Health assessments for benefits

We welcome the changes to the process for accessing benefits via the special rules for terminal illness, specifically replacing the six month rule with 12 months.

For most people, disability and health-related benefit assessments go smoothly. But in a sizable minority of cases, things continue to go very wrong. This has implications for claimant trust in the systems that extend beyond those directly affected by poor decision-making. Our predecessor’s inquiry focused on improving technical aspects of PIP and Employment and Support Allowance (ESA) assessments. There is a remarkable similarity between the recommendations made in evidence to this inquiry, and those made by our predecessor Committee in 2018. The Department has recognised that fundamental change is needed, but this will take time. The Department has taken some welcome and significant steps to improve health- related benefit assessments, but nearly five years on from the previous inquiry, important changes that could greatly increase transparency, improve trust in the process among claimants, and ensure more accurate assessments and fewer appeals, have still not been made. While it develops plans to replace the Work Capability Assessment, we urge the Government to make the changes we and our predecessor have called for to improve the current system for claimants. We recommend that the Department provide, in response to this Report, a list of actions it will take to improve the claimant experience of PIP assessments and Work Capability Assessments, while they remain in use. (Paragraph 16) The impact of assessments on claimants

The Department should provide the Committee with a quarterly update on progress with implementing the Section 23 Agreement once it is agreed.

We are deeply concerned to hear that nearly five years after our predecessor’s Report, people are still experiencing distress as a result of undergoing health assessments. In particular, our survey respondents spoke of the stress, anxiety and in some cases severe mental health impacts of the assessment process. That we are still hearing accounts of poor accessibility, factual inaccuracy, delays, and communication problems speaks to a system that is still not adequately supporting often vulnerable people. Accurate data is vital to addressing the serious impacts of assessments on claimants that this inquiry and other research have exposed. Prior to any changes to the health assessment process, including the abolition of the Work Capability Assessment, an external assessment should be undertaken on the potential physical and mental health effects of these changes on affected claimants.

In response to this Report, we ask the Government to outline the methodology used to determine when Internal Process Reviews are carried out, and how it has improved its collection of data on deaths and serious harms since the NAO report on Information held by the Department for Work & Pensions on deaths by suicide of benefit claimants in 2020. In addition, DWP should publish anonymised data annually on all instances Health assessments for benefits 89 of deaths or serious harms associated with health assessments, disaggregated to show incidence of suicide, the issues that led to these deaths, and the steps it has taken to remedy issues raised.

We note the Department has made changes to improve training for health professionals around mental health and safeguarding, and process changes, and also improved training for call handlers. Staff and contractors involved in any DWP health assessment process should undertake claimant safeguarding and suicide prevention training.

Following our predecessor’s 2018 Report, the Government commissioned research into the impacts of health assessment questionnaires and is now feeding that learning into its policy development. We have also heard important insight from academics on the mental health impacts of assessments, but studies have been sporadic and rely on the data made available to them. As the Government reforms health assessments, quality research will be vital to measure success. The Government should commit to undertaking regular reviews of the mental health impacts of its end-to-end process of health assessments, including comparing them to assessments undertaken elsewhere in Government, such as social care. It should also ensure external researchers have access to good quality, anonymised data to complement this with independent research.

Face-to-face, in person assessments were the main form of assessment for Personal Independence Payment and Employment and Support Allowance/Universal Credit before the pandemic, despite widespread agreement amongst claimants and the organisations that support them that they are frequently unnecessarily stressful and poorly suited to measuring the impact of some health conditions. The pandemic forced the Department’s hand in making greater use of other formats, and feedback from stakeholders has been broadly positive. One size does not fit all, however: what matters in reducing the stress associated with assessment is choice. We recommend that the Department build on its successes introducing video and telephone assessments during the pandemic. In particular, now it knows that remote assessments are possible on a large scale, that it completes its evaluation as soon as possible and commits to informing claimants of the options available and allowing them to choose what suits them best before booking an assessment. (Paragraph 42) Technical and operational challenges

The application and assessment process can be very stressful for claimants, and unacceptable delays are exacerbating these problems. We recognise that waiting times have begun to fall but are concerned that with increasing demand this could be a recurring problem. We recommend that the new contracts for assessment providers contain explicit clearance time targets with appropriate sanctions where these are missed.

