Independent reviewer of WCA said it was not fit for roll-out

When the Coalition government rolled ESA out nation-wide we were assured that ESA was fit for purpose, and that the independent reviewer (then Professor Harrington) had confirmed this. What we were told, by the then Employment Minister Mr Grayling, was that Professor Harrington had said, “I believe the system is in sufficient shape for you to proceed with incapacity benefit reassessment.”

But Sue Marsh, disability rights campaigner, was not convinced by this. In her own words, “Harrington was clearly an intelligent man who had made thoughtful and intelligent suggestions for improving the assessments. I could never understand why he agreed to put the most vulnerable claimants through a failing test.

So she decided to ask him.

And this is the response she got:

“To your question:

I NEVER—repeat–NEVER agreed to the IB migration. I would have preferred that it be delayed but by the time I said that, the political die had been cast.

I then said that I would review progress of that during my reviews.

The decision was political.

I could not influence it.

IS THAT CRYSTAL CLEAR?

Malcolm.”

As Sue said, I’d say that’s very clear. Professor Harrington did not agree to the roll-out of ESA to Incapacity Benefit claimants.

Just last week a report revealed that Atos assessors do, in practice, face targets to keep the percentage of claimants awarded ESA low. A judge ruled that the WCA discriminates against people with mental health conditions. Another judge ruled that a physiotherapist has no expertise to comment on the abilities of a person with mental health conditions. A study on the descriptors used for ESA found that alternative descriptors (albeit based on the flawed WCA model) resulted in more information being gathered, higher satisfaction from both the HCP and the claimant, and more claimants being found to have limited capability for work. The People’s Review of the Work Capability Assessment reports multiple evidence that ESA does not work, as does a related report, also by the Spartacus Network, on the failings of ESA.

ESA now faces massive backlogs for both the original assessment and then for appeal. Appeal success rates are rising, and currently stand at 42%. Just 25% of those told they are fit for work are in work 12-18 months later.

In the face of all this evidence, can the government really say that the Work Capability Assessment is working?

Meeting with Mr Hoban

From Sue Marsh, Stef Benstead and Sam Barnett-Cormack

So, yesterday, as most of you will know by now, representatives from Spartacus finally got to meet with Mark Hoban to discuss Employment and Support Allowance and Work Capability Assessments after almost a year of trying.

Other online groups representing sick and disabled people had felt very strongly before the meeting that it should be made explicitly clear that WCAs should be scrapped. They are unfit for purpose and no amount of tinkering with descriptors or processes will change that.

We agreed, but felt that for that approach to be credible, there had to be alternative suggestions in place. Happily, in just 24 hours, all of the online groups representing sick and disabled people were able to agree to this solution in time, meaning that we could go into the meeting with the whole weight of the online campaigning community behind us.

We agreed that we would raise the issues people had agreed in extensive consultations on my blog to be the most important and “listen” to what the minister said on these issues, suggesting things that could at least make the process safer in the meantime until we were able to put together an alternative proposal.

With this in mind, here is a summary of the issues we raised and Mr Hoban’s responses. We feel that the meeting was remarkably productive in this sense.

“Before any further discussions took place, Sam explained that there was widespread support for abolishing WCAs. The system causes stress, fear and anxiety, it is not trusted and we doubt that any amount of “reform” would now be able to change that.

Sue opened the meeting by saying that we hoped we could break down the oppositional, partisan and confrontational stance that has often blighted discussions over ESA. She asked for genuine engagement. She pointed out that we had only ever tried to present helpful, evidence based research, aimed at showing how WCAs affect real people. She suggested that we all had experts and networks that could be valuable in re-designing a new system.

Mr Hoban appeared to listen carefully. He and three civil servants all took notes during the meeting. They did seem to genuinely want to discuss issues openly with us. We’re delighted to say that the meeting had none of the frustrating stonewalling or fudging of some parliamentary debates.

