Fourth independent review of the Work Capability Assessment (WCA)
August 2013
At Leonard Cheshire Disability, we work for a society in which every person is equally valued. We believe that disabled people should have the freedom to live their lives the way they choose - with the opportunity and support to live independently, to contribute economically, and to participate fully in society.
Introduction
We welcome this opportunity to provide evidence which looks at the overall effectiveness of the Work Capability Assessment (WCA) as a discriminator for fitness to work.
How we consulted
For the purpose of this review we have surveyed over 100 people who had gone through a Work Capability Assessment (WCA), a large proportion of which had undergone a face-to-face assessment. The evidence they provided is outlined below in answer to the questions of the review.
1. The WCA seeks to identify and differentiate between claimants whose condition(s) means they are:
a) unable to undertake any form of work related activity (Support Group);
b) currently unable to work due to illness or disability (Work Related Activity Group); and
c) fit for work. What evidence and examples can you provide as to the effectiveness of the WCA in doing this?
In your opinion, what are the strengths and weaknesses of the WCA identification process?
1.1 We have previously called for an independent review of work in relation to ill health and disability with the aim of producing a clear and applicable definition of “fit for work” which can then provide the basis of any eligibility assessment for ESA. This is yet to happen and whilst this is missing from the WCA, we feel that identification process will struggle to adequately differentiate between claimants who are fit for work and those who are not due to illness or disability. An effective assessment needs to measure the impact of an individual’s impairment on work opportunities and also take into account wider factors such as their skills and past workplace experience. The WCA should be reviewed to ensure it is relevant to all workplaces and to the opportunities and barriers provided by the wider labour market.
1.2 Furthermore, it is pertinent to note that the original intention of ESA was to identify “whether a person’s “capability for work” is limited by his physical or mental condition” (Welfare Reform Act 2007, 8.1) and then further distinguish between those who might be able to prepare for work through undertaking “work related activity” or those for whom this would not be appropriate. However, currently far fewer people are being awarded ESA than originally predicted and far lower numbers are being placed into the Work Related Activity Group. We are concerned that the role of the Work Related Activity Group has been increasingly side lined and further that the focus of the WCA is increasingly on identifying only those unable to undertake any work. This indicates that the Work Related Activity Group is not performing its intended function and that the Work Capability Assessment is not successfully identifying those individuals who might face extra barriers to accessing work due to an illness or disability and would therefore benefit from the additional support provided by ESA.
1.3 The findings from our recent call for evidence in response to this review helped us to identify what claimants felt were the strengths and weaknesses of the identification process. These included:
· The ESA50 form did not allow people to explain how their condition impacted on them;
· The face-to-face assessment was stressful and they did not feel it was an opportunity to adequately explore the impact of their condition on their ability to work;
· The assessment did not allow claimants the opportunity to explain whether they were able to complete activities reliably, safely and repeatedly;
· Particular groups of disabled people were at risk of inadequate or inappropriate assessments;
· The physical tests during the assessment contributed to already serious physical problems.
· The assessors lacked the necessary medical specialism’s to complete the assessment appropriately; and
· The final report was often inadequate, and misleading;
ESA50 form
1.4 The identification process begins with claimants filling in the ESA50 form, which is the claimant’s first chance to provide information about their illness or disability. For those where it is decided it is not necessary to attend a face-to-face assessment this is the only evidence provided to the decision maker at DWP and so it is an important part of the identification process. However, many respondents reported that they found the form very difficult to fill in because the questions were too complicated and did not provide the opportunity and flexibility for them to explain the impact of their particular condition. This was particularly the case for those who have fluctuating or multiple conditions. For example, one respondent said she was not able to explain in the form the problems caused by her memory loss, which was a secondary condition to her main disability, and it was not clear to her where she should be able to explain this.
1.5 The following quotes from respondents also highlight this problem.
There was not enough room for putting what one wanted to say and quite often I felt very stupid and almost pathetic having to try to work out if I could ' lift an empty cardboard box ' when there were no indications as to the dimensions, weight or if I had to lift it from the ground or from waist height. Can one push a telephone button? It feels as if you have a working finger it's a foregone conclusion that one finger makes one fit to work.
The forms do not cater for multiple conditions and certainly not people who suffer chronic pain. The wording is ambiguous and does not indicate that an explanation can be given even in the event of a no answer.
1.6 Some respondents even remarked that they felt that instead of giving them the chance to explain how their condition affected them, they felt like it was designed to catch them out, creating a lot of stress for them and contributing to an overall distrust in the process itself.
The ESA form was a nightmare to fill in as the questions were so vague and did not really ask the right questions, they seem to have been designed to either steer one in the direction that would lead to one looking much healthier than one really is or were loaded towards an answer of either yes or no when something in between would be more appropriate.
Its soul destroying, every step of the process is a trial designed to stress us out as much as possible, and to fail us at every opportunity.
