Written evidence from the Association of Disabled Professionals (HAB0031)

 

Background

  1. The Association of Disabled Professionals (ADP) has been providing a peer support service for disabled professionals since 1971.  It is a national organisation where disabled people and people with long term health conditions can seek advice on employment training and vocational rehabilitation issues, as well as on issues associated with self-employment and entrepreneurship. Moreover, all of our Executive Committee and volunteers are disabled people. 

 

Executive Summary

The Association of Disabled Professionals welcome the opportunity to comment on the Work and Pensions enquiry on the effectiveness of PIP and ESA assessments. 

 

  1. Because of time constraints, our comments are mainly applicable to PIP assessments only.  We have also commented on the PIP process in its entirety, when these issues have a direct impact upon the claimant experience and the transparency of the process.  Nonetheless, although our comments are more limited than we would like, we are aware that many of the issues relating to PIP assessments also directly apply to the ESA assessment and process, through the issues raised by disabled people and people with long term health conditions, who approach the ADP Work Advice Service.

 

CLAIMANT EXPERIENCES

Difficulties with completing the application form to get to the assessment stage

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  5. The PIP application form is not accessible to everyone. As many people cannot write or find writing difficult and painful, they may have no option but to type out their answers.  Many others have to ask for support from someone else to complete the form, due to difficulties with reading, writing or indeed numerous complex health conditions or hidden impairments. 

Recommendation 1:  It would be particularly helpful if the PIP application form was also available in an accessible electronic format to overcome many of the barriers that disabled individuals face.  Indeed, as the form is scanned onto the system by the DWP, upon receipt, and the process from this point is all online, the availability of an accessible online form would seem to be an easily resolved barrier to the application process. 

Recommendation 2:  Although we appreciate that the ESA form is available for people to complete online, as the document is only available as an inaccessible pdf, Read Out Loud will only read the notes correctly, and the actual form itself (from pages 1 to 55) merely states blank whatever is actually on the screen.  This again creates significant barriers to completion for many individuals with visual or reading difficulties.

Correspondence and Deadlines

  1. Upon making initial contact for a claim form, a letter is sent out for a response within four weeks of the date of the letter. However, we are made repeatedly aware that in both PIP and ESA claims, the letter from the DWP (with the attached claim form) is dated at least one week prior to the letter being received by the client.  Indeed, in our experience, it is extremely rare for a letter to reach the claimant within five to seven working days of the letter being sent.  This results in claimants only having two weeks to gather all the information they need and arrange to complete the form, as well as return it to the DWP.  Considering that the PIP form consists of 33 pages that require a detailed response, and the ESA form of 55 pages, this is highly inappropriate.  Although we appreciate that the DWP allows claimants to call and ask for further time, if required, we believe that the inappropriate deadlines for a response are unrealistic and intimidating.  Indeed, we are often contacted by clients who are in significant distress and panicking that they cannot complete and return the form, as there is not enough time. 

Recommendation:  Deadlines for return of correspondence at all stages of the PIP process should be reasonable.  Claimants can only have a more realistic timeframe to gather information and complete the form (with support if necessary), by either:

 

Access to Assessment Centres /Telephone calls

  1. Assessment centres are based in cities and very large towns. Often, they do not have accessible parking or appropriate drop off facilities. This process causes stress to some clients because of the lack of access prior to their assessments.   Moreover, long journeys to assessment centres are detrimental to some clients pursuing PIP, as they are too tiring and stressful.  Whilst we know that assessors sometimes offer home visits, some clients would prefer to attend an assessment centre nearer to home, but have no choice other than to request a home visit, as they are unable to travel for any distance, due to significant pain or fatigue.  This is particularly evident amongst our clients who live in rural areas. During the pandemic the assessments were moved to telephone. This worked for some clients . Often the conversation lasted 1- 3 hours. Clients, who had a three hour call, after about 60 minutes was refused a break. HP ended the call at 90 minutes . The HP arranged another telephone appointment and this lasted 90 minutes too.