45 minutes passed in the blink of an eye and sadly, though we did ask the questions, there was no time to pin down answers on where things stand on mental health assessments/champions and the decision to divide physical and cognitive conditions when it comes to scoring points during an assessment. However, the Chief Medical Officer gave us his card at the end of the meeting and we agreed to chase up or define any issues that we weren’t clear on, so this will be an opportunity to clarify.

Mr Hoban appeared to particularly agree on gathering medical evidence earlier in ALL claims. Civil servants confirmed that an ESA113 was only sent to GPs in limited circumstances. Mr Hoban agreed that medical evidence was crucial at the earliest stage andaccepted that sending an ESA113 in ALL cases as soon as the claim is received might be a solutionThey accepted that GPs don’t always return this evidence and agreed to do more to make sure that they do. 

Sue suggested that explaining and suggesting the use of “Reliably Repeatedly and Safely” on the ESA50 form more often would be very helpful and Mr Hoban appeared to agree that this would be a helpful change. He particularly agreed that there is a need for more guidance to help people complete their forms in a way that would ensure they give the information needed to make decisions. He told a story of one of his own constituents who had filled in the form particularly badly. He said he thought he could have done a better job himself after just 5 minutes with the constituent and that it was clear much more guidance could be included to help with the process. They committed to looking again at what could be done with some urgency. 

We asked about universal audio recording of assessments and urged that this was the only way to truly know that assessments had been conducted fairly and accurately. Mr Hoban was not entirely convinced that this was the case and cited examples of HMRC losing audio files, which had created even more suspicion. He didn’t rule it out however, and did say that letters would be amended to say that the option was available to all claimants.

We asked about the Evidence Based Review (EBR) and trials of new descriptors for Mental Health and Fluctuating conditions. It was clear from the civil servants that this was taking longer than they had originally envisioned. It had proved harder than anticipated to develop robust descriptors that claimants could
be compared against and which could be tested; some of the original submissions had been too vague to be of practical use. They did agree that so far it is clear that lessons can be learned from this alternative assessment. Sue asked what would happen if the new descriptors were more generous to claimants and would cost more to implement. Would they say it was just too expensive or would the Treasury veto any changes? Mr Hoban confirmed that they would do what was right. There was no financial limit on how generous a new set of descriptors might be and these will be based on evidence not cost. He cited examples of more people going into the Support Group and how that had cost over a billion pounds extra in the first year, but that it had been accepted financially. 

Mr Hoban was particularly concerned by how long it was taking to assess people. He said that he was concerned about what is right even when improvements are difficult to implement and is keen to learn what works and doesn’t work so that the process can be improved. He wants to see a test that is robust, is the right test and has credibility. If changes are identified that would improve the system, then the DWP accepts that. He said that the EBR is a good example of that, as it has proved harder to run than originally anticipated but the DWP will use the evidence from the EBR to improve ESA. There are no financial limits from the Treasury, and no consideration of cost will be used to decide which descriptors are the best to use.

Sue mentioned concern about targets. Mr Hoban said DWP set no targets. He said they are only concerned about quality. If an assessor was an outlier (ie putting more claimants into the Support Group or WRAG than colleagues) then it is not that the assessor is an “outlier” that matters but that a need to check his or her assessments are right was all that mattered; if the assessments were correct then it doesn’t matter that the assessor was an outlier. Mr Hoban was very clear that targets are the wrong thing, and that they have no place in a credible system. We suggested that Atos are using “norms” either way, even if not part of DWP guidance and it might be worth re-iterating with Atos that this shouldn’t be the case. 

Sam mentioned concern that assessors are saying they are told to presume zero points and award points grudgingly. We want to see an inquisitorial approach, not adversarial. Sue said that the balance of comments from claimants is that the HCPs are trying to trip people up. but maybe all that is needed is to remind Atos that their role is not to be denying people points or benefits.

