PIP and ESA assessments Contents

1The importance of trust

1.Personal Independence Payment (PIP) and Employment Support Allowance (ESA) provide financial support to disabled people and those with long-term health conditions. The two are separate and serve different purposes. ESA is an out of work benefit, supporting people under the state pension age who have limited capability to work. PIP is intended to cover some of the additional costs of having a long term health condition, and is available to people in or out of work. Assessments for both benefits are carried out by contractors—Atos Independent Assessment Services (Atos), Capita, and Maximus Centre for Health and Disability Assessments (Maximus)—on behalf of the Department for Work and Pensions (DWP/the Department - see Box 1 and Figure 1).

Box 1: PIP and ESA Assessment processes

PIP and ESA have similar assessment processes. All claimants begin by filling in application forms detailing their conditions and their effect on their day-to-day lives. These are submitted, alongside any supporting evidence (for example, from medical professionals or carers) to the Department. The Department then forwards the forms to one of three contracted assessment providers. The contractors assess the claimant’s functional impairment against a series of descriptors provided by DWP. For some claimants, the assessment is made on the basis of written evidence alone. Most, however, are required to attend a face-to face assessment carried out by a healthcare professional (HCP) employed by the contractor. Following the assessment the HCP sends a report recommending descriptors to DWP, where a Decision Maker decides on entitlement.

If the claimant disagrees with the decision, they can challenge it by requesting a Mandatory Reconsideration (MR). This is an internal review of the original decision by a second DWP Decision Maker. If claimants are still unsatisfied with the outcome after MR, they can go to a Tribunal.

Figure 1: PIP and ESA assessment and dispute process

2.PIP was introduced in England, Scotland and Wales in 2013, replacing Disability Living Allowance.1 Atos and Capita have held the contracts since its introduction. Capita carries out assessments for around 23% of PIP claimants, covering Wales and the Midlands. Atos provides the remaining 77%, covering the rest of England and Scotland.2 ESA was introduced in 2008, replacing Incapacity Benefit. Maximus has delivered ESA assessments throughout the UK since 2015, after the previous contractor, Atos, left the contract early.3 Table 1 contains data on numbers of applicants, assessments and awards for PIP and ESA since 2013.4

Table 1: PIP and ESA applications, and assessments and awards since 2013



Number of applications

3.2 million

3.1 million

Number of assessments completed

3.0 million

1.7 million4

Number of claims in payment/awards made

1.6 million

1.0 million

Source: DWP official statistics5

3.The Department told us that PIP and ESA assessments work well for the majority of claimants.6 A minority of PIP and ESA claimants choose to challenge the initial decision made on their claim, however. Claimants of both benefits who want to challenge the Department’s decision are required to request a Mandatory Reconsideration (MR). MR was introduced in 2013, in an effort to reduce the number of disability and incapacity benefit cases going to appeal.7 670,000 PIP claimants—22% of all claimants—have submitted an MR request since 2013, with 187,000 of those going on to appeal. 227,000 PIP claimants—7% of all those assessed—have had their initial award changed at either:8

In the same period, a total of 260,000 ESA claimants submitted an MR, and 53,000 went on to appeal. 63,000—4% of all those assessed—received a change of award:9

Taking MRs and Appeals for both benefits together, this means there are at least 290,000 claimants of PIP and ESA for whom the correct decision on entitlement was not made at the earliest possible point in the process. Many more will have disagreed with their initial or MR decision, but felt unable to face challenging it further.10

The scope of our Report

4.Our inquiry focused on identifying technical changes to the assessment processes for PIP and ESA. Many witnesses supported this approach.11 Victoria Holloway, Public Affairs Manager at Sense and a co-Chair of the Disability Benefit Consortium, warned us that the impact on disabled people of a more extensive overhaul of the systems would be “enormous”.12 This would be especially so coming soon after the introduction of PIP, and alongside considerable changes to out of work support under Universal Credit. She cautioned it would likely cause great anxiety. Paul Gray CB, leader of the Government’s two independent reviews of PIP told us:13

The sheer scale of this operation I think means it is prudent to have a degree of caution about saying, “Let’s scrap it and start again”. [ … ] I would say, as far as PIP is concerned, I would put the primary emphasis on I think there is a lot to be done [ … ] that could make the operation of the current system better.

