Watchdog’s ‘issues of concern’ over regulator’s treatment of PIP complaints

PSA logo

A regulator has been told there are “issues of concern” about the way it deals with complaints against health and care professionals, including those who write dishonest benefit assessment reports.

The Professional Standards Authority (PSA) agreed in January to look at concerns about the way regulators deal with complaints about nurses, physiotherapists and paramedics who carry out personal independence payment (PIP) assessments for the outsourcing giants Capita and Atos.

It agreed to act after being contacted last year by disabled activist Mark Lucas, who has twice appealed successfully against the results of what he believes were dishonest PIP assessments.

Hundreds of disabled people have come forward over the last 18 months to tell Disability News Service (DNS) how assessors working for Atos and Capita wrote dishonest PIP assessment reports on behalf of the Department for Work and Pensions.

Many also raised concerns about the apparent refusal of the Health and Care Professions Council (HCPC) and the Nursing and Midwifery Council (NMC) to take their complaints about these assessments seriously.

Only this week, Lucas received an email from HCPC, explaining that it would not take any further action over his complaint about an occupational therapist who had assessed him for PIP.

He believes the assessor deliberately downplayed the seriousness and frequency of his seizures, but HCPC told him it did not believe this had happened and even if it had, “it would be considered a minor error, which would not be capable of amounting to an allegation of impaired fitness to practice”.

Lucas has twice been found ineligible for PIP following assessments, but on both occasions was later awarded eligibility for the PIP standard daily living rate after appealing to a tribunal.

Frustrated at HCPC’s failure to take another complaint about a PIP assessor seriously, he contacted PSA – which reviews the work of the regulators of health and care professionals – last year.

PSA incorporated Lucas’s concerns into its annual review of HCPC, which found this month that the regulator was meeting only four of the 10 required standards for the way it deals with complaints against healthcare professionals, including those who carry out PIP assessments.

Last year, before Lucas contacted the regulator, PSA had reviewed 100 complaints made to HCPC, including a small number relating to PIP assessments.

David Martin, PSA’s concerns and appointments officer, said the 2017-18 review “concluded that there were issues of concern about the HCPC’s process across all of its activity”, in relation to fitness to practise.

These concerns include the way it deals with the initial stages of the fitness to practise process, and how it determines if there is a “case to answer” against a health and care professional.

Among PSA’s concerns are that HCPC makes it too difficult for complaints about a healthcare professional to be accepted into the fitness to practise process, while other cases are closed at the initial stage instead of being referred to an investigating committee panel.

Martin said HCPC had confirmed that PIP assessment work “should be considered in the same way as any other professional activity of its registrants” and that its procedures “require it to fully consider the concerns it receives about PIP assessors”.

He said: “The HCPC was clear that it considers registrants, acting as PIP assessors, are exercising their professional judgement.

“It therefore considers that allegations of misconduct or lack of competence when carrying out PIP assessments could constitute a fitness to practise concern to be investigated in accordance with its usual process.”

He said HCPC was now “undertaking an action plan” to address the concerns PSA has raised about its fitness to practise processes, and that PSA would probably review further HCPC cases in detail over the next couple of years.

A similar annual review by PSA of NMC is due to be published later this year.

An HCPC spokesman said: “The PSA audited a sample of 100 of our cases as part of their review of our yearly performance review in 2016-17.

“While a small number of these cases related to PIP, the audit was not specifically looking at HCPC’s handling of PIP cases.

“HCPC registrants who are employed in assessor roles are recruited because of their skills and experience as registered health professionals. Therefore, their work and conduct needs to comply with our standards.

“If in the course of conducting a PIP assessment a concern is raised regarding a registrant’s fitness to practise, ie lack of competence or misconduct, then this will be investigated following the same robust and thorough processes and applying the same tests as concerns raised in relation to any other area of a registrant’s practice.

“We have also provided input into the PSA’s review into how regulators approach fitness to practise concerns in relation to PIP assessments and have confirmed our view that the PIP assessment process requires the registrant to employ their professional competencies.

“This year we continued to meet the majority of the PSA’s Standards for Good Regulation.

“Although we did not meet all the standards relating to fitness to practise, the PSA has acknowledged our on-going work to improve our performance in this area and stated that we have made ‘significant progress during this review period’.

