Health and Disability Green Paper – a cause for concern

Tue,31 August 2021
News Benefits

On 20 July the DWP published its long promised Health and Disability Green Paper consultation titled “Shaping Future Support”. It considers the options for addressing some “short-to medium-term issues in health and disability benefits”. It also aims to “start a discussion about the opportunities for wider change to deliver on the objectives of the health and disability benefit system”.

Ken Butler, DR UK’s Welfare Rights and Policy Adviser, considers some of the principal proposals of the new Green Paper.

There are some positives in the Green Paper – but unfortunately these are outweighed by some worrying negatives.

Positives include:

  • the extension of special terminal illness rules from six months to one year – a clear step in the right direction;
  • the continued use of video and audio recordings of assessments [although there is no commitment to providing the informed choice of which being that of the Disabled claimant];
  • giving DWP Decision Makers extra time to look at evidence and make decisions;
  • increasing the number of paper based decisions;
  • an Access to Work passport to reduce the need for repeated assessments where someone’s needs remain the same or they change jobs;
  • improving DWP signposting [but not the DWP providing benefits advice].


A major concern must be the Green Paper’s repeated references to “affordability” and the rising spending on disability benefits, which, the DWP says “suggests there is more we can do to enable independent living and employment”.

In a section titled “Why Further Change is Needed”, the increasing numbers of claimants who are assessed as having limited capability for work and work-related activity under universal credit (UC) and ESA is highlighted.

The Green Paper claims that spending on PIP and ESA (and its earlier and later equivalent benefits) has risen in real terms from about £8 billion in 1980/1981 to £31 billion in 2020/2021, and is forecast to reach £40 billion within five years.

It also says that ministers want to “explore making bigger changes to the benefits system” that will mean the system is “more affordable in the future”.

A single new benefit?

A related cause for alarm is that the Green Paper suggests that ministers could create a “new single benefit” so as to simplify the application and assessment process. One that could “put more focus “ on supporting people with their extra costs, or alternatively place “more of an emphasis” on helping people to find and stay in work.

Any reduction in disability benefit spending can only happen if new rules exclude more Disabled people or benefit amounts were reduced.

Is the promotion of a new simplified single benefit a way of achieving both?

While the precise form of what form this new benefit might take, a suspicion must be that it would be created by merging PIP – which contributes towards the extra costs of disability – with the income based ESA and Universal Credit (UC).

This is likely to exclude many Disabled people who rely on PIP to try to maintain independence. Yet the whole purpose of PIP is to compensate for the extra costs of disability.

A single benefit has the potential to remove all a person’s income in one sweep. At present, a Disabled person in receipt of both benefits can challenge a flawed assessment while still receiving the other benefit.

It is doubtful if many Disabled people would support a single assessment if it meant PIP would be abolished and with just a ‘single disability benefit’ remaining.

In addition, the Green Paper’s idea of replacing benefit payments with the provision of aids and equipment was something the Government ruled out in 2016 – shouldn’t aids and adaptations be freely and widely available now under NHS provisions in any case?


Much of the Green Paper is framed in terms of getting Disabled people into employment, including talking about independent living in terms of jobs.

In addition, work is promoted as leading to good health.

However, employment related suggestions are concentrated around the Disabled person, rather than changing the attitude of employers and the nature of work and the workplace.

While there is mention of reasonable adjustments, this is something by law employers should legally be doing anyway.

In brief, the consultation reflects the flawed logic that employment is a route out of poverty, linking worsening health outcomes with unemployment instead of recognising the impact of poverty.

The issue of low benefit rates resulting in poverty for those Disabled people not in work is not raised.

In addition, it is clear that there is no proposal to end work conditionality or sanctions.

Unlike ESA, under UC this means that a Disabled claimant can be asked to job search before their work capability assessment (WCA).

For UC, this means that a Disabled claimant’s conditionality is at the discretion of their work coach, and they may be asked to job search before their WCA.

Emphasis is also laid on getting members of the support group to take up work support. But nothing on how to allay fears that in doing so they may lose their limited capability of work related activity status.

Meeting mobility needs?

