Work Capability Assessments
The final item of business today is a members’ business debate on motion S4M-04043, in the name of Kevin Stewart, on work capability assessments. The debate will be concluded without any question being put.
Motion debated,
That the Parliament understands that there are ever-increasing concerns in Aberdeen and across Scotland regarding the work capability assessments for Employment and Support Allowance that are being carried out by Atos; notes the reported fears of stakeholder organisations and individuals that similar concerns will be reproduced with assessments for Personal Independence Payments, and understands that members are receiving significant casework from constituents regarding negative experiences of work capability assessments.
17:03
I thank all the organisations and individuals who have supplied us with information and briefings for today’s debate. I apologise in advance if I do not mention all the organisations during my speech—I am sure that colleagues will mention those organisations that have made submissions. I thank them very much indeed.
The headlines in today’s Daily Record read “Heartless Tests Leave Disabled Penniless” and “The Atos Scandal”. Although I am no cheerleader for Atos, the reality is that its contract has been laid down by the Department for Work and Pensions. It is Westminster that is to blame for the situation and, although Atos is doing its bidding, it is doing so under the contract that has been written by the DWP in London.
I am sure that work capability assessments have featured in the postbag of every single member of late. I am sure that many members will have had people coming to their surgeries with their tales of woe. From my own perspective, some of the stories that I have heard are absolutely heart wrenching—it is an absolute disgrace.
Unfortunately, some folk are unwilling to have their individual cases told in Parliament, because there is a fear about going on the record. However, last week in this Parliament, at the Welfare Reform Committee meeting, three very brave individuals gave evidence. I am sure that their evidence will feature in later speeches.
The Crisis report “Single homeless people’s experience of the Work Capability Assessments” notes that almost a quarter of single homeless people have to wait more than six weeks to receive the outcome of their assessment. Given that the overall assessment process can be daunting, frightening and incredibly stressful for claimants with mental health issues, it is imperative that the time between the assessment and communication with the claimant is kept to a minimum. I agree with Crisis in that regard.
For many, work capability assessments are a frightening experience. In my opinion, assessments should be as easy and as flexible as possible in order to take into account fluctuating conditions and extenuating circumstances, but they most certainly are not like that at present. It is most concerning that service providers and advice agencies are being significantly affected due to the nature of the assessment, with citizens advice bureaux in Scotland dealing with almost 20,000 new employment and support allowance issues in 2010-11. The Consultation and Advocacy Promotion Service individual independent advocacy service has reported an increase of more than 75 per cent in the number of cases relating to ESA from October 2010 to March 2011. It is clear from those statistics that the work capability assessment process needs to be made clearer and easier for those completing the assessment. That trend is echoed in many other agencies.
We know that 76 per cent of claimants appealed the outcome of their WCA and more than 50 per cent of those people have been successful and given a higher score on appeal. Those are concerning statistics. They show that few claimants trust the decision made by their assessor, and the fact that more than half are successful in an appeal shows that the decisions were incorrect. Appealing a decision, in what can be a stressful assessment for many with mental health conditions, can lead to further health conditions caused by stress, which can trigger depression and other fluctuating conditions.
The decisions of healthcare professionals at an assessment need to be trustworthy and free from error to result in fewer appeals and an easier process. The questions and point system of the assessment need to become relevant and fit for purpose when dealing with all conditions, and healthcare professionals should be given some discretion when discussing work capability with claimants.
There are significant issues around certain illnesses. For example, the treatment of claimants with blood-borne viruses is often misunderstood. Many of those claimants feel that the healthcare professional who is assessing them has no understanding of blood-borne viruses, the treatment for them and the side effects of that treatment. Terrence Higgins Trust has offered the Department for Work and Pensions free training on blood-borne viruses, which it has not taken up. That is a disgrace.
Today, I received a letter from the Royal College of General Practitioners Scotland, which says:
“With specific reference to people living with Hepatitis C, we would argue that patients undergoing eradication therapy for Hepatitis C should be viewed in a similar capacity to patients undergoing chemotherapy treatment. Hepatitis C can be lengthy and involve debilitating side effects. Indeed patients with Hepatitis C who are in employment are often reluctant to embark on an extensive course of eradication treatment as this might necessitate being off work for a long period as treatment can be arduous and not without side effects. The same can be true of HIV positive patients who have developed complications from their disease.”
