Sickness and Disability Benefits

HC Deb 03 February 2004 vol 417 cc208-29WH

2 pm

Sir Archy Kirkwood (Roxburgh and Berwickshire) (LD)

I am pleased to spend some time this afternoon discussing some of the implications of the important report produced by Citizens Advice Scotland at the end of last year, entitled "Riding the Benefits Roller-coaster". The report reminds us that, although we are always looking to the future and seeking to improve policy—which is right and proper—there are significant lessons to be learned from examining how the existing system works. I hope that we shall be able to get the Minister to listen to some of the real experiences of people that are mentioned in the report. We can learn from the existing system, and we must, if we are to do justice to the needs of our constituents who suffer from sickness and various sorts of mental illness and other disability.

I am sure that I echo the view of all colleagues in saying that we recognise the service that citizens advice bureaux provide nationally, as well as in Scotland. As professional politicians we can never be experts in all things, but the valuable service, volunteers and expertise that are enshrined in the citizens advice network make up an invaluable resource, assisting our deliberations and helping our constituents to get the entitlements that they deserve. I hope that this debate will be taken in that spirit.

Reading the report, I was struck by the extent to which we do not consider disability in a long-term way. I know the particular circumstances of the Government's drive to abolish child poverty by 2020. That is an ambitious plan and it has made the research community and the pressure groups involved think a little bit more about the long term. Perhaps that is a lesson that we can learn from by applying the same long-term thinking to sickness and disability. I hope that the Government will start thinking about that in future.

I have come to the conclusion that the piecemeal review and reform process that we have had until now has left us with a conflicting system that is contributory and means-tested, has an element of medical testing and is increasingly work-related. In relation to sickness benefit, it becomes ineffably complicated—even those of us who study such matters struggle. Perhaps there is a case for asking, if we want to change things in the long term by 2010 or 2020, where we want to be at that stage. That would give us a focus with which the rest of the policy could be configured. Such things take time to change, and if one adopts a piecemeal approach the temptation will be to fix a short-term problem, which means one ends up adding to the complexity. The question is not an easy one, but a longer-term view—a five or 10-year strategy—on sickness and disability is greatly needed.

In the short term, there are things that we can do to fix the existing system, and I want to concentrate on the contribution that the Citizens Advice Scotland report makes in that regard. I acknowledge at the beginning that the Government have done an enormous amount in the field of benefit policy and reform. Work-focused active benefit policies have been successful, but it is fair to say that it is now time to turn to the other half of the promise. Arguably, not nearly so much has been done for those who have no realistic prospect of work. We must turn our attention to giving security to those who cannot be expected to work.

Perhaps the Minister can put me right, but I do not believe that the Government have stated recently which cohort of the population they consider to be excluded from work. Which people in today's circumstances does society believe can legitimately be excused from work? There must be some, and we need to be clear about how we serve them, as well as those who compete in an increasingly competitive labour market.

From my constituency experience and from watching carefully the work of the Select Committee on Work and Pensions, it is increasingly obvious that the transition phases are often the worst for sickness and disability claimants. The transition from school to work—going from the education system to the benefit system—is not always easy, nor is the transition when a person falls out of work and goes back to benefits. People always find it difficult to deal with transition phases. Finally, the transition into retirement is another vulnerable period in a person's life history, particularly if they are on incapacity benefit. It would be constructive if we were to start concentrating a bit more on how changes take place in transitional phases.

Jobcentre Plus must be monitored very carefully, because whatever successes it may have in its more active focus on work, there are real and exceptional needs for the specialist expertise that is available in its regime, as well as for the package of continuing support that must be offered to disabled and sick claimants. I have always believed that the success or otherwise of the work-focused policy depends on realistic case loads. I sometimes worry and fret when I hear stories about case loads that I consider unrealistic in terms of meaningful delivery of support and back-up, even for able-bodied claimants trying to get back into the labour market. If that is true for such claimants, it is certainly true of people with sickness and disability. New structures by themselves are not the whole answer, particularly when there is still, alas, a highly discriminatory aspect of the labour market that is often a hurdle on which people who are seeking work, and especially those with disabilities, flounder.

If that is all true for people who are sick and disabled, it is certainly true in spades for people with mental illness. I have noticed a dramatic change in my constituency during the past 20 years. I do not know whether diagnoses are cleverer or whether the medical services are better at picking up on mental illness, but it is now a huge issue. If that is true in a constituency such as mine, it must be more so in urban constituencies and centres.

That is some background to issues that Parliament must consider. The report, "Riding the Benefits Roller-coaster", was very stimulating. Nothing that I read took me by surprise, but I came to the conclusion that we really need a period of considered reflection on some of the evidence that it presents. It was compiled on the basis of real evidence and was submitted by Citizens Advice Scotland, including the excellent CAB in Hawick.

The report examines the complex statutory regime governing entitlement to social security benefits for sickness and disability. It reports experiences of CAB clients throughout the whole process, not just when claiming benefits but from decision making and medical examination all the way through to the appeals system. It is true and fair to say that the report finds that obstacles are being put in the way of legitimate claimants at every stage in that process.

While the report recognises, as I do, that the Department for Work and Pensions is pursuing several initiatives and that it hopes to improve the way in which medical benefits are assessed and administered in future, it concludes that the present system is not delivering what the Government have promised, and if that is true we must consider the matter further. I hope that the Minister will get a chance to answer some of the points raised in this afternoon's debate.

The report covers a lot of ground, and it would be impossible to do it justice in the course of a 15 or 20-minute opening statement. I shall consider just two aspects for illustration: incapacity benefit and disability benefit. I have some constituency experiences in this regard, and I think they would be valuable to share with colleagues.

On incapacity benefit, the report rightly highlights the question of permitted work. The changes to the new permitted work rules came up in evidence to the Select Committee when the Secretary of State was in front of us, and it was my hon. Friend—I call her that in the context of our Select Committee work—the hon. Member for Aberdeen, South (Miss Begg) who acutely raised the important question of the different phases of the 26-week rule for permitted work. The new rules disregard income for those in permitted work, working fewer than 16 hours a week on average, with earnings of no more than £67.50—but that lasts for only 26 weeks. That period can be extended for a further 26 weeks if a person is working with a personal adviser or a job broker, and if that adviser agrees that another 26 weeks will help them move towards work of 16 hours or more, but after that time the disregard falls to £20. As the hon. Lady acutely pointed out to the Secretary of State, there is a real danger of ping-pong as people float between the two rates.

