Written evidence from Jane Clout (HAB0081)

Suitability of assessments

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

Pay the assessors by the time they spend, not by the number of claimants they process.  Hire HCPs with fluent English, to assess people with English as their first language.  This is not always the case.  Some claimants have communication difficulties themselves, if the assessor is also verbally disabled a farce ensues.  Been there done that.  I have a recording.  

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

Yes, ESA WCAs are less adversarial, and the HCPs seem better informed, as if they had read the form and evidence before the assessment.  WCAs are cut short if the assessor decides a support group descriptor has been met.  


No, for PIP.  They if anything are returning more inconsistent assessments, with claimants refered to by the wrong gender and even the wrong name, with diagnoses missed, and with extraordinary assumptions. For instance the following paragraph has appeared in several reports I have seen to justify refusing points on preparing food, mobilising etc:

 

“The activity of driving a car is in itself a multi-tasking activity requiring significant physical function in terms of grip, power and upper and lower joint movements in conjunction with substantial cognitive powers of thought, perception, memory, reasoning, concentration, judgment and co-ordination…”


This argument is very weak. When driving one sits, semi-reclined and fully supported. It takes much less strength to operate pedals and the wheel than it does to mobilise on foot. 

Most of us have been driving for years, and learned long before we got ill. We don't even have to think about it.  We only drive when symptoms allow, and only for a limited distance to known destinations, as a rule. 

 

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?

Not known.
 

 

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

It has always puzzled me that keeping one's surrounding from turning into a poisonous slum is not included.  I guess men with wives and housekeepers make the rules.  But on the whole, bearing in mind regulations 4 and 7 of PIP 2013, they do work if applied fairly. Tribunals tend to take more care to do this, hence, partially, the high rate of overturn. 

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

Again, bearing the regulations in mind, the ESA descriptors work well if applied correctly. 

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?

I've seen some strange AA and DLA for under 16s decisions.  They are rarer than incorrect PIP decisions though. 

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?

Not so.  Many of us went to a centre or had a home medical for DLA.  It was performed by a doctor employed by the DWP, pre PIP.  But, putting greater reliance on paper evidence and the claimant's description of their situation is perhaps more accurate than relying on an HCPs snapshot made under pressure and often with extreme prejudice. 

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?

Many very disabled chronic sick have little input from their GP and have exhausted the possibilities for treatment offered. Some of us have been disabled by illness for decades.   At present GPs and hospital consultants are overwhelmed with work.  So without a reduction of GPs other workloads, I can't see this being practical.

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

Because the DWP decision makers and their sub-contractors don't have time to do their job properly, and hence apply the law wrongly. Often the first time the claim form and evidence is studied is in the run up to an SSCS tribunal hearing, hence the (to Jan 20) 29%(!) of appellants getting an award offer from PIP DWP prior to hearing, and thus the appeals lapsing.  It would be better to do the assessment once, properly, every time.

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

Allow the HCPs more time for assessments, pay them by the hour instead of by the case, and give Case Managers more time to study the paperwork.   Make sure case managers actually read mandatory reconsideration submissions and don't just rubber stamp the original decision. Take the regulations into account, as well as the descriptors.  Better training, less adversarial.   

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)?

No, a combined assessment would make what are often inaccurate decisions apply to all of a chronic sick and/or severely disabled person's income streams.  When one's been poor and poorly for decades, and physically incapable of earning a living, this prospect is terrifying. 
The benefits are different - PIP is to compensate for the additional costs of being disabled, you need to pay others to do things your condition prevents you from doing yourself, and you can't shop around.  You need to buy expensive equipment. 
- ESA/UC WCA is to help people who are too ill and/or disabled to do much paid work.  People eligible for LCW may not be eligible for PIP and vice versa. 
If there's a case for a combined assessment, then there's a case for combining ESA/UCWCA and PIP.  And that would be a major error.  Think of Stephen Hawkin, supremely eligible for PIP, definitely able to do important paid work. 

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

As I've outlined above.  Assessors paid by the hour or by salary instead of piece rate, case managers to have more time on each case, removal of the assumption of fraud.  While the official statistics show this increasing to 3% from a historic level of 0.7%, in my experience this is driven by an overzealous recovery unit.  I have helped people accused of fraud.   In one case the lady was said to have claimed income support fraudulently between 2003 and 2007 - a large amount.  When she asked to see the records with a breakdown of the claim, she was told they no longer have it as it is too old.  She could not remember ever being on IS.  She is not the only one.  There was a directive, I'm guessing, to drag in the overpayment cash and some employees were keen to show their zeal. 

