PIP vs DLA.pdf

Personal Independence Payments

vs.

Disability Living Allowance

Will our clients be better off?

Derbyshire Dales, Amber

Valley and Erewash CAB

April 2013

PIP vs. DLA: Will Our Clients Be Better Off

2

Contents

Executive Summary 3

Methodology 4

The Survey 6

In Conclusion 9

Appendix 12


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Executive Summary

In April 2013 Personal Independence Payments (PIP) will begin to replace Disability

Living Allowance (DLA) for claimants aged 16-64. This is one of the key changes of

the Welfare Reform Act 2012. Both benefits are designed to provide financial

assistance for people with a long term health problem or disability, enabling them to

meet costs associated with their care and/or mobility needs.

The benefit will be introduced in stages. In Derbyshire clients will be able to make

new claims for PIP from 10 June, 2013. In October, existing DLA claimants reporting

a change of circumstance, claimants whose DLA claim is due to end in February

2014, and claimants approaching the age of 16 will be invited to apply for PIP.

Reassessment of the remaining DLA claimants will begin in October 2015.

Although PIP is designed to broadly meet the same needs as DLA, there are

differences in both the criteria and in the way the benefit is assessed. This has led to

some concern that our clients may be worse off under PIP. With this in mind,

Derbyshire Dales, Amber Valley and Erewash Citizens Advice Bureau (DAECAB)

undertook a project to assess how claimants would fare under the new system and

anticipate the needs of our clients going forward.

Our findings revealed that there is some concern amongst our clients over the

requirement to attend face-to-face assessments. Partly this is down to mobility

problems and also mental health issues such as agoraphobia or schizophrenia. We

can also speculate that previous negative experiences of Employment Support

Allowance (ESA) assessments contribute to these concerns. Furthermore, the

availability of home visits will vary according to location: assessments will be carried

out either by Atos or Capita, according to postcode, and it appears that Capita are

committed to carrying out more assessments in the client’s home.

We have also identified that a significant number of claimants may no longer receive

the maximum available support for their mobility needs due to changes in the

descriptors. As a consequence many will no longer be eligible for the Motability

Scheme.

The overall picture regarding the care element, known as the Daily Living

Component, is less clear. The component has two rates as opposed to DLA’s three,

and when we anticipated our client’s scores under PIP the results were varied, with

some clients being better off, some worse.


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Methodology

DAECAB provides advice sessions in all GP surgeries across our three districts. Our

advice work within these primary health care settings regularly sees us helping

clients to apply for Disability Living Allowance. It therefore seemed fitting to work

with our client base at surgeries to investigate how applicants for DLA may fare if

applying for PIP instead.

The focus of this survey was;

- To investigate how our clients will be affected by the introduction of PIP

- To find out how our clients feel about attending face-to-face assessments

- To identify areas for further social policy work going forwards

Each time an adviser assisted a client in completing a DLA application form they

estimated what level of benefit they believed the client should be entitled to. This was

an educated guess based on evidence provided by the client whilst completing the

application form. This enabled the bureau to project outcomes and identify clients

that may want to consider challenging DLA decisions.

We designed a pro-forma1 for the advisers to complete to compare the estimated

DLA award to the 2nd draft assessment criteria for Personal Independence

Payments2. We were then able to assess whether the client would be better, or

worse, off. We also hoped to be able to identify whether specific groups of clients

may be affected more than others.

Finally our advisers asked the client one question ‘How would you feel about

attending a face-to-face assessment? We wanted to gauge how many DLA

applicants would find it difficult to attend an assessment outside of the home and

what emotional impact this may have.

Sample

We started to collect evidence in May 2012 and by September we had had a total of

57 responses from across GP surgeries in Derbyshire Dales, Amber Valley and

Erewash.

1 Appendix 1

2 Personal Independence Payment: second draft of assessment regulations November 2011.


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Restrictions of research method

We recognise that evidence generated and collected is not impartial. Advisers are

not medically trained nor are they completely objective in their views, since the

function of our organisation is to act for the benefit of and in support of clients. Whilst

we accept that the evidence may be skewed in clients’ favour we feel it provides a

valuable insight into the possible impact of PIP on our clients, and the anticipated

demands on our service.


