Ten Years of the Work Capability Assessment

Justin Madders Excerpts

Wednesday 24th April 2019 Westminster Hall

[Laura Pidcock (North West Durham) (Lab)]

I beg to move,

That this House has considered 10 years of the work capability assessment in relation to employment and support allowance and universal credit.

This feels like such an inadequate environment to describe the work capability assessment and its brutal consequences. I wish that every single person affected by the system could be here with us in the Chamber and look in the eyes of those who defend the system. I hope that when they have heard what I am about to describe, Conservative Members—there are not many of them—will feel shame, and that in this debate we can do justice to the experiences of those subject to the work capability assessment.

The work capability assessment for the employment and support allowance and universal credit should be a simple concept: people who have a physical or mental health problem or a disability that means that they cannot work or have a limited ability to work will receive a replacement income from the state. I will talk about the face-to-face application process and the assessment, which are draconian, elicit fear, deny justice and have, in some circumstances, ended up contributing to the end of life. As Frances Ryan wrote recently in The Guardian, suicide is becoming a feature of the system.

Everyone in the Chamber will know someone who is unable to work for whatever reason. Those with personal wealth are often able to avoid having to prove that they are worthy of income replacement. Because they have that personal wealth, they are safe from having to share every single detail of a condition or illness, and do not have to wonder if they will be believed. People without savings, on the other hand, are only one step away—one accident or one conversation with the doctor—from being subject to that system.

Let me set out some of the elements that we believe are wrong with the system; this is based on evidence gathered from my constituents when they come to surgeries, on submissions by professionals, and on the vast number of submissions I have received from people currently applying for this social security payment. In both the application form and the face-to-face assessment, the descriptors that enable a score to be given to assess a person’s ability to carry out tasks are essentially a functionality test. They cannot capture the fluctuating nature of physical and mental unwellness or disability and how that could prevent or limit the ability to work. People often describe feeling punished for telling the truth. Yes, perhaps they could go out unescorted on a journey somewhere, but the test is not interested in, for example, the panic attack before leaving the house, or the emotional recovery afterwards. Perhaps venturing to the supermarket will have been their only trip out that month, but making that journey could lose them their entitlement.

In reality, one day someone may be in the depths of despair, and the pain from their condition may be unbearable; the next day, they may be able to have a laugh over a cup of tea with a loved one. The question is, should they lie about that laughter or feel shame about it because they might get points deducted? Does that laughter render meaningless the pain felt the day before? Fundamentally, does that have any bearing on someone’s ability to work? I think not. The test ignores the complex reality of living with long-term or fluctuating conditions.

Many people have told us that they do not feel accurately represented by the reports written about them. Advisers have openly claimed that they see copy-and-paste jobs. A constituent read that they were apparently happy and confident during the assessment, when in fact they were crying and shaking. No wonder as many as 74% of ESA decisions are overturned at appeal, according to Citizens Advice. That, of course, is one of the consequences of using a private company to assess the medical conditions of people who need support. Not having people qualified in the condition or illness with which assessors are presented is also a huge issue.

It is claimed that Maximus incentivises health professionals through the number of reports they complete. Logic says that that could directly lead to a proliferation of inaccuracies. Ultimately, profit should not be made from ill health; it leads to corner cutting and misplaced priorities. To defend the marketisation of the process is obscene.

I am not sure whether the Government or Conservative Members realise just how truly terrified some people are of the brown envelope from the Department for Work and Pensions. They know that they will be forced through a long and extremely difficult process. They will have to attend an assessment, and the decision notice they receive about the outcome of their work capability assessments is often inaccurate and misleading, leading to a long and stressful appeal process of up to 18 months; that is 18 months without the entitlement that those people deserve and need.

The process exacerbates poor health, and the Government make things worse. When people, because of their physical or mental health condition, ask that their assessment be carried out at their home, the answer given is almost always no. My caseworkers and agencies have sent substantial evidence to private contractors to show that my constituents would have severe difficulty attending the assessment centre. The stock response is, “If the claimant can get to their GP or to the hospital, they can attend the assessment centre.” How cold-hearted is that?

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Does my hon. Friend not agree that there is a difference between someone going to a location quite close to their home, which they are familiar with, and an assessment centre that may be many miles away and difficult to get to unless they have their own transport?

[Laura Pidcock]

That is right, and in a place like North West Durham, where we have an inadequate and expensive transport system, it is unjustifiable not to have assessments carried out at home if someone is feeling unwell and faces stress in having to go to that assessment.

If the person does manage to get to the assessment centre, the assessor uses that as evidence of their ability to travel, walk, sit comfortably and cope with social interactions. One person got in touch with me to say that they had to sit in the assessment centre waiting room in soaking wet clothes due to their incontinence issues. Is this a system anyone can really defend? Is anyone really comfortable with a private provider forcing people to attend assessments in pain and with worry, to be degraded by the DWP?

