House of Commons - Government support towards the additional living costs of working-age disabled people

Government support towards the additional living costs of working-age disabled people - Work and Pensions Committee Contents

6 Implementation of PIP

131. This chapter discusses the assessment model for PIP in more detail. As described in the previous chapter, the assessment will award points to claimants on the basis of their ability to complete a range of activities. The assessment model is similar to that used in the Work Capability Assessment (WCA) for Employment and Support Allowance (ESA). We consider the lessons that need to be learnt from the WCA experience. We assess DWP's view that "most claimants" will require a face-to-face-assessment. We look at DWP's plans to deliver the assessment through contracts with private companies. We also consider DWP's plans for implementation of the new benefit and what needs to happen before implementation begins.

Similarities with the WCA

132. DWP's proposed assessment will be similar to the WCA in that claimants will "score" points against activity descriptors and their cumulative score will be used to help determine eligibility and level of award. A total of 8 points in activities 1 to 9 will be required to qualify for the standard rate of the daily living component; 12 points will be required for the enhanced rate. The same thresholds will apply for the mobility component, assessed against activities 10 and 11.[168]

As an example of how the PIP assessment will be structured, set out below are the descriptors in the "moving around" activity along with the proposed number of points a claimant will "score" for satisfying each descriptor:

No points - If they can move at least 200 metres either -

Unaided; or
Using an aid or appliance, other than a wheelchair or a motorised device

4 points - If they can move at least 50 metres but not more than 200 metres either -

Unaided; or
Using an aid or appliance, other than a wheelchair or a motorised device

8 points - If they can move up to 50 metres unaided but no further
10 points - If they cannot move up to 50 metres without using an aid or appliance, other than a wheelchair or a motorised device
12 points - If they cannot move up to 50 metres without using a wheelchair propelled by the individual
15 points - If they cannot move up to 50 metres without using a wheelchair propelled by another person or a motorised device
15 points - If they cannot either -

Move around at all; or
Transfer unaided from one seated position to another adjacent seated position.[169]

133. DWP is still in the process of developing the delivery model for the PIP assessment but it outlined some if its intentions:

Claimants will be allowed to bring another person with them to the assessment (e.g. family member, friend or advocate)
The assessments will take place on official premises or at a claimant's home where necessary
The outcome of the assessment will be advice to the Department to support decisions on benefit award and duration
Final decisions on entitlement will be taken by Decision Makers (DMs) within DWP
DMs will be able to consider all evidence provided as part of the claim before making a decision
There will be an independent review of the operation of the PIP assessment, the report of which will be laid before Parliament.[170]

This seems remarkably similar to the WCA model.

134. As we have noted, Professor Malcolm Harrington's first independent review of the WCA found some significant failings: it could be impersonal and inflexible; it lacked transparency; and poor decisions were being made due to a lack of communication between those involved in the process. He made several recommendations aimed at: improving DWP decision-making; making the process more compassionate; improving the transparency of the assessment; and taking account of particular difficulties in assessing certain conditions, in particular mental health and other fluctuating conditions.[171]

135. The Government accepted the Harrington recommendations and has made progress in implementing them.[172] In our report on the IB reassessment, we welcomed improvements made to the WCA process following the first Harrington Review but also noted that the WCA, as introduced in 2008, was flawed and that claimants had received a service from Atos Healthcare, the private company contracted to deliver the WCA, which fell below acceptable standards.[173]

136. Professor Harrington recently published his second annual independent review of the WCA, making recommendations aimed at further improving the process. He found that communication between those involved in the decision-making process (Jobcentre Plus Personal Advisers and Decision Makers, Atos Assessors and the First-tier Tribunal) still needed to improve. He also recommended regular audit of Decision-Makers' performance and regular publication of data to "ensure consistency and that standards are not allowed to slip".[174]

137. A number of witnesses urged DWP to heed the lessons learned from the Harrington reviews. For example, Citizens Advice Scotland stated:

CAS is deeply concerned that the introduction of a medical assessment for DLA will be similar to that used for Employment and Support Allowance (ESA) claims. The consultation does not acknowledge the recently published review of the work capability assessment, which raises serious concerns over how the system functions and clearly highlights how ESA claimants are not being treated with dignity and respect. The Harrington Review recommendations for changes to the WCA are enthusiastically accepted in an ESA context. Lessons need to be learnt from this review before any PIP assessment is introduced.[175]

