The government has published a green paper "Shaping the future of care together". Encouraging a debate that needs to be had.
"Simplifying and integrating sources of support
The 2006 report by the King’s Fund, Securing Good Care for
Older People, highlighted these and other problems in the
system and made the case for integrating the support provided
through some disability benefits and the social care system to
improve the effectiveness of state funding.
The review recommended that, if the social care system were
able to mostly meet the care needs of people who may currently
only be supported through the disability benefits system, there
would be less need for some of these benefits, and there might
be a case for integrating some disability benefits such as
Attendance Allowance into the care and support system"
For example mentions Attendance Allowance but merely as an example of disability benefits which of course, ambiguously includes Disability Living Allowance (DLA).
Why should this matter? The paper is drafted in the context of older people but mentions disabled people also. The paper talks about the mounting cost of FUNDING the increasing burdens of providing existing care for older and disabled people. It clearly wants to reduce this burden.
Whereas a debate on Social Care is welcome and long overdue. Disability Living Allowance provides a degree of independence for those who receive it to make the best use of these funds to help overcome the issues relating to their individual care needs. Any loss of these funds to pay for the provision for direct services would create more dependance not less.
The government needs to come clean on further detail of its plans for Disability Living Allowance generally not just wrapped up in the elderly to distract. We need to know exactly what anyone who relies on this funding stream can expect and how much control they will have under proposed changes.
I have yet to read the Paper in full. However to add further to the confusion there are several "bills" from various departments all shaping the total delivery from government for disabled people and the elderly not least the "watered down" Right to Control in the Welfare Reform Bill. Typically Green Papers are kept ambiguous and lack detail with government as with the Welfare Reform Bill using Statutory Instruments at a later date to provide the detail.
There is also an impact for Independent Living & Direct Payments. We note that HIV+ people seem to be particularly disadvantaged when it comes to accessing Direct Payments from the very small figures we have seen.
You can take part, respond to the Green Paper and write to your MP with your thoughts and to seek clarity.
Sign the Petitions to save Disability Living Allowance & Attendance Allowance
Below are many links to stories around this issue, please take time to read through them -
The Green Paper on the Department of Health website. You can also find it on the Care and Support website. The launch video is available on youtube.
Row delays green paper on care funding for older and disabled people- raid on benefits? - Guardian - on this website
DLA and AA to be abolished - Benefits and work website.
100 days to save DLA & AA from the Axe - Benefits and Work website.
Of note "Even Paul Treloar, until recently Disability Alliance’s Director of Policy and now Head of Information at Gingerbread, wrote that:
“From what I understand at the moment, it is certainly attendance allowance that is being considered for the chop and reallocation to means-tested social care provision via local authorities - but given that the ultimate aim is to come up with a comprehensive and sustainable system of social care for all ages, it's difficult to see how DLA care component won't be similarly up for inclusion, in my opinion.”
A squeeze on attendance allowance support - guardian online.
Disability Alliance Press release (NAT is a member of the Disability Benefits Consortium).
NAT (National Aids Trust) Press release.
Tory leaders plan 10% spending cuts and benefits set by councils - guardian online
Shaping the future of care together - our analysis - The Kings Fund.
PDF version 
The final piece of the jigsaw
Our care and support system is in dire need of overhaul as the population ages. A green paper proposes ways to do just that - not least how to pay for it
- David Brindle
- The Guardian
Preventive care at home in later life to avert emergency hospital treatment is a key element of the government's plan to overhaul the welfare state. Photograph: Third Avenue
The task is enormous. As care services minister Phil Hope has put it, the challenge is nothing less than completing the construction of the welfare state that Beveridge and Bevan undertook more than 60 years ago.
Hope is talking about comprehensive reform of the system of care and support for older and disabled people. When the architects of the welfare state created the National Health Service, they did not follow through and devise a national care service for people needing not a doctor or nurse, but some form of non-medical intervention to help them live independently.
The omission is something that the green paper, Shaping the Future of Care Together, proposes to put right. A national care service would be established for England, overseeing a system that was "fair, simple and affordable" for everyone, underpinned by national rights while services were personalised to individual needs. With a fair wind, it could become a reality in or shortly after 2014.
