Written evidence from the Grand Union Housing Group (HAB0033)

Grand Union Housing Group have been in business for over 25 years and provide 12,000 homes for more than 27,000 people across Bedfordshire, Buckinghamshire, Northamptonshire, and Hertfordshire. We’re a £75 million turnover social business with almost 400 staff.

Our mission is to build more homes, stronger communities, better lives. We build affordable homes, provide personal support and care, and help people to learn, work and be healthy.

We’re a financially stable and innovative not-for-profit organisation that believes in partnership and collaboration. We plan to build 2,160 more new homes in the coming years to play our part in ending the housing crisis.

 

 

Suitability of assessments

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

In our experience home assessments are the most accurate, because it is only then that the assessor can really see how the person lives and deals with day to day life. We appreciate this comes with higher cost, but this is worth considering for ‘borderline’ cases.

Another approach could be to do away with assessments altogether though. A large amount of public money is spent on assessments which can be viewed by claimants as demonstrating a level of distrust towards them and is a rather adversarial process. Money and staffing could be freed up for the NHS, and greater reliance on the medical opinion of the health care professionals involved in patient’s care could be utilised to determine whether someone is fit or unfit for work. 

One challenge for assessments is trying to gauge the level of disability/inability to work from a snapshot in time, especially where conditions are variable or worsened by exertion. We would recommend providing claimants with an optional symptom/function diary ahead of the appointment which they can provide to the assessor as evidence to consider. This could provide an excellent prompt to the assessor to find out more about why claimants had more difficulties on a certain day. Consideration needs to be given too, where relevant, to the fact that more activity (such as work) would exacerbate symptoms so presenting function may be better by not working and is not therefore reflective of their day to day ability while working.

In our experience questions are repeated during assessments that are already answered on the PIP2/UC50, especially telephone assessments. Greater work needs to be done to personalise the assessment, to demonstrate knowledge of the customer and their health conditions before it starts.

There appears to be a lack of understanding of mental health among many assessors. More needs to be done to match assessor’s knowledge to issues. Each assessment centre should have champions in specific groups of illnesses/conditions, e.g. a mental health champion, autistic spectrum champion etc.

Not just for remote assessments but face-to-face too: greater leeway given to non-attendance of appointments as this is usually due to health. For example, the assessment provider could give the claimant 14 days to rebook an appointment. The overbooking of face-to-face assessments also needs to stop; it can be very distressing for claimants to be turned away after making the long journey to an assessment and having arranged to have support with them although we do recognise that sometimes this will be unavoidable due to sickness.

When prompting repeat assessments, we recommend you provide a copy of the original assessment report and decision to the claimant. Ask them to review whether it has gotten better or worse (like PIP reviews) but add an option to explain the claimant feels their function was worse in an area originally than stated by the HCP. It should be clear then where claimants are reporting worsening or unchanging conditions that a repeat assessment is not required unless it is deemed reasonably likely that change could have been expected. You could also consult more routinely with claimant’s own HCPs as to whether their health has changed and for better or worse.

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

No.

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?

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

There are several areas where we think this could be improved:

PIP Daily Living Activity 3: The wording on the PIP2 form could be improved by calling it “managing treatments and medication” and give more examples of types of treatment.

PIP Daily Living Activity 5: Award of points should be based on whether claimant has accidents resulting in needing to change clothes, like the Work Capability Assessment. This still has a significant impact on someone’s day even if they don’t need the help of another person to deal with it. The possibility of this happening is still very disabling.

PIP Daily Living Activity 6: In practical terms, inability to dress lower half is just as limiting to daily living as upper half even though inability to dress upper half suggests a higher level of restriction. Descriptors d and e should be combined into one descriptor scoring 4 points.

PIP Daily Living Activity 8: This activity needs to have another descriptor to reflect someone who needs assistance to open and read letters, e.g. where prompting is not enough. This activity also needs to cover writing as communication is two way.

PIP Daily Living Activity 9: 2 points for prompting does not reflect how limiting this is, we would recommend awarding 2 points for prompting some of the time and 4 points for prompting most of the time. This activity also needs to reflect a claimant’s need for assistance or prompting to behave appropriately.

Generally, supervision element is missing from many PIP activities.