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The Survey

Face-to-face assessments

Of our sample just 14 believed that they would not find it difficult to attend a face-to-

face assessment. Of the remainder, we identified both physical and mental barriers

to visiting an assessment centre.

Limited mobility was frequently cited as a cause for concern by clients contemplating

the need to attend a face-to-face assessment, with many stating that they would

need physical support from another person. It is clear that if premises used for face-

to-face assessments are easily accessible and have disabled parking nearby then

this could alleviate some problems, but not all. Our evidence suggests that there is a

significant need for home visits, as many PIP applicants struggle to leave the house

and would find it challenging to visit an unfamiliar location.

Dev had his left leg amputated above the knee in July 2012. His mobility is

severely limited and he can only leave the house in an electric wheelchair

or scooter. Without significant support from another person, including

transport in an adapted vehicle, he cannot go anywhere beyond his

immediate locality. To attend a face-to-face assessment he would have to

pay for an adapted taxi and get a friend to take a day off work. He is

scared that he would not be able to park close enough and that he may

then not be able to manoeuvre his wheelchair within the premises. Dev

states that he would really struggle both physically and financially to

attend a face-to-face assessment. He feels a home visit would be more

appropriate in his case.

17 of the clients we asked would find it difficult to attend due to overwhelming

psychological distress or anxiety. This evidence highlights the need for mental health

specialists as part of a fair and transparent assessment process. Several clients

spoke of previous experiences of face-to-face assessments in relation to their claim

for Employment Support Allowance (ESA). Many of these clients mentioned that their

ESA assessment with Atos had been a negative experience with reports of

inaccurate assessments mentioned a number of times to our advisers. The

overwhelming response to this question from clients with previous experience of the

ESA work capability assessment strongly indicates that lessons need to be learnt.

Jim has paranoid schizophrenia, he constantly hears voices telling him

that someone is coming to get him. He lives in constant fear and

experiences severe anxiety. Recently Jim was transferred from Incapacity


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benefit to ESA. Jim did not have to attend a work capability assessment

because of his severe mental health problems. We asked Jim how he

would feel if asked to attend a face-to-face assessment to claim PIP. Jim

stated that he would be put off from even applying if he knew it was

probable that he would be asked to attend an assessment. Jim has read a

lot about Atos in the media and he is scared about what they will say

about his condition.

Many of our advisers involved in this research project questioned why a face-to-face

assessment is needed where a client’s consultant or GP has provided detailed

medical evidence. Several saw face-to-face assessments as a barrier to applying,

designed to put applicants off completely. Overwhelmingly our advisers felt that face-

to-face assessments should only be used in cases where a clear decision could not

be made using other available evidence. It was also commented upon that a GP’s or

consultant’s opinion should be valued and considered alongside a face-to-face

assessment, with appropriate weighting given to the opinion of the medical

professional as they have a more extensive knowledge of the client’s medical history.

The mobility component

Our research shows that for some clients the change to the way in which the mobility

component is assessed may be positive; this is particularly the case for those with

mental health problems and learning difficulties, due to those PIP’s descriptors which

address planning and following journeys. However, for those with physical

restrictions on their mobility who do not use a wheelchair, the changes could see

them becoming much worse off.

The high rate of Disability Living Allowance mobility component does not have the

same eligibility criteria as the enhanced rate of the mobility component for Personal

Independence Payments. In the majority of cases to qualify for DLA high rate mobility

you need to be ‘unable or virtually unable to walk’.3 To qualify for the enhanced rate

of the PIP mobility component you must be unable to move more than 20 metres,

either aided or unaided. Of our sample 12 clients who currently receive DLA at the

high rate for mobility would not qualify for the enhanced rate of the PIP mobility

component. A further 14 should continue to qualify for the enhanced rate having met

criteria for DLA high rate mobility. This means that from our sample of clients a

massive 46% are estimated to lose some of their mobility award.

