Disability Benefits: Assessments

Wendy Chamberlain Excerpts
Monday 4th September 2023

(8 months, 4 weeks ago)

Westminster Hall
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Justin Tomlinson Portrait Justin Tomlinson
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Absolutely. It would be valuable twofold. I talk to a lot of the assessors, and I know we are all going to highlight where there are challenges, but something like 95% of claims go through. Satisfaction is still relatively high for those claimants; as I said, we are spending £10 billion. The vast majority of assessors want to get it right first time and want to have that knowledge and support, so if we can allow some assessors to specialise, they can develop their training with charities and health organisations with specific knowledge of the area. That will increase the chance of getting the decision right the first time.

Not everybody presents with one single health condition, so it may be that people would have a hybrid assessment in two parts. There would be a general assessment, which in many cases would pick up things on the mental health side that people did not realise were having an impact on their day-to-day life; there would also be a specific assessment of the primary health condition. As the hon. Member for Bristol East (Kerry McCarthy) so clearly articulates, where people have fluctuating health conditions we really need the knowledge to ensure that we are looking not just at one particular day but, as the guidance says, at the typical impact over a one-year period.

During covid, we had a significantly reduced workforce. All our health assessors have a medical background and then have extensive training, and they were the first port of call for secondments to the NHS to provide the covid jab, so we had an incredibly depleted workforce. That really focused our mind on the volume of assessments. At Work and Pensions oral questions earlier today, I raised a point about whether lessons have been learned on extending the severe conditions criteria. When we looked at it, we estimated that about 250,000 to 300,000 assessments, with a change, could be lifted out of the system every single year. That would speed up the process for those who remain and would obviously be beneficial for those 250,000 to 300,000 people.

At the moment, PIP does not look at individual conditions—it is about the menu of health conditions that have an impact on someone’s daily life—but I think that, in some cases, we can do so. We have shown that with the changes to the special rules for the terminally ill, which will look at health conditions. I will give one example, but no doubt there are many organisations that would lobby for a change in respect of particular health conditions.

Motor neurone disease is a horribly degenerative disease, and there is a pretty clear trajectory once someone has been diagnosed, so I have never understood why on earth we assess people who have it. From the moment they have been diagnosed, we should be able to say, “We expect their condition to go like this,” and then provide an automatic level of support. They would start at the lower level immediately after diagnosis and, as their condition, sadly, deteriorated, they would automatically move on to the highest level. If, sadly, their condition deteriorated more quickly, they would be able to contact the PIP assessors, speak to the MND specialist team, have a light-touch conversation—a GP’s note would probably be sufficient—and be automatically upgraded.

Wendy Chamberlain Portrait Wendy Chamberlain (North East Fife) (LD)
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I am grateful that the hon. Member has brought up MND. Does he agree that one thing that the current system must do is prevent delays? Not only do people with the condition sometimes deteriorate more quickly, but the adaptations that local authorities are making, and so on, mean that we are making the process much more difficult on every front for people with MND.

Justin Tomlinson Portrait Justin Tomlinson
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Absolutely, and that was one of the drivers behind our changes to the special rules on terminal illness. From the point of diagnosis, PIP is a gateway benefit that will unlock extra help from local authorities, so it will certainly speed up that process.

Before the Minister panics and thinks that he would need an office akin to Fort Knox because every single health group would lobby him and say, “These rules should apply to our particular health challenge,” let me say that the way around that is to look at the Industrial Injuries Advisory Council, which already operates within the DWP. In effect, that is a separate, independent body of medical and scientific experts with far greater brains than mine. They are the ones who decide which health conditions qualify for industrial injuries benefits. We could apply the same principle and, as medical care and scientific knowledge evolved, they could update the guidance. That could potentially lift 250,000 to 300,000 people out of the process and help some of the most important people. Since the changes on terminal illness came into force, we have seen all pluses and little else. I hope that the Minister’s commitment to trying to pilot initiatives in this area will continue, ahead of the White Paper.

Many colleagues have mentioned the appeals process. There are different ways of looking at the statistics but, by and large, for the vast majority of people who are successful in the appeals process, either at the mandatory reconsideration stage or at the end, that is because of additional evidence that is presented. We have to look at why that additional evidence is being presented so late in the day. There are many things that could be done. The Department could be more proactive in chasing up sources that have supportive evidence. Getting evidence from a GP is a bit of a postcode lottery. Some GPs will reply to a claimant immediately and give chapter and verse; some are much slower. Some will seek to charge. Some do not necessarily have the right information.

