Examination of Witnesses (Question Numbers
100-119)
JONATHAN SHAW
MP, MR JEREMY
GROOMBRIDGE CB, MS
VIVIEN HOPKINS
AND MR
KEVIN SADLER
9 NOVEMBER 2009
Q100 Miss Begg: We have the figures
from the Department, but it is not clear from them whether the
67,000 in DLA that you said were revised in favour of the claimant
included those who went on to appeal or whether they relate purely
to the reconsideration process.
Ms Hopkins: That was at the reconsideration
stage.
Q101 Miss Begg: That is 51%?
Ms Hopkins: Yes.
Q102 Miss Begg: For Attendance Allowance
59% of case were decided in the claimants' favour at the reconsideration
stage?
Ms Hopkins: That is right.
Q103 Miss Begg: The Department has
failed to say how many then go on to appeal. It appears that there
is no data. The question asked was: "How many decisions are
sustained at the reconsideration stage and then progress to the
appeals process?" There is no information. "How many
decisions are sustained at the reconsideration stage and do not
progress to the appeals stage, as the claimant decides not to
proceed with his claim?" There is no information. As to the
first question the PDCS management information systems do not
have the facility to track these kinds of cases from one stage
to the other. We also asked, "How many claimants that reach
the reconsideration stage are assisted by welfare rights advisers?"
You do not keep that data. "How many of the decisions that
are appealed are found in favour of the claimant when they are
reconsidered by the DWP in preparation for the appeal?" Again,
there is no information. There is a whole raft of areas where,
surely, it is important to have data but such data either does
not exist or you do not have the mechanism to collect it?
Jonathan Shaw: You will be aware
that the Department collects a huge amount of data. In order to
do that someone must input it. If we are not able to provide it
we do not collect it, but we shall certainly reflect on whether
we can efficiently collect more data to produce a better service
in terms of what we want to deliver. The collection of data and
what it does will always be a judgment call. We must always ask
the question: will it help the process? I cannot answer that question
immediately but I shall certainly reflect upon it.
Q104 Miss Begg: If welfare rights
workers are right that the very process which was designed to
speed things up and reach a decision acts as an extra barrier
to people going straight for an appeal you do not know that according
to this?
Jonathan Shaw: Looking at the
transcripts of previous evidence sessions, the anecdotal evidence
of witnesses was that they regarded the reconsideration process
as helpful. It is perhaps a mixed picture.
Ms Hopkins: In relation to DLA
in 2008-09 we registered nearly 96,000 appeals and of those reconsidered
70,000. That is a small part of the data you are looking for.
But even with those appeals we have a very high rate of reconsideration
for these very complex disability benefits.
Jonathan Shaw: In the case of
DLA it is a judgment-based rather than rules-based decision and
so it is more complex. We believe that the reconsideration process
reduces the amount of time within which a person makes a decision
on whether or not he or she will get a benefit and obviously that
is a very anxious time for the claimant.
Mr Groombridge: Although Jobcentre
Plus does not set it as a specific target in the decision making
and appeal strategy document that our decision makers receive
we have set an expectation that they will turn round those reconsiderations
within five days.
Q105 Miss Begg: In terms of reconsiderations
and appeals decided in the claimant's favour it appears from the
figures you have quoted that the percentage is going up. Surely,
if so many are found in favour of the claimant at reconsideration
stage that reflects very badly on the original decision making,
does it not?
Jonathan Shaw: In making a reconsideration
very often the decision maker will be provided with additional
evidence which obviously weighs upon whether or not the person
receives the benefit. That is again the case at Tribunals. You
are aware that the President of the Tribunals has said that very
often within a number of benefit areas evidence in both written
and oral form is presented which has an impact on the decision
making process.
Q106 Miss Begg: Do you think, therefore,
that the reconsideration process was worth putting in and is working,
or do you believe that you still need to review how well it is
doing?
Jonathan Shaw: Anything that speeds
up the process and accurately provides a benefit or not to a customer
is worth having because it reduces costs and importantly anxiety
in terms of the wait by the customer. As we develop our staff
and decision making this needs to be an important part of the
process. What can we learn from when new evidence is submitted?
