Written evidence from the Citizens Advice Service in Three Rivers (HAB0096)



Citizens Advice Service in Three Rivers (CASTR) serves a population of 93,000 people. We assist clients to make claims for sickness and disability benefits, to challenge and appeal decisions, and we also represent clients at Tribunal hearings.

We deal with many cases where our clients experience the following issues:

       a long delay in an assessment being scheduled;

       a poor quality assessment;

       a decision-maker not picking up and correcting problems with the assessment, leading to an incorrect decision on entitlement;

       Mandatory Reconsideration not identifying or correcting the problems with the decision; and

       a long delay in getting the right decision on entitlement via an appeal to tribunal. 

To evidence these problems, we analysed data from 75 clients we advised on PIP from April 2019-March 2021. Our key findings were:

       Two-thirds of the clients' cases went to appeal.

       95% of those appeals were successful at the Tribunal.

       A third of the clients that we supported at appeal were originally awarded 0 points by the DWP.  All of them were awarded PIP on appeal, and in 50% of cases Tribunals awarded an enhanced level of benefit (either the daily living component, the mobility component or both).

       In no case did a Tribunal agree with the number of points awarded in the original DWP decision – all resulted in an increase.  Tribunals awarded on average 14 more points than the DWP, and increased the total points awarded by 6 or more in 87% of cases.

       At Mandatory Reconsideration (MR) stage, where the DWP reviews its own decision prior to appeal, the original decision was maintained 80% of the time. 95% of these confirmatory decisions were overturned at Tribunal. 

       After making a PIP application, our clients had to wait an average of 115 days for the DWP to make an initial decision about their eligibility.  Prior to the pandemic (pre-April 2020), the average time our clients had to wait between an initial PIP decision and appeal outcome was 390 days.  Since the pandemic this has risen to 427 days.

       The highest back payment of benefit after a decision was changed was over £13k. The average was in excess of £4k.

Our evidence shows that claimants are currently waiting far too long to get the right decision on their benefit entitlement. Backdated benefit is paid when they eventually receive an award, however this never fully compensates these vulnerable individuals for the hardship and stress they have suffered in the interim, which often makes their health conditions worse.   


Claimants also suffer wider impacts of these delays, as a PIP award can entitle a claimant to additional support such as a Motability vehicle, the removal of the benefit cap, additional benefit premiums and the Warm Home Discount on their electricity bills.  The longer the wait for a PIP decision (either initially or at appeal), the longer our clients have to wait for these other sources of support.  Our research identified 3 instances where PIP reassessments led to a client losing their Motability vehicle for a year or more until it was subsequently restored by Tribunal decision.


Action must be taken to get more decisions on entitlement to sickness and disability benefits right first time

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

Provide assessors with sufficient time, training, and access to specialist support

We see many assessment reports that do not fully explore how a claimant’s health conditions impact their ability to carry out the ESA, UC or PIP activities for the majority of the time.  Too often broad conclusions appear to be drawn from how the claimant appears on the day of the assessment.  In our experience, the impact of mental health conditions on the ability to carry out the activities is particularly poorly assessed until a claimant gets to the Tribunal.

In order to reach the right decisions about entitlement first time:

       assessors must be allowed sufficient time to fully explore all the relevant activities and descriptors with claimants, and to properly consider the majority, reliability and significant risk rules;

       assessors must be properly trained to identify the impacts of a claimant’s health conditions on their ability to manage the relevant activities, particularly for mental health conditions;

       if an assessor feels unable to assess a particular claimant’s health conditions and abilities to the required standards, they should have access to specialist advice to help them do so.

Provide reliable audio-recording facilities for all assessments

We welcome the information in the recent Health and Disability Green Paper that, in addition to offering audio-recording for face-to-face assessments, the DWP is also offering audio-recording of telephone assessments. 

Clients frequently tell us that the assessor’s report does not accurately reflect what they have said, and this reduces their trust in the process.  For example, a client who told their assessor that they sit on a bench for 20 minutes while their dog runs in the park for exercise saw this described in the report as “walks their dog for 20 minutes every day”.  This gives the decision-maker a very misleading impression of the claimant’s ability to walk, and increases the chances of an incorrect decision and an appeal.

Audio-recording assessments increases the chances of making a correct decision on entitlement first time by enabling decision-makers:

       to check statements made in the assessor’s written report;

       to resolve any discrepancies between information in the application form and the assessor’s report;

       to provide feedback to assessors on any shortcomings so that these can be corrected for future assessments.