“We continue our programme of improvement work to address the issues that were previously identified.”

But Lucas was heavily critical of PSA’s efforts to address his concerns.

He said PSA was “a joke” and a “toothless quango”.

He said: “I am not happy with the way PSA have treated me and it is behaviour that I have been subjected to on many occasions over the last few years.”

Lucas said that complaints processes are “designed to abuse” disabled people because they first “promise the earth”, then “forget” the complaint, and finally “communicate the result from the complaint in a letter with preapproved techniques of neutralisation and consolatory phrases like ‘we realise you will be disappointed’”.

He said: “This experience of the last few years has given me anxiety over making complaints.

“I have spent much time and written many letters, but it is all for nothing because organisations like the PSA are just for show.”

source


 

A note from the [DNS] editor:

For nine years, Disability News Service has survived largely through the support of a small number of disability organisations – most of them user-led – that have subscribed to its weekly supply of news stories. That support has been incredibly valuable but is no longer enough to keep DNS financially viable.

For this reason, please consider making a voluntary financial contribution to support its work and allow it to continue producing independent, carefully-researched news stories that focus on the lives and rights of disabled people and their organisations.

Please do not contribute if you cannot afford to do so, and please remember that DNS is not a charity. It is run and owned by disabled journalist John Pring, and has been from its launch in April 2009. 

Thank you for anything you can do to support the work of DNS…

Advertisements

The DWP hoped we’d miss it changing a PIP rule

The DWP hoped we’d miss it changing the rules surrounding a crucial benefit. Wrong.

The DWP hoped we’d miss it changing the rules surrounding a crucial benefit. Wrong.

The Department for Work and Pensions (DWP) quietly updated the guidance for a key welfare payment on Monday 16 July. It probably hoped no one would notice – as the change seems to completely ignore a court ruling from December 2017.

The DWP: words are everything

The DWP has issued an update for assessors of the Personal Independence Payment (PIP). It states that the update is for:

Part 2 [of the PIP assessment guide] – the term ‘anxious’ changed to ‘panicked’ in the illustrative example for descriptor B in activity 11 ‘planning and following journeys’.

The change forms part of the guidance for “Activity 11 – planning and following journeys”, an element within the PIP assessment on which assessors score claimants. It specifically relates to “descriptor B”, the second-lowest level on which people can score points towards their PIP claim (there are six levels in total). In context, “panicked” replaced “anxious”. Below is the DWP’s example of what a claimant would need to display to get the points for the descriptor:

The claimant becomes panicked before any journey and they are only able to get out of the door if someone provides encouragement and reassurance that there are no dangers or threats as a result of going outside.

This is instead of: “The claimant becomes anxious before any journey…”. The changing of one word may appear insignificant. But there’s a major reason why it’s not.

Ignoring a court judgement 

Firstly, the DWP was forced to change the Activity 11 part of the PIP guidance in June. This followed a court ruling in December 2017 which stated that this part of the PIP guidance was discriminatory against people living with mental health conditions.

A claimant, known as “RF”, brought the case against the government because she believed changes to the PIP would have a “significant negative impact” on her life. It was because the government had previously altered the PIP criteria around making journeys in such a way that people living with mental health conditions were adversely affected.

The court ruling specifically related [pdf, p11] to other descriptors, which the DWP has changed. But in now changing descriptor B, the DWP may well have re-discriminated against people living with mental health conditions.

A professional speaks

Clinical psychologist Dr Jay Watts explained the importance of the word change to The Canary:

It will essentially reduce the number of people who meet that part of the PIP criteria – saving the government money, yes. But this will be at the cost of the welfare of people with mental health conditions.

‘Panicked’ implies experiences akin to a panic attack – things like heart palpitations, sweating, thinking one is about to die or have a heart attack etc. It carries with it the idea of a response with a sudden onset clearly linked to going outside. Only a small subsection of mental health patients experience panic attacks whilst anxiety is a core feature in nearly all mental health conditions.

