Adult Disability Payment - mobility component: consultation analysis

6. Other considerations

The final section of the consultation asked respondents to consider alternative approaches to a points-based system, how the independent review can ensure its recommendations are deliverable, and the impact of any changes on passporting benefits.

Alternative approaches

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)?

Almost one third of respondents answered this question. The three most common themes all focused on the need for a more holistic approach to ADP. Most common were the overarching themes of a more flexible, person-centred approach, and making sure that the criteria reflect real life; these are described in Chapter 2 and not repeated here. Another prevalent theme was adopting a social rather than medical model of disability.

Adopting a social model of disability

Several respondents advocated a move away from a medical model of disability that had underpinned the previous system to a social model. Respondents felt moving away from this narrow approach was necessary to help facilitate a more rights-based approach in Scotland, as it would incorporate social and environmental factors. For instance, a few highlighted the application process could feel like a test to determine disability levels leading to fears of a person seeming too able.

Respondents argued that adopting a social model focused on treating people with compassion and respect would allow the client to describe their mobility in their terms and more fully incorporate relevant factors. It was felt the focus should be on addressing any barriers to mobility to enable people to live meaningful and independent lives. MS Society Scotland noted a Scandinavian approach that supports people to meet additional costs associated with their disability. Similarly, CAS argued a vital feature of a human rights approach would ensure adequate financial support to offset such costs.

"It would also move away from a deficit model towards assessing the support that people may need to achieve the best possible quality of life across a range of parameters that are most relevant for them, rather than those defined by non-disabled people designing assessments." Parkinson's UK Scotland.

Comments on the application process

Several respondents requested changes to the application process, mainly related to the use of a form, with a small number referencing broader issues. It was felt the points system might disadvantage those who complete the application form independently, e.g. individuals may fail to understand the descriptors and entitlement criteria or feel unable to describe themselves adequately in the boxes provided. Conversely, Inclusion Scotland believed many welfare rights workers liked the points-based system because they understood how to word the application to maximise points. A few argued against using a form, as it could cause negative emotions. Suggested alternatives were to make the application process more visual or discussion based.

"I have friends who are dyslexic who would absolutely hate this approach, and I've seen someone reduced to tears having to fill out a two page form for a gym membership. But they expressed themselves visually quite well, and I imagine the option to supplement with videos and pictures would go a long way, even if there would need to be a fair bit of work done to set a standard for a review process for something like that." - Individual

Other comments on the application process included the need to ensure equity of access e.g. by auditing award decisions regularly, minimising bias, having sub-scores which contribute to an overall score for each ADP category and the need to ensure joined-up information systems to avoid clients having to retell their story multiple times.

Another issue mentioned by some respondents was the emotional impact of applying for benefits, such as anxiety or frustration. They suggested a points system could compound this, for instance, when someone just falls short of receiving the required points for an award. Similarly, a small number argued the previous system had focused on reducing social security expenditure, and clients remained fearful this was the key driver for decision-making rather than a person's needs.

Some suggested using alternative approaches to a points-based system to determine awards. These included using medical or other professional supporting information, passporting from Disability Living Allowance and a qualitative client personal statement.

Less commonly mentioned themes

Some suggested specific alternatives to the points system. Over half suggested using a sliding scale rather than points depending on the severity of the client's disability. Comments varied as to how best to do this. For instance, the scale could be descriptive, e.g. not at all, sometimes, all the time, or more quantitative, e.g. high to low. Other specific suggestions included using a Lived Experience Panel to review anonymous applications.

Other themes detailed in Appendix F include:

• Some who highlighted the importance of taking a system-wide perspective.
• Examining examples of best practice from elsewhere.
• A few commented that indefinite awards should be made in relevant cases.

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

This question was answered by one third of respondents. Some reiterated their support for a holistic and person-centred approach, arguing that adopting a human rights-based approach would have positive benefits for both individuals and society.

The most prevalent theme was the benefit to disabled people's wellbeing. Some felt this would occur through increased trust in the system, reducing stress and anxiety during consultations. A more conversational approach could also help put people at ease.

"If we let go of this basic assumption that we can put people in boxes, rather acknowledging the uniqueness of our individual needs and then opening up the possibility of our being able to enrich our communities. This could be a direct result of our energy not being used up in preparing for and then completing forms that have previously been degrading. It also means using less pain medication saving that cost. When I talk about my experience it outrages people. If we work to improve things surely that benefits us all." - Individual

A few highlighted longer-term health and wellbeing benefits arising from people living more actively such as are improved physical and mental wellbeing, a reduction in poverty, remaining in employment and the ability to live more independently.

