Written evidence from Citizens Advice Nottingham (HAB0035)



The evidence submitted below is made by Citizens Advice Nottingham. It is a collation of feedback from volunteers who assist in benefit applications and challenging benefit decisions as well as paid staff.


Suitability of assessments


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


A key factor that would significantly improve the quality of the assessments would be for assessors to have a greater level of specialisation. This is especially true when assessing claimants with a mental health condition. Whilst physical conditions may be self-evident, mental health conditions are often more complex in their manifestation. Consequently,  an accurate assessment of the claimant demands that the assessor has the appropriate skill and knowledge to draw out information from the claimant and understand the niceties of the condition.


If health assessments were recorded by default this would ensure greater accountability on the part of the assessors. It would also ensure that they were conducting the assessments to the requisite level of skill and care. Currently the claimant has to ask in advance for any assessment to be recorded.


Whilst telephone appointments do offer a number of advantages to claimants, such as not requiring any travel, there is concern among advisers that telephone appointments result in a poorer quality assessment. Many claimants often report that they have felt pressured, especially with phone assessments, to answer questions as quickly as possible. This can mean that the claimant does not have the opportunity to fully explain how their condition impacts them and may feel pressured to provide the ‘right’ answer to the assessor to complete the phone call as soon as possible. Furthermore, telephone appointments remove the ability for the assessor to visually assess the claimant. Something which may be self-evident when seeing the claimant face to face may not be so when speaking on the telephone. This can of course be mitigated by appropriate questioning on the part of the assessor.


As a general point, evidence seems to be often disregarded by assessors. It appears that the assessors often replace submitted evidence with their own assumptions drawn from their conversation with claimants. This can lead to an erroneous understanding of how the claimant’s condition impacts them.



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


Generally, the main issue is not the descriptors themselves but rather that assessors are failing to correctly assess claimants against the criteria. This stems from a broader systemic issue, a distrust over the claimant’s reported conditions. This distrust leads to the disregarding of information supplied by the claimant when assessing them against the relevant criteria.  


However, in specific situations, the descriptors may fail to correctly capture the claimant’s condition. By way of illustration, Q12 of the PIP2 form ‘Making decisions about money’ may not be suitable for someone who has recently turned 17 years old; they may not have had to make financial/budgeting decisions before and therefore it is difficult to objectively state whether they fulfil any of the descriptors in this section. 


It would be beneficial to emphasise to claimant’s in the PIP2 form that the performance of any descriptor has to be done to a reliable and acceptable standard. Failure to make this evident could potentially have a significant impact on the accuracy of a claimant’s application. The impact may be especially clear for those that have a mental health condition, in the abstract they may have the required motor skills and range of movement to complete a task however in actuality, because of the impact of their condition, they cannot do it reliably and to an acceptable standard.


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


Some of the descriptors appear to be arbitrary. As an example one of the descriptors for Activity 1 on the ESA 50 forms asks whether the claimant is able to walk up two stairs. A claimant who is able to walk up three stairs but no more would not satisfy this descriptor. Within the context of a work environment the functional difference between someone who, because of their health condition, cannot walk up three stairs and someone who cannot walk up two stairs is arguably non-existent.


Other descriptors however suffer from being too broad in their scope and it can be difficult for claimants to understand specifically what the DWP are looking to assess. As an example, the way the questions are formulated for Activity 8 it is unclear whether this only relates to eye sight, as the heading suggests, or whether it includes other reasons for not being able to cross a road safely (as the third part of the questions seems to imply). This can be confusing for claimants not familiar with the descriptors.


The descriptors do not directly correspond with the questions on the ESA 50 form. This can lead to claimants over-estimating their abilities.


  1. 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?


It is clearly highly important that the DWP taking into account any formal medical documents provided by clinicians. Where a condition is adequately demonstrated through the supporting medical evidence, it seems redundant to require an assessment to confirm the clinician’s findings. This also brings the benefit of circumventing a potentially distressing assessment for the claimant.


Relying on a clinicians input without a separate assessment would be particularly beneficial where the claimant’s health conditions are either progressive or permanent. This is especially true in the context of re-assessments.



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


It is difficult to provide a response to this question due to lack of transparency of how the system operates. Anecdotally, it appears that the assessors do not take the same investigatory approach that tribunals take. Closed questions appear to be asked and the claimant’s answer is taken at face value without any further probing. This is unsatisfactory, especially where the claimant’s needs are more complex. 


Tribunals also  clearly apply the law and the point system, justifying their decision based on this. Mandatory Reconsideration notices in contrast do not seem to take this systematic approach. It is not clear what information has been used, what information has been discarded, and how the Decision Maker has reached their decision. Instead Mandatory Reconsideration notices seem to make categorical statements of what the claimant can perform with no explanation of how this conclusion was reached.


The best model for commissioning health assessments would be to provide penalties to providers for all cases and for all instances where the outcome of the assessment is challenged successfully at Tribunal. This would help stop Mandatory Reconsiderations being an administrative hurdle. 


