Conclusions and recommendations
The importance of trust
1.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. (Paragraph 12)
Before the assessment
2.Applying for PIP or ESA can be daunting. The Department has so far only made limited efforts to provide support and guidance in a variety of clear, accessible formats. It should not rely on already stretched third sector organisations to explain the Department’s own processes. A concerted effort from the Department to help with applications would be both reassuring to claimants, and of great practical benefit. We recommend the Department co-design, with expert stakeholders, guidance in a range of accessible formats on filling in forms and preparing for assessment. This should include accessible information on the descriptors for each benefit, to be sent out or signposted alongside application forms. We also recommend the Department makes clear to claimants being reassessed that they should not assume information from their previous assessment will be re-used, and should be prepared to re-submit any supporting evidence already provided. (Paragraph 18)
3.Many PIP and ESA claimants have multiple health conditions that bring with them severe limitations. Focusing on what they are able to do is a common coping strategy—one that is often incompatible with filling in PIP and ESA application forms. It is impossible to draw a causal link from application to claimant health. The Department should demonstrate, however, that it is alert to the risk to mental health posed by parts of the application processes and seek to offset this. (Paragraph 20)
4.We recommend that the Department commission and publish independent research on the impact of application and assessment for PIP and ESA on claimant health. This should focus initially on improvements to the application forms, identifying how they can be made more claimant-friendly and less distressing for claimants to fill in. The Department should set out a timescale for carrying out this work in response to our Report. (Paragraph 21)
5.As a result of their health conditions, many PIP and ESA claimants require communications in a specific format. The Department’s resistance to meeting even some of the most basic of these needs makes applying for PIP and ESA unnecessarily challenging for some claimants. Its failure to provide a widely-used, accessible alternative to telephone calls, and Easy Read communications, is extraordinary. We recommend that the Department enables claimants with hearing impairments to apply for PIP and ESA via email, ensuring this service is appropriately resourced to prevent delays to claims. In the longer term, it should look to offer this option to all claimants. It should also ensure key forms and communications—especially the PIP2, appointment and decision letters—are available in Easy Read format, allowing claimants to register this as a communication preference at the start of their claim. (Paragraph 25)
6.Home visits are an important option for claimants whose health conditions make attending an assessment centre difficult. Contractors interpret the Department’s guidance on home visits differently. They take varying approaches to granting them and require different standards of supporting evidence. This leads to inconsistencies between the benefits and between contractors. It can also place additional burdens on claimants and the NHS. (Paragraph 30)
7.We recommend the Department issue new guidance to PIP and ESA assessors on the procedure for determining whether claimants receive a home visit. This should specify that GP letters are not required where other forms of evidence and substantiation are available. This should include evidence from the claimant, as well as from carers, support workers and other health professionals. To ensure guidance is being followed, we recommend contractors be required to gather evidence and the Department audit requests made and granted for home visits, as well as reasons for refusal. (Paragraph 31)
The assessment
8.Atos, Capita and Maximus all use a generalist assessor model. They pay no regard to the specialist expertise of individual assessors in assigning cases. They therefore assess claimants with the full gamut of conditions. The success of this model depends on a consistent supply of high quality, relevant expert evidence. There is ongoing confusion amongst claimants and those supporting them alike about what constitutes “good evidence” for functional purposes.We recommend that the Department sets out in response to this Report its approach to improving understanding amongst health and social care professionals and claimants of what constitutes good evidence for PIP and ESA claims. This should include setting out how it will measure, monitor and report on the supply of evidence into PIP and ESA assessments. (Paragraph 39)
9.Successive evidence-based reviews conducted on behalf of the Department have identified a pervasive culture of mistrust around PIP and ESA processes. This culminates in fear of the face-to-face assessments. This has implications far beyond the minority of claimants who directly experience poor decision making. It can add to claimant anxiety even among those for whom the process works fairly. While that culture prevails, assessors risk being viewed as, at best lacking in competence and at worst, actively deceitful. Addressing this is a vital step in restoring confidence in PIP and ESA. The case for improving trust through implementing default audio recording of assessments has been strongly made. We recommend the Department implement this measure for both benefits without delay. In the longer term, the Department should look to provide video recording for all assessments. (Paragraph 44)
