Welfare Reform Bill

My Lords, there is a great deal of evidence that decisions are frequently inaccurate when made on the basis of reports from face-to-face assessments on their own without being informed by evidence from the claimants and healthcare professionals. The purpose of the amendment is to ensure that in all cases, as a part of the decision-making process to decide eligibility to PIP, evidence is collected by the DWP from the claimants’ own healthcare and other care professionals. If sufficient evidence is collected to decide entitlement to PIP, it should not be necessary to have a face-to-face assessment. There have been ongoing problems with the assessments for ESA. Recent figures published by DWP show that nearly one-third—29 per cent—of those in the work-related group were originally found fit for work and had to appeal to be placed in the right group. Even more worrying, a staggering 60 per cent of those who won their appeal had been awarded no points at all in their initial face-to-face assessment, and at least 15 points are needed to be awarded ESA. These are not borderline decisions. Why are so many decisions going wrong? The assessment reports frequently contain a partial or inaccurate account of what the claimant has said. The reports done by the healthcare professional are meant to record accurately what the claimant says about the effect of their condition. The second half of the report is where, on the basis of what the claimant has said and their observations, the healthcare professional comes to their own decision about the level of the claimant’s functionality. However, welfare rights workers have consistently reported over the years that many of the reports contain a partial or inaccurate account of what the claimant has consistently reported is the impact of their impairment on their everyday life. Regular feedback from welfare rights workers, who are dealing with these reports every day, is that although there have been some improvements, such as in the reconsideration process, there are still considerable problems with the accuracy of these reports. It has not been solved and will not be while relying on these assessments on their own. The healthcare professional doing the assessment sees the claimant for only a relatively short time on one day, which may well be a good day. They are unlikely to be a specialist in the condition and know the likely effects or how they vary, and will not have access to all the medical records and the tests that have been done establishing the level of seriousness of that condition. DWP and Atos now recognise the value of medical evidence from the claimants’ own doctors—this is a really valid point—which was acknowledged by Dr Crawford, clinical director of Atos, in evidence to the Work and Pensions Select Committee. Healthcare professionals working for Atos also acknowledged that when a sample group was interviewed in a survey for DWP. The following is an extract from that DWP report, and it demonstrates that Atos healthcare professionals themselves believe that medical evidence from the claimants’ own healthcare professionals should make the assessment process more accurate: "““GPs’ reports were particularly well received because they tended to know the claimant so well. Some HCPs felt that would help to contextualise what they observed on a single appointment ""… In addition, it was felt that greater access to medical evidence ahead of the face-to-face WCA might improve the quality of decision-making by providing a more rounded picture of the customer’s condition than was really possible in a one-off assessment: ‘It can be very difficult sometimes when you’re assessing somebody in a short space of time as to whether what they’re telling you and whether all your examination findings, whether they all tie together. It can be very difficult, and I think if you had some supporting evidence from a health practitioner, it would make your decision making a lot more robust’””." So Atos healthcare professionals themselves are saying that their decisions about the level of functionality would be more robust if medical evidence were collected, yet the DWP collects evidence for ESA only when it is likely that there will be no assessment. Unsurprisingly, in view of all this, the deciding factor in tribunals overturning decisions is frequently evidence from the claimant’s own doctor or healthcare professional. The Government say that they are committed to getting the right decision first time, yet the following is an extract from guidance sent to GPs: "““DWP may ask you to complete a factual ESA113 report on your patient. You can complete this form from your medial records … DWP will only ask you to complete an ESA113 if it could result in us confirming your patient’s benefit on claim evidence alone, without need for a face to face assessment””." Despite evidence from all sides—welfare rights workers and claimants, the tribunal service and the Atos healthcare professionals themselves—that decision-making in the assessment would be much more likely to be right first time if medical evidence were collected, the only concession is to encourage claimants to send in their own medical evidence. Not getting it right first time will cost money as well as create stress for the claimant. The numbers of ESA appeals are mounting, as are their costs. We do not want PIP appeals to follow a similar trajectory. It clearly makes sense to get this right. In addition to the costs of appeal, people are too often called in for face-to-face assessments when they should not be. One claimant had recently had a spinal operation. The HCP was shocked that she had been called in for an assessment; he sent her back home immediately and commented that she should not have been asked to leave her house. The stress for the claimant was obviously dreadful but the cost of that face-to-face assessment was also wasted. The Government estimate that the cost of implementing the changes to DLA, including implementing the new assessment regime, will total £675 million, yet a large number of people receiving DLA could be placed on to the new benefit by a combination of their own evidence in their application together with evidence from their own healthcare professionals, without recourse to a face-to-face consultation or assessment. This is particularly true for those with a lifelong condition or with long-term degenerative conditions, and for those currently receiving the higher rates of benefit. If there is recognition that medical evidence from claimants’ own healthcare professionals is needed to make the assessment process more accurate, the onus must not be placed on the claimant to collect that evidence. Claimants are often charged for medical reports, and while advisers are sometimes able to negotiate with the doctor to drop the charge where a claimant is going to tribunal, doctors who charge will not make that concession in the case of every claim. The charge is often £30 or £35 and sometimes more. Citizens Advice reported one case where the consultant initially wanted to charge £200 an hour. If someone is living on the basic ESA of £67 a week, or even on the ESA main rate of £94, they cannot afford to pay this amount of money to claim PIP. It must be DWP’s responsibility to collect the evidence that is needed for an accurate assessment. It is vital that the assessment process for PIP includes a requirement for the decision-maker to collect evidence from the claimant’s own healthcare professionals as a core part of the decision-making process. Without that requirement, there is a danger that there will be a two-tier system, with the poorest and most vulnerable claimants unable to afford to pay for the evidence themselves and, as a result, at risk of receiving a less reliable decision. I beg to move.