As you said, convener, I was invited by the Secretary of State for Work and Pensions to undertake the first statutory review of PIP. The fact that I am chair of the SSAC is kind of parallel to the fact that I was asked to undertake the first independent review of PIP. In responding to the invitation, I made it clear that I wished to avoid any possibility or perception of conflict of interest between the two roles, given the possibility that, while I was undertaking the PIP review, routine business on PIP might come to the SSAC. I made it clear at the outset that, were that to happen, I would step outside the SSAC’s consideration of any routine business on PIP so that I was not seen to be wearing too many hats at once. As it happens, no business came to the SSAC on PIP, so the issue did not arise. However, I am keen to make that distinction clear.
When I started the review in April or May of last year, there was already a huge amount of noise around the early introduction of PIP as a result of the major problem that had developed with delays in processing and in particular delays in people being called to the new-style PIP assessments. A lot of the initial evidence that I gathered focused heavily on those delays.
After a short period, I decided that, although it was important for me to understand the impact of the delays, a lot of attention had already been paid to those issues by the Westminster Parliament and indeed this Parliament. I made it clear in my report that resolving or completing the process to resolve the delays was a fundamental priority, but in my view it was a necessary but not sufficient factor in addressing a number of fairly major underlying issues with regard to the operation of the process. As a result, I sought in the review to look beyond and behind the delays and focus on what seemed to me to be important underlying issues that ought to be addressed as and when the delays were resolved.
Given that this was a statutory review that was, as the convener has pointed out, mandated by the Welfare Reform Act 2012, I felt it right to look at the broad structure and parameters of the assessment criteria that had been established in legislation. Major consultation processes had led to the final design and although, as I have said in the report, it was clear that the measures might not have commanded universal support, I felt that the right focus of my review was not the basic parameters of what the Westminster Parliament had decided but the implementation of the whole process.
As I gathered and distilled the evidence that I was getting from a whole range of approaches—I had received a lot of written evidence and had had lots of meetings, focus groups with claimants and many conversations with all the players involved, including the organisations representing disabled people—it seemed to me that the issues fell under three broad headings that have been summarised in the report that the committee has received from the Scottish Parliament information centre. The first heading was the claimant experience of the process of claiming PIP and ultimately receiving a decision; the second was processes and procedures for obtaining evidence to support the assessment and decision-making process; and the third was the overall effectiveness of the assessment.
In very broad terms, my summary findings under those three headings were, first, that even putting to one side the very unfortunate reality of long delays, the claimant experience as currently designed is very disjointed. Important issues have to be addressed in that respect. Secondly, as far as obtaining the necessary evidence is concerned, the more discussions and conversations I had, particularly with claimants, the more it struck me that the PIP process was widely viewed as “having a medical”. The benefit has been designed to emphasise that this is an assessment of the functional impact on disabled people of underlying health conditions, not an assessment purely and solely of medical conditions. However, as I observed assessments in process and examined other sources of evidence, I noticed that there were a number of ways in which the progress seemed to feel overmedical and underfunctional. I also thought that the current arrangements for collecting evidence, whether medical or functional, left a fair amount to be desired.
On the overall effectiveness of the PIP assessment process, my summary conclusion was that, frankly, it is a little bit too soon to judge whether it is being effective in the intended way. Even by the time I got to the end of my review in December, only quite a limited number of award decisions had been reached. I could see some indications that there were questions to be asked about the consistency and reliability of the early outcomes, but the evidence was rather patchy.
In my third area of focus, I concentrated my recommendations on ensuring that processes and systems are significantly improved so that, as the case load starts to build under the PIP roll-out, there will be much more reliable means of assessing the fairness and consistency of awards across different claimant groups.
Those were my three broad areas of focus. The Scottish Parliament information centre report that the committee has received has a summary of my 14 key recommendations, which were spread across those three areas of focus. I decided to make another three-way split in my recommendations, based on the time period in which should be fully implemented.
The first group, which unimaginatively I called short-term recommendations, were things that I emphasised should be fully completed before the PIP roll-out gets to the stage of what has been termed managed reassessment. That is a critical point to focus on. As I am sure the committee is aware, the roll-out has been phased, with all the early focus being on new claimants—people who are not in receipt of the legacy benefit, disability living allowance, and are coming fresh to the process. The great majority of claims that have been decided on so far fall into that category. The fairly small proportion of reviews of existing DLA awards have involved either the small minority of cases in which the initial DLA award was time limited, or cases in which claimants have concluded that they wish to reapply for PIP, possibly because they felt that the functional impact of their condition had significantly worsened since their original DLA award.
However, the great majority of current DLA claimants have yet to go through the PIP process. The Westminster Government’s announced schedule is to start that final principal stage in the autumn of 2015. The more I thought about it, the more that seemed to be the point at which any kind of underlying difficulties, strengths and tensions in the PIP process will come into sharp focus, because at that point people who have been in receipt of DLA, which quite often was awarded without any time limits placed on it, will face the start of a process of mandatory reassessment under PIP. The expenditure projections that the Westminster Government provided as PIP was developed and in successive budget documents assume that a significant proportion of existing DLA claimants will not receive a PIP award or will receive a PIP award that is lower than their DLA award. In some other cases, the assumption is that people will receive a higher award under PIP but, in net overall terms, the plans and expectations of the Westminster Government are for significant reductions in expenditure under PIP compared with DLA.
