Written evidence from Rethink Mental Illness SVC0064

About Us

Rethink Mental Illness is the charity for people severely affected by mental illness. Our mission is to lead the way to a better quality of life for everyone severely affected by mental illness. This includes people with lived experience, their carers, families, and friends. 

We have a dual role, first, as a provider of services directly, but not exclusively, for people living with severe mental illness such as schizophrenia, bipolar disorder, and borderline personality disorder. Secondly as a campaigning organisation, bringing to bear our experience of working directly with carers and people severely affected by mental illness to shape the health system, public attitudes, and the wider social and economic environment.

We work tirelessly to ensure people living with mental illness and their carers are listened to, treated fairly, and have easy access to services that meet their mental health needs and wider physical health, financial, housing, work, and volunteering needs.

Our values of hope, understanding, expertise, equity, commitment, passion, and openness underpin everything we seek to achieve.

Please contact julia.aggio@rethink.org regarding this submission.

Reason for Submitting

Since 2021 Rethink Mental Illness has been campaigning alongside families who have lost loved ones and are seeking answers about the Department for Work and Pension’s role in deaths and serious harm of people supported by the benefits system.

We are submitting evidence to this inquiry to ensure that the voices of people with lived experience of mental illness are heard in order to ensure that the DWP takes steps to improve its current safeguarding measures and address where it has failed in safeguarding vulnerable benefits claimants.

The benefits system is meant to be a safety net for people across the country who find themselves unable to work or in need of financial support. However, we are continuously told by people living with severe mental illness that the system is currently failing them. Many aspects of the benefits process are causing severe distress including applying for benefits, being assessed or reassessed, the threat of sanctions and the impact of administrative errors. This can lead to tragic instances of serious harm and deaths by suicide.

Together with bereaved families we have been calling for a public inquiry into deaths linked to the benefits system and for a new body to investigate future cases. We are also calling for the DWP to have a statutory duty of care and to be more transparent and accountable.

Executive Summary
 

1.       The absence of a statutory duty of care within the Department for Work and Pensions (DWP) is a pressing issue. The DWP's processes and actions have been linked to adverse effects on claimants' wellbeing and, tragically, even deaths.

2.       Interacting with DWP staff and their contractors, as well as navigating the processes for claiming benefits[1] has proven to be overwhelmingly harmful for individuals living with severe mental illness (SMI). The Work Capability Assessment (WCA) is also a major source of distress, especially when resulting in incorrect decisions and reassessments. In addition, other actions such as sanctioning and receiving letters with administrative errors, have caused detrimental consequences on claimants’ mental health and overall quality of life. These processes and practices have resulted in numerous cases of harm and deaths of individuals living with SMI.

3.       The DWP’s lack of transparency of its safeguarding processes, in combination with several publicised and linked cases of harm caused by DWP, strongly suggests that there are no effective safeguarding processes embedded and enforced in the benefits system. It also indicates that the DWP do not have effective mechanisms that identify and address systemic safeguarding issues in the benefits system. The limited information on existing safeguarding measures, demonstrate fundamental flaws in practice and the need for a statutory duty of care.

4.       These issues with transparency extend to the Internal Process Reviews (IPRs), as the DWP withholds the details of the process and does not routinely publish the lessons learned. Furthermore, a troubling lack of communication exists, as claimants and their families are not informed if they are the subject of an IPR. The recent publication of basic IPR data by DWP is a step towards transparency, but it falls short in providing insights into the effectiveness of the process and the lessons learned. Despite claims of a holistic approach, it remains unclear whether IPRs have led to changes in policy and practice. These issues underscore the pressing need for greater transparency, accountability, and a statutory duty of care within the DWP.

Key Recommendations

Statutory duty of care 

5.       The DWP must implement a duty of care and have it applied to all DWP staff, including their external agencies and contractors. 

6.       The DWP needs to co-design the duty of care with EbEs (experts by experience) and organisations that protect the interests of people living with disabilities and long-term conditions. 

7.       We recommend that the DWP embeds the following elements to the duty of care:

1. Promotion of claimant wellbeing,
2. Prevention and address harm,
3. Facilitation of holistic and integrated support between the DWP and other organisations,
4. Guarantee of transparency
5. Enforcement person-centred, compassionate, and empathetic care from the DWP,
6. Introduction an independent regulatory body, and
7. Adoption of a duty of candour.

Internal Process Reviews (IPRs)

8.       The DWP must investigate more cases of "customer harm", without deprioritising cases involving deaths.

9.       The DWP must inform claimants and their carers if their case is the subject of an IPR. 

10.   The DWP need to provide a full and public explanation of what they consider to be cases of "serious harm".

11.   The DWP must extend the power to submit IPR requests, to claimants and their carers. 

12.   The DWP must share monthly qualitative and quantitative data releases that show details of all IPR requests and outcomes, while anonymising all claimants' personal details. 

