An Independent Review of the Work Capability Assessment – year four (Paul Litchfield)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265351/work-capability-assessment-year-4-paul-litchfield.pdf

Context

The Work Capability Assessment (WCA) is a process purported to determine whether a sick or disabled person has “limited capability to work”, which is required for a UK benefit claimant to continue receiving the Employment and Support Allowance (ESA).  The process has been bitterly criticised by many who are in fact sick or disabled, and is subject to an annual “independent” review.

Some understanding of the process and criticisms that have been made can be found here and here.

The author of the 2013 review is Doctor Paul Litchfield, who has had a long and distinguished career connected with government and corporate initiatives on health care.

Summary

Boiled down even further from the Executive Summary, this is my impression of the gist of the review.  I’ve tried to be reasonably fair and objective, but my prejudices may be showing through in places.

WCA is a functional assessment, not of the claimant’s diagnosis or condition, but of their ability to function.  

This review can determine whether, following various changes, the WCA operates as intended.  The length and complexity of the process makes people feel it’s unfair even if it isn’t, and some recommendations are made here to improve these perceptions.  Improvements are also proposed with regard to mental health.

The DWP has made progress with the recommendations made by previous reviews.  A major exercise on mental, intellectual and cognitive descriptors was not completed in time for this review.  Properly evaluated pilots are important.

Key findings

  • The WCA is an effective way to assess eligibility for ESA, though the points score is somewhat arbitrary and can be distracting.

  • There is considerable dissatisfaction about the objectivity of the WCA.  People need to be treated with respect and must understand the system better, particularly the roles of HCPs and DMs.  The DWP needs to convey a clearer narrative with the assistance of the “nudge” unit.

  • Healthcare providers (HCP) are not sufficiently regarded as trusted advisers in decision making, by comparison with medical records.  Treatment of cases identified as more or less complex may create a bias toward finding people unfit.  More senior staff should see the borderline cases.

  • The WCA takes too long and can be improved, particularly by work with the BMA on the ESA113 medical report form.

  • Mental health is difficult to assess; medical diagnoses may not help in determining fitness [for work].  The ESA50 now asks for non-medical evidence on functional capability.  DMs and HCPs need to be better informed and better trained.

Northern Ireland

The system in Northern Ireland is similar but smaller and therefore less complex.  Previous recommendations, where relevant, have mostly been implemented.  Mental health has an even higher profile.

Issues

I have not yet made it to page 102 of the report, so anything I have to say for now will be based on the Executive Summary.

The review goes so far as to conclude that the WCA is a “reasonable and pragmatic tool”.  It does not concern itself with whether people found “fit for work” are actually fit for work, or with what kind of work they may be fit for, whether such work exists, or whether it would be a useful application of their resources and those of the State to require particular groups of people to seek work in particular circumstances; nor with the consequences for those who, having been deemed “fit for work”, cannot actually work in the real world.

It is largely assumed that if individuals have a poor impression of the WCA, that must be because the DWP has failed to communicate a sufficiently clear narrative; or at most, because it has failed to exhibit sufficient respect.  The idea that the WCA might be seriously flawed or abused for cynically political purposes is nowhere in this conceptual landscape.

It must also be a humorous suggestion that the HCP (Atos Healthcare) should be regarded as a “trusted adviser”, even though the abuses and failures usually blamed on Atos plainly must result from the (overt and implicit) demands of the DWP rather than from any special malice or incompetence belonging to Atos themselves.

One has to wonder, even without regard to the concerns about Litchfield’s background expressed by DPAC below, whether this is a usefully independent and thorough review.

Responses

Scope

Disabled people face huge challenges when it comes to work, such as a lack of skills and experience, confidence and even negative attitudes from some employers. The Work Capability Assessment ignores all of this. It’s a tick-box test of someone’s medical condition.

Disabled people have lost all faith in this test.

[…]

The fitness-for-work test is broken. If the Government is serious about getting more disabled people into work, they need a test that is the start of the process that gives disabled people the specialist, tailored and flexible support they need.”

Disabled People Against Cuts (DPAC)

Dr Paul Litchfield […] was part of the Mental Health Technical Working Group commissioned by DWP in 2006, with, among others, Sue Godby from the College of Occupational Therapists and Unum Provident, and Dr Angela Graham from Atos Origin, to develop ‘proposals from transforming the Personal Capability Assessment (the forerunner to the WCA), from an incapacity-based tool for determining entitlement to Incapacity Benefit to a more positive assessment incorporating assessment of capability and of health related interventions which would contribute to overcoming health-related barriers preventing people with disabilities  from engaging with work’.  

Disability Rights UK

There is little or no recognition by Dr. Litchfield of the widespread anger and criticism of the poor standard of medical assessments carried out by Atos Healthcare Professionals. Instead, he advises that DWP Decision Makers “view Atos HCPs as trusted advisers”.

Ekklesia

Independent reviews are supposed to be just that. It is hard to understand how our findings can be so very different to those of the Mr Litchfield. We think that he and the government owe an explanation.

Papworth Trust

The Department for Work and Pensions (DWP) should restart publishing statistics showing the comparison between outcome at assessment, reconsideration and appeal stages to allow greater transparency and monitoring of the system.

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