Social Justice, Housing and Local Government Committee - 23 September 2026

Good morning and welcome to the uh fourth meeting of the social justice uh housing and local government uh committee for session seven of the Scottish Parliament. Apologies have been received this morning from uh Mark Griffin. But without further ado, we'll turn to agenda item one, which are two panels uh on pre-budget evidence uh for the 2026 20 26 27 budget um so sorry 2728 will it be 2728 um which is obviously of critical importance in the uh first um parliament. We're pleased to welcome to the meeting uh Michael Davidson the head of social security and devolved taxes and Dr. Ela Ryan, a commissioner who are both from the Scottish Fiscal Commission and also Hannah Randolph uh who is an economic and policy analyst from the Fraser of Islander Institute. Obviously, the committee has determined this year that we'll be taking pre-budget scrutiny on social security and specifically on the adult disability payment, which is obviously a very significant portion uh of the Scottish government's budget. So, it is critical that that we do capture uh the evidence from you uh today. Before we turn to the specifics uh of social security and uh ADP um and I'll take you uh both in turn starting I think with the fiscal commission obviously the backdrop to the UK budget is very challenging and as a consequence of that the backdrop to the Scottish budget particularly given the potential for a 5 billion pound black hole looks to be um equally challenging. There are storm clouds on a number of horizons, including this morning a warning to the UK government and all governments about the cost of borrowing and the need to therefore curtail public expenditure uh potentially off the uh back of that. We have a new prime minister who said that we uh national security cannot come at the expense of social security but it could be that the real economy and real politic determines that they have to revisit that. So what are the risks uh from the UK budget potentially that could flow into the Scottish budget that could then potentially create risks for the present level of social security spending that we have in Scotland. >> Good morning convenor. Um so I uh I mean you would as you would expect I'm going to wind up seeing we have to wait and see but um in in slightly more detail uh we're aware of the government's defense investment plans and which they've only set out part of how that will be funded but that is all capital expenditure. Um we don't yet know uh what other what other major shifts there might be and um we're following the the signals as you are. Um but I think on if there were moves for instance to defense spending or or equivalent then of course that has impacts for the Scottish budget because that is a purely reserved uh spending area and there no um barnet consequentials and if if other spending which is equivalent to devolved spending were cut then we would see cuts through the barnet formula but I think it's we don't yet know what that will look like or whether whether we will see any of those impacts. Um, and then of course there's other other choices open to the UK government around how it might fund additional spending. >> And the pressures on the Scottish government budget have obviously been laid out by other organizations including yours um in in the past. Um, at this point in the uh 26 27 budget, correct myself earlier. Um, where do you think we in relation to that? Are those pressures intensifying or are we getting the impression things are easing off? >> So I mean the the outlook is still very challenging. Um there there's a particular challenge uh there some additional funding has become available to the Scottish government in 2627 in the current financial year um as consequentials from the um special educational needs debt write off that was done for local authorities in England. Uh and that money lands in this financial year. there is almost nothing around that same policy for 2728 but then there is additional funding in 28 29 it's it's just a strange profile um and that profile creates some additional challenges for the Scottish government because the the resource budget was already looking very flat in in real terms over the or the resource block grant I should say was already looking very flat in real terms across the the financial years um and there's a now a significant dip uh in real terms going into next financial year because of this additional funding. So there are some some challenges for the government in managing the profile. the overall economic outlook remains very challenging which will of course impact on tax revenues UK and and Scottish um and um you know we're here to talk about disability spending and social security spending and and pressures that may come. The government has is set out a lot in its um public service reform plans um around efficiency savings, workforce reductions, um big savings to come from the NHS. Um and and we're really keen to see an update soon on how any of that is going. Um because those were plans that are helping to to ensure the budget is sustainable in the long term. >> Yeah. Mand. >> So in terms of specifically uh ADP and social security spending, um if the UK government chose to make cuts to PIP that they've indicated they may want to make, then that does have that's a devolved area of spend and that does have direct implications through the block grant for the Scottish government and the budget. Um, and so it would be nice to see an indication from Scottish government if they have some sort of backup plan in mind in case that does happen in the budget this autumn. Um, and another thing that they've uh discussed, but I've haven't uh made any announcements in terms of how this would impact Scotland is an intention to remove the work capability assessment from universal credit uh and replace it with the PIP assessment. And obviously in Scotland we don't have the PIP assessment anymore. We have the ADP assessment which is quite different. Um and so we haven't heard any answers yet about how that would work in Scotland if they would accept an ADP assessment in place of that. And so that would impact people in Scotland who are claiming universal credit and potentially has some implications if uh for instance the UK government says we that they won't accept the ADP assessment um and the arrangements for that would have to be made between the Scottish government and the UK government. So, we're not sure about that. And that's kind of directly on um AD ADP uh spending specifically. >> And just to capture for the record, I don't know who would want to come in on this, there were obviously predictions in terms of the way that the ED budget was going to progress, both in terms of the number of new applicants, the number of people that would be removed from the benefit and the disparity between what is spent in Scotland and the rest of the UK. Some of the more dire warnings about what was happening in Scotland versus the rest of the UK don't appear to be materializing. So how is the profile of that expenditure uh comparing to how we might have thought about it two or three years ago when that benefit was first evolved and we saw the initial trends in relation to ADP? >> Okay. Um so initially the authorization rate of ADP applications was quite high and that was compared to the authorization rate for PIP but there were a few reasons that we might have expected that anyways initially as people transitioned from PIP onto ADP in Scotland and one is just that people who were already on PIP transitioning over to ADP were likely to have pretty high authorization rates and so those initially high rates have come down. they look much more uh similar to the rest of the UK. I think um for new approvals it's something 35% or something like that. Um and so those concerns I think have abated somewhat and I believe the SFC can can speak a bit more to the exact uh gap but I think you guys have downgraded your or not downgraded have sorry >> downgraded the risk >> have brought down your your estimates of of spending over time. >> Mr. David. >> Yeah, I think the way when we first produced what our costing of of ADP relative to PIP, that was in August 2021 and that was before we saw this UKwide sort of rise in demand. So what so if you look at the overall sort of level of spending for on ADP, it's it's higher than we thought it would have been in August in 26 27. But what's happened is is the extra bits smaller and we think that's because of the unexpected rises in PIP at the UK level have kind of eaten into or or the sort of not a ceiling but but the extra bit is less if that makes sense because we have we've seen that trend across the UK which um is based on the deterioration in health and demographic changes which has led to overall um rises in the PIP case load along alongside EDP. So that means that all the spending and OBR forecast for PIP have increased which increase block grant adjustment funding then so even though sort of spending forecast we have revised it down at time but not relative to the August 2021 one it's just more in subsequent months when we get the latest data in um and so we did see when adult disability payments was launched there was a spike in applications and that sort of built in what is sort of a higher case load, but since that happened um the trends have um the trends are more more aligned and they seem to be now growing at at similar rates. So that got the table here. One second. Just find the numbers. Yes. So I think in 2627 um we estimate that uh for adult disability payment spending will be around 200 million higher than the block grant adjustment funding. But then over the the five years of our forecast out to 203031 we still think that grows a bit bit up to 290 million but I think when we first made the forecast in August 2021 we thought the gap might grow to 500 million. So it's it is smaller. Yeah. But how concerned should we be that spending on ADP or PIP or disability benefits, if we just use a generic term, is still rising year on year and with a finite budget or in the Scottish government's case a fixed budget. Um the capacity to spend that money only comes with either tax rises or cuts in another area of expenditure. And we've seen in the past that cuts in other area expenditure have hit areas where you could arguably say they would bring down poverty. So for example, housing and employability. So what is the risk for both governments unless they can arrest and potentially uh reduce the percentage of the overall budget that is being spent on social security and specifically on disability benefits. >> So I mean I think the risk is as you've outlined. I mean it would squeeze other parts of the budget or it will require um additional funding to be to be found from borrowing but you can't do that indefinitely or or from tax increases as you say. Um there are there are pressures in different directions here. I mean there the UK government as um as Hannah has pointed out um may may seek to uh reduce spending on PIP but they also have a review running at the moment and the early indications from that haven't been in the um haven't been suggesting that that that was a likely outcome. Um I think it is important for Scottish government because so much of the funding for Scottish government is driven by the fiscal framework block grant the the decisions taken at UK level are big big factor. It's very important for Scottish government to be thinking about what UK government might decide and to be ready to respond to significant shifts in UK policy. Mr. off and come on. >> I think it's also important to consider the counterfactual of what if you don't spend this money. Um so, and this is not to say that this is absolutely the best allocation that we could possibly have and it should absolutely never be changed, but it can't be cut and have no consequences. And I think that that's important to keep in mind. So this committee is also about local government and there's a potential that cutting disability benefits would have knock-on effects for other services and particularly ones that are left to local governments to deal with. Um so housing employability for example um and so that uh local governments as you'll all know are uh under a lot of pressure as well at the minute. Um, so I would be cautious about trying to balance the Scottish budget at the expense of the future service expenditure. Um, and to just be very aware of what the consequences of that might be and where that might show up in future spending. >> Thank you. I'll bring in Carrie B. >> Good morning. um going to start off with that the obviously a disability benefit is really important to the people that require it. I'm taking it to the personal side on this and I know we're going to be talking through a number of things which are on the financial side but it's obviously very important and to that end I would probably like to start with looking at um the case load increases across the UK and sorry I'll speak that way um so to what to what extent is the increase the number of people getting disability benefits simply a reflection of increased need driven by increasing levels or is it or is it driven by increasing levels of disability? There's three questions you want the three together and maybe sort of tie it may be easier. So the second question is there's obviously cost of living pressures at the moment and that may have encouraged people who have been entitled to these benefits who hadn't claimed them before. Um do you think that's a part of it? I know in councils council have been encouraging people to claim unclaimed benefits and and other factors about the design of disability benefits that might contribute to the rising case loads across the UK. Uh for example, the change from disability living allowance to personal independence payments they had an impact um or is moving away for facetoface assessments ma made a difference um as well. Sorry, I know that's quite a lot but I thought sort of tied together. So, it's probably better getting the three together. >> Who wants you first, >> Dr. Ryan? >> Okay. So, um financial need versus disability was I think your first Yeah. first point. >> Um I think there's slightly conflicting evidence on this. So, we we we might have expected I think I think we all have a sense that that might be a factor. um that cost of living pressures and and budgets being under pressure maybe caused people to think a bit harder about maybe they would have just managed without something before. Um but I I think that Scottish government's research that they commissioned on this was didn't reach any firm conclusion around that. Uh I think the TIMS review however did suggest that there that might be a factor in in the UK in PIP. Um so that I think um maybe is probably the best I can say. Um people who didn't claim before and the and the fact that um that uh there's been more um awareness raising and uh and of course just the launch of ADP itself, you know, when you launched the new benefit and all the stuff around that. Um we think that probably has been a factor in in increasing the number of applications. Um, but it, you know, that's about people claiming who are, excuse me, who are, um, potentially entitled. Um, I don't think I can comment on benefit design, but I don't know if Michael has anything wants to say about that. >> Um, yeah, I would more just comment on the ADP side, and this is something that we looked at back in when we first produced the the costings in August 2021. I think it was a it was a decision and and by the Scottish government in designing to make adult disability payment more accessible to ways that people are help with the application to have more application channels and to generally give more support and that was one of the factors back in 2021 that led us to think it was going to spending was going to be higher than it would have been on PIP and we think that's sort of transpired as well in looking at the trends on applications and