Memorandum submitted by Citizens Advice (DM 31)



Citizens Advice welcomes the opportunity to comment on this inquiry. In 2008-09, Citizens advice dealt with 144,000 enquiries relating to decision-making and appeals across all DWP benefits, including local authority administered housing and council tax benefit. The highest number of these enquiries relate to disability and incapacity benefits (including ESA) as Citizens Advice Bureaux help large numbers of people who have been refused, or have had these benefits withdrawn.


A delay in a decision - or a protracted appeal process - for one benefit can have a significant effect on another benefit - particularly housing benefit - which can then have desperate consequences (see section 3). Even when the consequences are not so extreme, the impact on our clients of poor decision-making includes significant stress and anxiety, as well as financial hardship:


A client in the North West failed her WCA, despite awaiting operations for the replacement of both her knees. The CAB was confident that she should have received some points in the assessment of the three physical functions of walking, standing and sitting. She needed two arm crutches for support and the support of friends to cope with her mobility needs. She was finding it very difficult to meet the extra expenses caused by her illness - travel to hospital appointments and various medical prescriptions for painkillers and antidepressants.


While the focus of this inquiry is on decisions relating to disability and incapacity benefits, we also take the opportunity to raise some important questions about the quality of decision making and communication of JSA decisions at a time when JSA claims are on the rise. We also mention housing benefit, and the case to improve decision making at asylum tribunal hearings, by providing legal representation. The response is in six sections as follows:


1. Medical assessments and decision making

2. Appeals and reconsiderations

3. Housing benefit

4. Decision making and appeals for JSA

5. Legal representation at asylum tribunal hearings

6. Appendix: evidence from Great Ormond Street hospital



1. Medical assessments and decision making


Deciding who is entitled to disability and incapacity benefits is much more difficult than for most other benefits. Claims for JSA, for example, may be decided on more objective measures such as a person's income, national insurance contributions and availability for work (although see below for a discussion on increasing complexity in decision making for JSA).


Although there are defined criteria for assessment for disability and incapacity benefits, there is a higher level of subjective judgement involved. For DLA and AA, DWP staff must decide if the claimant's care and/or mobility needs are debilitating enough to qualify them for the particular benefit. For incapacity benefits, the DWP decision maker must decide if a claimant meets the test of the Personal Capability Assessment (PCA) - designed to assess if the claimant's functional limitation prevents them from seeking work - or if an existing recipient continues to pass the PCA. For Employment and Support Allowance, there is an additional layer of decision making: not only must the DWP decision maker decide if a claimant meets the test of the Work Capability Assessment (similar to the PCA, but geared more towards what a claimant can do), but also whether they will be required to undertake work-related activity, or whether they will be included in the 'support' group, who are not expected to undertake work-related activity in order to receive benefit.


Since 1998, medical assessments and advice to the DWP have been provided under contract by Atos Origin. We see problems both with the medical assessments and the decision making processes based on these assessments. Our 2006 report, What the doctor ordered? highlighted our evidence in both of these areas and a copy is attached with this submission. We are disappointed that bureaux continue to report very poor experiences of clients during the medical assessment itself.


Assessing mobility and care needs, or evaluating the impact of a person's health condition on their ability to work, is difficult, and requires the exercise of considerable judgement. The Atos Origin contract requires that doctors follow standards of conduct, which include maintaining a non-adversarial manner and performing the examination in a way that avoids unnecessary discomfort. Despite this, CAB evidence indicates that the conduct of examinations still leaves much to be desired, causing substantial hardship and distress to benefit claimants and their families:


many clients report encountering rude or insensitive examining doctors

doctors frequently appear not to give sufficient consideration to mental health issues

bureaux continue to report that doctors produce inaccurate reports, giving an inaccurate assessment of the claimant's abilities; reporting incorrectly what the claimant has said about their own conditions and taking answers out of context.


A CAB in the North West saw a man in his late fifties who had been treated rudely and dismissively by a doctor carrying out the WCA. When the client told the doctor he had undergone an operation on his neck, the doctor said there was no scar. He was, in fact, looking at the wrong place and the client had to point out the scar. At one point the examiner told the client that it did not matter whether he got the benefit or not, the doctor would still get paid.


