Written evidence by Oasis Hub Waterloo (HAB0090)

Oasis background

Oasis is a movement of volunteers, activists and professionals that works in 36 communities across the UK. Oasis is a global family which collectively works around the world delivering a range of projects and services that help tackle social injustice in whatever form it manifests itself. We work to end disadvantage and create opportunity for all, providing education, housing, health, justice, youth and family support.

Oasis Hub Waterloo

Oasis Hub Waterloo offers a number of community services including welfare benefits advice, debt advice and also a food bank which is part of the Trussell Trust food bank network. Oasis Hub Waterloo offers its free, impartial, advice to anyone in the local community who needs support. We receive self-referrals and referrals through other services, including through our own food bank.

When providing welfare benefits advice we will support on all relevant welfare benefits (including Universal Credit, Personal Independence Payment and Employment and Support Allowance). If needed, we will support a client appealing a welfare benefits decision throughout the whole process of an appeal, including supporting them at tribunal stage.

At Oasis Hub Waterloo, we have taken 14 Personal Independence Payment (PIP) cases to tribunal over the last c.3 years and have 100% success rate at getting an increase in PIP allowance from these. We have taken on 1 Employment and Support Allowance (ESA) case to tribunal, also with the decision overturned and a positive outcome for the client. Primarily our evidence provided below relates to PIP.

Summary of overall issues with PIP assessments

The health assessments for benefits process is demonstrably failing clients, with the vast majority of decisions which are appealed overturned at an independent tribunal. For PIP appeals 76% are overturned in favour of the claimant. For the PIP appeals which we have supported clients with, we have seen 100% successful outcomes for clients.

In our experience those who are most in need of support of the system, are least able to navigate it. Trying to navigate the multiple stages of a PIP appeals process is exhausting and demeaning and would be difficult for anyone, let alone someone with ongoing severe health issues. Many of our clients who have poor mental health and physical health at the start of the process will find their health worsened as a result of the stress and strain of appealing the decision. They feel like they are not believed and find it demeaning feeling like they have to “prove” how unwell or disabled they are.

PIP is not a means tested benefit, and is available to anyone with an illness, disability or mental health condition to help them to manage the extra costs of living with a disability. However, it is probably less likely that those on medium/high income would put themselves through the process of applying for PIP. And certainly, for the clients which we support, they are not only struggling with significant health conditions, but they also tend to be struggling on low incomes and are the people who really need the financial support from PIP to help them to manage the extra costs of their disability or health conditions.

In our experience of supporting clients, the process of going through a PIP appeal (from sending a Mandatory Reconsideration to a tribunal hearing) can take between 4 months and 12 months. During this time, for many of our clients, their financial situation will worsen as they are not getting the financial support that they need and they may accrue debts.

We set out detail relating to the most problematic aspects of the PIP process throughout our submission below, including:

• Issues with indicators including the focus on physical aspects conditions and seemingly arbitrary aspects of these. There is insufficient recognition of the impact of mental health conditions.
• Assessors having lack of knowledge of conditions and writing reports with factual errors and over reliance on the basis of superficial evidence such as how a client was dressed at the assessment.
• The Mandatory Review process not functioning as a real review stage, with reports copied and pasted from the assessment and decisions rarely/never changed at this stage.
• The overall process is not functioning with 76% decisions which are appealed being overturned at tribunal stage. This poorly functioning system is not only providing poor value for money to taxpayers, but, more importantly, the long appeals process has a hugely detrimental personal and financial impact on the people who most need the support.
• The overall time of the appeals process which can be up to 12 months to go through. This lengthy process can be further worsened by the additional delays that clients often endure, such as because of admin errors, as well as the delays in receiving their payments even when the decision has been overturned.
• Going through an appeals process once is difficult, but people applying for support are often then required to re-apply in 3 years (even people whose health conditions have not changed or have worsened in that time), and may have to go through the whole appeal process again.

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

PIP indicators

• Indicators are shaped primarily towards physical conditions – preparing food, dressing and undressing. Many of the people we support have severe mental health conditions such as schizophrenia, bipolar disorder, Post Traumatic Stress Disorder, severe depression and anxiety. And often at assessment they receive 0 points, suggesting that there is not adequate reflection of the impact of mental health conditions within these descriptors.
• Within the descriptor breakdowns, the ones relating to mental health often cite something causing “overwhelming psychological distress”. Potentially this description is too specific or difficult to show that an activity leads to this, even if this is an activity that someone cannot do because of their mental health conditions.
• The descriptor ‘Planning and following a journey’– is described as a mobility descriptor. However the descriptor breakdown does include not being able to undertake a journey due to psychological distress, and the application form says to “tell us if you have severe anxiety or distress from leaving your home following or completing a journey”. This suggests that this is about daily living rather than mobility.
• There is also a focus on aspects of functionality that may lead to poor decision making. For example, the descriptor ‘managing a health condition’ focuses on the number of hours a week someone needs support. If someone needs to take medication every day to manage their condition and will become seriously ill if not, it may not be that significant how long it takes them to take their medication, but that they need support every day to do this, and the impact it will have if they don’t. The moving around indicator is also highly focused on the distance that can be travelled. But it is not always clear that other aspects are significant to this question such as whether they can move a certain distance, but are in a significant amount of pain.