Benefit application/assessment processes and the Work Capability Assessment (WCA)

13.   The UC, PIP, and ESA processes and the WCA need to be re-designed in collaboration with EbEs, in order to make each process fit for purpose and safe for all individuals living with SMI.  

14.   The DWP needs to introduce specialised assessors who have a background in mental health and professional understanding of SMI and ensure that individuals living with SMI are always assessed by a specialised assessor.

15.   To support people living with SMI in the claims process and to prevent unnecessary delays to their claims, the DWP must implement the four key measures which are explained in the submission.

Safeguarding measures 

16.   The DWP needs to conduct a thorough and transparent review of their current practices and policies that relate to the support given to vulnerable claimants by the department.

17.   The DWP must co-design appropriate safeguarding measures with EbEs and experts by training. 

18.   The DWP should collaborate with claimants and their clinical teams, social care services, carers when making changes/decisions about claimants' benefits. 

19.   We recommend that the DWP shares its process on preventing benefits withdrawal from vulnerable claimants, and to take onboard recommendations for improvement from the VCSE sector and EbEs. 

20.   In the short-term, the DWP should quickly introduce a temporary legal easement of sanctions for all benefit claimants living with SMI and during a mental health crisis. 

21.   In the long-term, the DWP must abolish all conditionality and sanctions on claimants living with SMI and other disabilities/long-term conditions. 

22.   DWP must roll out comprehensive and continuous training about SMI for all DWP staff and their contractors. 

23.   The UC Six Point Plan Framework needs to be re-designed with EbEs and experts by training, and it needs to be applied to all benefit claimants, not only UC claimants. 

24.   The DWP must establish a mechanism that will identify and address systemic safeguarding issues, in collaboration with external stakeholders, including the VCSE sector.

Effectiveness of cross-agency communication and collaboration 

25.   DWP must share a clear framework on how DWP communicates and collaborates with external agencies. If this framework does not exist, then it must be constructed with a variety of external stakeholders, including the VCSE sector.  

DWP’s responsibilities and accountability

Q1. DWP does not have a statutory duty to safeguard the wellbeing of vulnerable claimants. Should this change?

26.   The Department for Work and Pensions (DWP) does not currently have a statutory duty of care to safeguard vulnerable claimants. The DWP is interacting with people living with SMI and making decisions that seriously impact their lives. These decisions can harm people living with SMI, if not safeguarded, therefore it is essential that the DWP is held accountable for actions.

27.   The DWP’s process and actions have been found to negatively impact people’s wellbeing, causing severe distress and anxiety, creating financial hardship, worsening existing mental health conditions, and in very tragic cases, leading to death. These outcomes could be prevented if a statutory duty of care were implemented. We have found there to be a lack of public trust in the DWP which has created a cycle of fear amongst claimants when navigating an overly complex benefits system. Our 2021 report Tip of the Iceberg showed that the number of cases being internally investigated at the DWP (known as Internal Process Reviews, IPRs) is rising, with 124 internal investigations of deaths or serious harm conducted between 2019 and 2022 alone – almost triple the rate from 2012 to 2019[2].

28.   Rethink Mental Illness recommends DWP to implement a duty of care that safeguards vulnerable claimants. The duty must apply to the DWP, its agencies, and contractors. Implementing a co-produced statutory duty of care for the DWP would be the first step in building trust with the public and protecting claimants who live with SMI from harm.

Q1a. If so, what should this duty look like?

29.   We recommend the DWP to co-design a duty of care with EbEs (experts by experience) and organisations that protect the interests of people living with disabilities and long-term conditions.

30.   To inform this written evidence we met with EbEs who live with SMI and are in receipt of benefits. We also met with bereaved families who told us their loved ones died by suicide as result of failures by the DWP. Our research shows that the application processes for PIP, ESA, and UC have caused significant distress with devastating consequences for claimants, as well as the process of the Work Capability Assessment (WCA)[3]. Incorrect decisions on WCAs, administrative errors, and sanctions have also been linked with several cases where people took their own life or were otherwise seriously harmed[4].

31.   During our conversations with EbEs, we discussed what should be included in a statutory duty of care. In addition, Rethink Mental Illness has also evaluated the NHS’s duty of candour and local authorities’ duty of care[5], and adapted those parts that could be helpful for the DWP.

