Written evidence from Coventry Citizens Advice (HAB0014)

Coventry Citizens Advice (CCA) is a local charity which provides free, independent, impartial and confidential advice and guidance across a range of social welfare issues such as welfare benefits, debts, housing and employment.

In 2020-21 CCA supported 8,748 clients with nearly 29,000 issues; 3.3 issues per client on average. Of those issues 39% concerned either Universal Credit or other (mainly disability) benefits.

Enquiries about disability (and carers) benefits – predominantly, Personal Independence Payment, UC Limited Capability for Work, Attendance Allowance, Employment Support Allowance and Disability Living Allowance – are consistently the most common issues we see.

Our evidence below derives from our experiences of those cases over a number of years.

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Suitability of assessments

1.How could DWP improve the quality of assessments for health-related benefits?

The single most effective way to improve health assessments is to make them all paper-based (with an online application an alternative on request) with paid referrals to independent advice services for those that ask for them. Other forms of assessment could be offered if requested, in exceptional circumstances, by applicants.

If this is not to be considered, and multiple assessment formats are to be retained, the next most important improvement is to instruct assessors to provide provisional assessment scores (per question) to claimants at the end of each assessment; giving them the opportunity immediately to judge their next best steps (not, I hasten to add, as an excuse to argue with the assessor).

a. Have you seen any specific improvements in the process since the Committee last reported on PIP and ESA assessments, in 2018?

There have been a number of innovations but no marked improvements in the overall quality of the service. Indeed, as a result of the Government’s / DWP’s response to the pandemic, waiting times for assessments, challenges and appeals are all longer now that previously.

Avoiding delays in each of these phases is crucial for claimants but all available experience tells us that none are a priority for the DWP.

It is important to note that making improvements to non-paper based service delivery models, which are themselves flawed, is misdirecting energy and resources away from the primary problems; delays in assessments, delays in (appeal) decision-making, and inherent flaws in ‘in-person’ assessments.

 

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?

Don’t know.

3. Do the descriptors for PIP accurately assess functional impairment? If not, how should they be changed?

Descriptors such as these cannot ‘accurately assess functional impairment’ because there is no scoring system that can reflect such a thing accurately. Further differentiating clients by such black and white scoring between levels of ‘functional impairment’ compounds the original error.

Levels of / degree of impairment depends on time of the day, month of the year, the combined impacts of multiple conditions, the debilitating depth of a mental health condition and much more. Allowing non-specialist assessors to reduce a claimant’s entire life circumstances to a series of numbers is arbitrary and subjective in the extreme.

In the current flawed process the biggest flaws are the lack of emphasis given to whether claimants can perform listed tasks ‘safely, repeatedly, competently and in a timely manner’. These requirements are frequently ignored.

4. Do the descriptors for ESA accurately assess claimants’ ability to work? If not, how should they be changed?

See above. A particular flaw with this assessment is the inability to take into account the impact of mental health conditions on an ability to carry out seemingly simple physical tasks (repeatedly, safely, competently and in a timely manner).

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?

No assessment process is fool-proof but preventing these claimants from having to attend in-person ‘assessments’ is a major benefit of the paper-based process; for health, cost and logistical reasons.

In-person assessments compound and complicate an already difficult process, while giving the impression of being ‘customer-friendly’. Whether introduced in good faith or not they serve, in reality, as a significant discouragement to claimants claiming and a barrier them being successful.

It is ironic that in-person assessments are not deemed suitable for children or seniors because they are ‘too vulnerable’ whereas all those aged in-between, including those previous DLA claimants and soon-to-be AA claimants, are not considered too vulnerable even though their conditions are the same.

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?

The drawbacks from any paper-based system are two-fold: conceptual, and logistical. Conceptually, in such a subjective field it will be impossible to devise a ‘test’ which automatically determines an impartial and reasonable result; even if designed in good faith. Logistically, even where the ‘test’ is reasonable, if it is not offered promptly with an efficient and fair decision-challenge process it will, again, fail the claimant.

In the past, DLA was criticised for not delivering either conceptually or logistically. Despite improvements in the former, it failed claimants because insufficient investment was committed to making it work logistically.

If you cannot guarantee perfect decision-making then the next best promise is that assessments will be ‘cost-free’ to the claimant in terms of time, travel, cost and stress. Paper-based DLA assessments provided that. Telephone, video-call, health centre assessments and home visits did/do not.

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?

The value of input from clinicians, in our experience, varies hugely. Consequently, they cannot be trusted blindly to offer contributions that clarify an applicant's circumstances or conditions.

Primarily, many clinicians are either unwilling or unable to go beyond a strict description of a diagnosis which, in and of itself, is often insufficient to support a claim. Many require payment for their help. Many consider helpful, or timely, responses to requests for contributions a low enough priority to cause detriment to an applicant's claim. Many applicants, even those with long term debilitating health conditions, do not see a medical professional often enough for them to be able to offer insight.