How can we have those conversations with people who make claims
to ensure they have submitted absolutely everything they possibly
can in order for the decision maker to arrive at a decision? I
believe that will be an important, core part of professional development
for staff at both Jobcentre Plus and within the Pensions Agency.
Q107 John Howell: I want to ask about
the evidence base. On the one hand we have heard quite a lot of
criticism of the medical assessment process and how effective
it is. We have also heard that decision makers rely heavily on
the evidence provided by Atos Origin medical assessors. There
has been quite a lot of criticism that they rely too heavily on
that. Therefore, the question is really about the way in which
the department appraises the methods of collecting and evaluating
it to make sure the decision is based on the most reliable evidence.
Jonathan Shaw: Are you talking
about any specific benefits here?
Q108 John Howell: I am referring
to those that require medical evidence to be provided.
Jonathan Shaw: Let me start with
a topical example: the Employment Support Allowance which is about
a year old so it is still early days for that benefit. Within
the contracting arrangements with Atos prescribed professional
training and standards must be met. The Department's medical officers
regularly review the training and standards of the Atos medical
staff. If we have high levels of concern in particular areas obviously
there are discussions and systems are put in place to ensure that
people have the right skills and training to be able to provide
decision makers with accurate assessments. On EAS the concern
has been expressed that too much reliance is placed upon the medical
evidence. If we just step back and look at that for a moment,
of course that will fulfil the dominant part of the evidence before
the decision maker. If that is pretty overwhelming and the decision
maker has other evidence, whether from a GP or welfare rights
officer, it is unlikely that that evidence will be to the fore
in arriving at a decision, because the medical assessment is one
that has been developed in partnership with a number of different
organisations, including those representing disabled people. But
where perhaps the medical assessment provided to the decision
maker follows more of a fine line the additional evidence may
well be sufficient to push it over the line so that the person
is eligible for Employment Support Allowance. It forms a very
significant part of the decision making process.
Q109 John Howell: The collective
evidence from Citizens' Advice Bureaux around the country produced
three things. I draw your attention to their memorandum. One was
that many clients "report encountering rude or insensitive
examining doctors"; second, they said that "doctors
frequently appear not to give sufficient consideration to mental
health issues"; and, third, that Citizens' Advice 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."
Jonathan Shaw: If people are being
rude that is completely unacceptable. We expect high standards
of customer care for those who apply for particular benefits.
In terms of not taking account of evidence, I link that with a
point raised earlier by the Chairman. Although ESA is only about
a year old around 70% of the decisions appealed are found in the
Department's favour as against the ratio of 50:40 for Incapacity
Benefit and the personal capability assessment that preceded it.
That is quite a significant change.
Q110 John Howell: One of the issues
brought out by the Citizens' Advice Bureaux was the consideration
in terms of mental health. One of the difficulties raised by Mind
in relation to the work capability assessment is that it is not
particularly well suited to those conditions that might fluctuate
and many mental conditions fall into that category.
Jonathan Shaw: This is a really
important matter. The Committee may well be aware that in designing
the work capability assessment we worked in partnership with a
number of organisations including Mind. The previous personal
capability assessment looked at four questions that could be described
as considering an individual's mental health/fluctuating condition.
Within the new work capability assessment there are 10 questions,
including consideration of how people function in different social
settings and their interface with different people and situations.
Indeed, in the initial questionnaire we ask people to talk about
how their condition affects their ability to be able to function
not just on one day but over a period of time. However, we introduced
ESA only about a year ago and we need to look at it. We have had
an internal review that we shall publish. We shall have an annual
review. We are absolutely determined that we have the right assessment
because overwhelmingly people with mental health conditions tell
us that they want to work. There has been a higher than expected
disallowance and I want to look at that particular group. The
Committee will be aware that we shall publish a White Paper about
getting people back to work. There may well be those who have
not been assessed to receive ESA and who therefore will not get
the support of the Pathways programme in which we are investing
about £1 billion. Therefore, they may well need more immediate
support rather than waiting as people do on Jobseekers' Allowance.