In fairness to those founders of the welfare state, the nation now is very different to that in 1948 and it is the soaring demand for care and support that has put intolerable strain on the social care system that has sufficed since that time. People are living far longer lives and many more children born with disabilities are surviving into adulthood. By 2026, it is forecast, an additional 1.7 million adults in England will be in need of care and support.
Any reform will be controversial. As health secretary Andy Burnham candidly admitted at the green paper's launch in July: "In the past, let's be honest - and I take my own responsibility for this - politicians have flinched from this debate because it is difficult."
Response to the document has proved his point. Some local government leaders have reacted angrily to the perceived threat to councils' autonomy and flexibility in the idea of a national care service, though the detail of how this framework would work and involve councils is up for debate. Some welfare groups have warned of opposition to a proposal to integrate social care and some disability benefits - for example, attendance allowance - transferring the funding to councils to target help on older people in most need.
How will it be funded?
Most media attention has focused on three options set out in the green paper for a new approach to care funding. Dismissing the idea of a fully tax-funded system - a move that in itself has sparked criticism - the document outlines a "partnership" model, by which the state would meet between one-quarter and one-third of care costs for all people and up to 100% for those on low incomes; an "insurance" model, building on the first option, by which people could be helped to take out insurance to meet their share of costs; and a "comprehensive" model, by which everyone over retirement age who could afford to do so would be required to pay into a state insurance scheme to cover their care.
Cost would vary according to means, but individuals might typically need to pay from £17,000 to £20,000 under the comprehensive model, to £20,000 to £25,000 under the insurance approach - though the system would deal only with care bills, not accommodation charges. The cost of accommodation in a care home can be roughly the same as the cost of care.
Even if people did still need to draw on their assets, they would be able to take advantage of a deferred payment scheme to avoid selling their home while they lived.
The burden, at least initially, would fall very much on older people. Ministers say it would be unfair to ask younger generations to pay, especially at a time when so many young people are struggling to get on to the housing ladder and facing less job security. But this is one of several tough choices implicit in the green paper.
Burnham says he wants the current consultation on the document to indicate a "broad choice" on future reform. The green paper should not be read as a finished, detailed plan, he stresses. "A big outcome would be for us to be able to point to broad support for one of the options emerging quite clearly as the preferred way forward. Then we would take all the ideas that come out of the consultation process to knock that option into a workable proposal."
Ideas have already emerged from two roundtable discussions held by the Guardian in association with the Department of Health. Participants suggested that people would need to be given a clearer, more tangible idea of the "deal" under whichever preferred option emerged. They also called for greater clarity on the rights that people would have in any new system and how those rights would relate to duties placed on local councils that administered it.
Burnham wants the future of care and support to be a key issue at the coming general election. "I think the time has come for the country to be offered a big choice about this issue," he says. "I don't think it serves the public interest for this to be avoided any longer.
"Therefore if I can table a clear proposal, and if the other parties then have to respond by putting forward their own proposals, I think it would be a healthy thing to have that debate and make it part of the choice that people make at the next election."
Weblinks
See more of the debate at:
guardian.co.uk/careandsupportreform/roundtable-bear-the-burden
guardian.co.uk/careandsupportreform/roundtable-moving-forward
- guardian.co.uk © Guardian News and Media Limited 2009
From the Disability Now website
"DLA is not under threat and people can be very happy," he added.
The consultation period runs until November.
Comment from the benefitsandwork.co.uk website
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|
The health secretary, Andy Burnham, will today rule out a controversial plan to scrap disability benefit paid to 2.5 million younger people.
In a major speech on the future of social care, he will say he has decided not to use disability living allowance (DLA) to fund the new national care service.
But the abandonment of the idea, which would have saved £6bn, raises further questions about how the government will meet the spiralling bill for social care. Last night the Tories claimed there was a £4.6bn "black hole" in Labour's flagship health plans.
And the future of attendance allowance (AA), which is not means-tested and is paid to 1.6 million people aged 65 and over at a cost of around £4.4bn, remains uncertain.
