Thursday, 2 November 2017

Personal Independence Payments: 'Statistical norms' and the fight to come.

In her recent Guardian article, detailing the high levels of complaints about, and problems with, the assessment system for Personal Independence Payments, Frances Ryan says, "None of this exists in a vacuum".  She's referring to the other attacks on disabled people's benefits and services which  have been waged by governments over the last seven years, but there's also a wider, very worrying context that we need to be aware of. 

There are two factors which are creating a great incentive for the government to continue its efforts to reduce expenditure on Personal Independence Payments.  The first is that, although expenditure on incapacity benefits (Employment and Support Allowance) is now a smaller share of national income since 1990 (partly because the value of such benefits has fallen), expenditure on Personal Independence Payments has grown as a share of national income and is projected to keep growing.

The second is that, as the Institute for Fiscal Studies reports, the government's aim of reducing public expenditure - the drastic cuts to public services and to working age benefits which have happened since 2010 - have only brought public expenditure back down to what it was before the financial crash of 2007/8:  “Seven years of cuts have served merely to return public spending to its pre-crisis level as a share of national income”. This is bad news for a government ideologically committed to reducing public expenditure and, combined, with the first point, should alert us to the possibility of yet another assault on disability benefits. 

In these days when disabled people’s civil and human rights are under such attack in the UK that the United Nations has said that a ‘human catastrophe’ is unfolding in our country, it is crucial to remember that one aspect of our social security system is truly progressive - or at least it was in its origins.  The currently misnamed Personal Independence Payment was originally called a Disability Living Allowance, and when it was introduced in 1992 it was transformative in that it recognised that people with impairments or long term health conditions have additional costs in terms of their mobility and daily living requirements.  DLA provided a contribution towards these costs and what’s more it was not means-tested.  It was, like child benefit, a recognition that society should take collective responsibility for the costs that some of its members incurred because this would benefit our society as a whole.  (The origins of such a progressive approach in fact go back to 1972 when Mobility Allowance was first introduced.  This had the same principles but only covered mobility impairments.) 

Unfortunately following the 2008 financial crisis, DLA was a key target for the ‘austerity’ measures pursued by Tory-led Coalition government. The abolition of DLA and its replacement by PIP was clearly motivated by the intention of reducing expenditure - the then Minister for Disabled People told Parliament that she expected that almost 60% of people who were reassessed would either get a reduced benefit or no benefit at all.The aim was to significantly reduce projected expenditure (the amount that would have been spent on DLA without its replacement by PIP) and the government assumed that by May 2018, 607,000 fewer people would be eligible for PIP in comparison with the number who would have been eligible for DLA (see Tables 7 and 8). 

Many people may have forgotten that initially the government proposed to remove the mobility component of DLA/PIP from people in residential care (the care component is already effectively removed for many by being included in the means-test).  They climbed down from that proposal but, since the full implementation of PIP, when it became clear that it would be difficult to achieve the intended reductions, the government have continued to try and reduce eligibility.  First, they tried - unsuccessfully - to reduce eligibility for people who use ‘aids and adaptations’ and then, following a judge’s ruling which recognised eligibility for the enhanced mobility component of PIP for people with mental ill health, the government introduced a retrospective regulation which removed this eligibility

In 2016, the Office for Budget Responsibility sounded a warning that the government’s intended reductions were not materialising. The original forecasted reduction in eligibility was based on DWP’s analysis of 900 recipients of DLA who were reassessed for PIP.  However, the evidence of actual reassessments was that more people are successfully claiming than the sample suggested and, moreover, more are being awarded increased payments.  This isn’t surprising - as anyone might have told the DWP if you reassess people who were on so-called ‘lifetime awards’, most will not only continue to qualify but many who were on lower rates of DLA will now qualify for higher rates of PIP because their needs will have increased as they grow older. 

Expenditure on PIP/DLA is also increasing because an ageing population means there is a built-in increase in the numbers receiving the benefit (which continues to be paid, though cannot be claimed, after the age of 65) and because increasing numbers of children with significant impairments are surviving into adulthood.

The OBR concluded that the government was only likely to save 5% of projected expenditure instead of the 20% it aimed to achieve.  This follows a familiar pattern in that the Coalition government and this current Conservative government have consistently underestimated the numbers of people eligible for DLA/PIP and therefore the amount spent on this disability benefit.  The OBR warned the government that “The history of optimism bias in estimates of the impact of welfare reform is a real cause for concern”. Worryingly for the government this warning was sounded even though, at the time, the OBR assumed that a further cut in eligibility - which would have reduced the numbers qualifying by a further 290,000 - would take place.  In fact the government was forced to drop this proposed rule change thus reducing the intended savings on PIP expenditure even further. 