Where someone has already gone through a work capability assessment, which is very similar—I know there is potentially a review of whether we should have two separate assessments, but this is the case as it stands today—there will already be a lot of information on a similar system, and we should at least ask the claimant whether they would like us to look at that information. Remember that it is the claimant’s information and we should not do that automatically, but we should ask to bring that information over.

We should be proactive in encouraging claimants to bring a trusted colleague with them to the assessments. That is within the rules, but how assessors allow it is very inconsistent. Some assessors will encourage the colleague to speak. Some will tell them, “No, you’re not being assessed; you are just there to provide moral support.” We need consistent guidelines. In my opinion, they should be allowed to speak. I have sat in on a lot of assessments; a lot of people are understandably overwhelmed, and arguably do not do themselves justice in what they say. Sometimes, when a person has had a condition for so long, they just take it as the norm that, for example, they no longer sleep at night. Their partner who is woken up by their not sleeping at night would probably be better at articulating that. We should be doing that.

We also started testing phoning claimants at the mandatory reconsideration stage and asking them to tell us, in their own words, why they disagreed with the decision. One speaker mentioned earlier that the mandatory reconsideration success rate is only about 11%. My understanding is that when we piloted proactively speaking to the claimant, that figure went up to about 40%; when I talked to assessors doing that at the time, they felt they could go even further. We would invariably find that a claimant’s GP had told them something but they had not provided us with the information, or had not been able to get it, and we could chase the GP on their behalf and get that information.

We also allowed people to be lifted out of the system. In the past, people had in effect to take their chances. They had to wait for the MR, and once they triggered the independent appeal the Department could not come back and say, “Now you have provided us with this evidence, we agree with you and wish to do that,” because they were stuck waiting for the judge, which can be up to a 12-month wait. We changed the rules so we could lift people out, but if people still did not agree with us they had the right to stay in the process. All those measures that can help lift people out of the process would be very welcome.

I also want to highlight the need for us to start signposting support and help. PIP is geared up to identify people’s challenges and then to identify society’s financial contribution towards the impact on their daily lives, but we stop there; we do not signpost people on PIP to additional support that may exist in their communities. I visited many wonderful and innovative mental health pilots across the country—we will all have done loads of visits in the summer recess, seen something and thought, “Gosh!”—but time and again people said to me, “Our problem is that we can’t find enough people to come and test these things out.” Yet the PIP database has the list of all the people who have been identified as having a mental health issue. I am not saying that they should have to do it, but at the very least we should be writing and saying, “Right, you’re in this particular postcode. These are the local charities and organisations, this is the local authority, and these are the local health pilots to do with your primary condition, or menu of conditions, that may be of interest to you.” I think that would be hugely beneficial to many of the people who go through the system.

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David Linden Portrait David Linden (Glasgow East) (SNP)
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It is a pleasure to serve under your chairmanship, Mr Mundell. I pay tribute to the hon. Member for Carshalton and Wallington (Elliot Colburn) who opened the debate on behalf of the Petitions Committee. Elements of his speech felt like groundhog day, because the first Westminster Hall debate that I led, in 2017, was on the issue of work capability assessments. It is worrying that six years on we are still here debating the very same issues. All Members, regardless of party, know that those issues cause undue stress and misery to people across our four nations.

The British Government’s approach to disability benefit assessments is not just ineffective—the theme that has been developed today—but inhumane. Under the current regime, the application process removes the reality of people’s lived experience as the very foundation on which the system has been defined. It favours evidence provided by the assessor rather than the claimant. The system also operates on the presumption of scepticism. It is not a system that empowers its users. Instead it perpetuates a cycle of despair and frustration. That “one size fits all” approach to disability assessment is in my view not only short-sighted, but it completely disregards the reality of living with a disability or a chronic illness. Charities such as Scope have raised concerns about the process time and again, but their calls appear to be continually ignored—at huge expense to those living with a disability.

The impact of disability assessments has, unfortunately, featured significantly in my caseload since I became MP for Glasgow East in 2017. I will be honest: I am no stranger to hearing about dehumanising experiences that my constituents have endured as a result of this system. I sit week in, week out at surgeries across the east end of Glasgow in places like Baillieston, Parkhead and Easterhouse, hearing the same harrowing and sometimes traumatic experiences that people have had to endure at the hands of the disability benefits assessment process.