As clinicians are also human beings they are not immune from unconscious bias, especially when referencing either seemingly minor health conditions or somewhat 'controversial' health conditions - ME being an example from the recent past where many clinicians flatly denied it was a legitimate health condition per se.

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

In our experience two reasons stand out. Firstly, evidence not included in the original assessment is included in the appeal. Secondly, claimants often have the benefit of a trained advocate working on their behalf (usually from an independent advice agency). The trained advocate is simply able to better articulate the impacts of the claimant’s health conditions than the client alone and, if necessary, point out the flaws in the DWP’s assessment decision.

Initial applications, especially when completed by the claimant, friend or relative, are often poor; both in terms of supporting evidence provided and in terms of the articulation of a claimant’s circumstances. The unwillingness of the DWP to set the claim start date at anything other than the date the form is submitted forces claimants to hurry their applications and militates against them seeking trained advice support before they submit. This works against them in the long run.

  1. What could DWP change earlier in the process to ensure that fewer cases go to appeal?

Make the claim start date the date the claimant requests an application form and offer them a paid referral to an independent advice agency to help them with their form.

Make the ‘mandatory reconsideration’ an in-house review of the decision, not merely a review of the decision process.

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)?

No. PIP and WCA health assessments are for different benefits, with different purposes and with different eligibility criteria. One is not, and should not be, connected to the other.

If they are combined, among the many detrimental consequences will be the reality that a decision error or an administrative error in one with adversely and unjustifiably affect entitlement to the other.

The single most effective way to improve health assessments is to make them all paper-based (with an online application an alternative on request) with paid referrals to independent advice services for those that ask for them.

If assessments became paper-based the PIP process, for example, would not require two application stages before an assessment occurs. A single stage process would be sufficient.

If the claim date was changed, and claimants were given more time to seek assistance, better completed forms would also result in fewer challenges and fewer appeals.

9. What are your views on the Department’s “Health Transformation Programme”? What changes would you like to see under the programme?

Don’t Know.

  1. (For people claiming) Would you like to be able to manage your benefit claim online?

Not to the exclusion of offline options for those who do not feel digitally confident or who struggle with digital access.

  1. 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?

 

Bringing assessments in-house would/should:

  1. Save considerable time, energy, cost and stress to claimants in not having to go through an in-person assessment (arranging / re-arranging / arguing about / preparing for / worrying about / etc).
  2. Prevent missed and mixed communications involved in working with the outsourced provider and communicating between the provider and the DWP – especially around supporting evidence issues and third party support.
  3. Ensure the DWP remained publicly accountable for the entire process. As this is not the situation now, if it led to an improved service it would increase trust in the process.

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?

See elsewhere. Innovations should not be measured against efficiency and expense targets over their contribution to effective decision-making.

Surveying claimants on leading questions, and then lauding the results, over whether and how new processes have been improved without asking whether they would prefer a different system altogether is disingenuous and not conducive to developing a claimant-friendly service.

Claimants are only pushing for improved ‘in-person’ processes because they have been led to assume there is no alternative.

  1. Is there a case for making some of the changes permanent?

No. Move to all ‘paper-based’ (including an online alternative) assessments unless a client specifically asks for an in-person assessment.

11. Most assessments for Industrial Injuries Disablement Benefit were suspended during the pandemic. What has been the impact on people trying to claim IIDB?

Don’t Know.

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?

We agree with the analysis but would add that the chaos of a national shutdown, and its impact on every household, exacerbated matters.

  1. How can the Department best help the third sector to support claimants in their applications?

Financially support third sector advice organisations to increase their capacity.

Work harder to relax the application of ‘third party consent’ rules to make it easier for accredited advice agency advisers to talk to DWP staff on behalf of their clients.

Invest in an easier to access benefit administration system. The biggest frustration of any benefits adviser is the inconsistent and time-consuming nature of communications with DWP staff – telephone delays, call-back failures, failures to share information, delays in decision-making, inability to access decision-makers and so on.

 

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?

See elsewhere - take the stress out of the process.

Earlier (protected) claim start dates.

Paper-based single stage applications.

Quick (time limited) decisions.

Timely decision challenge processes.

Referrals to independent advice agencies (funded to increase their capacity to take referrals).

Waits for assessments

14. What could the Department to do to shorten waits for health-related benefit assessments—especially for ESA/UC?

Establish a meaningful customer service standard for when these assessments should take place; and be held accountable for it. That standard should be based on what a reasonable waiting time is for a disabled claimant, not what a reasonable waiting time should be for a unit of public administration.

  1. 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?

It doesn’t - and no.

Policy development

16. How effectively does DWP work with local stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?

  1. What steps could the Department take to improve its engagement with stakeholders?

The DWP cannot work more effectively with stakeholders locally while there is no local flexibility in delivery and while the DWP take no responsibility for health assessments carried out by outsourced providers - the 'accountability gap' noted earlier. The DWP are not concerned with working productively with local stakeholders and have no infrastructure to do so. They are more concerned with being seen to work constructively with national stakeholders and lauding the positive experiences of the few claimants who have had them.

 

October 2021