Tagged: disability benefits

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.

Confusion about PIP

There’s a report in the i this morning about a letter sent by Frank Field MP to David Gauke, the Work and Pensions Secretary, detailing some of the hardship and problems  that have been created in the benefits system.  Field calls for a thoroughgoing review of current benefits, which I’d fully support.  But one of the points in the article is a mistake, almost certainly made by the newspaper reporter:

He backed an urgent review of the assessment system for evaluating PIP claims amid frequent complaints that it was too rigid to assess accurately claimants’ ability to work.

Presumably this is meant to refer to the assessment for Employment and Support Allowance.  Personal Independence Payment, unlike ESA, is not an out-of-work benefit; it’s a general income supplement for people with serious disabilities, supposedly partly intended to cover extra costs, and it is paid regardless of whether or not the person is working or able to work.    But I have come across cases, and I’m sure that Frank Field will have done as well, where PIP assessors have wrongly and inappropriately been asking people about work.  It’s the wrong test for this particular benefit.

From DWP research, many people never understood what they were claiming when they applied for  Disability Living Allowance, and now it’s being replaced by PIP it’s probably true that they don’t really understand that either.  Part of a review should be an attempt to get benefits that make sense to the people who administer them and to the people who get them.


A ministerial announcement on the next devolved benefits

Angela Constance, the Cabinet Secretary for Communities, Social Security and Equalities, made a statement yesterday about the first changes to benefits reflecting the shift in powers in the Scotland Act.  The new schemes for maternity (the “Best Start” scheme) and for funeral payments will come on line in 2019; although the application process will be “simplified”, they will continue to be one-off, means-tested payments.

Carers Allowance will be the first new benefit to come on line, starting in Summer 2018.  The purpose of the benefit is to bring up the rate of Carers Allowance (currently £62.70 pw) to equal the rate of Jobseekers’ Allowance (£73.10 pw for those over 25).  Rather than taking over Carers Allowance, the Scottish Government has opted to pay a supplement to the DWP-administered  benefit. It will be done by making two payments a year, and while the payment will be made by the new Scottish Social Security Agency, it depends on information drawn from the systems and processes of the DWP.

Transferring responsibility from the DWP to the new agency would have been complex task; that has been avoided.  Paying a supplement weekly or monthly would involve constantly passing information back and forth; that has been avoided, too.  However, the decision will have some substantive implications.  Currently Carers Allowance is not actually paid to many people who are nominally entitled; that will still be true.  Claiming Carers Allowance may have negative effects on a disabled person’s entitlement to the severe disability premium; that will still be true.  There had been talk of extending the benefit to younger people or those in full time education; it looks like that is not going to happen. So, for the while at least, the decision is going to lock the basis of payment a little more firmly to the status quo.

Reforming PIP

The Government’s proposals for the reform of PIP make for curious reading.  The DWP press release explains that the purpose of the proposals “is to restore the original intention of the benefit which has been expanded by the legal judgments.”  The fullest account of the rationale for the policy is however given in the Equality Analysis, which covers the detailed arguments without saying much about equalities.

The problem that the proposals are supposedly addressing is that a couple of legal decisions have accepted that people with a range of disabilities might reasonably be said to qualify for support under the rules as passed.  Those disabilities mainly relate to people who have to manage a medical condition or therapy, which is expressly provided for in they regulations, and people who suffer from mental disorders that interfere with their capacity to travel.   The responsible minister has explained that

The Government continually monitors the effectiveness of PIP to ensure it is delivering its original policy intent and supporting those who face the greatest barriers to leading independent lives. Two recent Upper Tribunal judgments have broadened the way the PIP assessment criteria should be interpreted, going beyond the original intention.

The Equality Analysis goes into more detail about the apparent intention.

PIP is a payment that is intended to be broadly proportionate to the overall need of a claimant. The greater someone’s need, all else being equal, the greater the cost they will face as they go about their daily lives.

The analysis argues that  the tribunals’ interpretations of the points schemes go further than the DWP intended.

There are three problems with this account.  The first is the question of what PIP is supposed to be about.  If PIP is really supposed to be an extra cost benefit, it makes little sense to offer it without reference to people’s ability to pay.  The truth is that when the non-means tested benefits were introduced, they had a very different objective.  The Disablement Income Group had been campaigning for a recognition that the incomes of people with disabilities were consistently lower than for others.  Alf Morris explained, in Parliament (10th and 15th Jul, 1970):

“It is not only a question of finance we are discussing, but also the dignity of disabled people. … This provision must be seen as only part – a very minor part – of an entirely new financial deal for the severely disabled. … This is only one stage towards improving the financial status, and therefore the dignity, of every one of our severely disabled fellow citizens.”

The point of the non-means tested benefits was to introduce a   general income supplement, recognising that the incomes of people with disabilities were consistently lower than for others.

