What the doctor ordered?
CAB evidence on medical assessments for incapacity and disability benefits
The welfare reform green paper places new importance on the role of decision-making in the awarding of incapacity benefits, for people who cannot work because of illness or disability. Medical assessments form the basis for decisions about entitlement to incapacity benefits. They are also used to decide eligibility for disability benefits paid to help meet care or mobility needs. The welfare reform green paper proposes to transform the gateway to benefit, by reforming incapacity benefits, revising the assessment process, and by rolling out the more pro-active and work-focussed Pathways to Work programme.
Citizens Advice Bureaux have long been aware of flaws in the process and quality of medical assessments and the decisions based upon them. Far too often, incorrect decision-making causes substantial drops in income whilst clients have to go through an arduous and lengthy appeals process.
Over half a million medical examiniations for incapacity and disability benefits were carried out last year. However, the current system of medical assessments and decision-making is not working satisfactorily for claimants or the Department of Work and Pensions (DWP). Far too many original decisions to refuse or withdraw benefits are incorrect, and the reconsideration process is not working effectively. Too many cases go to appeal and success rates are very high - almost 60 per cent - for both disability living allowance (DLA) and incapacity benefits at oral appeal hearings; about 70 per cent when clients are represented by advisers. People with mental health problems appear to be especially likely to suffer from low quality assessements.
A quantum leap in the quality of medical assessment and decision-making is needed for welfare reform objectives to be realised, so that:
- applicants could be spared distress and hardship when they are wrongly denied benefits to which they are entitled
- the DWP would save resources devoted to unnecessary reconsiderations and appeals
- the Appeals Service would have fewer appeals to deal with
- advice agencies would spend less time helping clients challenge poor decisions.
- The Citizens Advice service assists large numbers of people who have been refused incapacity and disability benefits, or have had these benefits withdrawn. Our evidence suggests that the quality of the current system of medical assessments and the quality of decision-making is not acceptable, and that there is great scope to improve the experience fo these clients. This briefing recommends a number of ways to achieve this.
- Too often evidence from the Atos Origin doctor is preferred over other evidence supplied by practioners who are more familiar with the applicant's condition. Better use could be made of evidence from applicants, the people providing them with health and social care, and the applicants' carers.
- The administration and quality of medical assessments by Atos Origin still needs to be improved. CAB clients lose benefits immediately if they miss an assessment, even though they often have good cause.
- We continue to receive complaints about the conduct of medical examinations. Jobcentre Plus, the Disability and Carers Service (DCS) and Atos Origin should establish a task force with stakeholder organisations to improve the way medical examinations for incapacity and disability benefits are conducted and decisions are made.
- Procedures for stopping incapacity benefits should be improved to ensure that claimants receive adequate notice of the withdrawal of their benefits and constructive help from Jobcentre Plus to deal with the situation.
- The Personal Capability Assessment (PCA) does not assess mental health conditions adequately. A full review of descriptors and processes in the PCA should be carried out by DWP, with the involvement of advice service organisations and other stakeholders. More information should be provided to people undergoing the PCA.
- DWP should focus more strongly on providing a better service to people with mental health problems and improving the assessment of people with mental health problems. DWP should appoint a mental health champion.
- Systems used to complete assessment reports are inflexible and generate standard responses. The use and development of computer-aided decision-making in medical assessments for incapacity benefit should be subject to a transparent review involving stakeholders including Citizens Advice. This should be done before a similar system is introduced for examinations for disability benefits.
- We welcome the review of the decision-making and appeals processes for incapacity benefits announced in the welfare reform green paper. A similar review is needed for disability benefits. Both should be conducted openly and involve all stakeholders.
- Many CAB clients find that disability benefit awards are made for relatively short periods, and come up for renewal quickly and a long way in advance. The Disability and Carers Service should review their practices on the length of disability benefits awards, renewal procedures and the extent to which they need to use medical examinations by Atos Origin.