PIP Daily Living Activity 10: descriptor b needs to be expanded, or a new descriptor added, to reflect inability to control spending. Some claimants are capable of simple budgeting decisions and can calculate budgeting and paying bills but will also spend uncontrollably, e.g. learning disabilities, bipolar disorder, or addictions (including unacknowledged addictions).

We would also recommend adding an eleventh activity around managing the home. This would be about chores precisely, but it should reflect managing cleanliness of the home, hoarding and whether there is an impact on neighbours or other household members. This should of course be linked to a medical condition and not due to personal choice.

PIP Mobility Activity 1: Needing prompting to undertake any journey is more limiting than 4 points reflects. We recommend it could be broken down into prompting and support/accompaniment as separate descriptors with latter scoring more points. The descriptors around anxiety should also refer to dealing with unexpected events/changes or assessed including on that basis.

PIP Mobility Activity 2: Distances are too low. Only being able to walk 50m still indicates a high level of restriction yet doesn’t not qualify for PIP HRMC; comparably if does qualify for LCWRA. Distances are poorly understood by customers, and assessments tend to ask about length of time rather than distance which leads to confusion and a lack of transparency. As mentioned in an earlier question, in our experience ability to drive often equated to walking ability but this is not accurate.

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

There are several areas where we think this could be improved:

WCA Physical Activity 1: The UC50 needs to directly ask about using a wheelchair and whether upper limb problems prevent this. Sometimes a claimant will be unable to walk the specified distance but will be said to be able to use a wheelchair without proper consideration of their upper limb problems and without them having been prompted to mention this.

WCA Physical Activity 2: We would recommend re-wording this to remaining at a workstation, for example, can claimant stay in a location, chair or standing or combination to concentrate (with respect to pain) on a task for 30 minutes/60 minutes. Reclining on a sofa can be used as evidence a claimant can remain at a workstation but reclining on a sofa is not equivalent to standing at a supermarket checkout or even sitting on a desk chair. Changing this activity to specifically reflect work settings should help clarify the activity’s purpose.

WCA Physical Activity 3: The descriptors need to be more relevant to working, for example reaching into a cupboard to put in remove something, not just reaching.

WCA Physical Activity 4: Dexterity should reflect use of dominant hand. Furthermore, descriptors need to be reworded to reflect repeated action for a sustained period as this is more reflective of an actual working situation.

WCA Physical Activity 6: This activity needs to reflect inability to communicate urgent messages. For example, it would not be practical or desirable to write down ‘fire’ in an emergency. We recommend splitting speech and writing into separate descriptors so inability to do one scores points.

WCA Physical Activity 7: We recommend splitting sight and hearing into separate descriptors so inability to do one scores points.

WCA Mental Health Activity 12: We recommend awareness of hazards should also reflect self-harm, scoring 6 or 9 points depending on the frequency and/or severity of self-harm, and 15 points and LCWRA awarded if risk of, or recent attempt at, suicide.

WCA Mental Health Activity 13: This activity is key for those suffering with severe depression but the UC50 form does not go into enough detail to explain what is being looked for. We recommend expanding the supplementary information, or adding questions, around whether someone needs prompting to attend to personal care, household chores as well as whether they are frequently unable to complete tasks they start. Added to this as well, questions about whether they take too long due to lack of motivation or conversely obsessive compulsions.

WCA Mental Health Activity 17: We feel the definitions of occasionally and frequently are vague and it is not clear where the line is drawn and how. This makes it too subjective. Depending on the nature of the inappropriate behaviour, even occasional behaviour will be a barrier to work so points should reflect this better.

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?

These claimant groups are least suitable for assessments due to their age. In our experience, decision making is generally better with paper-based assessments and it is far less adversarial.

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 face-to-face assessment process is adversarial in its nature. We recognise it is intended to improve decision making by increasing the amount of information available to the decision maker, but unfortunately face-to-face assessments are all too frequently inaccurate resulting in misleading reports and bad decisions. DLA places a greater reliance on medical evidence and the word of the claimant, and this is a better approach. Where little medical evidence is available is the only time face-to-face assessments should regularly be used.

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?

Evidence from those involved in the claimant’s care is key to making the correct decision.