5.We also heard arguments, however, that PIP and ESA assessments suffer from deep-rooted problems. Some witnesses told us that that a fundamental overhaul of one or both processes is necessary.14 Others argued that there was a need to review and reformulate the descriptors for both benefits so that they accurately assess the functional impact of all conditions.15 Anna Bird, Executive Director of Policy and Research at Scope, told us this was a necessary, but not a quick process:16

Across both assessments, we think there are problems around trust, problems around transparency and problems around accuracy, and we do not think that tweaks to the system are going to tackle that level of difficulty [ … ] It needs proper consultation with disabled people. It is not straightforward, and in order to rebuild that trust back up I think we have a golden opportunity over the next two years to undertake that consultation.

6.The evidence we received for our inquiry spanned this range of arguments, from asking fundamental questions about the purposes of PIP and ESA to suggestions for more immediate and practical changes. We had an unprecedented public response, of over 3,500 individual submissions, as well as almost 200 from organisations.17 We acknowledge that the system works for a large majority of claimants and that the nature of our inquiry has meant we are most likely to hear from those who have been poorly served. The issues reported to us, however, have a severe impact on disadvantaged people, and so must be taken very seriously. This report is the second of two: our first report, drawing attention to the subjective experiences of claimants and requesting the Department’s response, was published earlier in February 2018.18 For this report, we aimed to identify technical policy changes that could improve both systems for claimants undergoing assessments in the immediate future. Our recommendations focus on building trust and increasing transparency.

7.The Department announced in January 2018 that it would not contest a High Court ruling that government regulation changes to PIP were unlawful because they discriminated against some claimants on the basis of disability.19 The Department’s decision means an estimated 220,000 claimants who experience psychological distress when making journeys will now be eligible for a higher rate of PIP, at an estimated cost of £3.7 billion up to 2023.20 It will now go back through all PIP claims currently in payment to establish whether claimants are entitled to a higher award as the result of the judgement, backdating claims as appropriate.21 We welcome this decision, and look forward to hearing more about how it will be implemented. We also welcome the Department’s announcement that it is committed to “continuous” improvement of PIP.22 The change of regulations will not, however, remedy the problems we identify in this report. These stem not from eligibility criteria, but from the way that applications, assessments and decision-making are carried out.

Why trust matters

8.Trust is fundamental to the overall running of a successful society. Likewise, trust in the assessment systems is essential to PIP and ESA functioning effectively. The final review of the ESA Work Capability Assessment (WCA), carried out by Dr Paul Litchfield OBE, highlighted a need for assessments to “not only be fair but to be perceived as such” by all parties involved.23 Paul Gray’s second review of PIP explained that although claimants will not always agree with decisions the Department makes on their entitlement to benefit, it is vital that they understand the decision and believe they have been fairly assessed.24 Mind and the Scottish Association for Mental Health told us that without this trust and transparency, applying for PIP or ESA can become “stressful, time consuming, and impossible to navigate without support”.25 The Department claims that the proportion of decisions overturned is low, when viewed as a proportion of all claimants.26 We heard that the ramifications of incorrect decisions, however, go far beyond those claimants directly affected. They contribute to a much wider perception of an unreliable process.27 The Department recognises this argument. It explained that claimant trust in Departmental decisions is “important” to its objective of “ensuring claimants have the best possible experience”.28

9.We heard much to suggest the Department is falling short on meeting this objective. The independent reviews of both benefits highlighted widespread scepticism amongst claimants and organisations supporting them about the extent of trust they can place in either process.29 Paul Gray stressed to us that a lack of trust “is at the heart of the problem of confidence or lack of it in the system”.30 Turn2us, a support charity, told us that for claimants of both benefits, this lack of trust “manifests itself in fear and confusion”. They argued this is “fundamental to the many of the problems claimants have with both PIP and ESA”.31 Numerous other witnesses that work with claimants, as well as claimants themselves, echoed this view.32 The human consequences of a lack of trust and confidence in PIP and ESA systems, in terms of distress and confusion amongst claimants, are easily observed. Our previous report, focusing on claimants’ experiences of PIP and ESA assessments, set out just a fraction of the evidence that we received illustrating these.33

