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BOGOF! Old IB medicals reused for new DLA decisions

29 July 2004

 

                  To save DLA & AA from the chop

The DWP has introduced a Buy On Get One Free medical report system to cut the cost of DLA decisions. According to a DWP report on the Glasgow DLA pilot, decision makers are using incapacity for work medical reports up to two years out-of-date and of ‘variable’ quality to make decisions on fresh DLA applications. And in spite of claims that the pilot DLA short form would be used simply to help decision makers select who to gather detailed evidence from, a higher proportion of claims are actually being decided using the form alone.

The report also shows that award patterns have changed significantly under the pilot, but it’s still not possible to say whether introducing the pilot nationally will result in more or fewer successful claims.

Glasgow pilot
Since November 2002, claimants in the Glasgow area have been used as guinea pigs for a new claims system (See previous Unspun articles). Claimants who ring up for a DLA claim pack are asked a series of questions. Based on their answers, claimants are then sent a much shorter claim pack. Instead of the current 20 pages provided to give evidence about difficulties with everyday activities the pack has a maximum of 4, one for each question the caller gave the 'right' answer to.

You can’t trust claimants
Back in April 2003, CPAG ran a very positive article on the DLA pilots. The article suggested that: ”Arguably, the shorter form together with a greater emphasis on decision makers talking to claimants keeps disabled people at the centre of the process . . .”. It went on to say that it was “. . . vital that decision makers and customer claims advisers are adequately trained to probe and elicit information from claimants who may be reluctant to discuss their personal needs over the telephone”. The author explained that it would only be possible to judge whether the pilot had been a success when the quality of the telephone interviews had been assessed

Unfortunately, the author had overlooked one vital point: the DWP don’t trust claimants. According to the DWP report:

“It should also be noted that CCMs [Customer Care Managers i.e. decision makers] have not been able to fully utilise the telephone as a means of gathering evidence as further (fee paying) medical evidence has to be sought to corroborate the stated needs”.

In other words, there’s no point in talking to claimants because you’d only have to pay a doctor to give an opinion as to whether they were telling the truth or not. So, far from there being a ‘greater emphasis on decision makers talking to claimants’, they are actually having less contact with them than before. According to the report, in only 4% of cases was additional information collected from the claimant, their carer or someone similar. This is actually down from 6% in non-pilot claims. We’ll look forward to CPAG publishing its assessment of the success of the Glasgow pilot.

In addition, the number of decisions based on the claim form alone, without any supporting evidence whatsoever, has actually gone up from 5% to 7%. The report baldly asserts that:

“Reducing the size of the current claim pack from 40+ pages to an 18 page (maximum) tailored claim form, has not restricted the ability to provide a decision based on the claim form alone”

Vintage medical reports
Not only the number of contacts with clients, but also the
number of visiting doctors reports, has been reduced, as more applications are now being decided on old incapacity benefit (IB) evidence. As the DWP report proudly explains:

The average cost of further evidence has reduced by £2.98 per case with the number of EMP [visiting doctor] requests decreasing significantly . . . the use of IB information minimises the number of EMP requests

It is this use of IB information that is one of the major changes under the new claims system. Prior to the DLA pilot, incapacity for work medical reports –more properly IB85 personal capability assessment medical reports – were not used by decision makers looking at DLA claims. However, under the pilot not only the IB85, but in some cases the much shorter IB113 ,are routinely being used as the only evidence other than the claim pack.

According to the report the “IB85 is considered in the main to be either very or fairly effective if less than 2 years old and is also a useful source of evidence to corroborate stated needs” and “The quality of information in the IB85 was variable but in all cases there was considered to be sufficient information to make a sound decision.”

Variable is one way of putting it: over 70% of appeals against a decision that a claimant is capable of work are overturned at appeals where a representative is present. All such overturned decisions are based on the “very or fairly effective” IB85 medical reports. It is extremely unlikely that decision makers are even able to check whether the report they are basing a DLA decision on has been successfully challenged at an IB appeal.

In relation to the IB113 - a very short form designed to decide whether someone should be exempt from the personal capability assessment because, for example they have a severe mental health condition – the report states that:

“Where a claimant was deemed to be 'severely mentally ill' for the purpose of the Personal Capability Assessment (PCA) the information together with the IB113 was sufficient for a sound decision to make an award”.

In fact, there is very little information in an IB113, which is usually very poorly filled out by GPs who have little understanding of its purpose, which would allow a decision maker to award DLA at the appropriate rates.

Nonetheless, in one test period in Glasgow, the DWP obtained IB evidence in connection with 59% of all DLA claims.

Doctor, I keep thinking I’m a mouse
The use of IB reports makes sense of a recent development in IB85 medical reports: the appearance of DLA related evidence.

All over the UK doctors working for Atos Origin – the European multinational which provides medical services to the DWP - are being trained to produce IB85 reports with the help of computer software. The latest generation of reports are entirely mouse driven: all the doctor can do is choose from predetermined options selected by the computer.

