The second independent review of the PIP process - departmental response

We agree with the Reviewer on the importance of addressing concerns or misconceptions about the assessment process.

Delivering trust in the overall accuracy of advice provided by Capita and in the consideration of this advice by Case Managers is paramount to reassuring claimants and those supporting them that decisions made are fair and balanced.

The Reviewer made the following Recommendation

Recommendation 5 - the assessment process

To support claimants and Healthcare Professionals to navigate the assessment process, and to improve the provision of information available and transparency of the process, the Review recommends that the Department take the following steps.

a) To support Healthcare Professionals and individuals in understanding the information used in the assessment process, the Department should make available the Condition Insight Reports, detailing the information contained and explaining how this information is used in formulating advice to the Department. These should be published on the Capita website in line with current accessibility requirements.

b) The Department, in conjunction with Capita, should consider the use of more targeted open questions throughout the assessment process to ensure a full picture of needs is established as early in the claim as possible and avoid cases passing to appeal stage unnecessarily.

c) The Department should ensure that evidence provided by the carer/parent/appointee during the assessment process is fully considered and used to inform the advice provided following the assessment.

d) The Department should ensure that evidence is sought from the person who knows the claimant best (medical/non-medical) and all evidence obtained should be weighted, considered and recorded on the assessment report and Department records.

The Department accepts this Recommendation.

The Department and Capita are committed to building increased trust and in the assessment process, including in the use and consideration of, any information used by the DA to help inform the completion of the assessment report provided to the Department. In order to address this Recommendation we will publish the Condition Insight Reports (CIR) on the Capita website to provide further clarity on the nature, content and purpose of these reports.

CIR’s are produced as a result of collaboration between a wide range of stakeholders including the Department, Capita, other PIP assessment providers and a broad range of advocate groups. Further work will be undertaken exploring the practicalities of obtaining the necessary approvals from those organisations and groups who have collaborated in, and contributed to, the development of each CIR. Therefore the Department, in conjunction with Capita, commit to seeking appropriate permission and approval prior to publishing CIR’s in line with this Recommendation.

CIR’s are intended for internal use by Capita Disability Assessors. They form just one part of a wide range of training and reference materials in addition to on-going professional support delivered by Capita. CIR’s support an assessor in preparing for a PIP assessment. They contain general information about the condition, advice on topics to explore alongside specific areas of sensitivity relating to the condition concerned.
CIRs are not used to inform or advise the Department as all PIP assessment reports are completed based on the assessment itself, information from the PIP application form and any additional evidence submitted from the claimant or carer.

In addition to the publishing of a CIR, further information on examples of what constitutes helpful supporting evidence will also be published on Capita PIP website.

Capita provide extensive disability assessment training to the Health Professionals completing assessments. Training on interview skills and questioning is linked to the information gathering requirements of the assessment report. The use of a mix of open, closed, clarifying and extending questions is covered in the Disability Assessor training provided. In response to this Recommendation, Capita commit to producing guidance on best practice in this regard providing this to all DA’s. To further improve on this, additional information on adapting questions to best explore different health conditions will also be provided to all DA’s. Furthermore, training for all new Assessors will be enhanced to include a demonstration of potential questioning to be used in both Face-to-Face and Telephony Assessments.

In order to ensure that the consultation between the claimant and the DA is conducted in a compassionate and empathetic manner, it is essential that the DA has flexibility in how they conduct each assessment. The Assessor should not ask pre-determined questions as they need to be able to tailor questions, style and delivery to ensure that both open and targeted methods are used to probe where necessary and enable the customer to present their lived experience in their own words.

The Department acknowledges the evidence presented to the Review which indicates there is a misconception that evidence from carers is not considered persuasive. 

The role of evidence from carers or companions is recognised as vital in understanding the true functional picture of needs especially where the claimant may understate their condition due to the nature of their disability. To further improve on the role of evidence from carers in the assessment process, changes were made to the PIP assessment guide following a Recommendation made by Paul Gray during his second Review of PIP in GB. Subsequent to this, the Department reiterated the importance of weighting all available evidence to their Case Managers and worked with assessment providers to better structure the assessment to incorporate input from carers. 

