Written evidence from the Liverpool Access to Advice Network

 

Summary

This response to your call for evidence has been provided by experienced advisors in each specialist field, drawing on years of experience and testimonies taken from anonymous client groups. Evidence is submitted without prejudice and in the spirit of working collaboratively with stakeholder partners for continuous reform. We remain ready and willing to engage in open and frank conversations with the DWP, working in partnership towards the aim of supporting people who are in need of benefits.

Suitability of assessments

1. How could DWP improve the quality of assessments for health-related benefits?
There is an enormous need for improvement on consistency, rationale and accuracy in point awards.
Surely the great number of cases being referred to mandatory reconsiderations and tribunals is also a waste of resources for the DWP just as much as it is for the claimants and their supporting organisations.
The department should create a quality assurance framework, adhere to it and publicise it to ensure transparency and accountability. This needs to be overseen by an independent regulator of benefit assessments.
Assessors must sufficiently understand the claimant’s disability or health condition and have access to experts with whom to consult.
Assessors need to treat the persons being assessed with dignity, respect and sensitivity as their disability or health condition already puts them in a vulnerable position, which is exacerbated by being put under duress and undue stress with probing questions during an assessment.
Particularly in relation to mental health issues and suicidal ideation, assessors must be provided with training to ensure that they stop insensitive and harmful lines of questioning.
There needs to be a separate application pathway for claimants with mental health issues, learning disabilities and neurological conditions – the language and format of the application induces stress in this group of people and often deters them from applying. The legal statements read out on the application request helpline are confusing and frightening to those wishing to apply. It can take a considerable amount of time to get through to the phone line and people with mental health issues often abandon calls without success. A wider range of contact channels should be offered to support this group.
Form PIP2 needs two clear sections one for mental health and one for physical disabilities this is not currently obvious to those applying.
Assessors should display an attitude of being there to help the claimant and stop creating an oppositional and adversarial atmosphere.
Conducting assessments via telephone is usually inadequate as too much information is lost and video-conference assessments should be made available.
Unnecessary repetition of assessments (in particular for progressive or life-long conditions) must stop and the expert opinions of specialist consultants need to be taken into consideration more.
The DWP should consider mandatory recording of assessments for quality assurance purposes for full transparency, training/re-training opportunities and to leave clear audit trails so contradictions cannot arise in the future.
A way needs to be found to avoid unnecessary repetition and misunderstandings by having to liaise with numerous DWP staff members: this could be accomplished by having small teams who are allocated claimants and are each knowledgeable about the claims they look after.
There needs to be a way of recording lasting consent to discuss claims with support organisations in order to avoid repeated unnecessary repetition of requests for explicit consent.
Processing time of applications needs to be drastically reduced as this causes significant hardship and distress often causing the claimant’s health to deteriorate.
More support is needed for claimants with other vulnerabilities, such as those for whom English is not their first language, history of homelessness, domestic abuse – more face-to-face support with applying and more interpreters rather than relying on language interpretation calls which can be distressing if they are three way calls.

 

a. Have you seen any specific improvements in the process since the Committee last reported on PIP and ESA assessments, in 2018?
On the contrary: especially since the start of the Covid pandemic the quality of assessment processes, which was already sub-optimal, has markedly declined.
Many claimants have reported significant difficulty with the telephone assessments citing misinterpretation of their oral evidence about their care and mobility needs. Some report arriving at assessment centres only for the appointment to be cancelled at late notice causing distress and confusion. Many have reported then being advised their application was refused or benefit cancelled due to non-attendance (even though they did attend and were told that it was cancelled). Customers attending for face-to-face assessments often report long waits of 1-2 hours past their scheduled appointment time which is particularly distressing in mental health cases where anxiety around social contact may be high.

