The thorny
issue of disability benefits reform rarely seems far from the headlines. Much
of the coverage is shaped by familiar themes: the cost of the system, questions
about its sustainability, and concerns about fraud. In the process, discussion
of the purpose of disability benefits and the difference they make to disabled
people’s lives is often relegated to the margins.
Against that
backdrop, the interim report of the Timms Review of personal independence payment
(PIP), published last week, is a welcome attempt to take a more considered
approach to disability benefits reform. Rather than focusing primarily on
expenditure, the Review begins by asking a more fundamental question: whether
PIP is fulfilling its intended purpose. The report is clear that PIP is ‘essential
to financial stability and independent living’ for many disabled people and
recognises the important role it plays in helping people participate in
everyday life. It is also forthright in challenging what it describes as the ‘false
and damaging narrative’ of disabled people as ‘scroungers’ or ‘fraudsters’.
Beyond the
noise of the daily political debate, what does the Review’s interim report tell
us about the direction disability benefits reform may take? This blog explores
the report’s analysis of the issues facing the current system and the questions
it raises for policymakers.
A
dehumanising assessment process that needs fundamental reform
The clearest
message to emerge from the interim report is that the current PIP assessment
process is not working as intended for many disabled people. The report
highlights widespread evidence that claimants experience the process as ‘dehumanising’,
‘soul destroying’ and ‘degrading’ – concerns that disabled people
and organisations including Z2K have been raising for many years. It is
significant and welcome that the Review has recognised these experiences so
directly.
Concerns
about the assessment process appear to have been the most prominent theme in
the Review’s call for evidence, which received 38,713 responses. The report
notes that ‘assessment-related issues were referenced in approximately 70%
of responses’ and that ‘over 90% of responses relating to [the
assessment] process were negative’. Responses pointed to a number of
recurring problems, many of which echo findings from Z2K’s own research: an
over-reliance on one-off assessments, shortcomings in the way medical evidence
is gathered and used, and a reassessment process that is unnecessarily
burdensome.
The report
also highlights the wider consequences of these problems. It notes concerns
that the experience of the PIP assessment can undermine the benefit’s intended
purpose by ‘discourag[ing] independent living and participation for some’,
with some respondents arguing that ‘the assessment penalises coping
strategies, work, or improvements that are interpreted as having reduced need’.
The report rightly highlights that, while receiving financial support via PIP
enables employment for many people who receive it through covering
disability-related costs, for other claimants engaging with employment has led
to their support being removed. For a benefit intended to support independence,
the finding that the assessment process itself can discourage activity and
participation in society represents a striking indictment of the current
system.
Eligibility
criteria or poor assessments: what’s really going wrong?
Another
important theme in the report concerns the design of PIP’s eligibility criteria
and the functional assessment model on which the benefit is based. Here the
picture is more complex. The report suggests that ‘in many cases, the PIP
functional assessment does not fully capture the extent or complexity of the
impact of certain disabilities and health conditions’ and highlights that
many responses to the call for evidence argued that ‘the descriptors for
both daily living and mobility insufficiently account for fluctuating
conditions, mental health, neurodivergence, and energy-limiting conditions’.
There is
little doubt that many disabled people with these conditions face significant
challenges in accessing PIP. Z2K’s advice services see examples of this
regularly. The more difficult question, however, is whether these problems stem
primarily from the design of the eligibility criteria themselves or from the
way they are implemented in practice. In the experience of Z2K’s advisers, many
disabled people are refused PIP not because the existing framework is incapable
of recognising their needs, but because key elements of that framework are
applied incorrectly during the assessment process.
Take the
‘reliability criteria’. These rules require decision-makers to consider not
just whether a person can undertake one of the 12 PIP activities, but whether
they can undertake it safely, repeatedly, within a reasonable time and to an
acceptable standard. If they can’t, then they should be awarded points. Z2K’s
research has found that these criteria are frequently applied inconsistently or
overlooked altogether, a concern that was also reflected in responses to the
Review’s call for evidence. Yet where the reliability criteria are properly
considered at tribunal stage, they frequently give the PIP activities and
descriptors a greater degree of flexibility that allows them to more nimbly
capture a more complex range of conditions and disabilities.
A similar issue
arises with the so-called ‘50% rule’, which is intended to ensure that
fluctuating conditions are taken into account. While there are legitimate
questions about whether the rule operates effectively in all cases, problems
often arise because it is interpreted too narrowly or applied inconsistently,
rather than because the principle itself is too rigid. The name is misleading:
the criteria do not require a claimant to be affected continuously by their
condition for at least half the time. Rather, it is enough that they experience
difficulty completing an activity for at least part of the day on the
majority of days. Properly interpreted, the rule is capable of capturing the
needs of many disabled people with fluctuating conditions.
