Health-related Benefits Assessments

Question

Asked by

To ask His Majesty’s Government what assessment they have made of the value of mandating that (1) all, or (2) more, health-related benefits assessments be conducted in person.

My Lords, face-to-face assessments are an important part of our multichannel approach. For some individuals, they are the best way for us to understand the impacts of their health condition or disability, and they can help boost public confidence in the health assessment system. This Government are committed to increasing the number of face-to-face assessments while acknowledging that remote assessments also have a role.

I thank the Minister for her Answer. She will know that the number of young people on health-related benefits has risen by more than 50% over the last five years and that four out of five of them are claiming for mental health or neurodiversity conditions. Yet these assessments, I understand, are largely carried out over the phone, when surely people would need to be seen face to face to assess what is wrong with them. Why is the Government’s ambition, as set out in the Timms review, to raise the assessments to 30% so low? Why not make it 100%?

My Lords, I agree with the noble Baroness about the challenge that we face with the number of young people not in employment, education or training. That is why the Government commissioned the Milburn review, and why we welcome that report, and that is why we have action clearly going on in this space. The Government are committed to increasing the number of assessments. There is a range of reasons why it is taking time. The noble Baroness may not be aware that, for example, before Covid, assessments were pretty much all done face to face. They collapsed in Covid and the numbers have barely come back up since. In 2023, about a year before the general election, the previous Government signed long-term contracts, making sure that most assessors could work from home. I understand why that would be attractive—because they can be anywhere in the country—and so it is a bit of a challenge trying to get face-to-face assessments in the right parts of the country. We are working with contractors and driving up face-to-face assessments. We will do the right thing and we are attacking this problem.

My Lords, can the department cope with more face-to-face assessments? How long will it take to put that into effect? Has the department come up with any other suggestions of how assessments can be made, particularly for people suffering from health issues which may make face-to-face assessments quite difficult?

The noble Lord raises an important point and I am grateful to him. There have traditionally been different ways of doing assessments: some are face to face, some are on the telephone and some are video assessments. The starting point is that the health professional must look at and assess all the written evidence—from the GP and the hospital, and evidence provided by the claimant—and then make a decision. There are some cases where, clearly, face to face is right, for reasons of identity verification, wanting to get details they cannot easily get online, where there is a physical examination and so on. There are other cases where people may have a particular reasonable adjustment that they need—it may be difficult for them to get to a centre—and for them a face-to-face assessment is not appropriate. We want to maintain all those things but drive up the proportion of face-to-face assessments to get the right results for individuals and for the taxpayer.

My Lords, I want to be clear that this is a policy that was introduced by the last Government, who had no policies whatever to address the problem. It has been left to this Government to come forward with policies that will address the problem. Is that correct?

That is so often correct, I have to say to my noble friend. In this case, we are in a situation where we are doing all we can to drive up face-to-face assessments. The most important question is that we get everyone into work who possibly can work. The biggest crisis of our time is in relation to young people. That is where the Secretary of State has put his focus; he has prioritised addressing the million young people we have not in employment, education or training. That is why we are investing in the youth guarantee, in support for employers, in subsidies for wages and in making sure we go out there to find the challenges and get people into work. This Government are doing something about that problem.

How many long-term claimants with severe long-term disabilities, who will never have a life devoid of dependence on disability benefits, has it been agreed will not be recalled to assessment—assessments which proved to be futile and quite damaging to their whole persona as they feel they are not being believed? These are often people who have got severe brain damage or ongoing congenital abnormalities and genetic difficulties.

I am grateful to the noble Baroness for raising such an important point and for her work and expertise in this area. Our job is to make sure that we assess the right people at the right time. There is always a danger when debating this that we forget the significant number of people who are absolutely dependent on sickness and disability benefits; frankly, most of them would give anything to not be dependent on those benefits and to not have had the condition, injury or accident that transformed their lives for ever.

Our job is to make sure that those who need our support get it. We have been looking at the way we review things, so that we are reviewing the right people to make sure they get the right level of award. If it gives the noble Baroness some reassurance, there will be cases where the health assessor can clearly make a judgment based on the medical evidence alone. In those cases, they will not necessarily need to see somebody face to face or call them to an assessment. Where there is any doubt, however, we need to make sure that people get the right support if they are entitled to it and give confidence to the public that we are doing those assessments in the right way.

My Lords, I was interested by the answer the Minister gave to my noble friend in relation to the signed contracts for work being undertaken virtually. Could she clarify whether there is an expiration date, or a time limit in some form or another, for these contracts in order that you can bring people back to a face-to-face arrangement quickly?

These were long-term contracts and were signed only in late 2023 and took effect shortly after, but we are not simply taking that as meaning that we cannot do anything. We are in close negotiations with all the contractors to look at how we can drive up the proportion of face-to-face assessments. It will take time because, having started with so many being home-based, we have to make sure we can get the numbers back up in time. There are limited numbers and assessors have to be either a registered doctor, a nurse, an occupational therapist or a physiotherapist; they have to be trained in disability assessment medicine; and they have to engage in continuous professional development. We need to make sure they are properly qualified to make those assessments, but we are working to get the numbers up as fast as we can.

My Lords, I thank the Minister for reassuring us that face-to-face appointments will be increased with trained professionals. I welcome the DWP initiative to reform the fit note system. There are millions of women who are absent from work due to women’s health problems and nearly 60,000 women are leaving work every year due to menopausal symptoms. What conversations has my noble friend the Minister had to ensure workplace adjustments will be made to get these women back to work or into new employment?

My noble friend raises a very important point—and one that I suspect at least maybe half of the House could empathise with in some way. I reassure my noble friend that the Government take menopause support seriously. We have been doing work specifically on this, having appointed a menopause champion, and are looking at women who are experiencing severe menopausal and perimenopausal symptoms and how that impacts their work.

This ties in with our reform of fit notes—we are piloting new ways to make the fit note system work better—and, crucially, the work we are doing with employers. We know that employers want to support their staff to keep them in work. We do not want women falling out of work unnecessarily when they hit the menopause for either lack of preparation or support on their part or from their doctors, or because employers do not understand and cannot make appropriate adjustments. I am really grateful to my noble friend for raising this.

My Lords, between July 2024 and July 2025, 1.1 million assessments were carried out remotely. Three-quarters of those were conducted by telephone and just 3% were conducted by video link. Notwithstanding the answers the Minister has given us already, how can a DWP assessor properly judge whether someone has significant difficulty with daily living or mobility as a result of their condition when the assessment is conducted by telephone and the assessor can hear but cannot see the person concerned?

I will not dwell on the point that the challenge we are facing is the challenge the previous Government faced, and we did not invent telephone assessments.

The noble Baroness raises an important point. The truth is that it depends on the case. The job of the health professional is to begin by looking at all the written evidence. As I said previously, sometimes that will mean that a case can be absolutely ruled in, or indeed ruled out, but there may be circumstances in which more information is needed. Video assessments can be effective in that, so can face-to-face assessments, but it depends on the nature of the question. There are questions that can be addressed in a telephone assessment. The same core assessment process is used across the piece to gather evidence and ask the right questions, so the health professional can justify their decision. At any point, if they need a different kind of assessment, then it is their job to request it. We want to make sure we have more face-to-face appointments available, but we want to make sure we get people into the most appropriate assessment, so we can get through assessments as fast as possible, get people who need help the right help, and get people who should not be getting help into work.