Specific groups who would benefit were mentioned by some, including people with long-term, rare and specific conditions, those who are neurodiverse and those with learning or severe disabilities. Multiple Sclerosis and Parkinson's Disease were explicitly mentioned. Two noted people with hidden disabilities would benefit, such as people with ME.

Some felt that in redesigning a more holistic, person-centred system, all disabled people would benefit. Two respondents reflected that a more flexible approach could help remove rigid lines between qualifying or not. ENABLE Scotland suggested discretion could be used to make awards for those who might not fit within existing parameters.

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

The prevalent theme among the quarter who answered Q16b was that some respondents did not perceive any negative impacts from their proposed changes. However, the second most prevalent theme was a negative impact on clients when applying. Comments centred around the likelihood of the process being more time-consuming or overwhelming if more qualitative supporting information is required or if accessible formats are unavailable. A less commonly mentioned theme was that negative impacts could arise from using more qualitative data collection methods. For instance, fraudulent applications or manipulation by articulate people or more significant potential for inconsistencies in decision-making.

Glasgow City Council argued that whilst the system may 'look' more complicated, the complexity of the benefits system should not be a reason to avoid making changes. They believed rationalising age-related benefits into a single lifetime benefit could aid simplicity. The same criteria could apply across all three benefits, with slightly different rules initially for children and then older people.

A small number highlighted the potential for increased workloads, which could be more intensive initially. For instance, ENABLE Scotland felt a provision for exceptional circumstances could be open to a high level of interpretation and subject to challenge, but this would ease as case law and experience progressed. Two mentioned workload issues that would be ongoing. One suggested case managers would have more work reviewing less standardised information or a greater volume of supporting information.

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

Addressing barriers to participation

Of the quarter of respondents answering this question, the most prevalent theme raised by some was the need to address barriers disabled people faced when engaging with the social security system. Some respondents noted the need to address obstacles when applying for or making awards. 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 therefore considered a priority by some.

Similarly, the second most prevalent theme was that some felt the independent review should prioritise ensuring the system is fair and equitable for disabled people. One individual articulated that being disabled was challenging enough, and case managers should listen with empathy.

Many other suggestions to overcome barriers, all of which have been addressed elsewhere in this report, are noted in Appendix F for completeness.

Other priorities

Some felt that a priority should be revising the ADP application form to: fully capture the impact of mobility issues and accommodate a broader range of conditions; ensure greater accessibility, e.g. someone explaining to the client what the questions meant or offering alternative formats; and to ensure it treats people with dignity, fairness and respect.

A small number mentioned other priorities are outlined in Appendix F.

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)?

Over two thirds of the 52 respondents who answered this question shared comments on making the system more compassionate, enabling and supportive for disabled people.

The prevalent theme, mentioned by some, covered the decision-making approach, mainly that case managers should receive sufficient training to understand different disabilities. Other comments included a call for a shift to using different sources of supporting information, e.g. from unpaid carers and health and social care professionals, whilst two, including SCoRSS, preferred to reduce the use and scope of consultations.

"Mental health is not black and white. It is such a vast medical subject and totally under-resourced that unless the assessor is mental health trained it is not a fair assessment. OT and physio assessors should only cover physical cases with mild mental health conditions." - Individual

The gap between ADP financial awards and the costs incurred by clients due to mobility issues was identified by some respondents. There was also a call for greater flexibility in how awards are made to accommodate individual needs such as to make a contribution towards equipment or travel costs, or to enable clients to top up their payments.

Some respondents raised the need to consider independent support and advice to clients, with independent advocacy mentioned most frequently. Multiple singular points were shared on this issue which are summarised in Appendix F.

Calls for the system to improve to minimise the distress during the application process were shared by some respondents, who used words to describe the existing process such as 'difficult', 'tortuous' and 'dread'. Two noted delays could cause stress, such as lengthy telephone waits or delays in awards. SCoRSS referred to Section 1 of the Care Act 2014 governing England and Wales which places a duty on local authorities to promote the wellbeing of clients during the assessment process, but did not explain further.

Less commonly raised themes, noted in Appendix F, included: calls for spot checks or an audit of decisions to maintain quality; a need to address delays in the system; suggested changes to the application form; and requests to co-design the criteria with clients.

17(a). If you proposed changes, what positive impacts could these have, and for who?

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

17(c). If you proposed changes, how would you prioritise these?

