Department for Work and Pensions

6. Mr O complains about DWP’s actions between April 2017 and June 2023. He says DWP: • delayed applying the Limited Capability for Work Related Activity (LCWRA) component (LCWRA) to his UC claim dated 4 April 2017 until June 2017.

• incorrectly applied the Limited LCW decision of 30 January 2018 from the date of review on 4 July 2017 instead of the date of the beginning of the assessment period in which the decision had been made i.e. 2 January 2018.

• failed to raise a mandatory reconsideration (MR) after he disputed the LCW decision dated 30 January 2018 in February 2018 • failed to respond when he expressed concerns on 15 June 2018, 5 April 2019 and 4 and 7 May 2019 about the overpayment decision dated 14 June 2018 and also delayed raising an MR until 14 June 2019 • failed to ask Debt Management (DM) to suspend deductions from his UC after the MR decision dated August 2019 cancelled the overpayment decision dated 14 June 2018 and did not notify DM about the decision until 6 November 2019 after it recalculated UC on 4 November 2019 • failed to respond to his request for the repayment of deductions taken incorrectly between 4 December 2018 and 3 November 2019 on 15, 17,22, 26 and 28 November 2019 and 4, 13 and 16 December 2019.

• failed to respond to his journal messages from 27 February 2023 to 8 April 2023 • failed to respond promptly to the complaint from his MP raised 12 April 2023 • failed to implement the Six Point Plan in February 2018 and again in December 2019.

7. Mr O says as a result of all the above issues, he experienced a significant deterioration in his existing mental health diagnoses. He says he started to self-harm, had suicidal thoughts and neglected his self-care.

8. He missed the opportunity of receiving support for the deterioration in his mental health due to the failure to apply the Six-Point Plan.

9. He experienced financial worry and in some cases hardship and consequent upset and distress as a result of: • the delay in applying the LCWRA • the incorrect start date of the LCW and consequent overpayment of £1155.90 which was raised for the period 4 July 2017 to 2 January 2018 • the delay in instructing DM to suspend recovery of the overpayment • the delay in repaying the deductions already taken.

10. Mr O would like: • a financial remedy to acknowledge the upset and distress caused to him • service changes in respect of the application of the Six Point Plan to prevent this happening again to someone else.

11. Mr O has a history of mental health diagnoses. As a result he was unable to work and claimed Employment Support Allowance (ESA) in 2015. ESA is a benefit for claimants who cannot work due to illness or disability.

12. UC started to replace ESA from 2013.

13. Prior to the introduction of UC, DWP referred new ESA claimants for a Work Capability Assessment (WCA) at the start of their claim. A WCA is an assessment to decide if a claimant is fit for work. If the WCA found the claimant not fit for work, a further stage of assessment would decide if they had either LCW (those who could potentially work with support) or LCWRA or support group (for those who could not work at all). Neither group had to work or carry out work-seeking activities. Both groups received an additional payment within their ESA entitlement. The support group received a higher payment.

14. A similar WCA assessment takes place to determine if UC claimants meet the criteria for LCWRA or LCW. However UC claimants with LCW receive the same amount of money as claimants found fit for work and have to carry out some work related activities.

15. When Mr O claimed ESA in 2015, a WCA decided he had LCWRA. DWP put him in the support group and paid him the LCWRA component with his ESA.

16. His ESA claim ended on 4 April 2017 when he claimed UC due to a change of address. He was still in the support group in receipt of LCWRA at this time.

17. When a claimant moves from ESA to UC, they keep their entitlement to LCWRA or LCW. DWP did not pay Mr O his LCWRA component in May or June. It paid him the correct amount in July, at which point it also gave him the money it owed from the three previous months.

18. Mr O was due to have his next WCA on 4 July 2017. This took place on 4 December. As a result, in January 2018 DWP decided Mr O had LCW rather than LCWRA. It backdated this decision from the scheduled July date of the WCA.

19. The change in entitlement meant Mr O was required to carry out some job-seeking activities and lost the additional payment he had received when he was entitled to LCWRA.

20. The new decision also meant that he had received too much money between July 2017 and January 2018. DWP raised this as an overpayment.

21. In December 2018, DWP started to take deductions from Mr O’s monthly UC payment to recover the overpayment.

22. On 14 August DWP revised the decision so that the change to LCWRA started from January 2018 rather than from July 2017. This meant there was no longer an overpayment.

