Written evidence from the Royal National Institute of Blind People (RNIB) (HAB0052)

 

About RNIB

 

The Royal National Institute of Blind People (RNIB) is the UK’s leading sight loss charity and the largest community of blind and partially sighted people. RNIB has significant expertise in the provision of benefits advice and assistance to blind and partially sighted people. The following answers contain direct quotes from our service-users in response to the issues in question.

 

Suitability of assessments

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

 

1.1. Blind and partially sighted people report issues with the assessment process. In our recent survey, 51% of blind and partially sighted respondents said they did not feel the assessor was knowledgeable about sight loss, the issues they face, and the support they need to overcome barriers when they were medically assessed for a benefit. 

 

“In my ESA interview, he wanted me to touch my toes and do more physical activities - which didn't make sense as I'm visually impaired not physically impaired. Yes, I can touch my toes, but that doesn't mean I can use a bus on my own. When I was called in to see him initially, he called my name and walked off, so I didn't know where to go. When I figured out where the door was, because he'd already walked away, the door suddenly shut directly on my face.”

 

1.2. The DWP should ensure all assessors have specialist training to understand sight loss and the support blind and partially sighted people need. We also recommend introducing a specific team to carry out assessments.

 

1.3. Assessments should make best use of pre-existing evidence from the claimant’s own healthcare practitioners, and this evidence should be sought earlier by the assessors. This is particularly the case in relation to claimants who are registered and have certificates confirming significant sight loss.

 

1.4. Less weight must be placed on informal observations made by the assessor, particularly without giving the claimant the opportunity for redress. RNIB strongly maintains that unless an accessor is ophthalmologically qualified, they should not be assessing a claimant for sight loss.

 

“I lost points originally before my claim was reviewed because I was able to go into my handbag and take out my passport and other documents to show her. I had put the items in my bag, my passport had a brightly coloured cover and there was nothing else in my bag. The assessor stated that as I had been able to take forms out without any difficulty my eyesight wasn’t that bad. Throughout [the] interview I just felt as though she was trying to catch me out. It was a horrible experience.”

 

1.5. Appropriate data sharing of medical evidence should be introduced, subject to the required data protection safeguards, to streamline processes and save both claimants and the DWP time and trouble.

 

1.6. When making a claim many clients send no supporting evidence and presume the assessor will contact the GP, consultant or other professional whose contact details they have provided for this. DWP should make it clearer that claimants need to provide medical evidence, including specifically mentioning Certificates of Vision Impairment in the application form as a potential piece of evidence.

 

1.7. Reasonable adjustments should ensure all benefit forms are available in paper form, large print, braille, audio, email, online, and telephone, and should be interchangeable from one format to another. Extra time should be permitted wherever necessary to facilitate this. Email signatures should also be accepted as a reasonable adjustment, including allowing claimants to type their name in a box, as for many people with sight loss providing a wet signature can be extremely challenging without sighted support.

 

1.8. There also needs to be improved understanding among DWP staff of the reasonable adjustments available. All DWP staff must be aware of DWP policy and understand the legal duty on the Department to make reasonable adjustments for disabled customers.

 

“The PIP application process is dreadful. There is no provision for completing it online and the form can usually only be submitted in handwriting. After considerable effort and escalation, I was allowed to submit it by email, but frontline staff were not aware of the email option. They will only offer to send documents in braille/large print/audio even though email is an option within the accessibility team. I did not manage to receive my assessment report in an accessible format.”

 

1.9. In addition, once a reasonable adjustment or communications preference is agreed, it must be clearly recorded on the claimant’s record, and should apply to all future communications.

 

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

1.1.a. RNIB is unaware of any specific improvements.

 

2. International examples of good practice:

Not answered.

 

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

 

3.1. New sensory descriptors need to be developed which take into account an individual’s ability to manage, see or identify money.

 

3.2. DWP PIP Guidance could also be improved by having more worked examples which relate to how the descriptors may apply to blind and partially sighted people.

 

3.3. It is essential that the assessment should reflect the individual’s realistic needs in order that all relevant activities are considered fully, as opposed to the present situation where assessors automatically exclude certain conditions from claims relating to sight loss in activities such as dressing, budgeting and engaging with other people.

 

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

 

4.1. The inclusion of braille in the wording must be removed as an exclusion from satisfying activity 7 of the Work Capability Assessment (WCA). It is our view that braille is generally irrelevant to employment prospects in the real world and should not be interpreted as being a given adaptation of communication in the workplace, as employers almost exclusively lack the means to produce information in braille or use it as a means of communication with a braille-user. 