In the light of all this, and in the light of the recent publicity given to the numbers of complaints and appeals about PIP assessment, the question needs to be asked whether, having failed to cut back on projected expenditure in the way intended, the government has introduced ‘targets’ or ‘norms’ for assessors which is resulting in some unjust decisions about eligibility.  Appeals of decisions are increasing as are success rates. Some people with terminal cancer are being wrongly refused PIP, and there is increasing evidence of ‘discrepancies’ in assessors’ reports.

These allegations sound remarkably similar to those previously made about Work Capability Assessments. Assessments for Employment and Support Allowance did not initially deliver the intended reductions in people qualifying for out of work disability benefits and this was followed by increasing accounts of people being assessed as ‘fit for work’ who patently were not. Accusations were made that the company who at that time was carrying out Work Capability Assessments had been given ‘targets’ by the DWP.  These accusations were strongly denied by the government but Kaliya Franklin showed, if assessments are carried out in the context of ‘statistical norms’ about expected outcomes, these can become part of a management tool for ensuring quality and consistency of assessment practice.  And if ‘statistical norms’ are determined by government priorities to reduce the number of people assessed as eligible then, as Kaliya Franklin argued, this may well lead to the increasing levels of complaints and successful appeals. 

A recent account by an ex-PIP assessor on Radio 4’s You and Yours programme seems to indicate that there are indeed practices being applied which exert pressure on assessors to reduce the numbers eligible. 

It is to be hoped that the Work and Pensions Select Committee, currently carrying out an inquiry into both PIP and WCA, address the question of whether government priorities to reduce expenditure are directly impacting on assessment outcomes. But in the meantime, we need to be aware that attempts to decrease expenditure on PIP are likely to continue, particularly because, as mentioned above, expenditure on this benefit is increasing as a share of national income.  

In the years to come the government may well try to make more fundamental changes to PIP - such as imposing a means-test and/or linking it to unemployment. Interestingly, one of the questions that PIP assessors ask is: “when did you last work” despite PIP being an additional costs benefit and nothing to do with employment status.  Is being in work taken to be evidence of being able to function without restrictions and therefore not eligible for PIP or only eligible for a reduced award?  This might fit in with what David Freud (at that point ‘welfare reform’ Minister) said during one of the parliamentary debates when PIP was being introduced: ”Sickness and disability are best overcome by an appropriate combination of healthcare, rehabilitation, personal effort and social/work adjustments” - does this mean that if you make enough ‘personal effort’ and ‘work adjustments’ you will no longer experience ‘sickness and disability’? When the government tried unsuccessfully in 2016 to restrict eligibility, much of the public debate was dominated by the misconception that, to qualify for PIP, you had to be judged incapable of working.  This is a dangerous message to give in the current climate - and unfortunately continues to occur in current debates on PIP (as illustrated most recently by the presenter’s questions on You and Yours).

Reforms to disability benefits have been and are still being fuelled by a government priority of reducing public expenditure.  John Pring, from the Disability News Service, states that 2016/17 has seen increasing complaints, particularly of dishonest assessors’ reports. Stephen Kinnock MP is only one of several MPs who are seeing increasing numbers of disabled people in their constituency surgeries, recounting experiences of “how claimants are treated, how they are humiliated, belittled and denied basic human dignity”; and  Debbie Abrahams, Labour’s Shadow Work and Pensions Secretary told the Disability News Service that “Labour is committed to scrapping these harmful assessments and replacing them with a holistic, person-centred approach, under our plans to ensure that, like the NHS, the social security system is there for us all in our time of need.”


In the meantime, there needs to be an investigation as to whether government policy to reduce the numbers of people eligible for PIP is resulting in ‘statistical norms’ being applied leading to disabled people being denied an additional costs payment to which they are entitled.  And we all need to beware that - if the Institute for Fiscal Studies and the Office for Budget Responsibility are right - then we may well see yet another onslaught by the current government on the living standards of disabled people.  

1 comment:

  1. Thanks for this post.

    I just thought I'd mention that the quote from Freud is from when Freud was quoting Aylward and Waddell. These two academics are key figures in the development of the policies which have done so much to harm the sick and disabled in this country, and really deserve more 'credit' than they get. There's an article on them here that might be of interest to readers of this blog: http://www.disabilitynewsservice.com/biopsychosocial-basis-for-benefit-cuts-is-cavalier-unevidenced-and-misleading/

    Aylward was also involved in the DWP funding the PACE trial, which has since become something of a scandal:
    http://journals.sagepub.com/doi/full/10.1177/1359105317722370
    http://www.thecanary.co/2016/10/02/results-really-didnt-want-see-key-mecfs-trial-data-released/

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