The Disability Benefits Consortium claimed that any "rush" to implement the PIP assessment risked "history being repeated".[176]

138. Dr Bolton told us that DWP had learned a great deal from the Harrington reviews and that this was "central" to the development of the PIP assessment. The Minister emphasised that the purpose of the two assessments was fundamentally different but there would be some common learning and that DWP officials working on each assessment could share their experience.[177] The PIP assessment was intended to be a "conversation" between claimant and assessor, avoiding the mechanistic approach originally adopted in the WCA.[178]

139. We were encouraged by the language used by the Minister in describing the PIP assessment as a "conversation" between claimant and assessor. It is vital that the PIP assessment does not take the same mechanistic approach, based on an inflexible computer system, originally adopted for the WCA in 2008. We believe that healthcare professionals administering the assessments should take an empathetic approach that allows claimants to describe the impacts of their disabilities or health conditions on their everyday lives. We recommend that DWP sets out this principle in the published guidance for healthcare professionals on the assessment process. This approach will have implications for the time allowed for face-to-face assessments, which in turn must be reflected in the contract arrangements with the third party providers of the assessments. We would seek assurances from the Government that this will be taken into account in the contracting process.

CLAIMANT EXPERIENCE IN THE TRIAL

140. The trial of the PIP assessment discussed in the previous chapter focused only on the reliability and validity of the criteria. It was not designed to test the assessment process or delivery. Nevertheless, Dr Bolton told us that DWP had received excellent feedback from volunteers about their experience.[179] Some 198 of the 838 volunteers whose trial assessment was conducted by G4S Medical Services returned a customer satisfaction survey. Of those who responded, 92% commented positively. Atos Healthcare carried out 99 trial assessments but did not conduct a similar survey and was not required by DWP to do so.

141. However, disability organisations had concerns about the trial. Sense highlighted several problems experienced by deaf-blind people who took part, including: information for participants sent out in inaccessible formats; overlooking individuals' preferred method of communication; failure to book the correct communication support for people attending the trial assessment; and assessors' lack of awareness of deaf-blindness.[180]

142. The Disability Benefits Consortium told us that it had offered to take part in trials of the assessment but DWP had turned down its offer. It was also not permitted to witness the G4S/Atos trial, which it said had not reassured disabled people that "the new assessment is being developed in the most inclusive or transparent manner".[181]

Ending automatic entitlement

143. People with severe mental impairment, deaf-blindness, severe visual impairment, double amputees and those undergoing haemodialysis qualify automatically for DLA. The Government does not propose to allow automatic entitlement for PIP on the basis of any specific condition or impairment. It believes that this approach will allow for more personalised support based on individual circumstances. It "does not think it right" that people should be "labelled" purely on the basis of the type of impairment they have.[182]

144. Mencap sympathised with an individualised approach but also urged DWP to adopt a "pragmatic" approach.[183] Other witnesses appealed for particular degenerative conditions, such as muscular dystrophy and multiple sclerosis, to confer automatic eligibility or exemption from regular reviews.[184] Disability Alliance and RNIB both highlighted deaf-blindness as a condition unlikely to change and likely to incur ongoing extra costs over a lifetime. Geoff Fimister's view was that it would be "totally pointless" to subject deaf-blind people to the new assessment.[185]

145. Sue Royston of Citizens Advice acknowledged the arguments both in favour and against automatic entitlement. Her view was that there should be "at least a minimum level of automatic entitlement" for some groups. She felt that, even if there was not automatic entitlement for particular conditions, it was clear that some people ought not to be required to undergo a face-to-face assessment. She gave the example of someone with cerebral palsy who was a wheelchair user and had no control of their bodily functions.[186]

DO MOST INDIVIDUALS NEED A FACE-TO-FACE ASSESSMENT?

