The government’s proposal to use independent medical professionals to decide who does and doesn’t get the new DLA is the best solution.

 Its a bit long (3000 words) and I will put a link to the references here: http://allbigideas.blogspot.com/2012/05/references-for-essay.html Hoping to have the summary of this essay up by the end of the day... (only 1000 words)heres the summary http://allbigideas.blogspot.com/2012/05/governments-proposal-to-use-independent_14.html... enjoy..

The government’s proposal to use independent medical professionals to decide who does and doesn’t get the new DLA is the best solution.

The Welfare Reform Act 2012 (Great Britain 2012) introduces a significant number of changes to the administration and distribution of welfare benefits in the UK.  Before 2008 welfare benefits for disabled people had two different functions. Incapacity benefit was designed to support people incapable of working, and Disability Living Allowance (DLA) focused on the additional costs of being disabled (DWP 2008b, Disability Alliance 2011). Both were paper-based applications with an element of medical expertise provided mainly by the claimant’s own Doctor (DWP 2008, Disability Alliance 2011). In 2008, Employment and Support Allowance (ESA) replaced incapacity benefit, and introduced a new form of assessment called the Work Capability Assessment (WCA) using a private company (ATOS) to undertake the medicals (DWP 2008b). In 2010, the government announced the replacement of DLA with Personal Independence Payment (DWP 2011a) (PIP). This also heavily focused on an independent medical test for eligibility (DWP 2011a, DWP 2012b). These changes are controversial for a number of reasons, and the shift to the use of an independent medical professional to determine eligility for benefits is just one of them (Campbell et al. 2012). It appears that the theory and the government’s rhetoric and reasoning behind this shift in the application process justifies the change (DWP 2011c, Freud 2012). However, this essay will argue that not only is the theory flawed, but also the practice.

The need for reform of DLA has been widely agreed by all sides (Butler 2012, Grey- Thompson 2012). DLA is an out of date benefit, not reformed for 20 years (Miller as cited in Butler 2012). Lord Freud, the minister for welfare reform states “our reforms make the benefit system less open to abuse.” (Freud as cited in Nottingham Post 2012, no page) One of the biggest flaws in the current system is that there is not inbuilt reassessment and it is heavily based on the claimant’s interpretation of their experience (Curtis 2012). According to Miller (as cited in Welfare reform 'being rushed through' 2012) this could lead to inaccurate initial claims that can be a lifetime award with no periodic assessment. According to Lord Freud (as cited in Nottingham Post 2012) introducing the independent medical assessment will ensure that this benefit “goes to those who need it” (as cited in Nottingham Post 2012) and will reduce the publics perception that this benefit is easy to claim and open to fraud (Walker 2011). As Marsh (2012) states “The media either ignored our struggle or discredited us with ever wilder rounds of "scrounger" headlines” and any case of disability benefit fraud reported in the media re enforces this perception and further weakens the intended purpose of the benefit. The new system of using an independent trained professional will reduce fraud and strengthen this benefits public reputation (Freud 2012).

Although 70% of claims for DLA are a lifetime (or indefinite) award (Welfare reform 'being rushed through' 2012), the reason for this is that it has been proven in the assessment process that the persons impairment is long term and unlikely to change in the future (latentexistence 2012). The onus is on the claimant to report a change in their circumstances and failure to do this against the law (Osborne 2007). At the assessment stage an appropriate length of award is decided upon based on the evidence gathered from the claimant and medical professionals involved in the claimants care and/ or support. Those with shorter awards are required to resubmit a new claim at the end of their current period of entitlement (Directgov nodatea). To re assess everyone regardless of their impairment is quite simply a waste of money, and extremely stressful (Great Britain, Work and Pensions Committee 2012d). The government has been accused of fuelling the medias over reporting of cases of disability benefit fraud to justify the need for reform (Great Britain, Work and Pensions Committee 2012c). In the past few years the reporting of disability benefit fraud in the media has increased and unfortunately there is a direct correlation between this and the rise in disability hate crime (This week 2012). The governments own figures show a fraud rate of only 0.5% (DWP 2012a) and by giving prominence to every case in the media over inflates the true figure. Disability campaigners agree on the need for reform (Butler 2012, Grey-Thomspon as cited in Barnett-Cormack et al. 2012). As Barrow (2012) states “Everyone agrees that the current system needs to be simplified and improved. But that is not achieved by cuts, shoddy statistics, late reporting, attempts to subvert parliamentary process (Lord Freud's procedural tactics last week) and statistical evasion.”  The government’s aim of cutting the caseload regardless of actual need using this so called “rigorous assessment process” (Nottingham Post 2012) will in fact cost more money (Great Britain, Work and Pensions Committee 2012b).

