Research and analysis

Summary: Claimant experience of telephone-based health assessments for PIP, ESA and UC

Updated 8 February 2022

Applies to England, Scotland and Wales

Background

Following the restrictions required due to the coronavirus (COVID-19) pandemic, the usual face-to-face health and disability benefit assessments were suspended and replaced with telephone assessments. The Department for Work and Pensions (DWP) commissioned NatCen Social Research to conduct 2 surveys to examine the claimant experience of telephone assessments and to gauge preferences for using telephone, face-to-face or video for assessment on an ongoing basis.

This report presents the key findings from the surveys of claimants who took part in a telephone health assessment as part of their benefit claim for Personal Independence Payment (PIP), Universal Credit (UC) or Employment Support Allowance (ESA). The first survey comprised PIP claimants who underwent a telephone assessment to determine their eligibility for the benefit. The second survey was of UC or ESA claimants who underwent a telephone Work Capability Assessment (WCA) to assess whether they should be considered able to undergo any work-related activity. Telephone interviews were conducted with 837 claimants of PIP and 1146 ESA or UC claimants between April and October 2020.

PIP telephone assessments

Nearly two-thirds (64%) of PIP claimants were making a new claim for PIP with the remainder undergoing a claim reassessment (where the claimant has migrated from DLA), a planned intervention (where DWP has scheduled a review of the claim) or unplanned intervention (as a result of a change of circumstances such as change in health). 6 in 10 (60%) claimants had previous experience of a face-to-face assessment either as part of this claim or a previous claim. At the time of extracting the survey sample, just over half (51%) had been awarded PIP, 34% had been disallowed and a further 16% had no outcome to date although some of this latter group may have been informed of a decision by the time of their survey interview. We refer to this group as the “unknown outcome” group within the rest of the report.

Communication and support before the assessment

Nearly all (90% of) claimants recalled receiving a communication before the appointment giving details of the assessment, typically in a letter or phone call. Over 4 out of 5 (83%) of these claimants found it helpful’. Over half (58%) did not think any more information was necessary but over one in 4 (28%) said they would have liked more information about what would be covered. Those who had no previous experience of a face-to-face assessment or who had been disallowed PIP were more likely to say they would have liked more information.

Nearly half (48%) of claimants drew on additional support or information before the assessment beyond DWP or the assessment provider. Over one in 4 (28%) spoke to a friend or relative and nearly one in 10 (8%) spoke to a social care or support worker. Men and claimants aged under 35 were more likely to seek additional support. Claimants who had been disallowed PIP were slightly less likely to have sought support.

Experience of the assessment

Over 4 in 5 (83% of) claimants experienced no technical difficulties during the call. Those that did tended to report difficulties hearing or being heard over bad lines or the lines cutting out. Most claimants reported no other practical difficulties during the call but nearly one in 7 (15%) had problems holding the handset for the duration of the call or not being able to use a loudspeaker. These tended to be older claimants and those with mobility issues. 7% of claimants said they found the assessment tiring or needed to take breaks.

Nearly two-thirds of claimants (63%) were aware that they could have a third person present on the call for support. Awareness was higher among those who went on to be awarded PIP and claimants aged 55 or older.

Nearly one-third of claimants (31%) were joined by someone to support them on the call, most commonly a family member (24%). Nearly all (96%) of this group, and particularly those with mobility issues, found having someone to support them helpful.

Nine in 10 (90% of) claimants were satisfied that the assessor called on time and 95% agreed that the assessor explained clearly what would happen at the beginning of the call. Over 3 out of 4 (78%) also agreed that the assessor listened to them and made sure they understood what the claimant was saying. Those who felt the assessor did not listen to them were more likely to have had their claim disallowed or have a stated preference for face-to-face assessments.

Explaining and discussing condition

Just over three-quarters (76%) of claimants agreed that they were able to explain to the assessor how their condition affected their daily life. Claimants who had their claim awarded or said they preferred telephone health assessments were most likely to agree with this statement. Of those who did not feel they were able to explain the impact of their condition fully, nearly half (45%) felt that the assessor was not listening, seemed uninterested or was not showing understanding of their condition.