32.   We recommend that the statutory duty of care embodies the following key elements:

1. Promotion of claimant wellbeing: actively seeking improvements in the aspects of wellbeing when conducting any function with or regarding a vulnerable claimant.
2. Prevention and address harm: intervening early to prevent issues from going unaddressed and escalating.
3. Facilitation of holistic and integrated support: for claimants to get high-quality social security support, the DWP must work more collaboratively with their clinical teams (i.e., private or NHS), social care services (i.e., supported housing), carers/families, and other key partners or agencies to ensure that vulnerable claimants do not slip through the safety net. This is crucial because when these different organisations work together, they can identify when a claimant is at risk more effectively and prevent them from being harmed and having their benefits cut unjustifiably. For example, if a claimant is not responding to calls or answering the door at a home visit, the DWP should contact the claimant’s GP, community mental health team, or other social support services they have, to understand what has happened and intervene as soon as possible.
4. Guarantee of transparency: claimants and their carers need the DWP’s policies, processes, and measures, including the statutory duty of care, to be communicated to them in a clear and accessible way.
5. Enforcement of person-centred, compassionate, and empathetic care: All interactions and correspondence between the DWP and claimants must be person-centred, compassionate, and empathetic. For example, claimants living with SMI must be assessed by a mental health professional (specialised assessors) who understands and treats them with respect and dignity.
6. Introduction of an independent regulatory body: The DWP must be monitored by an independent body like the CQC[6] or IOPC[7]. This independent body would regularly monitor and inspect activities at the DWP and submitting a complaint to this body should be easily accessible for claimants and/or carers. The independent body must hold the DWP to account and determine legal repercussions if duty of care is breached.
7. Adoption of a duty of candour: If it is confirmed that an individual has been harmed by the actions or inactions of the DWP, they are then owed a verbal and written apology and explanation of what went wrong. The explanation must include what happened, why it happened, which steps have been taken to make it less likely to happen again, and any support that is being offered as a result.

Q2. Is DWP adequately transparent about its safeguarding measures for vulnerable claimants, including how the Internal Process Review (IPR) procedure works and what is done to implement lessons learned?

33.   The DWP fails to adequately share its safeguarding measures. Such measures are not readily available to the public. While some details have been disclosed through Freedom of Information requests, the guidance provided lacks process and detail[8]. Based on the vulnerable claimants’ experiences when navigating the benefits system, the measures do not work adequately as claimants regularly have negative experiences while accessing and managing their benefits, going through flawed processes, and interacting with staff that do not understand their condition nor show genuine concern. This highlights the need for a statutory duty of care.

34.   The transparency issue extends to the IPR procedures, as information about how this process works is still hidden from the public. We know that IPRs are initiated internally and that there are two IPR panels. One panel conducts the IPRs and the other tracks the learnings and disseminates the learnings to the rest of the DWP. The DWP does not routinely publish the lessons learned which makes it impossible to track and monitor whether the DWP are following through with improvements and changes.

35.   DWP frequently completes more IPRs on “customer deaths”[9] than on “customer harm”[10]. In 2022-23, 60 IPRs were completed: 16.6% were cases on customer harm and 83.3% were about customer death[11]. Cases of self-harm, harms related to the inability to pay for essentials (i.e., food poverty), and suicide attempts are more common than suicide based on our research with EbEs. While it is imperative to investigate all cases involving death and this cannot be deprioritised, it is also critical to investigate all cases that involve any harm. By investigating and learning from all cases that involve harm, the DWP will be better equipped in preventing harm in the first place, which can reduce the likelihood of deaths.

36.   A vital concern is the fact that benefit claimants and families/carers directly affected are not told if they or their family member are the subject of an IPR. This raises serious questions about how the DWP investigates cases of serious harm and death involving vulnerable benefit claimants. The DWP must inform claimants and their carers whether an IPR is being conducted on their case. This would ensure that the review captures all the stages in which the DWP failed the claimants and DWP learn how to prevent issues from repeating in the future.

Q2(a). Is DWP adequately transparent about its safeguarding failures to ensure it is held accountable?

37.   The DWP only recently published basic IPR data for 2022-2023. Besides knowing the number of IPRs and completed IPRs involving harm or deaths, the DWP does not routinely publish conclusions or lessons of its IPRs. Therefore, the public cannot determine how effective the process is, nor the extent to which the DWP accepts their policies or actions as a factor in the death or serious harm of claimants (and therefore any action that may have been taken to prevent similar cases from happening again in the future). The DWP now claims to look holistically at all interactions between the department and a claimant when conducting an IPR, but we do not know whether this change in approach has led to policy recommendations being made or implemented. 

Ensuring benefits are accessible

Q3. What are the main challenges that vulnerable claimants face when trying to make a new benefit claim?

Benefit application processes:

38.   The initial application for UC can be anxiety-inducing, with our EbEs describing it as confusing, demeaning, and impersonal. People living with SMI are more likely to struggle through the process, especially if they are in crisis.[12]

39.   The ESA applications are long, complex, and confusing which makes it exceedingly difficult for people living with SMI to complete it[13]. Being found wrongly ineligible has caused deaths by suicide. The PIP eligibility criteria are far too narrow, not adequately assessing the mental health barriers, instead focusing more on physical health barriers which may not be as relevant for people living with SMI. These processes are not fit for purpose and often leave many people living with SMI to face financial hardships and unfortunately has been linked with many deaths by suicide[14].