The use of independent professionals will end the bias and the inconsistencies in the current system. The new assessment enables a much clearer and simplified method of applying for benefit (Peck 2012). The government describes this as an “objective assessment of individual need.” (DWP 2011a, no page).  The current process is dependent on the subjective opinion of a professional who is trained in and willing to engage with what is a very complex system (DWP 2008a). This has resulted in a poorly targeted benefit; with a 600 million pounds overspend (Curtis 2012). The new benefit will better support disabled people, and some cases will result in a higher award (DWP 2012b), targeting spending to those who need it most. Independent practitioners are needed to make independent and impartial decisions about a person’s entitlement to benefit. It will enable standardised and objective testing of all claims.

Although the government’s aim is to increase fairness and objectivity by employing this method of assessment the fear is that the reality will be the complete opposite. The published fraud rate for DLA is 0.5% (DWP 2012a) and the government aim to reduce the caseload by 20 % (Great Britain, Work and Pensions Committee 2012a). According to Grey-Thompson (2012) this equates to 500,000 people who are currently entitled to DLA that will no longer be entitled to PIP. The failure to combine fair and independent medical tests with a cuts agenda has already been proven (Greatrex 2012, Gentleman 2011).  Although the medical test to determine eligibility for ESA has been condemned as unfit for purpose (Greatrex, 2012) the test is still in use and the government is using the same model in the design of the new PIP benefits (DWP 2012b). One of the main concerns that disabled people have with the current system is that the outsourcing of the work to a private company has reduced the quality and independence of the tests (Gentleman 2011). All private companies are driven by profit and priotise their clients needs over that of the people they are being tested (Greatrex, 2012). As the government is the ‘client’ objectives such as value for money and conforming to the stated aims of cutting the caseload (DWP 2012c) are more important than the quality and accuracy of the tests being carried out (parliament). Failure to comply with this regime will result in the loss of the contract and loss of profit for the company. As a result of this, the current provide ATOS has admitted that they pay their staff per assessment (Great Britain, Work and Pensions Committee 2012a). This has resulted in shorter assessments and people feeling rushed. (foxylady2 2010) This clearly prevents the tests from being truly independent, reduces objectivity and also fairness for the claimant being assessed. When further medical evidence is needed in the current system of DLA then the DWP uses its own Doctors to carry out an assessment (Directgov no dateb). As these doctors are directly employed by the DWP there is no third party involvement or profit driven motive so the main aim is to accurately assess a claim. Although campaigners welcome the concept of having a fairer and more independent assessment process their fear is of a repeat of the current system, which is simply there to reduce the caseload (Campbell et al. 2012). Although the government claim to support disabled people in this change of eligibility assessment, as Bendygirl (2012) states “The govt have deliberately altered criteria so ppl don't qualify”.  What they are effectively doing is changing the definition of disability to include less people.

The need for a fair and independent assessment has been proven in the transition from incapacity benefit to ESA (Freud 2012). It clearly demonstrates the government’s commitment to support disabled people to have a full and active life, through ensuring that disabled people are given equal access to employment (Freud 2012). This will be further demonstrated in the proposed new PIP (DWP 2012b). This is another benefit that has left disabled people abandoned within a system that has no inbuilt reassessments, and hasn’t been reformed for over 20 years (BBC 2012, Curtis 2012). Disabled people have been at the heart of this new benefit and the government has carried out extensive and detailed consultations into every aspect of the new benefit (DWP 2011a). In the consultation report published (DWP 2011b) there were specific questions asked about the use of independent medical professionals and the results show this was supported and welcomed by disabled people. The change in responsibility from the claimant to a medical professional to gather supporting evidence will make it easier to claim for disabled people (DWP 2011b). Although there were some concerns raised with the process, and how some people might find it an inaccessible experience the aim of the consultation was to intenfy and take action on these areas before they are implemented (Great Britain, Work and Pensions Committee 2012d) Alternative forms of assessment will be available for those deemed incapable of engaging with the medical assessment (DWP 2011b). The overall concept of a face-to-face consultation with a medical professional was welcomed as the respondents felt that an appropriately trained professional would be able to advocate and translate their needs most appropriately and objectively (DWP 2011b).