In April this year, I understand that the system will have been in operation for two years. It would be interesting to have figures on the permitted work regime—what proportion of people are on the higher rate and what proportion are on the lower: how many have had that 26-week period extended, and indeed how many go on to raise their hours beyond 16. The Secretary of State said in response to the hon. Lady that he was trying to increase the then therapeutic earnings from a 1 or 2 per cent. base to a 2 to 4 per cent. base, and it would be interesting to know whether that has been achieved. I would not expect the Minister necessarily to have that information off the top of her head, but it would be helpful if she could write me a note on the matter if the figures are available.

The CAS report raised the fact that, while incapacity benefit may not be affected by the permitted work income, that is not the case with housing benefit and council tax benefit. They do not disregard these earnings, which means that a lot of people do not really gain financially from their permitted work. This is a shame, as the permitted work mechanism has a lot of potential and could be expanded. It may just be that the Government plan to run the current rules for a couple of years, see how it goes and then look at the possibility of expansion, and I hope that they will be encouraged to do that, but it would assist the rest of us in making sense of how effective the scheme is if the figures were available.

It will come as no surprise to any of us that passported benefits are raised in the report—I am sure that the issue comes up regularly in all our surgery casework. The report clearly shows a number of continuing problems relating to incapacity benefit. The most obvious one is that because the benefit is contributory, those in receipt of it do not automatically qualify for passported benefits—although they can if they are getting another means-tested benefit such as income support. Assistance in the form of free prescriptions is also sometimes available to incapacity benefit claimants through the lower income scheme.

One case that sticks in my mind is that of the incapacity benefit claimant whose payment was uprated by £2.50, but the amount relating to income support was uprated by only £1.20. The differential method of uprating income-related benefits and contributory benefits meant that he was no longer able to get passported benefits. That can involve a dramatic increase in weekly costs.

Another case clearly demonstrates the point in another way. A person who spends £20 a week on prescriptions had his application refused on the grounds that his income exceeded his requirements by just 15p a week. His income was £74.60 and his assessed requirement was £74.45. That is a high tightrope to fall off when £20 a week is being spent on essential medicines.

The report suggests creating some sort of buffer zone. I know that it is not easy. It would complicate the system, and I have already said that it is about time we simplified the system. I understand that such situations are complex and difficult, but the cases that are highlighted starkly and clearly in the report are unfair and should be considered.

The review process for incapacity benefit needs to be reconsidered. There are exceptions to the rule that incapacity benefit awards must be reviewed every three or five years. People entitled to the high-rate care component are an example. The report also found examples of people entitled to the high-rate care component within disability living allowance who continued to receive review questionnaires. The Government should consider that.

In passing, the report also makes the point that claimants waiting for an appeal relating to incapacity benefit face claiming jobseeker's allowance, which they do not like to do, or moving to income support, but suffering a 20 per cent. deduction. I remind hon. Members that the Government claim that the applicable amount for a single person over the age of 25 is £54.65 a week. If 20 per cent. is taken off, we are asking single people over the age of 25 to live on £43.72 a week. That is not fair.

It struck me in reading the report that the standards of decision making for disability living allowance are getting worse—if I read the figures correctly. I went back and checked, and according to last year's report on the standards of decision making in 2001—02, 55 per cent. of all decisions taken were correct. In 2000—01, the accuracy level was 61 per cent., so it seems to be slipping, which is a matter for concern. I would expect Ministers to be asking some pretty pertinent questions about the systems if they have been presented with those figures. I hope that the Minister will look carefully at that.

About 20,000 appeals are lodged each quarter. The figures for the second quarter of 2003 for disability living allowance and attendance allowance appeals show that in 62 per cent. of oral hearings the applicant was successful. That almost makes appeals relating to DLA and AA the most successful of all benefits appeals. The compensation recovery unit comes out top, with a success rate of 84 per cent., but far fewer cases are involved. That raises some real questions.

It was the conclusion of Judge Michael Harris, in his latest president's report on decision making within the Department's agencies, that the decision-making process, and in particular the process of information and evidence gathering that takes place at the first stage and subsequently, when the decision is reviewed following the appeal, ought to be more rigorous. That is true. The evidence in "Riding the Benefits Roller-coaster" underscored that for me very graphically indeed.

The example that leaps from the page and demonstrates the truth of the points that have been made is the case of the son suffering from a rare genetic metabolic disease that is new to me, called medium chain acyl-coa dehydrogenase deficiency, or MCAD. The diagnosis was confirmed by the child's GP and a consultant. His care needs were extensive. His claim was turned down, but his brother, who suffers from the same condition, got the award. It seems to me impossible to understand how the system can come up with two such blindingly different decisions. Poor decision making causes financial and emotional distress. I do not see enough evidence that it is being tackled by the Government, though it is a problem that they recognise.

I have raised the periodic inquiry process for DLA in the House before, because I am still concerned that the evidence shows that one in five who have DLA awards are underpaid. Every time I consider the results of the periodic inquiries, I find that that does not change. It is true to say that a small number of cases are overpaid, but it is always the case that significant numbers receive less than they are entitled to. The last time I did the calculation was in 2002. When I added up how much it might amount to if everybody's DLA was reviewed, the net cost of changes in the sample was more than £160,000 a week. That was something like a 3 per cent. sample, and grossing it all up would suggest that one in five DLA recipients are being short-changed throughout the United Kingdom, to the tune of about £5 million a week. That is a concern to myself and to colleagues.

To give a closing example from the report, there is evidence—I have had a recent example of this in my constituency—of people being afraid to challenge a DLA award. If claimants have both elements of a DLA award, both are considered, so someone who wants to challenge a higher-rate mobility and a lower-rate care award risks having both elements reviewed. People are frightened to take the risk, despite the fact that they think they have had a bad decision. I know that the situation is not an easy one to deal with, but I think that the Minister should consider it.

Moving away from the report, I was struck by the idea that John Wheatley floated in an article in The Guardian last week or the week before, that citizens advice bureaux might be able to act as electronic intermediaries for clients. The Department is spending a lot of money on getting the ICT system sorted out and it is troublesome because large technology projects are not always easy to implement, but if we could get to a situation where clients, working with dedicated CAB computers, such as in the Hawick office, have a direct link into the official system, and there is a direct delegated authority available to the Department from the client, the John Wheatley case is that, in those restricted, carefully controlled circumstances, CAB advisers could deal with complicated sickness and disability cases. There is a case for considering that as a way of short-circuiting the process and making it more transparent, providing a better service for the clients. All sorts of complications might make that difficult to do, but it is something that the Department should consider.