Mr Hoban agreed with this and said that this is what DWP guidance to HCPs recommends; the HCPs are to gather the evidence as it is. Sue pointed out that whilst this is indeed the written DWP guidance, anecdotal evidence from HCPs suggests that this is not the case during in-house training. Again, taking this issue up with Atos may be helpful. Mr Hoban appeared to agree to this. Mr Hoban mentioned that WCA is just one part of the information that decision makers use; this is why Decision Makers do increasingly disagree with HCPs based on other evidence although we don’t know what the ‘right’ number would be given that high levels of disagreement would also be concerning. 
Sue said how pleased we were to discover that such a high proportion of claims were successful based on paper assessments alone, with no need for a stressful and costly WCA. She suggested this should be even more widespread and almost certainly could be if more GPs returned evidence in time. Mr Hoban appeared to agree that this was the best way of conducting assessments where possible. 
On Mandatory Reconsideration, leaving people without income we pushed very hard, coming back at Mr Hoban several times to try to get some kind of compromise. We argued that it isn’t consistent to give claimants 4 weeks to get evidence in when the DWP has as long as they want for reconsideration. Mr Hoban indicated some agreement and agreed to review this 6 months He said they need to see how it works in practice. We argued that in the meantime people are going without money, and would it not be better to give them this money during those first 6 months, and then review it. However Mr Hoban felt that as it was appropriate for these people to sign on for JSA, then there is no poverty issue. Sue pointed out that many would not be able to do that – herself included as her husband works. They would simply lose nearly £500 a month while they waited indefinitely.
Stef pointed out concerns over the appropriateness of Jobcentre Plus conditionality agreements, and the concerns over the high percentage of successful appeals that were not borderline but instead had been severely under-awarded points initially when they should have very easily got over the 15 points mark. Sue pointed out that a very high % (16%) of Fit for Work decisions are inaccurate and that few disagreed that the system is flawed as it stands.
Unfortunately, Mr Hoban still insisted that these people had been found fit for work and it was reasonable to expect them to make other arrangements, time was running out and we had to leave the issue.
We devoted the final part of the meeting to arguing very robustly that Mr Hoban consider an alternative to WCAs that would be developed by all online groups in unity. We requested a follow-up meeting to present this alternative to ESA/WCA designed by the online disabled community. Mr Hoban agreed that he is very willing to listen to constructive and fully-worked out proposals. He was concerned that given the difficulties that large charities experienced in designing workable descriptors, that we need to be aware of the challenge we have set ourselves. He did however say that if someone has an alterative that works, that is fully worked out and includes an indication of why it would be effective, then that alternative should be presented. Michael Meacher pushed him on a follow up meeting. Mr Hoban concluded that if an alternative could be put together, they are always willing – including this meeting – to listen to ideas that are constructive.”
 
So, we did our very best for you all. We felt quite pleased that the meeting had been so constructive and we had managed to cover so much in the short time available. If nothing else, some of the clarifications make it easier to know where things stand and what changes the government are considering in the short term to make the system safer and fairer.
Everyone now has the chance to design a better system that is robust and which works and the knowledge that the minister will at least consider our approach.

If you could say just one thing to Mark Hoban…..

By Sue Marsh

Finally, after months of petitioning by Michael Meacher and myself, after a debate in parliament specifically on meeting “Spartacus”, next week (10th September) myself and two other “Spartacii” who have been heavily involved in all ESA research will be meeting with the DWP Minister Mark Hoban.

We have 45 minutes – a generous time slot in parliamentary terms, but the merest blink of an eye with so much to put right.

Before I go any further, and indeed before I discuss anything with Mr Hoban, I want to make it perfectly clear that I believe WCAs and indeed the entire ESA system is flawed and should be scrapped. This has always been my position and it remains my position today.

For all of this week, DPAC are running a week of direct action, “Reclaiming our Futures” http://t.co/6OzxELYePK I would strongly urge you all to take part if at all possible. This is the way we will ultimately achieve real change.