In most cases, and worryingly, people’s mental and physical health are only worsened by the assessment process. That leads to many further problems for the NHS through health problems, whether physical or mental, so it is counter-productive. My hon. Friend the Member for Livingston (Hannah Bardell) referred to the finding by Scope: from January to March this year, 68% of PIP appeal outcomes were changed in favour of the claimant. If such a proportion of wrong outcomes were found in any other Department, Ministers would ask serious questions. I respect the Minister, who I know takes a strong interest in this issue, but I ask him to look again at the figure of nearly 70% of appeal outcomes being overturned. That suggests that the system is fundamentally flawed.

As people continue to face the disability price tag, disabled people are also having to juggle the restricted funds available to them along with soaring food and energy prices. According to the Trussell Trust’s analysis, three quarters of people referred to its food banks reported that they or a member of their household were disabled. As disabled people are hit disproportionately by the cost of living crisis, to the tune of some £945 a month extra, it is vital that all financial support to which they are entitled is awarded. However, under the current system, that is not always the case; in many cases, it feels as if people are actively held back from the support they so desperately need.

The hon. Member for Warrington North (Charlotte Nichols) highlighted the recommendations in the Work and Pensions Committee report about the use of informal observations—a point also made by the MS Society in its briefing for the debate. Far too often, PIP assessors make inaccurate decisions based on those informal observations. Watching how someone looks or behaves during their assessment or observing someone walking from their car to the assessment centre are now used as tests of mobility. That is completely wrong and such things should not be taken into account. The Work and Pensions Committee, on which I am privileged to serve with the right hon. Member for East Ham (Sir Stephen Timms), has heard that, more often than not, those informal observations are given greater weight than medical evidence.

As others have outlined, when it comes to people with conditions such as multiple sclerosis or Parkinson’s, which fluctuate day to day and have many hidden symptoms, it is completely arbitrary for informal observations to be used to inform the assessor’s decision. The assessor’s limited understanding of complex fluctuating conditions such as MS, combined with the use of informal observations as a way of gathering evidence, results in greater emphasis being placed on the evidence provided by the assessor, rather than the lived experience of the disabled claimant. It therefore strikes me that the only purpose of asking a claimant to come for an assessment is to watch them literally walk from their car to the front door of the assessment centre, which seems utterly absurd.

As my hon. Friend the Member for Livingston made clear, when we look north of the border—this brings me to the substantive point from the hon. Member for North Swindon (Justin Tomlinson)—we can see the difference that devolution has made to how the policy has been implemented. It seems clear, not just to SNP Members but to those who work in the disability sphere, that the Scottish Government—on a cross-party basis, in fairness—are moving away from the regressive approach and becoming more committed to a process that has been designed around the lived experience of people with a disability.

Indeed, the adult disability payment from the Scottish Government is delivering an entirely new, simplified and—I would argue—far more compassionate experience for disabled people. It is a system that has been designed with the claimant, rather than against them; that is the key point that comes back when we speak to stakeholders north of the border. Putting compassion and people at the heart of the system must be the priority for any Government, regardless of their colour, so I am proud that we have taken that approach. Indeed, I am proud that Conservative Members on the Work and Pensions Committee unanimously approved its report praising the Scottish Government’s approach.

Wendy Chamberlain Portrait Wendy Chamberlain
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I am a member of the Scottish Affairs Committee, which did an inquiry into welfare in Scotland, and I certainly agree that what came through strongly from stakeholders was the need for a compassionate approach. As always, however, the processes have to be properly administered. Does the hon. Gentleman accept that at the moment the reality is that waiting times for the ADP in Scotland are longer than those for PIP assessments? Does he, like me, have casework in which there have been incorrect decisions? The approach might be different, but we need to see better outcomes.

David Linden Portrait David Linden
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Absolutely. I totally understand the hon. Lady’s point, and I am sure she will understand that a lot of the civil servants who were working on the design of the Social Security Scotland system were rightly deployed towards the covid pandemic. Ministers in the Scottish Government have acknowledged that the situation with the ADP waiting list is less than helpful. But I come back to the fundamental point on which I challenge the hon. Member for North Swindon, which is that our systems are about taking the view that the claimant is not on the make. That is the nub of the issue. With the UK Government’s system, there is a scepticism about whether the person sitting at the other end of the table is on the make or on the take, so it is about trying to find a way to catch them out. That is why there is an overturn rate of 68%, for example.