146. DWP stated that "an important part of the Personal Independence Payment assessment process for most individuals should be a face-to-face consultation with the assessor."[187] However, there will be some exceptions:

For example, where there is already sufficient evidence available to strongly support a decision on benefit entitlement, requiring individuals to attend a consultation may be unnecessary. In these circumstances, making an assessment based on paper evidence might be more appropriate. The Government believes, however, that such decisions on whether a face-to-face consultation is necessary, should be made on a case-by-case basis, considering the available evidence, not on the basis of the health condition or impairment individuals have.[188]

147. Some witnesses questioned the assumption that "most people" would require face-to-face assessment. Amanda Batten of NAS felt that this would be "impractical and unnecessary" for some people, although she could not estimate the proportion. At our public meeting in Neath Port Talbot, a parent with an autistic son aged 22 pointed out that his condition had required assessment over a two-week period by a clinical psychologist. She believed that an hour long PIP assessment by a medical professional with no expertise in autism would have little value in comparison. Her view was that evidence provided by medical experts with a long-term relationship with the claimant was the most reliable resource on which to rely.

148. Experience of the WCA shows that the prospect of a face-to-face assessment causes worry, stress and anxiety even amongst those who meet the criteria and easily qualify for ESA.[189] Geoff Fimister of RNIB believed face-to-face assessments had become "a bit of a fetish" within the current DLA reforms. He argued that the result could be not only unnecessary anxiety for claimants but also a waste of public resources. He also felt overuse of assessments ran counter to the Government's aim for more streamlined administration of the benefits system.[190]

149. The Minister confirmed that some individuals would not be required to attend a face-to-face assessment where there was already sufficient evidence on which to base a decision. She acknowledged that this would "not be a good use of either that individual's time or taxpayers' money." DLA face-to-face assessments, which are used much less frequently than is proposed for PIP, cost around £14 million in 2010-11.[191] The estimated cost of PIP assessment contracts is estimated to be between £300 and £500 million over seven years.[192]

POTENTIAL IMPACT ON THE TRIBUNALS SERVICE

150. Our Report on the IB reassessment drew attention to the increased number of social security appeals heard by the Tribunals Service. Our colleagues on the Justice Select Committee had found that appeals had increased from 242,800 in 2008-09 to an estimated 436,000 in 2011-12, mainly due to the introduction of ESA. They also reported that the cost to DWP of social security appeals heard by the Tribunals Service had increased significantly in recent years from £1.3 million in 2008-09 to £9 million in 2009-10 and an estimated £21.1 million in 2010-11.[193]

151. The Times recently reported that the Government had recruited 84 new judges to the Social Entitlement Chamber of the Tribunals Service in order to deal with the "bottleneck" of cases arising from the Government's welfare reforms. It reported that appeals in 2010-11 were up 23% on the preceding year and 72% on 2008-09 and that this "unprecedented workload" was a major contributory factor in increased running costs of the Tribunal Service.[194]

152. We agree with the Government that more reassessment of claims is necessary than has been the case with DLA. However, too frequent reassessment risks wasting public money and causing stress and anxiety to disabled people. The personal interview should play a part in assessing many PIP claimants. Face-to-face assessment should include the option for home visits where this is agreed to be appropriate. These steps may help to avoid cases going to appeal, with the accompanying costs and delays in resolving claims.

153. We consider that there is a case for automatic entitlement for some claims. The WCA is being carried out annually in a number of cases, which can cause considerable stress for some people. The case for annual assessment is less compelling for PIP than for WCA which is judging people's ability to re-enter employment. We recommend that there should be flexibility in the frequency of PIP reassessment and that the Government monitors the impact of this.

154. Once the initial assessments for PIP have been completed in the first geographical area, we recommend that the Government looks again at the value of face-to-face assessments for PIP claims where the condition is severe and unlikely to change. The Government should reconsider whether, in many cases, reliance on medical evidence gathered over a period of time and based on detailed knowledge of the claimant would have more validity than the snapshot of a claimant's condition and its impacts on their ability to participate in society which can be gained in a relatively short interview with a healthcare professional who is not an expert in their condition.

