PARLIAMENTARY DEBATE
Health and Disability Reform - 29 April 2024 (Commons/Commons Chamber)

Order. The sitting is now resumed. The reason for the suspension was because the statement, which under the ministerial code should have been delivered at a minimum of 45 minutes prior to the statement being made, was delivered late; I know the Secretary of State will want to look into the matter and report back to the Speaker.

First, may I apologise profusely to the House that a copy of my statement was not provided to Mr Speaker and indeed those on the Opposition Front Benches sufficiently in advance of my statement? May I also take this as my first opportunity in the House to say how saddened I was by the passing of Frank Field, a true champion of welfare reform who was always prepared to work across party? While we did not always agree on all matters, I share and admire his belief that welfare means transforming lives.

With permission, Mr Deputy Speaker, I shall make a statement on the consultation we are launching today on the changes to the personal independence payment, which aim to create a benefits system that can best support disabled people and people with long-term health conditions to live full and independent lives.

This Government’s priority is to make sure that our welfare system is fair and compassionate: fair on the taxpayer by ensuring that people of working age who can work do work; and fair on those in most need of the state’s help. Welfare at its best is about more than just benefit payments; it is about changing lives for the better.

In recent years the Government have delivered successive reforms to create a system that is fairer and more compassionate while providing value for the taxpayer. We have reformed an outdated and complex legacy benefits system and introduced universal credit—a new, modern benefit that ensures people are better off in work than on benefits. Last year we published a landmark White Paper announcing significant reforms to focus the welfare system on what people can do rather than what they cannot. We are delivering our £2.5 billion back to work plan, substantially expanding the employment support to help more disabled people and people with health conditions to start, stay and succeed in work. Our reforms to the work capability assessment will better reflect the opportunities in the modern world of work and ensure that more people get the support they need to move into employment, while protecting those unable to work, and in February we published the disability action plan to make this country the most accessible place in the world for people to live, work and thrive.

In addition, the Government have provided unprecedented help for the most vulnerable, including by implementing one of the largest cost of living support packages in Europe, which prevented 1.3 million people from falling into absolute poverty during a time of global inflationary pressures. We have increased benefits by 6.7% and raised the local housing allowance, benefiting 1.6 million households by an average of around £800 this year.

Our approach to transforming the benefits system for disabled people and people with long-term health conditions is guided by three important priorities: providing the right support to the people who need it most; targeting our resources most effectively; and supporting disabled people to reach their full potential and to live independently.

Although we have made significant progress, the disability benefit system for adults of working age is not consistently providing support in the way that was intended. It has been more than a decade since the introduction of the personal independence payment. The intention was that it would be a more sustainable, more dynamic benefit that would provide better targeted support to help disabled people with the extra costs arising from their disability. However, the nature and understanding of disability and ill health in Britain has changed profoundly since then, and the clinical case mix has evolved in line with those broader changes, including many more people applying for disability benefits with mental health and neurodivergent conditions.

Since 2015, the proportion of the caseload receiving the highest rate of PIP has increased from 25% to 36%. Some 7% of working-age people in England and Wales are now claiming PIP or disability living allowance, which is forecast to rise to 10% by 2028-29. In 2022-23, the Government spent £15.7 billion on extra costs disability benefits for people of working age in England and Wales, and the Office for Budget Responsibility has forecast that the cost will rise to £29.8 billion in nominal terms by 2028-29. There are now more than 33,000 new awards for PIP per month. That figure has almost doubled since the pandemic.

With almost a quarter of the adult population now reporting a disability—up from 16% in 2013—I believe that now is the time for a new conversation about how the benefits system can best support people to live full and independent lives. Today I am launching a consultation to explore changes that could be made to the current PIP system to ensure that support is focused where it is most needed. These options include: making changes to eligibility criteria for PIP; redesigning the PIP assessment to better target it towards the individual needs of disabled people and people with health conditions, including exploring whether people with specific health conditions or disabilities can be taken out of PIP assessments all together; and reforming the PIP assessment so that it is more linked to a person’s condition. We are also consulting on whether we should make fundamental changes to how we provide support to disabled people and people with a health condition.

We know that any additional costs arising from a disability or health condition, which PIP is intended to help with, can vary significantly and are unique to the individual’s circumstances. Some people on PIP may have relatively small one-off costs, such as walking aids or aids to help with eating and drinking, or ongoing additional costs related to their disability or health condition, such as help around the home or running a ventilator. Some claimants’ costs will be fully covered by their award, while others may find the current system does not provide enough support to meet their needs, yet the current system operates a one-size-fits-all model and does not channel people towards bespoke support tailored to an individual’s needs. We recognise that better, more targeted support could be provided by other local services.

