Written evidence from the Royal British Legion (HAB0097)

 

 

Summary of Recommendations

 

 

 

 

1        About Us

1.1  The RBL is at the heart of a national network that supports our Armed Forces community through thick and thin – ensuring that their unique contribution is never forgotten. We were created as a unifying force for the military charity sector at the end of the First World War and remain one of the UK’s largest membership organisations. The RBL is the largest welfare provider in the Armed Forces charity sector, helping veterans young and old transition into civilian life. We help with employment, financial issues, respite, and recovery, through to lifelong care and independent living. For further information, please visit www.britishlegion.org.uk.

 

1.2  The Benefits Debt and Money Advice (BDMA) Service provides free debt and money advice including advice on bankruptcy and debt relief, benefit checks and income maximisation, as well as benefit claims and challenging decisions up to and including the upper tribunal. The service works through England, Wales and Northern Ireland and has 33 advisers across the UK, 13 of which are based in our Contact Centre in Wales. In 2020/21, BDMA advisers provided support in 1,775 cases. 

2        General Comments

2.1  The UK Armed Forces community, including veterans and their families, face a number of challenges when accessing and navigating the UK benefits system, particularly for those veterans who are injured or disabled as a result of Service. RBL has long engaged with the Department for Work and Pensions (DWP) and assessment providers to improve the experiences of Wounded, Injured and Sick (WIS) veterans who claim Personal Independence Payment (PIP) and Employment and Support Allowance (ESA). The issues addressed throughout this submission are long-standing and are consistently reported by both beneficiaries and staff. 

 

2.2  Each year approximately 14,000 personnel leave the Armed Forces; of whom around 2,000 receive a medical discharge.[1] For a proportion of this group their injury maybe so severe that they are unable to work and rely on disability benefits. RBL’s 2014 Household Survey found that households with working-age veterans are more than twice as likely to claim sickness or disability benefits than their civilian counterparts.[2]  Whilst there are no robust figures on the number of veterans in receipt of PIP or ESA, research has found that the most persistent benefit usage amongst veterans is by WIS veterans.[3]

 

2.3  In 2020, RBL published Making the Benefits System Fit for Service, a study exploring the experiences and barriers faced by disabled veterans in the social security system. Whilst this research is drawn upon often throughout this submission, the lack of data on how many veterans make use of social security benefits means that it is difficult to know the extent to which these issues are faced. To fully understand veteran benefit usage, the RBL believes that all benefit application forms ‘ask the question’; whether claimants have served in HM Armed Forces. This data should be asked on all benefit forms and routinely collected so that veterans’ needs can be fully understood, and appropriate further support provided.

 

2.4  We have restricted our answers to the questions for which we can offer expertise and insight, and to areas where we believe that the Armed Forces community may be at a disadvantage.

3. Inquiry Questions

3.1 Improving Assessments

 

3.1.1                    A key issue with benefits assessments that impacts the Armed Forces community is the emphasis on physical health and functionality in assessments. A number of participants in RBL research noted that, when undergoing a Work Capability Assessment (WCA), their mental health conditions did not always manifest into a physical impairment, and no weight was given to the impact of their mental health conditions when ascertaining if they were fit for work.[4]  One claimant noted that their assessor ‘insisted that they only answer questions’ asked rather than explore the effects of their mental health condition.[5] This view was reinforced by research undertaken by Salford University, which identified a number of service leavers who felt that ‘limited attention’ was paid to their mental health conditions in their assessment.[6] This led to some research participants being incorrectly deemed as ‘fit for work’.[7] For assessments to most effectively assess veteran’s functionality, assessors should be allowed more time with claimants to explore mental health conditions and their impact.

 

3.1.2                    Whilst much has been done to destigmatize poor mental health amongst veterans and encourage help-seeking, many still hold negative attitudes and believe that they will be treated differently if they admit mental health struggles. Disregarding mental health concerns may discourage veterans from seeking help. A veteran with Post-Traumatic Stress Disorder (PTSD) who participated in an RBL research stated that their assessor had ‘no awareness’ of ‘how PTSD impacted their concentration, focus and memory’, and that the assessment overall was ‘very stressful and increased [their] anxiety and insomnia.’[8]

 

