Adult Disability Payment - mobility component: consultation analysis

Appendix F: Other considerations

16. If there was an opportunity to consider alternative approaches to a points-based system to understand disabled people's needs, what alternatives would you propose (if any)?

Less commonly mentioned themes

The importance of taking a system-wide perspective when considering criteria was noted by some respondents. Comments included views that changes to one part of the system could impact elsewhere, e.g., improving mental health funding could positively impact independent living and the need for better inter-agency working between Social Security Scotland and other departments. As explained in the overarching theme section, some respondents reiterated the need to broaden the criteria to include other conditions.

There was a call by some to examine more closely what works well, either in Scotland, Europe or further afield.

A few respondents commented that indefinite awards should be made in relevant cases, i.e. where no future improvement was envisaged. One noted occupational therapists were well placed to make such recommendations.

16(b). If you proposed changes, what negative impacts could these have, and for who?

"We recognised that a more individualised assessment model is likely to lead to more detailed questions, responding to which may feel more onerous for the applicant and that the assessment of responses may lead to outcomes which are potentially subjective and may be inconsistent." - Law Society of Scotland

16(c). If you proposed changes, which of these would you prioritise?

Addressing barriers to participation

Ensuring fairness in decision-making was mentioned explicitly by some, with one noting a wider range of conditions should be included in the criteria to facilitate this, e.g. Crohns and colitis. Another individual felt the exclusion of fluctuating conditions was illegal.

Some respondents noted that the priority should be to change the mobility component criteria. Two called for a removal of a points system. One organisation recognised the complexities associated with this and argued a scaling approach could be prioritised more easily:

"There is a concern, however, that budgetary and passporting implications may mean scrapping a points based system would not be feasible. As such, our next priority would be to implement a scaling approach and other measures to ensure points are not the final decider in whether a person is entitled to social security." - Sight Scotland and Sight Scotland Veterans

The Neurological Alliance of Scotland and MS Society of Scotland recommended the 50% eligibility criteria be modified and made more flexible to accommodate fluctuations in conditions over time. Some organisations including National Carer Organisation, Scottish Post Polio Network and the Cross Party Group on MS called for the removal of the '20-metre rule', with the MS Society Scotland suggesting replacing it with the '50-metre rule'.

Other priorities

A small number mentioned other priorities. These included: the need to be flexible and avoid 'tick box' approaches, involving carer views, not having reviews and recognising that aids do not remove mobility issues. EEPPIC highlighted the need to co-design and implement the new system with people with lived experience.

17. Other than changes to the eligibility criteria, are there any changes you think we could make to Adult Disability Payment to support people's mobility needs (if any)?

Improve decision-making approach

"I scored far higher in the everyday component than the mobility component. This meant that the payment was balanced in the wrong direction. I need to hold on getting up from the toilet and I can't kneel down or do anything below knee level. However, I'd say that the lack of mobility on bad days has a far greater impact on me as there isn't solutions. I've had to pay extra for an automatic car but that's not considered." - Individual

"A more flexible approach needs to be considered, such as allowing people on 8+ points to pay a supplement to get access to a motability car… People who score 10 points, for example, can only walk 50 meters. It's more than 50 meters to the bus stop. But they can't get a car or even a scooter. The Motability scheme really needs investigating. People who are disabled but don't get 12 points could still benefit from the scheme yet are prevented from getting access to it." - Individual

Independent support and advocacy

Citizens Advice Scotland cited findings from the Grey report that access to independent advice contributed to inconsistency in PIP decision-making and that those who reported the most satisfaction with the process tended to have additional support with their application.

Cerebral Palsy Scotland noted that those with neurological conditions had no legislative right to independent advocacy and urged the Scottish Government to remedy this. Issues with existing referral pathways were also highlighted:

"In terms of advocacy support for disabled people, we have serious concerns that (i) many disabled people with advocacy needs are not being referred for advocacy support and (ii) that the advocacy service that the Scottish Government has commissioned does not itself refer disabled people to welfare rights support. Advocacy staff are not welfare rights workers…Advocacy support that limits itself to assisting disabled people with completing application forms to ADP is neither holistic nor genuine independent advocacy - which should be motivated with providing support that meets the disabled person's needs rather than its contractual obligations with a third party." - Inclusion Scotland

One individual felt family members could support clients, such as carers, parents and guardians, whilst Age Scotland highlighted delays in processing ADP applications could impact carer finances. Two respondents felt disabled people should be able to nominate a representative to act on their behalf.