The term ‘anxious’ was a far more inclusive (though still problematic) term. Feeling anxious is an experience common to nearly all mental health conditions and there is less need to link it to a stand-alone episode. Unlike the word ‘panicked’. This is important as concern about going out tends to bleed into other anxieties and can be difficult to delineate from other concerns. The more general term ‘anxious’ also incorporated different forms of reactions to going out. For example, someone with a diagnosis of depression or schizophrenia might feel a blanket dread, a profound physical exhaustion or thought disorder as a response to the idea of going outside. Claimants are unlikely to categorise this as ‘panicked’, meaning they lose out on the financial support so crucial to improving quality of life.

A danger to claimants’ health

The Canary asked the DWP for comment, but it had not responded at the time of publication.

As Watts concluded:

One would have thought that the DWP would be bent on making the mobility criteria more inclusive after RF’s landmark high court victory on precisely this matter only seven months ago. Instead, we have yet another move seemingly designed to differentially discriminate against the majority of people with mental health conditions.

But with its track record on court cases, and when there have been five international reports (all scathing of the DWP and successive governments), observing the rule of law appears to be the last thing the department is concerned with. Its overriding preoccupation with forcing people into work is a danger to claimants’ health.

source


more DWP news

 

Review For PIP Planning And Following Journeys Cases Finally Starts

Since the Review For PIP Planning And Following Journeys Cases Finally Starts I thought I’d add this article on the subject


Mobility – Activity 1: Planning and following a journey

Activity 1 considers a claimant’s ability to follow the route of a familiar or unfamiliar journey as well as to plan and undertake a journey. As with all the other activities, a claimant is to be assessed as satisfying a descriptor only if they can do so reliably.

Descriptors

The descriptors for Activity 1 are –

  1. Can plan and follow the route of a journey unaided. 0 points
  2. Needs prompting to be able to undertake any journey to avoid overwhelming psychological distress to the claimant. 4 points
  3. For reasons other than psychological distress cannot plan the route of a journey. 8 points
  4. For reasons other than psychological distress cannot follow the route of an unfamiliar journey without another person, assistance dog or orientation aid. 10 points
  5. Cannot undertake any journey because it would cause overwhelming psychological distress to the claimant. 10 points
  6. For reasons other than psychological distress cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid. 12 points

Source: Part 3 of Schedule 1 to the Social Security (Personal Independence Payment) Regulations 2013 (SI.No.377/2013) as amended (with effect from 16 March 2017) by regulation 2 of the Social Security (Personal Independence Payment) (Amendment) Regulations 2017 (SI.No.194/2017)

NB – the March 2017 amendments made by SI.No.194/2017 to descriptors c, d and f – that added the words ‘For reasons other than psychological distress’ – have been held to be unlawful by the High Court in [2017] EWHC 3375 (Admin). Amendment regulations, in force from 15 June 2018 (SR.No.121/2018), have been issued in Northern Ireland to remove the words from descriptors c, d and f. Until the regulations that apply to Great Britain are amended, the descriptors should be read as if those words are not part of them. For further details, see our case law commentarybelow.


Definitions

Terms used in the PIP descriptors are defined in regulations and, in relation to Activity 2, are –

  • “aid or appliance” – (a) means any device which improves, provides or replaces [the claimant’s] impaired physical or mental function; and (b) includes a prosthesis;
  • “assistance dog” means a dog trained to guide or assist a person with a sensory impairment;
  • “orientation aid” means a specialist aid designed to assist disabled people to follow a route safely;
  • “prompting” means reminding, encouraging or explaining by another person;
  • “psychological distress” means distress related to an enduring mental health condition or an intellectual or cognitive impairment;
  • “unaided” means without – (a) the use of an aid or appliance; or (b) supervision, prompting or assistance.

Source: Regulation 2 and Part 1 of Schedule 1 to the Social Security (Personal Independence Payment) Regulations 2013 (SI.No.377/2013)

See also DWP guidance on the ‘planning and following a journey’ activity from the Personal Independence Payment assessment guide for assessment providers (part 2).


Case law

Commentary: A three-judge panel in [2016] UKUT 531 (AAC) (the MH case) considered the meaning of ‘to plan and follow a journey’ (descriptors c, d, and f) which had been subject to conflicting interpretations in earlier cases – [2015] UKUT 344 (AAC)[2015] UKUT 386 (AAC), and [2015] UKUT 694 (AAC). The panel held, in a decision dated 28 November 2016, that the descriptors could be met by a person experiencing overwhelming psychological distress. To reverse the effect of this ruling, the government amended the PIP Regulations from 16 March 2017 to explicitly exclude psychological distress as a means of meeting descriptors c, d. and f.