40.   The Work Capability Assessment (WCA) assesses to what extent a claimant’s SMI affects their ability to work and this determines the amount of UC or ESA they receive. WCAs have been found to be a major source of distress for many claimants living with SMI because of how humiliating and confusing the assessments can be and the experience of receiving an incorrect decision[15]. From 2010-2013, WCA reassessments were associated with an additional 590 suicides, an additional 279,000 cases of self-reported mental health problems, and an additional 725 anti-depressant prescriptions[16].

41.   We recommend that the UC, PIP, ESA, and WCA processes are re-designed with EbEs, in order to make them fit for purpose and safe for all individuals living with SMI.

Unsuitable assessors and general staff:

42.   Our EbEs have frequently told us about how the DWP staff often lack a proper understanding of SMI and disability in general, and staff do not understand the impact that they can have on claimants. Support workers who are meant to support claimants during applications/ assessments are essential. Our EbEs and experts by training (i.e., Mental Health and Money Advice advisors) often experience and hear about support workers being treated unprofessionally and dismissed by the assessors/DWP staff. An example from an EbE is below.

1. “When I did the re-assessment (WCA), my support worker was with me and was told to shut up. I have autism – I didn’t feel safe, I didn’t know them. I stared at the floor the whole time I was doing the assessment. The support worker should be there to prompt us because when we shut down, we will give monosyllabic responses. If your help is told to shut up and not say anything, what’s the point of them?!.”

To add to this experience, the assessor wrote in the assessment notes that the claimant “gave great eye contact,” even though he froze from the stress and could not even look at the assessor during the assessment.

43.   Benefit claimants living with SMI say that DWP staff view their SMI as if living with it is a choice, but as one of our EbEs said: “the truth of the matter is, we don’t get a choice to have this disability.” This incorrect view on SMI lends itself to claimants being seen as the harmful stereotype of lazy, fraudulent benefit claimants rather than people who are too unwell to work and require financial support. Another EbE said: “you’re treated guilty the moment you sit down!.”

44.   We recommend that all individuals living with SMI must to be supported/assessed by DWP staff and contractors that have specialised knowledge and skills in SMI.

Q3(a). How effective is the Universal Credit “Help to Claim” service at supporting vulnerable claimants to register a claim?

45.   We asked EbEs if they had accessed UC Help to Claim and if so, how effective it was. All reported that they had not heard of or accessed UC Help to Claim so could not comment on the effectiveness of it. However, this does suggest that the way it is promoted, and the way people are signposted to it is ineffective. Additionally, many people living with SMI do not access UC, but access ESA and PIP. All claimants should be supported by a quality service during the claims process, not just UC claimants.

46.   We recommend that the UC “Help to Claim” service is better signposted and that similar support services exist for other benefit claimants that are not receiving of UC.

Q3(b). What should DWP do to improve support for vulnerable people to make a claim and to ensure they do not delay making a claim?

47.   We recommend the DWP implement the following measures, to improve the support for people living with SMI when making benefit claims and prevent unnecessary delays:

1. Implement a statutory duty of care: establish a robust duty of care that prioritises the safeguarding of vulnerable claimants and considering the complexities of different vulnerabilities, such as SMI during all stages of making a claim. This includes a clear process for redressing any harms caused in the application or assessment process.
2. Introduce specialised assessors: employ and retain empathetic, knowledgeable, and skilled assessors who have a professional understanding of SMI (i.e., mental health professionals). If they are not assessed by a specialised assessor then the risk of the incorrect decision being made increased, which would likely result in harm. This is why mandatory SMI specialised assessors for people with SMI should be enforced. One EbE stated: “What people don’t realise about depression is that it can blindside you. You do not have to be crying all the rime. They haven’t got a clue. The biggest thing they need to learn is empathy and to hire people who understand and care.” The assessors should facilitate easy access to quality support workers who can guide and support claimants through the application and assessment processes.
3. Enable better access to support workers: Applicants/claimants must have easy, optional access to support workers, who can support them through the application process. An EbE recommended “It would be great to have someone there to fill the forms and support at each stage of the process” but that “it should ultimately be the choice of the claimant.” The support workers need to be respected by DWP staff and contractors. Due to the negative experiences that claimants living with SMI have had with the DWP, they prefer to bring their own independent support worker with them rather than have a DWP support worker.
4. Re-design the benefit claim processes and the WCA: collaborate with EbEs and experts by training (MHMA[17]) to re-design the processes for PIP, ESA, and UC. Their insights will help make these processes more inclusive, simpler, and less distressing for claimants living with SMI. Similarly, the DWP should replace the WCA with a novel approach that has been designed with the voice of lived experience. This new approach should comprehensively assess how claimants’ SMI impacts their ability to work and determine the appropriate financial support they require as a result.

