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Disability Rights UK response to the Work and Pensions Committee inquiry on Personal Independence Payment (PIP)

Disability Rights UK (DR UK) is a pan disability membership organisation led by disabled people seeking change. Our membership includes individual disabled people and organisations working on their behalf including disabled people led organisations (DPULOs).

Find out more about the inquiry

Among our membership are over three hundred organisations that give advice directly to disabled people, particularly in respect of benefit issues. DR UK run a second-tier advice line where we assist their front-line advice workers with supportive information and advice.

Our evidence to the inquiry has been informed by the response to a ‘snap’ survey we carried out among our individual members and organisation members.

We received over 80 responses and we attach these separately.

Q1 Which aspects of the current assessment process for PIP are and are not conducive to accurate decision-making?

What improvements could be made?

Most survey respondents were critical in different ways of the assessment process by Health Care Professional (HCPs).

Criticisms include inaccuracy, lack of knowledge, and additional evidence not being considered.

The following are representative of answers given:

“I asked for a copy of my report - I was shocked by the level of errors, inaccuracies, omissions and, quite possibly, lies contained within the report. I was judged against extremely outdated and unhelpful mental health stereotypes as opposed to the ways in which my condition makes life so difficult.

As a healthcare professional with a first-class honours degree in physiotherapy, I can also state with absolute confidence that the musculoskeletal assessment conducted was appalling and could not have provided sufficient information upon which a decision regarding my physical capabilities to carry out work for any period of time could be made. Lies were also told about the content of the musculoskeletal assessment - data was recorded for tests which were not conducted.” 

“Assessors lack appropriate/ any knowledge of conditions. Claimant asked to 'split up' co morbid conditions despite overlay. Submitted medical evidence not read/ understood. Civil servants lack medical knowledge. Assessors findings take precedence over medical condition experts. Privatisation of civil service not working. Findings of medical specialists should be only be used along with personal statements & GP info.”

“The process as currently defined is fundamental flawed, Information available not used, and the integrity of the process does not allow for accurate recording of information when provided, and many members feel that the assessor is ill informed and not suitably knowledgeable of the disability they are preparing to assess, a lack of clarity on the process.

Many feel that they are not able to answer fully and that information provided is then completely misinterpreted. Lack of consideration on the overall effect of the disability, travel times, appointments doubled booked.

A lack of consistency in the length of assessments. one point we would like to make here is the issue of conscious - sub conscious biased in decision making and would like further information on the training of those undertaking the assessments. What if any steps are taken to ensure that this element is removed from decision making and how is this undertaken?”

“Doctors won't give client the medical evidence that they need to back up their claim they say to our clients DWP will contact us for any information. DWP do not get information they tell our clients it is up to them to get the information to back up their claim for PIP. We have even asked on the form for DWP to get the information from a GP yet I do not know of one client they have done this with. So if a client writes on the form please get medical evidence off my GP because he won't give it to me as he says you will contact him for it then you need to contact the GP for the information.”

“The reliance alone on the PIP face to face assessments and the inaccurate reporting by assessors of what happened at the face to face assessments. More notice should be taken at the start of the medical information from a client’s own GP or consultant. The DWP should routinely write to and ask for a report from GP's/Consultants.”

“The assessment process does not seem to consider a person’s mental health and the impacts this has on their life. Also for people with brain injuries, the questions do not effectively capture the challenges and disabilities survivors of brain injuries are living with. In my experience, the assessors seem to have little understanding of brain injury when carrying out the assessment and this is reflected in the high number of initial PIP outcomes that we have had to appeal, as they have not been carried out accurately and therefore don't reflect the actual reality of the person living with a brain injury.”

“In the case of many of our clients, the process of being medically assessed when the claimant has a long term, incurable, progressive condition is flawed because the assessment is based on an hour meeting with the claimant and it is felt that this is not sufficient time in which to determine if a person meets the criteria for PIP.

The PIP 2 part of the claim is difficult to complete for a lot of people, who struggle with a visual or hearing impairment many of whom seek assistance from family/friends or outside help. The current time allowed for a PIP form to be completed and returned seems to be 2 weeks which is not long enough for people to gather all of the evidence to support their condition and also get assistance if they need it.

