Work & Pensions Committee - Minutes of EvidenceHC 1493

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Oral Evidence

Taken before the Work and Pensions Committee

on Wednesday 19 October 2011

Members present:

Dame Anne Begg, in the Chair

Debbie Abrahams

Andrew Bingham

Karen Bradley

Kate Green

Mr Oliver Heald

Glenda Jackson

Brandon Lewis

Stephen Lloyd

________________

Examination of Witnesses

Witnesses: Professor Steve Fothergill, Centre for Regional Economic and Social Research, Sheffield Hallam University, Sue Royston, Social Policy Officer, Citizens Advice, Professor Roy Sainsbury, Research Director, Social Policy Research Unit, University of York, and Claudia Wood, Head of Public Services and Welfare Programme, Demos, gave evidence.

Q1 Chair: Before I ask you to introduce yourselves, can I just make a declaration? I am in receipt of the mobility element of DLA, so I thought I had better make that clear. I appreciate that it is not general for Members of Parliament to declare what benefits they are in receipt of, but in light of this particular inquiry, I thought it might be worth pointing that out. Can I ask each of you in turn to introduce yourself very briefly for the record?

Professor Fothergill: I am Steve Fothergill. I am a professor at Sheffield Hallam University.

Sue Royston: I am Sue Royston. I work for Citizens Advice as a social policy officer.

Professor Sainsbury: I am Roy Sainsbury. I head up the Welfare and Employment Research Group at the Social Policy Research Unit at the University of York.

Claudia Wood: I am Claudia Wood. I am Head of Public Services and Welfare at Demos.

Q2 Chair: Thank you very much. This is our first evidence session into the Government’s plans contained in the Welfare Reform Bill that is going through Parliament to effectively end Disability Living Allowance (DLA) and introduce a new benefit called Personal Independence Payment (PIP). The first question really is, has the case been made for that essential abolition of one benefit and its replacement with a new benefit, or would it have been more sensible to reform, if reform is needed at all, the existing benefit? I wonder who would like to start. Is nobody going to speak first?

Professor Sainsbury: I could have a go. If you look at what the Government or DWP have said about the need for reform in their various documents, including the Impact Assessment, it boils down to just a few things: the poor understanding of the benefit, the lack of routine reassessment of claims, the inappropriate assessment criteria for certain impairments, and then the cost. They are the ones that are put forward.

I think everyone realises that DLA has its critics and no one would claim it is a perfect benefit, and it is always worth looking at benefits. When I looked at it, however, I thought the case was pretty weak apart from the need to save money, which was outwith the actual benefit itself. Yes, there is evidence some people do not understand the benefit very much. That is pretty much the case for most benefits. Most people do not understand a benefit until they need to claim it, and then they find out about it. There is an argument that people confuse it with an out-of-work benefit. There is some evidence of that but it is not very conclusive. There is counter-evidence some people have a very good understanding and do realise this is a benefit that can keep them in work and that is helpful to them.

The argument that the assessment criteria for DLA have been very heavily weighted towards physical impairments rather than cognitive or sensory impairments has been well made over many, many years. I think DLA has evolved and changed over the years to try to encompass that. The new regulations, or the draft regulations, on PIP seem to go a bit further, so that is an argument well made.

There has never been any argument that it is not needed or it is not doing its job properly, and I find that interesting as an omission from all the policy documents. Everyone says, "DLA is to contribute to the cost of disability for people," and in all the arguments, I have never seen anyone argue it is not doing that. I referred in our submission from York to the research we were commissioned to do by the DWP, which is looking at the impact of DLA, and AA1 as well, on peoples’ lives. That came up with interesting evidence that I am happy to talk about, which I put in my submission, but it has got no place it seems in this argument. No one is saying this benefit is doing a bad job. I think the arguments for reform, apart from saving £2 billion or whatever, seem not very well established.

Q3 Chair: Could the arguments that the Government is using be fulfilled by just reforming the benefit, including the cost element, by bringing in slightly tighter criteria, and reassessing everyone or putting everyone through regular assessments? Would that not achieve the same ends but be a lot cheaper ultimately in terms of the bureaucracy?

Professor Sainsbury: I think probably the answer is yes. You could reform the DLA and deal with some of those weaknesses, deficiencies, criticisms of the benefit. The reassessment one in particular is put up as a strong argument for reform, but as far as I know there is no legal impediment to DWP reassessing the whole DLA caseload now if they wanted to-it is just a matter of resources. It is interesting they seem to be prepared to put in the resources for PIP to do lots of reassessments, but not to do it now. There is nothing to stop them as far as I know. You might take that up with DWP.

Q4 Chair: Can anybody explain why the replacement is taking place, rather than just a reform of the existing benefit?

Sue Royston: We are very concerned that it is about saving money and it would be quite difficult to save that amount of money just from DLA. Like Roy, we do think there are some problems with understanding the criteria for DLA and that causes problems for clients. We do not think care needs have ever been a really good proxy for extra costs. Despite welcoming what the Government says are the aims of PIP-making people more independent, welcoming the social model and so on-we are very concerned it is moving in the opposite direction to that. The aim of making it a more objective test moves away from any degree of personalisation. I think you are going to talk later about that in more detail, but we are very concerned PIP is actually moving in the wrong direction.

Q5 Chair: One of the things the Government says is DLA is a very complicated benefit to apply for and there is a lack of understanding. Now you did not mention simplicity in your opening remarks, Professor Sainsbury. Is that one of the reasons why it needs to be replaced? If it is replaced, is there a guarantee that the replacement would be simpler and easier to administer?

Claudia Wood: Personally, I do not think doing away with the existing system at quite a significant cost and replacing it with a whole new system is necessarily the most efficient way of streamlining an existing benefit a lot of people are familiar with and quite like. I agree with Professor Sainsbury that there are potentially other ways of correcting some of the problems with DLA. For example, we know there is a high disallowance rate, which suggests people are applying for it and they do not know whether they should or should not be. Those sorts of things can be dealt with quite neatly with improved advice and information, and improved awareness raising about what DLA is for, the fact that you can get it while you are in work, and all those sorts of things. Other benefits have had similar problems-for example, Working Tax Credits and Pension Credits-around the complexity and the poor take-up. Those have been dealt with in various ways: streamlining the assessment system, improving information and advice, and improving advocacy in the application process. Those things potentially could be cheaper and more efficiently done than having a new benefit.

Q6 Chair: I suspect the answer might be no, but has there been any work done on comparing the relative administrative costs of bringing in a new benefit as opposed to reforming the existing benefit?

Professor Sainsbury: I do not think there has been any work exactly matching what you have just said. There is an estimate in the papers it is going to cost £625 million-

Claudia Wood: £675 million.

Professor Sainsbury: Sorry, £675 million in transitional costs.

Q7 Chair: That would include costs for people so that they are not worse off, rather than just the administration costs presumably.

Professor Sainsbury: I think it is just the administration costs. That is how I read it as it is presented in the Impact Assessment-that is to save over £2 billion in benefit payments. When you say, "Is a benefit too complicated to understand?" most benefits are complicated, all benefits are complicated. When you compare the criteria for PIP with DLA there is not a lot of difference. I suspect the experience for the claimant is going to be pretty much the same: a very long form to fill in, other evidence to gather if you can, and with PIP you have the additional layer of a possible or almost mandatory interview with one of these new assessors. If it is a problem of complexity with DLA I cannot see that PIP deals with it, because it is trying to capture a lot of things, as so many benefits are. I cannot see that PIP is going to solve that complexity. It is not simple.

Claudia Wood: I would also suggest, because DLA is not means-tested, it is probably one of the simpler benefits that we have. The main complexity with the majority of benefits is how they interact with other benefits and with your income, and whether you become ineligible when you change your income. With DLA you do not have that complexity.

Q8 Chair: Is that not one of the Government’s arguments? Once people are on it they stay on it and nothing changes, and they are still there 20 years later even though their condition may have improved.

Claudia Wood: That is a reassessment issue, though, isn’t it?

Professor Sainsbury: It is an interesting argument. It is as if that is a very, very bad thing. People are entitled to a benefit, and many people have very chronic disabling conditions and health conditions that will last for 20 years. It is almost an automatic assumption that if someone stays on a benefit for a long time it is a bad thing, whereas another interpretation might be that is society reflecting someone’s needs and supporting them for a long time because that is what they need.

Q9 Stephen Lloyd: That is also back to the reassessment point that you are making. There should not be any reason why, currently under DLA, you could introduce the whole reassessment model every year if you wanted to.

Professor Sainsbury: There is no problem with that at all, as far as I can see. It is big numbers. I looked at the fraud report from 2005, which makes very interesting reading because, as you know, hardly any fraud exists in DLA and it never has done. Over 11% of cases in this fraud study were found to be wrong at the time they were reassessed, and they were wrong because people’s circumstances had changed gradually. It was not that they had a change of circumstances like a sudden deterioration in health, or they had been given a new prosthesis or something, or they had gone into residential care, but a gradual change in health, which is most people’s experience. So by the time they were looked at again, they were wrong.

I can see why they mention reassessments in the policy documents, because it is a problem. If you have 11% of the cases that are wrong, but no one is at fault through fraud, or claimant or official error, then reassessment is clearly the way to do it. But having identified the problem, as you say, there is no reason why it cannot be dealt with within DLA regulations.

Q10 Glenda Jackson: Is there not evidence to show that people who could and should claim DLA do not? I mean that is quite a sizable chunk.

Professor Sainsbury: That is a very interesting point because the issue of take-up is another missing element from the policy documents. It has always been thought of way back from 1992 onwards, that take-up is an issue. I am doing my good research bit here. I looked at the last effort to measure take-up of DLA, done in the late 1990s by DWP officials, and it was incredibly low. I think I cited the figures in my paper. The estimate of take-up of the mobility component was 50% to 70%, and the care component was 30% to 50%.