3.1.3                    Veterans in our research found that this lack of understanding of common Service-related conditions was compounded by a lack of understanding of military culture. RBL’s research found that only 8% of surveyed veterans claiming PIP, and 6% of surveyed veterans claiming ESA, felt that the assessor had knowledge of the Armed Forces and Service-related conditions.[9] RBL advisers believe that characteristics of Armed Forces culture, such as always presenting smartly dressed or underplaying conditions, have resulted in assessors incorrectly perceiving veterans as not being significantly impacted by a condition. RBL has previously worked with DWP and assessment providers to raise the awareness of PTSD and other service-related conditions, yet these concerns still persist. RBL is grateful that assessment providers are working to implement Armed Forces champions to support assessors with understanding the Armed Forces community. For this to be most effective, assessment providers should offer mandatory training on military culture and ‘refresher’ modules on PTSD and other common service-related conditions, and the impact they may have on a veteran’s functionality.

 

3.1.4                    Whilst assessments are functional, Service medical records may go some way to speaking towards functionality or explaining a condition which may be helpful in determining the outcome of an assessment. In-Service medical treatment is provided by Defence Medical Services and records, upon leaving are not automatically transferred to the NHS. Service medical records must be obtained by the veteran, through an often challenging, bureaucratic process. The challenge of obtaining records leaves veterans with little time to collate this information prior to the deadline for which they must submit their benefits application. For example, there is a ten-day turnaround time for claimants between requesting a PIP2 form and receiving it, and only one month in total to complete and submit the form. Many veterans found that their Service medical records only arrived after this deadline. 

 

3.1.5                    Additionally, the effective use of Service medical records is often barriered by a lack of formal guidance on how they should be presented by veterans, and utilised by assessors; Our research found that only 8% of those claiming ESA, and 20% of those claiming PIP, believe that the assessor went on to take their service medical records into consideration.[10] Clear, formal guidance on how Service medical records should be presented, and how assessors can utilise this information could prove beneficial. DWP should also offer more time for Service leavers to obtain their Service medical records and submit them.

 

3.1.6                    Reducing the number of assessments that WIS veterans undergo would vastly improve veterans’ experience of assessments. Evidence suggests that frequent reassessments are detrimental to wellbeing and diminishes trust in the benefits system. Veterans found reassessment ‘profoundly depressing’. Many disabled veterans are also in receipt of military compensation awards issued by Veteran’s UK, such as War Pensions for those injured before April 2005, or the Armed Forces Compensation Scheme for those injured after. To receive compensation, veterans undergo a functional assessment, which could also be used to establish eligibility for welfare benefits. The DWP should work alongside Veteran’s UK to explore whether military compensation assessment reports can be used to determine eligibility to disability benefits.

 

3.1.7                    RBL contributed to the committee’s inquiry on PIP and ESA in 2018. It was hoped that the evidence collected by the inquiry would contribute to robust improvements in the system for veterans. Despite constant engagement with the DWP through consultations and through fora such as the Operational Stakeholders Engagement Forum and infrequent Armed Forces specific fora, our advisers and beneficiaries report that issues remain unresolved.[11] Our Making the Benefits Service Fit for Purpose report published in 2020 was based on research carried out in 2019, and continued to highlight issues that predate the committee’s last inquiry. Within that research, assessments and the points cited within this response above, proved to be the most contentious issue, faced by veterans accessing the welfare benefits system.

 

3.1   

 

3.2  Descriptors

 

3.2.1                    Regarding descriptors, and in line with the wider disability charity sector and Armed Forces charities, we share concerns around both PIP and ESA descriptors in thoroughly assessing mental health conditions, and their impact on functionality. As highlighted earlier in this submission, WCA descriptors emphasise the impact of a physical condition or disability on a veteran’s ability to work, whilst reportedly failing to adequately assess the impact of mental health conditions; veterans with mental health conditions who participated in the Salford University research recount that ‘there was nothing…about mental health mentioned within [the WCA)’.[12] Despite engaging with DWP and assessment providers on issues with the WCA, and working to improve training on the Armed Forces for assessors, regular feedback from our BDMA advisers suggests that underlying concerns around the descriptors themselves remain. RBL encourages DWP to undertake a fundamental review of the descriptors to create parity between mental and physical health.

 

3.2.2                    It is also concerning that PIP descriptors overlook the impact of fluctuating conditions on functionality. For veterans who have lost a limb the 20-metre rule descriptor fails to accurately record the fluctuating impact of a disability. Veterans may be able to complete the assessments on a particular day but may be unable to do so consistently as their amputation site can become painful and swollen, rendering their prosthesis unusable.

