16 February 2004 - Publication of DWP research report: Key Findings and Publication of DWP Research: Medical Evidence and Incapacity Benefit Appeals: Evaluation of a Pilot Study
A research report published today by the Department for Work and Pensions provides findings from the final element of the evaluation of the Medical Evidence Gathering for Incapacity Benefit pilot conducted in Sheffield and Rotherham in 2002.
The pilots tested an alternative method of collecting medical evidence for the Personal Capability Assessment (PCA) for Incapacity Benefit claims taking evidence directly from GP case notes rather than relying on a written report from the client’s doctor. The aim of this pilot was to improve the operation of the Personal Capability Assessment (PCA) process.
The report contains findings from research looking at the impact of the pilot arrangements for collecting medical evidence on (a) incapacity benefit claimants’ appealing behaviour, and (b) tribunal decision making.
Key findings
- Interviews with appellants and non appellants found that people put most emphasis on the medical examination in their decision to appeal or not to appeal rather than on any sources of written medical evidence.
- Appellants and non appellants who recalled details of the pilot arrangements were generally in favour of using the GP case notes as this was perceived as providing better information on their health conditions and seen to reduce the burden on GPs. Others stressed issues with confidentiality and felt their GPs were better placed to provide information about their health conditions.
- Tribunal members were attracted by the pilot arrangements since current arrangements produce limited and partial or no information at all from GPs and this way they were guaranteed at least some medical evidence.
- The evaluation showed that the alternative arrangements for obtaining information from GPs for benefit assessment purposes contributed little to people’s decisions about whether to appeal against benefit disallowance decisions.
- The study has been valuable for identifying the role that medical evidence, and information from GPs in particular, plays in the decisions of incapacity benefit claimants and in the work of appeal tribunals.
- It has also produced findings about the importance of the medical examination, the quality of medical reports, and about paper hearings that can inform future policy thinking about incapacity benefit decision making arrangements.
Notes for editors
- ‘“Medical Evidence and Incapacity Benefit Appeals: Evaluation of a Pilot Study”’ by Roy Sainsbury and Anne Corden is published today in the DWP In-House Research Series: report number 129. A summary and copy of the report are available on the DWP website at www.dwp.gov.uk/research
- Terminology:
The PCA process
The PCA arrangements for assessing limitations in physical and sensory function differ from those for assessing the effects of mental health problems. Both methods are described below.Physical and sensory health
The PCA assesses a person’s incapacity under fourteen specified activities in the area of physical and sensory function. The areas include, for example, walking, walking up and down stairs, vision and hearing.For each of these activities, there is a set of ranked statements, known as descriptors, which illustrate different levels of functional limitation.
The outcome of the PCA is determined by the choice of the descriptors which most accurately reflect the person's level of functional limitation across all relevant physical and/or sensory areas. Each descriptor has been assigned a specific points score, a person needs at least 15 points from the physical and sensory areas to reach the benefit threshold.
Assessment procedures
When a requirement for a PCA first arises a Jobcentre Plus officer will consider whether a client may fall into an exempt category on the basis of a severe sickness or disability. There is a list of exempt conditions set out in regulations that include such conditions as tetraplegia and paraplegia, terminal illness, being registered blind, chronic degenerative disease or schizophrenia.If a client potentially falls into this category then they will not be contacted. Rather their GP will be asked to provide information about their client’s condition and Medical Services will provide advice as to whether the client has one of the conditions listed. If they do the PCA process finishes at this point.
For those clients who are not exempt a questionnaire is sent out. In it the client is asked to select those descriptors which best describe any functional limitations they may have in each of the physical and sensory areas listed.
Clients are encouraged to provide any additional information which will assist the Decision-Maker in applying the incapacity test. Space is also provided on the questionnaire for the client to comment on any health problems they may have which affect their ability to perform work-related activities.
Doctors approved for the purpose by the Secretary of State, will consider the questionnaire and any other evidence, particularly the information provided by the certifying doctor in response to a request for a Med 4 statement or IB 113 report.
The approved doctor will advise the Decision-Maker whether the functional limitations reported by the client on the questionnaire are consistent with the medical evidence.
Where there is doubt about the stated level of incapacity the client will be called for a medical examination.
At examination the approved doctor will interview and clinically examine the client and make an assessment of the level of functional ability in each of the activity areas and the presence of any non-functional restrictions (exceptional circumstances). The doctor will prepare a detailed report (Incapacity Report) which is made available to the Decision-Maker.
In ascribing a particular level of functional limitation for an activity, account is taken of any pain and fatigue as well as any fluctuation of the medical condition.
It is not the aim of the test to judge whether a person can carry out a particular action on a one-off basis, but rather to assess the difficulties a person encounters in carrying out the activities in a reasonably sustained fashion over time.
Thus the approved doctor's assessment will not simply be based upon a 'snapshot' of the client's functional capacity at the time of the examination.
The Decision-Maker will weigh all the evidence – that is the client’s questionnaire, any evidence supplied by the client's own doctor(s) and the advice of the approved doctor set out in the Incapacity Report – before arriving at a decision on benefit entitlement.
A person may qualify for benefit on the basis of meeting the threshold for functional limitation in any one of the physical or sensory activities, or on the basis of a combination of less severe limitations across several areas of function.
Mental health
All cases where, on the evidence available, the client appears to have a mental health problem will be referred to an approved doctor for advice on exemption, before a questionnaire is issued.The approved doctor will identify those clients who have a severe mental health problem on the basis of factual evidence supplied by the GP. Such people will be treated as incapable of work. Clients who are identified as having a mild/moderate mental health problem will be sent the questionnaire so that any physical and sensory problems may be taken into account.
The questionnaire also gives the client the opportunity to give information about the effects of any mental health problems. The client will then undergo a mental health assessment and possibly also a physical/sensory assessment on examination by an approved doctor.
There are four specified activities which relate to capacity for work in the assessment of the effects of mental health problems: daily living, completion of tasks, coping with pressure and interaction with other people.
For each of these activities, there is a set of descriptors. Unlike those for the assessment of physical and sensory functions, these descriptors are not ranked on a rising scale of impairment. Instead, each set of descriptors covers a range of different problems that may be encountered within each activity.
Each of these statements has been assigned a points score. The points total for each activity is the sum of the points attached to all the descriptors which apply to the client. The mental health descriptors are not part of the questionnaire that the client completes.
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