There are big margins of error there, and it is very difficult to measure take-up and to measure the eligible population that are not claiming. They do not exist anywhere in the data, so you have to go and find them. So it is very difficult to estimate and there are wide margins of error cited. But even so, I think it was a bit of a shocker at the time that they were so low, and efforts were made to increase take-up by publicity, etc.

Q11 Glenda Jackson: This does sort of link in to the issue of reassessment as well, doesn’t it? You made the point that as a society surely we should be caring for people, but people out there do not know, so there is this dichotomy between reassessment and people actually being unaware. Presumably, those are things that could be changed now without needing necessarily to introduce another form of benefit. I think what I am working up to is, is there any evidence to say that is feasible and the cost would not be astronomical? Has anybody done any work on that?

Professor Sainsbury: Sorry, I am not quite sure what the question is exactly.

Q12 Glenda Jackson: I think what I am trying to say is that the Government’s argument is that DLA is too complex and people do not understand it, for the reasons you gave, and the issue of money comes right at the bottom of the list. I think it has been established-has it not?-that reassessment could be done now. But given the comparatively large percentage who do not even know they could and should be claiming DLA, what I am saying is this: would there not be a benefit as far as the proposed changes are concerned if we simply went for reassessment and greater advertising to the people who could and should claim?

Claudia Wood: Yes, but we have to bear in mind that the low take-up of the current benefit potentially works in the favour of the Government if they are looking to reduce overall costs of this benefit by 20%. In theory, by thinking that PIP will be more transparent and easily understood and more accessible and more people will apply for it, they are not going to reduce their 20% take-up rate. I do not think they have taken into account that the potential complexities of DLA means it actually has quite a low take-up rate, which is a benefit if you are thinking about keeping caseloads and costs down.

Q13 Glenda Jackson: I thought Professor Sainsbury said there is no evidence to show the actual qualifications necessary to claim PIP would be any less complex or any shorter than the current DLA form.

Claudia Wood: It will not, but if you look at the Impact Assessment on PIP they are very articulate about making this simpler, more transparent and raising awareness of it as a kind of "you will always know what you are entitled to before you apply" test. If they really try and promote it in that sense, they could potentially increase take-up.

Q14 Glenda Jackson: Surely, the promotion is to the existing claimants, and I am concerned with those people who could and should and do not.

Claudia Wood: I think if you promote it to disabled people as a population, you are not going to be able to not promote it to people who are not necessarily yet claiming it. It is hard to segment your target market and say, "We will cut down 20% of existing claimants, but in the furore of doing this, we may actually attract new claimants from the wider disabled population that had not been applying for DLA." There is a double-edged sword there.

Chair: I think we will move on.

Q15 Debbie Abrahams: Lovely to see you all. We have just talked about the unmet needs that we are currently experiencing in terms of DLA, and yet the Government is arguing that there has been such an increase in claimants over the last nearly 20 years, and there is a hidden suggestion there is something underlying this. What is the evidence around why there has been that growth, and are you also able to forecast, based on current understandings of claimants, how this will grow both for DLA and then thinking about PIP as well?

Professor Fothergill: Can I take this one, because I think it comes into my particular area of expertise and research? What I am about to say here may seem slightly unconventional, but it is supported by the evidence. The big increase in DLA claims over the last 20 years has very little to do with any deterioration in the underlying health or disability of the working age population. In fact, it has everything to do with the labour market. That comes through particularly clearly when you look at where the DLA claims are. We are not on about a phenomenon here that is spread evenly up and down the country. It is distinctly skewed.

In some of the older industrial areas of Britain-places like the Welsh Valleys, Merseyside, West Central Scotland, North East England-you will typically find something like 7% or 8% of all adults of working age are out of the labour market and receiving DLA as well as Incapacity Benefit (IB). If you come to the leafier suburban parts of southern England, it is around about 1% to 2%. What this is telling us is the big increase in DLA numbers is intimately bound up with the increase in Incapacity Benefit numbers we have had over the last two or three decades. What has gone on is that, in the difficult labour markets up and down Britain, we have had a diversion of people without work with health problems on to Incapacity Benefits rather than unemployment benefits.

Then many of those people on Incapacity Benefits have had to look around to see what they can do to maximise their household income. If they have considerable health problems or disabilities, they have then applied for DLA as well, and quite a high proportion have successfully qualified for DLA. So the process of causation, as I see it, and I think this is rooted in hard evidence and numbers, goes from a difficult labour market through to high Incapacity Benefit claims, and then on from that to high DLA claims amongst people of working age.

It has a further twist to it as well. Once you are on DLA, even if you then successfully return to work you do not necessarily have to automatically give up your DLA. DLA is supposed to offset the costs of disability whether you are in work or not. What you also find is that the adults of working age who are in work and receive DLA are concentrated in exactly the same older industrial areas and weak labour markets as the adults who are out of work on DLA. That is because through time some do manage to re-engage with the labour market.

Then a further twist beyond that is once people reach state pension age they lose their entitlement to IB and they go on to State Pension, but again they do not lose their entitlement to DLA. That has been carried forward into a generation that are now beyond State Pension age. So it is the weak labour markets in certain parts of Britain that is really driving all of this. That is what I would say.

Q16 Debbie Abrahams: Can I follow that up then? So you are saying the key driver is around labour market conditions.

Professor Fothergill: Yes.

Q17 Debbie Abrahams: So what proportion then of DLA claimants/recipients would you say that relates to? What proportion relates to people who have long-term if not lifelong conditions that will never change?

Professor Fothergill: I am not saying people who get DLA who are out of work are doing it in any sense fraudulently. They have real health problems and real disabilities. But ill health and disability has never been an absolute bar to working. What you find in the stronger labour markets of southern England is that people with health problems and disabilities largely do work. I mean there are still some who find their health or disability obstacles too formidable to secure employment. But in weaker labour markets, poor health or disability, along with low skills and advancing years, is one of the great discriminators that determines who is going to hang on in the labour market and who is not. So I am not in any sense saying there is fraud, but I am saying that a significant proportion of those on DLA in the weaker labour markets of Britain would almost certainly have been in work in a stronger local economy.

Q18 Debbie Abrahams: Can you quantify significant proportion?

Professor Fothergill: Not off the top of my head, but my hunch would be that you are talking about probably half.

Stephen Lloyd: Good Lord.

Q19 Brandon Lewis: Just on that point, I am interested in the comments you have just made. It builds on some thoughts from when you presented to a group I was in on the coastal town employment levels, which have some similar issues. If other reforms that are going on at the same time, such as the Work Programme, were successful, and social mobility and employment levels increased in those areas over a period of time, would you take the view that a reduction would therefore occur in those areas, with people getting back into a healthier work environment, if you like, in the sense there is more employment in those areas where the Work Programme is successful. There could be a gradual drop off in the people who would, if it was there, claim DLA, because they are now in a better working environment.

Professor Fothergill: To get people back into work you have to have two things going on. You have to have support for the individuals. I do not think we should ever underestimate the scale of the support individuals need if they are on IB or particularly if they are on DLA. They have real physical and mental obstacles to working that need addressing. You need that help for individuals and that is one of the things the Work Programme is designed to provide. But you also need the jobs out there.

At the present juncture, my suspicion would be that the Work Programme may have some chances of success in the parts of Britain where the labour market is still tolerably buoyant, such as large parts of southern England and London. But it is going to have huge difficulties in making any inroads into either the IB or the DLA numbers in somewhere like the Welsh Valleys. It is precisely in places like the Welsh Valleys where you find by far and away the highest proportion of adults of working age on DLA and IB.

Q20 Brandon Lewis: If it was successful and there was the ability for jobs to be created that the Work Programme helped people into, you are saying that there could be that tail-off in the claimant level because people are getting back into that work opportunity. I am also conscious that some of the providers of the Work Programme are saying that in some of those areas you have mentioned, their problem is not demand; it is supply and getting people to actually work, but that is their issue. But if those jobs are there, the Work Programme works, so that could see a tail-off.

Professor Fothergill: If jobs are there, you can bring down benefit numbers, but it happens in a certain order. The first people who re-enter employment are those closest to the labour market, so they tend to be the people on Jobseeker’s Allowance. That is what happened in the first part of the long boom we had before the present recession. Once you get numbers on Jobseeker’s Allowance down to historically low levels, you then begin to erode the Incapacity Benefit numbers.

We saw that happening from around about 2003 onwards. It was not eroded as much as it should have been, but that is a different story, perhaps because the support was not there. Unfortunately, the way I would see it, though, is that the very last group who will tend to get brought back into the labour market are those not only on Incapacity Benefit but also the DLA group within the Incapacity Benefit claimant group. They do have somewhat greater physical or mental obstacles to working. But the evidence of large parts of southern England does say that if the economy is strong enough people do not hang around on sickness and disability benefits-they mostly stay in work.

Q21 Oliver Heald: Is it not also the case that the areas you are talking about are areas with poorer health? How do you justify pinning this on the labour market?

Professor Fothergill: Yes, absolutely. There are poor underlying levels of health, and I think you would always find that in some of the older industrial areas the Incapacity Benefit claimant rate was higher than in the leafier parts of southern England. If you go back a generation or so ago, before there was the huge job destruction in some of these places, you had much lower rates of Incapacity Benefit claims. We did not have DLA back in the 1980s, but far fewer people were out of the labour market on sickness benefits even though in that era more of the adult population had been exposed to, for example, the harmful effects of working down the pits, in the steelworks, or in heavy industry. It was only when the jobs disappeared that you began to get this surge in the numbers out of the labour market on Incapacity Benefits.

Q22 Oliver Heald: That is not to do with the structure of benefits, which of course was different in those days.

