3 Collecting and Evaluating Evidence
56. The Department explained that all benefit
decisions followed the same process. A claimant submits an initial
claim, and may provide evidence to support it. A decision maker
will then assess the claim and issue a decision on it. Each benefit
decision is followed by a dispute period of one month, during
which time the decision can be reconsidered or an appeal lodged.
57. We received evidence to suggest that one
of the difficulties DWP faced in improving the decision making
process was the complexity of the social security system itself.
The Administrative Justice and Tribunals Council (AJTC), which
was established in 2007 (and is the successor non-departmental
public body to the Council on Tribunals), suggested that the "undue
complexity" of the benefits system complicated the decision
making process from the outset and made it more difficult for
claimants to know what they may be entitled to. It argued that:
"The complexity of the system derives not only
from the rules for particular benefits but also as a result of
the interaction between the conditions of entitlement for linked
benefits and the complicated arrangements for review, revision
and reconsideration of decision, which are not fully understood
even by the decision makers themselves."
58. Welfare rights adviser, Daphne Hall, concurred
with this, suggesting that complexity can lead to a "huge
amount of under-claiming".
The Parliamentary and Health Service Ombudsman highlighted a number
of cases featured in her annual report, which demonstrated how
complex rules can lead to fraud and error and lengthy complaints
by claimants. One such complaint, by a Mrs U in July 2006, was
upheld after she was misled about whether she could claim Jobseeker's
Allowance (JSA) because the Jobcentre Plus adviser did not understand
the "linking rules" that would apply. This complaint
took over two years to reach a resolution, over three years after
the original complaint was made.
59. Citizens Advice argued that deciding whether
to award benefits becomes increasingly complex for disability
and sickness benefits, such as Incapacity Benefit (IB), Employment
and Support Allowance (ESA), Disability Living Allowance (DLA)
and Attendance Allowance (AA). Unlike JSA, for which entitlement
is determined by employment status and national insurance contributions,
claimants of these benefits must satisfy a medical assessment,
which involves a greater degree of discretion and subsequently,
Citizens Advice argued, makes them more susceptible to error.
60. In 2006, we published a report on benefit
complexity, which concluded that whilst there are no easy answers,
a complex benefits system risks becoming a dysfunctional benefit
system. We concluded that DWP had to make simplification a key
priority to alleviate that risk.
61. Complexity in the benefits
system remains a significant challenge for claimants, their representatives
and the Department itself. We note the concerns raised to us
in evidence that errors in decision making are inevitable if the
social security system is too complex. We urge the Department
to re-examine the conclusions of our report on Benefits Simplification
with a view to simplification of the system.
62. A number of organisations argued that the
claim forms for some benefits are too long and can be difficult
for claimants to understand, resulting in incorrect or incomplete
information being provided, thereby increasing the likelihood
of errors in decision making. Welfare rights adviser, Daphne
Hall, told us that:
"The forms are not always the most accessible
to write down what you want to say. They are not always the easiest
to understand [or determine] what information is important."
63. Dr Mark Baker, Head of Social Research and
Policy at the Royal National Institute for the Deaf (RNID), agreed;
he emphasised the difficulties some claimants face in completing
the 58-page Disability Living Allowance claim form, noting that
many find it "utterly mystifying".
64. We have raised the issue of complex claim
forms in the past with DWP, and the Department has acknowledged
this is an area of concern. In 2003, the NAO also identified
the detrimental effects of "long and confusing forms"
on decision making accuracy, particularly for disability benefits.
Vivian Hopkins, Chief Operating Officer at PDCS, accepted that
"there are segments of our customer base which struggle more
than others with the claim packs" and told us that DWP agencies
are working with claimants and their representatives to tackle
65. West Lothian Council provided an example
of where efforts made by DWP have improved claim forms to good
effect. It welcomed the introduction of DWP's "Performance
Standard Fund" for local authorities, which it said had funded
"major redesigns of correspondence, customer guidance and
claim forms" and had been the "catalyst" for reductions
in overpayments of Housing Benefit and Council Tax Benefit.
