Posted 24.06.2021

The Northern Ireland Public Services Ombudsman (NIPSO), published their report 'PIP and the Value of Further Evidence' today (Thursday 24 June 2021). Disability Action welcomes this report which found 'systemic maladministration' in the handling of Personal Independence Payment (PIP) assessments.

The investigation found that the Department for Communities and Capita failed to properly obtain and use all relevant medical information to help them assess claims for the PIP benefit.

This led to the rejection of many claims, meaning applicants had to continually challenge the decision, often all the way to Appeal, before the correct decision was made.

The repeated nature of the failures led the Ombudsman to conclude that it constituted ‘systemic maladministration’.

The investigation, by Ombudsman Margaret Kelly, gave detailed consideration to a number of issues including:

• How the Department and Capita inform claimants of the role of further
  evidence in the PIP assessment process;
• How the assessment of further evidence is recorded and reviewed; and
• How the Department and Capita investigate and address complaints
  relating to further evidence.

The investigation found that:

• At the Initial Review stage, further evidence was requested by Capita Disability Assessors in only 35 of the 100 claims that were examined. This figure includes both written and telephone requests. Whilst 10% higher than the overall 25% average, given the importance of further evidence to the PIP process it is lower than would be expected.
• Despite Disability Assessors having the ability to request further evidence at all stages of the PIP process, of the 96 claims routed for face to face consultation, further evidence was requested in only one case at the Assessment stage.
• The most commonly recorded indicator for deciding not to request further evidence was that it was unlikely evidence would be obtained within the timescale required.
• Capita’s own written process, in respect of claims routed for a face to face consultation, almost acted as a deterrent to further evidence being gathered from other sources, despite claimants being left with the clear impression it would be an important part of the decision making in their claim.
• When evidence was requested from Health Professionals named by the claimant, the request letters sent by Capita were often poorly completed and did not specify what information was sought.
• In the face to face assessments, the evidence from the consultations was often the primary and in some cases the only source of evidence relied upon by the Disability Assessors when providing their advice to the Department.
• Disability Assessors did not explain or record why more reliance was placed on their observations at a face to face consultation than other available evidence from claimants, carers or professionals.
• In addition to passing quality audits, Capita use information about the number of assessment reports completed and submission times to decide bonuses for Disability Assessors. Time pressures and incentives have the potential to inhibit the appropriate use of further evidence to improve the quality of assessment advice

Recommendations

The report makes 33 recommendations to the Department for improvement, which are set out in full in the report. The recommendations centre on helping the Department to get the delivery of PIP to claimants right first time.

Read a summary of the NIPSO report

Read the full version of the NIPSO investigation report

Read more and watch a video on the NIPSO website