Health assessments for benefits: an analysis of the government's response
More than 8,500 individuals and organisations gave evidence to the latest Work and Pensions Committee inquiry into benefit assessments. Carri Swann considers the government’s response.
The DWP’s benefits system features two big ‘health and disability assessments’. These are the work capability assessment, introduced in 2008, and the assessment for personal independence payment (PIP), which began in 2013.
The assessments are meant to help the DWP award the right people the right amount of benefit. For most, the assessment means a meeting with a healthcare professional from one of the government’s sub-contracted assessment firms. The meeting can be face-to-face in a clinic or at home, or remotely by phone or video call. The DWP’s decision about benefit entitlement is made based on the assessor’s written report.
There has been a series of independent reviews into how these assessments are working: do they lead to good decisions, and what is the experience like for claimants? Regrettably, despite hearing many of the same answers and recommendations each time, the DWP has not made changes that are needed to improve the process.
We have seen this once again in the government’s response to the latest Work and Pensions Committee (WPC) inquiry on benefit assessments. This is the second time the WPC has conducted a detailed inquiry on this topic, hearing from claimants, assessment providers, civil servants and many others, and the second time that the DWP has failed to accept its main recommendations.
‘There is a remarkable similarity between the recommendations made in evidence to this inquiry, and those made by our predecessor Committee in 2018.’1
Work and Pensions Committee, April 2023
- 1WPC, Health assessments for benefits, 14 April 2023, at para 16. committees.parliament.uk/publications/34727/documents/191178/default/
Audio-record assessments by default
Why
For accountability and transparency. Opt-out audio recording has the potential to improve the quality of the assessments themselves, the reliability of the reports that assessors write, and, as a consequence, the quality of benefit decisions. This approach has been adopted by Social Security Scotland for devolved disability benefits.
DWP’s response in June 2023
Current arrangements will continue: audio recording is available only when requested in advance or arranged independently by the claimant. For the work capability assessment, the rules are particularly restrictive.2
The change had been recommended in
The second independent PIP review in March 2017; the first WPC report on assessments in February 2018; the second WPC report in April 2023; and by all three sub-contracted assessment firms in evidence to the WPC.
Let claimants choose their assessment format (clinic, home visit, telephone or video)
Why
To improve accessibility and the quality of assessments. The first WPC report on assessments in 2018 recommended that the DWP take steps to ensure claimants were being offered the option of a home assessment without needing a supporting GP letter. The DWP rejected this at the time. The second WPC report in 2023 makes a broader recommendation about giving all claimants a choice of assessment format.
DWP’s response in June 2023
There is no commitment to let claimants choose the assessment format that suits them best. As until now, they can make a request for a different format, but the assessment provider has the last word. The DWP says that it is undertaking research, due to complete later this year, which ‘will inform how the Department’s multi-channelled service capability can be optimised, including whether claimants will be able to choose their preferred assessment channel.’3
Research and learn more from decisions overturned at appeal
Why
‘The data on MRs [mandatory reconsiderations] 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.’4 Learning from cases where the decision was overturned at appeal could help the DWP spot problems in the assessment and decision-making process. The Committee recommended that the DWP commission and publish new research.
DWP’s response in June 2023
The DWP has not committed to new research into decisions overturned at appeal, or (for example) closer monitoring of overturn rates for individual decision-makers or assessors, as has previously been recommended. It talks about ‘small-scale internal learning exercises’ and work on ‘improving feedback… [which is] still in very early development.5
The change had been recommended in
The fifth independent WCA review in November 2014; the first WPC report on assessments in February 2018; the second WPC report in April 2023.
Research the impact of assessments on (mental) health
Why
Claimants across the board have described the adverse effects they experience before, during and after assessments. If assessments actually make health worse, this is in nobody’s interests and must be addressed. The DWP accepted the WPC’s recommendation on this in 2018, and research was done, but it went largely off-topic, focusing instead on how benefit questionnaires could be improved.6
DWP’s response in June 2023
The DWP refused to commit to regular reviews of the mental health impacts of health assessments, or to make data available for independent research, saying that ‘it would be extremely difficult to objectively separate the impact of the process on mental health from other confounding factors.’7
The change had been recommended in
The first WPC report on assessments in February 2018 and the second WPC report in April 2023.