I am alert to that and there is an opportunity to make some changes
to address some of those points.
Q111 John Howell: You said you would
not take a snapshot but would look at it over a period, but you
did not say what you had in mind in terms of time. What sort of
period would you be looking at in order to make that assessment
valid for somebody with a fluctuating mental disorder? Is it a
year or six months?
Jonathan Shaw: That is what the
assessment does now. It does not look at how somebody is on the
particular day; it talks about how he or she functions over a
period of time. Someone with a fluctuating mental health condition
may be able to function perfectly well for long periods of time
but then find themselves in a state of health that makes it very
difficult for them to be in the company of other people. Those
types of condition should most certainly be taken into account
when someone is being assessed for Employment Support Allowance
under the Work Capability Assessment.
Q112 John Howell: The criticism made
by Mind is that it is not sufficiently effective.
Jonathan Shaw: Mind was one of
a number of organisations that helped us with the design of that
programme. That does not mean they do not now raise issues; of
course it is absolutely right that they should do so, and we are
determined to work with them and a range of other different organisations
so we get it right. That is not to say we have got it wrong at
the moment. Obviously, we will publish our internal review of
this new system next month.
Q113 John Howell: We have had evidence
that claimants struggle to understand the process because of the
absence of any face-to-face contact with the person who makes
the decision. I think that ties in with the PDCS research carried
out with your partners; that also shows they were dissatisfied
with the lack of face-to-face contact and they hated telephone
call centres, as I imagine many people do. Does the Department
accept that decision making would be improved if there was face-to-face
contact or engagement in more direct customer contact rather than
just by telephone?
Jonathan Shaw: We do have face-to-face
contact with customers who we regard as vulnerable certainly when
assessing them for pensioner credit, for example. It may be the
pension service has determined that someone is so frail that he
or she is not able to understand the process or questions being
asked and so we have visits.
Ms Hopkins: There are about 700,000
visits a year.
Jonathan Shaw: I am aware that
for Jobcentre Plus there are also visits, but there is a limit
to how many people we can visit. Many people are satisfied with
the telephone service we operate within the budgets we have. I
do not know whether there have been any customer satisfaction
surveys on telephone contact.
Ms Hopkins: We complete quarterly
customer surveys and have just received the first results which
are not yet published. I am sure there is some rule which says
I should not disclose it.
Jonathan Shaw: Go on, I give you
permission.
Ms Hopkins: The overall satisfaction
rate was an astonishing 92%. Among the questions, which are taken
in real time—we do not wait months and months as we used
to—we ask people whether they are satisfied with the telephone
service. It is too easy to ask that sort of question and so we
go down more deeply because we want to understand the causes of
the satisfaction or dissatisfaction. The fact is that both our
disabled and pensioner customers have told us they are happy to
deal directly with us on the phone, which is the most frequently
used way to access our services these days, as long as we answer
the phones immediately, as we do, and as long as they speak to
someone who is knowledgeable and can give accurate information
all in one go. I believe we do that. We have made strenuous efforts
to improve how we deal with people, particularly given that we
deal with people who are elderly or disabled or both and who may
have special needs and the complexity of some of the benefits
with which we deal. Insofar as we are able given the construction
of these things we have also made an investment in simplifying
the claim forms and the letters we send people to supplement that.
I believe we have some success in that area.
Jonathan Shaw: Another important
area is people's concern about cost, particularly if someone rings
from a mobile and must wait a long time. That is something about
which we are concerned and are trying to improve. Perhaps Mr Groombridge
can tell the Committee what is being done to reduce costs in that
area.
Mr Groombridge: We provide a telephone
service for initial access to the benefits system using an 0800
line which is intended to be free, and for all other calls, which
are generally of shorter duration and are general inquiry-type
calls, we use 0845 numbers. Concern has been expressed about the
fact that people who use mobile services do not benefit from the
free phone number. What we have done specifically to address that
is that, while we continue to have discussions with service providers,
we instruct our agents proactively to make call backs on 0800
and 0845 numbers so we can ensure people are not saddled with
a large and unexpected cost at the end of that. Ideally, it would
be good if these numbers were included in call packages, but right
now that is the instruction we have given to our agents.