inflows and Then there's also on the other side of it for adult disability payment is that the um the review process um when someone's been on award for a certain amount of time they're reviewed um to to ensure that person's still receiving a right right amount of payment um it was previously called light touch although I think that terminology is no longer being used and so then we think and when we look at the numbers a far lower proportion of people who undergo review for adult disability payment um have that award ended then do uh for PEP although the proportions for PEP are coming down quite a bit as well so I think you're right there is something there in the design of the payment >> so to to come back on a little bit on it so it's do you agree with the terms review more than the others you referenced there was there was areas that said um the the the changes of people claiming um and terms of you saying that that the that that more people are now more people that are entitled are now cla are actually claiming the benefit. >> I can think it's it's more about the evidence. So it was a Scottish government evidence review I think in February this year just looking at what's caused um disability claims to rise and that that itself was a review of existing evidence and in that they didn't find any um conclusive proof around the the cost of living crisis but then the TIMS review ev and it's the Tim's evidence review so it's it's DWP research that they've undertaken so it only covers England and Wales but we think it's applicable to Scotland as well and in that they found the cost of living because when people were seeking advice on um people on low incomes were seeking advice they were directed to a certain extent to to apply for PIP in England and Wales. So that's the the sort of as you said the cost of living link is there when when people are maybe un maybe have eligibility on based on the condition but then are maybe unaware of it they might be eligible and then so then by seeking advice for their sort of wider finances they're directed towards um disability payment and make an application. >> Thank you Mr. Luc and Mr. R. I think that there has been so that's certainly true. Um and I think it's probably both factors are important. Um so there is a sense that since the pandemic that health has has gotten worse and there may also be a role played by greater awareness of disability or that people have a better understanding of the things that they're struggling with constitute a disability. Um and as um the others have said uh for ADP especially Scottish government had a big campaign around um spreading knowledge about the benefit and helping people to claim it. Um and so that can play a role as well. Um and then as you've said just the sort of worse economic conditions um cost of living pressures that people who already have an entitlement are likely to be um seeking out that entitlement and that's something that's supported um by previous research by the IFS had found that when certain conditions in the social security system had changed so for instance if uh universal credit got a little bit less generous um people were more likely to then take up a an existing entitlement to a disability benefit to kind of make up some of that loss. Um so there is some evidence to to support that kind of argument. >> Thank you. >> Brian King Campbell, >> thank you. It's been very interesting so far. I suppose um I wanted to pick up on what you said Michael which was very interesting that um you did pip rose unexpectedly in England and obviously um at the same time the cost of ATP was not as high as had been predicted. So I suppose I'm interested in your view. Is this because the trends are actually tracking much more evenly across England, Wales, and Scotland or are there other factors that meant you didn't see that unexpected rise in the number of claims for a PIP? >> Yeah. Um yeah, I think it's I think that when we're trying to talk about a forecast, we talk about these UKwide factors. Um and we would say that the um sort of health factors um are common in terms of in both looking beyond disability payments when you look at data from population surveys that the level of disability prevalence is rising in both Scotland and in England and Wales. So that's a factor for both PIP and ADP. And as we spoke about there's the um the cost of living factor. I think that's a factor in both as well. And then final one I guess back on the health aspect is that there's a factor of the the population a aging a bit so that even though PIP and adult disability payment it's only working age people can apply the working age bit of the population is getting older and people there there's higher rates of people receiving the payments over 50. So then when you've got more people in that group then the the um case loads go up. So you had those as common factors in both England and Wales and Scotland. And then in Scotland we at the same time we had the launch for adult disability payment. So we still think there's a difference there. It's just it's quite difficult to try and untangle those three factors in Scotland because they all kind of came at the same time after COVID and with the cost of living pressures. >> Okay. So would you say I suppose I'm just trying to understand do you think it's likely that the demand for PIP and obviously there'll be factors in how they're designed but do you think it's likely that the demand will kind of track along a civil similar level in Scotland as in England and Wales? Um I think based on our forecast if we just compare our forecasts and the OBR's forecast for England Wales the over the next five years they generally look like they're sort of broadly in line. Um we haven't looked at that in detail. I wouldn't want to sort of comment in detail. No BR forecasts. >> No but it's sorry it's important to remember of course that from a higher base. Yes. So in Scotland so the the case load in Scotland is still higher. Um and although we have seen the gap between um the overall spending in Scotland and the funding that is then received from the UK government towards it um come out a bit narrower than we had been forecasting right at the start. And although that may not be rising that gap may not be rising quite as much as we had thought at an earlier stage there is still that gap and it is we are still forecasting that it will grow. Um and so we we have to um we have to bear in mind that sort of health and demographics in Scotland are not in not in our favor on um disability payments. >> I suppose if I can follow up on that. I was quite interested in what you'd said Hannah about the um the cost of not paying and I suppose I'm I'm sort of wondering if there is if there's any work been done on what that might look like. Obviously, we've got we're talking about pressures on on budgets, but obviously in some ways you could consider ADP to be preventative and preventing critical services further down the line. So, is there any work that's been done and what that cost might look like? >> I haven't seen work specifically on that on on ADP and the preventative benefit, I guess. But one place to look um and to engage with the work that they're doing is the Scottish government prevention unit has been doing a lot of work around preventative budgeting and trying to explore how that can be brought into the budgeting process in Scotland. >> And so I think that has the potential to look at things like spending on ADP and say, you know, this spending is helping to prevent x amount of spending down the line in these other areas. And so, you know, that's one of the reasons that that we think this much should be spent on it. Um or to choose a different, you know, if you're choosing a different policy to just kind of evaluate what that what that means um for for other service demand. >> Okay. Thank you. That's helpful. >> Thank you. Um Hannah, just one question about this this balance between spending on social security and spending in other areas which could be deemed as preventative. The Tony Blair Institute has said that people diagnosed with conditions such as mild depression or ADHD shouldn't be eligible for cash benefits and it argues in turn that these conditions should be classed as nonwork limiting and therefore those people should be offered support rather than money and that support could be um improved housing, it could be employability schemes, it could be faster access to uh treatments. Um would this be an alternative route and what modeling might there be to say that actually spending a significant amount of money and it is a growing amount of money on um mental health uh um social security payments is perhaps the wrong route and that money could be better spent elsewhere. >> I think in terms of whether a condition is work limiting or not a lot of that will have to come from the person themselves. So, one of the things that's come out of the TIMS review has just been how much variation there is in across different conditions and over time in individual people of what they're able to do or what they feel they're not able to do. And it's been emphasized that that PIP is not particularly flexible in that way of responding to changes in people's abilities. Um, and I suspect the the second panel also will have maybe more interesting things to to say on this point. Um I don't have a particular view on whether particular conditions should be excluded or not. Um but I think it is something to uh to look into to see what sort of support do people need. Um I think that a lot of people would argue that uh financial support is very important but there's a lot of other support that's likely to be helpful and probably at some combination of those things for a lot of people would uh for instance help them support them into work. >> Great. I'm going to bring in Thomas >> CH my questions have been answered so I'm happy to go to the >> Okay. Um Steve B. >> Thank you chair. So obviously the transition periods have accounted for a kind of a rise and now it's kind of kind of leveled out in terms of ADP assessments but Scottish policy is improving uptake amongst eligible people. Should higher expenditure initially be regarded as policy failure or as evidence that unmet need is now being addressed? So the when you look at the number of applications that the percentage of applications that are successful there are two things going on there's um how uh how you know there there's a sort of uh success rate that but based on how many applications were there. So if you have been very successful in raising awareness and you get a very high number of applications that will tend to bring your success rate the success rate down in terms of or the the number of applications that are approved your approval rate down. Um so a low a lower approval rate doesn't automatically mean that there's something bad happening it or it it it may just mean that you've been very good at raising awareness and a lot of people have chosen to apply. >> Okay. Um, do we know anything about the characteristics and eventual outcomes of people who are refused at their initial decision stage? And I suppose following that, how how can we fiscally forecast that uh and accompanied by indicators such as redetermination rates, appeal outcomes, and financial circumstances of people who are unsuccessful. >> So, I'm going to ask Michael because he's >> Yes, it's a tricky one. I think it's an area that we're conscious of and we try and factor into our forecast is that yes that there will be people who make an initial application because I've got the numbers here thinking la in the last full year the um the initial success rate for adult disability payment was down to 34%. Having started in in a couple years ago it was above 50%. Um so what we don't know is how many people who are unsuccessful then go on to submit a future successful claim. So they we also do look at the um re redetermination and the appeal stats as well just to sort of make sure that we're capturing the the proper uh number of successful applications. Um but then we wouldn't sort of as I say we don't we wouldn't really look beyond that in terms of what then happens with unsuccessful applications but it it could be and this is um and it's something that we've sort of speculated about before is that in adult disability payment mentioned before about people who have their award stopped at award review um in 2526 that it was only 2.5% of people that had an award review had their award ended. And that's for for adult disability payment in Scotland. Whereas in England and Wales for PIP it was 11%. So wonder what could be the situation is in in England and Wales you have people who have their award ended for PIP and then they reapply and come back in as new applications. Whereas for adult disability payment, it may be that people with less severe conditions rather than having their ward stopped, they continue to re receive it without then having to to reapply. >> Yeah. So just one final question then I suppose are newer applica applicants more likely to lose support because their circumstances are different or because they're now being assessed differently and how sensitive is the spending forecast to small changes relatively small changes in the proportion of awards reduced or indeed ended at review >> um did have a number somewhere but it's not quite hand on on the sensitivity >> so 6% of ADP clients were had their award or reduced or uh kind of ended at review but the figure was 13% amongst newer clients undergoing planned reviews. >> Yeah. So I think our assessment of of why you know why that you see that in figures would be that I think people who've come across from PIP who've been case transferred would have maybe had more severe conditions or they've been receiving the payment for longer. So then when it does come to the review perhaps reviewed less frequently and there conditions less likely to have changed whereas um the more recent ones could be um less severe conditions perhaps people with lower awards. >> Um so then they are more likely to have perhaps fluctuations in their conditions and then they're eligible when they are assessed they're found to no longer be eligible. >> Okay. Thank you. Mr. Randolph, I don't know if you've got any particular comment in relation to that those those questions. >> Um, no, I don't really have anything to add. >> Fine. One, one issue obviously and I think Mr. Davidson, you alluded to it. There is the issue now in respect of what was once described light touch, but it's in terms of the the entry into um ADP and then the relatively low number that are coming off. And I think professor O, one of your colleagues put it to the finance committee that at one point the figure in Scotland was 2% at review and in the UK it was 16%. That obviously may uh potentially be narrowing but it still strikes me that there are data black spots in relation to uh these benefits both in relation to the number of people who are receiving ADP who may be in work or may not be in work relation to the number of reapplicants uh and then those who may come off the benefit and then come back into it again. So what would you encourage the Scottish government to do to address those data black spots that could potentially mean that by the time we get to 1 million Scots being on this benefit at a cost of 7.3 billion pounds, we have a greater understanding of the forces and the drivers underlying it. >> Yeah. Um yeah, no, I would say begin with um we um that we get all the data that we need from Social Security Scotland and they're really helpful in in providing us with so we get sort of what we would call the core data that we need to to run our forecasts. Um and we get that on a quarterly basis and it's it's really timely as well. So it's really helpful to inform the forecast. But I think you're right that there are some areas and it's sort of more broadly about that would help us to understand the trends. But I think it's like I say because we've got the the core data then it's