Disability Benefits: Assessments

Tom Pursglove Excerpts

Monday 4th September 2023 Westminster Hall

[The Minister for Disabled People, Health and Work (Tom Pursglove)]

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.

[Sir Stephen Timms]

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]

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.

[Charlotte Nichols]

The Minister speaks about reforms and live, ongoing discussions. Can he confirm that he is having conversations with Treasury colleagues about not just the eligibility criteria for the reforms and support, but their adequacy? To use MS as an example again, the average cost of having MS is an additional £337 a month. Can the Minister confirm that the issue is not just eligibility, but the adequacy of the support to meet the additional costs faced by disabled people with various conditions?

[Tom Pursglove]

There is ongoing work to review the cost of living payments that the Government have made available in the current climate. I anticipate that the results will come forward over the autumn and inform future decisions that we make. We continue to have conversations with the Treasury about the support that we provide. The Secretary of State for Work and Pensions will take his annual uprating decisions over the coming months as well, so we should be able to provide assurance in due course on where we go from here on the uprating or otherwise of benefits, taking into account the circumstances, as appropriate, in a thorough-going fashion.

The shadow Minister, the hon. Member for Lewisham, Deptford (Vicky Foxcroft), touched on means-testing for the personal independence payment, or changes to eligibility for PIP. I can confirm that there are no plans for that. I want to be very clear about that.

I will finish on a point that I made earlier. The UC health top-up will be passported via eligibility for any element of PIP. That reduces the number of assessments that people need to undergo and streamlines the process for claimants entitled to both benefits. I recognise that the work capability assessment is quite a point of difference between our Front Benchers. I was not a Member of this House when it was introduced, but I well remember debates on the work capability assessment in years gone by; we have moved on considerably since. There has been a lot of positive reform and improvement to the work capability assessment, but we think it is right to scrap it; we do not think it is right that people should have to prove that they are unfit for work to access the support that they seek.

[Vicky Foxcroft]

The point that I was making was about things that disabled people have said to me. If they lose one benefit, but maintain another, they still have some kind of safety net. If the assessment is all in one, however—the point being that assessments are flawed at times—they could end up with nothing to survive on. That is the point that disabled people make to me, and that is why I talk about the need for co-production, and working with disabled people to ensure that we get this right.

[Tom Pursglove]

Absolutely; that engagement is ongoing. We must move forward reform of the work capability assessment in a careful and measured way. We think that is the right approach to take, because it truly de-risks work.

I note that the Opposition policy related to the “into work” guarantee, for which the former shadow Secretary of State, the right hon. Member for Leicester South (Jonathan Ashworth)—of whom I am rather fond, by the way—argued passionately. I do not know whether it will be reviewed following the appointment today of his neighbour, the hon. Member for Leicester West (Liz Kendall), whom I welcome to her place as the new shadow Secretary of State, but the reforms that we are advocating for are the result of listening carefully to the responses to the Green Paper reforms.

I am keen to see the Opposition’s workings on the “into work” guarantee, but certainly from what officials have said to me, it seems that they do not think that it will have the effect on outcomes that the Opposition might think. I hope, however, that as we move forward with the reforms, we will see greater collaboration on a united basis. These are the right reforms to support more disabled people into work, following the abolition of the work capability assessment, which, in years gone by, I recognise as was controversial. Strong opinions have been expressed about it.

[Hannah Bardell]

I appreciate what the Minister is saying about the reforms, but perhaps he will reflect on the lived experiences that we have shared—the appalling treatment of our constituents and those on whose behalf we have spoken. Also, we have nearly £19 billion in unclaimed benefits every year, and 70% of appeals are overturned. If we add in the cost of the time, effort and trauma, we see there is clearly a long way still to go. Does he agree?

[Tom Pursglove]

I always make the point—I have done in the House on a number of occasions, as well as more widely in interviews and other engagements—that if people think that they are entitled to support, they absolutely should apply for it. I want that message to go out from Westminster Hall today. That is why the support is there; we want people to access the support to which they are entitled.

That leads nicely into a further point that I want to make about the White Paper reforms. As part of our reform package, we are testing new initiatives to make it easier to apply for and receive health and disability benefits. That speaks to the benefits journey that the hon. Member for Livingston (Hannah Bardell) touched on. For example, we are testing a new severe disability group. People who are eligible will benefit from a simplified process, and will not need to complete a detailed application form or go through a face-to-face assessment.

