Source · Select Committees · Work and Pensions Committee
Fifth Report - Health assessments for benefits
Work and Pensions Committee
HC 128
Published 14 April 2023
Recommendations
2
Acknowledged
For most people, disability and health-related benefit assessments go smoothly.
Recommendation
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 …
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Government Response Summary
The Department highlights ongoing initiatives, tests, and the Health Transformation Programme aimed at improving the claimant experience, building trust, and modernizing benefit services, without committing to specific new actions in response to the report's recommendations.
Department for Work and Pensions
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3
Deferred
Para 27
The Department should provide the Committee with a quarterly update on progress with implementing the...
Recommendation
The Department should provide the Committee with a quarterly update on progress with implementing the Section 23 Agreement once it is agreed.
Government Response Summary
The government deferred providing quarterly updates on the Section 23 Agreement, stating that discussions with the EHRC are ongoing and legally privileged, making it inappropriate to discuss the contents of any agreement or future information while confidential discussions are underway.
Department for Work and Pensions
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5
Not Addressed
Para 29
In response to this Report, we ask the Government to outline the methodology used to...
Recommendation
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 …
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Government Response Summary
The government responds by stating that the Department's assessments are not comparable to clinical assessments and that it routinely carries out evaluations of policy changes. It claims it would be extremely difficult to objectively separate the impact of the process on mental health from other confounding factors.
Department for Work and Pensions
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6
Accepted
Para 37
We note the Department has made changes to improve training for health professionals around mental...
Recommendation
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 …
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Government Response Summary
The government stated that all staff working with claimants undertake comprehensive training to support vulnerable claimants, including those at risk of suicide or self-harm, and that assessment providers deliver suicide awareness and prevention training to all their staff.
Department for Work and Pensions
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7
Not Addressed
Para 38
Following our predecessor’s 2018 Report, the Government commissioned research into the impacts of health assessment...
Recommendation
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 …
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Government Response Summary
The government's response focuses on the balance between providing sufficient time for claimants to return evidence and ensuring timely awards, particularly regarding the ESA50, UC50, and PIP2 forms; however, it does not commit to undertaking regular reviews of the mental health impacts of its end-to-end process of health assessments or ensuring external researchers have access to good quality, anonymised data.
Department for Work and Pensions
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8
Deferred
Face-to-face, in person assessments were the main form of assessment for Personal Independence Payment and...
Recommendation
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 …
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Government Response Summary
The Department is evaluating remote assessments through the Health Assessment Channel Trial, scheduled to complete later this year, and will use the evidence to inform how their multi-channelled service capability can be optimised, including whether claimants will be able to choose their preferred assessment channel.
Department for Work and Pensions
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9
Accepted
Para 47
The application and assessment process can be very stressful for claimants, and unacceptable delays are...
Recommendation
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. …
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Government Response Summary
The new Functional Assessment Service contracts include specific end-to-end clearance targets for PIP, WCA, and Special Rules for End of Life, with financial sanctions for repeated failures.
Department for Work and Pensions
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10
Rejected
Para 49
We recognise that reducing waiting times is vital to ensuring people get the support that...
Recommendation
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 …
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Government Response Summary
The government rejected the recommendation to pay PIP applicants an assessment rate if clearance time targets are missed, stating that PIP is not an income replacement benefit and payment could lead to inappropriate expenditure of public funds, as around half of new PIP claims referred for assessment do not receive an award.
Department for Work and Pensions
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11
Accepted
Para 51
The process of issuing a UC50 form should be automatic, and claimants should not have...
Recommendation
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 …
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Government Response Summary
The government stated it is already working collaboratively with welfare rights organisations to identify potential points of failure in the process of issuing UC50 forms and has identified some improvements to be delivered by the end of 2023.
Department for Work and Pensions
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12
Not Addressed
Para 54
Giving people sufficient time to gather relevant evidence for their claim could reduce the stress...
Recommendation
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 …
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Government Response Summary
The response discusses draft criteria focusing on claimants with severely disabling, lifelong conditions, reviews of guidance, covert surveillance, and informal observations, but does not address the recommendation to extend the deadline for returning forms.
Department for Work and Pensions
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13
Accepted in Part
Para 57
We welcome the improvements that have been made on accessibility but are concerned that these...
Recommendation
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 …
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Government Response Summary
The current PIP2 form is under review and the Department is planning changes to ensure the form is both simple to fill out and accessible, using a user-centred design approach; claimants now have the option to submit the form by email.
Department for Work and Pensions
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14
Not Addressed
Para 58
We welcome that DWP has made some improvements so that the assessments process is more...
Recommendation
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 …
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Government Response Summary
The Department states that the requested information is not stored in a way that would allow them to provide accurate figures on legal challenges relating to failure to make reasonable adjustments for health assessments.
Department for Work and Pensions
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17
Acknowledged
Para 77
DWP provides assessors with guidance on issues including evidence use, contributions of family members and...
Recommendation
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 …
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Government Response Summary
The government describes Mandatory Reconsideration as a valuable process and is undertaking a number of small-scale internal learning exercises to better understand what it can learn from the disputes stage. This work is still in very early development.
