House of Commons - The role of incapacity benefit reassessment in helping claimants into employment

The role of incapacity benefit reassessment in helping claimants into employment - Work and Pensions Committee Contents

3 The Work Capability Assessment—claimants' experience and Atos Healthcare

46. In this chapter we look at claimants' expectations and experience of the Work Capability Assessment (WCA), and its design and delivery. We also discuss DWP's contract with Atos Healthcare, the private company which carries out the assessments.

Design of the process

47. The Welfare Reform Act 2007 legislated for the introduction of the WCA as the assessment for Employment and Support Allowance (ESA), which replaced Incapacity Benefits for new claimants in October 2008. We have described how it works and summarised the range of assessment outcomes in Chapter 1.

48. The assessment was developed by DWP officials, working in consultation with experts in the field and disability organisations.[55] As we have described, it is an assessment of the functional effect of an individual's health conditions and/or disabilities on their capacity to work—it is not a medical assessment of those conditions. It also assesses the extent to which an individual's conditions and/or impairments limit their capability to work by focusing on everyday functional activities, both physical and mental, cognitive and intellectual.[56]

49. The physical activities assessed include: walking ("mobilising") (with a stick or other aid if such aid is normally used); standing and sitting; manual dexterity; making self understood (through speaking, writing, typing, or other means normally used); understanding communication (by both verbal (such as hearing or lip reading) and non-verbal (such as reading 16 point print) means using any aid it is reasonable to expect them to use); navigation and maintaining safety (using a guide dog or other aid if normally used); continence; and remaining conscious during waking moments. The mental, cognitive and intellectual activities assessed are: learning tasks; awareness of everyday hazards; initiating and completing personal action; coping with change; getting about; coping with social engagement; and appropriateness of behaviour with other people.[57]

50. The WCA assesses claimants' functional capability against "descriptors", which describe the extent to which the person can undertake the particular activities. Claimants "score" up to 15 points against each descriptor if they have limited function in the activity described. For example, for the manual dexterity descriptor, a claimant will score 15 points if they:

(a) cannot either (i) press a button, such as a telephone keypad or (ii) turn the pages of a book with either hand

[Or] (b) cannot pick up a £1 coin or equivalent with either hand.

9 points will be scored if the claimant:

[Or] (d) cannot use a suitable keyboard or mouse.[58]

If none of the limitations under each of the descriptors applies to the claimant, they will score no points, will not qualify for ESA and will normally be advised by Jobcentre Plus to make a claim for JSA. A score of 15 points in any one activity qualifies a claimant for ESA. If a claimant does not score 15 points in any one activity, points scored in all activities are combined. A combined score of 15 points also qualifies a claimant for ESA.[59]

51. The second part of the WCA assesses whether claimants qualifying for ESA should be placed in the Support Group, which is for those claimants whose conditions are considered to affect their function so severely that an expectation to engage in work-related activity would be unreasonable. This part of the assessment uses 25 descriptors under 16 headings which are similar to those described above. If a person satisfies at least one of the descriptors they will be placed in the Support Group and will not be mandated to begin preparing for or looking for work.[60]

Claimants' experiences of the process

Atos call-centres

52. The first stage in the assessment process is that the claimant receives a letter telling them that their claim is to be reassessed as part of the IB/ESA migration. JCP then telephones the claimant to provide any necessary advice, and the claimant is sent the ESA50 medical questionnaire to complete and return. Atos Healthcare call-centre staff then telephone the claimant to make an appointment for a WCA at an assessment centre.[61] All subsequent contact about the appointment time is via the call-centre: claimants are not able to contact the assessment centre directly.[62]

53. Evidence suggests that many people have experienced problems with the call-centre service. In one extreme case it took 135 telephone calls to get through to Atos.[63] People we spoke to at our open meeting in Burnley told of similar experiences. Lisa Coleman of Atos acknowledged that the call-centres had experienced significant problems a year ago, which were due to technical problems. She assured us that Atos had since invested heavily in new technology to rectify the problems. This, together with the retraining of call-centre staff, had enabled Atos to reduce call waiting times to less than 30 seconds. Over 90% of first calls are now picked up.[64]