There is perhaps an argument to be made here for those who have a physical

disability but who continue to try to walk without resorting to the use of a wheelchair.

3 CPAG Welfare benefits & tax credits handbook 2012/13, Chapter 9, pg. 138


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Will it become more sensible, financially, to give up trying to walk and use a

wheelchair instead?

Motability and PIP

On 14 December 2012 Motability announced that ‘Motability will continue to lease

cars, powered wheelchairs and scooters to disabled people who receive either the

Higher Rate Mobility Component of DLA or the enhanced rate of the mobility

component of PIP’4. This means that 46% of our client sample who currently meet

the criteria for a Motability vehicle may cease to do so once assessed for PIP.

We have a number of concerns for our clients. Many have come to rely on their

Motability vehicle in order to remain independent and information from Motability

indicates that if eligibility for the scheme ceases the vehicle will have to be promptly

returned even if the client chooses to appeal the decision5. There is the potential for

many severely disabled people to be left without a vehicle, therefore unable to leave

the house. This could have a significant negative impact upon health and wellbeing.

The Daily Living Component

The Daily Living component of PIP is equivalent with the Care Component of DLA.

However, there are only two rates, standard and enhanced, and as a result there are

some concerns that clients who had previously qualified for low rate care under DLA

may not qualify for an award under PIP. In fact, the picture appears to be more

complicated than that.

We predicted that 9 of our sample who should be awarded an amount for care under

DLA would be worse off under PIP, receiving no award for the Daily Living

Component. Interestingly, although we expected most of these to be awarded Low

Rate Care two were eligible for the Middle Rate. Equally unexpected was that 8 of

our sample who were eligible for Low Rate Care would be better off under PIP, as

they would be entitled to the Enhanced Rate.

4 http://www.motability.co.uk/about-us/news-and-information/personal-independence-payment-

motability 14 December 2012 5 http://www.motability.co.uk/about-us/news-and-information/personal-independence-payment 26

October 2012

http://www.motability.co.uk/about-us/news-and-information/personal-independence-payment-motability

http://www.motability.co.uk/about-us/news-and-information/personal-independence-payment-motability

http://www.motability.co.uk/about-us/news-and-information/personal-independence-payment


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In Conclusion

Inevitably many of our clients are facing challenges in respect of the help that they

receive with their care and mobility needs, both with regard to PIP and in the context

of wider changes to welfare. Agencies need to be aware of what our clients’ advice

needs will be in the new welfare environment, and what options are available to

them. Our PIP project has indicated that the following issues will be of significance

going forward.

Face-to-face vs Home Visits

The application process for PIP is in two parts: an application form to be completed

by the client, followed by a face-to-face assessment. The question of which

company carries out the assessment will depend on your postcode. For much of the

country Atos will carry out the assessments, working in partnership with the NHS,

private hospitals and national networks of locally-based health professionals, such as

physiotherapists, using their premises and staff to undertake face-to-face

consultations. For most of Derbyshire, Capita will be carrying out assessments, and

they expect that a large number of consultations will be in claimants’ own homes.

Their approach allows claimants to choose their preferred method of contact and

select their appointment time. The upshot is that your likelihood of getting a home

visit may depend on where you live.

Our survey has indicated that many of our clients would find it difficult to travel to a

test centre, and these clients will be seriously disadvantaged in areas where home

visits are not easily available. It may be that many clients will choose not to make a

claim, rather than endure the distress of attending the assessment.

There is a clear role for advice agencies in identifying clients for whom a visit to an

assessment centre is not appropriate. Clients need to be aware that they can be

assessed at home and help should be available to assist them in requesting a home

visit. Moreover, where it is possible for a decision to be reached purely on written

evidence, many claimants may need help completing the application and gathering

supporting evidence for their claim, such that any further physical assessment will be

redundant.


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Assessment

Although a physical assessment was never a standard component of the DLA

application process, they have been an integral part of ESA since its introduction.