Clients who have problems will have developed coping strategies, such that they may be able to perform certain tasks, but only with extra effort or adaptation that is relevant to their eligibility for benefit. In our 2006 report, we recommended that, if an examining medical practitioner (EMP) is going to use an answer as evidence, they should ask the client to explain in more detail how they do the task. Any evidence of ability which does not explore how the client actually achieves the activity is potentially misleading evidence.


Furthermore, the current system means that evidence from the assessment made by the Atos Origin doctor often outweighs other evidence supplied by medical practitioners who are more familiar with the applicant's condition. We suggest that decision making would be improved if greater weight were given to detailed evidence from applicants, their carers, and the professionals providing them with health and social care.


A CAB in the North West saw a man in his twenties, with severe heart problems. He was previously employed as a builder but when it was discovered he had a leaky heart valve he was warned that it would be dangerous for him to work. He was awaiting open heart surgery and had sick notes to verify his condition. When he moved from JSA onto ESA, however, he failed the WCA.


Computerised decision making

Since 2004, EMPs have used a computerised expert system to guide their questioning and record their findings during a PCA (and now a WCA). DWP and Atos Origin say that this helps the EMP to give the decision maker advice that is "logical, consistent with the evidence, and clearly justified".[1] It is hard to say whether the system has improved the quality of medical assessments. However, bureaux advisers continue to express concern that:


doctors pay more attention to the computer than the client

the system is inflexible and gives rise to inappropriate stock phrases in reports

options for investigation and findings are blocked off by the system inappropriately

doctors sign off reports without checking what they say, because the phrases have been generated by the system, not the doctor.


A CAB client in Birmingham with a genetic kidney disorder felt that the medical examiner's report, which led to her ESA being stopped, was inaccurate. She had one of her kidneys removed as well as part of the other and had various medical complaints stemming from this, yet she did not score any points in the assessment. The client informed the CAB that the medical examiner was impolite and did not look at her throughout the interview, merely staring at the computer screen and asked inappropriate questions. She had since been informed that her condition may be terminal and her regular doctor was writing a letter of complaint on her behalf.


We suggest that the use and development of computer-aided decision making in medical assessments for IB and ESA should be subject to a transparent review involving stakeholders including Citizens Advice. We urge that this is done before a similar system is introduced for examinations for disability benefits.


Review of ESA decision making process

As ESA becomes established, Citizens Advice Bureaux are seeing the same levels and types of problems with the decision making for ESA as they did with IB. We are disappointed that the current review of WCA descriptors is taking place before any appeals have occurred under the new ESA system. We feel that the two recent reviews represent two wasted opportunities, which have not addressed the effectiveness of assessments or the conduct of EMPs.


DLA renewals

Many CAB clients find that disability benefit awards are made for relatively short periods of time, and come up for renewal quickly and a long way in advance, resulting in repetition of medical examinations which can be highly stressful. PDCS should review their practices on the length of awards, renewal procedures and the extent to which they need to use repeat medical examinations by Atos Origin.


Citizens Advice has long held concerns about the training of EMPs, and the evaluation/feedback mechanisms available to them. Continuing evidence of poor conduct at medical assessments indicates that training is inadequate, while the number of decisions overturned at appeal suggests that individual EMPs are not given relevant feedback when inappropriate decisions are made by DWP following their reports from the medical assessments.


2. Reconsiderations and appeals


Claimants who think that the decision on their claim is incorrect can ask for the decision to be reconsidered, and when a claimant appeals, DWP automatically considers the decision again. A claimant can also ask for the decision to be considered by an appeal tribunal.


Judgements on eligibility for DLA, AA and IB are more complex than those required for JSA or IS, so a higher percentage of reconsiderations and appeals might be expected, but the number of decisions taken to appeal for IB and DLA are in the order of ten times more than for JSA or IS[2]. The DWP's own assessment concluded that only 55% of decisions on DLA and AA were correct in 2001-02.[3] In the year to February 2005, 39,000 out of 240,000 DLA awards (16 per cent) were the result of reconsiderations or appeals against initial refusals. There are no recent statistics available about cases overturned at the appeal stage. This is an important tool in monitoring performance and the DWP should make these figures available or give an explanation as to why they cannot. CAB advisers spend large amounts of time helping people who have been refused these benefits, or had them withdrawn, to challenge those decisions. To improve decision making at the outset would clearly save time and money for the Department, as well as reducing hardship and anxiety for claimants.