it's it's sort of the team at the fiscal commission lays in with social security Scotland see what's feasible in terms of their data systems >> and and just sort of working out to together to how to sort of solve those challenges in terms of areas where we're missing evidence. And it it's about like you say understanding those longerterm trends and what what might might be behind it because it's it's sometimes data beyond what would be collected >> to administer the payment like you say employment. >> So um that is an area where we would be interested in but I'm not sure what stage things might be at at Social Security Scotland. It seems to be it's a it's it's somewhere between DWP and Social Security Scotland. But I would just assume it can't be beyond the W of man on the form to say, you know, what is your employment history for the last six to 12 months and how do you project it moving forward which which have would have a greater give a great level of understanding perhaps in relation to whether or not this benefit is aiding people into work which is one of the kind of core missions. Mr. Randolph, I don't know if you've got any thoughts around data. Yeah, I would just echo the point about um Social Security Scotland doing quite a good job with the resources that they have. And I think if there are particular questions that that it's felt are very crucial to understand about ADP and what it's doing um and reflecting that through having more information about the case loads, how people are coming on, how people are coming off um then that probably needs to be put in a pipeline in Social Security Scotland and they need to make sure that they've got resources to to carry that out and provide that data because I think in terms of what they publish publicly. Um the quality of the data is is is very good and is very useful. >> Good. Good to hear. Morgan May, >> thank you. Thank you very much for your evidence um for your contributions, I should say, that you've given so far. It's much appreciated. The block grant adjustments are forecast to cover 97% of disability benefit spending by 2030. Um, I was just curious to know how exposed is the Scottish budget to changes in PIP spending in England and Wales. >> Quite here. >> Sorry, >> just the last part. >> So, I was just asking how exposed is the Scottish budget changes in PIP spending in England and Wales? >> Yeah, sorry. I I I I catch it now. Yes. I mean if there were very if there were very significant changes in PIP policy changes in in PIP um then yes of course uh Scottish government Scottish budget is exposed because of the way the block grant adjustment is is then uh calculated. Um I mean but that could go either way. I mean if if PIP were made more more generous or if more people were like to be on it that would have a you know positive impact perhaps that's less likely. um and that you know an a reduction um would would reduce the funding available in Scottish government. I I think um there's also the and what's going on underneath? So the demand so supposing the policy remains the same but is demand going to continue in um across England and Wales on a sim similar trajectory to Scotland and that that's always the harder part to unpick. So you can understand the policy shifts to some extent and hopefully forecast what the impact of those will be. Um but then we're trying to understand what's going on in Scotland, but always because of the way the fiscal framework works, always trying to understand it relative to what's going on in England and Wales or the rest of the UK. >> Thank you very much. Um, in September 2025, Audit Scotland said that the Scottish government does not have a clear strategy in place to manage um, risk rising from UK decisions on benefits spending. Would you agree with that analysis and are you aware of anything that's been put in place since then? >> So, I I think it's um that I don't know what strategy Scottish government may have in place. I think it would um the transparency of it would be would be good if the government felt that they could say a bit more about their um about the options that they see and how they might and uh and how they might deal with it. Um different scenarios then that would be always very helpful and very welcome and we'd encourage them to do so. Um but I don't think I could say categorically that they do or don't have a strategy because they will have thought about internally what they might do. Thank you very much. And just uh my last question is if the pit block grant adjustments were to fall, what options would realistically be open to the Scottish government and what are the potential tradeoffs? >> Um I mean there are many potential trade-offs. So, so o overall because because you cannot um borrow in Scotland for res resource day-to-day spending which would include social security spending other than in very technical circumstances. Um the government ha has choices of cutting other spending or cutting its cutting its social security spending, cutting other spending or raising tax. Those those are really your options. And obviously within all each of those there are many many possibilities. Um but that that's it. There isn't a kind of borrowing to plug the gap option. >> Thank you. >> Thank you. Just turning to the sort of broader landscape. At the outset we did identify that we think the future budget settlements are going to be challenging and for example next year there is a 700 million pound tax negative tax reconciliation. So there are real pressures on the Scottish budget which could be added to. So there is a there's a strong financial case for the government looking at uh social security expenditure. There's also I think a public opinion issue which is now developing which is a polling of more than 4,000 adults across the UK which included Scotland um suggested that 54% of people believe that the welfare system is too easy to access and does not do enough to prevent uh misuse. We saw an issue in uh within the Scottish government about 36 million pounds that's been claimed through um uh fraud or um overpayment not yet being recovered and there appears to be a dispute between DWP and the Scottish government. So there's a live debate about the future um of the benefit system in Scotland and one of the areas potentially in relation to ADP. looking would we'd be looking at means testing um potentially uh that that benefit the government says it is demandled and therefore you know assist people into work but if we get to a granular point what what would other potential options that would be open to the Scottish government to potentially look at how they bring down the cost of this benefit which as we say is projected to reach significant number of billions by the end of the decade >> we wouldn't generally comment on policy choices for the government. We we um our job is to understand what the policy is and then forecast what the um what what the government might choose to do. >> Hannah, >> well, I think one thing that's important to keep in mind is that PIP and ADP are both uh additional cost benefits. So, they're meant to cover the additional costs of disability rather than replace earnings. So they don't have the same argument for means testing that other benefits do that are are means tested. For instance, there are means tested incapacity benefits that are meant to partially replace earnings for people who aren't able to work because of their health or because of a disability. And so the purpose of ADP is to cover these additional costs that arise that may have the the impact of helping someone into work and particularly uh covering costs additional costs that are associated with them accessing work. uh but that's not the primary purpose of the benefit. So it's you certainly could make different choices about um limiting who has access to it. That could be means testing. That could be some other form of um age limiting. I know that that's been talked about with PIP is limiting the extent to which younger people could claim it. Um so you have many policy options um within that but I would encourage uh just keeping in mind that additional costs element of it as opposed to >> other means tested benefits. >> It was put to the cabinet secretary um for social justice when she was um before us that the benchmarking and the actual data the government have got assessing the additional costs that people with different uh disabilities face isn't yet properly uh baselined or or or modeled. And so when I put it to um Sheran Simmerville that what were the additional costs that somebody who suffered suffered mild anxiety um potentially would um experience. The one example she came up with was that potentially they may have to use other forms of transport because they may not be able to travel on on public transport which which is crowded. But it it has has been independent commentators have still said that particularly in relation to mental health issues. The government hasn't yet come up with sort of definitive numbers on what those additional costs would be. Would would you encourage greater modeling and greater assessment around that? >> I think it would be useful to understand the additional costs. I do know of um research that's planned. So there's a group at Lur University that produce a minimum income standard every year for for the UK and they do one um looking at different regions of the UK. Um and they are planning some work around looking specifically at the additional costs of disability and producing a minimum income standard for disability. Um so I'm interested to see potentially what uh could come out of that and if that gives us a better idea of how that varies across different conditions and so on. Um, I think another example in relation to anxiety, um, might be needing someone to accompany you places. And so basically, you're paying for two people to go there. >> Okay, great. Mr. Bunner, >> thank you, Chair. Um, the established kind of forecast 22 million pound shortfall. Um, everybody accepts that. The abandoned UK proposals could have widened that gap to around 770 million pound shortfall. What level of reduction in the PIP block grant adjustments would create in your opinion a severe a genuinely severe difficult choice for the Scottish government? And should their contingency plans then explicitly say how set out how existing recipients and new applicants would be protected if UK reforms reduce Scottish funding? >> Okay. So, I don't think there's a I don't think I could say there's a number, there's a line, and if it went if the gap went beyond this amount, that would be a problem. I think it's a it's a continuum. Obviously, the bigger the bigger the number, the the harder the the pressure to manage. >> Um I um so you you said about contingency plans. Sorry, I've forgotten the second part. So I was asking about should the contingency plans that were setting out explicitly uh detail uh how existing recipients and new applicants would be protected if UK reforms really begin to bite here in Scotland. >> Well I mean so it depends what your contingency plan is going to be. I mean your contingency plan might be that you protect social security benefits um and then I'd like to think so >> you have and and therefore you you have identified other areas where you would make cuts. That could be a contingency plan. Equally, your contingency plan could be to change something around the the social security eligibility or it could be it would depend on what the plan is. But I agree with you that yes, it would be helpful to understand what the impact would be on people who are in receipt of benefits. That that would be an important part of it. >> Thanks, J. Thank you. Just um one unless committee members got any other final question. Just one final question. And obviously as we go into the budget preparations uh period and I know the fiscal commission will be working very closely with the government and Fraser Valander will obviously be looking closely in terms of what is going through the the sausage making machine in terms of the next budget but there are a lot of stores being placed upon public service reform both in relation to social security and social security Scotland. Um, at what stage do you think we will start to see numbers potentially from the Scottish government in terms of the savings that might flow from those key public service uh reforms? >> I I mean to be honest I think you have to ask the government but we have suggested that it would be helpful if the government would say something about how um well about the progress in this financial year at its autumn budget revision. >> Yeah. and and then to maybe set out its longer term view with the you know a revised view of multi-year when it does its budget and when it sets out its budget in December. Um, so we we'd like to see updates and those that sort of time scale, but I I don't know. You know, you have to ask the government what >> we asked the cabinet secretary for public sector reform last week. I think the figure this year was 531 million, I think, potentially. Um, and I asked him how much of that had been banked and delivered and he couldn't yet give me um the answer. So potentially we could see a situation where they don't realize those uh savings which would obviously have you know negative consequences for future budgetary uh years. Hannah, I don't know if you've got any kind of closing thoughts in relation to public sector reform program because obviously that is potentially one of the downside risks to being the government being able to continue to spend at present levels in relation to social security. >> Yes. So, I think we're similar to the SFC and that we've um communicated to to Scottish government and to the finance committee and the public service reform committee that we'd like to see um the specifics ideally with this budget of where they've gotten to with the plans that were announced in the public service reform document and strategy um earlier this year. So, there's an appendex that lays out all of the numbers and where they're hoping to make the efficiencies. And I think, you know, it would be really nice to see essentially the same table with an update showing what's been achieved or what's not. I don't know if that's realistic to to expect this year, but it would be um useful to see. And with something as large uh as um the restructuring of health boards, which could potentially have an issue in relation to social security expenditure, if treatment pathways aren't there, would we realistically be expecting or should we realistically be expecting that they start putting pounds, shillings, and pence numbers around that program rather than just simply saying we're doing it because we need structural reform? I think we'd need to see more specific plans about what's intended before you could start putting monetary amounts on it. Um, ideally that's where you would get to so we can understand exactly where this is creating efficiencies both fiscally and for service users and citizens. So understanding how people interact with public services and with their local authorities, with health boards. Um, and is that making things easier for them? Um and so yes, it would be nice eventually to see the um see the pounds and pence and as well as to see evidence that this is u fundamentally representing public service reform and not just an adjustment. >> Thank you Dr. >> significant um a significant proportion of the one and a half billion pounds of public service reform or efficiency savings that the Scottish government mapped out in January is due to come from health >> health course. Yeah. Um and so at a at a minimum I think we would want to see has the profile of that changed as a result of planning to do these um uh these structural changes. Uh structural changes often have an upfront cost even if they wind up leading to savings in the long run. So I think we'd want to understand if that profile has is shifting as the as the plans are >> made more um detailed. >> Super. I think that's all