Department for Work and Pensions

4. Mrs M complained about the AP’s handling of her November 2021 PIP telephone consultation. She says the HP working for the AP did not give enough consideration to the impact of her mental health conditions on her ability to carry out the activities ‘engaging with others face to face’, ‘making budgeting decisions’, and ‘planning and following journeys’.

5. Mrs M said the HP’s actions caused her to receive a lower award of PIP than she should have. Mrs M had to appeal her PIP award at a First Tier Tribunal to get PIP awarded at the enhanced rate for daily living and mobility components. Mrs M found the appeals process ‘overwhelming, tiresome and anxiety-inducing’ and was only able to complete this with the aid of a representative.

6. To resolve her complaint, Mrs M wanted DWP to implement systemic changes to the PIP assessment process. She also wanted a financial remedy to reflect the emotional distress caused by having to pursue an appeal to secure the correct PIP entitlement.

7. In August 2021, Mrs M sent to DWP a completed PIP claim form. DWP asked its AP to assess Mrs M’s functional ability. In November 2021, the HP conducted a telephone consultation and completed a report for DWP.

8. Based on the HP’s report, in December 2021 DWP decided to award Mrs M PIP at the standard rate for daily living and mobility components.

9. Mrs M asked DWP for a mandatory reconsideration of its decision. Mrs M said she felt her physical health conditions were considered but the HP had overlooked how her mental health impacts on her functional ability.

10. In March 2022, DWP decided to maintain its decision because the HP’s report had included a history of Mrs M’s mental health conditions and the functional history section had documented the restrictions caused by Mrs M’s mental health that had been reported by her.

11. DWP noted that Mrs M felt the HP’s report was substandard. It signposted her to the AP to make a complaint.

12. In January 2023, Mrs M’s representative appealed to the Tribunal against DWP’s decision.

13. In March 2023, Mrs M’s representative complained to the AP that the HP’s report had not fully considered information Mrs M had provided about the difficulties she encounters when leaving the house, managing her finances and mixing with people. The representative said that ‘no real consideration has been given to the impact of Mrs M’s depression on her life’.

14. The AP responded to the complaint saying it found the HP’s report was completed in line with DWP’s guidance.

15. In September 2023, the Tribunal found that Mrs M had limited ability to carry out the activities of ‘engaging with other people face to face’ and ‘planning and following journeys’. As such it decided she met the requirements for daily living and mobility enhanced awards.

16. Explaining its decision, the Tribunal said it ‘had the benefit of oral evidence from Mrs M and her husband at the hearing today’ and had taken account of that evidence.

Issue 1 – November 2021 health assessment

19. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

Engaging with others face to face 20. Mrs M considered the HP’s assessment for the activity ‘engaging with others face to face’ was flawed because they had not had sufficient regard to her account of the restrictions she experiences due to her anxiety and depression.

21. Furthermore, Mrs M said the HP should not have relied on evidence of:

• her ability to engage with people over the phone as this was not face to face • short interactions at the hairdresser and swimming pool check-in as these did not evidence that Mrs M could reliably repeat engaging with others face to face to the expected standard

22. The HP had to follow DWP’s PIP Assessment Guides parts 1 and 2 when conducting their consultation and producing their report. Those guides describe the requirements of the PIP Regulations and how DWP expected HPs to conduct their assessments of claimants.

23. We saw indications that the HP appears to have acted in line with DWP’s guidance to: read all evidence submitted; record a succinct history of Mrs M’s health conditions; document Mrs M’s functional history and the variability of her depression and anxiety that impact on her ability to engage with others face to face on good days and bad days and the frequency of each; make informal observations of Mrs M and use this to help determine.

24. The evidence seen by the HP included Mrs M’s reported restrictions in her claim form. On ‘mixing with people’, Mrs M said: ‘On a good day I am able to mix normally with other people. On a bad day due to my mental health I have difficulty mixing with other people. This can be people in my social circle as well as strangers. My depression can cause me stress and anxiety which in turn gives me severe panic attacks. I feel that I do not want to face seeing people not even my own family.’

25. Mrs M then described the physical impacts of her panic attack and said: ‘A lot of time due to my depression I just do not mix with other people at all as I cannot face going out and seeing people plus I get panic attacks at the thought of it.’

26. The HP documented the following information in their report as the record of the issues discussed with Mrs M.

• On the variability of Mrs M’s depression, the HP recorded: ‘Feels depressed everyday, some days feels more depressed for the last 3 weeks hasn’t washed due to low mood. In a month 3 out of 4 weeks are bad where this happens. Today she is feeling better’.

• On the variability of Mrs M’s anxiety and panic attacks, they recorded: ‘Feels anxious everyday. Has triggers, assessments, leaving the house, meeting people, in the cab out the house, listening to the news. Today is a normal day’.

