Written evidence from Caroline Richardson (HAB0100)

 

Summary:

1.1 Offer choice from the following;

1.11 Use of an online app; Skype, Zoom, Whatsapp

1.12 Use of standard telephone calls

1.13 Use of more home visits

1.14 Use of more neutral venues – not centralised centres that may be significantly distanced from claimants, have poor parking and poor transport links.

1.2 Understand the difficulties of urban, sub-urban and rural transport services.

Realistic journey planning

Understand the negative effects of journeys on sick people

Pay GPs for what the DWP assessors demand re letters of ‘unfit to travel to assessment’.

Accept that most people who are sick are unfit to travel.

1.3 Health Care Professionals as Assessors;

The DWP is not unaware of the issues of unsuitable assessors, who have shown little or no understanding of the conditions they are presented with at assessments.

Claimants often highlight that the assessor didn’t understand their condition. This needs addressing. Understanding a condition and how it affects a person is essential to assessment.

Both the training and the ‘script’ need to be overhauled. 

Assessors need to have time to identify, from the evidence that is submitted by the claimant and medical evidence, what the health conditions are that they are going to be presented with, and have time to research what the implications of those conditions are.

Assessors should be able to reject assessing certain conditions if they feel they are not suitably qualified to understand the implications of the condition, i.e. a mental health professional being assigned to assess a person with a purely physical disability such as limb loss.

Assessors should be able to have a dialogue with the claimant as a ‘HCP’ – not as an assessor, perhaps prior to the assessment, to talk about the medical condition itself.

Assessors should not use the criteria as a checklist. If the DWP consider the criteria as a checklist then they are clearly NOT assessing people on their ability to get and sustain employment (with no negative impact on the claimant’s health or wellbeing).

The DWP needs to look again at the criteria for working and include what working looks like from an employer’s point of view. What is it employers want? How do people with chronic conditions fit into the employer’s view of what employees should be?

The criteria being used are not in line with the expectations of the workplace. This makes it very difficult for assessors to assess fitness for work accurately.

1.4 Quality of Assessments:

Assessor’s ability to assess to a high standard should be a key performance indicator, and monitored as such. Assessment accuracy is judged only on the competence to communicate the details of the assessment – not on the accuracy of the recommendation of award of the assessment.

This is a major failing given the system of recommendations from assessors being used as a basis to making awards.

Without a system of assessing accuracy of recommendations the DWP and contracted companies cannot identify poorly performing assessors.

Each assessor should have an accuracy target that is a KPI – where their conclusion and recommendation matches the final award – i.e after consideration, mandatory reconsideration, appeal and UTT.

3.1 The descriptors for PIP should be treated as proxies for functional movement – however they are often assessed as being task-orientated.

If the DWP insists on using tasks, then the tasks should be realistic activities that everyone engages in – such as getting up, washed, dressed, using the toilet, making three meals a day, making hot drinks, sitting, getting out of a seat, moving around the home, maintaining living conditions, shopping, hobbies and social and cultural activities, showering and bathing, retiring to bed, sleeping safely, moving around at night safely, accessing medications and being able to store, move and use aids.

3.4 The tasks/activities should be designed by people who are disabled. Able-bodied people do not understand being disabled. This is evidenced by the narrowness of the functional impairment criteria/descriptors.

There is no question that addresses safety of mobilising around the home, either during the day or at night, or including steps and stairs – either in the home or to access the home.

There is no question about making your home safe – such as opening or closing doors and windows, locking and bolting doors, testing fire and CO2 alarms. 

There is no recognition of normal activity – such as a social life, sports, hobbies, religious observances, shopping, maintaining a clean home, dealing with laundry, or being in work – and no recognition of the extra time, effort, energy and cost of such engagement.

 

4.1 ESA is a long term sickness benefit that can also be paid to those distanced from work due to disability, and for whom the jobs market is significantly reduced by their disability. It should be described as such – and it should be clear that it is a totally different benefit from the allowances paid for additional costs of disability, and that it is paid for a totally different reason.