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

Only if there was an easily-accessible analogue option for those that are not online at home and because they are ill/disabled can't get to facilities outside the home. One case yesterday, a couple with the wife lead claimant on an ESA IR couple claim (Support Group, PIP DL and mob) reached state pension age.  Husband is carer, younger.  They were moved to UC, we know not how, now only have personal element in payment, no rent element, no LCWRA no carers element. 
Carers allowance being deducted in full though. I hear of this often - CA deducted but CE not applied. 
No internet at home.  No smart phone.  We're getting them to where they should be but they've had three months of this before a daughter reached out for help for them. Staff should have seen the situation and set up their UC correctly.

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?

That would depend on the culture in the DWP assessment unit.  It would probably be better than the current commercial outsourcers. 

The impact of the pandemic

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?

Remote assessments miss some things - a person's body language, for example.  Video assessments are being trialed.  I think that would be a good thing more generally.  We'd all love a paper-based assessment - the process, however it's performed is hard for poorly people to negotiate.   Using all the options appropriately is probably the best way forward.

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

It has to be safer and cheaper to hold assessments remotely via phone.  However for some people this would not work.  There is no one size fits all here. 

For some claimants telephone interviews are a blessing, as it's hard for many to get to centres, and even staying upright for too long is aggravating to some illnesses. 

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

Not my field.

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?

By calculating the claim on the age at original application and not at assessment age?

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 are able to access health-related benefits consistently?

I run two facebook groups helping people access the benefits they are eligible for, and we're very busy.  We are a free voluntary service.  We've grown by 500 members in November 21 alone.  The CAB and other services also have a lot of information online, but typed words are not enough, people need explanations to suit their level of understanding. They need empathy. It's hard now to get a face to face appointment with an advisor, and then they're often untrained, unpaid volunteers too.

If the DWP worked on their macro standard letters that would be one help.  They can be very confusing.  For example, an ESA award letter will often include the paragraph 'we can pay you this until (a date in December)'  and people think it means their ESA will end then.  It actually means that on that date an extra £10 christmas bonus will be paid, so it will be another £10.  Then the next payment goes back to the standard rate.  ESA is ongoing until reassessment is completed.  That is not explained.
The regular annual ESA payment breakdown letters are confusing - why can they not say to start with 'You are receiving New Style ESA/Contributions based ESA/Income Related ESA (whichever it is)?  What it says is 'your income based amount... because of your contributions... 
A recent one I happen to have to hand is dated 9th November 2021 and at the bottom it says "The amounts on this page apply from 31 May 2018 to 28 November 2018" Ooops they forgot to update those dates.  And, there's that Christmas bonus anomaly again.

It's not just the ESA letters, all DWP communication needs sending to the plain English people for a rework. 
 

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

They do pretty well, allowing access to their staff guides, the legislation and their Touchbase news email.  It would be useful for us advisors to be able to speak on behalf of a client when they were not physically with you without having to go through the long appointee process.  Perhaps we could have some kind of accreditation for volunteer advisors?

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?

When you are too unwell/disabled to earn your own living, you are very vulnerable to the removal of your benefits.  So people do get panicked by the process of renewals and applications.  It's understandable.  Few of us have much in the way of savings left.  If the DWP makes an error and fails to award, it can take months to get your income back and you are not in a position to find alternative sources - you can't work.   Then, to give a clear picture on the forms, you have to tell all the gutty details of your life, things that you keep hidden from the rest of the world usually (if you can), and it makes you realise just how much you've lost through your illness/disability. 

I don't know what the answer is.  If the GPs had more time, I'd say take their word for it.  But they don't now. 

Waits for assessments

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

Hire more staff?  Train them more effectively?  None of which seem likely at the moment. 

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?

You were working and earning a good living.  Then something happens - a sudden sickness or catastrophic accident perhaps - and you are on sick pay for a while.  Hope springs eternal, you think you'll get better, and you start to spend your savings.  By the time you've accepted that you are going to need to claim benefits, your savings, and perhaps your contributions eligibility, are running out.  Now, you can't shop around, walk to save money, do the basic maintenance needed to keep things on an even keel, and you've got £74.70 a week, of which perhaps 80% is spoken for.  It's a difficult time.  I remember it well.  I had £30 a week for all incidental expenses including food, and a delivery costs 15% of that.  With a minimum spend..  That was after driving down my bills as far as they would go. 
 

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? 

Does it?  As part of the Spartacus Group I was deeply involved in the PIP consutation process (2012)  and I'm spending a bit of time on this - but this isn't a DWP consultation. Apart from that, writing in with concerns to the relevent DWP department meets a black hole. 

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


Allow email communication. 

 

 

November 2021