However, in December 2017, the High Court ruled in [2017] EWHC 3375 (Admin) that the March 2017 amendments were unlawful and should be quashed and, in a written statement in the House of Commons on 19 January 2018, the Work and Pensions Secretary announced that ‘after careful consideration’ she had decided not to appeal the High Court’s judgment and would implement the three-judge panel decision in MH. The Minister for Disabled People has stated in written answers on 30 January 2018 that anyone owed arrears as a result of the MH case would be paid either from the date of their claim or the date of the judgment, whichever is later.

In [2016] UKUT 420 (AAC) Judge Jacobs confirms that, although the DWP guidance on Activity 1 defines a journey as being a ‘local’ journey, the legislation does not state this and there is therefore no requirement for the descriptor to be assessed in relation to a local journey.

[2017] UKUT 480 (AAC) confirms that a ‘SatNav’ is not an orientation aid unless it has been specially designed or modified to assist the disabled.

source

A Rape victim who suffers with PTSD denied benefits

Rape victim who suffers with PTSD denied benefits for ‘not showing symptoms’ at the time of her assessment. The young woman also has seizures and blackouts, panic attacks, anxiety and depression

Female-victim-of-rape.jpg

A rape victim who suffers with post traumatic stress disorder has been denied benefits for “not demonstrating symptoms” at the time of her assessment. The young woman’s devastating story was raised in the House of Commons by her MP Wes Streeting who told how the attack had changed her life forever.

Labour MP Wes Streeting raised the case at Prime Minister’s Questions, telling MPs he saw examples such as this “week in, week out” at his constituency surgery. He said: “Until she was raped at the age of 18 my constituent led a healthy and happy life.

“Since then she’s suffered severe post traumatic stress disorder, seizures and blackouts, panic attacks, anxiety and depression, heavily reliant on her mother’s care.”

“The Department for Work and Pensions has refused to award her the enhanced rate of personal independence payment on the basis that when she presented for her assessment she wasn’t demonstrating these particular symptoms at the time.

“As a result her mother is unable to claim income support and carers allowance, placing financial hardship on top of severe emotional distress.”

The Ilford North MP demanded a meeting with the Work and Pensions Secretary and called for an end to the Government’s “cruel and inhumane” welfare policies.

Cabinet Office Minister David Lidington , who was responding at PMQs on behalf of Theresa May, said he would raise the case with Work and Pensions Secretary Esther McVey .

source

Medieval Torture: a.k.a Trial by Atos for sick/disabled claimants

Sick and disabled claimants are undergoing unnecessary benefits assessments, argues Patricia de Wolfe, while Dr Liam O’Toole says arthritis sufferers are being left in the dark about their entitlements. Eric Midwinter celebrates an unsung architect of the welfare state

Protestors demonstrate against disability benefit cuts
 Protesters demonstrate against disability benefit cuts. 
I welcome Max Fishel’s call for more reporting on the effects of benefits assessments on sick and disabled claimants (Letters, 8 July). The appalling quality of some assessments has been publicised, but less often mentioned is their unnecessary frequency.

People with long-term health conditions, repeatedly assessed and found unfit for work over a period of decades, may well just get a two-year award of employment and support allowance on reassessment despite no improvement, as though some healing miracle is likely to take place. Disability living allowance used to be granted indefinitely where appropriate; but it is now being replaced by personal independence payment, which is awarded for fixed time periods.

Atos assessors who recommend an indefinite award are overruled by the DWP. Benefits applications involve prolonged effort and intense anxiety. Frequent repeat assessments are dreaded and a blight on people who in any case have a very poor quality of life. They must be expensive for the government in the short term; the longer-term agenda is presumably to discourage claims.
Patricia de Wolfe
London

• In your article (A million older people ‘badly let down’ by lack of social care funding, 9 July), you highlight the striking number of older people who are being neglected by our social care system.

This is an issue we must urgently address, but it does not just affect elderly people in our society. Eight in ten people we recently surveyed, who would have been eligible for aids and adaptations from their local authorities, are missing out on free equipment. This can be a grab rail in the bathroom or kitchen aids to help someone make meals for themselves. By not providing people with these means to stay independent for longer, we are putting strain on other health and care services, which are already under pressure.

