Written evidence from Daniel Wrapson (HAB0127)


I am a Welfare Benefit Caseworker at Paddington Law Centre. The Law Centre serves people in Westminster and surrounding London boroughs representing people in the areas of Welfare Benefits, Housing and Employment law. My experiences have well placed me to provide evidence for the Health Assessment Inquiry, having assisted claimants through the claims procedures and successfully appealing against negative decisions. I have chosen to provide this evidence from my own experiences rather than on behalf of the Law Centre as some of my evidence has come from other organisations that I have worked for.


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?


Paper based assessments for DLA for Children and Attendance Allowance do offer some advantages, in that they are more accessible for the very young and old who may not be able to cope with a lengthy health assessment interview. However the assessment process could be improved further. 


Firstly a key area for claimants is a lack of assistance, completing the 52 questions on the Attendance Allowance Application and the 84 questions on the Child Disability Living Allowance questionnaire. Whilst the DWP does offer a visiting service to assist claimants to complete the application form, this is not promoted widely and often clients in these two groups are deterred from claiming due to the length of the application form.


The questions are often repetitive in the both forms. For instance the question 48 of the Child DLA application form asks whether the child needs assistance when moving around indoors. However these questions are comprehensively covered in the mobility section 35-45 of the questionnaire form. As this section is covered in detail in the outdoor sections, I would recommend that the indoors question is unnecessary as in most circumstances a persons ability to walk would have little variation between outdoors and indoors. Whilst this is only one example, repetitive questions, such as this could be reduced and the length of the overall questionnaire shortened.


Secondly the application form frequently asks the question, “How often each day?” Whilst both Child DLA and Attendance Allowance are measured on the frequency of the assistance required. It is often a difficult question for claimants to answer whose difficulty completing a daily living activity may vary on a daily basis. A more accurate method would be to use a conjunction of different methods, such as considering the nature of the claimants medical conditions and their impact, having a criteria similar to PIP identifying claimants individual difficulties with particular activities and placing greater evidential value on supporting evidence from Carers, support groups and Social Services.


Thirdly, an area of concern for claimants is the lack of information within the decision response both after an initial decision and Mandatory Reconsideration review. Additionally Child Disability Living Allowance and Attendance Allowance are based primarily on legislation and caselaw and that these sources of determination are not collated into a unified guidance for claimants.  Following a negative Attendance Allowance decision and a request for an MR I have seen letters stating that just, “the decision remains the same,” without any specific explanation as to why. Even following a phone explanation the reason can still be confusing to many claimants.


Similarly regarding Child Disability Living Allowance, I recently represented two autistic child siblings to appeal the highest rate of the mobility component of Child Disability Living Allowance. Again the decision letter was vague as to why they had been turned down. Having both a law degree and having received training as a Welfare Benefit Caseworker I have knowledge both locating and using legislation and caselaw to identify the main criteria for the highest level of the mobility component, the claimants’ appointee (mother) does not have the same tools or training available to her. As there was no clear guidance on the letter the clients’ appointee was unable to understand why they were turned down and construct a challenge against the decision. I recommend that a criteria based on both DLA/AA regulations and caselaw is developed, in order to enable claimants to understand, both why and what the requirements are needed both to claim and challenge DLA/AA decisions. 


In view of the above I ask that the Select Committee considers the above with a view of making the following recommendations.


  1. Promote the use of the Department of Work and Pensions Visiting service to assist people to complete the application form.


  1. Shorten the assessment forms, reducing the number of questions, in order to make the application forms more accessible.


  1. Whilst accepting that frequency is a key part of the test for Child DLA/AA. Instead of asking the claimant how many times a week, the decision maker could focus on the nature of a clients’ health condition and the likelihood that they would need frequent and continual needs throughout the day and night. Use a criteria to identify specific difficulties that a claimant faces from a health condition. Allow for greater evidential value on evidence given by carers, social workers and support groups.


  1. Provide explanations for decisions in a written format. Provide clearer guidance, of criteria from legislation and caselaw to give claimants a knowledge of the assessment criteria and provide them with the tools to challenge decisions.


Question 5A- Before PIP replaced DLA for adults, DLA was also assessed using a paper-based system. What were the benefits and drawbacks.


Disability Living Allowance paper based assessment had many of the same advantages and disadvantages as Attendance Allowance (AA) and Child Disability Living Allowance (DLA) discussed in my response in Question 5.


The paper based system offers less stress for claimants, who aren’t subjected to lengthy health assessments and allows greater evidential value on health professionals and support networks known by the claimant. The lack of a health assessment may also ensure greater protection for those who due to their health conditions are unable to attend an assessment or have a legitimate reason for missing them. Under the health assessment system, after 2 missed appointments a claimants benefit claim ends. As a Welfare Benefit Caseworker I have successfully had these types of decisions overturned at appeal, but it is very stressful for claimants who have no money during the interim period. A system which facilitates the claim process for claimants is welcome. 


