The Government have just closed a consultation on Work Capability Assessments. WCAs have affected a significant number of my constituents, many of whom have found the experience difficult, stressful and that it has made their situations and their disability harder to manage.
After consulting with many of them I have submitted a response to the Secretary of State for Work and Pensions, Damian Green. You can read the full response below.
Dear Secretary of State,
I am writing in response to the Government’s Work, Health and Disability Green Paper – and would like this submission to be considered as part of the formal consultation.
I think everyone can agree that if people can work, they should—that is not a contentious statement—and that work is beneficial for many people suffering from illness, be it physical or mental. However, while I also understand that the Government had hoped that less than 10% of those claiming Employment and Support Allowance (ESA) would go into the Support Group, a figure which is in reality much closer to 50%, I do not consider that it is acceptable to demand of individuals more than their disability allows, purely to be seen to be lowering this figure.
Further, while I appreciate the laudable intention to ensure that individuals receive a personalised employment and health support service, I am concerned that the current assessment process is far from an adequate basis on which it is possible to provide tailored support.
I have heard from constituents who have shared with me their experiences that their completed assessment report bears absolutely no relation to the assessment that they experienced with Maximus or Atos. The latest available DWP data shows that 57% of appeals against initial ESA fit for work decisions found in favour of the claimant in September 2016 – a rise from 41% in 2008. I have heard from constituents of their being made to feel like liars at assessment interviews and of being disbelieved on every score and subsequently awarded 0 points. One constituent, who had requested a copy of her report, commented to me: “My integrity was questioned in this report too, which I really object to”.
Evidence of Mr X: - a gentleman with learning difficulties whose case was highlighted to me attended his Work Capability Assessment, but during the assessment his support worker was shocked at the lack of care and attention given to him. When the assessment came through, there were some glaring factual errors, but nonetheless his ESA was stopped.
I have been similarly concerned about the lack of sufficient knowledge of progressive conditions such as muscular dystrophy, fluctuating conditions such as Parkinson’s and the lack of sufficient awareness and training in areas such as learning disabilities. It is my experience that contractors have a huge gap in their understanding, particularly of mental health issues. Having heard from many constituents who have explained to me that the assessor they saw knew nothing of their condition, particularly how it impacted on their everyday life, I am deeply concerned about the scope of such assessments to provide an accurate picture of what personalised support an individual might benefit from. This consideration of fluctuating conditions is particularly important given the seeming attitude of assessors not to take into account evidence provided from health and social care professionals – particularly the individual’s GP.
Therefore, although I understand that the Government has recognised in the Green Paper that stakeholders have repeatedly highlighted concernsabout the effectiveness of the Work Capability Assessment, it is not sufficient to focus on what happens post-interview. Whether the assessment for financial support and employment support are separate, for example, relies wholly on there being accurate assessments on which to make such decisions.
Reforming the assessment process
It is clear that the assessment process is in desperate need of reform, and this Green Paper is timely. I understand that the average cost of each individual assessment is now almost £200, for a 15-minute assessment. Further, individuals have to wait for almost half a year for a decision to be made on their benefits and there is no deadline for those decisions, or indeed for appears to be heard. There has been a huge rise in that timescale—almost a trebling—in recent years. For each person, that can and almost always does mean hardship. It is felt by many that the Government are forcing away from ESA people who need and rely on it, and the failing contractors are being overwhelmed. Indeed, the Office for Budget Responsibility has identified ESA and PIP as a major risk to planned public spending targets, given the uncertainty of the estimates. The NAO has gone so far as to say that PIP and disability living allowance performance issues have been the main contributing factor in the Department’s inability to save any money in the spending review period up to 2015.
As in the case of Mr X, there seems to be an alarming trend of cases being rejected based on factual errors or even falsification. A constituent reported to me that their “report was very unprofessional, very badly written the English was appalling and it was incomprehensible at times. Secondly the report is inaccurate, deliberately falsified, key points twisted and others omitted. I feel that this is done deliberately so as not to gain points despite me meeting the descriptors”.
I have personally seen blatant examples of where a report has no match whatsoever of the claimant’s recollection of the interview. One or two cases could be dismissed as an honest mistake, but the situation appears to reveal a disconcerting pattern of behaviour that indicates that the trade-off between cost cutting and profit maximisation is being felt by very vulnerable people.