The DWP need to look at the whole process again with regards to assessing people with long term, progressive, incurable conditions as from our experience this is resulting in incorrect decisions which causes a lot of unnecessary stress at the prospect of having to take it to appeal and or tribunal who are overturning the DWP decisions.”

 

Q2 Do Atos and Capita staff conducting PIP assessments possess sufficient expertise to make accurate decisions on claims involving a wide range of mental and physical health conditions?

None of those responding to our survey thought that Atos and Capita staff had such sufficient expertise.

For example:

“In my experience of attending assessments with our clients, I do not believe that any of the assessors have enough or in deed any experience of mental health conditions or knowledge. Many of the assessors are nurses, paramedics etc. I have yet to come across an assessor who has any experience of the condition which affects the person being assessed.”

“The physical examinations are very brief, I get reports of 2-3 minutes. Mental health is assessed according to a series of tick boxes. Clients state that the examiner rarely makes eye contact with them but spends their time using the computer.”

“No. In terms of brain injuries and long term complex neurological conditions, which vary in presentation, it is wholly inappropriate for a general nurse, physio or OT without specialist knowledge of brain injuries, assess such conditions. Some decisions have been poorly written with poor grammar and on occasion, contrary to what was said during the assessment.”

“Staff do not possess sufficient expertise to make accurate decisions, especially with regard to mental health conditions which can fluctuate. Claimants should not be penalised for being clean, presentable and educated as none of these things are an accurate indicator of a person's mental health. Additionally, physiotherapists should not be conducting assessments where mental health conditions are the main factor.”

“I've met claimants where additional evidence has been preferred instead of an assessment. I assume it's because their claim is so complicated. I'd suggest it's ambitious to think the staff can understand every claimant's situation and this is a weakness in emphasising these assessments when so many claimants have a range of consultants and similar with their own specialised areas.”

Q3 Do staff take enough account of additional evidence supplied by claimants?

No respondents thought additional evidence was fully considered.

For example:

“One of our members collapsed during an assessment. This was clearly additional evidence and yet had not been included in the report. Additional medical evidence forwarded after the assessment or MR was ignored in one case yet was a deciding factor in a successful Appeal.”

“No. The health assessor’s opinion seems to be preferred over a GP or consultant who may have known client for years”

“It is our experience that at times little if any consideration is given to the submission of additional evidence, although on occasions some have reported that the assessor was able to demonstrate a limited understanding of the disability. Personal accounts of the daily effects of the disability need to have equal value in the assessment report, as the expert in the room is the claimant.”

“Frequently not. Sometimes deny that they have any previous information. Question conditions e.g. why an applicant has not seen a specialist, had certain tests etc. Many disabled people are never had a specialist referral and are dependent on their GP who may not have specialist knowledge or be unwilling to refer a patient with conditions such as arthritis. There is little the patient can do about this but they can be penalised.”

“In my experience, no. This is evidenced by the number of clients who we have to support to appeal the decisions and ultimately have a very different outcome after it goes to the appeal stages (positive outcome) - this Appeal panel are basing this on the same evidence that the initial assessor would have had access to.”

“I don't believe that they do, one of our clients has M.S and supplied a lot of medical evidence to support her claim, an assessment I felt was not needed for this reason. She was assessed, and was not happy with the decision. We challenged, it was rejected, went to tribunal and the court upheld the appeal. If the staff had taken into account all of the evidence supplied, it would not have come to this.”

“No. The medical evidence supplied with a claimant’s application, or subsequently forwarded, are definitely not given enough credence. It appears this evidence is ignored at all stages from the receipt of a claimant’s application right through to the Mandatory Reconsideration process.”

Q4 Is the face-to-face assessment appropriate for claimants with a range of different conditions?

Responses included the view that a face-to face assessment should not always be necessary. In addition, that the process was problematic for those with mental health difficulties.

For example:

“Clients with severe disabilities who have supportive medical evidence should not need to go through assessment. Also assessments nearer to home e.g. in GP surgeries or other facilities would be less traumatic for some clients with severe disabilities and mental health issues. Also people being expected to travel long distances for early morning appointments.”