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


As a general point, it appears that evidence is often disregarded by assessors. The assessors seem to often replace this evidence with their own assumptions drawn from their conversation with claimants.  By way of illustration, claimants can sometimes complete tasks when there is a specific and unusual impetus. On this basis some assessors conclude that the claimant is able to complete these tasks as a matter of fact. This approach is not only be erroneous, as it fails to correctly capture the fluctuating nature of health conditions, but is also contrary to the Tribunal’s own approach.  Therefore, a greater focus should be placed on examining evidence that is already provided rather than relying on the assessor’s assumptions. 


There appears to be an overriding distrust of the claimant’s own self-reported evidence. Whilst evidence from medical professionals is vital, it must be remembered that a GP or consultant gathers information for diagnostic or treatment purposes, this information is therefore binary i.e. the person has a condition or not. Health conditions and their impacts are not static, they can affect individuals in a diverse range of ways. What is true for one claimant may not be true for another. Therefore, assessors should rely on the claimant’s own evidence as this should provide greater clarity as to how their conditions impact them. 


Some claimants report that they have felt pressured, especially with phone assessments, to answer questions as quickly as possible. This can mean that the claimant does not have the opportunity to fully explain how their condition impacts them and may feel pressured to provide the ‘right’ answer to the assessor to complete the phone call as soon as possible. It must be remembered that disclosing health conditions and their impacts is often a highly intrusive process and can cause the claimant to feel extremely vulnerable. It is therefore highly important that they are both allowed enough time, and also made comfortable enough, to fully explain how their condition impacts them.   The assessor should also take steps to ensure that they fully investigate the client’s condition by asking probing follow-up questions rather than taking evidence at face value.


  1. 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)?


Combining the assessments processes could pose some potential risks to claimants. There is already a level of confusion between the different types of health-related benefits and pooling assessments together could exacerbate this confusion.


Additionally, the potential impacts of a faulty assessment would be significantly magnified and cause claimant’s to experience an even more extreme drop in income.


However, it could potentially be an improvement if the information gathered in one assessment was able to be accessed by a Decision Maker for the purposes of assessing entitlement to a different health-related benefit. As an example, both ESA and PIP look at the claimant’s mobility, any evidence supplied for one of these would clearly be relevant to the other. 


  1. (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)? In particular, would this help to increase trust in the process? The impact of the pandemic


There no particular advantage for assessments to be either contracted out or carried out by the DWP. Rather, as previously noted, if there was a greater level of transparency of how the information was used this would arguably mitigate the distrust of health assessments.


  1. 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?


It is clear that a single approach to accessing health-related benefits is not in the best interests of clients. Allowing claimants to access health-related benefits through a variety of channels is clearly a positive step forward. As an example, having an online PIP form that could be completed by advisers on behalf of claimants would be beneficial for claimants. Many claimants require the support of local charities for help completing the forms. Where advice is given over the telephone, which is increasingly common, this leads to volunteers/workers having to use their own templates to record answers and then claimants attaching these notes to largely blank PIP applications. Potentially this makes it harder for assessors to read, and consequently understand, as the PIP form as it is not one cohesive document. 


Additionally, the DWP previously provided in-house assistance in applying for health-related benefits. Re-instituting this service would clearly significantly improve access to health-related benefits. However, if this was to be introduced it would be vital that there is appropriate oversight to ensure that the service delivered is of sufficient quality and was in the best interest of the claimant.



  1. 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?


There are several adjustments that would arguably improve a claimants experience of  applying for PIP or ESA, these are:

  1. Recording health assessments by default. Claimant’s often feel that what was verbally reported during the assessment becomes misconstrued. Recording these assessments would add a level of accountability and, hopefully, ensure accurate reporting
  2. Requiring assessors to have an appropriate level of knowledge of the medical conditions the claimant has may help. This is especially true for those that have a mental health condition or a complex health condition. However, this could also cause further issues as the assessor may import their own biases and assumptions of how the condition impacts claimants
  3. Removing or extending the date for the award to end for those conditions which are permanent and unlikely to either improve or worsen. This creates an unnecessary stress for a claimant. Furthermore, the DWP often send reassessment documents several months before the benefit award is due to end. This means that, in actuality, the claimant begins the process of being re-assessed much earlier than the award would suggest. It must be noted that re-assessments are a positive factor where the claimant has a progressive condition but is not awarded the highest rate as this allows a review of whether their award should be adjusted in light of any changes in their condition
  4. Allowing benefit to be paid during the Mandatory Reconsideration stage where there is a previous award that is under review. This would remove the fear of health-related benefits being removed immediately after an assessment and allow the claimant to fully challenge the decision
  5. Ensuring that assessors take an investigatory approach, using open questions to ensure that they uncover relevant information and that the correct decision can be reached 
  6. As previously noted, the current system lacks transparency, the mechanism for how claims are decided is unclear. Arguably, when paired with intrusive and distressing assessment process, this exacerbates the levels of stress and distrust felt by the claimant. This would mitigated by Decision Makers substantiating benefit decisions with reference to the evidence considered so that the claimant is able to understand why the DWP reached the decision it did



November 2021