23. DWP stopped the recovery of the overpayment in November 2019 and refunded the recovered payments in December 2023.

24. Mr O’s next WCA was due in December 2018 but was delayed due to COVID-19. It went ahead in January 2021.

25. In February 2021, as a result of WCA, DWP changed Mr O’s LCW to LCWRA.

26. Mr O agreed with the decision but considered DWP should backdate it to the period from when he should have had his WCA (December 2018).

27. DWP reviewed the case. At this time, due to multiple issues with Mr O’s UC claim, DWP looked at both its decisions. These were the initial one dated 30 January 2018 (where it changed Mr O from LCWRA to LCA) and the later February 2021 decision (where it made the change back to LCWRA). At this point it made a discretionary decision to say Mr O should have received LCWRA continuously from the start of his UC claim. It paid him a back-payment of £7500.

28. In April 2023 Mr O’s MP complained about DWP’s management of his claim.

29. DWP identified errors in the management of Mr O’s case and made a consolatory payment of £200.

30. Mr O referred his complaint to the Independent Case Examiner (ICE) who awarded a further £300 to acknowledge the extent of administrative failings. ICE reviews complaints about certain government organisations including DWP.

Delay applying LCWRA to UC claim

33. If a claimant moves directly from ESA to UC, DWP transfers their LCW or LCWRA decision to their UC claim. This is in line with DWP guidance: Work capability assessment outcomes.

34. Mr O had moved directly from the support group on ESA to UC in April 2017. He was therefore entitled to retain his support group status with his UC claim.

35. When DWP paid Mr O in May and June 2017, it did not apply the LCWRA component despite his enquiries about when this would happen.

36. On 27 June DWP agreed to transfer Mr O’s LCWRA from his ESA claim to his UC claim and paid it with his UC payment in July 2017.

37. DWP tell us that when a new UC claimant was previously in receipt of ESA, it sends a specific form to ESA. This form asks ESA to close the ESA claim and return details of the award, including whether the LCW or LCWRA component applies. Once UC receives the information, it can action this.

38. In this case DWP’s records show that UC sent the form to ESA on 13 April 2017. There is no record saying when it was returned.

39. DWP advised there is no set time scale for the transfer of LCWRA to a UC claim and has not been able to identify any specific reason why it took three months in this case.

40. In the absence of any specific DWP guidance, our view is that although we accept DWP cannot make changes immediately, within a month would have been a reasonable time frame to have done so. This is in line with our Principles which say all public organisations should deal with people promptly, within reasonable timescales and should tell people if things take longer than they can reasonably expect them to take.

41. For the reasons given above we consider the delay from May to July 2017 was unreasonable and amounts to a failing.

42. We have considered the impact on Mr O.

43. At this time the additional LCWRA component was approximately £340 and therefore we recognise that Mr O’s monthly benefit was significantly lower than it should have been. He says the sudden drop in his monthly income meant he had less money for daily living expenses, food and bills during this time and this caused him worry and distress.

44. We have not seen evidence of what we would consider to be financial hardship. We would say financial hardship is when people are unable to meet their basic needs. Mr O has described feeling anxious about affording his bills and food, he has said he was able to borrow money from a friend. He has not told us that he was unable to pay bills or that he got into debt. We also have taken into account the money due to him was repaid in full in July 2017 so he would have been able to repay his friend.

45. We recognise nonetheless that this was an incredibly difficult time for him. Benefit payments are only intended to meet basic daily living expenses. Therefore the shortfall in his monthly payment between May and July was upsetting and stressful for him.

46. Our view here is the unreasonable delay resulted in avoidable distress and financial worry to Mr O over a period of three months between May and July 2017.

Incorrect backdating of LCW

47. A new UC claimant, who is entitled to LCW or LCWRA, has a WCA review period linked to their previous ESA claim. This is also transferred to the new UC claim. Once DWP has processed the information from ESA, an automated notification will advise when to refer the claimant for their next WCA.

48. From Mr O’s previous ESA claim, he was due to have his WCA in early July 2017. It did not take place until the beginning of December 2017.

49. From this, in January 2018 DWP decided Mr O should only be entitled to LCW. It backdated the decision from July 2017. This was the date the WCA had initially been due.