Criticisms of the paper system mentioned in question 5 include, lengthy application forms, limited assistance to complete application forms, decision determination based on legislation and caselaw which is unclear for claimants and limited acceptance of secondary supporting sources. I have outlined how the paper based assessment system could be improved below.


The old system was limited in scope of making application forms completely accessible to everyone as it was only available as a paper based system. (Braille and Large Print were available.) However many claimants with a range of conditions still struggled to complete forms. Additionally relying on the postal system, meant that on occasions, forms went astray, causing additional stress for claimants, who had not made copies and delaying decisions being made, affecting other benefit entitlements. Reintroduction of a paper based system today, could be made more accessible by providing an online version alongside the paper based form. The claimant would be able to save their progress and the final version of the form, eliminating the worry of it becoming lost in the post. Computers have also increased the range of adaptions available, and thus it might make it easier for claimants to complete application forms. 


Secondly another key area is ensuring that all sources of evidence are used in order to assess the paper version. Whilst GP’s have a good overview of a claimants conditions, they do not always have full information available. For instance if a claimant moves between private and state health support, records are often not shared, so the GP won’t have access to full information. Additionally if the claimant has moved around, then information regarding their conditions may have become lost over time. A case I have seen, which represents this problem was a DLA case in which the claimant had been turned down due to incomplete information. I represented her at tribunal. The DWP had evidence from her GP that she was suffering from depression. On the basis of just depression the DWP determined that the claimant did not require frequent extra care throughout the day. Following an interview with the client, she gave me a letter from her mental health specialist also diagnosing her with Schizophrenia. On this basis of additional information the tribunal panel identified that the claimant had increased care needs and awarded her DLA. Therefore if paper version are reintroduced, a system needs to be developed in order to make sure that evidence is provided from all sources of support in order to get the most accurate picture of the claimant.


I recommend to the tribunal.


  1. Online application forms, in which the claimant can save their progress, with accessible website options.


  1. Wider and more publicised support to complete application forms.


  1. Decision Makers as a starting place should identify claimant support network and give equal weight to all supporting evidence in order to make informed decisions.  


Question 7 and 7a


Appeals data shows that, for some health-related benefits, up to 76% of tribunals find in favour of the claimant, why is that? What could DWP change earlier in the process to ensure that fewer cases go to appeal.


Prior to the appeal stage, claimants have to request a Mandatory Reconsideration (MR). A DWP decision maker will review the evidence again and establish whether the correct decision was made first time around. The process has a low success rate of overturning a decision compared to a appeal. The most up to date figures available showed only 49% of Personal Independence Payments claims were overturned at MR compared to 67% at appeal between April-July 2021 (UK Government Statistics 2021).


There are several problems with the Mandatory Reconsideration process. The decision makers, rely on the assessment reports, but don’t send out for further corroborating medical evidence or question the quality of the assessment undertaken by the health assessors. A particular case I have seen exemplifies this problem where a client who undertook an ESA assessment scored zero points at Mandatory Reconsideration, but then 48 points at appeal. The client suffered from autism, scoliosis, speech difficulties and asthma. The decision maker based his initial decision on the fact that the client went to the laundrette, which he did to watch the washing machines. That he could use a phone, which was not the case as they confused him, that he enjoyed reading, (a book on dinosaurs for 5 year olds) and that he spoke to people he did not know, despite the only interactions was from his Housing Officer and Jehovah’s witnesses. In this example the Mandatory Reconsideration Decision Maker did not request further medical evidence or question the report of the health assessor as fully as they could have done.


A second example also demonstrates the Mandatory Reconsideration Decision Makers’ reliance on a health assessment report is demonstrated in the case of a client who had experienced domestic violence from her husband and son. As a result the client experienced severe post traumatic stress disorder and found it very difficult to trust other people. The assessment report placed great evidential weight on the mental state examination, in which the health assessor reported, “You were orientated in time and place. Nothing indicated that you were experiencing any significant levels of low mood and anxiety.” At tribunal further evidence was considered alongside the mental state examination, including a statement from her Domestic Violence Support Worker and past history, which resulted in points being awarded for the ‘engaging with other people face to face’ descriptor. This highlights the overreliance by the Mandatory Reconsideration level on just the health assessor report compared to at tribunal were evidence is collected from different sources.


From the above cases I would recommend that the Select Committee consider the following.


  1. Train Mandatory Reconsideration Decision Makers, to request evidence from various sources and not rely on just the Health Assessors report. Extra resources should be deployed to support this such as extra admin support to ensure that requested evidence is obtained in reasonable timescales.


  1. Availability of health professionals that MR Decision Makers can consult with to give them insights into claimants conditions.



  1. Review of the Mental Health State examination used by health assessors. Whilst this does have it uses, mental health conditions fluctuate and a claimant with mental health conditions may not always display over characteristic sighs such as rocking, shaking and poor eye contact. This part of the assessment needs to considered in tandem with other evidence.


March 2022