Debate on the Address

My Lords, I begin by endorsing the comments made in earlier maiden speeches in recognition of the remarkable friendship that your Lordships have extended to so many newcomers, including me, in recent months. I warmly welcome the Government’s plans for a Welfare Reform Bill and their laudable objective to reduce by 1 million over 10 years the number of people claiming what are currently called incapacity benefits. I should at the outset perhaps explain that my interest in benefits, employment and mental health go back a very long way. Some 35 years ago, I produced the Child Poverty Action Group’s first research report on the benefits system and, shortly after, edited a book on new methods of mental health care—albeit that those new methods look anything but innovative today. Since the early 1970s, apart from nine years with the Police Complaints Authority and four years in Russia working on the development of the Russian employment service, I have concentrated on employment and mental health issues in this country. I should also declare my current interest: I chair the East London and the City Mental Health NHS Trust. Not surprisingly perhaps, I want to focus on the implications of the Government's welfare reform plans for the 50 per cent or so of incapacity benefit claimants who have mental health problems, 40 per cent of them as their primary diagnosis. As has already been alluded to, the cost to the Exchequer in benefits and lost taxes is huge—nearly £10 billion—and the social cost measured in misery is still more shocking. The welfare reform programme has many positive features. As has also been referred to, the Pathways to Work pilots of the reform show a clear benefit for many in terms of earnings and employment. However, the pilots show no significant benefit for people with mental health problems. If the reform is to succeed, the barriers to employment for this sizeable group—about 1 million people—must be overcome. What, then, are these barriers? The Social Exclusion Unit’s report Mental Health and Social Exclusion identifies low confidence, low expectations and stigma as some of the key problems. The reform programme as it stands does not effectively address these barriers. Indeed, the new system, without adjustment, could make matters worse. Without the right support, anyone with depression or anxiety, or with more complex disorders, may fail to attend a work-focused interview, fail to pursue an action plan on time or fail to engage effectively in work-related activity, thereby risking financial penalties. Probably the single most important reform to deal with all these barriers and risks will be the provision of evidence-based psychological therapies—notably cognitive behavioural therapy, although there are others, too. As proposed by NICE, these therapies should be automatically available to anyone suffering from psychological disorders. This includes people out of work and claiming the future employment and support allowance and people in work who are at risk of losing their jobs. All condition management, in my view, should become evidence-based psychological therapy delivered by well trained and supervised therapists. This will be a low-cost, high-return investment. Indeed the cost of £750 per person treated is small relative to almost any medical treatment for a comparable level of suffering. Moreover, it has been estimated that the resulting Exchequer gain due to the increased employment would fully offset the cost. The second set of issues that I wish to draw to the attention of the House is the fluctuating nature of many mental disorders combined with the particular sensitivity to stress of this group of claimants. It is simply not realistic to treat people with mental health problems exactly the same as anyone else. These problems—the fluctuating disorders and terrific sensitivity to stress—also contribute to the lack of success of the Pathways to Work pilots with this substantial group, which numbers 1 million. The majority of people with mental health problems receiving benefits may need to begin by taking temporary jobs. This is particularly true for those whose disorders fluctuate, but it applies more generally. Such is the stigma of mental illness that a permanent full-time job may be impossible to get, at least in the early stages of their return to employment. Now we come to the problem—and it is a major one. At the end of a temporary job, the individual can expect to have no money for two to three months or more while their benefits are restored. The linking rules extended this year should have provided an answer. However, job centre staff whom I visited recently in the East End of London made it clear to me that my fears were reality—that the linking rules simply do not work and that, yes, claimants trying to restore benefits after a spell in employment would indeed wait months for any money. I ask your Lordships: how many of us could really cope with that situation? The situation can be even more alarming with respect to housing benefit, which too often for people with mental health problems leads to threats of eviction and maybe homelessness. How many of the people whom we have seen on the streets have had their housing benefit denied? It is not surprising, then, that a mental health service user said to me recently that the prospect of taking a job was like ““jumping off a cliff””. He meant it. Yet people with mental health problems are not workshy—far from it. The majority want employment and are prepared to consider losing financially, within reason, in order to achieve it. We need a system that enables this particularly vulnerable sector of our society to move smoothly and securely between benefits and work until they are settled and stable. To achieve this, I have proposed a register of claimants with identified fluctuating or severe disorders, for whom benefits would be speedily and automatically restored. I know that the noble Lord, Lord Hunt, for whom I have great respect, does not much like my proposal. If he can think of a better solution, that would be splendid. But a solution must be found if the Government’s reform is to succeed—and I, for one, want it to. Finally, Ministers often emphasise the importance of mental health, but their recent response to the financial crisis in the NHS leads me to question their commitment. Indeed, their response has been absolutely devastating to the mental health community. I give just one example. In August, the East London and the City Mental Health NHS Trust was required to produce £4.7 million within the year to help to pay the bills of other trusts, mainly acute trusts that have deficits. This has resulted in savage cuts to many services, including psychological therapies, thus undermining the efforts that will become essential to the success of the Government’s welfare reform programme. If the welfare policy is to succeed in restoring people with mental health problems to employment and normal lives, the Department of Health cannot afford to treat this section of the community as the least deserving. People racked by anxiety or depression need proper treatment, as we assume with any other disorder. They also deserve a benefits system that supports their return to employment, rather than one that presents hurdles that they are likely to fall over.