If the Conservatives had read their own history, what would PIP look like?

 

A new disability benefit should reflect the policy intent that the important factor is not the medical condition but the effect that it has on people's care and mobility needs.

It is not necessary to have medical practitioners make the decision or involved in the assessment process. As the important factor is the disability, not the medical condition, it is not necessary that the decision maker have detailed knowledge of the medical condition. The essence of the approach at all levels is that, in many cases, it is not highly technical or difficult medical judgments that need to be made—it is, above all, judgments about the effect that a condition has on a person's life. Knowledge of the disability, regardless of the underlying medical reason, is what is needed.  By making administrative adjudication officers the decision makers, it is possible to reduce the medical input, reflecting the policy intention of moving away from focus on the medical condition.

The best that an examining medical practitioner can do is to take a snapshot of the person's condition on the day on which he sees that disabled person. Many conditions relapse or progress at different times. One exam on one day cannot accurately capture the long-term disability.

It is much better to rely on the evidence of someone continuously in touch with the disabled person who can give a much better and longer-term assessment of their condition and the effect on their way of life. That will be an improvement. The emphasis should be firmly on self-assessment and on supplementary evidence from those in contact with the claimant, giving proper weight to the judgment of those in the best position to know the effect that a claimant's condition has on his or her life.

This emphasis will give a better picture of the circumstances than the snapshot of a medical examination, which is too frequently all that is provided, so that adjudication officers have a better basis for their decisions.

It may be that in some circumstances a medical examination is desirable or necessary. By not having medical examination as the routine, the medical examinations that do occur can be cost-effective and of high standard. There will be significantly reduced demand for medical examinations, so that even where they do occur there is not a long wait of several months duration, and all claims can be decided more speedily.

A disability benefit should be shifted away from focusing exclusively on incapacity—on what disabled people cannot do—towards doing more to encourage people with disabilities to make the best of the capacity that they have—the things that they can and wish to do.

The claim and assessment process should be made easy for claimants in two ways: by giving them the opportunity to give us a fuller account of the effect that their condition has on their lives; and by giving the opportunity to marshall evidence about their condition from third parties who are involved in their care—their GP, health visitors, district nurses, relatives or other carers. This particularly important point picks up recommendations that have been urged by disabled peoples’ organisations.

 

What is unlikely to have been obvious to anyone who is not a politically-well-read historian of disability benefits is that the majority of what was written above is a direct quote from or otherwise based upon speeches made by Tory MPs – in 1990, when Disability Living Allowance was being introduced. The entire section above is a rebuttal of current Tory MPs positions on the disability benefits DLA and Personal Independence Payments.

Some of the issues have not changed – 23 years later, politicians are still telling us to move away from a focus on what disabled people can’t do to a focus on what they can do. Apparently in 23 years of change to disability-related benefits we haven’t moved very far. Or perhaps this isn’t about moving at all, but instead is all about finding any laudable-sounding reason possible for changing a benefit, even when the new benefit no more focusses on what disabled people ‘can’ do than did the old benefit. Nor is there any discussion here of whether focussing on what disabled people ‘can’ do is at all a sensible way to assess what assistance a person needs to live or work.

But most striking, and most concerning giving the design and policy intent behind PIP, is the repeated emphasis on not using a face-to-face assessment with a medical examiner. As disabled peoples’ organisations have repeatedly pointed out, the Tory government of 1990 knew and the current parties seem all to have somehow forgotten to the extent of believing the opposite, a one-off interview with an external medical examiner is a snapshot and is not necessary. What is needed is the claimant’s own knowledge – who else can know so well what is and is not possible? – and the supporting knowledge of those people who, through extensive contact with the claimant, also know well the claimant’s level of ability and disability. These are “their GP, health visitors, district nurses, relatives or other carers.”

What is most worrying is that the Tory ministers seem to have not read what must surely be one of the most important documents regarding the design of a new benefit – the arguments and reasoning behind the design of the current one. If only they had read it, maybe we would not now be in a position of regression where the experience and knowledge of what is wrong with the assessment method for PIP has been forgotten, overlooked or ignored.

 

The first section quotes come from the debate on the Disability Living Allowance and Disability Working Allowance Bill, 21st November 1990. It is recorded in Hansard volume 181 cc311-53 and is available from this link: http://hansard.millbanksystems.com/commons/1990/nov/21/disability-living-allowance-and#S6CV0181P0_19901121_HOC_257

The relevant paragraphs are copied below.

Mr Tony Newton, Conservative, Secretary of State for Social Security

For the new benefit, we want to make the whole thing easier for claimants in three main ways: first, by enabling them to make a single claim covering their mobility and their care needs, instead of two separate claims; secondly, by giving them the opportunity to give us a fuller account of the effect that their condition has on their lives; and, thirdly—this particularly important point picks up recommendations that have been urged upon us over a period—giving the opportunity to marshall evidence about their condition from third parties who are involved in their care—their GP, health visitors, district nurses, relatives or other carers.

We believe that this will also give us a better picture of the circumstances than the snapshot of a Department of Social Security medical examination, which is frequently all we have now, so that adjudication officers have a better basis for their decisions. It will, of course, still be open to a claimant to seek a medical examination if he wishes, rather than filling in what will inevitably be, in the light of what I said, a rather longer claim form. I acknowledge that, in a proportion of cases, we shall still need some further evidence which may be obtainable only by a specially conducted medical examination.

As a related and further improvement which has been widely welcomed, we will be introducing a right of appeal to an entirely new form of social security appeal tribunal—a disability appeal tribunal—which will be the third tier of adjudication for both benefits, the second being a new form of quick review of initial decisions where they are queried. Again we are determined that, besides the legally qualified chairperson, who it is right to have, and medically qualified member, who it is right to have, there should, wherever possible, be a third person who either has practical experience of the needs of disabled people or is himself disabled. The essence of our approach at all levels is that, in many cases, it is not highly technical or difficult medical judgments that need to be made—it is, above all, judgments about the effect that a condition has on a person's life.

Mr Nicholas Scott, Conservative, Minister for Social Security and Disabled People

The new system that we intend to introduce will be more speedy and more streamlined and will provide a simple and effective service to the public. We are anxious to achieve that. There will be one claim form, one adjudication system for both components, and a significant reduction in medical examinations, thereby improving the scope for dealing with claims more speedily.

I believe that we shall be able to reduce the medical input by making the decisions by administrative adjudication officers—reflecting the policy intention that the important factor is not the medical condition but the effect that it has on people's care and mobility needs. We intend to place the emphasis firmly on self-assessment and on supplementary evidence from those in contact with the  claimant, giving proper weight to the judgment of those in the best position to know the effect that a claimant's condition has on his or her life.

My right hon. Friend the Secretary of State made that point in his opening speech [take more notice of GP]. In essence, the best that an examining medical practitioner can do is to take a snapshot of the person's condition on the day on which he sees that disabled person. Many conditions relapse or progress at different times. It is much better to rely on the evidence of someone continuously in touch with the disabled person who can give a much better and longer-term assessment of their condition and the effect on their way of life. That will be an improvement. It will also make the best use of scarce medical resources. When we need an examination or judgment of one sort or another, we shall be able to have higher standards. The system will be cost-effective. For the first time, too, we shall be introducing a system in which people with attendance needs will have independent rights of appeal. The balance of membership of the disability appeal tribunals again shifts the emphasis from medical conditions to considerations of care and mobility needs. All those matters will result in substantial improvements, and they have been warmly welcomed by many disability organisations.

 

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