Disability assistance in Scotland: response to consultation

4. Section 3 - Disability Assistance for Working Age People (DAWAP)

Section 3 of the consultation focused on Disability payments for people of working age. Currently DWP provide Personal Independence Payment to people age 16 to age 65. The consultation set out Scottish Government’s intention to link the entitlement age for Disability payments for older people to the state pension age, it was therefore proposed the eligibility age for DAWAP would be from age 16 up to state pension age (age 66 by 2020).

4.1 Policy Proposal – Benefit rules: Points Based System

We know that there are mixed views on the use of a points based system for the devolved replacement for Personal Independence Payments. We will ensure that this system is administered in a much fairer, transparent and person-centerd way that will better consider the needs of clients including those with fluctuating conditions and with mental health conditions.

The consultation proposed the criteria for awarding DAWAP would be determined on a “points-based” test against a list of daily living and mobility activities.

Respondent Feedback

A majority of respondents agreed (57% of respondents who answered) with our approach to use a points-based system to assess eligibility for DAWAP. However, we received some feedback that a points-based system is unfair because it lacks the flexibility to determine levels of fluctuating or variable conditions. Respondents also suggested that a points-based system is incompatible with a person-centred approach.

Respondents made a significant number of alternative suggestions for determining eligibility:

• The system should be based on the input of professionals taking part in care (e.g. GPs, consultants, social workers) and not just one assessor or decision-maker;
• The system should include a qualified or trained assessor’s input;
• The system needs a more person-centred approach, and not just a medicalised understanding of disability, and;
• An alternative system based on medical supporting information rather than points.

Scottish Government Response

Our key priority is ensuring a safe and secure transition to devolved disability assistance, ensuring that individuals continue to receive their payments in the correct amount at the right time. That has driven our approach to introducing DAWAP largely using the existing point based system.

Under current DWP administration, clients in receipt of disability benefits may be entitled to additional 'passported' benefits and DWP premiums where the disability benefit acts as a 'passport' to automatic entitlement of additional benefits or premiums. There is a risk that, should eligibility rules diverge significantly from current DWP rules, Disability Assistance may not continue to be recognised as 'like for like' for passporting purposes. This would cause unfairness, confusion and disruption for clients by creating a two-tier benefits system, with two different sets of eligibility criteria and rules, whilst undertaking a significantly complicated transfer process.

That being said, the Scottish Government agrees that the way the current points based system is applied is not consistent in adequately assessing fluctuating, variable or mental health conditions. We are exploring how the rules surrounding the points based system can be developed so Case Managers and assessors can better use it to capture the needs of individuals with such conditions. In addition, we are developing guidance and training to assist Case Managers to use the current points system to take a person-centred approach to decision making.

This will include comprehensive information on how the descriptors should be applied when considering fluctuating, variable and mental health conditions. Case Managers will also have access to Specialist Advisors when required. Like assessors, Specialist Advisors will have professional experience in health and social care provision and will provide a comprehensive insight into assessing the impact of a condition.

Training for all staff will include an understanding of the social model of disability how to interpret legislation and supporting information, whilst Social Security Scotland staff will receive training to develop an understanding of the impact of common conditions.

4.2 Policy Proposal – Benefit rules: Mobility descriptor

We know that there are specific concerns regarding the way that the current assessment of mobility is undertaken in relation to Personal Independence Payments. We requested in the consultation views from respondents on the best way of assessment entitlement to the mobility component and will undertake further work with stakeholders to consider how these concerns might be addressed.

The consultation recognised that there are specific significant concerns about the way in which the ability to move around is currently assessed and measured, particularly the use of the 20, 50 and 200 metre rules and the ‘50% rule’ applied to all descriptors. We therefore sought views on the best way of assessing entitlement to the mobility component.

Respondent Feedback

Alternative methods of assessing mobility produced a high volume of responses with most respondents focusing on the sources of supporting information they thought should be used to assess mobility eligibility. Suggestions included seeking supporting information from:

• Medical consultants;
• Medical experts;
• Allied healthcare professionals including occupational therapists and physiotherapists;
• Mobility assessments conducted by a GP;
• Family members, carers or other personal contacts, and;
• Social work assessments.

