My response to the PIP consultation

Louise Haigh MP submits response to the Personal Independence Payment review and call for evidence.

Since being elected last May, the issue of incorrect assessments and the decision to remove people's disability benefits – leaving people struggling without money and in some cases without their mobility car - has been raised with Louise Haigh MP each week. Constituents have shared their experiences of the interview process, the disregarding of GP and specialist medical evidence and the way in which they have been made to feel like liars by the assessors. 

Louise commented: "Trust in outsourced companies has never been lower - the decision to strip Concentrix of the HMRC contract in the last few weeks is a clear recognition of the failings of private companies to deal with sensitive social security claims, and in my experience the way that assessments for Personal Independence Payments are handled is no different."

"I've been contacted by many constituents who have shared their personal stories with me - and of their distress and the upset which is created when it goes wrong. People feel that their very integrity is in question and have told me how they are made to feel like liars - guilty until proven innocent."

"After months of hardship and stress, many appeals are thankfully successful, though that they have to reach this stage at all is costing the country, not the private companies who are paid by results, a lot of money.  With this in mind, I had to respond to this review of the Personal Independence Payment system and I call on the Government to ensure that the system is now reformed. Clearly it is time that these process are brought back in-house and delivered by the Government - not by companies driven by profit".

 

Louise's response to the Consultation:

This review comes at an important time. The amount of money that the Government spend on outsourcing has never been higher, but public trust in outsourced companies has never been lower. Only 22% of people believe that they are motivated by providing the best service to the public.

Over the course of the last Parliament, as outsourcing grew, the public’s control over our own public services reduced in parallel. I have heard from constituents who have shared their personal experiences with me – of being made to feel like liars at assessment interviews and of being disbelieved on every score and subsequently awarded 0 points.  One constituent, who had requested a copy of her report, commented to me: “My integrity was questioned in this report too, which I really object to”

Evidence: Mr B: struggling to eat for fear of the repeated vomiting and the abdominal pain he experiences – awarded 0 points on the score for nutrition. The same case, Mr B stated that he is unable to manage his multiple, complex health conditions. He stated that this has been demonstrated by the fact he has required repeated interventions by the crisis team – again, awarded 0 points. On ‘Communicating Verbally’ the “Decision Maker’s Reasoning” stated that my constituent did not “present as overtly anxious” during the assessment. My constituent has stated that this is incorrect: he was extremely anxious during the assessment, and has stated that the assessor did acknowledge this by stating to him “you should get treatment for your anxiety problem”. He was confused therefore as to why the assessor would contradict this in the written report. On the point of “Engaging with People Face to Face”- my constituent has stated that he finds it extremely difficult to engage with other people and will shut himself away in bed. He felt that he was being penalised for making a very large effort to attend the PIP assessment and being polite to the assessor.  Six months later, Mr B’s appeal heard by HM Courts & Tribunal Service and the appeal allowed – with recognition that he has “severely limited ability to carry out activities of daily living”.  During this time, my constituent expressed his upset and frustration of having to repeatedly prove his condition and the impact that it has upon his life

Despite the fact that the Government have made it notably harder for people to appeal their decisions, figures show that a significant number of appeals are allowed – such as the case with Mr B. There seems to be an alarming trend of cases being rejected based on factual errors or manipulation of the facts. I have had several cases of people telling me that their assessment report bears absolutely no relation to the assessment that they experienced. One or two cases could be dismissed as an honest mistake, but my experience as an MP over my first year of Parliament appears to reveal a disconcerting pattern of behaviour that indicates that the trade-off between cost cutting and profit maximisation is being felt by very vulnerable people. I enclose a copy of my letter to the Minister in November 2015 which expresses this concern.  Numerous constituents have contacted me to advise that their assessment when received does not reflect their condition(s), their assessment form, the evidence provided or the interview with an assessor.  I provide examples of three such below.

Evidence: Mr R: Mr R reported to me that the assessor reported that he needed an aid or appliance to be able to cook a simple meal. My constituent advised that this was incorrect and in fact Mr R requires supervision given that he is liable to self-harm by deliberately burning himself if unattended. As such, no appliance could be sufficient as this would still allow him the potential opportunity to self-harm. On ‘Taking Nutrition’ – Mr R advised that the assessor reported that he could eat and drink unaided – a fact which my constituent disputes and advises that he informed the assessor quite clearly that his depression means that he will not eat or drink unprompted. Finally, in response to ’Making budgeting decisions’ – the assessor reported that he could do so unaided, another point which my constituent disputes and advises that he informed the assessor that to do so causes him extreme anxiety, meaning that he is unable to make such decisions. Indeed, I understand that this was demonstrated in the assessment when he was asked about this issue and he started to panic – resulting in the assessment having to be paused.