10.Some claimants may be unable or embarrassed to explain the full implications of their condition to their assessor. Companions can help them to articulate these and support claimants during a potentially stressful process. Their role in assessments is vital. The Department’s recognition of this in its guidance to contractors is welcome. We are concerned, however, that this guidance is not consistently followed. There is no reference to companions in the Department’s auditing or contractor training programmes. That none of the contractors could even reliably tell us how many claimants are accompanied to assessment suggests this is not a priority. (Paragraph 49)
11.We recommend that the Department develop detailed guidance on the role of companions, including case studies demonstrating when and how to use their evidence. Contractors should also incorporate specific training on companions into their standard assessor training. After implementing default recording of assessments, a sample of assessments where claimants are accompanied should be audited on a regular basis to ensure guidance is being followed. (Paragraph 50)
The report and initial decision
12.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. (Paragraph 55)
13.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. (Paragraph 60)
14.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. (Paragraph 61)
Disputed decisions
15.Mandatory Reconsideration should function as a genuine check, not an administrative hurdle for claimants to clear. Improving the quality of assessments and reports will ensure fewer claimants have to go to MR, but disputes will always happen. The Department deserves credit for a renewed emphasis on MR quality. MR decision making has not always been characterised by thoroughness, consistency and an emphasis on quality, however. Not all claimants who have, perhaps wrongly, been turned down at MR will have had the strength and resources to appeal. (Paragraph 66)
16.We recommend the Department review a representative sample of MRs conducted between 2013 and December 2017, when it dropped its aspiration to uphold 80% of MRs, to establish if adverse incorrect decisions were made and, if so, whether there were common factors associated with those decisions. It should set out its findings and any proposed next steps in response to this report. (Paragraph 67)
17.The Department argues that the high rate of decisions overturned at appeal is driven by the emergence of new evidence that was not available at initial or MR stage. It has displayed a lack of determination in exploring why it takes until that stage for evidence to come to light. In almost half of cases the “new evidence” presented was oral evidence from claimants. It is difficult to understand why this information was not, or could not have been elicited and reported by the assessor. The Department’s argument does not absolve it of responsibility. Its feedback to and quality control over contractors is weak. Addressing these fundamental shortcomings would not only ensure a fairer system for claimants. It would also reduce the cost to the public purse of correcting poor decision-making further down the line. (Paragraph 72)
18.The Department must learn from overturned decisions at appeal in a much more systematic and consistent fashion. We recommend it uses recording of assessments to start auditing and quality assuring the whole assessment process. When a decision is overturned, the Department should also ensure that the HCP who carried out the initial assessment is identified and that an individual review of how the assessment was carried out is conducted. Given what we know about reasons for overturn, this should focus on improving questioning techniques and ensuring claimants’ statements are given due weight. We also recommend the Department lead regular feedback meetings with contractors and organisations that support claimants. These should keep the Department informed of emerging concerns and ensure that swift action is taken to rectify them. (Paragraph 73)
Incentives and contracting
19.The Department’s quality standards for PIP and ESA set a low bar for what are considered acceptable reports. The definition of “acceptable” leaves ample room for reports to be riddled with obvious errors and omissions. Despite this, all three contractors have failed to meet key performance targets in any given period. It is difficult not to conclude that this regime contributes to a lack of confidence amongst claimants. (Paragraph 87)
20.The Department’s use of contractual levers to improve performance has not led to consistent improvements in assessment quality, especially in relation to PIP. Large sums of money have been paid to contractors despite quality targets having been universally missed. (Paragraph 88)
21.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. (Paragraph 94)
12 February 2018