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?

Currently, conducting an outsourced health assessment is not working well, as many poor and incorrect decisions are made as a result. The initial decision seems to made almost entirely on the basis of what the assessor perceives to be the situation at the assessment, with little regard for other evidence submitted.

Given the high percentage of PIP decisions that are appealed which are then overturned it may be that a greater number of correct decisions would be made if decision makers relied on clinician’s input without a separate assessment. However, we also understand that there could be complications if decisions regarding benefit entitlement were made solely by GPs/ other healthcare professionals. This could lead to detrimental relationships between patients and GPs, with a lack of trust and GPs worried that their patients did not want to be open with them because they know that they could impact their benefit status.

There should at least be a more balanced approach, which gives greater weight to reviewing and considering all the medical evidence, and other statements submitted by the applicant and the people supporting the applicant, alongside any health assessment. In the longer term, a system which does not lead to so many poor and incorrect decisions is needed.

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

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

PIP appeals

In our experience as providers of welfare benefits advice, 100% of the PIP cases where we are supporting someone to challenge a decision are successful. In almost all cases we go through the full appeal process, it is rare that a Mandatory Reconsideration will lead to a change in a result, but very common for the tribunal stage to overturn a result. In our view, the assessment stage needs to be improved, as well as the Mandatory Reconsideration stage, to prevent so many people needing to go to tribunal stage to get support that they are eligible for.

Issues with application stage

• Indicators – please see as above
• Accessing the form to apply – Whilst it is possible to appeal a PIP decision online, it is not possible to make an initial claim online. Instead, to apply, it is necessary to call the DWP (which can take an hour to get through to someone) and then a form is sent in the post which takes another week. Having an online option would make applying much quicker, and also easier for us as advice workers to support a client as we can see what information has been sent and keep copies.
• Completing the form – the form is very long and many of our clients find it difficult to fill in without support.

Issues with assessment stage

• As advisers whilst we do provide support on filling in PIP claim forms, most commonly we become involved in a PIP case when an application for support has been turned down. This means that we are less commonly involved in a case at the point of a health assessment and not as often present at these appointments. However, from what we do have access to, we are concerned that assessments can often be undertaken poorly. Firstly the notes from assessors which we view as part of the appeal process often show that superficial information such as how the client dressed that day are taken into account for decision making. For example: “You were observed to be of average build. You were seen to be well kempt”.
• We also often see factual errors in the health assessors’ reports. We have commonly seen reports citing for example that there is “no mental health input” or client is taking no current medication for a mental health condition even when these are aspects which are easily shown to be incorrect when reviewing a client’s medical evidence that they have already submitted.
• We also know that the health assessments for PIP are not done as well as they could as so many of them produce a result which is then overturned at appeal stage. Often at assessment stage clients will receive 0 points overall, and then may go on to being awarded higher rate support. This shows that it is not just slight differences in judgement, but huge changes between the initial assessment outcome and tribunal outcome. We do not think that the difference in these two outcomes is because there has been substantially different evidence presented at the final tribunal stage, but rather that the evidence that has been submitted at application stage is not properly considered.
• We understand that assessors cannot be experts in all medical fields, however sometimes the lack of knowledge of conditions is worrying. We recently supported a client who is living with a HIV diagnosis and multiple related physical and health conditions, as well as Post Traumatic Stress Disorder. This client was assessed by someone who said that they were a part-time paramedic. They told the client that they had little knowledge of HIV.

Issues with Mandatory Reconsideration stage

• The Mandatory Reconsideration stage is meant to be a point in the appeal process where the evidence is reviewed again. We would expect that this would allow for cases where the outcome was incorrect to be overturned. However we do not believe that we have seen any cases that have been overturned at this stage.
• When reviewing the notes of the assessor’s report that has conducted the Mandatory Reconsideration these often look as if they have been copied and pasted from the first assessment, and we can see no evidence that the case has been properly reconsidered.
• We do not think that people applying for support from PIP always understand that there is another appeal stage after a Mandatory Reconsideration. As we have had clients who have come to us for financial support who did not know that they could appeal a Mandatory Reconsideration Notice; once they have appealed once and are refused, they assume that there is nothing further that they can do. 