“It is not suitable for people with fluctuating conditions or invisible illnesses such as ME as it only provides a tiny snapshot of the illness and not the overall picture over days, weeks or months. Furthermore, it does not take into account the effect of any activity on health in the following hours or days: the assessors do not seen the pain, exhaustion and malaise which inevitably follow the physical and mental stress of the interview.”

“In some cases individuals with limited communication skills or those suffering from anxiety and mental health conditions will find face to face assessments stressful, in a system that is not designed to be flexible this will cause distress. Lengthy journeys to attend and cost prohibitive also adds to the burden for those attending, as does the timings or need to have support during an assessment.”

“As I have said previously it is difficult for people with mental health problems to have a face to face meeting sometimes and this is made worse when they suffer with severe anxiety and can't get appointments closer to home but instead are expected to travel miles (an hour or more) to get to an appointment.

A face to face is difficult for anyone suffering any form of anxiety or depression but if you have a physical disability to it seems that only one thing is focused on such as the physical side and not the mental or the mental side and not the physical.”

“No - I work with clients with spinal injuries and Brain injuries. spinal injuries - a face to face should not be necessary when someone is tetraplegic! Brain Injuries- often brain injured clients are not reliable witnesses and lack insight.”

“As stated before, the assessors are not qualified to assess particular medical conditions such as congenital eye conditions, the effects that being deaf has on a person, neurological conditions (not mental health) such as M.S, Parkinson's Disease. The assessor asks the same questions regardless of the person’s condition or disability, so how can the assessment be appropriate to the person sitting in front of them.”

“In some cases individuals with limited communication skills or those suffering from anxiety and mental health conditions will find face to face assessments stressful, in a system that is not designed to be flexible this will cause distress. Lengthy journeys to attend and cost prohibitive also adds to the burden for those attending, as does the timings or need to have support during an assessment.”

Q5 What changes are needed to improve the accuracy of decisions made in initial assessments and in mandatory reconsideration, given that the majority of decisions that go to appeal are overturned?

Opinions received felt that the causes of decisions being overturned included HCPs inadequate training, over-reliance on HCPs reports, and that the mandatory reconsideration process is flawed.

For example:

“Assessors that are familiar with that condition not a quick check list. The short training they receive is not enough to be applied to all conditions. Also assessors with up to date training and developments of the condition.”

“Having read decision letters, too much emphasis seems to be given to the assessment and from that too much to how the claimant appeared as recorded by the assessor.

As an example, if someone is said to have answered questions well, that seems to be used against them for some activities. It seems wrong to use the process against the claimants. Extra evidence could be gathered by PIP. Mandatory reconsiderations seem a waste of time except that claimants have to go through them. Decisions seems rarely to change.”

“Better training and opportunity for clients to explain their condition Claimants have to put GP and consultants etc. on form but they are rarely contacted but they often assume DWP has contacted them MR seems to be rubber stamp with little notice being taken of additional evidence.”

“It is not suitable for people with fluctuating conditions or invisible illnesses such as ME as it only provides a tiny snapshot of the illness and not the overall picture over days, weeks or months. Furthermore, it does not take into account the effect of any activity on health in the following hours or days: the assessors do not seen the pain, exhaustion and malaise which inevitably follow the physical and mental stress of the interview.”

“Information should be sought from any specialist involved and from the GP but the enquiry should be meaningful, not more boxes to tick. Doctors are often unwilling to provide reports to patients and charge, sometimes substantial amounts (up to £70) which applicants just cannot afford and should not have to. Mandatory Reassessments seem to have little useful function and greatly increase the stress on applicants because of the additional delay caused prior to an Appeal Hearing.”

“Consider all information supplied with the claim form or at mandatory reconsideration. If any doubt contact the appropriate HCP,s for more information or to clarify. The initial decision may take a little longer but the outcome should be more satisfactory and avoid appeals.”

“Better training of the staff looking at the initial PIP claim forms. Taking on board and paying closer attention to the medical evidence being submitted. In a lot of cases the Doctor's, Consultant's, Mental Health and Specialist teams will have worked and known the claimant for a long time.

“In some cases their letters might not be specific, but the whole PIP process is creating extra work for them and they are under pressure to find the time to be able to provide any medical evidence for the claimants in the first place.

The Decision Maker's need to spend the time to read all of the evidence submitted and not just taking the medical assessors written evidence, PA4, from meeting a client for 30-90 minutes.

