Dr Greg Wood (talk | contribs) add citations re leadership |
Dr Greg Wood (talk | contribs) →Concerns over quality: add whistleblower and Greatrex and citation and Gov response |
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The WCA was then loudly criticised: in the media,<ref>{{cite news |url=http://www.newstatesman.com/politics/2013/01/shadow-state-atos-and-work-capability-assessment |title=The Shadow State: the "dehumanizing, degrading" treatment of disabled people |first=Alan |last=White |work=[[New Statesman]] |date= 23 January 2013 |accessdate=12 April 2015}}</ref><ref>http://www.theguardian.com/society/2014/sep/30/welfare-rights-shame-iain-duncan-smith-nick-dilworth-reform</ref><ref>{{cite news|url=http://www.dailyrecord.co.uk/all-about/atos |title=All about Atos |work=Daily Record |date=7 February 2013 |accessdate=12 April 2015}}</ref> in Parliament,<ref>{{cite news|first=Amelia |last=Gentleman |url=http://www.guardian.co.uk/society/2013/jan/17/atos-attack-emotional-commons-debate |title=Atos comes under attack in emotional Commons debate | Society | guardian.co.uk |publisher=Guardian |date=15 January 2013 |accessdate=15 January 2013 |location=London}}</ref> by the [[Catholic Church|Church]],<ref>{{cite news |url=http://www.dailyrecord.co.uk/news/scottish-news/archbishop-tartaglia-joins-chorus-protests-1937204 |title=Archbishop Tartaglia joins chorus of protests against Atos assessments which 'trample on human dignity' |first=David |last=Taylor |work=Daily Record |date=7 June 2013 |accessdate=12 April 2015}}</ref> by the medical profession,<ref>{{cite news |url=http://www.guardian.co.uk/commentisfree/2013/jan/04/gp-atos-work-capability-assessment |title=This brutal new system': a GP's take on Atos and work capability assessments |first=Anna |last=Pilkington |work=The Guardian |date=4 January 2013 |accessdate=12 April 2015}}</ref> and by protest groups.<ref>[https://secure.38degrees.org.uk/page/s/fine-atos-when-it-fails Fine Atos when it fails. [[38 Degrees]]]</ref><ref>{{cite news |url=http://www.bbc.co.uk/news/uk-england-london-19437785 |title=Atos protest groups: Disability rights groups target firm |work=[[BBC News]] |date=31 August 2012 |accessdate=12 April 2015}}</ref><ref>[http://www.ekklesia.co.uk/node/17667 'War on Welfare' petition tops 5,000 in less than 48 hours]</ref> |
The WCA was then loudly criticised: in the media,<ref>{{cite news |url=http://www.newstatesman.com/politics/2013/01/shadow-state-atos-and-work-capability-assessment |title=The Shadow State: the "dehumanizing, degrading" treatment of disabled people |first=Alan |last=White |work=[[New Statesman]] |date= 23 January 2013 |accessdate=12 April 2015}}</ref><ref>http://www.theguardian.com/society/2014/sep/30/welfare-rights-shame-iain-duncan-smith-nick-dilworth-reform</ref><ref>{{cite news|url=http://www.dailyrecord.co.uk/all-about/atos |title=All about Atos |work=Daily Record |date=7 February 2013 |accessdate=12 April 2015}}</ref> in Parliament,<ref>{{cite news|first=Amelia |last=Gentleman |url=http://www.guardian.co.uk/society/2013/jan/17/atos-attack-emotional-commons-debate |title=Atos comes under attack in emotional Commons debate | Society | guardian.co.uk |publisher=Guardian |date=15 January 2013 |accessdate=15 January 2013 |location=London}}</ref> by the [[Catholic Church|Church]],<ref>{{cite news |url=http://www.dailyrecord.co.uk/news/scottish-news/archbishop-tartaglia-joins-chorus-protests-1937204 |title=Archbishop Tartaglia joins chorus of protests against Atos assessments which 'trample on human dignity' |first=David |last=Taylor |work=Daily Record |date=7 June 2013 |accessdate=12 April 2015}}</ref> by the medical profession,<ref>{{cite news |url=http://www.guardian.co.uk/commentisfree/2013/jan/04/gp-atos-work-capability-assessment |title=This brutal new system': a GP's take on Atos and work capability assessments |first=Anna |last=Pilkington |work=The Guardian |date=4 January 2013 |accessdate=12 April 2015}}</ref> and by protest groups.<ref>[https://secure.38degrees.org.uk/page/s/fine-atos-when-it-fails Fine Atos when it fails. [[38 Degrees]]]</ref><ref>{{cite news |url=http://www.bbc.co.uk/news/uk-england-london-19437785 |title=Atos protest groups: Disability rights groups target firm |work=[[BBC News]] |date=31 August 2012 |accessdate=12 April 2015}}</ref><ref>[http://www.ekklesia.co.uk/node/17667 'War on Welfare' petition tops 5,000 in less than 48 hours]</ref> |