 

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?
People with Academic research in several countries has shown that the strategy employed by the DWP of reducing the number of people claiming benefits (in order to replace income they cannot generate through work due to their disability or health condition) by changing the criteria for eligibility and assessing their work capability has no significant impact on bringing them into gainful employment. In short: It does not work. The current process serves only to increase barriers and therefore increases the effects of disability, thus moving individuals further away from the Labour market. In many cases, unresolved employment law issues are driving people to seek welfare benefits. More restrictive eligibility for disability benefits therefore made it difficult for participants to address the loss of income resulting from their employment law issue, while not solving the issue that led to the unemployment in the first place. 
Instead an approach should be sought which enhances the chances of people with disabilities or health conditions to acquire gainful employment (not least by ensuring that they have equitable access to education in order to be qualified for employment)
Some international approaches to this include financial incentives and practical support for businesses to overcome potential costs and make reasonable adjustments. This can be coupled with enforcing preferential access to disabled people of equal skill at interview and the responsibility on employers to reintegrate sick workers. There are public agencies actively seeking to employ disabled people and the public office which works with employers, government agencies and individuals seeks to improve disability employment through advice, guidance and technical assistance on workplace accommodations.

 

3. Do the descriptors for PIP accurately assess functional impairment? If not, how should they be changed?
There needs to be more rational thinking in how accurately the descriptors link in with one another.
For example, a claimant needing a commode for immediate bathroom use would be awarded maximum points under the bladder control section, but currently would not receive full points on the mobility section. If mobility was good there would not be a need for a commode so a more common sense approach is needed across the section.
The mobility criteria for enhanced points should be moved from 20m to 50m, in the acknowledgement that current range is virtually bed bound.
There need to be more descriptors added into PIP so that a more well-rounded assessment can be judged. There are many day-to-day activities that are not taken into account. For example, washing laundry, buying shopping, ability to write/manual dexterity. These should be taken into account when looking at the claimant as a whole. The ESA forms are much more comprehensive than the PIP forms and paint a fuller picture. Perhaps these activities would carry less points but would create a better overall picture of a claimant’s daily life.
There needs to be a better understanding of the reasonable regularity legislation – whether the claimant can do a task every time they need to in a safe manner in a reasonable time frame – performing the task once should not mean they are deemed able to complete it every time required.

4. Do the descriptors for ESA accurately assess claimants’ ability to work? If not, how should they be changed?
The ESA descriptors are much better than the PIP descriptors in that they cover a much wider range of activities which claimants may struggle with. In doing so, they paint a better picture as to how the condition affects the claimant.
In both PIP and ESA assessments, the thresholds are too low. A simple example: Knowing basic money or being able to speak three or more words fluently in a simple sentence – a reasonable regularity test should be given more consideration here.
The Work Capability Assessments currently fail to correctly assess the claimants’ situations and people perceive the denial of benefits as arbitrary and medical assessments as incorrect.
Examinations focus on issues not relevant to the claim, such as questions related to mental health for a claim over a physical disability. The assessments are therefore perceived as unfair or unjust.

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?
The transition from child DLA to PIP is particularly challenging. Supportive, high-quality assessment and decision-making and readily available advice and advocacy are crucial. As one of our member organisations powerfully remarked: “parents of disabled children are often exhausted by constant medical procedures and appointments, constant battles to access services and equipment they need at the time that they need it, in addition to the day-to-day worry and huge burden of responsibility of keeping their child healthy, happy, and developing. Child DLA or PIP should assist them – not provide them with another complex battle to fight.”
Despite there being no requirement for a formal diagnosis of a disability or illness for PIP, many claimants report that they are told they do not qualify because they have no specialist input or medical diagnosis. There has never been any such requirement and the over-reliance on medical practitioner evidence fails to consider other available evidence to the DWP such as oral accounts from parents and carers, community groups and other professionals which support the claimant’s own account of their needs. The inconsistency in Decision Maker interpretation of the law leads to wide variation and success of claims. The initial training of Decision Makers and wider PIP staff needs reviewing with more regular updating to ensure the staff are fully able to assess a claimant’s application.
As the DWP already contacts families to identify if an appointment is needed, this call could be used to explain the differences between DLA and PIP and highlight that independent advice can help.
In relation, the rule allowing DLA to continue to age 17 to facilitate a claim to be determined could be modified so awards of DLA can continue up to age 17 if PIP is refused, and to allow mandatory reconsiderations and appeals to be completed.
Moreover, the upper age limit for child DLA needs to be reviewed. In Scotland it is already the case that young people receiving DLA can now continue to get it until they turn 18, although they can opt to move to PIP earlier if they so wish. This provision should be extended to the rest of the UK.