Less commonly mentioned themes

Another theme mentioned by some related to the quality of the system, with the most prevailing issue being the need to spot check or audit decisions to ensure system principles are met, decision-making is correct the first time, and to identify fraudulent applications.

Some mentioned the need to address delays in the system, which could impact negatively on client and carer wellbeing and finances:

"Delays cause considerable distress and can entrench financial hardship. Social Security Scotland data shows …Of the 3,130 new applications processed in January 2023…1,105 …were processed in 81-100 days. Citizen's Alert: An East of Scotland CAB reports on the 2nd of March 2023 reports on the impact of delays to a decision on an application for ADP completed on the 24th of October 2022 on a client with progressive degeneration of the spine and his carer. The adviser reports that the carer, who is dyslexic, "stated that her cheerful positive attitude has been replaced by a sense of foreboding when the phone rings…. She feels overwhelmed, she lives in dread of receiving no money, she fears waiting for payments and receiving the wrong amount". - CAS

Delays could also impact carers, who cannot apply for Carer's Allowance until a decision about the client's ADP application has been made.

Some described changes to the form they felt should be made, such as simplifying questions or using images and having access to a paper version.

A few respondents argued for co-design with clients, offering a range of methods and focusing on engagement with those who face the most significant barriers.

18. How can the independent review ensure that any recommendations it makes are both deliverable and affordable?

An equitable, human rights approach

A fairer system will pay more out in benefits but should be less expensive to administer. Reducing poverty should be important, but also, the money received will boost the economy, improve claimants' health, lessen spending on the health service, social work, policing etc., and have generational benefits. Providing security and an adequate income helps those who can work to do so and means stability and mitigation against worsening health for those who can't." - Individual

Financial considerations

"In terms of ensuring any recommendation is affordable, this requires more accessible information and transparency on Scottish Budgets and future projections and scrutiny by the independent review. Priorities are for the Scottish Government." - EEPPIC

Improved practice and decision-making

"There is an opportunity to minimise additional costs through practice and effective decision-making. The getting it right first time approach may reduce extra staff costs through challenges of decisions." - Blesma

Falkirk Council suggested that health practitioners review supporting information to ensure the requested information is relevant to the client and their condition. The Scottish Government could disseminate guidance on what constitutes relevant supporting information to GP practices. They argued print and postage cost savings could occur through a reduced size form or digitised information transfer, e.g. a shared portal to share data between agencies, which could speed up processing speed.

Crohn's and Colitis UK noted that making a range of changes, including improved access to advocacy and welfare rights advice and a reduction in challenges due to implementing a human rights approach, would reduce overall costs arising from administering ADP.

"The DWP's approach to PIP which focussed on costs rather than disabled people's rights ended up being wholly counter-productive. In 2019, the Office for Budget Responsibility revised the estimated cost of the move to PIP from DLA to account for modifications to the PIP eligibility criteria following several successful legal challenges and the high number of appeals pursued by claimants and predicted an overspend of at least £1.5 billion (DLA-to-PIP-CHAD-Project-Report-26-March-final-report.pdf (chadresearch.co.uk).  Those legal challenges continue to be made and continue to succeed and the costs of PIP continue to rise." - Crohn's & Colitis UK

A small number recommended making use of data or improving the data collected. Comments included:

• Assess waiting list data to ascertain what experience case managers will require to speed up the process.
• Testing impact across client groups with anonymised case data from current workloads to allow direct comparison between current rules and proposed changes.
• Enhancing data collection about case outcomes, decision-making and appeals
• Capturing sufficient equality data to analyse the impact on those with protected characteristics.
• Analysis of wider impact on public expenditure of effective disability assistance.

Broader social security system issues

Some argued the review should consider the whole system when determining affordability, highlighting the inter-related nature of funding. Affordability should be considered alongside other Government spending on health and social care, transport and housing.