 

3.2.3                    To build an accurate picture of functionality (including fluctuating conditions) the reliability criteria in PIP should be considered alongside each descriptor. The reliability criteria determines whether an activity can be completed safely, repeatedly, to an acceptable standard, and within a timely manner. Unlike the descriptors alone, this criterion prompts discussion and insight into conditions and the way they may fluctuate daily. By considering the descriptors alongside the reliability criteria, decision makers will be better able to understand the impact of common service-related conditions such as PTSD, or those with an amputation, can be better understood through and this may also allow for trust to be built in assessments. The DWP should consider including the reliability criteria in PIP Decision Makers Guidance.

 

 

3.3  The Role of Clinical Input

 

3.3.1                    As previously mentioned, the RBL believes that Service medical records and previous compensation assessments should be included in decision making on ESA and PIP applications. Compensation assessments are conducted by a doctor and, alongside Service medical records, could contribute to clinician input if appropriate guidance for both the claimant and decision makers were provided. For veterans claiming disability benefits due to a Service-related conditions, this may go some way to reducing unnecessary, stressful, and repetitive assessments, and increase the likelihood of an appropriate award consistent with the veteran’s Service-related condition.

 

3.3.2                    Whilst clinician input forms an important part of the puzzle, input from a carer or close contact, such as family or friends can be pertinent to ensure veterans receive an appropriate award. A recent study on spouses and partners who supported veterans with PTSD found that partners are exposed to challenging and distressing effects of the condition, meaning that where veterans may be unable or unwilling to fully articulate the impact of their condition, spouses and partners may be better suited to speak on the worst effects of an injury or disability.[13] Witnessing the effects of impairments first-hand, family, friends and carers’ may be able to provide a longer term picture as opposed to a snapshot of wellbeing. In collaboration with Service charities, guidance should be produced for both claimant and decision makers explaining how input from clinicians and those closest to veterans will be used to determine their eligibility to benefits.

4. Appeals

 

4.1.1                    Veterans who took part in RBL’s research reported a more positive experience at appeal, compared to other stages of the benefits system.[14] This may be because veterans can present further evidence, such as their compensation award, which can then be further considered. Our research suggested that expertise on the tribunal panel contributed to greater trust in the system.PIP appeal panels are made up primarily of a judge, a doctor, and a disability expert.  It is not unreasonable to suggest that the disability expert is more familiar with how a mental or physical condition can impact functionality, as well as how conditions can fluctuate. For example, a disability specialist may understand how functionality can fluctuate for amputees, who for instance, can be entirely mobile on some days but immobile on others. Representation from an advocate or specialist on Service-related conditions, prior to the appeal stage, would encourage greater trust and transparency in the benefits system.

5.Covid-19 and Improvements to Benefit Claims

5.1.1                    A previous RBL survey found that 78% of those claiming PIP, and 58% of those claiming ESA, found assessments stressful.[15] More recent anecdotal evidence from RBL’s Benefit, Debt and Money Advice Team during the pandemic, suggests that greater flexibility surrounding assessment formats, may have mitigated some of the stress factors within the system and been beneficial to veterans applying for disability benefits.

5.1.2                    Over-the-phone assessments have worked well for some disabled veterans. Flexible assessments have mitigated some of the key issues with face-to-face assessments for example, veterans with mental health issues often struggled to navigate the sometimes-complex transport routes to and from assessment centres, and reduced the stress and anxiety that came with preparing for assessments. Routine provision of flexibility for veterans to decide how they wish to be assessed would reduce the stress and burden of the assessment process. In turn this may routinely lead to more accurate assessment outcomes through increased trust and engagement.

 

5.2 Improving PIP and ESA Applications

 

5.2.1                    RBL’s survey in 2020 found that nearly three quarters of those who had claimed PIP reported struggling to complete the application form.[16]  Similarly, 63% of ESA claimants found completing the application form ‘difficult’ or ‘very difficult’.[17]  Some of the main difficulties for veterans include having to repeat, sometimes traumatic and upsetting, information. For example, veterans with compensation may have to speak about their condition and how it occurred for both their compensation and benefit assessments. Compounding this, low levels of literacy amongst some groups of veterans may act as a barrier to completing an application form. Almost two-fifths of Army recruits have a reading ability of an 11-year-old, or lower, and may find it difficult to understand what is being asked of them in benefits applications, and in turn, how to communicate their issues and limitations.[18] Given the barriers mentioned above and combined with the length of the benefits forms, there should be greater flexibility with completing applications, potentially by offering both an online and paper-based application option and providing face to face support to complete applications.