• The HP noted Mrs M ‘found it very difficult to explain variability, explained it’s so variable she is unsure even with probing and support’.

• On Mrs M’s functional history of engaging with others face to face, the HP recorded: ‘Avoids meeting new people, just doesn’t go out. Makes her feel anxious, no panic attacks to report. When goes to the GP gets dropped there and goes alone, if it was a GP she didn’t know would still go to the appointment. Can answer the door to deliveries unless extremely depressed and then is embarrassed at how she looks. Is able to answer the phone to anyone. Is ok engaging at the hairdressers and at swimming to check in.’

• The HP’s informal observations said that Mrs M was able to communicate well during the telephone consultation.

• For the ‘mental state’ section of the form, the HP noted: ‘Interaction normal. Coped well at interview. Normal manner. Not anxious, agitated or tense’.

27. When evaluating all that evidence, the HP needed to consider DWP’s PIP Assessment Guide Part 2. The guide said:

‘This activity considers a claimant’s ability to engage with other people, which means to interact face-to-face in a contextually and socially appropriate manner, understand body language and establish relationships. The different aspects of the ability to engage with other people needs to be considered in the round.

This activity encompasses all forms of social engagement, whether the ‘relationship’ established lasts ten minutes, ten days or ten years. It should be considered in the context of everyday activities in which social and verbal interaction is required.

When considering whether claimants can engage with others, consideration should be given to whether they can engage with people generally, not just those people they know well…

An inability to engage face to face must be due to the impact of impairment and not simply a matter of preference by the claimant…’

28. When choosing the descriptor for each activity, DWP’s PIP Assessment Guide part 1 says the HP ‘must consider whether the claimant can reliably complete the activity in the manner described in the descriptor’. DWP’s guide says reliably means considering whether the claimant can do the activity safely, to an acceptable standard, repeatedly, and in a reasonable period.

29. DWP’s guide also says ‘the claimant’s health condition or impairment must affect their ability to complete the activity on more than 50 percent of days in the 12-month period’. That 12-month period being the 3 months before the claim and expected to last for at least a further 9 months.

30. Comparing what that guidance says should happen against the HP’s actions gives no indications of potential significant shortcomings.

31. When giving their justification for the descriptor choice, the HP set out the restrictions reported by Mrs M (using information from her claim form and documented by the HP during the consultation). The HP also gave their reasons for saying why they had not chosen a descriptor that met all reported restrictions.

32. That indicates to us that the HP appears to have given the required consideration to what Mrs M had reported about how her mental health impacts on her ability to carry out this activity.

33. The HP’s recommendation to DWP was that Mrs M ‘can engage with other people unaided’. Their justification for this was:

‘The evidence in the [functional history] showing she attends appointments alone, can answer the door to deliveries, is able to answer the phone to anyone and is ok engaging at the hairdressers and at swimming to check in. This is in keeping with [informal observations] showing good rapport establish quickly and [mental state examination] showing no restrictions suggests she should be able to reliably engage with other people independently.’

34. Mrs M’s representative considered Mrs M’s ability to answer a phone was not evidence that she could engage with someone face to face. They also considered the hairdressers and swimming pool check-in were short interactions. The representative said Mrs M would not be able to repeat this reliably.

35. Mrs M’s engagement with others around that time was limited. As such, we think the HP is likely to have acted appropriately by using the evidence of events that had happened even though these were short interactions of answering the door to accept deliveries or when checking-in at the swimming pool and the verbal only interactions of communicating with people over the phone.

36. It appears to have been appropriate for the HP to consider those activities where Mrs M was engaging with other people face-to-face. Unfortunately, the HP did not establish how frequently Mrs M does these activities, whether she can only do them on a ‘good day’, whether she can do then with support on a ‘bad day’ or not at all, and how many good and bad days the HP thought Mrs M had in relation to this activity. This information would have helped the HP to consider whether Mrs M could engage with others reliably.

37. DWP’s guidance said the HP needed to assess the variability of Mrs M’s ability to carry out activities. We can see from Mrs M’s January 2022 mandatory reconsideration request that she told DWP: ‘I felt the assessor was trying to pin me down to how many days of a week I am depressed which is a hard question to answer as depression does not work like that’. This description of what happened - along with the HP’s contemporaneous note that Mrs M ‘found it very difficult to explain variability, explained it’s so variable she is unsure even with probing and support’ - suggests the HP did take steps to understand the variability of Mrs M’s functional history of engaging with others during the November 2021 consultation.

38. As such, we think it is unlikely that further investigation of this point would establish the HP acted maladministratively when gathering the evidence required by DWP’s guidance and by using the available evidence. We recognise that while Mrs M disagrees with the HP’s conclusions, we have seen no indications the HP failed to follow DWP’s guidance.

