Is there a need for representation at PIP assessments

I am finding a lot of PIP assessors at the medicals find out and confirm the applicant’s inability to carry out the actions in the descriptors but award the incorrect descriptor based on the said findings. Would it make sense that a legally qualified person or a Decision Maker be actually present at the medicals to advise the medically qualified examiner what descriptor to award. Following on from this then would this be the best arena in which a representative could put over their opinion to the Health Professional in order that the correct descriptor is immediately awarded at this time thus avoiding lengthy MRs and FTT hearings.

Secondly we see that HPs make many statements eg applicant seen to open an envelope whilst sitting down without the help of another person at the assessment so therefore applicant able to walk, sit, get up and has no problems with their manual dexterity etc. Would there be anything wrong in the assessments centres having kitchen areas eg where the applicant can demonstrate (or fail to demonstrate) their ability to prepare food and cook it or how about the HP produces a mock bank statement and several bills including priority debts and therefore physically see what the applicant’s ability or non—ability to carry out the said actions etc. Therefore with this in mind should every PIP assessment be carried out at the applicant’s home to see how they actually cope with all day to day activities etc!

Is there benefit to taking someone with you? Yes, depending on what it is they contribute. That will vary from person to person.

I think our time would be best spent focusing on reliably, repeatedly, safely and in a reasonable time. Drill that into claimants and the person who accompanies them. Put in evidence which links one of the foregoing to each points scoring activity. Ask the assessor why their drop down menus don’t comply with the legislation in allowing them to select one of the foregoing as an option.

Mike - I was suggesting that experienced advisers like ourselves should perhaps rep at medicals to bring up the reliably, safely and timely manner requirements together with pointing out other matters eg appliances…

“aid or appliance”-
(a)
means any device which improves, provides or replaces C’s impaired physical or mental function; and

I had a client who could not use his right arm at all due to a crushing injury = the Tribunal (not the HP) said that he could prepare and cook meals with aids and adaptions eg chopping boards NB this would not be an aid or appliance as the device does not improve, provide or replaces the client’s injured arm. Would this type of representation at medicals speed up the process resulting in more favourable decisions.

I had understood. I am open to being convinced but:

a) I doubt enough of us are resourced to be able to commit time to doing so. Thus my comments about drilling key points into people. I have had some success with this with sensory impairment for example. Picking and choosing which to accompany is a mugs game and no more accurate than trying to identify which clients will perform well at a tribunal hearing.
b) I’m not convinced it speeds anything up or indeed improves it. Happy to be proven wrong on that though. There will always be exceptions.
c) I have had some success with clients filming themselves attempting certain activities. Assessor very reluctant to view on mobiles but had some clients take tablets and refuse to answer further questions until video clips viewed. That has been very effective. Hard to assert what someone ought to be able to do when you’ve just watched a video of the exact opposite and claimant insists that it’s in their statement.

You’re proposing a DWP panel, in essence, copying the tribunal model at the claiming stage. I actually think it would be a good idea and probably remove the need for quite a lot of tribunal hearings as well as giving greater credibility to the medical reports.

If this avoided the need to appeal decisions, I could possibly find a way to do it in some cases, but not all.

A lot of it appears to be a training issue with HCPs, or in other cases attitude of HCPs that is the problem.

I cant imagine them acting favourably if someone comes into their place of work telling them how to do their job.

It can be counter productive.

During my brothers WCA he took his friend along with him (who played dumb), who just happened to be head of a welfare rights service.

The HCP was asked by my brothers friend a variety of questions about reliably, health and safety (he won appeal on reg29 as WCA failed) discomfort, associative pain, repeated actions but the HCP simply said all of this was utterly irrelevant to the process, and subsequently passed my brother fit for work. 1 week before spine surgery….......

There is also the issue of the DWP not wanting this to be a fair and honest process anyway. I cant see them bringing in a system that will actually support claimants benefit rights when they have done nothing but try and curtail them in the last few years.

No.

The assessment should form only part of the decision making process and not the sole/major part of it.

I would think a statement from GP & med records.