50. This is not in line with ADM guidance A4: Supersession, supersession, suspensions and termination. This refers to decision making on claims for UC. It explains that when a decision is made which changes the claimant’s monthly entitlement, it takes effect from the start date of the Assessment Period (AP) in which the decision is made.

51. The AP is the one month cycle starting from the date of the claim which DWP uses to calculate the monthly payment. Any changes in circumstance or entitlement during the AP are reflected in the payment which the claimant receives around a week after the end of the AP.

52. As such, the January 2018 decision changing Mr O’s entitlement from LCWRA to LCW should have taken effect from the start date of the AP starting at the beginning of January 2018.

53. We would expect DWP to provide Mr O with the correct decision in line with the Charter and make decisions with regard to relevant legislation in line with our Principles. As this did not happen, our view is that it is a failing.

54. DWP had already paid Mr O the LCWRA component between July 2017 and January 2018. This meant it considered it had overpaid him during this period. It started to recover the overpayment from his monthly UC payment from November 2018.

55. Mr O subsequently successfully submitted a mandatory reconsideration of the decision which said he had been overpaid and DWP cancelled the overpayment. As such he did not have to pay it back anymore and DWP refunded him all the money he had paid back. We have looked at the matter of DWP’s delayed raising of an MR later in this statement.

56. Mr O is therefore not asking for a refund of costs. However it appears he was paying back an overpayment he did not owe for 12 months. This was from November 2018, when DWP first started to recover the overpayment until November 2019 when it stopped the recovery.

57. He says he suffered frustration and financial worry and hardship during this period due to the recovery of the overpayment. Initially DWP recovered approximately £40 every month until March 2019. At this time it agreed to reduce the recovery to £10 per month and continued to recover at this rate until November 2019. Mr O explains the recovery, more so when it was at £40 per month, affected his ability to budget for food and bills and caused hm financial worry.

58. We have not seen evidence of what we would consider to be financial hardship. We consider the monthly recovery of the overpayment was upsetting and caused Mr O to worry about his monthly finances for over 12 months.

Delay raising an MR for the decision of 30 January 2018

59. An MR is the first stage in the appeal process. DWP internal guidance: Mandatory Reconsideration, July 2018 is relevant to this part of Mr O’s complaint.

60. This says that all decisions, which can be appealed, can be subject to an MR. It explains that a claimant does not have to supply evidence or give reasons why they think the decision is wrong. The original decision can be revised on any ground.

61. Following DWP’s decision of 30 January 2018, Mr O expressed his concern about it to DWP on a number of occasions.

62. DWP did not review the decision until 5 March 2021. This was after Mr O requested an MR of the subsequent decision dated 18 February 2021. At this point DWP reviewed both decisions.

63. We do not consider DWP complied with the above guidance in a timely manner. This is because we see that Mr O expressed his concerns to DWP on three occasions in February 2018. Our view is this should have been sufficient to prompt DWP to raise an MR or a discussion about an MR.

64. We consider waiting just over three years was unreasonable delay. This is not in line with the Charter which says that DWP will follow processes correctly and deal with a customer’s request the first time they contact DWP, or as soon as it can.

65. We have considered the impact on Mr O from this failing.

66. After the decision dated 30 January 2018, Mr O had to comply with the harsher work seeking requirements and reduced payment associated with the LCW component for a period of over three years. This continued until DWP raised an MR and changed his claim back to LWCRA in February 2021.

67. We understand from Mr O’s account that this was a very difficult time for him and he has explained his mental health significantly deteriorated.

68. We have considered this matter carefully and decided that we cannot make a recommendation to put right any upset or distress he experienced due to being on LCW rather than LCWRA. We cannot say what the outcome would have been if DWP had raised an MR when Mr O first disputed the decision. This is because we cannot know about any other factors which may have influenced an earlier decision. This includes Mr O’s health at that time, whether he had representation or any other evidence which may have been or not been available.

69. Mr O missed the opportunity of challenging a decision, with which he strongly disagreed, for around three years despite setting out his concerns to DWP. We understand that this meant he experienced frustration and upset throughout this extended period.

Delay raising an MR for decision dated 14 June 2018

70. On 14 June 2018 DWP raised an overpayment of £1155.90 for the period from July 2017 to January 2018. This means it decided it had paid Mr O too much because he had only been entitled to the LCW component from July 2017. DWP had already paid Mr O the additional LCWRA component during this time.

