Rethinking disability assessments

Jeane Freeman, the Scottish minister for social security, has declared that rethinking disability assessments will be a priority for the new administration.  I haven’t dealt with this issue in my draft submission – I needed to cut down the length, I’ve had other opportunities to put the argument and in any case they’re on it.   None of those is a reason not to cover the issues here.

As things stand, nearly everyone who claims is being assessed.  According to the National Audit Office, the DWP had initially intended 75% of all claimants to undergo face to face assessments for PIP, but the actual rate has been 98%.  Most assessments relating to disability are pointless.  They either confirm the obvious or they duplicate information that is already held.  We can do something about that.  The problem is that some assessments are necessary: many people with disabilities cannot say whether they are disabled or not, and have no idea whether or not their disability fits the criteria for benefits.  Any general rule, no matter how sensitively it is administered, is going to have to deal with some grey areas.  But the same approach does not have to apply to everyone: the Scottish Government has the power greatly to reduce the numbers of assessments, by adapting the procedure to the circumstances.

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 qulaifying 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.

In all three categories, there will be some which should receive a long-term award or whole-life award and will not require reassessment. (Additional note, 2nd October:  this point has now been conceded by the DWP, but the minister has  also said that the ‘vast majority’ will continue to be assessed.)

Only after these three categories are considered is it appropriate to think in terms of further individual assessment. The points scheme currently used in a range of benefits was initially developed from work done by the Office of Population, Censuses and Surveys to establish the range and severity of disabilities in the UK. That study validated the approach through a range of tests, but it pointed to an important conclusion: that once the primary disabilities had been identified, it was very rare for further disabilities to make any notable difference to the findings, and that information served no useful purpose. It follows that it is neither appropriate nor necessary to ask most claimants whether they can go to the toilet unaided.  The question is embarrassing and the information obtained is for the most part irrelevant. The assessment process should begin by asking people to identify their most important disabilities, ask questions about those, and go further only in marginal or complex circumstances.

Finally, there will be a residual category of people who are not adequately dealt with by any of the four stages above, and who will require or ask for a more thorough comprehensive assessment. This category should be small.

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