6.Engagement with DWP

6.1.1                    RBL engages regularly with DWP through several channels to provide representation for the Armed Forces community where they face disadvantage in accessing statutory support. RBL engages with DWP through regularly held engagement fora such as the Operational Stakeholders Forum (OSEF). This provides an opportunity to share best practice and raise key issues with DWP, as well as discuss queries. Whilst attending this forum is beneficial, we have previously raised issues through this forum and received little response. For example, RBL has consistently urged DWP to mirror legacy benefit procedure and consider veterans in receipt of Unemployability Supplement (UnSupp) as having Limited Capability for Work Related Activity, exempting them from a Work Capability Assessment.  Although this concern has been raised in a number of engagement fora, responses often reflect the content of the WCA as opposed to the decision-making, and little has been done to progress the issue. Equally, we are concerned that the unique needs of the Armed Forces community, as outlined in the Armed Forces covenant, risk being lost and therefore unaddressed within wider pan-disability conversations. RBL and other Armed Forces stakeholders would benefit from a specific forum where interactions between compensation and benefits can be discussed and attended by representatives from the DWP and Veteran’s UK who have specific knowledge and understanding of these interactions.

 

6.1.2                    Consultation responses allow the sharing of best practice and an opportunity to offer expertise on the Armed Forces community and insight into the effectiveness of policies and initiatives for our beneficiaries. Consultation responses provide the opportunity to reflect on previous initiatives and record progress. For instance, responding to the Shaping Future Support Green Paper earlier this year encouraged RBL to reflect upon improvements made since the Improving Lives Green Paper, published in 2016. Additionally, we were pleased to be able to facilitate focus groups as part of the consultation which allowed for new ideas and perspectives to be shared directly the DWP and we would encourage their use wherever possible in future policy formation. However, we again are unsure of the ability for the unique needs, and interventions required, of the Armed Forces to be recognised and addressed via these mass participation exercises. The Armed Forces Act 2021 introduces a new duty for certain aspects of local authority policy making and delivery to pay due regard to the needs of the Armed Forces covenant. We believe that the Secretary of State for Defence should use the powers conferred within the Act to extend this duty to the DWP to ensure that members of the Armed Forces community do not face disadvantage as a result of their Service.

 

 

 

December 2021

 

 


[1] MoD (2021) Annual medical discharges in the UK Regular Armed Forces, 1 April 2016 to 31 March 2021

[2] Royal British Legion, (2014), A UK Household Survey of the Ex-Service Community, p. 55

[3] Burdett et al., (2018), Veterans and benefits Relationships between social demographics, Service characteristics and mental health with unemployment and disability benefit usage by GB ex-Service personnel

[4] Royal British Legion, (2020), Making the Benefits System Fit for Service, p. 21

[5] Ibid.

[6] Scullion, L., et al., (2019), Sanctions, Support and Service Leavers, p. 23

[7] Ibid.

[8] Royal British Legion, (2020), p. 22

[9] Royal British Legion, (2020), p. 21

[10] Royal British Legion, (2020), p. 28

[11] Consultations on this matter include: PIP and ESA Assessments Inquiry (2018); Welfare Safety Net Inquiry (2019); RBL response to Social Security Advisory Committee on Engagement with DWP (2020); RBL response to Shaping Future Support, the Health and Disability Green Paper (2021).

[12] Scullion, L., et al., (2019), pp. 24-25

[13] D. Murphy, et al., (2017), ‘Living alongside military PTSD: a qualitative study of female partners’ experiences with UK Veterans’, Journal of Military, Veterans and Family Health, 3:1, available at https://jmvfh.utpjournals.press/doi/pdf/10.3138/jmvfh.4011  

[14] Royal British Legion, (2020), p. 36

[15] Royal British Legion, (2020), p. 21

[16] Royal British Legion, (2020), p. 17

[17] Ibid.

[18] Vorhaus, J. et al, (2012), Armed Forces Basic Skill Longitudinal Study, p.1