Our plans include exploring how the welfare system could be improved with new approaches to providing support, such as: moving away from a fixed cash benefit system, so that people can receive more tailored support in line with their needs; exploring how to better align the support PIP offers with existing services and offers of support available to disabled people and people with health conditions; and exploring alternative ways of supporting people to live independent and fulfilling lives, which could mean financial support being better targeted at people who have specific extra costs, but could also involve improved support of other kinds, such as respite care or physical or mental health treatment, aiming to achieve better outcomes for individuals.

Crucially, we want to explore whether we can achieve our aims within the current structure of health and disability benefits, or whether wider change is needed. We are consulting over the next 12 weeks to seek views from across society, including disabled people and representative organisations, to ensure that everyone has a chance to shape welfare reforms that will modernise the support provided through the benefits system.

We know that these reforms are significant in their scale and ambition, but we will not shy away from the challenges facing our welfare system today. We owe that to the millions of people who rely on it and to the hard-working people whose taxes underpin it. That is what the next generation of welfare reforms is all about. These proposals will help to create a benefits system that can better support disabled people and people with long-term health conditions to live full and independent lives, and they are a crucial part of my mission to ensure that the welfare system is fair and compassionate and that it provides the right help to those who need it most. I commend this statement to the House.

I thank the Secretary of State for his comments about Frank Field. Both I and my hon. Friend the Member for Wallasey (Dame Angela Eagle), who is sitting alongside me on the Front Bench, thought the world of Frank. I thank the Secretary of State for his tribute to a person who was completely unique in every way.

With regards to advance sight of the Secretary of State’s statement, I say: apology accepted. Labour will carefully review the detail of the Green Paper, because the country that we want is one where disabled people have the same right to a good job and help to get it as anyone else. We will judge any measure that the Government bring forward on its merits and against that principle, because the costs of failure in this area are unsustainable. The autonomy and routine of work is good for us all, for our mental and physical health—and more than that, for women, work is freedom, too.

I have read the Secretary of State’s gibes about Labour. He says that he does not know what our position is on a set of reforms that he has not set out. The Prime Minister made a speech about this issue two weeks ago, but every single day since then the Government have failed to publish the Green Paper. The Secretary of State wants my views on his, until this moment, unpublished thoughts. What was the problem? Was the printer jammed? Rather, was it that the Prime Minister and Secretary of State realised that, as soon as they published the Green Paper, everyone would realise the truth about the Government: like the Prime Minister who leads them, they are long on questions and short when it comes to the answers?

The Green Paper is not a plan; it is an exam that the Secretary of State is hoping he will never have to sit. The reason he wants to know Labour’s plan is that he suspects he will be long gone before any of these proposals are a reality. Will the Secretary of State tell me where the Green Paper leaves the Government’s earlier half-baked plan to scrap the work capability assessment, given that the idea behind that was to use the PIP assessment? He said that some health conditions can be taken out of PIP assessments. Which conditions was he talking about?

PIP was the creation of a Conservative Government, so where is the analysis of what has gone wrong? PIP replaced DLA, and now we are hearing that PIP is the problem. How many more times will we go around this same roundabout? Do the Government’s plans involve treating people’s mental and physical health differently? Can he explain the legal basis for doing so? Importantly, on health itself, is this Green Paper not a huge admission of the Tory failure on the NHS, in that it takes as its starting point the fact that people today simply cannot get the treatment and care they need? What will the costs of any new system be, in particular those of any extra support of the kind he mentioned? Will we see a White Paper before a general election?

I am standing in today and for the next few weeks for my hon. Friend the Member for Leicester West (Liz Kendall), who believes that health and work are two sides of the same coin. That is the insight that the Government are missing today. I ask myself how we got here. The country today is sicker—that is the legacy of this Government. NHS waiting lists are longer than they have ever been—that is the legacy of the Secretary of State’s party. If he does not know how bad things are in mental healthcare, he needs only to ask my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). There are 2.8 million people who are locked out of work due to long-term sickness. That is the Conservative legacy: like ice on our potholed roads, the Tories have widened the cracks in our economy and society, making them all much worse.

With respect to mental health, in recent weeks the Secretary of State has decided to speak out of both sides of his mouth. On the one hand, he says,

“I’m grateful for today’s much more open approach to mental health”,

but with the same breath he goes on to say,

“there is danger that this has gone too far.”

He wants it both ways. He thinks that openness about mental health is good, but then he says the very thing that brings back the stigma.

Every time the Secretary of State speaks, he makes it less likely that people will be open about their mental health. On behalf of all of us who have ever had a panic attack at work, or worse, can I say that that stigma stops people from getting treatment, it makes getting help harder, and it keeps people out of work, not in it? A Labour Government will take a totally different approach. We will not only ensure more appointments but have an extra 8,500 mental health staff. The last Labour Government delivered the highest patient satisfaction on record, and that is the record on which we will build.

The issue that we are discussing is bigger than just health; it is also about work. Because of our commitment to serve working people, we will make work better, too. We will have the new deal for working people, improving rights for the first time in a generation, and we will drive up employment in every region because we will devolve employment support and end the tick-box culture in jobcentres. We will tear down the barriers to work for disabled people and provide help for young people. That will get Britain working again.