"We are looking at how we can make this benefit more progressive, so that the money works harder for those in greatest need," Burnham will tell delegates at the national children and adult services conference in Harrogate.
"The important principle is that nobody who is receiving disability benefits will lose out from the reforms.
"As we live longer and as the NHS helps us live longer, we have to look at different ways the NHS can help older people."
More than 18,000 people, supported by a coalition of disability charities, have signed a petition on the Downing Street website calling for DLA and AA to be protected.
Burnham will also admit there is still age discrimination in the NHS, and back a forthcoming expert recommendation that health and social care should meet rules set out in the Equality Bill by 2012.
"Meeting that deadline is ambitious, but achievable — and it's vital if a central tenet of the national care service, the pursuit of fairness and equity, is to be upheld," he will say.
Sir Ian Carruthers' and Jan Ormondroyd's report on discrimination in the health service, commissioned by former health secretary Alan Johnson, is set to be released shortly.
Shadow health secretary Andrew Lansley will today accuse ministers of being unable to explain where £4.6bn of funding for their plans, including a national care service, will come from.
"With everyday that passes Gordon Brown's administration looks more and more like it has run out of ideas and run out of steam," he will say.
"Labour's new health policies have no basis in reality and they have no idea how they will pay for them."
http://www.guardian.co.uk/society/2009/oct/22/social-care-nhs-disability...
Benefits for the middle classes should be taken away to avoid higher taxes, a centre-right think tank has suggested.
Reform says payments including maternity pay, child benefit, the winter fuel allowance and TV licences for the elderly could be scrapped.
It says the UK spends £31bn a year on such benefits, equivalent to an extra 8 pence on the basic rate of income tax.
In a report, it also argues that flexible savings accounts should be set up to replace pension contributions.
Chancellor Alistair Darling has predicted that public borrowing will reach a record £175bn next year.
Reform says while times are hard, the leanest welfare system focused on the most needy, is all the UK can afford.
It defines middle class as a household where the total income equates to £15,000 a year for each adult and £5,000 per child.
The message is provocative and reignites the long running debate about the scope of the state, says BBC
social affairs correspondent Sue Littlemore.
Small print
In its report, The end of entitlement, Reform suggests the "middle classes are being bribed with their own tax money".
It says there is a political consensus for limited aspects of welfare reform but to deliver real benefits the UK needs a radical plan.
Reform says recent proposals by the Conservatives did "not go far enough" as they promised to keep many middle class benefits in place.
In his conference speech, shadow chancellor George Osborne was wrong to pledge to keep winter fuel payments, free TV licences for the over-75s and child benefit for middle class families, it says.
Reform argues his plan to means test child trust funds and abolish tax credits for people on an annual income of more than £50,000 would only save £700m a year.
At the same time, the welfare system also has to improve for the poorest, the report says.
Reform says rules on social enterprises and other organisations providing welfare-to-work services are too tight for them to make a real difference to the unemployed.
Director of Reform Andrew Haldenby said: "The middle classes need to read the small print of the welfare state."
"They may think that benefits and subsidised higher education are a good deal. In fact they will cost an extra 8p on the basic rate of income tax in the next Parliament because of the hole in the public finances."
http://news.bbc.co.uk/1/hi/uk_politics/8319646.stm
Automatic direct payments of housing benefits to private tenants in England should be stopped, the Tories say.
The party says the government, which is to undertake a review, should follow its lead and change the policy.
The move comes after housing charities and landlords said changes in 2008 have meant some tenants are finding it hard to manage or are dodging rents.
Some landlords, who were previously paid directly, are said to have stopped renting to low income households.
In what it called a "radical reform" last year, the government replaced housing benefit with a local housing allowance for most new tenants in the private rented sector in England.
'Bad for everyone'
Under the old system, housing benefit could be paid directly to the landlord but in most cases, payments now go to the tenants. They are then expected to pass the rent money on themselves.
The change was meant to encourage greater financial responsibility but the housing charity Shelter say some claimants are finding it difficult to cope.
In a survey of 450 tenants, they reported a quarter of them said they had fallen into arrears.