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In 2012, Parliament's Office of Science and Technology analysed the WCA's performance and found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process"; in the same year, [[Member of Parliament|MP]]s first debated the WCA and Atos Healthcare.<ref name="parliament1">[http://www.parliament.uk/mps-lords-and-offices/offices/bicameral/post/post-news/work-capability-assessment/ Westminster Hall debate on Atos Healthcare, Parliament UK, retrieved 30 September 2012]</ref> Since then there has been considerable pressure applied by parliamentarians of all parties - but particularly by [[Michael Meacher]],<ref>[http://www.huffingtonpost.co.uk/2013/03/16/atos-michael-meacher-dwp-fit-to-work-tests-slammed_n_2889748.html Huffington Post. 16 March 2013]</ref> [[Tom Greatrex]] <ref>{{cite news |url=http://www.dailyrecord.co.uk/news/politics/bungling-atos-rake-500million-botched-1879598 |title=Bungling Atos rake in £500million of taxpayers' cash from botched fitness-to-work tests |first=Torcuil |last=Crichton |work=Daily Record |date=10 May 2013}}</ref><ref>{{cite news |url=http://www.bbc.co.uk/news/uk-22546036 |title=Disability benefit assessments 'unfair', says ex-worker |first=Sophie |last=Hutchinson |work=BBC News |date=17 May 2013}}</ref> and Sheila Gilmore - for improvements to the 'fitness to work' assessment. Greatrex also wrote to the Prime Minister to |
In 2012, Parliament's Office of Science and Technology analysed the WCA's performance and found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process"; in the same year, [[Member of Parliament|MP]]s first debated the WCA and Atos Healthcare.<ref name="parliament1">[http://www.parliament.uk/mps-lords-and-offices/offices/bicameral/post/post-news/work-capability-assessment/ Westminster Hall debate on Atos Healthcare, Parliament UK, retrieved 30 September 2012]</ref> Since then there has been considerable pressure applied by parliamentarians of all parties - but particularly by [[Michael Meacher]],<ref>[http://www.huffingtonpost.co.uk/2013/03/16/atos-michael-meacher-dwp-fit-to-work-tests-slammed_n_2889748.html Huffington Post. 16 March 2013]</ref> [[Tom Greatrex]] <ref>{{cite news |url=http://www.dailyrecord.co.uk/news/politics/bungling-atos-rake-500million-botched-1879598 |title=Bungling Atos rake in £500million of taxpayers' cash from botched fitness-to-work tests |first=Torcuil |last=Crichton |work=Daily Record |date=10 May 2013}}</ref><ref>{{cite news |url=http://www.bbc.co.uk/news/uk-22546036 |title=Disability benefit assessments 'unfair', says ex-worker |first=Sophie |last=Hutchinson |work=BBC News |date=17 May 2013}}</ref> and Sheila Gilmore - for improvements to the 'fitness to work' assessment. Greatrex also wrote to the Prime Minister to bring to his attention allegations made by a former Atos assessor that the WCA was "skewed" against the claimant. Downing Street did not respond and passed the letter back to the DWP, which issued a non-specific statement;<ref>http://www.dailyrecord.co.uk/news/politics/iain-duncan-smith-blasted-ignoring-2027336</ref> Greatrex described the government's response to this whistleblowing as "unacceptable" and "woefully inadequate". |