I am pleased to have the opportunity to spend a little time recognising the work done on the report and that CABs do generally. We should consider some of the benefits strategically and in the longer term. If it were left to me, I would take five or 10 years and ruthlessly simplify the whole thing. I would work with the research community and pressure groups and say to them that over that period we must make the system more understandable. It is too complicated even for me, and I am supposed to be a specialist. If it is too complicated for me, it is too complicated to be relied on to serve our constituents well.

2.24 pm

Miss Anne Begg (Aberdeen, South) (Lab)

I thank the hon. Member for Roxburgh and Berwickshire (Sir Archy Kirkwood) for securing the debate. I commend much of what he said—I hope that this does not sound too much like a Select Committee love-in, with cross-party agreement on the various things done—but, rather than repeating it, I start by paying tribute to the work of the Minister, who has always listened to the points that we have repeatedly made with regard to sickness and disability benefits.

The Minister understands the subject extremely well, and I think she is more aware than anyone of the difficulty of bringing about changes to those benefits. That is partly due to their complicated nature, as the hon. Gentleman mentioned: if we start changing one aspect of one benefit, that can have repercussions that not everyone appreciates, so it is very difficult to model or plan the exact impact on the other benefits.

Although I had not intended to say this when I came to the debate, I am tempted by what the hon. Gentleman has said. Perhaps we should be looking to the future, and some strategic plan for how we can involve the disabled community and society in general in a debate on where we want to be by perhaps 2015 or 2020 with regard to disability benefits, simply because the system is extremely complicated. We would hope that there is a means of simplifying it.

That must be a long-term aim, and we must engage with those who will be affected, because whenever any reform is suggested with regard to disability benefits there is a fear, first, that the Government are bent on saving money and, secondly, that in any reform there are often winners as well as losers. We must guard against that.

The discussion must be held more widely than within the confines of this place so as to look ahead and get some strategic views on how we can deal with this issue. Now is probably the time to start that, thanks to a lot of the work that the Government have already done, particularly in changing the attitude that once someone is on an incapacity or disability benefit, that is it— are essentially written off by society, and we no longer need to engage with them because they are getting their benefit, they do not need to bother anyone any more and they certainly should not be looking for work.

It has been interesting watching how the change has come about in my own constituency and elsewhere in Aberdeen. When it was proposed that the Government would perhaps like to get more people with disabilities into work, there was a lot of suspicion and anxiety as well as the fear that people would be forced into finding work. Now, a few years down the line, I have organisations coming to me seeking advice on how they can engage in the process and how they can get their client group into work and make them more work-ready. Voluntary sector organisations, which know that groups of people are sitting on incapacity benefit, are seeking advice on how they can get that group of people engaged.

I must also pay tribute to the work done locally by Jobcentre Plus, which has been very good at engaging with voluntary sector organisations and others in Aberdeen and has, in some cases, used them as subcontractors, which leaves the specialists to help people with disabilities into work. There is an enthusiasm that was not there five years ago, when there was fear and anxiety. Perhaps that is a lesson. We must ensure that if any changes are proposed to disability and incapacity benefits, they happen with the participation and consent of those who will be most affected.

I want to throw out for discussion a subject that I have pontificated on quite often—although I have not done the statistical and modelling work—and which is certainly something we have discussed in the Select Committee, and that is why incapacity benefit should exist at all. Why should there not be just one out-of-work benefit for everyone? Why should we let the benefits that deal with people's incapacity or disability involve differentiation between someone who is out of work because of disability and someone who is out of work because of unemployment?

I think that, sometimes, that is a false distinction, and the creation of one benefit would do away with the stigma of being on incapacity benefit or having to make the case that a person is unfit for work. The problem with incapacity benefit is that those who qualify have to make the case that they are unfit for work, when we want people to be judged on what they can do, rather than on what they cannot do. In spite of the introduction of the personal capability test, the thinking is still that someone has to prove how bad they are, so that they can get their incapacity benefit, rather than worrying about getting the right level of benefit or the appropriate work for them. It is worth looking into that.

Most of the other points that I would like to make I have already mentioned to the Minister. One is about disability living allowance and its associated problems. I have no argument with disability living allowance being a difficult benefit to get—it should be, because we want to ensure that the people who get it are genuine cases and that it goes to the right people. It is also a passport benefit that leads to many other benefits, so, if someone is judged to require the higher rate for care or mobility with regard to disability living allowance, the door is open for a lot of other benefits.

The criteria are very strict, which is absolutely right, but we should ensure not only that they are strict, but that they do not act as a barrier to the genuine claimant. This is a difficult assessment for the doctors to make, and very difficult for those making the judgement according to a filled-in form. The fraudster with an invisible disability can lie through their teeth—that their back is so sore that they cannot get out of bed in the morning—and what they say might be difficult to disprove, whereas, very often, the genuine claimant goes out of their way to show how much they can do.

I give as an example the lady who, when the doctor from medical services arrives, puts on a spread like your granny would put on, with all the scones and the tea, and the doilies and everything. The fact that she has done all that makes the medical examiner think that this woman can certainly look after herself, but he might not realise that it may have taken her three days to put the spread together and it will take her another four to recover.

I appreciate that there are difficulties, but one of the problems, which has been identified from a particular individual's case, is that sometimes the assessment is too mechanistic—there is too much box ticking to deal with whether something can or cannot be done. The example I am thinking of came out of a periodic review; I will come back to problems with those.

My constituent is partly blind and partly deaf, and has a bad back, but, because in the periodic review he did not hit the percentages needed to qualify automatically for his former level of DLA—regarding blindness or deafness or because of his bad back—his DLA was reduced. Anyone who knows this particular individual, and I know him very well, knows that, all those things considered, he is very disabled.

On my reckoning, my constituent should qualify for the higher rates of DLA, both in mobility and in care. He recovered some DLA on appeal, but there was a problem in the mechanistic way that the medical examiner considered his disability. Sometimes, a combination of different disabilities in the same person might make them extremely disabled because of the interplay of those disabilities and illnesses—it is not a case of 30 per cent. blindness and 30 per cent. deafness making someone 60 per cent. disabled.