The Department and Capita accept that obtaining supportive information from the person who knows the claimant best is key to making informed decisions on entitlement to PIP. In order to address this Recommendation, Capita commit to revising and re-publishing guidance for all assessors to ensure the source of this evidence is listed along with all other evidence and considered carefully. This will include notes of any telephone conversations undertaken with anyone supplying verbal evidence. The Department will also issue additional guidance to Case Managers to ensure evidence from carers is given careful consideration when making a decision on entitlement.

The role of audit

In addition to the above steps, the independent random audit of cases carried out by the Departmental Health Assessment Advisor (HAA) also provides assurances on the consistency of approach taken by assessors in both the use of questions and on the consideration given to available evidence, either medical or non-medical. Feedback from this and from direct observations of assessments, form part of the regular existing quality assurance mechanisms in place between the Department and Capita. The HAA raises any concerns at regular forums and clinical calibration events with Capita and ensures the advice provided to the Department complies with the required standards in that it is clear and medically reasonable.

In-house assessments

The Department uses DWP Information Technology (IT) systems to administer PIP. Maintaining parity with DWP where potential changes to policy or IT affect the delivery of PIP is fundamental to ensuring the service in Northern Ireland is future proofed.

The Reviewer made the following Recommendation.

Recommendation 6 - in-house assessment providers

The Department should consider the outcome of the DWP pilot to bring assessments for both Work Capability Assessment (WCA) and PIP assessment in-house. The Review recommends that the Department conduct a similar pilot in NI.

The Department partially accepts this Recommendation

The Department is developing a Business Case that will appraise options for the future provision of Health Assessment services from August 2023, including in-housing the assessment service.

Since the Reviewer met with DWP in October 2020, the scope and intent of the DWP pilot has continued to change and evolve. The focus of the DWP Transformation Area is now to provide a safe environment to test and scale their new in-house developed IT solution and to test and learn from new ideas and processes as opposed to testing the delivery of an in-house assessment service. The Department will closely track the work in the Transformation Area to ensure NI requirements are captured as part of any IT development work given the dependency on IT and where appropriate, we will also test any new ideas regarding processes.

Further evidence

The Department agrees with the Reviewer that additional evidence plays an important role in the assessment process.  Access to this at the earliest stage possible is key to ensuring decisions taken are correct. We acknowledge the importance of ensuring evidence is sourced as early as possible in the process as this can at times avoid the case passing to Tribunal stage.

The Department acknowledges the evidence provided to the Reviewer indicating a perceived lack of consideration given to any additional evidence provided and remains committed to building trust and confidence in the system.

The Reviewer made the following Recommendation

Recommendation 7 - further evidence

a) The Department should produce guidance/examples for claimants, advocacy services and Healthcare Professionals of appropriate evidence to support the PIP process and where this evidence should be obtained.

b) The Department, in conjunction with Capita and relevant Healthcare Professionals, should examine and implement new ways to improve the current poor return rate of GP factual reports.

c) Proper consideration and recording of evidence when making decisions is essential. All evidence needs to be carefully considered, in relation to the particular circumstances of the individual case, to ensure the correct decision is reached. The Department should ensure the evidence is fully documented and that further evidence, medical or otherwise, has been correctly weighted and documented.

The Department accepts this Recommendation.

In order to address this Recommendation the Department will publicise the new PIP2 and PIP Information Leaflet on the Departmental website. Both products have been re-designed with one improvement specifically highlighting the importance of the role of additional evidence in the assessment process. The new layout includes added prominence for the section detailing the need to seek additional evidence ahead of completing the form. The form has also been re-worded to further emphasise the role played by the claimant in obtaining additional evidence. The re-wording of this section reiterates that the Department will not automatically seek information from the Health Care Professional mentioned in the form. There is also a new section which includes a checklist detailing practical examples of good sources of evidence, this should provide some additional clarity on the role of supporting evidence in the assessment process.

The Department also provides existing information in the form of guides hosted on the Department’s website offering advice and support for claimants, advisors and Health Care Professionals supporting them. The Department has also enhanced this with short videos on NI Direct detailing key information, one of which is entitled ‘Providing Information to Support Your Claim’. In order to further embed the useful information contained in these short videos, the Department will further publicise and promote the videos using a range of communications so that Health Care Professionals who may have been contacted to provide information, are able to consult them. To further support the importance of ensuring the claimant best understands the importance of evidence in the assessment process, the Department will revise Telephony call scripts to include additional steps for PIP Centre Telephony team when the claim is first made. Staff will discuss potential good sources of evidence and will signpost the claimant to the information on NI Direct which provides further detail.

