Benefits health assessments often fail disabled people
3 things they get wrong and how to fix them
We help more people with disability benefits than any other topic. Last year we helped 383,704 people with over 900,000 disability benefit issues. We help at every stage, from initial eligibility queries to the appeal processes. With our unique insight, it’s clear to us the system needs changing.
Incorrect decisions and long wait times mean sick and disabled people are left without the benefits they’re entitled to. This causes undue stress, hardship and misery for thousands. With several past reviews and green papers for improving disability benefits, it’s clear the Department for Work and Pensions (DWP) shares our view that change is needed.
Every day advisers see issues with each step of the assessment process — from clients’ experience of their assessment appointment, the expertise of the person they meet and the quality of the report produced afterwards.
Claimants don’t feel listened to
People’s lives are complicated. How disability affects you isn’t some tidy formula; it doesn’t always fit a neat set of tickbox questions. But that’s the story claimants are expected to present to the DWP — to fit their real life experience into a conveyor belt of Yes or No questions. Advisers tell us that when claimants are only asked ‘Can you do x?’, this often leaves no room for the complex truth. No room for ‘rarely, with enormous effort that exhausts me for days’. Just the depersonalising frustration of saying Yes or No.
As well as feeling pressure to explain how their condition impacts on day to day life, claimants also want to look their best for their assessment. However advisers tell us that these preparations can often backfire. They go the extra mile to dress smartly and appear calm, but assessors may wrongly assume their appearance reflects their mental state or physical well-being, when this isn’t the case. Assessors don’t always recognise the disproportionate amount of time it takes to achieve and recover from this, and that it’s not realistic day to day.
The DWP say they “look well kempt, and they made eye contact, and the client says “well I made a great effort, I had my sponge shower of the week, I’d taken all my painkillers, I’ve dressed smartly, clean clothes, just so that I made a good impression” It’s taken against them that they’ve made a good impression’.
In contrast, if a decision reaches appeal, the tribunal panel will ask open and ‘forensic’ questions to build a more accurate picture of someone’s needs and capabilities, rather than draw quick conclusions based on checkbox answers or how someone’s dressed.
How to fix this
The DWP should make sure open-ended questions are used (‘How’ not ‘Can’) to get a full answer and a better idea of someone’s needs. And the assessment should be based on the information asked for and supplied, with DWP bringing to an end the practice of assessors drawing conclusions for how a person may present, their dress or their mobility in the short window in which they see them.
2. Assessors are not always specialised enough, and decision-makers can favour DWP evidence
“There is a massive issue of the cost of obtaining medical evidence, you can ask a GP to write you a letter, they can charge you £30 and then there’s three lines on it. Some of it is not worth the paper it’s written on. Clients find it difficult to go to their GP and ask for it, because they know they’re very busy.”
Our advisers say that disabled people feel their assessors don’t always understand their disabilities or health conditions, the medication they can or cannot take, and how this impacts on their lives. This is a particular problem for people with mental health problems who describe being assessed by people previously employed in unrelated fields like midwifery or physiotherapy.
Supporting evidence (like GP letters) can be costly and difficult to get. It isn’t always clear that the DWP have used all the evidence submitted or given fair weighting to it. Advisers tell us that decision makers can favour the assessment report that’s written after a short time with the claimant over other types of higher quality evidence from professionals who know the claimant very well.
In contrast, tribunal panels are made up of relevant experts. They explore all the evidence submitted, how medications affect people and how their conditions may impact on their daily activities. As a result, tribunals often overturn original decisions made by less specialist staff.
How to fix this
We welcome the DWP’s Green Paper plans to bring in access to specialist support for decision-makers. This will help decision-makers understand all the evidence supplied and make accurate decisions.
We also support Scope’s proposals to allow disabled people to pick health assessors from a category of specialisms. This will help people feel they have the best chance of being understood.
3. Poor assessment reports mean poor decision making
Advisers tell us they’ve seen assessment reports that get people’s basic details incorrect; such as the wrong name, pronouns, or aids. They’re often constructed out of impersonal cut and paste sentences. And advisers even see repeated sentences word for word across different client’s reports.
“It’s a template that’s used, some parts of the report aren’t relevant to the client’s medical condition and it’s not tailored. I’ve even had reports where names of clients have been mixed up, so it’s of really poor quality. Sometimes the client feels that they had a good assessor who was listening but the report is still made of assumptions. You repeatedly see the same thing over and over again “the client has a dog so they can walk for kilometres” but they never ask who takes the dog out- it could be the children, it could be the neighbours, or the dog could just go in the garden”.
Poor decisions are made based on these poor reports, and people endure lengthy appeals processes to receive the correct benefit award.
How to fix this
Assessment reports and decision making must be more transparent. The DWP must send claimants copies of their report. This should detail how they’ve used each piece of evidence to determine their support levels. And the claimant should be able to request basic corrections before the Mandatory Reconsideration (formally asking for the decision to be looked at again) stage if necessary. DWP’s planned online self-service portal could make it easier for individuals to access their reports, which we welcome.
Urgent change is needed
The impact of wrong decisions can be severe, and can take many months to rectify. It can push disabled people further from independence and the labour market. The stress of not feeling believed and having to appeal for financial assistance can worsen people’s health. The DWP must make the most of the upcoming white paper and do more to urgently address the problems disabled people face interacting with the benefits system.