RCGP Scotland argues that those folk are in the same position as those “undergoing cancer therapy” and I agree with that.
The Atos contract needs to be looked at very carefully. A new contract with a value of £206,703,507 has been awarded to undertake assessments for personal independence payments for Scotland and north England. I have received a copy of the tender for that, which was redacted. I cannot go into any depth on it. The redaction was not done particularly well, and I managed to access information that I probably should not have accessed. I will reveal that at a later date.
Finally, the DWP report in today’s Daily Record says that
“HALF of people stripped of disability benefits after being ruled ‘fit for work’ by Atos were left unemployed and without income”;
that
“55 per cent of people who lost benefits ... had failed to find work”;
and that only 15 per cent are in jobs and 35 per cent are on other benefits.
The paper also says:
“Atos have assessed patients with terminal illnesses as ‘fit for work’. And thousands of victims of genuine, chronic conditions have complained of being humiliated by the company’s tests.”
That is absolutely disgraceful. The only way to deal with the matter is by the Parliament taking full control of welfare. I hope that that will happen sooner rather than later so that folk do not have to put up with those situations any longer.
17:11
I am sure that all members will congratulate Kevin Stewart on securing the debate and that I will be only the first to do so. I apologise to him, the Presiding Officer and other members, as I may have to leave before the end of the debate to get back to my constituency.
Like Kevin Stewart, I am a member of the Welfare Reform Committee. It is clear that the committee is receiving evidence of the enormous damage that has been done to people’s lives through the United Kingdom Government’s wider welfare reform agenda. We have become particularly aware of the concern about work capability assessments; indeed, we received evidence about that last week. Mr Stewart referred to that, and I will try to pick up on it later.
All of us will be aware of the concern that exists as a result of constituents who have brought cases to us. It is clear that campaigning organisations are similarly concerned. Citizens Advice Scotland provided a very good briefing for members in which it gave a number of instances in which its clients have reported concerns. It informed us:
“A West of Scotland CAB reports of a client whose GP is ‘astonished’ that she has been declared fit for work in her work capability assessment. The client had spinal surgery which has led to chronic back pain and irritable bowel syndrome. The client is also asthmatic and has borderline personality disorder involving mood swings and considerable medication.”
The briefing also states:
“An East of Scotland CAB reports of a client who ... has long-term substance abuse issues and mental health problems ... The client’s GP states that the client is definitely not fit for work as she has been assessed as ‘psychotic’ and a danger to others.”
That person was assessed as being fit for work.
Kevin Stewart referred to the evidence that the committee has taken. I refer to the Official Report, as it is important that members hear some of the evidence. We have taken some very good evidence and, as Mr Stewart said, the witnesses were very brave to give it.
One of those witnesses was Henry Sherlock, who became blind at 31. He told us about his work capability assessment:
“I was asked whether I could pick up an empty cardboard box. In what job does someone pick up an empty cardboard box? That is not even work capability assessment. I said that physically, yes, I could pick up an empty cardboard box but that I would not know where the cardboard box was. I would have to have someone show me where the box was. Then, when I picked up the box, if I needed two hands I would become immobile—my mobility would be gone because I would not be able to use a cane or a dog to get around. I gave a full explanation of why that would be difficult, but I asked for the medical report to be sent to me and that was missing completely from the report.”—[Official Report, Welfare Reform Committee, 18 September 2012; c 253.]
Janice Scott, whose husband was injured in a traffic accident, had a stroke and subsequently could not work any longer, made a similar point. She spoke about the evidence that her husband gave during his work capability assessment. She took down in shorthand everything that her husband said but, when they requested the report, they saw that it did not reflect what he said. That is a damning indictment of the work capability assessment process.
We heard from the witnesses that it would often be noted in reports that they arrived at the interview on time and were well dressed. That is a completely anodyne point. How could a disabled person be assessed as being fit for work because they turned up at the appointment time and were well dressed? That might lead us to assume that it would have been better if they had adopted a more tardy and slovenly attitude, which highlights the ridiculous nature of much of the work capability assessment system, as do the wider experiences of people going through the system.
