Work Capability Assessment

The Work Capability Assessment (WCA) is the test designed and used by the Department of Work and Pensions (DWP) in the United Kingdom to determine whether disabled welfare claimants are entitled to Employment and Support Allowance. Atos Healthcare, part of the multinational company Atos, conducted the assessments until 1 March 2015 when the American firm Maximus - trading as the Centre for Health and Disability Assessments - took over. The test has been criticised for the high proportion of those tested being found 'fit for work'.

History of the WCA

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 and the Department of Social Security began commissioning its own medical assessments using a procedure called a Personal Capability Assessment (PCA). It was noted that clinical assessments do not necessarily reflect functional capacity and that obstacles to work such as pain and fatigue cannot be measured objectively.^[1]

In 2007 the New Labour government passed the Welfare Reform Act^[2] which replaced Incapacity Benefit with Employment and Support Allowance (ESA) and the Personal Capability Assessment with the new Work Capability Assessment (WCA). This was to make tests for benefits more stringent and take into account new disability legislation, changes in the workplace and developments in occupational health.

Professor Malcolm Harrington, an academic with a background in occupational health, was appointed to review the WCA system. In November 2010, he published an initial report that included 25 recommendations.^[3] 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.^[4]

In early 2011, the Conservative-Liberal Democrat coalition government expanded the scope of the programme to reassess the 2.5 million people the DWP had previously judged to be entitled to Incapacity Benefit. This was part of an outsourcing contract that would cost the Exchequer more than half a billion pounds over the next five years.

It also made lawful changes to the framework of the WCA to make ESA even harder to obtain, such as expecting someone who has difficulty walking to use a manual wheelchair, if reasonably practicable.

The WCA was claimed by the DWP to be a means of getting disabled people "off benefits and into work".

The ESA assessment process

When the New Labour government introduced the 'fit for work' test, it contracted out the medical 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.^[5][6] On 1 March 2015, Maximus assumed responsibility for carrying out the assessments.

Technically - if the system works properly - the process is supposed to first decide whether or not the claimant has 'Limited Capability for Work' i.e. whether they are entitled to ESA at all; if they are, the process then tries to decide whether they have 'Limited Capability for Work-Related Activity' i.e. whether they are able to participate in pre-employment training.

In practical terms, what happens is that healthcare professionals first scrutinize the claimant's paperwork before deciding on the need for a face-to-face assessment. If one is deemed necessary, an appointment is booked - usually in an Atos examination centre, but occasionally in the person's home. At face-to-face assessments, the assessors, who are doctors, nurses or physiotherapists, use a computer-based points system and a semi-structured interview technique - designed in conjunction with the DWP - in an attempt to gauge the impact of the disability on the person's daily life and to assess the person's fitness for work. There may also be a short physical examination and general observations of the claimant's mobility, speech, hearing, etc. are made. After the interview a report is sent electronically to the DWP that concludes with a points score purporting to reflect the level of disability, together with a recommendation on fitness for work.

These assessments 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.^[7][8]

A medically-unqualified civil servant - the 'decision maker' - then makes the final decision on eligibility for ESA. The decision is not purely a medical one and assessors' recommendations are not always followed.

Criticism of the WCA

The Work Capability Assessment has been criticized in the media,^[9][10] in Parliament,^[11] by the Church,^[12] by the medical profession,^[13] and by protest groups^[14][15][16] regarding its disability programmes. MPs didn't debate Atos Healthcare in relation to the Work Capability Assessment in Westminster Hall until 4 September 2012.^[17] Since then, there has been considerable pressure applied to Iain Duncan Smith, the minister for the DWP, by many including Michael Meacher^[18] and Tom Greatrex^[19][20] who have campaigned for the reform of the fitness to work assessment. Greatrex has also written to the Prime Minister to demand an investigation of allegations made by a former Atos assessor that Work Capability Assessments are biased against the claimant.^[21]

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’.^[22] The vote has not been acknowledged by Atos or by the UK Government, although it was reported in the media at the time.