the questions the committee have. I don't know if any of the three witnesses have any closing remarks or any thoughts you want to leave us with before you go. Okay. Well, thank you very much indeed for joining us and we'll just suspend the session to allow for a change of witnesses. Thank you very much. for the second panel of agenda item one of today's pre-budget scrutiny uh on disability uh benefit uh spending and I'm pleased that we now have three witnesses joining us after a brief suspension. Joining us virtually is Adele Harris, OBBE, the independent chair of the review of adult disability uh payment. And in person, we're joined by Christy McFaden, uh a knowledge exchange fellow from the Scottish Health uh equity uh research unit, and Craig Smith, who's the public affairs uh and policy manager from the uh Scottish Association of Mental Health. So, thank you uh for joining us today. You probably heard the parameters of the discussion that we had uh uh in the first session. And just really to kick things off uh as we go into perhaps more of the policy uh related uh detail uh for the second session and to bring in uh lived experience, I just want to put on the record a quote from uh Tony Blair uh who said this in relation to mental health bearing in mind that mental health is obviously a growing and significant proportion of the adult disability payment uh spending and Mr. or Sony said, "We need a proper public conversation about mental health because you really cannot afford to be spending the amount of money we're spending on mental health. I think we have become very very focused on mental health with people self diagnosing on it. We're spending vastly more on mental health now than we did a few years ago and it's hard to see what the objective reasons for that are. The ramp up of that in just these last few years has been uh dramatic and Sir Tony was criticized by some stakeholders for those remarks and for a report that his um uh institute prepared. But that does chime with I think and I identified a Yugov poll earlier with what a growing body of public opinion that is questioning the levels of expenditure on social security and in particular disabil disability benefits. Um Adele Harris, um I'll bring you in first just perhaps to respond to those remarks and perhaps to set the scene as to why you think the uh increase in disability and disability claimments in across the UK has has risen and to what extent we know the causes and potentially the remedies to reduce or at least to arrest the increase in expenditure if that's desirable and achievable. Good morning and um thank you for accommodating my attendance um via Zoom. Just before I uh try and answer that question um I'd just like to point out of course that the report into the independent review of adult disability payment came out in July last year. So although I I'm pretty confident that the principles um and my answers to your questions will still be relevant today, some of the data and some of the statistics that are used in that final report, which I'm sure you've seen, will obviously have been updated since then. Um I'm not sure I have very much to say really in response to Tony Blair's statement. I I heard it uh at the time. Um, of course, when I was conducting the independent review, I did meet with many people who had uh mental health uh conditions and they um took part actively and engaged actively with the review and there were people with lived experience uh on the advisory group that supported the um completion of the review. Um, and I suppose again, I'm sure these are things you already know, but it is worth stressing the point that having a diagnosis of any medical condition, long-term condition or disability doesn't equal access to or eligility for adult disability payment. And therefore, in and of itself, having a a mental health condition doesn't mean that you would necessarily be eligible. And a whole part of my review was looking at the eligibility criteria and recognizing that this really is a once-in-a-lifetime opportunity for Scotland to take a different approach um and really have a a worldleading human rightsbased approach to um supporting disabled people who need additional um resources. So although a lot of people with mental health uh conditions took part in the review and their voices and stories and experiences are captured um I wouldn't really want to make uh any comment particularly on on that statement from Tony Blair other than to say that in terms of the um reasons for the increase and of course we see an increase in people who are receiving disability benefits not just in Scotland we see an increase across the whole of the UK. I know the numbers differ and I can come on to that if that's helpful. But when I conducted the report um the potential drivers in demand for the um increase in disability payments were really complex and I did a lot of work um trying to research and and find out what evidence was available to me at the time of of doing the review. Um without any doubt the cost of living um crisis uh has had an impact. Um the uh report places quite a lot of weight on the economic pressures that disabled people are facing and that financial strain seems to have driven more individuals who've got pre-existing or worsening health conditions to seek out some additional support to offset their their living costs. Um there's obviously you've already referred to it a significant s sustained increase in applications related to mental health conditions and behavioral disorders. Um and this is a trend that accelerated rapidly following the coid9 pandemic and again we see that mirrored in the stats from the rest of the UK as well. There was a suggestion at the time of writing my report that NHS waiting lists and health care backlogs were a factor that people who were um experiencing delays in receiving medical diagnosis or treatment um meant that more people were living with worsening or unmanaged chronic health conditions and that was um playing a part in the uh increase in applications. But I did note towards the end of the report that um the Scottish Fiscal Commission revised its assumptions in that regard and moved away from including NHS waiting lists as a potential reason for the increase in the number of applications. So there's obviously a question mark um around that. And then finally in terms of why um the trends are different in Scotland um the report my report notes that the transition um which of course uh the pilot was in March 2022 with the launch in August 2022 so a few years ago now but um my report notes that the transition to um a more seen as and perceived a much more compassionate and accessible application process um that caused a sharp increase in claims and you can see that obviously when you look that back through the figures. Um and uh when we compare the um applications or the PE number of people in receipt of adult disability payment with those um who are in receipt of PIP in England, we saw that the numbers started to to diverge at the beginning of the pilot in March 22 and they widened further when uh ADP was launched nationally in uh August 2022. And I think the impact of the changes that were made by the Scottish government this time, not to the eligibility criteria of course, but to the way in which um people were treated with dignity and fairness and respect. Um also the Scottish government has a maximizing takeup strategy which I don't believe the DWP have for PIP and most importantly I think a different approach to reviews. So all of those things have had an impact and particularly um the different approach in Scotland to carrying out reviews which are described as light touch reviews resulted in a decrease in the number of people exiting the case load because of that more light touch approach when compared to um the rest of the UK. >> A lot to come back on there but I'll bring in Craig Smith and then Christy McFlatin on the original question before I bring in my colleague Thomas. Perfect. Thank firstly thank you so much for um having me um to give evidence to committee. I suppose on on the point in terms of mental health um I suppose key for us is there has been an increase in mental in in the prevalence of poor mental health that's kind of clearly demonstrated particularly if you look at the and the latest Scottish census where we've seen um the proportion of people with mental health problems increasing faster than any other kind of disability group or kind of group of conditions. um increasing 2.5 times from 4.4% in 2011. Um it increasing 2.5 to 15 point pardon me sorry there's been an increase to 11.3% of people in the census the most recent census and stating they have a mental health problem compared to 4.4% back in 2011 and particularly for young people there's been kind of a five times increase in that rate. We believe that's real. So absolutely respect what Tony Blair said and a lot of the debate particularly around the increasing case load around mental health and social security and I suppose we work from the premise that there has been an increase in prevalence in terms of mental health problems. Why that is I think is very contested and Adele's touched on that we've particularly seen postcoid an increase in in poor mental health but also predating that the role of the cost of living and the relationship between poverty and mental health being absolutely kind of key and cyclical um contributing to that increase in poorer mental health problems and I suppose in terms of social security for us it's really important to focus on the eligibility and there's often discourse around people with mild depression or mild anxiety accessing ADP or PIP. We don't necessarily see that or see the evidence for that. The eligibility for criteria for ADP is very clear. You have to meet a certain number of points against activities and descriptors. Um, and there's a significant amount of evidence that people need to provide while they're going through that process. The application form itself is tens and tens of pages long and there's a real reliance on supporting evidence um around someone's claim. We know just from looking at the recent data that actually that rate of successful applications to PIP has ADP has been falling and is now below PIP um if you compare the data. So I suppose it's just trying to challenge some of the assumptions that people with mild to moderate mental health problems however we would describe that are accessing ADP and PIP. I don't think the evidence is is clear there. People really do go for a rigorous process before being awarded the benefit. And a really key point as well, we know people don't just have one condition. So there's not clear data around this for ADP actually. That's that's very publicly available and that would be something that we'd like to see. But in terms of PIP, I believe the latest data is over 60% of people who have a mental health or behavioral issue as their primary condition also have physical health conditions. So many people engaging with ADP will have multiple conditions both. And so while in the stats they may fall into that mental health and behavioral 41% category which is the highest proportion of people who are in receipt of ADP there will be multiple health conditions potentially impacting them and also kind of fundamentally for us is the importance of ensuring that it the ensuring ADP in the future remains non-diagnost non diagnostic specific in terms of eligibility. I think it's really important that the benefit as it as it does at the moment looks at the impact of someone's disability or health conditions on their ability to engage in in everyday life tasks, engage in the community, their mobility and that that doesn't marry against diagnosises. So I know there has been some proposals from from different parties and and ideas floated particularly in the context of Tim's review or other about aligning diagnostic kind of criteria to eligibility. I think there's real dangers in that particularly in terms of mental health where we know that the impact on someone's daily living or mobility doesn't fit neat diagnostic criteras. So someone with depression may find it very difficult to leave the house. Other people with depression may be much more able to engage in in community and undertake daily living tasks without support. So having a focus on how an individual can engage in in those descriptors and activities is quite important. We do think and as the review um the independent review recommended there needs to be changes to descriptors and activities to better account for everyday situations and kind of modernizing those descriptors. We absolutely strongly would like to see that and the Scottish government making progress on looking at eligibility and how the descriptors work for people in a kind of 21st century context. But we'd strongly be opposed or very wary about any linking eligibility to diagnosis. So I know I talked around the houses a we bit in that answer. Just before I bring in Christie, just just in relation to that specific thing around diagnosis, diagnosis wouldn't necessarily determine eligibility, but why would a formal diagnosis not be part of that pre-elig eligibility screening so that you can't simply enter the system with a self diagnosis, for example, which seems to be potentially one of the concerns that some have because people are effectively now self diagnosing or self-declaring and then it is possible therefore for those who are criticizing the to say there are people within the system who shouldn't be within it because they don't have a formal diagnosis. >> I think I would question slightly I I don't think we know enough about self diagnosis or talks of over diagnosis and what is happening in terms of there in terms of any kind of stats. I would go back to the eligibility criteria. So a diagnosis can be very helpful and that and ADP forms will ask people what their health conditions are because that can provide a proxy in some circumstances about potential impact on daily living or mobility but we don't see it as being a shouldn't be a prerequisite. So it can be helpful further information a diagnosis but we know not everyone living with mental health for one have a diagnosis but they still may be very much impacted in their ability to undertake kind of daily living tasks. Um and again it comes back to the eligibility is quite clear that you are scored against different activities and different descriptors. So it's where would the diagnosis help in that what's almost what's the point in having the diagnosis as as a and I I know I know what you're saying. You're not saying it should be necessarily the a requit but potentially a prerequisite and and it almost already is there in terms of you are asked when you're going through the ADB ADP process about what conditions that you do have. Um but making it a condition of eligibility I think would have huge pitfalls in in terms of potentially many people losing out in that because the way that that their condition impacts them will vary hugely depending on the individual. >> There's a careful balance here obviously because um a formal diagnosis then therefore medicalizes a potentially a condition. But wouldn't also formal diagnosis then open up new pathways for treatments that perhaps people who don't go through that process don't achieve leading to the porative expression that some people are being part benefits when they actually should be seeking treatment that would enable them to tackle um the effects of the disability they have. >> I mean indeed and we'd like to see a lot more joined up support. So, and there was there was recommendations in the independent review around that in terms of not seeing social security as a replacement to to social care or health care, but actually where someone is engaging with the social security system through an ADP application or or another application to to a different benefit. Actually, there should be some sort of exploration of what other needs someone may have in terms of