The way the medical assessment process is carried out needs to be looked at, both in terms of the way it is handled and the questions that are being asked. Needs more adaption to consider the needs of more unseen disabilities. Improved consistency with the way claimant’s applications are dealt with.”

“Recorded assessments. A standardised list of relevant questions; Assessors re order client’s statements short hand and often change the original wording, which sometimes changes the meaning or evidence submitted. Due to the time restrictions on assessments I think they cut corners when making notes and do not fully or accurately record the assessments.”

Q6 What are the most common reasons you come across for decisions being overturned on appeal?

Once again, respondents a often criticised the inaccuracy of HCP reports and the ignoring of additional medial evidence by HCPs and Decision Makers as significant factors.

For example:

“Assessors ignoring evidence that was present at the beginning of the application.”

“Inaccurate reporting and evidence having been disregarded.”

“Assessors making inaccurate statements, assessors making false statements, assessors incorrectly interpreting things the claimant said or did. Failure to take into account supporting evidence. Inability of assessor to understand the severity of a claimant's health condition. Ignorance of rare conditions.”

“Not reading medical evidence, prioritising assessor 'informal observations' over claimant statements when supported by medical evidence, and 'snap-shooting' claimants at assessment (assuming how the claimant behaves in this very short space of time will accurately describe their circumstances over a 12-month period).”

“By far the most common are blatant inaccuracies in the Assessment Reports. Sometimes the applicant is unrecognisable - for example an individual deemed to be able to walk 200 metres who can barely manage 10 metres with someone's arm.”

“1/ Medical evidence supplied with claimant’s application not given any credence.

2/ Not enough care and attention given to a claim when initially received and processed. By not awarding PIP benefit at this point.

3/ Decision Maker not following the correct process of independently looking at the claimants PIP form answers and the medical evidence supplied, together with the PA4 submission, and awarding the correct points on the questions answered.

4/ Having to fight to get a claimant’s disabilities recognised because their issues are real, but the wording of the questions and/or the descriptors do not fully account for the claimant’s issues.”

In contrast, the performance of appeal tribunals was highly regarded:

“My experience has been positive at the appeal stage in that the evidence seems to have been read and understood, whether that be medical reports or support plans submitted by other services. I don't know if this is down to better training or more experienced practitioners dealing with appeals but it is a very stressful process to put claimants through for almost 6months for the decision to be overturned - when no new evidence is provided - the decision should have been correct at the first PIP assessment.”

“The appeal tribunal normally simply read and apply the medical information (the same information which has previously been provided in all communications in the assessment).”

“Points are more fairly and realistically awarded for tasks which the claimant clearly cannot manage reliably, repeatedly etc.; evidence is given proper weight; the overall picture is taken into consideration; the Tribunals seek to be fair in its judgements.”

Q7 Is the mandatory reconsideration stage functioning properly? How could it be improved, or should it be abolished?

The common viewpoint of survey respondents was that PIP mandatory reconsideration process “seems pointless” and appears simply to “rubber stamp” the initial decision.

Among advisers’ comments were -

“We get very few decisions changed at this stage even when all the information supplied is the same as used when going to successful appeals. SO, NO, abolish it.”

“In my experience, mandatory reconsideration don't change the decision made by the initial PIP assessment - it is at Appeal stage when the outcomes has been overturned. It feels like this stage is just drawing out the process for claimants”.

“I find hardly any decisions, even those highly evidenced are altered at this stage. They tend to stand by the decision of the assessor, even if further medical evidence has been supplied.”

“From my experience the mandatory reconsideration process only serves to delay a decision being made and means the claimant is left a long time waiting for a decision. Also in nearly all cases the reconsideration process only supports the original decision, thus leading to the more time consuming and court time wasting appeal process.”

In terms of those who suggested improvement, the following views are representative:

“I'm sure many claimants would prefer to keep it rather than to have to attend a tribunal but if kept it needs improving rather than rubber stamping the first decision.”

“The initial assessment stage should be improved to avoid the need for the unacceptable number of reconsiderations. Reconsiderations must take into account evidence from GPs, and other healthcare professionals who have spent more than 30 minutes with an individual.”

