Written evidence from Jones (HAB0067)


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


=(a) Return to the DLA approach of home-based assessments performed by a GP, because from the perspective of the claimant these were faultless. It would benefit the DWP to interview former GP assessors to gain from their experience in how assessors should interview/examine claimants - Otherwise, ensure that... (b) all assessors are properly trained; not simply in how to ask questions, but that they understand mental/physical health conditions and are not directed to bias in favour of the DWP and are neutral as the DLA GPs were (c) all assessments employ a non-biased, person-centred, client-focused approach (d) all the questions are directly relevant to the claim and to the health assessment; not an interrogation of the claimant's entire past employment history (e) all claimants assessed at home are free to record the assessment for their own personal use i.e. as a memory aid without being required to give a copy to the assessor/DWP (who could make their own audio recording on DWP equipment) and that assessments in DWP centres are automatically recorded and a copy on DVD/CD is handed to the claimant at the end of the assessment (f) everything the assessor writes must be read and verified by the claimant before it can be submitted by the assessor into the system - this will go a long way into repairing trust and ensuring truthfulness that therefore reduces the need to appeal (g) every claimant is free to have a witness with them when they are assessed and that if they want one, but cannot provide one, the DWP is obligated to provide a Social Worker, or other non-DWP professional to be a witness (h) During a home-based assessment the assessor should look at the kitchen and bathroom if relevant to the claim and not make assumptions; for example - if the claimant has no cooker, because they are unable to cook and so does not need one, or if they have no bath, because they can only shower (i) Assessors should not be directed to engage in underhanded pseudo-detective work making observations outwith the boundary of the actual assessment with the aim of 'catching out' the claimant, nor make dubious assumptions; for example - just because the claimant can do an action once does not mean they can perform this repeatedly and always - this is within the regulations, but assessors are renown for ignoring it (j) Instead of simply asking whether the claimant can read, write, or make calculations - or making assumptions that they can - the assessor must ask the claimant to perform a short task of reading, writing and performing calculations such as change counting; this is essential, because it is invalid for assessors to make these judgements without actually testing the claimant. This also needs to be done to test whether the claimant can fasten buttons, or pick up a coin, etc., as stated in the claim tasks, because the assessor should not be permitted to make judgements on these tasks without testing (k) Assessors need to have a thorough training/qualification in relating to people with severe mental health conditions, memory loss, learning disabilities and dementia - claimants with these issues need special protection and a non-DWP witness must always be present and provided. Claimants with memory/cognition problems must have a standard dementia test applied as used by GPs - if the result is poor it would be irresponsible to continue with the claim assessment, because the claimant would clearly not possess the capacity to respond with reliable answers and the claim must therefore then be approved without further distressing the claimant. Assessors must be properly schooled in how to ask questions about self-harm and suicidal ideation and the DWP needs to decide whether these types of questions are relevant within an assessment, because of the high level of distress and potential harm they have for the claimant - if the claimant does not want to talk about the reasons for their depression this should be respected and not judged to be a 'refusal' that will mean rejection of their claim (l) It is completely unnecessary for PIP claimants to have both a PIP assessment AND an ESA assessment - they are very similar and if the claimant is awarded PIP they should only require a paper-based assessment for ESA afterwards.


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


= Not in my personal experience.


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?


= Unknown.


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


= The PIP descriptors need to be completely overhauled and rewritten - there is insufficient time/space for me to do that for you here, which I'd otherwise gladly do. It would be a great improvement to simply reinstate the former DLA descriptors, which were far more relevant and easier to understand. However, the following PIP activities need to be addressed... (a) '4. Washing and Bathing' There needs to be points for whether the claimant can DRY themselves, because this is the most difficult aspect of bathing (b) There needs to be an activity for how well the claimant is able to use communication technology such as a touch screen, keyboard and the internet (c) There needs to be an activity for how well the claimant is able to maintain the hygiene of their home for the benefit of their health, or whether it is necessary for another person to do this for them - i.e. are they able to wash their own dirty dishes, can they clean the floor, can they wipe up if they spill food, can they remove dust from surfaces to maintain healthy air at home, can they launder their clothes/bedding, etc,.


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


= The descriptors for ESA are almost a direct copy of the DLA form and thus are very good for discerning the general physical/mental capacity of the claimant; however, virtually nothing on the form is work-related and the answers can only be used to guess and assume the claimant's ability to work, which can be influenced by personal bias and so leads to appeals. The descriptors for ESA need to be work-focused and the type of work should be defined, rather than using 'work' as a woolly term that can mean anything - i.e. can the claimant do their usual work, can they do any types of manual work, or deskwork, etc., are they able to wake every morning in a fit state for work, can they use public transport or drive a vehicle to work, etc., etc,. Also, could they undergo training or use aids to enable them to work in a specified field?


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?


= Unknown.


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?


= DLA is a superior system to PIP in all respects. The DLA form was clear and easy to understand. It is vital to maintain a paper option as PIP moves forwards, because a significant number of claimants do not have access to the internet and/or are unable to use the internet (or keyboard/screen). It is also not possible, or very difficult for many of these claimants to obtain help from others to enable internet use for the prolonged and personal time it takes to complete the forms.


