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Interim Update on the investigation into the Department for Communities’ administration of the Personal Independence Payment (PIP) benefit system
9 July 2020
1. The background to the own initiative investigation
On the 7 June 2019, the Northern Ireland Public Services Ombudsman (NIPSO) commenced an investigation into the Department for Communities’ (the Department) administration of the Personal Independence Payment (PIP) benefit system. The investigation is the first to take place under new ‘own initiative’ powers which can be invoked where the NIPSO has a reasonable suspicion of systemic maladministration.
PIP is a non means tested benefit for people of working age (16 -64 years) intended to provide help toward some of the extra costs arising from having a long term health condition or disability. PIP was introduced into Northern Ireland in June 2016, replacing Disability Living Allowance.
The decision to launch the ‘own initiative’ investigation followed a proposal sent to the Department. Following detailed consideration of the information available and the views of the Department, other oversight bodies, MLAs and citizens, the Ombudsman remained satisfied that the criteria for launching an ‘own initiative’ investigation had been met.
2. Scope of the investigation
A public announcement was made on 24 June 2019 and the terms of reference published. The scope of the investigation is to examine the actions of the Department and service provider Capita in administrating PIP with a particular focus on:
• Availability and application of further evidence in the PIP benefit decision making and internal complaints processes.
The full terms of reference for the investigation can be found at
If systemic maladministration is identified, the Ombudsman may make recommendations, the focus of which is to improve public services.
3. Interim Update
This is an interim update on the progress of the NIPSO investigation, outlining the actions taken to date, the sharing of observations and information and summarising the areas which remain of focus for the investigation.
3.1 Investigative Actions taken
NIPSO investigators have retrieved material and accessed information from wide ranging sources including:
• A case sample of individuals’ PIP files and final stage complaints files including all associated material held by the Department;
• Telephone calls recorded between the PIP enquiry centre and the claimants associated with the case sample;
• The Department policies, guidance and management information for the delivery of PIP;
• The contract between the Department with Capita to deliver PIP Assessments, and associated Capita policies, guidance and management information;
• Site visits and meeting with relevant business areas within the Department including PIP Complaints, New Claims, First Tier Decision Making, Mandatory Reconsideration, Appeals, Quality Assurance, Standards Assurance Unit and Health Assessment Advice;
• Site visits and meetings with relevant Capita business areas including PIP Initial Review, Paper Based Reviews, Face to Face Consultations, Assessments, Audit and Clinical Governance;
• Engagement and meetings with the Advice Sector and Support Groups who provide assistance to PIP claimants;
• Engagement with the Research Group for the Northern Ireland Assembly All Party Group on Learning Disability who are conducting research into PIP claimant experiences; and
• Consultation with other bodies as listed under Section 51 of the Public Services Ombudsman Act (Northern Ireland) 2016 (the 2016 Act), including the Northern Ireland Audit Office.
3.2 Observations and Information Shared
On 14 February 2020 the NIPSO provided the Department with a written progress update, and alerted the Department to some observations, which although identified in the investigation, sit outside the current Terms of Reference. Providing feedback to the Department, on a number of recurring issues which have the potential to impact both on outcomes for the claimant and their experience of the process, offered a further opportunity to engage on improving services.
Also on the same date, in recognition of the Comptroller and Auditor General’s current investigation into the management and performance of Capita’s PIP contract, the NIPSO shared further relevant information with the Northern Ireland Audit Office.
3.3 Investigative Focus
NIPSO Investigators are continuing to review the large volume of information and material gathered including detailed examination of how further evidence was handled in the individual claim and complaints files. The systemic issues that remain of focus in the NIPSO investigation include:
• The communication with the claimant, at the commencement of the claim, about the role of further evidence in the PIP process;
• The gathering and application of further evidence within PIP assessments;
• The application of further evidence within the decision making on the PIP application and how this is recorded;
• The communication with the claimant on what evidence was used and how the evidence was evaluated to reach the decision outcome on the PIP application;
• The role of evidence in mandatory reconsideration requests and lapsed appeals, and how this is communicated with the claimant; and
• The handling of complaints made by claimants about the gathering, use and application of further evidence in the PIP process.
Under the 2016 Act, the Ombudsman must give the Department an opportunity to comment on any evidence of systemic maladministration or systemic injustice, identified. It is expected that a draft report will be provided to the Department in October 2020 for comment.
At the conclusion of the investigation, which includes the opportunity for the Department to comment, the Ombudsman will publish a report of the investigation conducted and lay a copy before the Assembly.
The Ombudsman recognises the significant additional pressure and impact of COVID-19 has placed on the Department and service users. The Ombudsman is continuing to engage closely with the various stakeholders to progress the investigation effectively and respond to the ongoing challenges and developments.
24 June 2019
Ombudsman commences investigation into handling of Personal Independence Payments (PIPs)
The Ombudsman has informed the Department for Communities that she is launching an investigation into the way the Department administers Personal Independence Payments (PIPs).
The decision follows a proposal sent to the Department earlier this year, in which Ombudsman Marie Anderson stated that after an initial assessment of the Department’s procedures she was considering an investigation.
Following detailed consideration of the information available and the views of the Department for Communities, other Oversight bodies, MLAs and other members of civil society, the Ombudsman remains satisfied that the criteria for launching an ‘own initiative’ investigation have been met.
The Public Service Ombudsman Act (Northern Ireland) 2016 allows the Ombudsman to initiate an investigation if she has a reasonable suspicion of systemic maladministration, or if systemic injustice has been sustained as a result of the exercise of professional judgement.
The investigation will look in particular at the availability and application of further evidence (such as GP records, Occupational Therapist assessments, carers’ reports etc.) in the decision making, mandatory re-consideration and complaints processes.
The full Terms of Reference are available here.
21 January 2019
Ombudsman proposes investigation into Department’s handling of Personal Independence Payments (PIPs)
The Northern Ireland Public Services Ombudsman has informed the Department for Communities that she is proposing, under new powers, to launch an investigation into the way the Department administers Personal Independence Payments (PIPs). The welfare benefit replaced Disability Living Allowance in June 2016.
The investigation would be the first under the Ombudsman’s ‘own initiative’ power, which allows for an investigation to take place where there is a suspicion of systemic maladministration.
Ombudsman Marie Anderson has written to the Department’s Permanent Secretary stating that since June 2016 there have been a significant number of complaints about PIPs to her Office.
She also noted the high number of the Department’s decisions which have been upheld by Mandatory Reconsideration, but then overturned by an Appeal Tribunal.
Following an assessment of the Department’s procedures, she stated that she was satisfied that the criteria for an own initiative investigation have been met.
Ombudsman investigations are normally only carried out on receipt of a specific complaint. However, the ‘own initiative’ power allows the Ombudsman to act even when no complaint has been received.
The Ombudsman has received acknowledgement from the Department that they have received notification of the proposal, and she awaits further information.
Under the terms of the Public Services Ombudsman (Northern Ireland) Act 2016, the Ombudsman must publish a report of any ‘own initiative’ investigation.