Disability Benefits: Assessments Debate

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Department: Department for Work and Pensions

Disability Benefits: Assessments

Stephen Timms Excerpts
Monday 4th September 2023

(7 months, 3 weeks ago)

Westminster Hall
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Stephen Timms Portrait Sir Stephen Timms (East Ham) (Lab)
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I am grateful for the chance to speak in the debate, to the Petitions Committee for having arranged it, and to the hon. Member for Carshalton and Wallington (Elliot Colburn) for opening it. He kindly referred to my Select Committee’s report on health assessments for benefits, which was published in April, and my speech will draw on what we said in that report. We also published the Government’s response to the report in June, since when I have been in correspondence with the Minister about some of the key points that arose.

The annex to our report is well worth a look. It is based on a survey of 8,500 people, who told us about their experience of using the system and going through the assessments. They included people with lifelong conditions and people with experience of the use of medical evidence, both of which are topics covered in the petitions.

I will not comment in the debate on the adequacy of the benefits—the Select Committee has an inquiry under way on UK benefit levels that is focused on that—but I must say that over the summer a good deal of concern continued to be raised about the benefits we are talking about not meeting claimants’ extra costs, as they are intended to.

The Government have recognised the need to transform the system, including in their White Paper. I welcome many of the reforms that have been announced—including, to pick up on a point made by the hon. Member for Carshalton and Wallington, in respect of the testing of the use of specialist assessors—but the problem is that they are going to take years to implement. We need to take further action, given the gravity of the problems that we have already heard about in the debate.

A very important recommendation in our report was that assessments should be recorded by default. They should always be recorded, unless the claimant chooses to opt out of having their assessment recorded. The Government have said no to that recommendation, presumably because it would cost a little more, but I really think that is a mistake. All the assessment providers that are contracted by the Department support the recommended change, as do many of the respondents to our survey. It is the only way to get to the bottom of why things go wrong so often.

The hon. Member for Carshalton and Wallington rightly gave the statistics that show that the great majority of appeals against the refusal decisions that come out of assessments are upheld. Surely that shows that something fundamental is wrong. We will get to the bottom of why that is only if assessments are routinely recorded, so that when things go wrong it is possible to look at what actually happened in the assessment and try to learn from the errors to get things right in future.

In his recent letter to me, the Minister said:

“claimants may need to discuss sensitive and personal information at the assessment and may not want this to be recorded”.

Of course, he is quite right about that, which is why we need a proper opt-out for applicants who do not want their assessment to be recorded. Has the Department considered how, if recording by default were introduced, it would be possible to mitigate those risks, which the Minister is right to be concerned about? Has it also looked at what the impact would be on mandatory reconsideration if recording by default were introduced, because I think it would be extremely helpful. If those assessments are not routinely recorded, we will never get the feedback needed to put these serious problems right.

I want to pick up the point about covert assessment, which was raised by both the hon. Member for Carshalton and Wallington and my hon. Friend the Member for Warrington North (Charlotte Nichols). This is a serious and real problem. We called in our report for the Government to

“urgently investigate the use of covert surveillance by assessors”.

Unfortunately, in their response, the Government said no—I am afraid I will be using that word quite a lot in what I have to say today. They said:

“all assessment providers strongly refute the suggestion that they undertake”

covert assessment, but reports of this happening are much too widespread to be ignored, and the Government should look at that.

We are concerned as well about the system for claimants aged 16 to 18. On turning 16 in England and Wales, claimants must move from disability living allowance to PIP through a full-claim process requiring—until recently—a face-to-face assessment, but claimants in Scotland can stay on DLA until the age of 18. The Government’s White Paper acknowledged the need to help with the transition from DLA to PIP, but our conclusion was that young people in receipt of DLA should not be required to claim PIP until the age of 18, and where under-18s decide to claim PIP, they should have light-touch, paper-based assessments until the age of 18.

Justin Tomlinson Portrait Justin Tomlinson (North Swindon) (Con)
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Will the right hon. Member give way?

Stephen Timms Portrait Sir Stephen Timms
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I will gladly give way to the former Minister.

Justin Tomlinson Portrait Justin Tomlinson
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It is a difficult and fine balance, because the counter-argument is that the current approach allows people, before they turn 18 and therefore become fully responsible for their own living costs and housing arrangements, to know exactly where they are. So it is not a black and white issue.

Stephen Timms Portrait Sir Stephen Timms
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The hon. Member is right: these are often difficult judgments, but I would like to know what discussions the Minister has had with Ministers in Scotland about how things have worked in practice there. I would also like to know what progress the Department has made on plans for 16 to 18-year-olds in work in the severe disability group. I take the point that there are often quite fine judgments to be made, but the unanimous view of the Work and Pensions Committee was that it would be right to move to a system where applicants were not required to move on to PIP until the age of 18.

The Minister will know of concerns that were raised over the summer about pre-application screening questions in the new online PIP application form, which is being developed at the moment, and of the fears being expressed that people will be wrongly put off claiming by those questions, which have not been a feature of the application process before. In winding up, will he say something about those concerns and update us on progress with the online claims system for PIP, which, in principle, is something I very much welcome.

