Social Security Experience Panels: Personal Independence Payment health assessments

At the health assessment

Many Experience Panel members have reported that undergoing a health assessment as part of their disability benefit application is one of the most stressful aspects of the process. The stressful nature of the health assessment is due to:

• having little to no control over the time and location of the assessment;
• poor transport links to the assessment centre;
• assessment centres not being fully accessible;
• a lack of confidence in assessors, their qualifications, background, inclusiveness and accuracy; and
• negative media portrayal about assessments.

Respondents to this survey were broadly in line with past research, reporting health assessments as highly negative experiences. Respondents used words such as 'exhausting', 'degrading', 'humiliating' and 'stressful' to describe the experience.

There was, across most respondents, concern over the competence, reliability and integrity of the health assessors, as well as of the value and fairness of the way health assessments are currently implemented.

Conduct of health assessors

A great deal of the negative comments from respondents related to the conduct of health assessors during the assessment itself. Respondents reported feeling 'on trial' and 'under suspicion' whilst attending their health assessment.

"…we have been through this process with my son and it felt like we were on trial at court, not a good experience what so ever."

"I have attended PIP interviews with my children and been apalled at how little the person knew about their conditions. They wrote ridiculous comments on the report."

The conduct of assessors was seen by many as 'self confident' and 'arrogant'. Many respondents felt they made 'inaccurate and ill-informed assumptions' about clients and their conditions. Some reported cases of health assessors ignoring their requests or failing to report what they said accurately.

Many respondents also had concerns about the health assesor's knowledge of disabilities and their particular medical condition.

"Having been through two health assessments for PIP, it is obvious that health professionals have no real understanding of the effects of my condition and only very limited and out of date medical knowledge."

"Previous experience with assessments showed a distinct lack of knowledge regarding my symptoms."

Respondents with specific conditions felt particuarly misunderstood:

"My condition (epilepsy) is very misunderstood and I have had numerous problems with assessors in the past."

Some respondents said that they had felt 'condescended' as their assessor had said they had 'never heard of their condition before'. This caused the respondents to feel stressed and reduced their confidence of receiving an accurate, fair and comprehensive health assessment.

In other cases, health assessors who had little knowledge of conditions were seen to ask 'inappropriate requests' of clients, such as asking them to complete tasks which would either be impossible, or painful if they complied.

Many respondents could recall their assessor asking inappropriate questions or making insensitive remarks.

"[The assessor] didn't agree my daughter had problems using the toilet as she didn't wet/soil herself in the interview."

"[The assesor] told me they didn't agree my daughter had problems eating as she wasn't overweight…"

Knowledge of health assessors

It was generally felt that more knowledgeable assessors would lead to more accurate reports, higher quality assessments and fairer outcomes for clients:

"Having someone who has knowledge of the condition will ensure the assessment is fair and time isn't wasted trying to explain your symptoms."

"A decision cannot be made without empathy and a thorough understanding of how any condition impacts a persons life."

For mental health conditions, respondents told us that the manner of interaction would influence how open the client would be with the assessor. Respondents with particular conditions said they felt reluctant or unable to fully express how their condition affects them. In this case, it was felt to be the job of the assessor to work with the client to draw this out. In many cases, respondents said this did not happen.

Many respondents felt that it was 'unlikely' that an assessor could carry out an accurate, thorough and detailed health assessment without having at least a rudimentary understanding of their health condition, or the way in which being disabled can affect someones day to day life.

"You can't assess complex conditions without at least a working knowledge of the claimant's issues."

"I fear clients are not being fairly assessed if the Health Care Professionals do not fully understand their condition."

This was particuarly the case where people have multiple conditions with complex interactions between them and any medication being taken.

The lack of medical and disability related knowledge in assessors led to many respondents perceiving assessors to be lacking in competence. This was further demonstrated by health assessors asking generalised questions, making clients feel the assessment was a 'tick box' exercise, with an assessor 'disinterested' in presenting an accurate picture of their health and it's impact on their life.

"I have in the past been assessed by nurses who don't even know what my conditions are […] They always ask everyone the same questions. Not one question suits all."

"I am fed up of being assessed by nurses who have zero knowledge or experience of the conditions and illnesses that I have, and then the fact they disregard anything you say relating to your conditions as well as evidence provided to support the condition."

In future, many respondents said they would like to see a move away from standardised questions, in favour of a more individualised approach to assessing clients.

Most respondents felt that improving assessor knowledge of disabilities and a move away from generalised questions did not necesserily require assessors to have a medical degree - a well rounded understanding of disabilities and effective training was seen by most to be sufficient.

Assessment reports

At the end of a health assessment, the assessor will write a report detailing their views on the client's health. This report is then used by the decision maker (employed by the Department for Work and Pensions) in deciding whether to award the benefit, and the duration of the benefit award. The quality, accuracy and perceived fairness of the reports were a recurring theme amongst respondents. Respondents tended to not trust what was written by assessors, potentially as a result of the issues of perceived conduct and knowledge discussed above. Some felt it was 'inappropriate' for assessors to dispute evidence presented by the client's doctor or specialist, who was seen to be a 'medical 'expert' in comparison to the assessor.