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 benefits of a paper-based approach are that there is a clear audit trail and less room for conflicting accounts of what happened during an assessment.
However, it can only work if expert opinions are adequately valued and can exclude claimants who are struggling with accessing written information (especially if the register of language is not clear for them).
The drawback of the DLA form was that it insisted in quantifying in minutes and frequency of each day the care and mobility needs the individual required. This was problematic in cases where the individual’s disability or illness gave rise to varying levels of care and mobility needs each day or week. Many claimants previously reported finding it increasingly difficult to articulate their care needs on such a microscopic level. Rather a longer term view noting any discernible patterns of care/mobility needs would better support the overview of how the individual is over a period of time. For example people with Fybromyglia often report periods of increased care and mobility needs with seasonal weather changes. The DLA form often did not provide customers with adequate space to document their own evidence of their care and mobility needs they had arising from a disability or illness. The presentation of the PIP2 form is an improvement but there is still more work to be done to improve the PIP2 application form. DLA had the benefit of considering the night time needs of a claimant which can be particularly high in Neurodiverse and mental health claimants. PIP need to bring the night time care and mobility needs of the claimant back into scope of claim assessment.

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?
More focus should be on widening the scope of evidence a claimant can provide.
For example, it is common for a patient with mental health issues to disengage from their GP and they might not be compliant with treatment and medication – evidence from other than medical professionals is not given enough weight in the assessment process.
Specialist input is not currently given enough consideration. In the field of neurodiversity which is a broad, ever-changing field of public health, reliance on this input is vital to get the most accurate outcome for claimants, however the continuous need to re-evidence at reassessment stage is a further drain on the NHS and specialist clinician’s in demand time, and stressful for claimants.

7. Appeals data shows that, for some health-related benefits, up to 76% of tribunals find in favour of the claimant. Why is that?
In addition to the recommendations in section 1, for progressive, terminal or life-long conditions, input from specialists should be sought and trusted. The Department should also trust the evidence provided by third sector expert organisations that thoroughly understand the conditions.
A transparent and accountable quality assurance framework would help the department to review why such a high percentage of appeals find in favour of the claimant, as well as conducting interviews at lower management levels to understand the failings, mandatory recording of assessments to screen and provide continuous input.
There is a lack of thorough exploration of all available evidence upon first review by the DWP decision makers. Claimants report selective use of evidence provided and some evidence not being considered at all. Where there is doubt over to the claimant’s evidence further clarification should be sought from the GP, Consultant or other professional to confirm the creditability of the evidence provided by the claimant. Decision makers often do not take this step until a mandatory reconsideration is lodged and in many cases Appeals.

a. What could DWP change earlier in the process to ensure that fewer cases go to appeal?
In addition to the recommendations in section 1, applicants should be advised what additional evidence they can provide if an application is borderline for an award rather than outright refusal. This would reduce the number of cases going to mandatory reconsideration and/or appeal – this would also support successful applications without the need for a face-to-face assessment.
There needs to be more robust auditing of decision makers and the decisions they make on awards to improve consistency and compliance with this process.
The safeguarding of claimants needs to be reviewed, particularly on renewal cases where ending the benefit award could present serious risk to the claimant’s life. For people in receipt of a legacy benefit where removal of the PIP award would result in loss of a severe disability premium and potential premature move onto Universal Credit from the legacy disability benefit, the SDP should have an extension period and a fast track mandatory reconsideration should be considered to mitigate the risk to these vulnerable persons.