I said I would come back to the issue of the periodic review. The same constituent and a number of others have found the same problem: if they go through a periodic review where the mobility element of DLA is reduced, they lose access to their Motability car. The problem is that if they get their mobility element reinstated on appeal, it is too late because in the intervening two or three months they have lost their Motability car and have been unable to get around.

Moreover, my constituent was considerably out of pocket, because he could not access a new Motability car that he had already ordered and paid a deposit for. Perhaps it would be worth awaiting the outcome of the appeal before removing the mobility element, particularly when a Motability car is involved and the loss of the benefit cannot be backdated. The use of a car that someone has not had for the previous three months cannot be backdated, so, where possible, the final decision should not be taken until the appeal has been heard.

If my constituent had been aware, in the periodic review, that he needed to get supporting evidence at the time of the initial contact with the medical examiner, as he did for his appeal, he might have been able to hand it over then. He did that subsequently—after he had lost his benefit—which is probably why his appeal was successful. Therefore, there should be a warning mechanism to let people know that, when they face a periodic review, it is better if they have all the evidence available for the medical examiner.

I also want to back up what my hon. Friend the Member for Roxburgh and Berwickshire said about it being time to look again at the permitted work rules. I have used the words "hon. Friend" too—is there a Select Committee love-in going on? Those rules have certainly encouraged a number of people to go back to work, but I know of someone who is ping-ponging backwards and forwards. That person has had a year on permitted work but is now going back to the lower rate of £20 a week—the old therapeutic earnings—and in a year's time may be able to do permitted work again.

There is a group of people—I have spoken to the Minister about this before—for whom the 16 hours will never be possible, and seven or eight are all they can manage. The permitted work rules allow them to do that. Would it be possible for them to stay on permitted work a little longer or could they move on to something else that reflects the permanent nature of the disability? I appreciate, as the Minister pointed out, that people cannot stay on benefit for ever and keep earning money on top of that for ever, but there may be some leeway in the permitted work rules to take account of that example.

I thank the hon. Gentleman for allowing me to put this case, which I have spoken and written to the Minister about, on the record. I hope that, in years to come, we will be back here discussing the new strategic design for incapacity and invalidity benefits.

Mr. Frank Cook (in the Chair)

I should perhaps remind the Chamber that it is customary to start the first of the three winding-up speeches 30 minutes before the termination of proceedings—in other words, in 22 minutes.

2.39 pm

Annabelle Ewing (Perth) (SNP)

I assure you, Mr.Cook, that I shall not take up the remaining 22 minutes.

I, too, congratulate the hon. Member for Roxburgh and Berwickshire (Sir Archy Kirkwood) on securing this important debate. Having heard the two contributions that have been made so far, I hope that I do not unduly upset the Select Committee love-in, but I have a few strident things to say. I see that the Minister is not the slightest bit surprised to hear that.

The issue of sickness and disability benefits is of importance throughout the United Kingdom. Indeed, I believe that in Scotland, some 13 per cent. of the population receive a sickness or disability benefit. The key question today is whether unnecessary and/or disproportionate difficulties are encountered in claiming the benefits. To put it another way, the question is about how effective the social security system is in supporting those who are sick or disabled.

In my experience to date as an MP, which is not quite as long as that of the other hon. Members who have spoken, and in seeing constituents who have had problems vis-à-vis the social security system, I have found that the system is not particularly effective in providing the necessary support. Constituents to whom I have spoken perceive the process as unduly complex and full of unnecessary uncertainty.

Many share that perception, which echoes concerns raised by the Citizens Advice Scotland report to which the hon. Gentleman referred. I should like to associate myself with his comments on the report, which is excellent. Indeed, I appreciate the invaluable work done in Scotland and elsewhere by citizens advice bureaux. I imagine that an invaluable service has been provided to the Department for Work and Pensions, as many people are being referred to the helpful staff working at the bureaux.

The report noted the uncertainty facing claimants and potential claimants as a result of the ongoing assessment of entitlement. No one is suggesting that there should never be a review, but many people consider the frequency of reviews intrusive in some cases. The fear is that they are simply designed to take away benefits. I recall cases in which a review has resulted in benefits being reduced or taken away despite the fact that the claimant's circumstances have apparently not changed one iota. That must be looked at very carefully. It is a pity that discretion has not been reintroduced to the benefits system, as it would benefit from such an approach.

The decision-making system was another key area to which the hon. Gentleman referred. He mentioned statistics for the last quarter of 2003, and I received another set of statistics for the year 2002–03 on 27 January in response to a written question. It appears that, in the year to November 2003, about 53 per cent. of disability living allowance appeals were successful and 48 per cent. of appeals about personal capability assessment under incapacity benefit were successful.

From my previous life as a lawyer, I find those figures alarming, because they suggest that there are serious flaws in the accuracy of the initial decision making. I wonder why that is the case. The matter must be considered because, as the hon. Gentleman mentioned, those appeal rates, excepting a few other specifics, far outweigh the success rates for any other benefit. There must be something that can be done to improve the initial decisions.

Reference has already been made to the quality of medical reports. The Citizens Advice Scotland report says that underestimation of disability is the problem, and that is a serious matter. The hon. Member for Aberdeen, South (Miss Begg) rightly said that there might have been a failure to consider the situation of individuals in the round rather than with regard to the ticking of boxes. It has certainly been my constituents' experience with the DLA that the approach is to tick a box, and that if they fall outside the categories or do not have enough ticks, that is it. That is a peculiar way of assessing whether someone is capable of doing various tasks.

I hope that we shall find out more from the Minister about why so many appeals are successful in comparison with appeals on other benefits. I also hope that she will comment on the quality of initial decision making and on the medical assessments, which frequently differ from those of the GP. I have always found it curious when someone has been a patient with the same GP for many years, but that GP's knowledge of the patient seems to be completely at odds with the view of the official medical investigator.

The quality of decision making is central. If people are knocked back when applying for the DLA, they may be deterred from pursuing their claim further. If the appeals success rate is 53 per cent., however, such people will be well advised to continue the process, as I always tell my constituents. However, many people are put off, and that should worry the Department. I wonder what estimate the Government have made of the current level of disability benefits that remain unclaimed. I fear that the number is unduly high.