Preventing harm

Q4. What measures does DWP currently implement to ensure that vulnerable claimants are safeguarded against harm? How successful are these measures?

48.   It is extremely difficult to assess how successful the DWP are in safeguarding vulnerable claimants against harm due to their being a lack of transparency and data regarding the exact measures they take. Our EbEs and experts by training tell us about frequent failings, such as getting their benefits abolished without reason nor explanation, receiving letters incorrectly accusing them of fraud, staff mistreating them in a demeaning and stigmatising manner. There are more that we likely do not hear about and are not being addressed. The claimants and families we have spoken to feel that DWP do not want to safeguard claimants living with SMI and that the lack of concern and empathy has resulted in fear and complete distrust in the benefits system. The safeguarding guidance provided through Freedom of Information requests shows a lack of process and detail on what staff should or should not do when interacting with a claimant living with SMI/complex needs[18]. It seems to only be treated as guidance.

49.   We know there are cases where safeguarding measures had been initially taken but not followed through, leading to tragic consequences. One of the family members of a claimant who died by suicide because of the DWP’s actions, spoke about how DWP staff put red flags in the claimant’s case files but did not act upon them.

1. “Why put red flags on someone’s case files then ignore them?”

50.   A considerable number of EbEs report that they commonly receive written communication from DWP that is phrased in a way that they find extremely intimidating and threatening, and this causes a lot of anxiety and stress. The tone of the letters indicates a dismissal towards claimant wellbeing. When claimants who are already in crisis, receive this kind of letter which requires immediate actions over the weekend, then it can quickly escalate and result in serious harm or death.

1. “You've got 48 hours to stew on [the letter] before you can get hold of anyone…[DWP] wouldn't send those letters out deliberately to arrive at the time if [DWP] cared or protected wellbeing of people."

51.   Claimants become stressed because they have no one to advise them with their letter, as benefits support services are closed over the weekend. One EbE described the experience of getting his PIP abolished without any explanation through a letter. This decision made it difficult for him to afford his essentials and resulted in him attempting to take his own life.

1. “I would pay my bills, not have any money left to eat with. People noticed that I was looking rather pale and ill, and I’d lost a lot of weight during those 8 months that I was not in receipt of PIP. I had a suicide attempt in August because of the stress of all of this.”

52.   The DWP reinstated this person’s PIP after 8 months, but the DWP did not assume any accountability for what had happened to this person and did not show empathy for the pain that they caused them.

1. “No reflection at all about the impact this was having on me and my carers, and everybody around me!”

53.   The safeguarding measures that may exist are not successful in preventing harm in the DWP. Cases of serious harm and deaths will continue if these safeguarding issues are not properly resolved. We recommend that appropriate safeguarding measures are designed with EbEs and experts by training.

Q5. Does DWP have an adequate understanding of the vulnerable claimants that use the benefit system and the support they require?

54.   The DWP lacks adequate understanding of the vulnerable claimants that use the benefit system and do not understand the support they require. The system was not built to consider the unique needs of people living with SMI or other disabilities. Claimants living with SMI frequently feel misunderstood and stigmatised by the DWP. A clear example of this is when an individual was deemed ineligible for PIP because the assessor stated that “the client wasn’t trembling” or “wasn’t rocking backwards and forewords.” These are harmful stereotypes about mental illness and demonstrates the assessor’s complete lack of understanding of SMI.

55.   We recommend that the DWP conducts a thorough and transparent review of their current processes regarding the support given to vulnerable claimants, by DWP and their contractors. To understand and address the issues that people living with SMI face in the benefits system, the DWP must adequately engage with advocacy groups, mental health professionals, and principally – the claimants. Importantly, there must be a statutory duty of care in place to ensure that staff follow the improved policies and processes.

Q5(a) Does DWP do enough to monitor the wellbeing of vulnerable claimants?

56.   Our EbEs have not reported any instances where their wellbeing was monitored by the DWP. This suggests that while procedures might exist on paper, they may not be effectively implemented or comprehensive enough. This stresses the need for a statutory duty of care.

57.   Engagement needs to be done with EbEs to see in if and how wellbeing could be monitored. Many EbEs do not trust or believe that wellbeing monitoring conducted by the DWP would be done with good intentions. One of the fears they have is that if they are asked by the DWP how they are feeling and they are in a good place for the moment, then the DWP will pressure them back into work or work preparation. They fear that DWP’s lack of understanding of fluctuating conditions will impact their benefits.

58.   We recommend the DWP to collaborate with the claimants’ clinical teams, social care services, carers, and other relevant stakeholders when determining the claimants’ wellbeing. Information shared between the organisations can help determine the claimants’ wellbeing. Claimants must not be placed in the position to recount potentially traumatic events when the information is easily accessible elsewhere. All information needs to be considered before the DWP can make life-impacting decisions on their benefits.