54. Sue Royston from CAB suggested that claimants had found the appointment booking process inflexible and had found it difficult to arrange a convenient appointment time. She told us that Atos call-centre staff work to a rigid script and that claimants tend to be told, "You must come along because otherwise you might lose your benefit."[65] Lisa Coleman from Atos told us that the arrangement of an appointment time was "a negotiation" between call-centre staff and the claimant. She said that if the appointment time offered was inconvenient for the claimant "an alternative appointment will be offered if there is a suitable one available".[66]

55. Atos acknowledged that its call-centres had experienced significant problems in the past. We welcome the assurance that this has been addressed to ensure that waiting times are significantly reduced and most calls are picked up first time. We expect call statistics to be maintained and published to demonstrate that progress is being made and sustained. However, claimants are still unable to contact the assessment centre they are due to attend directly, and we believe they should be able to do so, even if calls are routed through the call-centre.

Over-booking of appointments

56. Atos told us that it routinely overbooks appointments for the WCA by about 20% (although this varies between assessment centres). It does this because the non-attendance rate is as high as 30% in some areas.[67] We asked Atos whether this overbooking resulted in clients sometimes being turned away without being seen. Lisa Coleman told us:

It does happen. I am not going to say it does not. We do have a waiting time of less than 10 minutes, and we do try to manage within that time. But we also try to make sure the customers have the appropriate time within the assessment. So I am not saying it never happens because it does, which is why we have a target. And in those instances we will investigate why that happened, put remedial action in place where we can, and then try to work with the customer to offer an alternative appointment. But it does happen.[68]

57. We asked the Department about its views on Atos's overbooking policy. Karen Foulds confirmed that this policy of overbooking by 20% is based on the 30% non-attendance rate for new ESA claims. She stressed that the rate for non-attendance in the reassessment trial was much lower, at 9%, and that Atos "will be reviewing their policy on that basis". However, she added that "the number of customers who have actually gone through the IB reassessment process is still very small in comparison to those that are going through ESA, and we have not seen that impact yet on the whole of ESA".[69]

58. Atos routinely overbooks WCA appointments by 20% on the basis of the non-attendance rate for new ESA claims, which was 30%. However, the non-attendance rate in the IB reassessment trials was much lower, at around 9%, although it is too soon to say whether this low rate seen in the trials will continue in the national roll-out. We recommend that Atos reviews its overbooking policy as a matter of urgency, to take account of this much higher attendance rate by IB claimants, to ensure that people are not turned away from assessment centres without being seen. Atos should also continue to monitor and adjust its overbooking policy as necessary.

"Failure to attend" and sanctioning

59. Sanctions are imposed by Jobcentre Plus on claimants who do not comply with the requirement to attend a WCA, known as "failure to attend", in the same way as they are applied in other parts of the benefit system. Sanctions can include stopping benefit payments. Witnesses were concerned that claimants were being sanctioned for "failure to attend" their WCA when it was not, in fact, a failure on their part. Atos told us that they do not routinely follow up non-attendance with the claimant to establish the reasons for it; they pass the information about non-attendance back to JCP, whose role it is to establish the reason.[70]

60. Oxford Welfare Rights believed that it was unlikely that significant numbers of people would wilfully not attend their WCA. It argued that sanctioning in these circumstances could have serious implications for claimants:

Whilst there is some protection within the "good cause" provision, in practice there are long delays in the determination of good cause by decision-makers. This means claimants are left without benefit for considerable periods. If good cause is not accepted there will be a further delay while a new claim for ESA (or JSA) is made and processed and a new date for a WCA is set. Frequently claimants in this situation are left reliant on Crisis Loans for income.

Its view was that JCP should make greater efforts to establish the reasons for non-attendance at WCA appointments and that sanctions should only be applied where failure to attend was wilful.[71]

61. DWP confirmed that sanctions can be applied to claimants for failure to attend a WCA but that people should only be sanctioned if JCP "considered there was no good cause for the person not attending". Karen Foulds of JCP set out an example of where sanctions would not be applied:

[...] if we know that somebody's got a mental health condition, then we would take that into account with good cause. We would do safeguarding visits to people's homes if they had not responded to either our telephone call, our letter, and had not attended the appointment. We put safeguards in place to ensure that, where there is a good reason why the person has not attended, or, in fact, they have not been able to engage with the process at all because they have not perhaps understood what is happening to them, we would put those measures in place.[72]

62. Karen Foulds was clear that sanctioning of people who turned up for their WCA but were subsequently turned away without being seen "categorically should not happen".[73]The Minister believed that it was a rare occurrence but that, where it had happened, it was "unacceptable" and that if it were found to be happening on a significant scale it would require "process changes".[74]

63. Instances have occurred where vulnerable claimants have had their benefit stopped as a sanction for non-attendance at a WCA appointment when the non-attendance arose because of administrative errors on the part of Atos or JCP, or because the claimant was too ill to attend but was unable to get in touch with Atos to inform them of this. We agree with the Minister that this is unacceptable. We recommend that DWP and Atos Healthcare jointly review the processes for recording non-attendance and change them where necessary to ensure that claimants are not sanctioned for "failure to attend" when the failure is on the part of Atos Healthcare and/or Jobcentre Plus.