To further supplement this work, we continue to build on exploring ways to make better use of evidence we already hold including whether information from different DfC assessments could be used in the decision making process.  Currently Case Managers are able to consult information from Work Capability Assessments when a PIP decision is first made and at Mandatory Reconsideration stage.

We are also closely following progress of a DWP trial where access to this information has been extended to Disability Assessors. The sharing of additional information at the Initial Review stage should ensure there are additional opportunities to conduct a Paper Based Review avoiding unnecessary assessments.

The Department and Capita accept that timely access to information from GP’s is vital in developing a full understanding of a claimant’s disabilities or restrictions and we have worked with representatives of GP’s in NI to build positive working relationships. As a result of this engagement a number of changes were designed, developed and implemented to improve the creation and presentation of GP Factual Report (GPFR) requests sent by Capita Health Professionals to GP Surgeries. These improvements include system changes introduced to provide assurance that GPFR requests are correctly populated by Capita Assessors, making it easier and clearer for GP’s to determine what information has been requested and how best to respond. The Department and Capita will continue this engagement with the representatives of GP’s such as the British Medical Association (BMA) and the Royal College of GP’s (RCOGP) and discuss what further measures could be introduced to improve the current return rate of paper-based GP factual reports, bearing in mind the current and possible long term pressures arising from the pandemic. To further improve on the provision of information early in the assessment process we are currently examining if a secure electronic method of making the request for information from GP’s can be developed which would support a longer term improvement to current return rates. 

Building on the Recommendation from the first Review on the introduction of a GP summary report, work was well underway with Capita and Healthcare Professionals to develop a digital pathway for an electronic GP Short Summary Report to enhance the evidence gathering process. This work had to be temporarily paused because of other priorities in relation to COVID-19. Capita have now recommenced work to develop a Proof of Concept to test an electronic GP Short Summary Report. This work is key to delivering on our commitment to ensuring we receive evidence early in the assessment process and will address this element of the Recommendation. We expect to make progress on this in the coming months.

A thorough consideration of the evidence provided is important in ensuring that the claimant feels assured that all aspects of their claim have been fully considered when making a decision on entitlement. In order to ensure that Case Managers demonstrate that they have fully considered all evidence received in support of PIP claim, a checklist was introduced in April 2021 to assist Case Managers. The Checklist will ensure that all Case Managers list, within their decision notification, all evidence considered, summarising the weight placed on each piece of evidence to justify the descriptors awarded for that claimant. This will enable claimants to decide on next steps if they intend to dispute the decision made.

Disability assessor training

PIP assessments are functional assessments rather than medical assessments. We agree with the Reviewer that there is an important role for access to expert opinion to ensure that the functional impact of the full range of claimant medical conditions presented are thoroughly explored and correctly assessed.

The Reviewer concluded that more work needed to be done to ensure Disability Assessors (DA’s) receive enhanced training and support on certain conditions to deliver increased confidence in the subsequent advice provided.

The Department acknowledges the evidence presented to the Review on the experience of those claimants who felt that the DA had displayed a lack of knowledge of their particular condition resulting in reported feelings of being misunderstood or misrepresented. Claimants having an assessment should have confidence in the skills and training of those carrying these out on behalf of the Department and in the subsequent accuracy of the report produced.

The Reviewer made the following Recommendation

Recommendation 8 - disability assessor (DA) training

Given the substantial supporting evidence gathered during the second Review, the Review recommends the Department revisits Recommendation 11 from the first Review and implements the Recommendation, taking into consideration the following factors:

a) The Department and Capita should ensure enhanced training and support is provided to DA’s on conditions, acknowledged by DA’s, as outside their normal experience and expertise.

b) The Department and Capita should consider training for DA’s similar to that provided to Departmental Case Managers and ensure that DA’s are aware of regulations and their interpretation.

c) The Department and Capita should provide more empathy skills training given the nature of the DA’s role.

d) The Department should ensure the annual Training Needs Analysis, completed in conjunction with Capita, reflects feedback from the Independent Panels recommended in Recommendation 9 (The Audit Process) and Recommendation 11 (The Complaints Process).