Q5(b) Does DWP have sufficient processes in place to ensure that benefits are not withdrawn from vulnerable claimants when there is a risk that this will cause serious harm to the claimant?

59.   As shown in the case study used in the Q4 answer, inappropriate benefits withdrawal causes severe financial difficulties for claimants living with SMI. The DWP has not publicly provided information on processes that ensure that benefits are not reduced or abolished from claimants living with SMI. Due to lack of transparency from the DWP, it is not possible to comment on any potentially existing processes, however it is evident that there is a lack of safeguarding as multiple deaths and cases serious harm are linked to the withdrawal of benefits[19]. We recommend DWP to share its process on preventing benefits withdrawal from vulnerable claimants, and to take onboard recommendations for improvement from the VCSE sector and experts by experience, if necessary.

60.   A family member of a claimant, who died by suicide when his ESA was cut, expects that suicides due to the DWP’s (in)actions will continue to happen. She is urging for adequate processes to be implemented to prevent harm from happening to more claimants and their families.

1. “We can’t get our loved ones back, but how many other people are now sat feeling the way that they were feeling because of this ongoing issue. It is going to keep happening because they’re made to feel worthless.”

Benefit Sanctions:

61.   Multiple studies have consistently evidenced that conditionality and sanctions on benefits causes adverse mental health effects on claimants; and the stricter the regime is, the worse mental health outcomes in claimants[20]. For example, a 2019 research study looking at Jobseeker’s Allowance (JSA) sanctions showed that “every 10 additional sanctions are associated with 4.57 additional antidepressant prescribing items, which translates to approximately one additional person receiving treatment”[21]. Sanctions reinforce fears about the DWP, worsens mental health, and overall, they significantly reduce claimants’ quality of life.

1. “I am scared to death that they will stop giving me my benefits and I’ll have next to no money to live on.”

62.   The Work and Pensions Committee stated that “until Government can show unequivocally that sanctions actually help to move these claimants into work, it cannot ‘justify these groups' [people with a disability or health condition] continued inclusion in the sanctions regime'”.[22] In 2019, The DWP commissioned a research report on the effectiveness of benefit sanctions. The findings show that sanctions reduce the time someone is on UC, but:

1. Exit rates into non-PAYE employment or economic inactivity increases,
2. Exit rates into PAYE employment decrease,
3. Working people to shift towards lower-paying jobs.[23]

63.   In the short-term, we recommend that the DWP must quickly introduce a temporary legal easement of sanctions for all benefit claimants living with SMI and during a mental health crisis (e.g., receiving treatment in hospital or community)[24]. Before the DWP makes the decision, they must contact the claimant, the claimants’ clinical teams, their social care services, and carers. The DWP must discuss the reason they might reduce/abolish their benefits and needs to determine whether claimants are in crisis. Worrying about finances causes and worsens symptoms of SMI, but this safety net would grant respite when it is most difficult for claimants living with SMI.

64.   In the long-term, the DWP must abolish all conditionality and sanctions on claimants living with SMI and other disabilities/long-term conditions.

Q6. How successfully does DWP work with external agencies (such as the NHS) to ensure that important information is shared between organisations?

65.   The DWP do not openly and clearly disclose the process in which they consult with external agencies, nor the success rate of these engagements. There are many cases of serious harm that do not get reported to the DWP because of a lack of awareness about the process and lack of trust in the department. We are also not aware of any adequate process for professionals outside the DWP who support claimants (i.e., clinicians, social workers) to report suspected incidents of serious harm. Unfortunately, instances of failure to engage with external agencies have had devastating consequences, as exemplified by the cases of Phillippa Day and Errol Graham.

