Social Security experience panels: Personal Independence Payment health assessments part two - main report

Personal Independence Payment Assessments

Previous assessment experiences

We asked respondents a series of questions about their previous PIP assessment experience. Three quarters of respondents (73 per cent) were currently in receipt of PIP and nearly one quarter (23 per cent) had helped someone else to apply for PIP. 2 per cent had received PIP in the past and 2 per cent were applying for PIP for the first time.

Table 9: What is your experience with Personal Independence Payment ( PIP)? (n=379)

	%
I am applying for PIP for the first time	2
I currently receive PIP	73
I have received PIP in the past	2
I have helped someone to apply for PIP	23
Total	100

Nine in ten respondents (90 per cent) had attended a PIP assessment before. Over half of respondents (57 per cent) had attended their own assessment, while just under two in ten (19 per cent) had attended an assessment to support someone else. 14 per cent had attended both their own assessment and to support someone else.

Table 10: Have you attended a PIP assessment before? (n=383)

	%
Yes, my own assessment	57
Yes, supporting someone else	19
Yes, both my own assessment and supporting someone else	14
No	9
Don't know	1
Total	100

Where the assessment was

Just under seven in ten respondents (68 per cent) had their most recent assessment at an assessment centre. Three in ten (31 per cent) had their most recent assessment at home.

Table 11: Where was the most recent assessment that you attended? (n=348)

	%
An assessment centre	68
At home	31
Another location	1
Total	100

How the assessment went

Around four in ten respondents (46 per cent) felt there were positive and negative aspects to their assessment experience. Around four in ten (44 per cent) felt their assessment experience was negative overall, whilst around one in ten (11 per cent) felt their assessment experience was positive overall.

Table 12: How would you describe your assessment experience? (n=343)

	%
I felt my experience was positive overall	11
I felt there were positive and negative aspects to my experience	46
I felt my experience was negative overall	44
Total	101[12]

Assessments over the phone

We asked respondents a series of questions about the possibility of having an assessment over the phone. Respondents were split on whether they would feel comfortable having an assessment over the phone. Around four in ten respondents (41 per cent) said they would feel comfortable and around in ten (43 per cent) said they would not. 16 per cent said they did not know.

Table 13: Would you feel comfortable with having an assessment on the phone? (n=384)

	%
Yes	41
No	43
Don't know	16
Total	100

We asked respondents who said would feel comfortable having an assessment over the phone or that they did not know what time would be the best for them to have an assessment on the phone. The majority of respondents (89 per cent) said that between 9 am and 5 pm would be the best time for them to have an assessment over the phone. Of those respondents, over four in ten (44 per cent) said between 9 am and 12 pm would suit them, whilst four in ten respondents (45 per cent) said between 12 pm and 5 pm would suit them best. Only one in ten (10 per cent) respondents said that times out with 9 am and 5 pm would suit them.

Table 14: What time would be the best for you to have an assessment on the phone? (n=216)

	%
Between 7am and 9am	2
Between 9am and 12pm	44
Between 12pm and 5pm	45
Between 5pm and 8pm	7
None of the above	1
Total	99

Of those same respondents, almost all (96 per cent) said they would be comfortable having an assessment over the phone in their own home. Around two in ten respondents said they would be comfortable at a building or office run by a charity (21 per cent) or at the GP office (18 per cent). 14 per cent said they would feel comfortable having an assessment over the phone at a Social Security Scotland venue. The least popular options were at a local authority office and a local library.

Table 15: Where would you be comfortable having an assessment on the phone? Tick all that apply (n=216)

	%
In my home	96
At a building or office run by a charity	21
At the GP office	18
At a Social Security Scotland venue	14
Local authority office	10
My local library	4
None of these	2

We asked those same respondents what devices they would use for the assessment over the phone. The most popular options were personal mobile phone (69 per cent) or landline (70 per cent). This was followed by personal PC or laptop (19 per cent) or tablet (22 per cent). Under one in ten respondents said they would use someone else's phone, tablet or laptop (7 per cent) or a phone that is available in a public area (8 per cent).