The Department accepts this Recommendation.

In response to this Recommendation, Capita will review the enhanced training material available to ensure that disabling conditions which assessors may not be familiar with, are appropriately covered. Gaps identified in this review will be addressed with the appropriate contents being updated. The availability of existing and new enhanced training material will be brought to the attention of assessors. This material, combined with enhanced training covering a broad range of topics and specific conditions, can be used as reference material to ensure they are familiar with the conditions reported by claimants before and after assessments. In order to ensure Disability Assessors are supported where they may be unfamiliar with a particular condition, they are also encouraged to access a wealth of available online material.

Personal Independence Payment (PIP) assessments are not condition based, but are instead intended to establish the individual’s level of restriction. Assessors are required to explore all conditions and the impact of symptoms. They need not have an expertise in the condition they are assessing as the training they receive enables them to accurately assess claimants with a range of conditions, including multiple conditions.  However, as DA’s already have access to specialist support in the form of condition specific champions and coaches, this will help address the need to provide access to expertise in certain conditions. In addition to this existing support, we would like to best understand if there are circumstances where further specialist support could be helpful. As a result we are currently examining whether extra support in the form of expert knowledge would improve outcomes and deliver increased confidence in the decisions being made.

The Department requires Assessment providers to put in place suitable training programmes to ensure that the Disability Assessors (DA’s) carrying out assessments meet their requirements. As documented in the response to the first Review, the Department confirms the required standard of skills and experience which candidates must possess in order to move into a DA role. At the time of this Review the average length of post registration experience of DA’s employed by Capita, was 12 years.

The Capita Disability Assessor Foundation Programme ensures assessors carefully explore each claimant’s particular circumstances to assess their individual needs. Candidates must achieve the required standard throughout this programme in order for the Departmental HAA to approve them to move into a Disability Assessor role.

Guidance for Assessors is contained within the PIP Assessment Guidance (PIPAG) which is a published document. Providers continue to deliver Assessments in line with this guidance which is kept under continuous review. We are actively engaging with Assessment Providers on the continuous quality of the training provided and ensure that guidance for assessors is reflective of emerging evidence.

The Department accepts the need to deliver increased confidence in the training of DA’s with regard to awareness of case law and the legislative backdrop of PIP. It is important to remember that the role of the DA is to provide an assessment report that meets the quality standards. The role does not include making decisions on entitlement to the benefit as this role is carried out by the Department. In order to address this Recommendation, we will work with the assessment provider to deliver enhanced training on this issue. The PIPAG confirms that the content of the existing initial training programme provided to assessors should contain ‘an understanding of the legislative framework and the legislative requirements for PIP’. The Review found that there was an inconsistent approach taken by DA’s in applying parts of the regulations relating to the Reliability and Majority tests in particular. These determine whether a claimant is able to perform the various activities in a reliable manner which is noted as being safely, to an acceptable standard, repeatedly and in a reasonable time period. The Majority test relates to whether the descriptor applies in more than 50% of the days in a 12 month period. Capita will review the training material provided to the Departmental Case Managers and incorporate into existing material thereby enhancing the training available to all DA’s.

Our aim is to ensure providers deliver high quality assessments and that all claimants receive a good service. The Department acknowledges concerns raised to the Review and notes evidence suggested poor empathy was not widespread and that there were many reports of good practice here.

All Assessors are Health Care Professionals registered to practice with their relevant licensing body and subject to their Professional Code of Conduct. The Nursing and Midwifery Code confirms they are expected to

‘Treat people as individuals and uphold their dignity 

To achieve this, you must: 

• treat people with kindness, respect and compassion 
• make sure you deliver the fundamentals of care effectively 
• avoid making assumptions and recognise diversity and individual choice 
•  make sure that any treatment, assistance or care for which you are responsible is delivered without undue delay
• respect and uphold people’s human rights’

 At all times, Capita clinical trainers, coaches and clinical specialists reinforce appropriate language, attitudes and behaviours towards claimants. Training materials are under continual review with particular attention paid to importance of empathy. For example, training has recently been adapted to help demonstrate good customer care during telephone assessments. Content on specific health conditions also includes consideration of the impact the assessment itself has on the claimant. Furthermore, practical work is underway to address this issue as the Departmental Health Assessment Advisory team have also been working closely with Capita following direct observations of telephony assessments providing direct feedback to DA’s on the importance of displaying empathy. The most recent Training Needs Analysis (TNA) report identified the need for more work on this. To address this Recommendation, Capita intend to develop a customer care skills training module for assessors which will include the use of empathy.

