Personal Independence Payment – a fair deal for people with mental health problems?

‘U-turn’, ‘Fiasco’, ‘Chaos’ – Personal Independence Payment (PIP) has been back in the news at the start of 2018 and the headlines don’t make good reading for the government. Back in March 2017, the government changed the eligibility criteria for the mobility component of PIP to exclude claimants experiencing ‘psychological distress’ from receiving the enhanced rate of the benefit. However, the High Court found that the government’s amendments ‘were blatantly discriminatory against those with mental health impairments and cannot be objectively justified, and concluded that ‘the wish to save nearly £1 billion a year at the expense of those with mental health impairments is not a reasonable foundation for passing this measure.’

The government decided not to challenge the High Court’s decision and now need to undertake a review of 1.6 million claims made for PIP over the last four years at an estimated cost of £3.7bn. It is understood that the review could take up to five years and result in 220,000 claimants receiving higher awards. What, then, does this recent development tell us about the adjudication of disability benefits for people with mental health problems? More broadly, what does it tell us about the ideology and administration that underpins PIP?

Personal Independence Payments and mental health

PIP was launched by the coalition government in April 2013 and was intended to assist claimants of working age with the costs associated with disability or long-term health conditions. The government argued that by replacing Disability Living Allowance, PIP would provide more targeted support for those in genuine need with decisions based on medical evidence. Initially, it was anticipated that the full roll-out of PIP would result in 600,000 fewer disability benefit claimants and annual savings of £2.5 billion. Analysis shows there are likely to be ‘winners’ and ‘losers’ from the new PIP regime, but this is difficult to accurately assess because the government has changed the timescales for its implementation and the standards for qualification.

The uncertainties created by the transition to PIP are a real issue for many people with mental health problems. It is not unreasonable for someone with mental health problems to ask, ‘Am I likely to get PIP?’ or ‘When will I have to go for a PIP assessment?’ At the moment, the system is so fraught with uncertainties and inconsistencies that these are very difficult questions to answer. And surely the whole point of a social security system is to provide some security for claimants.

I am in the early stages of a research project exploring the impact of the rollout of PIP and claimants with mental health problems have repeatedly told me that their mental health has been negatively impacted by the unpredictability of the system. Consider the following timeline of events over the last 12 months:

  • 23 February 2017: Department for Work and Pensions lays regulations before parliament that amend the eligibility criteria for the mobility component of PIP for those unable to undertake journeys due to psychological distress. It is estimated that this change would result in nearly 300,000 people no longer being entitled to the mobility part of PIP and will affect people with a range of conditions including schizophrenia and anxiety conditions. The government state that this amendment is necessary to restore the original aims of PIP.
  • 21 December 2017: The High Court found that the government’s amendments amount to direct discrimination against those with mental health impairments and the policy intention to save money was based on an untestable hypothesis about levels of need.
  • 19 January 2018: New Department for Work and Pensions Secretary Esther McVey states that the government will not challenge the High Court decision and a review of 1.6 million claims for PIP will be undertaken.

A charitable view of this timeline would be of the government and judiciary applying scrutiny to a new benefit in order to get things right. However, the impact on claimants, particularly those with mental health problems, is often damaging. Not surprisingly, the second independent review of PIP completed by Social Security Advisory Committee chairman Paul Gray and published in March 2017 described an ‘inherent distrust’ in the system by claimants. This means that a benefit system which should provide a safety net is, in fact, exacerbating anxiety for those living with mental health problems.

Criticism of the UK disability benefits system has also come from the UN Committee on the Rights of Persons with Disabilities, which found in 2016 that ‘there is reliable evidence that the threshold of grave or systematic violations of the rights of persons with disabilities has been met in the State party’. The committee recommended that the UK government should improve the administration of disability benefits and make it more accessible for disabled people.

Delayed implementation and chaotic administration

It should be acknowledged that designing and administering a disability benefit is not an easy task and this is underscored by the fact that few other countries have a comparable benefit to PIP. The eligibility criteria for PIP focuses on claimant’s ‘limited ability’ in relation to mobility and a range of daily living activities. This, in itself, seems reasonable, but as with all social security, the devil is in the details. Unfortunately, with PIP, the details seem to have focused on saving money and reducing the number of claimants.

The government appear to have overlooked the fact that the needs of disabled people don’t vanish because tighter benefit rules are introduced. This is important as the concessions that the government have been pressed into making are largely because claimants and disability campaigners have been able to clearly demonstrate (often through the tribunal and court system) that significant elements of PIP are not fit for purpose. An ill-conceived policy that seeks to save money invariably ends with compromise and additional cost that was not initially intended. It will be interesting to see to what extent the government’s initial forecast in terms of expected savings and number of claimants has changed once its review of PIP claims is complete.

The government’s intention was that PIP would create a more fair and objective assessment of need. However, from the early stages of the rollout of this benefit, there has been intense criticism of the assessment and adjudication process. Early concerns were voiced by the National Audit Office and the Work and Pensions Committee about unacceptable delays in the decision-making process. While there have been some improvements in this area, the second Gray review of PIP found that administrative processes need to be significantly improved. This should include improvements to the way evidence is obtained and the need ‘to broaden audit and quality assurance in assessment and decision-making.’ For many claimants, the experience of the PIP assessment process can be as damaging as the final decision that is made, with many reporting cancelled appointments, rushed assessments and a lack of understanding of individual conditions and resulting need. As with other areas of policy, the appropriateness of the involvement of private contractors (ATOS and Capita) has been questioned.

We should also recognise that public and judicial pressure are not the only reasons for the government U-turn on PIP. The challenges that the government face with the Brexit negotiations mean they must choose their domestic battles wisely and it seems that a fight over PIP was a step too far for Theresa May. (Remember, this is a Prime Minister who chose social justice as one of the central themes of her maiden speech.) While campaigners and social policy academics will rightly welcome the government climb-down on PIP, we must not forget that this creates yet more uncertainty for disability benefit claimants. Rather than a system underpinned by a fiscally-driven ideology, shaped by short-term political considerations and delivered in a chaotic manner, what we really need is a ‘real-world assessment’ of disability and a benefit which appropriately meets the needs of claimants.

First published by the Social Policy Association