To add a little more clarity to the response I gave to my hon. Friend the Member for North Swindon (Justin Tomlinson) in Question Time, the policy will be tested on a small scale across a range of health conditions. The criteria used for the severe disability group will be based on the impact of a disability or health condition; we are looking at those that are lifelong, have a significant effect on day-to-day life and are unlikely to improve.

As I said, the Department has made progress with its plans to test the severe disability group. We worked with an expert group of specialist health professionals to draw up a set of draft criteria, which focus on claimants who have conditions that are severely disabling, lifelong and with no realistic prospect of recovery. The criteria were shared with several charities, whose feedback was used to develop the criteria further. We started initial testing at small scale across a range of health conditions last year, and we plan to augment our testing approach in the coming months to develop our insight and evidence. That is a welcome development, which responds to the clear feedback in the Green Paper: people wanted to reduce the assessment burden on those with lifelong conditions that are unlikely to improve. This is an important step on that journey. We will continue to move forward in a collaborative way, particularly as we build our understanding and evidence base to scale the policy.

We are also improving the experience of assessments by testing matching people’s primary health condition to a specialist assessor. As one part of that test, our assessors will take part in training to specialise in the functional impacts of specific health conditions, so that they can better understand claimants’ needs. I hope that will help to build confidence in decisions, and respond to feedback that we have received. Again, that speaks to the change that colleagues from across the House have said today that they want. We are also committed to exploring ways to create a personalised welfare system. For example, we are testing employment and health discussions, which are led by a healthcare professional and focus on how we can help people overcome barriers to work. The pilot at Leeds Health Model Office is helping us to evaluate findings and possible next steps for expansion.

On the theme of tests and trials, I want to respond to the point made by the Chair of the Work and Pensions Committee, the right hon. Member for East Ham (Sir Stephen Timms), on the recording of assessments. The Government are advocating for an opt-in approach. We think that strikes the balance. That way, if people wish to opt into having their assessment recorded, they are able to do so. We are mindful that there is a balance to be struck. We would not want people to feel uncomfortable talking candidly about their condition or disability, and its functional impacts.

However, the health transformation programme is looking at how we can create greater awareness of the ability to record the assessment. We may see more people accepting the opportunity to record their assessment on the back of that. I will gladly update the Committee on that awareness work as we move it forward. I recognise that this issue has come up in many debates, and I recognise the right hon. Gentleman’s strong feeling on the subject, but that is the current position. We are exploring ways to generate greater awareness of that opportunity, should that be something that people wish to do.

Employment is central to our plans. Alongside the ambitious programme of work for the future, the Government recognise that good-quality employment is an important determinant of good health. We have a range of initiatives to support disabled people and people with health conditions in starting, staying and succeeding in work, including initiatives in partnership between DWP and the health system. We have schemes such as the employment advisers in the NHS talking therapies service. We are moving towards 100% coverage in talking therapies services, and the testimony from people who have had the benefit of that is powerful; I welcome it. That is a significant improvement in the services available. The individual placement and support in primary care initiative is also impactful. It is about identifying people’s abilities and needs, helping them to find a role that is right for them, and supporting them in starting and retaining it. We are also taking forward schemes announced in the spring Budget. IPSPC is the pioneer for universal support. We are also piloting the WorkWell partnerships programme, which aims to close the disability employment gap.

We have made good progress in recent years. In 2017, the Government set a goal to see 1 million more disabled people in employment by 2027. Last year, we surpassed that goal five years early. That is not just the Government’s achievement. It is the achievement of disabled people most importantly, as well as of businesses buying into it, and of charities and representative bodies working with people to support that important agenda and unlock potential. Again, an active policy discussion in the Department relates to where we go from here in terms of future employment goals.

I also want to touch on sanctions, which came up a number of times. Work coaches will consider individual circumstances when working with claimants as part of our new personalised approach. If someone has a mental health condition, the work coach can use their discretion to switch off voluntary or mandatory requirements if they deem that appropriate. We will focus on what people can do rather than what they cannot, but we will also ensure that, when people are unable to work, we continue to support and assist them to live independent lives. All requirements will be agreed between the claimant and their work coach. As happens now, claimants will only ever be sanctioned where, without good reason, they have failed to meet the requirements. All claimants will retain the right to mandatory reconsideration or to appeal a decision should they disagree.