1.7 Alongside difficulties filling in the form, many claimants said they had found it very difficult to attain the necessary medical evidence on time, as the following case studies illustrate.
I supplied them with copies of some recent doctor's letters and gave them contact names as my doctor was on annual leave and we found that for me with complex issues, 4 weeks was not enough time.
Amassing medical evidence should not be for the claimant to do. It is a nightmare trying to get these letters out of some doctors, with emails flying back and forth, reminders, printing, photocopying, etc. etc. The contact details of the medical professionals are clearly stated on the questionnaire: why doesn't the DWP contact the medical professionals directly if there is a need?
The Face-to-Face assessment
1.8 However, it was the face-to-face assessment with Atos which received the most criticism from respondents. The vast majority felt the assessment was unable to adequately capture the impact of their disability or condition on their daily lives.
1.9 Many problems with the Atos assessment appear to stem from Logic Integrated Medical Assessment (LiMA). Many disabled people told us that it was LiMA, or the interaction if Atos staff with LiMA, that drove impersonal, computer based medical assessments which are distressing to the individual and which discourage medical professionals from making an independent assessment of a person’s “capability for work”. For example, many respondents said they felt the assessor was asking a set of pre-determined questions rather than asking them questions which were relevant to their condition. The inflexible approach meant that they felt unable to fully explain the complexities of how their condition impacted on their daily lives, particularly where the impact did not fit into the tick boxes available to the assessors. Clearly, where important information cannot be communicated to the assessor, then mistakes will be made in the assessment process.
The assessor did not want to know any details really, just wanted the answers to their tick box questions. I tried my best to explain things but they weren't interested, even when I broke down in tears they were unsympathetic and just wanted to get on with their questions.
The Doctor was more interested in the computer screen and asked few relevant questions. Describing my health problems to suit tick boxes was very difficult, the assessor regularly had to re-word or change my answers to suit the system, luckily I had an alert friend with me who managed to help with the answers.
I felt as though I didn’t matter and if something I said didn’t fit into the system it didn’t count.
[I was] not able to explain anything. They had a set of questions to ask and only stuck to those did not want to know anything outside them
This is because they just go through the same things with everyone despite their condition. They never ask questions outside their questionnaire so never get a full picture of individuals.
I felt that I was never allowed to fully explain my ability to work, we just jumped from question to question with HCP just writing what he wanted to.
1.10 Further, disabled people told us that they did not see a clear connection between the questions asked by their assessor, and their ability to perform work of any kind. An effective assessment needs to measure the impact of an individual’s impairment on work opportunities and also take into account wider factors such as their ability to travel to work, and maintain their dignity while they were there. For many respondents, they did not feel this to be the case.
They claimed that I was able to sit down for over 30 minutes so a sedentary job would be OK. However, they fail to note how I could not stand for this length of time without experiencing extreme pain which I might have to do in a job. It was mentioned that because I could lift my arms up I could work in an office and lift empty boxes off a shelf. They made no mention how I would travel to work.
1.11 Many respondents felt the views of their carer were ignored, whereas they often had valuable insight into how the condition affected them on a daily basis.
I did not feel that [the assessor] asked me about my condition impacted on me on a day to day basis. When my husband, who accompanied me to the assessment, tried to explain to her [how my condition impacted on me] he was dismissed. I really did not feel the doctor felt his views were important, despite the fact he is my full-time carer and has seen how the condition had impacted on me during the last few years. When my husband tried to refer to the medical notes I had supplied, the assessor told us this evidence did not apply, that they were different to these doctors.
I was asked questions which did not seem to relate to my illness. I had taken a family member as support and they were not allowed to speak for me. I felt that I was not considered as an individual and although the nurse was courteous she did not seem interested in what I had to say. I was very anxious.
The assessor spoke [to my son] briefly. She was actually quite nice and understanding. She did her best to make everything as comfortable as possible for us, but I am aware that she doesn't have much scope for discretion when faced with a screen full of multiple choice answers in black and white, with no room for grey areas.
1.12 Those who felt they had particularly complex conditions were particularly critical of this approach.
The Atos doctor did ask how my condition affects to carry out activities. However, he did not listen to my replies in full and while I was still answering to his previous question he asked the next question already. Because my conditions are complex he did not ask enough or try to see it from other angles. I had a feeling I was just a number on his list of people to interview. He had no full understanding of my case - after I read his report it was a very limited view indeed.
Completing activities reliably, repeatedly and safely
1.13 There was also significant concern that the series of questions asked did not allow disabled people the opportunity to explain whether they were able to complete activities reliably, safely and whether they would be able to repeat the activity at all that day. Respondents also felt they were not given the chance to elaborate on the pain and/or exhaustion that resulted from attempting to carry out certain activities.
My issues don't fit snugly into a box and more emphasis should be placed on the reliably and repeatedly phase as this was completely ignored in my case