I want to end on a slightly optimistic note, which may surprise the Minister, by welcoming the good news that the over-complex and long forms are to be simplified. I believe that there is currently a pilot project. Such a project could have been introduced sooner, but I welcome it now and I hope that it will be assessed and implemented throughout the UK as quickly as possible. I hope that simplification will mean simplification and that we will not see yet another example of the Government's increasingly flexible use of the English language in the benefits system. I welcome the attempts to simplify the form, but I caution the Minister that the other problems that have been identified must be addressed, as simplification of the form will not by itself solve the problem of the difficulties that people perceive when trying to claim sickness or disability benefits.

Mr. Frank Cook (in the Chair)

For the benefit of the House, it might be advisable to remember that it is customary for those making winding-up speeches to take no more than one third of the time remaining in the debate, although they may take less if they want to do so.

2.48 pm

Paul Holmes (Chesterfield) (LD)

I congratulate my hon. Friend the Member for Roxburgh and Berwickshire (Sir Archy Kirkwood) on securing this debate. He speaks with great knowledge as the Chairman of the Select Committee on Work and Pensions and with his long experience in Parliament, working on behalf of his constituents.

I associate myself with many of my hon. Friend's comments, including those in support of some of the Government's improvements to benefits provision, which is certainly much better than it was before 1997. I also associate myself with his praise for the excellent report from Citizens Advice Scotland. The report and its contents apply not just to Scotland, but are widely echoed in England and in the report from the excellent citizens advice bureau in Chesterfield. I know from my work as a local councillor for more than 12 years and now as a Member of Parliament, as well as from my dealings with, for example, the unemployed workers' centre in Chesterfield, that the sort of issues, difficulties and problem that the CAS report picked up on are certainly reflected throughout Chesterfield.

The report highlights several different issues, which hon. Members have mentioned. I will not repeat what they said, but I will highlight one or two of the things it covers, including the sheer complexity of the system, the multitude of benefits and the different ways of gaining access to them. As Chairman of the Select Committee, my hon. Friend is a specialist and probably one of the most knowledgeable people in the country on how the labour system works, but even he has trouble understanding it. People have brought me forms in my role as party spokesman on the subject or as a constituency MP, but I have had trouble understanding them because of the complexity of the system. I am a graduate—I also have a post-graduate certificate—and I find the forms very complex.

The system is so complicated that there is an industry to help people to unravel it. I mentioned the citizens advice bureaux and in many areas there are excellent unemployed workers' centres, which pick up much of the work. In Chesterfield, Derbyshire, there are county and borough council advisers who try to plug the gaps in the system and help to guide people through it. In addition, many people go to their councillors and their MPs' surgeries for help. An industry is devoted desperately to trying to clarify the complex system for individuals who are caught up in it.

Some Government policies make the system more complicated. The means-testing of different types of benefit is increasingly complex, which makes the entire system more difficult to use. The time available for people who work in the system is reduced by the introduction of blanket work-focused interviewing for various things, in particular for IB recipients, which adds to the strains on the system.

The hon. Member for Aberdeen, South (Miss Begg) referred to the fear engendered in many people when they receive a summons to attend a compulsory work-focused interview. Many disabled people worry that it will lead to the removal of their benefit, often after many months or years spent establishing their right to it. Many cases in Chesterfield reflect the experience of those in Aberdeen.

The hon. Lady gave examples of how many disability organisations are trying to overcome that fear by working more positively with the system. That has been my experience when I have talked to organisations throughout the country. However, individuals who receive a summons to attend an interview are still fearful; they often feel that the interview is too brief and that they are dealt with rather brusquely.

I echo the hon. Lady's comment that in assessing disabled people, we need to shift the system from focusing on asking disabled people to prove what they are incapable of doing to emphasising what they are capable of doing. For a long time, my party's policy has been to have a partial incapacity benefit rather than an all-or-nothing system. People would be able to do some work rather than having to prove either that they are totally unfit for work or that they are capable of doing full-time work. Progress is needed on that.

The role of the staff of the Department for Work and Pensions is crucial. For most people they are the front line—their first contact with the benefits system. The report from Citizens Advice Scotland gives some examples. It tells of a local DWP office in Scotland which stated that it was not the responsibility of front-desk staff to advise people on their entitlement. Even though that is the first port of call for almost everyone, they are being told by the local office, "That's not our job. Find out for yourself."

The report also mentions 22 per cent. of DLA and attendance allowance cases that were overturned on appeal. The president of the appeal system said that the the initial decision maker was unwilling to accept evidence that was available at the start of the process. The tribunal, however, did accept that evidence and overturned the decision.

Clearly, there are problems in the service as delivered through DWP staff, but that is not to blame those workers. The Public and Commercial Services union released a survey in May 2003 which reported that 72 per cent. of its staff working in DWP offices had thought of resigning because they were overworked and lacked staff. Low pay is a big issue among those Government staff. People who work in Jobcentre Plus offices have told me that, as the system is rolled out across the country, their work loads are increasing dramatically compared with work under the initial Jobcentre Plus pilots. The sheer quantity of casework that individuals are supposed to deal with has been mentioned. Talking to Jobcentre Plus staff in Sheffield, I was told that the training available has been cut as the work load has increased. However, as the regulations change regularly, the need for constant up-to-date training becomes more, not less, important.

The report also discussed the shift in the regulations from therapeutic work to permitted work, as hon. Members mentioned. I have two examples of that. The first is a public example, because it appeared in the local press in the west country. Carole Lilly, who lives in the Truro constituency, is 47 years old and is disabled. In 1999, her doctor told her to finish work completely because of her disabilities. After a while, she felt that she could not cope with staying at home watching television 24 hours a day and doing nothing with her life. She returned to work for a reduced work load of 10 hours per week. Under the new rules on permitted work, as opposed to therapeutic work, she will have to give up work. She calculates not only that that will have a negative effect on her self-esteem and her life, but that it will cost the Government an extra £3,000 in benefits because she will give up the low amount of work that she can do.

Another example is anonymous. It was passed to me only this morning, so I have not had time to check whether to make the name public. It concerns someone who wrote to the Prime Minister on 8 January. She is a 28-year-old fully trained nurse who has had to give up work because of arthritis, osteoporosis and reflex sympathetic dystrophy. She did not want to waste her training as a nurse and did not want to spend her life sitting in front of daytime television", as she put it in her letter. Having retrained as a medical secretary, she has gone back to work for six hours a week of voluntary work in her local hospital. She will be forced to give that up under the new rules that relate to permitted work rather than therapeutic work. She says in her letter to the Prime Minister that that will have an intense effect on her depression. Her doctor encouraged her to do some work because of that depression, which she fears will only return.

