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Welfare Reform Green Paper

My Lords, this is something that is probably been overdue—something that we have been promised for a long time. I hope that it is the start of a very constructive process. To mirror what the noble Lord, Lord Skelmersdale, said, the general thrust seems to be a good one, based on a degree of consensus. It hints at the fact that we shall have the individual placed at the heart of the system and that we shall look at the individual need, treating individuals as units unto themselves and their own circumstances. Unfortunately, that is not a resource-light approach. A one-size-fits-all thing is a very bureaucratic and comfortable system—tick the right box, get the right answer, and you are off and running. GPs were mentioned in the Statement, which is quite right; GPs will be a vitally important part of getting the process right. However, the term ““general practitioner”” should give rise to a degree of caution in everybody. They are not experts; they are called on to deal with an extremely wide range of problems. What sort of support has been built in here, and what sort of formal link has been built in between health and the Minister’s department? Indeed, the Minister is probably historically very well based to assess the level of that link. The fact of the matter is that without such support, much of what we are talking about here—much of the aspirational stuff—is going to fail. You need expert support and intervention early on. Mental health is one of the biggest areas of growth. Can we realistically expect a GP, who has a wide-ranging generalist job to do, to be an expert in mental health? The answer is, quite simply, no. We now bring physiotherapists into most practices. Under the old idea of IB for a worker whose back has seized up or who has a repetitive strain injury to a hand, a physiotherapist is the right person to help that person back into work and to give support through that process. Does the Minister see a situation in which that sort of help will be provided for those in the mental health system? If it is not, you have already created a hole in the structure. You must have that type of support available, and I look forward to hearing more about the process. Many of the other hints in the system come down to the fact that we must give individually-based support throughout the process. If we do not, everything is going to start to slip. Can we have a little more guidance as to where we are going to find the extra resources and people to administer the system, if we are cutting staff numbers in the department? GPs will be able to do a lot, but there will have to be greater knowledge, awareness and training among those working within the Minister’s own department. Where are we going to get the increased training and awareness? The good generalist training that has been in place seems to show that there are problems about expertise. Where for the GP and those other workers is there going to be the course that tells them when they have to bring in the experts? I have asked this question before but I have never received a satisfactory answer. When are we going to make sure that when the GP does not know something, he is told that he must bring someone else in? It is better to act too early than too late—and not when the system has broken down, because that way would guarantee appeals. Can we have some guidance about that level of implementation and how it will relate to an individual person? If it does not, incapacity benefit, which had effectively become the way in which to hide unemployment statistics throughout a long historical period, going back longer than 1997, we will merely tickle the top of the iceberg and not the real problem.