66. In order for decisions to
be timely and accurate, decision makers must have access to as
much information as possible, relevant to a person's claim. If
claim forms are long and complex, which would appear inevitable
in an excessively complex benefit system, the likelihood increases
that errors or omissions will occur in the initial application
process which may, in turn, affect the quality of decisions.
We welcome the work the Department is undertaking to improve benefit
claim forms but we acknowledge the scale of this task given the
complexity of the system. However, we believe more work is required
to tackle this problem and to address the persistent concerns
of claimants and their representative groups.
67. The medical assessment is a fundamental part
of the claims process for individuals applying for disability
or ill health related benefits. DWP has contracted Atos Healthcare
to provide medical advice to assist decision makers in reaching
a decision regarding entitlement to Employment Support Allowance,
Incapacity Benefit, Disability Living Allowance, Attendance Allowance
and Industrial Injuries Disablement Benefit. Atos Healthcare employs
over 1,700 healthcare professionals, who are responsible for processing
over 1.2 million referrals for medical advice annually and completing
600,000 face to face assessments on behalf of DWP.
Atos Healthcare uses a computer programme, LiMA (Logic Integrated
Medical Assessment), during the medical assessment. This web-based
system was introduced by Atos "to improve legibility, consistency
and accuracy of the medical reports".
68. The Work Capability Assessment (WCA) was
introduced in October 2008, and is used to determine claimants'
entitlement to Employment and Support Allowance. The assessement
contains a series of questions, "called descriptors",
that relate to physical and mental functions, and from which claimants
score points. Those found fit for work must claim JSA; those
with severe restrictions on their ability to work are exempt from
work-related activity and are placed in the ESA support group;
and those with some, but limited, capacity to work are placed
in the "work-related activity" ESA group and are required
to attend work focused interviews. This categorisation is based
on the points score. There were 189,800 WCA assessments up to
the end of August 2009. Of these assessments:
a) 10% have been assessed as eligible for the
ESA support group;
b) 22% have been assessed as eligible for the
ESA work related activity group; and
c) 69% have been deemed Fit for Work.
69. Many organisations were critical of the medical
assessment process. Citizens Advice referred us to their 2006
report, What the doctor ordered? which they argued, raised
concerns that remain relevant to the current medical assessment
process. They claimed that:
"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
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."
70. CAB argued that the computer generated answers
narrowed the scope of the WCA because "stock phrases"
did not accurately reflect some conditions. The LiMA system used
by Atos Healthcare allows the doctor conducting the assessment
to "cut and paste" these stock phrases into the report.
RSI Action claimed that Atos Healthcare professionals have often
misrepresented claimants' responses on the assessment document.
71. We also received evidence from a number of
individual claimants, who reported poor experiences of the medical
72. We received many complaints
about the medical assessment process ranging from dissatisfaction
from claimants who felt they were treated badly to criticisms
of the computerised assessment process. We appreciate that DWP
must strike a balance between providing a personalised service
and ensuring a consistent approach to medical assessments but
it is crucial that claimants' responses are recorded accurately.
We ask the Department to investigate the concerns raised to us
with Atos Healthcare and inform the Committee of the outcome.
Claimants with terminal conditions
73. A report published by Citizens Advice and
Macmillan Cancer Support in December 2009 found that terminally
ill patients were not being fast tracked into the ESA support
group and were being required to undergo the work capability assessment
or attend work-focused interviews. The report also identified
that cancer patients receiving chemotherapy were being asked to
attend a work capability assessment or work-focused interviews.
74. Work Directions were concerned about the
number of claimants that were being placed onto the Pathways to
Work employment programme before a decision had been made on their
entitlement to ESA. They noted that over 50% of their clients
who had already been on Pathways for 14 weeks had not yet received
the results of their Work Capability Assessment (WCA). They explained
that "for some clients, who are later placed in the ESA Support
Group as a result of the WCA, it can mean that they are expected
to attend mandatory interviews despite the fact they may be undergoing
treatment or be terminally ill."
