The Work Capability Assessment (WCA) is used by the Department for Work and Pensions (DWP) in the United Kingdom to assess Employment and Support Allowance (ESA) claims and some claims for Universal Credit. Concerns have been raised over its design, its reliability in practice, its value-for-money, and the effect of wrong decisions on vulnerable claimants.
In response to criticism, the DWP said a group of outside experts had studied the test and concluded that it was "an accurate indicator of work capability compared with expert opinion". Conversely, Kent University academic Ben Geiger has made international comparisons of the test: he found "no transparent evidence that the WCA captures the demands of work in Britain today".
In practice, experience has shown that the WCA usually identifies these types of claims correctly:
- Claims for very severe disabilities
- Claims where there is little or no objective impairment
However, the process has largely struggled to categorise claims correctly if they fall between these two extremes, particularly where mental health is concerned.
In fiscal terms, the deployment of the WCA was expected to more than halve the sickness benefit bill over the course of a decade but it increased it by two billion pounds.
There is evidence of harm in individual cases from coroners' inquests. When responding to an inquiry by the United Nations, the government said there was no causal link between the WCA process itself and the deaths of people found fit for work.
Video Criticism of the Work Capability Assessment
Design
Dr Paul Litchfield helped to design the WCA in 2006 and he later reviewed its performance for parliament. Of the design phase, he said:
[It] was done very quickly to meet the legislative timescales for the Welfare Reform Act ... The department was forced into rushing the design of the WCA and we have what we have.
A review undertaken by occupational heath expert Professor Malcolm Harrington in 2010 found that the test was too reliant on "computer systems and drop-down menus" and "was not working as well as it should" -- but he felt that the suggestions he was making would improve the process, if adopted by the DWP.
In February 2011, Professor Paul Gregg, an economist and one of the original architects of ESA, warned that the WCA was "badly malfunctioning" and urged further pilot studies before the new version was used to retest existing sickness benefit recipients. Three months later, six experts in mental health -- including the chief executive of MIND, who was already a senior advisor to the DWP on the WCA -- wrote to The Guardian to say that the test was "deeply flawed".
In 2013, the DWP published an 'evidence-based review' of the WCA. The department said "a steering group of experts chaired by Professor Harrington oversaw the study" and named the lead experts as a professor of psychiatry, a consultant psychiatrist in learning disability, a professor of rheumatology, and an expert in human resources. The review's conclusion was that "the WCA produced consistent results on the whole, and is an accurate indicator of work capability compared with expert opinion". But the following year the firm that had carried out millions of WCAs on behalf of the DWP since 2008 said it had come to the conclusion that "in its current form, the WCA is not working for claimants, for DWP or for Atos Healthcare".
The United Nations Committee on the Rights of Persons with Disabilities said in 2016 that despite previous modifications to the WCA, it still paid too little attention to "personal circumstances and needs, and barriers faced by persons with disabilities to return to employment, particularly those of persons with intellectual and/or psychosocial disabilities". In its reply to the United Nations, the DWP stressed the efforts it was making to bridge the 'disability gap' and boost the number of disabled people in work.
In 2016, Iain Duncan Smith described the WCA as having been "unbelievably harsh" when introduced under New Labour; the Labour Shadow Secretary of State for Work and Pensions said the test, which her party had described as "tough but fair" in its 2010 manifesto, had been "discredited" by the coalition government.
In February 2018 Kent University academic Ben Geiger, who has made international comparisons of the WCA and who was also a policy advisor to the DWP in 2015 and 2016, described the WCA as having been "a failure by almost any criteria". He explained that "there is no transparent evidence that the WCA captures the demands of work in Britain today" and said the test was "perhaps the greatest failure of an incapacity benefits test that we have ever previously managed, and a greater failure than any other country currently achieves".
In March 2018, the Isle of Man government announced that it was scrapping its version of the WCA and replacing it with a more holistic approach characterised by "less checking up, more helping up".
Maps Criticism of the Work Capability Assessment
Reliability
Turnover of decisions
Parliament's Office of Science and Technology has analysed the WCA's performance; it found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process". Between 2011 and 2013, around 40% of claimants found 'fit for work' appealed to a tribunal and around 40% of those appeals were successful.
A 2012 study of 28,000 tribunal hearings analysed the reasons for overturning the DWP's decisions:
- In almost two-thirds of successful appeals, the tribunals found the appellants' descriptions of their difficulties, given in person on the day of the tribunal, sufficiently convincing for them to be awarded the benefit -- known as presenting "cogent oral evidence" in legal jargon. By implication, in these cases, the tribunal found the oral evidence more persuasive than had the assessor who had conducted the original face-to-face assessment
- In nearly a quarter of successful appeals, the tribunals agreed with the DWP on the facts of the case but decided that the DWP had come to the wrong conclusion based on those facts
- In 13% of cases, documentary evidence was provided that had not been available at the initial assessment
- In under 1% of cases, the assessment report was found to contain important technical errors.