If a person is found fit for work when they are not, that can have a huge impact on their mental and financial wellbeing. It can have a direct impact on their entitlement to housing benefit and council tax benefit, plunging them into destitution, and resulting in increasing debt, risk of eviction and untold stress. People wrongly found fit for work are then expected to do job searches and training, and are even sanctioned. It came as no surprise to any of us Opposition Members that in 2016 the UN concluded that the Government had committed “grave and systematic violations” of the rights of people with disabilities. That report should have seen an end to the Government, but they limp on.

For people who do go on to win at appeal, reassessment is too frequent. No sooner have they won than they are being reassessed—even people with terminal illnesses have to endure that. Imagine the retriggering of mental health difficulties when people have to describe, in assessment after assessment, historical sexual abuse to which they were subject.

Let me mention some of the contributions from people who got in touch. One person said:

“The process feels like psychological rape, expressly designed to make you feel that you are the absolute property of the state, that you are not a human being and that your continued survival is basically an affront to society.”

Another said:

“When you are disabled, you are defined by the able-bodied by what you cannot do, rather than what you can do. No disabled person wants to be a burden on society. They want to be an active contributor but are denied this by society”,

and that

“The whole thing should be abolished as it’s a cruel and pointless exercise in ideology.”

It is about ideology, isn’t it? This system, with its complexities, its high thresholds and the way in which employment and support allowance and higher rates of universal credit have been denied to so many, cannot be seen outside the context of almost 10 years of austerity and budget cuts, which have literally taken money from people who are disabled, unwell or dying.

What are the worst consequences, the ultimate results, of this brutality? Jodey Whiting, who lived in Thornaby, not too far from my constituency, took her life 15 days after her benefits were stopped for missing a work capability assessment when seriously ill. The independent case examiner found multiple failings on the part of the DWP, including it simply not following its safeguarding procedures. Her mum, Joy Dove, is campaigning for an independent inquiry into benefit death and I am sure everyone on this side would say “All power to her” in that campaign.

Stephen Smith, aged 64, who had chronic obstructive pulmonary disease, osteoarthritis and an enlarged prostate that left him in chronic pain, failed a work capability assessment in 2017, which meant that his employment and support allowance payments were stopped. Anybody who saw Stephen’s emaciated body on social media will have been horrified. Stephen died last Monday. Jeff Hayward, who won his appeal seven months after his death, had a debilitating skin condition and spent his last 18 months fighting a “fit for work” decision. Michael O’Sullivan, aged 60, from north London had long-term mental health problems, and the coroner found that the benefit process was a key trigger for his death.

These are the real-life tragedies of a broken system. I do not think I can bear to hear the Minister say, yet again and as his predecessor did, that we should come to him with our individual problems with the system. They are not individual problems; they are systemic failings, and a consequence of privatising social security and making £37 billion in welfare cuts.

Let us be honest: this is institutionalised bullying and harassment of sick and disabled people. I have no doubt that administrative ineptitude is part of it, but when the issue is on this scale, there can be no other conclusion. By deliberately stripping people of their rights, in order to disrupt the welfare state and the very concept of legal entitlement, the Government have trodden all over the expectation of citizens that they will be looked after in their hour of need. And what for? To replace the state with private and family provision, to boost the coffers of private insurers, and to replace legal rights with charity, subject to moral judgments of deservingness.

It does not have to be like this. How can our social security system be about security and not about punishment? The Labour party has rightly committed to scrap the work capability assessment. That will be a big step forward and will no doubt be welcomed by disability rights groups and welfare rights agencies alike. In the meantime, why do the Government not start rectifying injustices in the system by taking the vast amount of evidence from medical professionals, including GPs, consultants and nurses, into account? Testimony should be fundamentally believed. The culture permeating the DWP is one of disbelief that looks cynically on those who request help. Stressful, face-to-face assessments should be used only if there is an absolute necessity, such as a lack of evidence on which to decide on entitlement. Assessments should be a last resort.

The system should be designed by people who are experts through experience. Experts who understand how conditions affect the ability to work should be employed. Any social security system that replaces the work capability assessment as it exists today should not be a functionality test with arbitrary rules that do not account for the fluctuating nature of a person’s condition, disability or illness. There needs to be a revision of the assessment criteria, so that they are linked much more closely to the real world of work, or the work that the person was doing. Knowing whether someone can move a carton of milk with one hand cannot allow us to understand a person’s comfort or ability to work in a specific environment. Any process should include an assessment of the additional support that person would need to ease them back into the workplace. Recording of assessments should be standard, unless a person asks not to be recorded. The Government are dragging their heels on that recommendation.

Private outsourcing of the assessments has to be scrapped. The market has failed all aspects of the social security system, placing company profit before the needs of the people interacting with the system. When will the Government understand that private enterprise and illness are incompatible, and inevitably lead to the injustices that we see today?

