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.