64. Evidence from the trials of IB reassessment in Aberdeen and Burnley suggests that the reason for non-attendance at WCAs is rarely wilful non-compliance on the part of the claimant. The recent DWP research paper on the trials found that "there was very little evidence of active or deliberate non-cooperation". It concluded that the reason for non-attendance was most often "general confusion and inability to cope with the process". Others were unable to attend due to their fluctuating condition:

These customers had intended to go to the WCA and had generally planned for it; having a variable or unpredictable condition they stressed that the appointment had simply caught them on a "bad day". These customers expressed a clear intention to attend their WCA appointment if at all possible.[75]

65. Administrative error on the part of Atos or JCP was also sometimes to blame. The DWP paper reports that some customers who had their WCA appointment cancelled by Atos "were sometimes marked as having failed to attend this appointment. These customers were keen to comply with the process: all intended to attend their rescheduled appointment".[76]

66. We believe that Jobcentre Plus should be more proactive in establishing the reasons for non-attendance at WCAs, including by following up with a phone call as soon as is practical after an appointment has been missed.

Atos assessment centres

67. Several witnesses complained about the inadequacy of Atos assessment centres in meeting specific needs arising from their health condition or disability. One witness, a wheelchair user, described his experience:

The building is an old office block on a busy road junction halfway up a very steep hill. It is not on any bus route and there is no parking of any sort. The nearest car park is about half a mile away. To gain access to the building you have to ring a door bell to be let in. The only problem is that the door is at the bottom of a flight of steep concrete steps with no ramp. My carer had to leave me on the pavement to let them know I was there and we were redirected to another door to enter the building. Once in the building my carer had to fight the wheelchair past various tables, chairs and plants, through three sets of doors and down a narrow corridor with two sharp turns. The really big problem though was when I had to enter the actual examination room. The doorway was so narrow my wheelchair would not actually fit through. Surely at least Atos should be made to make the buildings they use easily accessible to all.[77]

At our public meeting in Burnley in March several people echoed this dissatisfaction and it was clear that this is not just an issue which affects wheelchair users. Cases were reported where reasonable adjustments to accommodate particular conditions were refused, such as a choice of chairs being offered, or lighting being adapted. People at the meeting told us that when they had made requests for adjustments they had been told that they were "asking for too much".

68. DWP told us that the majority of assessment centres are on the ground floor and that, where centres are not located on the ground floor, "prior to a customer being called to an assessment, efforts are made to identify customers who may have problems in evacuating via the stairs during an emergency". These customers are offered an appointment at the nearest ground floor centre or a home visit but: "Inevitably however, some customers in this category are not identified and still attend the centre."[78]

69. We asked Atos about the locations and accessibility of its assessment centres. Lisa Coleman told us that there are 148 assessment centres, 20 of which are owned by Atos. The remainder are provided by DWP and "usually co-located with the Jobcentre". She also reported that:

We are [...] working closely with the Department on individual locations. There are about 27 of them where disabled access is okay, but in the event of a fire, there are potential issues around evacuation. We are working with the Department to make sure that we can either get ground floor accommodation, or put some form of evacuation plan in place with the landlords. This usually affects sites not on the ground floor.[79]

Dr Gunnyeon of DWP said that Atos was "moving rapidly toward" having ground floor accessible centres suitable for the needs of "anyone with a disability".[80] The Minister told us he was "amazed that this was not part of the original process three years ago".[81]

70. Atos stated that people are asked if they need transport to the assessment centre and that taxis are provided "in some instances". Claimants receive, with their WCA appointment letter, "very tuned travel instructions", which explain the quickest route to the assessment centre via public transport. Atos also told us that people are not expected to travel more than 90 minutes by public transport to get to an assessment centre.[82]

71. It is unacceptable that disabled people should be called to attend an assessment at a centre which is inappropriately located, inaccessible to them or where reasonable adjustments cannot be made to accommodate special requirements arising from their health condition. We note DWP's assurance that Atos Healthcare is "moving rapidly toward" a situation where this is no longer the case. We request that, in response to this Report, the Government sets out progress towards this aim. This should include options for the relocation of assessment centres where necessary, increasing disabled access, and improvements to the mechanisms for ensuring a claimant's needs are known to Atos Healthcare in advance of the WCA.