Response to specific questions of the consultation:
6.2 - How can we ensure that each claimant is matched to a personal and tailored employment related support offer?
As above, in order to ensure that any support offer meets the individual’s needs, and accepts their limitations, in the very first place assessments must be accurate, carried out by trained medical professionals and take the individual’s medical history and advice from other medical professionals into account. Constituents have repeatedly raised particular concerns with me about the role of nurse assessors in conducting the assessments – and of their own experience in a nurse failing what they believe to be their duty of care. One constituent has expressed concern that when their sister relayed her conditions and answered questions asked by the nurse assessor, the nurse should have the ability to link these conditions and understand the clinical impact – thus potentially limiting the need to probe further with, often embarrassing, questions. Further, I was extremely concerned to hear that when her sister was asked to read a sentence to measure her reading score, the nurse laughed at her when she made mistakes. Further, I understand, from the experiences of my constituents, that they have had particular difficulties with assessors who do not understand their mental health and the impact it has upon their lives – although individuals with a mental health condition make up some 50% of ESA claimants in the Support Group.
Evidence of Mr G – a constituent suffering panic attacks, agoraphobia, epilepsy, stress and with serious mobility issues, required to attend a WCA and placed in the Work-Related Activity Group.
Difficulties with assessments is not only an issue for those with fluctuating conditions, as detailed above, but appears also to have a very real and negative impact on those with conditions which are never likely to change. Although I understand the Government’s stated intention to have contact with individuals who had perhaps considered themselves unable to work ever – there must be safeguards and systems in place to ensure that this kind of interference does not extend to those for whom it would be wholly inappropriate.
Evidence of Mr H – Contacted by the mother of Mr H, she explained to me that her son has Down’s Syndrome, autism and developmental delay. He was awarded Employment and Support Allowance some three years ago but received forms that he was to be reassessed. Mr H’s mother clearly finds this process extremely stressful, and feels that the time spent filling in forms would be better spent in providing the near-constant care that her son requires. Mrs H has questioned why individuals with conditions like her son’s, which clearly do not fluctuate and will not improve, have to go through the process again and again.
Both Mrs H and myself understand that the condition can of course affect individuals differently, but once an assessment has been made I share her position that claimants should not be persistently contacted – or contacted at all – with a clear responsibility on them that if their situation should change then they must make the DWP aware.
In addition to accurate assessments at centres, there is surely a requirement also for genuine access to at-home appointments, and clearer guidance for individuals who require such.
Evidence of Mr R - Mr R explained to me that he suffers from Myalgic Encephalomyelitis (M.E), functional disorder, disassociate disorder and anxiety. Mr R was required to attend an assessment centre, though he requested a home visit on his assessment form. I am advised that his M.E leaves him exhausted and confused and that his anxiety leads to dissociative episodes – both of which were exacerbated by the trip to the assessment centre.
Furthermore, it should be the case and made clear to claimants that if they wish to submit a Mandatory Reconsideration of a decision that they have been found as Fit For Work they are entitled to claim Jobseeker’s Allowance while the MR is being considered. There must be no lengthy transition period in which an individual is receiving no monies and likely to suffer extreme financial hardship. Further, advisors handling Jobseeker’s Allowance claims should be lenient, if a MR is pending, about the commitments expected of a claimant – and not sanction those who may be too poorly to meet the usual Claimant Commitments of JSA. It is clear that there needs to be a fixed deadline in which an MR is considered.
Evidence of Mr X – Gentleman with learning difficulties. On making his request for Mandatory reconsideration, he was appalled to find out that he would be ineligible for ESA, which was his lifeline, until the reconsideration decision was made, and due to his illness he was in all conscience unable to meet the conditions placed on him for jobseeker’s Allowance. He advised me that he now faces months of waiting until his Tribunal, and that he has concerns about a potentially annual battle if assessors continue to lack understanding of his learning difficulty.
6.3 – What other alternatives could we explore to improve the system for assessing financial support?
The levels of financial support available under any future ESA package should be sufficient for people to live on and manage their disability. Further, any changes to the levels of financial support available under alternative benefits should clearly be protected, as was the case for claimants transitioning from Income Support to Employment and Support Allowance.
