Miriam Smith-Cox

Adding to Life

pluss www.pluss.org.uk

Pluss
2™ Floor
Dr Emma E Carlyon See Centre
Coroner for Cornwall y
Marsh Barton
The New Lodge Exeter
Newquay Road EX2 8LB

Penmount

Truro To:

TR4 9AA

21° August 2015

Dear Dr E Carlyon BY nssnscoteeestnonenine
Re: Miriam Joyce Smith-Cox Deceased — Your Ref EEC/FR

Please consider the following as the response from the Pluss Organisation
following your directive dated 24" July 2015.

The Pluss Organisation has an Adult Safeguarding policy (appendix 1). This
policy clearly sets out the procedures (page 9) that Staff should follow if they
have a suspicion that a person is at risk of harm and how to make an alert to
the Safeguarding team in the area.

In addition, it is mandatory that all Pluss staff complete “Alerters” training
(appendix 2) and this training must be refreshed every 2 years.

| have fully reviewed the time-line of interactions Pluss had with Miriam and it
is clear that although the team were acting with best intention and did raise an
alert with the Education, Health & Social Care Department of Cornwall
Council in December 2014, there were potentially opportunities to raise an
alert earlier, in line with our procedures.

When Miriam left the Work Choice scheme in February 2015, we understood
that her social worker was putting together a care package for her.

As an organisation we will be utilising the learning from this unfortunate
episode to provide a case study to raise awareness with all Pluss staff,

MINDFUL
EMPLOYER

The Pluss Organisation, a company limited by guarantee.
Registered Office: 2nd Floor, Basepoint Business Centre,
Yeoford Way, Marsh Barton, Exeter, EX2 8LB

Company Number: 05171613 VAT Number: 864 2922 08

reinforcing their understanding regarding the Safeguarding policy and their
responsibilities within it.

We will also be carrying out additional Safeguarding, Alerters and Lone
Working training with the Truro Team with the company specialist within
September.

If you have require any further information or evidence from The Pluss
Organisation regarding this matter, please do not hesitate to contact me.

Department
for Work &
Pensions

2" Floor

Caxton House

Tothill Street

London
SW1A 9NH

11 September 2015

Dr. E.E. Carlyon

Senior Coroner for the County of Cornwall
The New Lodge

Newquay Road

Penmount

Truro TR4 9AA

Dear Dr Carlyon,
Re. Prevention of Future Deaths Report: Miriam Joyce Smith-Cox (deceased)

Please find enclosed the Department's response to the Prevention of Further
Deaths Report dated 24 July 2015.

Yours sincerely,

DWP Legal Advisers — part of the Government Legal Department

il

14 SEP 20%

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DEPARTMENT FOR WORK AND PENSIONS

RESPONSE TO REGULATION 28 PREVENTION OF FUTURE
DEATHS REPORT ON MIRIAM JOYCE SMITH-COX

Introduction

1.

This report fulfils the Department for Work and Pensions’ (DWP) duty to respond
to a Prevention of Future Death report made under the Coroners (Investigations)
Regulations 2013. The request for the report has arisen following an inquest on
20 July 2015, into the death of Ms Miriam Joyce Smith-Cox. Ms Smith-Cox was a
long-term DWP benefit claimant who, in the course of her life, variously claimed
Incapacity Benefit, Jobseekers Allowance and Employment and Support
Allowance depending upon the benefits available and her circumstances at the
time. Ms Smith-Cox died as a result of injuries incurred falling down the stairs
outside her flat.

The report is structured in two parts. The first describes the three benefits that Ms
Smith-Cox had most recently claimed- Incapacity Benefit (IB), Employment and
Support Allowance (ESA) and Jobseeker’s Allowance (JSA) as well as explaining
the Work Choice programme, and our policies for assisting with vulnerable
claimants. The final part explains what happened in Ms Smith-Cox’s case.

Incapacity Benefit

3.

IB was a benefit that was introduced in 1995 and was normally paid to people of
working age who could not work because of illness or disability and satisfied the
National Insurance contribution conditions. DWP used the Personal Capability
Assessment (PCA) to decide whether a claimant was incapable of work and
therefore eligible for benefit. Claimants in receipt of Incapacity Benefit were also
subject to regular reassessment through a PCA to determine whether they
remained incapable for work. People who were incapable of work but could not
satisfy the National Insurance conditions for IB could claim means-tested Income
Support (IS) instead.

From 27 October 2008, IB was replaced by Employment and Support Allowance .
(ESA) for new claims. Existing claimants who were in receipt of IB/IS are
gradually being reassessed under the Work Capability Assessment (WCA) to
determine whether they are eligible for ESA or fit for work. The WCA is a more

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robust functional assessment of eligibility than the PCA and is designed to
measure the effects a condition has on a person’s capability to work. Claimants
who are found fit for work are not entitled to ESA, but may, where they meet the
‘conditions of entitlement, claim JSA instead.