However, the Responsible Reform Report (Campbell et al. 2012) argued that the government’s consultation into the proposed changes doesn’t accurately represent the views of the public and that the whole process was flawed. Using a freedom of information request a group of disabled people obtained the 523 organisational responses to the consultation, analysed them and published the results (Butler 2012b). They clearly demonstrated that the concept of a face-to-face assessment with an independent medical professional was strongly opposed with 90% against this idea (Campbell et al. 2012).  The report summarises the key concerns about the use of an independent practioner as “lack of specialist assessors, quality, independence of assessor, target driven assessments, inappropriate to discuss intimate difficulties with a complete stranger, medicalised view of disability, cost and practical concerns.” (Campbell et al. 2012, p23)

Although the government used the consultation to push this ideology into legislation, the publication of the Responsible Reform Report (Campbell et al. 2012) highlighted the flaws in both the practical aspects of the consultation (mainly barriers to participation) and the responses selected to form the government’s response. This has led to the veracity of the consultation itself being questioned by the Joint committee on Human Rights (Great Britain, Joint committee of Human Rights 2012a). The letter raises serious concerns about the government’s methods, using the Responsible Reform Report as evidence of the lack of “involvement of disabled people in its implementation” (Great Britain, Joint committee of Human Rights 2012a), a requirement under the UN Convention of persons with disabilities.

Although it can appear that the disability movement is generally against the medical profession it is more complex than that. As Lloyd (1992, p5) states that “the narrow defining of disability as clinical condition results in an all-pervasiveness of doctors' power over disabled people's lives”, it is more about the relationships between doctors and disabled people. The main aim of the social model was to unite and empower disabled people to regain control of their own experiences including questioning the medicalisation of their disability (as oppose to impairment) (Oliver 1990). The underlying theme of both the social and medical model is the power and control that disabled people have over their own experiences. This has been recognised in the implementation of DLA (Great Britain, Work and Pensions Committee 2012b) but is under threat in the way PIP is being assessed (DWP 2011c, DWP 2012b). The balance of power moves away from the disabled person onto a stranger and as the Responsible Reform Report (Campbell et al. 2012) demonstrates it is this specific point that people are opposed to and not the involvement of medical professionals who know them. As the Responsible Reform Report (Campbell et al. 2012, p23) states “the person best placed to give information about the effects of their disability or illness is the disabled person themselves” but also acknowdges the need for medical information to ensure the process is accurate and correct.

Although the Responsible Reform Report (Campbell et al. 2012) appears to contradict the government’s response, the report was only focused on 523 responses and not the 5000 that were received (Diaryofabenefitscrounger 2012, Great Britain, Joint committee of Human Rights 2012a). As the consultation report clearly demonstrates the general consensus was a positive response to the proposals (DWP 2011b). This clearly demonstrates a commitment to supporting and valuing disabled people and is another aspect that the government has incorporated into the delivery of the new benefit (BBC 2012b). The independent medical examination will increase the value of the claimants experience in the application process. This method doesn’t focus on the person’s impairment but the effects, limitations and adaptations socially created and the impact that has on the individual (DWP 2011c). This is in line with social model ideology as it shifts the focus away from the individual and onto the socially created barriers (Oliver 1996). As with the current out of work benefits, the need for medical professionals to have specialist knowledge is not required, simflying the system and ensuring a fairer application of the eligibility test (DWP 2011c, DWP 2012c). The use of targeted questions from specialised trained medical professionals will reveal a more extensive but focused portrayal of a claimant’s experience (DWP 2012b). It will enable people to openly discuss the impact that their impairment has on day-to-day life and will result in a more accurate claim (DWP 2012b). Unfortunately in the present system the focus is on the form being filled in correctly by the claimant, which is in itself a barrier for a lot of disabled people (DWP 2012c). By providing an appropriately trained and independent medical professional the government is shifting the focus away from a form which claimants have described as impersonal to (DWP 2011a) an unbiased and independent face to face edibility test which is less restrictive and a fairer system (DWP 2011a). In addition, because the focus is no longer on the individual’s impairment it reduces the need for medical information and the medicalisation of the benefit which is another aspect of social model ideology being used in the new benefit (DWP 2011c). The current application process doesn’t give claimants the best opportunities to communicate their needs appropriately, is overly medicalised and isn’t a fair system (Dwp 2012d).