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Controversially, patients with serious conditions such as brain damage,<ref>{{cite news|last=Masters|first=Sam|title=Brain-damaged amputee fit for work, says Atos|url=http://www.independent.co.uk/news/uk/politics/braindamaged-amputee-fit-for-work-says-atos-8547539.html|accessdate=12 April 2013|newspaper=The Independent|date=24 March 2013|location=London}}</ref> terminal [[cancer]], severe [[multiple sclerosis]], and [[Parkinson's Disease]] have been found fit for work.<ref name="Guardian 22Feb2011">{{cite news|author=Amelia Gentleman |url=http://www.guardian.co.uk/politics/2011/feb/22/new-disability-test-is-a-complete-mess |title=New Disability Test is a Complete Mess |publisher=Guardian |date= 22 February 2011|accessdate=30 January 2012 |location=London}}</ref> On 24 April 2013, a woman who was a double heart and lung transplant patient died in her hospital bed only days after she was told, after a Work Capability Assessment, that her allowance was being stopped and that she was fit for work.<ref>[http://www.mirror.co.uk/news/uk-news/linda-wootton-double-heart-lung-1912498#ixzz2UVotuNmj Daily Mirror. "Linda Wootton: Double heart and lung transplant dies nine days after she has benefit stopped". 26 May 2013]</ref><ref>{{cite news |url=http://www.bbc.co.uk/news/uk-england-essex-22718700 |work=BBC News |title=Atos Assessments: Widower claims system 'unfair' |date=30 May 2013}}</ref> |
Controversially, patients with serious conditions such as brain damage,<ref>{{cite news|last=Masters|first=Sam|title=Brain-damaged amputee fit for work, says Atos|url=http://www.independent.co.uk/news/uk/politics/braindamaged-amputee-fit-for-work-says-atos-8547539.html|accessdate=12 April 2013|newspaper=The Independent|date=24 March 2013|location=London}}</ref> terminal [[cancer]], severe [[multiple sclerosis]], and [[Parkinson's Disease]] have been found fit for work.<ref name="Guardian 22Feb2011">{{cite news|author=Amelia Gentleman |url=http://www.guardian.co.uk/politics/2011/feb/22/new-disability-test-is-a-complete-mess |title=New Disability Test is a Complete Mess |publisher=Guardian |date= 22 February 2011|accessdate=30 January 2012 |location=London}}</ref> On 24 April 2013, a woman who was a double heart and lung transplant patient died in her hospital bed only days after she was told, after a Work Capability Assessment, that her allowance was being stopped and that she was fit for work.<ref>[http://www.mirror.co.uk/news/uk-news/linda-wootton-double-heart-lung-1912498#ixzz2UVotuNmj Daily Mirror. "Linda Wootton: Double heart and lung transplant dies nine days after she has benefit stopped". 26 May 2013]</ref><ref>{{cite news |url=http://www.bbc.co.uk/news/uk-england-essex-22718700 |work=BBC News |title=Atos Assessments: Widower claims system 'unfair' |date=30 May 2013}}</ref> |
Revision as of 11:52, 5 July 2015
The Work Capability Assessment (WCA) is the test designed and used by the Department for Work and Pensions (DWP) in the United Kingdom to determine whether ill or disabled welfare claimants are entitled to the main out-of-work sickness benefit: Employment and Support Allowance. The assessment is a key component of the 2007 welfare reforms that the subsequent government continued and developed.
The WCA sorts sickness benefit claimants into three groups: fit for work; unfit for work but fit for pre-employment training; or fit for neither work nor training. The DWP views this as the first step in a process that helps some disabled people "off benefits and into work" but the testing procedure has proved highly controversial, with concerns loudly expressed about harsh decision-making and the difficulties and delays faced by claimants when they launch an appeal.[1]
Atos Healthcare, part of the multinational company Atos, conducted the core assessment on behalf of the DWP until 1 March 2015, on which date the American firm Maximus - trading as the Centre for Health and Disability Assessments - took over.
Politically, Labour and the two former coalition parties remain in broad agreement on the principles behind the programme of welfare reforms begun in 2007, but few people now argue that the WCA itself has been anything but a failure, even in simple economic terms.