Meanwhile, the National Landlords Association say many of its members are discouraged from renting to anyone on benefits.
The Conservatives want to allow tenants to choose whether to have benefits paid directly to the landlord or maintain responsibility for passing on rent payments themselves.
At the national conference for homeless charity Crisis, shadow housing Minister, Grant Shapps will say: "It strikes me that the current situation is bad for everyone and I can see no reason why people on Local Housing Allowance shouldn't enjoy the freedom to have their Housing Benefit paid direct to their landlord. Our proposal will de-stigmatise the system and increase the amount of affordable homes available."
The government say the new system is fairer and simpler than the one it replaced but are beginning a review of the system later in the year.
http://news.bbc.co.uk/1/hi/uk_politics/8319686.stm
4 Reviewing Decisions
110. The Improving decision making and appeals in Social Security Green Paper proposed the establishment of "informal reviews" which would allow claimants to have decisions looked at again by a DWP decision maker, rather than having to proceed straight to appeal. In July 1997, the Government published an analysis of the responses to the Green Paper, which demonstrated mixed views on the introduction of review arrangements (which already existed for DLA) for other benefits:
"There were several submissions which endorsed the formal review arrangements currently in place for Disability Living Allowance […] In contrast to this positive view of the DLA model there were many submissions which argued against it. Opponents referred to DLA reviews as confusing and complicated and acting as a hurdle which claimants had to overcome in order to reach an independent tribunal hearing. Several respondents argued that imposing the model on other benefits would by definition add an additional tier to existing arrangements counter to the intention expressed by the Green Paper."[79]
111. Informal reviews were incorporated into the new DMA system following the introduction of the Social Security Act 1998 and in 2006 the Welfare Reform Green Paper committed DWP to incorporating a reconsideration process into the initial assessment of any appeal to reduce the number of appeals progressing to a tribunal. The Green Paper also promised clear feedback to appellants and an assurance that any new evidence would be included at the reconsideration stage, rather than at tribunal. [80]
112. DWP told us that "the ability to revise decisions is key to the decision making system".[81] The National Association of Welfare Rights Advisers and the National Deaf Children's Society felt that the reconsideration was a positive part of the decision making process because it allowed decisions to be rectified, without necessarily having to proceed to a lengthy appeal. However, both organisations also commented that decision makers needed to be more proactive in seeking new evidence from claimants during the reconsideration stage. [82]
113. Under the existing rules, if a claimant is unhappy with a decision, there is a dispute period of one month in which they can either ask for their decision to be reconsidered or lodge an appeal. When the Committee met with Jobcentre Plus and PDCS officials in Leeds, we were told that decision makers did not have targets for case clearance at the reconsideration stage. The Committee also met with claimants and welfare rights advisers in Leeds who argued that, in particularly complex cases, it was unfair that claimants were expected to dispute a decision within a month when there was no obligation for decision makers to complete the reconsideration process expeditiously. In oral evidence, Jeremy Groombridge CB, Director of Transformation and Product Management at Jobcentre Plus, told us that, whilst there is no specific target for decision makers to complete reconsiderations, there is an "expectation" that this process should be completed within five days of registration.[83] We asked the Minister whether a target should be introduced. He replied:
"That is a very good point. Perhaps they should. Staff are given targets in many other areas but not in that one, so we need to reflect on whether we could introduce a target for them."[84]
114. We recommend that DWP formalise the expectation that reconsiderations should be completed in five days by introducing this as a target for decision makers against which performance is measured.