Making budgeting decisions 39. Mrs M considered the HP’s assessment for ‘making budgeting decisions’ was flawed because they did not consider how her depression impacted on her ability to complete this activity.

40. As explained above, the HP had to follow DWP’s PIP Assessment Guide parts 1 and 2 when conducting their telephone consultation and producing their report.

41. Part 1 of DWP’s guidance for this activity explains:

‘Complex budgeting involves calculating household and personal budgets (e.g. knowing how much money is left to spend once bills and rent is paid), managing and paying bills (e.g. setting aside money from income for gas and electricity bills) and planning future purchases (e.g. knowing that saving is required when necessary).’

42. We saw indications that the HP appears to have acted in line with DWP’s guidance to: read all evidence submitted; record a succinct history of Mrs M’s health conditions, including her depression; document Mrs M’s functional history and the variability of her depression and anxiety that impact on her ability to make budgeting decisions when she is depressed and when she is not.

43. The evidence available to the HP shows the variability in Mrs M’s depression impacted on her ability to complete this activity. When depressed she was unable to manage her bills and would leave them unpaid. Mrs M said she would spend money when depressed to make herself feel better.

44. The evidence also included that when she was not depressed Mrs M can manage her bills and make arrangements to pay.

45. When explaining their choice of descriptor as ‘can manage complex budgeting decisions unaided’, the HP correctly summarised the restrictions Mrs M had reported. This indicates they were aware of how Mrs M’s depression impacted on her ability to complete this activity on bad days.

46. The HP justified their choice of descriptor by saying the evidence given by Mrs M when describing her functional history and variability shows ‘she understands and manages all her own bills without help and although has got into debt is managing this debt independently’.

47. Similarly to the issue above, the HP did not establish how many good and bad days the HP thought Mrs M had in relation to this activity. Again, DWP’s guidance said the HP needed to assess the variability of Mrs M’s ability to carry out activities. For the same reasons as given above, the HP encountered difficulties in establishing the variability of Mrs M’s functional history of making budgeting decisions.

48. As such, we think it is unlikely that further investigation of this point would establish the HP acted maladministratively when gathering the evidence required by DWP’s guidance and by using the available evidence.

49. We recognise that while Mrs M disagrees with the HP’s conclusions, we have seen no indications the HP failed to follow DWP’s guidance. Furthermore, we note Mrs M asked the Tribunal to agree she needed prompting or assistance to make budgeting decisions (and award her 2 points for this activity). The Tribunal did not do that. Instead, it decided the correct descriptor had been chosen.

Planning and following journeys 50. Mrs M considered the HP’s assessment for the planning and following a journey activity was flawed because they gave no real consideration to how her anxiety and depression impacted on her ability to complete this activity.

51. As explained above, the HP had to follow DWP’s PIP Assessment Guide parts 1 and 2 when conducting their telephone consultation and producing their report.

52. In relation to this activity and mental health conditions, Part 2 of DWP’s guidance says for the lowest points scoring descriptor:

• ‘applies to claimants where undertaking any journey causes overwhelming psychological distress (OPD) and where they need prompting (‘prompting’ means reminding, encouraging or explaining by another person) on the majority of days to be able to undertake the journey.’

• ‘“Any journey” means that in order to satisfy the descriptor on a day the person must require prompting when undertaking every single journey on that day to avoid OPD. If the person can manage to leave the home to make a journey once without prompting then on that day the descriptor is not satisfied. For example, a claimant who can make visits to the local shop or collect their children from school without prompting on most days will not satisfy this descriptor, even if they’re unable to undertake other journeys without prompting during the same day.’

• ‘OPD means distress related to a mental health condition or intellectual or cognitive impairment resulting in a severe anxiety state in which the symptoms are so severe that the person cannot undertake a journey without being overwhelmed. The threshold is a very high one - a claimant who, without prompting, would be left feeling anxious, worried or emotional does not meet it. OPD may occur in conditions such as generalised anxiety disorder, panic disorder, dementia or agoraphobia.’ (Emphasis added)

53. The HP said they had read Mrs M’s claim form. For this activity, Mrs M said:

‘This difficulty is variable dependant on my mental health. The difficulty is leaving my home to go out. I have this as I suffer from depression, stress and anxiety. When my depression is bad I get severe stress and anxiety and panic attacks. At this time I am unable to leave my home. I have to get my husband or son to do things for me outside. Whether this be shopping or getting gas/electric etc. If I do manage to be prompted to go out I usually will need someone to assist me by coming on the journey with me.’

54. During the November 2021 consultation the HP noted:

• on social and occupational history: ‘Anxiety also stops her from going out. Used to get a cab to work because of mobility restrictions due to arthritis, always uses cabs, ubers or gets lift from husband.’