--- Later in debate ---
Wendy Chamberlain Portrait Wendy Chamberlain (North East Fife) (LD)
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It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Carshalton and Wallington (Elliot Colburn) for introducing the debate, the petitioners who signed the petitions and the Petitions Committee for its work.

As other Members have said, as a constituency MP I find that DWP casework, particularly regarding PIP assessments, takes up a substantial part of my caseworkers’ time and often causes extreme distress to those who come to me as their MP. It is always nice as an MP to feel good when we have had a result and managed to overturn something, but frankly we should not need to be involved in the process at all.

I thank the right hon. Member for East Ham (Sir Stephen Timms), the Chair of the Work and Pensions Committee, for highlighting a number of the Committee’s recent report findings. I echo the thoughts of the hon. Member for Glasgow East (David Linden): this is a cross-party issue. There are a number of areas on which we would be likely to find agreement in order to straighten out and improve some of the systems. That would not only help some of our most vulnerable constituents but, frankly, surely save the public purse some money, given the failures and inefficiencies in our system.

It is useful to reflect on why we have a disability benefits system in the first place: because we know that those with a disability often find that their ability to work is impaired or that they are unable to work at all. Our social security system accepts that such individuals need support to compensate them for their inability to work and to meet the additional costs that their disability involves.

It is important that we remember that work capability assessments are not strictly disability benefit assessments, but they predominantly impact on disabled people when they apply for benefits and need to be considered in this debate. The Government have said that work capability assessments are unlikely to be abolished until 2026-27 at the earliest, so there are some key questions that we need answered. We need to know what will be done to improve them in the meantime—we have already heard a number of points about that. How are we avoiding over-testing? What has been done to protect claimants’ mental health? It would be great if the Government could provide clarity on the timeframe involved.

Without work capability assessments, is there a blanket requirement to look for work? It is vital that we avoid unnecessarily extending sanctions to those who are not in a position to work because of their health. All the evidence suggests that sanctions are not effective in encouraging people to work, and they also penalise people with mental health difficulties. Surely we should all want to see a scheme based on incentives.

My party wants to see a separation of the administration of benefits from employment support. Being supported to access training, education or employment ought to be separate from social security. People are not motivated to do things because there is not a sanction; they are motivated to do things because everyone wants a life that is as fulfilling as possible.

I am conscious the fact that at this point in the debate, although we still have plenty of time left, I am touching on things that have already been covered by other Members. On the application process for PIP, the forms are long, difficult and stressful, particularly for applicants with cognitive difficulties, fatigue or mental health difficulties. I firmly echo the thoughts of the right hon. Member for East Ham in relation to the time limit to complete the forms. It is certainly my experience as a constituency MP that forms sometimes take up to a week to arrive, which leaves applicants with only two weeks to apply. That is simply unrealistic.

There is an option to call the DWP and ask for an extension, but frankly it is not well known about, and having to engage again with the DWP causes unnecessary stress. Surely we could look at increasing the time given for applicants to complete the form to two months, and perhaps even longer. We also need to review the form so that we properly take account of relapsing and remitting conditions. I refer to the remarks that I made in an Adjournment debate that I secured on long covid, in which we considered how to support people with that condition.

[SIR GARY STREETER in the Chair]

It is a pleasure to see you in the Chair, Sir Gary. On the PIP assessment process, we all have inboxes full of correspondence from unhappy constituents. I am aware that there will potentially be happy constituents out there who have not had any issues with PIP and therefore have not got in touch with us as MPs, but for those who do get in touch I suspect that the reality of their experience is that they feel the process was degrading and designed to trip them up. The Government can say all they want that that is not what is meant to happen, but it is the experience of the vast majority of people we talk to. One of the petitions we are debating suggests abolishing assessments entirely and focusing only on the medical evidence. We have heard comments from other Members as to why that might not be the best approach, but I agree that it is hard to find a system that is worse than the current one.

Delays in getting assessments is a real issue. According to Citizens Advice, in April this year some 720,000 people were waiting either for an appointment for a new claim or for a review—that is some backlog. We must see a shift in how assessments are offered, with a choice for claimants between them being in person or on the phone. One of the benefits of the pandemic was seeing how that might be possible.

