Written evidence from The Big Help Project HAB0142

 

Executive Summary The views expressed in this report represent the views of the Big Help Project, but were voiced by Welfare Rights team leader, Mr Andrew Wilson.

We respectfully make the following recommendations to the committee:

1.       Introduction

The Big Help Project is a multi-award-winning, national charity that works to alleviate and eradicate poverty in all its’ forms. Our local catchment area includes the boroughs of Knowsley and Liverpool which ranked 3rd and 4th most relatively deprived, respectively, on the 2019 Indices of Multiple Deprivation[6]. Our Big Help Money Advice project includes Welfare Rights advice, which has recovered circa £250,000 in backdated welfare benefit payments for clients who had had claims declined or were not awarded their full entitlement. We therefore have a breadth of experience working directly with the client group affected by the issues being discussed by this Select Committee, and we have witnessed first-hand the material deprivation and psychological and emotional harm caused to our clients by issues arising from their experience of claiming sickness-related benefits in the UK today.

2.       Response to Section 5, subsection a): before PIP replaced DAL for adults, DLA was also assessed using a paper-based system. What were the benefits and drawbacks of this approach?

Our clients reported that they preferred to be able to complete such forms online. However, it was made clear to us that clients preferred to still have the option of a paper-based form. One client who was in receipt of DLA and reached the age of 16 and was required to complete an application for PIP. The client had a learning disability and did not understand what they needed to do. This could have been avoided with steps such as a letter and a contact number for a caseworker to support them through it. This is especially important for this vulnerable group.

3.                   Response to Section 6: how practical would it be for DWPs decision makers to rely on clinician input, without a separate assessment, to make decisions on benefit entitlement? What are the benefits and drawbacks of such an approach?

We consider that it would be eminently practical for the Departments’ decision-makers to rely on clinician input for the following reasons:

  1. It would remove the cost of awarding WCA contracts to external providers
  2. It would remove the costs of procuring premises as assessment centres
  3. The funds saved in these two areas could be invested in G.P. hours to accommodate the increase in workload that these changes would represent
  4. In addition, this would be more practical for claimants as it would replace what is, in some case, a long journey to as assessment centre, with a visit to their usual G.P. or specialist, thus improving the claimant experience as per this Select Committees objectives.

4.                   Response to Section 7: Appeals data shows that, for some health-related benefits, up to 76% of tribunals find in favour of the claimant. Why is that?

It is our view that the rate of successful appeals at tribunal is in part the result of clients being – in their words – ‘listened to’ at the tribunal. They also get to see their assessment reports. We also believe that the rate of success of the tribunals cannot and must not be viewed in isolation but as a reflection of the problems within the claims and assessment system.

5.    Response to Section 7, sub-section a): What could the DWP change earlier in the process to ensure that fewer cases go to appeal?

It is our view that the Department could improve the quality of the assessments by having those assessments the claimants’ G.P. or equivalent medical practitioner, including specialist medical professionals where the claimant is under the care of a specialist. This should include specialists in mental health and psychiatry, as per the principles of parity of esteem between physical and mental health[7]

6.                   Response to Section 9, sub-section 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?

We believe that there would be no drawbacks to bringing the assessments ‘in-house’. Having assessments ‘in-house’ would streamline the process to get the right people onto the right benefit more quickly. This will mitigate against a claimant’s condition deteriorating between them making the claim and having the assessment, and has the potential to, at the same time, mitigate against the additional expense to the public purse that such deterioration of a claimant’s condition would cost

Our experiences echoes research by Dwyer et al (2019) that concluded that, for people with mental health conditions, ‘welfare conditionality was not only inappropriate but counterproductive’[8]. Barr et al (2016) found that the Work Capability Test was “independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing”[9] Whilst we recognise the need for some kind of assessment to take place in most cases - though, in our view, not in cases of permanent or terminal illness, condition or disability – we consider that the policies and practices of the claim process undermine trust in that process by skewing the balance of power – in all already asymmetric power relationship – further in favour of the DWP. We also consider that these policies and practices indicate a clear difference in treatment and expectations of the DWP and claimants and communicate covert messages that place the claimant at a disadvantage.

We consider the following to be example of such policies and practices:

  1. Claimants needing to answer multiple questions when they ring to make a claim, before they can even be sent the claim form – we believe that this is unnecessary, as the claim will be rejected anyway once the form is processed by the DWP if the qualifying criteria are not met
  2. Claimants who attend an assessment and then receive their decision letter do not receive a copy of the report. We believe it is unfair that claimants are not given the same courtesy and respect as, for example, a person being appearing in court. We believe that this policy is dehumanising and diminishing and should be abolished as policy as soon as possible
  3. We consider the current mandatory reconsideration deadline of one month for the claimant to be arbitrarily unfair. We consider that this rule creates a ‘catch-22’ for the client where, if they are very ill or have period of chronic illness within a long-term diagnosis, they may not be able to meet that deadline. They would therefore not be able to appeal the decision because they were too ill, which we suggest runs entirely counter to the principles of the welfare state.
  4. In addition, we consider that the absence of any timescale at all for the DWP to respond to said mandatory reconsideration creates an asymmetry of power in favour of the DWP

7.                        Section ten: 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?

In our experience of talking to our clients, some of our clients preferred telephone referrals. However, as per the feedback we received from our clients, they felt aware that they could not see and been seen by the assessor. We believe that technology has progressed in the past few years and that technologies such as Zoom could be used to address this feedback from our clients.