We would suggest the following evidence: Support plans, reports from consultants and directly asking HCPs for more information. Currently evidence of support workers can frequently be rejected yet is very relevant when determining a claimant’s typical day and their level of function. We also find in our experience HCPs are often reluctant to take evidence at assessment which reduces quality of decisions.

When assessing claimant’s PIP2/UC50 form, an HCP should highlight which areas the claimant appears to meet criteria by their own account, and specifically ask claimant’s HCPs to comment. Currently, a short form is sent which GPs frequently do not complete at all or very poorly – this could improve by focusing the questions on the key issues.

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

At a PIP appeal, there is a three-person panel – a qualified doctor and a disability expert who support the judge, a qualified legal practitioner, to arrive at a decision. The quality of decision making is much improved because those making the decisions are much higher qualified and better trained. ESA appeals don’t include a disability expert but there is still a qualified doctor to provide support to the judge to interpret medical information and make an informed decision.

In contrast, the decision-making process involves the claimant being seen by a medical professional of some capacity, who may have little or no experience with the medical complaints of the claimant. They do not make the decision, they just write a report, which reduces scrutiny. The decision lies with a clerical worker who likely has no medical or legal training, was not present at the assessment, has likely never seen or spoke to the claimant before and has to interpret a medical report which is full of stock phrases and frequently contain errors and misrepresentations. Although decision makers often phone the claimant at this stage, our impression is that this is only after the decision maker has formed an opinion as to what the decision will be, and only if the claimant points out something glaringly erroneous and is believed, might the decision be rectified at that stage. Furthermore, all too often medical evidence is not gathered or considered, whereas it is provided in the appeal process, thereby giving the tribunal panel a much greater understanding of the claimant’s condition and how it affects them.

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

It may be impractical financially to employ legal and medical experts to make every decision, but the disconnect between assessment and decision could be rectified, and greater effort to match medical complaints with relevantly trained medical professionals could be made. For example, decision makers could be present with medically trained assessors and come to a decision together. This coupled with more paper-based decisions utilising medical evidence could result in greater decision using similar resources.

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 (e.g. PIP and ESA)?

Combining the assessment processes would only be helpful for those making a claim for both benefits at the same time, which does happen, but it is not necessarily common. Whilst there are some shared criteria, there are also a lot of differences between activities on each assessment. Furthermore, given how frequent bad medical reports are, our concern would be that a claimant would wrongly fail both assessments due to one bad report, whereas now if they get one good report and one bad, they have at least secured some income.

There are certain trigger points from one assessment that could inform the other around shared activities. Also, the law could be changed to allow some ‘passporting’ – for example, an award of the enhanced rate of the daily living could passport a status of ‘limited capability for work-related activity’.

Information from one report could be used towards the decision of another claim, but this should be avoided where the claimant is disputing the decision and/or the quality of the report.

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

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

b. What would be the benefits and drawbacks of DWP bringing assessments “in house”, rather than contracting them to external organisations (Capita, Atos, and Maximus)? Would this help to increase trust in the process?

Referring to our above suggestion of eliminating the disconnect between assessment and decision, bringing the assessments in-house could enable this.

Due to many years of poor-quality reports resulting in bad decisions which severely impoverish vulnerable people, all these external organisations have very poor reputations among claimants and benefits advisors alike. That said, the reputation of the DWP can be said to be similar. However, bringing the process in-house and combining this with ensuring the assessment process is much improved could repair the reputation of the DWP to an extent, and therefore the 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?

The best method of assessment depends on the person and their conditions. A large reason why many claimants fail to attend physical assessments is it is so difficult for them to get there, either because of lack of money and/or lack of transport and/or lack of needed support. For example, someone with severe mobility issues or who struggles with interacting with others will typically find a phone assessment much easier to cope with. Remote appointments offer greater flexibility to the claimant and the assessors; the claimant does not have to travel to a faraway location and in most cases, it is much easier for them to be available at the specific time. Frequently claimants can be turned away from face-to-face assessments after arriving because of staff sickness or because too many appointments were booked, which can be very distressing to claimants who may be exacerbating physical conditions or battling mental health conditions to attend, only to have to do it all over again another day.