Harold Wilson said that unemployment, above all else, made him political. Those of us who grew up seeing people thrown on the scrapheap in the ’80s and ’90s feel the same. Every young person out of work today will never forget whose hand was on the tiller when these Tories robbed them of hope. It is time for a change, and a general election.

I thank the hon. Lady for her response and the gracious manner in which she accepted my apology, which is much appreciated.

The hon. Lady said that she cannot be expected to comment on the PIP proposals, but I remind her that the work capability assessment proposals went through a consultation, and we still do not know where the Labour party stands on those. We have spoken about fit note reforms, we are setting up WorkWell, and in the autumn we will trial some of those fit note possibilities. We do not know where the Labour party stands at all on those matters.

One would have thought that given the central role that PIP plays in the welfare system in our society and country, the Labour party would have some kind of view on that benefit. But we hear precisely nothing on that matter because the Labour party has no plan. The consequence of that will be that, as under previous Labour Governments, the welfare bill will continue to spiral out of control. That will fall to hard-working families up and down the country to pay, by way of higher taxation.

The hon. Lady asked about the abolition of the work capability assessment, which, as she said, is set out in the White Paper. Those measures will not be due to come into effect until 2026. We will take into account the conclusions that may be drawn as a result of this consultation when we consider that matter. She raised numerous other questions, many of which are included in the consultation. I am sure that she will actively take part in the consultation as we work towards the answers to those questions.

I was rather surprised that the hon. Lady raised the NHS. This party is spending more on the national health service than at any time in its history, with a 13% real-terms increase in spending over the last couple of years, 21,000 additional nurses and 7,000 more doctors in the last 12 months alone, and from next year £2.4 billion additional spend on mental health services, to which she referred. That is on top of the additional £4.7 billion that the Chancellor previously set aside for more mental health treatments and, at the last fiscal event, 400,000 additional talking therapies within the national health service.

The hon. Lady concluded by referring to Harold Wilson’s comments on unemployment. I simply refer her to the fact that under every single Labour Government in the history of this country, unemployment has been higher at the end of their term of office than at the beginning.

A constituent who has cerebral palsy has been in touch with me this afternoon to outline how he currently uses PIP. It gives him the freedom to live independently and work full time, as he uses it to buy mobility aides such as hoists and wheelchairs. His concern is that any changes to PIP might push those costs on to the NHS and reduce his flexibility to choose what to spend the money on and when. He does not want to be pushed into a cycle of renewal that may be too rapid and therefore cost the NHS more money. What reassurance can my right hon. Friend give that this consultation will enable those sorts of concerns to be highlighted and that, in the long term, it will give more choice and not restrict my constituent’s freedom?

I thank my right hon. Friend very much indeed for that question and for raising the issue of her constituent. The reassurance I can give her is that we are aiming for the best outcomes. There will be a number of ways in which those best outcomes may be achieved—that is the purpose of the consultation—but it is reasonable to at least explore the issue of whether cash transfer payments are always the right solution, particularly given the growth in mental health conditions we have seen in recent times. The final point I would make is that we are absolutely interested in examples of situations where people have lifelong regressive illnesses from which, unfortunately, they are not going to recover, and to ask whether, under those circumstances, it is right to require them to go through re-assessments.

Following today’s statement, the announcement made a couple of weeks ago and all the proposed changes, people are scared. They are scared because they rely on these payments, which have changed their lives. They have been able to access support that they otherwise would not have been able to get. It is very clear that the announced changes are not being created by disabled people, with disabled people at their heart of the decision-making process. This is a Government consultation and then people are being asked to input into it. It is totally different from the situation in Scotland, where the adult disability payment was created with disabled people in the room talking about the best way to make the payments work and the best way to have assessment processes. Basically, the answer that came back was, “Do not do them anything like the assessment processes for PIP.”

Everybody should have the income to live with dignity, whether or not they are able to work. I am massively concerned by the comments that the Secretary of State and the Prime Minister allegedly made about people with mental health difficulties only facing the “ordinary difficulties of life”. It is very clear that anybody who is able to say that has not suffered from depression, and has not felt that absolute energy-sapping that comes alongside suffering depression or anxiety. These are real conditions. These are real things that people are struggling with. And the lack of the ability to work is just as serious for people with mental health conditions as it can be for people with physical health conditions.

I have a couple of specific questions. In relation to universal credit, it is a gateway benefit. Will the Secretary of State assure us that any changes that might be made to eligibility criteria around universal credit will be fully consulted on and fully discussed, particularly with anybody who administers benefits that are allowed through those gateway benefits?

Has the Secretary of State spoken to the Scottish Government about the creation of the adult disability payment with disabled people in the room, ensuring that at the forefront of every decision is dignity and respect? Those are the two key columns of the Scottish benefits system. The Secretary of State could learn a lot from that approach.

