4 Reviewing Decisions
110. The Improving decision making and appeals
in Social Security Green Paper proposed the establishment
of "informal reviews" which would allow claimants to
have decisions looked at again by a DWP decision maker, rather
than having to proceed straight to appeal. In July 1997, the
Government published an analysis of the responses to the Green
Paper, which demonstrated mixed views on the introduction of review
arrangements (which already existed for DLA) for other benefits:
"There were several submissions which endorsed
the formal review arrangements currently in place for Disability
Living Allowance […] In contrast to this positive view of
the DLA model there were many submissions which argued against
it. Opponents referred to DLA reviews as confusing and complicated
and acting as a hurdle which claimants had to overcome in order
to reach an independent tribunal hearing. Several respondents
argued that imposing the model on other benefits would by definition
add an additional tier to existing arrangements counter to the
intention expressed by the Green Paper."[79]
111. Informal reviews were incorporated into
the new DMA system following the introduction of the Social Security
Act 1998 and in 2006 the Welfare Reform Green Paper committed
DWP to incorporating a reconsideration process into the initial
assessment of any appeal to reduce the number of appeals progressing
to a tribunal. The Green Paper also promised clear feedback to
appellants and an assurance that any new evidence would be included
at the reconsideration stage, rather than at tribunal. [80]
112. DWP told us that "the ability to revise
decisions is key to the decision making system".[81]
The National Association of Welfare Rights Advisers and the National
Deaf Children's Society felt that the reconsideration was a positive
part of the decision making process because it allowed decisions
to be rectified, without necessarily having to proceed to a lengthy
appeal. However, both organisations also commented that decision
makers needed to be more proactive in seeking new evidence from
claimants during the reconsideration stage. [82]
The dispute period
113. Under the existing rules, if a claimant
is unhappy with a decision, there is a dispute period of one month
in which they can either ask for their decision to be reconsidered
or lodge an appeal. When the Committee met with Jobcentre Plus
and PDCS officials in Leeds, we were told that decision makers
did not have targets for case clearance at the reconsideration
stage. The Committee also met with claimants and welfare rights
advisers in Leeds who argued that, in particularly complex cases,
it was unfair that claimants were expected to dispute a decision
within a month when there was no obligation for decision makers
to complete the reconsideration process expeditiously. In oral
evidence, Jeremy Groombridge CB, Director of Transformation and
Product Management at Jobcentre Plus, told us that, whilst there
is no specific target for decision makers to complete reconsiderations,
there is an "expectation" that this process should be
completed within five days of registration.[83]
We asked the Minister whether a target should be introduced.
He replied:
"That is a very good point. Perhaps they should.
Staff are given targets in many other areas but not in that one,
so we need to reflect on whether we could introduce a target for
them."[84]
114. We recommend that DWP formalise
the expectation that reconsiderations should be completed in five
days by introducing this as a target for decision makers against
which performance is measured.
Reconsiderations for DLA and
AA
115. Welfare rights advisers told us that the
reconsideration process could be a "huge benefit" to
claimants, providing decisions were genuinely looked at again
and "not just rubber stamp[ed]".[85]
We were also told that, at a recent National Association of Welfare
Rights Advisers meeting, there "was a general feeling that
now the DLA reconsideration process is working well."[86]
116. We asked DWP to provide us with data on
the reconsideration process to assess its usefulness for the claimant.
PDCS holds information in relation to Disability Living Allowance
(DLA) and Attendance Allowance (AA) only. The tables below show
the number of DLA and AA reconsiderations that were registered
in 2007-08 and 2008-09 and the number that were revised in the
claimant's favour:
Figure 7: Disability Living Allowance and Attendance
Allowance reconsiderations registered by the Pensions, Disability
and Carers Service[87]
| 2007-08
| 2008-09
|
| DLA Reconsiderations registered
| 125,233 | 132,338
|
| AA Reconsiderations registered
| 17,800 | 17,368
|
Figure 8: Number of DLA and AA reconsiderations
that result in a decision revised in the customer's favour[88]
| 2007-08
| 2008-09
|
| DLA | 55,416
| 67,668 |
| AA | 9,924
| 10,373 |
117. The tables show that 44% of DLA reconsiderations
were found in favour of the claimants in 2007-08; this figure
rose to 51% in 2008-09. 55% of AA reconsiderations were found
in favour of the claimant in 2007-08, rising to 60% in 2008-09.