8.                   Response to Section 9, sub-section a: Is there are case for making some of the changes permanent?

 

We are encouraged to learn through the call to evidence that the DWP is intending to create and pilot a ‘digital platform’ for use by claimants which will have cost and environmental benefits. We believe that such a platform would offer the best experience for claimants if the platform included features that enabled claimants to access their claim, view its progress, upload and download documentation including decision letters, upload evidence and schedule a reassessment if their illness or disability has changed and view their claim history.

However, we emphasise in the strongest possible terms the need for the Department to accommodate the many people who are digitally excluded and for whom it would be disastrous for the process to move entirely online. In addition to the reduced library provision nationally[10] that for some means the difference between digital inclusion and digital exclusion, certain physical and mental illnesses and disabilities, for example multiple sclerosis, agoraphobia and acute or chronic physical immobilisation, can make accessing resources such as libraries impossible or at least detrimental to health. Finally, the compulsion to use the platform in order to access a benefit claim and therefore have an income would, we feel, represent a discriminatory element to the claim process for a group that not only should not be discriminated against, but who should have proactive accommodation made for their physical or mental illness or disability.

9.                   Bibliography

BAKER, C.; GHEERA, M.; 16th January 2020. Mental health: Achieving ‘parity of esteem.’ House of Commons Library. Accessed 13th May 2022. Available from https://commonslibrary.parliament.uk/mental-health-achieving-parity-of-esteem/#:~:text=Parity%20with%20physical%20health&text=Section%201%20of%20the%20subsequent,physical%20and%20mental%20health%20services.

 

BARR, B.; TAYLOR-ROBINSON, D.; STUCKLER, D.; LOOPSTRA, R.; A REEVES, A.; WHITEHEAD, M “‘first, Do No Harm’: Are Disability Assessments Associated with Adverse Trends in Mental Health? A Longitudinal Ecological Study”. Journal of Epidemiology and Community Health 70, no. 4 (2016): 339–45. Accessed 12th May 2022. Available from http://dx.doi.org/10.1136/jech-2015-206209

 

CENTRE FOR MENTAL HEALTH WEBSITE, "Parity of esteem". Accessed 13th May 2022. Available from https://www.centreformentalhealth.org.uk/parity-esteem#:~:text=%22Parity%20of%20esteem%22%20is%20the,and%20Social%20Care%20Act%202012.

 

DAVIES, M., PORTER, L., LEPPS, H., ICARDI, R. AND BICQUELET, A., 2017. Experiences of Personal Independence Payment (PIP) for people with sensory loss. Thomas Pocklington Trust, Sense, RNIB (forthcoming). Accessed 13th May 2022. Available from https://www.pocklington-trust.org.uk/wp-content/uploads/2020/10/PiP_for_people_with_sensory_loss_2017_full_report.pdf

 

DWYER, P.; CULLION, L.; JONES, K.; MCNEILL, J.; STEWART, ALISTAIR B.R. Dwyer, P., Scullion, L., Jones, K., McNeill, J. and Stewart, A.B., 2020. Work, welfare, and wellbeing: The impacts of welfare conditionality on people with mental health impairments in the UK. Social Policy & Administration, 54(2), pp.311-326. Accessed 12th May 2022. Available from https://doi.org/10.1111/spol.12560

 

FLOOD, A., 6th December 2019. Britain has closed almost 800 libraries since 2010, figures show Accessed 13th May 2022. Available from https://www.theguardian.com/books/2019/dec/06/britain-has-closed-almost-800-libraries-since-2010-figures-show

 

MILLS, C., 2018. ‘Dead people don’t claim’: A psychopolitical autopsy of UK austerity suicides. Critical social policy, 38(2), pp.302-322.

 

MINISTRY OF HOUSING, COMMUNITIES AND LOCAL GOVERNMENT, INDICES OF MULTIPLE DEPRIVATION 2019, Statistical Release. Accessed 13th May 2022. Available From https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019

 

PARLIAMENTARY WEBSITE, House of Commons

Guide for witnesses giving written or oral evidence to a House of Commons select committee. Updated February 2016. Accessed 13th May 2022. Available from https://www.parliament.uk/globalassets/witnessguide.pdf

 

TOMLINSON, J., M.P.; Minister of State for Disabled People, Health and Work. 9th July 2020. Accessed 13th May 2022. Available from https://questions-statements.parliament.uk/written-statements/detail/2020-07-09/HCWS353

 

UK Parliament website, September 2021-May 2022. Call for evidence, Health assessments for benefits: Inquiry. Accessed 13th May 2022. Available from https://committees.parliament.uk/work/1468/health-assessments-for-benefits/

 

YOUNG WOMEN’S TRUST. Written evidence for the House of Commons Select Committee on Health Assessments for Benefits. 11th May 2022. Accessed 13th May 2022. Available from https://committees.parliament.uk/committee/164/work-and-pensions-committee/publications/

 

May 2022


[1] Baker, C.; Gheera, M., 2020, cited on Centre for Mental Health website

[2] ibid

[3] ibid

[4] DWP, 2013, cited in Davies, M. et al, 2017, pp 62

[5] Tomlinson, J., M,P., House of Commons Statement, 9th July 2020

[6] Ministry of Housing, Communities and Local Government, Indices of Multiple Deprivation 2019 Statistical Release, pp 11

[7] Baker, C.; Gheera, M.; 2020

[8] Dwyer et al, 2019, pp 321

[9] Barr et al, 2016, pp 339

[10] Flood, A., The Guardian online