Q114 Mrs Humble: Minister, in relation
to claim forms you will be aware that Warbreck House, the national
headquarters of DLA and AA, is in my constituency. Ms Hopkins
also knows that very well. When I have spoken to decision makers
and looked at the claim forms individuals send in I see first
hand how difficult their job is. Referring specifically to DLA
sometimes the people who make the claims do not understand what
the benefit is for and so they make the claim and in some instances
give the wrong information. My first question is: are you happy
with the information that is given to claimants about the nature
of the benefit? Second, does the claim form ask the right questions
in order to enable the decision maker to reach the right conclusion?
Minister, as you have said DLA is subject to the judgment by the
decision maker on whether or not the individual has the care needs
to satisfy the entitlement to benefit. I still meet people who
believe that because they have an illness, injury or disability
that is sufficient; they do not realise what the benefit is about.
To what extent are you looking at the information that is given
out to claimants and also the nature of the claim form to do what
the Chairman said earlier, that is, reduce the number of errors?
If it can be done simply by asking the right questions let us
do it.
Jonathan Shaw: More people claim
DLA and that is reflective of an ageing population of which the
Committee will be only too well aware. An area on which we have
done some recent work where there has been a particular concern
is disabled children. The service has worked in partnership with
a number of disabled children's organisations to improve the form
and make it easier. I have had some positive feedback about that.
Perhaps Ms Hopkins can say something about it and whether there
are plans to take that process through to adults.
Ms Hopkins: First, the claim packs
are under constant review. You are quite right that there are
segments of our customer base which struggle more than others
with the claim packs. We work with their representatives to try
to improve them. You are also absolutely right when you say it
is still a common belief that DLA relates directly to the nature
of the disability diagnosis rather than the impact. They are under
constant review. The current version which is still a lengthy
and unwieldy process if one is completing it is much improved
and has received a lot of acclaim from customer groups. In relation
to specific progress for children the whole DLA claim process
was very generic. We knew that it was not serving well the families
of disabled children. Therefore, in the new claim pack which we
are testing instead of asking what the child cannot do it is a
shorter, simpler form which asks what the child can do. It is
very early days yet. We have coupled it with new guidance and
training for decision makers and have expanded the PiDMA approach.
I now have a specialist team testing the whole thing. My intention
is to specialise for various complex cases including children.
Referring to Warbreck House, we have expiring awards and then
people make a renewal claim. We have introduced a new renewal
claim form which is four pages long instead of the 40-odd pages
which comprised the original one. We are testing it and looking
for customer and customer representatives' responses to it. I
believe that as we learn from them those two things may well give
us something we can introduce into the adult claim pack. I hope
that we shall move away from entirely generic claim packs over
time because it is very clear that in mental health cases, for
example, there are specific questions that you may want to ask
and others that you simply do not need to. It is under constant
review.
Q115 Mrs Humble: It might be useful
if the Department could share with us some of the variations on
the claim forms that it is looking at.
Jonathan Shaw: We shall provide
that to the Committee.[1]
Q116 Tom Levitt: Perhaps I may turn
to the quality of decision making. Minister, you were quite right
to point out that a lot of the reconsiderations or appeal decisions
result in a reverse based on new evidence. That leaves quite a
lot that are not based on new evidence. What is the mechanism
for the DWP picking up the patterns of those cases and learning
from them in order to improve the quality of decision making?
Jonathan Shaw: There are processes
in place whereby if we see a regular amount of error within decision
making that is picked up. Staff are then offered training, whether
it is rudimentary or more complex, in order to ensure that does
not happen with particular individuals. Overall, I have described
what we are doing and what we intend to do within the two parts
of the organisation in terms of staff development. I think that
is key to improving existing performance. Perhaps Ms Hopkins would
like to talk more about PiDMA in order to provide you with the
answer you are looking for in terms of improving performance because
that is the crux of it.