Miss Begg

It is worth pointing out that no one will be forced to give up work. If someone on the new permitted work rules is not working for 16 hours a week after a year, there is still provision for them to move to the £20 therapeutic earnings. Plenty of people—my cousin is one—work three days a week and still earn only £20 because they are on therapeutic earnings and have not shifted to permitted work. I accept, however, that the situation is not ideal and I want the Minister to consider the system. I hope that people are not saying, "I have to give up work." They are not allowed to earn as much as they did the previous year, but they still have their benefits and the extra £20.

Paul Holmes

I thank the hon. Lady for that explanation. In the first case I mentioned, the person works for 10 hours, but fears that she will have to give up that work. She gives the example of a colleague in the same situation who has already given up work. Whether, after going into the details of the system, she will have to give up work is another matter. The second instance—as I said, I received it only this morning and have not had time to reply to it—may fall into the category that the hon. Lady describes.

The system is complex. Many people's initial response to the complex regulations that they get through the post, and the instructions on how they reply to them, is often one of fear. The system must be simpler and better explained, and there should be more up-front support and advice from the Department for Work and Pensions. What we have is a network of other people, such as the CAB, unemployed workers' centres and MPs' surgeries, having to piece everything together.

On the issue of appeals, the hon. Member for Perth (Annabelle Ewing) picked up on the alarmingly high rate of successful appeals in some categories. I asked parliamentary questions on 9 June 2003, which I updated on 13 January 2004, on the number of successful appeals by the PCS. The rate of successful appeals is climbing markedly. In 1998, the successful rate of appeals was 41 per cent., which rose to 45 per cent. in 2002. In response to my January question, the most up-to-date figures, up to November 2003, showed that the rate had risen to 48 per cent. A Public Accounts Committee report on the subject found that there is clearly something wrong with any system that has a successful appeal rate of more than 40 per cent. Given that successful PCS appeals have risen from 41 per cent. to 48 per cent. in five years, there must be something wrong with the system.

So what is wrong with the system? It is clear from my dealings with constituents and Schlumberger Sema—it has shortened its title to Schlumberger—that there are alarming issues, which at least one hon. Member highlighted. The Scottish report points out that the time allowed for assessments is sometimes too short. People feel that the compulsory assessment by a doctor from Schlumberger is far too short to judge properly their medical capabilities. The report includes the comment from one doctor that the living room was neat and tidy, as if that had any relevance to the case.

Last November, a constituent of mine told me that the Schlumberger doctor commented that the garden was well maintained and that the recipient must be fit and capable because they opened a heavy garage door to park their car. If the doctor had asked about that, the recipient would have told them that the car—an automatic—is always parked on the road and the garage is never used. He would also have been told that the family tend the garden. In response to my intervention in that case, I received a letter apologising for the doctor's behaviour. It is interesting that the Scottish report outlines similar examples.

3.2 pm

Mr. Paul Goodman (Wycombe) (Con)

At the cost of being accused of prolonging a Select Committee love-in, I begin by congratulating, as I always say, my Chairman on the Select Committee, under whom I am happy to serve, the hon. Member for Roxburgh and Berwickshire (Sir Archy Kirkwood), on instigating this intimate but important debate and on tabling early-day motion 496 on "Riding the Benefits Roller-coaster".

The hon. Member for Perth (Annabelle Ewing) was right to draw attention to her experiences at her citizens advice bureau, and I attended a quarterly meeting of my local CAB on Friday. All hon. Members present will know that top of the list of items raised by people going to CABs is the complexity of the benefits system. That was the case in High Wycombe on Friday, and I expect it to be so when I return.

The charity Carers UK claims that between 40 and 60 per cent. of disability-related benefits go unclaimed. That is only one example of the intrinsic difficulties to which the hon. Member for Roxburgh and Berwickshire referred. He perhaps did not have an opportunity to put on record the words of Kaliani Lyle from Citizens Advice Scotland on the report that is the centrepiece of the debate, who said: Even civil servants and medical professionals don't always understand the regulations". As the hon. Gentleman said, we often do not understand the regulations ourselves. Ms Lyle continued: The welfare system should work smoothly to give people with sickness and ill-health an opportunity to live their lives with some dignity and security, not condemn them to a roller-coaster experience of labyrinthine regulations, endless reviews and poverty incomes". She also said that the system too often fails those with a disability or illness". Those are strong words, but I want to step back from them, be fair to the Government and point to the intrinsic difficulty faced by all Governments, to which the hon. Members for Aberdeen, South (Miss Begg) and for Roxburgh and Berwickshire both referred.

At the risk of saying something that I might regret later, it occurs to me that there is a peculiar aspect of disability-related benefits that might not apply to all others. If one is a member of an ethnic minority, for example, one is always a member of that minority, whatever choices one may make in life. It is not the same for people with disabilities, as one can move in and out of disability, as I have done myself. The hon. Member for Aberdeen, South referred to the interplay of disabilities, which is another complexity. Governments of any party will always have to deal with assessments and appeals and the difficulty with time lags—the hon. Lady referred to that in relation to Motability.

Having bent over backwards to be fair to the Government, I should also say that the system is far too complex and rigid, and it does not seem to be in the process of being made much simpler. The hon. Lady made an interesting suggestion, which she has made in the Select Committee in relation to the Employers Forum report, about having a single work-related benefit and reconsidering incapacity benefit. That is the type of long-term reform to which the hon. Member for Roxburgh and Berwickshire referred in introducing the debate. As the hon. Members for Perth and for Chesterfield (Paul Holmes) said, if the number of successful appeals is rising, there must be a flaw in the system somewhere.

In the remaining time, I shall rattle through a series of quick questions to the Minister. I realise that she will not be able to answer them all today, but she may be able to deal with them in writing. Will she make a formal response to the CAS report? Does she have an estimate of the sum of benefit entitlement unclaimed by potential claimants with disabilities?

Representations might have been made to the Minister about extending the winter fuel allowance to those who receive the middle or higher rate of the disability living allowance mobility component. She may, like me, also have had representations about extending the allowance to those who care for children with severe disabilities. Has she made any costing on that, and what is her view of the proposal?