Seven years since it was introduced it is still not clear that the test will ever work, and there is persistent criticism of the leadership skills and integrity shown by ministers as they attempted to manage the WCA project and its numerous problems.[2][3]
Background
Before 1995, entitlement to Invalidity Benefit was decided by an adjudication officer but largely based on the opinion of the claimant's general practitioner.
In that year, Invalidity Benefit was replaced by Incapacity Benefit (IB) and the Department of Social Security began commissioning its own medical assessments using a procedure called a Personal Capability Assessment (PCA). The change came about partly as a result of the view that a clinical assessment by a person's GP would not necessarily reflect functional impairment. It has also been noted that obstacles to work such as pain and fatigue are difficult to gauge objectively.
In 2007 the New Labour government passed the Welfare Reform Act[4] which - for fresh claims, initially - would replace Incapacity Benefit with Employment and Support Allowance (ESA) and the Personal Capability Assessment with the new Work Capability Assessment (WCA) the following year. The aims were to accentuate the positive by looking at what you can do, not what you can't do; to make the test for out-of-work sickness benefits more stringent; and to take into account new disability legislation, changes in the workplace and developments in occupational health.
To comply with the terms of the 2007 Act the DWP appointed Professor Malcolm Harrington,[5] an academic with a background in occupational health, to review the WCA system in 2010.[6] In November of that year he published an initial report that included 25 recommendations.[7][8][9] The second year of his review was to include refining the criteria relating to people with mental health problems and conditions that can fluctuate in severity from day to day[10][11] (in 2012, ministers decided to replace Professor Harrington;[12][13] his successor was Dr Paul Litchfield, a senior figure in the Royal College of Physicians' Faculty of Occupational Medicine).[14][15][16]
In early 2011, the Conservative-Liberal Democrat coalition government brought forward the planned expansion of the programme to assess once again the 2.5 million people whom the DWP had previously judged, before the introduction of the WCA, to be entitled to Incapacity Benefit.[17][18] At the same time the DWP revised the framework of the test, with the result that the eligibility criteria became even more stringent: the 03/11 version awarded no points when a claimant who had difficulty walking could overcome the disability by using a wheelchair, if reasonably practicable.
Official projections then envisaged many hundreds of thousands of claimants of Incapacity Benefit moving onto Jobseekers Allowance or into a training programme and then into work.[19] As a result, a saving of £3billion annually in the IB/ESA budget was anticipated by the middle of the parliament.[20][21]
The assessment process
When the New Labour government introduced the 'fit for work' test, it contracted out the core medical component to its existing partner for disability assessments: Atos Healthcare, which was already conducting assessments on people claiming a range of other disability benefits, including Disability Living Allowance and Industrial Injuries Disablement Benefit.[22] On 1 March 2015, Maximus assumed responsibility for carrying out these assessments.
The assessment process is ultimately a legal one that uses social security legislation as its main reference point (which is why appeals are made to lawyer-led tribunals overseen by the Ministry of Justice). In practice, however, entitlement to ESA is largely determined using a framework of medical criteria that draws on occupational health theory, broad clinical knowledge and the field of 'functional assessment' - a subspecialty concerned with gauging the practical impact of a physical or mental impairment on a person's daily life and, in the context of the WCA, on their ability to work.
The standard of proof used is 'the balance of probabilities': a claim should be accepted if it is more likely than not that the claimant does have a significant disability, where what is considered to be significant is reflected in the assessment's criteria, known as 'descriptors'.
DWP officials' first task is to establish whether or not the claimant has 'Limited Capability for Work' i.e. whether they are entitled to ESA at all; if they are, officials then try to decide whether the disabled person has 'Limited Capability for Work-Related Activity' i.e. whether they are able to participate in pre-employment training. If the person qualifies for ESA but is deemed not to have limited capability for work-related activity, they will be required to take part in mandatory training and will receive a lower rate of ESA than those who are deemed to have limited capability for work-related activity (but the ESA they do receive will nonetheless be paid at a higher level than if they were only receiving Jobseekers Allowance).