Although a majority of reconsiderations of decisions on DLA and
AA found in favour of the claimant in 2008-09, 43% of DLA cases
reaching an appeal hearing and 31% of AA cases reaching appeal
found in favour of the claimant, indicating that reconsideration
is still failing to pick up a large proportion of claims that
should be awarded.[89]
118. Whilst welfare rights advisers have suggested
that the reconsideration process is working well with respect
to DLA and AA as a relatively high proportion of decisions are
overturned at this stage, these statistics equally raise questions
about the quality of the original decisions made in DLA and AA
cases. If standards of decision making on initial claims were
high then it is logical to expect a low rate of overturned decisions
at the reconsideration stage.
119. The quality of decision making depends in
large part on the quality of the information provided to the decision
maker. DLA and AA claimants carry out what amounts to a self-assessment,
with variable results. The claim forms for DLA and AA are notoriously
complex and many claimants find them confusing. Vivian Hopkins,
Chief Operating Officer, Pension, Disability and Carers Service,
acknowledged that many claimants believed that eligibility to
DLA related directly to the "nature of the disability diagnosis"
rather than how it affected the claimant's mobility (for DLA)
or ability to carry out everyday tasks and care needs (for DLA
and AA). She told us that PDCS had made great efforts to improve
the way in which it worked with those who were elderly or disabled
(or had disabled dependents) in dealing with very complex benefits.
The claim packs for DLA were under constant review and PDCS was
working with representative groups to improve them. She noted
specific initiatives to make DLA claim packs more tailored for
those claiming for disabled children:
"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. […] My intention is to specialise for various
complex cases including children."
She also noted the steps that had been taken to simplify
the renewal application form "which is [now] four pages long
instead of the 40-odd pages which comprised the original one".
She added that:
"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."[90]
120. We note in Chapter 5 the value of welfare
rights advice for those navigating the appeals process. Welfare
rights advice is also important for many claimants at the stage
of the initial claim and can make a big difference to the chances
of whether a claim will be successful. However, many claimants
are unaware of the sources of advice that may be available in
their areas.
121. We are not convinced by
the evidence that the reconsideration process is working well
in respect of claims for DLA and AA. We are more inclined to believe
that the quality of the initial decision making in respect of
these benefits is a cause for concern. This does not reflect a
particular criticism of DLA and AA decision makers, but rather
concern that the "self-assessment" claim forms are misunderstood
by many claimants. We commend the Pension, Disability and Carers
Service on its efforts to improve the claim forms for DLA and
to make them more tailored towards the needs of specific groups.
However, given the nature of our generic concerns, we recommend
that the Standards Committee should examine decision making in
respect of these benefits as a matter of urgency.
122. Many DLA and AA claimants
are unaware of the welfare rights advice that is available. We
recommend that the Pension, Disability and Carers Service should
pilot a scheme whereby it works with welfare rights advisers and
representative groups to prepare a leaflet detailing sources of
local advice which should be included with the claim pack for
these benefits.
