Work Capability Assessments

Eilidh Whiteford Excerpts

Tuesday 9th February 2016 Westminster Hall

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

It is a pleasure to serve under your chairmanship for what I think is the first time, Mrs Moon. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing this debate.

The dysfunctionality of the work capability assessment has been a recurring theme in Parliament for as long as I have been here. It has been a running sore for the Government, so I am glad that in recent months they seem finally to have acknowledged that tinkering with the system will not fix it, and that a fundamentally different approach is required. I look forwarded to the much-heralded White Paper expected this spring, which I hope will tackle some of the problems.

We have heard about a wide range of problems associated with the work capability assessment. If the Government are serious about devising a better system, it is important that we all understand the present shortcomings fully, so that we are not destined simply to reinvent the wheel and create another heartless bureaucracy that fails to provide the safety net of support that people need when they are sick or disabled.

Over the last few years, successive reviews of the work capability assessment have been conducted by Professors Harrington and Litchfield, and various attempts have been made to improve the process, some of which it is fair to say have helped around the edges. However, due to recurrent problems with getting appropriate medical background information on claimants’ conditions, with how claimants are categorised and with the accuracy of the assessments, the impact has been limited. One private sector contractor has left early under something of a cloud, as the hon. Member for Sheffield, Heeley described in some detail, and another company has taken over the contract with a remit for changes, spending more money per assessment and awarding support to a larger proportion of claimants.

However, the underlying problems are still there. The work capability assessment itself remains unfit for work. Many claimants wait an inordinate time for assessment: as we have heard, it takes an average of 23 weeks for a decision, and the current backlog is 280,000 cases. I know that my constituents are still battling the challenges of travelling significant distances from remote and rural locations to assessments. In the past, constituents of mine who have made long and expensive journeys have been sent home unassessed because their appointment was double or even triple-booked. That does not apply only to my area; it echoes a point made by the hon. Member for West Lancashire (Rosie Cooper). Such administrative issues, particularly delays in assessment, cause claimants distress and financial hardship at a time when they may be exceptionally vulnerable and facing severe financial worries due to a sudden and sharp drop in income after a breakdown in their health.

However, the greatest weaknesses of the work capability assessment relate to how it measures the impact of fluctuating and progressive conditions on a person’s fitness for work. Several hon. Members, including the hon. Member for Birmingham, Selly Oak (Steve McCabe), my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) and the hon. Member for Glasgow East (Natalie McGarry), mentioned the situation of people with mental health conditions. My hon. Friend the Member for North Ayrshire and Arran mentioned Parkinson’s UK, which cites examples of assessments conducted by staff who lack the basic clinical knowledge to understand that Parkinson’s is a progressive and incurable condition that will deteriorate over time. I am not a medic, but even I know that. It seems pretty basic to me.

That is why it is crucial that additional evidence from qualified clinicians familiar with the claimant’s health be brought into the assessment process from the start. I pressed Ministers on this issue repeatedly during the previous Parliament, but we now have an opportunity to get it right and ensure that we have the information in the system to make good decisions possible.

[Mark Durkan]

Does it not strike the hon. Lady that although we often hear from the Government, in relation to many other arguments, that policy and Government decisions must be based on evidence, on this fundamental matter the Government rigged the legislation, so that medical evidence could be ignored in favour of the bizarre assumptions and interpretations that the people who carry out the tests come up with?

[Dr Whiteford]

As ever, the hon. Gentleman makes an important point clearly. There is no reason why people’s medical history should not be included in the assessments. Often, consultants—sometimes it is a GP, but in cases of serious illness it is more likely to be a consultant—are in a position to provide insight into the longevity of a condition as well as its immediate acute effects.

[Neil Coyle]

Is the hon. Lady aware that the Government, during the last Parliament, also shortened the timeframe within which individuals can provide independent medical evidence? As it takes longer to see a consultant or specialist, that inevitably means that some people cannot provide that information in time, which contributes to the number of reassessments, the backlog and the cost to the taxpayer.

[Dr Whiteford]

The hon. Gentleman is absolutely right. The shortening of the timeframe makes it extremely difficult for people to contribute, which is why that opportunity needs to be included right at the start. If people can nominate someone—an advocate, a consultant, a GP or a community nurse—to provide such information as part of the application process, we could get around a lot of those problems.

For people with complex disabilities, people who suffer from more than one condition or people whose condition fluctuates, the tick-box exercise of the work capability assessment fails to capture the impact of their health on their ability to work. Around half of those in receipt of employment and support allowance have a mental health condition, yet the work capability assessment has proved poor at accurately assessing conditions that are not visible, and people with mental health or incapacity issues are not always able to articulate well the effects of their condition.