Reconsiderations for DLA and AA
115. Welfare rights advisers told us that the reconsideration process could be a "huge benefit" to claimants, providing decisions were genuinely looked at again and "not just rubber stamp[ed]".[85] We were also told that, at a recent National Association of Welfare Rights Advisers meeting, there "was a general feeling that now the DLA reconsideration process is working well."[86]
116. We asked DWP to provide us with data on the reconsideration process to assess its usefulness for the claimant. PDCS holds information in relation to Disability Living Allowance (DLA) and Attendance Allowance (AA) only. The tables below show the number of DLA and AA reconsiderations that were registered in 2007-08 and 2008-09 and the number that were revised in the claimant's favour:
Figure 7: Disability Living Allowance and Attendance Allowance reconsiderations registered by the Pensions, Disability and Carers Service[87]
| 2007-08 | 2008-09 | |
| DLA Reconsiderations registered | 125,233 | 132,338 |
| AA Reconsiderations registered | 17,800 | 17,368 |
Figure 8: Number of DLA and AA reconsiderations that result in a decision revised in the customer's favour[88]
| 2007-08 | 2008-09 | |
| DLA | 55,416 | 67,668 |
| AA | 9,924 | 10,373 |
117. The tables show that 44% of DLA reconsiderations were found in favour of the claimants in 2007-08; this figure rose to 51% in 2008-09. 55% of AA reconsiderations were found in favour of the claimant in 2007-08, rising to 60% in 2008-09. Although a majority of reconsiderations of decisions on DLA and AA found in favour of the claimant in 2008-09, 43% of DLA cases reaching an appeal hearing and 31% of AA cases reaching appeal found in favour of the claimant, indicating that reconsideration is still failing to pick up a large proportion of claims that should be awarded.[89]
118. Whilst welfare rights advisers have suggested that the reconsideration process is working well with respect to DLA and AA as a relatively high proportion of decisions are overturned at this stage, these statistics equally raise questions about the quality of the original decisions made in DLA and AA cases. If standards of decision making on initial claims were high then it is logical to expect a low rate of overturned decisions at the reconsideration stage.
119. The quality of decision making depends in large part on the quality of the information provided to the decision maker. DLA and AA claimants carry out what amounts to a self-assessment, with variable results. The claim forms for DLA and AA are notoriously complex and many claimants find them confusing. Vivian Hopkins, Chief Operating Officer, Pension, Disability and Carers Service, acknowledged that many claimants believed that eligibility to DLA related directly to the "nature of the disability diagnosis" rather than how it affected the claimant's mobility (for DLA) or ability to carry out everyday tasks and care needs (for DLA and AA). She told us that PDCS had made great efforts to improve the way in which it worked with those who were elderly or disabled (or had disabled dependents) in dealing with very complex benefits. The claim packs for DLA were under constant review and PDCS was working with representative groups to improve them. She noted specific initiatives to make DLA claim packs more tailored for those claiming for disabled children:
"In relation to specific progress for children the whole DLA claim process was very generic. We knew that it was not serving well the families of disabled children. Therefore, in the new claim pack which we are testing instead of asking what the child cannot do it is a shorter, simpler form which asks what the child can do. […] My intention is to specialise for various complex cases including children."
She also noted the steps that had been taken to simplify the renewal application form "which is [now] four pages long instead of the 40-odd pages which comprised the original one". She added that:
"I hope that we shall move away from entirely generic claim packs over time because it is very clear that in mental health cases, for example, there are specific questions that you may want to ask and others that you simply do not need to. It is under constant review."[90]
120. We note in Chapter 5 the value of welfare rights advice for those navigating the appeals process. Welfare rights advice is also important for many claimants at the stage of the initial claim and can make a big difference to the chances of whether a claim will be successful. However, many claimants are unaware of the sources of advice that may be available in their areas.
121. We are not convinced by the evidence that the reconsideration process is working well in respect of claims for DLA and AA. We are more inclined to believe that the quality of the initial decision making in respect of these benefits is a cause for concern. This does not reflect a particular criticism of DLA and AA decision makers, but rather concern that the "self-assessment" claim forms are misunderstood by many claimants. We commend the Pension, Disability and Carers Service on its efforts to improve the claim forms for DLA and to make them more tailored towards the needs of specific groups. However, given the nature of our generic concerns, we recommend that the Standards Committee should examine decision making in respect of these benefits as a matter of urgency.
122. Many DLA and AA claimants are unaware of the welfare rights advice that is available. We recommend that the Pension, Disability and Carers Service should pilot a scheme whereby it works with welfare rights advisers and representative groups to prepare a leaflet detailing sources of local advice which should be included with the claim pack for these benefits.