- 2DWP, Work Capability Assessment Handbook, para 4.1.3 assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1126075/wca-handbook.pdf; DWP, Personal Independence Payment Assessment Guide, paras 1.6.58-64 www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-1-the-assessment-process#the-consultation
- 3Health assessments for benefits, 26 June 2023, at p7 committees.parliament.uk/publications/40554/documents/197772/default/
- 4WPC, Health assessments for benefits, 14 April 2023, at p7 committees.parliament.uk/publications/34727/documents/191178/default/
- 5Health assessments for benefits, 26 June 2023, at p13 committees.parliament.uk/publications/40554/documents/197772/default/
- 6DWP, Claimant views on ways to improve PIP and ESA questionnaires, 20 July 2021 gov.uk/government/publications/claimant-views-on-ways-to-improve-pip-and-esa-questionnaires
- 7Health assessments for benefits, 26 June 2023, at p7 committees.parliament.uk/publications/40554/documents/197772/default/
‘When it came to questions of self-harm my daughter was asked about ‘suicidal ideation’ and then asked, "what stops you?" I tried to intervene and unfortunately I was unsuccessful in preventing this line of questioning. After the assessment had finished my daughter told me that she found the whole thing humiliating. I wanted to spare her this experience and questioning and I couldn't. I feel like I failed her.’
An appointee who contacted CPAG’s Early Warning System
A very few repeat recommendations seem to be finally finding their mark:
Provide a copy of the assessment report with the decision letter
Why
For accountability and transparency. Claimants can see, at an early stage, the evidence that is being used to decide their entitlement, and can make an informed decision about whether to challenge it. This approach has been adopted by Social Security Scotland for devolved disability benefits.
DWP’s response in June 2023
The DWP made its intentions known in its Health and Disability White Paper in March 2023, where it said that it had ‘begun to test the feasibility of sharing assessment reports with people making the claim before a decision is made.’ In its response this week, it confirmed this meant ‘sharing assessment reports with people by default rather than on request’.8
The change had been recommended in
The second independent PIP review in March 2017; the first WPC report on assessments in February 2018; the second WPC report in April 2023.
- 8Health assessments for benefits, 26 June 2023, at p17 committees.parliament.uk/publications/40554/documents/197772/default/
‘The assessment report is littered with errors, contradictions and bare-faced lies that I now have to point out to the DWP. This report is made up of 31 pages and there repeated inaccuracies on nearly every page. I am telling you this because I am sick of it - I am sick of how we are treated.’
A claimant who contacted CPAG’s Early Warning System
Improve the use of evidence by assessors and decision-makers
Why
A wide range of evidence is relevant in the assessment process.9 Concerns have been raised that certain types of (particularly non-medical) evidence is undervalued by assessors and decision-makers. Various improvements have been recommended over the years: introducing a checklist for assessors to confirm how they have weighed the claimant’s different pieces of evidence; improving assessors’ and claimants’ understanding of ‘good evidence’; and reviewing the guidance on evidence from carers and family members.
DWP’s response in June 2023
On the specific topic of evidence given by carers and family members at assessments, we are told that the DWP ‘will review the health professionals’ guidance and training material, assess the evidence and work with the assessment providers to ensure compliance.’10
The change had been recommended in
The second independent PIP review in March 2017; the first WPC report on assessments in February 2018; the second WPC report in April 2023.
Assessment by a specialist
Why
An assessment seems likely to be of better quality when the assessor is knowledgeable about the claimant’s condition. Being assessed by someone with little or no clinical experience of your condition undermines trust in the process. Support for specialist assessors has been widespread but not unanimous, with some concerns about the potential to delay assessments and the difficulties where a claimant had more than one health condition or disability.
DWP’s response in June 2023
Again the DWP picked this up in its Health and Disability White Paper in March 2023, where it said that ‘this year, we will begin testing matching a person’s primary health condition to a specialist assessor. As part of this, assessors will take part in training to specialise in the functional impacts of specific health conditions.’
The change had been recommended in
Evidence to the first independent PIP review in 2014 and the second independent PIP review in 2017, and evidence to the WPC inquiries in 2017 and 2021-22.
- 9DWP, Work Capability Assessment Handbook, paras 1.4.1-1.6 and throughout assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1126075/wca-handbook.pdf; DWP, Personal Independence Payment Assessment Guide, at (eg) paras 1.4.5 and 1.6.54; R(I) 2/51 gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-1-the-assessment-process#the-consultation
- 10Health assessments for benefits, 26 June 2023, at p11 committees.parliament.uk/publications/40554/documents/197772/default/
‘My son is a bright, talented, caring young man and in the assessment report the assessor uses my son’s qualities against him and even blurs ‘cognitive impairment’ with a mental health condition (…) This assessor was completely unprofessional and did not know what they were doing.’
A parent who contacted CPAG’s Early Warning System
Note: This briefing looks at only some of the recommendations in the Work and Pensions Committee’s April 2023 report, many more of which were rejected by the DWP in its June 2023 response.
Read the Work and Pensions Committee’s April 2023 report into benefit assessments in full.
Read the DWP’s June 2023 response in full.
CPAG’s Early Warning System is a database of case studies submitted by frontline workers and individual claimants about the problems people experience accessing social security benefits. We are grateful to everyone who has submitted a case study about assessments. You can see some of your evidence cited by the Work and Pensions Committee in its April 2023 report.