“Some of our members report that written medical evidence still ignored at this stage; most feel this is just a formality as it is carried out by the DWP internally and is not a genuine reappraisal of the evidence; it just creates more distress for the claimant. The only advantage is that it gives the claimant time to gather more evidence before an Appeal hearing.”

Q8 What is the impact on claimants of delays in getting an accurate decision on their claim, and how could this be reduced or better managed?

The comments by disabled people responding to the survey show how damaging the PIP assessment and appeal process is with common references including “poverty”, “debt” “worsening of condition”, “stress”, and “depression”.

These three responses encompass points many gave:

“My process took 42 weeks. From start to decision at tribunal. I suffered damaging impact on my mental health with the stress of trying to get further evidence within two weeks. And then to have to sit in front of three people, doctor, judge and disability expert and the rep from the DWP question me for an hour while I was in tears shaking because I was terrified of being in a room with them. Essentially they were lucky they didn't retraumatise me or cause total dissociation. Which was close.

The financial deficit made it hard to afford heating or food. My house sitting at -1 at some points in December. It all comes down to how they decide their decisions, clearly the policies and processes in place are inaccurate and inconsistent.

Initially I was given 0 daily living and 2 for mobility. It tribunal I was awarded 8 daily and 10 mobility. It's not as if they were off by one or two points, they were miles off and it seem like those with mental health illnesses experience this more often than most. They don't really consider it.

And because they lack competency and ability to read the evidence they make hugely inaccurate statements regarding your decision and essentially make what should have taken 8 weeks last 42.”

“Extreme distress, which has immediate detrimental and profound adverse effect on health which may continue for many months. Financial hardship and poverty. Isolation and depression.

If the assessment process were conducted in a fair and unbiased manner, there would be far less need for MRs or appeals. The process of filling in forms, gathering evidence and attending face to face assessments, MRs and Appeals, often alongside ESA awards reviews is a punishing process for our members who have very limited resources of energy and the continual stress caused by this relentless process leads to relapses and more members becoming housebound and bedbound as a result.

A benefit originally intended (as DLA) to increase independence is (as PIP) restricting independence and damaging health so that fewer claimants have any hope of living an independent life or returning to work.”

“I had to wait for a year to get my PIP decision overturned - in the meantime I lost everything - blue badge, Motability car & income. I ended up in even more debt & discomfort, which as a lone parent was/is very hard. Even when I won my tribunal, I did not receive the Enhanced rate of Mobility, which when I was originally awarded DLA I received at the higher rate, so I did not regain my access to the Motability scheme - something I was hoping for as I am now in need of adaptations for my car - which I was obliged to purchase from Motability, but because I get standard rate PIP, I can no longer afford. I struggle to keep my car on the road now, but without it, I would not be able to get out & about.”

This is an Adviser’s experience:

“It is massively stressful for claimants. For example, one claimant who has a brain injury whose Appeal I attended with her was very anxious about the whole process. She expressed this at the Appeal and said she felt like she was having to justify her disability, even though there was plenty of medical evidence and other reports contradicting the outcome of the initial PIP assessment and reconsideration.

The outcome from the Appeal overturned the initial PIP decision and the claimants was awarded enhanced rates of mobility and daily living and this was back dated for 6 months.

While the claimant was delighted at the outcome, she said it was 6months of worry and stress about paying bills etc. She said she had become very depressed during this period and is now on medication and accessing psychological support.”

In terms of improving the delays in accurate PIP decisions, responses included: 

“Proper assessments given by qualified professionals related to their conditions i.e. not a physiotherapist or CPN for a neuro condition.”

“If majority of claims were based on application supported by medical reports and assessed by true medical professionals, then it would be done accurately and effectively at the start.”

“By getting people who actually understand the illness and getting people who look at both physical and mental health rather than focusing on just one will obviously help when it comes to getting the right decision.”

“Having more faith in the medical staff and medical history that are already working with the claimant. Giving the DWP access to medical records. I struggled to afford requesting it from my doctors and had to wait 2-3 months for them to release them to me.

Get properly mental and physically trained staff who used to work on wards to interview people.”

Compiled by:

Ken Butler

Membership Organisations

Welfare Rights Adviser

Disability Rights UK

Direct Line: 020 7250 8184

Email: ken.butler@disabilityrightsuk.org

18 April 2017