Table 16: What devices would you use to have an assessment on the phone? Tick all that apply (n=216)

	%
My own landline	70
My own mobile phone	69
My own PC/laptop	19
My own tablet	22
A phone that is available in public areas (e.g. local authority site)	8
Someone else's phone/tablet/laptop	7
None of these	1

Difficulties with an assessment over the phone

Most respondents thought there would be difficulties with having an assessment on the phone. Seven in ten of all respondents (72 per cent) thought there would be difficulties compared to 16 per cent who did not. One in ten respondents said they did not know.

Table 17: Do you think there would be any difficulties with having an assessment on the phone? (n=383)

	%
Yes	72
No	16
Don't know	11
Total	100

Of those respondents who said there would be difficulties with having an assessment over the phone, nearly four in ten (39 per cent) said the main difficulty would expressing themselves properly. Over one in ten (14 per cent) thought the main difficulty would be not being able to see the assessor. Collectively, problems with call quality, signal issues, not being able to hear the assessor and finding it hard to speak loudly accounted for around two in ten responses (19 per cent).

Table 18: What do you think would be the main difficulty in having an assessment on the phone? (n=319)

	%
I find it hard to express myself properly over the phone	39
Other	27
Not being able to see the assessor	14
Not being able to hear the assessor	8
Problems with call quality	5
Problems with signal issues	3
I find it hard to speak loudly	3
I do not have access to a phone	0
Total	100

Of those respondents who selected 'other' to indicate that they thought another issue would be the main difficulty in having an assessment over the phone, most respondents referred to a combination of the responses already listed. Many respondents said their health condition would be the main difficulty. For example, a few respondents explained that they would have difficulty holding a phone for a period of time or said that their hearing loss meant phone would not be an option. Other respondents explained that their mental health condition would be the main difficulty, with some stating that phone calls make them anxious.

"I get anxiety with being on the phone and have panic attacks afterwards."

"Autism makes it very difficult to know how to speak on the phone, and I would feel rushed. I can't answer questions quickly. There's also no way to take a break."

A few respondents said there would not be enough time to think over the phone, or that they may struggle to understand the assessor or respond in the way they wish to.

"Understanding the assessor and my being able to reply with exactly the right words."

Some respondents said the main difficulty in having an assessment over the phone would be the lack of in person contact. These respondents considered body language and non-verbal indicators a vital aspect of communication. Many respondents said the main difficulty in having an assessment on the phone would be the assessor not being able to see them. These respondents felt that it was important that an assessor see them physically to get a full and accurate understanding of their health condition or disability.

"I would want visual confirmation that the assessor was actively listening and picking up on non-verbal input from me."

"The assessor in my opinion, needs to see people in the flesh so they can see for themselves how the disability impacts a person."

Without an in person interaction, some of these respondents felt that their assessment may be inaccurate, or certain aspects may be misinterpreted if conducted over the phone.

"Any point, no matter how well expressed, can be misinterpreted at the telephone. It is only by face to face that a proper assessment can be completed."

"Not being able to see the facial expressions and body movements and language of person being assessed inevitably means fewer factors on which to base assessment and higher risk of misunderstanding and underestimating their issues. Vice-versa, not seeing assessor's face and body language can lead to less trust and less inclination to participate leading to lack of vital information."

Other respondents felt that an assessment over the phone may be 'impersonal', whilst a few raised concerns about security.

"Misrepresentation of my true situation by the assessor."

"Can't be sure if it is a genuine PIP assessor."

Assessment preferences

If applying for PIP for the first time, over half of respondents (54 per cent) said they would want to find out when being told they need an assessment. Just under half (47 per cent) said they would like this information before they apply. Just under three in ten respondents (28 per cent) said they would want to find out what happens in an assessment immediately after submitting their application. Around one in ten respondents said they would want to find out what happens in assessment the week (10 per cent) or day (8 per cent) before the assessment itself.

