A new disability benefit should reflect the policy intent that the important factor is not the medical condition but the effect that it has on people's care and mobility needs.
It is not necessary to have medical practitioners make the decision or involved in the assessment process. As the important factor is the disability, not the medical condition, it is not necessary that the decision maker have detailed knowledge of the medical condition. The essence of the approach at all levels is that, in many cases, it is not highly technical or difficult medical judgments that need to be made--it is, above all, judgments about the effect that a condition has on a person's life. Knowledge of the disability, regardless of the underlying medical reason, is what is needed. By making administrative adjudication officers the decision makers, it is possible to reduce the medical input, reflecting the policy intention of moving away from focus on the medical condition.
The best that an examining medical practitioner can do is to take a snapshot of the person's condition on the day on which he sees that disabled person. Many conditions relapse or progress at different times. One exam on one day cannot accurately capture the long-term disability.
It is much better to rely on the evidence of someone continuously in touch with the disabled person who can give a much better and longer-term assessment of their condition and the effect on their way of life. That will be an improvement. The emphasis should be firmly on self-assessment and on supplementary evidence from those in contact with the claimant, giving proper weight to the judgment of those in the best position to know the effect that a claimant's condition has on his or her life.
This emphasis will give a better picture of the circumstances than the snapshot of a medical examination, which is too frequently all that is provided, so that adjudication officers have a better basis for their decisions.
It may be that in some circumstances a medical examination is desirable or necessary. By not having medical examination as the routine, the medical examinations that do occur can be cost-effective and of high standard. There will be significantly reduced demand for medical examinations, so that even where they do occur there is not a long wait of several months duration, and all claims can be decided more speedily.
A disability benefit should be shifted away from focusing exclusively on incapacity--on what disabled people cannot do--towards doing more to encourage people with disabilities to make the best of the capacity that they have--the things that they can and wish to do.
The claim and assessment process should be made easy for claimants in two ways: by giving them the opportunity to give us a fuller account of the effect that their condition has on their lives; and by giving the opportunity to marshall evidence about their condition from third parties who are involved in their care--their GP, health visitors, district nurses, relatives or other carers. This particularly important point picks up recommendations that have been urged by disabled peoples' organisations.
What is unlikely to have been obvious to anyone who is not a politically-well-read historian of disability benefits is that the majority of what was written above is a direct quote from or otherwise based upon speeches made by Tory MPs - in 1990, when Disability Living Allowance was being introduced. The entire section above is a rebuttal of current Tory MPs positions on the disability benefits DLA and Personal Independence Payments.
Some of the issues have not changed - 23 years later, politicians are still telling us to move away from a focus on what disabled people can't do to a focus on what they can do. Apparently in 23 years of change to disability-related benefits we haven't moved very far. Or perhaps this isn't about moving at all, but instead is all about finding any laudable-sounding reason possible for changing a benefit, even when the new benefit no more focusses on what disabled people 'can' do than did the old benefit. Nor is there any discussion here of whether focussing on what disabled people 'can' do is at all a sensible way to assess what assistance a person needs to live or work.
But most striking, and most concerning giving the design and policy intent behind PIP, is the repeated emphasis on not using a face-to-face assessment with a medical examiner. As disabled peoples' organisations have repeatedly pointed out, the Tory government of 1990 knew and the current parties seem all to have somehow forgotten to the extent of believing the opposite, a one-off interview with an external medical examiner is a snapshot and is not necessary. What is needed is the claimant's own knowledge - who else can know so well what is and is not possible? - and the supporting knowledge of those people who, through extensive contact with the claimant, also know well the claimant's level of ability and disability. These are "their GP, health visitors, district nurses, relatives or other carers."
What is most worrying is that the Tory ministers seem to have not read what must surely be one of the most important documents regarding the design of a new benefit - the arguments and reasoning behind the design of the current one. If only they had read it, maybe we would not now be in a position of regression where the experience and knowledge of what is wrong with the assessment method for PIP has been forgotten, overlooked or ignored.
The quotes used in this post can be found at the end of the same post on my website, www.stefbenstead.co.uk