Written evidence from the Disability Advice Project (HAB0091)
Introduction
Disability Advice Project is a charity established for more than 20 years. We help people in South Wales with long-term health conditions and disabilities. We provide advice on entitlement to services and benefits. We help with completing forms, compiling evidence to support claims and appeals. In the last 18 months we have helped more than 500 disabled people.
They should be carried out by people who are qualified in the field of that disability, especially in learning disabilities and mental health cases.
Assessors should be compassionate. Assessors need to be more objective and less judgemental – some assessors have made their minds up before they start the assessment.
Carers should be able to contribute to the medical assessment as very often the claimant does not give the full story.
Why are assessments continuing to be carried out on long-term, degenerative conditions? Surely this is unnecessary?
Ensure assessors are not under pressure to get people off the benefit, whether under written rules or contractual pressure. It should be about the people getting the right award in every case.
Assessments are written in such a way that if a claimant can achieve one activity/descriptor it is presumed that they are able to achieve others, without any real explanation in the reports. It is always pertinent to explore each activity/descriptor to form a balanced/accurate view. More time needs to be spent asking questions.
a. Have you seen any specific improvements in the process since the Committee last reported on PIP and ESA assessments, in 2018?
No! Especially since covid, as telephone assessments are, in the main, not fit for purpose. How can you assess somebody’s ability to walk on the telephone? There are too many assumptions about a person’s mental health because they can have a conversation on the telephone.
They are too narrow! They do not cover the claimant’s ability to look after their surroundings to make sure that they are safe.
They also do not accurately assess mental health conditions.
No, they do not. Take for example - 4(c) Cannot transfer a light but bulky object such as an empty cardboard box. When ESA was introduced, we were told that the above descriptor was a representation of a claimant who could be considered for work in a supermarket, sat at a checkout. If the claimant was observed carrying a bag or moving in a certain manner at their WCA they are deemed ‘able’ to do this in a work environment. The words repeatedly, reliably, and safely are not used as they were intended.
Time and time again, claimants are assessed on their ability to carry out an activity – such as washing and bathing. If the claimant lives alone, they might score 2 points for needing an aid or an appliance. In reality, some claimants need assistance to wash, the fact that they live alone penalises them when you read their PA4.
The descriptors which ask if you can carry out tasks with either hand take no account of the fact that you have a dominant hand. For many people, using their non-dominant hand is not possible or not possible to a good enough standard.
Also, for many people who are unable to do manual labour any longer and are nearing retirement age the ability to carry out a different sort of work is limited. As the retirement age increases this will become an increasing problem.
The descriptors do not consider the danger of the working environment when someone is only able to do something using one hand.
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?
In the current situation getting clinician input is very difficult. Consultants still say that the DWP will contact them for any further information. This is not the case in our experience. The DWP say that getting evidence to support their claim is the claimant’s responsibility. The clinician will in most situations charge to provide anything other than medical records. Making it unaffordable.
The length of time a claimant has had a condition is not considered. Often when a condition is chronic and long-term, they will have exhausted all the medical options and are therefore not having clinical input.
Claimants’ health can be worsened if faced with being found fit for work/appealing. The clinician is often asked to provide additional evidence in the case of an appeal.
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 standard of most assessments is so bad! Tribunals give more weight to the claimant’s evidence. Assessors are making the vast majority of ‘decisions’ before it reaches the case managers/decision makers. The assessors’ reports, in the main seem to have adopted a ‘you are dishonest, unless you can prove otherwise’ approach. The system seems to have a ‘catching people out’ style. The DWP/medical services do not seek the views of a claimant’s GP, and or their specialist’s. Perhaps this is why so many decisions are overturned at appeal? As previously mentioned, the reliability test is not used as it was intended, by medical services/case managers.
Would it be feasible to take a holistic approach to ESA/PIP/DLA/AA claimants? Treat claimants with an open mind. Not all conditions present the same. Chase evidence from claimants’ relatives/carers/therapists/GP’s/consultants. DAP attends the Tribunal Users Group. Judges there have urged caseworkers to seek ‘personal statements’ from those close to claimants. Such statements do not seem to carry any weight with the DWP/medical services. The current system is disjointed.
Work with third sector/organisations like DAP to streamline claims/advise etc. The cost to prepare/represent and hear an appeal must be considerable. It is always cheaper to do the job right the first time.
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)?
It would be difficult for the assessor as the criteria are different. However, the assessment for both should be available to the assessor and the decision maker so that some of the clear contradictions we see in decisions may be reduced.
9b. 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?
People do not trust the DWP anymore than they trust the external assessment agencies. It would need to be a self-governing unit, not influenced by hidden agendas. It should work to the concept of the right benefit for the right person at the right time. It should be a ‘not for profit’ organisation.
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?
We have not seen any difference in the number of paper-based assessments carried out and the telephone assessments are not, in the main, fit for purpose. The assessor’s report seems to be relied on more than the medical records by the decision makers. However, when you get to tribunal the panel rely heavily on the medical records and the testimony of the claimant.
With regard to remote/telephone assessments the way people communicate is made up of:
Body language – 55% Tone of voice – 38%
Words – 7%
Unfortunately, in medical reports and decision maker comments they now rely too heavily on the words.
a. Is there a case for making some of the changes permanent?
DWP need to look at the system in Scotland and learn from that before making any changes.
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?
There was no help, especially for those who are unable to use the telephone or electronic means.
DAP has worked all the way through the pandemic to support clients, but it has been difficult.
CAB is supported through public funds for some of its activities. We must rely on grant applications or fundraising. Welfare advice is not a ‘sexy’ activity that attracts lots of fundraising support. As a consequence, a lot of our time is spent trying to find funding which is extremely scarce. DAP needs long-term funding of 5 years minimum.
We cannot access DWP funding streams, as we have been told this would be a conflict of interest. However, if the ethos is to ensure that the right benefit is gained then there would be no conflict of interest.
The DWP need to recognise that we save them money by providing a triage service which prevents people from making claims that are not eligible.
16. How effectively does DWP work with stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?
We have not had any meaningful consultation other than an audit office meeting. There was not any feedback from that meeting. This limited consultation was tokenistic.
What steps could the Department take to improve its engagement with stakeholders?
We spend so much time waiting for an answer on the phone. A dedicated adviser helpline could significantly reduce time wasted. This would be beneficial to the DWP and advice organisations as often a two-minute call can prevent a lot of work on both sides. Organisations like DAP should be on an approved ‘register’ so that DWP can speak to us without us having to have the client with us to give permission.
December 2021