Recommendation: We would suggest that more flexibility is applied to venue choice and alternative community based venues should be considered, for example, using local health centres, rather than some of the inaccessible premises that are suggested.  And we suggest telephone assessments are timed for a  limited duration. Facetime/zoom/Teams meetings could be another way forward for some clients. 

Cancellation of Assessments on the day

  1. Some of our clients have reported attending an assessment centre only to be told that the assessment is cancelled. Some have waited for a telephone assessment call and not told they are cancelled   They are then often just sent a further appointment for an assessment, which can be given with little notice.

 

Recommendation:  If the PIP applicant find the assessment has been cancelled, an apology should be issued immediately.  Any rearranged assessment should be scheduled, with at least 28 days’ notice.  Allowances should also be given for hospital appointments already booked and getting more time off from work when an assessor cancels an assessment.   

 

CONTRACTOR ASSESSORS

Expertise and Knowledge

  1. Often the Health Professional (HP) is not knowledgeable about the potential impact of impairments (and thus the application of the correct descriptors and appropriate PIP awards), particularly in relation to rare, hidden, fluctuating and mental health impairments.

 

Recommendation: We suggest that Assessment Providers should ensure that some of their HPs are appropriately trained to understand certain impairments, and their potential impact on assessing the PIP descriptors.    These HPs could then be allocated accordingly and hopefully fewer mistakes and errors would be made due to a total lack of understanding of the impact on day-to-day living.

 

Manner and format of questions posed by assessors during assessments

 

  1. Our clients have reported obvious instances where the HP has not read any of their application or supporting evidence, or worse still misrepresents/ignores what the applicant and other medical professionals have said during the assessment. The HP should not be totally reliant on clinicians’ information as often the clinician only confirms the impairment. The clinician often does not know what tasks the client can or cannot perform. This often results in applicants being subjected to a face to face/telephone assessment that involves very intense and persistent questioning. There have been telephone calls where the clients have been very distressed with the questioning that they were denied a break when requested.     

 

Recommendation:  We believe that HPs who are asked to conduct assessments should thoroughly read the application and any evidence provided. They should only ask appropriate questions confirming or otherwise what the client has said.  Additionally, applicants should be asked if they need a break should the assessment be over 20 minutes in length, or if they state that they need to have a break due to fatigue, pain or anxiety. 

 

  1. Our clients find assessments very confusing as questions seem to be randomly asked during the interview, rather than following any logical order or pattern.  This has been described by some of our PIP clients as akin to ‘… deliberately trying to confuse you so that they don’t have to give you PIP, even if you are entitled to it!’.  This can result in situations where although a claimant has printed off their application and information to assist them during the face to face assessment, they are unable to use the information they have prepared to support them.  It can also cause significant additional stress to the individual, who is likely to already be anxious about the assessment in the first place, and as such is likely to be relying on the prepared information as a memory aid.

 

Recommendation:  The assessment should include questions based on, and in the same order as, the descriptors/questions on the application form, rather than seemingly currently at random.

 

  1. The PIP questionnaire does not pose questions about work-related tasks, but the HP often asks questions about work and volunteering roles, during the assessment. However, they often omit to ask about the barriers that people face at work, any specialist support provided in order that they are able to remain in work (such as reasonable adjustments provided at work by employers or the Access to Work Scheme), or indeed the number of hours worked.  This is particularly disheartening for many applicants as the fact that they can undertake work appears to be used as a reason for refusing PIP.  This also appears to be entirely contradictory to the virtues and additional values of work proclaimed not only by Government themselves in “ the Disability Employment Gap” (as well as in other policy and guidance documents for numerous government departments), but also by others

 

Recommendation: Questions about work should not be permitted unless all aspects of impairment related issues are also noted.  Additionally, recognition should be given that many individuals are not afforded the same level of equipment and support at home, as they are at work, so they may require assistance from family and friends to carry out similar tasks at home. 

 

  1. Many clients tell us that they told the assessor that they were not feeling very well, during the  assessment, but this was not noted.  Indeed, many HPs record do not just omit this information, but there have been instances where the HP states that the client appears well despite the HP having been informed to the contrary.

