WCA is simply not fit for purpose

A major component of the ‘New Labour’ government and the current coalition government’s radical welfare reforms has been the Work Capability Assessment (WCA) for disabled people. But the assessment has been made much more stringent, with people with often multiple impairments being found ‘fit to work’ through the test. This has led to much debate about the efficacy of the WCA and today the Work and Pensions Select Committee will hear evidence from Atos Origin on the very subject. Members of the Select Committee might like to take a moment and read this short article before the cross examine their witness.

From now until Spring 2014 all those who are receiving Incapacity Benefit, Severe Disablement Allowance and Income Support paid on the grounds of illness or disability will be assessed for Employment and Support Allowance (ESA), undergoing a stringent Work Capability Assessment (WCA) carried out by the French Company Atos who are contracted by the Department of Work and Pensions (DWP).

First introduced in 2008, the much criticised WCA has become even more punitive since changes in the 2011 edition of the training manual for assessors. Pilots in Aberdeen and Burnley have raised more criticisms of the process adding to the raft of criticisms from the British Medical Association, GPs, Citizens Advice Bureaus (CABs), Members of Parliament and disability organisations.

Those going through the test can be put into one of three groups: ESA Support Group not required to undertake work-related activity – but will be reassessed continuously; ESA Work Related Activity Group, for those deemed fit for work with support and preparation. It will be limited to just 12 months before ESA is stopped, and also may be subject to reassessment in the 12 month period; or Fit for Work, not entitled to ESA but transferred to a lower amount on Jobseeker’s Allowance.

Case studies have repeatedly shown the inhumanity of a system based on government targets and the pain and misery of the increasing stringency of these tests. One example from the 2010 Citizens Advice Bureau’s report on ESA and WCA testing procedures highlights the experiences that someone considered ‘fit for work’ through WCA might endure:

She was in a great deal of pain in her muscles and joints and had extreme fatigue. At times her balance was affected and she could not walk without someone to support her. Sometimes she lost sensation in her legs, and on her worst days she could not walk at all. Any exertion such as walking 40 or 50 metres led to days in bed. She had had a bad reaction to some of the treatment and an ECG showed her heart muscle had been damaged. Her husband had to come home from work each lunchtime to help her. Her immune system was weakened, so she had to be careful when mixing with others.

She claimed ESA but was given six points in the Work Capability Assessment (WCA) and found capable of work. Her doctor supported her claim and she is currently appealing, but under Incapacity Benefit she would probably have been exempt and would have avoided this process.

There are many other stories like this. There are also increasing stories of suicides committed by people left without any means of income fighting and winning appeals, only to find they are called for WCA reassessments shortly after. As part of the recognition of the increasing trend of those going through assessments to take their own lives Job Centre Plus staff have been issued with guidelines on how to deal with people who they think might be suicidal because of the WCA testing.

One estimate claims that up to 500,000 people have been wrongly denied Incapacity status. In the Guardian, Amelia Gentlemen reminds us that since its rollout people with terminal illness have been found ‘fit for work’, those with mental health issues have said the system cannot appreciate complexities of mental health, and others that the tick box system is unable to cope with any nuances of long term impairments or illness.

Citizens Advice Scotland reported that under incapacity benefits, 37 per cent were found ‘fit for work’. Under Work Capacity Assessment, the figure had soared to 66 per cent. In 2008 The DWP and Atos were severely criticised by Robert Martin, the President of the Appeals Tribunal Panel, a position now abolished:

Criticism was made of ATOS Healthcare medical practitioners who did not appear to pay sufficient attention to the appellant at the medical examination and who produced findings in medical reports based on observations that were inconsistent, or recorded in the medical report findings that were contradictory

In a later 2010 independent review of the WCA tests Professor Harrington concluded:
There is strong evidence that the system can be impersonal and mechanistic, that the process lacks transparency and that a lack of communication between the various parties involved contributes to poor decision making and a high rate of appeals.” and that “evidence has consistently and regularly highlighted problems with each stage of the WCA process, which limit both the assessment’s fairness and effectiveness.

Moreover Atos’s own staff have said the assessments are too harsh. Prospect, the trade union who represent 135 Atos doctors, has also stated that the target of seeing ten or more people a day is unrealistic and will lead to wrong assessments, especially in complex cases.

Despite the overwhelming evidence that WCA was not working, Atos were awarded a further 3 year contract by the DWP at the end of 2010, with a contract for £300 million based the perceived expertise of a software system LiMA, which comprises the central part of the WCA testing.

There has been a 56 per cent increase in ESA appeals with figures up from 25,700 in the second quarter of 2009/2010 to 52,000 in the same quarter of 2010/2011. Almost half of cases are overturned at appeal. Paul Hoggarth of Burnley Citizens Advice said that as many as 80 per cent of those supported in their claims to overturn a ‘fit for work’ decision win. Figures from the DWP show that of those declared ‘fit for work’ by the WCA system, just 13 per cent are in employment. The ‘fit for work’ myth does not convert into any form of reality.

A representative survey carried out by Ipsos MORI and reported in ‘Employment and Support Allowance: findings from a face to face Survey’ commissioned by the DWP, found that nearly a third of those going through the WCA process were described as having ‘literacy problems’. A further six per cent ‘problems speaking English’ and 11 per cent had ‘numeracy problems’. Twenty two percent were described as in one or more disadvantaged groups including those with mental health issues, ex-offenders, and those with perceived learning difficulties.

An overwhelming 69 per cent of those going through the WCA process had ‘multiple health conditions’, with 81 per cent of people receiving medical treatment for their condition and 38 per cent waiting for treatment or additional treatment in all ESA groups. These statistics do not present us with a set of fraudsters pretending to be sick or disabled, nor a set of individuals who have been languishing on incapacity benefits for years; in fact 71 per cent of applicants to ESA were new claimants making their first ever claim.