The conflation of ESA and PIP has to stop. There needs to be clarification that ESA is about work.

Whilst sickness can be disabling, and disability can cause sickness, a person can be sick without being disabled, and more frequently can be disabled without being sick – as demonstrated by some Paralympians.

4.2 ESA fails to address in its descriptors if a person is too sick to work. That aspect is never addressed in the application.

4.3 ESA tests functional impairment. Most sick people have a full range of movement. ESA asks the wrong questions. It has no real world situations and fails to assess to the standard that employers need. 

4.4 ESA is weak at testing for protections in the workplace – such as assessing if a person can meet their hygiene needs. ESA seems to assume that once in a workplace that adaptations will be found, and issues such as hygiene, nutrition and wellbeing will be covered. Most workplaces are classified as ‘small’ and therefore may not be suitable for adaptations.

ESA should be assessed according to employer needs –

The ability to attend a workplace

The ability to attend a workplace without significant sick leave or other absences caused by sickness or disability.

The ability to attend a workplace and complete a task to a deadline

To be punctual

To be functional

To be reliable

Given the unreliable nature of sickness most sick people are unable to fulfil the needs of an employer; work or employment is unsustainable. Work, employment or work-related activity can be damaging.

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?

6.1 A clinician who is a GP can:

State or confirm the claimants condition(s)

Indicate expected levels of disability

Indicate if the claimant suffers from pain, exhaustion, and other non-visible/non pathological conditions

Indicate if the claimant is expected to recover, stabilise at their current level of impairment, or to degenerate, and to give approximate time frames

Indicate if the person is fit for work

Provide a comprehensive list of medications, treatments and investigations, results of tests and interactions

A clinician cannot:

Explain the day to day lived experience of the claimant, or the barriers that the claimant faces regarding working, living or experiencing and accessing life.

The clear advantage is that the clinician has the medical notes and the medical experience to understand the condition and its implications.

The drawback is that GPs do not want to be seen as the gatekeepers to benefits, as this can damage the GP-patient relationship.

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

7.1 The assessments are not asking the right questions. Sometimes the assessors are not recording the right answers. See earlier preamble regarding Key Performance Indicators.

When the wrong data is sourced in the wrong way, then the answers paint the wrong picture – and this ‘picture’ is passed down the line through the DWP.

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

7a.1 Introduce Key Performance Indicators for Accuracy of Assessment, thus empowering Contractors to identify under-performing staff.

7a.2 Decision makers should decide awards from submitted forms and medical evidence, and only after they have decided an award should they cross reference that with the Assessors report. This will reduce bias and give DMs more autonomy. If the two parties awards differ significantly then a second DM should repeat the process.

7a.3 Be less adversarial. Claimants are already frightened of adverse decisions, as they will have no recourse to income if the award does not go in their favour – and they then have to go through an additional anxiety inducing process of a tribunal. Most employees at DWP had a reputation for being kind and compassionate. Since the introduction of assessors claimants feel that that link has been broken.

7a.4 Assessors are the main issue – its felt that some consider themselves gatekeepers to benefits, use the criteria and descriptors as a checklist, and are biased against certain people. Assessors who are inappropriately trained – such as a Mental Health nurse seeing a person with a degenerative muscular-skeletal condition – or other area where they have no relevant expertise, is a barrier to a good assessment regardless of in-house ‘disability training’.

7a.5 Alternatively employ disabled people to conduct ‘soft-assessments’, and use medical evidence more. ‘Soft assessments’ where sick and disabled people can ‘chat’ to claimants about their lives would be much more revealing than any assessor.

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)?

8.1 There is no case for combining assessments for differing benefits. The two benefits test for very different things.

The only similarity is medical evidence.  The same medical evidence can be used for both PIP and ESA.

