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ESA – Employment Support Allowance
JSA – Job Seeker’s Allowance
DWP – Department of Work and Pensions
DLA – Disability Living Allowance
PIP – Personal Independence Payment
The government in Britain, whether Labour or Conservative, has always made it difficult for people to claim the benefits that they need. This article is intended to point out some of the key contradictions in several of the government disability benefits schemes. The information in this article has been gathered mostly from first-hand experience and has been assembled so that we may point out the clear problems within the current system, but also in an effort to help educate people on the basics of claiming benefits in Britain today. First then, it is important to note that there are several different types of disability benefits in Britain today:
- Employment support allowance (ESA) – This is what you should be entitled to if you can’t work, instead of JSA. To apply for this benefit, or to continue to receive it, you have to have a doctor declare you as ‘unfit to work,’ and have to continue sending the DWP sick notes until you are assessed by them. ESA is split into two different groups:
- Work related activity – if you’re put into this group the DWP have decided your disability or condition does limit your ability to work, however they see you as capable enough to be able to take part in work related activities and attend work focused interviews to improve your chances of finding work in the future.
- Support group – if you’re put into this group the DWP believe you can’t work and they don’t expect you to do anything to improve your chances of finding work.
- Personal independence payment (PIP) – This can be given to working people as well as the unemployed, used as a ‘top-up’ on income for specific needs, such as money for taxis and care needs. PIP is split into two parts:
- Daily living – Which is in turn assessed on twelve different criteria, the ability to: prepare food, take nutrition, wash and bathe, manage therapy or the monitoring of a health condition, manage incontinence or toiletry needs, dress and undress, communicate verbally, read and understand signs, engage with other people face-to-face, and make budgeting decisions.
- Mobility – Which is assessed on the claimant’s ability to plan and follow journeys as well as their ability to move around.
Issues with the specification(s):
Claimants must score a certain amount of points in these areas to get the benefit at either the normal or an enhanced rate for the daily living allowance (as mobility is separate). To get the points needed for the specification claimants must have difficulties which present themselves 51% of the time, which poses an issue for people with conditions such as epilepsy – despite not being affected 51% of the time, they are disabled and will still need financial support to help with their condition.
Most claimants do not know about the 51% rule and are never told about the specification, so most people will navigate the process with no knowledge of what they’re entitled to, or how to present themselves in order to get benefits.
Claimants must prove that they meet the specification which, (to reiterate) they are never given, in order to prove their entitlement to PIP. However, the assessor may use the specification to refute the entitlement of the claimant, so the award of the claimant is the result of a struggle between them and their assessor. This struggle decides whether or not they will be able to claim the money which allows them to afford help and disability aids, without which they will often end up in impossible situations.
Additionally, the claimant’s diagnosis of a disability could confirm that they had issues in one or more of these areas; but if the assessor does not agree that these difficulties were presented at the assessment, then the claimant will not be awarded that part of the benefit. It seems that every aspect of the claimant’s disability or condition must be presented or proved at an assessment, despite the 51% rule presumably allowing for their disability to not affect the claimant 49% of the time.
Issues with the assessment and the assessors
Assessments are undertaken by private companies, often without appropriately qualified assessors. For example, a neurological problem could be assessed by a physiotherapist, as happened to a contact of this writer. It is rare that any of the assessors are themselves doctors and they cannot possibly be suitably qualified to assess every single health problem that they encounter.
In the case of ESA, essentially, the claimant must have a doctor declare them unfit for work in order to apply for the benefit in the first place. At which point, a privately contracted nurse (on behalf of the DWP) can suddenly decide that the claimant is actually fit for work. In a lot of cases, when people are declared fit for work by an assessor, a doctor will disagree with the findings and re-declare them unfit to work, at which point they have to again re-apply for ESA.
These decisions are made regardless of whether someone can actually work, or indeed find and apply for a job, and such decisions do not take into account that disabled people are discriminated against. For example, among autistic people, there is a 16% employment rate, regardless of ability or apparent “functioning level”.[i]
Additionally people can have incurable conditions and still have to undergo regular reassessment, as often as the assessor decides (this decision is overseen by the DWP, but they very rarely go against an assessor’s recommendation). I have autism and always will, yet at my previous assessment I had a four year recommendation, this time I have one and a half years until my next assessment, despite the unchanging nature of my condition.
There is also an issue of accountability for assessors during the assessment process. They can lie, falsify medical evidence, be negligent, rude, and at the end of the day it’s “your word against theirs”. As they are not the final decision-makers, they never hear if their decision has been overturned, however decision-makers very rarely go against assessors’ recommendations, thus, realistically, the decision comes down to the report that the assessors make.
A contact of mine spoke to a DWP representative after their tribunal hearing and found that the assessor had lied; the DWP representative openly told her there was probably no point in complaining to ATOS, the provider of assessments, as nothing would be done as a result of their complaints. In fact, people have been known to complain about blatant lies, rudeness, discrimination, and have been told that it’s simply “your word against theirs.”