The Minister will also have had representations on incapacity benefit and prescription charges. The hon. Member for Roxburgh and Berwickshire also referred to that, so will she comment on whether any estimate has been made of the cost, and her view of the proposal? She will also have had representations about extending disability and attendance allowances to 52 weeks for those who are hospitalised. Has she estimated the cost of that proposal, and what is her view of it?

Representations will also have been made on people who are over 65 with mobility needs, who are inevitably a growing group, and attendance allowance, which does not include a mobility component, and we would all be interested to hear the Minister's views. It was announced that the disability and carers service is to gain formal Executive agency status. Does the Minister have any news on when that is likely to happen and when a chief executive may be appointed?

I want also to probe the Minister on the Downing street strategy review on disability that I understand is taking place. It has been suggested that the review is largely concerned with incapacity benefit. Any comment that she has on that would be welcome, as would any comment on the extent to which she will examine the issues that we have debated this afternoon, which were encapsulated in the CAS report that has been the centrepiece of our discussion.

3.10 pm

The Parliamentary Under-Secretary of State for Work and Pensions (Maria Eagle)

I add to the general congratulations that are being aimed at the hon. Member for Roxburgh and Berwickshire (Sir Archy Kirkwood). I feel rather alone, although I know that I am not completely alone, in not being on his Committee. He is to be congratulated on securing the debate and on setting out with such clarity his reactions, some of which were quite strategic, to the report and to the questions that he believes arise from it. I intend to do my best to deal with the points that have been made, but there will inevitably not be enough time to deal with all of them. However, I undertake to do what I can to plug any gaps that remain at the end of the debate by writing to hon. Members.

Let me also add my congratulations to citizens advice bureaux in Scotland. I am sure that they are similar to those in England and Wales. I believe that all hon. Members find them a tremendously valuable asset. We all have two or three in our constituency and tend to swap case loads: they send stuff to us and we send stuff to them, and that is of mutual benefit in all kinds of ways. They do a valuable job in my constituency, and I am sure that that is the case elsewhere. I can tell that that is the case in Scotland on the basis of the quality of the report that we have been discussing.

The report raises some serious issues of administration and policy, although some issues that appear to be about administration are actually about policy, but let us not quibble. Let me just say a little about the modernisation programme. The Department for Work and Pensions has undertaken a rather enormous programme of modernisation. When one deals with it on a day-to-basis as I do, it is tempting sometimes to assume that everyone out there knows about it. Alas, people do not follow such things with quite the assiduity with which they follow the activities of their local football club, so it is wrong of me to assume that everyone knows about the programme. The Department is making improvements to its programme for people who claim incapacity and disability benefits. I am grateful for the general acknowledgments in this Chamber that some improvements have been made, although they are always offered with a caveat.

The Department follows some key principles: first, to provide a better service for all its customers, including those who are on sickness and incapacity benefit, whether or not they are trying to get back to work. We talk a great deal about the work focus, but as the hon. Gentleman said, the other half of the equation is about making things better and improving security for those who cannot work. We all accept that work is not a sensible option for many people, so we want a better service for all our customers.

Better assessment of disability or incapacity for work in order to improve the quality of decision making about benefits, and better work-focused help for those who in the past have been written off but who these days want to get back to work and feel that they have something to offer are also important. In conjunction with the improvements that we are making in civil rights and in tackling discrimination, those people have a right to expect us to be ambitious about their future, just as much as anyone else's.

On the process of claiming incapacity or disability benefit, the hon. Gentleman quoted from the report and referred to obstacles put in the way of legitimate claimants. That is not something that we seek to do. The hon. Member for Wycombe (Mr. Goodman) made the point rather kindly—my hon. Friend the Member for Aberdeen, South (Miss Begg) also mentioned this-that there is a legitimate requirement to ensure that those people who are entitled to benefits should receive them, because we spend a great deal of money on them in the average year.

There is no doubt that we have to have proper and rigorous assessment, but it is very difficult to get it right if a benefit involves a medical element. Both disability living allowance and incapacity benefit have an element of medical assessment, although its importance varies from one to the other. There is no perfect way of getting that right, but we know that we have to improve the way in which we deal with it.

I recognise that the need for care and help with mobility can be a very personal matter. The effects of a disability, and how one copes with those effects, can vary tremendously from one person to another, as can the ability to express those needs, particularly in respect of disability living allowance. The benefit is designed to take that into account. Disabled people sometimes find it difficult to express their needs: they make the best of it, when perhaps they should be a bit more honest with the doctors and make it clear how bad things are. It can also sometimes sound—and be—impertinent to ask such personal questions. People get offended by the forms and by feeling that they have to jump through hoops to make their entitlement clear. We are sorry about that, and do our best to minimise it, but inevitably that can be a problem.

The very diversity that the benefits have to cater for has meant that the system has become more complex to administer, and in an attempt to enable people to express the full range of their needs, the claiming process has become unwieldy. Until recently, changes to the claim forms meant that they increased rather than decreased in size. However, we have now acknowledged that it is not possible to devise one claim form that fits everyone, nor is it desirable or sensible as a means of dealing with those issues, because that is not sufficiently sensitive to the individual needs of our customers. Our IT improvements are helping us to address that issue.

Hence, as the hon. Member for Perth (Annabelle Ewing) acknowledged—I am grateful to her for doing so—there has been some improvement in the forms. We have introduced a new single-part attendance allowance claim form, which is 16 pages shorter. It is a single pack instead of a double pack. A new disability living allowance claim form, based on a similar model, is currently being tested at the Wembley disability benefits centre, with a view to introducing it at the earliest opportunity, if it proves as effective as the attendance allowance form. The reaction from our customers and their advisers has been generally positive in respect of the attendance allowance claim form, which is encouraging. If the exercise is successful, we will have halved the size of both those forms. That is harder to achieve than one might think, and is certainly a move in the right direction.

The changes focus on devising a more interactive form, designed to discern the needs of the individual by speaking to them. That might not be a revolutionary concept outside Government, but is sometimes hard to do when one is administering a massive system that deals with millions of claims. The idea of talking personally to people is not always as obvious as it might seem to the rest of humanity—but we have made progress. The changes encourage greater interaction and a more personal relationship, which should lead to better understanding between us and our customers and to better decision making.