Professor Fothergill: It is in the sense that, if you are going to be out of work, the best benefits to be on long term have tended to be Incapacity Benefits, in the sense that financially in most household circumstances you are marginally better off being on IB rather than Jobseeker’s Allowance. You also have fewer demands placed on you. You do not have to sign on every fortnight and you do not have to look for work. Those would be quite onerous demands if you know you also have health problems, and out there in the world employers are not going to look at you because of your poor qualifications, your age and your poor health.

Q23 Oliver Heald: Unemployment is bad for your health anyway, isn’t it? I mean it leads to depression, for example.

Professor Fothergill: It does. There is quite a lot of evidence that, once on Incapacity Benefit, a single health problem can then multiply. Many people who may go on initially for physical reasons develop things like depression as well after an extended period out of the labour market.

Q24 Karen Bradley: Picking up on what Brandon was saying just to clarify, are you suggesting that the evidence is that for people on IB and DLA who get back into work, because DLA is a benefit to enable them to live and to support them with their disability, the DLA claims will not go down even if the IB claims go down?

Professor Fothergill: We have not had a system where DLA has been automatically reassessed periodically, and reassessment is not necessarily triggered by reentering employment. If you do successfully move from being on Incapacity Benefit with DLA into work, you can carry your DLA forward. That has resulted in the situation where exactly the same areas that have high DLA claims out of work have high DLA claims in work as well.

Q25 Karen Bradley: So I am correct in understanding that, if we had the Work Programme, for example, and there were jobs available, we should not expect to see a sharp drop in DLA claims? They would still carry on at a plateau?

Professor Fothergill: It would not happen automatically, but of course the introduction of regular reassessment in the Personal Independence Payment system would presumably tend to begin to filter out some of those people who have managed to go back into employment. At least a proportion will have done so because their underlying health problems or disabilities have eased.

Q26 Chair: Does your analysis therefore explain the low take-up we have heard about already, because basically it is an economic driver? In other words, when a family or an individual’s income drops because they are out of work, they look around to see how else they might maximise their income, realise they have a disability and apply for DLA, and get it and keep it, whereas someone who is in work or living in a more affluent family does not even think of applying for it at all, even though they may have the same level of disability as the person who has been out of work.

Professor Fothergill: I think that is a very plausible theory that is consistent with the evidence.

Q27 Chair: So the take-up is high in the areas you are talking about.

Professor Fothergill: Yes.

Q28 Chair: But the take-up is low in the more affluent areas.

Professor Fothergill: Yes.

Q29 Chair: When I applied for mobility allowance, I was a student, and had I become as disabled as I am once I was an MP, would I have applied for it? Probably not. I suppose that is very much an economic determiner of who applies.

Professor Fothergill: Yes, if people with health problems or disabilities do manage to get by successfully in work they probably do not need to turn their attention to what they can get out of the benefit system. If we are honest, we are not talking about terribly large amounts on the lower rates of, for example, the mobility payments. This is only £17 to £18 a week. It is not going to be a central thing in your existence.

Claudia Wood: I just wanted to point out that we have to be careful not to think of DLA as an out-of-work benefit and that therefore increasing employment will resolve the number of DLA claimants. No one knows exactly how many DLA claimants work, but polling suggests it is around 27%. The DWP’s own research from last year suggested that a lot of people used DLA to keep in work. They use it for childcare and transport costs to enable them to stay in the labour market. There were suggestions that, if we think about it as slightly more of a benefit for people who are not working to prop up their income, there is a risk of assuming that once people are in work they will not need DLA or PIP. We have to remember that additional top-up of income is there for those additional costs that disabled people have to get into work and stay in work. I think we cannot lose sight of that.

Professor Sainsbury: I just wanted to add to what Steve said about the drivers for the increase in numbers, because the increase in the numbers is very striking, and it does deserve some sort of answer. A piece of work that came out earlier this year, again by DWP statisticians, tried to unpick some of this. From 2002-03 to now, there had been a 29% increase in the numbers on DLA, which I must admit struck me as very high. But this analysis attributed a third of that growth just to demographic features like the ageing population and the growth in the postretirement age numbers on DLA, so some of that growth went away. There is no reason to think DLA is doing a bad job or anything like that; it cannot be criticised for that increase.

The remaining increase was a genuine increase, and Steve has given one of the drivers for it. The analysis also draws attention to the big growth in the numbers of young people on DLA. There are a big spikes in the numbers of young people claiming DLA-teenagers and younger. This suggests to me the reason those numbers are increasing is because young children are living longer with severe disabling conditions, and probably take-up campaigns by disability organisations are having an effect. We know some representative organisations around specific disabilities and child disabilities are very, very effective. They will campaign, lobby and advertise.

Q30 Stephen Lloyd: I think there is another reason. As Professor Fothergill was saying, in those areas where there is high employment, historically you have a higher percentage of people on DLA. One of the challenges is unfortunately there has been very high youth unemployment for the last few years, and that might fit with Professor Fothergill’s premise that consequently you are going to have a spike in DLA.

Professor Fothergill: Yes and no on that one, actually. Although the increases might have been quite sharp amongst younger people, we do need to bear in mind the DLA stock of claimants is still very skewed towards the older age groups. I am just looking at some figures here, admittedly for 2008, where the stock of DLA claimants who were also claiming IB, so were out of work, amongst the under-25s is only 75,000 compared with around 400,000 who were over 55. I do think we need to keep all of this in perspective. Generally speaking, ill health and disability does rise with age, irrespective of people who are coming through from childhood with disabilities. So it is this particular group towards the back end of their working lives who are often, if we are honest, discriminated against because of their age. If they then have poor qualifications and health problems, their chances of finding work are negligible. They have to maximise their benefit package. They look around and it becomes IB and DLA.

Q31 Glenda Jackson: Surely, one of the possible reasons for the spike in the number of young claimants has been simple improvements in medicine.

Claudia Wood: Absolutely.

Q32 Glenda Jackson: Children who normally would have died are now living.

Professor Sainsbury: There are a variety of reasons why these numbers have gone up and by so much, but in all this analysis I cannot see there is a bad reason for the increase. They are all understandable reasons. In some ways the increase could be seen as a success, given the low take-up that people have been concerned about for a long time.

Claudia Wood: And obviously the success of modern medicine.

Q33 Andrew Bingham: Claudia, you said broadly that when people get back into work they are using DLA for things like childcare. My question is: do we think that is appropriate? Obviously, there will be people who are in work who are not on DLA who have to find their childcare costs, so is that appropriate use of the benefit? Also, you remarked about the increase in the younger cohort, which disturbs me greatly. Have we got the figures to see whether that mirrors the regional variations in the wider take-up of DLA?

Professor Sainsbury: I will give the quick answer to that second point. The analysis from the DWP does not give that.

Andrew Bingham: Right, okay.

Professor Sainsbury: I do not know if we know.

Q34 Andrew Bingham: No, I was just curious given what Professor Fothergill had said about the regional variations.

Claudia Wood: DLA and PIP are not ring-fenced. You can spend it on whatever you want. One of the great things about this benefit is that you spend it on any additional costs you have related to a disability. Disabled parents may well have greater childcare needs and childcare costs than non-disabled parents.

Q35 Andrew Bingham: In what circumstances?

Claudia Wood: For example, if you have been at work all day and you are in a wheelchair, when you get home you need help with bathing your child and putting them to bed. Disabled parents often need more help in general, and having that childcare cost is related to your disability or your inability to lift your child as they get bigger and older, transport to school and all those sorts of things. There is nothing in the rules around DLA or the new proposed PIP that suggests you can only spend it on things that are related to-

Andrew Bingham: I was not suggesting that; it just caught my attention when you remarked on that, and I thought actually there are people who are not on DLA who will have childcare costs. It was the difference.

Q36 Karen Bradley: Presumably, they will have those childcare costs whether they are in work or out of work. If they have a need for childcare support because of their disability, it is irrespective of whether they are in work or not.

Claudia Wood: Yes, of course. One of the things that DWP found-it was done by Corden et al, if you want to look at it-was that a lot of working disabled parents said they found childcare quite costly, and they were using it and often needed it when they got home, because they were too tired and wiped out to get their children into bed after a day working. So it was not just childcare for non-disabled people, but that additional bit.

Q37 Andrew Bingham: That was the point I was trying to get to-the difference in the childcare costs that somebody in receipt of DLA would have as opposed to somebody who does not qualify.

Chair: I am going to bring Sue in, and then back to Professor Sainsbury.

Sue Royston: Just on that point, what clients tell us is that, if somebody has multiple sclerosis for example, if they have a part-time job two days a week, that wipes them out, so they need a lot more help with chores, ironing, washing and cooking. If they had been staying at home and not working, they could have perhaps managed those challenges. The other great cost that we find disabled people have regarding going into work is the transport to work, which is not usually covered by things such as Access to Work. We hear a lot more evidence about people using the extra help they get for taxis to work, etc.

Regarding the fact this is not a small amount, people on a low income would be entitled to the disability element of Working Tax Credit. The DLA will passport them to that, and the two together will make a quite significant difference to their income and will enable them to go into work. One of the things we are concerned about with PIP is if you remove that lower rate in effect, you are going to lose that passporting, and those people are going to find it increasingly difficult to go into work.

I just wanted to come back to something Steve said. We want to stress we see no evidence at all that on the whole people are receiving DLA that do not need it. If you look at the test for DLA, you need quite a lot of care to qualify, or for mobility. So these are people with very significant problems that do have considerably extra costs. There is a problem with take-up, and I did want to say about the complexity because there is an area where DLA is actually complex. It is about care in association with bodily functions, and it is very difficult for people sometimes to understand that. So there is a valid criticism of DLA there, but there would be ways round that.