employability support, health care needs. So absolutely we'd like to see a much more joined up system across the public sector more broadly about actually people being to access appropriate support either for their health or for the impact that their health is having them on on their finances or other places. Um so yes I mean the principle is key but we need to be wary about the discussion around people being parked on benefits. There's huge structural issues around people's ability to access health care, which is slightly different different issue. In an ideal world, we would like to see people being and we know in terms of mental health, people are waiting too long for support. people are finding it incredibly challenging to kind of navigate quite complex local systems in terms of p being able to find appropriate community support and potentially supporting them when their mental health is maybe at those early stages of of becoming worse and avoiding crisis. Absolutely. We we we really want to see the whole kind of scale of public sector reform to be in that direction in terms of preventative spend, a much more kind of focus on community placebased mental health support and ultimately down the line that may indeed reduce cost in the social security system because we know if people can have support at the earliest opportunity they will avoid becoming more mentally unwell and then therefore fall into that kind of eligibility criteria for AD. ADP which for our as our view kind of said at the at the start we do feel is quite robust and there still is a high threshold for um for receiving ADP. So but yes again I've talked around the houses a bit in that but in terms of joining up where we can to identify need is really key and being able to direct people into appropriate support um and some of that will be within the community in terms of NHS support but more broadly community based kind of mental health support being key. Christie. >> Um yes, so I agree with a lot of what um Adele and Craig have said there. I think something that might be useful to add is just a little bit of an update on the statistics. Um so myself and my colleague Hannah did have a look at the most recent statistics which are July 2026. Um so we had a look at the sort of what's happened since the transition to ADP because obviously we changed from PEP to ADP um around sort of 2024 2025 um which is now complete. Um the total case load of disability benefits has come down from a high in July 2025 of 550K to now just over 510K. Um, initially there were concerns raised and I think this was around the time of the the independent review of ADP that there was high rates of approval of applications compared to PEP. But this was partially expected at first because many new applications were people on PEP transitioning to ADP who would naturally be accepted. So the the higher rate of approval was was partially due to that. Um, and it has actually come down now. um award rates like percentages of awards being awarded. Um so overall just over 30% of new applications are awarded as of June 2026 compared to the max of around 55% in April 2024. So those um approval rates have come down and I think that that the sort of significantly increased approval rates in comparison to PEP was largely or at least partially due to the transition that we were going through. Um, so I think that's important to kind of understand is that the approval rates are not as high as as the sort of the point in the data where we were kind of considering ADP um and looking at the independent review. Um, but in terms of um the position of the Scottish Health Equity Research Unit, we're obviously focused quite a lot on prevention um prevention preventative policy um in terms of reducing health inequalities. And as Craig and Adele have mentioned, there's obviously this really complex two-way relationship between poverty and mental health. Um, and we have found in our research with people with learning disabilities, for example, that they were having to use ADP to cover pretty basic needs. Um, so in terms of financial hardship, these benefits can be really crucial in terms of ensuring that people aren't out of or aren't dealing with a lot of financial hardship. Obviously, that's not the situation we want to be in ideally with additional cost benefits. They should be paying for additional costs rather than basic income. Um, but they are filling that void in some ways at the moment. Um, and then just on a point that Craig picked up as well, um, in terms of participating in society, um, we do think that, um, adult disability payment can be a way of helping people to continue to access the labor market. um in terms of whether that's seeking a job for the first time or maintaining employment um having enough money to like go to interviews or continue to get accessible transport to work um all these kinds of things is really important for that and as Craig mentioned that can sort of if you are able to support people to access the labor market and close the disability employment gap which is another key goal of Scottish government at the moment then you'll be able to hopefully reduce the overall um income security payment that Scotland fund is is paying for. >> Thank you. Um I think Adele Harris wants to come and before I bring in Thomas. >> Yeah, was just um really on the point of the diagnosis. Sorry to take us back there, but just very briefly um during the course of the review um we debated for hours, days, um the medical model of disability versus the social model of disability and and how a a system of disability payment should be framed. you know, the the context. Obviously, it's already set out in the charter that it's um within the context of of this being a human human right and most disabled people that I spoke to um were in favor of a much more sort of social model of disability approach, which you'll see in my report is is where the leaning is. However, the point I just wanted to make was um that we also felt that the diagnosis, not just in and of itself, but having a diagnosis of a disability or a long-term health condition um was obviously um helpful when applying for ADP. Craig was very clear and he's quite right that the decision isn't taken on the diagnosis, but part of the process is that you have to provide some supporting evidence of how your in this case mental health condition is impacting on your daily life. And many people choose to to um put into their supporting evidence some uh evidence of a a diagnosis. So, I just wanted to to make that point. And there's also consultations obviously in the system. Everybody that I spoke to unanimously didn't want to bring back the assessments that are uh common in PIP applications um which obviously do focus more on impairments and on diagnosis. Um but uh Social Security Scotland does have the option of asking for a consultation if they need further evidence to help them make a decision. So I wouldn't want to to come across that it's one or the other, you know, medical diagnosis or self diagnosis. I think the best uh process is where we combine the two if we can. >> Thomas G. >> Thank you, Chair. I'm keen to go back to the start speaking about mental health because I think it's it's a really really interesting thing that we've seen over the past 10 years in particular, which is the rise of people um obviously showing mental health issues are speaking about it a lot more openly. I'm just wondering, Craig, with your background, is there a reason as to why you think over the past 10 years that has been the case particularly amongst young people? Has co had an impact? Has social media had an impact? because we have seen a rapid rise over the past 10 years. >> We absolutely have. Um as I said the the census data particularly for young people there's been a kind of five sixfold increase in mental health pre mental health illness prevalence amongst that group and that's not the only kind of data source for that that's kind of widely recognized. It's a really complicated answer and there's not a clear answer to why that has happened and I think there's a lot more work that needs to be done. Um we are looking forward to see the UK government's kind of review into prevalence of mental health problems and neurodiversity which is due to be published next week I believe and professor Peter Figgy who I think I've got his name right who is chairing that that review that was commissioned by the UK government has made some comments in the press this week very much trying to emphasize while the findings are coming out next week there has been a clear and genuine increase in mental distress particularly around around young people and and kind of discussions about so-called snowflake generation and others have been quite unhelpful. Um so there has been a real increase. I think why that is will be really complicated. So CO absolutely has had an impact. We saw that through the Scottish government commissioned research across CO and beyond looking at mental health co kind of wave study I think it's called and it particularly highlighted that young people were the group that was kind of most negatively impacted on mental health grounds during the pandemic and subsequently post pandemic. And we know there's a huge impact on their education and that social connection as well during the pandemic. I think you're absolutely right to point to social media and there's lots of evidence kind of growing evidence about the potential negative impact of social media on young people as well as potential benefits around people having a sense of community particularly if they're from minority communities in social media. So there's a bit of a mixed bag there, but we know that there is definitely dangers associated um with that real kind of transition socially to the online space. Fundamentally as well, we we have the legacy of austerity and a cost of living crisis. And we know that the link between poverty and mental health is absolutely clear and well established and is cyclical in terms of if you have a pre-existing mental health problem, you're much more likely to be living in in poverty and if you are living in poverty, you're much more likely to develop a mental health problem. There's a wide range of complex reasons. I don't think anyone has the the exact answer, but I think we very much still are kind of battling with that legacy of the pandemic and kind of changes to the online space. And overlining that is the impact of kind of poverty and inequalities more broadly. >> I think I think it's really the co one in particular is something I'm quite passionate about because I think we as a society haven't quite understood the ramifications of what actually happened through that particular process. And I'll give you an example on part of my council when I I done licensing visits back in 2022. I went to a well-known nightclub in Glasgow when I used to go to as a student and they had a first aid room. that first aid room had been turned into a panic room for kids who are having panic attacks because they'd not been in a nightclub in that sort of setting. And I think that at that point I actually there's a big issue here that's coming with our young people in particular when it comes to mental health. So I think that's really interesting on the poverty side. I'm really intrigued with that because I grew up in East of Glasgow and a very povertystricken background. So poverty has existed obviously for you know hundreds of years. It's something that we're we're also trying to grapple with but there has been that rise in in mental health in particular. So, I'm very intrigued to see, do you think it's because we broke down the stigma around mental health that people are now openly speaking about stuff that did exist before in society, but we just feel a lot more comfortable with and is that maybe why we're seeing a lot more people diagnose themselves, but then also claim for stuff that that they wouldn't have done before in the past. Do you think that might be part of the reason? >> I think that that's potentially part of that and I think there is a positive story around stigma in some aspects. So we know there has been a reduction in in stig stigma around me some aspects of mental health particularly the past kind of 10 15 years there's been a lot of work done in Scotland through the national program um run by funded by the Scottish government um CE to tackle stigma around mental health and we know there has been a change of attitudes we know that's not universal so can the most recent research commissioned by kind of see me a few years ago looking at the Scottish context show that while there's been a reduction of stigma in terms of depression In some conditions, for many other conditions, schizophrenia, bipolar, what you might consider kind of severe and enduring mental health problems, there's still significant stigma. We see that most starkly if you look at health outcomes for people. So, people living with kind of severe mental mental illness die or tend to die 10 to 15 to 20 years earlier than than those who don't. And that's mainly due to prevental health conditions, which kind of goes back to the earlier point about people living with multiple health conditions. So that premature mortality um the vast bulk of that comes from cardiovascular disease, cancer and other preventable um conditions that are impacting that group which is a hugely kind of stigmatized group and facing multiple inequalities and those living with serious mental illness. But I think yes there is potentially more people coming forward, more people accessing social security because there has been reduction stigma in some aspects of mental health. Um, and that's a positive thing. And I suppose for us thinking about the case load of ADP, it's not really a a positive or negative. I mean, our position is that anyone who is eligible and would meet the criteria, which we believe is robust criteria for ADP, we would hope would would if they would like to would be applying for that and having going through the pro process in a kind of fair and balanced way. So we very much welcome that for example the Scottish government have a benefit takeup strategy um and that um that's continually renewed and should be a focus. So for us it's ADP there is there to meet need. So if there is an increase in case load, if there's an increase in proportion of people with mental health problems, accessing ADP, well to give some context, mental health and behavior problems have including in PIP being the largest group for a long time. That's not a new a new thing. Even though there has been an increase in in the numbers and proportion, we don't necessarily see that as a bad thing of case loads going up. We see that as saying something about what's happening in wider society in terms of mental health prevalence and disability prevalence more broadly. And that is definitely something that needs to be explored and support needs to be put in place not just within within the social security system but more broadly to think about that and and to support people with their mental health which ultimately may take down case load kind of further downstream. But yes, for us it's we need to think about why case loads are increasing and reduction stigma may be part of that. But we are key that people who would fit the criteria should be encouraged to access their entitlement because it is part of their human rights and it will support people engaging in communities and living more fulfilled independent lives. >> Perfect. And I've got one last question as I know some of my colleagues would recommend particularly at this point. Um to what extent do you think both Scottish and UK governments have been effective at trying to tackle the mental health crisis that we're finding? And do you think that if if we were to find a better balance of dealing with some of the services that would particularly help people with mental health? I think you're right. Auststerics had a big impact in a lot of local services in