In the same year, a parliamentary committee heard evidence from welfare advisors that, in nearly two out of three successful appeals to tribunals against fit-for-work decisions, appellants were seeing their points rise from zero in the original assessments -- meaning that the original WCA had detected no relevant disabilities at all -- to at least 15 points after the tribunals had independently assessed their claims.
Outcome targets
Professor Malcolm Harrington, the first external reviewer of the operation of the WCA, was asked by a parliamentary committee whether he had ever found any evidence that Atos assessors had been put under pressure to reach targets. He replied:
They say not, and whenever I have gone anywhere, they say not. This is purely anecdotal, but there was one Atos assessment centre I went to where the bosses walked out and I was left with a couple of assessors having a cup of coffee at the end of the session, and they told me they were under pressure.
In 2012, a GP posed as a trainee Atos assessor and recorded undercover video footage that was later broadcast by Channel 4's investigative current affairs programme Dispatches. In the film, trainers warned the NHS doctor that if on average he were to recommend more than one disabled person per day for the Support Group, he would be subject to an increased level of management scrutiny through a mechanism known as "targeted audit". The undercover doctor was told:
If it's more than I think 12% or 13%, you will be fed back 'your rate is too high'
An assessor on "targeted audit" would also no longer be allowed to recommend a claimant for the Support Group without asking an authorised colleague for permission to do so. When the doctor asked an experienced assessor where these rules had come from, she replied: "DWP".
Both the DWP and Atos categorically denied ever having had any target for getting claimants off sickness benefits. However, both eventually admitted that Support Group "norms" were being used nationwide, though they both denied that the purpose of "targeted audit" was to limit the number of claimants placed in the Support Group. Atos said that the audit process triggered by the breach of a "norm" was intended to ensure consistency across the firm's UK team: if the assessor's reports met the DWP's expectations, the healthcare professional would not be asked to change their recommendations.
However, in 2012, the Work Programme firms responsible for training people in the Work-Related Activity Group said they had "ongoing concerns about the accuracy of the WCA" and rated earlier improvements to the WCA as only "4 or 5 out of 10". In 2013, the same organisation complained that claimants who were "clearly unfit for any type of work-related activity" were nonetheless being put in the Work-Related Activity Group rather than the Support Group, and that "claimants with terminal cancer, whose life expectancies were shorter than the work-ready prognosis" had been referred to them for pre-employment training.
Outcome bias
In May 2013, another doctor who had recently resigned from Atos blew the whistle on biases in the testing process, telling the BBC:
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
He claimed that:
- At the face-to-face assessment, the strength of a case was often not weighed as it should have been -- on the balance of probabilities -- but to a loosely-defined and higher standard of proof, so claimants faced "an uphill struggle" to establish legitimate claims
- Atos made too little effort, before an assessment, to obtain clinical information that could have a bearing on the case
- The DWP was "skewing" the WCA in its favour -- "pulling strings behind the scenes" by manipulating the training curriculum and the audit protocols it stipulated for the medical assessors who furnished the department with recommendations on claimants' fitness for work
The news report drew particular attention to misleading interpretations of the test's eligibility criteria that the doctor claimed were being taught to new assessors as off-the-record rules of thumb during their initial classroom training (and used as benchmarks when assessors' reports were audited). An Atos executive interviewed by the BBC acknowledged that the guidance referred to "might seem somewhat odd" but said it had been "taken out of context" and was part of a much bigger set of questions considered during assessments.
On the same day, an Atos spokesman made it clear that the training curriculum was set by the DWP and duly followed by Atos, stating: "We do not deviate from government guidelines in our training". The Employment Minister was asked by the BBC about the allegations of bias but he replied with a general explanation of the principles underpinning the Incapacity Benefit reassessment programme. Tom Greatrex MP wrote to the Prime Minister to bring to his attention the whistleblower's allegations that the core assessment was "skewed against the claimant". Downing Street made no reply but simply passed the letter back to the DWP, which issued a non-specific statement.