For instance, we had a client with a child that was severely visually impaired. The parents in fact got help from the health visitor, and put down lots of care needs, but they were about feeding and so on. They were refused DLA. Of course, with a child that is severely visually impaired, you have to structure the language a lot more. Whereas you would point out a dog across the road and say "dog" to develop the child’s language, you would have to push the pushchair over and think about how you were going to get across the concept of the dog to the child. That counts as care, but a parent would not necessarily see that. So something could be done.

Every severely visually impaired child is going to have that need. The decision maker should not be refusing that child because the parent has not written that down. At the very least, they should be ringing up the parents and saying, "Well, don’t you have to structure the language more?" So there are things that could be done. There are levels of complexity we did not talk about, but things could be structured to get rid of that complexity. If you structured it in that way so people knew who were going to be entitled, then take-up would be better.

Chair: I am very conscious of the time.

Sue Royston: Sorry.

Chair: I just want to know if Debbie has actually finished her line of questioning.

Debbie Abrahams: I think I have actually. It has probably been covered.

Q38 Chair: Everything has been covered. Professor Fothergill now.

Professor Fothergill: Could I just come on in this point as to whether or not DLA is going to people who should not be getting it. When I first came into this area, I was struck by how demanding the tests are for eligibility for DLA. It seemed to me that, if the rules are being properly applied at the present point in time, there is little reason to suppose anyone who is moving onto DLA does not have very considerable mobility or care needs, even to get the lower rate. But what does seem to me to be missing from the system as it has operated to date is that there has been no regular reassessment. In practice, about a third of the awards that are made by DWP are indefinite-in other words, for life. What that feeds through to over a period of time, because some of the people with short-term awards do drop out after a period, is that two-thirds of the entire stock of DLA claimants currently have that entitlement for life. So they can continue to get DLA on the basis of a medical assessment that might be 10, 15, even 20 years out of date. That is the area where I think there is a distinct question mark about whether the present system operates properly.

Q39 Stephen Lloyd: I am now going to move on to PIPs. The Government predicts that the working age PIP reform will result in a 20% reduction in expenditure by 2015 to 2016. You have touched on that a wee bit, but just on that premise, do you think that is a realistic target based on the approach they are going to be doing with PIP?

Professor Sainsbury: This is a really interesting aspect of all this because the 20% reduction in expenditure was mentioned last year, I think, in the Budget statements, before any consultation documents came out. And I wonder where that figure came from, because I have no idea. I can understand it as a target; if the Treasury wants to save 20%, then that makes sense. But to say it will without knowing what the criteria are going to be, what the thresholds are going to be on the points, what the rates of the new benefit are going to be, I really am at a loss to know where that 20% came from. As I say, if it is a target that is entirely understandable, because you then adjust your threshold rates, your points and your rates of benefit for each component, and you could achieve 20%. But you cannot say this will achieve a 20% target from the start. I think it is a very odd bit of the story.

Q40 Stephen Lloyd: Before I come to you, Claudia, I wonder if their premise underpinning that, not target as you say but apparent reality, is that the model they have used around re-assessment may well mean they think about 20% are going to drop out through re-assessment. That could be one possible answer. Claudia?

Claudia Wood: I took the 20% the same way as Professor Sainsbury did. Essentially, it is a slightly arbitrary target and they feel 20% of DLA claimants do not deserve it or that seems about the right level of saving, whatever the reason is.

Q41 Andrew Bingham: I think that is a very strong comment, to say that 20% do not deserve it.

Claudia Wood: Well, maybe that is the sort of level of saving they want to achieve, and I think you can retrospectively set your test to achieve that. It is not impossible to achieve; you just have to essentially make your test 20% harder. You can pilot it and reduce your numbers. So it is certainly achievable, but you could not say that 20% was based on anything. They are not psychic; they had not set the new PIP test up when that 20% was agreed, and I assume it is more of a savings target than anything more evidence based.

Q42 Chair: If you get rid of the lower tier, does that not add up to about 20%?

Claudia Wood: No.

Sue Royston: I have done some calculations on that and we think it is about 8%. So that is significant extra savings that have got to be made.

Q43 Oliver Heald: Yes, but of course the National Benefit Review did show about 11.5% overpayment. So if you take the two figures together, you are at about 20%.

Professor Fothergill: There is perhaps a salutary lesson to be gained from looking across at what has happened with the Work Capability Assessment for Incapacity Benefit. The initial assessments there by DWP were just 10% of people qualifying for IB would not qualify under the Work Capability Assessment for Employment and Support Allowance. In practice that figure has turned out to be at least 30%. We could be looking at a very much larger reduction in the numbers qualifying for DLA, depending on exactly how the criteria are set and interpreted. That 20% could turn out to be 40% if the experience of the Work Capability Assessment is anything to go by.

Q44 Stephen Lloyd: And also perhaps adding to that, going back to what you and others have just been saying, DLA by its very nature has not had any reassessment.

Professor Fothergill: Time-limited claims have been reassessed. If people are awarded just it for three years, then at the end of the three years it is reassessed.

Q45 Stephen Lloyd: In comparison with other benefits there has been very, very little reassessment. So I think where the Government’s model is coming from, similar to with the WCA, is when you have that reassessment, there will be a sharp drop-off. But if anything, it strikes me then as even more odd that they are bothering to spend £670 million on a new benefit. Why do we not just start assessing people on DLA? But anyway, we have covered that.

Moving on to my next point, because we have a lot to get through, from an empirical evidence perspective is it possible with the data that you have received, or that you have been working on, to accurately assess the likely impact of a cut in DLA or PIP expenditure? Have we got any evidence of what you think will be the consequence?

Professor Sainsbury: It is a good question, but a very hard one to answer. We do not know where these cuts are going to come and who is not going to get the benefit. If we think in the future existing claimants of DLA will be reassessed and those on the lower tiers will probably lose, then we can say that you could easily measure the financial impact on those individuals and families. There will be an impact there. How that feeds through to their lives will be very different for individuals-what they spend their money on, etc. So there will be an impact, and I suspect you would be able to do it, but you cannot do that now because we do not know exactly where the cuts are going to come.

Glenda Jackson: We do.

Professor Sainsbury: No, sorry, we do not know the levels.

Q46 Glenda Jackson: Not in hard statistical terms, but we are all, I am sure in every constituency, receiving notices from people, for example, of closures. My big one is day centres for certainly adults who are claiming DLA, and they are going to close. Those people are severely disabled, there is no way they are going to be able to form a company and provide a day care centre by grouping together. So there are already implications in train. Those kind of external supports that at the moment are provided by society, which are not individually bought necessarily by someone claiming DLA, are going.

Professor Sainsbury: I cannot disagree with that. I thought the question was slightly different though.

Glenda Jackson: Sorry.

Chair: I think we have questions that will wrap some of that up anyway.

Q47 Stephen Lloyd: Well, anyway, Sue?

Sue Royston: The Government have said they want to protect those with the highest level of impairment, but obviously the people with the highest level of impairment get the most money. So you are cutting more people if you are cutting the people on the lower level. We are particularly concerned, right throughout the Welfare Reform Bill, with the people with significant but not the most severe level of impairment. They are going to be the people who drop out of PIP and out of ESA because the descriptors have tightened on ESA. At the moment, if you are on lower rate care, you would get the disability element of Working Tax Credit.

The gateway through Universal Credit is going to be through ESA, so if they do not meet the descriptors there they will not get any extra help compared with somebody without a disability. So people with quite substantial levels of disability throughout the system are going to lose all the help, and it will be the same group that are going to lose throughout. They in effect are going to lose any sort of marker that says they are disabled even though they do have an impairment, which even more importantly, in some ways, will also mean that they cannot access things from a local authority-travel passes, leisure passes.

Glenda Jackson: It is already going on.

Q48 Stephen Lloyd: Those are very important points. How has the DWP responded specifically to you and others when you have made those very particular points-that the middle range group with pretty severe disabilities are going to lose out all the way down the piece. How are they are responding to you?

Sue Royston: I do not think they deny it. We have not had a firm response, but I think it is Government policy to help those with the highest level of impairment, and therefore the people that drop out of the system are going to be those with the less high level of impairment.

Professor Sainsbury: It is really interesting to reflect on why we had DLA as it was in 1992. The lower rate of care was introduced at that time because of research by OPCS, a disability survey in the late 1980s that showed people with less severe disabilities had significant costs because of their disability that were not met by the system as it was then with the old Attendance Allowance and Mobility Allowance. So it was a positive response to recognising there were costs of disability that were not addressed by the benefit system at the time, and DLA was reformed and a lower rate came in.

I have seen no evidence to suggest those costs have gone down for that group of people, or disappeared. They are still there. But this is the group to whom in the future society will say, "We recognise you have extra costs because of your disability, and we are not going to meet them."

Q49 Oliver Heald: Of course, when we introduced that in 1992, the estimate was that there were about 140,000 people who would need this help. In fact, I think it is 900,000-isn’t it?-who are receiving it. So isn’t it right for the Government to just re-examine this?

Glenda Jackson: But what followed on from that-

Chair: Glenda, I think we should let our witnesses answer the questions, rather than discussing it across the Committee.

Professor Fothergill: Could I just try to take up directly this question of who is the reduction in expenditure on DLA to impact on? The DWP’s own assessment is that DLA is principally but not exclusively received by households with below average income. Around about two-thirds of DLA goes to households that are below the average, though actually the very, very poorest households, the worst 10%, tend not to be great recipients of DLA. What we also need to bear in mind is there is more than one thing happening simultaneously here, as has been mentioned.

The reduction in DLA will often hit the very same individuals and households who can expect to lose entitlement to Employment and Support Allowance, as Incapacity Benefit is becoming. They will lose it either because they do not qualify for ESA, or because they find their ESA is means-tested after one year, and other sources of household income then disqualify them from getting ESA. So for at least a proportion of people this is going to be a double whammy in terms of benefit loss, and that is going to be concentrated in the lower half of the income scale, if not always necessarily right at the bottom.