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 against the Department for Work and Pensions (DWP) were successful. The Committee declared the Work Capability Assessments resulted in too many wrong decisions being overturned. Whilst Atos are paid to make the assessments, it is the government who pays for the tribunal appeals, with £500 million being the cost to the taxpayer for these appeals.^[23] "The Department's got to get a grip of this contract", concluded Margaret Hodge,^[24] saying "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."^[25]

Also in 2013, the UK Statistics Authority challenged Grant Shapps' claim 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.^[26] Therefore, Shapps had no conclusive evidence to back up his assertion.^[27]

On 22 May 2013, a decision in a judicial review brought by two individuals with mental health problems ruled that the Work Capability Assessments were not fit for purpose, and that they substantially disadvantage people with mental health conditions.^[28]

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".^[29] Furthermore, the "great majority do not have associated parking".^[30] The councillor characterised this national situation as, "a disgrace".^[30] It has been revealed that Atos has already made an out-of-court settlement with one user, "for disability discrimination […] over access."^[29]

Around the same time a doctor who had resigned from Atos after being told to change a report about an individual blew the whistle^[31] to the BBC, pointing out that in certain circumstances "the General Medical Council makes it clear that doctors must not change a report and risk being disciplined for unprofessional conduct if they do".^[32] He also drew attention to widespread and unduly harsh misinterpretations of the assessment's system for awarding points, on key abilities such as mobility and manual dexterity, that were promulgated through the training programme for new WCA assessors^[33] – to which Atos replied that it was the DWP that was responsible for setting the curriculum for new assessors, not Atos.^[34]

More recently there has been critique of the choice to reassign the WCA contract to Maximus, a company who were sued in 2009 for disability discrimination against one of their employees. The corporation has also been the subject of criticism for ineffectiveness in relation to previous contracts and in this instance has raised flags due to the movement of Atos executive Michael O’Donnell to Maximus in the same month as the contract change was announced.^[35]

Atos exits the WCA contract

On 22 July 2013, the barrage of criticism of the Work Capability Assessment appeared to be vindicated when the DWP announced that it had directed Atos to put in place a "quality improvement plan" - as part of which, all WCA assessors would be obliged to undergo complete retraining - and said it would be bringing in new providers to carry out assessments, at this point supposedly in addition to Atos. The move followed a retrospective audit of 400 Atos reports produced over a six-month period in which the DWP claimed that it had found 164 that were unsatisfactory - yet the DWP said that these "unsatisfactory" reports had nevertheless come up with the correct recommendation on fitness to work.^[36][37]

At the same time, the Coalition's attitude towards the WCA underwent a sea-change. PricewaterhouseCoopers were called in to audit undisclosed quality issues 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.^[38] 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 - a mess so vast it was "astronomical".^[39]

Meanwhile Atos abruptly backtracked on a promising arrangement to carry out fitness-to-work assessments for Incapacity Benefit on the Isle of Man^[40] and began to secretly negotiate an early exit from its contract – worth half a billon pounds – in the United Kingdom,^[41] later publicly citing death threats to its staff, criticism from Labour MPs and Atos's own opinion that the WCA itself was "not working" as its reasons for wanting to leave.^[42]

In March 2014, when responding to Dr Paul Litchfield's review of the WCA's performance for the DWP published the previous year, 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 had been trying to fix the assessment since coming to power.

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 (in what was officially described as a mutual agreement but which, by the time it reached the press, had been 'spun' to give the false impression that Atos had been sacked owing to the poor quality of its reports).^{[43] [44]}

Over the summer, it emerged that there was a growing backlog of hundreds of thousands of ESA claims.^[45]

Maximus awarded contract

At the end of October 2014, the DWP announced that the US firm Maximus would take over the WCA contract from Atos - but not until March 2015, only five months short of the planned termination date of the five year Atos contract.^[46] Maximus will be paid £595 m to carry out the work capability assessments over a three year period.^[47]

Figures

A government study published in 2012 found that one-half of the people identified as "fit for work" by the Work Capability Assessment in the UK, remained unemployed and without income.^[48][49]

In 2012, 43 complaints against Atos doctors and nurses were being investigated by the General Medical Council or Nursing and Midwifery Council.^[6] Criticism has been directed at Atos over the ability of its staff to deal with complex mental health problems and conditions whose symptoms vary with time.^[50] In August 2012, Atos Healthcare claimed they had appointed 60 Mental Function Champions to provide additional training.^[6]

Dangerous conclusions and deaths

Government statistics reveal that between January 2010 and January 2011, 10,600 sick and disabled people died within six weeks of being assessed.^[51] Government statistics also revealed that of those who had been put into the 'Work Related Activity Group' (which prepares claimants for future work), 1,300 died within six weeks.^[52] Critics of Atos allege that the number of deaths is far greater. In mid-January 2012, there was a significant scandal as media were alerted to the fact that the WCA had found a man in a coma to be 'fit for work'.^[53]

Work Capability Assessments have found patients with brain damage,^[54] terminal cancer, severe multiple sclerosis, and Parkinson's Disease to be fit for work.^[55] 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.^[56][57]

In August 2011, twelve doctors working for Atos as disability assessors were placed under investigation by the General Medical Council because of allegations of misconduct in relation to their duty of care to patients.^[58]

References