1. Philippa Day passed away from an overdose in August 2019. She had a previous diagnosis of borderline personality disorder (BPD). Her income had gone down from £228 to £60 a week (PIP payments[25]). Her case had been managed by Capita (a business provider contracted by the DWP). An inquiry found that the way her assessment claim was dealt with was a ‘predominant factor’ in her overdose. According to the family’s lawyers, the DWP had written her a letter where the department stated that it refused to undertake a home assessment. Day had also sought representation from her ‘trusted community psychiatric nurse’[26]. Her family’s lawyer further claims that: “a call by her community psychiatric nurse to a DWP call handler had agreed that the assessment should not happen, and another appointment was arranged simply to keep her place in the system’’. During the inquiry around her death, a court was told that Ms Day had called the DWP to state that she was ‘starving’ and ‘couldn’t survive like this for much longer.’ However, Ms Day was met by alleged ‘cold’ Capita contractors who did not listen to her cries for help. An FOI by the BBC showed that since the case and in response to Regulation 28 (Prevention of Future Death) 7000 staff had received mental health training by June 2021. Since the inquiry, the family have settled outside of court. Read the full BBC article here[27]. 
2. Errol Graham passed away in 2018, eight months after having his ESA withdrawn. Graham had long-term severe mental health difficulties and a review into his death asserted that he could have received better support if agencies had communicated better. Graham weighed 30 kg at the time of his passing. Safeguarding concerns over Graham’s well-being seemed to fall between the cracks of Nottingham Council, his housing association, and the DWP. The independent safeguarding review into his death affirmed that: “multiple failings by the Department for Work and Pensions (DWP), his GP practice, and social landlord meant that chances to save him were missed’’[28]. Over the previous months, Graham’s electricity and heating had been cut off. Graham’s housing benefit had also been stopped after he failed to attend an assessment and to provide repeated requests for information as part of a review of his ESA. The review notes that the DWP and Nottingham City Homes failed to understand why Graham did not respond to letters, texts, and home visits and therefore did not grasp the extent of his vulnerability when they left him without any financial support. Graham’s daughter-in-law stated that: “DWP must accept a legal duty of care to prevent vulnerable claimants from slipping through the safety net’’[29]. 

66.   To improve collaboration and effectiveness between the DWP and external agencies like the NHS, we recommend that the DWP adopt a statutory duty of care. We recommend the DWP implement and reinforce a person-centred and holistic framework when making decisions about claimants’ benefits. This method must involve consistent collaboration with multiple stakeholders including but not limited to:

1. The claimants themselves (and their support workers, if applicable) to understand their complex needs and circumstances,
2. The claimants’ clinical teams within the NHS or elsewhere to gather their medical insight,
3. Other social care services involved in the claimants’ network (e.g., supported housing), and
4. The claimants’ carers or family members who can provide valuable insights into their wellbeing.

Q6(a). Is there a framework in place that enables DWP to review the effectiveness of its cross-agency communication and collaboration?

67.   There is a lack of public information available regarding whether the DWP has a formal framework in place to review the effectiveness of its cross-agency communication and collaboration.

68.   We recommend that if such framework exists, the DWP must publicly disclose the details of the framework. However, if this framework does not yet exist, then they must establish one that assesses the impact of collaborative efforts with external agencies, identify areas for improvement, and ensure that lessons learned are shared and implemented to improve service delivery.

Q7. Is DWP’s staff guidance for dealing with vulnerable claimants, including the Universal Credit Six Point Plan Framework, adequate?

69.   The DWP’s staff guidance for caring for vulnerable claimants, such as the Universal Credit Six Point Plan Framework, raises significant concerns about its appropriateness and adequacy in safeguarding. While the framework exists, it seems to be often overlooked or not consistently implemented by staff. This underscores the urgent need for a duty of care to safeguard within the DWP. Our EbEs state that staff, especially call handlers and assessors, need to show genuine concern and empathy for claimants living with SMI. We have heard criticism from EbEs that when a claimant is suicidal, staff are only interested in protecting themselves and their jobs rather than listening empathetically to the claimant. One of our EbEs told us about their negative experience in a PIP assessment session when speaking about suicidal ideation.

1. “I was talking about suicidal thoughts during one session. The judge at one point couldn’t understand if I had ideas of suicide, then why hadn’t I attempted to kill myself.”

70.   We recommend that all DWP staff and their contractors complete comprehensive and continuous training on SMI and how to support claimants living with SMI.

71.   The framework lacks sufficient and empathetic questions that should be directed to the distressed claimant, to demonstrate empathy and understanding on the part of the staff. To start with, it might be useful to add these kinds of questions to the framework which include but are not limited to how they are feeling, if they have anyone with them, if they can call someone for help, and if there is anything they would like help with. Staff also need to say that they hear what they are saying and that they are taking it seriously. We can understand that the plan is wants to protect the staff members, however the wellbeing of the claimant is just as important.

72.   We recommend that the DWP redesigns this framework with EbEs and mental health professionals. Their insights would help create a more effective and empathetic approach to supporting vulnerable claimants. This could then lead to some co-produced training for DWP staff and their contractors in how to best manage such situations.

73.   Lastly, the framework focuses on what to do in the case that UC benefit claimants plan to take their own life. We recommend that the framework protects all benefit claimants, not only UC benefit claimants.

Reviewing failures in safeguarding

Q8. How successful is the IPR process at investigating allegations of case mishandling?

74.   The IPR process, aimed at investigating allegations of case mishandling, is ambiguous as the DWP do not share sufficient information about the IPR process. While we welcome that the DWP began publishing basic data on IPRs in their DWP annual report and accounts 2022-2023[30], there is a lack of published guidance, official analysis of cases, trends and IPR recommendations and lessons learned. Benefit claimants and families are excluded from this process, and without their insight, the investigations are already fundamentally flawed. This lack of transparency leaves those claiming benefits, their families, and members of the public in the dark. This hinders accountability and prevents meaningful improvements.