Claudia Wood: I just wanted to point out some research that I carried out last year looking at the drivers of disability costs. We did a survey of about 850 disabled people to look at what they were spending and how that related to the amount of hours of care they needed every week. We did not find a strong correlation between the amount of care you need every week and your disability-related living costs. So we do have to think about what PIP is trying to target. If PIP is to compensate people partially for the costs of living with a disability, should we not be targeting the people with the greatest costs, not necessarily the greatest needs? They do not necessarily coincide.

If we reserve it just for people with the greatest needs, there are going to be people there who have complex conditions who may have very well adapted homes, a partner who supports them and accessible transport, and do not necessarily have huge living costs. So there is a mismatch on the targeting there, and that could be inefficient for the Government. It is not just about people with low needs and high costs, but also about people with high needs and low costs getting more than they necessarily need. I think that is important.

Q50 Karen Bradley: I want to turn now to the overlap and what evidence there is as to whether DLA is providing help for people that also are being provided with help from, for example, social services at local authority level for the same care.

Sue Royston: Certainly, what we have seen is that people sometimes do use their DLA to get specialist equipment or therapies, but usually because they are not available. A Macmillan advisor told us she asked a Macmillan nurse why all her clients were having to buy extra pads, and she was told it was because the NHS was rationing the pads, and so people were being told they had to wait until the pads were thoroughly soaked. If it is about independence; those people were embarrassed to go out in that situation, and so the DLA is actually helping them to be independent if they use it. That is one small example, but it is the sort of thing where people will use their DLA because things are not available that are currently thought to be so in other places, and that prevents them from being independent and socially included.

Claudia Wood: Additionally, if you look at the Dilnot Commission Report around social care funding that came out in July, it explicitly was saying people should be using their DLA for things that fall beneath the eligibility criteria of social care if you are a self-funder or if you do not have substantial and critical needs but you still have some care needs. If you have moderate needs, that is still a substantial amount of care you need; you are not going to get anything from local authorities necessarily, and your DLA can top up on that shortfall.

Ironically, I think the PIP assessment focusing the funding more on higher need, if you look at the descriptors of the assessment, would suggest you are increasing overlap between social care and benefits by pushing it up towards the acute end of the needs spectrum. We were talking about the double whammy; essentially people below the eligibility of local authority social care will also be below the eligibility of DLA and PIP.

Q51 Karen Bradley: So could you see a situation where local authorities start to withdraw free services that they consider are covered by the DWP DLA or PIP payment?

Claudia Wood: At the moment, I think about a quarter of local authorities ask people to contribute their DLA towards their care costs, and the majority take it into account as a form of income. So it is not as if there is not an interrelation there.

Professor Sainsbury: The policy overlap in social care is very interesting because DLA is not a social care benefit. It is very easy to conflate the two because we have proxy measures for measuring the cost of disability, and we have care and mobility. It is something that has got fixed, I think, in people’s minds-that this is a benefit for social care. I think that is where Wanless got it wrong some years ago by assuming that was what it was for. It is not, and what people spend it on and use it for is much, much wider than social care.

I will correct my figures if I get a chance later, but I think I am right in saying studies have shown recently that only about a quarter of people spend their DLA on what we understand as physical social care-people helping them dress, wash, etc. Most expenditure goes on a huge range of other things, such as gardening, dog walkers, paying for the television licence, etc, which enhances people’s lives and offsets the cost of their disability, because costs of disability are not just financial costs. If we are going to take the social model seriously, there are social costs of disability.

So when we did our research some years ago and found people using their DLA very imaginatively, it blew our minds. If I can give just a couple of examples: the lady who did spend her DLA on a dog walker, because if she did not, because she could not get out, she could not have a dog. Her dog was her friend, and her well-being was enhanced accordingly. Another example is a lady who spent it on a carpet. You think, "What, on a carpet?" She said, "Yes, now I have a new carpet I feel confident enough to ask my neighbours and friends round for a cup of tea." You may think these are incredibly imaginative uses of DLA, which we should all be proud of in some ways, rather than saying, "You have to spend it on extra food, extra fuel or extra heating," or something like that.

Glenda Jackson: Absolutely.

Q52 Stephen Lloyd: So what do you think then when the Government originally made the announcement of removing the mobility component for residents of care homes? There was an outcry on the Coalition backbenches as well as in the Opposition. The Government reined back and said that they would not do it for a year or two, but clearly their direction of travel is, "Listen, social services should be doing this, and DLA mobility means that social services are not doing it. That is not right because social services should be doing it." So what do you think of their whole direction of travel?

Professor Sainsbury: Just to reiterate that example: if someone’s mobility is restricted, they might use their DLA to compensate in some way-not actually use it for travel even, but get the big telly in. This is what people do so they have a nicer life. They cannot get out and they do not want to go out particularly, but the social costs of having difficulty with mobility are offset by having a nice telly because their wellbeing goes up.

So the point you are making there is about people in residential care homes, isn’t it?

Stephen Lloyd: Correct.

Professor Sainsbury: There was an outcry about restricting the mobility components of that group of people, and you are right-the Government is now treading water on that for a few years and reconsidering it. But again, it is sort of misunderstanding of what this benefit was originally about, still is about it seems to me, and how it is actually used to enhance people’s lives and offset the social and financial costs of disability.

Q53 Karen Bradley: Do you feel that there is a communication exercise the Government has to do on DLA, and obviously PIP in the future, to make people aware and understand what they envisage DLA will be used for?

Professor Sainsbury: I do not think the Government does envisage what DLA should be used for, do they? I have never heard a statement from any Government to say how you should use your DLA. I mean it is the best personal budget you could have, isn’t it? It is like having a wage. No one is telling me how to spend my wages.

Q54 Karen Bradley: Maybe the communication should be that it is free for people to spend as they see fit.

Professor Sainsbury: That is the message. I think it is only confused when you get other debates about paying for social care and the overlap with the social services transport budgets, for example. So the answer is probably yes, there is never any harm in getting that message across loud and clear, but no one is giving the other message. When we get our work with advisers in DWP, Jobcentres and Citizens Advice, etc, they are all telling potential claimants of DLA, "You can use this for anything. Don’t be worried; don’t think you have got to use it for anything." "Oh, but I don’t need anyone to actually get me out of bed." But if it takes you two hours to get out of bed and then you are knackered for two hours, you might qualify, and then you can use it however you want to spend it. The message going out from advisers within and outwith Government is always that this is a benefit for you to use because you have a disability or health impairment.

Q55 Karen Bradley: To summarise, are you saying there is no overlap with DLA and other budgets within the NHS and social care?

Professor Sainsbury: It is hard to say whether there is or there is not, but people do spend their money on care, and there are care budgets elsewhere, but they are separate.

Claudia Wood: I personally think that because money is quite tight for most disabled people-I mean a lot of people who receive DLA are unemployed and have care needs which are not meeting eligibility criteria on the social care side-out of necessity that DLA will have to be used on the most important things to them, which is getting them out of bed, for example. That is not to say that everyone is using it for that purpose; I just think in some cases where money is tight, DLA has to go on the basics, and when you are disabled the basics are care and food.

Sue Royston: Our experience is it is a very efficient benefit because people are able to spend it as suits them best. Some people will use it on pain therapies they cannot get with the NHS, because they say if they cannot get rid of their pain they cannot do anything else. Other people will use it for transport. It depends on the individual circumstances, and the person is best placed to see what will help them be more socially included and enhance their lives and enable them to take a fuller part in society. So it seems to us an incredibly useful extra costs benefit that, by allowing people to spend on what will best enhance their life, is very efficiently used.

Professor Sainsbury: One of the interesting findings from our piece of work, and this was not a survey so we have got no numbers here, was those people who used it effectively to keep themselves out of social care, because the money they used could allow them to stay in their home. They could give their neighbour a little treat because they came in and helped them and maybe got them out of bed when they needed it. They were using it to enable them to stay at home rather than make a call on the social services budgets. So there was a sort of overlap in the opposite direction, if you like.

Q56 Karen Bradley: But because local authorities have different approaches, presumably some people are using it for social care, perhaps to pay for their meals on wheels or something like that, because their local authority does not provide that free of charge. In other local authorities there would be an overlap because they are getting free meals on wheels, which they therefore do not have to pay for out of their DLA.

Sue Royston: I think obviously there is an overlap in the sense that DLA is taken into account for social care, so some of the DLA is actually used to pay for social care.

Q57 Glenda Jackson: Increasingly, local authorities are means-testing for everything at the moment, and taking things away.

Sue Royston: Yes.

Q58 Debbie Abrahams: Can I ask a slightly different question then? In those areas where there might be different eligibility criteria around social care, so we get the meals on wheels example, are we then saying there are disabled people in other areas who are less likely to get as comprehensive and as wide quality of life because of the eligibility criteria there? So it is enabling an enhanced quality of life for some people but not for others. Would you say that is fair?

Professor Sainsbury: I think that is the nature of local autonomy, isn’t it? That would apply to so many areas of life. It depends where you live, on your local council and what they provide. No one from central Government is telling local authorities what to do, so the experience of individuals, whether they are DLA recipients or not, will be very, very different. And you are right, a good example is free meals on wheels or pay for meals on wheels. But I cannot see how that can drive DLA policy, to be honest.

Claudia Wood: Similarly, DLA levels are not regionally variable. So obviously what you can get for your income, regardless of where it comes from, will be different in London, when you are paying for transport, than it will be in other parts of the country, although we do have to remember about 80% of local authorities are at substantial and critical needs now. Those using DLA for the preventative, lower-level services would be the norm, I imagine.

Q59 Chair: From what you are saying, Professor Sainsbury, a single assessment would not work therefore between social care and DLA because they are actually assessing different things.

