Written evidence from Mr John Sutton (HAB0015)


Personal Background

I am 62 years old and was medically retired from work in October 2017. I had been disabled and ill for many years and had undergone many Occupational Health (OH) assessments by qualified OH doctors, which finally resulted in being awarded a full Tier 1 Local Government Pension early. I was assessed by an independent, qualified Senior OH doctor, as being incapable of undertaking work of any kind for at least as long as it was until the UK Pension age, as according to the Department for Local Government regulations.


I applied for ESA and PIP for the first time in 2017. At the time of my applications I was mentally unwell due to stress and anxiety as well as being physically disabled via several conditions (so much so that the OH view was ‘permanently incapable of work of any kind’). It should be noted that I was awarded no points for the PIP ‘mental health’ section.


General Comments

The document file size I am allowed to submit for the Committee limits my contribution. There is much to say about the whole process, especially about the ESA and PIP descriptors/questions but I have to leave these unanswered. In simple terms it appears to me, from my personal experience, that the DWP is misleading applicants with unclear information and relying on 3rd Sector organisations to do their ‘information support’ job.


In my view the purpose of ESA and PIP is to get the legally available State financial resources to disabled and unwell people. The process should be simple to complete without undue stress and anxiety placed on the applicant. All genuine applicants are disabled and/or unwell in some manner (often multiple conditions). Many will have some form of compromised ability to complete application forms. Many will be of low education attainment and many will have mental health illnesses. A simple process that is biased towards believing the applicants statements should be in operation – my experience does not support this as the current process by the DWP.


Government statements, over the period of my contact with the DWP regarding these benefits are at best contradictory e.g. ‘we want to get support to those who need it’ and ‘too many people are receiving benefits’. This stance by the DWP and Government politicians give me no confidence about how my applications are being to be dealt with by the DWP. I ask myself, what is truly underpinning the assessment process, is it ‘we are here to help you get what is available for you’ or is it ‘our aim is to minimise the cost to the tax payer so we are not going to be as helpful as we could and make the whole application/assessment process vague, while also making it look easy on the surface’.


ESA and PIP Applications

One aspect of my overall disability is that I have weakness in my hands and gripping can be difficult resulting in poor hand writing, so I provided a 7,200 word MS Word document that gave all the information required by the ESA application form and a 4,400 word document for the PIP application form. Both documents provided detailed responses to the various questions contained within the two forms. I further provided a similar 2,400 word document for my PIP Review form.  All the documents were completed over many weeks due to concentration restraints and typing capability.


Stating that I had typed my information to complete the PIP Reassessment Information was cited by the DWP as one reason for no award being made. This was reversed by the Mandatory Reconsideration (MR).


The PIP Reassessment process was a farce. The form was about what changes had happened since the previous assessment. Very little had changed and what had was minor and negative to my overall health and disabilities. I did not anticipate a medical assessment and I did not expect a ‘no points’ award that followed. I wrote a 20 page supporting evidence document to go with the MR. The MR resulted in my pre-reassessment points being re-awarded. Something went badly wrong in the initial process for a broadly ‘no change’ situation to result in an unwarranted medical assessment and the subsequent ‘no points’ outcome. I wrote to my MP about this and the DWP reply was that they had done nothing wrong. In my opinion, both the medical assessor and the DWP caseworker were poorly suited to assess a PIP Review.


I completed my ESA and PIP forms with written assistance by several 3rd Sector organisations. The DWP suggest using 3rd Sector organisations to help complete the forms but I believe it should be the DWP’s responsibility to fully and clearly provide all the information along with detailed examples of the types of answers that are acceptable to them, e.g. in the ESA ‘Manual Dexterity’ question, it asks "Can you use either hand to: press a button, such as a telephone keypad, turn the pages of a book, pick up a £1 coin, use a pen or pencil, use a suitable keyboard or mouse?" – There is no reference to how long, how many, how often, over what period of time, the quality of writing etc. are required in each activity. No reference to the Reliably, Repeatedly and Safely statement by Lord Freud (see below).


An example from the PIP form is the ‘Managing therapy or monitoring a health condition’. In my PIP Review form I forgot (mental health I guess) to add the correct information so when I had the opportunity through the MR process I added that I had extensive previous Physiotherapy including ‘Managing Pain’ classes and that all the Physiotherapy outcomes required me to continue with home based therapies. Due to my various health conditions my wife assists me by monitoring my therapies and medications to the extent of ‘Needs supervision, prompting or assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week’.  I have never been awarded points for this section. No explanation has been given by the DWP for their decision. May be because my wife is the monitor and the therapies are not done at a clinic or hospital I am bared from a points. There are no clear notes as to what the DWP require as an acceptable answer for this question to be awarded points.


