Work Capability Assessments

Sheila Gilmore Excerpts

Wednesday 12th June 2013 Commons Chamber

[Sheila Gilmore (Edinburgh East) (Lab)]

Most people here will probably be familiar with the employment and support allowance. Between the introduction of the assessment in October 2008 and February 2012, 1.36 million new claimants were assessed and of those 794,000 were declared fit for work. Of those, 311,900 appealed their decision and 116,400 were successful. That means that nearly one in 10 of all ESA assessments have been overturned. Although the proportion of decisions overturned has started to fall, the overall number remains very high. And those figures do not include all the incapacity benefit claimants currently being migrated to ESA—a process that started last year and is due to be completed in 2014. The cost of appeals is a considerable issue for the Government. This year it is projected to rise to £70 million, up from £50 million.

I have considered a number of detailed aspects of this issue. In May last year I secured a Westminster Hall debate on the recommendations for new descriptors for mental, intellectual and cognitive conditions that were drawn up by a number of charities. In December last year I secured another debate, in which I highlighted the fact that people are regularly called back for reassessments just months after their previous claim has been granted. Today I want to focus on the provision of audio recording equipment in assessments. I sent the Minister an advance copy of my speech, because this is a serious issue that deserves an attempt to reach a constructive solution. I will spare him the need to spend time telling me that it was my Government who started the employment and support allowance. I know that. It is people’s experience of the system that has shown many of us that it needs substantial reform.

The assessments carried out by Atos have been much criticised. Assertions have been made about some of the questions asked and the attitude of assessors. For example, I recently met a constituent—by no stretch of the imagination is she a disability activist—who told me that the assessor made a comment about her handbag, saying, “Well I couldn’t afford that, even on my salary.” My constituent tells me it was a present, but she felt the comment was irrelevant and carried the implication that she did not need the benefit. Such assertions are regularly denied by Atos and not accepted by the Department for Work and Pensions. We even have differences of opinion on the Select Committee on Work and Pensions, with some members feeling that campaigning organisations exaggerate such claims.

Audio recording of assessments would allow such disputes to be settled once and for all. Importantly, they would provide new evidence in the event of appeals, but should also improve the quality of assessments, thereby reducing the number of appeals and helping to get things right first time. Assessors would be prompted to ensure that their work was of the highest possible standard—for example, taking more time, asking open as opposed to closed questions, and probing for possible follow-up issues.

[Heidi Alexander (Lewisham East) (Lab)]

My hon. Friend is making an excellent speech about the importance of quality in the work capability assessment. May I bring to her attention the situation of my constituent George Rolph, who is currently on the 23rd day of his hunger strike about his treatment at the hands of Atos? When he failed his work capability assessment, he felt he had no choice but to take such drastic action to bring to the Government’s attention the failures of the system.

[Sheila Gilmore]

I thank my hon. Friend for giving such a graphic example of the human issues that lie behind what might seem to be quite a dry subject in many respects.

I was pleased when the year 1 Harrington review recommended that Atos should undertake a pilot to test the hypothesis that audio recording would make a difference.

[Jim Shannon (Strangford) (DUP)]

This is a vital issue in my constituency. Every week my office deals with issues arising from the Atos work capability assessment. People who go in for the work capability tribunal test receive no points at all or very few points. The question they ask is: “How can they disregard my health?” Would not the introduction of audio recordings enable my constituents and the hon. Lady’s to have confidence in the system?

[Sheila Gilmore]

That is exactly the point I am trying to convey. We want to improve the scheme and give people that confidence.

I was quite interested today to come across an online headline in the Daily Mail that said: “Record your builder to make sure he sticks to his word”. That was the recommendation from the Under-Secretary of State for Business, Innovation and Skills, the hon. Member for East Dunbartonshire (Jo Swinson). She was suggesting that that would help to resolve disagreements in those situations.

The pilot went ahead in Atos’s Newcastle assessment centre between March and May 2011, and an evaluation report was submitted to the DWP on 4 June 2011. In a Westminster Hall debate on 1 February 2012, the previous Minister, the right hon. Member for Epsom and Ewell (Chris Grayling), set out the Government’s position. He said that owing to a lack of demand, audio recording would not be rolled out for all assessments. Specifically he said:

“We decided not to implement universal recording because, based on the trial experience, people did not want it.”—[Official Report, 1 February 2012; Vol. 539, c. 292WH.]

