The transition from DLA to PIP will harm disabled claimants

Causes for concern from a care worker.

I am a care worker supporting disabled people to live independently within my community. Many of my service users claim disability benefit, and I am concerned that the new assessments for Personal Independence Payment (PIP), which has replaced Disability Living Allowance (DLA), will not only cause them unnecessary stress and anxiety but threaten the freedom and standard of living they are used to having - and have a right to have.

The assessment for PIP requires claimants to attend face-to-face consultations, unless they’re housebound or unable to travel for medical reasons. Dave* has multiple sclerosis. Although he is not technically “housebound” it would be an enormous task for him to attend a consultation because he is wheelchair bound and doesn’t have easy access to disabled-friendly transport. It would be mentally overwhelming too, because beneath the bravado of a bloke who used to run a building site, Dave like many other disabled people has suffered a huge loss of confidence. The prospect would cause him unnecessary distress and it would take days to recover from the mental and physical upheaval of having been. But practical obstacles and vulnerable states of mind do not count as excuses to avoid these consultations.

The new assessments also prioritise testimonies from GPs and specialists rather than those from families, carers and social workers. Whilst a doctor’s input is invaluable in proving what disability a claimant has, they are no more qualified to comment on how that disability affects the claimant on a daily basis outside of the doctor’s surgery or hospital. 

Jane* has Parkinson’s disease and a rare condition that causes jaw spasms and excessive dribbling. She sees a specialist twice a year who is “managing” her well - she receives treatment, of varying success rates, for her medical conditions. So her doctor could feasibly suggest that Jane copes alright at home. If this testimony is the extent of Jane’s supporting evidence then her assessment will be inaccurate and overlook the practical tasks she cannot complete and the social interactions she cannot have. Jane’s doctor doesn’t know she spends her days hunched over a bin of wet tissues, often crying, with a constant stream of saliva pouring from her mouth. Nor should they be expected to, because they do not live and work alongside her. Since PIP is supposed to improve disabled people’s “ability to participate in society”, assessors should surely be concerned with living socially as opposed to surviving medically. As it stands, the new assessment and its preoccupation with medical evidence will fail people like Jane.

Claimants will be regularly reassessed for PIP once they receive it to ensure their circumstances have not changed. Bizarrely this will even apply to permanently disabled people like Tony*, a paralysed stroke victim, and Sue* who has Multiple System Atrophy (MSA). Their condition will never improve but they will nonetheless have to endure routine reassessments causing unnecessary stress and disruption – lest they forget that it is not their right to have this support; it is their short term privilege which can be taken away at any time.

Indeed it will be taken away. People who have leased ‘motorbility’ cars using their DLA risk losing them because the ‘walking distance’ that decides your eligibility has been decreased from fifty metres to twenty. Lucy* has cerebral palsy but whilst she cannot walk fifty metres, she can struggle to walk twenty. She lives in a remote village, miles from amenities and relies on her car. The infrequent and unreliable bus service clashes with her shifts as a ‘blood bikes’ co-ordinator (a voluntary courier service for the NHS) and besides, she suffers terribly with travel sickness. If her car is taken, Lucy’s independence will be taken as well.

Lucy said to me last week “we talk about vulnerable disabled people, but my disability doesn’t make me vulnerable – this government does!” As PIP sweeps across the country, I fear she is right. My service users will face a lifetime of exhausting assessments or have the disability benefit safety net pulled from underneath them altogether, simply because our government has decided to move the goal posts closer together in a bid to reducing welfare spending.

We must raise awareness about the impact these PIP assessments will have on disabled people. The MS society has campaigned successfully for PIP assessors to allow for the fluctuating nature of multiple sclerosis, something they previously failed to consider. Parkinson’s UK has campaigned to postpone reassessments for current DLA claimants until October 2015, to allow time for an independent review on how PIP works for new claimants. More of us need to follow suit, and I for one wouldn’t be doing my job properly as a care worker if I didn’t speak out against these PIP assessments, and the harm they are likely to bring my service users.

*Some names have been altered to protect the identities of affected individuals.