Issues at tribunal stage /overall appeals process

• The high level of success rate for PIP appeals at tribunal stage (76%) shows that many decisions made the first time round are wrong.
• We know that our clients find going through the appeals process mentally and physically draining. Many say that they found the assessment humiliating, and they feel like they are not being believed. Many tell us that they would give up the appeal and not get to the tribunal stage if we were not supporting them.
• As an advice provider almost all of the cases in which we support to tribunal stage are overturned. We think that the small number of PIP appeals which are not successful in overturning the decision may include some people who are not being supported by an advice provider, and as such they may have been successful if they had received advice or support. For example this could be because applicants do not always understand the relevant things that they need to speak about in the tribunal hearing, some applicants may have spoken about conditions which were less relevant to their claim, or may not have understood that they do not need to prove financial need to be eligible for PIP. If they had had some guidance on what the tribunal was about then they might have been successful in overturning the decision. 
• The experience of the PIP appeals process is significantly worsened for our clients due to the length of time that it takes to go through it. We have provided an example below of a timeline that we went through. Please note we have provided an example of a case from before the Covid pandemic, to show the types of delays clients experienced even before the additional pressures and delays due to the pandemic.
• We have also had cases where the lengthy “usual” appeals process has been further delayed by administrative errors. For example for one client that we were supporting the HM Courts and Tribunals Service did not send out the tribunal pack to the client or ourselves ahead of the hearing, nor did they send a digital copy instead. In this case the tribunal hearing had to be cancelled and then re-booked whilst we waited for the tribunal pack to be posted, which led to further delays of c.8 weeks.
• It is worth noting as highlighted by the example below, that even when a client has the decision successfully overturned they often face delays in a payment being made by the DWP. We have seen delays of 8 weeks following a tribunal hearing. During this time a client’s financial situation, as well as the continued impact of the stress of going through the process will continue to exacerbate their mental and physical health.
• PIP awards tend to be for a fixed period of time, which can be only 3-4 years. The re-applying process involves starting from scratch. The whole form needs to be filled in again, even if there have been no significant changes. This then leads to a further delay and people being without money for weeks or months again before a new decision is reached.
• Finally, our understanding is that the companies that conduct health assessments never receive any follow-up data from the DWP which lets them know which of their decisions were successfully challenged. Therefore there is no data going back to help them improve their decisions.

Case study:

• Client is a vulnerable adult diagnosed with severe depression and anxiety, and a personality disorder.
• May/ June 2018 – Client first applies for PIP with help from a housing support worker and attends PIP assessment.
• August 2018 - Client notified that application is refused, 0 points awarded
• September 2018 - Client sends Mandatory Reconsideration with help from housing support worker.
• September 2018 – The Mandatory Reconsideration is refused with no changes to the decision. Client and housing support worker do not think there is anything further that they can do.
• August 2019 – Client and housing support worker come to Oasis for support regarding client’s financial situation. Client is advised by Oasis that there is another PIP appeal stage, and are supported to appeal the decision.
• November 2019 – Client has tribunal hearing and appeal is allowed. Client is awarded the enhanced Daily Living Rate and the standard Mobility Rate.
• January 2020 - Client receives first PIP payments after 8 weeks since the decision was overturned at the tribunal. The payment is only made after the housing support worker has called the PIP helpline to chase the payment.
   

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?

There have been some changes made to PIP as a result of the pandemic including virtual health assessments and virtual tribunal hearings. These changes have had mixed impacts for our clients.

Some of our advisers have supported clients during virtual health assessments. In one case in which we were present, the session took 90 minutes when it was schedules to take 60 minutes, the questions weren’t asked in order, and the client was asked what felt like irrelevant questions such as about what the client fed her dog. All of this made the experience stressful for the client.

We have also had experience of supporting clients to attend tribunal hearings remotely (via video link or conference call). Most of our clients have come to our offices so that we can support them to take part. Some needed technical support to participate remotely; they would have been unable to use the online video links to access the hearing without our help, others came to our offices for the remote hearing for emotional support.

Even with some of the issues with clients accessing the remote assessments and tribunal hearings online, for some clients this change to remote participation is more accessible than the situation before the pandemic when clients had to attend assessments and tribunals in person. This is because for many of our clients having to navigate to a new place is often difficult and stressful and attending the tribunal centre in person can be intimidating. We have had clients who have said that they did not attend health assessments or tribunal hearings because they found the process of planning the journey and attending the centre too stressful or difficult because of their health conditions. We think that different options to participate should continue to be provided.

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?

ESA provides a basic assessment rate whilst someone is awaiting an assessment. Whilst the basic rate is not sufficient to cover living costs and should do so, it is still helpful that there is some provision during long waiting times.

There should be a similar basic rate which people receive whilst they are appealing a PIP decision. In our experience with PIP, the appeals process can often take 12 months or longer. We then know that the majority of people who appeal a PIP decision (76% of those who appeal, and 100% of our clients who appeal) will eventually have this decision overturned. Clients often come to us needing support because they are in financial crisis. During the appeals process clients will often build up debts. When the decision is finally overturned, the next stage for many of our clients is then to provide them with debt advice to help them manage the significant debt that has built up during this time. If people appealing a decision were paid a basic PIP rate during this process, that would be a significant improvement and a good short-term solution. For the minority that did not win their appeal, this money would need to be recovered gradually. In the long-term, improving the system so that it did not produce so many incorrect decisions would be the best for our clients.

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

We would like to see the DWP engage better with people with disabilities and with experience of the system when designing their policies and systems. This would lead to better policy making and services which are more likely to work for the people who will be impacted by them.

We know that the DWP already regularly engage with different charities and groups of charities who represent people with a range of different disabilities, such as the Disability Benefits Consortium. We think that they should continue to do this regularly and take on board the input of these groups and outline the changes they have made as a result. The DWP should also consult advice organisations and organisations which represent the views of advice workers such as the National Association of Welfare Rights Advisers.

December 2021