I thank the hon. Lady for her response to my statement. I reassure her that disabled people will be very much involved in the process and the consultation. It will be a 12-week consultation and of course we will take them, their comments and representative organisations extremely seriously.

The hon. Lady’s comment about the importance of recognising that many, many people unfortunately suffer from very serious mental health challenges is extremely well made. I am absolutely determined that whatever conclusions we draw from the consultation, they should lead us to a position where the Government are better able to support people who are in those circumstances.

On whether there will be questions in the consultation on the passporting of PIP into other benefits, the answer is yes. That is something we are most certainly consulting on.

On the Scottish equivalent of PIP—this is, of course, a devolved matter—yes, the Department has been in discussions with the equivalent officials in the civil service and the Scottish Government. We are looking forward to considering, as I know the Scottish Government will be, the independent review of that benefit, which is being conducted at the present time.

May I ask the Secretary of State about his comments on the one-size-fits-all model not working if people incur very different costs from their disabilities? Surely he is not expecting people to send in invoices to prove how much support they need, so is he looking at having more tiers of award? For example, disability living allowance used to have three tiers, rather than two. Is that one of his options for trying to reduce costs?

By mentioning “one size fits all”, I am saying that we should explore whether the approach we have at the moment has the best outcomes. We have much to learn from the experience of countries around the world that have a similar benefit but go about its organisation and application in a different way. New Zealand makes payments based on invoices for equipment submitted by those who receive the benefit. Norway does not have assessments in the way that we do; it relies more on evidence provided by medical practitioners. We should go into this with an open mind. Bear in mind that there has been no fundamental review of PIP for over a decade.

I call the Chair of the Select Committee.

PIP assessment providers confirm that worsening delays in NHS treatment are a big factor in the increase in the number of people applying for PIP. The Secretary of State has confirmed this afternoon that the work capability assessment is to be scrapped and replaced by PIP assessments. There are people who are too ill to work, but not disabled, and so not eligible for PIP. How will their support be assessed in the absence of work capability assessments?

As I have set out, we will need to look at the conclusions that can be drawn from the consultation in the context of the replacement of the work capability assessment and PIP becoming the gateway to future universal credit health benefits, as the right hon. Gentleman mentioned. These are questions that are being asked in the consultation.

In the spring of 2019, before I was elected, I was diagnosed with an anxiety disorder. I was extremely ill with it, and could not work for several months, so I know for myself how debilitating that can be, but I also know that with treatment and support, you can lead a fulfilling career and a normal life that is extremely rewarding. I would have been devastated to have been out of the workforce for the long term. How will the reforms in the Green Paper help anxiety sufferers to get the treatment and support that they need to return to work, and also to take back their life?

I thank my hon. Friend for a powerful and moving contribution to today’s statement. I am pleased that she is in such fine form nowadays, knowing her as well as I do. The answer to her question lies in the consultation, and the recognition that the one-size-fits-all approach is not necessarily right. Those whom she describes may well be better served by receiving treatment, rather than cash transfer benefits. That is not a preconceived outcome that I have in my mind, but it is one of the possibilities on which we are seeking opinions.

The charity Sense has criticised the Government’s narrative around disability benefits, highlighting the divisive and deeply damaging language used, which further stigmatises some of the most vulnerable people in society. Disabled people have told Sense that they are sick with worry about whether they will lose their personal independence payments, which are vital—a lifeline—for them. Given the Tory cost of living crisis that we have been living through for multiple years, does the Secretary of State not think that disabled people need more support, not dangerous rhetoric that casts them as undeserving?

We are certainly not stigmatising anybody—far from it. Indeed, in the consultation, it is explicitly recognised that there might be some disabled people who need additional help, beyond the help that they are getting at the moment. I made reference earlier to those who have lifetime progressive illnesses and conditions that, sadly, are not going to improve. The question is being asked: do we need to ask those individuals to attend reassessments and jump through bureaucratic hoops, with all the anxiety that may go with that, or should we have a better system that better looks after them?

I totally agree with the Secretary of State that everyone gets dignity from being in work, but he will be aware of the very high levels of unemployment experienced by those with learning disabilities and autism. Bearing in mind that able-bodied people over 50 struggle to find work, let alone those with a disability or long-term health condition, what does he propose doing to change the attitude of employers, so that they recognise that everyone has a skill and a role to play, and that everyone is an asset?

I thank my hon. Friend for that really pertinent question. She will be familiar with the Buckland review, which has reported. I was very keen to pursue that review when it came across my desk, and I made my officials and the necessary infrastructure available to ensure that it was able to go ahead. It addresses many of the issues to which my hon. Friend rightly points, in terms of employers accommodating and benefiting from those who have autism and other conditions.