In practical terms, this starts with a healthcare professional approved by the DWP scrutinizing the claim form and deciding whether to seek further evidence from the claimant's GP or another appropriate source. If the evidence shows that a claimant probably has both limited capability for work and limited capability for work-related activity then a face-to-face assessment is not normally required, the claimant is placed in a category known as the 'Support Group' and the higher rate of ESA is usually granted. Otherwise, the healthcare professional arranges a face-to-face assessment - usually in an examination centre, but occasionally in the claimant's home.
At face-to-face assessments, the assessors, who are doctors, nurses or physiotherapists, use a semi-structured interview technique - designed in conjunction with the DWP - to try to gauge the impact of the disability on the person's daily life and to assess the person's fitness for work. General observations of the claimant's hearing, mobility and posture, etc. are made and there may be a short physical examination. The claimant's mental state will to a large degree become apparent as the interview progresses, but specific questions might be asked in order to elucidate any disordered thinking, abnormalities of perception or cognitive impairment.
During the face-to-face assessment, if it becomes clear that the claimant qualifies for the Support Group, the interview should be brought to an early close and the finding recorded on the claimant's file.
After the interview and examination a report is typed and sent electronically to the DWP - a report which attempts to illustrate the claimant's 'Typical Day' and to compare and contrast the disabilities described by the claimant against the criteria constituting the framework of the test (as well as considering other factors, such as whether there would be a substantial risk if the claimant were declared fit for work). This report normally concludes with a points score intended to reflect the level of disability, together with a final recommendation on fitness for work. If the assessment has been carried out in the claimant's home, the report is usually written by hand. If assessors encounter practical difficulties or are unsure how to apply the test's criteria in specific cases, telephone advice is available.
These assessments[23] have been criticised for their repetitive impersonal style, while the reports have been criticised for several aspects of their overall quality and for the accuracy of their recommendations.[24][25]
Upon receipt of the WCA report a civil servant makes the final decision, taking into account non-medical aspects of social security legislation and any other available medical evidence, e.g., a sick-note or another DWP report, for example one from a previous Disability Living Allowance assessment. As many as 20% of fit-for-work recommendations from assessing healthcare professionals are overruled by a DWP decision-maker.[26]
If the claimant disagrees with the decision, he or she is entitled to ask the DWP to formally reconsider, though the onus is on the claimant to initiate this. If the result of this formal review is unfavourable to the claimant, he or she can then appeal to an independent tribunal - consisting of a judge, a doctor and a layperson - operating under the auspices of the Ministry of Justice. At the reconsideration stage 20-25% of initial fit-for-work decisions are reversed and a further 15% are reversed by tribunals (or to look at it another way: historically, as many as 40% of appellants who have got as far as a tribunal have seen the DWP's decision overturned).[27][28]
Concerns over quality
Although the first disability assessments using the WCA format took place in 2008, the test only came to the attention of the general public after 2011 when the DWP began to reassess welfare recipients it had previously judged to be too ill to work. Although, technically-speaking, claimants were simply being evaluated for transfer onto a new benefit using more stringent eligibility criteria than before, the purpose of the process was not made clear to the claimants going through it - nor to the wider world, where it was often assumed that when an application for ESA from an established IB claimant was unsuccessful, it meant that there had never been anything really wrong with the claimant in the first place.[29] As a parliamentary report that was compiled at an early stage of the 'migration' of IB claimants onto ESA concluded: "It has caused controversy because some people previously considered disabled and entitled to invalidity benefits are now being found fit-for-work".[30]
The WCA was then loudly criticised: in the media,[31][32][33] in Parliament,[34] by the Church,[35] by the medical profession,[36] and by protest groups.[37][38][39] In 2012, Parliament's Office of Science and Technology analysed the WCA's performance and found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process"; in the same year, MPs first debated the WCA and Atos Healthcare.[40] Since then there has been considerable pressure applied by parliamentarians of all parties - but particularly by Michael Meacher,[41] Tom Greatrex [42][43] and Sheila Gilmore - for improvements to the 'fitness to work' assessment. Greatrex also wrote to the Prime Minister to bring to his attention allegations made by a former Atos assessor that the WCA was "skewed" against the claimant. Downing Street did not respond and passed the letter back to the DWP, which issued a non-specific statement;[44] Greatrex described the government's response to this whistleblowing as "unacceptable" and "woefully inadequate".