Mr C: Mr C contacted me in relation to receiving 0 points on several descriptions. On ‘Planning Journeys’ – received 0 points despite advising the assessor that he is paranoid of cars and finds it very difficult to travel for this reason. On ‘Making budgeting decisions’  the assessor reported that he could do so unaided, despite Mr C requiring the help of a Social Worker to make all of his budgeting decisions. Finally, on ‘Administering medication’ the assessor reported that he could do so unaided, despite Mr C’s medication being via injection and his reporting that he is unable to do so unaided.

Mrs G: Mrs G reported to me that, having received DLA for an indefinite period, was required to apply for PIP and had a home assessment. Upon receiving a notice that she did not meet the criteria she requested a copy of the assessment and was astonished at the report. She advised me that “firstly the report was very unprofessional, very badly written the English was appalling and it was incomprehensible at times. Secondly the report is inaccurate, deliberately falsified, key points twisted and others omitted. I feel that this is done deliberately so as not to gain points despite me meeting the descriptors”.

 

Constituents have repeatedly raised particular concerns with me about the role of nurse assessors in conducting the assessments – and of their own experience in a nurse failing what they believe to be their duty of care. One constituent has expressed concern that when their sister relayed her conditions and answered questions asked by the nurse assessor, the nurse should have the ability to link these conditions and understand the clinical impact – thus potentially limiting the need to probe further with, often embarrassing, questions. Further, I was extremely concerned to hear that when her sister was asked to read a sentence to measure her reading score, the nurse laughed at her when she made mistakes.


As you are aware, for some individuals attending a face-to-face assessment at a centre is impossible – and even the possibility of a home visit is inappropriate for some. As such, it is my understanding that a paper review of their medical evidence, forms etc. can be requested. However, my experience is that requesting a home visit is extremely difficult for the applicant – with supporting evidence being required from their GP that this is necessary and the feeling from applicants that the GP’s letter may still not be sufficient. Further, despite providing specialist reports from health care professionals, it is my experience that this is also not sufficient to act as a suitable alternative to a face-to-face consultation for those individuals who have requested a paper review.

Evidence: Mr G – In the case of Mr G, he contacted my office and explained that in addition to his medical needs, he is the victim of sexual abuse and at the time had been called to give evidence of this – understandably impacting greatly on his mental health.  In light of this, and of his extensive medical needs, the circumstances were explained to ATOS and a request was made through my office that his case was considered on the basis of the paper evidence he had provided – and which could be requested if required from other health and social care professionals. This was however refused, with very little explanation of why the review could not be carried out in this way – despite the obvious benefit that this would have had to his wellbeing at this time. Further, this constituent had requested that the DWP and ATOS not contact him by phone, but rather email or letter – a request which was ignored on several occasions.


Further, I have been contacted by several constituents who have shared with me the impact and distress caused when assessments are cancelled or changed at the last minute.

Evidence: In the case of Mr G – having been refused a paper-evidence review and thus requiring a home assessment – my constituent requested that he had a Support Worker be present to assist him with this. The appointment was cancelled with just a few days notice – and rescheduled for the following week. Mr G’s Support Worker was unable to attend the rescheduled date, causing much distress for my constituent.  In addition to this, Mr G’s situation was made further complicated due to his transition from support provided by Mind to the Local Authority – leading to further confusion about when it might be possible for a Support Worker to be present.

In addition, I am concerned that there seems to be inconsistency in the frequency in which assessments are called – with individuals given dates to which their decisions run and assessors being able to override those without further consultation with the DWP. Constituents have expressed to me the upset and distress that this causes – having to once again go through the assessment process in a short space of time. This is particularly pertinent for cases in which the individual has been through HMCTS and may have only had the final decision a few months prior.

Evidence: Ms J – In the case of Ms J I was advised that my constituent was assessed for PIP in November 2014 and awarded Standard Daily Living and Standard Mobility until May 2016. She was unexpectedly called however to attend an interview on 14 September 2015 and was told that this was to allow ATOS to “get ahead of all the reviews due next year”.

