Actually, it may not work, so I really think that you should pilot it. It may prove to have a negative effect.” We therefore tested recording and found that there was little enthusiasm among those being assessed to have their assessment recorded. In the end, the conclusion was that we should make recording available on a voluntary basis, but it should not be something that we do across the board.

I do not rule out recording. If there was overwhelming evidence showing that it was necessary, I would make it available, but let me give some statistics. There are 300 claimants waiting for an audio-recorded assessment, while Atos is conducting 8,000 assessments a week. We are ordering additional audio-recording machines so that people can have their assessment recorded, if they want. They are perfectly entitled to bring their own recording equipment to an assessment as long as it can record two copies of an assessment, because they need to be able to take one copy with them and leave the other behind. That is why we have to buy what is fairly expensive equipment, and we have ordered additional equipment because there has been an increase in demand in the last few weeks.

I am perfectly relaxed about recorded assessments and I am perfectly happy to make recording facilities available. However, the advice that I received from Malcolm Harrington was that we should test recording. The result of the pilot was not only that there was not a need for recording, but that many people felt uncomfortable being assessed with a tape recorder running.

The right hon. Gentleman also asked about the new descriptors that were brought forward by the charities, but he is out of date. The charities have been working with us for the past few weeks on the assessment project of the package that they brought forward. The work was finished last week. The charities actually wanted more time to work with us because the process is complicated and we are trying to mesh mental health issues and fluctuating conditions. As I said in Westminster Hall about 12 months ago, the problem that I had with the recommendations that the charities made in the first place was that they did not come forward simply with adjustments to the existing descriptors, but instead with a comprehensive reorganisation of the whole assessment, which would also have involved a redesign of the physical descriptors. Given that the right hon. Gentleman has carried out such projects in the DWP, he will know well that that would be a two or three-year project.

We have tried to take forward some of the suggestions that the charities made and embed them into elements such as the ESA50 form, and we are now working with the charities to road test all this work to see if it really makes a difference. However, I am not going to embark on a major overhaul of the whole exercise based on a set of recommendations that are not backed by evidence without our having tested them in the way in which the previous Government tested recommendations: by putting real cases against proposed descriptors and making a comparison between the outcomes of the theoretical new descriptors and the old descriptors. Such work is on track. We are pushing the charities to make progress, because I want to get the work done, and we are still on track to complete the gold standard review in the spring.

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The hon. Member for Rutherglen and Hamilton West (Tom Greatrex) referred to the National Audit Office report. I have had the benefit of having read that report, although I know that he has not. The reality is that the report highlights a number of what I regard as not particularly major areas of improvement. If he reads the report, he will see that it reflects a big and complicated contract. It makes some suggestions for improvement, but it is not as he portrays it.

When the hon. Gentleman talks about the performance of Atos during the last two years, the key point he must remember is that the recommendations that Malcolm Harrington made, combined with some fluctuation in volumes coming through to Atos, which are certainly beyond its control, have caused significant operational difficulties. I can give him my word that I have sat in meetings with representatives of Atos and put them under intense pressure. Atos has brought in extra capacity at cost. We have made sure that we deliver at every stage. However, it is not possible to change the goalposts totally and then expect the subcontractor to take it on the chin with no consequences.

We have seen some consequences of the introduction of the Harrington recommendations, particularly the personalised statement. However, as I stand here today, we are on track to close the backlog time to where it should be later this autumn. The numbers that the hon. Gentleman gave are already well out of date. We have brought down the backlog in the number of appeals that we inherited two years ago, but it is a big task. We are dealing with a large number of people and this is a big challenge.

Let me be clear that we want to get this process right and we want to do the right thing. I want people who need long-term ongoing support to be in the support group. The Government have no interest in doing anything other than looking after those people who need that, but we will also give encouragement and support—and a bit of a push—to those who can get back into work, because I believe that that is the right thing for them.

Mr Philip Hollobone (in the Chair): I thank those Members who have attended this important debate for coming along today, and I encourage everyone to leave Westminster Hall quickly and quietly so that we can proceed to the next important debate.

Hansard