Many of the recent reports appear to include criteria relating to DLA as well as incapacity for work. For example, two frequently selected item in the new reports are ‘Cooks safely and eats well’ and ‘Always manages to use hob safely’. The ability to prepare a cooked meal is not one that attracts any points under the personal capability assessment, the closest descriptor being ‘Cannot turn a sink tap or the control knobs on a cooker’. Until the latest generation of computer generated reports doctors seldom commented on a claimant’s ability to cook.

However, the inability to plan and prepare a cooked main meal entitles the claimant to the lower rate of the care component of DLA. Thus the choice of ‘Cooks safely and eats well’ by the Atos Origin doctor will be enough to allow the DLA decision maker to refuse an award based on the cooking test. And yet the cooking test is a complex and detailed one, the idea that it can be decided upon by the choice of ‘Cooks safely and eats well’ from a drop down list by a doctor racing through the PCA is an absurd, but cost cutting, one.

Many other statements from the new PCA reports also read more like they were prepared for a DLA decision. For example, the following will all be familiar to anyone who has completed a DLA claim pack:

Can move indoors from room to room on the level without difficulty
Has no difficulty getting out of bed
Has no problems in the bathroom
Has no significant problems with dressing

Moreover, one of the problems the Glasgow team have been facing in relation to IB evidence is the time and cost of chasing it up, with much of it having to be requested more than once. However, the new computerised IB85 reports are stored online, allowing decision makers immediate access without any papers having to be dug out of storage. The conclusion that the DWP are working towards a two for the price of one IB and DLA medical report seems inescapable.

Dip, dip, dip
For many people, however, the only question that matters about the new system is whether more or fewer claimants will get awards. In this respect, at first sight the news is good. As the table below - taken from the DWP’s report - demonstrates, in the period February to September 2003, 46% of all applicants in Glasgow received awards using the short form as opposed to 36% using the standard form. In addition, the average value of the award (based on the level of the award multiplied by the length of the award, the DWP say) is greater. So that’s a claimant “win-win” situation: shorter form and higher award.

Award

Short form

Normal form

higher rate care

0%

1%

middle rate care

2%

4%

lower rate care

15%

15%

higher rate mobility

12%

9%

lower rate mobility

3%

4%

higher rate mobility/higher rate care

20%

18%

lower rate mobility/higher rate care

6%

7%

higher rate mobility/middle rate care

16%

12%

lower rate mobility/middle rate care

9%

14%

higher rate mobility/lower rate care

7%

8%

lower rate mobility/lower rate care

8%

9%

     

Total awarded

46%

36%

Av. Award value

£21,114

£18, 934

     

Disallowances

54%

64%

 

 

 

 

 

 

 

 

 

 

 

Unfortunately, if you compare these figure with the national average for DLA claims and awards, the picture is rather different. In the period from August 2002 to 2003, the closest period we could find statistics for, there were 431,620 initial claim decisions. Of these, 231,780 resulted in awards and 199,845 resulted in rejections (you’ll have to ask the DWP where those extra 5 came from). My maths is shaky at best, (as those of you who’ve been on my training courses will know), but I make that around 54% receiving awards as opposed to 46% being refused. In other words, around 8% fewer claimants received awards under the Glasgow pilot than the average for the country as a whole. It’s impossible to be certain whether we’re comparing like with like here, without more transparency from the DWP, but it does raise the possibility that when the pilot goes national there will be a significant fall, rather than rise, in the number of successful claims.

Worse still, for certain conditions you may be very much less likely to receive an award under the new system. Compared with standard form applications in the Glasgow area, all awards of lower rate mobility under the pilot are down. On the other hand most awards of higher rate mobility are up. Indeed, the award patterns are so significantly different between the pilot and the standard claim systems that it almost appears as if awards are being made randomly. In reality, the suspicion must be that, due to the lack of detailed evidence, awards for easy to understand physical conditions, such as arthritis, have increased under the pilot whilst awards for mental health, ME and other less obvious conditions – which often attract an award of lower rate mobility – have gone down.

However, this must remain only a suspicion, because although the DWP do keep statistics on the conditions giving rise to awards, they claim it is impossible to separate the pilot statistics from the national ones. Whether this was deliberate choice or merely a badly designed pilot, the effect is that only after the new system has been running nationally for some years will we find out who the losers really are.

Appeals down
In common with the results of the new AA claiming system, challenges to decisions made under the Glasgow pilot have also plummeted, with request for reconsiderations down from 15% to 12% and appeal requests almost halved, down from 28% to 15%. This is in spite of the fact that around 70% of all DLA appeal hearings nationally are won by the claimant, so many of those choosing not to appeal the pilot results would be likely to receive an award if they did so.

Uncertain future
It seems certain that the Glasgow pilot will be introduced nationally, probably next year. If there were ever any doubts, the decision of David Harker, Chief Executive of Citizens Advice, to claim in a speech in June of this year that the DWP “are working with us to develop a shorter form, based on a pilot telephone service which reduces the size of the form” put an end to them. (For more on this see the Unspun article: Citizens Advice, big business and the DWP “win-win together”. 29 July 2004). Citizens Advice’s apparent claim of ownership of the pilot give the DWP virtually unassailable grounds for asserting that they are working with the voluntary sector in the best interests of claimants.

What is far from certain, however, is which DLA applicants will be the losers, and which – if any – the winners in a system in which the claimants’ voice has been all but silenced.