Anyone who has been through a benefits assessment and then waited to hear the decision will know the stress it can cause. The process has been found to create a lack of trust and impact negatively on some claimants.
The government previously proposed simplifying and streamlining the assessment system. After our work with military veterans, we would argue that reforms should be guided by the principles of trauma-informed practice.
This sort of care incorporates knowledge about trauma into the design of services, recognising that good processes can support engagement while avoiding harm to vulnerable people. In the UK, Scotland has led the way with the National Trauma Transformation Programme.
Working-age claimants with long-term health conditions or disabilities are assessed by the work capability assessment, which determines if someone is eligible for universal credit and employment and support allowance (ESA). There is also a separate assessment of support needs, which decides if they’re eligible for personal independence payments (PIP).
The work capability assessment looks at how a condition or disability affects a claimant’s ability to complete tasks. It is used to determine whether someone can work or look for work.
It also determines the level of out-of-work benefits someone will receive and the conditions attached. The PIP assessment is about eligibility for money to cover some of their extra living costs.
The Department for Work and Pensions outsources benefits assessments to organisations that employ healthcare professionals to make recommendations. Staff at the department (known as decision-makers) then decide on benefit entitlement.
For veterans, this can be part of an ongoing process of assessment after leaving service, and our recent report, produced alongside co-researchers Dr Celia Hynes, Philip Martin and Dr Joe Pardoe, found confusion from some about these different processes.
Alongside the mainstream system, veterans can also have assessments for the War Pension Scheme, the Armed Forces Compensation Scheme and the Armed Forces Independence Payment.
These separate assessments can cause confusion about what is being assessed and distress about repeating the processes.
As one veteran explained: “Even the Ministry of Defence have agreed that most of my medical conditions were caused by my service, but I then had to go to have an assessment for ESA and PIP, even though there’s concrete evidence to say that I have these conditions.”
We also spoke to healthcare professionals who work for an assessment provider, and who recognised this confusion but also the importance of explaining the purpose of the assessments. More specifically, they flagged the sensitivity required when explaining that being “unfit for service” (and therefore medically discharged) does not mean that someone is necessarily unable to work in civilian life.
However, for some veterans, the stress of the assessments, and reassessment of a worsening condition, is detrimental to their health.
“The system has made me five times worse (than) when I first went to the doctor for help,” another veteran claiming ESA told us.
The military veteran population is diverse but within our study we found common experiences, cultures and health conditions. These partly explain how veterans engage with the mainstream benefits system and face difficulties navigating it.
Experiences while serving could have lifelong impacts, including on mental health. We spoke to 108 veterans at different time periods between 2017 and 2023. Ninety of them said they had a mental health condition, with 74 attributing it to their service.
Post-traumatic stress disorder, anxiety and depression were the most common conditions they reported, with symptoms including hyper-vigilance, claustrophobia, anger and memory difficulties.
Military culture was also a strong factor for those going through benefits assessments. Many placed extra value on strength of character, resilience and self-sufficiency. For some, this meant a reluctance to acknowledge their need for support.
“Being a military man, I’m actually quite proud. If I had a broken back now, you wouldn’t know I had a broken back,” said another veteran claiming ESA and PIP.
This mix of health conditions and a culture of not opening up can make benefits assessments challenging. One way this has been addressed is through armed forces charities, which provide benefits advice and guidance. We found these charities played a significant role in mediating the assessments process, showing how the costs of navigating the benefits system are often displaced to other organisations.
A trauma-informed approach
Within our research, we heard examples of good practice, but our data also shows that assessments can be blind to veterans’ trauma. Sometimes they can even be re-traumatising. This is particularly true when there is a lack of clarity around the purpose of the assessments, repeat assessments and where those assessing them don’t understand the veteran experience.
For some, they might be subject to multiple assessments, both in the mainstream system and through military compensation schemes. As we have previously found, trauma-informed principles should guide our benefits system.
This good practice has recently been embraced by the Department for Work and Pensions, which has pledged to become a more trauma-informed organisation. A recently established role (the trauma-informed approach integration lead), which is tasked with bringing trauma-informed practice into the department, is welcome as a first step.
But we would suggest the government goes further. It should encourage the external organisations that carry out the assessments to follow this approach too.
And whatever assessment reforms the new government decides to make, it should be guided by trauma-informed principles. Although our work focuses on veterans, trauma-informed approaches could be transformative for a wide range of claimants.