Around two-thirds (66%) of claimants reported feeling comfortable sharing information about their condition with the assessor over the phone. Claimants with mental health conditions and those whose claim was disallowed were less likely to feel comfortable. Discussing mental and physical health were the most commonly reported difficult topics of the assessment.

Overall satisfaction

In total, three-quarters of PIP claimants (75%) were satisfied with how the telephone assessment was conducted. Satisfaction was higher among those awarded PIP and those with unknown outcome than those who were disallowed. Nearly 4 in 10 of those who were dissatisfied (38%) described issues with the assessor’s behaviour such as not appearing to listen, understand or care about the claimant’s condition. Other reasons included wanting face-to-face contact (24%), questions not being tailored to claimants’ circumstances (21%) or general discomfort or emotional difficulties undergoing the assessment (19%).

Preference for assessment channels – telephone or face-to-face

Claimants were first asked, if given a choice and assuming government advice allowed, they would prefer a telephone or face-to-face assessment in the future. In total, 45% of claimants said they would prefer telephone and 42% face-to-face. Others had no strong preference. Those who were awarded PIP were more likely to favour telephone (62%) than those with an unknown outcome (49%) and those who were disallowed (18%). Those undergoing a reassessment were most likely to prefer a telephone assessment (62%) than those submitting a new claim (41%). Reasons for preferring a telephone assessment included finding it easier/more comfortable, not needing to travel and it feeling less stressful.

Those who preferred a face-to-face assessment reported a range of reasons, the most common being that they would be better able to explain their condition, would find it easier/more comfortable to speak to someone in person, could communicate more easily and build rapport with the assessor.

Above we describe how claimants with certain characteristics were more or less likely to prefer a particular assessment channel, for example those disallowed PIP were less likely to prefer telephone assessments. However, this type of analysis does not let us take into account how this relationship might be influenced by other, covarying factors. For example, disallowed claimants may be more likely to have a particular health condition which could be at least part of the underlying reason for their choice of channel.

To investigate which factors predicts a preference for either a telephone or face-to-face assessment, above and beyond other covarying factors, a statistical technique known as logistic regression was employed to estimate the impact of 5 key variables on channel preference, namely assessment outcome, previous experience of face-to-face assessments, age, gender and health conditions. This approach allows us to estimate the relationship between each of these 5 variables on channel preference, while controlling for the other 4 factors. Here, only the PIP assessment outcome was a statistically significant predictor of channel preference. Namely, claimants with a PIP award were more likely to prefer telephone over a face-to-face assessment even after controlling for other factors likely to influence choice.

Preference for assessment channels – video

The survey then went on to discuss video calls as an option. Almost two-thirds (63%) of claimants had experience of a video call with rates higher among younger claimants. Over half (56%) of claimants said they would be comfortable conducting an assessment via a video call. The most common reasons for feeling comfortable with this assessment mode included being able to see the assessor whilst staying at home and being able to give visual evidence of health conditions. Reasons given for not being comfortable with a video assessment included a dislike of video calls, not wanting to be on camera, feeling nervous or anxious and not knowing how to use the technology. Those with mental health conditions who were not comfortable with a video call were more likely to say it would make them nervous or anxious.

When then asked which of the 3 channels they would prefer for an assessment, 15% of claimants changed their preference to a video call. Nearly 4 in 10 still preferred a telephone (39%) or face-to-face assessment (41%). Those who changed their preference to video call tended to have previously opted for telephone assessments or had no preference. Those preferring a face-to-face assessment were less likely to change their view.

Logistic regression was also conducted to model claimants’ preference when choosing across the 3 assessment channels, using the same key variables as above. As with the regression analysis for claimant preference between 2 channels, only the assessment outcome was a significant predictor of claimants’ preference from a choice of 3 channels. Namely, claimants with an assessment award were more likely to prefer telephone over face-to-face assessments. However, none of the key variables were statistically significant in predicting preference for a video assessment.

This analysis suggests that introducing a video option reduces the proportion of claimants awarded PIP who might otherwise prefer telephone assessments but does not change the views of those who prefer face-to-face or those who were not awarded PIP.