Contracting

155. As noted, the potential value of PIP assessment contracts is estimated to be between £300 and £500 million over seven years.[195] In our inquiry into the migration of claimants from IB to ESA, we recommended that DWP consider contracting more than one company to undertake benefits assessments when the current Medical Services contract with Atos Healthcare expires in 2015. We believed this approach would act as a lever to drive up standards through competition between suppliers. We also concluded that there were insufficient levers within DWP's contract with Atos Healthcare to ensure it produces accurate assessment reports on a consistent basis. We recommended DWP review the performance indicators in future contracts with a view to linking payment to a quality standard which ensured that assessment reports are "right first time".[196]

156. DWP's original intention was that the PIP assessment would be delivered separately from other benefits assessments through "a third party" contracted to the Department. Simon Dawson of DWP told us that the procurement process for the PIP assessment contract had already commenced. A Prior Information Notice (PIN) for potential suppliers of a separate PIP assessment was published in the Official Journal of the European Union in September 2011.[197] Mr Dawson reported a "considerable amount of interest" from a range of suppliers.[198]

157. The initial PIN has since been superseded by a PIN for potential suppliers to a new Health and Disability Services Framework. The competition for the Framework will identify "organisations (including consortia) that have the capacity and expertise to deliver" services in support of a range of functions, including decisions on social security benefits. The PIN states that the framework agreement will be divided into lots, meaning there will be more than one potential supplier for each region or area. The number of lots and the number of suppliers allocated to each lot is yet to be decided.[199]

158. The model for the framework appears to be similar to the framework for the provision of Employment Related Support Services (ERSS), used for the delivery of the Work Programme. The ERSS is essentially an umbrella agreement between DWP and potential suppliers who have in effect been pre-approved to bid for specific Work Programme contracts in specific lots. Our Report on the contracting arrangements for the Work Programme welcomed the establishment of the ERSS as a way of encouraging innovation and competition amongst different providers. We also welcomed the fact that it allows DWP to replace poorly performing providers with others from a pre-approved list.[200] We understand the competition for the PIP assessment will be the first to draw on suppliers under the new Health and Disability Services Framework.

159. We recommend that DWP contracts with private companies for delivery of the PIP assessment directly link the payment of public funds to the production of reliable assessment reports that are "right first time". We welcome the framework approach which has now been adopted for benefit assessment contracts and request further details about how it will operate, in response to this Report.

160. Experience with the Work Capability Assessment has demonstrated the need for large Government contracts with private suppliers which involve sensitive health and disability assessments to be properly monitored. We therefore request further information on how the Government plans to oversee and regulate the contracts for the PIP assessments. We would also like to see the contractors' communication with individuals who are deaf-blind reflecting their communication barriers.

Implementation plans

161. HM Treasury's original announcement of DLA reform included an assumption that PIP would be implemented from 2013 over 3 years, with 25% of current working-age DLA recipients reassessed in 2013-14, 75% of the total by the end of 2014-15 and 100% by the end of 2015-16.[201] DWP's submission contained no more information on timescales beyond confirming its intention to introduce the benefit for both new claims and existing working-age DLA recipients from 2013.[202] In December the Minister told us DWP would set out further details in the new year and that DWP was likely to consult on how the new benefit would be phased in. She expected implementation to begin with new claims then "build up from there".[203]

162. The DWP Minister Lord Freud, speaking in the Lords Report Stage debate on the Welfare Reform Bill on 17 January 2012, confirmed that DWP would move away from a "big-bang" approach to implementation. DWP's intention was that PIP would be implemented for new claims only from April 2013 and that the number of new claims would be limited to "a few thousand per month for the first few months". An amendment to the Bill tabled by Baroness Grey-Thompson, calling for a trial period for new and existing claims before full implementation of PIP, was narrowly defeated. However, a Government Amendment to the Bill agreed on 1 February 2012 allows the Government initially to implement new PIP claims in one geographical area.[204]

163. Reassessment of existing DLA claims is planned to commence in autumn 2013, beginning with fixed-term claims that were due for renewal or in which the claimant had reported a change in circumstances. DWP also plans to conduct a three-month "pathfinder trial" in autumn 2013 of reassessment of claims which would not, under the existing DLA system, be due for reassessment. Lord Freud expected the pathfinder trial to enable DWP to ensure the processes were working satisfactorily ahead of a full national implementation.