We are helped in that progress by improvements in our IT, which will assist us in providing a more modern and customer-focused service. I am sure that most of the hon. Members who served on the Select Committee have visited a disability benefits centre. When I, as a Minister, first went to visit one, I was shocked by how old-fashioned the administration was. Our decision makers were still using paper and pen—I nearly said quill and ink—to set out their decisions. We were therefore starting from a difficult base, but we are now seeing some important improvements, because of the kit that we have been able to put on people's desks. There is more to do, but we are moving in the right direction.

The Government set stringent medical targets covering the speed, accuracy and quality of the medical advice that informs decision making on benefit entitlement. We review those targets monthly, and the vast majority are met, although there are always blips. Last October, the National Audit Office acknowledged that good progress had been made and there had been significant improvements in the contracted service. That is not to say that it is perfect, but there have been improvements.

All our medical services doctors receive specific and ongoing training in the specialist field of disability assessment medicine. We are developing a computer-supported system in medical services to try to improve medical assessments, to ensure that they are performed in a fair and consistent manner, and supported with up-to-date, evidence-based medical information.

We should also acknowledge that only a very small proportion of assessments result in a complaint about the doctor. I know that there are people who do not complain when they feel that they would like to. I urge hon. Members to get their constituents to complain if there is a valid reason to do so. We do not defend the actions of doctors who fall short of the high standards expected of them. We heard one or two anecdotal instances from the hon. Member for Chesterfield (Paul Holmes) about the kind of thing that can happen. We will not tolerate such poor practice. We have peer review, and we have retraining, and if at the end of the day doctors do not come up to our required standard, we throw them off our lists and we stop using them. Over the past year we threw 58 doctors off our lists for not achieving high standards. That shows our determination to ensure that we get this right.

Miss Begg

Has the Minister thought about her Department giving any advice to GPs, not those who are working through the medical services? I often find that constituents have been told by their GP that they cannot work any more. What the GP means is that they cannot be forced to work and should qualify for incapacity benefit, but if they are feeling better they should be encouraged to work. There is quite a job to be done at that level with GPs. Attitudes have changed, and someone who is ill today need not be out of work for the rest of their life.

Maria Eagle

That is an important point. GPs may not often want this, but they have a role to play in the original certification for an IB or statutory sick pay claim. They are the clinical adviser of our customers. Of course, our customers take what they have to say very seriously, so we recognise the important role that GPs play in providing advice on fitness for work. We do our best to ensure that GPs understand this. Many of them do not come at this from the point of view of work: they rightly come at it from the point of view of clinical advice to their patients.

The Department's chief medical adviser issues advice to all GPs, which tries to deal with many of these issues. We have a website link that GPs can use. Some interesting work is going on in the pathways pilot areas. We are trying to work much more closely with GPs on what people coming into incapacity benefit might gain from seeking to return to work. My Department and the Department of Health are working closely together on this. It will be interesting to see what impact that has both on the relationships that we manage to have with GPs in the local area and on our customers who often feel that their GP has definitely told them not to touch work with a bargepole. We are doing some work in that area.

I shall try to deal with some of the specific points raised in the debate. I will deal first with permitted work, because almost everyone who spoke had something to say about it. I am particularly interested in this. I get many letters, including some from hon. Members, about permitted work and the change from the therapeutic earnings rules to the permitted work rules and the impact that has had. The hon. Member for Wycombe raised it as one of his specific issues.

The aim of the change was to try to remove the need for our customers to get a doctor to say that it would be therapeutic for them to take advantage of this. That is entirely right. Another aim was to ensure that the rules act as a stepping stone from not working and being on incapacity benefit into work: hence the rules about 26 weeks and another 26 weeks. We have to bear in mind the fact that incapacity benefit is an out-of-work benefit. It is not generally available for those who are in work. We do not want there to be a huge cohort of people claiming incapacity benefit for ever, while working. We need an arrangement to ensure that it does not go on for ever: hence the limit.

As the hon. Member for Roxburgh and Berwickshire said, it is almost two years now since the changes came in, and we are evaluating them. I cannot tell the Chamber when I shall have the information that emerges from that evaluation, but we are considering carefully how the rules work.

The hon. Gentleman also suggested that I might not have to hand the figures for the number of those on higher-level, lower-level and supported permitted work. By some great feat of organisation on the part of my officials, I do have them here. About 1 to 2 per cent. of the IB case load—about the same level as those taking advantage of therapeutic earnings—are on some form of permitted work. The numbers at 15 January were 12,705 on permitted work lower limit, 14,635 on permitted work higher limit and 9,010 on supported permitted work. That is as accurate as I can be. I hope that that helps the hon. Gentleman. We shall keep the figures updated. Because permitted work is seen as a stepping stone back into work, we want to see what happens to those with a deteriorating, chronic condition who are never likely to aspire to go back to 16 hours. We need to find a way to provide support for those people, but I have not found the answer yet, so answers on a postcard, please, if hon. Members have any great ideas.

The other broad theme in the contributions to the debate related to the accuracy of decision making. I acknowledge that there is a high level of successful appeals. I think that the reasons in DLA are slightly different from those in IB personal capability assessments, although, the personal capability assessment being a medical assessment, there is always scope for disagreement. With PCAs it is much more about the evidence that is available at a certain time, and often the appeals are successful because more evidence comes forward.

With DLA, it is not about finding a diagnosis, so that one can then have the benefit, but about the impact that the disability or the illness has on one's ability to look after oneself or get around—care or mobility—and that can vary. The same diagnosis can require radically different levels of support. A person who loses a leg may sit in their chair in the front room for ever, being depressed about it, and never stand up again. The reaction of another person is to get a prosthesis and run a marathon. The second person would not retain their DLA once they started walking well again.

That is a radical example, but similar examples occur in DLA all the time. The benefit is not designed to recognise a medical diagnosis—the disability lobby would lobby us if we said that it was—but is about the impact that a disability has on a person's ability to look after themselves or get around. That must be borne in mind when considering the number of successful appeals for DLA, but I am not trying to hide the fact that there are many successful appeals, and always have been.

The increase in the number of successful DLA claims is still high and is still increasing at about 5 per cent. of spend a year. Indeed, I believe that there has been a 44 per cent. increase in successful claims for DLA in the hon Gentleman's constituency. He is clearly working hard, but there is no evidence that complaints about the obstacles are stopping people making successful claims and getting the benefit, because the levels of benefit are significantly increasing recipients' spend.

I realise that I am running out of time and I have not dealt with half the questions that were raised. However, I undertake to write to hon. Members to try to answer some of the points that I have been unable to deal with.