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What the doctor ordered?

2 March 2006

Health and social care briefings cover

Citizens Advice evidence on medical assessments for incapacity and disability benefits

Summary

What the doctor ordered? [ 100 kb]

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 eligibity for disability benefits paid to help meet care of mobility needs.  The welfare reform green paper proposes to transform the gateway to benefit, by reforming incapacity benefit, 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 examinations for incapacity and disability benefits were carried out last year.  However, the currernt system of medical assessments and decision-making is not working satisfactorily for claimants or the Department for Work and Pensions (DWP).  Far too mnay 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; around 70 per cent when clients are represented by advisers.  People with mental health problems appear to be especially likely to suffer from low quality assessments.

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.