75. We were concerned to hear
that 50% of one provider's Pathways to Work caseload have been
in the programme for 14 weeks, despite not yet having received
the result of their WCA. It is unacceptable that terminally ill
claimants or those undertaking treatment that affects their work
capability should be expected to undertake mandatory work focused
interviews. We call on the Department, as a matter of urgency,
to ensure that arrangements are made to ensure that terminally
ill claimants are fast-tracked to the Employment and Support Allowance
76. In its written evidence, Mind echoed the
concerns of other submissions that the medical assessment process
was ineffective for many claimants with fluctuating conditions,
stating that "the assessment does not take account of the
fluctuating nature of people's mental health conditions and the
assessment remains biased towards physical functions."
77. However, the Minister argued that the Work
Capability Assessment for the Employment and Support Allowance
was far more responsive to fluctuating conditions than its predecessor,
the Personal Capability Assessment:
"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." 
Review of the Work Capability Assessment (WCA)
78. In December 2008, the Government published
the White Paper Raising expectations and increasing support:
reforming welfare for the future, which outlined its
plans to undertake a review of the WCA. This is in addition
to the statutory obligation on the Department, under section 10
of the Welfare Reform Act 2007, to produce an annual independent
review of the WCA for each of the first five years of its operation.
79. RSI Action told us that it had been involved
in the Department's internal review of the WCA (as announced in
the December 2008 White Paper), and expressed considerable concern
at the process:
"The DWP invited a small panel of their expert
advisers. DWP members and their advisers were provided with a
number of specific cases to be considered, whereas charity representatives
were denied access to such information. [
] RSI Action has
written two letters to DWP raising its concerns on this process,
and is concerned that the issues raised have not been adequately
considered by DWP. Having seen the DWP proposed changes to the
WCA that we understand will be presented to the Secretary of State
for approval, we are very concerned that the WCA will migrate
even further from the intent of primary legislation, to provide
benefit for those who have limited capability for work.
"A particularly alarming change that we understand
will be proposed to the Secretary of State, is to replace using
a pen or pencil, with making a purposeful mark!" Such a descriptor
takes no account of the ability of the claimant to use a pen or
pencil for the purpose for which it was designed, to write legible
text in a reasonable time so that others can understand what has
80. The Department recently completed this internal
review of the WCA. The first of the statutory reviews will be
published this year and we were told that the Government expected
to make the findings of the internal review available "more
81. We ask the Department to
confirm when it intends to publish the findings of its internal
review of the Work Capability Assessment (WCA). We note the concerns
raised by some organisations that are contributing to the review.
We urge our successor Committee in the next Parliament to examine
carefully whether these concerns have been addressed and to maintain
close scrutiny of the operation of the WCA.
82. Migration of existing claimants
from Incapacity Benefit to Employment and Support Allowance, subject
to a Work Capability Assessment, will be trialled from October
2010 with a view to being rolled out for all customers from February
2011. We recommend that this process should not commence before
the review of the WCA has been completed and its recommendations
Evaluating the evidence
WEIGHT GIVEN TO MEDICAL ASSESSMENTS
83. The Asbestos Victim Support Group's Forum
UK and Lancashire County Council Welfare Rights Service argued
that DWP decision makers rely too heavily on the conclusions of
the Atos healthcare medical assessment and claimed that not enough
attention was given to claimants' own statements and their medical
84. Welfare rights advisers, Patrick Hill and
Daphne Hall, both agreed that there was an overreliance on the
conclusions of DWP medical assessments. In some cases, they argued
evidence should be sought from specialists, such as community
psychiatric nurses, who might see a claimant on a regular basis
and could provide an expert opinion about how that person functioned
85. We asked the Minister whether the advice
of DWP contracted Atos healthcare professionals took precedence
over other evidence claimants may provide and he agreed this was
sometimes the case:
] If the evidence provided by the Atos
healthcare professional] 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."