 

4.2. The potential to learn braille should also be removed as a reason to exclude someone from “the severe and enduring conditions criteria” in the WCA. The result of this exclusion is that blind and partially sighted claimants are forced to endure repeat assessments, when their condition remains the same or has worsened. The notion that braille could or should be learned by a claimant is wholly unrealistic in most cases.

 

4.3. Activity 8 in the WCA should be featured under schedule 3 as well as schedule 2. We consider the ability to navigate and maintain safety is fundamental when determining an individual’s limited capability for work-related activity, as well as their limited capability for work. The fact that these factors are not considered relevant in this respect is intrinsically unfair to people with sight loss and significantly disadvantages them financially.

 

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?

 

5.1. RNIB considers that this is working well.

 

5.2. We recommend providing advice and advocacy support to parents on how to complete the forms.

 

5 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?

 

5.1.a. The objectivity of the paper-based system was preferable as it did not allow informal observations to influence a benefit assessment (see answer 1.4.).

 

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?

 

6.1. Most decision-makers lack the specialist knowledge of sight loss to accurately and realistically interpret clinician input. We recommend introducing specialist decision-makers who are trained in sight loss.

 

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

 

7.1. RNIB considers the DWP should employ and promote a generally better-informed and more compassionate approach to the assessment process, applied to real-life circumstances. At present this is far more likely to happen at appeal and the decisions are being changed in the claimants’ favour in the vast majority of cases. The appeal success rate for blind and partially sighted claimants supported by RNIB’s legal rights and welfare benefit sight loss services is some 97%. Any assessment process for benefits and support needs to respect and listen to individuals, giving proper weight to their own evidence, including evidence from family, friends and carers. RNIB consider decision-making needs to lean more towards the appeal model, i.e. independent, inquisitive, applied to reality, and taking all evidence into account.

 

“The panel I had at my appeal was very knowledgeable of my diagnosis which made the appeal very easy.”

 

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

 

7.1.a Assessors should believe claimants and make best use of medical evidence, including Certificates of Vision Impairment, and not make assumptions based on informal observations (see 1.4.). We recommend the DWP adopts a position whereby they accept the claimant’s testimony and their medical evidence unless proven otherwise.

 

7.2.a. The DWP should also provide regular specialist sight loss training to assessors, to equip them with the skills to respectfully conduct assessments and expand on questions when further information may be required from a claimant.

 

7.3.a. Assessors should also be made aware when their decisions are overturned at tribunal, and the reasons for this, to help identify where things could be done differently. 

 

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)?

 

8.1. We are opposed to the idea of any form of integrated health assessment for benefits. This raises great concern, due to the possibility that all benefits may be lost in one inaccurate assessment, leading to extra hardship. We consider the emphasis here needs to be placed on the quality of existing assessment processes which clearly require significant improvement, without adding any greater weight and importance to the outcome of the assessment.

 

8.2. PIP is a benefit to help with the extra costs caused by illness or disability. ESA is a benefit for someone with a disability or health condition affecting how much they can work. The benefits are therefore serving different purposes and should not be combined.

 

8.3. In our recent survey, 72% of blind and partially sighted respondents said they are repeatedly giving the same information at assessments. Appropriate data sharing, subject to the required data protection safeguards, could streamline processes and save both claimants and the DWP time, money and trouble.

 

8.4. Less recent evidence should also be given greater weight, as older evidence can still be fully relevant. Many conditions (including many sight loss conditions) do not get constantly reviewed by a specialist once diagnosed.

 

8.5. AR1 should be reduced, allowing claimants to confirm nothing has changed without the need for a face-to-face assessment. Repeat assessments in cases where there is clearly no possibility of change are both frustrating and stressful for claimants and a general waste of resources.

 

“My eyesight will never improve but they keep repeating the process.”

 

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

 

9.1. We welcome the DWP’s commitment to improve trust and transparency in the assessment process. We recommend the DWP prioritise publishing regular Mandatory Reconsideration (MR) statistics, including the outcomes at initial decision and MR, percentage progressing to appeal; and percentage upheld at appeal, in order that the progress of the programme can be monitored closely.

 

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

 

9.1.a. RNIB welcomes the development of an online claims process, which will significantly address the accessibility issues many of our customers have when claiming benefits and help reduce waiting times for the telephone lines.

 

9.2.a. It is important any digital portal is formally tested for accessibility, to ensure it works for blind and partially sighted people. RNIB’s technical team are available to advise with this.

 

9.3.a. Blind and partially sighted people are disproportionately more likely to be digitally excluded than the general population. It is critical that other methods of benefit claims must not be abandoned to digital, to ensure that an individual’s preference is respected, and to avoid digitally excluded people being unable to apply for vital provision. 