When people are dealing with the stresses of not being in full health and of needing support for their disability or mental health condition, they should fundamentally not be subject to further stress, degradation and even abuse by the state. The system should be designed on the presumption that people are telling the truth when they come to see the assessors. They should not be forced though a humiliating and exhausting process that often results in them winning appeals at tribunal, with the help of the excellent but underfunded advice agencies and many of our caseworkers. For many people, their last fight on this earth is not with their illness, but with the state, and that fact alone should lead us to scrap this dreadful system.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Henry. I congratulate my hon. Friend the Member for North West Durham (Laura Pidcock) on securing the debate and on the excellent way in which she introduced it, covering a range of issues. I felt compelled to speak because many of my experiences with constituents are similar to those we have heard. I have received the clear message—I hope the Minister receives it as well—that improvements to the assessments process are very much needed.

Some constituents who have attended assessments have raised concerns with me about the fact that assessors carry out the assessments very quickly and do not listen to their answers. We have touched on the refusal to conduct home assessments, sometimes despite medical evidence that they are necessary. On one occasion, a constituent suffering from agoraphobia was refused a home assessment. Surely the need for one in that situation was obvious.

I note from an overview of the work capability assessment mandatory reconsideration and appeals process that, from October 2013 to June 2018, 33% of assessments were closed by the claimant. That is 1.3 million people—not a trifling number. The Government line may be that all those people pulled out of the process because they were fit to work, but I doubt it is as simple as that. My worry is that there are people within that 1.3 million who would be entitled to ESA but did not go through with the process because they were too anxious or worried about the assessment or because they simply could not cope with the idea of having to discuss their intimate medical issues with a stranger. I would like to know from the Minister whether any research has been done into those 1.3 million people, the reasons why they withdrew and whether people in genuine need have been failed.

The study goes on to say that 15% of all applicants go on to register a mandatory reconsideration, which is 370,000 people within that five-year period. Some 85% of those reconsiderations stick with the original decision, and 21% of those people then go on to submit a formal appeal. There is sometimes a misconception that the mandatory consideration is the appeal stage, and that there are no further opportunities to challenge. However, those who carry on to launch an appeal have a success rate, according to these figures, of 63%, although we heard from my hon. Friend that, according to the CAB, it is more like 74% or 75%.

[Danielle Rowley (Midlothian) (Lab)]

My office team has experience of constituents challenging assessments and getting nowhere until they come to our office and we get a reconsideration straightaway, which gives the impression that they are not taken seriously. It is the exact same evidence, but they are not listened to until we get involved. Does my hon. Friend agree that that is a sad state of affairs?

[Justin Madders]

I find that disappointing, but not surprising. The fact that the appeals success rate is so high suggests that not only the initial assessment is flawed, but the mandatory reconsideration stage is not a proper appraisal of the full merits. Perhaps that takes place only when Members of Parliament get involved. A cynical view would be that the mandatory reconsideration stage is just a hurdle put in front of people to make life a little more difficult for them. I am shocked that recent figures for the appeal stage show that the DWP does not even bother to turn up to about 80% of the appeal hearings.

I want to pay tribute to my fantastic local CAB, which represents people at the appeal hearings. However, it cannot help everyone, and it is the people who are not able to get representation I worry about.

Given my constituents’ experiences, there is no doubt that the original assessments are flawed. Many decisions are overturned at tribunal, and it seems the system does not learn from its mistakes. For example, one constituent was assessed five times in eight years of being on ESA. At each assessment she was found fit for work. On each occasion she appealed and on each occasion she won that appeal. In the process she paid £150 to get medical evidence to support her appeals. How can the assessment process get it wrong five times? How can the absolute waste of public money that five separate appeals must have cost be justified when the final decision was the same every time? What does it say about the Government’s approach to people with long-term conditions? How many times does someone have to prove that they are ill and unable to work?

Last-minute cancellations have also been an issue. I have heard from constituents whose assessments have been cancelled on the day the assessment is due to take place, and in some cases the constituents were actually at the assessment centre when their appointment was cancelled. That seems to be particularly the case when the assessment is scheduled for a time after half past three. The most recent example involved a lady who was struggling when entering the assessment centre. Obviously, it is a very stressful experience. She was shaking, crying and not engaging, and then she was told that her assessment would be delayed by another 45 minutes, at which point she became so distressed that she had to leave the centre and cancel the appointment. That is a callous and uncaring way to treat someone. When one of my constituents rang up two days before her assessment to give notice that she would not be well enough to attend, she was told that it was too late for the assessment to be rescheduled and she would be recorded as a no show. It is double standards of the highest order.

In conclusion, people with long-term conditions deserve compassion, respect and support. They should not be made to feel they are on trial because they are ill.