Employment and Support Allowance

5. ESA is a benefit paid to people of working age who have limited capability for
work as a result of a health condition or disability. It was introduced in 2008 in
place of Incapacity Benefit and certain other benefits paid on the ground of
incapacity and severe disablement. ESA is designed on the principle that
eligibility is based on the effects of a health condition or disability rather than on
having a particular condition. With the right support claimants can therefore be
expected to return to work once they have the capability to do so.

6. Section 1 of the Welfare Reform Act 2007 sets out the conditions a claimant must
meet in order to be entitled to ESA. There are a number of conditions which must
be met, including financial conditions. However, the primary condition is that the
claimant must have “limited capability for work”. Section 1(4) sets out that a
person has ‘limited capability for work” if their capability for work is limited by their
physical or mental condition, and the limitation is such that it is not reasonable to
require them to work.

Claimant groups

7. DWP uses the Work Capability Assessment (WCA) to assess an individual’s
functional ability, focusing on what they can do, rather than what they cannot do.
The assessment is not intended to be a measure of employability, but simply to
measure how the claimant’s ability to function is affected by their condition or

disabilities.
8. The WCA allows three groups of people to be distinguished:

e those who would be capable of work in spite of any health problems. This
group is commonly called ‘fit for work’ (and should claim JSA)

e those who, with additional support, could eventually return to work (the Work-
Related Activity Group of ESA)

e those with the greatest impairments or disablements who, at the present time,
it would not be reasonable to expect to work (the Support Group of ESA)

9. The Support Group comprises claimants whose conditions mean that they have
limited capability for both work and work-related activity (LCWRA) as measured
against descriptors set out in Schedule 3 to the ESA Regulations 2008. These

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are claimants who are most seriously affected by their disabilities or conditions
and they are not expected to do anything to receive their benefit.

10.The Work Related Activity Group (WRAG) comprises those claimants whose
conditions mean that they have limited capability for work (LCW), as measured
against descriptors contained in Schedule 2 to the ESA Regulations, and it is
considered that they should be able to return to the work place in due course.
These claimants are generally expected to engage in work-related activity in
order to receive their benefit.

Jobseeker’s Allowance
11. Jobseeker's Allowance (JSA) is a benefit for people who are looking for work,

and who do not have limited capability for work. It was introduced in 1996
replacing a complex system whereby those who were unemployed received
Unemployment Benefit and/or Income Support depending on their circumstances.

12.Section 1 of the Jobseekers Act 1995 sets out the conditions a claimant must

meet in order to be entitled to JSA. There are a number of conditions which must
be met, including financial conditions. The key conditions are the so-called
‘jobseeking conditions’ — a claimant must be available for work, be actively
seeking work and have a jobseeker’s agreement with DWP. If a claimant does
not comply with these conditions, then their entitlement to JSA will end

13. However, there are easements for claimants with a health problem/disability and

they may restrict their availability in any way - provided the restrictions are
reasonable in the light of their physical or mental health condition. The
Government remains committed to supporting those who cannot work because of
a health condition or disability and to help as many people as possible to find
suitable work, stay in employment or keep them close to the labour market and
move to employment as soon as possible.

14.A claimant’s JSA payments will be stopped (sanctioned) if they refuse to do

something they have been asked to do without a good reason, for example they
turn down a job offer, fail to participate in an interview or in an employment
programme. If a claimant is sanctioned, their benefit is not paid for a period; the
length is determined by the type of failure and whether or not it is the first
sanctionable failure.

Appealing a decision
15.Any claimant who is not happy with a decision can ask DWP to reconsider the

decision within a month of the date of the decision — this includes decisions such
as those who have been found “fit for work” at a WCA or where a sanction has
been imposed on a JSA claimant. DWP will reconsider the claimant's case, and

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respond with their decision in a Mandatory Reconsideration Notice. If a claimant
disagrees with the Mandatory Reconsideration Notice, they can appeal against
the decision to the First-tier Tribunal (Social Entitlement Chamber). The First-tier
Tribunal consists of a judge and a medical representative (where appropriate). It
is a free to access service, funded from the public purse.

Disability Employment Advisers

16.In many of our Jobcentres, we have Disability Employment Advisers (DEA) who
offer specialist assistance to disabled people facing a more complex employment
situation, mainly arising from their disability. A DEA will help the claimant identify
a job goal linking the claimant’s aptitudes and abilities to that goal, providing or
sourcing the extra support or work experience required to help them find or keep
a job, or which leads them towards their job goal. DEAs have in-depth knowledge
of the local programmes, services and support organisations available for
disabled claimants to address skills gaps or other issues.