Professor Sainsbury: I think so. Clearly, there is an overlap because some people will use their DLA to pay for bits of social care if they want to, but they are doing very, very different things. This is not a care benefit. We use care as a proxy, and some people have criticised that, and that is a historical legacy too because when we amalgamated the old Attendance Allowance and Mobility Allowance we brought in care and mobility, and we stuck with them. We could have done something else and we could do something else now. The proxies are the proxies. This is not a care benefit; it is about offsetting the cost of disability.

Q60 Glenda Jackson: We are moving on now to the changes in the qualifying period. At the moment for DLA the qualifying period is three months. It is now going to be doubled for PIP to six months. Has anybody looked-well clearly, Sue, you have-at what the likely impacts are going to be?

Sue Royston: Yes, this is something we are very concerned about because obviously the two big things that Citizens Advice Bureaux (CAB) advise people about are debt and benefits. Consistently, CABs over the years have done surveys of the reasons why people get into debt, and consistently in about a quarter of cases serious illness is the most important reason, particularly when somebody has a sudden onset. Say somebody is working and earning say £400 or £500 a week, and then has a diagnosis of cancer and suddenly has to stop work. Their budget and their life is fixed at that level of income, and they suddenly find themselves dropping to SSP2 levels. It is a dramatic drop in income and it is very hard to adjust. They may have a small amount of savings, but those savings very quickly go. It is not surprising that people get into financial difficulties.

We see a lot of people in financial difficulties because of this-a stroke, a serious accident. We see a lot of people that get into serious financial difficulties because they have to wait three months. Obviously, at three months, not only does the DLA kick in but also, if they live on their own, for instance, at the moment the Severe Disability Premium then kicks in as well. If they have got a partner, then the Carer’s Allowance kicks in. So this makes a huge difference. We are seeing a lot of people in serious financial difficulties after three months. The idea of it stretching to six months really appals us. We are really very frightened about the results of that.

Q61 Glenda Jackson: Presumably, there are backdated payments after the three-month period.

Sue Royston: No, because to qualify for DLA you have to have had those care needs for three months, so your DLA starts at the three months. So you have three months just living on SSP basically.

Glenda Jackson: Right.

Q62 Chair: Is the answer to that, if the Government are going to go all this way of bringing in a brand new benefit, there should be a temporary benefit that people could apply for.

Glenda Jackson: A bridge.

Chair: Because I think part of the problem is DLA is a long-term benefit and therefore you have to prove a long-term need. But if the reassessments are coming in and more frequently, and they could happen at six months, that might help to answer the point you have made: somebody who for six months or a year has very high care or mobility needs, but after that they won’t at all.

Sue Royston: Yes, absolutely. If something could start immediately, that would be wonderful.

Q63 Chair: But that is not what the Government is proposing at all.

Sue Royston: No. One of the things that we have suggested, which we hope might be taken up, is that instead of the six months qualifying and the six months ongoing, if they want to go to a year they move to three months and nine months. That would be less good than the present system, but would at least be better.

Q64 Chair: Is the reason the Government has not thought of having a temporary benefit that once you have given people the money it is very difficult to take it away from them? That is why they want to prove that long-term need, because the Government is not going to be the big, bad Government taking money away from you after six months.

Professor Fothergill: I would not want to necessarily quibble with the notion that at the front end, when claims would first be made, the time limit of six months is going to have a detrimental impact on some people. But I think we need to keep it in perspective. The vast majority of DLA claims are long-term claims-very, very long-term claims. Of the 1.25 million who are out of work and receiving DLA, about 1 million have been receiving it for at least five years. So I do not think tinkering at the front end is going to make a very big difference to the overall numbers.

Q65 Glenda Jackson: But it is not the only change that is coming down the pipe, is it? We have already spoken about the kind of passporting of benefits, which is not going to happen, and how people will be taken off existing benefits for a variety of reasons. So I think we are justified in raising the possibility that this is, as Sue has said, going to cause really serious harm to people.

I have a constituent in precisely the case that Sue has quoted to us, and it is having serious implications over and above the illness she is actually suffering from, and she is going to be much, much more damaged.

Claudia Wood: Yes.

Q66 Stephen Lloyd: But also picking up on what Glenda is saying, Professor Fothergill, other than cutting costs, what is the rationale for the DWP to move it to six months?

Professor Fothergill: I think you would have to address that one to DWP, but I would assume they want to cut costs but also minimise administration, and particularly cut out what might be a very small number of very short-term claims that would be costly to administer.

Chair: I am going to move on because I realise we have still got some important stuff to do, particularly about the assessment criteria.

Q67 Brandon Lewis: I am aware that we are quite short of time. I want to ask something specific. We have had a general discussion, so I won’t go too far. There is a view that it would be too complex and expensive to have an assessment in time taking account of all the extra cost. But bearing in mind what was said earlier, particularly by you, Professor Sainsbury, do you think there is or could be a way that is not too complex or too difficult to assess as part of the assessment the social environmental factors, particularly obviously in an objective way, that could be taken into account?

Professor Sainsbury: The short answer is anything can be taken into account. As I say, we have care and mobility proxies as a historical legacy. You asked earlier, isn’t it right that we look at this benefit? I would say absolutely. But we have not had the discussion between Government and outside about what the benefits might look like in the future-a sort of blank sheet, as we have done with Universal Credit; very much, "Let’s start from scratch and see what we need."

We haven’t had that discussion with DLA. The reform was introduced last summer as something that was going to happen. The consultation paper itself only says, "This is a consultation paper about the assessment criteria," not about the need for reform or about the architecture of PIP. So we have not had that. I think if we did, it would at least allow us to look at, if you do want a benefit that is going to offset the cost of disability, how do we best do it? We have this historical legacy of care and mobility needs. They do not work perfectly. Could we do better? The answer is we do not know, because we have not even talked about it.

Q68 Brandon Lewis: You have probably answered my next question. Is there a way you can think of that you could assess these more social environmental factors in a way that does not become a huge grey area that is extremely subjective.

Professor Sainsbury: No, I think as soon as you add in things like that, which are very locally based, my social environmental factors are going to differ from someone across York, let alone in a different part of the country. Whether it is a good idea or not is one issue. Would it be complicated? Absolutely. But I know Claudia has got things on this.

Q69 Stephen Lloyd: On the 12-month issue, the DWP’s current thinking is the PIP assessment will consider impacts of disability over a 12-month period. In your judgment is this likely to be a more effective and objective way of assessing fluctuating conditions? Because that has been an issue. Sue, going to you?

Sue Royston: I am concerned they are just using a timing thing rather than looking at the intensity of the problem as well as how often it fluctuates-having a system that just says, "Do you have this level of disability half the time?" and if you do not, you are out of it. I think it is worrying because that does not take everything into account. We would like to see a more personalised model. I accept there are problems. Scope has done some work looking at a more personalised model that considers all the barriers and takes an overall view. We think this would deal with fluctuating conditions in a rather better way than this, which seems objective, but actually by being objective fails the Government’s criteria of being personalised and looking at who has the greatest costs.

Q70 Stephen Lloyd: Would you agree, though, that it would provide more of an opportunity to take on board fluctuating conditions than the current system or not?

Professor Sainsbury: I do not think it does. DLA regulations allow time to be taken into account in making an assessment about whether the criteria are met. It is not set out in points, and it is not set out in half the time over a period of a year. But certainly all the DLA criteria are meant to take into account things like how long things are going to last, fluctuating conditions, how long it takes you to do things, etc.

I think the PIP draft regulations are an attempt to deal with fluctuating conditions, which are really very difficult to deal with, but I think it will be a nightmare for the assessors and for claimants. What evidence is going to be used over the course of a year to show I have a fluctuating condition that creates needs 51% of the time? I really do not know how assessors are going to do it, and I do not know what I have to do as a claimant to meet this particular criteria.

Q71 Stephen Lloyd: Have you seen the more personalised Scope proposals that Sue is alluding to?

Professor Sainsbury: I have seen them, and I cannot bring them to mind.

Q72 Stephen Lloyd: Do you think they could be a bit better? Because the reality is, as Roy has said, measuring fluctuating conditions, whether it is MS, mental health or what-have-you, is fantastically difficult. It is something I think is incredibly important. Other colleagues and I on the Work and Pensions Committee have been drilling away at the Government on this. It is quite difficult to come up with something that is a better measurement than I have seen than a 12-month period, even though I accept what you are saying, Professor, about how you show proof over a 12-month period. So what ideas would you have?

Professor Sainsbury: Do not forget, we are only talking about this because we have proxies of care and mobility. Fluctuating conditions are particularly relevant for the amount of help you need, certainly if you have good and bad days. It is only because we are stuck with these care and mobility proxies that we are actually having this conversation. If we went down your route and had a wider look at how we should be assessing costs of disability, we might come up with something completely different that would take a different approach to fluctuating conditions or do away with their relevance altogether.

Claudia Wood: I think we may not need to get hung up on that too much if we think your level of need or the complexity of your condition does not necessarily drive your disability costs. Having your own transport, suitably adapted housing and informal care networks drive a lot of disability costs. If we were to move to PIP, it would be really good to see that you would have to report changes in your circumstances to include, "I have been bereaved; I have been evicted and I now live in a top floor flat, which is completely unsuitable for my needs." But it will actually be, "Well, my condition has changed," which does not necessarily mean your life is more or less expensive. I think that would be an interesting one to do.

Q73 Stephen Lloyd: Sue, anything else?

Sue Royston: The Scope model basically uses the social care model, and the assessment would be similar to how social care is assessed.

Q74 Stephen Lloyd: Moving on to aids and appliances, which is a challenging one. They can be incredibly relevant to certain disabilities. The DWP have said it will deal with the issue sensitively and proportionately. In your view, is there a danger taking account of aids and appliances in the PIP assessment could discourage people from using them or not?