This is not
to suggest that the current eligibility criteria should be beyond scrutiny.
There is a strong case for a targeted review of particular descriptors where
specific issues have been highlighted – for example, the concerns highlighted
by the MS Society about the ‘20 metre’ rule under the ‘Moving Around’ activity.
Moreover, as Z2K has previously highlighted, any future move to merge PIP with
the work capability assessment would almost certainly require a more
fundamental review of eligibility, given the need to reflect both the extra
costs of disability and barriers to employment.
Nevertheless,
the broad structure of the current framework – a points-based assessment
supported by activities, descriptors and additional rules like the reliability
criteria and ‘50% rule’ – has important strengths. As the Review continues its
work, it will be important to distinguish between shortcomings in the design of
the system and failures in its implementation. Focusing too heavily on the
former risks overlooking the extent to which many of the problems experienced
by disabled people may arise from the way the existing rules are applied in
practice – and could risk making those problems worse.
Encouraging
progress on co-production
The interim
report also provides an update on how the Review is seeking to embed
co-production. When the government first committed to co-producing the Timms
Review with disabled people, there was a good degree of scepticism, including
from Z2K, about how meaningful that commitment would prove to be in practice.
The Review had originally been presented in the Pathways to Work Green Paper as
a DWP-led exercise supported by stakeholder engagement, and it was not
initially clear whether the government fully recognised the distinction between
engagement and genuine co-production. As a result of these concerns, a
coalition of disability and anti-poverty charities convened by Z2K and Turn2us
published two open letters outlining practical recommendations for ensuring
that co-production was embedded throughout the Review’s design and delivery.
It is
therefore welcome that the interim report indicates that the Review is taking
co-production seriously. A substantial section of the report is devoted to setting
out the Review’s approach to co-production, which it defines as ensuring that ‘disabled
people and people with lived experience and expertise are the key drivers for
both how the Review works and what it concludes’. The steering group
appears to have played a clear role in shaping the Review’s development, with
members now leading particular strands of evidence gathering through an agreed
working-group structure.
The approach
described in the report is consistent with a number of recommendations put
forward by stakeholders during the Review’s development. The report places a
notable emphasis on transparency, offering a detailed account of how the Review
is operating and publishing the DWP’s review of internal and external evidence
that was shared with the steering group. It also sets out plans for a broad
programme of engagement, reflecting its acknowledgement that the steering group
alone cannot represent the full diversity of disabled people’s experiences. Finally,
the Review has committed to carrying out an in-depth evaluation its
co-production processes through a dedicated working group, with the stated
ambition of generating learning that may inform future approaches to
co-production across government.
It remains
too early to reach firm conclusions about the success of the Review’s use of
this model. The Review is still ongoing, and the most challenging stage – developing
and agreeing final recommendations – lies ahead. The interim report notes that
key decisions will be subject to a vote and that the steering group has agreed
a simple-majority quorum, although Stephen Timms has previously suggested that
he hopes decisions on recommendations can be reached through consensus. How
questions of disagreement and decision-making are ultimately handled may prove
to be one of the most important tests of the Review’s commitment to shared
power. Nevertheless, the interim report provides clear grounds for optimism
about the direction of travel so far.
An
opportunity to build a better disability benefits system
There
remains understandable uncertainty about where the Review will ultimately lead.
Given the importance of PIP to millions of disabled people, it makes sense that
many will be watching the process anxiously. The interim report is broad in
scope and makes few definitive conclusions, leaving open a range of possible
directions for reform. Some of those possibilities may prove more promising
than others. For example, questions remain about whether aspects of the support
currently provided through cash payments could be replaced by in-kind support –
a debate that is likely to generate significant discussion as the Review
develops its final recommendations.
Yet caution
should not obscure the significance of what the Review has already established.
Many of its central findings echo concerns that disabled people have raised
consistently for years. In particular, the report acknowledges the extent to
which the PIP assessment process can be experienced as dehumanising and
distressing, and recognises the impact of a system characterised by poor
quality assessments, a blanket approach to reassessments, and lengthy,
stressful routes through mandatory reconsideration and appeal. That recognition
matters. It provides an important foundation for a more informed conversation
about how the system can be improved. (On the latter point, stay tuned over the
next few months for forthcoming Z2K research exploring reforms to the mandatory
reconsideration and appeals processes.)
The wider
political debate about disability benefits is unlikely to become any less
contested in the months ahead. But it would be wrong to view the Review simply
through the prism of wider political and media demands for the kind of ‘crude
cuts’ rightly criticised by our presumptive next prime minister. We should
remember that the Review also presents a significant opportunity to address
longstanding problems within the PIP system and to consider how disability
benefits can better support independence, participation and financial security.
As it moves towards its final recommendations, the challenge for all of us will
be to ensure that this opportunity is not lost.
