Welfare Reform Bill

I support the amendment. I have been a lifelong supporter of welfare-to-work policies, so I favour the general principles of conditionality. But people with treatable conditions also need treatment. The shocking fact is that less than half the people who are mentally ill and on incapacity benefit receive any treatment. If any one cancer patient was not receiving treatment, we would consider it unacceptable and insist they were offered treatment. Compared with that, we would think the offer of condition management secondary. The same should be true of mentally ill people. Before we impose conditions, we must ensure that adequate treatment is available to mentally ill people on incapacity benefit, nearly all of whom are suffering from clinical depression or chronic anxiety disorders such as agoraphobia and the like. We have treatments, we have drugs, but we also have modern evidence-based psychological therapy, lasting for fewer than 16 sessions, which can cure about half of all those treated. These therapies also have a better record on preventing relapse than drugs. That is why NICE says in its guidelines that all people with depression and anxiety, unless very mild or very recent, ought to be offered cognitive behavioural therapy or, in some cases, other specific therapies. The problem is that the guidelines are not implemented. This is the greatest case of disregard of NICE guidelines in the whole of the National Health Service. They are not implemented because the therapists are not available. Surveys show that the majority of patients want these therapies; one reason why they are not in treatment is because the therapies are not available and the patients do not want drugs. Their GPs want to refer them for therapies. The president of the Royal College of General Practitioners has told me of the massive frustration among GPs because they cannot implement the guidelines, simply because there are not enough therapists. We urgently need a plan to train and employ enough therapists to satisfy the guidelines. As part of the process of the Bill, we need a Government commitment to provide a plan that will enable people on incapacity benefit to receive the therapies they need in just the same way as patients with cancer receive the treatment they need. This plan needs to be published and we need to know how it will be done. I hope that the Minister can assure us that such a plan will be forthcoming. As has been said, it is essential to do this if the Government are to achieve their target of reducing the numbers on incapacity benefit by 1 million over 10 years. I do not want to go into the discussion we had earlier on the Pathways to Work pilots, but I worked rather carefully through the first set of data which led to the published report. I found that however you went at it, the finding of no significant effect on mentally ill people and a very big effect on physically ill people kept showing up. I know that other data are now being studied, but I would be surprised if they showed a fundamentally different result. That is why a plan of the kind I mentioned is so essential. One of the problems of mentioning proposals like this is that they appear to cost money. What is so fortunate in this case is that this one would not, because large savings would be made by reducing incapacity benefit payments and increasing tax receipts as a result of more people being able to work. The arithmetic is simple. I shall give noble Lords only one figure: a course of treatment costs roughly £750, which is exactly what it costs to keep someone on incapacity benefit for one month. So if, by treating someone, we could reduce on average the amount of incapacity benefit being paid out to one person per month, we would be doing something that paid for itself. The evidence shows that treating people will have at least that effect. If a person is in work it reduces the probability that they will lose their job and have to go on to IB. If they are out of work and receiving IB, it increases the probability that they will go into work and therefore come off it. That brings me to my final point. If we want to reduce the level of incapacity benefit, it is not just a question of how we treat those in receipt of it, it is also a matter of how to stop people coming on to it. Indeed that is probably even more important than moving people off the benefit, and somewhat easier to achieve. Given that, we must have adequate mental health services, not only to help people get off IB, but to help those in work but in danger of losing their jobs. If you look at the problem from that angle, it is obvious that this has to be handled as part of a general service being provided within the NHS, for both those on IB and the rest of the community. Is this going to happen? My view is that we are in quite an extraordinary situation. We would enjoy two benefits as a result of providing adequate mental health services. The first is the health benefit and the second is the saving to be made on IB. When you add those benefits together, I have not met anyone who does not think that the proposal to provide adequate services could meet any form of cost-benefit test and ought therefore to be implemented. In fact, almost everyone says that the general idea is a no-brainer. But I have to ask myself this question: is it actually going to happen? The answer is that it will happen only if the different government departments that would benefit in their different ways could agree on how the costs should be shared and from where the gross expenditure should come. That still appears to be a huge problem, even though we talk about joined-up government. Finding a joined-up solution seems to be incredibly difficult, and we do not yet know whether the Government will be able to rise to the challenge. I do not know, and I do not know whether anyone else knows either, but it is essential both for the people who suffer and for the taxpayer that a solution is found and treatments are provided as they should be, according to the NICE guidelines. I earnestly hope that the Minister can reassure us that a plan will be produced for providing what is needed. That is what I and the supporters of this proposal most want to hear.