Then to DM

Statement from any other health/social care workers.

Then to DM

Copy of any local authority assessments - if none request one?

Then to DM

Then the Assessment - if necessary

Then to DM.

Same process for ESA.

If it becomes obvious to the DM that an award can be made then discuss this with claimant or appointee making a no prejudice conditional offer? If not accepted then the evidence gathering continues?

Isn’t the essential (and unanswerable) question how much difference does input / action by the claimant / adviser / representative / a.n.other at any stage of the WCA /PIP / DLA process, up to and including a tribunal hearing, make?

Does attending a F2F assessment, helping complete claim forms / MRs / SSCS1s / gathering & submitting further evidence etc. make any difference to the quality of decisions in practice (or, in general, constitute an effective use of advisers time and other resources)?

One would hope so but .... possibly not in many cases at any stages before tribunal for all of the reasons we have all reheresed for donkeys years about the quality of decision making.

Although one would hope it would at the tribunal stage!

So it comes down to the old crystal ball question -will it make any difference in a particular case?

Edmund Shepherd - 30 September 2015 11:45 AM

You’re proposing a DWP panel, in essence, copying the tribunal model at the claiming stage. I actually think it would be a good idea and probably remove the need for quite a lot of tribunal hearings as well as giving greater credibility to the medical reports.

If this avoided the need to appeal decisions, I could possibly find a way to do it in some cases, but not all.

I can’t be the only person who remembers the Medical Boards for Industrial Injuries Benefits.  They comprised at least two doctors, who were usually eminent in their particular field.  Medical Boards were scrapped long ago, I suspect because they were very expensive, and I know of no evidence which showed that they reduced the number of cases which proceeded to appeal tribunals.

I would suggest that there really is no doubt that a trained and respectful companion can do wonders at a PIP or ESA HP assessment. I seem to remember some CAB research from a few years ago that said that a companion doubled the length of the assessment, and doubled the accuracy of the eventual outcome by 100% (apologies if I have got that wrong).

I have been training people to become effective companions at HP assessments for ESA and PIP for the last few years. I have produced a simple summary of a the HP’s duties, distilled from the PIP Assessment Guide and another from the ESA WCA Handbook. That sits on your knee when you are the companion. You gently challenge HP errors for example (i) not reading the papers beforehand, (ii) the majority requirements in regs 34 (ESA) or reg 7 (PiP), (iii) lack of probing on regularity (case law for ESA and Reg 4 for PIP), (iv) lack of open questions etc. This is not always appreciated by the HP, but I am not interested in that. These assessments are supposed to assist the pursuit of an accurate assessment - they should not be crumbs from the HP table.

This approach sometimes makes the HP uneasy. They sometimes call in the supervisor etc. That is ok. You remain respectful and always resist an attempted adjournment. You make notes of any breach of guidance, for use in eventual revisions and appeals. You may even suggest that any ongoing and uncorrected errors will be referred to in your revision or challenge, if this becomes necessary. You remain charming and helpful. I have drafted an ESA/PIP Companions Job Description in my infinite sadness, setting out what you need to do before, during and after the HP assessment to be an effective Companion.

I can offer no scientific evidence of whether this approach works, but the many emails I get after training courses suggest it has had a powerful impact on the success rates in terms of first time awards, with far fewer silly refusals.

An effective companion can assist the HP to do their job effectively - that is enshrined in the WCA Handbook and PIP Assessment Guide. That means being allowed to intervene and take notes etc.

When I hear from clients about the way in which some of the descriptors are “tested” at assessments, it really seems that they aren’t testing what they think they’re testing.

For example, descriptor 8 was tested by getting the client to read a recipe aloud. To me, that only tests literacy, not comprehension. I could read aloud a book on quantum physics, but I wouldn’t understand much more than “and ” and “the”.

I attended a WCA with a client with a learning disability and one descriptor was tested by telling her 3 words, asking her to remember them, and then asking her to repeat them later on in the assessment. That proves nothing other than her ability to remember words - not that she can learn how to do things or understand things.