86. In Leeds, we met a claimant who had scored
zero points in his Work Capability Assessment; his experience
had been that the assessment did not properly take account of
his condition. With the support of welfare rights advisers he
challenged this decision and was eventually successful on appeal.
A score of zero might appear to be a "pretty overwhelming"
report, but in cases such as this, it would clearly have been
preferable if other evidence, if available, had been considered
by the decision maker.
87. We note widespread concerns
that decision makers appear to give excessive weight to the conclusions
of DWP medical assessments over other evidence claimants may provide.
If a claimant is able to provide statements from specialists,
who have regular contact with them, this evidence should be given
due consideration. Furthermore, if a decision maker does not
award a benefit based on the recommendation of a DWP medical assessment,
despite the fact that this conflicts with the conclusions of expert
evidence provided by the claimant, DWP should ensure that claimants
are given a clear and full explanation of the basis for this decision.
TRAINING FOR DECISION MAKERS
88. DWP told us that all decision makers received
training in relevant benefits and are able to access additional
support from the Department's DMA unit in Leeds, which provides
support and guidance to DWP and local authority decision makers
on certain common subjects. DWP told us that the unit responded
to more than 3,300 guidance requests per year from decision makers
on specific cases.
89. In addition to existing resources, we were
told that Jobcentre Plus was reviewing all of its decision making
training, with the aim of improving the quality of decisions.
From April 2010, all new Jobcentre Plus decision makers will
undergo Foundation Decision Making Training and more complex subject
areas will be introduced, as and when staff require it. In PDCS,
decision makers currently undertake a Technical Evaluation Package
(TEP) after being in post for 9 months. We were told that the
overall programme of training offered in the agency was scheduled
for a review by the DWP Standards Committee, as part of its 2009-10
90. West Lothian Council Revenues and Benefits
Unit emphasised that the complexity of benefit decisions, in particular
housing benefits, made it essential that decision makers had access
to sufficient training to deliver confidently accurate decisions
to claimants. It argued that the Department was successfully
91. Some evidence we received suggested shortcomings
in training for decision makers. PCS claimed that the quality
of training was varied. It argued that classroom-based training,
using live cases, was most valued by decision makers whilst the
increase in web-based learning was "almost universally loathed"
by PCS members, who found this method of training to be largely
Sargent reported a lack of understanding amongst decision makers
about cancers that affect children and young people and argued
that this could lead to "insensitivity and inappropriate
questioning on the part of decision makers who are not given the
education and guidance they need to understand this complex disease
92. We welcome Jobcentre Plus'
decision to review its training provision for decision makers
and the DWP Standards Committee's commitment to examining the
training available to decision makers in the Pensions Disability
and Carers Service.
Professionalism in Decision Making and Accreditation
93. A number of organisations commented on the
introduction of accreditation for PDCS decision makers in 2006
called "Professionalism in Decision Making and Accreditation"
(PiDMA). The diploma was developed in partnership with the University
of Chester and consists of a modular work-based learning programme.
We were told that the programme cost around £300,000 to
deliver each year and over 200 decision makers had been accredited
since 2006. An internal
evaluation report is currently being produced and is expected
to be finalised in early January.
94. Although staff who gain accreditation do
not receive any financial reward, Vivian Hopkins, Chief Operating
Officer, PDCS explained that the diploma:
] 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."
95. The National Deaf Children's Society welcomed
the accreditation, saying that it had been a positive introduction,
which was improving the quality of decisions on DLA claims.
Likewise, the Administrative Justice and Tribunals Council 2008-09
annual report praised the PiDMA programme and encouraged DWP to
"consider rolling out similar programmes across all its Agencies".
96. We are encouraged by the
positive responses to the introduction of the Professionalism
in Decision Making Accreditation (PiDMA). However, with only
200 decision makers accredited at a cost of £300,000 per
year, this is an expensive diploma to deliver. We ask DWP to
publish the internal evaluation of PiDMA once the report is finalised.