particular, which would have helped a lot of people and particularly young people who are suffering from mental health. If if we were to try and give more support to trying to prevent issues of mental health, try and talk about it. Would that then do you think ease the pressure on the social security budget overall because we could then try and balance that out? >> Yes. And I'll try I try and be brief because I could talk a long time about all the different things that we should be doing to better support mental health and policy changes that we need. In that in short, I I don't I probably can't speak too much for the UK government. There has definitely been progress and there's been and there has been good work that's done by the Scottish government. We have seen an increase in mental health spending on on mental health both within the health service and without the Scottish government didn't meet their targets last term around that. But there is much more to there's much more to be done and kind of to your point shifting to a much more preventative community placebased system where people can access support for their mental health at the earliest possibility to get proper um appropriate support to prevent smaller problems becoming larger problems or more serious problems is really key. So there's a lot of good things out there in terms of the Scottish government recently published um the population health framework and the service renewal framework kind of setting the direction for kind of health and social care and community health more broadly with a really big focus on a shift to prevention and a kind of community based kind of model. We're very much in favor of that. We need to see how that's implemented. We can have lots of good strategy but actually how is that funded and implemented on the ground is really key. We very much welcome something that we do at Sam. We recently um have launched our network of walk-in mental health hubs, the Nuke. So we opened our first one in Glasgow last year um and our second one in Aberdeen. We welcome that there was broad cross party support and we're selfunding that network at the moment. We welcome that there was kind of cross party support at election time in terms of that and we welcome that the Scottish government's program for government recognizes the nuke and has some commitments in terms of expanding that network and and we believe that is absolutely not the only solution but is one of the solutions about walk-in no referrals people can get support and be rooted to appropriate community support at the earliest opportunity because we know there's significant issues in terms of accessing mental health support looking at children and young people over a third of referrals to CAMS are rejected Ed, we don't really know what other support is being offered to those young people in adults for psychological psychological therapies. We've never met the national waiting the Scottish government waiting time standards for that. So there's significant gaps in the system. There's a lot of positives in terms of strategic direction and the shift to prevention, but we need to see budget particularly and follow through with that and implementation and that to be at the heart of the kind of public service reform agenda. >> Thanks J. >> Thank you. I bring in Steve Boner. Thank you very much, chair. I first of all, I'm glad that Miss Harris opened up by articulating that just because you have a mental health condition does not mean that you're automatically in receipt of ADP because I think there's a lot of bloodlines there and a lot of intentional intentional misconception permeating around that. Um, poor mental health is very debilitating. Some of the most successful people in our communities and our societies are susceptible to it. It knows no class. It knows no borders. It does not discriminate. Um so and we've done a lot of work to reduce stigma. I I definitely think particularly here in Scotland um you know to have these conversations and and to let people know it's okay to not be okay etc. But is reducing stigma enough to explain the scale of the increase in demand for these services or would that actually understate the worsening mental health of our communities? uh and is also an indicator of unmet need that is still in our communities. >> First, I I'll try not to repeat everything that I've said, but absolutely >> um the reduction of stigma is is not enough in terms of there has been a genuine and real increase in poor mental health that's been captured in kind of populationwide kind of census data and others. We we know that's happening. We know as we've spoken about multiple reasons around that particular link to inequalities and and poverty. I think we absolutely have to welcome the reduction in stigma but be cautious around that for the reasons I said earlier in terms of particularly for what's seen as more severe and enduring mental health conditions. We know stigma is still a huge barrier and a barrier for people accessing support and is having a huge impact on them including on ultimately and their life expectancy with people with mental illness dying 20 15 to 20 years earlier due to largely due to preventable causes. Um so yeah so I don't think reduction in stigma kind of is the only answer for the increasing kind of prevalence rates or in the social security context the kind of increasing numbers of people mental health problems accessing social security I think it is down to need um and a real increase in in need and across the country and as you say that is very kind of much stratified by people's experience of poverty and other inequalities which will increase your chance of experiencing poor mental health greatly. Yeah, you also touched and said and I think it's clear in the data that a lot of the prevalence is around about teenagers and young people, but is there any other groups of communities that we are overlooking that and we're maybe seeing a a deterioration in these communities? A lot of AfroCaribbean communities for example, they tend not to come forward in as much numbers as is as is is that something that you're taking cognizance of? >> Um I don't have the data on kind of stats but absolutely. So we know me someone's relationship with mental health and poor mental health is very much impacted by other factors and is intersectional. So for example there's been a lot of work done on the refugee community and other inequalities in terms of people's experience of trauma and much higher rates of poorer mental health there. As you said young people again coming back to people experiencing poverty and living in deprivation will have a negative impact on on your mental health. We know there's a big relationship and it's very topical at the moment in terms of neurodiversity and mental health which are separate but we know there's a big relationship in terms of if you're neurodyiverse having a much higher chance of experiencing poor mental health um as well and there's a clear relationship between people experiencing physical disabilities and poor physical health and that relationship with mental health. So, so yes, there's a wide range of factors which will increase your chances of experiencing poor mental health and but but kind of race and ethnicity is absolutely one of those the experience of being a refugee or kind of new Scott as well. Um, and we can look at the the suicide data for the starkkest examples of that in terms of if you're living in one of our poorer communities, you're up to four times more likely to die by suicide than people living in the most affluent communities. And we know the data is also stratified by different employment groups as well and different risks but also of a kind of minority statuses. >> Yeah. Um, >> I would also say that um, so we did a report on um, case loads back in 2024. Um, and one of the things we looked at was um, case load by age and we did see that while the relative increase by population was highest for young people, um, the absolute increase was actually highest for those aged 40 to 50 and 30s to 40s have had a significant absolute increase in mental health conditions as well. So I do think this problem is often sort of characterized as a a young people's problem but um it is shown across the age range as well. >> Thank you very much Adele. Do you have anything to add to that? not too much other than uh during the course of the review. um what I found in relation to stigma and this sometimes mental health in particular came up in the conversation but it was just more generally the stigma associated in some cultures particularly in the black and minority ethnic communities that I met with this stigma about applying for any form of um state support uh was deemed to be a barrier um to accessing what people were entitled to. And then of course there were some cultures where um someone in the family having a mental health condition and that being known and and publicly talked about um produced elements of sort of shame and again this sort of stigma. So there were definitely um this definitely came up during the course of the review uh as an issue. >> Yeah, thank you very much. So it does sound to me uh chair that Tony Blair, you know, his comments have not been very helpful and I don't think they have actually kind of very well informed either. But thank you for your consideration. >> Thank you. But before I bring in uh Gary, uh Kirsty, just one question. Um, STRU has said that rising benefit case loads can signal or often are the consequence of upstream problems in public services, treatment waiting times, the absence of of counseling, for example. So as uh waiting lists for example came down for orthopedic surgery or potentially as other pathways open up, would you is it reasonable to expect that disability benefit uh spending could fall? And is that something that is is desirable because it means that the root cause of the problem has been rectified and therefore we're enabling that person to get back to work or back to routine life. You would definitely hope so. Yes. Um particularly when we think about severity, you know, the a mental health condition might not go away necessarily or a disability might not go away, but it may be reduced in severity with adequate support. Um and support doesn't always have to be financial. One of the things that we looked at um when we did a report in the Fraser of um learning disabilities and financial security was the interplay between um people feeling their income was adequate and people feeling that their social care was adequate. Um and we did see a correlation in our sample between those two. So I do think that it's something that needs to be looked at holistically in terms of spending is it's not just about how much money are individuals getting um through disability payments but also where else are they being supported by the government what services are being provided and are those adequate and timely. It does make a big difference. >> Thank you Craig. I don't know if you want to come see nodding in agreement but if you want to elaborate on that. No, absolutely agree. And I suppose if we think about ADP the purpose being to support people with additional costs associated with disability and we know there's been some research from scope and others about what does that look like in monetary terms. I think we do have a gap I think it came up in the first panel a gap about what does that look like in terms of of mental health? what is the additional costs associated with mental health and and there's a lack of research there and that would be good to see particularly in a Scottish context but the money mental health in policy institute have done some work as have rethink and both in the English context looking at how people with mental health problems were spending their their pit money in this context and it was on really key things like additional costs associated with transport for people who were really whose anxiety prevented them um using public transport and underlying taxis is having supporters but also what came out really strongly was people using their PIP for additional mental health support so for counseling provision for other sort of therapeutic interventions because they were waiting on NHS waiting lists or that they felt the support that they were receiving wasn't adequate to meet their needs. So there definitely is a link there in terms of people using um and I I can't imagine it be very different in the Scottish context using disability payments to support kind of therapeutic interventions. Um so ultimately if we did have appropriate support at the earliest time that may reduce some of that need. Um, but there's there's kind of big data gaps there in terms of in terms of what those costs are. And we know there are clear associated costs with mental health in terms of, as I've said, transport, others where people feel like they can't leave their house, having additional heating costs, food costs, costs being supported. But aspects of that is people using in payments to support their own um through counseling and therapies and other mental health inputs which hopefully in an ideal system should be being addressed earlier by different aspects of the state. >> Thank you. I'll bring in Carrie B. >> Thank you convenor. Um I'll start off um on mental health. I'm going my question is not going to be entirely on that on its own. Um I really appreciate the work that's been done with Sam. been working with and Denny um and getting to see that hopefully we're going to develop and start to talk to fourth valley regarding the nuke I know the success um that that has been and I know you survey your people as well and when you 86% of the people that you actually spoke to that are actually saying that their mental health is better following that it's is a fantastic service I know I'm sort of picking out one person here but but um I think it should be noted about about how well well it is But you've also got organization like Andy's man club which has changed men men's mental health as well. But overall on disability um and I think he's the presentation you did was very good at the start but particularly appreciated Adele we following through on the dignity, fairness and respect. I think that was always an important thing for the Scottish government. Um but you also talked about the filling of the gap and and in terms of you covers that. Um so what do you think uh is possibly the scope for broader public service reform to hopefully reduce the upward pressure and disabilities or at least hold it where it is? >> That question for me. Sorry I wasn't clear. >> Sorry. >> Was that a question for me? I wasn't clear. Sorry. >> It's a question for all. So >> for all of you. >> So So okay. >> Okay. So So again, I'm accepting a point that that he's a he's recognized that PIP um uh and ADP are to a part filling um in between services and support. Um so what is the scope for broader public service reform to reduce in particular the upward pressure or at least to maintain it um on disability benefits as a whole rather than just mental health disability. >> I I can start if that's helpful. I think the other two witnesses will probably have more detailed information because this wasn't a particular focus of the review. But uh in my um report um we did talk about the frustrations that many disabled people shared uh with me about social security not being seen in a wider context um uh in Scotland. So we have the disability quality plan um for example which does mention social security in the context of um providing financial support for disabled households but it just sort of stops there. there was a very clear um preference amongst all the people I engaged with that we shouldn't dilute adult disability payment and kind of merge it into other public services. Um I don't think this debate's been had in Scotland, but I have been um supporting Sir Stevens and the the group there on the PIP review. And there is a conversation, a sort of ongoing conversation about