There were a lot of questions embodied in that one question.
You asked why so many appeals are successful. There are degrees of success, as you know, because there are different grades or different awards that people can get for PIP, so not everyone is entirely satisfied even if their appeal is allowed. With appeals, essentially, we are looking at a snapshot of the healthcare professional’s assessment of the person’s abilities on a particular day, whereas the tribunal looks at what the person is like over a longer period, even if there is one date of decision. It is functionally based. A lot of people with mental health problems find it very difficult to convey those problems to healthcare professionals who may not have any expertise in that area. That has been quite well documented.
I do not know that tribunals always get it right, because this is a very complex area. A number of appeals that come in are very finely balanced, and tribunals are very conscious that the financial implications for someone who is not successful at appeal can be quite devastating.
As I think you are aware, we get letters from GPs expressing concern, perhaps not so much about the individual’s health, but about the impact of the loss of income to the household, and the added stress that would follow. A lot of people who we see have been quite traumatised by the loss of their transport, their ability to interact with other people and their ability to pay their bills, because they have got used to that additional income. We are talking about awards of up to about £600 a month that are tax free. You can imagine how devastating it is for the individual to go from that benefit to nothing. Sometimes, the process itself impacts on the mental health of the people involved, and there is a very complex association between mental and physical disabilities that impacts, too.
On the evidence that we get, as I think you are aware, the tribunals quite often adjourn or preview cases and decide that it would be a good idea to get medical case notes, perhaps for the past year or two, in order to get some primary evidence on the diagnosis, the treatment and the reasonable range of expectation around that. That is one way of assessing how reliable the individual’s perception of their condition is.
We now very rarely ask the GP to write a report to say, basically, whether they think that the person meets the criteria, because we know that that can impact on the patient and doctor relationship. I am aware that there might be difficulties around involving GPs more in the assessment process, but I understand that there are ways of getting an extract of GP computer records, which might set a baseline for somebody’s entitlement and mean that it is not necessary to call them in for a face-to-face assessment.
Ultimately, however, it will depend on the secondary legislation and the criteria that are applied. Sometimes, in relation to someone’s function, we cannot make a direct correlation between their contact with their GP, their treatment and their loss of function. Some people, particularly those with drug or alcohol abuse issues or mental health problems, may not want to or feel able to engage with their GP, and they may become heavily dependent on support from family, which might not be reflected in medical records.
It is such a complex area that I would like some more research and a bigger factual base of information to come before the Parliament, at least at the stage of the secondary legislation and the regulations, that captures some of those issues a bit more accurately.