Contact with claimants
97. A number of organisations suggested that
claimants often failed to understand how the decision process
worked and this was exacerbated by the fact that claimants were
rarely given the opportunity to speak to the decision maker responsible
for the outcome of their claim. The National Association of Welfare
Rights Advisers (NAWRA) explained that:
"The main point of contact is through the telephony
(letters often remained unanswered)this is to a member
of staff who is trained to read the computer screen but without
full benefits knowledge."
98. The Committee was told by welfare rights
advisers, Daphne Hall and Patrick Hill, that claimants often struggled
to understand the decision making process in Jobcentre Plus because
they were unable to speak directly to the person responsible for
deciding the outcome of their claim. Daphne Hall said:
"Within the Jobcentre it is virtually impossible
to speak to somebody who knows about benefits because [
jobcentre staff are not trained in benefits, they are trained
to help people find work. [
] If you phone the benefit
delivery centre, you have a telephony service first where people
are trained to read the screens so they can give you certain information,
for example what premiums you are getting, but they cannot tell
you why decisions are made. The only way you can speak to somebody
is to ask for call-back, which currently is coming within three
days. If you are not in [
] they will leave a message to
say they have called, but they are not allowed to leave a number
you can call back on, so you have to start the whole process again."
99. Recent research by the Pensions, Disability
and Carers Service found that their local third sector and voluntary
sector partners were similarly dissatisfied by a lack of face-to-face
contact and had a strong dislike of the telephone call centre
contacts. Individual accountability in the decision making process
was considered crucial to local partners, who often felt that
their input disappeared into a "black hole".
100. The latest report by the DWP Standards Committee
(formerly the DWP Decision Making Standards Committee) highlighted
the findings of the President of Appeals Report 2007-08, which
reported that, of all the DLA/AA cases that are presented to appeals
tribunals, 40% are overturned. In 73% of the overturned cases
the tribunal accepted new evidence at the hearing from the claimant,
sometimes in the form of medical evidence and other times it was
the claimant's verbal account of living with a disability. In
order to try and reduce the number of cases going to appeal, the
Standards Committee concluded that a better understanding of the
claimant's viewpoint could significantly impact upon the number
of appeals that are processed and the number of appeals that are
overturned in the claimant's favour. It recommended that:
"In all cases that get to reconsideration/appeal
the appeal writer/decision maker should ensure they [
made meaningful contact with the customer and/or carer before
the issue is referred to appeal to ascertain how the customer
experiences their disability."
101. Speaking to a claimant
directly is an effective means of ensuring that decisions are
based on accurate evidence. We ask the Department to explain
what actions it has taken in response to the DWP Standards Committee's
conclusion that decision makers would benefit from a better understanding
of claimants' viewpoints.
102. We recommend that the Department
should pilot a scheme whereby claimants who proceed to a reconsideration
of their claim or appeal against a decision are allocated an individual
decision maker and are given a direct telephone number on which
to contact them. We recognise that this will place an additional
burden on decision makers, but we believe that it is justified
on the grounds of fairness to claimants. We believe that it could
also reduce costs in the system by reducing the number of cases
that go to appeal.
103. DWP told us that claimants are informed
of their appeal rights "in a clear and unambiguous way"
in decision notices, which explain what further action can be
taken if they are unhappy with a decision and the timeframe in
which to take it.
104. The content and structure of decision notification
letters have been subject to criticism in the past. The 2003 NAO
report on decision making and appeals highlighted the problems
that poor written communication from DWP can create for claimants.
The NAO found that some decision letters may list the reasons
for a decision but did not explain the decision in terms of claimants'
specific situations. It noted that, although DWP accepted the
"unsatisfactory nature" of some decision letters it
believed the required computer changes would be too costly to
warrant significant changes.
105. We highlighted the problems unintelligible
computer-generated letters can cause in our report on benefits
simplification in 2007.
In response, the Department told us that Jobcentre Plus would
review its correspondence and develop an action plan for improving
106. However, during this inquiry, we received
evidence to suggest that notification letters remain of an unsatisfactory
standard. Alan Barton from Citizen's Advice and welfare rights
adviser, Daphne Hall, were critical of the "very poor"
decision letters some claimants received.
