Profound lack of trust in the benefit health assessment system still a constant theme, say MPs

Tue,18 April 2023
News Benefits
The health assessments system to access benefits for those who cannot work or face extra costs due to disability or ill-health continues to let down those who rely on it, a new Work and Pensions Committee report finds.

The MPs stress that assessments must be fit for purpose and fairly assess people’s needs and that there is not only a cost to the individual if the system is not functioning effectively, but also to the system itself.

For example, through increased mandatory reconsideration reviews and appeals and increased pressure on other services, such as the NHS, who feed into the health assessments process.

In addition, the MPs say that there “is a remarkable similarity” between the recommendations made in evidence to its inquiry, and those made in its earlier 2018 PIP and ESA assessments report.

While they acknowledge that the Department of Work and Pensions (DWP) had taken some welcome and significant steps to improve health-related benefit assessments, there remain “important changes that could greatly increase transparency, improve trust in the process among claimants, and ensure more accurate assessments and fewer appeals, that have still not been made.”

In particular, the MPs say that: “our survey respondents spoke of the stress, anxiety and in some cases severe mental health impacts of the assessment process.”

They add: “That we are still hearing accounts of poor accessibility, factual inaccuracy, delays, and communication problems speaks to a system that is still not adequately supporting often vulnerable people.”

As a result, the Committee recommends the following, that:

  • prior to any changes to the health assessment process, including the abolition of the work capability assessment (WCA), an external assessment should be undertaken on the potential physical and mental health effects of these changes on affected claimants
  • the Government should outline the methodology used to determine when Internal Process Reviews are carried out, and how it has improved its collection of data on deaths and serious harms since the National Audit Office report on Information held by the DWP on deaths by suicide of benefit claimants in 2020
  • the  DWP should publish anonymised data annually on all instances of deaths or serious harms associated with health assessments, disaggregated to show the incidence of suicide, the issues that led to these deaths, and the steps it has taken to remedy issues raised.

Other recommendations include that:

  • in line with its recommendation that the DWP set clearance time targets, where these are missed, PIP applicants are paid an assessment rate for the remaining time until their claim is decided. This should be non-repayable in the event that a claim is disallowed
  • the process of issuing claimants a UC50 incapacity for work questionnaire should be automatic, and claimants should not have to remind the DWP to send it to them, and that the deadline for ESA50 completion should be extended from one month to two months
  • the DWP should build on its successes introducing video and telephone assessments during the pandemic and commit to informing claimants of the options available and allow them to choose what suits them best before booking an assessment
  • the DWP instructs providers to record assessments by default, with a clear opt-out rather than opt-in option and with the plans to test sending medical reports to claimants by default be rolled out as soon as possible
  • the Government should set out how many legal challenges it has faced relating to failure to make reasonable adjustments for health assessments for benefits in the last five years, broken down by year
  • the DWP commission and publish research focusing on the costs and effectiveness of mandatory reconsideration, as well as practical recommendations for learning from Tribunal decisions, and options for incorporating this into wider reform of health assessments

In launching the Committees report, its Chair Stephen Timms MP said: “We surveyed eight and a half thousand people as part of our inquiry and found a profound lack of trust in the system as a consistent theme.

“Many will welcome abolition of the work capability assessment.  The Government’s process improvements, and recognition that the system causes undue stress and hardship, are steps in the right direction.

“However, waiting years for changes won’t cut it when quicker wins are available:  flexibility of choice on assessment by phone or face-to-face; recording assessments by default; extending deadlines to reduce stress; and sending claimants their reports.

“All this will give much-needed transparency to a process that so few trust yet affects their lives so fundamentally.”

The Committee’s report Health assessments for benefits and DR UK’s evidence to the MPs inquiry are both available from