The assessment

72. Many witnesses highlighted concerns about the assessment process itself. Professor Paul Gregg of the University of Bristol believed that claimants go to the WCA expecting to "present information about their illness and be tested against their perception of that illness". Instead, they experience what they perceive as a "tick-box" process. He described this as a "profound disconnect" between what claimants expect and what they actually experience.[83]

73. This disconnect between claimant expectation and the reality of the experience is borne out by evidence we received from disability organisations and a number of individuals. Evidence from Citizens Advice Scotland sums up the typical concerns about the WCA that many witnesses have told us about:

The WCA is often rushed, and can last just 20 minutes, leaving claimants with the impression that they have not been properly assessed.
The yes/no format of the assessment is too narrow, leaving little opportunity for the client to explain their condition.
The health care professionals often fail to listen or interact with the client, which can lead to mistakes and a failure to properly assess conditions.[84]

74. One witness who wrote to us had a mental health condition and had experienced two WCAs. She felt she was prevented from explaining her circumstances more fully during the WCA: "I would have appreciated it if she [the Atos assessor] had taken her time more and let me put more time in to my answers so she could get a better picture." She also expressed frustration at not being able to present documentary evidence to back up her answers.[85]

75. The Minister stressed that these types of examples were of individual experiences of the WCA before recent improvements had been made. He told us that:

Almost nobody has experienced the system that we have put in place over the past few months, and we have learnt lessons from the trials in Burnley and Aberdeen, which have been put into place. We have learnt lessons and put in changes as a result of the Harrington Review. Any experience that you are hearing from individuals or recounted from pressure groups, unless they are from people in Burnley and Aberdeen going through the trials, will by definition have come from the previous system as new claimants for ESA—a system that I fully accept was flawed and that we sought to improve.[86]

76. Most of the submissions we received from individuals were from claimants who were dissatisfied with the WCA process and who did not believe that they had been accurately assessed. The Minister asked us to bear in mind that much of the evidence submitted to us related to assessments carried out prior to implementation of the two sets of review recommendations and experience from the Aberdeen and Burnley trials. We fully acknowledge this fact. However, we believe that there is no room for complacency and we have identified a number of areas where further improvement is required.

The LiMA computer system

77. Atos healthcare professionals (HCPs) use a computer system, the Logic Integrated Medical Assessment (LiMA), to enter information as they go through an individual's WCA. LiMA records the responses claimants give at the assessment and builds a final report for each claimant, which is then passed on to the JCP decision-maker (DM). LiMA helps the Atos assessor focus on particular descriptors and obtain and record evidence in a relatively short space of time. It uses stock phrases such as "can load washing machine (front loading)" that can be input into the system quickly.[87]

78. DWP stated that LiMA was designed to "improve and ensure consistency and quality of the reports [...] It serves as a guide only and the healthcare professionals are required to use their own clinical judgement to justify the medical opinion contained in the medical report."[88] However, many witnesses complained of an over-reliance on the part of Atos HCPs on the LiMA IT system and therefore a perceived lack of human contact in the process. One person, a carer for a disabled relative, described Atos HCPs as "computer-driven operatives"; another individual, who had been through the WCA process twice, told us that "the whole thing is done via a computer program".[89]

79. In his first annual independent review of the WCA (considered in more detail below), Professor Harrington was critical of the LiMA computer system, calling it "not very intuitive". He also found that Atos HCPs were over-reliant on the system, despite the existence of guidance that warns against this:

The Atos Training and Development handbook encourages their HCPs to use open questioning and not to rely on the LiMA system, but in evidence to this review, this seems to be uncommonly invoked in practice. It can, perhaps, be too easy for HCPs to use stock phrases generated by the LiMA system that do not necessarily capture the whole assessment or allow nuanced responses to be reflected.[90]

80. Professor Harrington told us that there had been recent changes to the LiMA system to make it more intuitive and that there was now a free text paragraph for the HCP to fill in to allow more individualised information to be provided. He told us the system now "appears to be more responsive".[91] We saw how the latest version of the software worked in practice when we visited the Atos Medical Examination Centre in Marylebone, London in June to observe a mock-up of a WCA.