Lessons learned from ESA can be applied to PIP, particularly with regard to the way

that health professionals make judgements based on observations made at the

assessment. One criticism that has emerged is that whereas the ESA assessment

may have effectively identified symptoms and limitations that were apparent at the

time, they do not accurately reflect how claimants fare in real-life, day-to- day

situations.

To address this issue, guidelines require PIP assessors to consider what activities

claimants can carry out safely, to an acceptable standard, repeatedly and in a

reasonable time period. This is a welcome qualification but ultimately, as there is no

way to empirically test such things, the claimant’s score will still rely on the

judgement of the assessor. Our experience of ESA assessment indicates that

despite guidelines there can still be considerable differences in the way client’s

physical and mental capacities are scored from one case to another. If, as has been

indicated in the case of ESA, clients are assessed very differently depending on

which assessment centre they visit, then discrepancies between two different

providers may be even more pronounced.

We envisage that clients may not agree with the assessor’s interpretation of their

performance, will wish to appeal and will look to advice agencies for help. Bureaux

will consequently begin to build up a picture of how accurate assessments are,

whether there are common failures and clear discrepancies, and will be able to share

this information with policy makers.

Mobility

PIP claimants will score maximum points for the mobility component if they can move

no more than 20 metres, aided or unaided. This is a more restrictive criteria than

DLA, and means that many more clients whose ability to walk is severely limited will

not qualify for the enhanced rate. This, as we noted earlier, will also affect their

eligibility for the Motability scheme. With less help available to them we are likely to

see more clients turning to advice agencies for help, and a greater demand for other

voluntary and community schemes. This change could also leave many vulnerable

people confined to their homes, where they will be unable to access many services,

including advice.


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Daily Living

The indications from our survey are that the Daily Living Component of PIP will not

map directly over from DLA. There are significant differences such that many

claimants currently receiving the care component will find themselves treated very

differently under PIP. The changes will also have repercussions for carers who may

find themselves losing Carers’ Allowance or providing greater and different types of

care. At the same time, we may see clients who are better off under the new benefit.

Bearing in mind the limited nature of our survey and the difficulties of anticipating the

judgements made by assessors and decision makers, it is clear that there is a

continuing need to monitor the effects of these changes. Evidence gathered whilst

working with clients will help us to identify discrepancies and weaknesses in the

system, prepare clients for the changes that may lie ahead and provide feedback to

policy makers about the effectiveness of PIP.


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Appendix 1: Survey Pro Forma

Personal Independence Payments and Disability Living

Allowance - a comparison

Adviser:…………………………… Client ref:………………………….

Activity Descriptors Points

Please tick box to highlight descriptor which best

applies

Daily Living Activities

Preparing food and drink a. Can prepare and cook a simple meal unaided 0

b. Needs to use an aid or appliance to either prepare or cook a simple meal 2

c. Cannot cook a simple meal using a conventional cooker but can do so using a microwave. 2

d. Needs prompting to either prepare or cook a simple meal. 2

e. Needs supervision to either prepare or cook a simple meal. 4

f. Needs assistance to either prepare or cook a simple meal. 4

g. Cannot prepare or cook food at all. 8

Taking nutrition a. can take nurtition unaided. 0

b. Needs either - (i) to use an aid or appliance to take nutrition; or (ii) assistance to cut up food. 2

c. Needs a theraputic source to take nutrition. 2

d. Needs prompting to take nutrition. 4

e. Needs assistance to manage a theraputic source to take nutrition. 6

f. Needs another person to convey food and drink to their mouth. 10


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Managing therapy or monitoring a health condition

a. Either - (i) Does not receive medication, therapy or need to monitor a health condition; or (ii) can manage medication, therapy or monitor a health condition unaided or with the use of an aid or appliance. 0

b. Needs supervision, prompting or assistance to manage medication or monitor a health condition. 1

c. Needs supervision, prompting or assistance to manage therapy that takes up to 3.5 hours a week. 2

d. Needs supervision, prompting or assistance to manage therapy that takes between 3.5 and 7 hours a week. 4

e. Needs supervision, prompting or assistance to manage therapy that takes between 7 and 14 hours a week. 6

f. Needs supervision prompting or assistance to manage therapy that takes at least 14 hours a week. 8

