Disability Assistance: the consultation paper opts for too many of the wrong answers

The Scottish Government has launched A Consultation on Improving Disability Assistance in Scotland, with a closing date set for the end of May. The consultation paper makes the important assumption that the design of Disability Assistance should be based broadly on the existing pattern of benefits.  In particular, it proposes

1. A distinction between benefits for children and young people, for people of working age and for older people
2. The continued use of a functional assessment, and
3. The maintenance of components to cover ‘daily living’ and ‘mobility’

A risk of confusion  At three points (on pages 15, 16 and 17) the document suggests that they want to reduce the “risk of confusion between benefits being delivered by both UK and Scottish Governments”.  The existing system of benefits is already deeply confusing, and as a consequence it fails in many important respects to reach the people it is meant to help. The approach laid out in the consultation paper is designed to make sure it is at least as confusing as it was before.

I would point here to three pieces of evidence.  The first is from an ad hoc study done for the DWP.  Three-quarters of the people who benefits are supposed to support do not recognise themselves as being ‘disabled’.  Most of them do not think of themselves as being disabled; others answer that they’re disabled ‘sometimes’.   The second is that people do not understand the basic premise of a benefit that is supposed to cover daily living or care.  A study of unsuccessful claims for Disability Living Allowance found that people receiving Employment and Support Allowance – the long-term sickness benefit – did not understand that DLA was there for different purposes from ESA; that they sometimes made claims with no reasonable hope of success, thinking that they may as well have a crack at it anyway; and if they were refused, they put it down to luck rather than the operation of appropriate criteria.  The third issue is that takeup of these benefits is worryingly low.  None of these figures is certain, but the best guesses are that the mobility component of DLA is claimed by something in the region of 60% of the people entitled, Attendance Allowance by 50% and the care component of DLA (now the ‘daily living’ allowance of PIP) is taken up by 40%.

Distinctions on the basis of age.  Wherever a distinction is made on the basis of age, there will be problems in managing the transition between benefits.  The suggestion that people of “working age” have different needs tends irresistibly to give the impression that the criteria have something to do with working, and one of the problems with PIP at present is the mistaken assumption that ability to work is somehow a relevant criterion in assessment – that is not what disability assistance is supposed to be about.

The most important problem, however, is that distinctions on the basis of age can lead to serious inequity, and anomalies in the operation of the benefit.  As things stand at present, people under the age of 65 get PIP, and people over the age of 65 are supposed to get Attendance Allowance.  That implies, on the face of the matter, that people under 65 can get help with mobility, and people over 65 cannot.  However, that is not what happens.  A person who becomes disabled before the cut-off date can continue to receive DLA/PIP after the date.  Fully a third of PIP and DLA claims are made by older people under this rule.  And that means that people with the same disability can get different benefits, depending on when their disability was incurred.  One of the most common causes of disability for people aged 50-70 is stroke; some people who have strokes recover, some others recover partially.  So a person who had a stroke at 63 and recovers partially may get help with mobility, while another person who has a stroke at 67 cannot, even if the functional limitation of the older person is more serious.

The use of a functional assessment. DLA was made by clumping together two rather different benefits: Attendance Allowance for adults below pension age and mobility allowance.   Mobility Allowance was based on a functional assessment – whether or not people could walk; Attendance Allowance was not.  While there have been many challenges to the mobility component, for example those related to conation, it is the care or daily living component which causes most confusion.

The points-based approach to functional assessment was initially based on work by the Office for Population Censuses and Surveys, when the scheme had a very different purpose.  There was no intention to develop a mechanism for individual disabilities to be precisely measured, and points were not the sole test: when the OPCS scheme was initially worked out, one of the critical points made about it was that disability reflected the nature of each person’s most serious impairments, not a cumulation of smaller functional limitations.  The points scheme has never worked well, and one of the reasons why entitlement to DLA and then PIP grew beyond the government’s expectations was that repeated challenges drew attention to groups of people who were simply left out – first people with learning disabilities, then mental disorders, then people with terminal illness and most recently people with fluctuating conditions.  The central problem is simply this: most disabilities do not have a strict, constant and precise relationship to functional capacity or daily activity.  People cannot clearly relate their circumstances to the tests.

There are alternatives.  I have made the case before on this blog, and it bears repetition here.  First, it is possible to identify certain conditions which should imply automatic entitlement, offering benefits on minimal or secondary evidence – either accepting on sight that the person has a qualifying disability (double amputation, severe disfigurement) or passporting benefits on the basis of provision by other agencies (congenital disability, blindness).  Second, there are conditions which will have led to prolonged long term contact with health services, and certification from a consultant is sufficient to establish that the condition is there without requiring further detailed examination of personal circumstances. Examples are terminal illness, multiple sclerosis, MND, malignant neoplasms or brittle bones. Third, there are conditions where existing services in long-term contact with the individual are far better placed to judge the impact of a condition than an independent assessor could be, and it would be appropriate to accept medical certification. Examples are continued psychosis, epilepsy, dementia and learning disability. Only after these three categories are considered is it appropriate to think in terms of further individual assessment of function, or a points scheme.

Daily living and mobility components. The other main issue to consider is whether there should be two components of a combined benefit, at least for people of working age.  The key problems have already been identified here.  People do not understand it, and ‘have a go’ instead; takeup is poor; there are serious inequities because of the treatment of the mobility component.  If there was a separate Mobility Allowance, its rules could be reconsidered to sort out which older people should get it, instead of the arbitrary current rules; and people do understand, more or less, what a Mobility Allowance is about.  Then we could have a reasoned discussion about the other component – whether it is supposed to respond to extra needs, or to provide extra income, some compensation for disability, or some other purpose.  (My own view is that we ought to revive SDA, rather than abandoning it, but I appreciate that that probably puts me in a minority of one.)

Whatever we do, we need to recognise that the current arrangements do not work, and that minor tweaks are not enough; it is time to bring them to an end.