Social Security Experience Panels: Personal Independence Payment health assessments

Summary

Booking a health assessment

Respondents preferred booking options that allowed them the freedom to choose when and where the health assessment would take place. Only one in twenty respondents said they would like to be automatically assigned the first available appointment within one hour's travel time of their home (5 per cent). No statistically significant associations were observed in booking preference between respondents who lived in urban and rural areas, or between respondents who had a disability or were a carer.

Respondents who wanted home visits tended to say this was due to mobility issues, or a specific health condition which would make travelling to a Social Security Scotland venue difficult.

When asked what factors were important to choose when booking a health assessment, respondents said the most important was being able to choose an assessor who had knowledge of their specific medical condition. Many respondents felt that having an assessor who was knowledgeable about their health condition would lead to a higher quality assessment through a more accurate assessment report. The location and time of the assessment also ranked highly.

Respondents told us that the nature of their health condition meant that having the flexibility to book and choose their own appointment was important to them.

Re-arranging a health assessment

Just under one in five respondents had missed or cancelled a health assessment in the past (17 per cent). Of those who had missed or cancelled an assessment, just over seven in ten had cancelled (71 per cent) and just under three in ten had missed it (29 per cent).

Respondents told us they missed or cancelled their assessment for a number of reasons, the most common being:

• the respondent lost the appointment letter, or the letter arrived giving insufficient notice to allow arrangements to be made to attend;
• the respondent being unwell, in hospital, or caring for an unwell family member or friend;
• the respondent could not arrange suitable transport to the location where the health assessment was due to take place; and
• the respondent's disability had flared up and they were having a bad day.

Travelling to the health assessment

Respondents told us the location of the assessment centres were 'hugely important' for reasons of accessibility, privacy and cost. Respondents told us that they felt the current location of assessment centres did not suit them, with some respondents saying they had been asked to travel far from home. Others said that when they arrived, the assessment venue itself was not fully accessible to them.

Many respondents said that they could only travel at certain times of day. For some, this was the morning as that was when they felt most rested. For others, they wanted an assessment in the afternoon to allow them time to get ready and for their medication to 'kick in'.

Many respondents said they would value being able to book a parking space at the assessment location as they did not want to, or could not use public transport due to their disability.

Overall, respondents said they would like to choose when and where their assessment took place, and that Social Security Scotland should understand and be prepared for the inevitable need for flexibility that is inherent to their client group.

At the health assessment

For many respondents, undergoing a health assessment as part of their benefit application was described as one of the most stressful aspects of the process.

Respondents used words such as 'degrading', 'humiliating' and 'stressful' to describe the experience. There was, across most respondents, concern about the competency, reliability and integrity of the health assessors, as well as the value and fairness of the way health assessments are currently implemented.

Many respondents felt that their assessor did not understand their disability, with some saying they were asked inappropriate or insensitive questions as a result. Some respondents felt 'condescended' as their assessor said they 'had never heard of their condition before'. This caused stress amongst clients and reduced their confidence of receiving an accurate, fair and comprehensive health assessment.

Respondents suggested more knowledgeable assessors would lead to more accurate reports, higher quality assessments and fairer outcomes for clients.

Respondents felt that it was especially challenging to communicate the impact of mental health conditions to assessors. Some respondents said they struggled to vocalise the impact of their condition, or found talking to strangers very difficult. Being placed into the stressful and unfamiliar situation of the health assessment made them 'close up'. It was felt that in these cases, it was the job of the health assessor to work with the client to draw out the required information. In many cases, respondents said this did not happen.

Respondents who had multiple conditions felt that assessors could not accurately determine how their conditions interacted with each other and their medication. Some also felt it was inappropriate for the assessor to doubt written evidence supplied by their doctors or health professionals.

Respondents suggested that in the future, they would like to see a move away from standardised questions in favour of a more individualised approach to assessment. This included tailoring health assessments to someone's health condition and reducing the instances of assessors asking inappropriate questions.

Most felt that assessors did not need to have a medical degree - a well-rounded understanding of disabilities and effective training was seen by most to be sufficient.

A recurring theme throughout the research was the accuracy, fairness and quality of the report written by the health assessor. The assessment report is intended to summarise the findings from the health assessment and offer an accurate overview of the applicant's health. Many respondents reported that the report contained inaccuracies or omitted key information they had said at the assessment. Consequently, many respondents said they did not trust the report's content and felt that it was often inaccurate.

Recording health assessments

Almost three quarters of respondents (72 per cent) said they would like health assessments to be recorded. Respondents said they wanted a verifiable record of what took place in the assessment, which could be used to check what either party said. Many respondents wanted this as they did not trust the assessor to be truthful as a result of their past experiences. Other respondents wanted to record their assessment to assist with any later appeals or to help them remember what was said due to memory issues.

A small number of respondents referenced the current rules around recording assessments and felt that universal recording would introduce 'fairness'. They felt that conforming to the current rules, such as clients providing an approved recording device, could be expensive and therefore not possible for poorer clients.

Respondents who did not want their health assessment recorded tended to refer to privacy concerns over their personal data. They said it was 'a step too far' and did not trust the government to keep such sensitive data.

Of those who wanted an assessment recorded, just over half of respondents preferred an audio recording (56 per cent). Those who favoured audio recording described it as 'less intrusive' and 'less intimidating' than video recording. For some, video recording was seen as a 'scary prospect'.

Those who favoured video recording said it captured 'the whole picture' and noted that body language was important when conducting health assessments. Respondents also felt that a video recording was most appropriate where physical examinations were to be conducted to show the client's actual response.

Duration of health assessments

Just under six in ten respondents said health assessments should last 'as long as necessary' (58 per cent). When asked how long would be too long for them personally, almost nine in ten respondents said the assessment could be over 30 minutes (87 per cent), however less than three in ten said they could manage more than an hour (28 per cent). Just over one in ten said they could manage over 1 hour 30 minutes (14 per cent).

Respondents who told us they would prefer a home visit, or who were carers tended to say health assessments should be shorter.

When asked what should happen if they felt they could no longer continue during a health assessment, most respondents said they would like to be able to arrange another assessment at a convenient date and time, including being able to select another assessor if required. Some requested that there be a written record of what had happened up to that point so the future health assessment would be shorter.

Other respondents suggested that it be made clear to clients that they had the right to stop the appointment if they wished, to avoid feelings of stress or worry about consequences should they choose to do so. Some felt that incorporating breaks into the process would reduce the need for clients to cut assessments short.

Claiming expenses after a health assessment

Just over a fifth of respondents had claimed, or had claimed and received expenses after a health assessment (21 per cent). Respondents tended to be satisfied with the expenses process saying it went 'very quickly' and that it was a 'good solution'.

Respondents differed in the length of time they reported it taking to receive the expenses, however most said it was four weeks or less.

A minority of respondents were unhappy with the process, saying it was 'more hassle than it was worth'. Others felt having to be out of pocket before the assessment was inconvenient, and that some clients couldn't afford to be without the money for such a long time.