Continuous improvement is fundamental to the relationship between the Department and the assessment provider. We are always improving what we do and Capita are equally committed to continuous improvement. As mentioned earlier there are many layers of support available to DA’s, one of which is regular training events. As well as the Continuous Professional Development mandatory training to maintain registration, Capita offer targeted training every quarter with experienced trainers and coaches.  There is an existing feedback loop between the Department’s Health Assessment Advisor and Capita with recommendations following audit, observations and learning from complaints being incorporated into the annual Training Needs Analysis (TNA). A recent example of this resulted in Capita producing additional material and delivering training on the issue of recommended review periods.

Extensive collaborative working and feedback quality mechanisms are currently in place in the Department involving Case Managers, QAM’s and the HAA team. Alongside the continuous improvement approach taken by the assessment provider, this highlights the significant arrangements in place which underpin the continual scrutiny of PIP assessments through audit and decision making processes.

The Department understands this particular issue received significant support as it was raised by a number of groups. We, in conjunction with Capita, are committed to delivering quality, adopting a continuous improvement approach to delivering fair and robust decisions enabling disabled people to have trust in the assessor’s ability to accurately assess their functional needs.

The audit process

The role of the Departmental Health Assessment Advisor (HAA) team is an important one. The HAA team are responsible for the provision and quality assurance of Health Assessments undertaken by providers on behalf of the Department for Personal Independence Payment, Employment Support Allowance, Attendance Allowance, Disability Living Allowance and Universal Credit. Audit is both the responsibility of the Assessment Provider, Capita and the Department. The PIPAG, which is a published document, confirms the types of audit performed.

The Reviewer made the following Recommendation.

Recommendation 9 - the audit process

a) The Review recommends that the Department bring all auditing functions in-house as this would go some way to improving trust in the auditing process.

b) The Review recommends that the Department’s Health Assessment Advisor (HAA) uses the audit process and observations to identify the conditions/disabilities where DA’s require enhanced training. This should be regular, updated and kept under review. The Department’s HAA should engage with expert organisations and Medical Professionals to deliver the condition specific awareness/training required.

c) The Review recommends that the Department appoint an Independent Panel to scrutinise and provide support mechanisms for reviewing the standard of assessment, quality of reports, outcomes from the audit process and incorporate any learning identified.

The Department partially accepts this recommendation

Capita complete an audit of cases before they are sent to the Department.  This is comprised of, new entrant, targeted and rolling audit and forms part of internal quality assurance mechanisms and processes in place in Capita as set out in the contract. Capita also complete a further random sample audit of cases, this is called Lot-wide audit.

In her report the Reviewer recommended that all auditing functions should be brought in-house. The Department is currently reviewing the Audit process in PIP and during the current financial year, will bring the Lot Wide Audit function in-house. This will be carried out by the independent HAA team.

To further improve upon the existing quality assurance mechanisms, the HAA team have since January 2020, been directly observing PIP Assessments. This has been extended to include telephony assessments following the suspension of Face-to-Face Assessments in March 2020. The HAA team also continue to use the existing audit functions in combination with observations of Assessments to determine any required gaps in training or learning for DA’s. The TNA (Training Needs Analysis) tool provides a wider holistic view of DA performance, highlighting defined indicators of poor quality and importantly how these can be improved. It has been designed to allow for quick identification of areas of improvement at an individual DA or team level and provides for signposting opportunities to a resource or activity to aid in understanding or learning. It also provides specific insight into conditions or descriptor choices an individual or group may require support with and allows Capita to assure the Department that any changes to the PIPAG have been incorporated into training.

Other measures overseen by the HAA and which feed into the annual TNA are, learning from complaints, trend analysis on certain conditions, clinical calibration events, stakeholder engagement and learning from re-work cases.

