PIP and ESA assessments Contents

4The report and initial decision

51.Following the assessment, contractor HCPs produce reports for the Department. Reports should take into consideration both further evidence supplied by the claimant or obtained by the contractor, and the outcomes of the face-to-face assessment.160 They make recommendations on whether the claimant should be awarded PIP or ESA, and at what level. The final decision on the award rests with DWP’s Decision Makers—administrative staff. They are free to reject the assessor’s recommendations. They can also query points of the report that are unclear, or request further expert evidence if they feel this is necessary.161 Witnesses told us, however, that contractors are in practice heavily dependent on the report.162

Viewing the report

52.The Department’s research suggests many claimants understand little or nothing about how decisions on their entitlement are reached.163 This applies whether or not the decision is ultimately correct. In some cases, difficulties are due to claimants misunderstanding eligibility criteria.164 Breakthrough UK gave the example of an ESA applicant, medically retired due to their employer being unable to make further adjustments, being surprised to find that under DWP criteria they were “fit for work”.165 This is because a refusal by one employer to make further adjustments does not necessarily mean another employer would not be willing to. In other cases, claimants who are denied PIP or ESA, or receive a lower than expected rate, surmise that a mistake has occurred.166 Claimants receive a summary of the reasons for a decision with their decision letter, but they do not automatically receive a copy of the assessment report unless they go to Appeal.167 It is therefore difficult for them to know whether the problem is one of their understanding, or due to a mistake on the part of the decision maker or assessor. We heard this opacity in decision-making detracts further from claimant trust in the assessment systems.168

53.Some organisations told us that to address this, claimants should be allowed to view their report while it is being written up. They could then verify its content and rectify any perceived errors.169 Independent reviews of PIP and ESA recommended ensuring assessors consistently sit side-by-side with claimants when assessing them to facilitate this.170 This would have the additional benefit of helping to put claimants at ease, building trust and a perception of fairness.171 Witnesses also widely agreed with Paul Gray’s recommendation that a copy of the assessor’s report should be provided by default to all claimants, alongside the initial decision.172 This would help make clear to all claimants the basis on which their entitlement has been decided, improving transparency and helping claimants make an informed decision on what to do next. A report by the Social Security Advisory Committee explained:

If claimants had access to the HCP report earlier in the process, they would be able to see for themselves the evidence on which the DM has based their decision. This would allow them to better understand the decision and help inform what evidence they may need to provide to bring about a change in decision. This potentially saves time for all involved and facilitates evidence to be provided earlier and thereby to avoid the need for a tribunal.173

54.The Department has resisted both suggestions. It initially accepted in principle Paul Litchfield’s recommendation on allowing ESA claimants to see what is being written by the assessor during the assessment. It later became hesitant, claiming this would add substantially to the duration of assessments—although as Paul Litchfield noted, this is unlikely if what is recorded is what was said.174 It also argued that the principle of an “open engaging consultation” could be delivered “without the need to be prescriptive” on room configuration.175 More recently, the Department explained in response to Paul Gray that the cost of providing reports to claimants after the assessment by default meant this was “not an option we will be pursuing”.176 Paul Gray told us he was “not persuaded by the Government’s response that [providing a copy of the report] will be very costly”. Conversely, he argued that the costs of not providing it—in terms of claimant trust and transparency—are “very considerable”.177

55.DWP decisions on PIP and ESA claims are often opaque, even when decisions are correctly made. Ensuring claimants can see what is being written about them during assessment, and providing a copy of the assessor’s report by default would prove invaluable in helping claimants understand the reasoning behind the Department’s decisions. Both steps would increase transparency and ensure claimants are able to make informed decisions about whether to challenge a decision. In turn, many tribunals could be avoided, the workload of Decision Makers at Mandatory Reconsideration reduced, and overall costs lowered. We recommend the Department proceed without delay in sending a copy of the assessor’s report by default to all claimants, alongside their initial decision. We also recommend it issues instructions to contractors on ensuring claimants are able to see what is being written about them during assessment, and allowing their input if they feel this is incorrect or misleading. This should include, for example, emphasising to contractors that rooms should be configured by default to allow the claimant to sit next to the assessor or be able to see their computer screen.

