Category: Scotland

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’

At three points (on pages 15, 16 and 17) the document suggests that they want to reduce the “risk of confusion risk of confusion between benefits being delivered by both UK and Scottish Governments”.

The risk of confusion  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%.

There are also serious inequities in the delivery of the existing benefits, and that leads to the second major issue: maintaining distinctions on the basis of age.

 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.

Policies for devolved disability benefits

The Scottish Government has decided not to ask for the transfer of responsibility for Severe Disablement Allowance, which will continue to be managed by the DWP. I was asked by a journalist for a reaction, and what follows is my answer.

The decision is  understandable, because SDA was closed to new claimants many years ago, and the government does not want to create disruption for the small numbers of people who are currently entitled to Severe Disablement Allowance. Having said that, the power to deliver a benefit similar to SDA could be important for the future. SDA was always a relatively small, residual benefit designed to fill in the gaps when other benefits were not available. The distinctive feature of SDA was that it was the only benefit paid to people simply because they were severely disabled. Other benefits like Attendance Allowance, DLA and PIP have tied the conditions to people’s care needs, which usually means, for example, that people in residential care may not get them. I think it’s valuable to have a mechanism of the sort, and hope that the Scottish social security system will be able in the future to recognise needs that the current UK system doesn’t.

More generally, I’d also like to see benefits for people with disabilities to be made more accessible. The proposed reforms will make it possible for older people to continue to receive Personal Independence Payments without repeated assessments, and that’s a good thing. But the basic reason why older people are continuing to claim DLA or PIP, instead of moving on to Attendance Allowance, is that Attendance Allowance doesn’t cover mobility needs. This means, for example, that someone aged 63 can get long-term mobility support after a stroke, but someone aged 67 can’t, even if the restrictions the older person faces are more severe. It would make more more sense, and it would be fairer, to have a separate Mobility Allowance without the age restrictions that currently apply.

A levy on workplace car parking is a bad idea

As part of the price for the cooperation of the Green Party in the Scottish parliament, the Scottish Government has agreed to give local authorities the power to introduce a levy on workplace car parks.  “Plans to give powers to councils to introduce a workplace parking levy, as already allowed in England, will come forward via an agreed Green Party amendment to the Transport (Scotland) Bill. ”  This is intended to reduce the numbers of people who travel to work by car.  It’s been tested in Nottingham, where it’s been claimed to reduce congestion and raise revenue.

Both of those claims may be true, but it’s still a rotten idea.  It falls into the same category as a raft of proposals, and sometimes actual policies, which try to regulate behaviour by using price as the main lever.  Policies of this type have often been favored by market economists, because the most basic economics courses tell us that the way to reduce demand is to raise the price until the market is cleared.  There have been loads of suggestions about policies where the same principle could be applied:  they include congestion charges, road pricing, charges for GPs, water metering, and charges for rubbish collection by weight.  (Often they go hand in hand with some kind of gee-whiz technology that just happens to be sold by the companies that are pressing for the policy, but that’s not the main issue here.)

The key objections to rationing by price are threefold.  First, the demand for any activity depends on the resources that people have, and the people whose behaviour are most likely to be affected are those on the lowest incomes.   Almost by definition, people on lower income have to be more sensitive to marginal cost than people on higher incomes can be –  and the introduction of a flat-rate levy takes far more from the incomes of lower paid workers than it does for higher paid workers.  It’s important to consider for any policy what the distributive implications are. Second, it’s essential to understand what the effect on behaviour might be, and changing the price of an activity is a blunt instrument.  Some substitutions may be desirable – such as cycling to work instead – but it can lead to people substituting different, less desirable  behaviours instead – for example, parking on residential streets instead, driving more and longer while looking for parking places, absenteeism or resignation.  Third, it may conflict with other policies – recruiting specialist staff such as nurses and teachers, encouraging people to take up work at a distance, getting people to take longer hours by flexible employment practices.

I’ve argued before on this blog that there is a wide range of rationing measures, and rationing by price is markedly inferior to some of the alternatives.  None of that means that rationing by price is never appropriate – there may be exceptions (reducing the demand for cigarettes by price could be one) – but it does mean that it’s hard to justify, and there are usually better ways to achieve the ends.   Before penalising people for turning up to work, try some of the alternatives: encouraging collective transport such as employer-funded buses; provide rail season tickets and bus passes; tilt the balance towards remote working; tie site development planning to transport provision.  It’s odd to see the Green Party advocating a set of market-driven measures that would sit more comfortably with the Institute for Economic Affairs than they do with the people-centred economic policies that the Greens claim to support.