10.Witnesses told us this perception is driven by recurring problems throughout the application and assessment process. These result in some claimants perceiving the processes as opaque and unfriendly throughout. They include:

a)claimants experiencing difficulty filling in application forms and understanding the basis on which they are being assessed;34

b)basic accessibility issues relating to the forms and to arrangements for assessments, including home visits;35

c)the inconsistent application of guidance on claimants being accompanied to assessments, including whether the comments of their companions are given due weight in assessment reports;36

d)concerns about the expertise and diligence of contractor HCPs, and how weaknesses in this area affect decision-making;37and

e)the effectiveness and rigour of Mandatory Reconsideration as a check on initial decision making, and consequential reasons why Departmental decisions are overturned at appeal.38

11.Equally important in policy terms are the consequences of a lack of trust for government itself. Disputes over decisions on benefit eligibility are inevitable. Disability charity Scope told us, however, that low levels of trust have substantial implications for this part of the Department’s workload. Scope argued that low confidence and trust is likely to motivate claimants to challenge decisions at MR, and to progress to appeal if their award remains unchanged.39 In turn, this increases pressure on decision-makers and may mitigate further against quality decision-making at MR—continuing the cycle of declining trust.40 The financial consequences of this loss of trust for the public purse are readily apparent. Since letting the PIP and ESA contracts, the Government has spent hundreds of millions of pounds—in addition to the money paid to contractors for carrying out assessments—checking and defending DWP decision-making.41

12.For most claimants, PIP and ESA assessments go smoothly. But in a sizeable minority of cases, things go very wrong indeed. For at least 290,000 claimants of PIP and ESA—6% of all those assessed—the right decision on entitlement was not made first time. Those cases, set alongside other problems throughout the application and assessment process, fuel a lack of trust amongst claimants of both benefits. The consequences—human and financial—can be enormous. Our recommendations aim to correct the worst of these problems and rebuild claimant trust. Properly implemented, they will bring real improvements for claimants going through the system now and in the near future. The question of whether a more fundamental overhaul of welfare support for disabled people is necessary remains open. We do not intend this to be the end of our work on PIP and ESA.

1 PIP was introduced in Northern Ireland in 2016. Assessments there are delivered by Capita, under a separate contract.

2 National Audit Office, Contracted out health and disability assessments, HC 609, January 2016, p.14. Atos’s contracts are split into two separate “lots”, while Capita’s is one lot.

3 Work and Pensions Committee, Employment and Support Allowance and Work Capability Assessments, First report of session 2014–15, HC 302, July 2014, p. 29

4 Only 57% of ESA applicants complete a Work Capability Assessment. Almost 1.1 million claimants withdrew their claim before the assessment took place.

6 DWP (PEA0441)

10 Turn2us (PEA0392). See also: Parkinson’s UK (PEA0119), Islington Law Centre (PEA0397), Spartacus Network (PEA0358), Revolving Doors Agency (PEA0227), Rethink Mental Illness (PEA0405), Epilepsy Action (PEA0491)

11 Q339 (Victoria Holloway), Q331 (Rob Holland), Sense (PEA0368), Disability Benefits Consortium (PEA0294), Dr Ben Baumberg Geiger, Professor Robert Thomas and Dr Joe Tomlinson (PEA0122), Turn2us (PEA0392), MS Society (PEA0443), Shaw Trust (PEA0424), Mind and SAMH (PEA0421), RNIB and Thomas Pocklington Trust (PEA0393), Epilepsy Action (PEA0491), DOSH Financial Advisory (PEA0225), Royal British Legion Industries (PEA0384), Inclusion London (PEA0370), National AIDS Trust (PEA0371), MEAM (PEA0366), Helen Bamber Association (PEA0308), Start Ability Services and the Association of Disabled Professionals (PEA0336), Muscular Dystophy UK (PEA0285), Age UK Bristol (PEA0233), ASLI (PEA0346), Disability Agenda Scotland (PEA0414), Circle Housing (PEA0267), Citizens Advice Camden (PEA0278), Motor Neurone Disease Association (PEA0283), Auriga UK (PEA0284), CLIC Sargent (PEA0292), Mencap (PEA0398), Citizens Advice (PEA0369)