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?


= The main disadvantage is that the client's clinicians will not have any knowledge at all about how the client performs the PIP/ESA activities and will not be in a position to make an accurate statement - nor will they have the time in their schedules to devote several hours to properly completing DWP forms. The claimant is already required to supply medical evidence from their clinicians, which for many medical conditions should be enough proof for their PIP claim together with self-reporting without the need of further DWP assessment. Otherwise a DWP assessment should be performed by a hired independent GP at a centre, or in the claimant's home - this is the most accurate, fairest, trusted and unbiased method.


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


= I believe you would find this information by actually reading the Judge's remarks that are given with each verdict. However, in my personal experience is it due to the fact that assessors are inaccurate; either because they are deliberately lying, which I know is a harsh statement, but the facts show it to be true - or otherwise, they are incompetent and not hearing what the claimant is saying - or the assessor is making their own assumptions. There is also the fact of assessors being directed to pursue bias in favour of the DWP during assessments and when in doubt to err in favour of the DWP.


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


= Clearly there is something wrong with the current system of the case being reviewed by a DWP manager before the claimant can appeal; clearly too few legitimate cases are being overturned in favour of the claimant by managers and the DWP needs to examine why this is happening and whether managers are being directed to make decisions in favour of the DWP as their default setting.


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)?


= Absolutely there is a legitimate case for combining PIP/ESA assessments, because it's ridiculous for the DWP and for claimants to undergo two separate, almost identical assessments. It would be radically saving in expense, time and resources for the DWP to combine the ESA assessment with the PIP assessment whenever PIP is claimed, so that successful PIP claimants will not have to undergo a second unnecessary assessment for ESA. The PIP/ESA questions are almost identical and so it can be logically assumed that a successful PIP claimant will also be a successful ESA claimant. Little or nothing will need to be done to the PIP assessment, except to add any of the ESA questions that are not already repeated in the PIP claim/assessment. However, for those people solely claiming ESA without PIP they would need to undergo the ESA assessment if necessary. Existing PIP claimants should never need, nor be required to undergo a repeat ESA assessment and it should only be necessary for them to complete a repeat claim ESA form, because the repeat PIP claim assessments are enough.


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


= Frankly, it's warm words and pie in the sky; in reality I find it impossible to imagine this entire plan will come to fruition, because not only does it require gigantic resources that will not be forthcoming, but it also requires a complete attitude change from doctors and health workers from a mentality that has been engrained since the beginning of the NHS. Person-centred, client-focused health care is an alien concept in the UK - however, certain EU countries are beginning to adopt it successfully - so perhaps there's hope.


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


= No I would not want to manage my claim, nor repeat claims online, because I do not have access to the internet, I cannot use the technology and as I live alone it is almost impossible for me to get help from another person for such a prolonged, difficult, personal length of time to complete it. The option of paper is essential for those claimants. Reading from a screen is very difficult. The form, and writing in general, takes me a very long time and the paper-form is ideal to go through bit by bit over a long period.


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


= In my experience there is zero trust in Capita, Atos and Maximus. Personally trying to deal with them, even for simple enquiries has been a horror show and very distressing. One of the worst things the DWP/government has done is to farm out sensitive services such as benefits to third parties. It would certainly be a step towards redeveloping trust if benefits were brought 'in house' again - in particular relating to the protection and sharing of personal data. It would also lower administration costs and therefore begin to reduce public anger at the gigantic sums paid out to Capita, Atos and Maximus for what the public perceive, rightly or wrongly, as failure.


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?


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


= There's a very good case for making some changes permanent, such as relying more on written evidence/forms rather than putting every claimant through regular unnecessary assessments, which will also save a lot of DWP money. Claimant's should only need an assessment if there is genuine doubt about their claim - for example, those claimants with deteriorating chronic conditions who require ongoing PIP/ESA shouldn't need to be assessed continually, because they're never going to get better and it can be reliably assumed that they will become steadily worse/incapable of work.


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


= Unknown.


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?


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


= CAB needs much more funding in order to help the government - if it is in effect working for the government it needs to be paid. In the past there was a CAB office in every town with someone available to visit you at home, all day if necessary, to complete the DLA form. Since then most CAB offices have closed or have restricted hours and do not home visit - this need urgent change.


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?


= The entire process is extremely stressful primarily because the DWP and its agents send poorly worded letters that read like threats, plus harsh deadlines are placed of claimants and no leeway is given, plus trying to get advice/info via telephone is either impossible or a horrendous experience. There is a huge amount of pressure on the claimant and zero understanding that most of the claimants are very unwell and often incapable of dealing with these very complex claims, plus the fear of losing their benefit and leaving them helpless is terrifying. I can't tell you how the DWP can solve these problems using a few lines.


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


= Employ more assessors, or only assess those claims that appear genuinely doubtful rather than routinely assessing everyone.


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?


= I have no comment.


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?


= It is a person-centred, client-focused approach and will "significantly reduce" assessments.


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?


= No answer.


Policy development


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


= In my experience I've never heard of this happening from any claimant.


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


= Study the Scottish approach/method.



November 2021