However, I have a chance to explain to the minister how some of the worst elements of ESA and WCAs affect us and to petition for them to be changed. I will make my position on abolishing WCAs clear, but it would be naive to believe that we will come away from a 45 minute meeting having achieved that ultimate goal.

I DO believe however, that some elements of WCAs are intolerable and I already have an idea from previous consultations with you all what those things might be. However, before next week, I wanted to give you all one last chance to feed into this important opportunity.

If you were there with us and could say just one thing to Mr Hoban, change just one thing that might make the WCA process less harmful, what would it be? While DPAC, Black Triangle and other groups continue their excellent work to scrap the tests, what might make the process safer and less destructive in the meantime? 

I’m a pragmatist. If we can achieve any change for the better, I believe it is worthwhile. If we can save just one person from taking their own life, or falling into starvation or despair, I believe it is worth trying. If we achieve nothing at all, we will be able to say that we tried. And tried. And tried. That we engaged with democracy whenever the chance arose and did all we could to make ESA safer.

I really hope that as many of you as possible leave comments here and share this post on Twitter, Facebook or other networks you use. If I go alone, I am one voice. If it is just the three of us attending, we whisper. If you all come with us, we shout and have the credibility to demand real change. 

A Very Courageous Man

Letter by Malcolm Mort, member of RNIB and Hardest Hit.

written for the Hardest Hit

    Through media sources the other day I discovered that Dr Greg Wood had resigned from his job as a fitness-to-work assessor with ATOS in May of this year after nearly three years in their employment. Matters came to a head when on an increasing number of occasions he had been asked to change his reports on claimants making it unlikely that they would qualify for sickness benefit. This he was not prepared to tolerate because as a doctor he considered the welfare of patients to be more important. He considered the actions of ATOS pressuring doctors to change their reports from the true conditions of health to be unethical.
     For a considerable time, he had decided to leave as he felt the company were unethical to pressure a doctor to change his conclusions of an assessment. Concerns about ATOS and their system has been criticised by charities and claimants for years.
    Dr Wood being the first to blow the whistle on ATOS gave evidence to the BBC suggested the methods used to assess whether claimants were eligible for the new incapacity benefit- employment  support allowance (ESA)-were “unfair” and skewed against the claimant.
Dr Wood joined ATOS in 2010 after serving 16 years as a Royal Navy doctor. Iain Duncan Smith has
been criticised for ignoring the warnings of Dr Wood concerning his experiences while working for ATOS. Over the years ATOS has faced fierce criticism from disability campaigners for the work capability assessments (WCAs) it carries out on behalf of the Department for work and Pensions (DWP).
    The response from I D Smith on this matter is considered woefully inadequate. On one hand Duncan Smith says he wants to improve the ATOS situation but then ignores the specific allegations made to him by the doctor who was working for ATOS. It is just like all the protests which have been ignored from charities and disabled people by this incompetent ignorant Con-Dem Coalition Government who have no understanding of disability or care. This leaves me asking why the Liberal
Democrats supported the Conservatives to pass the legislation allowing the persecution and exploitation of disabled people. My common sense tells me that ATOS and some of this new Benefits
and Welfare Legislation is unfit for purpose.
    In conclusion I have just received this information from Disability Rights Wales: ATOS to lose monopoly after ‘flawed and unacceptable’ disability benefits assessments following months of complaints about allegedly unfair slapdash decisions made by ATOS, the Department of Work and Pensions audited around 400 of the campany’s written reports concerning disability claimants, grading them A to C.  Of these, 41% were graded as C, meaning they were unacceptable and did not reach the required standard. For further information, please visit, http://www.disabilitywales.org/1168/4646. This should encourage rejected benefit claimants to challenge all DWP benefit rejections!
    There are also problems with ATOS not having sufficient examination facilities to meet their  promised obligations prior to being awarded their latest DWP Benefits contract.
Yours faithfully,
Malcolm H. Mort
Hardest Hit and RNIB Cymru Member.