However, although the wording of the latest impact assessment which states that the aim of PIP is “To create a new more active and enabling benefit that supports disabled people to overcome the barriers they face to leading full and independent lives” (DWP 2012d, p1) might appear to be centred on social model ideology it could be argued that its use is flawed (Scope 2012). The social model’s primary purpose was as a large-scale societal model and not applicable (or relevant) to individuals (Oliver 1990). The Future of PIP: A Social Model Based Approach (Scope 2012) highlights that the social model is being misapplied as the benefit fails to place the barriers experienced by disabled people in a societal context. By keeping them within the disabled person, is more akin to the medical model (Scope 2012). The social model splits off impairment and disability, and focuses solely on the redefined nature of disability (Oliver 1996). To attempt to apply the social model to impairment is a misapplication of its intended use.

It would be more appropriate to use a model similar to Crow (1996) who critiqued the social models large scale focus on disability, focusing more on the value of an individuals experience and impairment in shaping their disability in the context of the disabling effects of society. She argued that to ignore a person’s impairment takes away part of their identity (Crow 1996). Shakespeare (2006) also argued that for some disabled people the medicalisation of their experience is essential for their survival and denial of this within the social model fails to consider the individual nature of impairment and disability and homogenises disabled peoples experiences. The over simplication of impairment and disability within what is an inherently complex, nuanced and individualised benefit will result in a bias towards impairments that are consistent and easy to define and describe (Scope 2012, Campbell et al. 2012). Within the current system the form allows the claimant to provide a detailed account of their experience and allows them to shape and define it. As the DWP’s latest impact assessment states “the application for DLA is … subjective” (DWP 2012d). However, this is not a bad thing as it is used in conjunction with medical professionals who know the disabled person, to validate and verify their claim. Although this system might appear to be more medicalised it allows the claimant more autonomy (Great Britain, Work and Pensions Committee 2012b) than the proposed use of independent medical practitioners, which will shift the focus and power away from the claimant.

Taking into account all the flaws within the proposals it might appear that the use of face to face assessments with an independent medical practitioner to assess entitlement to benefit is inappropriate (Campbell et al. 2012, Oliver 1990) and will not work. However, the application process for Disabled Students Allowance (DSA) provides an interesting solution, combining all the aspects that both the government and disabled people have deemed essential. In order to be eligible for DSA students need to provide medical evidence of the nature of their impairment using Equality Act parameters (Directgov nodatec).  The student then has an interview with an educational specialist to determine what barriers exist in accessing education and how they can be overcome using various technologies and practical solutions (Directgov nodatec). As Crowther (2012) states the application of this to the welfare system will result in a more holistic and rights based approach to benefits. It will enable disabled people “to realise his or her rights and to enjoy equal freedoms and opportunities.” (Crowther 2012, no page). Although this may appear to be a costly solution, by enabling disabled people to fully participate within society will result in financial benefits for all.

The government’s proposal to use independent medical professionals as the assessment process is just one example of how flawed this benefit reform is. Failing to involve disabled people within the reform process has resulted it being based on inaccurate assumptions about disabled peoples experiences and their needs. There is much opposition to reform, from charities (Scope 2012) The Joint committee on Human Rights (Great Britain, Joint committee of Human Rights 2012a) and disabled people (Campbell et al. 2012). Although the government has clearly stated their support of disabled people (BBC 2012), their intentions are different, which has resulted in fear and uncertainty, based on the impact the ESA reform is having (Greatrex 2012, Gentleman 2011).