Employment and Support Allowance and Work Capability Assessments

Anne Begg Excerpts

Thursday 5th February 2015 Westminster Hall

[Dame Anne Begg (Aberdeen South) (Lab)]

I am delighted to be given the opportunity to discuss one of the more recent reports of the Work and Pensions Committee, on the operation of employment and support allowance and the work capability assessment.

Many people going through the ESA claims process are unhappy with the way they are treated and the decisions made about their fitness for work. Atos, the current provider of the WCA, became a lightning rod for all the negativity about the ESA process and is exiting its contract at the end of the month. Our report concluded that the flaws in the ESA system are so grave that simply rebranding the assessment used to determine eligibility for ESA—the WCA—by appointing a new contractor would not solve the problems we identified.

We called on the Government to undertake a fundamental redesign of the whole ESA process from end to end to ensure that the benefit’s main purpose—helping claimants with health conditions and disabilities to move into employment where that is possible for them—is achieved. We acknowledged that a redesign could not happen overnight, but the current system needs to be improved now, because it is causing claimants considerable distress and anxiety.

During our inquiry, the Department for Work and Pensions announced that the contract with Atos to carry out the WCA would end and that a new private contractor would be found. We believed that that provided an ideal opportunity to make shorter-term improvements to the process. We recommended a number of changes to help claimants receive an improved service and to make the decision-making process and the outcomes for claimants more accurate and appropriate.

The DWP announced that the new private contractor—Maximus—will take over the WCA contract from 1 March. We hope that the DWP and Maximus will use this new start to address the problems our report identified. However, it is important to remember that the DWP makes the decision about a claimant’s eligibility for ESA—it is not Atos, and nor will it be Maximus. The face-to-face assessment is only one part of the process. On its own, putting a new private provider in place will not address the problems with ESA and the WCA.

In response to our report, the Government said they were already doing some of the things we said were necessary. They rejected some recommendations altogether, including our call for a fundamental redesign. However, since our report was published, Dr Litchfield has published his independent review of year 5 of the WCA, and he clearly shares many of our concerns, as Professor Harrington did in the first three reviews.

One key issue our report identified is that ESA is not achieving its purpose of helping people who could work in the short-to-medium term to move back into employment. Our recommendations for the ESA redesign therefore focused on ensuring that the process properly identifies claimants’ health barriers to employment and the particular support they need so that the conditionality they are subject to, and the employment support they receive, can be tailored more closely to their circumstances.

Linked to that is our finding that the outcomes of the ESA claims process are too simplistic. Claimants can be found fit for work, in which case they are not eligible to claim ESA. They might be able to claim jobseeker’s allowance, but many are reluctant to do that, because they know they will not be able to meet the job search commitments required as a result of being on JSA. The DWP has repeatedly said that jobcentre staff can tailor conditionality to the needs of individuals with a health condition or disability, but the extent to which that happens in practice is very patchy.

Claimants found to have such limited functionality that they cannot undertake work-related activity are placed in the support group, where they are subject to no work-related conditionality. The numbers placed in the support group have increased steadily since ESA was introduced, because the Department has now realised that, surprisingly enough, many people who were claiming incapacity benefit had serious long-term conditions that meant they were unable to look for work—that is why they were on incapacity benefit in the first place. Such people should be not only not expected, but not mandated, to look for work.

We therefore have two extremes: people are either fit for work or not fit for any work. In the middle, however, there is a huge group that has become known as the work-related activity group, and everyone else is placed in it. These people are not yet fit for work, and they may even have a deteriorating condition, but they are required none the less to undertake work-related activity. Our report concluded that the WRAG covers too wide a spectrum of claimants with very different prognoses. Their employment support needs are not being properly assessed in the WCA or by the employment support providers they are referred to, so they are not getting the help they need to return to work. Proper account needs to be taken of where a claimant in the WRAG is on the spectrum of readiness for work, given the wide range of conditions and disabilities this group of claimants encompasses and the different impacts the same condition or disability can have on an individual claimant’s functional capacity.

To improve the process of assessing health-related barriers to employment, we recommended that a separate assessment of those barriers be reintroduced. The original design of ESA included a work-focused health-related assessment, which the Government suspended in 2010, and such an assessment, or something similar, should be introduced.

We were also concerned about the descriptors used in the WCA process, because they are a very blunt instrument for assessing the functional impact a particular condition or disability has on an individual. That is particularly true of mental health problems, cognitive problems and fluctuating conditions. The descriptors, including their effectiveness and the way they are applied, should be re-evaluated as part of the redesign.

The Government turned down our request for a major redesign, but there are things we thought they could do in the short term, so let me list some of the changes we would like to see. The DWP acknowledged that the contract with Maximus will cost more money, but that is justified if the service to claimants is better. To ensure that it is, the DWP needs rigorously to monitor Maximus’s service. If the service to claimants falls short, the DWP must take immediate action, including imposing contractual penalties on Maximus. Such careful monitoring by the DWP of service standards did not always happen with the Atos contract.