Respondents highlighted that the mobility descriptor should be more effective in assessing the ways in which mental health can affect mobility, for example, how mental health issues may restrict an individual’s ability to travel.

Suggestions made to address this included:

• Widening the descriptors to include more than just ‘psychological distress’;
• Providing extra support or counselling for those with mental health conditions, and;
• Producing paper-based reports to reduce face to face assessments.

Another issue highlighted by respondents was the need to improve application of the current rules to better accommodate fluctuating or hidden conditions like multiple sclerosis, lupus, Ehler’s Danlos syndrome, dyspraxia, fibromyalgia or myalgic encephalomyelitis. Respondents suggested assessing an individual on an ‘average’ day or considering symptoms on a ‘worst’ day rather than a ‘best’ day.

Many respondents felt that the system used to assess mobility, in particular, whether a person can stand and move more than 20 metres, was overly simplistic and lacks consideration of scenarios individuals will encounter in their everyday life. Respondents suggested that an alternative to this rule could be a focus on whether an individual can undertake everyday activities incorporating an element of mobility.

Scottish Government Response

We are working with stakeholders to consider how we can amend the 20, 50 and 200 metre descriptors to better assess the impact an individual’s condition has on their mobility. The responses to the consultation will be key to informing that work. In addition to developing quality guidance and training to enable Case Managers to assess mobility in a person centred way will contribute to an improved decision making process. We are similarly exploring what changes could be made to the 50% rule so that the needs of individuals with fluctuating conditions can be better captured.

4.3 Policy Proposal – Full list of Descriptors

We know that there are concerns about the current application of the system of points based descriptors and the proposal in the consultation set out how a points based system might be delivered for Disability Assistance for Working Age People. We will further consider how to best take account of client needs, within the points based system, in a way that better ensures fairness and transparency.

The consultation proposed that Case Managers will determine DAWAP claims by applying a points-based test that largely includes the existing daily living and mobility activities, except where commitments to review specific descriptors were made. Each activity has a number of descriptors with a number of points associated with each descriptor.

Respondent Feedback

Many organisations provided comments and recommendations on the individual descriptors, these included:

• A requirement to take more account of extra support needed in terms of people needing prompting, continuous supervision or motivation;
• To apply points in a person centred way, for example to take account of the quality and range of food consumed or time required for self-monitoring;
• Providing clarity about what the descriptors mean and what is being assessed, and;
• Improving how the activities and points are applied to clients with a sensory health condition.

Scottish Government Response

We are committed to taking a person-centred approach to determining entitlement to DAWAP. Our Case Managers will look holistically at each client’s case, taking account of how each person’s conditions affect them on a daily basis. We will publish clear and transparent guidance that clearly communicates what Case Managers are assessing and what information we need.

We will work with stakeholders to consider how application of the descriptors can better accommodate individual circumstances. The Scottish Government recognises that there are limitations to the existing descriptors, particularly as they apply to individuals with particular conditions and disabilities. Once the transfer of individuals to devolved disability assistance is complete we are committed to considering more aspirational changes to the DAWAP framework.

4.4 Policy Proposal – Face-to-Face Assessments

We know that one of the key areas of concern within the current system is the delivery of face to face assessments for Personal Independence Payments and we understand that this is a key priority for disabled people, and their families, that the devolution of social security must address. Our proposals are designed to ensure that face to face assessments will only be used where it is the only practicable way to assess entitlement, significantly reducing the anxiety of attending assessments for many disabled people.

We know that many people have said that they have had to travel to far to attend an assessment and we sought views on acceptable distances to travel to start to understand how we can better meet the needs of disabled people in delivery of the assessments service.

We also know that some clients felt that what they reported to their assessor was not reflected in their award and to address this and to further embed the principles of trust and transparency, we sought views on the use of audio recordings at face to face assessments.