ESA, WCA and the Telegraph

Hardest Hit was pleased to see Isabel Hardman’s piece in the Telegraph on ESA. Ms Hardman wrote to explain that, “Disability testing isn’t working as it should – and Conservatives must have the courage to admit it.” This is an encouraging stance from a right-leaning newspaper and could become the start of increased accuracy in the debate around welfare.

When one knows most of the facts around an issue, it is easy to pick out the misleading from the less misleading newspaper articles. Newspapers don’t routinely cite the sources of their data, which can make fact-checking difficult. If one already knows the facts, this stage is automatically much easier. Knowing ESA as I do, it is refreshing to read an article that is not misleading in either direction.

The Work Capability Assessment for ESA has come under a lot of criticism. As we know, and Ms Hardman points out, 42% of appeals against ESA are successful.[1] Other information exists supporting the claim that the ESA assessment process is inaccurate. The Citizen’s Advice Bureau has reported high levels of inaccuracy in reports made by Atos assessors.[2] Tribunals report that most appeals are overturned due to new oral evidence presented to the tribunal – that is, evidence that would have been available to the Atos assessor had he or she asked the right question(s).[3] The independent Review, headed by Professor Harrington, has said that Decision Makers’ decisions vary in quality and consistency.[4]

The National Audit Office said that there are “serious questions about the quality of the overall decision-making process.”[5] A court judgement on Wednesday ruled that the current system is unreasonable to people with mental health conditions.

There are many reasons to believe that the ESA assessment process does not work; these are just some of the outcome data that suggest flaws in the decision-making process. As Ms Hardman says, the method of assessment is also unreliable. “It fails to assess, beyond someone’s ability to move a cardboard box in the test room, whether they are capable of doing a real job. The activities in the test are removed from workplace realities. … There are some simple changes that could improve the test, although they are unlikely to remedy the inherent flaw: the fact that it doesn’t realistically assess a person’s ability to do a day-to-day job.” Unfortunately, a real-world test – realistically assessing a person’s ability to do a day-to-day job – was the one thing that then Minister for Employment Chris Grayling was “absolutely unreservedly and implacably opposed to.”[6] Incorporating a real-world test has since been rejected on the grounds that there is a lack of “clear, evidence based advice” for what such a test might look like.[7] This “inherent flaw,” which most disabled organisations agree to be a flaw, appears set to remain.

Despite this, there are possibilities for improvement to the ESA assessment process. There could be more time for both the claimant and Atos to request and receive medical evidence; the questions asked of the claimant could be more relevant to the ability to work; the claimant could be provided with more space and time to fully explain the impact their condition(s) has. Other small, or less small, improvements could be made without first radically over-hauling ESA to include a real-world test.

There doesn’t have to be a public collapse of faith in these tests. Although Hardest Hit amongst others may feel that the collapse of faith should already have occurred, the fact that it hasn’t means there is still time for the Coalition government to get ESA right. It is vitally important: it is not just that this “distresses people who deserve better,” but that it drives into poverty and worsened health people who deserve full support. A catastrophe in the welfare reform may well “be enough to prevent any government looking at welfare reform for another generation,” so the Coalition must get this right.

There is potential for great harm, but there is also potential for great good. It is for us to ensure that everyone knows both what is wrong and what can be done right, to ensure justice for all the sick and disabled of this country.


[2] Right First Time, 2012, Citizen’s Advice Bureau

[3] Social Security and Child Support Tribunal hearings: Early analysis of appeals allowed from pilot data, Nov 2012, DWP

[4] Professor Harrington, An Independent Review of the Work Capability Assessment – year two, Nov 2011

[5] 23rd Report; Contract management of contract services, Feb 2013, National Audit Office

[6] Work and Pensions Committee hears from Chris Grayling on migration to employment and support allowance, June 2011

[7] Professor Harrington, An Independent Review of the Work Capability Assessment – year two, Nov 2011