Until the PIP squeaks

Even for a non-lawyer like myself, there is something deeply interesting about Henry Brooke’s arguments showing how the tribunals service are trying to cope with social security appeals.

His most recent comments focus on the issues the quality of evidence from the Department for Work and Pensions (DWP), especially in health related benefit decisions, for Personal Independence Payments (PIPs) and Disability Living Allowance (DLA) that PIP is replacing. Try and remember those acronyms- I’m going to be using them a lot!

From my time as a welfare rights worker (ending just as PIP was being brought in) I’ve seen the confusion and upset that poor decision making can have first hand and the successes and failures of individuals as they go through the tribunal system. What I want to try and spend a little bit of time contemplating is how we got here and what can be done to overcome this dire situation.

I believe Henry’s arguments can be boiled down to the concerns that decision makers often rely too heavily on medical evidence provided by the DWPs own contractors, that this contracted medical evidence is, itself, often of quite a low quality and that the loss of legal aid for most social security cases has made life much more difficult for applicants.

If you want my two pennies on why this seems to be happening, it is the DWPs approach that tries to turn decision making and then appeals work into a bulk job. Indeed, that’s something that really come through when you consider how PIP works in comparison to DLA.

I’m not about to argue that DLA was perfect or that there were no bad decisions; far from it. But there’s a real policy point here about what we want from disability benefits. If you’ve been reading my blog from the early posts you’ll know what I’m going to say next: reality is complicated.

In that post I looked at the ways complexity can come about in policy. Hopefully I got across that complexity can pop up either from law not being detailed enough (in which case ambiguities arise) or being too prescribed and not flexible enough to cope with people’s real circumstances. DLA was arguably the former, but PIP is most definitely the latter.

Who got what under DLA was one of those situations where the law itself could be summed up in a few sentences. But what that meant filled entire books, could change based on caselaw and often turned on very small facts in individual cases. Decision makers would have to consider each of these points when coming to a view and, if needed, would be required to justify this in light of the available evidence.

Coming on to the evidence, this was mostly the account provided by the applicant on their claim form and any other medical evidence that had been collected. Applicants could provide evidence alongside their claim, but the DWP often wrote to some of the people working with them (whether it was the GP, specialist, counsellor, etc) for further information. This usually included the set questionnaire which asked general questions when what was really needed was specific information. The final decision often relied very heavily on this third party information. Whenever I filled in a DLA form (and at times that was 4 a day) I would ask the person what their GP knew of their condition. If they said not much (for example they’d referred to a consultant years ago) I would always expect their claim to be knocked back in the first decision, whether or not I thought they had a good claim.

At least information from a GP was someone who could be aware of the condition. Under PIP the government has moved further towards carrying out their own assessments and this usually means a generalist health professional making very quick decisions.

What’s worse is that many of the assessments appear to be very generic and generalised, with it feeling like it is a tick box exercise rather than a robust assessment of someone’s specific needs.

Coming back to the underlying policy, PIP uses a points system with a range of different descriptors. So those few sentences for DLA are now 7 pages of finely gradiated areas. Each of these descriptors lead to points and points, eventually, mean prizes. So where once a decision maker had to weigh a few big areas together, based on the evidence they had to hand, now they have to look at descriptor after descriptor and make a decision on each individual area.

With the DWP contracted report in their hand, I’m not surprised that decision makers just follow this. It essentially advises them how to make a decision. Do we expect them to unpick a consultant’s circumlocutory response to the wrong question (DWP requests for information are often oblique and I don’t think anyone trains medical staff in how to reply to these questions) or look at what the nurse from Capita says about the exact descriptor?

Over time the reports from the DWPs contractor get very samey, but at least the answer the questions we are expecting decision makers to answer. So, as is the case with Employment and Support Allowance, what the contracted health professional says becomes more and more right, even when it is wrong. What’s more, do decision makers feel that the contracted report is “their” version of events, which has to be weighed against, but is somehow more virtuous or accurate than another health professional’s?

Henry is right to point to mandatory reconsiderations as a way to try and improve this. Too often it looks like these are there to provide a final check on truly ridiculous decisions and to ensure that the the DWP hasn’t totally erred before confirming the decision and seeing whether the applicant will formally appeal.

What really needs to happen is for the decision makers undertaking the mandatory reconsiderations to put themselves in the position of the judge and panel. Is it reasonable to weigh this evidence in this way? Is everything in the right place to ensure this evidence is verified and we know who it is from? Will the medically qualified panel member read something in this report that the original decision maker has not? Do we need more evidence to make the decision we have come to?

Making disability benefits a points game and then basing the points overwhelmingly on medical reports from your own contractor sounds like a recipe for poor decision making and plenty of appeals. Indeed, as Henry says, lots of appeals are coming through and the DWP is losing a high proportion of them.

At the moment it feels like this bad decision making has too low a risk for the DWP and high externalities for other people. Applicants are left in limbo for months as appeals wind their course, tribunals are full of basic decisions that can be made easily on paper in the applicant’s favour. The Courts and Tribunal Service may suffer, but is that a worry for the DWP? Whatever the underlying thinking of decision makers, the idea that political rhetoric is impacting on how we think about those claiming benefits means trying to make arguments about improving benefit processing to the public can be a sticky wicket.

So can these externalities be internalised? At the very least the DWP should be offsetting some of the costs of HMCTS whilst decision making is so poor. But should they be nudged further, maybe by a surcharge on each overturned decision- with a waiver for hard cases? Should successful applicants receive a generous rate of interest on any backpayments? Do DWP need to be forced to represent themselves in person at appeals, so that only those worth fighting for get through? Or is there something about the process, particularly about how medical evidence is compiled and then examined, that needs to be sorted out first?

3 thoughts on “Until the PIP squeaks

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s