5 The draft PIP eligibility criteria
103. DWP worked with an advisory group of specialists
in disability, health and social care to design the proposed new
eligibility criteria for PIP. The aim of the criteria is to enable
"accurate, objective, consistent and transparent consideration"
of individuals' eligibility.[137]
The first draft was published in May 2011. An informal consultation
on the criteria ran until August 2011. Alongside the consultation,
DWP also contracted Atos Healthcare and G4S Medical Services to
conduct trial PIP face-to-face assessments, using the draft criteria,
with volunteers who were current or previous working-age DLA recipients.
Following the completion of the trial, DWP published a second
draft of the criteria in November 2011, inviting further comments
from disabled people and their organisations. A further impact
assessment was published on 16 January and a formal consultation
on the second draft of the criteria was launched.[138]
This chapter considers the development of the PIP criteria and
the views on them put forward by disabled people and their representative
organisations.
The first draft
104. The PIP assessment will assess claimants'
ability to complete a series of activities that are "key
to everyday life". The level of ability in these activities
will be used as a proxy for eligibility for each component of
PIP and the rate to which claimants will be entitled—standard
or enhanced. The initial list of activities and an "indicative
weighting"—whether they would attract a low, medium
or high score in the assessment—were published in May 2011:
Daily Living component
1. Planning and buying food and drink - medium scoring;
2. Preparing and cooking food - medium scoring;
3. Taking nutrition - medium scoring;
4. Managing medication and monitoring health conditions
- low scoring;
5. Managing prescribed therapies other than medication
- low scoring;
6. Washing, bathing and grooming - medium scoring;
7. Managing toilet needs or incontinence- medium
scoring;
8. Dressing and undressing - medium scoring;
9. Communicating with others - high scoring;
Mobility Component
10. Planning and following a journey - high scoring;
and
11. Getting around - high scoring.
105. DWP has stated that the activities were
chosen to retain the same strong focus on care and mobility as
in DLA as these are still considered to be the best proxies. However,
they are designed to provide "a more holistic assessment
of the impact of a health condition or impairment on an individual's
ability to participate" than under DLA. The criteria also
aim to take account of a wider range of impairments than is the
case with DLA, including "sensory impairments, developmental
disorders, learning disabilities, cognitive impairments and mental
health conditions." DWP's intention is that the PIP criteria
take a less medical approach: "developing criteria which
are not based on the type of impairment individuals have but how
these affect their everyday lives".[139]
TRIAL ASSESSMENTS
106. The draft criteria were tested in trial
face-to-face assessments of 937 volunteers in summer 2011. Some
838 of the trial assessments were carried out by G4S Medical Services
and 99 by Atos Healthcare. They were conducted by health professionals
who produced a written report following each assessment. The health
professionals were "experienced" and had a "strong
knowledge of a wide range of health conditions and impairments".
They also underwent specific training in preparation for the trial.
[140]
Criticisms by disability organisations
107. There are two widely-used models for understanding
disability: the "social model" and the "medical
model". Under the social model disability is understood as
deriving from barriers placed on people with impairments by society.
These barriers include, for example, environmental and practical
barriers such as accessibility, where the physical environment
has not been designed with the needs of disabled people in mind.