164. Lord Freud also announced revised plans for independent reviews of PIP; there would be two biennial reviews within the first four years of implementation. The first review would report within two years of the relevant Regulations coming into force; the second within four years.[205]

165. The high number and cost of appeals in the original WCA process highlights the risk in introducing a new benefit assessment without full consultation and thorough testing. The challenge of accurately assessing DLA/PIP claims is arguably greater than incapacity benefit claims. The WCA simply assesses capacity to work. The PIP assessment will need to provide an accurate indication of the impact of complex conditions and combinations of conditions on participation in society in a variety of life contexts. It is therefore essential that DWP allows itself sufficient time to get the assessment right and to be able to convince disabled people and their representatives that this is the case. Implementation timescales should not be driven by artificial deadlines set by HM Treasury before the details of the reform were known.

166. We welcome the Minister's confirmation that DWP does not intend to press ahead with a "big bang" approach to implementation of PIP and his commitment to begin with new claims only from April 2013. We note that the Government plans initially to introduce new PIP claims in one geographical area. The area should be selected on the basis of carefully defined criteria. The period prior to national roll-out should be used to prepare a methodology for monitoring the early lessons to emerge from implementation and to ensure that recommendations for changes can be made quickly, in consultation with interested bodies.

167. We welcome the Government's decision to bring forward the first independent review of the PIP assessment to within two years of the assessment Regulations coming into force and to have a second independent review within four years of that date.

168. As has been shown with the WCA/ESA process, reassessment of existing claims is even more complex and challenging than dealing with new claims. We therefore believe that reassessment of existing DLA claimants should only proceed once the Department is confident that the assessment is accurate.

INTERACTION WITH OTHER ASSESSMENTS

169. As we have highlighted, the Government plans to reassess around 1.5 million IB claimants for the new ESA benefit by 2014. Many of these claimants will be among the current approximately two million working age DLA recipients. The Disability Benefits Consortium reported that many disabled people already feel "over-assessed". Its view was that in many cases further "stressful and intrusive" assessments of the type proposed for PIP could cause harmful stress and anxiety and aggravate medical conditions.[206] Neil Coyle of Disability Alliance told us that many disabled people would prefer information to be shared between relevant agencies to establish entitlement for PIP and that the drive to personalise the assessment should be balanced against the potential impacts on health and wellbeing that frequent reassessment can have.[207] Mental health organisations urged the Government to make efforts to use existing medical evidence, for example that provided for WCAs, wherever possible to avoid the need for face-to-face assessments.[208]

170. The phasing in of the reassessment for Personal Independence Payment should take account of the timing for individuals of the Work Capability Assessment for Employment and Support Allowance. There is likely to be a significant overlap between the two groups of claimants and many disabled people may already have had one or more WCAs by the time the PIP reassessment is introduced. The cumulative impact of frequent reassessment on a vulnerable group of people should not be underestimated.

THE MOTABILITY SCHEME

171. DLA higher rate mobility component currently acts as a gateway to the Motability Scheme, which is designed to help disabled people to contract hire a specially adapted car, powered wheelchair or scooter. Some 95% of participants in the Motability Scheme use it to contract hire a car for three years, with the costs of tax, insurance, servicing and breakdown covered.[209] It is not yet clear which rate of PIP will confer eligibility for the Motability Scheme.[210] However, a number of witnesses were concerned that the new eligibility criteria for PIP could result in some current DLA higher rate mobility component recipients failing to meet the criteria for the enhanced rate of PIP and therefore losing their eligibility for the Motability Scheme.[211] Although, as we noted in chapter 4, it is not possible to ascertain from which DLA rate combinations the reduction in PIP caseload will come, it does appear likely that a significant number of recipients of higher rate DLA mobility will not meet the criteria for the enhanced rate of PIP mobility component.[212]

172. We recommend that the Government clarifies, in response to this Report, which rate of PIP mobility component will confer eligibility for the Motability Scheme. It should also clarify whether a three-year lease for a Motability car, signed when the claimant was a recipient of higher rate DLA mobility component, will be terminated if that person is found ineligible for the Motability Scheme under PIP. We believe it is important for the Government to provide certainty on these issues before reassessment of the working-age DLA caseload commences.