17.A DEA can refer a claimant for an occupational health assessment, or seek the
help of Work Psychologists to support the claimant if required. They can also
advocate on behalf of the claimant with prospective employers, aiming to identify
work solutions, overcoming or minimising any difficulties related to an individual's
disability in the work place. The DEA can also refer claimants to a range of local
programmes, including Work Choice.

Work Choice

18.Work Choice is a voluntary contracted specialist support programme that helps
people with disabilities whose needs cannot be met through other employment
programmes, Access to Work or workplace adjustments. This might be because
they need more specialised support to find employment or keep a job once they
have started work.

19.Work Choice providers such as Pluss support disabled people who have complex
needs, primarily those who are more likely to need more intensive specialist
support. The provision is tailored to meet an individual's needs. It focuses on
helping individuals to reach their full potential and move towards being more
independent. Work Choice also ensures employers get the support they need to
employ more disabled people. Work Choice provision is open to all ESA and JSA -
claimants who could benefit from the assistance provided.

Safeguards for vulnerable claimants

20.DWP aim to identify and assist vulnerable individuals with complex needs who
may require additional support. Our definition of vulnerability is: “an individual who
is identified as having complex needs and/or requires additional support to enable

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them to access DWP benefits and use our services”. The aim of this approach is
to ensure that the targeted additional support to individuals enables them to
access benefits, use our services, and meet their individual responsibilities.
‘Vulnerability’ is not treated as a static state; there are stages at which an
individual may require extra assistance, and it is likely that they will move in and
out of situations where they do/do not require support. DWP remains committed
to ensuring that we identify these individuals and the situations in which they
require assistance. The provision must, by its very nature, remain fluid and
reactive, but DWP provides detailed guidance to assist work coaches and other
members of staff in identifying those claimants who may be “vulnerable” and the
type of support that they may require, from assistance in making a claim and
proving eligibility for benefits to help with managing their finances and using
banking services.

In the Devon, Cornwall and Somerset District, there is also a well established
Vulnerable Customer Network, which provides a forum for wider consultation
regarding “vulnerable” claimants, and to consider possible solutions for improving
support for vulnerable claimants. It provides an opportunity for customer
representative groups to feed back to DWP in order to help us enhance our
service.

Ms Smith-Cox’s case

Benefit claim history
22.Ms Smith-Cox started claiming benefits in the 1980s after holding down various

jobs. We no longer have full records, but we understand that she was on various
benefits, and became an Incapacity Benefit claimant in the mid 1990s. She
undertook a PCA on 21 September 2005, and it was decided that Ms Smith-Cox
did not meet the threshold for benefit to continue from 29 September 2005. Ms
Smith-Cox appealed the decision, but the appeal was disallowed, and she no
longer received benefit from 7 February 2006. There were special arrangements
for IS to be paid where a person is appealing an IB decision. Regrettably we do
not have details of this aspect of Ms Smith-Cox’s claim history but we assume
she also had a claim for IS, which also ended in February 2006. Thereafter she
made a claim to JSA, and this was paid from 9 February 2006. Ms Smith-Cox
was able to comply with her JSA responsibilities for the next 6 years, and was not
disentitled or sanctioned during this period.

23.Ms Smith-Cox made a claim to ESA on 30 October 2012, closing her claim to

JSA. She attended a face-to-face WCA on 12 May 2014 with a healthcare
professional (HCP). The HCP did not award Ms Smith-Cox any points for any of
the mental or physical health descriptors. On 28 May 2014 a DWP Decision
Maker disallowed Ms Smith-Cox’s ESA claim on the basis that she had scored no

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points, and was not found to have limited capability for work. Ms Smith-Cox
requested a mandatory reconsideration and this took place on 10 June 2014, but
the decision was not revised. Ms Smith-Cox was advised of the outcome, her
right to appeal the decision, and how to appeal the decision, but decided not to
appeal.

24.Ms Smith-Cox then claimed JSA again from 28 May 2014 until 3 November 2014.
She had 2 periods of sickness during this time; on the third period of sickness, as
per the rules at that time, Ms Smith-Cox withdrew her JSA claim in order to make
another ESA claim. She was in receipt of ESA and waiting for a face-to-face WCA.
when she died.

25.At no point during her JSA and ESA claims was she sanctioned or disentitled.
This means that during her JSA claim, she was maintaining her obligations to be
both available for and actively seeking employment on a weekly basis, and was
fulfilling any other requirements imposed on her. In 2009, work coaches at the
JCP helped Ms Smith-Cox to enhance her skills by referring her to the local Adult
Education Centre ‘Link into Learning’ where she achieved Levels 1 and 2 Word
Processing and Maths and English Level 3. She attended an appointment with
the National Careers Service in July 2014 and agreed to attend a weekly Job
Club from August 2014 to assist her with job search and work preparation
activities and help in making applications.