Suggestions for improvement

When asked if anything could have improved their experience of the assessment, around half of claimants (51%) did not feel any changes were necessary. Of those who made suggestions one in 10 (10% of) claimants stated that the assessment needed to be face-to-face and 8% asked for more information prior to the call. Others mentioned improvements in the assessor’s behaviour, needing to talk to someone who understood their condition or having someone to support them on the call.

Work capability telephone assessments

Two-thirds (66%) of claimants undergoing work capability telephone assessments were making a new claim while the remainder were taking part in a reassessment. By the time of the interview, over 7 in 10 (72%) had been placed in the Limited Capability for Work Related Activity (LCWRA) group deeming them unfit for any type of work-related activity. The remainder were placed in a group awaiting a further assessment via face-to-face (to take place once the COVID-19 easements allowed) to confirm whether they were able to undertake some work-related activities. This group are referred to as “awaiting further assessment” throughout the report. Eight in 10 (80%) of claimants recalled previously experiencing a face-to-face assessment, particularly if they were taking part in a reassessment (96%), but also those submitting a new claim (64%).

Communication and support before the assessment

Most claimants (90%) recalled receiving a communication before the assessment giving them details of what to expect, most commonly a letter or phone call. Nearly all (90%) who recalled a communication found it helpful and 70% of all claimants felt that no further information was necessary prior to the assessment. However, about one in 5 (21%) said they would have liked more information about what would be covered. New claimants were more likely to say they would have liked more information. Also, those who had been awaiting further assessment were more likely to say they would like more information than those who had been placed in the LCWRA group.

Nearly one in 3 (32%) of claimants drew on additional support or information before the assessment beyond DWP or the assessment provider. One in 5 (20%) spoke to a friend or family member, while others spoke to a social care or support worker, GP, other health professional, charity or support group workers or Citizens Advice. Claimants who had gone on to be placed in the LCWRA group and those undergoing a reassessment were more likely to have sought support.

Experience of the assessment

Just over one in 10 of claimants (11%) made at least one adjustment request before the interview, such as planning breaks, spreading the assessment over a number of calls or receiving information in large text or braille. But nearly one in 4 (24%) were unaware that they could make such requests. For the most commonly requested adjustment of having breaks, the assessment provider was able to make the adjustment in 93% of cases.

Most claimants (87%) experienced no technical difficulties during the call. Those that did tended to have problems hearing the assessor or being heard due to bad lines or lines cutting out. 4 out of 5 claimants (80%) did not experience any other practical difficulties although nearly one in eight (13%) had trouble holding the handset for the duration of the call or not being able to use a loudspeaker. Those who were placed in the LCWRA group were more likely to report this problem than those who were awaiting further assessment.

Third person support

Nearly two-thirds of claimants (65%) were aware that they could have a third person present on the call for support. Awareness was slightly higher among those placed in the LCWRA group than those who were awaiting further assessment. Claimants who reported mental health conditions were less likely to know they could have support in this way than those with other conditions.

Around one in 5 (22%) of claimants were joined by someone to support them on the call, most commonly a family member (18%). Claimants undergoing a reassessment were more likely to be supported in this way than new claimants. Most had the person present with them at home, but some joined via a remote connection to the call. Nearly all (98%) of this group found it helpful having someone to support them.

Over 9 in 10 (93% of) claimants were satisfied that the assessor called on time and 98% agreed that the assessor explained clearly what would happen at the beginning of the call. Similarly, 97% agreed that the assessor listened to them and made sure they understood what the claimant was saying.

Explaining and discussing condition

Most (95%) claimants agreed that they were able to explain to the assessor how their condition affected their daily life. Those who were awaiting further assessment or had a stated preference for face-to-face assessments were less likely to feel they were able to explain (91% and 86% respectively). The small number who felt they were not able to explain their condition were most likely to say they felt that the assessor was not listening, that the questions were not appropriate, or they needed to be face-to-face with the assessor to explain their condition properly.