Two main themes emerged on potential positive impacts based on 32 responses to Q17a. Some felt no adverse impacts would arise from suggested changes. However, a less commonly mentioned theme was that they could create a more positive experience for the client navigating the benefits system. Respondents suggested changes might reduce the need for appeals or reduce client financial hardship due to addressing delays.

Fewer than one in twenty respondents answered Q17b. Again, some felt there would be no adverse impacts, while a less common theme was that suggested changes could have workload or financial implications for Social Security Scotland. Two felt there might be more applications or improved ADP take-up; another thought it may take time to allocate cases to a practitioner leading to a longer wait for the client.

No consensus was identified across 17 responses to Q17c. Many singular suggestions were raised, all of which are covered elsewhere in this report.

Deliverability of recommendations

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

An equitable, human rights-based approach

Over a quarter of respondents answered Q18. The most common theme was prioritising a human rights approach, ensuring fairness and equity in the system and the benefits this could bring. Respondents called for an adequate budget, used equitably, to be allocated to achieve this. Some highlighted the Scottish Government should expect costs to increase in a system based on human rights. A small number noted disabled people are more likely to live in poverty and that offering sufficient financial assistance could help address this.

"While we recognise the financial limitations the Scottish Government is operating under, we believe decisions on social security should be made on a people-centred, human rights basis. Social security should be there to support people in need and enhance dignity. Cost considerations must be balanced with the intent behind policy decisions to lift people out of poverty and help people who face associated costs due to disability or an unpaid caring role." - Age Scotland

Financial planning

Financial considerations were noted by several and mentioned in the stakeholder event discussions. The main emphasis was to ensure sound financial planning – identifying needs, forecasting costs, and determining the required budget. A few felt financial management could be improved, with the independent review having a role in scrutinising budgets. Other suggestions included allowing client contributions as part of an option to buy a vehicle or cost savings from making lifelong awards and reducing fraud. One respondent reiterated the Scottish Government's commitment to covering additional expenditure arising from more awards being granted under wider eligibility criteria.

Streamline services

Several argued the system could be streamlined, particularly by moving to indefinite awards for those whose condition is unlikely to improve; this was also mentioned in the event discussions. Others felt minimising fraud, better planning or management, or quicker processing rates could improve deliverability. One individual felt the independent review should develop a detailed plan and realistic timetable, with funding guaranteed.

Improved practice and decision-making

Several highlighted the need to improve decision-making and the use of supporting information for decisions. They argued there would be fewer appeals if the right questions were asked and better decisions made the first time. Cerebral Palsy Scotland noted case managers could only notice vital information if they understood relevant conditions well.

A number of suggestions for improved use of supporting information were made by very small numbers. These are detailed in Appendix F.

Broader social security system issues

Some highlighted the need to ensure affordability considerations do not constrain aspirations for social security in Scotland. The Health and Social Care Alliance Scotland stressed the importance of viewing social security as part of a whole government approach, while Parkinson's UK Scotland felt that as one of the Scottish Government's flagship programmes, the social security system provided a significant opportunity to improve people's lives and should not limit itself to an inherited 'broken' system. Half of the respondents mentioning this theme explicitly endorsed the recommendation of the Disability and Carer Benefits Expert Advisory Group that a reduction in expenditure should not be the purpose of this consultation and subsequent review. More detail on this theme is provided in Appendix F.

"Careful consideration should be given to how to best raise and maximise the revenues available for public services… We recognise that a comprehensive social security system must be adequately funded and would encourage the Scottish Government to approach budgets and revenue raising from the perspective of what services will promote wellbeing and human rights in society, rather than what level of taxation may be seen as "appropriate" and only then fitting public service provision to that arbitrary level." - Health and Social Care Alliance

Less commonly mentioned themes

A few specific comments about co-design and transparency were made by small numbers. These are detailed in Appendix F.

Considering the impact of recommendations on reserved benefits and entitlements – "passporting"

Disabled people receiving a specific rate of PIP or ADP may be entitled or passported to other means-tested benefits retained by the UK Government, including Universal Credit, Employment and Support Allowance and Housing Benefit. Changes to devolved benefits, such as widening the ADP eligibility criteria, could financially impact people receiving passported benefits. The Scottish Government wishes to ensure changes to ADP do not disadvantage or create barriers to receiving passported payments and is seeking views on what the independent review should consider about passporting issues.

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

Just under a quarter of respondents answered Q19. While responses from organisations provided detail, answers from some individuals did not directly address the question.