At the moment, claimants have 20 days to return ESA and universal credit forms and a month for PIP forms, and of course they have to send all the supporting evidence in at the same time. Each of those forms runs to tens of pages. The Association of Disabled Professionals told us that this deadline is very difficult to comply with. The deadline starts from the date on the letter, not the date the letter was received. The Association said:

“it is extremely rare for a letter to reach the claimant within five to seven working days of the letter being sent.”

In the pandemic, claimants had three months in which to return the forms. I think there were considerable advantages to that. Mind told us that extending the deadline could

“reduce the need for Mandatory Reconsiderations or Appeals”

by ensuring that the right decision was made first time around. So we recommended a compromise whereby claimants would have two months in which to return forms. Unfortunately, in its response, the Department said no. However, I wonder whether the Minister recognises that the time to return forms is being reduced by delays in getting those forms out to people. We have been hearing that, typically, at least a week—seven of the 20 days—is disappearing before the claimant receives the request.

As we have heard, one of the e-petitions is about considering disability benefit claims on medical advice alone. I am sure the Minister will point out—he will be right to do so—that, as the Work and Pensions Committee heard, GPs and other medical professionals may not know exactly what is needed for a functional assessment. We certainly heard repeatedly that the British Medical Association is absolutely clear that doctors do not want to take on this additional job.

However, the Committee wanted better use of another kind of evidence, which is evidence from family and carers. We heard that the way in which their input is received “is incredibly patchy”, as is whether their input is welcomed or not. The PIP guidance for assessors is explicit that evidence from carers and family should be considered but, anecdotally, it appears quite often that it is not. So we called on the Government to review the guidance, and I am pleased to say that, on this occasion, the Government did respond positively to our recommendation. Will the Minister update us on progress with that review and say when it will be completed?

Debbie Abrahams Portrait Debbie Abrahams (Oldham East and Saddleworth) (Lab)
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Is my right hon. Friend as concerned as I am about the safeguarding of our most vulnerable claimants when they apply for PIP or have a work capability assessment and about their inability in some cases to complete that process? As a consequence, we are seeing an increasing number of prevention of future death reports from coroners that are directly related to work capability assessment or the PIP assessment process?

Stephen Timms Portrait Sir Stephen Timms
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My hon. Friend is absolutely right, and she has done a great deal of extremely valuable and important work on this subject, both on our Select Committee and in the Chamber. I do share her concerns and, as she knows, because it was substantially at her instigation, we are undertaking an inquiry specifically on the safeguarding of vulnerable claimants to look at these issues. I do share her concerns, and they are reflected in our report. The point about the time people have to send the forms back is important for people who are struggling, for the kind of reasons she sets out, to complete the forms within the very tight deadline that is set at the moment.

Shortly before we published our report, the Department published its long-awaited health and disability White Paper. The Minister knows, because he has kindly given me the opportunity to tell him about it, of my concern that people may miss out on support under the new system because they will not meet the eligibility criteria, although they do under the current system. Quite how that will be resolved is not yet clear, but can the Minister provide reassurance today that claimants and groups representing them will be involved in developing the new system?

There is much more I could say based on our report, but it is absolutely clear—it is already clear from this debate—that these assessments are not working well. We need significant changes to make them work better in the future, and I hope that, before too long, more of the recommendations in our report will be accepted than have been as yet.

--- Later in debate ---
Tom Pursglove Portrait The Minister for Disabled People, Health and Work (Tom Pursglove)
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It is a pleasure to serve under your chairmanship, Sir Gary. I thank colleagues across the House for their contributions to the debate, and I particularly thank the Petitions Committee and my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for facilitating it. I thank the petitioners who have gone about collecting signatures to get a debate in Parliament; I am very grateful to them for their interest and efforts.

It is important that we come together regularly to debate these matters, and that there is proper scrutiny of the Government’s work in this area. This debate follows on from what I would argue was quite extensive questioning during Work and Pensions questions in the House today. There is no doubt that issues including reforming assessment processes, the role of medical evidence in decision making and other such aspects of the system are vital to the Government and to people across our society, including disabled people and people with long-term health conditions. I am pleased to be able to say something about the current situation, the steps the Government are taking to improve matters, and our quite extensive reform plans, some of which we touched on at DWP questions. I would argue that significant work is already under way.

First, I want to put the assessments in context, because when we debate these matters it is vital to set out why the Government think assessments are important. We use functional assessments to help to determine entitlement to disability benefits. Each benefit has its own assessment criteria to ensure that people receive the right level of support. All our assessments are currently carried out by healthcare professionals with clinical experience. We recognise that assessments can be a difficult experience, so we are committed to improving our assessments and acting on feedback from claimants and stakeholders. We want to make the journey time and the overall experience as good as it can be. Why would any Government not want to ensure that? Where paper-based assessments can be carried out, because there is the required evidence, that should and does happen.

