Fitness for work
– a test too far
Are half of all claimants for
disability benefits really fit for work? A report by
an independent occupational health specialist is highly
critical of the Work Capability Assessment, the government’s
medical test to assess claims for incapacity for work
benefits. However, the process of transferring claimants
onto ESA is continuing while the review is still ongoing.
Charlie Callanan looks at the initial
findings and recommendations.
The government is continuing in its determination to
curb the culture they perceive of disabled benefit claimants
being “written off to a lifetime on benefits”.
It is undertaking a review of the work capability assessment
involving both legal and procedural changes. However
the migration of claimants of incapacity for work benefits
onto employment and support allowance (ESA) is going
ahead before the review is complete.
Some changes follow a critical report by an independent
occupational health specialist. ‘An Independent
Review of the Work Capability Assessment’ (WCA)
by Professor Malcolm Harrington found various problems
with the WCA, the medical test used to assess claims
for ESA. He said in his report : ‘There is strong
evidence that the system can be impersonal and mechanistic,
that the process lacks transparency and that a lack
of communication between the various parties involved
contributes to poor decision making and a high rate
of appeals.’
Rubber stamping
Problems he highlighted are the ‘rubber stamping’
of the Atos Healthcare’s medical assessments by
Jobcentre Plus decision-makers and that they often do
not have, or do not appropriately consider, additional
evidence submitted to support a claim. Regarding mental
health and other fluctuating conditions, he said that
some ‘descriptors’ used in the medical assessment
‘may not adequately measure or reflect the full
impact of such conditions on the individual’s
capability for work’. Communication between the
agencies involved is often fragmented and in some cases
non-existent. Professor Harrington gives the example
that Jobcentre Plus and Atos Healthcare are not given
the reasons for an appeal tribunal’s decision.
Stakeholders and representative organisations contributed
to the review. The review – a statutory requirement
– was published in November 2010 (see box). The
government accepted the vast majority of the recommendations.
The government is introducing regulations to amend
certain aspects of the WCA. The changes include simplifying
the descriptors by removing unnecessary complexities
and overlaps; taking greater account of the beneficial
effects of adaptations and aids in improving an individual’s
function; and improving the assessment of fluctuating
conditions by ensuring that the effects of exhaustion
and discomfort are recognised.
Some of the mental, intellectual and cognitive descriptors
have been amalgamated. So 'Initiating and completing
personal action’ focuses on planning, organisation,
problem solving, prioritising or switching tasks. Some
other descriptors are amalgamated into two new descriptors,
‘coping with social engagement’ and ‘appropriateness
of behaviour' due to cognitive impairment or mental
disorder. And the support group - for claimants not
expected to engage in work-related activity - will be
expanded in relation to certain mental function and
communication problems. The amending regulations come
into force on 28 March.
Ongoing process
Despite the ongoing review process for the WCA, the
government is proceeding with the migration onto ESA
of claimants of incapacity for work benefits (incapacity
benefit, income support and severe disablement allowance).
All claimants, with a limited number of exceptions,
will be medically reassessed during the migration process.
There has been criticism of this plan by welfare rights
charities as some claimants will be reassessed under
the old WCA (pilots for migration begun in Aberdeen
and Burnley in October 2010) and claimants who are transferred
from 28 March onwards will be reassessed under the new,
hopefully improved WCA. The main ESA migration programme
began on 28 February 2011 and is due to finish in March
2014.
But regardless of which WCA claimants are subject to,
the government has estimated that 50 per cent of claimants
who were found to be ‘incapable of work’
under the test of incapacity for work – the personal
capability assessment – will be found fit for
work under the WCA. The statistics for new claimants
of ESA do not provide comfort for those people waiting
to be transferred. For all completed initial assessments
of new ESA claims (ie not including assessments still
in progress or people who left ESA before completing
assessment). For new ESA claims, from October 2008 to
31 August 2010, 65 per cent of claimants were found
fit for work. But the other side of the coin is seen
in the appeals data. Of the people who made a claim
for ESA between October 2008 and November 2009 and who
were initially found fit for work, 33 per cent have
had an appeal heard by the Tribunals Service and 40
per cent of those appeals were successful.
The government has said that the initial WCA review
is the first of five annual reviews, and that Professor
Harrington has already been engaged to carry out the
second one. As with all the other changes going on in
the world of welfare rights, changes to ESA and its
medical assessment is something stakeholders, professionals
and clients will have to keep an eye on.
Professor Harrington’s recommendations:
• Jobcentre Plus to manage and support the claimant.
This includes explaining the WCA process, their decision
and the support that is available after assessment.
• Inclusion of a personalised summary of the recommendations
in the Atos healthcare medical report, to be sent to
all claimants.
• Atos Healthcare to employ ‘mental, intellectual
and cognitive champions’ in every medical examination
centre to spread best practice and build understanding
of these disabilities. A task group looking at the mental,
intellectual and cognitive descriptors, including representatives
of Mencap, Mind and the National Autistic Society, will
make recommendations to Ministers by May this year.
• Empower and invest in decision makers so that
they are able to make the right decision, gather and
use additional information appropriately and explain
their decision to claimants.
• Better communication and feedback between Jobcentre
Plus, Atos Healthcare and the Tribunals Service to improve
the quality of decision making on all sides.
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