I am afraid that that assertion is not justified. The Atos pilot concluded that

“68% of customers agreed to the recording when contacted by telephone prior to the appointment.”

Owing to some claimants not turning up for their assessment, or eventually deciding that they did not want a recording, the figure for those whose assessments were recorded dropped to 46%. That figure is still substantial, however, and the demand for audio recordings is reflected in one of Atos’s key conclusions, which stated:

“Our recommendation would be that recording should be become routine as it is in a call centre or, for example, NHS Direct.”

Parliamentary questions and freedom of information requests have yielded another metric to defend the Government’s position—namely, that only 1% of the claimants in the pilot requested a copy of their recording. However, that cannot be regarded as an accurate reflection of demand, for two reasons. First, assessors in the pilot used hand-held devices and the recordings had to be transferred to computers and burnt to CDs after the assessments. That meant that claimants could not pick up their recording on the day but had to go to the added effort of making a request in writing. In effect, that required claimants to opt into the pilot and then opt in again to get their recording. We also do not know what the claimants thought the pilot was about. Often, when we phone helplines, we are told on a recorded message that the call will be recorded for staff training purposes. It is possible that the claimants in the pilot were not clear about its purpose.

Secondly, claimants were told that recordings would be of use to them only in the event of an appeal. Given that the report was completed just days after the pilot concluded, most of those involved would not yet have received a decision on their claim, let alone come to a view on whether they would appeal. Demand for copies might well have been higher had this metric been measured after a longer period. I therefore ask the Minister to accept that the number of claimants in the pilot who requested a copy of their recording is not an accurate reflection of demand, and that the number of people acquiescing to their assessment being recorded is a more appropriate metric to use.

Turning to what has happened in the two years since the pilot, I want to refer back to the statement given by the previous Minister in Westminster Hall on 1 February 2012. In addition to claiming that there had not been much demand for audio recordings, he said that

“we will offer everyone who wants it the opportunity to have their session recorded.”—[Official Report, 1 February 2012; Vol. 539, c. 291WH.]

In practice, however, it is hard for anyone to have an assessment recorded. The option to request recordings is not mentioned in the official DWP communications to claimants. I was reassured to see that the DWP website was updated last week, on 6 June, and that it now states that the Department and Atos are going to amend written communications. It states:

“We are working to introduce more widespread information for all claimants as soon as possible.”

However, it is now two years since the pilot, and the Department is still “working” to have this included in its communications. It does not seem to be too complicated a sentence to include in letters to claimants.

My right hon. Friend the Member for East Ham (Stephen Timms) said in a debate on 4 September that even when requests are made, they are not always met because of a lack of equipment. A freedom of information response from 22 May this year indicated that Atos now has some 50 audio recording machines, but this is inadequate given that over 11,000 assessments are undertaken across the country every week. Another freedom of information request from 23 May suggests that this national roll-out may even be a temporary measure that will end later this year.

Will the Minister confirm when DWP communications will be able to inform claimants that they can have their assessment recorded? To how many audio recording devices does Atos now have access? Will he confirm whether the recordings currently taking place are part of a wider roll-out that is intended to be permanent or merely a further pilot?

The report from Professor Harrington in 2010 prompted the Newcastle pilot, and it is worth looking at what he has had to say on this issue since then. In his December 2012 report, which was his third and final one, he said:

“The pilot of audio recording of assessments has also been subject to much debate…The Review has seen little evidence from the DWP evaluation of the audio recording pilot of 2011 that the universal audio recording of assessments would improve their quality…further monitoring and evaluation work needs to be completed before a decision can be made.”

The Minister might like to interpret Harrington’s reference to “little evidence” as suggesting that audio recordings make no difference, but I would argue that what he was getting at was the inadequacy of the pilot commissioned and accepted by the DWP, which was why he called for more examination of the issue.

What the assessors did in this pilot was to take a small number of reports, review them in light of the recordings and conclude that they tallied with each other—that what the written report said and what the recording said were the same. Subsequently, to justify their policy, the main arguments from the Government have both highlighted and ignored the various metrics of demand mentioned in the report. Neither of those approaches answers the key question: do audio recordings improve the quality of assessments?