The Green Paper says that: “The ability to move around and make journeys is a key part of independent living. We currently provide mobility allowances through PIP and DLA. People can choose to spend these allowances however they wish.”

It asks: “Are we meeting Disabled people’s mobility needs?”

In 2020, Motability said that around 102,000 DLA claimants have lost their Motability vehicles after PIP reassessment (which would have been due to the stricter 20 metre rule).

The answer to the DWP’s question has to be “No”.

The 20 metre rule has to be removed and the 50 metre rule reintroduced.

Why not Scotland?

The Green Paper offers case studies of four countries – Australia, France, New Zealand and Switzerland – that approach disability benefits in a different way to the UK. Three of these appear to provide a less generous system, or at least offer less control to Disabled claimants over their support.

However, the Green Paper is silent about the disability benefit reforms to be made by Scotland, despite it starting from the same DLA, PIP and AA benefit regime as the rest of the UK.

In January 2020, the Scottish Government published Welfare reform: impact report on benefits for Disabled people. This too, like the Green Paper. was informed by consultation with Disabled people and their organisations. However, the contrast between the two documents is stark.

Among the several Scottish reforms, based on the testimony of Disabled people include:

  • replacing DLA, PIP and AA with three new benefits that make decisions a using a claimants account of their circumstances and existing supporting information where possible;
  • for adults, significantly reducing the number of face-to-face assessments and with a formal assessment held when it is the only practicable way to make a decision;
  • basing entitlement to the new DLA Child benefit using the claimant’s account of their circumstances and existing supporting information and holding no face-to-face assessments being held.

All the above are very welcome changes.

Having listened to Disabled people, this is the way Scottish Government policy, unlike the UK Government’s, has been framed to alleviate Disabled people’s stress and anxiety and a lack of trust in the disability benefits system.

Telephone and video assessments

The DWP claim that in a recent survey, the majority of people who had a telephone assessment for PIP or for their WCA were ‘satisfied’ or ‘very satisfied’” and that 56% of people said they would feel ‘comfortable’ or ‘very comfortable’ having their WCA or PIP assessment by video call.

However, while saying that it wishes to increase the amount of face-to-face alternative methods there is no proposal to give Disabled people the informed choice of these. At present, private company Health Care Professionals decide which form of assessment someone will face.

A Severe Disability Group?

The DWP propose that the number of repeat assessments may be cut by the introduction of a ‘Severe Disability Group’ (SDG).

The DWP say: “People who do not come within the special rules for terminal illness may still have severe and lifelong conditions that will not improve. These people are unlikely ever to work again and will always need extra financial support to live independently.”

The intention is to place people in this position into the SDG so that they “can benefit from a simplified process without ever needing to complete a detailed application form or go through an assessment.”

However, it is unclear whether the intention is to decide the SDG membership solely by the diagnosis of certain disabilities or health conditions.

Another concern is that the new SDG could replace the present support group with a fewer in number of claimants.

In short, it’s absolutely right that the government is looking at how to improve the welfare system for Disabled people.

But this is not the way to do it.

The Green Paper consultation ends on 11 October 2021 and will run alongside a series of DWP events with Disabled people. Following the consultation, detailed proposals will be published in a White Paper in mid-2022.

The Green Paper – Shaping Future Support, along with accessible versions and a link to the consultation site, is available from

The DWP is to hold a series of Green Paper meetings with Disabled people (see below):

The first of the DWP Green Paper meetings with Disabled people:

Face to face

Those attending are entitled to £30 retail vouchers to thank them for their time, and travel & parking costs reimbursed.


Wednesday 8 September, 1-4pm

Booking link: DWP Health & Disability Consultation Event: Norwich


Tuesday 14 September, 1-4pm

Booking link: DWP Health & Disability Consultation Event: Wrexham


Thursday 16 September, 10-1pm

Booking link: DWP Health & Disability Consultation Event: Canterbury


Thursday 23 September 1-4pm

Booking link:


Tuesday 28th September, 10am-4pm

Booking link: DWP Health & Disability Consultation Event: Leeds Tickets, Tue 28 Sep 2021 at 10:00 | Eventbrite

Virtual events