Health assessments for benefits – Report Summary

Summary

DWP currently uses health assessments to help inform decisions on a range of benefits that provide important financial support to people who cannot work, or who face extra costs, because they are disabled or have a health condition. For many this extra support is vital, so the assessments must be fit for purpose and fairly assess people’s needs. However, our predecessor Committee found in its 2018 inquiry that there were significant problems with these assessments. We found many of these remain, despite some improvements. Important changes to improve trust and transparency have not been made, and the system continues to let down some of the often vulnerable people who rely on it. The Government has announced major reforms in its Health and Disability White Paper, including abolishing the Work Capability Assessment (WCA). However, this will take several years to implement, and assessments for Personal Independence Payment (PIP) are expected to continue. Prior to any changes to the health assessment process, including the abolition of the WCA, an external assessment should be undertaken on the potential physical and mental health effects of these changes on affected claimants. There are changes the Government can make now to improve the experience of health assessments for claimants.

We were deeply concerned that nearly five years after our predecessor’s Report, people are still experiencing psychological distress as a result of undergoing health assessments. In some cases, issues or errors in the system are associated with or have been found at Coroner’s Inquest to have contributed to the deaths of claimants. The Government should commit to undertaking regular reviews of the impacts of assessments, as well as making data available to external researchers. In particular, the Government should make clear how it identifies cases for Internal Process Reviews, and publish disaggregated data to help establish how far health assessments specifically are contributing to cases of death or serious harm among benefits claimants. We also recommend that all staff and contractors involved in any DWP health assessment process should undertake claimant safeguarding and suicide prevention training.

Our survey responses were clear that trust in the system is low, and this will not improve without better transparency. We recommend, as our predecessor Committee did, that the contracts with assessment providers require them to record assessments by default, either in video or audio, with clear opt-out options, to ensure an objective record exists. All three providers support this. This would be the key step in allowing systematic audit of the reasons for assessments reaching the wrong conclusions, as evidenced by subsequent change at Mandatory Reconsideration (MR) or appeal. The Department should also commit to sending assessment reports to claimants as standard as soon as possible.

The data on MRs and appeals show there is still a fundamental problem with decision-making. The Department’s decisions were overturned in 69% of Tribunal rulings for PIP in the quarter ending December 2022, despite the operational changes it has introduced at earlier stages. We heard the failures identified at Tribunal are not reliably fed back to assessors and the Department has not conducted significant research on appeal overturns since 2012—before both PIP and MR were introduced. The Department must commission new research and start learning from these outcomes. It must also start publishing figures on Universal Credit (UC) MRs, and work with His Majesty’s Courts and Tribunal Service to ensure it understands the scale of health and disability-related UC tribunals. This is vital to understanding how the system is working for one of the biggest groups of claimants.

Covid-19 forced the Department’s hand in making greater use of remote and paper assessments. This has both improved accessibility and reduced stress for claimants, but one size does not fit all. The Department must build on this success and commit to allowing claimants a choice of format when booking their assessment. Just as one size does not fit all for assessments, the same is true for contact channels and applications. As the Department moves towards a single digital platform for health assessments, it must maintain alternative formats, so that people’s independence is not compromised by a lack of choice. We also recommend the Government extend the deadlines to return forms. As the impact of the pandemic on waiting times recedes the Department must focus on how to keep delays to a minimum against a backdrop of increasing demand for health-related benefits. We recommend clearance-time targets be included in new contracts with assessment providers, and an assessment rate for PIP be introduced where claimants are waiting beyond these times.

We heard that there have been improvements in the quality of reports from assessment providers, with all three now meeting their targets. However, our witnesses and survey respondents still talked about problems with the use of evidence and a lack of knowledge of conditions. This was especially true of fluctuating conditions, and mental health conditions. Despite the then Government accepting our predecessor’s recommendation on improving understanding about what constitutes good evidence, many of the same concerns remain, such as carers’ and family members’ evidence not being considered, even though guidance states that it should be. The Department must review this again, to understand why key evidence is not being given due weight. We also heard worrying examples of covert surveillance, which the Government should investigate further, working with organisations that support claimants to establish if this practice is widespread. We welcome plans for specialist assessors and improvements to assessing fluctuating conditions but were surprised to see no detail on updating descriptors in the White Paper and ask the Government to update us on this work.

We welcome the work the Department is doing on the Health Transformation Programme, particularly to improve data sharing and streamline the process for applicants. We also look forward to more detail on testing of the Severe Disability Group, and we support measures to end unnecessary reassessments for PIP. We urge the Government to recognise, however, that many people with severe disabilities work, so the criteria for ending PIP reassessments cannot simply be linked to work capability as it currently is for Employment and Support Allowance (ESA) and UC.

We were reassured to hear that Attendance Allowance (AA) and Industrial Injuries Disablement Benefit (IIDB) appear to be working well, with fewer cases being overturned at MR and appeal. Awareness and take-up of AA, much like Pension Credit, appears to be low however, and we recommend the Government develop targeted interventions to address this. For Disability Living Allowance (DLA), most of the concerns we heard were around the transition to PIP at 16, and we recommend the Government follow the route taken by the Scottish Government of allowing people to stay on DLA until they are 18 instead, with only light-touch paper-based assessments for people who claim PIP before they turn 18. In developing an equivalent of the severe conditions criteria for PIP, the Government must carefully consider those who are moving from DLA, to ensure those with conditions that will not improve do not have to start attending assessments when they claim PIP.

We were very interested to hear from the Scottish Government and Social Security Scotland about plans for the Adult Disability Payment, which is replacing PIP. This is likely to provide a good test of whether problems with PIP are in its policy framework or its implementation. We look forward to seeing its evaluation and urge the Department to watch this process closely and consider what changes, if any, it should make following this.