Three challenges for the Timms review

Last week, the Department for Work and Pensions published the revised terms of reference for the Timms review of PIP . In theory this is the biggest opportunity to reform disability benefits we’re likely to see for quite some time. This blog sets out three challenges the review will likely face — alongside reflections for anyone invested in improving the system.

1. The PIP assessment is being asked to do a lot

Disability assessment is already a difficult thing to do. Assessors and decision-makers are expected to be able to make nuanced judgements about people who often have multiple, overlapping health conditions. In doing so they need to take into account a complex and ever growing body of caselaw and guidance. Anyone who has spent any time reading PIP assessment reports (or who has read the previous two independent reviews of PIP) will know that as it stands the system often fails to do the basics. Reports frequently contain factual inaccuracies, copy and paste phrases, and point scores which aren’t backed up by their wider findings.

Against this backdrop, the Timms review is being asked to consider some major new jobs for the PIP assessment. The first is becoming the gateway to incapacity benefits, replacing the existing fit-for-work test — the Work Capability Assessment.

Currently the WCA tests a range of things which just don’t form part of the PIP assessment. Would there be a risk to a person’s health if they were required to work? Is someone able to sit or stand for long periods of time? Can someone cope with unexpected changes to their routine or behave appropriately around other people? If there’s no attempt to get the PIP assessment to recognise these challenges then we’ll see increasing numbers of disabled people being forced into inappropriate jobs that they simply can’t sustain — or else attempt to survive on levels of income which don’t cover the basics. But there’s a real challenge in building these considerations into an assessment that already risks being too complex to be delivered well.

2. Fear and power dynamics affect what a PIP assessment can realistically achieve

The review will also consider whether and how PIP could become a gateway to wider support and services for disabled people. This has been a feature of government consultations about disability benefits for at least the last ten years, and fits with an instinct that many policymakers have, that if more people were accessing the right services, fewer people would need support from the social security system.

It might be trite to say it but the first big problem is that it’s hard to help people find support which either doesn’t exist or requires an extraordinary amount of work and energy to get to. Access to Work is being scaled back, and thresholds and waiting lists for both social care for working-age adults and community mental health services remain very high. Just speaking from experience of the mental health system, helping someone access support appropriate to their level of need isn’t something you can do in a 30 minute phone call.

But the second and more specific difficulty for trying to provide this help through the PIP process is the fear and the imbalance of power which is inherent to assessing someone’s eligibility for benefits. In my time as an adviser I rarely worked with anyone who wasn’t anxious and scared ahead of their PIP assessment. That was true even on the occasions when the process was smooth, the assessor was friendly and empathetic and the result was fair. There can be a temptation from policymakers to see an assessment as an opportunity to go beyond asking people to describe their problems and into actually providing a route towards help. This is partly motivated by the sensible instinct that we shouldn’t be asking people to repeat difficult and often traumatic experiences countless times as they move through different services and interact with different bits of the state.

But the psychology of assessments matter. You know that a PIP assessment will determine your financial support. You’re often worried about forgetting to mention important things, or not being able to express yourself properly, especially when assessments can feel like a quick barrage of closed questions. Getting someone to engage in an open and vulnerable way about what support they might benefit from would be a bit like inviting someone to a high-stakes job interview and then part way through asking them if they’ve considered talking therapy. The same consideration is true throughout the PIP process until at least the point in which someone has their decision.

This isn’t an argument for total fatalism. But there are trade-offs in giving assessors or DWP staff extra jobs to do, especially if this isn’t accompanied by increased investment in the staff time and skills which go into the process. It’s also worth thinking about the impact on disabled people’s lives of the alternative: investing in making accurate first-time decisions happen more often, having fewer people needing to spend time and energy challenging decisions, and providing an accurate and comprehensive assessment report — which incidentally may well be useful when accessing other services. The risk of fitting more aims into the PIP assessment is that it comes at the expense of making it better at achieving its core purpose.

3. Addressing gaps in the PIP criteria requires investment

The terms of reference make clear the review will operate within Office for Budget Responsibility projections about future PIP spend. In other words it won’t be aimed at making cuts, but it also won’t recommend anything that would increase PIP spend. That puts it in a real bind when it comes to making any substantive recommendations on criteria.

The OBR have repeatedly criticised the DWP for not being able to accurately model changes to the PIP criteria. This includes not being able to anticipate that PIP cost more than its predecessor DLA. It also includes underestimating the effects of various legal rulings which have had the effect of broadening eligibility for PIP, at least when compared to how the DWP had been interpreting the law on the ground. In recent years leading figures involved in designing assessments have essentially suggested there’s a degree of pseudoscience involved in the idea that you can have a consistent and predictable points-based system for assessing incapacity or disability.

All of this means that the OBR will likely be very hawkish when it comes to scoring the cost of any changes to the PIP criteria. We saw a similar kind of dynamic over the summer when they reduced their estimates of the effects of DWP’s proposed cuts by about half. At first look it’s hard to see how the review will be able to recommend changes to the PIP points or descriptors- particularly the kinds of changes that disabled people and their organisations have been calling for — without falling foul of this.

But alongside that challenge there’s a more fundamental question about whether reforming the criteria is going to be the thing that makes the biggest difference. The tribunal system is far from perfect but it shows that it’s possible to take the criteria we have now and make decisions which are far better into taking into account the reality of disabled people’s lives.

It’s not hard to see why tribunal decisions are made differently. They’re made by an independent panel including a judge, a health professional and a disabled person, who have the benefit of seeing every past assessment report, and the time, skill and confidence in their own judgement to deviate from a prescribed list of questions. Arguably one of the biggest opportunities for the Timms review to explore is how you can get closer to having every PIP decision made in this way and save 50,000 disabled people a year from having to spend a year challenging decisions in tribunal — often falling into hardship along the way.

What comes next?

I get the sense that the sheer complexity of this task, in a context where the political narrative on social security and disabled people has become increasingly toxic, is driving a lot of pessimism about what the Timms review can achieve. But it’s important not to lose sight of the fact that a genuine opportunity to open up and improve PIP is what so many people have spent years campaigning on. And whether the review will drive radical improvements to PIP is going to at least partly depend on there being good, concrete ideas on the table for the 12 people co-producing it to consider.

That’s a challenge for any of us who know too well that the problems with the current system are too big to let this opportunity slip past.