I pressed hard during the last Parliament for improvements to how mental function champions operate within the assessment process, but there is increasing evidence that as things stand, the work capability assessment causes so much distress and anxiety for some people that it is actively harming their health, pushing them further away from being able to work and—in extreme cases such as the ones mentioned by the hon. Member for Glasgow East—towards harming themselves.

The Royal College of Psychiatrists has expressed serious concerns for some years about the impact of the work capability assessment on the health of people with mental illness, but as evidence of harm grows, the college is becoming more outspoken. As my hon. Friend the Member for North Ayrshire and Arran pointed out, robust research conducted at the universities of Liverpool and Oxford suggests a correlation between mental health problems and the roll-out of work capability assessments. That backs up the findings of voluntary sector service providers such as the Scottish Association for Mental Health, which has extensive experience of people who use its services suffering setbacks in their recovery due to the assessment process.

The bottom line is that too many people are still being wrongly assessed. We know that because of the extraordinary success rate when claimants who have been found fit for work appeal that decision. Between 2010 and 2013, it hovered around the 40% mark; since the introduction of mandatory reconsideration in 2013, it has shot up to around 54%. In other words, more than half of those who appeal are likely to get the original decision overturned. Successful appeals on that scale indicate major underlying flaws in the assessment process, and they cost the Government a lot of needless time and money. More than that, they mean that sick and disabled people are left feeling abandoned and desperate for months without the support that they need. The human cost is enormous, as is the financial cost, as the National Audit Office has pointed out.

We must also remember those who do not appeal but who are nevertheless extremely unwell or seriously disabled. Many people in our constituencies who are destitute or living in extreme poverty are people whose access to ESA has expired, or who have been found fit for work but cannot qualify for jobseeker’s allowance—because they really are not fit for work and cannot comply with the conditions attached to JSA, or because they have tried to comply but have been sanctioned, or because they have disengaged from the system altogether and have simply dropped out of view.

I have no idea how many people fall into that latter category, but I know that I am meeting such people regularly. They live off other family members or friends, some of whom are themselves not wealthy, and they depend on food parcels from church voluntary groups or food banks. Consequently, when the Government consider how they might proceed with a replacement for the WCA, they need to take on board the systemic failures of the current approach and think beyond simplistic functionality.

The first and probably the most valuable thing that the Government could do is to work with disabled people and their representatives from the outset. Throughout the past few years, health and disability organisations have been coming forward with constructive suggestions to improve the existing system, and contributing to the successive reviews. Some of their ideas have been taken on board, at least partially, but the opportunity presented by a new White Paper to get stakeholders around the table and—more significantly—really listen to what they say has never been more important.

I also urge the Government to go back to the work that was done around the evidence-based review of 2012-13 and the alternative assessment that was developed under that process. I know that Ministers were not convinced by that review at the time, but a lot of water has flowed under the bridge since then, a much stronger evidence base has been developed and I think there is a lot of substance in that review, not least in the way that it suggests descriptors that would account for the impact of pain and fatigue on a person with an illness or a long-term condition. That review could really usefully inform a new approach.

Lastly, I urge the Government to learn from international experiences. The UK does not have a disproportionately high number of sick and disabled people compared with the rest of the OECD. Clearly, there are regional variations, even within the UK, with higher numbers of claimants in economically deprived or heavily industrialised areas, where health outcomes and life expectancy are significantly lower than average. On the whole, however, we are grappling with the same challenges as other industrialised countries and on a broadly similar scale.

A number of countries have used what have been called “real world incapacity assessments” that take account of a person’s age, skills and work experience, as well as their health or disability, when assessing their fitness for work and considering what kind of work they might be able to do. This seems just to be common sense and means that someone is assessed as a rounded human being. The same condition with the same severity will affect two people differently in relation to their ability to work, depending on whether their work experience has been in physically demanding manual jobs, whether they sit at a desk or whatever. The Government should explore the models used in other countries to see what is working well.

We all agree with the Government that the social security system needs to support people to move towards work, but it also needs to provide a safety net and a dignified life for those who are not fit for work, and not only those who will never return to work but those with long-term conditions and those who need time to recover from serious illness or injury.

The work capability assessment has failed a lot of sick and disabled people, and it has proved extremely inefficient. What follows must be better, and I hope that the Government’s keenly anticipated White Paper will reflect the concerns that have been raised today.