Can I start by commending the hon. Member for Rushcliffe (Ruth Edwards) on her comments? They really went to the heart of some of what we are discussing. One of the challenges for the Government in talking about PIP is that they started this whole conversation by referring to the back to work plan, which makes many disabled people feel that this is about getting them back to work and reducing the overall welfare budget, when PIP is supposed to be about ensuring that they get the right support for their disabilities. On PIP, a big challenge that all MPs deal with is the number of errors in the system, and particularly the number of cases that end up at a tribunal. If we are looking into having a system that targets support better, what assurances can the Secretary of State give that it will actually be a better system, with fewer errors?

There were two points there. First, errors in the benefits system—overpayments, underpayments and so on—are relatively rare. Secondly, on how we approach those who have long-term sickness or disability, the hon. Lady will see, if she refers to the back to work plan, that we are giving the 2.8 million people on those long-term benefits the opportunity to try work without fear of losing those benefits at all. We have made that extremely explicit. That is simply freeing up the system, and trying to get rid of some of the barriers that those people otherwise face.

I need to read the detail, but on the face of it, there is much to be welcomed in the Secretary of State’s statement. However, there are 2.6 million DLA and PIP working-age recipients and their families who will no doubt be concerned about the future of their support, so can my right hon. Friend assure the House that he will tread carefully and think really carefully about tone and the language that we use, and that we will listen to those with lived experience and the charities that support them?

I thank my hon. Friend; he has done a great deal in the important area that this statement and consultation are addressing. As he knows, my door is always open to him, at every step along the way, so that I can listen to his thoughts. I can assure him that questions of tone, language, and treading carefully are absolutely at the forefront of my mind.

There are 4,500 people in Newcastle Central who are out of the workforce and economically inactive due to disability or ill health. The Government have failed them when it comes to the benefits system, failed them when it comes to supporting them to work, which is so important, and failed them when it comes to the NHS. How will the £46 billion black hole in the Government’s plan to abolish national insurance payments enable the Government to fix their failings?

On the hon. Lady’s political points, I should point out that economic inactivity is lower today than in every single year of the last Labour Government—that is our record, compared with her party’s. She will know full well that reducing the £46 billion national insurance figure still further, and finally eliminating it, is a very long-term aspiration. I understand why the Labour party tried to make it more than that. What is more than that is the £28 billion that her party suggests will be made available through its energy and net zero offering, which it is still talking about to the electorate.

I commend the Secretary of State’s approach as being entirely realistic, given that the disability benefits system is not consistently providing support in the way that it was meant to. He is also right to take a strategic look, because he is correct that the understanding of disability and ill health has changed quite significantly in Britain, in some ways for the better, and there is an imperative to consider that, in the light of our labour market and the broader economy.

The Secretary of State is also correct to be comprehensive in his approach in today’s Green Paper, the prior White Paper and other connected work. Will he also be comprehensive in delivering on those measures, across Government? Can he give us assurances about the way that he is setting up for the work that will need to be done if this is to be a success, including with the NHS and local authorities, for those who need support with their disability or ill health? It is my understanding that the NHS perhaps knows less than it could about how to help people, holistically and individually, to move back into work, or with the things that they need and care about.

Finally, how is the Secretary of State working with employers to ensure that we unlock the workforce productivity needed in this country?

I thank my right hon. Friend for her very astute comments, which are built on her great experience of the exact issues that we are discussing, both as Secretary of State and, before that, as a very successful Minister for this area in the Department for Work and Pensions. She is absolutely right to recognise that society has changed a great deal in the 10 years since this benefit was fundamentally reviewed. I will, of course, continue to work very closely with my colleagues in the national health service and the Department of Health and Social Care. We collaborated on setting up WorkWell, which will be rolled out in 15 of the 42 health areas of England this autumn, bringing together the world of work and healthcare.

The White Paper specifically invites thoughts on how local authorities could be more involved in PIP or any successor. My right hon. Friend is absolutely right to mention employers, and I have no doubt that she is aware of the two consultations we have run on increasing occupational health, in which employers have a particularly important role to play.

The Secretary of State questions the need to reassess certain groups. After visiting my local Motor Neurone Disease Association support group, I can tell him that those with motor neurone disease are one group who absolutely do not need or deserve reassessment.

On the wider point about mental health conditions, I hope that the Secretary of State will talk to his colleagues in the Department of Health and Social Care. I have had many experiences of constituents waiting months, if not years, for the assessment of neurodivergent conditions or mental health support. We clearly cannot address the issues that he wants to address in the consultation if we do not fix the NHS workforce crisis.

The hon. Gentleman raises a very important point about mental health, and I can reassure him, as I reassured my right hon. Friend the Member for Norwich North (Chloe Smith), that we will continue to work very closely with the DHSC on the proposals as they emerge. In response to an earlier question, I mentioned that the Chancellor has brought forward funding for 400,000 additional NHS talking therapies, for example, which may be an important part of what we develop.

