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

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 125,233132,338
AA Reconsiderations registered 17,80017,368

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
AA9,924 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

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