CHILDREN AND YOUNG ADULTS

173. The current proposals do not apply to children under 16 years of age. DWP has said that it will not come forward with proposals for reform of DLA for children until working-age PIP has been implemented and the experience can be used to inform its decisions.[213] A number of witnesses welcomed this approach.[214] The Disability Benefits Consortium reported that DWP had initiated discussion about how best to include children in PIP.[215] Citizens Advice recommended a separate and full consultation before any extension of PIP to children.[216] As we have noted, we are likely to look again at DLA reform once the Government has come forward with its proposals for non-working age claimants.

174. Several witnesses raised the issue of the implications of the introduction of PIP for young adults and those in the transition to adulthood. CLIC Sargent felt that the Government's distinction between non working-age (0-15 years) and working age (16-64 years) risked establishing a system that would not adequately recognise the "unique needs" of young people. It also argued that this approach would run counter to proposals to increase the participation age to 18 and those outlined in the Department for Education's recent Green Paper, which sets out proposals for a single coordinated assessment of disability and special educational needs and the creation of an education, health and care plan for those up to the age of 25.[217] CLIC Sargent argued that young people aged 16 to 18 should be treated as a distinct group from the working-age population and that reforms affecting them should be considered alongside those for children.[218]

175. DWP has stated that its objective in relation to young adults is to ensure "effective transition [...] from DLA to PIP at age 16". Its view is that 16 is the correct age at which people should be assessed against adult criteria. Its rationale is that young people over the age of 16 will have a choice of whether to remain in education, undertake training or enter employment and therefore applying PIP to 16 to 18 year-olds is "broadly compatible" with provisions to raise the participation age. However, DWP is undertaking work with organisations representing disabled young people on specific proposals for delivery of PIP for those aged 16-25. Views expressed during workshops in October 2011 included:

Young people moving from DLA to Personal Independence Payment at age 16 have specific needs and so should be a separate group—comparisons were made with the introduction of specialist child DLA teams which have been welcomed by children's organisations;
The Department should use learning from the assessment process for those aged over 25 to inform arrangements for children moving from DLA to PIP at age 16;
People aged 16-25 should be the "last" group to be migrated from DLA to Personal Independence Payment so that processes have been well-tested beforehand;
Young people should be encouraged to seek advice from a support organisation by signposting in claimant facing letters; and
Face-to-face assessments should be conducted by someone with experience in working with young people.[219]

176. We welcome the Government's decision not to include child recipients under 16 years of age in the current DLA reforms. We believe that DLA for children should not be considered until the reassessment of working-age claimants has been completed and fully assessed. For clarity, we recommend that the Government give a commitment that it will conduct a full and separate consultation on any future changes to DLA relating to children.

177. We welcome the work DWP is undertaking on the specific needs of young disabled people aged 16 to 25. We recommend that this cohort should be the last to be migrated to the new benefit. We also believe there is a strong case for 16 to 18 year-olds to be treated as a distinct group from the rest of the "working age" population. One option which should be explored is for the reassessment at the time of the migration to PIP to take place in, and with the assistance of, the young person's school or college.

168 Department for Work and Pensions, Personal Independence Payment: assessment thresholds and consultation, January 2012, para 1.4.

Back

169 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, pp 61-62. Back

170 Ev 105. DWP originally specified that the independent review would take place "within three years" but this was amended at Report Stage of the Welfare Reform Bill in the Lords to two biennial reviews; the first within two years and then within four years of implementation (see paragraph 164 below). Back

171 Professor Malcolm Harrington, An Independent Review of the Work Capability Assessment, November 2010. Back

172 Department for Work and Pensions, Government's response to Professor Malcolm Harrington's Independent Review of the Work Capability Assessment, November 2010. Back

173 Work and Pensions Committee, Sixth Report of Session 2010-12, The role of incapacity benefit reassessment in helping claimants into employment, HC 1015, para 92. Back

174 Professor Malcolm Harrington, An Independent Review of the Work Capability Assessment - year two, November 2011, p 8. Back

175 Ev w42 Back

176 Ev 65 Back

177 Qq 216-217 Back

178 Q 235 Back