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As that process starts to roll out, the system will clearly come under a lot more pressure. It is one thing, however difficult, to say to a new claimant for PIP, “I’m sorry, but you haven’t met the criteria and you haven’t got an award,” but it seems to be a significantly larger issue and challenge to say to somebody who has been in receipt of a DLA award for some years that they have been reassessed for PIP, and that it has been concluded either that they are not entitled to any PIP award or that they are entitled only to a reduced award.
That is why I wanted to put a time plan on my recommendations. There are some things that I thought it was essential to have fully in place and properly operational before the next phase of the roll-out started. There were other things, which I unimaginatively called medium-term recommendations, which I felt should be well on the way to implementation at the start of that phase.
There is one recommendation that I termed long term . I have recommended a fundamental redesign of the whole claimant process for PIP to make it much more integrated and joined up—and, in this day and age, increasingly digitally enabled for the increasing proportion of people for whom that will become a preferred approach.
In making that time split on my recommendations, I was influenced by the political calendar, in two respects. First, we have the United Kingdom election in May 2015. The recommendations that I was making, which would take a fair time to implement on any basis, are likely to fall, in UK terms, to whoever forms the next Government in Westminster.
Secondly, we had the Smith process in Scotland towards the end of my review period. It concluded and recommended that PIP and some other disability benefits should be devolved to the Scottish Parliament and Scottish Government. Therefore, I thought that it was appropriate also to flag up some things that I thought were for longer-term consideration, which could, in UK terms, fall under a different jurisdiction and which, in Scottish terms, would certainly fall to this Government and Parliament.
I will give a flavour of where the focus of my specific recommendations was regarding the claimant experience. I have stressed the importance of improving claimant communications in all kinds of ways, including a fundamental revamp of the decision letters that are sent to claimants once a decision is reached, which I found quite difficult to follow and interpret. My suspicion was that many claimants would find them at least as difficult to understand.
I highlighted the importance of improving the relationships between different players in the decision process. There are the outsourced assessment providers—the health professionals doing the assessments—and the Department for Work and Pensions staff who make the final decisions, based on the input from those assessments. I saw some evidence of improving relationships between those two groups, but I saw a lot of scope for more work to be done to improve those relationships and, as a result, to achieve a much better process for claimants.
As I have already indicated, I think that the current process can be made significantly better in the longer term. There can be much better joining up of different parts of the process. The onus is currently largely on the claimant to navigate their way around different bits of the process and to ring up different people to find out where their claim has got to. In this day and age, in any claimant or customer process the onus should be on the providers—in this case, the DWP and the outsourced providers—to do the joining up and give single points of contact and ease of claiming. That is a fundamental long-term change. In particular, claimants should be allowed a simple way to check where their claim has got to. Currently, that is extraordinarily difficult. Claimants have to make lots of phone calls to different places and they get lots of unsatisfactory hand-offs.
On improving the way in which evidence is obtained, I have recommended looking at the scope for much better joining up of the information that various parts of Government or Governments already hold. Currently, the PIP process is very insular and self-contained. Quite a lot of people have to go through an assessment process for ESA and also the PIP process separately. During the review, the DWP started the process of seeing whether some of that information could be brought together. I have encouraged it to go a lot further.
There is potentially a lot more scope to think about joining up other aspects of evidence collection, particularly in relation to social care assessments. Again, there is a significant overlap of the case load there.
I have made recommendations about the way in which the face-to-face assessment processes operate. Having observed quite a number of them, I felt that there was not enough transparency for claimants to see what information was being recorded by health professionals.
Finally, on the effectiveness of the assessment, I highlighted two specific aspects of the 12 criteria for assessment that I did not think were working terribly well. I thought that there was a lot of confusion around activity 11, on understanding people’s mobility needs. Similarly, I thought that people’s need to use aids and appliances was possibly not being considered in the way intended.
To look a bit further ahead, as I said earlier, I was quite concerned that early evidence suggested to me that there could be some inconsistency in the way in which awards are being made. I was particularly concerned that focus should be given to ensuring that assessments of people with mental health conditions or fluctuating conditions are done consistently. I was concerned to note that there was not yet a full and proper evaluation strategy published and in place for how the department would over time fully assess the consistency of awards as PIP is rolled out.
I hope that that gives a flavour of the areas of my recommendations.
I am pleased to say that the UK Government agreed to publish my report as soon as it was completed without making any observations about the recommendations, so they were out in the public domain and everybody had an opportunity to see them. The DWP produced its initial response in February this year, I think, around two months after my report. In that response, it focused just on my short-term recommendations, which was broadly what I intended when I structured the recommendations in the way that I did. I am pleased to say that, out of nine recommendations, something like eight and a half have been fully accepted.
In the case of the recommendation that was only partially accepted, I am happy that the spirit has been met. Of course, it is one thing for a Government to say that recommendations have been accepted and another thing for them to be fully implemented. Therefore, I reserve judgment as to how comprehensively my recommendations will be implemented.
I have taken a little too long, but I hope that that is helpful and gives the background to the review.