That sort of knowledge can be really handy when it comes to an appeal, and is why I encourage clients to take someone with them who can note what methods are used.

I recently attended a PIP with a client (enduring mental health issues, assessor was a paramedic!).

It was very enlightening and it’s worth an adviser worth doing this at least once to get an idea of what goes on. 

What I thought worked well:  Being able to prompt and fill in the client’s evidence when key things were overlooked,provide support in a stressful situation and point the HP to looking at repeatedly, most of the time, reliably, etc.

I also took verbatim notes of what was said and what happened. 

What worked less well:  It takes up a lot of time with travel and waiting times and the claim for PIP was refused with nil points, so my presence made no difference to the outcome.  This is because there was the usual nonsense of the DWP ignoring any evidence from or on behalf of the client including relevant and specific evidence from a support worker and therapist and instead basing the decision entirely on what the HP concluded.

The record of the assessment bears almost no relationship to what was actually said and what happened.  Some of the HP’s conclusion are just staggering to the point of looking like a deliberate misrepresentation.  For example, client had very poor eye contact, continually wrung hands, hesitated throughout, looked exhausted, because of her anxiety would not have got there unless I had taken her myself (which I told the HP) and spent a large part of the interview in tears.  The HP even passed over a box of tissues.  Yet it was stated that the client coped well at the interview!

It was also stated that the musculoskeletal assessment was normal when no such assessment was done (though not actually relevant in this particular case).  This may be a drop down menu answer based on it not being relevant, but of course that further paints a picture of the client being happy, fit and well.

I think if you read this thread as a whole the answer is clearly not that we turn up and represent or advocate in any way. It is useful as Neil says to do this at least once but it does not have an impact. Attending such a meeting addresses the symptoms of a wider problem and not the cause. The cause is that HCPs are not trained on reliably, repeatedly etc. and the software simply does not allow for it. That should really be the point of attack and it needs to start at ministerial level down and not HCP up. I’m sure there’s room for both but I’ve read nothing in this thread to suggest that top up is going to be effective in this instance.

One should ultimately view face to face assessments in the same context as the private prison companies threatening legal action in the US because they haven’t got enough “customers”. It’s not really in the interests of HCPs to reduce their customer base.

Yes I agree entirely with Mike.  Presence may make little difference to outcomes.  Other than actually getting my petrified client into the room after a 45 minute drive, my input made no difference - didn’t even get any points for planning and following the route of an unfamiliar journey!

Just a couple of thoughts:  Is it worth disability activists who have had some PIP training trying to attend as many PIP medicals as possible in order to get evidence to press for change?

Also, I wonder whether:

a) ATOS and Capita have “norms” for scoring which just happen to coincide with the DWP’s original target of a 20% reduction in DLA expenditure as a result of implementing PIP. 

b)  What agreements or “understanding” do ATOS and Capital have with DWP about referral rates for assessments?  They must have a pretty good idea of what the numbers would be or else they could not plan their workloads or even to be able to bid for the work in the first place.

c) What informal “guidance” is issued to DWP staff about the weight to be given to HP evidence compared to other evidence?

stevejohnsontrainer - 30 September 2015 10:27 PM

These assessments are supposed to assist the pursuit of an accurate assessment - they should not be crumbs from the HP table.

This is a good and concise way of putting it which I may have to steal in future.

One ESA example that has stuck with me vividly is a tribunal judge who told me that I was asking for “rather a lot of points” - I had submitted, I believe correctly, that nine applied for an activity - not even enough to qualify for the benefit.

A further thought on this matter of early representation on behalf of clients is should a representative have the right to put their client’s case to the Decision Maker (“DM”) in person when the DM is deciding whether the client should be awarded PIPs. The DM may have the opinion of a health care professional and other evidence eg ESA50 or GP supporting letters but are DMs themselves legally qualified to award the correct descriptor after a careful Statutory or Regulatory interpretation of the PIP Regs themselves. I know that the DWP appeals section have qualified lawyers but are DMs themselves legally qualified. Should this be the initial opportunity for representation of putting our client’s cases forward.