My Lords, I speak to Amendment 52, the purpose of which is to remedy an extraordinary anomaly. We have nearly a million people on ESA due to depression or anxiety disorders, which are extremely treatable conditions. However, only about half these people are in any form of treatment. Most of them have never even had a diagnosis. None of this makes sense and the solution is obvious: we must help these claimants into treatment if we possibly can.
The key services here are those belonging to the national system of Improving Access to Psychological Therapies, otherwise known as IAPT. Last year, these services saw and assessed 900,000 people and roughly half of those treated recovered during treatment. The average cost of treatment was about £1,000, which
compares strikingly with the cost to the Exchequer of a person being on ESA for a year rather than working, which is £8,000. Obviously, we want as many as possible of these claimants to enter into treatment with IAPT, for both their sake and that of the taxpayer.
Amendment 52 proposes that as soon as claimants are awarded ESA by virtue of mental illness, they should immediately be referred by the jobcentre to the local IAPT service for assessment and treatment—unless they are so ill that they need to be referred to step 4 care, in which case they should be referred to secondary services. The proposal does not involve compulsion. It says that the claimant should be offered assessment and treatment. However, if this is organised in a friendly way which assumes that this is simply what happens next, most claimants would accept it—though they should be offered the opportunity to say no.
Let me review a number of possible problems that have arisen in the discussion of this proposal—the proposal is not new. First, why is the referral to a psychological service rather than to something else? The answer comes of course straight from the NICE guidelines. Those say that all people with depression and anxiety disorders, which are the most common forms of mental disorder, should be offered modern, evidence-based psychological therapy. Clearly, that is what we need to bring about. The secondary mental health services are too busy with people who are more severely ill to be able to provide that to the vast body of people suffering from depression and anxiety disorders. That is the reason why IAPT was created and why it should have a key role in helping mentally ill people to get better and back into work. People can self-refer into IAPT, so there is no problem in having the jobcentre facilitate that without delay.
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Secondly, can IAPT deliver that volume of treatment? The answer is that it has the duty to do so. The NHS has a duty to treat any other medical condition and it is the same for this one. IAPT has had generous funding in the spending round, so there need be no waiting times, since the NHS accepts that employment issues are a legitimate ground for clinical priority. That is another important point. In my personal experience of trying to organise pilots for the kind of arrangement proposed in the amendment, it has always been the jobcentres, not the NHS, which have declined to co-operate. That is why I am proposing this legislation.
However, it has been argued in some quarters that for patients with employment issues, it would be better to develop a separate system of mental health care, with special emphasis on employment. That would be a very costly way to deal with this problem, because we already have a system in IAPT that has good quality-control mechanisms and outcome measurement, which would be much more difficult to re-establish elsewhere—so why not build on what we have? IAPT is constantly improving itself including, with government encouragement, increasing the use of digital methods. With adequate funding it could provide the required employment support.
I urge the Committee to adopt the very simple proposal embodied in Amendment 52. As I understand it, this Bill is primarily about saving money on welfare.
If we think about it, there are other ways to do that than just cuts, and this would be a very effective way of saving money on welfare. I know that the Minister cares deeply about these issues and I hope he will support the principle of this proposal. I am sure there are details that can be improved, but I do hope it will be possible to work with him to develop this into a government amendment. I know that the Minister and his department are envisaging a White Paper on these issues next year, but next year is next year. This proposal has been around for about four years now. In the mean time, millions of claimants have suffered unnecessarily and have cost taxpayers billions in the process. I believe that this proposal has pretty much universal support and I urge the Minister to implement it forthwith.