A CAB client in the East Midlands helped a client who was wrongly refused DLA for her autistic child. The child had high care needs, especially linked to a lack of control over his bodily functions. His sleep was very disturbed, leading to the client and her partner regularly experiencing broken nights. The decision maker made reference to the fact that the child was at school for a substantial portion of the day. The client appealed and when she appeared at the hearing the panel told her that they had agreed to award her the middle rate of DLA care for her son, based only on the paperwork. When they asked her a few more questions about the case, they increased it to higher rate care. The client was put under a huge amount of stress by the original decision and was tearful and bewildered when she attended the CAB.


3. Housing Benefit


There is an inherent tension between the requirement of most landlords to have rent paid in advance and the fact that housing benefit is paid in arrears. This means that HB claimants looking for private rented accommodation start off at a disadvantage compared to others not on benefit, and it is therefore essential that this is not compounded by slow decision making at the local office.


While there has been significant improvement in processing times for HB claims over recent years, there remains far too much variation between the fastest and slowest authorities. Initiatives such as those of Wolverhampton City Council which has introduced fast track processing of claims within 48 hours of the customer providing all the necessary information show what is possible. Regrettably, however, claimants in many other authorities receive a far less efficient service, with potentially desperate consequences for their tenancy:


A CAB in the east Midlands reported a client who applied for Housing Benefit and Council Tax Benefit in February 2009. Following his application, he did not hear anything from the council, so assumed all was well. His landlord contacted him in early May to say that he had not received any rent. He therefore visited the council's office, where he was asked to provide proof of his sickness. Eventually this was cleared up. However he had to visit the council office many times before his application was processed. On two occasions, on a Friday, the computer system was down, and hardly anything could be done as a result, which delayed matters. It then transpired that his application had been held up because when the council scanned his application, some of the scanning did not work properly, and the information supplied by the client on paper was deemed by the Council to 'be missing'. He tried to ring the council many times, but couldn't get through, or spent a lot of money on calls which never got him through to the person he needed to speak to. When he came to the bureau he was facing a possible possession order due to rent arrears.


4. Decision making and appeals for JSA


While the focus of the inquiry is on the quality of complex decisions involved in disability and incapacity benefits, this inquiry provides the opportunity to raise some important questions about the quality of decision making and communication of JSA decisions at a time when JSA claims are on the rise. Second only to the rise in redundancy enquiries, the number of JSA enquiries to Citizens Advice Bureaux rose 61 per cent to 109,400 in 2008/09 compared with the number of enquiries in the previous year. Though the majority of enquiries are about eligibility, bureaux are particularly concerned about:


the decision making processes around the 'right to reside' test

the application of benefit sanctions.


Over the last year Citizens Advice Bureaux have been reporting an increasing number of problems experienced by EEA nationals when claiming benefits. Some claimants are denied the opportunity of claiming benefit as poor advice by local Jobcentre Plus staff and inadequate contact centre scripts mean that lone parents without the right to reside are incorrectly advised to claim income support - which is then correctly refused when they fail the right to reside test. They then claim JSA, but have missed several weeks of money in the meantime. However, CAB evidence also suggests a level of poor decision making when applying the right to reside test. Lone parents who have lived in the UK for many years and should have acquired the permanent right to reside, and A8 nationals who have worked for more than the required 12 months under the workers registration scheme, are both failing the test. In these cases it is not clear whether the problem is with the decision making itself - all of which is centralised at Wick in Scotland - or the quality of information and evidence submitted by the benefit delivery centres on which the decision is made.


A Polish client was a lone parent with an eleven year old daughter. She had lived and worked in UK for more than four years but had recently lost her job due to the economic downturn. She was advised by her local Jobcentre Plus office to see their lone parent adviser who then advised her to apply for income support. She applied but was turned and told she had no right to reside. She was then advised to apply for contribution based JSA but the wrong advice has caused nearly a six week delay in getting any money, leaving her with difficulties paying her rent and other living expenses.