The HAA will also continue to be involved in any decisions taken regarding identification and delivery of any enhanced or additional training following feedback from various sources listed above. The HAA is an existing key stakeholder in decisions taken with a view to continuous improvement where additional training is concerned.  

The Department understands that DWP will shortly publish a Green Paper which will look at Health and Disability Support including the WCA and PIP Assessment processes. In light of this and the plans to strengthen the existing scrutiny arrangements through aspects of the audit process being brought in-house, it would be premature at this stage to put in place an Independent Panel. Taking forward an Independent Panel and any emerging recommendations will also need to be considered within the Department’s constrained 2021/22 budgetary position and/or in-year funding bids submitted to Department of Finance as required. In the interim, the Department will consider how existing structures such as the Disability Consultative forum and the Independent Standards Committee can be used to ensure that learning from audits is further embedded in the process.

Decision making

It is important that those claiming PIP have trust and confidence in the decision making process. We agree with the Reviewer that Case Managers should feel empowered to make accurate decisions regardless of the title of their role. This should include determining eligibility, the correct rate and length of award and ensuring claimants do not face unnecessary assessments.

Those receiving a PIP decision should be clear on how the Department reached that decision, including how the rate and length of award is established.

The Reviewer made the following Recommendation

Recommendation 10 - decision making

a) The Department should ensure that Case Managers are empowered to carry out their role as Decision Makers and amend descriptor choices, recommended by Capita, if they have evidence to support this.

b) The Department should ensure that the process for renewing a claim for PIP is the same for all claimants. The current process means that those without a review end date have to complete the new claims process rather than the shortened AR1 form.

c) The Department should ensure on-going awards are made on all cases where the claimant’s condition is lifelong, life-limiting or degenerative. This should include adopting a subsequent 10 year light touch review on awards made.

d) Given the substantial supporting evidence gathered during the second Review, the Review recommends the Department revisits Recommendation 14 from the first Review and provides a copy of the DA’s report, including audited versions, to claimants along with their decision letter.

The Department accepts this Recommendation

We acknowledge the wide support received for this Recommendation amongst the advocacy sector. The Department has put in place a process to ensure Case Managers feel empowered to make decisions. We will support Case Managers in their role and will also ensure they continue to feel empowered to critically challenge advice in an assessment report where there is evidence which may suggest a different descriptor choice is appropriate.

Case Managers make decisions on Award Review applications if they feel it is appropriate to do so, without the need for Capita to carry out an up-to-date assessment.

The Department also has the ability to request advice from Capita where subsequent evidence is received which could impact on the original Disability Assessor report. In addition to this, the Quality Assurance team in the PIP Centre, who are a team of senior decision making experts, will where appropriate ask the Departmental Health Assessment Advisory team to consider cases and provide advice, without the need to return the case to Capita. Healthcare Professionals from the Departmental Health Assessment Advisory team also provide a Virtual Advice Line to PIP Case Managers which provides them with clinical based advice to support decision making in addition to advice on preparation for outbound calls to claimants to ensure the most relevant information is gathered.

The Department accepts the evidence presented to the Review indicating the different application processes involved depending on the type of award of PIP made and the impact on claimants where there is no review date set. There are 3 types of PIP awards

• on-going awards (reviewed at 10 years)
• longer term fixed awards (awards from 2-10 years) with a review date
• short term fixed (no review date set) – minimum of 9 months up to 2 year award where needs are not expected to be present beyond this period (this currently accounts for 2% of all awards) or fixed term awards made by an appeal Tribunal.

Many claimants receive awards which are for 5 years or more. Published Department figures from November 2020 indicate that out of 151,530 people receiving an award of PIP, 32% of whom (47,970) have been awarded for 5 years or more. Only 2% of customers were awarded PIP for 3 years or less. 

The current process governing how fixed term awards are made is currently being considered. We are currently working in partnership with colleagues in DWP on this and will take forward any changes arising from this work.