We recognise that reducing waiting times is vital to ensuring people get the support that they need. However, we are keenly aware that delays are still happening. In line with our recommendation that the Department set clearance time targets, we also recommend that where these are missed, PIP applicants are paid an assessment rate for the remaining time until their claim is decided. This should be non-repayable 90 Health assessments for benefits in the event that a claim is disallowed. Where an award is made, claims should continue to be backdated at the rate awarded, less any amount paid at assessment rate.

The process of issuing a UC50 form should be automatic, and claimants should not have to remind the Department to send it to them. DWP should investigate the process for issuing UC50 forms urgently and confirm in its response to this Report what steps it is taking to fix any points of failure identified to improve the process while the Work Capability Assessment and UC50 forms remain in use.

Giving people sufficient time to gather relevant evidence for their claim could reduce the stress involved for claimants and improve the quality of information available to the assessment provider. In turn this could lead to better initial decisions and reduce the number of Mandatory Reconsiderations due to either unreturned forms, or missing evidence. DWP should extend the deadline for returning ESA50, UC50 and PIP2 forms and accompanying evidence to two months.

We welcome the improvements that have been made on accessibility but are concerned that these efforts have not gone far enough. Support and guidance are also welcome, but simplifying forms will improve the experience for all. In response to this Report, the Department should detail what changes it plans to make to the PIP2 form to make it easier for claimants to complete it themselves.

We welcome that DWP has made some improvements so that the assessments process is more accessible. However, we heard that these changes “are quite ad hoc and reactive”. In response to this Report, the Government should set out how many legal challenges it has faced relating to failure to make reasonable adjustments for health assessments for benefits in the last five years, broken down by year.

Just as a one-size-fits-all approach does not work for assessments, the same is true for applications and contact channels. We welcome progress towards better online provision, but digital does not work for everyone and people’s independence should not be compromised by poor accessibility. As the Department moves towards a single digital platform for health benefits, it must ensure the system is accessible to everyone, and that alternative formats and channels are easily available to those that need them, and maintained and updated in the long-term alongside the digital platform.

We welcome efforts to reduce unnecessary reassessments for people whose conditions or needs are unlikely to change. However, ESA/UC and PIP are different benefits with different purposes, and this must be reflected in any criteria for reassessment. The Department should adopt a version of the severe conditions criteria for PIP, effectively ending the need for reassessment as it does in ESA/UC. If this is achieved through the Severe Disability Group, which the Department is currently testing, the criteria must be developed to recognise the differences between ESA/UC and PIP, and not focus solely on a claimant’s ability to work.

DWP provides assessors with guidance on issues including evidence use, contributions of family members and carers, and informal observations which, if correctly followed, would address many of the concerns raised in this area. The accounts we have heard in this inquiry, and those from the previous Committee’s Health assessments for benefits 91 inquiry, suggest that, too often, guidance is not followed correctly. We believe this points to fundamental weaknesses in the Department’s quality control over its contractors, which we return to later in this Report. We recommend the Department reviews the guidance on carers’ and family members’ evidence to assess why they may still not be being given due weight, and confirm what action it will take to ensure assessment providers are following it correctly. We also recommend the Government urgently investigate the use of covert surveillance by assessors, working with organisations that support claimants to establish whether this practice is widespread, and work with the assessment providers and contractors to ensure claimants are treated fairly and in line with the guidance.

We welcome the plans outlined in the Government’s Health and Disability White Paper to test specialist assessors and to address the challenges of assessing fluctuating conditions. But we were disappointed that there do not appear to be wider plans to overhaul descriptors. We request that the Government confirm in response to this Report whether it is still reviewing the descriptors, and if not, what evidence it has found that those currently in use are fit for purpose. (Paragraph 78) Decision-making

DWP has introduced changes to the Mandatory Reconsideration process that it says make it a more effective check on decision-making. A worryingly high number and proportion of appeals still result in the Department’s decision being overturned, with implications for wider trust in the system beyond those directly affected. The Department does not provide any data on Mandatory Reconsideration decisions for UC WCAs. Without this, we cannot know whether Mandatory Reconsideration is functioning effectively for one of the largest groups of claimants that rely on it. We recognise the Government has announced it intends to scrap WCAs, but they will remain in use for several years. When the Government begins to publish data on UC WCAs from June 2023, it must also include data on Mandatory Reconsiderations. DWP should also work with HM Courts and Tribunal Service to ensure it has an accurate understanding of the scale of disability-related UC Tribunals as part of the wider Tribunal Service caseload.