The application form, in my view, must say in their preambles what Welfare Reform Minister, Lord Freud, said in a statement to the House of Lords in “The assessment was designed to take account of chronic and fluctuating conditions. It is not intended to be a snapshot but looks at what someone can do reliably, repeatedly and safely.” – Reliably, Repeatedly and Safely. Questions, answers and the assessments must be with these things central to everyone – applicants and assessors.


ESA and PIP Medical Assessments – General

In my opinion neither ‘capability’ medical assessment are conducted or assessed by an appropriately qualified medical professional and DWP caseworkers.


ESA and PIP Medical Assessments

From my experience of three medical assessments (one for ESA and two for PIP) is that the medical assessors are not suitably qualified for the function they are engaged to undertake. For the ESA assessment I had already explained in the application that I had been medically retired assessed under a stringent government regulation (Local Government Pension Scheme, LGPS) and been assessed by specialist OH doctors whom had concluded that I met the highest tier for the LGPS (see point under Background).


One recommendation that I would make about the process is that if an applicant for ESA has already been assessed by specialist OH doctors about their fitness for work/work capability and evidence of this is provided with the application then there is no need for DWP officials to require any further medical assessor of a lower qualification, such as a nurse, a GP or other none OH specialist. To require a medical assessment is to both waste public money and risk assessment errors made by none specialist doctors (or other assessors). In my case I provided the DWP with the OH repots and the medical assessor with a copy of the specific LGPS regulations to aid her assessment; however I still had to answer the DWP’s questions she had been sent about me which were largely reiterations of questions I had already provided written answers to in my application. Nevertheless, I was required to provide verbal replies to her DWP questions. The process seemed complete madness to me and my wife (who is my carer) as we could not understand why the DWP was wasting public money on such a simple case to assess from a DWP office desk – Specialist OH doctors independently assess my health (capability for work) and confirm I was medically unfit for any kind of work under another Government department’s regulations – easy case – any competent DWP caseworker should have assessed my case without additional medical assessment.


While I expect that the nurse in question met the level of competence to be a nurse, I believe medical assessments must be done by people who are qualified in OH Medicine, such as those who had assessed me while I was at work and ultimately decided my incapability to work. Anything less than this standard is leaving incorrect assessments to be done (both ways) by poorly qualified health workers.


Specific Responses

  1. How could the DWP improve the quality of assessments for health-related benefits?
    1. Pay for medical reports from specialist OH doctors and therapists.
    2. Pay for in-depth, quality, GP reports.
    3. Pay Consultants and Registrars for quality in-depth medical reports on how the specific medical conditions affect patients/applicants.
    4. DWP caseworkers to accept the reports from HO doctors, GPs, Consultants etc. that are provided as supporting evidence without the need for further medical assessment. ‘Medical Professionals’ engaged by Capita et al are of a lower standard because these people are unlikely to be specialists in OH or the medical specialisms of the Consultants. (NB in my ESA case is was possible that a nurse could have provided ‘evidence’ to a caseworker that would have over-rule much more qualified OH doctors).
    5. Many (if not most) DWP officials are poorly suited to grasping the complexity of serious chronic medical conditions that often form part of a multi-complex medical condition application – DWP officials need to have a much deeper and wider understanding of the presentation of medical conditions.
    6. It is critical that DWP officials know what questions to ask a medical professional regarding a patient’s health. Simple “what’s wrong with ‘Mr Bloggs’” are not adequate for a GP, for example, to provide the fullest answers about their patient. Questions such as “how does Mr Bloggs’ medical conditions affect his daily life” are better. (The GP may need to have a consultation with the patient to talk over how the various medical conditions concerned affect the patient).
      1. A GP partner at my surgery told me that they don’t do reports for the DWP because the DWP do not pay for them. He went on to say that if they do receive a DWP request the questions asked are so basic that any answer he provided would not be adequate to help the DWP with the application.
    7. DWP to provide fully explained supporting information with the application forms, that have a range a detailed sample answers, rather than relying on 3rd Sector organisations that applicants widely do not use. Most questions imply that a simple ‘yes’, ‘no’ (or similar) answer is sufficient. This is not the case because most situations are significantly more complex than a short answer conveys. As I have already stated, I provided multiple and detailed answers to the questions that showed deeper and wider examples of what I could and could not do. These showed that my disabilities were wider and deeper than a simple answer could provide.
  2. ‘International Examples’: No comments
  3. ‘Descriptors’: There is so much to say about the application forms. Hopefully other evidence providers will cover these in detail. I do not have space to fully cover these in this submission.
  4. ‘Descriptors’: As above
  5. ‘DLA and Attendance Allowance’ No comments
  6. ‘DWP decision makers relying on clinical input alone’: If the DWP asked the clinicians the correct questions about the applicant it may lead to no need for a further assessment (and save some money).
    1. However, consultants and GP’s don’t, generally in my experience, provide the detail in a report about what their patients can and cannot do.
    2. Many disabilities and conditions (including the ones I have) are complex, have variable outcomes and generate inter-condition complexities (multiple conditions working together that produce effects on a patient) for a reliable and clear ‘what a person can do or not do’ report. For example, I am currently under the care (in one way or another) of four different consultants (Rheumatology, Urology, Bowel and General Surgery) as well as a variety of care via my GP. All of which have an impact on my disabilities and overall health when it comes to these DWP benefits. None of these highly skilled professionals has ever written (for me) such a detailed report that would lead a DWP official to be able make a positive benefit award for either ESA or PIP.
    3. Most consultants are specialist in only their area and do not generally know how any other condition a claimant has affects the whole person.
    4. It would be better if the DWP believed the applicant (who very often knows how their various conditions interact with each other for the purposes on the applications)!
    5. The ‘so called’ Medical Professionals engaged by Capita et al, also do not have the professional skills to assess complex medical condition relative to the application form questions (and answers).
  7. ‘Appeals’: One reason that 76% of tribunals favour claimants is that the whole process is done by poor quality DWP officials following poor quality medical professionals. Someone once said to me that “it’s the blind being led by the partially sighted”. When sensible people, who are independent, get to see and speak to claimants sensible outcomes are reached. I wonder if there is direct or indirect pressure on officials and medical assessors to fail or minimise awards to claimants. 76% success implies to me that there are many claimants (like me) who are too ill, too disabled, unable to produce a good submission or (like me) are just tired of the process and can’t take any more poor bureaucracy.
  8. ‘Combining Assessment’: It would be useful if the DWP actually referred to the medical assessment from (in my case) the ESA assessment when making the PIP decision. I was told by the DWP (PIP) that my successful ESA application was not read and was not relevant to my PIP assessment. In practical terms I would contend it is relevant because it should lead the DWP (PIP) caseworker to read the application in a manner that reflects the ESA positive outcome. To dismiss any official medical assessment is wasteful and could lead to poor DWP decisions.  However, I would add, a previous erroneous decision could lend inappropriate weight to the new application.
  9. ‘Health Transformation Programme’: I have browsed through the DWP document and it is waffle about improvements and it is code for taking financial support away from the disabled and those with chronic health conditions. It is also code for making the sick work in jobs that don’t exist within easy reach of their homes, in jobs they do not have the skills to achieve.