Other barriers can include discriminatory attitudes and institutional
practices. The social model understands that it is these barriers
to participation that have the disabling effects on the individual
rather than the individual's impairments themselves. The social
model is able to encompass physical, mental, sensory, cognitive
and intellectual impairments. In contrast, a medical model understanding
of disability considers that people's impairments have the disabling
effect. It is generally accepted that the medical model is less
able to encompass the full range of impairments and is more likely
to focus on physical conditions. The Office for Disability Issues,
the public body whose role is to promote disability equality across
Government departments, fully endorses the social model and considers
the medical model to be outdated. [141]
108. A key concern of disability organisations
was that the first draft PIP criteria were overly medical and
did not pay due regard to the social model of disability. Scope
drew attention to the Minister's assurance, made before the publication
of the draft criteria, that the Government was "absolutely
committed to a social model" for DLA reform.[142]
The Minister reiterated this assurance to us, and told us the
assessment would be about asking claimants, "What are the
barriers to your living an independent life?"[143]
109. Scope argued that severity of medical condition
or impairment was not, on its own, a good indicator of additional
disability-related costs. According to research carried out by
Demos, social, practical and environmental barriers such as lack
of access to public transport, unsuitable housing and lack of
family or friend support networks are some of the most important
drivers of disability-related costs.[144]
This point was highlighted by a man who attended our public meeting
in Neath Port Talbot. He was a wheelchair user who was fit enough
to have recently completed a half-marathon. However, he faced
the same barriers to using public transport, for example railway
stations which are not fully wheelchair accessible, as less physically
able wheelchair users. As a result he incurred the same extra
costs using taxis. Eugene Grant of Scope was concerned that the
draft criteria as set out indicated an "overarching principle"
of defining ability rather than assessing barriers. He argued
this would only give part of the picture, allowing assessors to
only partly establish the barriers people faced.[145]
110. Scope, with the support of a range of disability
organisations, welfare advice groups and charities, has put forward
an alternative PIP assessment. The alternative assessment adopts
an approach that Scope says would take greater account of the
social model of disability by "accounting for the social,
practical and environmental barriers and the disability costs
that come with these". [146]
111. Dr James Bolton, DWP Deputy Chief Medical
Adviser, argued that, although the assessment as drafted was "not
a fully social model", it was "not a medical model at
all" as impairments would not be considered in a purely medical
way.[147] The DWP Minister
Lord Freud has also responded to criticism that the assessment
was based on the medical model of disability. He emphasised that
the assessment would not merely assess level of impairment but
would assess the impacts a range of biological, psychological
and social factors have on claimants' ability to complete a range
of activities vital for participation in everyday life. He referred
to this as a "bio-psycho-social model". He emphasised
that it would not be administratively feasible to take account
of every barrier or every extra cost a disabled person might face;
an assessment that attempted to do so would be "long, intrusive
and costly".[148]
112. However, a recent report on the Welfare
Reform Bill by our colleagues on the Joint Committee on Human
Rights concluded that an approach that took better account of
the social, practical and environmental barriers disabled people
face would be less likely to lead to incompatibilities with the
UK's obligations under the UN Convention on the Rights of Persons
with Disabilities.[149]
FOCUSSING ON THOSE WITH "GREATEST
NEEDS"
113. There was consensus amongst disability representative
organisations that "greatest need" was not an accurate
proxy for extra costs. Blind people's organisations argued that
a focus on need could run counter to the intention of the benefit,
the aim of which is to help towards the extra costs of disability.[150]
114. Claudia Wood of Demos thought that the Government's
approach risked conflating the definition of "greatest need"
with severity of impairment and that this would be an inefficient
method of measuring extra costs:
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.[151]
APPROACH TO FLUCTUATING CONDITIONS
115. In our inquiry into the reassessment of
Incapacity Benefits claimants using the Work Capability Assessment
(WCA), we highlighted the findings of Professor Malcolm Harrington's
independent review of the WCA for DWP. [152]
He identified that the WCA faced difficulties in assessing variable
and fluctuating conditions and pointed to the widely held view
that the WCA provided only a "snapshot" of health conditions
on the day of the assessment as it was not sufficiently flexible
to take a longer term view. The WCA also failed properly to assess
claimants' ability to repeat tasks and to take account of the
impacts of pain and fatigue.
116. After considering the issues in more detail
in his second annual independent review, Professor Harrington
concluded that the WCA descriptors needed to be more multi-dimensional,
in particular taking into account frequency, severity and duration
of symptoms. He also recommended that the criteria were clearly
worded to encompass claimants' ability to complete activities
"reliably, repeatedly and safely" and, where appropriate,
"within a reasonable amount of time".[153]
It is clear from Professor Harrington's second report that there
remains considerable difficulty in agreeing descriptors and the
assessment process in relation to fluctuating conditions (and
also for mental, cognitive and learning disability descriptors)
in relation to the WCA. This illustrates the need to give the
fullest possible consideration to these issues in designing the
PIP assessment.