The WCA is not really about assessing fitness for work, nor supporting people into work. The ‘capability’ tests were always part of a mutual interdependence between successive Governments’ need to reduce social claims on the state and business identifying financial benefit in such a process. The misery it causes is deemed irrelevant by all parties.

The 2011 manual issued by the DWP to Atos provided new regulations including:
…infrequent loss of consciousness would not substantially impact on a person’s ability to work and therefore only those experiencing weekly or monthly episodes of loss of consciousness will be awarded scoring descriptors.

Thus if you spontaneously lose consciousness once every five weeks, you will be assessed as ‘fit for work’. This is one example of the non reality of new WCA ‘fit for work’ standards. It undermines the logic, and the economic and social realities of any reasonable employment criteria. The WCA is presented under the guise of state and market efficiency. It serves neither criterion.

Why many ESA claimants aren't 'fit for work'

The government is on its latest tirade against the poor, the sick and the unemployment. Now they have discovered three-quarters of people who apply for sickness benefit are found fit to work or drop their claims before they are completed, official figures show. Department for Work and Pensions figures showed 887,300 of 1,175,700 employment and support allowance (ESA) applicants over a 22-month period failed to qualify for assistance. Of those 39% were judged fit to work, while 36% abandoned their claim.

As a result, Employment Minister Chris Grayling has said the welfare system needed changing. He said the figures underlined the need to reassess people still on the old incapacity benefit - a process which the government began rolling out last month.

"Once again we have clear evidence of the need for change in our welfare system. We now know very clearly that the vast majority of new claimants for sickness benefits are in fact able to return to work. That's why we are turning our attention to existing claimants, who were simply abandoned on benefits. That's why we are reassessing all of those claimants, and launching the work programme to provide specialist back to work support. We will, of course, carry on providing unconditional support to those who cannot work, but for those who can it's right and proper that they start back on the road to employment."

Before he opens his mouth this man really should engage his brain. When people go to doctors, health visitors, Citizen’s Advice Bureaux, or welfare rights organisations they are often advised to apply for incapacity benefit (or employment and support allowance as it is now). There is no subterfuge on the part of the working classes, no plot to overthrow the state and we aren’t a nation full of social security scroungers either.

The reality is that many of these assessments have been found to be inhumane, lacking or evidence of genuine care and designed exclusively to trap people into a situation where they can no longer claim benefit.

Take some of the following cases:

“In Hull, my Atos doc showed up on the cancelled day (I had another appointment to go to that I could not reschedule) and I had to send him away, then I attended the centre for the next attempt, it is in a busy area, buzzer at door, terrible chairs and long corridors. My wheelchair broke in the car park they watched me and my friend struggling with it out of the window and did not offer help. In the end we gave up and I used my crutches. We told the doc exactly what happened so she made no mention of it on my assessment and said I only use crutches! Amongst other 'mistakes' and flat out falsification, I was refused all help and am still awaiting an appeal date a year later.”

“The fellow came to my house as I was housebound - they knew I was housebound and yet they kept trying to find evidence of me walking.”Don't you go round to the shops?" No, I don't, it was too far in winter and unsafe, and if they had called my carer at all she could have told them that (The DWP never even contacted her). He managed to drag out that I had been fed up with being stuck at home for three months so I dragged myself into town to get some flowers and visit my favourite coffee shop - it was the same day my son ended up getting excluded and so I spent the three days afterwards trying to recover with an autistic hyperactive child, drugged to the gills on Tramadol. Result on the assessment form? "Can walk up to 500 yards pain free." Once I got the arthritis scan in there which shows damage to the bones in my feet, I wanted to appeal the "no mobility allowance" grounds but missed the appeal date by three days. I now have to file, yet again, for change in circumstances, which is the second time I've had to do this after appealing my first claim. It's doing my head in, and I'm appalled that it seems they never bothered to follow up either my GP report, the OT report or my carer's input.”

“The centre in Bristol is at flowers hill. It's a concrete bunker at the end of a long and boring bus ride. Very awkward to get to and depressing place. Not great if you're suffering from post-traumatic stress and depression. Having let food rot in the fridge and been too stressed to leave the house I figured out I could demand a home visit so I did. Haven't been back there since and I have no intention of doing so if I can avoid it. The first and only time I went there the assessor twisted everything I said and dumped me off incapacity benefit. The copy of the form (I had to request in advance) was full of lies. Didn't have it in me to appeal at the time and it took ages before I could reapply to go back onto IB. Home visits have been better for all the obvious reasons. The first home visit was done by a real doctor and I had a person from the mental health authority there as a witness. (The doctor was shocked at the earlier story and didn't believe it until the health worker confirmed it). The last visit was done by someone who came over as being helpful and pleasant enough. That surprised me. I did my prep work like all these well connected tax dodging bigshots so gave him the answers I wanted to give him. As far as I'm concerned if they put as much effort into finding the sort of job I'd like to do that paid an amount I could live on it would be a better use of their money. But they won't do that because they'd have to give up control and admit they're wrong. “

These are just a minute sample of the vast quantity of complaints customers have about the assessment process. So before Grayling sounds off about the number of people who are refused ESA he needs to look at two things. Firstly he needs to understand the process and acknowledge how many social care workers advocate clients make a claim for ESA, even if their chances of success are small. Secondly he needs to completely revamp the entire assessment process and make it far more client-friendly.

But then if he did that he wouldn’t get the kind of results he is getting at the moment and he would find the vast majority of claimants are genuinely in need.