Compassion has to be at the heart of this consultation. I have seen patients who had to be reassessed repeatedly, which does not seem fair, but I have also seen patients who do not engage with services and do not take medication, yet are signed off, which is not compassionate either. One practical way forward is to bring DWP closer to GP surgeries, so that people can have their hand held when they get to a diagnosis, whether it is of anxiety or a physical complaint, or whether they are recovering from an operation. Will the Minister consider that in the consultation? DWP joining up with primary care would be a fantastic way to help GPs help their patients—and to help the DWP.

I thank my hon. Friend for a sensible set of questions. He refers to the importance of bringing GPs together with advice and support to get people into work. That is very much the focus of our fit note reforms, upon which we have a call for evidence at the moment.

I am grateful to the Minister for his swift response to my request earlier this afternoon for support for the people at Everest in Treherbert, who look likely to lose their jobs in the next few days.

Depression and anxiety are real, are they not? It is not just a question of people pulling up their socks, as some in the crueller parts of the commentariat have suggested. All too often, talking therapies are least available in the areas with the highest levels of economic inactivity, so how are we going to change that?

On the intersection between mental health and physical health that is acquired brain injury, does the Department even know how many people who have had an acquired brain injury are in receipt of PIP or of universal credit? If the Minister does not know the answer today, will he write to me? If both he and his Department do not know the answer, as I bet is the case, will he make sure that the Department finds out before it implements something that could provide even more problems for people who are trying to get their lives back together?

First, I thank the hon. Gentleman for his comments about the jobs situation in his constituency. Let me reassure him that my Department will do whatever it can to assist with those circumstances.

The hon. Gentleman rightly points out that depression, anxiety and mental health conditions are very real, and in many cases extremely severe, which is why I am absolutely determined that we should do whatever we can, where appropriate, to provide as much support as possible to people. As for his question about acquired brain injury and how many PIP recipients are in that situation, I do not think he would expect me to know off the top of my head. It would be rather impressive if I did know. I will, as he has suggested, write to him.

You have never impressed me before, and I have known you a very long time!

That is probably fair. As the hon. Gentleman points out, he has known me for a very long time, and I recall that when we were at university together he was a young Conservative, as I was. How things have progressed, or perhaps I should say regressed, since then?

Does my right hon. Friend agree that my proposals over the past few years to improve support in the workplace for mental health are essential as part of this programme of work? Does he also agree that one aspect of that, which I have raised repeatedly in my work and suggestions, would be to make sure that physical and mental health are given firm parity in the Health and Safety Executive guidelines? I believe that would help both employers and employees, both in my constituency and nationally.

We are considering the issue of parity that my hon. Friend has raised. He is absolutely right to raise the issue of mental health support—occupational health support—within businesses, which is why we have consulted on that matter. I am particularly keen to see what we can do not just for large companies, but for small and medium-sized enterprises, to make sure that they engage more fully in that respect.

A considerable number of constituents have already contacted me because they are worried about what the Government are proposing; the key message they want to get across is that having disabilities or a serious mental illness is not their choice and not something they have control over. The Secretary of State mentions tailored support an awful lot in his statement. My experience is that when people with disabilities have engagement with the system and have to go through the process of making an application, being assessed and so on, that is a cause of great anxiety and often the decisions are wrong. If he is proposing more tailored support and more engagement with bureaucracy, particularly for people with fluctuating conditions such as myalgic encephalomyelitis, how is he going to get it right? He has not managed to get it right so far.

I am absolutely determined that we are not going to be seeing more bureaucracy. Indeed, I set out that one question we are exploring in the consultation relates to those who, sadly, have conditions from which they are not going to recover or improve. In those circumstances, I want to see less bureaucracy and a system where we are not having to reassess people in a superfluous way, causing anxiety and putting them to that inconvenience. The other points that the hon. Lady raises are of course exactly the kind of questions we are asking in the consultation, and I urge the constituents who have written to her to engage in that consultation process over the next three months.

My right hon. Friend is right to emphasise the importance of focusing on what people can do, rather than what they cannot, and it is worth noting that there are 2.2 million more disabled people in work than 10 years ago. However, as he mentioned, the benefits system is not just about work; it is about ensuring people live full and independent lives. He said that during the consultation there will be engagement with disabled people and their representative organisations, which is critical, but each individual’s needs are personal to them, so how will he ensure as many voices as possible are listened to during the consultation?

The consultation will be very thorough. It is available in accessible formats to ensure we cater to the greatest extent that we can, and that we get the best possible and most universal feedback. I am pleased that my hon. Friend spoke to the issue of the employment of disabled people. In 2017, we set a 10-year target of a million more disabled people in employment; we broke that target in five years rather than 10.