In the circumstances where someone is required to attend a face-to-face assessment we want to make sure the process is right for people and will treat people with dignity and respect. The consultation therefore sought views on the types of observations that may be appropriate when conducting a face-to-face assessment.

To ensure that the system we build is fair and meets the needs of the people using it, we sought further views on:

• Acceptable distances to travel to attend a face-to-face assessments;
• The rescheduling of failure to attend a face-to-face assessment, and;
• The use of audio recordings at face-to-face assessments.

Respondent Feedback

Respondents provided us with examples of the types of observation that they felt should not be taken into account, including:

• Movement, strength and sight tests (if unsafe or painful);
• Behavioural observations;
• Judgemental observations or assumptions made by the assessor (i.e. observations unsupported by any other supporting information);
• Informal observations are inappropriate for certain conditions or disabilities (e.g. autism, Asperger’s syndrome, cognitive recall issues, mental health, brain injuries, depression, neurological issues, hearing loss);
• Observations about how the individual travelled to or arrived at the assessment appointment (e.g. with or without an aid);
• Observations where supporting information already exists to back up the effects of the condition (or only have observations supported by supporting information);
• Observations relating to protected characteristics (i.e. age, race, gender or sexuality), and;
• Observations taken out with the face-to-face assessment.

Respondents also cited provisos or problems with travelling to face-to-face assessments, however some cited potential appropriate distances to travel from less than 5 miles up to 30 miles. A consistent viewpoint was that the assessment should be local to where the client lives. Respondents suggested we should consider:

• The nature of the individual’s disability or health condition;
• Transport availability;
• Financial implications of travel;
• Levels of care or support required to travel, and;
• The potential health implications of travelling.

The majority of respondents provided suggestions to the number of times a client should be able to reschedule or fail to attend an appointment for a face-to-face assessment. The most popular answer was three times. However, some organisations felt there should be no limit to rescheduling appointments.

Respondents felt that the following reasons justify missing an assessment due to exceptional circumstances:

• Hospital admissions;
• Illness;
• Bereavement;
• Care responsibilities;
• Lack of carer availability;
• Lack of childcare availability;
• Transport issues on the day, and;
• Adverse weather.

Many respondents to the consultation were positive about the proposals to use audio recording for face-to-face assessments. Respondents caveated this with the view that any recording requires the client’s consent. It was felt that introducing this into the assessment process would promote honesty and integrity and introduce a method of clarifying contentious issues.

Scottish Government Response

We know that the current approach to the use of informal observations is not well received, often leading to inaccurate conclusions in assessment reports. Significant numbers of respondents made comments about how they perceived and how assessments should be conducted; a key concern being that informal observations need to be discussed openly during the assessment in order to be transparent.

In response to this feedback and advice received from the Disability and Carers Benefit Expert Advisory Group, we will therefore ensure that:

• Specific guidance, training and resources are developed for assessors regarding informal observations;
• Clients must be made aware of what informal observations are, why they are being made and what impact they will have on the decision;
• All clients must be informed of what observations have been made in the assessment and any inferences the assessor draws from them;
• The client, or person accompanying them, must be given the opportunity to respond to the assessor’s observations;
• All observations made and any response provided by the client, or their advocate, must be recorded; and
• Informal observations must be restricted to the assessment itself – observations cannot be made in the assessment centre (e.g. from the waiting room/car park etc. to assessment room) or on the person’s journey to and from the assessment centre.

Individuals will be able to cancel and re-arrange their assessments. Work is underway to model the impact this will have on the efficiency of the assessment service to ensure, for example, that this policy does not have a detrimental impact on the length of time clients have to wait for an assessment. This will help us refine how many times and on what basis appointments can be cancelled including any exceptions that can be applied.

We remain committed to ensuring that individuals who require an assessment are able to undergo the assessment in a way that meets their needs, this includes the provision of home assessments for those who require them. As we continue working to put the various arrangements required to deliver assessments in place we will work with stakeholder organisations and carry out user testing to ensure the procedures developed in this area are person centred, and deliver dignity, fairness and respect.

Audio recording of assessments will be standard practice but a client will be able to opt out if they choose.