Sue Royston: It strikes us that DWP are slightly trying to have their cake and eat it, in that they are using the social care model to take money away from people in terms of aids and appliances but not using it where it increases people’s costs. We are concerned about the use of aids and appliances if it means that people are not then going to be seen as having those needs because using aids and appliances is often a very good proxy for extra costs. If somebody is in a power-assisted wheelchair, that makes them very independent but there are extra costs.

Q75 Chair: They need to buy the power-assisted wheelchair though. Has there been a softening of the DWP? It was really quite hard in the original consultation around this, but in drawing up the criteria has that softened a bit? Have they realised there are expenses attached to it?

Claudia Wood: I do think they recognise they would have built in an almost counter-intuitive feedback loop, which is, "Use your DLA or PIP to buy an aid and appliance"; you are therefore more independent, therefore you lose your PIP.

Professor Sainsbury: Therefore you lose your appliance.

Claudia Wood: Yes. I think we do have to recognise that aids and appliances generate their own costs. What you are really doing is transferring your costs. Before you had an aid and appliance you had to get someone to help you with it, and now you have one you have to charge your battery.

Q76 Chair: This takes us back to the questions that Karen was asking about the double accounting. The assumption was that the aids and appliances were provided free by either the health service or social care, when everybody with a disability knows that what you get free is often not what you require, or indeed not necessarily adequate to give you independence. Do you think that is why that came in in the first place? Perhaps on closer examination the Government is beginning to realise the overlapping expenditure they thought was there is not necessarily there.

Sue Royston: Yes, I think that probably has been an issue.

Chair: Okay, we had better move on.

Q77 Andrew Bingham: Given the timetable for the introduction of the assessment, do you think the DWP have made enough progress to finalise an assessment, or should they have made more?

Sue Royston: We are concerned that, although we have the draft regulations about what the descriptors are going to be, we have not actually got a points level. We still have no idea who is going to qualify, because unless we know what the points thresholds are going to be we have no idea.

Professor Sainsbury: My understanding from DWP’s submission to this Committee is they seemed to be engaged in testing over the summer. I have not seen anything in the public domain.

Q78 Chair: They certainly recruited people to take part in the test, but I do not think we have had any feedback. We might get that from officials.

Professor Sainsbury: I will just read this from their submission: "The assessment testing will be complete by mid-September." That was a month ago.

Chair: All right, so that is a question for us to ask.

Professor Ray Sainsbury: You might want to pursue that with DWP. If there is anything coming out of that, we would all be extremely interested in seeing what they think. We need to know where the points are going, how many, the thresholds, and the amounts of benefit.

Q79 Andrew Bingham: The DWP plan to use a commercial organisation to do the assessment, as they have for the WCA. Is that an inevitability and do you think there are some other commercial organisations, or is it just Atos and nobody else?

Sue Royston: We have been saying for a considerable number of years there is a systemic problem with face-to-face assessments. To be honest, there was a problem with face-to-face assessments when they were done within DWP as well.

Q80 Andrew Bingham: Such as? When you say a problem, can you give an example?

Sue Royston: Well our advisers have repeatedly reported that the accuracy of the reports produced in these assessments is not good, but there are two parts to an assessment report. The first part is meant to be a straightforward account of the interview the client has with the assessor and record what the client says. Then the second part is the healthcare professional using their own-

Q81 Andrew Bingham: Interpretation of it.

Sue Royston: Judgment, yes. Our advisers have repeatedly reported that first part is inaccurate. When we have presented evidence, Atos or DWP have always said, "Yes, of course there are some errors; it is a tiny proportion." We saw 200,000 queries last year about ESA. We see a huge throughput through Bureaux. Our advisers are telling us it is a systemic problem. Because Atos have a review, we have repeatedly requested they send a copy of the report when they do customer surveys, so that when the client is saying whether the doctor listened to them, it is an informed response. They can actually look at what the doctor has recorded they said.

We got nowhere with that request, so we have just done an indicative study where we looked at the accuracy of the reports. In order to make sure that we were not looking at clients who had had a poor assessment already we asked clients to take part in our survey before they had been to an assessment, and then the adviser spent the year following them through the process, and then asking for the report, and then going through the report with them and looking at the accuracy.

Q82 Andrew Bingham: I am sorry to interrupt you. Are these inaccuracies mistakes or are they assessments that people did not like? They were expecting one thing and got another, and they were more concerned about the result than a distinct factual inaccuracy.

Sue Royston: It was not about the result. In fact, out of 16 of the 37 reports we did, the adviser and the client felt they were seriously inaccurate. In nine of those 16, the person had actually been awarded ESA, so they would not have even known had they not seen the report.

Andrew Bingham: Sorry to interrupt you again, but the other 19 were fine?

Sue Royston: Sorry, no. We had a medium level and a good level. There were 11 that were absolutely fine-reports where there might have been one or two small mistakes, but they would not have made a difference.

Andrew Bingham: Tolerable, yes.

Q83 Stephen Lloyd: When were these done? Was it prior Harrington changes or post?

Sue Royston: Well, it would be done over the period, so some were prior and some were post.

Professor Sainsbury: Is this the DLA?

Sue Royston: This is for ESA, but we are looking at face-to-face assessments and the accuracy of them.

Q84 Stephen Lloyd: That is a shockingly high percentage. You are talking in the region of 35% inaccurate factual reports.

Andrew Bingham: But this was on a sample of 37.

Sue Royston: Yes.

Andrew Bingham: Not a big sample.

Q85 Stephen Lloyd: It is a tiny sample, I agree, but that is quite shocking.

Sue Royston: Statistically for those numbers if we had an approximately random sample, we could be 95% confident that, based on the criteria we used, and obviously it is the customer’s reaction to this report, the accuracy is between 27% and 53%. So we are just looking at a ballpark figure, but we used it as an indicative study to say, "This is evidence there needs to be independent research on the accuracy of these reports." We would like to see an independent study where the customer gets the copy of the report and reports on how well they are recorded. In some cases, there were really dreadful levels of recording of what the client had said.

We would also like to see some independent survey of the inconsistencies, because there were a number of inconsistencies. For instance, one healthcare professional recorded the person had epileptic seizures once a week, and then awarded the descriptor of once a month. The decision maker did not even notice that, and awarded the points for once a month. So we also looked at the inconsistencies.

Andrew Bingham: I would not contest you for that. My only observation on that would be 37 is not a huge number to do a sample on. I am not contesting your findings-I would not do that-but I think if you want to get a real body of evidence you have to get more than that.

Q86 Chair: To move it on, we are very well aware of the flaws of the ESA and the WCA, and we have taken evidence on that, so as a Committee we are very well aware of that. I think part of the suspicion amongst people reporting to us is they think that same technique will be used for PIP, and therefore they are particularly worried. So I suppose the question Andrew has asked is whether there is another commercial organisation other than Atos that can do these kinds of assessments, and do they have to be done in the way they are being done? You can still have the criteria; you can still apply it; but are there other companies anywhere in the UK or the world that do this kind of assessment, but much more sensitively and more accurately than what you have experienced from Atos?

Sue Royston: I do not know, but we are saying there is a problem with the way they are doing it in the 40 minutes.

Andrew Bingham: Yes, we have got that.

Chair: No, we understand that.

Q87 Andrew Bingham: I think we have got that. The question is, is it inevitable we have to do it the same way or is there another way?

Professor Sainsbury: There is one simple change you could make to this whole assessment procedure and that is to have a co-produced factual report. It is not left to the assessor, whether it is a medic or anyone else from Atos or anyone else, writing down what I have said and then doing this factual and then the interpretative report. Instead they say, "This is what I am writing down about you, Mr Sainsbury. I put down you can do this, you can do that." "No, I did not say that." "Oh, right, well…" and then you both sign that and you have got an agreed factual statement.

Now the interpretation by the assessor can be, "I have looked at all this; I have looked at the criteria; I think this." It is what happens with the advisors in Jobcentre Plus. They will sit down with a jobseeker and say, "I am putting down this; I am putting down this, because that is on the action plan."

Q88 Chair: And they show them the screen.

Professor Sainsbury: They show the result, "This is the action plan," and they both sign up to it.

Q89 Chair: If you phone the Tax Credit helpline, they automatically tape your call, which you can then recover if you have any dispute. Would there be any advantage in doing that kind of audio taping, or what you just suggested?

Professor Sainsbury: That is belt and braces.

Q90 Andrew Bingham: Sorry to stop you finishing, but if you start recording it, it almost has an air of "anything you say will be taken down," and you get the two tapes, and it all looks a bit like The Bill, doesn’t it?

Sue Royston: They are actually piloting recording it as a result of a recommendation by Professor Harrington.

Q91 Andrew Bingham: It could just give the wrong impression; that would be my concern with that.

Sue Royston: Yes, and you can get a copy of the report.

Andrew Bingham: Not by default

Claudia Wood: Professor Sainsbury’s suggestion would be far more low-tech but far more successful. Have it co-produced by essentially sitting down next to the person rather than opposite on the table. Not only does the person see what is going on, but there is less risk of tribunal and that sort of thing later. If you go through the process with someone and they buy into it and see the outcome, even if the outcome is not what they want, the chances of them complaining are much lower because they have actually been included in that process. They understand why that decision has been made as opposed to the more opaque system of someone putting something on a computer and you get the result without knowing why.

Professor Sainsbury: Because the criticisms are not always that he or she got it wrong, but, "I said all that stuff about going shopping and it is not there; it has been ignored." So again, a co-produced report would give the claimant the chance to say, "No, I want to put down that bit about how difficult it is get to the shops."

Q92 Andrew Bingham: Okay, I am just trying to move us along a bit because I am conscious of the time. The Welfare Reform Bill envisages an independent review of the PIP assessment within three years. Do you think three years is too long, too short or about right?

Professor Sainsbury: I suppose it is like a Harrington approach to it-to have a rolling review of these assessment criteria. Three years, you say?

