Welfare Reform Bill

Although I seek to encourage the Committee to reject the proposition that Clause 12 should not stand part of the Bill, I recognise that the thrust of the debate has been about what we share with regard to the outcomes that we want from this reform. That is a good starting point. This country has led the way in designing and implementing a world-leading approach to helping people with a health condition or disability to get back into work. As recently as five years ago, these customers were written off as incapable. Today, Pathways has clearly shown the value of our ““something for something”” offer. Combining the right system of help and support with the expectation that customers will engage with the system has delivered tangible rewards not just for the economy as a whole, but more significantly for the health and well-being of the customers themselves. It is only right that we go further to help people to meet their ambition of moving into work, and so Clause 12 provides for regulations requiring employment and support allowance customers to participate in some form of work-related activity. I understand the sensitivities around the work-related activity requirement. At previous stages of the Bill we have made it clear that we will proceed and develop our proposals in the light of evidence and experience from the rollout of Pathways to Work. The provision of work-related support available to customers will be built on the basis of services currently provided in Pathways. We will introduce this extra level of conditionality to most customers who are not in the support group as resources allow and in line with emerging evidence. I am particularly mindful of concern expressed about the impact of work-related activity on customers with a mental health condition. I should like briefly to outline the requirements we envisage under this clause and the safeguards that we anticipate. I hope that that will go some way to allay those concerns. Subsection (7) makes it clear that work-related activity can include anything that will help customers to obtain or retain work. The requirement that we will place on customers will be to engage in activity that meets that definition. This matter formed the debate that we had just now. The requirement will not and cannot be to ask a customer to undertake any specific activity. We shall be very clear about that. Instead, it will be a collaborative approach with the customer choosing the right support for him, and it will be tailored to help him to overcome his barriers following discussions with, and advice from, his personal adviser. One activity that would fulfil the requirement is a condition management programme. This aims to help customers to manage their own condition and firmly refocuses them on their potential to work. In many cases, it may include voluntary psychological interventions, such as CBT where appropriate, and where the claimant consents. It is worth remembering, however, that these programmes are not designed to be a replacement for NHS treatment, and noble Lords will no doubt be aware of the current Treasury review in this area. Regulations will set out the amount of work-related activity that we require claimants to undertake in a fixed period. For example, such a requirement could be to engage in a minimum of one step of work-related activity every four weeks. I can commit that the safeguards provided for in regulations and in guidance will build on those that we have set out in draft for requirements under Clause 11. These safeguards are part of the safety net designed to ensure that every customer, including those with mental health conditions, are dealt with sensitively and professionally in all cases. Regulations will list some of the factors that may be taken into account in determining whether a person has shown good cause to ensure people are not penalised where they have failed to participate through no fault of their own. A system of waivers and deferrals, under regulations provided for in subsection (6), is also important in protecting more vulnerable customers. We will consider these further as we look to introduce the requirements under Clause 12 to ensure that they can operate effectively and protect people properly where a requirement can be spread over a number of weeks. The key challenge will be to ensure that those people with fluctuating conditions of different durations can be dealt with fairly and consistently. Reconsideration of an action plan is another of the safeguards which has been designed into the system and is the focus of Amendment No. 74. The action plan is not binding or liable to sanction. It is best considered as a route map which will identify clearly the steps that a customer can take to fulfil the requirement to undertake work-related activity. Reconsideration would provide for a situation where a customer believed that the steps originally set out in the action plan were or had become inappropriate. We would not wish to include or preclude any particular circumstance concerning reconsideration at this point. However, we intend that the regulations will provide that if the customer thought that the activities included in the action plan were unreasonable they could ask for reconsideration. This is likely to include circumstances where the activity was inaccessible or resulted in a detrimental effect on their health. The maximum sanction relating to work-related activity will be set out in regulations under subsection (4) and will continue to be capped at the level of the work-related activity component. This is the same as under the Clause 11 draft regulations and reflects our intention that sanctions should be an incentive to engage, not a punishment. I can commit that those in the support group will be able to volunteer to take part in appropriate work-related activity, but as subsections (1) and (5) make clear, they will never be required to engage or be sanctioned for not doing so. I also wish to make it clear that we do not accept that everyone with a mental health condition should be placed in the support group automatically. The intention of the ESA is to treat each customer individually. Sympathetic engagement with every customer for whom it is appropriate—I accept that there is a resource issue attached to that—will help far more than simply writing people off as incapable. Perhaps I may comment at this stage on the debate around mental health, CBT and the support from government in general. Research clearly shows that mental ill health is one of the biggest barriers to gaining, remaining in or returning to, work for adults in the UK. Evidence shows that one in six adults in the UK suffers from some common mental disorder such as depression, anxiety, phobias and panic disorders, whereas more severe mental disorders such as schizophrenia and manic depression affect only about one in 200 adults. We know that that is reflected in the number of claimants who are currently on IB. I turn to the Government’s approach to mental health. Since the first National Service Framework for Mental Health was produced in 1999, it has been the target of a number of initiatives. More money has been made available; more patients have been helped; there are more staff—I think that we now have 15 per cent more consultant psychiatrists, 75 per cent more clinical psychologists and at least 20 per cent more mental health nurses than in 1997—and more services. However, there is clearly more to do. Improving Access to Psychological Therapies is a key Department of Health programme which is supported by the DWP and carries forward a manifesto commitment that the Government put forward in the 2005 general election. As has been explained, the programme is intended to test the effectiveness of providing increases in evidence-based psychological therapy services to people with common mental health problems such as anxiety and depression—we know of the two pilots that are taking place in Newham and Doncaster. I am advised that there is currently no firm evidence of the impact of the Newham and Doncaster sites because they are in their early stages. I think there has been an interim report from the Newham pilot, although that covers just a small number of participants, but the report states that participants are satisfied with the service, and clinical outcomes appear to be positive. My noble friend Lord Layard talked with authority about the work he has been doing and the proposition of the benefit, and indeed the cost benefit, of cognitive behaviour therapies. The pilots that are taking place seek in part to test the hypothesis that has been advanced, so there is more work to do before definitive judgments can be made on that. However, a number of randomised control trials have found that CBT has positive effects on mental health and that it gets people better quicker and for longer than drugs. CBT is also cheaper in the long run than medication. We should acknowledge that there are some critics of CBT who argue that it is not a panacea and that other forms of therapy may be effective. There is some argument that the trials to date have been with patients who are duly presenting with mental health conditions and who do not have other problems. There is perhaps more work to do before more definitive conclusions can be drawn, but the direction of travel seems clear. We have touched on the issue of the Treasury review of mental health and employment. We expect announcements in, or even prior to, this year’s Budget. If our reforms are going to work, it is important that there is appropriate support for people with mental health conditions. One can see the emerging evidence about CBT and the role that it can play, but obviously there are issues surrounding that and the question of how the Government act collectively to address this issue. But I am grateful for the input, specifically on CBT and the impact that it is having. I believe the approach that I set out previously, building on a successful Pathways to Work model, is the right one. It would allow us to maximise the effectiveness of mandatory work-related activity as we envisage it under this clause. Accordingly, I hope that the noble Baroness will feel able to withdraw her objection to the clause.