Adult Disability Payment - mobility component: consultation analysis

Executive Summary

A public consultation on the eligibility criteria for the mobility component of Adult Disability Payment (ADP) ran between 31 January and 25 April 2023. The consultation aimed to gather a broad range of views on alternative approaches to the mobility component and identify any gaps, issues or unintended consequences of changes suggested by respondents.

In total, 210 consultation responses were received from 173 individuals and 37 organisations. Of these, 102 responses were received via a survey tool created, launched and promoted by MS Society Scotland. Six consultation engagement events were also organised by the Scottish Government, independently facilitated by The Lines Between and attended by 22 individuals and 12 representatives of stakeholder organisations.

Overarching themes

Across the consultation, many respondents suggested or called for broad improvements to ADP. The main request was for a holistic, person-centred and flexible approach to ADP decision-making, considering each application holistically, including the wider context of clients' lives and circumstances when making a decision. Some suggestions were raised repeatedly, including:

• Ensuring all aspects of mobility are considered, including a range of additional impacts reflecting clients' lived experiences before, during and after moving around.
• That the criteria should not judge movement in isolation from the reality of moving around and should consider the complexity of the circumstances people encounter when moving.
• Broadening the eligibility criteria to consider other conditions, including mental health conditions, and a wider range of mobility aids.
• That the eligibility criteria are not appropriate for those with fluctuating conditions.
• For the ADP criteria to consider, clarify and include additional aspects of mobility beyond simply the ability to move a certain distance or plan and execute a journey.

The moving around activity

Clarifying the language or meaning of the moving around activity criteria was requested by many respondents, for example by using examples and real life scenarios. Several also argued that the criteria would benefit from a clearer definition of what moving means. While there was appreciation of, and support for, the visual examples now included in the ADP application form, the need for clearer images was mentioned by several respondents.

There was positive feedback on changes made to the ADP application guidance. Respondents thought the changes would lead to more accurate decisions, allowing clients to receive benefits that fit their needs. A more individual approach was also thought to be more understanding, fairer and truer to life. Several also approved of the move from Department for Work and Pensions (DWP)-style face-to-face assessments to only using a consultation with a practitioner when there is no other practicable way to understand a client's needs. However, concern about the application process was raised by some and reiterated at events, including that the application form is long, intimidating and confusing.

Changing the distance measure in the moving around activity was frequently suggested as another opportunity for improvement. These responses ranged from eliminating the 20-metre measurement in the criteria – the '20-metre rule' - to not using any distance measures. Respondents argued that 20 metres is an unrealistic and limiting distance. They suggested a system that focuses on the qualitative aspects of movement, i.e., how people move, captured through open-ended questions and a flexible approach dependent on people's real life experiences. Several suggested that these changes would improve ADP clients' circumstances and independence and positively impact those with fluctuating conditions as the decision-making process would be more inclusive, holistic and nuanced.

Planning and following journeys activity

Many respondents repeatedly criticised the term 'overwhelming psychological distress', which they found to be limiting, subjective and unclear, and suggested it should be defined, amended or removed. Several also noted confusion about the meanings of 'orientation aids', 'planned', 'unplanned', 'familiar' and unfamiliar', while a few suggested 'journey' could be confusing. Conversely, many also felt the criteria were easy to understand.

Several respondents called for greater consideration of mental health in relation to this activity. These comments often focused on clients' experiences during the journey, such as impacts on mental health if the journey does not go to plan or anxiety related to specific types of journeys but not others. Some respondents requested that the definition of orientation aids include technology like satellite navigation tools and mobile phone map applications, which respondents noted as being crucial to their ability to move around.

The effectiveness of the planning and following journeys section of the ADP application form was noted by many. Several noted that the form was clear, while a few noted it was an improvement on the PIP form. Some others suggested the form was more inclusive of those without physical disabilities and clearly spoke to those with mental health conditions. There was also positive feedback about removing assessments and support for the decision to use professionally trained practitioners instead of assessors for ADP.

Support for people with fluctuating conditions

Many commented on their difficulty understanding the criteria for fluctuating conditions, which they felt were unclear and overly complex. Respondents highlighted the formal, overly complicated language, including using fixed or confusing statements and the lack of examples or sufficiently detailed guidance. A common theme was calls to simplify or clarify the criteria. However, some individuals and organisations felt the criteria were clear, easy to understand, and comprehensive.

Another recurring theme was that the 50% of the time criterion – often referred to as the 50% rule - was not a useful measure and that it should no longer be used. Several commented on using the 'good day, bad day' criteria, either stating that it was impossible for clients to average their symptoms or advocating for a client's experiences on a 'worst day' to be used as a basis for decision-making. It was felt that doing so would simplify the process and make it easier for people to describe their experiences compared to trying to measure and record their fluctuating conditions.

Respondents also called for a more open-ended approach to allow clients to express themselves in their own way. A key concern was for the application form to allow sufficient space to adequately describe conditions, particularly for those with multiple conditions. However, several respondents gave positive feedback about the fluctuating conditions section of the application form, stating they welcomed the broader range of conditions, found the contextual information helpful or felt it improved the previous application form.

Other considerations

When considering alternative approaches to a points-based system, several respondents advocated a move away from the medical model of disability that underpinned the previous system to a social model. It was argued that moving away from this narrow approach was necessary to help facilitate a more rights-based approach in Scotland, which could benefit disabled people's wellbeing through increased trust in the system and reducing stress and anxiety during consultations. Respondents called for an adequate budget, used equitably, to be allocated to achieve this, with several emphasising the need to ensure sound financial planning to determine the required budget.

The negative impact of the existing system on client wellbeing was highlighted; for instance, a perceived need to mask abilities or the disappointment experienced when awards were not made. Changes to build trust in the system and avoid loss of entitlement were considered a priority by some. Respondents commented on making the system more compassionate, enabling and supportive for disabled people, minimising any distress during the application process. A prevalent theme covered the decision-making approach, mainly that case managers should receive sufficient training to understand different disabilities. Some raised the need to provide independent support and advice to clients.

Regarding passporting benefits, prevalent themes were for the Scottish Government to work in partnership with the DWP to ensure a smooth transition to a new Scottish social security system, and that the independent review should not be constrained by passporting considerations when determining the criteria for devolved benefits, including ADP. Several argued that changes should not disrupt or adversely affect clients i.e., clients should retain their existing entitlements regardless of any changes made to ADP, and none should become worse off.

Conclusions

Many individuals and stakeholders with detailed knowledge and lived experience participated in this consultation, providing their opinions and insight on various aspects of the ADP mobility component. Their views will assist the independent review and the Scottish Government in deciding and delivering on further improvements to ADP.