Joint working between the Scottish and UK Governments

The most prevalent theme was calls for the Scottish Government to work in partnership with the DWP to ensure a smooth transition to a new Scottish social security system. Some felt this should be prioritised and start at the earliest opportunity. Respondents highlighted this would facilitate a more rights-based approach as it would allow the new system to be built on foundations of dignity, fairness and respect. Such work could involve:

• Undertaking impact analysis on potential options to aid decision-making.
• Social Security Scotland supporting transitioning clients to inform appropriate agencies and receive associated passporting benefits.
• Addressing issues anticipated from changes e.g., potential passporting issues caused by using entitlement to ADP to determine qualification for the health element of ESA and Universal Credit.
• Maintaining existing passporting arrangements whilst a new system is introduced e.g., to allow for renegotiation of contracts such as with the AVE Scheme.

Not being constrained by passporting arrangements

The second most common theme was that the independent review should not be constrained by passporting considerations when determining the criteria for devolved benefits, including ADP. There were calls for the Scottish Government to maximise its responsibilities for devolved social security benefits, ensuring it recognises and responds to the specific needs of Scotland's population.

"Consideration around the impact on passporting arrangements must start from a position of refusing to limit the ambition to deliver leading, transformative disability assistance in Scotland." - SCoRSS

Two respondents suggested that any decisions by the independent review to broaden the mobility component criteria should be based on need rather than being driven by financial considerations. EEPPIC and one individual called for a distinct system in Scotland, whereby Scottish clients would not be dependent on passported benefits.

Impact on specific benefits

Another recurring theme was how changes to the ADP eligibility criteria could impact specific passporting benefits. These comments are detailed in Appendix F.

Financial implications

Some respondents commented on the financial implications of the proposals. Comments included the potential financial impact of changes to UK legislation and that the proposals would have little impact if criteria remained similar, as client numbers would be similar. A few argued clients should not have to re-apply for passported benefits:

"Any move away from automatic passporting would have a negative impact on take up of the passport reserved benefit. If claimants in Scotland need to undertake an additional assessment to be eligible for reserved benefits... this is unlikely to be in the best interest of claimants. Furthermore since presumably the cost of an alternative assessment process would fall on the Scottish government, this is also unlikely to be cost effective." - CPAG in Scotland

There were also calls for the independent review to address the needs of the population rather than focus on financial factors. Respondents argued that if that led to an increase in awards, then the Scottish Government should have further discussions with the UK Government over passporting benefits. Conversely, two argued that more independence for clients could lead to cost savings in health and social care, linked to lower staff hours for example, which should be considered when evaluating cost.

Support for passporting

Some participants explicitly supported passporting arrangements and felt these should continue. However, many others assumed that passporting is continuing and implicitly supported this in their comments.

19(a). How much of a priority to you is maintaining the current "passporting" arrangement?

19(b). Please explain why you chose this answer.

Base	n=	% Very high	% High	% Medium	% Low	% Very low
All answering	66	50	23	14	9	5
- Individuals	44	39	25	16	14	7
- Organisations	22	73	18	9	0	0

Just under a quarter gave reasons for their answer to Q19, though a third of these, mostly from individuals, did not directly address the question. The main reasons for high or very high priority ratings were not only to minimise the disruption for clients, but to enhance their quality of life. Other themes covered the need to work with DWP, information provision and the benefits of an improved approach.

The most prevalent theme, raised by several, was 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. A small number highlighted many disabled people already found it challenging to navigate the system:

"Applying for social security has historically been a long and often challenging process, requiring people to large amounts of their personal life and speak about instances in their daily life when they are vulnerable. It is vital that people don't lose out on access to other payments, even if the changes to ADP mean a greater number of those in receipt of payments which would undoubtedly have a knock-on effect on other payments." - Sight Scotland and Sight Scotland Veterans

The value of passporting arrangements in maintaining client wellbeing and a meaningful life was the second most prevalent reason given by some for prioritising passporting arrangements. These comments focused on the improved client quality of life that comes from maximising benefit take-up through automatic passporting, for instance, more secure or adequate incomes and better health and wellbeing. However, some also felt that maintaining passporting arrangements would reduce client stress and anxiety that might occur as a result of changes, especially those requiring a client to reapply.

Some respondents felt the existing system should be maintained or improved to aid the client journey, for instance, by retaining more compassionate criteria and decision-making processes, reducing waiting times and bureaucracy. Keeping the system simple and clear for clients was also highlighted by some respondents to ensure clients are given timely information about their benefit entitlements. RNIB specified this could include giving clients information about their awards, any changes and any action they may need to take.

Very few of the several respondents who rated maintaining passporting as a medium or low priority elaborated on why they felt this way. Most of those who commented indicated that they did not receive passporting benefits, or that they were not essential to them.