8.2 If the DWP uses medical evidence more, then it would be streamlining the system.  There also could be a return to the passporting of people who require sufficient care to get the Care Element of PIP onto ESA, as anyone with significant care needs is unlikely to be able to access work or employment in any meaningful or sustainable manner.

9b.1 If there would be more accountability and transparency and reduced costs if the DWP brought assessments back in-house, then there would be more trust. However the dependency on assessments (and the ignoring of medical evidence) is an issue. Assessments that are conducted in the same manner as they currently are would not improve the system. Only testing the accuracy of the parts of the system will improve it – so KPIs for accuracy of awards throughout.

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?

13.1 See previous points. The system will always cause anxiety – however the addition of an additional qualitative assessment introduces an additional level of anxiety. The failing of assessors is more commonly known than the successes of assessors. Introducing a KPI that assesses for accuracy of awards would be a clear indicator that action against poor assessments is being taken by the DWP, which eventually may lead to increased trust in the system

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

14.1 Give longer awards.

14.2 Employ more people.

14.3 Reduce assessments and believe GPs and medical evidence more.

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?

14.a. 1. The assessment rate is set as JSA rate – which is set low to prevent people being ‘comfortable’ on an unemployment benefit. However it is too low to live on – especially for those who have the additional costs of becoming sick or disabled. These people may have financial commitments that they could cover when working – but cannot cover when they become ill – thus compounding sickness with additional financial stress. Financial stress exacerbates illness – there is a direct link between poverty and illness, and placing people in poverty when they have a health crisis can accelerate the sickness or cause additional illness – such as depression and anxiety.  If the sick note and medical evidence indicates that the sickness is substantial and  long term, then a higher assessment rate should be given – as any award would be likely to be higher.

16. How effectively does DWP work with stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?

16.1 It isn’t effective.

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

16.a.1 Ask us to sit on panels, to look at policies. Use ordinary people on a jury system – where you avoid the charities and groups that would otherwise dominate any discussion. Ask people to submit their names and have a random selection of people. Engaging with Charities and Groups that claim to speak for disabled people isn’t what disabled people want. Talk to ordinary claimants.

End of summary

 

Main body:

Suitability of assessments

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

1.1 Offer choice from the following;

1.11 Use of an online app; Skype, Zoom, Whatsapp

1.12 Use of standard telephone calls

1.13 Use of more home visits

1.14 Use of more neutral venues – not centralised centres that may be significantly distanced from claimants, have poor parking and poor transport links.

1.2 Understand the difficulties of urban, sub-urban and rural transport services.

Example: A 9.30 appointment that is at a centre 20 miles away:

The claimant has to navigate a road to a bus stop a mile away, on a road with no pedestrian paths/pavements. The bus company cannot assure the claimant that the buses (two needed) will be wheelchair or scooter accessible, and that if they are, that there will be capacity. Only one bus (consecutively) will get the claimant on the journey to the assessment centre, and the two buses needed are not connected services.

The claimant has to navigate to the the first bus stop, then to a second bus stop, then to the centre. The claimant discovers that there is no bus early enough to make the journey on time. The cost of the journey is in excess of £10. The journey would need to start before daylight hours on unlit roads in winter months.

This scenario is real. It took repeated conversations by email, including evidence of maps, bus timetables and a GP letter (£16) to get a home assessment.  The company doing the assessment seemed not to understand that the journey couldn’t be made by the claimant even if the time of day was altered due to; the danger of rural roads, the distances involved, the claimants condition not being compatible to this amount of travel on public transport, and the lack of taxis services.

Solutions:

The DWP and assessing companies need to take action regarding considering how difficult journeys are for people who are disabled and ill. A long and complex journey for a person who is sick can result in serious deterioration in a person’s condition. Expecting claimants to pay up front for GPs letters – which are in themselves an additional burden for the claimant in terms of money and energy, and for the GP in terms of time, is an unfair burden and barrier to accessing benefits.  It adds considerable stress to what is already recognised as a stressful situation. This is especially incongruous for people already on the benefit, where they have an award, and the DWP is aware that the claimant is, by the DWP’s own judgment, not in a position to have the capacity to undertake journeys.