"We acknowledge that at present, depth of analysis involving, for example, modelling of the tax revenue impacts of extended and/or increased financial support for mobility, is currently unavailable; this picture strongly suggests that improvements to the design and delivery of extra costs disability support are likely to have inextricably linked and profound positive social and economic effects." - SCoRSS

A few respondents noted the inter-related nature of benefits, for instance, the impact on passported benefits or different qualifying criteria, and felt clients should not be disadvantaged. ENABLE Scotland suggested a further review could occur once the Scottish Government identified options that did not adversely impact reserved benefits.

"Other benefits mentioned in consultation e.g. Scottish carers assistance, pension age winter heating assistance, pension age disability payment, target those of pension age; as such, younger people won't qualify due to their age. Access to ADP is therefore vital, and other social security payments should not be relied upon to fill gaps." - Sight Scotland and Sight Scotland Veterans

Less commonly mentioned themes

Some respondents felt it necessary to co-design any new system by engaging with and listening to stakeholders, mainly clients and carers. Parkinson's UK Scotland argued reform must be transparent, subject to stakeholder and Scottish Parliament scrutiny before any Bill is passed and that Ministers must be accountable for the new system. Another theme identified by some was that they felt the review team and Scottish Government should take decisions about which changes to make, rather than asking respondents for suggestions. However, Inclusion Scotland also noted the Scottish Government is bound to uphold international treaties to which it is a signatory, including the Convention of the Rights of Persons with Disabilities.

The Scottish Association for Mental Health argued the review team should make recommendations through the lens of a social model of disability, equality and human rights law, principles and standards, including "how reform of ADP can further realise people's rights under the UN Convention on the Rights of Persons with Disabilities."

19. How can the independent review consider the impact of any recommendations on existing "passporting" arrangements?

Joint working between the Scottish and UK Governments

"With appropriate partnership working between the governments, this mechanism could be used to allow the Scottish Government to pursue further changes to Scottish social security whilst maintaining passporting by assuming liability for any additional costs arising for the UK Government. In line with our responses to other questions, this should form part of a human rights-based approach to social security and be paired with measures to maximise revenues available for public services." - Health and Social Care Alliance Scotland

Impact on specific benefits

Respondents noted that an enhanced rate mobility award under ADP provides access to the Accessible Vehicles and Equipment (AVE) Scheme and a passport to the Scottish Government's Blue Badge parking scheme, a disabled person's bus pass and local transport schemes.

"Increasingly, a blue badge is being used as a way to identify disabled people in relation to, for example, Low Emission Zones exemptions as well as parking spaces. People with Parkinson's tell us that this form of passporting is invaluable, and we know that the lack of passporting from Attendance Allowance to the Blue Badge scheme can be a major barrier to some older people applying for, or being granted, a Blue Badge." - Parkinson's UK Scotland

Respondents felt it essential to retain entitlement to these passporting benefits, with one noting this could ensure an individual does not need further assessments. Inclusion Scotland highlighted that the power to grant passporting to these benefits is already devolved and noted that CAS does not anticipate a significant impact on benefit arrangements resulting from changes to ADP entitlement but acknowledges potential increased costs for the Scottish Government.

A few specifically mentioned that vehicle tax exemptions are currently not devolved. SCoRSS also highlighted that VAT applies to the leasing of a Motability vehicle, again not a devolved matter, and wished the independent review to consider "…the existence of a road tax exemption for those in receipt of high rate of Mobility, and a 50% discount for those awarded standard rate mobility; this is not devolved."

Concerns were noted about a passporting issue if entitlement to ADP determines eligibility for the health element of Employment Support Allowance and Universal Credit in the UK's Transforming Support: The Health and Disability White Paper.

"Scottish Government needs to begin negotiating now with the UK Government about the almost certain additional costs (i.e. in both processing and administering thousands of additional claims, a large proportion of which may prove unsuccessful as the qualifying criteria for ADP and ESA are entirely different) and additional benefits claimants (i.e. some current ESA/UC claimants who do not claim PIP/ADP will nevertheless be entitled to these benefits). If such UK-wide changes do result in additional costs for Scottish Government we hope that these will be refundable via the renegotiated Fiscal Framework." - Inclusion Scotland

A small number mentioned that Carer's Allowance could be impacted by changes, as ADP may allow a carer to apply for Carer's Allowance. One participant noted that Carer's Allowance in Scotland will shortly be replaced by Carer Support Payment, and therefore the Scottish Government will hold powers to continue passporting.