Specifically on the health transformation programme, we know that demand for disability benefits is increasing and we need to modernise our systems and processes to deliver better value for money for the taxpayer and a better experience for claimants. The health transformation programme is doing just that, transforming the entire PIP service—from finding out about benefits through to decisions, eligibility and payments. It will create a more efficient service and a vastly improved claimant experience, including speedier management of claims and improved trust in our services and decisions.

The programme is introducing an online PIP application service, giving the option to apply online 24/7 and to upload medical evidence digitally. I am pleased to say that claimants in selected postcodes are already able to apply for PIP entirely online, and we plan to make that available across England, Wales and Northern Ireland in 2024. Again, during the summer recess we announced some additional postcodes in which the new application service is now live.

I want to provide a bit of reassurance about a couple of comments made about the online service during the debate. The online service is optional; it is a voluntary alternative to the existing method for claiming PIP. Claimants who are unable to use an online service, or do not want to, will still be able to make a claim through existing routes. Claimants can receive third party assistance to support them in using the online service as long as the claimant is the one making the claim. Claimants who require formal support, such as an appointee, are not included in this current testing phase. However, making the service available to this group of claimants is a priority for us as we safely and gradually expand the service. We aim to make the online service available across England, Wales and Northern Ireland in 2024 for those who choose to use it. A point was made about being able to more readily reuse evidence: this system should be able to help people to do that.

We are also improving the way health assessments are delivered. We currently use a range of providers, depending on the benefit in question. Once new arrangements begin in 2024, one provider will deliver health assessments in a given area. Claimants will need to interact only with their local health assessment provider, regardless of which benefit they are applying for. That provides a stepping stone to our longer-term aim to create, from 2029, a single new health assessment service for all benefits that use a health assessment. That will transform the delivery of health assessments to provide an improved, clearer and more joined-up experience for claimants. The new service is being gradually developed in a safe environment known as the health transformation area. The approach will allow us continually to improve the new service in a controlled way, before expanding and ultimately rolling the service out nationally. We could not carry out this enormous endeavour alone.

We have also had regular engagement with stakeholders and will continue to listen and build on our successes as we move forward. Drawing on advice from across Government, on 25 May we published our evaluation strategy. That provides an overview of our plans to robustly evaluate the programme.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned safeguarding. I should say that I am meeting representatives of Mind tomorrow, along with a family; that will be of interest to colleagues across the House who campaigned for that meeting to happen. We had a very productive meeting with Mind a few weeks ago. It is important that Ministers should have those direct and perhaps even difficult conversations to make sure that at the Department any and all learning takes place and that all our processes are conducive to being responsive to claimants’ needs and are the best they can be, building on work that I have previously set out. I will not repeat those comments today as we will no doubt revisit these matters in future.

I care passionately about that individual focused support and supporting claimants appropriately through the benefits journey, and want to ensure that all the reform we are taking forward has that support very much at the forefront, building on initiatives such as the advanced customer support senior leaders and the various upskilling work that has gone on within the Department to support staff to best support the most vulnerable claimants.

As well as the ambitious visions of the White Paper and the health transformation programme, we are continually listening to and acting on feedback on the current PIP system to make significant positive improvements. Reducing customer journey times for PIP claimants is a priority for the Department. We are seeing an improvement in average clearance times for new PIP claims, with the latest statistics showing that the end-to-end journey has reduced from 26 weeks in August 2021 to 13 weeks in April 2023. We also recognise that assessments can be a difficult experience, so we now undertake most by telephone to alleviate some of the stress associated with travelling to and attending observational assessments, but I reiterate that if people want to have face-to-face assessments, that should happen; there is the optionality for claimants to seek a face-to-face appointment if that is right for them and they wish it to happen.

More generally, the PIP assessment criteria were developed in collaboration with independent specialists in health, social care and disability, and they focus on needs arising from a range of impairments—including physical, sensory, cognitive and mental health impairments —rather than the condition itself, to ensure that the greatest level of support goes to those who are least able to carry out the activities. PIP and its descriptors are kept under continued review to ensure that they meet the needs of claimants and help the Department to reach an accurate assessment of an individual’s entitlement, but I take on board the points raised during the debate and will raise them with officials back at the Department in future conversations and decisions around PIP and its descriptors.