We are calling on local authorities to ensure people with arthritis know about, and can access, the support they’re entitled to. But we also need central government to step up and support local authorities in fulfilling their duties.

With 17.8 million people with arthritis and related conditions in the UK, the potential impact of the proper provision of aids and adaptations should not be underestimated.
Dr Liam O’Toole
Chief executive officer, Arthritis Research UK

source

Woman whose body is riddled with tumours and cannot work is denied PIP

Pearl Kelly is awaiting a decision from a tribunal about whether to overturn the decision by the Department for Work and Pensions to cancel her benefits payments

A disabled woman who suffers from a rare condition that causes tumours to grow all over her body has had the benefits she relies on stopped by the government. Pearl Kelly, 21, has a genetic disorder called neurofibromatosis. It causes benign tumours to grow along her nerves all over her body.

In order to treat the condition she has had around 20 operations over the past 15 years and her first operation when she was just five-years-old. When she was eight-years-old doctors fused her spine to help fight the rare genetic disease. The operation stopped her from growing taller than 4ft 2 (127cm). Pearl, from Orrell Park, in Liverpool, also suffers from other health conditions including a curvature of the spine, rheumatoid arthritis, osteoporosis, and heart problems, the Liverpool Echo reports.

The young woman said she cannot walk without using crutches and also suffers from poor mental health . All of these factors, she said, means she is unable to work.

She has now been told the Department for Work and Pensions (DWP) has stopped paying her personal independence payment (PIP) – a benefit awarded to people to help them with the added costs of disability. Pearl, who has contested the decision, said she needs the benefit, worth around £450 a month, to help with the costs of travelling to hospitals across the North West.

She is now waiting to appear before a full appeal tribunal when she hopes to overturn the decision. Pearl said: “I am an out-patient at several hospitals across Liverpool and Manchester. I have to use public transport to travel some fairly long distances. Sometimes my appointment might be first thing in the morning so I have to travel at peak times.

“And there are the cups of coffee and snacks while I am waiting around. Just the odd coffee and a biscuit. Although I receive another benefit I need the PIP money too.” Pearl said she has spent a year filling out massive forms to become eligible for the PIP benefit.

She said: “I first applied in April 2015 and became eligible in March the following year. Some of the forms I had to fill out were nearly 60 pages long.” Athough the benefit is not means tested, claimants are medically assessed by private companies who employ health professionals. Claimants need to secure eight points to be eligible for the benefit.

Pearl said: “I have found the whole process bewildeirng. I am someone that can can’t walk from one room to another without becoming short of breath. How can they say I am not eligible.” She also said that her childhood was complicated by her illness and that bullies made things worse. “I hated school because of the bullying. I was picked on because I was different. In the end though I just felt sorry for the bullies because they were so ignorant. ”

As a teenager she relied upon crutches to move around but still managed to get 11 GCSEs at grade C or above at Walton secondary Archbishop Beck. The school played its part by offering her assistance upstairs, helping carry her bags and providing extra comfy chairs. Pearl later spent two years studying at Hugh Baird College but missed large chunks of the course to poor health.

Pearl said that she was determined to fight the DWP. She said: “I need this money and I think I am entitled to it. I get out of breath walking from one room to another and cannot walk without crutches.

“Travelling around the North West on public transport is stressful and expensive. I need help. I am obviously hoping that the decision will be overturned at a tribunal later this year.”

A DWP spokesperson said: “PIP takes a much wider look at the way a person’s health condition or disability impacts them on a daily basis. The quality of assessments has risen year on year since 2015, but one person’s poor experience is one too many.

“We’re committed to continuously improving assessments and have announced we’re piloting the video recording of PIP assessments with a view to rolling this out widely. Under PIP 30% of claimants receive the highest rate of support, compared to 15% under DLA (Disability Living Allowance).”

source

Disability benefit assessments were designed to fail

Charities are missing the point – disability benefit assessments were designed to fail
Charities and others are letting the government off the hook, writes Mo Stewart.

pipx

Another significant report, this time by Z2K, has just been published by yet another well-meaning charity, demonstrating once again the numbers of chronically ill and disabled people suffering, due to the policies of this dangerous neoliberal, extreme right-wing Conservative government. The difficulty is, we’ve heard it all before…

How many more reports will we see, all telling the same story, whilst totally missing the point?

