Exclusive: DWP Questioned NHS Consultant Three Times Over Terminally Ill Patient's Condition Before Granting Benefits
A terminally ill patient had their benefits application queried by a DWP contractor (PA)
A terminally ill patient had their benefits claim questioned by a DWP contractor despite an NHS consultant diagnosing them with six months to live.
Under the current rules, people estimated to have less than six months to live can be given a DS1500 form by their doctors, allowing them a fast-track process for applying for benefits.
But despite providing the DWP with the form, an NHS neurologist was repeatedly contacted by a benefits assessor for further information about a terminally ill patient who had been diagnosed with motor neurone disease.
The doctor called the practice "unfair and inhumane" after he was emailed multiple times by a health assessor working for Capita on behalf of the government department questioning the clinical details of the case.
In an email exchange seen by PoliticsHome, Capita's health assessor told the neurologist that in order for the form to be "appropriate" they wanted further information about "bulbar involvement" and "respiratory difficulties" experienced by the patient, adding that "on the DS1500 it does not seem as if he has these clinical features".
Despite receiving further details about the case from the NHS neurologist, including a timeline of the patient’s conditions and a reassurance that “based on our experience and expertise” that the form was correct, they faced further follow up questions from the Capita staff.
In a final exchange, the doctor told the assessor: "All MND patients will develop bulbar symptoms and will die from respiratory failure... I hope you appreciate that it is difficult to be absolutely sure about predicting that will happen in the coming months.
They added: "We are usually asked about whether the patient will live less than a year and we always say based on our experience that this is the case for each MND patient (we are right in the majority of the cases).
"This is the first time we have been asked to estimate someone's prognosis to be less than six months."
Following the exchange, the NHS consultant told the MND Association charity it was “so difficult” to give a six month prognosis for those with the condition, adding the benefits process was “so unfair and inhumane”.
Capita, one of several firms contracted by the DWP to conduct healthcare assessments for those applying for Personal Independence Payments, say that each assessor must have a minimum of two years experience in a healthcare role before working on the PIP programme.
A Capita spokesperson said their assessors are following rules set by the DWP, that include contacting a claimant's doctors, to ensure speed and accuracy of claims.
But speaking to PoliticsHome, Susie Rabin, head of policy at the MND Association, said the assessment was “heartless and utterly unnecessary”.
“The real frustration is we are talking about people dying of a really awful disease who are entitled to these benefits because of the condition they have,” she said.
“To have questioned their clinician on whether this person has got six months to live is so insensitive, so heartless and utterly unnecessary.”
Rachael Marsden a MND nurse consultant at Oxford University Hospitals, said she received calls from assessors every couple of weeks, but she felt the calls were not "questioning my judgement".
"The impression I get is that they are wanting to tick a box, that they've been given a box to tick," she said.
She added that her centre has not experienced rejections for claims because they tend to use generic statements setting out the clinical features of the disease for every patient who requires a form, a process which has been accepted by the DWP.
"In a sense we are bending the rules... but I think it seems to be an acceptable thing."
But Rabin warned that the process could introduce delays into the fast-track system, saying this case had resulted in delays of several weeks for the patient who was already in the final stages of their lives.
"I think three emails went back and forth and a couple of phone calls that delayed that person's benefits by several weeks and once the assessor has got the responses, they then have to go back to the DWP for a final decision.
She added: "The more they question and the more they look into it and decide to question the view of clinician signing that DS1500 the longer the process will take."
She said that the system also risked failing those with other conditions, such as terminal cancer or other degenerative illnesses, especially if they relied on their GP to grant a DS1500.
"We've spent quite a lot of time trying to reassure our connections that there's no penalty if the patient is lucky enough to live longer than six months.”
She added: "There have been concerns particularly with inexperienced and non-specialist clinicians over whether there is a penalty, or if they will get into trouble if someone gets something they're not entitled to if they live longer than six months."
The comments come amid growing calls from campaigners for the government to urgently publish a review of the benefits process for the terminally ill which was first announced over two years ago.
A Capita spokesperson said: "In partnership with the DWP, we are committed to delivering a professional, efficient and kind service for every PIP applicant we assess.
"Our assessors work to rules set by the DWP and speedily and accurately complete reports for all claimants, including those with terminal conditions.
"When doing so, they are mandated to contact the claimant's health professionals on any issues which may require further clarification."
A DWP spokesperson said: "Terminal illness is devastating, and our priority is dealing with people's claims quickly and compassionately.
"That's why throughout the pandemic we have continued to ensure fast-track access to benefits for those nearing the end of their lives.
"To ensure people receive the financial support they are entitled to, an assessment provider health professional may contact a claimant's medical practitioner, where additional information is required to help them make a decision."