Reconsideration for Incapacity
Benefit (IB) and Employment and Support Allowance (ESA)
123. We also heard that the system was not working
well for IB and ESA. Welfare rights adviser, Patrick Hill, told
us that "a straw poll of many" of his colleagues in
the North West suggested that decisions on ESA or IB were not
being revised on reconsideration.[91]
Alan Barton from Citizens Advice agreed, saying:
"I think the feeling we get often, particularly
with the Incapacity [Benefit] reconsiderations, is it is just
viewed by the people concerned in Jobcentre Plus as an annoying
step they have to go through before the case goes to appeal and
their focus is on producing the appeal papers."[92]
124. Judge Martin argued if claimants chose to
lodge an appeal, despite the fact that this should trigger a reconsideration,
often at this point "the Department then opts out of the
process". We asked DWP for data on reconsiderations undertaken
by Jobcentre Plus but were told that it "does not maintain
detailed statistics on the reconsideration process."[93]
125. We were disappointed to
learn that Jobcentre Plus could not provide us with detailed statistics
on the reconsideration process. If Jobcentre Plus is not collecting
this data it is impossible for either the Committee, or the agency
itself, to assess performance in this area. We call on Jobcentre
Plus to start collecting and publishing data on reconsiderations
as a matter of urgency. We hope that, once these statistics are
available, our successor Committee will be able to re-visit this
issue and conduct the examination of the reconsideration process
for Jobcentre Plus benefits that we were unable to complete.
126. A common criticism of the reconsideration
process was that, if DWP are committed to reconsidering all decisions
once an appeal has been lodged, there was no need to have a separate
reconsideration stage. When we met with welfare rights advisers
in Leeds, they told us that they would often advise their clients
to bypass the reconsideration process and go straight to appeal.
This approach, they argued, could significantly reduce the time
it takes for a claimant to get a decision overturned because it
effectively removed one tier of the decision making and appeals
process.[94]
127. The President of the Social Entitlement
Chamber, Judge Robert Martin, believed that the option of a reconsideration
for claimants was in reality a "false choice". A reconsideration
might seem to be a quicker and simpler option than a full appeal,
but Judge Martin believed that a more accurate description of
the choice between the two processes would be to ask
"Would you like us to look at your decision
again superficially or would you like us to look at our decision
again seriously?"[95]
128. He went on to ask:
"What is the advantage for the claimant in asking
for a reconsideration rather than lodging an appeal straightaway?
Lodging an appeal is free, informal and involves scarcely more
effort than writing in asking for a reconsideration."[96]
129. For some benefits, the
reconsideration process appears to be ineffective. Anecdotal evidence
suggests that disputed IB and ESA decisions are not being reviewed
properly by decision makers and, as a result, some welfare rights
advisers are advising claimants to bypass this stage and pursue
an appeal. We believe that they may be right to advise their clients
to pursue this course, although without more detailed statistics,
this is impossible to prove.
130. Many claimants will be
deterred from an appeal by an unsuccessful request for a reconsideration.
Our greatest concern is that, if this reconsideration is not being
conducted thoroughly, they may miss out on the benefits to which
they should be entitled.
131. The reconsideration process
should provide a quick and efficient way of reviewing decisions
which provides a swift resolution for claimants and reduces the
caseload of the tribunals. It is also intended to be a stage at
which a decision maker has the opportunity to consider new evidence.
However, the current operation of the reconsideration process
is a missed opportunity. We do not believe that the reconsideration
process is currently operating in the best interests of the claimant.
We urge the Department to examine the operation of this process
as a matter of urgency, and we hope that our successor Committee
in the next Parliament keeps the matter under close scrutiny.
79 Department for Social Security (1997), Consultation
on Improving Decision Making and Appeals in Social Security: Analysis
of Responses, para 5.6 Back
80
DWP,(2006) A new deal for welfare: Empowering people to work,
Chapter 2, page 72 Back
81
Ev 127 Back
82
Ev 80 and Ev 111 Back
83
Q104 Back
84
Q97 Back
85
Q21 Back
86
Q1 Back
87
Ev 136 Back
88
Ev 136 Back
89
Annex A Back
90
Q114 Back
91
Q12 Back
92
Q26 Back
93
Ev 136 Back
94
Annex D Back
95
Q72 Back
96
Ev 116, para 24 Back
| 
