DWP PIP reforms could change rules on medical evidence needed to claim benefit

The Department for Work and Pensions could require much stricter evidence for putting in a claim for Personal Independence Payment. Under a Government shake-up of the disability benefits system, it is considering a new system for the way PIP applications are decided.

If rule changes do require a professional diagnosis of a medical condition or disability at the start of a claim - something that isn't compulsory at present - the DWP says that this might mean assessments aren't always needed to see how much a person is affected by their illness.

As part of its Modernising Support for Independent Living: The Health and Disability Green Paper, the DWP is planning a major overhaul of welfare benefits, particularly PIP which has seen unprecedented demand with 70,000 new applications every month. Spending on PIP payments is expected to soar from £21.6 billion in 2023/2024 to £35.3 billion in 2028/2029.

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In the consultation, the DWP explains: "We want to understand if evidence of a clinical diagnosis made by a healthcare professional could provide a more objective assessment of need than the current functional assessment. This would mean that people could receive entitlement to PIP based on specific health conditions or disability, evidenced by a health care professional, without undergoing an assessment.

"Some other countries, such as the United States, have a model of disability support that places more emphasis on a list of prescribed conditions. In comparison, the current PIP eligibility is based on an assessment of functional needs with no mandatory requirement for evidence of a specific health condition or disability provided by healthcare providers.

"We want to understand how we could account for the variation in the severity of the disability or health conditions and the effect on the individual if we moved to a full or hybrid condition-based approach. We also want to understand how claimants could provide clinical evidence for this approach."

At present, PIP applicants are encouraged to send their own evidence such as hospital letters or care plans to support their claim. If further evidence is needed, the assessment provider contacts the GP or hospital via a form for further information but the DWP says this form is often not returned or contains limited information.

With the NHS becoming more digital, it often shares hospital letters by post or through online services with patients, and people now have access to their health records through the NHS app. The DWP is considering whether this access to documentation could be used better as evidence of a health condition or disability to support the assessment for eligibility for PIP.

However, there are concerns about the increased pressure on the already-stretched NHS if every PIP claim requires a full diagnosis before it is considered. The consultation document goes on to say: "We think an assessment based on condition would require a greater emphasis on the provision of medical evidence of a diagnosis and we would need to consider the requirement this would place on the NHS and health professionals.

"We have committed across government to reduce administrative burdens on general practice. We would need to carefully consider how to ensure this approach would be fair and whether it would be the best use of resource."

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