Instead, I would contend that the key performance indicator for the work capability assessment should be the proportion of decisions that are subsequently overturned on appeal. A more robust pilot would have involved taking larger samples of both recorded and unrecorded assessments and examining the proportion of successful appeals for both. If they were the same, it would have been fair to conclude the recordings make no difference; but if there were a smaller proportion of successful appeals from those that were recorded, it would be equally fair to conclude that they were worth while.

We need to be clear, too, whether the current roll-out is actually just another pilot still to be evaluated. If it is to be evaluated, it would be useful to know what is going to be evaluated. This has a relevance beyond the employment and support allowance because the DWP now says that it will make a decision about audio recording of personal independence payment assessments after the evaluation of the ESA experience. That is despite the fact that one of the companies tendering for that PIP assessment, Capita, originally offered to audio record all its assessments. Asking the right questions about what the evaluation is for is crucial.

[Nic Dakin (Scunthorpe) (Lab)]

Is it not important to test not only the impact on quality but the impact on the confidence of those assessed?

[Sheila Gilmore]

Indeed. As I think I said earlier, this may well answer some of the issues. If people are anxious about these assessments, their confidence would certainly be improved in this way. If, as some suggest, the assertions made by claimants are exaggerated, that would be established, too, and we would all be happier. We need to know—it is a bit unclear—whether we are going to re-run another pilot, whether what is going on is a pilot and, if so, how it is going to be evaluated.

In conclusion, I want to raise three sets of questions. First, will the Minister accept on the basis of how the pilot was carried out that requests for copies of audio recordings should not be cited as a reflection of demand, and does he accept that the number of people who want to have their assessment recorded is a more appropriate measurement to use? Secondly, will the Minister tell me exactly what steps are being taken, and how quickly, to inform claimants that their assessments can be recorded? If people do not know that that service is available, they will hardly ask for it. Will the Minister also tell me how many audio recording devices Atos now has access to, and whether there will be a wider, permanent roll-out or merely a further pilot? Finally, will the Minister accept Professor Harrington’s call for more work to be done, so that there can be a proper evaluation?

--- Later in debate ---

[Mr Hoban]

My hon. Friend is right to draw attention to how difficult it is for people to provide their own equipment, and to the importance of ensuring that proper controls govern such matters as consent.

Atos has access to 31 audio recording machines, three of which are currently being repaired. It also has access to 21 cassette machines which are on loan from the DWP. We constantly monitor the updating of audio recording assessments to ensure that the supply of the equipment meets demand.

Let me put our commitment into more context. Those who want an audio recording can request one, but a claimant has no legal right to an audio-recorded assessment, and neither the DWP nor Atos Healthcare has a legal obligation to provide an audio-recording service or equipment. Our commitment is based on our intention to provide the best possible service for claimants, but the unavailability of audio recording facilities does not mean that the WCA process can be delayed indefinitely. That could slow down the process unnecessarily. Since the introduction of audio recording, only nine requests have been refused owing to the unavailability of equipment.

As the hon. Member for Edinburgh East said, Professor Harrington’s first independent review of the WCA recommended that the Atos Healthcare pilot audio recording of assessments should be used to determine whether such an approach is helpful for claimants and improves the quality of assessments. In making that recommendation, Professor Harrington rightly noted the need to balance potential drawbacks such as the increased burdens on tribunals and the sharing of sensitive personal data, with potential improvements in both assessor and claimant behaviours.

Following that recommendation, the audio pilot took place in the Newcastle assessment centre during spring 2011. The pilot involved 500 claimants being offered the chance to volunteer to have their assessment recorded. The results of the pilot showed that less than half of those offered ended up having an audio recorded assessment and only a handful, less than 1%, requested a copy of their assessment.

The hon. Lady has raised concerns about the metrics we use when considering demand for audio recording. We feel that the metrics used are key in showing the exact demand during the pilot.

[Sheila Gilmore]

Perhaps the Minister was about to come to this point, but I am sorry that he has chosen simply to repeat the 1% figure without addressing the criticisms that have been raised—I have heard them from others, too. The context of the pilot made it difficult for people to get a copy and the pilot was then evaluated very quickly.