Realistic journey planning

Understand the negative effects of journeys on sick people

Pay GPs for what the DWP assessors demand re letters of ‘unfit to travel to assessment’.

Accept that most people who are sick are unfit to travel.

1.3 Health Care Professionals as Assessors;

The DWP is not unaware of the issues of unsuitable assessors, who have shown little or no understanding of the conditions they are presented with at assessments.

A paramedic is not trained to deal with chronic illness – their primary role and training is centred around acute health incidents. Their training defines their thinking.

A nurse or physiotherapist is trained to deal with treatment. Their goal is to cure a condition, or relieve the pain and suffering, in addition to other needs arising. Their training defines their thinking.

Assessing the capacity of a claimant to work is more complex than either the level of disability or the medical condition. The assessors have their hands tied due to the format of the assessment.  Assessments fall on a spectrum – from ‘sticking to the script’ to using the criteria as a proxy for work/employment.  The Assessors are being asked to assess the wrong thing due to the criteria – which at no point asks whether the claimant is too sick to work. Employers wont employ people who are too sick to work – yet this question is never asked. The criteria are not designed to assess fitness to work at all, leaving good assessors having to make the criteria work, and bad assessors using the criteria as a checklist.

Previous training affects the assessor. They may believe that a person can be cured – or indeed that they are not acutely ill. This should not be what is being assessed.  However neither are HCPs employment advisors – they are not trained in understanding the demands of work, or the demands of commuting to work, or the demands of organising life outside of work. ‘Some capacity’ to work may be negated by the demands of everyday life – cooking, eating, bathing, keeping a home.

Solutions;

Claimants often highlight that the assessor didn’t understand their condition. This needs addressing. Understanding a condition and how it affects a person is essential to assessment.

Both the training and the ‘script’ need to be overhauled. 

Assessors need to have time to identify, from the evidence that is submitted by the claimant and medical evidence, what the health conditions are that they are going to be presented with, and have time to research what the implications of those conditions are.

Assessors should be able to reject assessing certain conditions if they feel they are not suitably qualified to understand the implications of the condition, i.e. a mental health professional being assigned to assess a person with a purely physical disability such as limb loss.

Assessors should be able to have a dialogue with the claimant as a ‘HCP’ – not as an assessor, perhaps prior to the assessment, to talk about the medical condition itself.

Assessors should not use the criteria as a checklist. If the DWP consider the criteria as a checklist then they are clearly NOT assessing people on their ability to get and sustain employment (with no negative impact on the claimant’s health or wellbeing).

The DWP needs to look again at the criteria for working and include what working looks like from an employer’s point of view. What is it employers want? How do people with chronic conditions fit into the employer’s view of what employees should be? Everyone knows this is the elephant in the room.

Purely physical disability can be adjusted for in a workplace. However being too sick to work, being in pain, being exhausted, being on certain medications, having to work sporadically, having extended time off sick, having constant medical interventions such as hospital visits and treatments – none of these things are compatible with employers and the world of work. These are the criteria that assessors need to be looking at, and instead they are trained to watch to see if someone can make eye contact or lift a handbag.

The criteria being used are not in line with the expectations of the workplace. This makes it very difficult for assessors to assess fitness for work accurately.

1.4 Quality of Assessments:

Assessor’s ability to assess to a high standard should be a key performance indicator, and monitored as such. Assessment accuracy is judged only on the competence to communicate the details of the assessment – not on the accuracy of the recommendation of award of the assessment.

This is a major failing given the system of recommendations from assessors being used as a basis to making awards.

Without a system of assessing accuracy of recommendations the DWP and contracted companies cannot identify poorly performing assessors.