A response from the Minister for Disabled People, Esther McVey, to this piece is published here 

The assessment for PIP requires claimants to attend face-to-face consultations, though many are not able. Photograph: Getty Images.
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The NHS's sustainability is under threat if more isn't done to look after its staff

More work is needed to develop the health service's most precious resource.

As the NHS nears its 70th anniversary, the time is ripe for a workforce rescue plan. Staffing worries, even more than funding pressures, are the biggest cause of concern for NHS trust leaders. There are not enough trained health workers in the UK to meet today’s needs, let alone those of the future.

Demands on hospitals, mental health and community trusts, and ambulance services are growing. More patients need treatment. Increasingly, they require complex care, with specialist expertise. This is not just about numbers. We need a clinical workforce that is skilled and equipped to work in new ways to deal with the changing needs of the population it serves. 

That means improving the supply of people coming to work for the NHS, and doing more to develop and motivate them so they want to stay. These problems are not new but the scale of the challenge has reached a tipping point which threatens the future sustainability of the NHS.

Ministers rightly point out that the NHS in England has more clinical staff than ever before, but numbers have not kept pace with rising demand. The official "shortfall rate" for nurses and midwives across England is close to 10 per cent, and in some places significantly higher. Part of this is down to the recognition, after the events at troubled health trust Mid Staffordshire, of the importance of safe staffing levels. Yet for successive years during the coalition government, the number of nurse training recruits fell.

Far from being a problem just for hospitals, there are major nursing shortages in mental health and community trusts. Between 2009 and 2016 the number of district nurses employed by the NHS in England fell by more than 40 per cent. Just as the health service tries to accelerate plans for more treatment closer to home, in key parts of the workforce the necessary resources are shrinking.

There are also worrying gaps in the supply of doctors. Even as the NHS gears up for what may prove to be its toughest winter yet, we see worrying shortfalls in A&E consultants. The health service is rightly committed to putting mental health on an equal footing with physical health. But many trusts are struggling to fill psychiatry posts. And we do not have enough GPs.

A key part of the problem is retention. Since 2010/11 there has been a worrying rise in “leaver rates” among nurses, midwives, ambulance staff and scientific technical staff. Many blame the pressures of workload, low staffing levels and disillusionment with the quality of care. Seventy per cent of NHS staff stay on for extra hours. Well over a third say they have felt unwell in the past year because of work-related stress.

Add in cuts to real basic pay, year after year, and it is hardly surprising that some are looking to other opportunities and careers outside the public sector. We need a strategy to end pay restraint in the NHS.

There is also a worrying demographic challenge. Almost one in three qualified nurses, midwives and health visitors is aged 50 or older. One in five GPs is at least 55. We have to give them reasons to stay.

NHS trusts have made important strides in engaging with their workforce. Staff ratings on being able to report concerns, feeling trusted to do their jobs, and being able to suggest improvements are encouraging. But there are still cultural problems – for example around discrimination and bullying – which must be addressed locally and nationally.

The NHS can no longer be sure that overseas recruits will step in to fill workforce gaps. In the early 2000s many trusts looked beyond Europe to meet nursing shortages. More recently, as tougher immigration and language rules took hold, a growing proportion came from the EU – though not enough to plug the gap.

Now we have all the uncertainty surrounding Brexit. We need urgent clarity on the status of current EU nationals working in the health and care systems. And we must recognise that for the foreseeable future, NHS trusts will need support to recruit and retain staff from overseas. The government says it will improve the home-grown supply, but that will clearly take time.

These problems have developed in plain sight. But leadership on this has been muddled or trumped by worries over funding. Responsibility for NHS workforce strategy is disjointed. We need a co-ordinated, realistic, long-term strategy to ensure that frontline organisations have the right number of staff with the right skills in the right place to deliver high quality care.

We must act now. This year's long-delayed workforce plan – to be published soon by Health Education England – could be a good place to start. But what we need is a more fundamental approach – with a clear vision of how the NHS must develop its workforce to meet these challenges, and a commitment to make it happen. 

Saffron Cordery is the director of policy and strategy at NHS Providers