Controversially, patients with serious conditions such as brain damage,[45] terminal cancer, severe multiple sclerosis, and Parkinson's Disease have been found fit for work.[46] On 24 April 2013, a woman who was a double heart and lung transplant patient died in her hospital bed only days after she was told, after a Work Capability Assessment, that her allowance was being stopped and that she was fit for work.[47][48]
Criticism has been directed at the test over the ability of assessors to deal with complex mental health problems and conditions whose symptoms vary with time.[49] Atos Healthcare did train selected assessors to be 'mental function champions' who provided mainly telephone advice to other assessors on mental health issues as they related to the WCA's criteria[50] - a response to one of two key recommendations made by Professor Harrington. The other legacy of his tenure was the introduction in 2011 of the 'personalised summary statement'. This was intended to be a written explanation to the claimant in plain English of how the assessor's recommendation had been reached, but the DWP decided not to send them to claimants; instead, the department sent a 'decision-makers justification' written by a civil servant.[51] Nevertheless, the DWP insisted that assessors still write summaries, saying that decision-makers found them helpful when trying to understand the main reports. This summarisation, though time-consuming for Atos assessors, made little discernible impact on the level of criticism of the WCA.
At a meeting in June 2012 British Medical Association doctors voted that the Work Capability Assessment should be ended ‘with immediate effect and be replaced with a rigorous and safe system that does not cause unavoidable harm to some of the weakest and vulnerable in society’.[52]
In 2013 the Public Accounts Committee made up of MPs and chaired by Margaret Hodge heard that in 2011/12 Atos was paid £112.4 million to carry out 738,000 assessments. 38% of appeals to tribunals were successful and the Committee took the view that the WCA resulted in too many wrong decisions being overturned. Whilst Atos was paid to do the assessments, it is the government that pays for the tribunal appeals, with £500 million being the potential cost to the taxpayer for these appeals over ten years.[53] "The Department's got to get a grip of this contract." concluded Margaret Hodge, adding[54] "We saw no evidence that the Department was applying sufficient rigour or challenge to Atos given the vulnerability of many of its clients, the size of the contracts and its role as a near monopoly supplier. We are concerned that the profitability of the contract may be disproportionate to the limited risks which the contractor bears."[55]
Also in 2013, the UK Statistics Authority disproved a claim by the Conservative Party chairman that 878,300 benefit claimants dropped their claims rather than be assessed by Atos. Andrew Dilnot, chairman of UKSA, found that the figure appears to "conflate" new claims, where the claimant might simply have recovered, with established claimants coming up for reassessment.[56][57]
On 22 May 2013, a decision in a judicial review brought by two individuals with mental health problems ruled that the WCA process was not fair to people with cognitive impairments and other mental health issues, because the upper tier tribunal felt that these claimants were at a disadvantage when attempting to gather and present evidence to support their own claims.[58] The DWP disagreed.[59]
In the same month, a Freedom of Information request by Reading councillor and Chair of Reading Borough Council’s Access & Disabilities Working Group, Pete Ruhemann, revealed that: "28 of the 140 medical assessment centres, or 20 percent, do not provide wheelchair access," and, "[m]any, including the larger centres, are on the second or third floor". Furthermore, the "great majority do not have associated parking".[60] The councillor characterised this national situation as, "a disgrace".[60] It has been revealed that Atos has already made an out-of-court settlement with one user, "for disability discrimination […] over access."