Existing processes, introduced in August 2018, acknowledged this issue ensuring those who have degenerative or progressive conditions, who had been awarded the highest level of PIP and whose needs are unlikely to change, receive an on-going award with only a ‘light touch’ review at the 10 year point. From May 2019 this was extended to all PIP claimants who are over State Pension Age, regardless of the rate they are awarded. They will also receive an on-going award with a ‘light touch’ review at the 10 year point. The changes were communicated to PIP Case Managers when introduced with training updated to incorporate these changes. Our internal monitoring indicates that Case Managers are implementing this guidance, this is borne out by the breakdown of the existing PIP caseload in terms of length of award. However, as an additional assurance we will re-issue the guidance to all Case Managers.

We acknowledge the need to strike the right balance in ensuring we take note of the feedback provided to the Review on the frequency of assessments and the feasibility of making longer term awards for those with the most severe and long-lasting conditions.

The Department understands the provision of the Disability Assessor report may be an important part of helping claimants, and their advocates, understand how their PIP decision was reached.

Currently claimants are provided, in their decision letter, with the number of points they scored against each activity and a summary of the reasons that informed our decision on their entitlement to PIP. The provision of additional information as described in response to Recommendation 7 will further enhance this aspect. We believe that sending this information is the still the best way to explain to claimants how a decision has been reached. In addition to this, claimants can continue to request a more detailed explanation of the decision and a full copy of their assessment report at any time. Also copies of the Assessment report, including any previous versions and audit findings, are provided as standard if a claimant lodges an appeal.

However, in order to fully assess the benefits of providing the Disability Assessor report in every case, we will carry out a ‘cost benefits analysis’ exercise to address this part of the Recommendation. The Department is keen to establish whether the automatic provision of the report will be necessary in every case or whether this can be provided at Mandatory Reconsideration stage only. The Department will explore this further and discuss with representatives of the voluntary and community sector at the Disability Consultative Forum. This will help explore and best understand any benefits and or issues involved in issuing the report with the decision letter which would be a completely clerical process resulting in additional costs.

Improvements to the complaints process

The Department is in agreement with the Reviewer that those who are unhappy with any element of the service should view the complaints process as an impartial means of seeking redress. It is important to note that claimants who do not agree with a benefit decision can dispute that decision through the Reconsideration and Appeals process. This is the legal form of redress and is separate from complaints about how the service was delivered.

Individuals making a complaint should not face barriers or excess bureaucracy when raising an issue about any aspect of the assessment process. They should feel able to comment on any aspect with impunity or perceived negative impact on their claim.

The Reviewer made the following Recommendation

Recommendation 11 - improvements to the complaints process

a) The Department and Capita should publish more comprehensive guidance on how the complaints process works. More comprehensive guidance will help allay fears and assure claimants that making a complaint does not impact or influence the final decision.

b) The Department should establish an Independent Panel to monitor and scrutinise complaints and responses from the Department and Capita. This will remove any mistrust around effective complaint handling

The Department partially accepts this Recommendation.

We are aware of the Northern Ireland Public Service Ombudsman (NIPSO) work to put in place the Complaints Standard Authority and the changes that this will bring about. In the interim, we commit to taking additional steps to make improvements to the current complaints procedures

The Department’s existing complaint procedure, which is applied across all benefits, is laid out on the website with instructions to contact the benefit office involved to raise a specific complaint. We will take steps to ensure this is given greater prominence with the process signposted on the PIP page of NI Direct and/or on the Department’s website itself. We will refresh the information held on both sites and will ensure that this is made clearer to anyone wishing to make a complaint highlighting that complaints do not impact any decision made on eligibility.

Capita similarly agree to publish further guidance on how the complaints process works. The current website content will be enhanced to make it clear how the Capita PIP complaint process operates, clearly explaining each stage of the process, who to contact, the timelines in which the Department requires Capita to respond and how to escalate a complaint to the Department if they are in any way dissatisfied with how Capita have handled the complaint. In addition, the enhanced website content will make it clear that making a complaint will not adversely influence the outcome of an individual’s PIP claim.

Claimants and their representatives should be assured that complaints made to either Capita or the Department do not have a negative effect on the claim. Complaints are viewed as a valuable opportunity to improve our service and we are committed to ensuring any mistakes are rectified as soon as possible. Claimants can make a complaint to either the Department or to Capita. Where a complaint is made to the Department and the person is dissatisfied about any element of the service provided by Capita, we will seek feedback directly from Capita.