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)?
There is a case for combining assessment processes for different benefits if the infrastructure is in place internally to allow DWP departments to do so. Currently, failures to protect the most vulnerable in society occur because cross cutting communications and links across organisational departments are not intelligent enough. Combining assessments processes must be well thought out in advance and include input from a stakeholder consultation before roll out.
If moving to one single assessment for both PIP and ESA there should not be a refusal of both benefits but rather two separate considerations and mandatory reconsiderations and appeals to ensure where people might not qualify for one benefit, they might still qualify for another and are not left without access to any benefits at all and therefore likely to become destitute as well as disabled.

9. What are your views on the Department’s “Health Transformation Programme”? What changes would you like to see under the programme?
There is a danger that in combining certain benefits under one health assessment, that the purpose of those benefits will be conflated. For example, the ESA health assessment looks at someone’s capability for work whereas the PIP assessment looks at someone’s day-to-day functioning. Claimants on PIP are still able to go to work if they wish and are capable of doing so. Combining the health assessments together under one assessment might make it even more difficult for those who work to claim PIP.
With regard to the enhanced mobility element, greater consideration and access to this element should be considered for mental health applicants whereby the applicant is severely restricted by their mental health and cannot go outdoors on a regular and safe basis or unaccompanied.
Currently, the threshold is too high.
It should be made clear to victims of sexual assault that they can request a preferred gender for assessment or a remote video conference assessment. There should be more emphasis on processing applications on the evidence provided on paper based applications thus removing the need for medical assessments.
There needs to be less emphasis on applicants with mental health issues being engaged with specialist mental health teams and on high levels of medication – during the pandemic many severely unwell customers with mental health issues were unable to access the specialist support they required due to a lack of local resources. Many people cite that they are unable to tolerate medication and a lack of this evidence should not detract from the person’s care and mobility support needs.

a. (For people claiming) Would you like to be able to manage your benefit claim online?
Not applicable in this evidence submission.

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 disadvantage of contracting assessments out to private external organisations is the obvious cost implication and thus, feeding private sector profits. The disadvantage of bringing the assessments in house is that it may create or worsen public trust and reduce DWP accountability and transparency. A better working alternative would be to, via a thorough, fair and transparent procurement process, award assessment contracts to third sector or not for profit organisations as the trust is usually already built between claimant and supporting organisation, as most face-to-face appointments have already been conducted and the knowledge expertise already exists.
It would also be an opportunity to give back to the charitable sector.

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?
An agile approach is needed based on what is best for claimant, not DWP or indeed the assessment agency. There is no one method which is suitable for all people and therefore different ways of handling claims need to work alongside each other.

a. Is there a case for making some of the changes permanent?
As mentioned in section 1, telephone assessments fail many within the neurodiverse community, therefore due attention must be given to practical considerations relating to an assessment, especially where travelling is involved. For example: there should be flexibility regarding the location of face-to-face assessments; providers should be unable to double-book claimants; there should be no alterations to scheduled assessments – cancellations, time or location changes – without plenty of notice being given; telephone calls must be answered promptly; there must be safe and comfortable waiting areas for face-to-face assessments (claimants often have to arrive early, in order to minimise the risk of arriving late); and the potential need for reasonable adjustments should always be considered. 

11. Most assessments for Industrial Injuries Disablement Benefit were suspended during the pandemic. What has been the impact on people trying to claim IIDB?
The obvious impact being that if the Department suspends a service, claimants who ordinarily would have been eligible for this type of benefit are then left worse off than they should have been through no fault of their own.

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?
Yes, by offsetting the payments to the date when they were received not when the date they were reviewed (post suspension).

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?
Understanding and taking ownership of how a full shut down of a service can have a great and dire impact on the livelihoods, physical and mental health of people who are already vulnerable.
Become more agile and proactive in processes such as using secure electronic portals (rather than post) and allowing supporting organisations to advocate on a claimants behalf when they are instructed to do so (as highlighted in section 1).

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?
It is clear that the DWP has a responsibility and moral duty to ensure that third sector organisations have the funding to enable them to be resilient to any external factors and can continue to provide the necessary support to the people who need it.

