Call for Evidence
Health assessments for benefits
Scope of inquiry and background information
The Department for Work and Pensions pays benefits to people who cannot work, or who cannot work a lot, because they have a long-term health condition or because they are disabled. These benefits include:
• PIP (Personal Independence Payment), which is intended to help disabled people meet the additional living costs that can result from their health condition/disability;
• ESA (Employment and Support Allowance) and its Universal Credit equivalents (the “Limited Capability for Work” [LCW] and “Limited Capability for Work-related Activity” [LCWRA] components, which are equivalent to the ESA Work-Related Activity [WRAG] and Support Groups, respectively). People who want to claim either ESA or the equivalent support under UC have to undergo a Work Capability Assessment (WCA);
• DLA (Disability Living Allowance). PIP replaced DLA for adults from 2013, and the Department is in the process of transferring DLA claimants to PIP. DLA can still be claimed for children under the age of 16.
• Industrial Injuries Disablement Benefit (IIDB), for people who have become ill or injured through work.
• Attendance Allowance, for people over the State Pension Age who need extra support from a carer.
To help decide who is eligible for these benefits, the Department carries out assessments. These can be paper-based, face-to-face, or remote, depending on the benefit being claimed and the person’s health conditions.
The Department has announced its intention to reform the assessment processes for PIP and ESA through its “Health Transformation Programme”. It intends to create a “single, integrated health assessment service”; to create a “single digital platform”, and to “test and learn” on these new system in a single “Transformation area”. The Department announced in July 2020 that this work had been extended due to the pandemic.
The Work and Pensions Committee has heard previously that these assessments, and the decision-making process after the assessment, are often flawed. This can lead the Department to make the wrong decision on whether someone is eligible to receive a benefit. The problems with assessments and decision making are reflected in the proportion of people who take the Department to court to appeal their decision and win. For most of the benefits listed above, a majority of claimants win their appeals. For example, in early 2020:
• 76% of PIP appeals found in favour of the claimant, along with;•
75% of ESA appeals;
• 69% of DLA appeals; and
• 55% of IIDB appeals.
The vast majority of appeals that take place—73% of all social security appeals in 2019/20—relate to PIP and ESA.
Beyond appealing a decision, many people trying to claim these benefits and the organisations that support them have identified problems with the assessment processes. These include very long waits for assessments; concerns over the quality of reports and the expertise of assessors; how effectively the Department uses expert additional evidence in coming to a decision; stresses placed on claimants as a result of the application and assessment processes; concerns about how accessible the assessment processes are for disabled people, and concerns about whether the descriptors (the basis on which the Department decides eligibility for benefit) accurately reflect the impact of people’s health conditions on their daily lives and ability to work.
Terms of reference
The Committee would like to hear views on the following questions. You don’t have to answer all of the questions. You can respond on behalf of an organisation, or as an individual.
The Terms of Reference for this inquiry are available in accessible formats:
• Microsoft Word
If you require a different format, or if you need us to make reasonable adjustments to enable you to send us your views, please contact us via email on firstname.lastname@example.org or call 020 7219 8976/text relay 18001 020 7219 8976.
Suitability of assessments
1. How could DWP improve the quality of assessments for health-related benefits?
a. Have you seen any specific improvements in the process since the Committee last reported on PIP and ESA assessments, in 2018?
2. Are there any international examples of good practice that the Department could draw on to improve the application and assessment processes for health-related benefits?
3. Do the descriptors for PIP accurately assess functional impairment? If not, how should they be changed?
4. Do the descriptors for ESA accurately assess claimants’ ability to work? If not, how should they be changed?
5. DLA (for children under the age of 16) and Attendance Allowance usually use paper-based rather than face-to-face assessments. How well is this working?
a. Before PIP replaced DLA for adults, DLA was also assessed using a paper-based system. What were the benefits and drawbacks of this approach?
6. How practical would it be for DWP’s decision makers to rely on clinician input, without a separate assessment, to make decisions on benefit entitlement? What are the benefits and the drawbacks of such an approach?
7. Appeals data shows that, for some health-related benefits, up to 76% of tribunals find in favour of the claimant. Why is that?
a. What could DWP change earlier in the process to ensure that fewer cases go to appeal?
8. Is there a case for combining the assessment processes for different benefits? If not, how else could the Department streamline the application processes for people claiming more than one benefit (eg. PIP and ESA)?
9. What are your views on the Department’s “Health Transformation Programme”? What changes would you like to see under the programme?
a. (For people claiming) Would you like to be able to manage your benefit claim online?
b. What would be the benefits and drawbacks of DWP bringing assessments “in house”, rather than contracting them to external organisations (Capita, Atos and Maximus)? In particular, would this help to increase trust in the process?The impact of the pandemic
10. What lessons should the Department learn from the way that it handled claims for health-related benefit claims during the pandemic: for example, relying to a greater extent on paper-based assessments, or using remote/telephone assessments?
a. Is there a case for making some of the changes permanent?
11. Most assessments for Industrial Injuries Disablement Benefit were suspended during the pandemic. What has been the impact on people trying to claim IIDB?
a. Some IIDB claimants will receive a lower award than they might have, due to the suspension of assessments, because IIDB awards are linked to age. Should the Department compensate these claimants? How?
b. What lessons could the Department learn for how it deals with these claims in future, in the event of further disruption to normal services?
12. DWP believes that applications for some benefits dropped sharply at the start of the pandemic because claimants weren’t able to access support (for example, from third sector organisations) to complete their applications. What are the implications of this for how the Department ensures people are able to access health-related benefits consistently?
a. How can the Department best help the third sector to support claimants in their applications?
The impact of assessment/application on claimants
13. DWP recently published research on the impact of applying for PIP or ESA on claimants’ mental and physical health. What would be the best way of addressing this?
Waits for assessments
14. What could the Department to do to shorten waits for health-related benefit assessments—especially for ESA/UC?
a. How effectively does the “assessment rate” for ESA cover disabled peoples’ living costs while they wait for an assessment? Is there a case for introducing an assessment rate for other health-related benefits?
Health assessments in the devolved administrations
15. The Scottish Government intends to introduce its own assessment process for the Adult Disability Payment, which will replace PIP in Scotland from 2022. What could DWP learn from the approach of the Scottish Government?
a. PIP started rolling out in Northern Ireland in 2016. Is there evidence that the Department learned from the experience of rolling out PIP in the rest of the UK?
16. How effectively does DWP work with stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?
a. What steps could the Department take to improve its engagement with stakeholders?