With regard to oversight of complaint handling, there is an existing independent mechanism in place for this. The Department’s final complaint response clearly signposts the person to either the Northern Ireland Public Service Ombudsman (NIPSO) or the Independent Case Examiner (ICE) if they remain dissatisfied with this response.

In light of this existing oversight and the changes that will flow from the Complaints Standard Authority and the on-going NIPSO review when published, it would not be appropriate to put in place an independent panel at this point. Taking forward the Independent Panel and any emerging recommendations, will also need to be considered within the Department’s constrained 2021/22 budgetary position and/or in-year funding bids submitted to Department of Finance as required. However, in addition to the proposed changes the Department will in the interim, examine what further steps could be taken to build trust in the complaints process through further discussions with the PIP Consultative Forum.

Improvements to published statistical information

The Department acknowledges the importance of publishing data to ensure transparency and agrees with the Reviewer’s findings that access to comprehensive statistical information will help increase confidence and trust in the system.

Professional Services Unit (PSU) in the Department compile statistical data in relation to PIP publishing these on the Departmental website. These statistics provide information on a number of key areas such as

• number of claims registered and cleared
• time taken to clear claims
• awards
• claims in payment
• mandatory reconsiderations
• DLA to PIP reassessment outcomes

The Reviewer made the following Recommendation.

Recommendation 12 - improvements to published statistical information

The Review recommends that the Department provide in-depth statistical data in line with DWP published information to promote confidence and transparency.

The Department accepts this Recommendation

The current suite of published information is undergoing evaluation and as such is experimental in nature. We agree that access to interactive information can promote confidence in the transparency of process allowing end users to interrogate information directly.

DWP use Stat X Plore which is an online tool that allows the creation and download of customised statistical tables, as well as data visualisation through interactive charts. The NI PIP Statistics are currently defined as ‘Experimental Statistics’. New statistics are normally defined as experimental as these are still in the early stages of development as stakeholders are involved in their final design. The NI PIP Experimental statistics are currently under review as part of a process of assessment by the Office for Statistics Regulation (OSR) who are part of the UK Statistics Authority, for National Statistics status.

National Statistics are Official Statistics that have been assessed as fully compliant with the Code of Practice for Statistics as meeting the highest standards of trustworthiness, quality and value. An invitation was posted on the Departmental website inviting users of the NI PIP statistics to take part in this assessment.

A report on the assessment of the NI PIP Statistics by OSR is scheduled for publication shortly. Any recommendations arising will be incorporated into the design of any new statistical information.

We have also listened to feedback provided by end users of the published data and have incorporated their ideas into the requirements for this design. We welcome the opportunity to make improvements to the current suite of published information.

Other considerations

The Reviewer has outlined evidence, which although did not result in a Recommendation, clearly impacts on people’s experience of the PIP assessment process. The Review received evidence from rural communities in relation to the accessibility of the Assessment Centres, access to advocacy services and lack of reliable broadband. Information received also highlighted the issues presented by GDPR, the COVID-19 response and safeguarding in the Assessment process. The Department acknowledges the important points raised by the Reviewer and will consider carefully the issues highlighted.

Abbreviations

Abbreviation	Meaning
AP	Assessment Provider
AR	Award Review
BMA	British Medical Association
CM	Case Manager
CIR	Condition Insight Report
Covid-19	Coronavirus
DA	Disability Assessor
DfC	Department for Communities
DLA	Disability Living Allowance
DWP	Department for Work and Pensions
ESA	Employment and Support Allowance
GB	Great Britain
GDPR	General Data Protection Regulations
GP	General Practitioner
GPFR	General Practitioner Factual Report
HAA	Health Assessment Advisor
HP	Health Professional
HTP	Health Transformation Project
ICE	Independent Case Examiner
IT	Information Technology
MtC	Make the Call
NI	Northern Ireland
NIPSO	Northern Ireland Public Service Ombudsman
OSR	Office for Statistics Regulation
PIP	Personal Independence Payment
PIPAG	Personal Independence Payment Assessment Guide
PSU	Professional Services Unit
QAM	Quality Assurance Manager
RCOGP	Royal College of GP’s
SRTI	Special Rules Terminally Ill
TNA	Training Needs Analysis
UC	Universal Credit
VRS	Video Relay Service
WCA	Work Capability Assessment