Reconsideration for Incapacity Benefit (IB) and Employment and Support Allowance (ESA)
123. We also heard that the system was not working well for IB and ESA. Welfare rights adviser, Patrick Hill, told us that "a straw poll of many" of his colleagues in the North West suggested that decisions on ESA or IB were not being revised on reconsideration.[91] Alan Barton from Citizens Advice agreed, saying:
"I think the feeling we get often, particularly with the Incapacity [Benefit] reconsiderations, is it is just viewed by the people concerned in Jobcentre Plus as an annoying step they have to go through before the case goes to appeal and their focus is on producing the appeal papers."[92]
124. Judge Martin argued if claimants chose to lodge an appeal, despite the fact that this should trigger a reconsideration, often at this point "the Department then opts out of the process". We asked DWP for data on reconsiderations undertaken by Jobcentre Plus but were told that it "does not maintain detailed statistics on the reconsideration process."[93]
125. We were disappointed to learn that Jobcentre Plus could not provide us with detailed statistics on the reconsideration process. If Jobcentre Plus is not collecting this data it is impossible for either the Committee, or the agency itself, to assess performance in this area. We call on Jobcentre Plus to start collecting and publishing data on reconsiderations as a matter of urgency. We hope that, once these statistics are available, our successor Committee will be able to re-visit this issue and conduct the examination of the reconsideration process for Jobcentre Plus benefits that we were unable to complete.
126. A common criticism of the reconsideration process was that, if DWP are committed to reconsidering all decisions once an appeal has been lodged, there was no need to have a separate reconsideration stage. When we met with welfare rights advisers in Leeds, they told us that they would often advise their clients to bypass the reconsideration process and go straight to appeal. This approach, they argued, could significantly reduce the time it takes for a claimant to get a decision overturned because it effectively removed one tier of the decision making and appeals process.[94]
127. The President of the Social Entitlement Chamber, Judge Robert Martin, believed that the option of a reconsideration for claimants was in reality a "false choice". A reconsideration might seem to be a quicker and simpler option than a full appeal, but Judge Martin believed that a more accurate description of the choice between the two processes would be to ask
"Would you like us to look at your decision again superficially or would you like us to look at our decision again seriously?"[95]
128. He went on to ask:
"What is the advantage for the claimant in asking for a reconsideration rather than lodging an appeal straightaway? Lodging an appeal is free, informal and involves scarcely more effort than writing in asking for a reconsideration."[96]
129. For some benefits, the reconsideration process appears to be ineffective. Anecdotal evidence suggests that disputed IB and ESA decisions are not being reviewed properly by decision makers and, as a result, some welfare rights advisers are advising claimants to bypass this stage and pursue an appeal. We believe that they may be right to advise their clients to pursue this course, although without more detailed statistics, this is impossible to prove.
130. Many claimants will be deterred from an appeal by an unsuccessful request for a reconsideration. Our greatest concern is that, if this reconsideration is not being conducted thoroughly, they may miss out on the benefits to which they should be entitled.
131. The reconsideration process should provide a quick and efficient way of reviewing decisions which provides a swift resolution for claimants and reduces the caseload of the tribunals. It is also intended to be a stage at which a decision maker has the opportunity to consider new evidence. However, the current operation of the reconsideration process is a missed opportunity. We do not believe that the reconsideration process is currently operating in the best interests of the claimant. We urge the Department to examine the operation of this process as a matter of urgency, and we hope that our successor Committee in the next Parliament keeps the matter under close scrutiny.
http://www.parliament.the-stationery-office.co.uk/pa/cm200910/cmselect/c...
Bernard Pidcock, manager of Blyth Valley Citizens Advice Bureau, and Professor Hugh Brayne, a legally qualified panel member in the Appeals Service were members of the now-abolished North East Regional Legal Services Committee (NERLSC). It set up a project to see if it could help decision-makers at the Department for Work and Pensions (DWP) to make the right decision first time. Views expressed in this article are personal to the authors.
This article first appeared in the June 2006 Journal of the Legal Action Group, and we have reproduced it by kind permission of the authors and the Legal Action Group.