71. Mr O queried the overpayment in June 2018 and twice again in 2021. In response to one of his enquiries, DWP told him to contact DM but did not take any action itself. DM is responsible for managing the recovery of an overpayment and has no discretion to change the original decision.

72. In May 2019 DWP told Mr O the overpayment and recovery were correct and he should ask for an MR if he disagreed with the decision. He requested an MR in June 2019 which DWP completed in August 2019. As a result DWP revised the decision. It changed the start date of the LCW and this had the effect of cancelling the overpayment decision.

73. Mr O made DWP aware that he did not agree with the overpayment at the time of its decision, but it did not raise the MR until around a year later.

74. Therefore DWP did not act in line with its internal guidance on MR because it did not raise an MR in response to Mr O’s concerns for a year.

75. The delay in raising an MR meant that DWP continued to recover a monthly payment from Mr O’s UC payment that was not due. We know DM reduced this to £10 per month in March 2019 but initially from November 2018, it was about £40 per month. We recognise this caused Mr O financial worry and frustration. We cannot say if an earlier MR would have had the same outcome or if therefore recovery of the overpayment would have ended sooner. This is for the same reasons as above.

76. The delay in raising an MR meant Mr O missed out on the opportunity of challenging a decision which he clearly disputed, for over a year. He has told us this caused him significant stress and frustration.

Failure to ask DM to end recovery of overpayment

77. When an MR decision cancels a UC overpayment which DM is already recovering from the claimant, the UC department will send a UC overpayment form (UCOP) to DM. Its purpose is to notify DM that an overpayment of UC has occurred and also to amend or cancel a previously referred overpayment. Once DM has received the UCOP, it is DM’s responsibility to end the recovery and pay any reimbursements due to the claimant.

78. From August 2019, Mr O made several requests to DWP to stop recovering the overpayment. On 6 November 2019, the UC department sent the necessary notification to DM who ended the recovery. It has not been able to provide any reason for the delay.

79. There is no specific guidance saying how soon DWP should notify DM about a decision which cancels an overpayment. However the Charter says DWP will follow processes correctly and provide customers with the correct decision or payment. In this case we consider DWP did not act in line with the Charter because it failed to make DM aware of the MR decision and as such it continued to take money out of Mr O’s UC payment when he did not owe it.

80. DWP continued to recover payments from Mr O that were no longer outstanding. As such, for three months between August and November 2019, Mr O suffered avoidable financial worry and frustration.

Failure to refund recovered payments

81. After the UC department notified DM of the decision cancelling the overpayment in November 2019, it stopped recovery of the overpayment but did not refund the deductions it had already taken.

82. In November and December 2019, Mr O asked DWP on several occasions to refund him the payments it had taken from his UC towards the overpayment between November 2018 and November 2019

83. DM refunded the money in late December and apologised for the delay.

84. We consider the failure of DM to immediately reimburse Mr O’s payments is not in line with the Charter. This says DWP will follow processes correctly. Therefore, not doing so is a failing.

85. DWP delayed giving Mr O his refund for around seven weeks. We consider this caused him further frustration during this period.

Failure to respond to journal messages

86. Mr O wrote in his journal on 27 February and did not get a response until 8 April 2023.

87. We have referred above to the Charter which says DWP will deal with a customer’s request the first time they contact it, or as soon as it can. The failure to respond is not in line with the Charter and is an administrative failing.

88. Mr O has said during much of the time relating to the events of his complaint, he felt as if nobody was listening to him. We see that the lack of contact during February to April 2023 further supported his belief that he was not being heard.

Delay in responding to MP’s complaint

89. DWP: Complaints procedure was relevant at the time of Mr O’s complaint.

90. This says the customer should first contact the office, with which they have been dealing, about the matter. A complaint resolution manager will initially acknowledge receipt of the complaint and where possible telephone the customer to explain next steps. They will attempt to resolve the complaint in 15 working days. If this is not possible due to the complexity of the complaint or workload they will keep the customer updated.

91. If the customer is not satisfied with DWP’s initial response or it needs to investigate further, the customer can then make a formal complaint to DWP’s complaints team.