Audio-recording presents challenges.  In the past clients have told us about problems with the equipment, or delays in their assessment due to the technology not being widely available.  Others are not aware that audio-recording is an option. 

DWP should:

       ensure that all claimants are aware of the option to have their assessment recorded by asking on the application form if they would like an audio-recording;

       ensure that the technology is widely available and reliable to avoid delays;

       provide a copy of the recording to both the decision-maker and the claimant, together with the assessor’s report.

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 drawback is that vulnerable claimants often struggle to gather evidence from clinicians to support their applications for sickness and disability benefits. 

       Many have difficulty finding letters/reports that they have been sent and are unable to obtain copies without support.

       Some have been discharged from specialist care or have stopped engaging with support, even though their conditions have not improved.

       Many don’t know what information the DWP requires as they have no knowledge of the assessment criteria (activities and descriptors).

       Many are told by their GP that they are only able to provide a medical record, do not have the resources to write letters (or will have to charge to do so) and cannot provide evidence related to the assessment criteria as the impact of their health conditions on their daily activities has never been discussed.

       Some assume that because they have provided contact details for GP/specialists on their form, the DWP will contact them and they do not have to provide this evidence themselves.

Input from clinicians will be a key part of any assessment process, whether separate assessments also take place or not.  In order to reach the right decision about entitlement for the first time, we would like to see the DWP take on more responsibility for helping claimants with medical evidence.

       The DWP should send out information about the assessment criteria (activities, descriptors and points) with application forms and encourage claimants to share this with medical professionals so that the right kind of evidence can be provided.

       Where evidence is lacking, decision-makers should seek this from health professionals themselves, particularly where there is conflicting information in the application form and assessment report. There should not be a standard approach to this – as the recent Green Paper makes clear, a holistic approach leads to better decisions.

       There needs to be a recognition that an absence of medical evidence does not necessarily mean that someone is fit and healthy and can, on the contrary, indicate a long-term condition that is unlikely to improve or problems engaging with health services.  Assessors and decision-makers should thoroughly explore the reasons for a lack of evidence.

       The assessment and decision-making processes need to be robust enough to reach the right decision about entitlement first time in cases where little or no medical evidence is available, through the correct application of the majority, reliability and substantial risk rules.

7. Appeals data shows that, for some health-related benefits, up to 76% of tribunals find in favour of the claimant. Why is that?
7a. What could DWP change earlier in the process to ensure that fewer cases go to appeal?

Proper application of the majority, reliability and significant risk rules by assessors and decision-makers

Many of the decisions we see overturned at tribunal can be traced back to assessors and decision-makers not having due regard to:

       the “majority” rule.  Very often if claimants indicate they might be able to complete an activity as a one-off, assessors and decision-makers fail to explore if they would be able to do it for the majority of the time;

       the “reliability” rule.  We see many cases where assessors and decision-makers fail to explore whether a claimant is able to carry out an activity safely, repeatedly, within a reasonable time or to an acceptable standard, even where a claimant has stated this in their application;

       the “substantial risk” regulations for ESA and UC.  In our experience, the regulations stating that a claimant should not be found capable of doing work/work-related activity if doing so would pose a substantial risk to their health are frequently overlooked by assessors and decision-makers, and are not properly applied until Tribunal.

We see these same issues time and again at the Tribunal, with little sign of anything changing. In our experience DWP representation in person at tribunals is rare so there is little opportunity for issues to be fed back to decision-makers and assessors.

       An effective feedback loop must be established between Tribunals, the DWP and their contracted assessors so that lessons can be learned and decision-making improved. 

       Where a decision on entitlement changes significantly on reassessment it must be flagged for review by a senior decision-maker, particularly where the applicant has a chronic condition.

       Decision-makers must seek additional evidence where there is considerable discrepancy between the assessor’s report and the application form.

Inform claimants about the assessment criteria from the outset

When clients seek our help at the appeal stage, we sometimes find that they have not provided relevant information or evidence at application or MR stages because they are unaware of the assessment criteria (activities, descriptors and points). 

This information should be provided to claimants at the application stage, by being:

       sent out with application forms;

       signposted via links from the main benefit pages on www.gov.uk

Claimants should be also be encouraged to share the assessment criteria with medical professionals from whom they are seeking evidence.

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? 
10a. Is there a case for making some of the changes permanent?

Claimants should be offered a choice of assessment method

The new methods of assessment during the pandemic have been beneficial for many of our clients.  Before this, applicants in our area were expected to travel to assessment centres except in the most exceptional circumstances, and in some cases clients were prepared to choose loss of benefit over having to make this journey. 