potentially um PIP or a disability payment not being given in financial terms, but actually people accessing support. Well, that only works obviously if the public services are there for the people to access um that support. As I say, in my experience, I haven't heard that debate um happening in Scotland. But I do think uh in a country the size of Scotland, it should be possible for the Scottish government and all the agencies um to use their reach to ensure that everyone who makes an application for ADP, whether they're successful or not, they obviously have felt they um should be entitled to a disability payment by by the very nature of applying. um that they could be signposted with their consent to other statutory or voluntary services that may be able to provide additional advice or support. But as I say, that um uh point in my report is predicated on there being that support available uh for people. But I don't think it should be seen as an alternative to a disability payment if you qualify under the eligibility criteria. And one just small point as well which isn't directly related to that question but comes in on a point that was made earlier um which I would like to stress. A lot of the recommendations in the review which haven't been taken up or responded to directly yet by the Scottish government refer to the uh complete review of the eligibility criteria. And one of the factors is related to making sure the criteria better meet the needs of people with mental health conditions. Um and I'll just give you one example which is people who have eating disorders at the moment the current eligibility criteria does not take into account uh their particular needs. So I just wanted to stress that point as well. >> Thank you. >> Um so in terms of my work at Sheru um we are really focused on again that prevention angle um and that's with public service reform. something that Scottish government is very much focused on as well and we really welcome the prevention units work and look forward to see what their their processes and do and how they're incorporated into the budget process. I think that's going to be really important. Um in terms of prevention, what we focus on in Sheru is really thinking about social and economic conditions um and how we can improve those to prevent health issues from coming up in the first place. Um so for me those two things are thinking about poverty specifically and thinking about employment um for those who want to work. Um we know that there's a big disability employment gap currently of about 33%. And if you look at the prevalence adjusted disability employment gap this has actually gone up um in recent years over the last 10 years or so whereas the sort of general disability employment gap looks like it's closing but when we take prevalence into account actually we're seeing an increase in the dis disability employment gap. Um and there's lots of people who are disabled who want to work. Um so a big part of sort of filling that gap as you were saying is for me thinking about how can we enable people to reach the labor market in a way that that works for them um which will improve the tax base um and also probably reduce social security spending in the long run um and helps with poverty as well. Um but it's also thinking about those who aren't able to work um due to their disability and ensuring that they do have adequate um secure income from social security as well. >> Excellent. Thank you for your very detailed response as well. >> I mean I would echo what's just been said and also point to kind of previous comments. I mean in terms of that broader public service reform agenda for us the focus really is that shift to preventative systems of health and social care. So um as I said we broadly welcome the strategic direction that's been set by the Scottish government through the population health framework and service renewal framework um but we need to see how that's implemented. So as I say having great strategy, good priorities in terms of a shift to kind of place based, community based um health and social care system, a positive role for digital healthare where that is appropriate. Um and ensuring those systems link up so that that there links between housing, social security, health and social care so people can navigate that wider system with ease is key. We very much do welcome the shift or the commitments towards preventative budgeting and I know there's The sports government's done some piloting around preventative budgeting. Again, we just need to see how that translates into into actual spending decisions and how we can actually have that strategic commitment to prevention and early intervention and community based support. How does that filter down to the local decision-m in terms of budgets? We've seen real challenges over the past few years where again there's that national commitment when it comes to integrated joint boards, local council and the health board making budget decisions within very tight financial context. What has been lost are those preventative early intervention services on the ground where there's not statary duties or commitments and to maintain them. So, it's how do we ensure there's a follow through from from positive national strategy to local decision- making and budgets obviously a huge part of that and local communities need to have that money to be able to make those decisions. Um, so yes, we want to see how that happens kind of on the ground. Um, so that's very much to the wider point in terms of public sector reform and we do agree ultimately that may lead to reductions in social security case loads where we can get people support as early in their kind of journey as possible but but not in all cases. We know there will be people living with lifelong mental health problems which they will always have and will always require support including support from social security um through disability payments or income replacement payments at the UK level as well. And to echo points already made um that Adele was was making in terms of those discussions around potentially moving to systems where instead of a cashbased benefit we're giving services or agent appliances. We would be very cautious and and ultimately against that particularly at this moment in terms of we think putting cash in the hands of disabled people including people with mental health problems is the best way people can make decisions in dignified way about what's going to support them the most. That's not to say that people should not be rooted into appropriate support which should already be there and and be provided in terms of people's right to health care and social care. Um but absolutely we think people need to be in control of those decisions about how they they they spend that money in terms to account for the additional needs um due to their disability or mental health conditions. >> Thank you all very much. Thank you. >> Thank you. I'll bring in Kate Campbell. Thank you and thank you so much for your evidence and to be honest most of my questions I think probably have been answered in what's been a really interesting discussion but I suppose I keep coming back to the point that this is pre-budget scrutiny and so the thing I'm really interested in is this point about so ADP is to it's about rights it's about equity it's about meeting people's needs because they have a disability but also to what extent do you think it is and this has been touched on before but just how much impact you think it has in helping people to sustain employment. >> So to be honest, I don't know how much research has been done specifically into that. Um I like have heard throughout my work anecdotally that it does have a big impact, but I think it's something that requires more research. Um and I would be really interested to see that. Um I don't know if Adele might have more thoughts in terms of of that connection. So I I suppose I am aware that there's not been that research and I'm kind of asking in terms of your anecdotal experience of of the people that you've spoken to. >> Yeah, certainly during >> Thank you. Sorry. Thanks Adele. >> No, apologies. Spoke over you. certainly during the course of the review. Um it was really interesting because obviously adequacy of payment was not part of the was not in scope for the review and yet irrespective of that a lot of disabled people that I engaged with and spoke to during the course of the review wanted to raise that that point with me. Um and and linked to that of course was um the stated purpose of adult disability payment which we all know is about covering the additional cost of living with a disability. We also know it's not means tested and it's not uh I I totally accept the premise of your question, but we also know it's not um a work-related benefit in the the sense um I certainly find myself shouting at the uh the radio and the TV a lot at the moment when the debates are happening at UK government level and and people are making that link between PIP stroke ADP and um going into work because you could be in a full-time well- paid role and still be eligible for pay uh for ADP, excuse me. So, I think uh there is a gap. There's very little information available on what people spend their money on. Again, when we raised this in the course of the review, there was a general hesitation or reluctance uh to be asked. I mean, obviously I wasn't asking people that question directly, but I was saying it would be really helpful if the Scottish government um uh when they're thinking about budgets uh understood what people were spending that money on. Um we also don't have very much data on the number of uh disabled people uh in Scotland. Um so I do think there is um plenty of uh information available on client satisfaction with the or otherwise with the process. There's lots of data on the performance of the agency since um the devolved u nature of social security came into place in Scotland, but we have very little information on what difference the Scottish government's approach to ADP is making for people. Um, and it links also to if the Scottish government accept the recommendations about reviewing the criteria, there'd be a huge amount of work that would need to be done um about what those costs could potentially be. I get a little bit frustrated because when we have these conversations, the assumption is always that this will bring about any change will bring about additional cost. But what we don't do is we don't think about it as an investment in the people of Scotland and the economic value of the um well-being and the employment impacts of disability benefits which significantly outweigh the cost. Um and also this underlying assumption that if we change anything it will come with the cost. Of course, there'd be a cost of implementing the changes and the systems and the training that would be required, but it doesn't necessarily follow that if you have more modern outcomebased more relevant criteria that the actual costs in terms of benefit would increase. And yet in the response from the Scottish government to my review, that was the kind of underlying assumption. So I would just leave that there really as a challenge. >> Okay. I suppose just to slightly reframe the question then maybe and I accept um you've left a challenge on the table and I recognize that but I suppose the point I'm trying to drive at is we're having a pre-budget discussion and I think there's people around this table not myself but people around this table who think that we should spend less on social security and my I I feel like part of that consideration that we have to have as a committee is if we were to spend less on social security what would the likely impact So I suppose that's maybe flipping the question back around. If we were to withdraw it, do you think there would be an impact for example on people able to access work? And I was so interested in what you said about people using it to access um counseling or therapy for mental health. Like that absolutely makes sense. And again, if people weren't able to access that that counseling, do you think we'd be more likely to see people um unable to then go to work and what kind of impact that could have obviously on the budget overall as well if we had fewer people in work as well as the impact on the economy. So, I suppose I'm kind of interested. I want to make sure we leave this session having had all the kind of doom and gloom about oh you know the potential overspend that we're also really really recognizing the value of this um of social security but particularly ATP and that we are very much warned about what might happen if it were to be reduced. I think there is um uh I'm looking through my notes here. Um Craig might be able to say more because this is actually a quote from Sam H that was included in my report, but there was some research done from the money and mental health policy institute. This was in relation to PIP, not ADP, but the same principle would apply that it was the payment is essential to supporting many people living with mental health problems to retain employment. And I'm sure you could um include not just people with mental health problems in that statement. And again, anecdotally from the many disabled people I engaged with, so many people were using it to support um their ability to be able to go to work. Whether that was transport related costs, you know, maybe they needed to use a taxi because they they couldn't use public transport, maybe it was aids and adaptations to help them to be able to work from home. I mean, there's a whole list of of of things, but I I don't know that there's any research that backs up your um question or your statement there, but I think it follows very logically that if we reduced or withdrew adult disability payment from some people, because as I say, some people who are in receipt are in work and are contributing to the economy and holding down really good jobs. But if we withdrew that support then I think it's inevitable that it would have an impact on other parts of the system. People wouldn't be able to work. They'd need to go and get maybe additional support from NHS or social uh social care for example. So it I think more work should be done to make sure we're not just assuming all of these things. But I think it's very logical from the stories I heard that if you took the payment away, it would have a devastating impact not just on people's lives, but on their households, on their children, on levels of poverty, on levels of employment. So anecdotally, I would say a resounding yes to to that question. >> Yeah. And I I would add so there is a real lack of data as Adele said around that relationship between ADP and how people use that money and and what kind of protective factors that that money provides them including accessing employment and and as has been discussed and something that we I get incredibly frustrated as as Adele was point as was saying herself the conflation of income and non-income related benefits and their purposes is is quite frustrating in this debate particularly when we look at what's happening in terms of the Tim review ADP is a non-related non-income related benefit about additional cost of disability and that's a really key and important principle to continue with but um as I said we know some people are using ADP to or PIP as well down south to support them to stay in work um to support them with transport costs or support maybe to support them to reduce their hours so actually they can cope with in terms of engaging with employment and their mental health without having to to work full-time and if they did they would probably be out job entirely. There's a kind of real lack of like hard and fast data on that, but we do have some some stuff from the money and mental health um policy institute. So they did kind of surveying work. So they have a group of lived experience um people who work with them who engage with their research and they surveyed that group and about 500 responses