Lancashire County Council Welfare Rights Service argued that letters
frequently failed to explain exactly how a decision has been arrived
at; for example:
"DLA/Attendance Allowance decision notices [
tend to make reference to the basic qualifying criteria, yet not
explain why the decision maker thinks these are not met in the
claimant's case. For example, simply saying "you are not
virtually unable to walk", of itself, is of no real help
to a claimant (or adviser) when deciding if they have legal grounds
to challenge the decision. What would be more helpful would be
a full explanation as to why a customer's needs do not meet the
relevant criteria. This information should be made available to
the claimant at the time the decision is issued."
107. Some of the welfare rights advisers we met
in Leeds suggested to us that making the rationale behind decisions
clearer to claimants, particularly the grounds for disallowance
of ESA, would significantly reduce the number of appeals that
108. The National Autistic Society highlighted
the problem of unclear communications from Jobcentre Plus which
confused claimants and could subsequently lead to significant
delays in payment. It proposed that ESA letters, in particular,
should be written in accessible format, or be accompanied by an
easy-read version, to ensure that claimants understood the decision.
109. We are disappointed to
hear that computer-generated notification letters continue to
make it difficult for some claimants to understand how a decision
on their benefit claim has been reached. Both this Committee and
the National Audit Office have raised the issue of incomprehensible
written communications from DWP in the past and yet this continues
to be a problem. We ask the Department to outline what work it
is undertaking to improve its notification letters and to ensure
that decisions are properly explained and easily understood by
claimants. We believe that better explanation of the rationale
behind decisions could reduce the number of appeals and requests
for reconsideration that are brought forward, delivering savings
elsewhere in the system.
33 Ev 127, para 2.1 Back
Ev 148, para 18 Back
Parliamentary and Health Service Ombudsman (March 2009), Putting
things right: complaints and learning from DWP, page 23 Back
Ev 140 Back
Seventh Report, Session 2006-07, HC 463, Summary Back
National Audit Office (2003), Getting it right, putting it
right- Improving decision making and appeals in social security
benefits, p. 5 Back
Ev 66, para 5 Back
Atos Origin/DWP (2006) LiMA- Evidence based medicine in action Back
DWP (2009) Employment Support Allowance: Work Capability Assessment
Statistical Release (October 2009) Back
Ev 141 Back
Ev 52 Back
Citizens Advice and Macmillan Cancer Support (2009), Failed
by the System Back
Ev 59, para 18 Back
Ev 109 Back
Q 110 Back
Ev 53 Back
Department for Work and Pensions' Annual Report 2009, Oral and
written evidence, 14 October 2009, HC 977, Department's supplementary
evidence, paragraph 5.2. Back
Ev 67, para 4 and Ev 119, para 2.2 Back
Q14 and Q17 Back
Ev 128, para 3.11 Back
Ev 128, paras 3.2-3.7 Back
Ev 66, para 12 Back
Ev 76, para 10 Back
Ev 47, para 2.1 Back
Ev 128, para 3.9 and Q120 Back
Ev 111, para 3.2 Back
Administrative Justice and Tribunals Council (2009), Annual
Report 2008-2009 Back
NAWRA, para 6 Back
Department for Work and Pensions (2009) Research Report No 604
Pension, Disability and Carers Service partnerships
Research, page 3 Back
DWP Standards Committee Annual Report 2007-08 PDCS (DCS)-Recommendation
4, page 12 Back
Ev 129, para 4.1 Back
NAO (2003) Getting It Right, Putting It Right: Improving Decision
Making And Appeals In Social Security Benefits, page 32 Back
Seventh Report, Session 2006-07, HC 463. Back
Third Special Report, Session 2006-07, HC 1054, Benefits Simplification:
Government Response to the Committee's
Seventh Report of Session 2006-07. Back
Ev 121, para 4.3 Back
NAS, para 5 Back