Claimants were generally comfortable (79%) sharing information about their condition with the assessor over the phone. However, claimants with mental health conditions were less likely to feel comfortable (72%). Older claimants were more comfortable (82% of those aged 55 or older) than younger claimants (72% of those aged under 35).

Over half of claimants (59%) did not find any topics during the assessment difficult. Less than one in 10 claimants mentioned discussing mental health (7%) and physical health or disability (8%) as difficult topics during the assessment.

At the end of the assessment, 91% of claimants felt they were given clear information about what would happen next with their claim.

Overall satisfaction

In total, 94% of claimants were satisfied with how the telephone assessment was conducted. Satisfaction was highest among those placed in the LCWRA group, those with mobility conditions and those who said they preferred telephone assessments over face-to-face. The small group who were not satisfied tended to have complaints about the assessor’s behaviour, having insufficient time to answer the questions or not feeling that the questions were tailored to their condition.

Preference for assessment channels

When asked initially for their choice between telephone or face-to-face assessments in the future, over 6 in 10 (62% of) claimants would prefer a telephone assessment, with nearly one in 4 (23%) wanting face-to-face. The remainder had no preference. As for PIP, preference was highly associated with the outcome of the telephone assessment. 70% of those placed in the LCWRA group stated a preference for telephone compared to 42% of those awaiting further assessment. Those undergoing a reassessment were also more likely to favour telephone, as were women.

Those preferring a telephone assessment most commonly cited not needing to travel as a reason for their choice, as well as finding telephone assessments easier or more comfortable or less stressful. The most common reasons among those who preferred a face-to-face assessment included feeling that they would be better able to explain their condition, finding it easier or more comfortable to speak to someone in person, communicating more easily and being able to build rapport with the assessor.

Above we describe how claimants with certain characteristics were more or less likely to prefer a particular assessment channel. However, as described above, this type of analysis does not let us take into account how this relationship might be influenced by other, co-varying factors. For example, LCWRA claimants may be more likely to have a particular health condition which could be the underlying reason for their choice of channel.

The logistic regression analysis showed the outcome of the assessment and gender continue to be statistically significant predictors of preference even after controlling for the other factors. In particular, claimants placed in the LCWRA group had a strong preference for telephone (over face-to-face) after taking their other characteristics into account.

Women had a strong preference for telephone assessments over face-to-face even after controlling for other characteristics. Men were also more likely to prefer a telephone assessment, but not to the same extent as women.

Preference for assessment channels – video

Over 6 in 10 claimants (62%) had experience of a video call. Rates were higher among younger claimants. Over half (56%) of claimants said they would be comfortable conducting an assessment via a video call. Reasons given for feeling comfortable with a video call included being able to see the assessor whilst staying at home and being able to give visual evidence of health conditions. Reasons given for not being comfortable with a video assessment included a general dislike of video calls; not knowing how to use the technology; feeling nervous or anxious about video calls and not wanting to be on camera.

When then asked which of the 3 channels a claimant would prefer for an assessment, 13% of claimants selected a video call. But over half (54%) still preferred telephone and over one in 4 (26%) still wanted face-to-face. Claimants who had initially opted for face-to-face over telephone were least likely to change their view at this stage.

Again, logistic regression was used to understand better the factors that explain claimants’ preference for each of the 3 assessment channels over the other channels or having no preference. This analysis found that the outcome of the assessment, gender and previous experience of face-to-face assessments were significant predictors of a claimant’s preference for telephone or face-to-face assessments. Women and those placed in the LCWRA group were significantly more likely to prefer telephone assessments, given a 3-way choice, even when taking their age, health conditions and previous experience of assessments into account. When all other relevant variables were controlled for, those awaiting an assessment were equally likely to prefer either telephone or face-to-face assessments. Those with previous experience of a face-to-face assessment were also slightly more likely to prefer telephone than face-to-face. No variables were significant predictors of preferring a video assessment when given the choice of all 3 channels.

Suggestions for improvement

When asked if anything could have improved their experience of the assessment nearly three-quarters (72%) of claimants did not feel any changes were necessary. Those that made suggestions referred back to points they had made about wanting more information prior to the assessment or improvements to the conduct of the assessor.