 

Recommendation:  It is not possible to know how someone is feeling, purely by looking at them, particularly if you have no knowledge of the individual or the impact of their impairments.  If clients state that they are not well when they are called for assessment and when they are being assessed, this information should be recorded by the HP.  

 

  1. People have reported that they were afraid that if they refused to do an exercise, requested by the HP at the assessment, this would automatically disqualify them from any PIP claim.  Consequently, our clients have stated that they have attempted to carry out an activity, during an assessment, despite the fact that they are in severe pain or have a very good impairment related reason for not doing so. 

 

Recommendation:  At the beginning of a face to face assessment, applicants should be informed that if a requested exercise is going to cause them significant pain or discomfort, or there is another valid reason why they cannot carry out the exercise, they should inform the HP of the difficulty.  The HP should then make a note of the applicant’s difficulty and the reason stated by them for not undertaking the activity.

 

Accessibility of information recorded during an Assessment

 

  1. Hearing impaired people are sometimes at a disadvantage in assessments, as the HP is looking at and typing into the laptop .  Thus, they are often not directly facing the applicant, which can cause significant communication difficulties and frustration. 

 

Recommendation:  All HPs should be trained in the access barriers that disabled people face and should, as a minimum, have the necessary knowledge in how to reduce communication barriers with applicants.

 

  1. As the transcript of the assessment is not currently available to the PIP applicant, this gives an opportunity for the HP to amend the assessment between the interview and the submission to DWP decision makers.  Indeed, this may account for the number of our clients who have a totally different recollection of the assessments to that recorded by the HP and submitted to DWP decision makers.  It is also potentially the reason for the number of requests for mandatory reconsideration and appeal. 

 

Recommendation:  To avoid mistrust, we believe the transcript of the assessment should be passed to the client on completion of the face to face interview. The client should then be given the opportunity to correct at the interview. We recognise this action may not be accessible to some applicants, in which case, the assessment transcript should be read out to the applicant, again noting their comments.   

HPs should then provide applicants with a print out of the face-to-face assessment, after checking contents with the applicant and including any comments or amendments they make.

 

Because of apparent mistrust of HPs some clients have recorded the telephone assessment. The recording should be the norm for both HP and client , The information  can be transcribed to  paper as evidence to tribunal . This action could be used as further evidence but only of it is transcribed.  

 

We appreciate that there is currently the opportunity to request a recording of the assessment, but many of our clients have had difficulties in relation to being required to provide 2 tape recorders so that one can be left with the assessor and one goes with the client.  Therefore, if a recording of the assessment is refused, or is entirely impracticable, a transcript of the information submitted should be read out to and printed off for the applicant (as above). 

 

A mobile telephone recording should be permitted  for both the HP and client this action may  be used  as  part of the evidence for the decision maker.    

 

MANDATORY RECONSIDERATION

  1. We do not think Mandatory Reconsideration is working well.  We have evidence that the number of clients needing to request Mandatory Reconsideration is increasing, and that at least 50% clients are rejected at this stage, despite clear evidence from professionals and the claimant that they meet the descriptors. We suggest that this is the reason why they then go on to be successful at appeal.

 

Recommendation:  We believe that requests for Mandatory Reconsideration would reduce if the measures detailed in the above paragraphs were implemented.  We also believe that the increasing requests for appeal tribunals may be avoided if the Mandatory Reconsideration process was independent of the PIP team at the DWP. 

 

 

CONCLUSION

In conclusion, we fear that the current PIP and ESA Work Capability assessment process is not fit for purpose.  We believe that the only way forward is to coproduce and implement a new system, with support from disabled people and people with long term health conditions and their user led organisations.  It is only in this way that the assessment process will fairly and accurately reflect the support needs that disabled people and people with long term health conditions have in relation to daily living tasks and their mobility.

ESA and PIP are very different benefits. We believe health assessments need to be tailored for the purpose for which they designed. Clinical information should only be used to confirm the medical impairment. Medical practitioners do not live with patients and often do not know what if any tasks they can undertake.

 

November 2021