Further, despite it being the same Department, constituents often raise with me the inability within the DWP for information and evidence sharing.  I have raised this point previously and although I understand that the assessment for whether an individual is fit for work (ESA) and whether someone requires help with the extra costs caused by a long-term illness or disability (PIP) may require some different information, it seems counter-productive that at the very least the evidence is not available across the Department for the purpose of assessments.  Numerous constituents have expressed to me their frustrations at having to provide the same evidence from health care and social care professionals to the same Department, for the purposes of different assessments – though they are often spaced within a relatively short time of one another.  This evidence is often not easy to obtain, with individuals waiting for reports and indeed in some cases being requested to pay for a report which can be used by the DWP.

Evidence: Ms J - Although being called for an assessment some eight months earlier than anticipated, and being turned down for PIP with 0 points – my constituent is in the Support Group for Employment and Support Allowance and it was found in this assessment that her conditions prevent her from working. The ESA assessment acknowledged that she requires 24 hour care and cannot be left. Despite this, her PIP assessment differed substantially from that carried out only a few months earlier for ESA – despite no improvement in her medical condition or on the impact to her life.

I have been similarly concerned about the lack of sufficient knowledge of progressive conditions such as muscular dystrophy, fluctuating conditions and the lack of sufficient awareness and training in areas such as learning disabilities. It is my experience that contractors have a huge gap in their understanding, particularly of mental health issues. Indeed, you will be aware of the campaign by Parkinson’s UK to highlight the fluctuating nature of Parkinson’s and the difficulties that people with Parkinson’s have experienced – many of whom have found applying for PIP frustrating, upsetting and stressful.

This consideration of fluctuating conditions is particularly important given the seeming attitude of assessors not to take into account evidence provided from health and social care professionals – particularly the individual’s GP. 

Evidence: In the case of Ms J – my constituent suffered from a condition which causes frequent, unpredictable losses of consciousness; although chronic and incurable and, at present, uncontrollable by medication she again was awarded 0 points.

With this in mind, constituents have expressed to me their frustration that their GP’s supporting documentation often appears to be dismissed entirely, despite their long-term relationship with their GP and the feeling that they know them and their health well – not only in terms of a short face-to-face assessment but with an understanding of their overall health and the impact on their life.  In the case of Mrs S, I was advised that her GP provided a statement setting out her needs but that this was not taken into account by the assessor – who seemed wholly disinterested in the GP’s report. Indeed, I have heard from several constituents who have expressed their frustrations that they are required to provide reports from health and social care professionals but that these are then seemingly disregarded and overridden by the face-to-face assessment, which they then report to be inaccurate. 

Yet despite all of this, such contractors continue to get paid despite repeated failures. Even worse, after being deemed unfit to perform in relation to one contract, contractors simply get to continue with another lucrative long-term deal, as Atos has done. After failing to handle the Work Capability Assessments contract, it is still running a seven-year contract for Personal Independence Payment assessments for the same Department. You will be aware that the Office for Budget Responsibility has identified ESA and PIP as a major risk to planned public spending targets, given the uncertainty of the estimates. The NAO has gone so far as to say that PIP and Disability Living Allowance performance issues have been the main contributing factor in the Department’s inability to save any money in the spending review period up to 2015.

I am concerned about the lack of accountability and measures to ensure that those making assessments are supplying the right information. Although I am aware that there are targets – such as for the numbers of assessments which should be held without a complaint – I am concerned that there is no regular method for publishing whether they are met. What exactly is the point in setting targets if the public cannot see whether they are being achieved?

They include the number of face-to-face complaints following an interview; the number of serious complaints; the percentage of face-to-face consultations without complaints, which is supposed to be at 99.5%; and the target of 100% payment of travel expenses within nine working days. Those targets are all sensible, but there is no regular method for publishing whether they are met. That is why we talk about a democratic deficit in outsourced public services.

What exactly is the point in setting targets if the public cannot see whether they are being achieved? A supplier could manipulate the data, and we would have to rely on an overstretched Department to pick it up. And that would not be unusual or unprecedented. In 2007, Maximus was fined $30.5 million over accusations that it had cheated Medicaid in the United States by making tens of thousands of false claims on a payment by results contract. Maximus effectively stole money from US taxpayers by making claims for children who had not received care. After that was exposed, Maximus said it would not sign any more contingency-based contracts where it was paid from savings in state expenditure, but the contract you are reviewing is just such a contingency-based payment by results contract.

Panic, fear, distress, dread and anxiety are just some of the words people use to describe their experience of the benefits system while dealing with health concerns. 

 

I hope that the system is reformed to ensure greater accuracy and accountability at assessments, that health professional’s reports and GP reports are given appropriate consideration and weighting and that full consideration is given to how data can be shared across the Department and with external organisations in the health and social care sectors in order to minimise any unnecessary stress and impact on often vulnerable individuals.

Yours sincerely