Table 19: If you were applying for PIP for the first time for yourself or someone else, when would you want to find out what happens in an assessment? Tick all that apply (n=378)

	%
Before I apply for the benefit	47
Immediately after I have submitted my application	28
When I am told I need an assessment	54
The week before my assessment	10
On the day of my assessment	8

Nearly half of respondents (47 per cent) said that a face to face assessment in their home would suit them best. This was followed by one quarter of respondents (24 per cent) who said a face to face assessment at a location near them (e.g. GP, Third Sector venue) and nearly two in ten (18 per cent) who said an assessment over the phone would suit them best. Face to face assessment at a Social Security Scotland venue was the least popular option, with just over one in ten respondents (12 per cent).

Table 20: If you had to have an assessment, which option would suit you best? (n=381)

	%
Face to face assessment in my home	47
Face to face assessment at a location near me (e.g. GP, Third Sector venue)	24
Assessment over a phone call	18
Face to face assessment at a Social Security Scotland venue	12
Total	101

Home assessments

Of those respondents who said an assessment in their home would suit them best, seven in ten respondents (70 per cent) said this was because their disability, mental health or long term health condition makes it difficult for them to leave home. Just under seven in ten respondents (69 per cent) said they would feel more comfortable in their own home. One quarter (26 per cent) said an assessment in their home would suit them best because they would not need to spend time travelling. These findings are broadly similar to previous research with Experience Panel members on home visit appointments more generally, where the most common reason survey respondents said they would need a home visit was due to their disability, mental health or long term health condition (78 per cent). Around a fifth of respondents said caring responsibilities restricted them from visiting a Social Security Scotland office (22 per cent) with a further 16 per cent saying they would struggle with transport.^[13]

Table 21: Why would having an assessment in your home suit you best? Tick all that apply (n=177)

	%
My disability, mental health or long term health condition makes it difficult for me to leave my home	70
I would feel more comfortable in my home	69
I would not spend my time travelling	26
It would not cost me money to travel	14
There are poor transport links in my area	12
Other	11
I have caring responsibilities	10

Of those respondents who selected 'other' to indicate another reason that an assessment in their home would suit them best, most responses referred to the existing themes above. Others said that a home assessment provided the assessor with a better understanding of their condition.

"I can demonstrate how I manage my conditions with aids etc. here, I am unable to do that elsewhere."

Three quarters of respondents (76 per cent) said they would like to state their preferences for an assessment on the initial application form. Two in ten respondents overall (24 per cent) said they would like to tell Social Security Scotland their preferences after being invited to an assessment, either online, over the phone or by post.

Selecting assessment preferences

Table 22: How would you like to tell us about your preferences for your assessment, such as whether you want it at home, at Social Security Scotland venue or over the phone? (n=379)

	%
On the PIP application form	76
Online after receiving an invite to an assessment	10
Over the phone after receiving an invite to an assessment	8
By post after receiving an invite to an assessment	6
Total	100

Assessment guidance

Nearly half of respondents (47 per cent) said Social Security Scotland's website is the first place they would look for guidance about assessments with Social Security Scotland. The second most popular place to look for guidance would be at a support organisation e.g. Citizens Advice Bureau or Welfare Rights, with over one third of respondents (35 per cent) stating this. Combined, all other potential places to look for guidance about assessments were only chosen by under two in ten respondents (19 per cent). None were chosen by more than one in twenty respondents (5 per cent).

Table 23: Where is the first place you would look for guidance about assessments with Social Security Scotland? (n=379)

	%
On Social Security Scotland's website	47
Support organisation e.g. Citizens Advice Bureau or Welfare Rights	35
Online forums	5
Other	5
An advocate	4
On the phone to Social Security Scotland	3
Family and friends	1
GP office	1
Total	100

Of the respondents who selected 'other' to indicate they would look for guidance about assessments with Social Security Scotland elsewhere, most indicated a combination of the options listed above. A few respondents said they would look first to their carer for guidance.