The second problem lies in using an assessment of functional activity as the basis of an assessment of costs.  This makes no sense – and the Equality Analysis explicitly acknowledges that it doesn’t work.  Testing people’s activities is “a proxy for their overall need”, but then it goes to explain that assessing costs is not practical:  “it would not only lead to inconsistent outcomes but would also be expensive and difficult to administer.”  If there was a direct relationship between need and cost, this would not be true – and the outcomes wouldn’t be inconsistent.  As far as I can tell, there isn’t such a relationship, or at least not one at the level there would need to be to make it the basis of an individual assessment.

The third problem concerns the Government’s intention.  It’s clear that the Government thought that introducing PIP would save money, and that the benefit would be more restrictive than the Disability Living Allowance.  I challenged that assumption more than four years ago, when I wrote this:

the target is a reduction of 600,000 people taken off benefit by 2018. I am not sure how a cut in numbers of that size is supposed to be achieved, but it is most probably made up of three elements: people who will lose the lower rate for the care component, people who fail to turn up for assessment, and people whose conditions have improved sufficiently not to qualify. (There is a fourth element, which is the attempt to individualise assessments more closely – blind people, for example, will no longer qualify automatically for higher rate mobility – but that can work both ways.)

On general principles, I think the predictions are likely to be wrong. The common experience of selective benefits has been that when governments try to impose firmer boundaries, they are liable to discover that needs are deeper, more complex and more difficult to reject than they imagine. The distinction between the lower and middle care rates on DLA has always been confusing, and many people can argue persuasively for higher banding. There are new opportunities to include people with psychiatric disorders. And the PIP rules do not exclude the growing numbers of older people claiming DLA.  Short term reductions have to be offset against the general trend, and as time goes on, inexorably, there will be pressure to extend protection. That happened with Single Payments, it happened with Incapacity Benefit, it has happened with DLA, and it will probably happen here, too.

And so it has proved.

The IEA fails to understand some basic facts about disability

The Institute of Economic Affairs has published a briefing on Disability Benefits.   They claim that the cost of disability benefits could be reduced by making sure that more people with disabilities went into work.  The approach has been sympathetically reported in the Mail and the Independent.  Unfortunately, the briefing is written with a cavalier disregard for the most basic facts about disability benefits, which rather tends to undermine any arguments they wish to make about what should be done.

There are three quite simple reasons why a greater emphasis on work will not do very much.

First, disability benefits are mainly provided for people who are not part of the labour market.  Half the population with disabilities consists of elderly people (the figures used to show more than half; the 2011 census puts it at 48%).   Claims for Attendance Allowance, and a third of the claims for Disability Living Allowance, are made by older people.

Second, disability benefits are provided for many reasons which have nothing to do with work – among them meeting special needs like mobility, supporting care,  compensation for injury and even (in War Pensions)  reward for merit.  The main justification for DLA is not really to cover extra costs, as many suppose, but to compensate for long-term low incomes of people with disabilities.   None of these reasons disappears if people are in work.

Third, and following from that, many disability benefits (such as DLA and PIP) are provided regardless of people’s income or employment status.  The main benefit supporting disabilities for people of working age who are not in work is Employment and Support Allowance – and while it is true that ESA has been used to cover a hotchpotch of different circumstances, sometimes including disability, it is a sickness benefit, not a disability benefit.  Disability is neither a necessary or sufficient reason for getting it.

It’s true that the numbers of ESA claimants have persistently failed to go down, unless it is by the rather brutal approach of using disentitlement and sanctions to throw people off benefits with no income.  The main reasons why so little has been achieved for ESA claimants  are

  • the failure of psychiatric services to achieve valuable outcomes for people with long-term mental illness
  • the use of ESA as the low-income equivalent of schemes for early retirement
  • the preference of employers for employees who do not have long-term limiting health conditions
  • the penal treatment in the benefit system of part-time and therapeutic work, and
  • the perverse emphasis on individual effort to find a job, mainly focused on people who are too ill to work.

If what the IEA is saying is that more people on ESA need to work, they have about 25 years of policy failures to show that policies which try to do this are ineffective.


Benefits for people with mental illnesses

I helped out today at a consultation event arranged by SAMH, the Scottish Association for Mental Health.  Their latest report focuses on Personal Independence Payment, and the experiences of people with mental illness claiming the benefit.  The report is based on comments from claimants, who felt disbelieved and stigmatised, and had no trust in the process.  The people I spoke to today had been treated as if their benefits were all to be judged on their capacity to work, and as their capacity to work was judged by their ability to do things physically, they weren’t entitled.  Assessors seemed not to understand, one participant explained eloquently,  that an invitation to explain what things were like at the very worst was equivalent to a request to revisit hell.

