WCA evidence-based review

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/265471/wca-evidence-based-review.pdf

Context

Resident citizens of the UK who are disabled or ill may be supported by State payments called “Employment and Support Allowance” (known as ESA).  Continuing entitlement to these payments rests on the “Work Capability Assessment” (WCA), in which a Decision Maker (DM) from the government Department for Work and Pensions (DWP) assesses evidence that results, in part, from the ESA50 form and an interview conducted by Atos Healthcare.

The WCA has been criticised as producing harsh and unreasonable results that are often overturned on appeal – a lengthy process that must in itself deter many sick and disabled people – and which in the interim causes immense hardship and distress.  The British press provides an unending supply of anecdotes about claimants who were deemed fit for work while very obviously unwell or disabled, and who in many cases died shortly after being assessed.  A number of suicides has been connected with the WCA and its consequences.

The Conservative government (“centre right”), in power since the General Election of May 2010,  has been blamed for most of the problems caused though the ESA and WCA were introduced on a more limited scale by the preceding Labour (“centre left”) government.  The government’s general response to criticisms has been to withhold information and to introduce obstructions in the appeal process.

More detail can be found in the 2013 report from the Spartacus movement.

Summary

This “evidence based review” was an attempt to measure the effectiveness of the existing Work Capability Assessment (WCA) as compared to an Alternative Assessment (AA)

600 ESA claimants were recruited (73% consent rate) when they attended a WCA at one of two centres.  Participants were asked to cooperate with

  • a standard WCA with an observing “health care professional” (HCP) as well as the HCP conducting the assessment

  • an additional interview with only the observing HCP, to collect any extra details needed for the AA

  • in 250 cases, the assessment was repeated from paper evidence, “independently by another two HCPs”.  It isn’t clear if these HCPs were independent of each other (2 further assessments per case) or only of the original assessment (1 further assessment per case).  [Update:] That is, the papers were assessed twice more, once by each of two new and separate HCPs.

  • An additional set of criteria was devised by a panel of 90 experts and applied to the evidence collected in the WCA and AA interviews.

The AA tended to produce higher scores for limited capacity to work.  Claimants preferred the AA; HCPs found the (partial) AA was useful though it’s not clear whether they preferred it.  However, the expert panels tended to produce results nearer to the WCA than the AA.  The paper reassessments were highly consistent for the WCA, but only moderately consistent for the AA.

Issues

  • Claimants arriving for a WCA were asked whether they wished to participate in the exercise.  This might systematically exclude claimants whose health condition or other circumstances made this extended process difficult.

  • The examinations were conducted by Atos Healthcare.  In view of various news reports it might be rash to assume good faith or appropriate diligence.

  • On the other hand, the claimants and HCPs were all aware that an exercise was being conducted and might be expected to be on their best behaviour.  We would not expect this exercise to detect the effects of any deniable targets (or “norms”) that might be significant for WCA in normal  conditions.

  • The WCA, the AA, and the expert panel criteria were all devised by individuals from a limited set of experts who may well subscribe to an industry-wide consensus on health issues as they relate to capability for work.  These methods of assessment were compared with each other and tested for consistency.  There was no comparison with any objective criteria, nor with actual health or employment outcomes.  This exercise should not be understood as supporting or vindicating the WCA except in these very limited terms.

[Updated 14 December to add Context section above]

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  1. Pingback: Mind film about the Work Capability Assessment (WCA) « Derby People's Assembly

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