Andrew M. Jones, James Lomas, Suzanna Nesom and Joe Spearing – Evidence submission to the Timms Review

Executive Summary

This briefing presents new evidence on the causal effects of replacing Disability Living Allowance (DLA) with Personal Independence Payment (PIP) among older disabled people in England. Using a Regression Discontinuity Design (RDD) and data from the English Longitudinal Study of Ageing (ELSA), we exploit the exemption from reassessment for claimants aged 65 or over at implementation. We find that the reform caused significant deterioration in mental health without reducing disability benefit receipt or expenditure for this group.

Key findings

• PIP reassessment worsened mental health. Older DLA claimants exposed to reassessment
  eligibility experienced a substantial deterioration in mental health, equivalent to at least one
  additional depressive symptom (around 0.6 standard deviations).
• The reassessment process itself appears harmful. The deterioration in mental health cannot be explained by reductions in benefit receipt or payment amounts. The evidence instead
  points to distress, uncertainty and the burden of reassessment as the main mechanisms.
• The reform did not reduce spending for this group. Among older claimants, the reform
  produced no measurable reduction in disability benefit expenditure. Once wider mental health
  and public service impacts are considered, the policy may have increased overall public costs.

Recommendations for Policy

1. Differentiate policy design by age group to avoid unintended impacts
   Reforms to disability benefits designed for working-age claimants may not be appropriate for older groups with different health trajectories and policy needs. Age-specific reassessment rules or exemptions, alongside consideration of different claimant groups, should be considered.
2. Account for the psychological costs of reassessment, not only its fiscal effects
   Reassessment, or the anticipation of it, caused significant deterioration in mental health among older claimants, even where entitlement was unchanged. Reforms aimed at tightening eligibility through reassessment should therefore consider impacts on mental health and associated public-sector costs alongside any projected expenditure savings.
3. Reduce unnecessary reassessment for claimants with stable, long-standing conditions
   The psychological costs of reassessment appear particularly pronounced for older claimants with long-standing disabilities, a group for whom the reform produced no fiscal saving. Longerterm or indefinite awards for conditions unlikely to improve could reduce uncertainty and administrative burden without sacrificing targeting accuracy.
4. Improve linkage of administrative reassessment records to health and mortality data
   A key limitation of the current evidence base is the inability to observe reassessment timing, outcomes and health trajectories in linked data. Improved linkage would support better evaluation of the long-run effects of disability benefit reform.

Background and Study Design

DLA was replaced by PIP from April 2013, introducing more frequent reassessment and greater use of time-limited awards. The reform was projected to reduce the caseload by 20%; instead, both caseloads and expenditure rose relative to pre-reform levels.
We exploit the rule that DLA claimants aged 65 or over on 8 April 2013 were exempt from reassessment, creating a sharp birthdate discontinuity at 8 April 1948. Comparing individuals on either side of this cutoff – using data from the English Longitudinal Study of Ageing (ELSA) – identifies the causal effects of reassessment eligibility on health and benefit outcomes. The assumptions underpinning this approach are checked, and the findings are shown to be robust.

Key Findings

1. The reassessment process worsened mental health
   Reassessment eligibility increased CESD depressive symptom scores by 1.5–1.6 points on an eightpoint scale – around 0.6 standard deviations – and raised the probability of exceeding the clinical threshold for elevated depressive symptoms (CESD > 3). Effects are larger over longer follow-up periods, consistent with sustained exposure to reassessments.
2. Harm was not caused by benefit loss
   The reform produced no statistically significant change in overall disability benefit receipt or weekly payment amounts and this result is unchanged when including Attendance Allowance. There is some evidence of heterogeneity by gender, with larger effects for men.The evidence instead points to psychological burden – uncertainty and perceived income risk – rather
   than realised income loss as the main mechanism driving these effects.
3. No fiscal saving was achieved for this group
   With no reduction in benefit expenditure but clear mental health costs and likely downstream increases in NHS and social care demand, the reform may have increased net public spending for older claimants.

Implications for the Timms Review

Our evidence speaks directly to Themes 1, 2 and 3 of the Review.
Theme 1: Role and purpose of PIP
A reassessment process that generates significant psychological distress without delivering expenditure savings is misaligned with PIP’s stated purpose of supporting independent living. These findings suggest that the structure of reassessment – not only award levels – is central to whether PIP achieves its objectives.
Theme 2: Eligibility, fairness and equity
Our findings show that the assessment process itself can generate harm independently of its financial outcome, and that these effects may differ across claimant groups, including by gender. The shift from largely indefinite DLA awards to periodic PIP reassessment introduced ongoing uncertainty that appears harmful even for claimants whose entitlement was ultimately unchanged.
Theme 3: Experience of claiming PIP
Our causal estimates provide quantitative corroboration of qualitative accounts of the claiming experience. Reassessment is a source of anxiety and depressive symptoms independent of its financial consequences, including among claimants whose entitlement is ultimately maintained.

Further information
Jones, A.M., Lomas, J., Nesom, S. and Spearing, J. (2026). The Effect of Disability Benefit Reform on the Mental Health of Older People in England. SSRN Working Paper 6314900. https://ssrn.com/abstract=6314900 Funded by the ESRC (ES/Z503356/1). Data: ELSA Waves 1–10 (1998–2023).
We are grateful to members of our academic, policy and lived experience advisory group