Andrew Bingham: Yes, it is three years.

Professor Sainsbury: It sounds a long time to me.

Andrew Bingham: Right, that is fine.

Q93 Andrew Bingham: Without wishing to put words in your mouth, would you support an annual review, say, for the first few years while it settles down?

Professor Sainsbury: Absolutely, for the first few years, not for ever, because it is going to be so different. As Steve said about the WCA testing, the forecasts were very wrong. They said some 10% were going to lose IB but it is 30%. I think we need to make sure this test, whatever it will look like, is on the right track early on. So I think annual to start with would be very sensible.

Andrew Bingham: Do you want me to carry on?

Chair: I think Stephen has a question on this, and then you can carry on.

Q94 Stephen Lloyd: I was going to go onto the media one, because it is something that has come up an awful lot-the reporting in the media around both DLA and PIP, and generally the whole changes around disability. Because we have four of you here, I would value your thoughts. The Select Committee and individuals on the Select Committee and in the Chamber have been quite robust with the Ministers, saying, "Change the language. It is not helpful," etc. The Ministers for quite a few months now said they have changed the language. Obviously, they do not have any power over the Daily Mail, God bless it, but despite that there is still a view out there that the language is very negative. However, the Government are saying, "What can we do? We have changed; Ministers are not using the sort of language that they may have been using seven or eight months ago. It is not our fault, guv." What is your take on that, bearing in mind we do have a "free press" who obviously have a particular line and agenda whenever they are talking about disability and benefits. So what is your take?

Sue Royston: Just very recently there has been an article about naughty children syndrome and getting a higher rate of mobility if a child is naughty, which was completely inaccurate. We are very concerned. Disabled people are repeatedly telling us how worried and concerned they are about the situation and find it very distressing when they have a serious impairment to have this continuous assault in the media.

One area we would be particularly concerned about is, in the same way as the reduction in numbers of ESA was played in the media, there is clearly going to be a reduction in the number of disability benefits, and we are very concerned about how that is going to be portrayed in the media. We would like to see that very carefully done.

Q95 Stephen Lloyd: I agree. Whether I like it or not, I have got no control over The Mail, The Sun, The Express whatever on this issue. What we are very careful about, though, and have been very specific with the Ministers, is they must change their language. The DWP must change the way they put out press releases, so they are more objective and, if anything, glass half full. This is trying to get people back into work, etc, as opposed to "benefit scroungers". The Ministers are insistent they have changed their language over the last X months. I am interested in from your academic and CAB background, is whether you think the DWP and the Ministers have changed and it is the usual suspects just writing the way they always do about benefits, or have the DWP not taken it on board?

Professor Fothergill: I was not going to comment specifically on the use of language, but I was going to say that where I think the Government has a very fair point that it does need to make is that DLA has been subject to remarkably little scrutiny over the years, given the extraordinarily large numbers of people who claim it and the very large amounts of public money that fund this benefit-£12 billion a year. Normally, there would be an absolute raft of studies and investigations into that sort of level of spending. So there is a fair point there. But I think the whole issue is never characterised very accurately. This applies not only to the Government but also the way the media seem to handle it, and that is to characterise the issue as being about individuals with acutely high levels of disability, electric-wheelchair users, for example. It is often quite wrong. We are talking about a much wider swathe of the population here. I think that needs to be made very clear.

The other thing that tends to be overlooked by virtually everyone is that this is about particular places. This is a benefit and a policy change that will overwhelmingly impact on certain parts of the country, but virtually leave the people in other parts of the country unaffected. They will not be completely unaffected, but this has a distinct geographical policy impact, and I do not think anybody has really addressed that very centrally at all.

Claudia Wood: In terms of the language, I think one of the common errors that the press make around ESA, which I am assuming will be applied similarly when the assessments come out, is they conflate new claimants with existing claimants. So they will say 800,000 people have been fiddling the system. Actually, that is the number of new claimants who have failed the new test, so they have not fiddled-they have not claimed anything they were not supposed to get-they just failed the new test. When that sort of press release comes out with the DWP, and these are recent and objective press releases, the quote from the Minister that comes out is, "This is why we must reform the system," as if there is something broken with the old system, which is why new claimants are failing the new test. It is that conflation that encourages this idea of fiddling when all it really is is the Government has decided rightly or wrongly to move the goalposts of the assessment.

At the Conservative Party Conference a couple of weeks ago, in Iain Duncan Smith’s speech there was a clear linkage between a long-term benefits claimants, IB claimants, and moral problems and rioters. In the same breath as talking about long-term benefits claimants, he talked about Baby P’s parents. The idea that somehow you have moral delinquency as a result of being on benefits for a long time potentially is true for a very, very small minority, but to make it into a social problem and create a moral panic I do not think is helpful.

Q96 Chair: The question of the figures for ESA is quite an interesting one. I tried to find out what the drop-out rate was for IB. Unfortunately, the Department did not keep those figures, so there are no comparable figures for new IB claimants and new ESA claimants. In fact, the profile might have been identical, but we do not know. For IB you would have to add the support and the WRAG (work related activity groups) groups together, but it could be quite similar. Would they be able to do the same with DLA, or do the figures exist for the numbers who are not awarded DLA? I think somewhere in our briefings it said 50% of those who apply are not awarded, which would suggest it is perhaps quite a tough test to get. So if the new claimant figures come out as 50%, then actually it is no different from existing DLA. But do those historical figures exist to make those comparisons?

Professor Sainsbury: There are certainly figures on numbers of DLA claims disallowed. They exist, and I have got them here actually somewhere in this pile. But to understand and get a better picture of what is happening, you would also need to feed into those the numbers that appeal after that and are successful. We are not just talking about tribunals.

Q97 Chair: And of course the new claimant figures are pre-appeal as well.

Professor Sainsbury: Exactly, so I think the figures are only about half of DLA original new claims succeed, but quite a lot of those go on and ask for reconsideration. That is a middle-tier appeal, if you see what I mean, before the tribunal, and a lot get overturned there. Then the success rate of cases going to tribunals is very, very high-somewhere in the region of 40%. So, ultimately, much more than 50% get their award. Some people indicated there is something wrong-that this is people making speculative claims.

Q98 Stephen Lloyd: Being realistic, is it possible that DWP or the Government would ever be able to change the language approach that certain sections of the media use?

Professor Sainsbury: I was very intrigued by your question, because I have not noticed any change in the language.

Q99 Stephen Lloyd: I have, to be fair. I mean other than the Iain Duncan Smith thing; I was a bit miffed by that.

Professor Sainsbury: You have been watching and I have not, but I think it is a very difficult one for the Government to sell because this is a policy that is going to save money. It is designed to save money. This is one of the rare policy changes where there are no winners. There are absolutely no winners; there are just losers-losers from people who are at a low level of disability who will not get PIP in the future, and for existing DLA claimants, who are going to be reassessed on to PIP. There are no winners, and this is a very, very hard one to sell. So the language we see in the documents is about fairness and responsibility and focus on very disabled people, but no one is fooled that this is a policy whose effect, in these austere times you can see why, is effectively to save public money.

Claudia Wood: I think some of the quotes at the bottom of the press releases, whilst they no longer say "scroungers and fiddlers," still often have a dichotomy between taxpayer and disabled person, which you see quite regularly as if they are mutually exclusive groups. You will often see, "We have tightened up the goalposts." In the appropriate ministerial quote that could be, "We have tightened this up because there is an austerity package in place and we have to have a narrower perception of what we mean by disability supported by the state." But what they say is, "This is why we have to get rid of people who have been on benefits for years," willingly conflating long-term benefits claims with new applications, and I think that is still disingenuous.

Q100 Chair: I think it is that conflating of figures we would be particularly concerned about as a Committee. One final question: is there a case for automatic entitlement to the new PIP for either particular conditions or people who have been assessed to death everywhere else and it is clear they have a severe disability-so some kind of either online assessment or a triage system so they do not have to go through the face-to-face interview? I am thinking here particularly of when the Benefits Integrity Project was introduced and the more severely disabled were getting visits or called into Jobcentres, or whatever they were called at the time, to go through interviews. Is there a case for automatic entitlement?

Sue Royston: I think there is a case for and against. We would like to see at least a minimum level of automatic entitlement, because there are some groups where it is quite clear they are going to be entitled to some. I think it would certainly help with take-up. I think part of the problem with take-up, going back to the beginning, is it is a complex benefit. If a doctor does not feel confident that you absolutely will get the benefit, they often will not recommend it. Therefore, if you could say that for certain groups of people there was an automatic entitlement to at least the lower level, that would be very helpful.

We can see a case for many groups putting an exact level on because we do not want to go too far down the route of the medical model, so we would like to see it more personalised beyond that.

Q101 Chair: But if someone has cerebral palsy, has no control over his bodily functions and lives life in a wheelchair, why do they need to be assessed?

Sue Royston: Yes, absolutely. We certainly see a case for not having face-to-face assessments in a lot of cases, even if there is not automatic entitlement.

Q102 Karen Bradley: Isn’t that the case with the Work Capability Assessment? If you reach a certain level of points on the completion of the form, then there is no face-to-face assessment. It is automatic.

Sue Royston: Yes, you can if you are in the support group.

Q103 Karen Bradley: So you would hope they might have something like that.

Sue Royston: Yes.

Chair: Okay, I am going to have to bring this to a close, because the House is now sitting and we always overrun. I think that has something to do with me and my chairmanship. Thank you very much for coming along this morning. I know there were lots of other things you wanted to say, but I think we have a good flavour for us to now go and interrogate some of our other witnesses with these aspects as we continue this inquiry. Interestingly, we are going off to Neath in South Wales, which has one of the highest level of DLA claimants anywhere in the UK, which we have discovered, I think, as a result of your research, Professor Fothergill. So that will give us a good insight into some of the things you have said. Thank you very much for coming this morning.