Q117 Tom Levitt: That is to be my
next question. Citizens' Advice Bureaux tell us, "They do
not seem to have any process whereby as an organisation they then
learn [...] The individual people who have had decisions overturned
never know that this has happened, which seems extraordinary."
Therefore, has the CAB got hold of the wrong end of the stick?
Jonathan Shaw: I do not believe
that is a fair reflection of how we seek to improve performance.
That rather suggests we are not interested, which is far from
the case. We want to make accurate assessments as spelt out in
the Department's charter. We would not be making the type of investments
in our staff that we have been making—£300,000-odd—for
professional development. I do not believe that that is a fair
accusation in the blanket way it is charged, but if we drilled
down into some specifics I am sure we could find systems that
at the moment did not provide the necessary feedback that would
be of benefit to the organisation and improve decision making
and accuracy. Perhaps Ms Hopkins can provide further details on
how we are getting better feedback and what we are doing in the
field of staff development.
Ms Hopkins: In relation to the
disability benefits at local level we have local databases that
record all the appeal outcomes and they track back into the reconsideration
and then to the initial decision by the individual decision maker.
We use that information to look for trends in decision making
so we can identify whether they have training needs or some other
needs and whether they are complying with the guidance. We have
invested a good deal in customer case management guidance. That
is up-to-date medical guidance on the interpretation of evidence.
We also have things like training evaluation packages that deal
particularly with non-medical conditions, so we train someone
and test them; we let them consolidate for a little while and
retest them to check whether that training has been imbedded.
We have local and national checking regimes so that cases are
picked by line managers for accuracy. There are also one can argue
more objective teams whose role it is to go out and provide us
with the assurance that the standards are being met without going
into PiDMA.
Q118 Tom Levitt: So, one would expect
to see the number of successful appeals in relation to a particular
benefit which do not involve new information being reduced year
by year?
Jonathan Shaw: We are. In relation
to the Employment Support Allowance, when one compares the work
capability assessment with its forerunner, the personal capability
assessment, it is very different. 76% of appeals are upheld in
the Department's favour. It is early days as far as that particular
benefit is concerned, but the comparison is based on one year
for the personal capability assessment and one year for the work
capability assessment.
Q119 Tom Levitt: I feel there now
ought to be a fanfare because I am going to ask about PiDMA. Professionalism
in Decision Making and Appeals (PiDMA) initially came in for DLA
and Attendance Allowance. When you described it earlier you said
there were plans to bring it in for Jobcentre Plus from January.
First, what assessment have you made of the effectiveness of PiDMA?
Presumably, it is positive. Second, how will you spread that philosophy
throughout the Department?
Jonathan Shaw: I did not say that
we would introduce it for Jobcentre Plus; I said that from January
there would be a new arrangement for accredited staff training,
but Mr Groombridge will give you the detail of that after Ms Hopkins
deals with your first point.
Ms Hopkins: PiDMA is itself still
used only in DLA and AA decision making. The evaluation shows
many things. The two outstanding matters are: first, it works
really well for the decision makers because it is work-based learning.
It deals with the reality of decision making and does not take
people off to a classroom. It also takes quite a long time to
reach accreditation level. People are appraised all the way through.
It gives staff more confidence because it provides them with greater
skill particularly in interpreting the evidence that the customer
produces. For DLA and AA the primary source of evidence is the
customer rather than doctor. We may use a healthcare professional
somewhere else in the process, but to begin with we rely heavily
on what the customer tells us. Second, given that it is quite
an expensive programme we have found it particularly useful in
relation to more complex cases. Our strategy is to make sure we
get the greatest effect first by investing in those decision makers
who deal with the more complex cases involving children and mental
health issues and some of the multiple disability groups. The
other thing that is in it for the decision maker is that it is
a recognised external qualification at graduate level which makes
it a very attractive proposition for them and is highly motivating
in getting people to want to do it. In PDCS what we want to do
is have accreditation programmes for everybody. We are now working
on that. Obviously, there are issues to do with affordability.
It does not need to be as complex as PiDMA because many of the
benefits that we deal with are rules-based, but the approach is
well proven and the PiDMA evaluation shows that.
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