 

The Social Security Charter promises a different kind of service

There are a couple of days left to comment on the draft Scottish Social Security Charter, but I’m not going to do that, for a simple reason: it’s excellent, and I have no criticism to make.  I’m going to pick out just five points:

  • the Charter promises that the agency will listen to people and to trust them.  There is long-standing evidence that threatening people with prosecution during the process of claiming is simply destructive.
  • the Charter promises that the agency will learn from its mistakes.  I commented during the passage of the Bill that while the UK system treats complaints, rectification and review as a quasi-judicial, adversarial process, “other public services attempt to learn from complaints and use them as feedback to improve their processes.”  They’re on it.
  • Payments will continue while people are appealing a decision.  In the UK system, penalties are routinely imposed without a hearing.
  • People will be told about their entitlements, including services delivered by other agencies. 
  • People will not have their time wasted.  They promise to “recognise that your time is precious and handle your application and enquiries as quickly as we can.”

This may be a challenge, but can anyone spot the difference between this and the DWP?

ScotPHP: Scotland can use benefit and tax powers to improve people’s health

I missed it when it came out at the beginning of this month, but an interesting report from  the Scottish Public Health Observatory has been trying to identify the possible impact of new benefit policies in Scotland on the health of the population.  The figures are complex, but the basic principle behind them is reasonably straightforward.  Their argument is built on the case that higher income leads to fewer deaths and less health inequality.  Effectively, then, their report is an assessment of the potential distributive impact of different policies in Scotland.  Critically, however, the distributive impact they are considering is not the distribution for individuals or households, but for deprived areas.

Part of their summary is a fairly confusing graph, which seems to suggest that the best method by far would be to increase means-tested benefits by 50%.  The comparison being made, however, is with other policies with very different sizes and shapes – for example, increasing takeup by 1% (a very marginal increase, costing little) or introducing Citizens Basic Income and abolishing all other benefits (a very major change, costing a great deal).  The details about what’s covered and what’s not are sketchy, and the figures are, of course, indicative rather than certain.  The core of the message is this:

increasing means-tested benefits by 50% is modelled to have the biggest effect on reducing premature mortality (5% prevented) and narrowing inequalities in premature mortality (-8%). The results also suggest that the real Living Wage, Local Income Tax and increasing devolved benefits by 50% would be good policies for reducing premature mortality (~2% prevented for each). The two illustrative CBI schemes are also likely to be effective at narrowing health inequalities (-4% for CBI, and -6% for CBI Plus).

In the supplementary papers, Table 2a, it’s possible to find a statement of costs per outcome.  This also needs to be treated with caution, because the costs of CBI cannot be introduced in part; but the best value for money, in the sense of effect for each pound spent,  comes from CBI , improving DLA and PIP, increasing takeup and increasing basic means-tested benefits.  The powers of the Scottish Parliament don’t cover all these options, but they do include powers to improve disability benefits and to increase takeup.  There’s a case to consider, but there has to be a major reservation: at the level of individuals and households, there would be losers among those who are poorest.

The Scottish Government can’t mitigate all the effects of ‘welfare reform’

In the comments to my previous post, Ian Davidson drew attention to the Scottish Government’s report on ‘mitigating’ the effects of welfare reform.  It’s beyond the scope of the SG; they lack the powers and the resources.  I was asked by Common Weal journalist David Jamieson  yesterday to pick out a couple of leading issues, and I couldn’t oblige: my comment was that every one of the issues was a tragedy for the people affected, and that’s pretty much what he ran with.   His report is here.

I’m privileged to have perceptive, well-informed comments to the blog – thank you all.

 

Social Security Scotland lays out its stall

The Corporate Plan published by the new agency, Social Security Scotland, is brimming with good intentions.  Under the agency’s name is the motto: dignity, fairness and  respect.  The key to this rests in how the agency deals with mistakes, and there will be mistakes: introducing complex systems for people with complex problems to resolve makes that inevitable.  There are some good signs: a commitment to resolving issues “resolved quickly and at the point of contact”, listening, and ‘continuous improvement’, using feedback to improve the quality of services.  The problem, however, rests in a bitter legacy of conflictual, adversarial approaches to managing agency mistakes.  Several elements of the new system create hurdles to overcome:  mandatory ‘re-determination’ (the decision should have been checked anyway on first complaint), referral out to the Scottish Public Services Ombudsman (another hurdle), and heavy reliance on the appeals structure.  This may all work work against speedy and effective resolution.

A glimmer of hope for disability benefits?

I’ve just spent a productive afternoon at a round-table discussion of benefits for disability, at the Scottish Parliament.  While many groups are understandably concerned with the transition from UK to Scottish administration, there is also some interest on seizing on the opportunities that the new legislative framework offers.  The need to protect people’s current situation is however emphasised by a recent report from the MS Society, charting the impact that the transition from DLA to PIP has had on people with multiple sclerosis.  The transition had had a major negative effect on daily life, emotional well being and the medical condition of sufferers.

There’s a limit to what the Scottish Government can hope to do; the system is a mess, and resources to revive it are limited.  The best hope probably lies in reforming the culture of the administration:  moving, if it can be done, from an adversarial system to one that listens, learns and corrects its mistakes.