Assessment support

Nine in ten respondents (89 per cent) said they would want to involve someone such as a family member, carer or advocate to support them during the assessment.

Table 24: Would you want to involve someone to support you in your assessment? For example, a family member, carer or advocate? (n=380)

	%
Yes	89
No	11
Total	100

Of those who said they would want to involve someone to support them at the assessment, seven in ten (70 per cent) said they would like to involve a family member. Half of respondents (51 per cent) said an advocate and over one third (35 per cent) said a carer.

Table 25: Who would you like to support you at an assessment? Tick all that apply (n=339)

	%
A family member	70
An advocate	51
A carer	35
Interpreter	2
Other	10

Of respondents who said they would involve another person to support them at their assessment, most said they would involve a friend. Other responses included: social worker, welfare rights worker, support worker, an official from Citizen's Advice Bureau.

Almost all respondents (94 per cent) said they would said they would like the person to support them by being in the room or on the phone with them. Over one third (36 per cent) would ask their supporter to provide a written statement of support.

Table 26: How would you like the person to support you at an assessment? Tick all that apply (n=339)

	%
I would want them in the room with me or on the phone with me	94
I would ask them to give me a written statement of support	36
Other	10

Of respondents who indicated they would like the person to support them in another way, most said they would want the person to help them communicate or speak on their behalf. This including clarifying questions and helping them to remember to convey important information to the assessor. A few respondents said they would like the person to support them by remembering the assessment and discussion afterwards.

"I may wish them to speak on my behalf if I get confused or have sensory/mental impairment."

"The person usually helps me to mention things that I forget or they can explain things better than me."

"To help remember the information given to me or to help with my memory loss."

Improving assessments

We asked respondents if there is anything else Social Security could do differently when it takes over responsibility for PIP assessments. Many of the themes covered by respondents in this question mirror and confirm those from previous Experience Panels research on assessments.^[14] These findings have already informed decisions about assessments which were outlined in the introduction:

• Use medically trained health and social care professionals to conduct assessments. Assessors should have in-depth knowledge of a particular clients' health conditions.
• Assessments should not be carried out by an external, third party organisation.
• Assessments should be conducted in a way which treats people fairly and respectfully and assessors should believe and listen to clients.
• Assessments should be reported on truthfully and accurately. Assessments should be recorded and clients should be provided with a copy of the assessment report for checking before it is formally submitted.
• Reduce assessments if medical evidence can be provided at the application stage to show qualification for the benefit.
• Ensure assessment spaces are accessible, close to home and friendly and offer flexibility to book, choose and change assessment appointments.

Digital devices and services

Finally, we asked respondents about their access to a range of devices and services. Nearly all respondents (96 per cent) have access to an internet connection in their home. Landline, laptop or computer and smartphone were selected by around seven in ten respondents. Only three in ten respondents (30 per cent) have access to a webcam.^[15]

Table 27: Which of these do you have access to in your home? Tick all that apply (n=376)

	%
Internet connection	96
Landline	78
Smartphone	77
Laptop or computer	75
Tablet	53
Webcam	30

Just under three in ten respondents (28 per cent) said that they use assistive technology.

Table 28: Do you use any assistive technology? (n=381)

	%
Yes	28
No	72
Total	100

Of those respondents who said they use assistive technology, the various types are listed in table 29. The most common responses were a mobility stick (50 per cent), and a magnifying glass (41 per cent), followed by screen magnification software (21 per cent). The least common responses were literacy software (7 per cent) and assistive joystick/trackpad (5 per cent). Head pointer and eye tracking keyboard were not selected by any participants.

Table 29: What kind of assistive technology do you use? Tick all that apply (n=101)

	%
Mobility stick	50
Magnifying glass	41
Screen magnification software	21
Other	19
Screen-reader	16
On-screen keyboard	16
Speech input software	13
Literacy software	7
Assistive joystick/trackpad	5
Eye-tracking keyboard	0
Head pointer	0