PIP and ESA assessments Contents

Summary

Employment and Support Allowance (ESA, introduced in 2008) and the Personal Independence Payment (PIP, introduced in 2013) provide vital financial support to disabled people. Claimants of PIP and ESA should be able to rely on assessments for those benefits being efficient, fair and consistent. Failings in the processes—from application, to assessment, to decision-making and to challenge mechanisms—have contributed to a lack of trust in both benefits. This risks undermining their entire operation.

Most claimants proceed through their PIP and ESA assessments without significant problems, but a sizable minority do not. Since 2013, 290,000 claimants of PIP and ESA—6% of all those assessed—only received the correct award after challenging DWP’s initial decision. Those cases, set alongside other recurring problems with applications and assessments, have ramifications far beyond the minority of claimants directly affected. Applying for PIP or ESA—and in doing so, facing up to the full limitations imposed by a health condition—can be stressful and challenging. A deficit of confidence in the assessment processes adds considerably to claimants’ distress.

Central to the lack of trust are concerns about the ability of the Department’s contractors to conduct accurate assessments. We heard many reports of errors appearing in assessment reports (which may or may not effect eligibility). Such experiences serve to undermine confidence amongst claimants. So does the proportion of DWP decisions overturned at appeal. At worst, there is an unsubstantiated belief among some claimants and their advisers that assessors are encouraged to misrepresent assessments deliberately in a way that leads to claimants being denied benefits. This reflects poorly on contractor assessors and on the Department. The Department must urgently address these concerns. Offering audio recording of assessments by default would reassure claimants that an objective record of their appointment exists, to call on in the event of a dispute. Providing a copy of the assessors’ report by default with claimants’ decision letters would also introduce essential transparency into decision-making.

All three contractors carry out assessments using non-specialist assessors. Without good use of expert evidence to supplement their analysis, the Department will struggle to convince sceptical claimants that the decision on their entitlement is an informed one. The Department should introduce new requirements on contractors explicitly to indicate how they have used all additional evidence supplied. The resulting checklist should be supplied to DWP’s Decision Makers, and to claimants alongside a copy of their report.

It is extraordinary that basic deficiencies in the accessibility of PIP and ESA assessments remain, five and ten years respectively after their introduction. The Department must ensure it and its contractors communicate with claimants in ways that meet their needs, providing Easy Read and non-telephone options where necessary. It should give clear, consistent guidance on home assessments, ensuring all claimants who need a home visit receive one in a timely fashion, and that the process for obtaining it does not place burdens on claimants or the NHS. It should also issue refreshed, clearer guidance on the role of claimants’ companions during assessments, ensuring their contributions are appropriately reflected in assessment reports. These are small, but valuable steps.

The Department maintains that high overturn rates of its decisions at appeal reflect the presence of new evidence that was not available to its decision makers. It has displayed a lack of determination in exploring why it takes until that stage for new evidence to come to light. This is all the more striking because by far the most common form of “new evidence” is oral evidence obtained from the claimant. It is difficult to understand why this evidence was not, or could not have been elicited and recorded by the assessor. The Department and contractors should use audio recordings to quality assure the whole assessment, rather than just the resulting report. Given what we know about reasons for overturn, this should focus on questioning techniques and ensuring claimants’ statements during the assessment are given appropriate weight. It should also ensure that, when claimants bring a companion to assessment, their input is sought and recorded appropriately. All of this will improve the quality of decision making and cut down on Mandatory Reconsideration requests, allowing for a more thorough investigation of decisions that are disputed. It will also save public money, reducing the cost of poor decision-making to the Department and the Courts.

Ultimately, while the Department sets quality standards, it is up to contractors to meet them. The Department’s existing standards set a low bar for what is considered acceptable. Despite this, all three contractors have failed to meet key targets on levels of unacceptable reports in any single period. In Capita’s case, as many as 56% of reports were found to be unacceptable in recent months. The Department’s use of financial penalties to bring reports up to standard has not had a consistent effect. Both Capita and Atos have seen increases in the proportion of reports graded “unacceptable” in recent months. Large sums of money have been paid to contractors despite quality targets having been universally missed. The Government has also spent hundreds of millions of pounds more checking and defending the Department’s decisions.

The PIP and ESA contracts are drawing to a close. In both cases, the decision to contract out assessments in the first instance was driven by a perceived need to introduce efficient, consistent and objective tests for benefit eligibility. It is hard to see how these objectives have been met. None of the providers has ever hit the quality performance targets required of them, and many claimants experience a great deal of anxiety over assessments. The Department will need to consider whether the market is capable of delivering assessments at the required level and of rebuilding claimant trust. If it cannot—as already floundering market interest may suggest—the Department may well conclude assessments are better delivered in house.





12 February 2018