Mental illness poses a whole series of issues for benefits, which are not ideally covered by an emphasis either on disability or on long-term illness.   What should benefits for people with mental illness look like?  The benefits have to cover lots of possible contingencies – among them,

  • meeting income needs
  • offering social protection/insurance
  • support for carers
  • income smoothing
  • support while out of work
  • social inclusion
  • compensation for long-term low incomes and disadvantage
  • support for rehabilitation
  • facilitating employment
  • promoting engagement with medical services
  • protective income while in hospital
  • providing social care

As usual, most of these objectives have little do with the world of work – getting people into the labour market has only a limited role, as it does in lots of other benefits.

There is some limited reason to think that people with mental illnesses face higher costs, too, but the basic case for benefits is not based on extra costs.  Alf Morris MP, defending the introduction of Attendance Allowance, argued that the purpose of such benefits was to invest people with dignity.

“It is not only a question of finance we are discussing, but also the dignity of disabled people. … This provision must be seen as only part – a very minor part – of an entirely new financial deal for the severely disabled. … This is only one stage towards improving the financial status, and therefore the dignity, of every one of our severely disabled fellow citizens.”

That is as valid now as it ever was.

Questions are raised about the validity of the WCA

I’m intrigued, but not convinced, by Jonathan Hume’s analysis of the Work Capability Assessment in the new edition of Radical Statistics.  He identifies a significant bias against claimants in poorer and less healthy areas. “Counter-intuitively”, he writes,

healthier areas were finding claimants fit for work less frequently and placing claimants into the Support Group  more frequently. This is the opposite of what would be expected of an accurate test of disability.

I’m not sure that his expectations are right.  The numbers he’s been processing are not about what happens to people with disabilities, but what happens after claims for Employment and Support Allowance, which is a long-term incapacity benefit.  In areas of higher employment, there should be fewer people of working age with disabilities (because people with disabilities tend to suffer lower long term incomes and can’t afford to live in the more salubrious areas), but the disabilities which do lead to ESA claims will tend to be more serious, because people with lesser disabilities have more opportunities for employment than they do in poorer areas.

What he does establish, however, is that there are unexplained variations between areas, and clear biases in the outcomes of WCAs – for example, that more people are placed in the Support Group when more WCAs are done.   The WCA was developed on the basis of a population-based assessment, and if it’s producing inconsistent results at the level of the population, that does raise questions about its validity.

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.

After IDS

It’s difficult to know what has motivated Iain Duncan Smith to resign.   He claimed he was dissatisfied with the cuts to PIP, but suggested at the same time they might have been justified if they had gone towards deficit reduction.  That makes little sense.  If the government was serious about deficit reduction, it would have increased taxes.  So in both cases, benefit cuts have been made necessary in order to protect the incomes of people who are better off.  Apparently he was also frustrated because he was unable to cut payments to pensioners.  So one possible explanation is that IDS felt he should have full control, rather than being subject to the constraints of the Treasury.

A second possibility is that IDS thought it prudent to go before things unravel.  Universal Credit is not working, but the model that IDS said he believed in – a benefit that would be paid regardless of work status – has been fatally undermined by sanctions and the cuts to the Work Allowance coming in in April.  A court decision last week should require the DWP to publish information on the early development of UC, and that is likely to reveal a combination of managerial incompetence and misleading statements to the Commons.

Either way, Stephen Crabb, the new Secretary of State for Work and Pensions, is inheriting a pig’s breakfast.  There could be scope to review and simplify some of the policies that have incapacitated the benefits system in recent years:

  • decouple Housing Benefit from the Universal Credit reforms
  • individualise claims, rather than expecting couples to make joint statements online
  • exempt select categories of need from redundant assessments
  • relate means-tested benefits to previous periods, rather than to uncertain current income
  • limit any sanctions to a proportion of benefit, so that contact is not lost
  • address the inconsistent treatment of provision for mobility between people of different ages.

However, if – as seems likely – he has been given the brief to impose more cuts, it can only get worse.





The Budget hints at reform of disability benefits

There’s very little in the Budget directly on benefits – the main things are on page 103.  The main point of interest is probably about benefits for disability, and two of the three points are pre-announced.  The first is a modification of the PIP assessment to reduce credit for using aids and appliances.  As we’ve seen relatively few PIP assessments so far, it’s difficult to know how much effect this will have, but I suspect the government’s prediction that it will exclude huge numbers of people will have to be set against other changes in rules relating to fluctuating illnesses and mental health.  Tightening rules rarely works as governments expect.

The change on supported housing has bought a year for specialist agencies before the cuts come, but it’s only a moratorium.

The third point is the vaguest, but it could be the most important.  The government wants to consider “the case for long-term reform of disability benefits and services that is fair for the taxpayer and for those with disabilities or health conditions”.  I’ve no idea what that means, but  the implication of that phrase seems to be that they think the present system is unfair to taxpayers and costs too much.  Most people who become disabled have been taxpayers, and what they pay is supposed to ensure social protection for them when things go wrong.  Depending on how you count, there are something like eight to ten million people with disabilities in Britain.  Most of us will know someone in our own family who has been disabled or ill for a long time, and many of us could be disabled ourselves in time to come.  We should be telling people: it could happen to you.