I am seriously concerned with the statement under Priority Outcome 4We have an ambitious strategy to do this which looks to move the balance from downstream detection to upstream prevention, including through initiatives such as improving and automating our verification processes and increasing the use of data analytic”. Catching the fraudster is more important than throwing out reasonable applications because of the use of algorithms (‘automating verification’ and ‘data analytic’). The DWP must remember that many applicants are unable (for a variety of reasons) to complete an application in the most effective manner. These people often have a mental health aspect to their overall medical health when making the application. Using algorithms (or whatever the DWP want to call the process) already throws out reasonable applications. To increase the quantity of this form of assessment process will make matters worse for sick and disabled people rather than better. It sounds to me like ‘less focus on fraud and more focus on eliminating claims at an early stage’.


    1. Would you like be able to managed your benefit claim on line.
      1. On line claims would be easier for some but not for others.
      2. Being able to correspond directly with the DWP would be better than through a mail sorting centre.
    2. What would be the benefits and drawbacks of DWP bringing assessments “in house”, rather than contracting them to external organisations…
      1. The whole process, forms, requirements, assessments, needs an overhaul.
      2. Bringing assessments ‘in house’ will just enlarge a civil service department with more people who fail to provide an excellent service. So called ‘medical professionals’ would be employed directly by the DWP, these would be the same people who are part of the current problem.
      3. It would, however, save some money by not paying profit making organisations.
      4. The starting point must be ‘how do we allow the disabled and sick easy access their legal entitlement’ and not one of ‘saving money’. There must be absolutely no policy, statements, or ethos in the Government or DWP that suggests that ‘there are too many people getting benefits’.
      5. In my view, no DWP official that holds a view that is anything other than one of helping the public get what they are legally entitled to should be part of the assessment process.
      6. May be the process of caseworker and medical assessment could be undertaken by a combined 3rd Sector organisation (as in the Disasters Emergency Committee) where charities work together for the best outcomes) funded by the DWP.
      7. Trust in any process is underpinned by a claimant having a view that the system is biased towards rather than against them. The fact that the appeal process has such a high percentage success rate shows that the system is not working for many. (I would add that I did not appeal my initial PIP award or my PIP Review Mandatory Reconsideration. This was based upon my state of health and not my case for an increase in points awarded. I have always felt I was fighting a poorly managed and assessed process by people who generally did not know what they were talking about. My health is more important than a few extra pounds per week.
      8. The Pandemic was clearly not helpful and slowed/stopped assessments or reassessments. It was helpful for the existing award to be rolled-on until an assessment could be done (even though when it happened it was a farce – see earlier).
      9. As with many responses by the Government, it is my view that the action taken on these benefits was too slow.


No further comments in this document



October 2021