There is also concern that benefit delivery centres are often unable to explain why the claimant has failed the test, and the decision letters contain no explanation. This makes an efficient reconsideration of the decision difficult and an appeal more likely. Advisers winning their clients' appeals have also reported concerns about quality of the DWP appeal submission, where it often fails to address the issue in dispute.


Despite the rise in overall JSA enquiries, the proportion of JSA enquiries concerned with sanctions and hardship payments remains constant. CAB evidence highlights the many claimants who have been sanctioned apparently inappropriately. Others, it is clear, do not know why they have been sanctioned, and get no explanation or warning in advance of the sanction being applied. The failure to warn the claimant that they are being referred for sanction means that the decision maker will only have evidence from one party - Jobcentre Plus - when coming to their decision about whether to apply a sanction or disallow a claim. CAB advisers report seeing clients who have been sanctioned several times because they have failed to understand what was required of them, or who haven't attended courses or applied for jobs because the options have been inappropriate to their disabilities or levels of literacy. Unless Jobcentre Plus has sufficient Disability Employment Advisers, and properly examines the reasons why a claimant has failed to attend, there is a serious risk that vulnerable claimants will be unfairly and inappropriately sanctioned.


A London CAB client had been claiming JSA for a couple of months when he had been threatened with sanction for failing to apply for three jobs a week. He was a driver by trade and reported that despite looking for work, there were not three jobs a week advertised that he could apply for, as he was restricted to public transport because did not own a car. He felt that the requirement was an unreasonable expectation in the present job market. The bureau commented that Jobcentre Plus only mentioned not applying for three jobs a week whereas there were many other actions which would qualify for the '3 steps a week' required to continue to receive full JSA. The client was very worried about the threat of sanctions, to be discussed at a meeting later that day.


A disabled client had been sanctioned for failing to attend a job interview. She was in her forties and had never had a paid job, though she had done voluntary work. She was paralysed down one side since birth and suffered from other conditions including memory loss. She had forgotten about the interview and said she felt under increased pressure to attend different appointments and she was struggling to remember what was required when. She said she found it difficult to cope with a lot of things at the same time, and was getting stressed which caused her to forget things. The bureau assisted her to complete a form challenging the sanction and advised her to make a copy of it and attach supporting evidence from her GP. The sanction caused her further stress, exacerbating her health condition.


5. Legal representation at asylum support tribunal hearings


While this subject does not strictly lie within the scope of this review, we feel it is worth raising awareness of the issue: asylum seekers are some of the most vulnerable people in this country, and decisions made at asylum support tribunal hearings have a critical impact on their well-being - losing an appeal results in destitution and homelessness.


In a recent oral appeal against a refusal of section 4 support, the AST judge concluded that "the position for the appellant is extremely grave. There can be no dispute that she suffers from a number of debilitating medical conditions. She is depressed and has mobility problems, [and] I have heard clear evidence that [she] has had to resort to night buses and sleeping in corridors within the past month or so. This is inappropriate for a woman with these medical conditions and who is nearly sixty years of age...In these circumstances, and upon a balance of probabilities, I do consider that the appellant does not have adequate accommodation and that it is certainly arguable that her essential living needs are not being met - she has had to resort to approaching British Red Cross". In both cases, the appellant was represented at the hearing by the ASAP, and the appeal was allowed.


There is a significant body of evidence that legal representation at a tribunal hearing has a significant impact on the decisions made. A landmark research study, published in 1989, indicated that such legal representation increased the chances of success from 30 per cent to 48 per cent in Social Security Appeal Tribunals, from 20 per cent to 38 per cent in Immigration Tribunals, from 20 per cent to 35 per cent in Mental Health Review Tribunals, and from 30 per cent to 48 per cent in Industrial (now Employment) Tribunals - a 'representation premium', across the board, of 15-18 per cent.[4] And a further academic study, published in 2006, found a 'representation premium' of 14 per cent among a sample of 1,697 users of Social Security and Child Support Tribunals.[5]


More recently, research by Citizens Advice has shown that legal representation increased the chances of success from 39 per cent to between 61 and 71 per cent in the First-Tier Tribunal (Asylum Support), a 'representation premium' of between 22 and 32 per cent.[6] And the Tribunal's own outcome and representation statistics indicate a 'representation premium' of 28 per cent.