The DWP contract with Atos Healthcare

81. Atos Healthcare's role is to carry out the Work Capability Assessments, scoring claimants against the descriptors in each activity, and then preparing a report. The report is then passed to a Jobcentre Plus decision-maker who decides on a claimant's eligibility for ESA and, if they qualify, to which ESA group they should be assigned. We discuss the decision-making process in more detail in Chapter 5.

82. Atos Healthcare has held the DWP contract for medical services (the Medical Services Agreement) since 2005. It has therefore been responsible for all the WCAs that have taken place since ESA's inception in October 2008.

83. The 2005 contract was for £100 million per annum, which includes "the total number of examinations undertaken across all benefits and also includes costs relating to written and verbal medical advice, fixed overheads, administrative costs, investment in new technology and other service improvements". DWP has reported that the total amount paid to Atos Healthcare by DWP "for the scrutiny, face to face and work focused health related assessment reports" was £1.7 million for 2008-09 and £24.4 million in 2009-10. These figures do not include costs relating to fixed overheads, administrative costs, investment in new technology and other service improvements.[92]

84. Atos Healthcare's contract with DWP was originally for seven years from 2005 and was therefore due to expire in 2012. DWP took the decision last year to extend it until 2015. When we asked the Minister why he took this decision he told us that it was because "it seemed to be a bad idea to try to change the supplier in the middle of the migration process".[93] DWP told us that the contract extension was negotiated on the basis of Atos "delivering substantial savings against the current estimated cost of £100 million per annum".[94]

85. We were keen to find out how Atos Healthcare expected successfully to deliver an increasing number of WCAs during the IB/ESA migration process while simultaneously delivering cost savings to DWP. Lisa Coleman told us "we have reduced our prices to do that. Future savings are around making the process more efficient, looking at where we can make sure that we are using technology to support the end-to-end process, and that we are using the right people at the right point in time."[95] The Minister said that savings were expected across all Government contracts and that the coalition Government had renegotiated all such contracts on this basis when it took office. Dr Gunnyeon of DWP told us:

It is reasonable to expect any organisation to look at how it can do things more efficiently, and certainly Atos have been doing that. There has also been a move to look at how we can use different healthcare professionals, and that is in keeping with what is happening across healthcare generally: for example, the use of more nurses to undertake assessments after appropriate training. That happens in different aspects of the NHS, where there is more responsibility being devolved to other healthcare professionals who have the right skills to do things, and that has an impact on costs as well. A number of things were part of that process.[96]

Karen Foulds also pointed out that not all of the claimants coming to Atos as part of the IB/ESA migration process would constitute additional work for them: some IB claimants would have had a Personal Capability Assessment carried out by Atos as part of their IB claim.[97]

86. We were aware of considerable public suspicion that payments to Atos Healthcare are made on the basis of the outcomes of WCAs. Some claimants clearly believe that Atos healthcare professionals (HCPs) are encouraged through targets within the DWP contract to find people fit for work. DWP has made clear that this is not the case: "the result of the assessment has no bearing on Atos Healthcare targets or remuneration"; and that the Medical Services Agreement "does not include any provisions either from the Department or from Atos Healthcare to incentivise health care professionals to find claimants undergoing the WCA fit for work".[98] Lisa Coleman of Atos confirmed that, contractually, Atos is paid for the number of satisfactory assessments it completes, not on the basis of the results of those assessments.[99]

Monitoring quality

87. We wanted to know what quality control procedures were in place in relation to the contract. Lisa Coleman told us that Atos was monitored by DWP on both the quality and timeliness of assessments and reports. She told us that Atos faced financial penalties if it did not meet the required standards.[100]

88. DWP stated that Atos Healthcare have put in place several measures to ensure that "consistent, high quality, independent" assessments are provided to the Department:

a rigorous selection process to recruit the best medical and non-medical staff—less than 15% of applicants who apply are successful;
comprehensive training in disability assessment on joining for all doctors, nurses and physiotherapists plus on-going training to ensure skills and knowledge are up to date;
a continual programme of internal and external audits to ensure high standards in medical assessments and reports are maintained; and
strong performance management governance to enable high performance of all staff and to support their career development.[101]

