A pre-mortem for PIP reform
Why a shared diagnosis doesn’t mean that everyone is on the same page
Last week the government published the interim report of the Timms review into PIP. But in the days surrounding the launch, we saw two very different stories emerge.
The political story
Ahead of the report, lobby journalists carrried briefings pointing to a clear programme of reform.
Caroline Wheeler at The i reports from an interview with Pat McFadden in which he, characteristically, puts three considerations side-by-side - the rise of people claiming for mental health problems, the cost of PIP, and whether the assessment process is ‘fit for a range of conditions’.
Jessica Elgot at The Guardian reports that the review would conclude specifically that the points-based system for PIP was worthless, did not work for people with fluctuating conditions, and should be replaced.
Chris Smyth at The Financial Times completes this thought, reporting that there were ‘discussions’ about replacing the points-based assessment with a more flexible approach offering a wider range of payments and ‘alternatives to cash’, including therapy.
And later Stephen Timms himself confirmed to MPs that, while the provision of cash is ‘vital’, the review was considering the question of providing services in addition to and ‘in some cases perhaps instead of’ cash.
Taken together those briefings suggest a coherent direction of travel which runs something like this: Too many people with mental health problems, autism, and ADHD are claiming PIP and the cost of the system is rising. Making the points scores or descriptors harsher is politically difficult and will be received as crude cuts of the kind that Andy Burnham specifically ruled out. Removing PIP’s points system altogether, restructuring its rates, and replacing it with an assessment system that at least sometimes replaces cash with in-kind support can address this problem without being received as a push for cuts.
All things being equal, services are usually cheaper than financial support. A year of PIP at the standard rates is 3-5x the cost of delivering an intensive course of therapy under the NHS talking therapies programme.
It also speaks to a growing instinct among policymakers and politicians that a cash benefit is the wrong response to people who face restrictions in their daily life because of treatable mental health problems.
But substituting cash for services at any meaningful scale would sharply increase the number of disabled people facing hardship. People in receipt of PIP are disproportionately concentrated in the poorest households. As we saw from the attempted cuts last year, any reforms that reduce that financial support at scale will still result in a significant increase in poverty among disabled people. Therapy is unlikely to shift the dial for someone who is unable to pay for rent, utilities and food.
The report itself
The second story came through the interim report. It was entirely unrecognisable from those briefings. While it concludes strongly that PIP is not fit for purpose, it intentionally does not yet provide any policy recommendations. The points system isn’t singled out as the primary cause of the distress and dehumanisation that disabled people experience during PIP assessments - which instead is attributed to different elements of PIP’s design and delivery.
The report talks about unmet health needs as a driver for people needing support from PIP, but doesn’t anywhere suggest that those services should be a replacement for cash. In fact it points out that the cash PIP provides is an incomplete contribution towards disabled people’s extra costs, and too often ends up being needed to cover the very basics like rent and food.
Lessons from the history of WCA reform
A trailed briefing of a policy announcement which doesn’t come to pass isn’t unusual in politics. But the gap between the political briefing and the content of the report raises the risk of co-option. This is the idea that a shared language between disabled people and government can mask two competing agendas for reform.
In the mid 2010s we were in a similar position on the Work Capability Assessment. The government and disabled people had converged on a consensus that the WCA was not fit for purpose and that there was a radical need for change. But an impreciseness of language and diagnosis meant that two conversations started to develop in parallel.
Everyone said the WCA needed to be replaced with something personalised and holistic. For disabled people and those supporting them, it meant an end to an inflexible assessment which often disregards fluctuation and people’s real life barriers to work. For the DWP of the time, personalising the assessment meant no longer using it to determine which people would be exempt from requirements to look for work - instead giving that decision to individual members of Jobcentre staff. For a long time the same broad principle was used to support two very different visions for change, making it harder for there to be real scrutiny of the reforms that were actually taking place.
It became difficult to highlight the gap between the problem the government said it was addressing and the effects of its actual proposals - especially with MPs and journalists who are understandably not experts in the exact mechanics of the social security system.
Three risks of co-option
One is the claim that PIP isn’t working for people with mental health problems and fluctuating conditions. We’ve seen this week how this claim is a sort of Rorschach test. To some people it means that people with fluctuating conditions are more likely to be denied PIP unfairly, to others that people with these conditions would be better off getting services rather than cash. Something that is often missing from the commentary here is that PIP already contains strong provisions to protect people with fluctuating conditions - but the DWP routinely disregards these when making initial decisions. While few people hold love for PIP’s points system, we should be wary of the idea that scrapping it is the only way to make PIP work better for people with fluctuating conditions.
Another is the emphasis on PIP’s role in enabling participation. This can be understood as a claim about how the fear of losing PIP shouldn’t deter disabled people from doing the things that matter in their lives, including work but also getting physically active, volunteering, and being part of their community. However it can also be used to motivate reforms which prioritise connecting disabled people to support as an alternative to providing a financial contribution towards the extra costs of disability. It also has the potential to smuggle in employment-focused reforms to a payment whose purpose has been to provide for disabled people’s extra costs.
A third is the argument that PIP focuses too heavily on what people can’t do. The review is right to highlight that part of the distress caused by PIP assessments comes from the fact disabled people are forced to recount in detail the ways in which their daily life is restricted by their condition. But this problem is connected to PIP’s status as a cash benefit in a way which may not immediately feel obvious.
When they work well, assessments for services and support have a positive arc. You describe what would help, and if the resources exist, you are given at least some of that help. Assessments for cash don’t have that arc because you are dealing in proxies, broadly trying to work out whose difficulties are greatest in order to set a level of payment.
And as Stef Benstead points out on X, describing the help you need to do something is in practice the same as saying you can’t do that thing without help.
That’s not a reason to be fatalistic - there are plenty of ways you could change both the design and frequency of assessments to reduce the distress they cause. But campaigners should be wary of a move that conflates reducing distress with a wholesale move away from functional assessment.
None of these fears are about the interim report itself, but about how a seemingly shared diagnosis can fuel reforms which are designed to solve a very different set of problems.
Positive reform of PIP is absolutely possible. But to get there we need to be wary of pushing for reform in the abstract, precise about the exact mechanisms driving the problems disabled people face with PIP, and unambiguous about what it would take to fix them.