117. DWP has stated that it is "essential"
that the PIP assessment deals effectively with variable and fluctuating
conditions. It originally set out its proposed approach as follows:
[...] decisions should be made having considered
the impact of impairments over a twelve month period and [...]
should consider impacts that occur for the majority of the time
in that period. If one of the assessment criteria cannot be completed
in the way described within the descriptors for more than six
months, aggregated over the twelve month period, then it should
be viewed as not being able to be completed at all.[154]
118. Professor Sainsbury acknowledged that effectively
assessing fluctuating conditions was "very difficult"
but he felt the above approach would be "a nightmare for
the assessors and for claimants".[155]
Mental health organisations agreed that this approach risked failing
to recognise the true nature of fluctuating conditions; they argued
that it would be perverse for claimants with moderate mental health
conditions that were present more than 50% of the time to be assessed
as eligible if claimants with severe mental health conditions,
such as acute psychoses, present less than 50% of the time were
not entitled to the benefit. This approach was unlikely to reflect
either need or additional costs accurately.[156]
TAKING ACCOUNT OF AIDS AND APPLIANCES
119. Disabled people often use aids and appliances
to help them overcome barriers to participation. Aids and appliances
include, but are not limited to: walking aids such as sticks;
wheelchairs; hearing aids; and computer equipment and software.
DWP's view is that the PIP assessment should take some account
of the use of aids and appliances to establish the correct level
of benefit people are entitled to.[157]
120. Several witnesses argued that taking account
of successful use of aids and appliances in assessing eligibility
for PIP could act as a disincentive to people actually using them.[158]
One individual who used a computer, in part financed through his
DLA, to help him to communicate felt that it would be "ridiculous
and discriminatory" if his successful use of the computer
to overcome his communication barrier counted against him in the
PIP assessment.[159]
121. The Disability Benefits Consortium emphasised
the importance of taking account only of aids and appliances that
are actually used rather than those that could potentially
be used. It also argued that people using aids and appliances
should still be able to qualify for the benefit, to reflect the
additional costs they often incur. These costs could include "buying,
charging and maintaining an electric wheelchair, fuelling and
insuring an adapted vehicle or even feeding an assistance dog".
It argued that such an approach would be necessary to maintain
the benefit's focus on meeting additional costs.[160]
122. DWP has accepted that aids and appliances
do not "remove an individual's impairment" and might,
in any case, incur ongoing costs to the people who use them. It
therefore acknowledged that its approach needed to be undertaken
"sensitively and proportionately". DWP gave an assurance
that the assessment would award points to people who successfully
use aids and appliances and stated: "It will be entirely
possible for individuals who use aids and appliances to receive
sufficient point scores to qualify for the benefit, as long as
they meet the criteria."[161]
The second draft
123. Following the summer 2011 trial assessments,
DWP issued revised draft criteria in November 2011. It stated
that, although "it has not been possible to reflect all comments",
the revised criteria "build heavily on the views of disabled
people and their organisations". The key changes that have
been made since the first draft are:
- The criteria now take account
of where the presence of another person is needed by referring
to "supervision" where this is required to enable
an individual to carry out an activity safely.
- Descriptors are designed to establish the impacts
of conditions which are present "the majority of the time"
i.e. on the majority of days. However, in order to "accurately
capture" the impact of fluctuating conditions, "where
two or more descriptors in an activity apply on less than 50 per
cent of days individually but reach this threshold when combined,
the descriptor which applies for the greatest proportion of time
will apply".
- In order to "ensure a broader assessment
of ability to make everyday decisions" the previous "Planning
and buying food and drink" activity has been replaced with
the new "Making financial decisions" activity.