After their experiences during the pandemic our clients have told us that, in future, they would like to be given a choice.  Their preferences depend on their health conditions.  For example, our clients with mental health conditions who are anxious about leaving the house often prefer a telephone assessment where they can sit in their home with someone they trust to support them.  Our clients with hearing or speech difficulties who struggle to communicate over the telephone prefer to see someone face-to-face.

We believe that giving claimants a choice of assessment method will increase the chances of a correct decision being made first time because:

       people will choose the method they feel most comfortable with;

       this will help them to provide the best possible information to the assessor about their health conditions.

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?

Support and advocacy from third sector organisations like ours is crucial to many people claiming sickness and disability benefits who are unable to complete the application forms or exercise their right to appeal independently.  They rely on our support with:

       understanding the criteria against which they will be assessed. The activities and descriptors are not sent out with the application forms and are not explained on the main benefit pages on gov.uk and as a result the vast majority of our clients are not aware of them;

       completing application forms, MRs and appeals;

       collecting relevant medical evidence;

       accessing their assessment report.  Many of our clients are unaware that this can be requested after they receive their decision.

In response to the pandemic, CASTR adapted its services to deliver this support over the telephone and digitally, but we know that some people struggled to access our help via these methods.   The benefits system must be designed to be accessible to all claimants, even in unprecedented and emergency situations.

12a. How can the Department best help the third sector to support claimants in their applications? 
16. How effectively does DWP work with stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?
16a. What steps could the Department take to improve its engagement with stakeholders?

Over the past year CASTR have developed a positive working relationship with the PIP assessors in our area (IAS/Atos).  They have provided training for our advisers to help us prepare clients for assessments, listened to our feedback about common problems with the process and helped unblock issues in individual cases.  This has been of great benefit for our clients.   We intend to initiate a similar dialogue with our local UC/ESA assessors.

By contrast, the DWP send us contact lists for local Partnership Managers to whom we can escalate clients’ problems with sickness and disability benefits, but in practice it either takes a long time to get an answer this way, or we get no response at all.  

The DWP could do more to create effective feedback loops between assessors, decision-makers, tribunals, support organisations and other stakeholders to help them monitor operational concerns and develop policy about sickness and disability benefits.

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?

Identifying claimants with long-term health conditions that are unlikely to change

Clients with long-term conditions that are unlikely to change tell us how stressful they find frequent reassessments.  If decisions on appropriate lengths of award and light-touch reviews were made correctly first time, it would remove this source of anxiety for a particularly vulnerable group of claimants.

To reduce repeat assessments, the assessment process needs to get better at identifying these claimants.   For example, we see many cases where decision-makers assume our clients’ conditions have improved because they are no longer receiving specialist treatment.  There needs to be a recognition that an absence of treatment can also indicate a long-term condition that is unlikely to change.  This can apply to claimants with:

       arthritis, where nothing more can be done except the management of their pain through medication; or

       mental health problems, where they have tried counselling/medication in the past but have not seen benefits and have given up on engagement with health professionals.


We would like to see the DWP improve its identification of clients with conditions that are unlikely to improve at all stages of the decision process:

       at application by encouraging claimants to submit evidence from GPs/specialists about the likelihood of their condition changing;

       at assessment by investigating if there is a reason why such evidence is not available;

       at decision by considering the need to seek more information, instead of penalising claimants for lack of evidence.

If this process identifies a small likelihood of someone’s condition changing, the award duration should be set accordingly, with infrequent “light touch” reviews.  The options on the assessment form for a recommended review date should be amended to include 5, 7 and 10 years.

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

Our evidence shows that our clients are waiting a long time to be assessed.  There does seem to be a particular problem with UC where claimants inform their work coach of their health condition but arrangements for their Work Capability Assessment (WCA) get “lost in the system”.  We have recently advised clients who were still waiting for their WCA 2-3 years after informing UC of their health conditions.  We helped them to get payments backdated, but they suffered significant hardship in the meantime.

We welcome the news that the DWP is developing a fully digital version of the UC50 and an online PIP2 form that can be saved and uploaded onto the DWP’s systems.  Digital applications can:

       save the time it currently takes for postal applications to be received by the DWP and to be scanned onto its systems;

       reduce our clients’ anxiety about the risk of paperwork being lost in the post.

However, it will be very important to continue to offer non-digital alternatives to people who cannot access online forms.


December 2021