Using additional evidence

56.Witnesses emphasised that improving the supply of evidence into assessments is only one part of ensuring a well-informed report. Contractors must also make good use of this evidence.178 Action for ME explained that without careful interpretation of additional evidence, assessors may form a “snapshot” view of the claimant’s limitations based on the face-to-face assessment.179 Assessors must, therefore, exercise discretion and professional judgement, weighing up all the evidence available to obtain a rounded picture of claimants’ functional capacities. Both the PIP and ESA assessor handbooks stipulate that assessors should justify their weighting of evidence. This includes highlighting and resolving any contradictions between pieces of evidence and explaining their choice of resolution. Assessors are expected to justify particularly clearly any recommendations in their reports that contradict what the claimant has told them.180

57.Paul Gray’s review noted that the assessors for PIP tend to privilege some forms of evidence over others. Evidence from medical professionals is often given more weight than evidence from carers, support workers and family members, as assessors believe the former to be more objective.181 Mencap explained that, as PIP and ESA assessments consider functional capacity, people who work and live closest to the claimant may offer very useful, accurate information on their capabilities and limitations.182 We also heard that some claimants may not access formal treatment. Action for ME told us, for example, that many people with ME choose to self-manage their condition.183 People with common mental health conditions, such as anxiety and depression, also sometimes struggle to obtain referrals for treatment or find themselves on long waiting lists, meaning sources of expert evidence are not accessible to them.184 Non-medical parties may provide their only source of additional evidence. Paul Gray therefore suggested that the Department should take steps to ensure that evidence from carers and family members is given due weight, “while recognising that all sources of evidence should be probed and tested”.185 This suggestion was echoed by several witnesses.186

58.We heard that claimants often perceive that additional evidence submitted in support of a claim—medical or not—appears not to have been given appropriate consideration by either the assessor or by DWP decision-makers. Leonard Cheshire Disability told us that 45% of ESA claimants, and 63% of PIP claimants in one survey felt their assessor had failed to take into account any of the evidence they submitted in advance of the assessment.187 There are justifiable reasons why additional evidence may not be used or referred to: for example, if it lacks relevance to the claimant’s functional capacity, or is judged to be out-dated. The assessor might also have made a judgement that its relevance was outweighed by other factors: for example, information given by the claimant during the assessment.188

59.We heard, however, that decisions not to use evidence were frequently hard to justify, and that little justification was offered in the decision letter. RNIB and the Thomas Pocklington Trust, organisations that support people with sight loss, told us they saw “systematic poor quality” in both PIP and ESA assessment reports. This included “many examples” where there had been “no sign” of additional expert evidence setting out functional impact having been used to inform findings and descriptor choices.189 The subjective nature of decisions on evidence weighting means that, sound or not, they are not always easy for claimants to understand. Parkinson’s UK recommended that to counter this, HCPs should be required to confirm explicitly that they have reviewed all supporting evidence in making their recommendations.190 PCS Union supported this approach, noting that where PIP Decision Makers ask HCPs to ‘“clarify” their descriptor scoring in light of apparent contradictions with the expert evidence, the descriptor recommendation and consequent decision will “often be changed in the claimants favour”.191

60.Claimants often go to considerable efforts to collect additional evidence for their claim, providing important information for generalist HCPs. Contractors and the Department should ensure that it is clear to claimants how and when this evidence is used. Without doing so, they will struggle to convince sceptical claimants that the decision on their entitlement to benefits is an informed one. Knowing how their evidence has been used will further empower claimants to understand the Department’s decisions, and to decide whether an MR is necessary.

61.We recommend that the Department introduce a checklist system, requiring HCPs to confirm whether and how they have used each piece of supporting evidence supplied in compiling their report. Decisions not to use particular pieces of evidence should also be noted and justified. This information should be supplied to Decision Makers so they can clearly see whether and how supporting evidence has been used, making it easier to query reports with contractors. It should also be supplied to the claimant along with a copy of their report.

162 Public and Commercial Services Union (PEA0357), Equity Trade Union Benefit Advice Centre (PEA0364), Islington Law (PEA0397), Parkinson’s UK (PEA0119), Greater Manchester Law Centre (PEA0217), Understanding Autism North West (PEA0192), Shine (PEA0188)

163 Blake et al., PIP evaluation wave 2, p.16

164 Breakthrough UK (PEA0246), Auriga Services Ltd (PEA0284), Surrey Welfare Rights Unit (PEA0088)

165 Breakthrough UK (PEA0246)

166 Mind and SAMH (PEA0421), Surrey Welfare Rights Unit (PEA0088), The Down’s Syndrome Association (PEA0205), Understanding Autism North West (PEA0192), City of Wolverhampton Council (PEA0123), Parkinson’s UK (PEA0119), Auriga Services Ltd (PEA0284), MND Association (PEA0283), Citizens Advice Sheffield (PEA0247), Citizens Advice Camden (PEA0278), Scope (PEA0262), AdvoCard (PEA0239), Zacchaeus 2000 Trust (PEA0297), Disability Rights UK (PEA0412), National Deaf Children’s Society (PEA0402), Mencap (PEA0398), Islington Law (PEA0397), Aspire (PEA0395), Salford Citizens Advice (PEA0394), Turn2us (PEA0392), Salford Welfare Rights and Debt Advice Service (PEA0388), Royal British Legion Industries (PEA0384)