In the words of one Government-funded research study, "tribunals cannot be expected to compensate entirely for the disadvantages of some users. It has to be recognised that there are situations in which an advocate is not merely helpful, but is necessary to the requirements of procedural fairness and may also be crucial to substantive outcome".[7] We therefore recommend that the Work and Pensions Committee urges the Government to fund legal representation at asylum support tribunal hearings, in order to ensure sound and reliable decision making for this vulnerable group.


September 2009



Problems with claiming income support - experiences of families at Great Ormond Street Hospital.


Camden Citizens Advice Bureau runs an advice service at Great Ormond Street hospital for sick children. Its aim is to support the families of children who use the hospital services at a time when they face reductions in income through reducing or ending of employment, or through not being able to meet the labour market conditions of being available for work for Job seekers Allowance and the conditionality requirements for Employment and Support Allowance. These problems are typically caused by needing to be at the hospital to provide care and support but also at home where care may be needed on a 24/7 basis after discharge. They can also be linked to changes involving adjusting to becoming a full time carer for children with long term disabilities.


Over its first year of operation, the service has identified continuing and repeated problems for families claiming income support. These problems occur at the time of application where the Customer Management System (CMS) appears unable to identify any entitlement other than as a single parent or a person in receipt of Carers Allowance. After completing the telephone-based questionnaire style application, the claimant is informed that they have no entitlement and the situation is then compounded by poor knowledge amongst decision makers. The process of revision and appeal is time consuming, often taking several months, leaving families in what can only be described as a nightmare of worry and stress with little financial support. Many families may well give up after the initial telephone-based application.


For those dependent on housing costs for help with mortgage interest payments, delays and poor decisions could mean the loss of their home.


The bureau is concerned that the provisions in Schedule 1B of the Income Support general regulations are not identified by either the CMS or by decision makers.


The following cases illustrate current problems. The bureau has never experienced a successful claim through the Schedule 1B provisions. In terms of advice options, others at the hospital are rumoured to advise their clients not to inform the Job Centre of their inability to be available for work and if family members are so stressed (not an uncommon occurrence) as to be incapable of work, the option of an ESA claim is suggested.


Relevant law -


Schedule 1B


Persons temporarily looking after another person

3. A person who is-

(a) looking after a child because the parent of that child or the person who usually looks after him is ill or temporarily absent from his home; or

(b) looking after a member of his family who is temporarily ill


4. A person (the carer)-

(ii) the person being cared for has claimed attendance allowance [or disability living allowance] but only for the period of 26 weeks from the date of claim.




The client's daughter, aged 8 months, was diagnosed with Leukaemia. Onset was sudden and she was admitted as an inpatient for chemotherapy. The client's wife stayed at the hospital while the client mostly stayed at home looking after 2 other children aged 3 and 2 years.


The client had been claiming Job Seekers Allowance, but this terminated when he explained he could not be available for work due to caring and regular visits to the hospital. He was advised by the Job Centre to make a claim for Income Support on 1st August 2008. This was refused in a decision letter dated 16th August as 'you have to be available for work' and that he should claim Job Seekers Allowance.


At first interview on the 28th of August the family had been living on Child Benefit and Child Tax credit only since the 16th of July 2008 and had been supported with some small payments through social services. The client appeared very distressed.


The bureau successfully asked for the decision to be revised on the basis of paragraph 3(a) of Schedule 1B of the Income Support General Regulations as he was caring for a person while their usual carer was temporally absent. The revision date of 1st September meant that the family had been without payment of Income Support since the 10th of July 2008, although payment was backdated to this date.





This client's daughter, 16 years, was admitted to hospital for a spinal operation; she had multiple physical disabilities and learning and behavioural problems. She was an inpatient from 8th of February 2008 to the 5th of August 2008 and the client lived at the hospital - as she was encouraged to do - in order to provide care and look after her daughter. The hospital's policy is that children's health is best served by their parents being in close proximity to provide care and reassurance. After 28 days as an inpatient, her daughter's DLA stopped and after a run-on period the client's Carers Allowance stopped. As her Carers Allowance stopped, Income Support also made a decision to cease entitlement and she was advised to claim Job seekers Allowance. The client's living costs were much higher living at the hospital due to travel, laundry and extra costs of food. She was left with child benefit and child tax credit as her only income and of course she continued to provide care to her daughter.