Each assessor should have an accuracy target that is a KPI – where their conclusion and recommendation matches the final award – i.e after consideration, mandatory reconsideration, appeal and UTT.

An assessor should be accurate in over 95% of cases – i.e. be in line with the final award.

It is only by having a KPI can employers of assessors judge if their employees are failing occasionally, or are failing consistently. Its unfair that claimants are running the risk of being assessed by a consistently underperforming Assessor that cannot be identified to the employer. 

The DWP is shirking its responsibility to both its contractors and claimants by failing to have an ‘Accuracy of Assessment’ Key Performance Indicator.

The DWP is also failing the tax-payer because inaccurate assessments are costing the UK unnecessarily due to appeal procedures which find against the assessment system 75% of the time.

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

1a. 1. I am not aware of any improvements – and indeed the number of awards overturned at tribunal stage suggests that there have been no improvements.

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?

2.1 Spain uses degree qualified assessors in employment – in addition to medical evidence.

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

 

3.1 The descriptors for PIP should be treated as proxies for functional movement – however they are often assessed as being task-orientated.

It would be simpler to say “Can you lift your arm across your body at chest height” – than to describe it as “if putting something in a top pocket”. In a minimal way this is superfluous, however assessors and claimants often assume that this is a task – and it’s a task people rarely use.

If the DWP insists on using tasks, then the tasks should be realistic activities that everyone engages in – such as getting up, washed, dressed, using the toilet, making three meals a day, making hot drinks, sitting, getting out of a seat, moving around the home, maintaining living conditions, shopping, hobbies and social and cultural activities, showering and bathing, retiring to bed, sleeping safely, moving around at night safely, accessing medications and being able to store, move and use aids.

3.2 The use of aids reducing awards.

The DWP should recognise that the use of aids does not negate disability – for example the availability of a scooter is pointless if the person cannot use that scooter in a way that improves their life (because they cant store it, or they cant get it into or out of the house without assistance, or they cant use it on public transport etc – and that some aids actually just change the disability – such as crutches, which can aid mobility but then restrict the use of arms and can increase falling. Some aids can make a task or activity take longer to achieve.

Aids are not magical – they are alternatives which have downsides additional to the cost, upkeep, repair and replacement, plus the downside of no-one having all the aids they need, i.e. a lowered cooking surface is great – but then having adapted knives and chopping boards, scissors for opening food and then a pick up tool for collecting the dropped packaging etc is  idealistic – in the real world people have neither the kitchen space or the funding for every aid that would allow them to cook more independently. Using all these aids would also increase time in food preparation, and cleaning up afterwards and would have an ongoing cost.

3.3 The criteria for and descriptors should follow a person’s daily and nightly activity.

I.e. “Do you struggle to get out of bed?”

With a follow up asking why, how often, if it’s a safe activity if attempted without assistance, if it takes time.

“Can you get to your kitchen easily?”

With follow ups asking about pain, risk, assistance, use of stairs and steps inside the home.

3.4 The tasks/activities should be designed by people who are disabled. Able-bodied people do not understand being disabled. This is evidenced by the narrowness of the functional impairment criteria/descriptors.

There is no question that addresses safety of mobilising around the home, either during the day or at night, or including steps and stairs – either in the home or to access the home.

There is no question about making your home safe – such as opening or closing doors and windows, locking and bolting doors, testing fire and CO2 alarms. 

There is no recognition of normal activity – such as a social life, sports, hobbies, religious observances, shopping, maintaining a clean home, dealing with laundry, or being in work – and no recognition of the extra time, effort, energy and cost of such engagement.

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

4.1 ESA is a long term sickness benefit that can also be paid to those distanced from work due to disability, and for whom the jobs market is significantly reduced by their disability. It should be described as such – and it should be clear that it is a totally different benefit  from the allowances paid for additional costs of disability, and that it is paid for a totally different reason.

The conflation of ESA and PIP has to stop. There needs to be clarification that ESA is about work.