Department for Work and Pensions
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18
Acknowledged
We welcome the plans outlined in the Government’s Health and Disability White Paper to test...
Recommendation
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 …
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Government Response Summary
The Department states that the PIP assessment criteria were developed with independent specialists, focus on needs arising from a comprehensive range of conditions, and consider an individual’s ability over a 12-month period, and they will test the introduction of a new Health Impact Record.
Department for Work and Pensions
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19
Accepted
Para 91
DWP has introduced changes to the Mandatory Reconsideration process that it says make it a...
Recommendation
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 …
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Government Response Summary
The Department will publish the first set of UC WCA statistics, covering April 2019 to March 2023, on 8 June 2023, with future releases including data on Mandatory Reconsiderations.
Department for Work and Pensions
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20
Not Addressed
Para 92
DWP has not conducted any research on reasons for its losses at Tribunal since 2012—before...
Recommendation
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 …
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Government Response Summary
The government's response discusses the differences between DLA and PIP assessments and plans for the Severe Disability Group, but does not address the recommendation to commission and publish research on the costs and effectiveness of Mandatory Reconsideration.
Department for Work and Pensions
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21
Rejected
Para 98
The vast majority of assessments are still not recorded and auditing the reports may not...
Recommendation
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 …
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Government Response Summary
The Department remains committed to retaining audio recording on an opt-in basis, giving claimants the choice of having their assessment recorded.
Department for Work and Pensions
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22
Acknowledged
When recordings are available, in cases where the findings of assessments are overturned on MR...
Recommendation
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 …
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Government Response Summary
The Department is committed to ensuring individuals receive high-quality assessments as part of the evidence used to decide benefit entitlement and continually looks to improve the efficacy of the assessment process by working closely with providers.
Department for Work and Pensions
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23
Not Addressed
Para 104
We heard that PIP assessments can be particularly challenging for young people.
Recommendation
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. …
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Government Response Summary
The government response focuses on testing plans for the Severe Disability Group, feedback used to develop criteria, publishing UC WCA statistics, reviewing guidance for health professionals, testing sharing assessment reports, and exploring recording assessments; it does not address light-touch, paper-based assessments for under 18s and DWP ensuring 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.
Department for Work and Pensions
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24
Accepted
Para 109
We are reassured to hear that the process for claiming Attendance Allowance seems to broadly...
Recommendation
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 …
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Government Response Summary
The Department states information on Attendance Allowance is already widely available, and they are introducing a digital claim journey as part of wider Service Modernisation plans.
Department for Work and Pensions
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25
Rejected
We agree that the easement for signing forms on behalf of people with terminal mesothelioma...
Recommendation
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 …
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Government Response Summary
The Department considers that there is already appropriate provision in place given appointee provisions and generous entitlement rules for the most vulnerable IIDB claimants, and states there is no equivalent legislative provision within IIDB for the definition of 'terminally ill'.
Department for Work and Pensions
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26
Acknowledged
Para 115
We welcome the opportunity the Health Transformation Programme presents to improve data sharing and reduce...
Recommendation
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 …
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Government Response Summary
The Department recognises the benefit of reviewing and reusing previous evidence and is currently exploring how reusing previous evidence can provide a potential opportunity to reduce the burden on claimants.
Department for Work and Pensions
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27
Accepted
We recommend that the Government evaluate the performance of the Health Transformation Programme within the...
Recommendation
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 …
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Government Response Summary
The Department has published an evaluation strategy for the Health Transformation Programme on the 25 May 2023, and commits to publishing information about the programme’s performance and evaluation at points when the service is suitably developed and robust.
Department for Work and Pensions
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28
Accepted
Para 122
The Scottish Government is attempting to take a different approach to disability assessment.
Recommendation
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. …
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Government Response Summary
The Department agrees and has published an evaluation strategy for the Health Transformation Programme which will use a combination of impact and process evaluation to assess current and future performance, with metrics used to monitor progress and inform decision-making.
Department for Work and Pensions
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29
Accepted
The Department has made, and continues to make, reforms to improve PIP assessment and WCA...
Recommendation
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 …
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Government Response Summary
The Department has made progress with its plans to test the Severe Disability Group, so that the relevant claimants can benefit from a simplified process.
Department for Work and Pensions
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Conclusions (4)
1
Conclusion
Not Addressed
Para 15
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.
Government Response Summary
The government's response discusses Internal Process Reviews (IPRs), when they are conducted, and how feedback is supplied to providers following the outcomes of IPRs.
4
Conclusion
Accepted
Para 28
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 …
Government Response Summary
The Department acknowledges its responsibility to support vulnerable claimants and details existing training programs and support roles, as well as unexpected findings processes, to address the potential mental and physical health effects of assessments.
15
Conclusion
Accepted
Para 61
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 …
Government Response Summary
The Department is transforming the entire PIP service and will make improvements to existing ways to claim and create a new digital PIP service, giving claimants the option to apply online, while also continuing to offer a telephony service and paper-based forms.
16
Conclusion
Acknowledged
Para 65
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, …
Government Response Summary
The Department has made progress with its plans to test the Severe Disability Group, so that the relevant claimants can benefit from a simplified process.