75.   Furthermore, the DWP must apply a clear duty of candour within its IPR process. A duty of candour would require the DWP to be open and honest about any errors or mistakes made during case handling, ensuring that both the findings of IPRs and the subsequent actions taken are shared with the affected claimants and families, and the wider public. Such transparency is vital to prevent harm, build trust, and rectify mistakes.

Q8(a). Are the IPR criteria for accepting a case for review appropriate? How could the process for submitting a case for review be improved?

76.   The IPR criteria for accepting a case for review, which include cases of death, suicide, self-harm, attempted suicide, serious harm, and ‘other,’ appear reasonable but requires improvement. There is a significant concern regarding the ambiguity surrounding the definition of “serious harm”[31]. We recommend that the DWP must clarify the definition of this criterion and ensure that it includes situations where people face severe consequences from benefit withdrawals or reductions, such as destitution or exacerbation of SMI symptoms. Ensuring a comprehensive understanding of what constitutes “serious harm” will enable a more thorough review process that addresses a wider range of potential adverse outcomes for claimants. We also recommend the DWP to engage with EbEs to review the IPR criteria and process.

77.   At the moment, an IPR request can only be lodged from within the DWP. A staff member can fill out a form which will be sent to a designated team, who will decide whether the case should go through an entire IPR. There is no other public information about the process of submitting an IPR request and we believe that the public, particularly claimants and their families/carers, must have easy access to details on the full IPR process. We recommend the DWP to extend the power to submit IPR requests, to claimants and their carers. This would decrease the likelihood of cases not being detected and submitted by DWP staff and increase opportunities to learn from failures in the system.

Q9. Does DWP adequately implement lessons learned from IPRs to ensure that mistakes are not repeated and that the safeguarding process improves?

78.   The DWP does not publicly share the lessons learned from the IPRs, making it difficult to assess if they adequately implement these lessons. The continued existence of issues that have led to deaths and serious harm suggests that effective implementation of lessons learned has not happened. The DWP have stated that they cannot release data from IPRs because Section 123(1) of the Social Security Administration Act 1992 deems it to be an offense to share unauthorised, personal information of the claimant(s) in question. By not sharing information publicly, they cannot be held accountable for their failures and implement their learnings.

79.   Section 123(3) states that it is not an offense “to disclose information in the form of a summary or collection of information so framed as not to enable information related to any particular person to be ascertained from it; or to disclose information which has previously been disclosed to the public with lawful authority”. As Section 123(3) suggests that information can be shared in a way that protects the claimant’s data (i.e., anonymisation, pseudonymisation), we are recommending the DWP to release monthly qualitative and quantitative data[32] that display anonymous data regarding,

1. All IPR requests: what went wrong, the impact on the claimant, characteristic of claimant (i.e., SMI, musculoskeletal, etc).
2. All IPR outcomes: lessons learned, actions to prevent issues from reoccurring.

80.   In combination with implementing a statutory duty of care to safeguard vulnerable claimants, publishing data from IPRs would make it possible to hold DWP accountable for their safeguarding failures and to prevent failures from happening again.

Q9(a). Does DWP have effective processes in place to identify and address larger, systemic issues around safeguarding?

81.   As the DWP has not publicly shared whether they these processes in place and based on the mounting evidence that show DWP’s consistent disregard and mistreatment towards people living with SMI, it can be expected that are no effective processes in place for identifying and addressing larger, systemic issues. Throughout this written evidence, a consistent concern has been the absence of a structured and transparent approach in collecting, analysing, and publishing data associated to the safeguarding failures in the DWP. This omission of data conceals the actual extent of the deaths and harm caused by the DWP.

82.   The DWP must establish a mechanism that will identify and address systemic safeguarding issues, in collaboration with external stakeholders including the VCSE sector.

Q9(b). How effectively does this process communicate and share learnings with other bodies involved in case reviews such as Coroners and local Safeguarding Adults Boards?

83.   The effectiveness of the DWP’s process of communication with external agencies, such as Coroners and local Safeguarding Adults Boards has been a matter of concern. These external bodies play a critical role in investigating the cases of death or harm linked to DWP actions Yet information on the process in which these organisations communicate and work together is not readily accessible in the public[33].

84.   In the past, a significant issue has been the DWP’s failure to provide all the relevant documents/correspondence relating to a case, to these bodies[34]. This omission hindered the ability of the Coroners and Safeguarding Adult Boards to determine the true cause of death or harm and understand the underlying factors contributing to these tragic incidents. The lack of complete information not only hampers their investigations but also prevents meaningful lessons from being learned and impedes accountability for the DWP.

85.   We recommend that the DWP establishes a transparent process that facilitates information sharing between relevant external agencies in a timely manner, in order to aid investigations and reviews.

October 2023