Kim Long: 24 hours

Councillor Kim Long has agreed I can share her full thread with you, but asked me to include links to donate to two causes:  the Refugee Survival Trust and Positive Action in Housing.  Here’s what she wrote on Twitter, minus only a couple of (understandably furious) swear words.

RIGHT. i am so angry. We have established that Trump is a monster, yes? Let’s talk about my past 24 hours and what that says about our esteemed UK government.

So Tuesday night i got a call from a church minister in a total panic because one of her congregation had recieved a letter, out of nowhere, saying her she had 24 hours to vacate her accommodation because her asylum support was being stopped. Her support (a whole £35/week) plus accomodation, was being immediately removed because they did not believe she was destitute. One of their reasons was she had toys (handmedowns from a kind neighbour) & money in her account – money she had recieved from the home office.  So because she could not prove her destitution according to their insane criteria they decided to MAKE HER AND HER 4 KIDS HOMELESS AND DESTITUTE. With 24 HOURS notice. Before her 3 days to appeal rights were even close to up.The letter had no email address, no phone number, no way of contacting except to send said appeal by POST. Which would be impossible within 24 hours. She was advised to FAX an appeal to a number NOT ON THE LETTER. A FAX. I have never even TOUCHED a fax machine.

So there she was, out of her mind with worry. Oh yes also she’s a single parent, she has an 8 year old, a 5 yo who is severely autistic (& so incredibly sensitive to disruption) & twin toddlers (omg). She has also survived horrific domestic violence, sexual assault, & abuse. (As an interlude i need to say how in awe i am of this lady, her strength and courage and parenting skills are just out of this world. She used to run her own small business, she is articulate and clever and hospitable and kind. It was a pleasure to spend my day with her) … anyway i went to her home yesterday morning, to try to work out a support plan, so that if Serco showed up there was Cllr observing their behaviour, and so that if they were made homeless i could ensure immediate social work support.

let’s pause here to observe that Glasgow City Council would be picking up the bill if the Home Office made this family homeless. The UK government is literally pushing people through the cracks + local authorities are financially penalised for not being so inhumane – let us also observe that if there were no kids involved the council would not be able to give her accomodation. Also if she was (now) fleeing domestic abuse she would not be able to go to a shelter because she is not eligible for housing benefits. Yes, things are that bad.

So – long day of emails and phone calls and then a wonderful lady from her church was there to watch most of the kids while i took this lady & kid to @GovanCP , who were just incredible. They met us, applied for an emergency grant, gave £ for food + an appt for the next day.We went home with cake from the foodbank 😁 & via aldi for essentials. Lady has been through hell but thanks to the support she’ll now receive to fight for her £ to be reinstated, thinks she will be able to sleep. Meanwhile locks were unchanged, nobody showed. Scare tactics.

So that was yesterday. And THEN on my way home today i met our neighbour who was frantic that he’s not seen me around (i’ve been away) – what if i had moved and he had nobody? He is also an asylum seeker & is living in limbo, waiting for news that his case is being looked at. He has been living with toothache for maybe 7 weeks because he is waiting for a form from the Home Office to give him access to dental treatment. He was recently given a card to say he was allowed to work, but now they have sent him a new one saying he is not allowed to.

He is bored. Fed up. Hungry. His wife is the same – he tells me they have nothing to do but quarrel because they are under so much pressure. They have a kid – the cutest, smartest, daughter, who comes to ours to play with/terrorise our cat & laugh at our music choices.  Today he said he is struggling with school holidays. “There are free things to do – but what if, when we’re out, we see someone with a lolly? Or she wants some candy? How can i say i can’t afford it? I feel so ashamed. So perhaps it’s better for her to be inside & not see.”

And then he said that while we were away they had their big interview with the Home Office. (They had first been summoned months ago, went through sleepness nights, showed up, to find the wrong interpreter provided. Interview postponed – back home. More waiting.) So last week they went back again. He was grilled for 8.5 hours, with 1 hour break & one further 15 mins. His wife had 6.5 hours. No kids allowed, but no childcare. They questioned every minute detail. He was so exhausted when he got home he didn’t speak for 2 days. And then – after he explained the danger they fled from, after he explained that as both religious and cultural minorities they could not possibly be safe in their country of origin – he said that he had also brought his daughter away because of the threat of FGM. We were standing in the sunlight but suddenly the world went grey as i realised the gorgeous kid who made me a birthday card last month would have been mutilated as soon as she hit puberty – could still face this if they are put on a plane. And then – i don’t know if i can type this because i am shaking – the interviewers said:”But 98% of the people in your country do FGM. Why is this a problem?”It took me several minutes to understand. UK HOME OFFICE AGENTS ASKED HIM WHY HAVING HIS DAUGHTER CUT WAS AN ISSUE.

This is our UK government. This is what they are doing to people – people who live in your close, whose kids are pals with your kids, people who are just trying to live their lives and survive.

This has been ONE DAY.

Kim’s requests for donations again:  they were the Refugee Survival Trust and Positive Action in Housing.