I have been researching this subject for very nearly ten years, to the point where there are some academics who acknowledge me as the lead independent researcher in the UK regarding the American corporate influence with UK social policies.

But, does anyone in the disabled community or charity sector take any notice of the vast amount of evidence exposed over the years?  Seemingly not, as demonstrated by the conclusions to these many reports which are invariably wrong because they are concentrating on the wrong priorities.

The political rhetoric willingly reported by the national press, and repeated by various charities writing more official reports, is that the Employment and Support Allowance (ESA) and the Personal Independence Payment (PIP) were introduced by the government as ‘cost-saving measures’, with the ambition to reduce government spending on disability benefits.

That claim was a political smokescreen that most seem to have fallen for…

Clearly, the introduction of the ESA and PIP have not reduced the costs of disability benefits funded by the Department for Work and Pensions (DWP); not least because the corporate contracts paid to the private sector to conduct these test runs into £multi-millions, money which if better spent could save the NHS, and has trebled the expenditure by the DWP in the last ten years.

The reality is that the assessment for both ESA and PIP uses the fatally flawed Waddell and Aylward biopsychosocial (BPS) model of assessment, with this 2005 DWP commissioned research funded by UnumProvident Insurance, and designed to restrict access to benefit as the BPS model disregards diagnosis, prognosis, past medical history and prescribed drugs.

In other words, the totally bogus Waddell and Aylward BPS model of assessment, as used to assess claimants for the ESA and PIP benefits, and for the new Universal Credit too, is designed for sick and disabled people to fail the assessment, and is a replica of the assessment model used by Unum (Provident) Insurance to resist funding income protection insurance policies.

“Life costs more if you’re disabled, but the current PIP assessment does not accurately reflect these extra costs. The Government must now overhaul the PIP assessment so it accurately identifies these extra costs and works for disabled people, not against them.” James Taylor, Head of Policy and Public Affairs at Scope source

Rather than government ‘cost-saving measures’, these assessments were designed to reduce public confidence in the welfare state, which would lead to the removal of the welfare state to eventually replace it with private healthcare insurance, as a replica of the American system.

That is why the second worst insurance company in America, who were identified as an ‘outlaw company’, have been official government advisers for ‘welfare claims management’ since 1994, and distinguished academics were warning about the American influence with the UK’s welfare policies as long ago as 2004.

If nothing else, the DWP and the UK government stand back and watch as more and more protests build, and reports are written about assessments, mandatory reconsiderations, appeal tribunals, the cruelty, suffering and despair, the removal of Legal Aid, the closure of the Independent Living Fund, etc, etc, etc. This was all planned a long time ago, and this is what the DWP want to happen because, with all that effort concentrating on the many different atrocities, no-one is concentrating on the real agenda; which is the planned demolition of the UK welfare state.

In reality, all the atrocities that people are experiencing are only possible because the tyranny is securely in place, following many years of misleading political rhetoric, geared to reduce the public psychological confidence in the welfare state, to make it much easier to remove.

Chronically ill and disabled people live in fear of the DWP and the inevitable brown envelope, calling them for another meaningless assessment using the totally bogus and very dangerous Waddell and Aylward BPS assessment model.

The negative impact on public mental health of these assessments has been very well documented, and suicides linked to the ESA are at disturbing levels, with one NHS report advising that almost 50% of ESA claimants had attempted suicide.

Considering the possible combined resources of the disability support groups and the charity sector, it should be possible to pool resources and concentrate on one subject, and one subject only.  The BPS assessment model used for the ESA, PIP and UC ‘assessments’ has failed all academic scrutiny and is demonstrated to have created preventable harm. It should be stopped with immediate effect.

If all effort and resources were combined to that one goal then progress could be made, not least because the DWP will not see it coming…


Mo Stewart is an independent researcher, retired healthcare professional, and regular Welfare Weekly contributor. Her book “Cash Not Care: the planned demolition of the UK welfare state” was published in 2016 by New Generation Publishing. You can find out more about Mo’s research by visiting her new website at www.mostewartresearch.co.uk.

source