It is absolutely right that the Scottish Parliament has a chance to report and highlight those concerns. Once again, I congratulate Kevin Stewart on providing us with that opportunity.
17:15
I congratulate Kevin Stewart on securing this debate and on shining a light on the practice of work capability assessments. He is absolutely right to say that they are having a deeply disturbing impact on people in our constituencies. I join him in thanking the organisations that have provided briefings for this debate.
When discussing welfare reform, I always remember that David Cameron promised that the cuts would fall on those with the broadest shoulders, which I assumed would mean people such as his Cabinet of millionaires. However, the hardest hit are not those with the broadest shoulders; they are those who are among some of the most vulnerable people in our society.
I recall that, when work capability assessments and employment and support allowance were first introduced, there was broad support for the principles underlying the policy. We would all agree that the principle of helping someone to secure employment is reasonable. I am in no doubt about the benefits of work for the individual, for families and for society, and therefore I believe that, if someone is able to work, we should help them to do so. However, those who genuinely cannot work should not have to endure a chaotic shambles of a system that denies them dignity and makes them out to be scroungers, because nothing could be further from the truth. However, on that issue, we have a battle of hearts and minds to win in Scotland.
The system is so incompetent that, I understand, half of the decisions that are made are overturned on appeal. That alone tells me that the system is not fit for purpose. Like Kevin Stewart, I want to take this opportunity to congratulate the Daily Record on its campaign to highlight the problems that have been experienced by people across the country such as Crawford Leask, Tom Meikle, Janice Mills and Margaret Monaghan, whose stories demonstrate the indignity of the process and the incompetence of Atos, which is charged with carrying out the assessments. That is campaigning journalism at its best.
There are many people in my area who want to work, but they are not given the opportunity to do so or the support that they need in order to do so. I know of one young man with a learning disability whose dearest wish is to work but who is unlikely to be able to do so without a huge amount of support, given the nature of his condition. The work capability assessment would probably say that he is fit for work, because it is not very good at identifying those with disabilities that are not obvious. It focuses on physical disability and mobility but fails to recognise the real problems that are associated with things such as mental health, learning disabilities or autism. The systems are more about information technology than people. They do not recognise that someone who is disabled might have a progressive condition that means that they will have good days and bad days.
All of that is putting a huge strain on the voluntary sector and the advice services in particular. We know that Citizens Advice Scotland has reported a huge increase in case load and that it is struggling to meet the demand. I ask the Scottish Government to ensure, if it is at all possible, that the formula consequentials that it has for this area are released to the voluntary sector as quickly as possible, because it is struggling to cope with the demand that is out there.
A postcode lottery is emerging, poverty is leading to destitution, some people are giving up because they are depressed and others are contemplating suicide, which I find quite distressing.
I know that the pilots that were run identified that there were problems and that a cross-party select committee highlighted those problems. Unfortunately, the coalition Government rolled out the contract in 2010 without taking on board those issues. It has also failed to apply financial penalties against Atos in 90 per cent of the cases in which it could have done so, for which it has been criticised by the National Audit Office. I understand what Kevin Stewart says, and I know that he is not a cheerleader for Atos, but there is a problem with the contract and with the methods that are used.
The Scottish Government needs to review whether it is appropriate for it always to co-operate with Atos. I know that lots of disabled people were genuinely concerned when Nicola Sturgeon welcomed its sponsorship of the Commonwealth games, because they could not understand why she had done that.
This issue is not about independence. People are suffering now and I think that it is incumbent on this Parliament to alleviate that suffering if we can.
17:20
I, too, congratulate my fellow SNP MSP Kevin Stewart on securing this debate on the important subject of the London Government’s work capability assessment.
The box-ticking approach to the determination of disability was indeed, as Jackie Baillie rightly remembered, introduced under Labour when Tony Blair and Gordon Brown were in charge and it was they, of course, who awarded the contract for the assessments to Atos.
Will the member take an intervention?
I want to make progress, not least because Ms Baillie overran her time by some 30 seconds.
