The story of the introduction of Personal Independence Payment (PIP) and new work capability assessments for Employment Support Allowance (ESA) echoes what we found in our recent report on Universal Credit: contrary to media and popular perception, they are working for many.
The majority (82% and 81% respectively) of PIP and ESA claimants report being satisfied. Between April 2014 and March 2017, out of 4.9 million PIP and ESA decisions that were made, only 8% of decisions were appealed. However, these appeals are very significant, having already affected hundreds of thousands of individuals with physical or mental health problems, and things are getting worse.
All claims of PIP, and majority of ESA claims, involve face-to-face assessments with a ‘health professional’. The process of disputing these assessments involves two stages: the Mandatory Reconsideration, done by the Department of Work and Pensions, followed by a tribunal appeal if the claimant was unsatisfied with the outcome of the former.
In 2017-18, there were 153,760 heard tribunal appeals for PIP and ESA assessments. As can be seen in Table 1, 68% of them were upheld in favour of the claimant, with this proportion trending upwards from 65% in 2016-17. Though the 2018-19 year is not yet complete, the numbers for the first three quarters suggest that these proportions will climb even higher, likely into low 70s for both benefits.
Table 1: PIP and ESA heard tribunal appeals upheld in favour of the claimant
| Year | PIP (% of all heard appeals) | ESA (% of all heard appeals) |
| 2014-15 | 3,571 (50%) | 32,810 (54%) |
| 2015-16 | 30,236 (61%) | 28,949 (58%) |
| 2016-17 | 45,697 (65%) | 42,927 (65%) |
| 2017-18 | 56,971 (68%) | 47,788 (68%) |
| 2018-19 (Q1 – Q3) | 45,204 (72%) | 30,970 (72%) |
Source: Ministry of Justice, Tribunals Statistics (2019)
The waiting times for appeals are also an increasing source of concern, as can be seen in Table 2. While the Government has managed to decrease waiting times between 2014 and 2016, this trend has now reversed. In 2017-18, the mean time between opening a case and obtaining a decision has risen to 29 weeks. Furthermore, there is significant variation in waiting times in different areas, with claimants in Wales and Yorkshire having to wait the longest, meaning that 25% of appeals take 40 weeks or longer to resolve. Combined, the rise of successful appeals and waiting times paint an alarming trend.
Table 2: Mean waiting time for an appeal decision
| Year | PIP (weeks) | ESA (weeks) |
| 2014-15 | N/A | 24 |
| 2015-16 | 17 | 17 |
| 2016-17 | 16 | 14 |
| 2017-18 | 23 | 20 |
| 2018-19 (Q1-Q3) | 29 | 29 |
Source: Ministry of Justice, Tribunals Statistics (2019)
However, it is important to temper these statistics with two considerations. First, the appeals process acts as a filter, as many claimants choose not to contest the decision or withdraw their appeal. Hence, the cases reaching the tribunal tend to be stronger, inflating the success rate. Second, the Government has argued that claimants often provide additional evidence at the appeal stage, bolstering their case, though it should be noted that 63% of overturned appeals were made on the basis of oral, rather than documentary evidence.
Yet, this evidence still suggests that assessment processes could be significantly improved, especially as it does not address the above trends. One way forward is decreasing the caseload through fewer reassessments for specific groups, which will decrease waiting times and potentially increase accuracy. Since the summer of 2018, the Government has already announced that it will only review PIP awards of pensioners and those with the most severe and life-long conditions once every ten years.
However, more substantive changes to the assessments are probably needed. If oral evidence is frequently the deciding part of appeals, then more effort needs to be made to ensure that it is obtained in the initial face-to-face assessments. This might be achieved through substantive changes to the types of questions asked, the manner in which they are asked or through improvement of knowledge and skills of the decision-makers.
Our current disability benefits work for most, but every year tens of thousands of people still have to struggle for months to await a correct decision, and things are getting worse, with both accuracy and timeliness in decline. It is vital for the Government to examine what is going wrong to reverse these trends, helping some of the most vulnerable in our society.
Anvar Sarygulov is a Researcher at Bright Blue.