89. The quality of Atos assessments is monitored in two ways. Firstly, Jobcentre Plus decision-makers must judge that the Atos report is of acceptable quality; if it is not it is sent back to be re-done at Atos's own cost. Dr Gunnyeon, Chief Medical Adviser at DWP explained:

[...] the decision-maker needs to be able to have a report that shows why the recommendation of the healthcare professional is as it is. They have to be reassured that the points that have been allocated look right on the basis of the information that the claimant has provided and the assessment report itself. Clearly if the decision-maker cannot see why the recommendation is as it is, for example, if it looks as though points should have been scored on some descriptors where they have not, then that would not be acceptable, and the decision-maker would send that back.[102]

DWP was not able to tell us in oral evidence what proportion of Atos reports had been sent back by JCP decision-makers but in subsequent written evidence informed us that this was only 0.22%.[103] Such a low percentage would seem to indicate that this aspect of DWP quality control over Atos's service is not functioning as it should. It also reinforces Professor Harrington's point, discussed in Chapter 5, that decision-makers rarely question the advice provided by Atos.

90. The second strand of quality control is Atos's internal audit of assessments, which DWP described as follows:

Each healthcare professional is subject to audit once they have completed their training until they have reached an acceptable standard, and they are then subject to random audit, so that we are continuing to check the quality. Those reports are graded either A, B, or C, and C are of an unacceptable standard. The proportion of Cs is very small, and remedial action is taken. The challenge is to try to have as many at grade-A standard as possible and to continue to look at that, and there are certain standards set.[104]

Atos aims to audit each of its HCPs every six months.[105] If an HCP demonstrates persistent unsatisfactory performance, their approval to perform assessments can be revoked. Atos told us that five of its HCPs had had their approval revoked in the last six months. This is from a total of about 1,500 HCPs.[106]

Atos Healthcare as the sole provider of the WCA

91. We asked the Minister whether it would have been better, from the outset, to have had two providers delivering the WCA in order to provide competition and to drive up performance. He told us that it "probably" would have been better and that other companies had been interested, but he reiterated that he thought it would have been unwise to change providers during the reassessment process.[107] The Minister defended Atos Healthcare, saying that although they "get a lot of grief", the quality of the service provided by Atos "has steadily improved as time has gone by".[108]

92. We recognise that Atos Healthcare, as the sole provider of the Work Capability Assessment, takes the brunt of public criticism about the WCA. Some of this arises from the understandable anxiety which claimants feel about the process. We accept that considerable efforts have been made on the part of both Atos Healthcare and DWP to improve the quality of assessments. However, it is also clear that many claimants have not received the level of service from Atos which they can reasonably expect.

93. We remain concerned about whether there are sufficient levers within the DWP contract with Atos to ensure that Atos consistently gets the assessment right first time. We therefore recommend that, when the contract is re-let in 2015 and in future contracts for other medical assessments, DWP reviews the performance indicators, with significant financial penalties built in if standards are not met.

94. We agree with the Minister that it would not have been practical to introduce a second provider for the IB reassessment but we believe that the Government should consider contracting a second provider to deliver the ongoing Work Capability Assessments for new ESA claims when the reassessment of existing claimants has been completed, in order to drive up performance through competition. We recommend that the Government publishes proposals, before the end of 2012, for how such a system of competition could work in practice.

55 DWP, Explanatory Memorandum for the Social Security Advisory Committee: The Employment and Support Allowance (Limited Capability for Work and Limited Capability for Work-Related Activity) Amendment Regulations 2011, August 2010. Back

56 Ev 71 Back

57 DWP, A Guide to Employment and Support Allowance - The Work Capability Assessment, ESA214, June 2011, pp 17-23 Back

58 DWP, A Guide to Employment and Support Allowance - The Work Capability Assessment, ESA214, June 2011, p 19 Back

59 The Work Capability Assessment for Employment and Support Allowance, SN/SP/5850, House of Commons Library, February 2011, p 7 Back

60 DWP, A Guide to Employment and Support Allowance - The Work Capability Assessment, ESA214, June 2011, pp 24-26 Back

61 Q 81 Back

62 Qq 101-2 Back

63 Ev w110 [Tom Greatrex MP] Back

64 Q 120 Back

65 Q 41 Back

66 Q 83 Back