12 Q339 (Victoria Holloway)

13 Q335 (Paul Gray)

14 Zacchaeus 2000 Trust (PEA0297), Green Party Northern Ireland (PEA0390), British Psychological Society (PEA0379), Royal College of Psychiatrists (PEA0389), National AIDS Trust (PEA0371), Equity Trade Union Benefit Advice Centre (PEA0364), New Freedom Project (PEA0363), Leonard Cheshire Disability (PEA0334), AdvoCard (PEA0239), WinVisible (PEA0438). Several organisations focused on the need for fundamental reform of the ESA Work Capability Assessment. They included Disability Agenda Scotland (PEA0414), Disability Rights UK (PEA0412) , Mencap (PEA0398), Royal British Legion (PEA0384) , Citizens Advice Richmond (PEA0332), Disability Benefits Consortium (PEA0294), British Psychological Society (PEA0379). Our predecessor Committee recommended a fundamental redesign of the WCA. See Work and Pensions Committee, Employment and Support Allowance and Work Capability Assessments, First report of Session 2014–15, HC302, July 2014

15 Q339 (Victoria Holloway), Ben Baumberg Geiger, Parkinson’s UK (PEA0119), Disability Rights UK (PEA0412), MS Society (PEA0443), Zacchaeus 2000 Trust (PEA0297), Disability Agenda Scotland (PEA0414), The Royal College of Psychiatrists (PEA0389), Epilepsy Action (PEA0491), The Royal British Legion(PEA0384), Sense (PEA0368), Citizens Advice North Lincolnshire (PEA0367), Disability Benefits Consortium (PEA0294), Breakthrough UK (PEA0246)

16 Q333 (Anna Bird). See also: Q348 (Paul Litchfield)

17 We received individual submissions via our web forum, hosted on parliament.uk, as well as in response to our formal call for evidence. All submissions are available on the Committee’s website.

18 Work and Pensions Committee, PIP and ESA assessments: claimant experiences, Fourth report of Session 2017–19, HC 355, February 2018

19 HC Deb, 19 January 2018, col. 414W

20 HC Deb , 30 January 2018, col. 703

21 Ibid.

22 HC Deb, 30 January 2018, col. 706

23 Paul Litchfield, An independent review of the WCA, year five, November 2014, p.6

25 Mind and SAMH (PEA0421), City of Wolverhampton Council (PEA0123), The Shaw Trust (PEA0424), Disability Agenda Scotland (PEA0414), Mencap (PEA0398), Turn2us (PEA0392), The Royal British Legion (PEA0384), National AIDS Trust (PEA0371), Coventry Citizens Advice (PEA0360), Headway (PEA0330), Scope (PEA0262), Green Party NI (PEA0390), Advocard (PEA0239) , Public Law Project (PEA0439)

26 DWP (PEA0441)

27 Mind and SAMH (PEA0421), City of Wolverhampton Council (PEA0123), The Shaw Trust (PEA0424), Disability Agenda Scotland (PEA0414), Mencap (PEA0398), Advocard (PEA0239), Citizens Advice Coventry (PEA0360), Green Party Northern Ireland (PEA0390), Headway (PEA0330), National AIDS Trust (PEA0371), Scope (PEA0262), Turn2us (PEA0392), Royal British Legion Industries (PEA0384)