The UK Tory-Liberal Government—I note that we do not have the benefit of any Liberal members for this debate but that we do have one Tory—has extended the Atos contract. It is a matter of fact that, via the DWP, the UK Government calls the shots on the parameters of the contract within which Atos is required to work, in terms of both the policy and the criteria to be employed. The DWP is of course the decision taker in respect of disability benefit claims. That is where the problem lies, because it is clear beyond any doubt that the system of box-ticking assessments to which successive Labour and Tory-Liberal London Governments have been so thirled is fundamentally flawed.
Sadly, this is not a mere arcane discussion of what appear to be very odd contracts indeed; rather, it is a debate that serves to highlight the deeply damaging impact on some of the most vulnerable members of society that the work capability assessments have already had in relation to Labour’s ESA and will continue to have in relation to the new Tory-Liberal PIP, which is to be introduced next year.
We have heard in the debate of the experiences of some individuals. I, too, have received a number of inquiries, as I suspect every other member has, from constituents who are worried about the new welfare cuts. I cannot refer to the individuals in any detail because of issues concerning confidentiality, but for a detailed examination of all that is wrong with the current approach one need only read the Official Report of the Welfare Reform Committee’s meeting of Tuesday 18 September, which has already been referred to. Committee members heard the powerful testimonies of Mr Norman Gray about his son, Mrs Janice Scott about her husband and Mr Henry Sherlock about his own situation.
I respectfully suggest that that should be essential reading for all members of the Parliament, for it is quite clear that no account is taken of the individual situation. Indeed, it is claimed that, in many instances, the individual is not even listened to and medical orthodoxies are turned on their head. That that approach is fundamentally flawed is witnessed by the fact that some 40 per cent of ESA appeals are successful, which is an astonishingly high figure.
In a speech of four minutes, it is impossible to convey the truly abhorrent nature of what is going on, but what is clear to me is that this inhumane system simply cannot be allowed to continue, for it misses the fundamental issue as far as disabled people are concerned. Mrs Scott said in evidence to our committee:
“Lots of disabled people can do lots of things, but they cannot do them consistently. They did not ask about anything like that at all.”—[Official Report, Welfare Reform Committee, 18 September 2012; c 254.]
That says it all to me. The sooner we in Scotland take control over the welfare of our citizens, the better, so that we can restore dignity and fairness to the system. Roll on the 2014 referendum and a yes vote to end Tory rule over welfare in Scotland.
17:24
I sincerely welcome the fact that Kevin Stewart has brought the matter of work capability assessments to the chamber. I enjoy my role on the Welfare Reform Committee although, as many members will realise, my role is slightly different from that of other members, as I am a representative of one of the governing parties at Westminster.
The specific issue before us is work capability assessments. Like other members of the committee, I have sat through many heart-wrenching stories. Nobody could fail to be moved by some of the stories that have been brought to the committee. However, it is important that we address the issues regarding Atos in a specific way. Many of the stories that we have heard are what I would describe as anecdotal. I do not wish to use that word in a way that undermines the authenticity of or honesty behind the stories, but at present it is difficult to find empirical or statistical figures that allow us to say exactly what the problems are.
Will the member take an intervention?
Will the member take an intervention?
I will continue.
We are aware that there is a series of inconsistencies as well as a significant burden on the appeals process and a growing burden on the medical professionals who are required to support that process.
I believe that assessment is necessary. It is vital that we have an effective assessment process that is functional and can be relied on to produce evidence. At this stage, I am not convinced that the process that Atos is running is the relevant and fit process that is necessary. It is important that adequate support is provided for those who are in the process and that effective, reliable and quality advice is available to all those who are caught up in it. We need to assess whether that level of support is currently available.
We must have an assessment process, but we must have confidence in it. At this stage, confidence in the process has been undermined. The Scottish Parliament’s Welfare Reform Committee has a key role in the current circumstances. We must take an objective and evidence-based approach and we must not repeat some of the mistakes that Atos has made, but simply in reverse. The Welfare Reform Committee has the opportunity to deliver the empirical evidence that is necessary to achieve the change that we all have as an objective.
I look forward to working with members of the committee and the Parliament to come to the appropriate conclusion and produce evidence that can be used to change the process from one in which few people, if any, have confidence to one that can continue with the confidence of all who are reliant on it.