167 Social Security Advisory Committee, Decision making and Mandatory Reconsideration, July 2016, p.53–54

168 Breakthrough UK (PEA0246), Turn2us (PEA0392), Royal British Legion Industries (PEA0384), Macmillan Cancer Support (PEA0383), MND Association (PEA0283)

169 CLIC Sargent (PEA0292), Rethink Mental Illness (PEA0405), Roma Support Group (PEA0337), Welfare Rights and Money Advice Service (PEA0293), Parkinson’s UK (PEA0119)

172 Q51 (Yolanda Barker, Denise Martin, Amanda Browning), Q65–66 (Gary Edwards, Kayleigh Nor-val), Q68 (David Bryceland), Q267 (Victoria Holloway), Mind and SAMH (PEA0421), Turn2us (PEA0392), Macmillan Cancer Support (PEA0383), Motor Neurone Disease Association (PEA0283), Action for ME (PEA0382), Roma Support Group (PEA0337), Disability Rights UK (PEA0412), Helen Bamber Association (PEA0308), Oxfordshire Welfare Rights (PEA0315)

173 Social Security Advisory Committee, Decision making and Mandatory Reconsideration, July 2016, p.53

177 Q349 (Paul Gray)

178 Citizens Advice Salford (PEA0394), Epilepsy Action (PEA0491), MS Society (PEA0443), Zacchaeus 2000 Trust (PEA0297), Sense (PEA0368), PCS Union (PEA0357), Leonard Cheshire Disability (PEA0334)

179 Action for ME (PEA0382), Headway (PEA0330) , Citizens Advice North Lincolnshire (PEA0367)

180 Maximus CDHA, Revised WCA handbook, p.42; DWP, PIP assessment guide, part 1, pp.40–44

181 Paul Gray, Second Independent Review of PIP, p.6. See also: Action for ME (PEA0382), City of Wolverhamption Council (PEA0123), Headway (PEA0330), Motor Neurone Disease Association (PEA0283), New Freedom Project (PEA0363), NHS Health Scotland (PEA0353)

182 Mencap (PEA0398). See also: Action for ME (PEA0382), Cystic Fibrosis Trust (PEA0425), Mind and SAMH (PEA0421), Royal College of Psychiatrists (PEA0389)

183 Action for ME (PEA0382)

184 Citizens Advice Isle of Wight (PEA0304), Revolving Doors Agency (PEA0227), Welfare Rights and Money Service (PEA0293), Welfare Rights Team (PEA0432)

186 City of Wolverhampton Council (PEA0123), Headway (PEA0330), Motor Neurone Disease Association (PEA0283), New Freedom Project (PEA0363), NHS Health Scotland (PEA0353), Action for ME (PEA0382)

187 Leonard Cheshire Disability (PEA0334). See also: Disability Benefits Consortium (PEA0294), Disability News Service (PEA0103), Down’s Syndrome Association (PEA0205), Hammersmith and Fulham Mind (PEA0041), MS Society (PEA0443), Royal College of Psychiatrists (PEA0389)

188 DWP, PIP assessment guide part 1, p.40; Maximus CDHA, Revised WCA handbook, p.67–70

189 RNIB and Thomas Pocklington Trust (PEA0393). See also: Sense (PEA0368), Citizens Advice North Lincolnshire (PEA0367), New Freedom Project (PEA0363), Islington Law (PEA0397), Coventry Citizens Advice (PEA0360), PCS Union (PEA0357), Roma Support Group (PEA0337), START Ability Services (PEA0336), Leonard Cheshire Disability (PEA0334) , Citizens Advice Richmond (PEA0332), Community Union (PEA0318), Citizens Advice Isle of Wight (PEA0304), Welfare Rights and Money Advice Service (PEA0293), Alzheimers Society (PEA0290), Citizens Advice Sheffield (PEA0247), Understanding Autism North West (PEA0192), Possability People (PEA0085), Salford Citizens Advice (PEA0394)

190 Parkinson’s UK (PEA0119). See also: Headway (PEA0330), Breakthrough UK (PEA0246), Understanding Autism North West (PEA0192)

191 PCS Union (PEA0357)

12 February 2018