Introduction
The Access to Justice Act 1999 created a Community Legal Service (CLS) intended not just to throw resources at disputes, but to promote the elimination of disputes. This is one of the three priorities of the latest five-year strategy for the CLS.[1]
In this article, we will explain the problem of payment for advice on avoidable disability living allowance (DLA) appeals, as NERLSC saw it, and the committee's attempts to address it. We talk about DLA but the same issues affect attendance allowance (AA) claims.
The problems with DLA decisions
Only 55 per cent of DLA and AA decisions are considered by the DWP's auditing as accurate,[2] and 54 per cent of DLA appeals succeed at tribunal.[3] According to DWP statistics in August 2004, 13 per cent of new DLA awards required an appeal.[4]
Many claimants are not getting their correct entitlement immediately, some possibly never. Presumably some claimants are getting DLA when they are not entitled to it – but they do not appeal, so numbers are speculative.
Many factors account for this unsatisfactory record. According to Appeals Service research,[5] the reasons for a successful appeal are:
- New evidence (72 per cent);
- Credible evidence wrongly rejected (22 per cent);
- Improper weighting of evidence (13 per cent);
- Reaching a different conclusion on the evidence (42 per cent) or on the medical evidence (25 per cent);
- The medical evidence underestimated the disability (27 per cent);
- The decision was simply wrong (7 percent).
More than one reason could apply in any case so the figures exceed 100 per cent.
Many errors are rectified at appeal, but the appellant has faced uncertainty and stress. Some claimants may give up. Also, claimants will resent the implicit accusation of having lied or exaggerated in the claim.
The DWP's performance is kept under review by the Comptroller and Auditor General, who has suggested several approaches which might improve accurate decision-making, including the following:
...obtain more evidence about customers' conditions from professionals involved in their treatment, such as consultants, occupational therapists, social workers and community psychiatric nurses, to help achieve better decisions, as well as reducing the need for medical examinations.
...Develop better feedback on the outcomes of appeals. Decision-makers and doctors receive little or no notification of the outcomes...[6]
DLA pilot to improve decision making
In the northeast, disability probably affects a larger number of people than the average. For example, in August 2004, 6.2 per cent of the population received DLA, as against 4.5 per cent for Britain as a whole. Only in Wales is the figure higher.[7]
So there was good reason for NERLSC to explore these problems. It organised a seminar for key agencies: the Appeals Service, doctors, the Legal Services Commission (LSC), claimants' representatives and DWP decision-makers.
It was the first time that these individual parties in the DLA process had been brought together to share their experiences. After working through two case studies, several improvements seemed blindingly obvious. These included more training for GPs and for advisers who complete claim forms, and feedback to decision-makers when decisions are overturned at appeal. GPs needed to know how their reports are used in making DLA decisions.
The seminar recommended a pilot to see if, with better medical evidence at the start of a DLA claim, successful appeals would reduce. Could the claimant who was entitled to the benefit get it first time? The rest of this article discusses that approach.
Reducing appeals through early information
NERLSC invited the Citizens Advice service in Blyth, Northumberland, to work with local GPs to see whether better medical evidence could be made available at the application stage. This would reduce the chances of the decision-maker making a wrong finding at the outset.
Blyth was chosen because there is an excellent local partnership infrastructure, where professionals talk to each other. From the outset, participants were enthusiastic about the pilot and open to taking suggestions back to their organisations.
The initial meeting of the pilot was able to bring together local GPs, DWP decision makers and caseworkers. An indicative pro forma of medical and functional questions about a claim was tabled to indicate issues where initial medical information might lead to better medical evidence for the decision-maker.
Soon into the discussion the focus changed unexpectedly. The doctors rejected the suggestion that they are competent to give advice about a patient's functional needs. They describe the patient's condition, symptoms, self-report and history, but not how this affects care or mobility, the key issue for DLA. They also identified an inherent conflict between this process and their relationship with patients, which is potentially undermined by any perception that they do not believe patients' versions of their problems. Medical expertise did not equip them to make functional assessments.