Diversifying the assessment channels is an important step that has been taken in recent years. There is the opportunity for people to have a face-to-face assessment, if that is right for them and if that is what they wish to have, but there are other people who would like a telephone or virtual assessment. It is right that those routes be available to people, so that they have some involvement and choice, but of course it is important that there should be the backstop that if somebody wants a face-to-face assessment, they can have one. That came up a lot in the debate. The changes that I have outlined have come about in recent times, but they are certainly not the end of the journey; that is why we have an ambitious reform agenda, with long-term transformation at its heart, to go alongside the positive steps that we are taking now to help us reach our goals.

There has been quite a bit of debate about informal observations, which were raised by my hon. Friend the Member for Carshalton and Wallington, by the hon. Members for Warrington North (Charlotte Nichols) and for Chesham and Amersham (Sarah Green), and by other colleagues, so let me address the issue directly. Informal observations are important to the consultation, as they can reveal abilities and limitations that are not mentioned in the claimant questionnaire, in the supporting evidence, or in the history taking in the consultation. They may also show discrepancies between a claimant’s reported and actual needs. Health professionals are trained to treat claimants fairly and with respect. They are professional clinicians who use their skills in history taking, informal observation and examination to provide the DWP with an impartial, independent and factual assessment.

Of course, we want every report to reflect a high-quality, functional assessment that the Department can use to make benefit-entitlement decisions, and we do not want reports to be of an unacceptable standard. We have set for providers a threshold for unacceptable reports, above which there are performance guarantees. The DWP audits a statistically valid sample of assessment reports to ensure that the standards that the Department expects are met. Let me be clear: healthcare professionals should be clear and open about that when they assess people. If colleagues have examples where they do not believe that that has been the case, I am keen to hear them so that my officials and I can look at them carefully.

Earlier this year, we published the health and disability White Paper, which set out how we will transform the disability benefits system over the coming years. Our reforms will help more disabled people to start, stay and succeed in work without worrying about being reassessed and losing their benefits—that jeopardy that is most definitely out there. I regularly have conversations with people who want to try work, and have perhaps even identified an opportunity that they might like to have a go at, but they fear it not working out, losing their benefit entitlement, and then having to go back through reapplication and reassessment in the hope of re-establishing their benefit entitlement. That cannot be right. That is why it is crucial that the Government take forward the legislative reform that we are determined to make happen.

More widely, we intend to achieve our ambitious aims by improving the benefits system, so that it focuses far more on what people can do, rather than cannot do; by stepping up our employment support for disabled people and people with health conditions; and by ensuring that people can access the right support at the right time, and have a better overall experience when they apply for and then receive health and disability benefits. Fundamentally, it is not right that people should be written off, but of course in any civilised society there must be a safety net, whereby support is available for people when work is just not a realistic prospect or appropriate for them. It is with that principle in mind that we move forward with our reforms.

We developed the proposals through extensive engagement with disabled people, disabled people’s organisations, charities, GPs and healthcare professionals, businesses and other experts. As our work progresses, we will keep those voices at the heart of how we deliver our reforms. In fact, that engagement is ongoing, and we are beginning to progress the various work streams in the reform model. To pick up on a point made earlier, I reassure the House that people’s lived experience will be heard in that work, which will have stakeholder input, because fundamentally we want to get this right. I want the process to be inclusive, to make sure that we unlock people’s potential, to ensure that they are not written off, and to provide employment support to help people into work when that is right and appropriate for them. We want to unlock the ambition and aspiration that we know is out there among many disabled people and people with health conditions.

Ultimately, our aims will go a significant way towards reducing unnecessary reassessments and the duplication of information provided to the DWP, which is a change that I think we can all welcome. We will achieve that by legislating to remove the work capability assessment, so that there is only one health and disability assessment: the PIP assessment. That will mean that there will be no need to be found unable to work, or to be found to have limited capability for work and work-related activities, to get additional income-related support for a disability or health condition, and there will not be any of the negative connotations around people having to prove that they are unfit for work.

Stephen Timms Portrait Sir Stephen Timms
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On a point that was raised by me, and by my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), what will happen to people who are too unwell to work but not disabled, and therefore not eligible for PIP? The Minister’s proposal seems to be that they will not get any help at all, but I cannot imagine that that is what he intends.

Tom Pursglove Portrait Tom Pursglove
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The right hon. Member will be aware that the Government have set out that there will be transitional cash protection. There was the statistical release that we undertook to make available, which has now been published. We are carefully working through what the reform model means, and how individuals can best be supported to ensure that we unlock the potential to work where that is right and appropriate for people. As I say, it is important that the transitional protection be in place as we move to the new system.

There was a question about timescales for reform. We will seek to legislate for the reform in the next Parliament; we will then roll it out in a safe, stable way, and bring about the change incrementally and gradually, area by area, to ensure that we get this right. These are live discussions as we workshop and work through specific aspects of the reforms.

I am conscious that the Chair of the Work and Pensions Committee raised quite a lot of questions; I will answer as many of them as I can. If there is anything that I miss, I will gladly follow up with the Committee.