Decision making and appeals in the benefits system - Work and Pensions Committee Contents

Examination of Witnesses (Question Numbers 100-119)



  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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