26.We have also checked our records for the periods where she transferred between
benefits, and on each occasion, the claims were processed quickly and efficiently,
for example when she claimed JSA in 2014, her claim was made on 28 May 2014
and payment was made on 3 June 2014 (4 working days). We have not found
any evidence in our system to support the assertion that her benefit “was stopped
with no money coming in” — it is clear that her benefits were paid on a continuous
cycle not exceeding a fortnight between each payment. At the time that Pluss
refer to taking Ms Smith-Cox to a food bank (January 2015), Ms Smith-Cox was
in receipt of ESA. We assume that if she was lacking money, it was a budgeting
issue. We could have assisted Ms Smith-Cox with her budgeting if we had known
about it, and this is also something that Pluss were equipped to assist with.

Further assistance

27.Ms Smith-Cox was a frequent visitor to Penzance Jobcentre Plus (JCP), was very
well known and popular with many staff members, who had, on numerous
occasions, assisted her with benefits advice and provided help in accessing
entitlement. She had attended many appointments specifically to support her with
regards to improving her job prospects and received advice and guidance to
improve her health and wellbeing.

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28.Ms Smith-Cox participated in the Work Programme from July 2011 to July 2013.
When she returned to the JCP in July 2013, she saw a Disability Employment
Advisor (DEA), who offered her specialist support to assist her to move closer to
the job market, but Ms Smith-Cox turned down her offer. The DEA saw her again
on 11 July 2014 to discuss her options as to whether to stay on JSA or to claim
ESA because of her health. She then saw her on the 29 July 2014- Ms Smith-Cox
informed us that her GP would not issue a fit note, and so she remained on JSA
for the time being as without the fit note, she could not claim ESA. In order to
assist her further, the DEA referred her to Pluss, one of our Work Choice
providers. Providers like Pluss work on behalf of the Secretary of State to help
support disabled people and those with health conditions who are more likely to
need intensive specialist support to find a job.

29.The DEA felt that this personal assistance would benefit Ms Smith-Cox because
of her mobility issues, personal presentation and health conditions. Although Ms
Smith-Cox had a very positive attitude towards seeking and returning to work,
with job goals to secure employment working with children or animals, it was
recognised by both Ms Smith-Cox, her work coach and her DEA that she was at a
disadvantage in finding and securing work because of her health conditions which
impacted her appearance and personal hygiene. Ms Smith-Cox was in full
agreement with her referral to Work Choice, and seemed positive about the offer
to provide extra one-on-one help. As demonstrated by the evidence that Pluss
provided, they adopt a holistic approach, and were trying to assist Ms Smith-Cox
with all of the areas of her life which prevented her from returning to work,
including asking for Social Services to intervene.

30.Whilst Ms Smith-Cox claimed JSA, she had to regularly attend the JCP to sign
on, and staff would always take time to engage with her positively, treating her
with dignity and respect and taking a full interest in her circumstances and any
progress made. When she returned to ESA in November 2014, she no longer had
to visit the JCP to sign on, and no conditionality requirements were placed on her.

31.

—*

Following a discussion between the DEA and Mr Perrin of Pluss on 7 December
2014, our DEA suggested convening a multi-agency review meeting to discuss
Ms Smith-Cox’s circumstances and living conditions. Pluss made a request in
writing to Social services on 4 December 2014, but this did not take place. The
JCP did not receive any contact from Social Services in relation to Ms Smith-
Cox's circumstances.

Conclusion

32.We are content that in this particular case Ms Smith-Cox received extensive and
committed assistance from DWP and its service provider, Pluss. Although the
Secretary of State for Work and Pensions has no role in the provision of social

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services or health, staff at the JCP and Work Choice provider did go beyond their
statutory remit in their attempts to assist Ms Smith-Cox, including by trying to
convene a multi-agency conference with Social Services. Additionally and
importantly, at no point during her JSA and ESA claims was she left without
benefit payments. She was a long-term benefit claimant who was very well known
and popular with staff at Penzance JCP who assisted her on multiple occasions
over the years with benefits advice and help in accessing the relevant benefits.
She had attended many appointments specifically to support her with regards to
improving her job prospects and received advice and guidance to improve her
health and wellbeing. When Ms Smith-Cox accepted assistance from our DEA,
she made substantial efforts to assist Ms Smith-Cox. Pluss were working on
behalf of the Secretary of State for Work and Pensions to assist Ms Smith-Cox
because she was identified by JCP as needing one-on-one support in order to
overcome her barriers to work. Together we provided the support necessary to
help Ms Smith-Cox progress towards finding work, and continually provided the
benefits she needed to live on.