So, assessors’ lack of accountability allows them the theoretical power to not write down what you tell them and simply make things up. Questions asked by assessors can also be intentionally misleading or overly simplistic. This differs from assessor to assessor but in my own case, I have difficulties with food preparation and the assessor simply asked me “can you put something in a microwave,” which of course I can as my issues are with preparation. Yet, because of this overly simplistic question I wasn’t awarded the benefit, despite being entitled as according to their specification.
Furthermore, the stress of assessments can exacerbate existing health conditions, especially mental health conditions. The assessors call themselves healthcare professionals and yet they are making people worse.
Apparently there are no bonuses in place for assessors who find applicants not to be eligible for the benefit they are seeking to claim, however, it was recently discovered from an undercover investigation into ATOS by Channel 4 Dispatches that apparently if assessors find more than 12%-15% of claimants eligible for the highest part of the benefit, they will be talked to about this statistic being “too high” and their work will be audited.[ii]
There are also clear time restraints upon the assessors, as, if they are able to assess more people in a given time (as agents of a private company) they will generate more profit. As found in another Channel 4 Dispatches investigation, in which an assessor claimed they could earn £20,000 a month “most months” by rushing through claims, even completing forms before the assessment. An undercover reporter was also told by a senior member of staff to do “as many assessments a day as you can possibly manage.”[iii] The issue with this is that the rushing assessor can miss out vital information that would have seen you being awarded the benefit.
It should also be noted that new information has recently emerged which shows that thousands of applicants could have had their claim denied on ‘unacceptable’ assessment reports. This information clearly shows that these reports should have been sent back to the assessor.[iv] Instead, these reports deprive people of their much-needed benefits.
The Appeals process
The first stage of the appeals process is a mandatory reconsideration, for which the applicant has up to 6 weeks to give the DWP any additional medical evidence that they have to strengthen their claim and their mandatory reconsideration letter. The DWP have an unlimited amount of time to respond.
At one point in time, appeals at this stage of the process were very successful (around 70%), but changes have been made to limit the success of the appeals claims to under 20%, which the DWP has pushed down further still to 12%.[v]
After this, claimants have to continue the escalation process by bringing it to a first tier tribunal, which is known to be comparatively fair within the community, but this process can take years. In one contact’s case, they were without the disability benefits that they were entitled to for two years whilst they waited, which detrimentally affected their life and independence.
Britain’s most senior tribunal judge, Ernest Rider, argued that most of the benefits cases that reach court are based on bad decisions, for which the DWP has no case at all. He also said that the quality of the evidence submitted by the DWP was so poor it would be “wholly inadmissible” in any other court.[vi]
Sometimes, where poor decisions have been made, justifications are fabricated for not awarding the benefit such as lack of specialist intervention. This can be the true even in cases where specialist treatment is not an option, not provided on the NHS, or after people have exhausted all the specialist treatment available for them and are told nothing more can be done.
Similarly, where incorrect decisions are concerned, the DWP often justifies such decisions by saying that they did not have enough medical evidence at the time. Even in my own case, when I allowed the DWP full access to my medical records, they still tried this tactic.
Issues with the DWP and government
The current system allows the government to decide not to give people with mental health problems money for mobility, despite needing this money to carry out their usual, necessary activities. The DWP has gone against tribunal decisions to refuse to award mentally ill people mobility benefits.
Often it is said in government, as a response to criticism of the benefits system, that more disabled people are now getting the higher rate of PIP than they were on DLA.[vii] While this is true, it is an intentional distraction from the real problem that 47% of disabled people have seen their claim for benefits reduced, or stopped altogether. So while more people may get a higher rate under PIP, many more people than before get a reduced rate or nothing at all.[viii]
In fact, assessments cost the DWP more money than they would if the system were ran properly because of the amount overturned decisions and admin fees caused by their flawed system. Often they will deny someone their disability benefits for years and eventually have to pay them back for the time that the claimant was entitled to the benefit and received none, although there are some limits upon this amount of reparations.
In conclusion, every stage of the application to disability benefits is incredibly stressful for the claimant. It’s hard to fill in the forms, it’s hard to attend the assessment and it’s even more difficult to appeal incorrect, unfair decisions. I suggest here that I do not believe there is an actual need for face to face assessments. The DWP could simply go along with the recommendations of GPs and specialists. Or, similar to the DLA system (that PIP replaced), people could fill in a form explaining their needs without having to rely upon assessments.
It should be said that Labour has suggested reform of disability benefits into “a more holistic approach focusing on strengths and weaknesses.” We find this a mockery of an answer, which fails to address problems. In fact, it is Labour that brought in the face-to-face assessment in the first place. Labour are no better at dealing with these issues than the Conservatives, and a complete societal change is required if we are to be able to provide for the people that need support.
Written by AP