They advised that functional ability is the realm of an occupational therapist. However, in Blyth Primary Care Trust (PCT), there are 50 GPs and two occupational therapists. The likelihood of occupational therapists being able to help with assessments is remote. The doctors' suggestion was that the pilot should explore the potential for occupational therapists to supply the evidence that would support (or not) the claim to DLA entitlement.
The pilot project reports to the CLS Partnership (CLSP) in Northumberland. The CLSP agreed that the Blyth pilot, if successful, would be rolled out to the rest of Northumberland. It agreed to explore the possibilities of funding the post of 'occupational therapist assistant'. This person would be employed by an independent organisation such as a PCT or NHS trust, and would supply decision makers with an independent report on the claimant's care and mobility needs. This report would enable decision-makers to make a better adjudication at the first stage. (Such a report might also lead to abandonment of non-viable claims.)
Unfortunately, Blyth PCT, which is a member of the CLSP, was unwilling, at the time, to pay for occupational therapist assistants because of funding pressures. Both the DWP and the LSC, as a source of funding for the pilot, had been ruled out from the start. In any event, LSC targets at the time prioritised new matter starts and not dispute reduction.
The CLSP agreed that this project will remain part of its agenda and that, come a better financial situation in the PCT, lobbying for 'assistant occupational therapists (DLA/AA)' will be resurrected. Goodwill and good communication between advice agencies, primary care trust committees, decision-makers and tribunal members has been generated.
Conclusion
In Northern Ireland (NI) accurate decisions are made in 85 per cent of claims – 30 per cent more than in Britain, but a figure the NI department is keen to improve on. Initial decision-making can be improved. However, there is little will at high levels of funding or decision making bodies to try new approaches. Investment in improved decision-making would save other resources, including legal aid funding for advice and medical reports on avoidable appeals.
But for now the DLA pilot has run out of steam and, with the abolition of regional committees, lost its sponsor. But the ideas could mean a better deal for claimants, a reduction of inappropriate pressures on doctors, better information to decision-makers, fewer appeals and wrongly granted awards, less money spent on medical reports, less time spent on submissions by case-workers and, most importantly to those who have the right to DLA, the benefit of the correct award. For now, money will instead continue to be spent on avoidable appeals.
Footnotes:
- Making legal rights a reality. The Legal Services Commission's strategy for the Community Legal Service 2006–2011, March 2006 (download pdf, 356KB) p13. [back]
- Secretary of State's report on the standards of decision making in the Benefits Agency, Child Support Agency and Employment Service – 2001–2002. [back]
- Progress in improving the medical assessment of incapacity and disability benefits. Report by the Comptroller and Auditor General, HC 1141, Session 2002–2003: 17 October 2003. [back]
- See: www.dwp.gov.uk/asd/asd1/dla/dla_quarterly_statistics_aug04.asp. [back]
- The results of the research are set out in Getting it right, putting it right. Improving decision-making and appeals in social security benefits. Report by the Comptroller and Auditor General, HC 1142, Session 2002–2003: 7 November 2003. [back]
- See note 3. [back]
- See note 4. [back]
http://www.council-on-tribunals.gov.uk/adjust/item/comment_benefits2.htm
There is much speculation as to the "what this means" of this Green Paper. The context of the paper is the care provision of our growing senior citizens. Senior Citizens, if they have additional care needs can receive one of two benefits to help. It depends on the age they apply. Attendance Allowance is awarded to those that apply at/over 65 years of age and is similar to the Care Component of Disability Living Allowance. Attendance Allowance is specifically mentioned in this paper.
However it is possible for someone to be at/over 65 years of age and on the Disability Living Allowance benefits. This will only be because they became entitled as they applied and were awarded before they reached this age.
You can therefore have some at/over 65 years of age being in receipt of either but not both of these benefits, age determines what you can apply for.
However, we should be concerned enough to ask for more clarification of the ambiguous phrase "other disability benefits" as the paper does also talk about disabled people. Experience tells us that generalisation usually, in due process, bring hidden problems.
To ensure we as a community put our point of view. Please respond to the consultation and get any HIV support group you use to to the same. It will help tremendously.
Click here for comments from The ME Association.
Click here for the article "Adult care green paper: can local authorities deliver?" from The Social Care Experts Blog.