Also in May, a doctor who had resigned from Atos after refusing to downgrade his rating of the disability of a mentally ill claimant blew the whistle on biases in the testing process to the BBC and said: "These assessments need to be done independently, impartially, considering all the evidence and with proper use of medical knowledge - and that's just not happening at the moment. Pressure is being put on healthcare professionals in many cases to come up with a particular outcome, really regardless of the facts of the case" and accused the DWP of "pulling strings behind the scenes" to boost the number of fit-for-work recommendations being made by the outsourcing firm. The subsequent news report drew particular attention to widespread and unduly harsh misinterpretations of the assessment's system for awarding points, on key abilities such as mobility and mental concentration, that the former assessor had claimed were being promulgated through the training programme[61][62] for new WCA assessors[63][64] – to which Atos replied that it was the DWP that was responsible for setting the curriculum for new assessors, not Atos.[65]
Atos "exits" the contract
On 22 July 2013, the barrage of criticism of the Work Capability Assessment appeared to be vindicated when the DWP announced that in June it had directed Atos to put in place a 'quality improvement plan' - as part of which, all WCA assessors would be obliged to undergo retraining - and said it would be bringing in new providers to carry out assessments, at this point supposedly in addition to Atos. The move ostensibly followed an audit of reports produced in the six months to April 2013 (when Atos furnished more than 300,000 recommendations on fitness for work) in which the DWP claimed that it had found 164 that were unsatisfactory - yet the DWP went on to suggest that these "unsatisfactory" reports had nonetheless come up with the correct recommendation on fitness to work! [66]
At the same time, the Coalition's attitude towards the WCA underwent a sea-change. PricewaterhouseCoopers were called in to audit 'quality issues'[67] and in the autumn reshuffle the Prime Minister ordered the incumbent of the ministerial post with responsibility for the WCA to return to the backbenches.[68] In December, in a statement to the Work and Pensions Committee, the new Disabilities Minister criticised the test and blamed the Labour government which introduced it, describing the assessment process as a "mess" that the Coalition had been obliged to pick up when it came to power.[69]
Meanwhile, Atos abruptly backtracked on a promising arrangement to carry out fitness-for-work assessments on the Isle of Man and began to secretly negotiate an early exit from its £500m WCA contract with the DWP in Great Britain (but not in Northern Ireland, where the contract with the devolved Department for Social Development remained intact).[70][71]
In February 2014 the French firm went public, citing death threats to its staff, criticism from Labour MPs and its own opinion that the WCA was "not working" as the reasons why it wanted to quit.[72] At the same time, the company removed the 'Atos Healthcare' branding from its occupational health division and rebadged it as 'OH Assist'.[73]
In March 2014, when responding to Dr Paul Litchfield's review of the WCA's performance for the DWP published the previous year,[74] the Disabilities Minister poured more scorn on the WCA process and once again blamed the previous Labour government. The minister said: "...the system we inherited from the previous administration was not fit for purpose. The process was riddled with problems..." and declared that as well as extending the testing process to the 2.5 million people already on Incapacity Benefit, ministers and officials had been trying to fix the problems since coming to power.[75] At the same time, the minister told Parliament that the contract with Atos was in the process of being brought to a premature close, with Atos paying a "substantial financial settlement" to the DWP as part of a mutual agreement to terminate the WCA contract early (but which was erroneously represented by some media organisations as Atos being 'sacked').[76][77]
The DWP nonetheless continued to employ Atos to carry out the bulk of its Personal Independence Payment assessments[78] (and the Veterans Agency voiced no concerns over the quality of the work of Atos doctors when assessing claims for War Pensions).
Over the summer, it emerged that there was a backlog of more than half a million ESA claims caused by longer assessments and a dearth of assessors - unintended consequences of the 'quality improvement plan' begun the previous year.[79]
Maximus wins the contract
At the end of October 2014, the DWP announced that the US firm Maximus would take over the WCA contract from Atos in March 2015, five months short of the planned termination date of the five year Atos contract.[80][81] Maximus would be paid £595m to carry out the work capability assessments over a three-year period. On signing the contract, Maximus said that it would improve evidence-gathering prior to a face-to-face assessment, introduce specialist assessors for particular types of disability and communicate more effectively with claimants.[82] However, concerns were expressed about whether this was truly the start of a new chapter when it emerged that the assessments would continue to take place in buildings that were often difficult for disabled people to access and that key former staff were transferring to the new provider.[83]