Bathing and grooming a. Can bathe and groom unaided. 0

b. Needs to use an aid or appliance to groom. 1

c. Needs prompting to groom. 1

d. Needs assistance to groom. 2

e. Needs supervision or prompting to bathe. 2

f. Needs to use an aid or appliance to bathe. 2

g. Needs assistance to bathe. 4

h. Cannot bathe or groom at all. 8

Managing toilet needs or incontinence a. Can manage toliet needs or incontinence unaided. 0

b. Needs to use an aid or appliance to manage toilet needs or incontinence. 2

c. Needs prompting to manage toilet needs. 2

d. Needs assistance to manage toilet needs. 4

e. Needs assistance to manage incontinence of either bladder or bowel. 6

f. Needs assistance to manage incontinence of both bowel and bladder. 8

g. Cannot manage incontinence at all. 8

Dressing and undressing a. Can dress and undress unaided. 0


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b. Needs to use an aid or appliance to dress or undress. 2

c. Needs either - (i) prompting to dress, undress or determine appropriate circumstances for remaining clothed; or (ii) assistance or prompting to select appropriate clothing. 2

d. Needs assistance to dress or undress lower body. 3

e. Needs assistance to dress or undress upper body. 4

f. Cannot dress or undress at all. 8

Communicating a. Can communicate unaided and access written information unaided or using spectacles or contact lenses. 0

b. Needs to use an aid or applicant other than spectacles or contact lenses to access written information. 2

c. Needs to use an aid or appliance to express or understand verbal communication. 2

d. Needs assistance to access written information. 4

e. Needs communication support to express or understand complex verbal information. 4

f. Needs communication support to express or understand basic verbal information. 8

g. Cannot communicate at all. 12

Engaging socially a. Can engage socially. 0

b. Needs prompting to engage socially. 2

c.Needs social support to engage socially. 4

d. Cannot engage socially due to such engagement causing either - (i) overwhelming psychological distress to the claimant; or (ii) the claimant to exhibit uncontrollable episodes of behaviour which would result in a substantial risk of behaviour which would result in a substantial risk of harm to the claimant or another person. 8

Making financial decisions a. Can manage complex financial decisions unaided. 0

b. Needs prompting to make complex financial decisions. 2

c. Needs prompting to make simple financial decisions. 4

d. Cannot make any financial decisions at all. 6

Mobility activities


15

Planning and following a journey a. Can plan and follow a journey unaided. 0

b. Needs prompting for all journeys to avoid overwhelming psychological distress to the claimant. 4

c. Needs either - (i) supervision, prompting or a support dog to follow a journey to an unfamiliar destination; or (ii) a journey to an unfamiliar destination to be entirely planned by another person. 8

d. Cannot follow any journey because it would cause overwhelming psychological distress to the claimant. 10

e. Needs either - (i) supervision, prompting or a support dog to follow a journey to a familiar destination; or (ii) a journey to a familiar destination to have been planned entirely by another person. 15

Moving around

a. can move at least 200 metres ether - (i) unaided; or (ii) using an aid or appliance, other than a wheelchair or a motorised device. 0

b. Can move at least 50 metres but not more than 200 metres either - (i) unaided; or (ii) using an aid or appliance, other than a wheelchair or motorised device. 4

c. Can move up to 50 metres unaided but no further. 8

d. Cannot move up to 50 metres without using an aid or appliance, other than a wheelchair or motorised device. 10

e. Cannot move up to 50 metres without using a wheelchair propelled by the claimant. 12

f. Cannot move up to 50 meters without using a wheelchair propelled by another person or a motorised device. 15

1. After completing a DLA application with the client what award of DLA do you expect them to receive?

2. Would the client find it difficult to attend a face to face assessment? If so why?

Documents

PIP vs DLA.pdf