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?
No routine reassessments for those with progressive conditions, unless the client informs DWP of a change of circumstances.
Establishing far clearer rules relating to end of life. Some conditions are not fast-tracked even when it is accepted by all that the condition is terminal. This creates totally unnecessary delays and anxiety for clients and their families;
DWP assessments should be far more sensitive to neuro-diverse clients – those with communication or cognitive impairments are often not recognised within the assessment process. There is an over-reliance on the clients’ education history e.g., attendance at a special school, to evidence cognitive impairment. Too often, the effects of conditions that impair processing of information are missed.
DWP assessments often miss the significance of fatigue on clients. This is not merely ‘feeling tired’ and is very often the direct impact of conditions/neurological conditions (such as strokes) which impact on the client feeling very fatigued and compromise day-to-day functioning. Guidance on fatigue should be expanded and made clearer and drafted accordingly with the help of professionals who work with a variety of conditions, as well as with those who are diagnosed with such conditions.
Specialist health professionals should be involved in the assessment processes for specific conditions such as neurological and mental health conditions, as some conditions are not properly assessed.
Guidance on mental health conditions needs to be reviewed and strengthened. Health professionals and DWP staff too often look for interventions of tertiary care to evidence mental health conditions.
For cancer patients being treated with Radiation and Chemotherapy the physical and mental health impact on the claimant wellbeing should be considered rather than dismissed as side effects of the treatment. The disability gives rise to the need for the treatment which then increases the claimant’s need for care and mobility support.
Where a claimant has an advocate agency assisting with the application more communication with the advocate is needed to ensure a smooth and efficient claims process.
 

Waits for assessments

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

Far more effective sharing of information is needed, e.g. all necessary documentation regarding claims for benefits. Presently, many delays are caused by third sector agencies waiting for information before supporting clients.
Greater use of electronic forms of communication to allow speedier sharing of information: presently, the usual practice of using postal service is expensive and slow with reported unhappiness of lost documentation.
A named account manager or team per organisation so accountability is upheld within the department.
Targets should be introduced for the length of time cases need to wait to be heard by a tribunal. Some claimants have to wait up to a year for a hearing. A target will help reduce waiting times.
The number of tribunal panel members should be increased, so that tribunal waiting times can be brought down to more reasonable levels.
Tribunals are increasingly moving online. It is important that this process should be carefully monitored, in order to assess both advantages and disadvantages for disabled claimants.

Full audits should be conducted of decisions that are subsequently changed at tribunals. This will help restore confidence in the system and provide ways of improving decision-making and inform ongoing departmental training.
There is a serious problem where extra costs benefits such as PIP are reduced or terminated and there is a lengthy wait for an appeal to be heard. Consideration should be given, in consultation with disability organisations and disabled people, as to whether the Scottish Short-Term Assistance scheme should be replicated in the rest of the UK.

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?
Not well, as it does not match statutory sick pay which ESA often follows and should match as a minimum, noting realistically that it should be more since people who take ESA after SSP are more likely to have a long-term condition and need more support than someone who may take SSP for a short period.
Furthermore, many claimants are having to chase this payment and due to issues with poor administration, their claims are not being ‘received’ until months after they have been sent.
The impact of the pandemic and the rising costs of living and fuel mean that the assessment rate of ESA no longer provides a basic income upon which the claimant can maintain and manage their health conditions: often a lack of heating and access to adequate diet is contributing to rapid and serious deterioration of the claimant’s existing health conditions.

 

Policy development

16. How effectively does DWP work with stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?
Currently, this is not effective at all and there is a great need for consultation with a variety of stakeholders, including people with lived experience, advocacy groups, support organisations and academic researchers.

 

a. What steps could the Department take to improve its engagement with stakeholders?
The department could listen to what they suggest, understand the suggestions and then find ways to implement them.
There needs to be a willingness to engage in open and frank conversations and to put the aim of supporting people who are in need of benefits at the top of the agenda.

 

November 2021