17:28
I join other members in thanking Kevin Stewart for bringing the incredibly important matter of work capability assessments before Parliament so that we can debate it and put some facts and figures on the record to show that there is evidence behind what we are saying.
I begin by echoing something that Kevin Stewart said. I remind members that we are talking about the work capability assessment as undertaken by Atos but that it is being done on behalf of the United Kingdom Department for Work and Pensions and on the basis of that department’s contract, which was let in 2005 by the Labour Government. Atos is also working towards the Liberal Democrat-Conservative coalition’s stated intention to cut the budget for welfare such as DLA by 20 per cent.
Will the member take an intervention?
I will not take Ms Baillie’s intervention, as she did not take mine. That sounds a bit petty, does it not?
To remind members about the contract and Atos’s position, I will quote an Atos spokesperson, who has said:
“Our trained doctors, nurses and physiotherapists use their clinical knowledge and apply the government’s policy and criteria to each assessment.”
That means the UK Government’s policy and criteria.
When I read that, I thought, “That could not possibly happen here in Scotland, could it?” Well, I perhaps thought that until yesterday, before which I thought that the Scottish political consensus was for social justice for those in need of welfare reform.
To answer Alex Johnstone’s claim that the stories about assessments are anecdotal and that evidence is needed, I will use some facts and figures from the evidence that was heard at the Health and Sport Committee when we first looked at welfare reform—members know that, as a former librarian, I like my facts and figures and evidence. We found that, in general, 40 per cent of appeals against an assessment are successful and that 69 per cent of those appeals are successful when someone is represented by, for example, a citizens advice bureau worker or a welfare rights officer. Clearly, if only 30 per cent of refusals stand on appeal, the system does not work.
If Alex Johnstone is looking for more evidence, he need look no further than the evidence that was presented last year to the Health and Sport Committee by organisations such as Citizens Advice Scotland and act now for autism. As a little extra, the former health librarian in me wants to remind members that case studies build towards an evidence base; evidence does not always have to be empirical. Case study is another term for anecdotal evidence.
We have talked about whether we can reveal certain peoples’ experiences. I have 1,280 constituents who are in receipt of ESA, but there is one person that I can talk about quite happily and without breaking any confidences—that person is me.
I have been through the assessment process and I was found fit for work. I appealed the decision and my appeal was upheld. I was assessed because I was unable to work due to depression. Some of the things that happened in that assessment included being asked to pick up a pen. Jamie Hepburn used other examples, but that was mine. My mental health and depression did not prevent me from picking up a pen. I then had my stomach examined—I am not quite sure what that had to do with my mental health.
Jackie Baillie said that the systems are more about IT than people. My assessment was all about IT: the medic sitting behind the computer was only interested in the fact that his computer did not work.
The system is profoundly unfair and philosophically flawed, and it must be challenged by individuals and, collectively, by society. Ultimately, however, it is a political matter. If we want a socially just Scotland where such obscenities do not continue, then, as Annabelle Ewing said, there is a referendum on Scottish independence in 2014 and we can take charge of welfare in this country.
17:33
I add my thanks to Kevin Stewart for bringing the motion to the chamber for debate. He gave a powerful and punchy contribution. All of us who know him know that he is never a man to mince his words.
Other members, including Jackie Baillie, Jamie Hepburn, Annabel Ewing and, most evocatively, Fiona McLeod brought more personal accounts; I say to Alex Johnstone that, yes, many of them are heart-wrenching.
We have heard the personal testimonies of those who are being unjustly and unfairly treated by the work capability assessment process. The process is clearly flawed when the DWP’s own figures show that 40 per cent of appeals against being found fit for work are overturned—a figure that increases to 70 per cent when an individual is represented by an organisation such as Citizens Advice Scotland.
We also know that disabled people and their representatives are concerned about the reforms to the disability living allowance and the introduction of its replacement, the personal independence payment, and the potential knock-on effect on carers’ allowances. Those concerns about the proposals and the lack of detail about the changes have—understandably—caused a great deal of anxiety and uncertainty among many of our most vulnerable people, yet the UK Government continues to pursue the sick and the vulnerable and to take no account, it seems, of the reality for people who live with health conditions or disabilities.