Let me turn to assessments and medical evidence. We are committed to improving how our decision-making processes work. Medical evidence from GPs and other healthcare professionals play an important part in decision making. We ask claimants to provide relevant evidence at the outset of their claim, and we take that fully into account. However, although this is a valued part of the decision-making process, we recognise that doctors do not want to be the guardians of the benefits system, which is why we do not use it as the sole gateway. I note the testimony and evidence from the BMA mentioned by the Chair of the Select Committee, the right hon. Member for East Ham. Additionally, for PIP and the WCA, awards are not condition-based, as individuals may be impacted by their health condition in different ways. Medical evidence may not describe the functional impact of a disability or health condition on the individual and therefore may not be sufficient on its own to determine entitlement to the benefit. Where it is possible to assess a claim based on the paper evidence alone without an assessment, we will do so.

We are committed to ensuring that claimants receive high-quality, objective and accurate assessments to inform the right decision. Consequently, our assessors are all health professionals with specialist training in assessing the impact of a disability. We recognise that assessments and reviews are not suitable for our claimants with lifelong conditions and disabilities specifically. Although we still have the work capability assessment, we do not routinely reassess people with the most severe health conditions and disabilities with no prospect of improvement, and instead the severe conditions criteria apply. In PIP, our claimants on the highest level of support with long-term conditions receive an ongoing award with a light-touch review at the 10-year point that involves a short form to check whether anything has changed and to confirm that we hold updated information. In most cases, an assessment with a health professional is not required. Our severe disability group test is also part of our focus to reduce unnecessary applications and assessments.

A number of Members posed a very legitimate question about what we are doing to improve the quality of decision making. We have made improvements to the decision-making process, both at the first decision and the MR stage, giving decision makers additional time to contact proactively claimants if they think additional evidence may support the claim. That tailored, more bespoke approach, making sure that decision makers can follow up with claimants to try to ensure that their entitlement is delivered as quickly as possible, ought to complete the jigsaw of the claim and get support out to people.

We are also continuing to learn from decisions overturned at appeal, with our presenting officers going out to hear those tribunals and then sharing that feedback with the Department to help improve our processes. We also work closely with providers on the quality of assessments, with the quality assurance that all of us would want to see, to help ensure that there are high-quality reports that then lead to more correct decisions. To set that in context, since PIP was introduced 5.1 million initial decisions following an assessment were made to the end of December 2022, with 8% appealed and 4% overturned at tribunal. As my hon. Friend the Member for North Swindon highlighted, a significant proportion of those decisions are overturned as a result of new evidence presented at the tribunal. It is important to take that into account, but we are not complacent, and we want more decisions got right first time, hence the efforts to try and achieve that.

Finally, for people nearing the end of life we have the special benefit rules. They allow faster and easier access to certain benefits without needing to attend a medical assessment or serve waiting periods. Eligibility has recently been extended from six months or less to live to 12 months or less, and individuals are now able to claim PIP, DLA, attendance allowance, ESA and UC under the special rules, and that is administered in a pragmatic, flexible, clinician-led way. The hon. Member for Motherwell and Wishaw (Marion Fellows) raised that point, so I want to provide reassurance about the clinician-led approach. I have done this before, but I want to thank all those colleagues across Parliament who campaigned for the changes to the special end of life rules that we have brought about, as well as the stakeholders and the charities who were instrumental in delivering that change. I know that extending that benefit entitlement to people at an earlier stage and for longer is a lifeline to many people across this country.

In conclusion, we are committed to ongoing action to improve people’s journeys through the benefit system both today and by advancing the longer-term reform that I have set out, which I hope all of us will feel able to get around in the coming years with that proper input from disabled people, from stakeholders, and from the representative groups to help us get this right. This is arguably the biggest welfare reform for over a decade, and it is crucial that we hear that lived experience in shaping it and that we work carefully through that change to ensure that it is the best that it can be. We must ensure that we do not write people off, and that where work is appropriate for someone, they are able to access that if it is something that they want to do, recognising the benefit of the health and work join up. All of us, I think, want to see people reach their potential, supported by a benefit system that not only is fit for the future, but has that vital safety net in place that all of us in a civil society expect to see.