to that and that was to inform kind of UK government's reaction to UK government's um PIP proposals and then Tim's review. So it is a self- selecting survey, but what they found was that over half of the people who in that survey said that they were in work and in receipt of PIP would probably have to reduce hours or leave the workplace entirely if they lost that PIP support because um they would not be able to attend. They would not be able to attend with transport costs or to have those digital adaptions in their in their home place to work from home. um or there would be a huge pressure in terms of to increase their hours which have a negative impact on their mental health. And kind of to the early points that we've spoken about across the first panel and across this panel, we know people will be using understandably disability payments including ADP to meet the essential cost of living. While that might not be the purpose of the payment, we know from that research and research that Rethink um did again in the English context looking at PEP, people were using their PIP to mitigate mental health crisises and financial crisises. So it was to pay to support paying the rent, paying the heating bills and the impact of that including ultimately the financial impact of reducing um those payments or withdrawing them completely could be very you know could be very severe for the individual themselves but ultimately on public spending too if other if people are being driven into kind of mental health crisises or more broadly their health is deteriorating and their reliance on wider public services increases. So absolutely there needs to be that two sides of the debate and that's why we always go back to social security being an investment in the people of Scotland is how we would see it and very much rooted in terms of a human right in itself but also supporting people to live independently and realize for other human rights and while there's obviously a budgetary cost and we know the case load and the cost of social security has been increasing it's not just a cost it's an investment and actually giving people that support allowing people to engage in society um more fully has social and economic benefits. >> Yeah. Um I would echo what Adele and Craig have said. Um and I guess just to sort of emphasize the fact that cuts, you know, while on the surface may look like a saving. Um I do think that they could put a lot of pressure on other areas of spend as was mentioned. So things like health, employability, housing. Um cutting money for people is not going to solve the crisis that we're having. So it is going to probably come up in other areas of the system and that's why we're so interested in this idea of um focusing more on preventative measures because if we can solve the root cause um of the problem then we're much more likely to to be able to fiscally save money in the long term. Okay. >> Thank you. And just just to that point uh Kirsty if when governments make tough choices if a government preserved the current trajectory of social security expenditure but cut for example housing, health and um potentially employability. Could you foresee a situation where we don't manage to get to that step change where we're taking people off benefits and getting them uh into work or into a more routine uh uh daily life which is presumably what everybody around the table would want to see happening. >> I'd say it's really difficult to say to be honest. Um it's people do people need to be supported um in various different ways. Um I do think it's ultimately a political decision um where cuts are made and where spending is done and I think that Scottish government just needs to have a clear idea of what their ultimate goal is in that process. Um if there's an absolute need to save money somewhere then it needs to just be carefully thought about in terms of what the potential impacts could be wherever that is cut. >> Okay. More from me. >> Thank you. Thank you very much for all the information you've given so far. It's been incredibly insightful. I was curious to know a bit more about the TIMS review because it states that there's a lack of evidence that the NHS capacity has had a strong impact on disability benefit claimments on an aggravated level. However, the Tims in report also says that PIP is often filling the gap that arises between services and support and to me that was quite a contradiction. So I was really curious to get an insight from you as to how you felt about that. I can I can go first. I mean I suppose again unhealthy it comes back to kind of lack of data but I think more broadly speaking the mental health context we know there's long-standing issues around a lack of appropriate support. We know as I said earlier I think we have we have limited data in terms of the me the mental health system more broadly actually in terms of performance in Scotland but where we do have data for example on waiting times for psychological therapies we know that target has never been met. We know that people are waiting extremely long times to access um appropriate NHS support in terms of children young people. If we look at CAMS um in terms of the NHS as I said over a third of young people are being rejected from CAMS on referral while we very much welcome that the waiting the 18we waiting time target has now been achieved there's a huge group of young people who are being shifted off that waiting list or are being rejected from it. So that's longstanding issues in terms of challenges in accessing mental health support. So I think it it kind of chimes anecdotally that that would be having an impact in terms of both someone's health, their mental health or health more broadly um getting worse while they are waiting hence becoming eligible for disability payments. So I think there's there's likely a kind of clear relationship between those kind of systems and and I believe that came out a we bit in terms of some engagement around the independent review in terms of people facing barriers to kind of health and social care having a detrimental impact on on their health leading to higher potentially higher case loads. But I think there is probably a lack of clear data and I know the data is a bit mixed in terms of that in terms of the terms review kind of pointing towards that where other people saying that's there's not a clear picture there. But it kind of chimes true for us that we know from the people that we we engage with and that we support through our services that they've often experienced huge long structural weights in terms of getting appropriate support. >> Um yeah, I'm I'm hopeful that that's something we'll be able to answer as a couple more years pass. um because we've obviously had this big crisis of really long waiting lists the last few years and they are starting to come down but we kind of want to see how that progresses. Um and then in terms of the sorry I forgot I was going to say um but yeah so I think in terms of that we we do need more data um 100%. And um I think when it comes to um yeah waiting list that's really important. Thank you. >> Don't really have very much to add to that other than again anecdotally because we just don't have the the data available. Um during the course of the review when I spent time uh at Social Security Scotland uh shadowing some of the case managers who were making the the decisions so I could really understand the process. It was a it was apparent that in some people's lives obviously those that are living with um a a long-term health condition or a disability that's lifelong. So, um, to use not a great phrase, but they're, you know, they're not going to if if you if you have, um, a learning disability, for example, that's unlikely to change and the impact of that learning disability on on your life is unlikely to change. But there were um several cases that we uh I I I saw where the um people making the application for ADP did not have a long-term um or a uh a medical diagnosis of something that was going to be with them for life. They were living in chronic pain or they uh maybe had had an injury and because of the waiting lists um the uh operation wasn't coming as fast as they they needed it to. And there was a number of people who were applying for ADP. I would imagine on that kind of temporary basis um with a view to uh you know getting the the right uh NHS treatment and therefore change of circumstance would mean that they could come off uh the adult disability payment once they had received that treatment. But it's very anecdotal and that's just a handful of stories that I was uh exposed to during the course of the review. We definitely need more uh research to answer that question. >> That's really interesting. Thank you. And just tapping into your answers a we bit there. I was curious beyond the NHS, which services are having the biggest bearing on people's need for disability benefits, for example, um social care or housing adaptations, transport or sort of employment support. Um so again that's something I I don't know if we really have clear data on. Um again it's anecdotal but um I do think that it is having an impact on um a variety of services. Um but yeah again it's it's something that I can't really confidently answer. >> Thank you very much. And I had a question which is possibly more directed towards Miss Harris. Um, so I appreciate there's a a wide range of um, packages and your recommendations for review and I was curious to know considering the cost implications of implementing them all, could you outline which ones you would recommend would have the greatest difference for those with fluctuating health conditions? >> Yes. Um I don't know if you've seen um my uh written response to the uh independent review of adult disability payment response from the government but I do do go through this and interestingly I've given evidence to other committees and someone always asks the question you know if you could only choose one which would be your sort of top priority which when there's 58 recommendations that's quite a challenging question um but in terms of fluctuating uh conditions um I was very disappointed that in the government's response. I mean there was a lot in the response that I welcome but I was disappointed that there was no mention in the response particularly of the 50% rule and the reli use of the reliability criteria which if you have read my full report or even the summary you'll see this was a really important um point um for people who were living with fluctuating conditions. Um, and there wasn't also any direct reference to um a d a decision-making process that better recognizes people who live with fluctuating conditions. So I think um I I would uh answer your question by saying the recommendation that's in the better future chapter of my report which uh asks for or suggests that we remove the 50% rule altogether and we better apply the reliability criteria. um that would in my view be much better meet the needs of people who live with fluctuating conditions because all the evidence is that um if you're living with a fluctuating condition you don't just have good days and bad days which is the way the application process at the moment is kind of framed. you can have uh impact of having that condition um that isn't simply just occurring on 50% of the days in the year or 50% of your of your um time. So that would be the one that I would um stress would bring the uh greatest impact to people who are living with fluctuating conditions and it would demonstrate that the application process was much better able to to meet their needs in the reframing for questions around the reliability criteria. >> That's incredibly helpful. >> Thank you, M. H. I've just got one final qu actually perhaps two final questions. One's in relation to uh something you noted in your final report which was concerns from welfare rights advisers about inconsistent decision-m and again that appeared to be largely anecdotal. Um I suppose my my concern would be that if there are in imprecise decisions being taken or if they are potentially um not being as consistent as they could be and where for example um a a redetermination comes up with a very different um uh conclusion than the original decision but obviously that points to perhaps some systemic failure. Now we've seen since your original report that um the initial authorization rate has fallen to 31% which is quite a significant um difference. Now that may be welcome because there may have been people who were in receiving the benefit who for other reasons maybe should not have been approved but also does point to the fact that this could still be quite um haphazard. So what evidence would you want to establish uh to reflect whether or not that reduction in um authorizations reflects a changing applicant mix for example or potentially a change in decision-m um practice? Yes, certainly. When I conducted the review, as you'd probably expect, I spent a lot of time at Social Security Scotland and as already said, I shadowed case managers and health and social care practitioners as they went about their their daily life. And I think I do make the point um quite strongly in the report that despite the quality assurance process which I witnessed firsthand which includes obviously the guidance that's available to case managers, all the training that they have, um the very um uh the very uh robust kind of quality assurance checking that goes into how they make the their decisions. um everything that goes, you know, with being a case manager and ultimately making that final decision is is pretty good. I I was quite impressed by it. However, if you have a system that ultimately relies on um a an individual assessing a particular set of information and there's some obviously some um subjectivity uh in there, then you are going to end up with with different decisions. And I did experience one where I quote in the report that at the initial assessment of the application, the person was a awarded no points for either the um mobility or the daily living component. And that person with some additional supporting information to be fair went through the redetermination process and ended up being awarded the higher rate for the daily living. And that was that was one case, but it was an extreme example of how one person looking at a set of information could award nothing and someone else could award the higher rate. So I think it's just inherent in a system that that relies on humans, compassionate, you know, well-trained, kind human beings trying to do their best that you will always have that that element of um difference. And I suppose that's why we have redetermination and appeal system built in so that can be challenged. Um, but to to answer the point about the reduction down to 31%. I don't know. I didn't see evidence of that, bearing in mind my report came out in July last year when the numbers were slightly different. Um, so I don't know if since I conducted the review there's been a change in policy or or kind of direction or training around the case manager's decision making or whether it is simply to do with the number of people that are applying. >> Okay, that's that's helpful. and uh Kirsty. >> Yeah, thanks. Um I'd just like to reemphasize the point I made earlier as well about the award percentages um that part of the reason that it was so high um originally was because of the transition from PEP to ADP. So a lot of people were basically already shown to need an additional cost benefit and to meet those those requirements. Um and it has come down and been quite stable over the last um year or two now um around that sort of 30%. So um although obviously there is that sort of subjectivity like um we have seen pretty stable um award percentages since. >> Okay, thank you. I'm just looking at the committee to see if there any final questions with that. I just again like to thank our witnesses for um joining us and we'll move into private session. Thank you very much indeed. >> Thank you.