 

9 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?

 

9.1.b. In-house assessments would make it clearer for claimants or third parties to know who to go for clarification, as at the moment it is unclear who is responsible for each part of the claim process.

 

9.2.b. If in-house assessments are introduced it is critical separate staff work on assessments and first and second decision-making for Mandatory Reconsideration to ensure independent decision leads.

 

9.3.b. A fairer and less stressful application and assessment process so that more blind and partially sighted people receive their statutory entitlement to benefits first time around is key to building 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?

 

10.1. Many blind and partially sighted people have to rely on expensive transport methods such as taxis due to access and mobility barriers in using private and other public transport methods. Many RNIB customers reported preferring telephone to face-to-face assessments during the pandemic for these reasons.

 

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

 

10.1.a. RNIB considers remote/telephone assessments are fairer as the assessor cannot unfairly disregard evidence based on informal observations (see 1.4.), and instead makes decisions based on medical evidence and the lived experiences of blind and partially sighted claimants.

 

“I was assessed for PIP during the first lockdown over the telephone by a clinical nurse. She was very good and asked very relevant questions. For ESA I wasn’t interviewed at all, just asked to fill in a form and provide medical evidence.”

 

10.1.b. All assessment methods (face-to-face, telephone and video) should be available and optional.

 

11. Assessment Suspension for Industrial Injuries Disablement Benefit during the pandemic.

Not answered.

 

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?

 

12.1. Without sighted support, completing a physical form can be difficult for many blind and partially sighted people. The DWP needs to ensure adequate support is provided so all claimants can access telephone as a reasonable adjustment to filling in forms, through a bigger and better funded telephone form-filling service. An online form-filling service should also be made available wherever necessary and appropriate to suit claimant needs. It is vital all those providing this service have specialist training on sight loss so they can adequately support claimants through the process effectively and appropriately.

 

“Reaching the correct department for help with disabled benefit queries by telephone is an onerous and time-consuming task.”

 

12.2. Many blind and partially sighted people reported difficulty reaching the DWP phone lines during the pandemic. The development of the online claims portal is welcome, helping to reduce the amount of calls to the phone line.

 

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

 

12.1.a. DWP should introduce an Adviser Helpline as third sector advisers currently have to wait for a significant amount of time to talk with staff about the progress of individual claims. This helpline should connect third sector staff with DWP with a higher level of authority to help concerns and issues to be quickly resolved.

 

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?

 

13.1. RNIB’s customers regularly report negativity about receiving the outcome of their benefit decision, noting that it has caused them stress and anxiety. They feel that their condition and its effects have not been taken seriously. Many clients also have a strong sense of injustice when they receive an inaccurate assessment or the wrong decision which feeds into their disillusionment with the whole process. 

 

13.2. There needs to be a fairer and less stressful application and assessment process so that more blind and partially sighted people receive their statutory entitlement to benefits first time around. 

 

13.3. We consider that better training in how people manage when blind or partially sighted would improve assessments and get better decisions the first time round. DWP and assessment providers should ensure that all staff receive sensory impairment training as part of wider disability awareness training.

 

Waits for assessments

 

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

 

14.1. RNIB considers the DWP needs to employ more staff, especially staff supporting claimants to complete forms via telephone or via the home-visiting team (see 12.1.), use more paper-based or remote assessments and introduce the online claims portal as a matter of priority, to reduce problems with paper-based evidence.

 

“More staff to cope with excessive waiting times. At present, I feel like I am holding up the next customer whenever I have to phone DWP, and this applies pressure on me to get through things as quickly as possible.”

 

14 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?

 

14.1.a. Travel, technology, social activities, food and extra domestic help are the five main areas of life that present additional costs for those who have sight loss. The assessment rate for ESA is currently not enough to cover the extra costs associated with being blind or partially sighted.

 

14.2.a. RNIB would welcome the introduction of an assessment rate for other health benefits.

 

Health assessments in the devolved administrations

 

15. Lessons from the new Scottish processes:

Not answered

 

Policy development

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

 

16.1. The DWP has made some steps to consult with stakeholders recently. We consider these relationships should be increased and developed.

 

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

 

16.1. a. A regular stakeholder forum, similar to the Access to Work Stakeholder Forum, should be established, to discuss and seek to resolve issues arising from health-related benefits. We consider it essential that any forum of this nature proactively engages with RNIB over accessibility issues. We welcome the opportunity to liaise with decision-makers in order to ensure more decisions are made fairly and correctly at the earliest stage. We also consider this form of liaison should be made available to all stakeholder organisations dealing with disabled claimants.

 

 

November 2021