Announcing that disabled people suffering from certain conditions will no longer receive support payments, but instead get improved access to treatment, is one of the most absurd policies to have come out of this Government in the past 14 years. The Government plan relies on imagined brilliant mental healthcare support being available. Is the Minister even aware how long people have to wait for treatment after being referred? After 14 years of this Tory Government gutting our NHS and our mental healthcare, even basic access to treatment does not exist, let along the improved access the Minister is relying on in the fantasy world he lives in.

I simply do not recognise the comments the hon. Gentleman has made about our national health service. There are more people working in the national health service than at any time in its history: 21,000 more nurses and 7,000 more doctors in the past year alone. We are spending a record sum on the national health service. I will not give chapter and verse, as I did earlier, as to the other things we are doing, but we are completely committed to the health and mental health of people up and down the country. There will be new ways of doing things. If we do not have a grown-up conversation, as I describe it, about those matters, we will not discover those new ways. WorkWell is a completely new way of addressing issues, such as mental health, and encouraging people to stay or go back into work. It did not exist 18 months ago; it came about because we consulted people and came up with a solution.

I would like to give the Secretary of State the benefit of the doubt, and he has made a number of important points, but those 2.6 million people and their families who will have heard his statement will be absolutely terrified. A lot of them will feel that the reforms are just about providing some kind of cuts to services. I believe that we need to try to support those people and put compassion at the heart of our welfare system. There are reports of up to 2 million people waiting for mental health treatment at the moment, so does the Secretary of State believe that in this “compassionate” review, where we are going to have a “grown-up conversation”, we will be able to see more money invested to ensure that those 2 million people can get more mental health support?

My hon. Friend raises important points that are core to the consultation that is being carried out. The corollary to my hon. Friend’s argument is that we should not do anything and stay with a system that has not been revisited for over a decade, despite the fact that the terrain has changed substantially, not least in terms of the increase in those suffering from mental health conditions. I say no to that. We need to have a grown-up conversation about these matters if we are to provide better support for the people whom hon. Members across the House care about.

The Minister is right: economic inactivity rates have soared because of ill health, and where possible we want those people to get back into work. It is for their own good. It is also for the good of the hard-working taxpayers to have those costs minimised. However, given that these proposals come at the tail end of a Government, who have just weeks or months to go, I doubt very much that the measures will become a reality for many people. I have one question for the Minister: as this issue is devolved to the Northern Ireland Assembly, has he had any discussions with the Executive about these proposals? If he has, what response did he get? Should the Executive go in a different direction, what will the economic consequences be for the Northern Ireland Executive’s budget?

The right hon. Gentleman is absolutely right to talk about the importance of work in the context of mental health. That is my strongly held belief. He is also right to raise the issue of the fiscal sustainability of our welfare system. If the public are to continue to have confidence in that system, we must get the balance right between the requirements of the taxpayer and our absolute determination to support those most in need of help.

The right hon. Gentleman asked a specific question about the Northern Ireland Executive. He is right: it is possible for Northern Ireland to decide to manage its benefits in a different way to England. That is not traditionally what has happened. Traditionally, Northern Ireland has followed the moves that we have made. As to discussions, absolutely, there are always close, ongoing discussions between my Department and our counterparts in Northern Ireland.

The Prime Minister shares my view, which is that it is really important that we achieve the best possible outcomes for the people whom we are discussing in this statement. He cares a great deal, and I think he said at the end of his speech that he wanted to help many people, some of whom are watching the screen flickering away while their opportunities drift off into the distance—or words to that effect. That speaks from the heart. That says that we have a Prime Minister who cares deeply that opportunities in our society should be made as widely available as possible. That is a view, a characteristic and a quality that I admire and that I share with him.

The Secretary of State has upset many disabled people and organisations with his clumsy, negative and juvenile approach. Mind, for example, has asked for a grown-up conversation. Furthermore, the Secretary of State said at the Dispatch Box today that there has never been a review of personal independence payments, but there have been two independent reviews commissioned by the Department, so perhaps he could correct the record when he gets to his feet. PIP is not an out-of-work benefit, so when will the Department publish its assessment of the impact of these latest cuts on disabled people using PIP to support themselves in work?

It is the case that there has not been a fundamental review of PIP on the basis that that has subsequently led to a change in that benefit. Therefore, it is the case that that benefit has remained fundamentally the same for more than decade—it actually came in in 2013, as the hon. Gentleman will know. On what assessments may or may not be made available, I think they will come at a point when the Government arrive at their conclusions having conducted the consultation.

Members of this House may remember that I had to take a leave of absence from this role three years ago because I have post-traumatic stress disorder. I can tell the House that the insinuation that mental health conditions are not debilitating, do not affect people’s ability to go about their daily life or to go to work, and do not incur additional costs could not be further from the truth. The Prime Minister’s comments about so-called “sick note culture” and the changes that the Government are proposing will do nothing to help people with mental illnesses, and will just make their lives harder. Why are the Government setting back the clock on the acceptance of mental illness as a disability instead of truly tackling the crisis in mental health support?