The Scottish Government has made it clear that it wants a welfare system that is simpler, that makes work pay, and that lifts people out of poverty—a system that reflects Scotland’s values. We must acknowledge that being in some sort of meaningful employment is good for the long-term health of most people of working age. Conversely, being out of work for prolonged periods has been shown to be harmful. Jackie Baillie made that point.
Does the minister accept that it is the preferred choice of disabled people to work if they have the ability to work?
I accept that 100 per cent. We should recognise that many people who have long-term health conditions or disabilities can and do continue to work, but those who are unable to work should be supported to enable them to lead dignified lives.
Professor Malcolm Harrington’s independent reviews of the work capability assessment process have identified many failings. The DWP has accepted the findings and has said that it is committed to addressing them. However, despite implementing recommendations to improve the process, it is still not meeting its aims of providing a fair and effective assessment. I am advised that Professor Harrington had been commissioned to continue his work and that he issued a call for evidence, which would have been an ideal opportunity to look at those case studies—nothing is more powerful than the real-life testimonies of real people in real communities—but I am told that Professor Harrington has stepped down and that the DWP is considering options for his replacement and the terms of reference. I urge the DWP to pick up the pace, because the situation needs to be sorted out now.
Processes for reassessing people who are currently on benefits, such as the work capability assessment, need to be fair and transparent and must treat the individual with respect. They must also be able to distinguish between those who are genuinely disabled to the point of being unable to work, and those who might genuinely believe that they cannot work, but could if they had the right support. Those latter people might have been out of work for a long time and might need significant support if they are to adjust to the prospect of working again. They should not be punished for that, but it is difficult to see how such people will not be punished given the massive £2.5 billion cuts in welfare that will come our way by 2015. Housing benefit will be cut by £100 million to £150 million annually, and the changes that will happen when DLA becomes PIP could result in £250 million being taken from some of our most vulnerable people.
We are all aware that advice services are critical at times of substantial change. I know that the Government could provide budget consequentials to advice services. Could it do that quickly?
I am sure that Mr Swinney looks at everything in the round, and it is important to recognise that the Scottish Government funds programmes such as making justice work and citizens advice direct. Next week, we will debate the employability refresh: we want to put people who have disabilities or who might need additional support at the heart of that.
I know that time is pressing, but I want to focus on Atos. The Scottish Government shares concerns about the work capability assessments as they are administered by Atos on behalf of the DWP, but we need to be clear that Atos delivers within the terms and conditions of a contract with the DWP. It is not making decisions about benefits eligibility and it is not making policy decisions.
Atos is, however, responsible for the technology and the assessments. As a former mental health officer, I am quite appalled by the quality of assessment that some personal testimonies have revealed. It is quite clear to me that it is not possible to contract for such work on the cheap, and that we need a range of suitably qualified professionals who have the skills and expertise that are necessary for dealing with all the varied needs of people who receive health-related benefits.
In the tender documents, it says that Atos employees should have seven and a half days’ training before they start doing assessments. Does the minister agree that seven and a half days’ training is certainly not enough to allow those people to deal with some of the complex cases that they face day to day?
As a former mental health officer and front-line social worker, I have some insight through knowing how long it took me to get to grips with the vast array of mental health problems—never mind learning disabilities. A high proportion of people who claim DLA are learning disabled. The many vulnerable people who turn up for work capability assessments and express their desire and willingness to work—particularly those who are learning-disabled citizens—need particular understanding, support and coaching to allow them to progress towards and into work. There is no point in setting vulnerable individuals up to fail.
I know that time is marching on, so I will close by saying that I am very grateful for members’ contributions. I commend the work of the Welfare Reform Committee, CAS, all the disability organisations and even the Daily Record for shining a light on people’s personal testimonies, which should never be dismissed for being anecdotal, given how difficult it is for vulnerable individuals to step forward.
I am deeply worried that the Scottish Government’s good work in supporting vulnerable individuals through our social wage initiatives will be undermined by the scale of UK Government cuts, austerity and welfare reforms. We need all the levers of tax and benefits if we are to realise the ambition that we have of having a welfare state that is simple and fair, and which lifts people out of poverty.
Meeting closed at 17:42.