End assessments and consider disability benefit claims on medical advice alone

The Government should remove the requirement for people claiming disability benefits, such as the Personal Independence Payment (PIP), to have to go through an assessment process. Claims should be based solely on evidence from medical professionals, such as a letter from a GP or consultant.

We are concerned about how the disabled, with conditions such as inflammatory Arthritis. Heart disease, lung disease, respiratory diseases, poor mental health etc, are treated by the benefits system. Claimants with medical evidence of their condition should not to be subject to degrading assessments.

These delays in assessing claims risk deterring genuine claims. It has to stop.

The Government has no plans to assess eligibility for all disability benefit applications based on medical evidence alone. DWP uses assessments to help determine entitlement for a number of benefits, including Personal Independence Payment (PIP); Industrial Injuries Disablement Benefit (IIDB); Employment and Support Allowance (ESA); and, for those claiming due to a disability or health condition that affects their capability for work, Universal Credit (UC). These benefits were designed for specific purposes, be that support with additional costs associated with long-term ill-health or disability; compensation following a work-related accident or illness; or income replacement. Each benefit has its own assessment criteria, to ensure that those who meet the entitlement conditions get the support they are entitled to.

The Work Capability Assessment, which assesses entitlement to ESA and the additional health-related amount of UC, ensures that people receive appropriate financial and tailored work-related support. This supports those who can work to do so. It assesses people’s functional ability over a range of physical and mental/cognitive criteria, as well as several non-functional criteria covering circumstances such as cancer treatment and kidney dialysis.

PIP contributes to the extra costs of disability or long-term ill health regardless of whether someone is in work. The PIP assessment looks at the impact of a disability or health condition on someone’s ability to do a range of day-to-day activities, e.g., washing; using the toilet; communicating; and mobility needs.

IIDB provides non-contributory benefit for people who become disabled because of an accident at work or due to certain prescribed diseases caused by their job. The aim of the IIDB assessment is to establish the causation of the illness or disease and a percentage disablement. For all benefits, we encourage people to provide any relevant evidence at the outset of their claim. This includes letters from their outpatient clinic or specialist; or information from other professionals involved in their care, e.g., support workers or carers. Healthcare professionals who carry out the assessment are expected to seek further evidence if it may help them to provide advice without requiring the claimant to attend a face-to-face, telephone, or video assessment. Whenever it is possible to assess a claimant on the basis of paper evidence alone, we will do so. Increased use of paper assessments is also helping to reduce waiting times.

The assessor’s role is to evaluate the effects of a claimant’s health condition or disability on their ability to perform everyday activities, and/or to advise DWP whether the evidence, including that provided by a doctor, supports the legislative intent of the benefit in question. Factual information from a clinician about an individual’s diagnosis or treatment can be helpful, but is often not sufficient to determine entitlement to benefit. We do not expect clinicians to have an expert knowledge of the benefit system; their role is to diagnose and treat a person’s illness.

DWP provides fast-track access to certain benefits for people nearing the end of their lives through special benefit rules (or “the Special Rules”). These enable people who are nearing the end of their lives to get faster, easier access to certain benefits without needing to attend an assessment; serve waiting periods; and in most cases, receive the highest rate of benefit. The Special Rules are now being changed to apply to people who have 12 months or less to live, instead of 6 months or less. These changes are well underway. From 4 April 2022, the Government changed eligibility for Special Rules access in UC and ESA. The Social Security (Special Rules for End of Life) Act 2022 enables similar changes for PIP, Disability Living Allowance and Attendance Allowance.

We continue to review our benefit processes and procedures, for example, in 2021 we published Shaping Future Support: The Health and Disability Green Paper. This explored how the benefits system can better meet the needs of disabled people and those with health conditions. It also considered how to build a system that enables people to live independently and move into work where possible.

Looking ahead, we want to test a new Severe Disability Group so that some people can benefit from a simplified process without needing to complete a detailed application form or go through an assessment. We will work directly with disabled people and people with health conditions to develop and test the approach. This will ensure that it delivers the desired improvements. We will consider the test results alongside the responses to the Green Paper when determining whether the policy should be rolled out further.

We received over 4,500 responses to the public consultation, and we are grateful to the individuals and organisations who contributed. We will respond with a White Paper in the coming months.

Department for Work and Pensions