I am at pains to say this: every time I have come to the Dispatch Box this afternoon, I think I have made it extremely clear that serious mental health conditions are very real. I take them very seriously, as I think does everyone in this House. I say to the hon. Lady—[Interruption.] This is where we need a grown-up conversation. [Interruption.] This is really important. We need a proper conversation about this, because if at every stage, whenever a Minister suggests that we need to look at a particular area, their motives get impugned in the way that the hon. Lady has—[Interruption.] She inferred that I am actually saying that mental health conditions should be trivialised in some way. I am definitely not saying that.

My constituent Elizabeth has been a very hard worker, but also someone who has suffered from ill health. She came to see me at my surgery on Friday to express her alarm about the Prime Minister’s speech on 19 April, his proposals for sick notes, and what she sees as his lack of respect for the professionalism of general practitioners. If the issue came up in the Chamber, she asked me to ask the relevant Minister this question: how can a random DWP assessor, faced with a complete stranger, based on the briefest of interactions, be relied upon to produce a more accurate and objective assessment of a patient’s condition than her own general practitioner?

I know the Prime Minister shares the view that we owe a huge debt of gratitude to our GPs, right up and down the country. They have a highly pressurised job, and they do it extremely well. DWP assessors are highly trained individuals, and there are very clear guidelines on how assessments should be fairly conducted. They are, as the hon. and learned Lady will know, open to appeal where that is necessary. She mentions GPs. As part of the assessments, which are concluded by a DWP team member, rather than the assessor themselves, taking into account all the evidence, it may well be that GPs have an input into many of the decisions.

The Secretary of State must understand that the rhetoric coming from the Government over the past few weeks has been brutal, divisive and inducing unimaginable terror in the two thirds of people already in destitution who have a chronic health condition or disability. The prospect of further cuts is making the situation worse. Can he confirm whether he expects overall Government PIP spending to be reduced and, if so, by how much, and what assessment he has made of how his proposals will affect those who are already in material deprivation?

The presumption that the hon. Lady makes is that the alternative to consulting on a different and potentially much better way forward is to do nothing at all. To me, that is unacceptable. In terms of ensuring that we truly support all those who need support, I have already given that reassurance from the Dispatch Box. It is made very clear in the consultation that we recognise that there will be people who need more support than they are receiving at the moment, but we need to have that conversation in order to get the best outcomes.

Language matters, as we have heard, and the Government have been warned that the language and rhetoric—perhaps not from the Secretary of State himself but from others—risks minimising the impact of mental health conditions, which are real and serious. What are the Government’s plans to ensure that proper treatments are available—not just talking therapies but whatever treatment is appropriate—to ensure that people with mental health conditions are treated appropriately?

The hon. Lady raises an extremely important point: the prevalence of mental health conditions in our country has grown. There are many reasons for that—I know the Labour Party like to say it is all about the NHS, but it is about many other things, not least social media among young people. There are many causes. The consultation will look at exactly the question she quite rightly raises. She mentioned the NHS talking therapies; I think that, particularly for some less severe mental health conditions, combined with work, they can make a real difference. I was very pleased when my right hon. Friend the Chancellor brought in 400,000 more of those talking therapies at his last fiscal event.

Back in 2018, a bad concussion left me out of work for several months. Over time, I became deeply depressed, worried and anxious that I would never get back to full-time work at all. I was lucky that my employer was able to find and to pay for me to get the support I needed to get back to work, and I am lucky enough to be here today. However, for many across the country that simply is not the reality they face. Why are the Government not focusing on making sure everyone has the support they need to get back into work, rather than falling back into the kind of political posturing that will only add to the stress and anxiety that thousands already feel?

If I may say so, first, I am very pleased that the hon. Gentleman is now fit and well and I am sorry he went through the difficult time that he describes. We are doing a huge amount; he may or may not be familiar with universal support, which is there not only to place the kind of people he has described into work, but, critically, to stay with them for a period of up to 12 months to make sure they have the support to hold that job down. We know that work is good for those with mental health conditions. I have already referred to WorkWell, which brings together those who have mental health challenges and work coaches who are able to see how work can fit within their recovery programme. We are very much doing those things. If he would like to see me at some point after this statement, I would be happy to sit down with him and talk him through some of the other approaches we are taking.

Today’s statement has been made necessary by the huge deterioration in the nation’s health and mental health since the pandemic. I think the whole House has to take responsibility, because this House voted for draconian lockdowns that devastated mental health, particularly among the young. This House voted to mandate untested experimental treatments, threatening people that they would lose their jobs if they did not take them, while giving immunity from prosecution to the manufacturers for their dangerous and defective products. Will the Minister do the best thing he can for public mental health by assuring the British public that these mistakes have been learned from and will never be inflicted upon them again?

I am afraid I simply do not subscribe to the theories that the hon. Gentleman promotes. I think it is probably best to leave it at that.

I thank the Secretary of State for his statement and for responding to questions.