As with assessments themselves, assessments for financial support could draw on existing information that has been gathered by other agencies than the DWP – including the social care system, the NHS, mental health services and other benefit applications – such as PIP. Such sharing of information however must take into account the age of information and have a clear system in place in which a claimant is aware that this sharing of data will take place and have an opportunity to provide further evidence and information.
Furthermore, recognising that disabled people are more than twice as likely to be unemployed as non-disabled people, financial support must consider the impact that an individual’s health condition has upon them and be seen as a means of enabling and empowering that individual to lead a fulfilling life – which may include work if that is appropriate and possible for the claimant concerned.
Finally, I am concerned that any assessment of disability should always be taken as a holistic approach, taking into account not only the financial support an individual requires to meet their disability needs but also mindful of their ability – or inability as the case may be – to attend the Jobcentre or return to work. It should never be solely about the money an individual receives and I am aware that other stakeholders have expressed their concerns that Jobcentre staff should not be given the ability to sanction individuals currently in the Support Group.
7.1 How might we share evidence between assessments, including between Employment Support Allowance/UC/PIP to help DWP benefit decision makers and reduce burdens on claimants? What benefits and challenges would this bring?
Constituents have frequently raised concerns that evidence provided to the DWP by other healthcare professionals including specialist consultants and their own GPs who they have known for a considerable period, is often discounted by the current assessment process. I understand that claimants often provide extensive amounts of information, detailing their current health, the medication they are taking, tests they are waiting for etc. but am told that these are frequently not taken into consideration.
Further, one of the challenges felt to be most avoidable by the individuals who have shared their experiences with me is the frequent requirement to repeatedly provide the same information to the same department – DWP – on a regular basis, usually due to one assessment being for ESA and another for Personal Independence Payments (PIP). It would seem logical therefore that there could be a greater sharing of information across Government departments and with related services including the NHS, mental health services and social care of, at the very least, basic information. I received contact from one individual who had been called to a Work Capability Assessment while serving a short prison sentence.
It must be clear to claimants what their responsibilities are in updating information and to whom. It would be unfortunate if assessments were made on outdated information, leading to unnecessary appeals and stress on the individual concerned. There would need to be a clear outline from the DWP as to what information was being concerned for any assessment, and an opportunity for individuals to make additions and to provide further evidence – not only to ensure that their condition is fully understood but also to avoid any possible overpayment burden.
Clarification is required of the intention to share evidence between assessments, does this mean that the DWP intend to make reviews between assessments without prior notification to the claimant? And, if so, will there be an opportunity for the individual concerned to make further submissions, or to correct information, before any decision is made in their case? Further, what consideration has been given to the impact on outside agencies, many of whom report to be over-stretched, to update records and share information with the DWP?
Finally, helping people to get into work is a necessary objective of any Government, but some things are not compatible with helping people with physical illness, disabilities or mental health problems to get into appropriate work. I am of course referring to targets, profit-driven motives and a focus above all on cutting expenditure. When one side is trying to cut costs and another is employed to maximise profit, something has to give, and unforgivably that has been the sick, the disabled and anyone who comes into contact with this failing and occasionally brutal system. This is about providing not just a good-quality service for clients, but best value for money for the taxpayer.
Any separation of the financial support element and a ‘work coach’ focused on assisting an individual into work must not work against one another. I accept that in principal separating the element of financial support and that which is required for an individual to prepare for work may be beneficial to claimants and could have the potential to reduce stress on the individual concerned, thereby making them more likely to feel fit for some type of work in future. I would strongly object however to any system of arbitrary sanctioning, the likes of which we have seen with Jobseekers Allowance, which might punish an individual for an inability to engage with work-related support. Further, while I acknowledge that the one-size-fits-all model does not have the flexibility to consider the nuances of individual’s conditions, there must be clear guidelines and structures in place which prevent a situation in which the outcome of any assessment is down to the personal judgement of an individual assessor or work coach.
Finally, in order for there to be tailored, personalised support available to individuals – we need to retain our Jobcentre Plus offices within their communities – and not, as the proposals for Eastern Avenue in Sheffield, close them without even conducting an impact assessment.
Louise Haigh MP