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

Based on the above, yes. As part of deciding whether an assessment is required, consideration should also be given to how best to conduct an assessment, with phone, video and face-to-face all being possible. Only if a physical examination is key to the decision should face-to-face assessments be required. Depending on how much physical examinations can be reduced, it may be practical to make most assessments in the claimant’s own home except perhaps in the most built-up areas.

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

a. Some IIDB claimants will receive a lower award than they might have, due to the suspension of assessments, because IIDB awards are linked to age. Should the Department compensate these claimants? How?

b. What lessons could the Department learn for how it deals with these claims in future, in the event of further disruption to normal services?

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 can access health-related benefits consistently?

In addition to the above, we believe it was also a perception that their claim would not get decided as assessments were suspended. Furthermore, as health services were directed to deal with the pandemic, other health services were suspended meaning patients stopped getting diagnoses and treatment for other conditions.

Third sector organisations such as ourselves had to change our approach at the start of the pandemic to avoid face-to-face contact, which limited access to services. Many vulnerable people rely on face-to-face contact for support which they could not get at that time. Completing applications for disability benefits with claimants was impractical during lockdown, as so much is lost by not being able to see the customer when filling out the initial form. The DWP needs to continue to ensure there is sufficient third sector support for claimants.

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

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?

Waits for assessments

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

As above, reduce face-to-face assessments and the need for assessments generally by using medical evidence. Lengthen awards/the time before reviews are conducted – this would significantly reduce the load on assessments.

a. 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 does not cover costs sufficiently at all. The assessment rate, and all benefit rates, need to be properly reviewed and updated to current day living costs. Due to the four-year benefit freeze, there is now no connection between the rate and actual real-life costs. We very frequently see customers who cannot afford just their basic costs on this rate, and this will only worsen this winter due to rising fuel and food prices.

The assessment rate is of course linked to the Jobseeker’s rate. The argument for the low rate on short-term claims may be that many claimants could bear this low income by putting off bills in expectation of getting a job and then being able to catch up. However, in reality this results in enduring debt for claimants unless they can find a very well paid job, and if they cannot find a job at all (either due to employability or sickness/disability), then they have little chance to recover from that debt which will keep worsening.

There is therefore absolutely a case for raising the basic rate of all benefits, but especially the amount paid for someone who is unable to work but is waiting for a DWP decision on this matter, either via ESA or Universal Credit.

Health assessments in the devolved administrations

15. The Scottish Government intends to introduce its own assessment process for the Adult Disability Payment, which will replace PIP in Scotland from 2022. What could DWP learn from the approach of the Scottish Government?

a. PIP started rolling out in Northern Ireland in 2016. Is there evidence that the Department learned from the experience of rolling out PIP in the rest of the UK?

Policy development

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

Our experience of working with the DWP is via local liaison meetings at regional level with Jobcentre Plus. Our experience of this varies per region, with some regions actively seeking engagement with stakeholders by arranging their own meetings, some attending third party meetings and others avoiding it altogether. More than anything we believe this comes down to the priorities of individual liaison managers.

We and other third sector organisations had for many years enjoyed regular meetings with the Beds & Herts region at the St. Albans office. These regular meetings allowed DWP to disseminate information, but also made time for third sector organisations to highlight trends of issues so that management could resolve this. Regretfully over time less space was left for the latter part of the agenda and then meetings eventually stopped pre-pandemic and were not resumed even virtually during the pandemic.

The relationships built through this process were very effective for dealing with complex issues on ESA (and other JCP benefit) cases. There were escalation lists at processing centres for use with cases that could not be resolved by the general enquiry which were vital. This has now been lost, except with Universal Credit, although the escalation lists are with Jobcentre sites and not processing centres, meaning the staff at the Jobcentre must act as liaisons themselves.

There has never been, to our knowledge, any such relationship with disability benefits such as PIP, or other parts of the DWP such as the Pension Service. This means that we are reduced to writing official complaints instead of just talking to an appropriate person to try to resolve issues, with issues often remaining unresolved.

To summarise, DWP has worked well with stakeholders in the past with Jobcentre Plus benefits but this has diminished, and the DWP simply does not work with stakeholders on an operational level for disability or pension-age benefits at all, and must improve this.

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

Reintroduce regular liaison meetings with customer representative groups and make sure there is a standard for them across the country. Extend these to disability and pension departments.

 

November 2021