92. The complaints team will contact the customer to discuss the complaint in more detail in another 15 working days to tell the customer the outcome or when they can expect a response if it will take longer.

93. With the above in mind we have looked at what happened when Mr O’s MP complained on his behalf.

94. In April 2023, Mr O’s MP contacted DWP to complain about its management of his UC claim. We consider at this stage that DWP responded to this complaint in line with its complaints procedure.

95. This is because: • a complaints manager confirmed receipt seven days later and spoke to the MP on 9 May • they contacted the MP again within 15 days and since it had not resolved he matter at this stage updated the MP again within another 15 days • it confirmed that it had identified things that had gone wrong and made a referral four days later to the special payments team • DWP notified the MP of the special payments team’s decision approximately a week later.

96. We are of the view DWP acted in line with the Charter which says DWP will follow processes properly and say sorry and put it right if it makes a mistake.

Failure to implement the Six Point Plan

97. In 2009, DWP introduced the Six Point Plan for DWP colleagues. The plan is regularly updated and developed locally depending on local working environments.

98. The Framework summarises the main intentions of the Six Point Plan. These are to help ensure the customer is given the appropriate support and may involve notifying emergency services if a customer states that they intend to attempt suicide or self-harm.

99. The Framework says DWP should record that it has involved the Six Point Plan and give details of: • what the customer has said in regard to self-harming or suicide • key information it has provided to the customer about local mental health support or other relevant organisations • any actions the customer has said they would take such as contacting their GP or a friend.

100. Where a third party reports that a customer intends to attempt suicide or self-harm, the Framework says it is reasonable to expect the third party to manage the situation. For example by encouraging the customer to go to their GP or call emergency services if they consider the customer to be in immediate danger. If the third party is capable to managing the situation, DWP will tell them that it will take no further action but if the third party cannot do so, then DWP will contact emergency services if necessary.

101. As above, DWP must record details of the incident and discussion with the third party.

102. Mr O told DWP in February 2018 that he was self-harming when his LCWRA changed to LCW.

103. In December 2019, his friend told Mr O’s work coach that Mr O was self-harming and he was concerned about Mr O’s mental health. The same friend contacted Mr O’s MP about their concerns and the MP relayed the message to DWP.

104. In response to the friend’s notification to the work coach in December 2019, the work coach contacted the case manager. This did not result in any further action in line with the Framework. There is no evidence of any action taken in response to the MP’s email at the same time or to Mr O’s earlier notification in February 2018.

105. In light of the above, our view is DWP did not comply with the Framework as it did not respond to notifications about Mr O’s deteriorating mental health.

106. If DWP had responded in line with the Six Point Plan in February 2018, it may have signposted Mr O to other agencies or called the emergency services or discussed with him seeking help from his GP. We cannot say how Mr O would have responded to any advice or support offered. Similarly, if DWP had responded to his friend’s concerns about his mental health in December 2019, we cannot say if it would have deemed the friend capable of supporting Mr O or what they may have done to provide that support.

107. As a result Mr O missed the opportunity of receiving advice and support and a recognition of his deteriorating mental health. This may have made the events of the complaint less difficult for him.

Cumulative impact 108. We have also at this stage taken into account the cumulative impact on Mr O.

109. The impact of some of the identified failings extended for a few months and in two cases went on for one and three years respectively. In summary, Mr O continued to experience frustration, upset and at times financial worry due to a series of mistakes on the part of DWP over a significantly long period and this increased the overall impact on him.

DWP financial remedy

110. The Guidance sets out how DWP determines an appropriate financial remedy. It explains the actions DWP can take to put right maladministration. These actions include a special payment.

111. There are different categories of special payment, including consolatory payments. Consolatory payments are considered where the customer has suffered injustice or hardship arising from maladministration which has affected their wellbeing. These types of payments usually range between £50 and £500, or £1000 in a case that has been considered by ICE.

112. The Guidance suggests three different possible impacts on the complainant. These are: • gross inconvenience which goes beyond general trouble or annoyance but is short of a significant impact on the complainant’s health • gross embarrassment, humiliation or unnecessary personal intrusion • a significant impact on a complainant’s physical or mental health causing ‘severe distress’.