[Mr Hoban]

I do not think that it was that difficult to get hold of a copy. The recording might need to be held on a handheld device before it is transferred to a computer and a transcript is printed, but that does not stop people asking for a copy. I thought that was one point in the hon. Lady’s thoughtful speech that was not well substantiated.

The results also provided little evidence that audio recording of face-to-face assessments improved the quality of assessments. There was only limited evidence of improvement in the customer experience for some individuals. Of those who took part, fewer than half the claimants thought that audio recording would be helpful to them. Those are the key areas that Professor Harrington wanted to understand when he called for the original pilot. As a result the Department decided not to introduce audio recording of face-to-face assessments universally on the basis that a facility for all assessments would be extremely costly, with no apparent substantial benefit or improvement in the quality of assessments. We ensured that when claimants asked for an audio recording, we were in a position to provide that facility. That was not intended to provide a permanent solution, but it is important in helping to provide the evidence for further changes.

Let me say a little about current demand. Since the introduction of a limited audio recording facility in September 2011, fewer than 4,000 claimants have requested a recorded assessment. To date, Atos has conducted more than 2,000 audio-recorded assessments. During that period almost 1.5 million face-to-face assessments for both ESA and incapacity benefit reassessments have been completed. Therefore, the proportion of recorded assessments is less than 0.2% of all assessments carried out during the period. We need to continue to monitor that take-up, but universal recording for such low numbers does not seem prudent and might not provide value for money.

We have always been clear that the provision of a limited audio recording service is a temporary measure that needs to be evaluated fully before a final decision is taken on the future of the service. As I have already said, we need the evidence to show that investing potentially large sums of money into the provision of universal recording will improve quality and will be used by claimants.

We agree with the comments in Professor Harrington’s third report in which he expressed views about audio recording needing to improve the quality of assessments. He said that

“further monitoring and evaluation work needs to be completed before a decision can be made”.

That is why we have decided to extend the evaluation period until the end of the summer to allow us to gather additional data on quality and potential take-up for a subsequent robust decision on any potential future audio-recording provision. We now have a benchmark for current take-up but, as has been rightly pointed out, we cannot get a true comparison until we routinely let people know about its availability. I am pleased to say that we are therefore taking steps to boost awareness of audio recording.

The Department and Atos are in the process of amending written communications to claimants by updating the WCA AL1C form. The document is sent to claimants when they need to arrange a face-to-face assessment and will provide more information on how to arrange an audio-recorded assessment. We expect the revised form to be sent out to claimants by the end of next month, once the necessary changes have been made and the form has been cleared for use.

--- Later in debate ---

[Sheila Gilmore]

Perhaps the Minister might be able to explain why it has taken nearly two years to make that amendment. If I understood him correctly, he said that the evaluation of all this process was being extended to the end of the summer, so if the revised letter is not going out until the end of this month or the end of next month, there will be very little time to judge whether that has made any difference.

[Mr Hoban]

The volume of people going through the WCA on a monthly basis is significant—I believe that 100,000 claims are made for ESA every month—so it will not take long to find out the take-up rate, although we need to make sure that the pilot has the right amount of time to gather sufficient evidence. Earlier the hon. Lady was arguing in favour of a shorter pilot and now she is potentially arguing for a longer pilot in order to get the evaluation right, but she makes an important point.

In addition to the letter I mentioned, the Department has recently provided more information about the audio-recording facility on the “Inside Government” section of the gov.uk website. By ensuring that more people are aware of the facility we will get a much better picture of how many people are applying for an audio recording and a better assessment of the level of demand. The hon. Lady rightly made the point that we do need to understand what the demand actually is.

In the past, the Department has asked Atos Healthcare to apply a processing safeguard whereby requests for audio-recorded assessments should be accommodated within four weeks, and where that was not possible, the assessment should go ahead without a recording. However, during the remainder of the evaluation period, to help ensure that claimant expectation can be met, the four-week safeguard for requesting audio-recorded assessments has been removed. That will enable us to gather a fuller picture of demand and capacity, in order to inform a full and robust evaluation.

To conclude, we are continuing to evaluate the costs and benefits of the current approach, and will await the results of a further evaluation during the summer before making a further decision on the future of this service and how it can improve the WCA.