The bureau helped the client appeal the Income Support decision and a number of appeal letters were written asking for the decision to be revised as she remained a prescribed person for Income Support purposes. Paragraph 3(b) of Schedule 1B applied as she was looking after a family member who was temporally ill. These were not answered despite several follow-up calls, no direct access to the appeal section was allowed, and promises that a decision maker would telephone back never materialised.


On discharge, Income Support started again and the disputed period 11/06/2008 to 03/08/2008 was decided at an appeal hearing on the 2nd of June 2009. The Secretary of State's submission relied on a Deputy Judge's decision, CIS 866/2004, a decision which basically suggests that a disabled person can not be 'temporally ill' This case law has been superseded by CIS 4312/2007 where the judge found that the previous reasoning was 'not helpful'. The appeal was accepted and payment of Income Support finally made several months after the original decision to supersede entitlement. However, in the following ongoing case the decision maker from the same Benefit Decision Centre uses exactly the same argument.




A client who had limited English received Income Support for caring for his sick wife after her recovery. His son, 1 year old, was diagnosed with a rare immune system disorder requiring extreme attention to hygiene to prevent life threatening infections. His son was admitted as an inpatient for a period in October 2008 and continually from December to May 2009 before being discharged and payment of disability living allowance at the highest rate of the care component was awarded. Both he and his wife stayed at the hospital and they also had two other young children to look after.


The client claimed Income Support on 20th of October 2008 and was refused entitlement as he had to 'be available for work' By the time the client visited the bureau in April 2009, he had claimed ESA but had not been paid any benefit for the intervening period.


The bureau assisted with an appeal, but there was no contact from the decision makers despite the matter being chased up on a number of occasions. The Secretary of State's submission eventually read exactly the same as CASE 2 and additionally stated that the client had been in receipt of ESA from the 10th of September 2008. ESA is a new benefit that did not come into effect until the 27th of October 2008. The bureau contacted the decision maker and although he accepted that ESA could not have been in payment was unable to explain what the relevance of CIS 866/2004 was to this case. The matter is awaiting a hearing date at time of writing.




The client's wife is 7 months pregnant and their daughter, 10 months, was an inpatient; with tuberculosis and meningitis, she was very poorly. The client spent every day from 9am to 12pm at the hospital looking after his daughter returning home at night. He visited the bureau as he had told the Job Centre of these circumstances and they had terminated his claim.


The bureau assisted with a telephone claim for Income Support, but he was told he was not eligible as he was not in receipt of Carers Allowance. The bureau provided a detailed letter to take to his Job Centre interview setting out his eligibility, as he was caring for a family member who was temporarily ill and had just returned a Disability Living Allowance claim form for processing. A decision to refuse Income Support was made and when the client telephoned he was told again that this was because he was not in receipt of Carers Allowance. He described the person as off-hand and rude when he tried to explain his circumstances and why he should be entitled.

The client had travel and extra living costs from his visits to the hospital and had already used the maximum amount of his crisis loan. His application for Child Tax Credit had been lost by HMRC on two occasions and further delayed by the need for his wife to get a national insurance number. He was provided basic food supplies through section 17 of the children's act and was very distressed. Following an appeal and revision request, Income Support was paid in a decision in early June 2009 some 2 months after his original claim.



[1] DWP (2005) Touchbase, August 2005

[2] The NAO reported that 0.3% of JSA decisions and one per cent of all income support decisions in 2002-03 were taken to appeal, but six per cent of all IB decisions and eight per cent of all DLA decisions were taken to appeal.

[3] NAO (2004) Getting it right, putting it right: improving decision making and appeals in social security benefits

[4] Genn, H. and Genn, Y. (1989), The effectiveness of Representation at Tribunals, Lord Chancellor's Department (now the Ministry of Justice), 1989.

[5] Genn, H., Lever, B. and Gray, L. (2006), Tribunals for diverse users, DCA research series 01/06, Department for Constitutional Affairs (now the Ministry of Justice), January 2006.

[6] Dunstan, R. (2009), Supporting justice: the case for publicly-funded representation before the Asylum Support Tribunal, Citizens Advice, June 2009.

[7] Ibid, Note 23.