Whilst sickness can be disabling, and disability can cause sickness, a person can be sick without being disabled, and more frequently can be disabled without being sick – as demonstrated by some Paralympians.

4.2 ESA fails to address in its descriptors if a person is too sick to work. That aspect is never addressed in the application.

4.3 ESA tests functional impairment. Most sick people have a full range of movement. ESA asks the wrong questions. It has no real world situations and fails to assess to the standard that employers need. 

4.4 ESA is weak at testing for protections in the workplace – such as assessing if a person can meet their hygiene needs. ESA seems to assume that once in a workplace that adaptations will be found, and issues such as hygiene, nutrition and wellbeing will be covered. Most workplaces are classified as ‘small’ and therefore may not be suitable for adaptations.

ESA should be assessed according to employer needs –

The ability to attend a workplace

The ability to attend a workplace without significant sick leave or other absences caused by sickness or disability.

The ability to attend a workplace and complete a task to a deadline

To be punctual

To be functional

To be reliable

Given the unreliable nature of sickness most sick people are unable to fulfil the needs of an employer; work or employment is unsustainable. Work, employment or work-related activity can be damaging.

Employers are not charities. They pay people to perform and engage with a set of rules that are incompatible with sickness. If a person cannot conform to the demands of work, or an employer due to ill health, then they are not employable or suitable for self-employment. The question “Is this person too sick to work” is essential – but also the question “Is this person employable with this level of ill-health” should also be addressed.

The current assessment process fails both these tests.

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?

5.1 When DLA was for working age adults as a paper based assessment it work adequately well. I have no experience of AA or under-16-DLA.

5a. Before PIP replaced DLA for adults, DLA was also assessed using a paper-based system. What were the benefits and drawbacks of this approach?

5a.1 When DLA was for working age adults as a paper based assessment it work adequately well for claimants – but the scope of the assessment was wider, and encompassed more real life experience and identified more activity.

5a.2 There were fewer face-to-face assessments, which reduced stress and anxiety.

5a.3 The process for DLA felt less adversarial.

5a.4 There were situations where forms were lost, or parts of forms were lost. That’s an issue with paper based systems. Retrieval of files in paper based forms was commonly given to explain delays.

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?

6.1 A clinician who is a GP can:

State or confirm the claimants condition(s)

Indicate expected levels of disability

Indicate if the claimant suffers from pain, exhaustion, and other non-visible/non pathological conditions

Indicate if the claimant is expected to recover, stabilise at their current level of impairment, or to degenerate, and to give approximate time frames

Indicate if the person is fit for work

Provide a comprehensive list of medications, treatments and investigations, results of tests and interactions

A clinician cannot:

Explain the day to day lived experience of the claimant, or the barriers that the claimant faces regarding working, living or experiencing and accessing life.

The clear advantage is that the clinician has the medical notes and the medical experience to understand the condition and its implications.

The drawback is that GPs do not want to be seen as the gatekeepers to benefits, as this can damage the GP-patient relationship.

The additional drawback is that this would be very time consuming for GPs to produce this information in a form different to the way it is currently stored.

Additionally, few patients have a single clinician. Often there is no continuity of care, and patients see different clinicians who don’t have time to read the patients case notes. Its becoming increasingly difficult for a patient to see a GP who knows their condition(s) and can see a bigger picture of the life and health of the patient. This isn’t always necessary (Sick and disabled people get ordinary illness too) but if the DWP wanted input from a GP it may be more difficult to obtain a true picture.

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

7.1 The assessments are not asking the right questions. Sometimes the assessors are not recording the right answers. See earlier preamble regarding Key Performance Indicators.

When the wrong data is sourced in the wrong way, then the answers paint the wrong picture – and this ‘picture’ is passed down the line through the DWP.

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

7a.1 Introduce Key Performance Indicators for Accuracy of Assessment, thus empowering Contractors to identify under-performing staff.