- The previous "Communicating with others"
activity has been split into two new activities: "Communicating"
and "Engaging socially". The aim is to capture both
ability to communicate and ability to interact with others
in "an appropriate manner, understand body language and establish
relationships".
- A number of definitions have been broadened.
A "simple meal" is now one defined as made from fresh
ingredients — not frozen. Medication and therapy may now
be "recommended" rather than only "prescribed".
"Communication support" can be from any person experienced
in communicating with the individual, not just from someone who
is trained to provide that support.
- DWP states that it recognises that aids and
appliances "do not necessarily remove barriers and may
attract costs". Therefore descriptors that refer to use of
aids and appliances "normally attract a score".
The descriptors relating to mobility still concentrate
on the ability to move prescribed distances and on the need for
supervision. The opportunity has not been taken to consider more
fully the difficulties encountered by users of public transport
and the differential impact of location (for example, where the
routes to shops, workplaces or to reach public transport are hilly
or stepped). The explanatory notes accompanying the second draft
included suggested point scores for each of the activity descriptors.
However, the points thresholds for eligibility were not published
until 16 January 2012.[162]
124. The DWP Chief Medical Adviser told us that
a number of people who had taken part in the trial had fluctuating
conditions. DWP had learned from the trial and its approach to
such conditions had changed slightly. The assessment would now
assess a condition's impact on ability in "the majority of
the day" rather than "the majority of the time".
He felt that this approach would be easier to understand and apply.
The Minister told us that the assessment would consider whether
activities could be completed "safely, reliably, repeatedly
and in a timely manner". If a claimant could not repeat a
task due to pain or fatigue they would be considered unable to
complete the task at all. Dr Bolton said the approach to fluctuating
conditions would be considered further during a formal consultation
in 2012 and this has now been announced by DWP (see below).
[163]
125. Some of the changes outlined above have
been welcomed by disability representative organisations. Geoff
Fimister of RNIB told us that they signified that DWP officials
had been listening to their concerns.[164]
Amanda Batten of the National Autistic Society felt the revised
criteria were a significant improvement on the first draft and
"perhaps on the DLA form". She thought the descriptors
on social interaction and communication better reflected the difficulties
faced by people with autism, for example. However, witnesses also
felt that it would be impossible for 12 activity descriptors to
capture the impacts of complex conditions; Amanda Batten and Paul
Farmer of Mind felt that there needed to be some way for claimants
to describe their own conditions, as was the case with DLA.[165]
126. Scope believed the second draft of the criteria
was an improvement on the first but felt the changes made amounted
only to "tweaks". It was disappointed that its recommendation
to incorporate a range of social, practical and environmental
factors had not been implemented. Its view was that the assessment
remained a medical model test and therefore the risk remained
that the assessment would not be an effective measure of disability-related
costs. It highlighted what it saw as inconsistencies in the language
used to describe the purpose of the benefit; DWP had referred
to targeting "those with the greatest needs", "needs
arising from a health condition or impairment", "those
most affected by their health condition or impairment" and
"those who face the greatest barriers to participating in
everyday life". Scope urged DWP to make it clear that PIP
is intended to support those facing the greatest barriers to participation
in society. It was also concerned that DWP had included, at this
stage of the design process, suggested points scores for the descriptors
in each assessment activity. Its view was that this was an attempt
by the Government to move the debate on before proper consideration
of the "underlying principles" of the activity descriptors
themselves.[166]
Plans for further development
127. DWP has stressed that the development of
the PIP criteria will be an iterative process. On 16 January 2012
it launched a 15-week consultation on the second draft of the
criteria which will run until 30 April 2012. Its intention was
that "final draft regulations" would be laid before
Parliament later in 2012.[167]
128. We welcome the changes
made to the first draft of the PIP assessment criteria. We believe
they demonstrate that the Government has listened to concerns
expressed by disabled people and their representatives. DWP deserves
credit for the way it has involved them in the "co-production"
approach it has adopted to the development of the PIP criteria.