• on functional history including variability: ‘Anxiety and Panic attacks (1997) Feels anxious everyday. Has triggers, assessments, leaving the house, meeting people, in the cab out the house, listening to the news. Today is a normal day’ • ‘claimant found it very difficult to explain variability, explained it’s so variable she is unsure even with probing and support.’

• On ‘Planning and following journeys’: Leaves the house for appointments and to get hair done and to visit a friend has only left the house 3 times in the last month. Yesterday went out the house to get her hair done but did this because she felt better, was a better day and wanted to make herself feel better. Feels anxious when comes to leave the house, gets butterfly feeling, stomach goes over, feels nauseous, feels shaky, head feels weird. Feels like heartbeat is faster and gets shaky. Always uses breathing exercises and pushes herself to go, never goes out alone always goes with family or friends. Once out anxiety is variable. Has had to abandon situations in the past because she’s too anxious, she is normally with husband who is driving or in an uber and tells them to take her straight home. Gets panic attacks, gets hot sweaty, feels like can’t breathe, body feel tight and like she’s having a heart attack and she’s going to die, she reports she has to grab herself and has to remember to relax her shoulders, then does breathing exercises and things positive thoughts, distracts herself with music or phones someone. Has had an attack outside the house and used this same method to fix the situation. Has never had to call an ambulance for attacks or panic. Has [named medication] for her chest which she occasionally uses to try and help but she does not take any specific anxiety medication to leave the house. Has spoken to therapy in the past and they taught her breathing and distraction techniques which she finds effective.’

55. When setting out their recommendation, we saw the HP correctly recorded Mrs M’s reported restrictions. These included that she needs ‘prompting to go out, goes out with assistance’.

56. The HP explained their recommendation and the evidence used as follows:

‘The evidence in the medications showing she has been on her [named medication] for over a year indicating good efficacy and a more stable condition, [functional history] showing although she doesn’t leave the house on [majority of days] she is able to use her strategies independently to attend appointments, to get hair done and to visit a friend. In addition she reports she is able to independently apply her techniques from previous therapy during a panic attack to manage the situation and is able to calm herself and ring someone which is not indicative of [overwhelming psychological distress (OPD)]. This is in keeping with [informal observations] showing no signs of OPD were evident during [telephone consultation] and [mental state examination] showing no restrictions suggests she should be able to plan and follow a journey independently.’

57. The HP then explained why they decided Mrs M’s reported restrictions were not supported by evidence, saying: ‘Although reports panic and anxiety [history of condition] sees no recent or current specialist input for mental health and medical history sees first line medication for mental health’.

58. We can see that DWP’s PIP Assessment Guide part 2 required the HP to consider whether Mrs M suffered overwhelming psychological distress when attempting this activity. The guide says: ‘the threshold is a very high one – a claimant who, without prompting, would be left feeling anxious, worried or emotional does not meet it’.

59. It appears from the evidence set out above that the HP did consider in line with DWP’s guidance how Mrs M’s mental health affected her ability to complete this activity. The HP gave a clear explanation for the reason why their opinion differed from Mrs M’s reported restrictions. This is in line with DWP’s guidance for what a justified report should contain. As such, we have seen no indications the HP may have acted with maladministration.

60. We appreciate that Mrs M and her representative consider the HP’s choice of descriptor was wrong. In support of their view, we can see the Tribunal reached the decision that Mrs M was severely limited in her ability to plan and follow a journey. The Tribunal was entitled to prefer its own views on Mrs M’s abilities, and we can see it heard additional evidence from Mrs M and her husband.

61. The Parliamentary Commissioner Act 1967 says we cannot question the merits of a decision taken without maladministration. For the reasons explained above, we have not seen indications of maladministration by the HP when considering their recommendation for this activity.

62. We appreciate that Mrs M was successful in her appeal against DWP’s decision on the level of PIP she was entitled to receive. We can also recognise that the appeals process will have been overwhelming for her. We hope this information helps Mrs M and her representative to see why we have decided to stop our investigation at this point.

1. We have carefully considered Mrs M’s complaint about DWP’s Assessment Provider (the AP). We have seen no indication that anything went seriously wrong.

2. DWP’s guidance said the healthcare professional (the HP) working for the AP had to consider Mrs M’s evidence and explore with her the limits of her functional ability to carry out certain activities. The information we have seen indicates that the HP followed DWP’s guidance by documenting Mrs M’s restrictions caused by her anxiety and depression, including the variability of her condition. As such, we saw no indications of maladministration by the HP.

3. We appreciate that Mrs M was successful in her appeal against DWP’s decision on the level of PIP she was entitled to receive. We can also recognise that the appeals process will have been overwhelming for her.