The president of the new outsourcer's health services division acknowledged that hundreds more healthcare professionals would have to be recruited in order to clear the backlog of 500,000-600,000 ESA claims and boost capacity in the future.[84]
Economic effectiveness
A government study, obtained through a Freedom of Information Act request in 2012, found that one-half of the people in the study who had been declared "fit for work" after a WCA remained unemployed and without income.[85]
More recently, the National Institute of Economic and Social Research analysed the effectiveness of the WCA process in reducing the IB/ESA claimant count.[86] It found that the broad downward trend since 2004 in the number of people claiming out-of-work sickness benefits continued - at a faster pace - from 2011, only for the trend to abruptly reverse in the second half of 2013.[87]
In October 2014, the government's fiscal watchdog found that between 2010 and 2014 no savings at all had been made from the IB/ESA budget, which remained at more than £13billion a year.[88] Six months later, the Office for Budget Responsibility raised its forecast for spending on IB/ESA by a further one billion pounds a year, mainly because more claimants than before were being placed in the Support Group.[89]
Jonathan Portes, formerly a senior economic adviser to the DWP and later the Chief Economist at the Cabinet Office, has described the post-2010 incapacity benefits reforms as "the biggest single social policy failure of the last fifteen years".[87]
But after the General Election in May 2015, a spokesperson for the new Conservative government said welfare reform was about creating "a complete shift in welfare culture" and pointed to the large number of jobless people who had found work during the economic recovery that began in 2013[90]- as part of which, the number of people claiming Jobseekers Allowance (JSA) fell back dramatically to pre-recession levels[91]and a consequent saving of up to one billion pounds a year was anticipated in JSA costs[92] (although the hundreds of thousands of jobless claimants on the WCA waiting list were not included in the JSA claimant count).
Credibility
In 2011, between January and November, the DWP's own figures show that 10,600 sick and disabled people died within six weeks of their benefit claim ending;[93] it is widely believed that these deaths occurred after - and even because - the claimants were declared fit for work. The Daily Telegraph has questioned this: it posits that the 10,600 deaths include some people who happened to die from natural causes, after which their benefit payments ceased.[94] Nevertheless, there have been numerous media reports of unexpected deaths after assessments where the claimant seems to have been at risk: a vulnerable man who starved to death;[95] a woman with a weakened immune system dying days after the DWP denied her appeal;[96] a paranoid man jumping from a bridge;[97] and a man with brain damage from a previous suicide attempt killing himself after being found fit for work.[98] In response to a campaign using the Freedom of Information Act, the Information Commissioner has ordered the DWP to disclose the number of people that have died within a year of a WCA since May 2010;[99] the DWP has sought to withhold this information, arguing variously that it was too time-consuming, the department was about to publish it anyway or it would not be in the public interest because the data might be misinterpreted.
In 2012, The Independent reported that 43 complaints against Atos doctors and nurses were being investigated by the General Medical Council or the Nursing and Midwifery Council[100] but Atos has countered that the number of formal complaints is small in comparison to the total number of assessments.
In 2013 government figures were cited in Parliament to show that in the first year of the Incapacity Benefit reassessment programme, 1300 claimants put into the 'Work Related Activity Group' which prepares claimants for work died within six weeks;[101] there are perennial questions about the wisdom of trying to rehabilitate people who suffer from diseases that are only going to get worse, to which the DWP has never been able to give a satisfactory answer.[102][103]
In 2014, a campaigning MP asked the UK Statistics Authority to analyse the high overturn rate of fit-for-work decisions by independent tribunals, as well as by the DWP itself at the pre-tribunal 'Reconsideration' stage.[104] The DWP has suggested that this high overturn rate demonstrates the effectiveness of the system's checks and balances; critics say that it demonstrates the unreliability of the core assessment. When giving its reasons for exiting the contract to carry out the core assessment, Atos said: "In its current form, the WCA is not working for claimants, for DWP or for Atos Healthcare"[105] but at the end of 2014 the medical reviewer of the WCA for parliament declared that "we have taken the WCA about as far as it can sensibly go in terms of modification and adjustment" and warned that "there is no better replacement that can be pulled off the shelf".[106]
In 2015, the Prime Minister asked a former president of the Royal College of Physicians to consider whether the WCA could be used to identify claimants with conditions deemed potentially remediable and then require them to undergo compulsory treatment or lose their entitlement to social security benefits.[107][108] The Conservative MP Sarah Wollaston - a former GP and the chair of Parliament's select committee on health - described the plan as "unworkable" and "illegal".[109] It soon emerged that such ideas had been considered and rejected before[110][111][112] and the proposal was quietly shelved.[113]
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