In July, the former assessor gave an interview to The Guardian. In it, he described how he had first heard trainers advocating the "bogus" interpretations of the test's descriptors in 2011 during a one-day conversion course covering the new version of the WCA and its new criteria. In response to the article's description of auditors instructing assessors -- at the point when a report of a face-to-face assessment had been written, but had not yet been sent to the DWP -- to alter their reports and reduce the number of points awarded, Atos said:
There is no ethical conflict in advising a doctor that aspects of their work require further attention to meet the standards expected
In August, the whistleblower expanded on his allegations in a first-hand account published by the British Medical Journal. He suggested that the DWP's alleged actions might have been at least partly driven by pressure to "reduce government debt". The DWP's senior doctors made no reply but the clinical director of Atos did respond. In relation to the claim that some Atos assessors had been led to interpret the test's criteria too harshly, she did not deny that the "bogus rules of thumb" had been used in training talks but she said that assessors were expected to follow the written guidance contained in the 255-page instruction manual issued to all assessors:
All reports must fully comply with the Department for Work and Pensions guidance contained within the WCA Handbook; all our practitioners are expected to be fully aware of this guidance and are responsible for ensuring that the advice they offer complies with it.
The foreword to the WCA Handbook states:
This Handbook is not a stand-alone document, and forms only a part of the training and written documentation that a Healthcare Professional receives. As disability assessment is a practical occupation, much of the guidance also involves verbal information and coaching.
On 22 July 2013, the DWP announced that all Atos WCA assessors would be retrained, as part of a "quality improvement plan" that followed "a DWP audit which identified an unacceptable reduction in the quality of written reports produced following assessments."
Fiscal effectiveness
In 2006, the New Labour government set out its plans for welfare reform: over the course of a decade, it expected the deployment of the WCA to shrink the number of people on out-of-work sickness benefits by one million, thereby saving £7billion a year. A reassessment of long-term recipients was expected to start in 2009 but the start was delayed until 2011 while the test's criteria were reviewed.
In 2012, the DWP's handling of its contract with Atos was the subject of a critical report by the National Audit Office (NAO). The Public Accounts Committee heard that in that year the DWP had paid Atos £112m to carry out WCAs. The chair of the committee told the BBC that the DWP got "far too many decisions wrong on claimants' ability to work" and that this came at a "considerable cost to the taxpayer" because the independent tribunals that corrected the wrong decisions, funded by the Ministry of Justice, added a further £50m a year to the costs.
The Office for Budget Responsibility (OBR) found that in the period up to 2014, no savings had been made in the sickness benefit budget, which remained at more than £13 billion a year. In 2015, because many more claimants than forecast were now being placed in the Support Group, the government's fiscal watchdog had to raise its estimate for annual spending on ESA by at least one billion pounds. In 2016 the OBR confirmed that the reforms themselves had done nothing to reduce levels of welfare spending -- although a simple freezing of benefit payments, so that they did not rise with inflation, had limited the extent of fiscal failure. But in fiscal year 2016-17, the budget in question had nevertheless risen to £15 billion a year.
In 2016, the NAO published another evaluation of the DWP's disability assessment contracts: it said the cost of each WCA had risen from £115 under Atos to £190 under Maximus, to no benefit to the Exchequer.
A former chief economist at the DWP, Professor Jonathan Portes, has described the use of the WCA to reassess long-term recipients of sickness benefits as "the biggest single social policy failure of the last fifteen years".
Deaths
The WCA's designers acknowledged that being found fit for work and ineligible for sickness benefit could, in some circumstances, harm a recipient's physical or mental health. For this reason, one of the WCA's eligibility criteria -- the descriptor Substantial Risk -- applies where there is, on balance, more than a small risk of harm if the claimant were to be declared 'fit for work'.
The deployment of the WCA since 2010 has been associated statistically with the unexpected deaths of hundreds of people. There is evidence of harm in individual cases from coroners' reports, and from the DWP's own internal investigations into dozens of claimants' deaths. However, data suggesting that thousands of people have died has not withstood expert analysis.
Officially, the DWP does not accept that the WCA or the way it has been carried out has caused any deaths. A committee from the United Nations wrote, with regard to 33 deaths investigated in secret by the DWP, that it was "not aware of any attempts at objective, thorough, open and impartial investigation regarding those deaths by an independent body".
Expert opinion
Professor Louis Appleby leads the National Suicide Prevention Strategy in England. In February 2018 he told Disability News Service that sickness benefit recipients were "a high risk group" and, while it was rare for one thing alone to trigger suicide, "a protracted stressful benefit claim, feelings of being treated unfairly, and of course financial problems themselves can all contribute". Furthermore, on the question of claimants committing suicide as they tried to qualify for their benefits, Professor Appleby said: "I've no doubt for some people claiming is damaging and a causal factor".