We recommended that, where possible, paper-based assessments are used to place people in the support group, where a person’s health condition or disability clearly has a severe impact on their capability to work, and that people are not required to go through a WCA. Unnecessary and too frequent reassessments should also be avoided, especially for people with deteriorating conditions and for claimants who have just been successful in an appeal. That will be quite important in the new contract, because Atos has effectively given up on doing those reassessments as it exits the contract, and Maximus will have to address the issue. There is still a problem with too frequent and inappropriate reassessments for people with deteriorating conditions.

The DWP should improve the way it communicates with claimants. The letters sent to claimants are too technical and complex. They need to be in plain English and to avoid using jargon. We wanted to ban the terms “limited capability for work” and “limited capability for work-related activity”. Mr Walker, if you can tell which one puts somebody in the support group, the WRAG or the JSA fit-for-work group, you probably understand these letters better than most claimants, and certainly better than some members of the Committee. I think that having “limited capability for work” means someone is in the WRAG, and that “limited capability for work-related activity”, means that they are in the support group; but who knows? It is part of the confusion. We want the DWP to make changes to the language in the letters to claimants.

In response to our report, the Government said that they are reviewing all ESA communications and that they plan to introduce a new version of the ESA50 form that claimants complete to apply for the benefit. It would be helpful if the Minister would tell us whether the new form is now being used and what progress has been made in reviewing the ESA letters and other communications.

The aim of some of our recommendations was that the DWP should take greater responsibility for the end-to-end ESA claims process. Atos became the target for claimants’ anger at the way the process was carried out, as if somehow the Department for Work and Pensions was not involved. We believe that the DWP rather than Maximus should decide whether claimants need a face-to-face assessment. Again, the Government did not seem to be persuaded by our arguments for that change, and it would be helpful if the Minister would explain why.

We also recommended that the DWP should proactively seek “supporting evidence” for the impact of a claimant’s condition or disability on their functional capacity, rather than, as is the current arrangement, leaving it primarily to claimants, who often have to pay. We also believe that the DWP should stop relying so heavily on GPs for supporting evidence, because they are often not best placed to provide the most useful information. Other professionals, including social workers and occupational therapists, often have a better idea of the impact that a condition has on a person, as opposed to knowing about the medical condition.

Paul Gray made similar recommendations about seeking supporting evidence from professionals other than GPs in his review of the personal independence payment assessment. He also made the very sensible point that the DWP should take steps to share information from the different assessments that many disabled and sick people go through in rapid succession—particularly in the WCA and PIP processes, but also for social care assessments—rather than persisting with the current duplication and repetition. That happens again and again, and claimants feel angry when they have already given information once or twice. Sharing information is important. It would be helpful if the Minister could tell us whether he envisages the DWP acting on Paul Gray’s proposal.

Our report also dealt with the issue of putting claimants in the WRAG when their prognosis is that they are unlikely to experience a change in their functional abilities in the longer term. Perhaps the problem is that the WRAG encompasses such a wide range of conditions. Some people’s prognosis is that they will get better, while others’ is that they will get worse. Yet they tend at the moment to be treated as a homogeneous group. The WRAG serves as a default group, and because there is no work-focused health-related assessment those in it are not properly assessed to see what would help them back to work.

We were particularly concerned about people with progressive conditions such as Parkinson’s disease. If they are not expected to be able to work within a reasonable time scale, because their condition is getting worse, they should be placed in the support group, so that work-related conditions that they cannot fulfil will not be imposed on them. The Minister said in oral evidence to the Committee last week that he would respond to that point more fully today, and I hope he is now in a position to do that.

We made recommendations about the mandatory reconsideration and appeals processes, but time is moving on and perhaps other hon. Members will raise those important matters.

Providing financial support to people who are too ill or disabled to work is a fundamental part of the benefits system. Of course it is right that people should be encouraged and supported to return to work when their condition allows them to, but the help that they need through that process must be properly assessed and tailored to their personal circumstances. The Committee does not believe, on the basis of the evidence from our inquiry, that the current ESA process has been shown to be effective in fulfilling those functions. We stand by our call for a fundamental redesign of the ESA and the WCA. I look forward to hearing the Minister’s views on why the Government do not agree with us.

--- Later in debate ---

[Dame Anne Begg]

I thank the Minister for his reply, and he has been thoughtful in his interpretation of some of our recommendations. It goes without saying that we would always like him to go further, but there has been some movement since the publication of our report.

The new contract, as the Minister has just said, kicks in on 1 March, when will see whether Maximus makes a difference. We are saying that the whole system is flawed, however, particularly the WRAG. Even if the WCA is improved, there is still a problem if the majority of people—a wide range—end up in that group by default. It is impossible to reconcile the preparation required by people who are moving towards work with the needs of those alongside them who are moving away from work. There is a wider context, because we live in a society that treats disabled people in a particular way, so the fact that someone is ready and able to work does not necessarily mean that they can get a job. That depends on a whole range of other things, from access to prejudice or discrimination by employers.

I pay tribute to the members of my Committee; I think I must have the hardest working Committee of any in the House. We have quite a wide range of political views and personalities, but when we are dealing with an important issue and we want to get it right for our constituents, we often bring very specific knowledge from our own constituency casework, which informs the work that we do in the Committee. We think that the subject is very important, and we are always grateful when the Government listen, but sometimes they need to listen a wee bit more.

Question put and agreed to.