129. We fully support the Government's
intention to ensure PIP is fairer, more consistent and takes a
more holistic, "social model" account of the impacts
of disability. One of the Government's declared aims for PIP is
to improve on the assessment used for DLA. So far, mobility descriptors
still concentrate heavily on ability to move a fixed distance
and do not include barriers to accessing public transport, or
the difficulties of some locations for individuals where routes
to shops, public transport etc are particularly hilly or stepped.
The PIP assessment criteria, as drafted, tend towards the medical
model of disability. We recommend that, as part of the consultation
with disability representative organisations on the second draft
of the criteria now under way, the Government considers how activity
descriptors could take account of the impact of such factors as
housing, access to public transport and hilly locations.
130. We recommend that the Government
undertakes a further trial of the assessment criteria once they
have been revised following the consultation and that the results
of the trial are published before the criteria are laid down in
Regulations under the Welfare Reform Bill.
137 Department for Work and Pensions, Personal Independence
Payment: initial draft of assessment criteria: A technical note
to support the initial draft of the assessment regulations,
May 2011. Members of the advisory group are: Anne Byrne, College
of Occupational Therapists; Itai Chikomo, Community psychiatric
nurse/Deputy Manager, attending as an independent member; John
Chisholm, Royal College of General Practitioners; Hugh Constant,
Social Care Institute for Excellence; Judith Holt, Occupational
Therapist, attending as an independent member; Andy Rickell, Equality
2025; Marije Davidson, RADAR; Tom Sensky, Consultant psychiatrist,
attending as an independent member; Jenny Storer, Health visitor,
attending as an independent member; and Annette Swinkels, Physiotherapist
and researcher, attending as an independent member. Back
138
Department for Work and Pensions, Personal Independence Payment:
assessment thresholds and consultation, January 2012. Back
139
Department for Work and Pensions, Personal Independence Payment:
initial draft of assessment criteria. A technical note to support
the initial draft of the assessment regulations, May 2011. Back
140
Department for Work and Pensions, Personal Independence Payment:
second draft of assessment criteria: An explanatory note to support
the second draft of the assessment regulations, November 2011,
para 5.3. Back
141
See http://odi.dwp.gov.uk/about-the-odi/the-social-model.php Back
142
HC Deb, 30 November 2010, col 220WH. Back
143
Q 217 Back
144
Demos, Counting the Cost, December 2010. Back
145
Q 157 Back
146
Scope, The Future of PIP: a social model-based approach,
October 2011, p 4. Back
147
Q 239 Back
148
HL Deb, 14 November 2011, col 198GC. Back
149
Joint Committee on Human Rights, Twenty-first Report of Session
2010-12, Legislative Scrutiny: Welfare Reform Bill, HL
Paper 233/HC 1704, para 1.75. Back
150
Ev 72 Back
151
Q 49 Back
152
Work and Pensions Committee, Sixth Report of Session 2010-12,
The role of incapacity benefit reassessment in helping claimants
into employment, HC 1015, paras 101-105. Back
153
Professor Malcolm Harrington, An Independent Review of the
Work Capability Assessment - year two, November 2011, para
24. Back
154
Ev 103 Back
155
Q 70 Back
156
Ev 55-56 Back
157
Ev 103 Back
158
See, for example, Martin Wilsher, Ev w4 and Geoff Fimister, Q
161 Back
159
Martin Wilsher, Ev w4 Back
160
Ev 65 Back
161
Ev 103 Back
162
Department for Work and Pensions, Personal Independence Payment:
assessment thresholds and consultation, January 2012. Back
163
Q 240 Back
164
Q 157 Back
165
Q 157 Back
166
Scope briefing on the second draft PIP criteria, available at
www.epolitix.com Back
167
Department for Work and Pensions, Personal Independence Payment:
assessment thresholds and consultation, January 2012, para
1.8.
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