Polly MacKenzie is the director of the think-tank Demos. Previously, she helped draw up the Coalition Agreement in 2010 that foresaw the Incapacity Benefit reassessment programme going ahead and she was Nick Clegg's director of policy until 2015. In 2018, she was quoted by The Observer as saying that: "...capability assessors too often have a culture of disbelief about disability, especially mental illness".
Inquests and media reports
There have been several media reports of unexpected deaths after assessments where the claimants seem to have been at risk of harm if found fit for work. The most widely reported deaths followed assessments that took place in the seven months from December 2012 to June 2013. The deaths themselves were clustered around the summer of 2013:
- Tim Salter (assessed December 2012; deceased September 2013)
- Linda Wootton (assessed February 2013; deceased April 2013)
- Mark Wood (assessed March 2013; deceased August 2013)
- Michael O'Sullivan (assessed March 2013; deceased September 2013)
- David Barr (assessed June 2013; deceased August 2013)
Tim Salter
Tim Salter was visually impaired as a result of brain damage from a previous suicide attempt. He killed himself after being found fit for work. At his inquest, the coroner said: "A major factor in his death was that his state benefits had been greatly reduced, leaving him almost destitute and with threatened repossession of his home".
Linda Wootton
Linda Wootton had undergone two heart-and-lung transplants and was left with a weakened immune system caused by the immunosuppressant therapy she was taking to prevent her body rejecting the transplanted organs. She died days after the DWP upheld its decision to declare her 'fit for work' (neither the assessor, the first decision-maker nor the second official who reviewed her case had deemed her to be at substantial risk of harm).
Mark Wood
Mark Wood was receiving Incapacity Benefit and Disability Living Allowance because of long-term mental health problems, including a "phobia" of some types of food and overvalued concerns about his food's freedom from contamination. He had been losing weight for many months before his WCA. He died, weighing 35 kg, after he was declared fit for work and his Incapacity Benefit and Housing Benefit were stopped (the DWP continued to pay him Disability Living Allowance). His family believes that the stress of his forthcoming WCA and then afterwards the loss of the bulk of his income damaged his already fragile mental state, worsened what the DWP called his "eating disorder" and so contributed to his death.
The Oxfordshire Coroner delivered a narrative verdict in which he said the final pathological event was "unascertained", but he saw no significant evidence of neglect or self-neglect (neglect has a very precise legal definition), suicide, or unlawful killing (for which a high evidence threshold must be crossed before a coroner can deliver it as a verdict).
The DWP carried out a post-mortem case review then admitted that the decision to declare him fit for work had been wrong, but the department denied that its decision had contributed to his death.
In response to the case, Tom Pollard of the mental health charity Mind said:
Unfortunately this tragic case is not an isolated incident. We hear too often how changes to benefits are negatively impacting vulnerable individuals, who struggle to navigate a complex, and increasingly punitive, system. We know the assessment process for those applying for employment and support allowance is very stressful, and too crude to accurately assess the impact a mental health problem has on someone's ability to work. This leads to people not getting the right support and being put under excessive pressure which can make their health worse and push them further from the workplace. We urgently need to see a complete overhaul of the system, to ensure nobody else falls through the cracks.
Michael O'Sullivan
Michael O'Sullivan suffered from long-term depression and anxiety and was receiving sickness benefit in the form of Income Support until it was stopped by the DWP following a WCA. He committed suicide after being on Jobseekers Allowance for six months. After the inquest, the coroner said: "The intense anxiety that triggered his suicide was caused by his recent assessment...as being fit for work". The assessor -- a former orthopaedic surgeon -- admitted during the inquest that he had not fully explored the risk of suicide at the face-to-face assessment, despite suicidal ideation being described on the claim form.
The coroner wrote to the DWP in January 2014. She was concerned that neither the Atos doctor nor the DWP decision-maker had sought information from Michael O'Sullivan's own doctors. The DWP wrote back, referring to the guidance issued to the Atos healthcare professionals who, before face-to-face assessments, scrutinised the paperwork submitted by claimants -- guidance called the Training and Development ESA Filework Guidelines. The DWP confirmed that suicidal thoughts had been described on Michael O'Sullivan's application form but said "further evidence was not requested in line with the stated policy [in the Training and Development ESA Filework Guidelines] where the claimant has referred to suicidal ideation". These policy guidelines say: "Where there is evidence of a previous suicide attempt, suicidal ideation, or self-harm expressed in the [information on the claim form], the healthcare professional must request further medical evidence".