The formal part of the assessment, as Members know, involves reviewing the claimant’s functional abilities against a range of descriptors. Evidence gathered by organisations such as Scope shows overwhelmingly that the descriptors do not allow claimants to properly explain their needs and what they might have difficulty with. Let us take, for example, the question on food preparation: the ability of someone to feed themselves is not as simple as whether they can cook a meal unaided. So many aspects of that are not covered by that simple statement. Perhaps someone can prepare a meal if their pain is not too bad, but they need someone to reach for the items on the top or bottom shelves of a cupboard. Perhaps someone asks the question based on whether the claimant has had help cooking in the past day or week. The answer might be no not because they do not need help, but because they simply have not had the opportunity or support, so they have been eating food like cereal or a ready meal to compensate.

The descriptors are even more problematic for people with relapsing and remitting conditions. At the moment, a 50% rule is applied, so someone has to experience a symptom and have a resulting difficulty for half a given time period for that difficulty to count. That means that if they are in pain so severe that they cannot wash, dress or go to the shops, but only for 14 days in a month, they would not qualify for any support. The criteria also fail to take into account the impact of performing the activities being assessed. “Can you walk more than 20 metres or 50 metres?” Perhaps they can, but slowly and with difficulty, and they are then in so much pain that they cannot do anything for the rest of the day. A mere yes or no does not consider the better test of whether someone can do something safely, repeatedly, competently and in a timely manner.

Other Members have touched on this, but informal observations are a real concern. Particularly given the use of non-specialist assessors, it seems deliberately careless to ask someone to make a judgment on another’s abilities without any deep understanding of that person’s experience. I am grateful to the hon. Member for Warrington North (Charlotte Nichols) for highlighting MS in that regard. In any case, the mere fact that people know they are being watched makes them feel that they are being distrusted, which speaks to the point that the hon. Member for Glasgow East made. In fact, that is why we are all here today: because the people who are meant to be supported through benefits like PIP have so little trust in the system that they want it to be completely overhauled. That is why they signed the petition. We absolutely need to restore that trust, and the first thing the Government could do very simply is to review the use of informal assessments.

I agree with the right hon. Member for East Ham that all assessments must be recorded by default, with the option to opt out if the applicant wants. I do not understand why the Government have not accepted that recommendation from the Select Committee. All reports simply ought to be shared so that claimants can see how and why a decision has been made. That seems reasonable, particularly if we are then moving on to reassessments.

It is important to think about reassessments, and I hope the Minister will explain why it continues to be DWP policy to over-review claimants who have no chance of improving. If something gets worse for a claimant and they think they should be entitled to a higher level of support, they are entitled to start that review process themselves. There is absolutely no need to call people back year in, year out for a stressful process that uses up taxpayer money and just creates more and more backlogs. The backlog will soon be well above a million if we continue in that way.

Worse than that, all the stats for mandatory reconsiderations and appeals show that incorrect decisions at first assessment are commonplace. That means that when someone is called back for an unnecessary assessment, the chances are that they might have had their benefits wrongly stopped. We know that families with at least one disabled person are far more likely to be in poverty than those without—42% compared with 18%, according to the Social Market Foundation—so stopping those benefits, even for a short period, can have devastating effects.

The process halts any chance of someone improving and being able to enjoy a more active and fulfilling life that might include employment, with frequent reassessments linked to stress and further deterioration. That has been the experience of one of my constituents. She does not want to be named, but she wants me to share this with the Minister. She suffered a spinal cord injury in the early 2000s. She was initially assessed in 2016, then reassessed in 2017 and 2019. She has had multiple incorrect assessments. She finds dealing with the DWP incredibly traumatic. Despite being told by her doctor that her condition will never improve—something the DWP eventually accepted—she is still being told that she needs reassessments every two years. That will not fix her spine. All it does is risk her losing the little she receives while causing immense distress. Her needs might worsen over time, but she should be able to exercise her own autonomy about requesting a review rather than being stuck in an endless cycle. What are the Minister’s thoughts about what I can go back and say to my constituent to show that he understands and cares about her and others in that position?

In conclusion, it is clear that the assessments need to be reformed from top to bottom. None of us knows what will happen to us or our loved ones, and our social security system should be a safety net. Its purpose should be to reduce poverty and, where possible, increase employment. I hope the Minister will take on board the comments made by Members today.

Gary Streeter Portrait Sir Gary Streeter (in the Chair)
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We now turn to our Front-Bench speeches. I call Marion Fellows.