DWP has not conducted any research on reasons for its losses at Tribunal since 2012—before either PIP or Mandatory Reconsideration were introduced. We recommend DWP commission and publish research focusing on the costs and effectiveness of Mandatory Reconsideration, as well as practical recommendations for learning from Tribunal, and options for incorporating this into wider reform of health assessments. The Department should commission this work within three months of this Report.

The vast majority of assessments are still not recorded and auditing the reports may not pick up discrepancies between what a claimant has said or done in an assessment, and what is recorded in the report. We recommend the Department instructs providers to record assessments by default, with a clear opt-out rather than opt-in option, as recommended by the previous Committee and endorsed by all three 92 Health assessments for benefits current contractors. This will ensure that an objective record of assessments exists, providing reassurance to claimants and enabling quality auditing. This should be included in the new contracts for assessments from 2023.

When recordings are available, in cases where the findings of assessments are overturned on MR or appeal, the recordings of the original assessment should be checked at least on a sampled basis, to establish whether the erroneous assessment outcome should have been avoided. We welcome the plans to test sending reports by default and recommend that this be rolled out as soon as possible. (Paragraph 99) Other health-related benefits

We heard that PIP assessments can be particularly challenging for young people. We recommend that young people in receipt of Disability Living Allowance should not be required to claim PIP until they are 18, as is the case in Scotland. Where under 18s decide to claim PIP, they should be given light-touch, paper-based assessments until they are 18. DWP should also ensure that in the development of an equivalent of severe conditions criteria for PIP, consideration is given to those moving from DLA, to ensure that young people whose conditions are unlikely to improve do not have to undergo repeated assessments when they move to PIP.

We are reassured to hear that the process for claiming Attendance Allowance seems to broadly be working well. However, we were concerned about the challenges around take-up, which reflect those around Pension Credit. We recommend DWP develop targeted interventions to improve awareness of Attendance Allowance, working closely with organisations that could reach people who may be eligible. The Department’s work on support and advocacy as part of the Health Transformation Programme should also specifically consider tailored support for Attendance Allowance applicants.

We agree that the easement for signing forms on behalf of people with terminal mesothelioma and lung cancer was a positive development in the pandemic. The Department should make this permanent and bring the rules on advisers signing forms in line with those for other benefits, including Attendance Allowance. (Paragraph 111) The bigger picture: reforming health assessment systems

We welcome the opportunity the Health Transformation Programme presents to improve data sharing and reduce the frequency with which claimants have to submit the same information. We recommend that as well as accessing medical information, the single digital platform should allow evidence from previous applications and renewals to be saved and used again, with the appropriate consent processes and safeguarding practices in place.

We recommend that the Government evaluate the performance of the Health Transformation Programme within the current Health Transformation Areas, and publish its findings, before further rollout, akin to the Scottish Government’s evaluation of the Adult Disability Payment. (Paragraph 116) Health assessments for benefits 93

The Scottish Government is attempting to take a different approach to disability assessment. Its Adult Disability Payment (ADP) is likely to prove a good test of whether problems with Personal Independence Payment are in its policy framework, or its implementation. We are encouraged by its plans to evaluate fully the ADP pilot, and in particular plans to engage with disabled people as part of the evaluation. We recommend DWP take a similar approach in evaluating its Health Transformation Programme measures. Furthermore, when the Scottish Government publishes its planned evaluation, DWP should learn from the results and consider what changes, if any, it should make to its benefit assessments.

The Department has made, and continues to make, reforms to improve PIP assessment and WCA processes. But the pace of change has been extremely slow. The plans to scrap WCAs are significant and will require further scrutiny in the months and years to come. In the meantime, too many people claiming disability and health-related benefits, even those not directly affected by poor decision- making, continue to view the processes with great trepidation, and for a minority the experience of assessment can be devastating. The continuing high overturn rates at appeal suggest fundamental flaws in the assessment system. We recommend that while it develops its long-term plans to remove WCAs, DWP accelerates improvements to health assessments in the short-term. We have suggested some areas for change in this Report to start that process—recording of assessments and sharing reports to increase transparency are key, and these should be implemented without delay. (Paragraph 125) 94 Health assessments for benefits