The DWP said the specific action it would take in response to the coroner's concerns was to issue a reminder to the relevant members of staff. Michael O'Sullivan's daughter's MP said:
The coroner said there was a causal link between his intense anxiety, the assessment and the consequences. His daughter has been asking for answers to how that happened, what went wrong...and she hasn't got answers for three years...it really deserves to be looked at.
The case had many similarities with an earlier death following a WCA, where a coroner had also written to the DWP about the lack of an attempt to contact the psychiatrist who had been treating a person with mental health problems who went on to commit suicide.
David Barr
David Barr suffered from paranoid delusions and had a history of self-harm. He was taking anti-psychotic medication prescribed by his psychiatrist. He jumped from a bridge to his death after a risk assessment -- by a physiotherapist -- that led the DWP to deny his claim for ESA. The department later admitted that its decision was wrong; it said he should have been categorised as being at substantial risk of harm.
Post-mortem case reviews
The DWP has looked into the deaths of at least 49 benefit claimants (not all of whom were claiming disability benefits). The department was compelled to publish their findings in May 2016 after a campaign by Disability News Service. The conclusions of the heavily redacted reports included:
- A "persistent area of possible concern" was "a dislocation between policy intent and what actually happens to claimants who may be vulnerable"
- The Incapacity Benefit reassessment programme lacked a clear system for identifying vulnerable recipients
- DWP staff did not always check the DWP's database for indicators that claimants were at risk
- The WCA's medical criteria for identifying risk were not properly applied
- Claimants with cognitive problems were not filling in their claim forms in the manner that the DWP had envisaged (or at all)
- Requests by claimants for a reconsideration of the department's initial decision - while waiting for which, the claimant receives no sickness benefit - were not prioritised in a "common sense" way
- Appeal dates for tribunals took too long
- The failure to apply the department's Six Point Plan for dealing with people with suicidal ideas was "a recurring theme"
Epidemiology
A study published in the Journal of Epidemiology and Community Health in November 2015 found an independent correlation between the deployment of the Incapacity Benefit reassessment programme in England and an increase in reported mental health problems, higher levels of antidepressant prescribing and 590 additional suicides. The DWP responded by pointing out that association does not imply causation: the rise in mental health issues when the WCA was deployed after 2010 could have been caused by something else entirely and the temporal association with the reassessment programme could just have been a coincidence. The researchers said they had found no other explanation for the rise.
Mortality rates after WCAs
In response to a campaign using the Freedom of Information Act, the Information Commissioner ordered the DWP to disclose the number of people who had died in the 12 months after their WCA since May 2010 - the DWP had 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. But in August 2015, the DWP was forced to reveal that between December 2011 and February 2014, 2,380 claimants had died after being declared fit for work. However, as Dr Ben Goldacre has explained, an imprecise question in the original FOI request and an unhelpful DWP response -- which Goldacre characterised as "essentially a PDF and an excel spreadsheet full of red herrings" -- meant that no firm conclusion could be drawn from these figures alone about whether the death rate of people found fit for work is any higher or lower than expected.
Deaths and claims ending
DWP figures show that, between January and November 2011, 10,600 sick and disabled people died within six weeks of their benefit claim ending; many disability campaigners believe 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 people who happened to die from natural causes, after which their benefit payments ceased. The newspaper said that when the DWP states "within six weeks", this "does not mean 'within the following six weeks': it means 'within six weeks either side'. What that means is that the large, presumably overwhelming, majority of those 10,600 people died, and then their claims ended because they were dead."
United Nations report
In November 2016, the United Nations Committee on the Rights of Persons with Disabilities published its report on the situation facing disabled people in the United Kingdom. Of deaths after WCAs, it said:
The [DWP] initially stated that it did not monitor deaths that occurred after assessments. Evidence gathered during the inquiry indicated that, in 2012 and 2015, such information was released by the Department for Work and Pensions following freedom of information requests. Additionally, information originated from official sources indicated that 33 deaths of claimants who died after being assessed were examined. The [DWP] claims there is no causal link. The Committee is not aware of any attempts at objective, thorough, open and impartial investigation regarding those deaths by an independent body.
The DWP responded by confirming that it did not systematically monitor or investigate deaths following WCAs. It admitted that it had reviewed the deaths of at least 49 claimants, but said it only did this a): when formally notified of a death by "a family member or solicitor", and b): where a link between the death and the DWP's actions has been alleged by the family member or their legal advocate. The department said that an internal review might "make recommendations for possible improvements" but would not "seek out or apportion blame" (internal reviews have though been used by the DWP to deny any culpability for deaths following WCAs).
The DWP drew the committee's attention to the role of the coroner in England and Wales.
References
Source of article : Wikipedia
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