30 Q344 (Paul Gray)

31 Turn2us (PEA0392)

32 Disability Agenda Scotland (PEA0414), Headway (PEA0330), Mencap (PEA0398), National AIDS Trust (PEA0371), Shaw Trust (PEA0424), Citizens Advice Sheffield (PEA0247), Advocard (PEA0239), Citizens Advice Coventry (PEA0360), City of Wolverhamption Council (PEA0123), Green Party Northern Ireland (PEA0390), Mind and SAMH (PEA0421), Royal British Legion Industries (PEA0384), Start Ability Services and the Association of Disabled Professionals (PEA0336), Scope (PEA0262), Dr Heather Lister (PEA0045), Leah Starling (PEA0280), RNIB and Thomas Pocklington Trust (PEA0393), Names withheld (PEA0257, PEA0139, PEA0132, PEA0004, , PEA0352, PEA0345, PEA0331, PEA0312, PEA0253, PEA0496)

33 Work and Pensions Committee, PIP and ESA Assessments: claimant experiences

34 Citizens Advice North Lincolnshire (PEA0367), Headway (PEA0330), Leonard Cheshire Disability (PEA0334), MEAM (PEA0366), Start Ability Services and the Association of Disabled Professionals (PEA0336), Halton Housing (PEA0387), Disability Equality Scotland (PEA0341)

35 Aspire (PEA0395), Royal Association for Deaf People (PEA0411), Breakthrough UK (PEA0246), Disability Benefits Consortium (PEA0294), Inclusion London (PEA0370), Mencap (PEA0398), MS Society (PEA0443), Turn2us (PEA0392), Macmillian Cancer Support (PEA0383), Start Ability Services and the Association of Disabled Professionals (PEA0336), Age UK Bristol (PEA0233), DeafLink North East (PEA0040), Merton Centre for Independent Living (PEA0355), Disability Equality Scotland (PEA0341), The Action Group (PEA0403), National Deaf Children’s Society (PEA0402), Citizens Advice Eastbourne (PEA0478), RNIB and Thomas Pocklington Trust (PEA0393)

36 Q262 (Rob Holland), Q261 (Kayley Hignell), Citizens Advice (PEA0369), Citizens Advice Sheffield (PEA0247), Halton Housing (PEA0387), Mencap (PEA0398), One Stop Advocacy (PEA0416), Veterans Association (PEA0502)

37 The Action Group (PEA0403), Aspire (PEA0395), City of Wolverhamption Council (PEA0123), The Down’s Syndrome Association (PEA0205), Mencap (PEA0398), Royal Association for Deaf People (PEA0411), Shaw Trust (PEA0424), Turn2us (PEA0392), Zacchaeus 2000 Trust (PEA0297), Parkinson’s UK (PEA0119), Rethink Mental Illness (PEA0405), Oxfordshire Welfare Rights (PEA0315), Understanding Autism North West (PEA0192), Central and South Sussex Citizens Advice (PEA0197), RNIB and Thomas RNIB and Thomas Pocklington Trust (PEA0393), Islington Law (PEA0397)

38 City of Wolverhamption Council (PEA0123), Social Security Advisors in Local Government (PEA0272), Greater Manchester Law Centre (PEA0217), Citizens Advice North Lincolnshire (PEA0367), Citizens Advice Richmond (PEA0332), Welfare Rights and Money Service (PEA0293), Local Support Team Southwark Council (PEA0099), Possability People (PEA0085), Shine (PEA0188), RNIB and Thomas Pocklington Trust (PEA0393)

39 Scope (PEA0262)

40 Citizens Advice Camden (PEA0278), City of Wolverhamption Council (PEA0123), Disability Benefits Consortium (PEA0294), Halton Housing (PEA0387), Inclusion London (PEA0370), Leonard Cheshire Disability (PEA0334), Motor Neurone Disease Association (PEA0283), , Action for ME (PEA0382), RNIB and Thomas Pocklington Trust (PEA0393), PCS Union (PEA0357), Kidney Care UK (PEA0296), Salford Welfare Rights and Debt Advice Service (PEA0388), Free Representation Unit (PEA0365), Spartacus Network (PEA0358), Caring for Life (PEA0259), Social Security Advisors in Local Government (PEA0272)

41 See Chapter 6

12 February 2018