7a.2 Decision makers should decide awards from submitted forms and medical evidence, and only after they have decided an award should they cross reference that with the Assessors report. This will reduce bias and give DMs more autonomy. If the two parties awards differ significantly then a second DM should repeat the process.

7a.3 Be less adversarial. Claimants are already frightened of adverse decisions, as they will have no recourse to income if the award does not go in their favour – and they then have to go through an additional anxiety inducing process of a tribunal. Most employees at DWP had a reputation for being kind and compassionate. Since the introduction of assessors claimants feel that that link has been broken.

7a.4 Assessors are the main issue – its felt that some consider themselves gatekeepers to benefits, use the criteria and descriptors as a checklist, and are biased against certain people. Assessors who are inappropriately trained – such as a Mental Health nurse seeing a person with a degenerative muscular-skeletal condition – or other area where they have no relevant expertise, is a barrier to a good assessment regardless of in-house ‘disability training’.

7a.5 Alternatively employ disabled people to conduct ‘soft-assessments’, and use medical evidence more. ‘Soft assessments’ where sick and disabled people can ‘chat’ to claimants about their lives would be much more revealing than any assessor.

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)?

8.1 There is no case for combining assessments for differing benefits. The two benefits test for very different things.

The only similarity is medical evidence.  The same medical evidence can be used for both PIP and ESA.

8.2 If the DWP uses medical evidence more, then it would be streamlining the system.  There also could be a return to the passporting of people who require sufficient care to get the Care Element of PIP onto ESA, as anyone with significant care needs is unlikely to be able to access work or employment in any meaningful or sustainable manner.

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

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

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?The impact of the pandemic

9b.1 If there would be more accountability and transparency and reduced costs if the DWP brought assessments back in-house, then there would be more trust. However the dependency on assessments (and the ignoring of medical evidence) is an issue. Assessments that are conducted in the same manner as they currently are would not improve the system. Only testing the accuracy of the parts of the system will improve it – so KPIs for accuracy of awards throughout.

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?

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

10a.1. There is a case for choice. See Q1.1

 

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?

13.1 See previous points. The system will always cause anxiety – however the addition of an additional qualitative assessment introduces an additional level of anxiety. The failing of assessors is more commonly known than the successes of assessors. Introducing a KPI that assesses for accuracy of awards would be a clear indicator that action against poor assessments is being taken by the DWP, which eventually may lead to increased trust in the system

13.2 Make public aware about how often the DWP get the correct decision, and encourage an ethos of ‘right first time’ within the DWP. Make people aware that you want to return to a better experience for sick and disabled people that isn’t so adversarial towards claimants, and expects better performance from contractors and staff. 

Waits for assessments

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

14.1 Give longer awards.

14.2 Employ more people.

14.3 Reduce assessments and believe GPs and medical evidence more.

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?

14.a. 1. The assessment rate is set as JSA rate – which is set low to prevent people being ‘comfortable’ on an unemployment benefit. However it is too low to live on – especially for those who have the additional costs of becoming sick or disabled. These people may have financial commitments that they could cover when working – but cannot cover when they become ill – thus compounding sickness with additional financial stress. Financial stress exacerbates illness – there is a direct link between poverty and illness, and placing people in poverty when they have a health crisis can accelerate the sickness or cause additional illness – such as depression and anxiety.  If the sick note and medical evidence indicates that the sickness is substantial and  long term, then a higher assessment rate should be given – as any award would be likely to be higher.

Policy development

16. How effectively does DWP work with stakeholders—including disabled people—to develop policy and monitor operational concerns about health-related benefits?

16.1 It isn’t effective.

 

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

16.a.1 Ask us to sit on panels, to look at policies. Use ordinary people on a jury system – where you avoid the charities and groups that would otherwise dominate any discussion. Ask people to submit their names and have a random selection of people. Engaging with Charities and Groups that claim to speak for disabled people isn’t what disabled people want. Talk to ordinary claimants.

 

December 2021