113. The Guidance explains that severe distress should be distinguished from general stress, which is better described as ‘gross inconvenience’. ‘Severe distress’ indicates a stronger impact which may lead to a higher consolatory payment than gross inconvenience. It is indicated when the complainant’s health and wellbeing have been seriously and demonstrably affected and where there has been a significant deterioration in their physical or mental health as a direct result of DWP’s maladministration.

114. The Guidance also says that consideration needs to be given to the duration of any impact arising from maladministration on a case by case basis.

115. DWP considered Mr O’s complaint and made a consolatory payment of £200. ICE increased this to £500.

116. We considered, in light of the above guidance whether DWP’s remedy in this case is appropriate to put right the impact on Mr O.

117. It is our view the impact on Mr O is distress and frustration with some periods of financial worry. The duration of impact for the different identified failings ranges from two months to three years. We recognise the cumulative nature of the impact over several years adds to the overall effect on Mr O.

118. DWP has refunded any costs due to Mr O in respect of the above matters.

119. We understand Mr O already had significant mental health needs before the events of his complaint. We recognise from his own account and his DWP records, he experienced a further deterioration which he attributes to the identified failings set out above. We have not been able to make this link. This is because we do not have any objective evidence of his deterioration and we cannot quantify what other factors may have caused this to happen.

120. We also cannot take into account any upset or distress which resulted from the fact Mr O had to comply with the job seeking activity requirements and decreased payment related to LCW for over three years. This is because, as we have explained above, we cannot say what the outcome would have been if DWP had raised an MR when Mr O first disputed the decision.

121. ICE recommended DWP pay Mr O £500. This is at the higher end of the available range in the Guidance and indicates the impact on Mr O falls in the severe distress category.

122. To decide on a level of financial remedy, we review similar cases where the person has experienced similar injustice.

123. We also use our ‘severity of injustice scale’ to determine the degree of impact on an individual. This ensures any recommendations we make are consistent and transparent for everyone who uses our service. The scale contains six different levels of injustice which increase in severity.

124. We agree that a consolatory payment at the higher end of DWP’s range of payments is appropriate. However given the cumulative nature and extended duration of the impact in Mr O’s case, we consider that a total payment of £700 in total is appropriate.

Service improvements 125. Mr O is also seeking service changes to make sure DWP applies the Six Point Plan effectively in the future.

126. We have considered the additional standards and guidance DWP has implemented since the events of Mr O’s complaint which are intended to ensure it provides support to vulnerable claimants.

127. In 2020 DWP implemented new guidance that placed a greater emphasis on safeguarding vulnerable customers if a decision was made to stop benefits. The guidance was the ‘Advanced Customer Support: Stopping Payments’. It has been regularly updated and its purpose is to identify vulnerable customers in this position and make sure they had any necessary support or advice.

128. The Advanced Customer Support overview, November 2022 sets out the steps DWP will take if it considers that there is risk of suicide or self-harm or where a vulnerable customer needs additional help or support with their benefit claim.

129. The above procedure makes use of DWP’s Customer Experience and Advanced Support Team (CEAST). CEAST was introduced in January 2021. Its function is to provide support to customers who have been identified as vulnerable or having complex needs and in need of additional support. CEAST works with Vulnerable Customer Champions to provide specialist support to vulnerable customers and work closely with DWP advisers to resolve any complaints raised.

130. The ‘District Provision tool’ was created in December 2022 and most recently updated in July 2024. This is a list of local and national support services and organisations which DWP and Jobcentre staff use as a resource for signposting vulnerable customers.

131. Having taken the above into consideration, we consider this is evidence DWP’s awareness of vulnerable customers has significantly increased and it has introduced a number of positive changes to the provision of its support. As such we do not consider it proportionate to recommend further improvements in line with our Principles for Remedy. We hope it reassures Mr O that positive changes have already been made.

1. We have carefully considered Mr O’s complaint about DWP’s handling of his Universal Credit (UC) claim. We have seen failings in some aspects of DWP’s management of it.

2. We consider that the provisional failings caused Mr O upset and frustration, and in some cases financial worry over an extended period of time.

3. We have not found failings with DWP’s complaint handling in 2023.

4. DWP has paid Mr O £500 to recognise the upset caused to him. We do not consider that this is enough to remedy the impact caused to him and therefore partly uphold this complaint.

5. We recommend DWP makes an additional payment of £200 to fully put right the impact caused to Mr O.