Written evidence
submitted by A4e
INTRODUCTION
1.1 This formal response is submitted on behalf
of A4e in relation to the Work and Pensions Select Committee inquiry
into "Migration from Incapacity Benefits to Employment Support
Allowance". We would be happy to provide further clarification
on any aspects of our response, and willing to give oral evidence
to the committee if required.
1.2 A4e currently delivers a range of contracts
across the UK on behalf of the Department for Work and Pensions
(DWP), including Flexible New Deal, Pathways to Work and New Deal
for Disabled People. These contracts will be rolled into the Work
Programme, which is due to commence in summer.
1.3 A4e has been confirmed by DWP as preferred
bidders for five of the Work Programme contracts.
EXECUTIVE SUMMARY
2.1 Customers have been critical of DWP's communication
around their assessment and possible migration. Though there is
an inevitable bias in that those customers who have felt well
informed by the process may be less motivated to express their
opinion. A4e recommends that a more flexible strategy is required
in relation to communication [See Paras 4.1-4.4].
2.2 The Work Capability Assessment (WCA) is more
focussed on physical capability, it is less directed towards mental
health issues [See Paras 5.1-5.7].
2.3 Practitioners sampled have suggested moving
to two or more assessments when an individual's health conditions
are unclear. This would negate the necessity for appeals and periods
of inactivity. [See Paras 6.1-6.6].
2.4 The speed of rollout, from the Aberdeen/Burnley
pilots to mainstream IB migration seems ambitious. A4e believes
that DWP needs to balance the pace of reforms against the risk
of a high level of customer appeals. A more pragmatic migration
could reduce errors and the consequent rate of appeals [See Paras
9.1-9.2].
EVIDENCE BASE
3.1 The comments, observations and recommendations
within this response are based on a number of sources:
— Experience
of national delivery of the New Deal for Disabled People.
— Experience
of Pathways to Work prime contractor provision in five contract
areas.
— Direct
feedback from 30 Pathways Advisors and Occupational Support Practitioners
across a wide geographical spread (England and Wales), including
case studies.
— Feedback
and insight gained from the A4e National User Group (Disability
Services)—which consists of 20 customers who are all in
receipt of incapacity-related benefits.
— Feedback
from eight Information and Advice providers in Merseyside and
Derbyshire.
— Feedback
from Mencap, Mental Health in Further Education and Citizens Advice
Bureau in South Yorkshire and Derbyshire.
— Discussions
with five GPs in South Yorkshire and the West Midlands.
— DWP
published Work Capability Assessment statistics (January 2011).
The effectiveness of the Department's communications
to customers and the information, guidance and advice provided
by DWP and JCP
4.1 There have been a number of common themes
in the feedback A4e received across England and Wales.
4.2 The majority of customers that we contacted
have expressed confusion due to a lack of awareness and understanding
of the necessity for change and the structure of the assessment.
Despite clear information to the contrary being available online,
many customers perceive the Work Capability Assessment and the
Medical Assessment as the same process. This can often cause unnecessary
distress and can affect the way the customer perceives the assessment's
rigour. Some customers have stated that any information given
to them has been too complex and has fallen short of describing
the possible impact on them as individuals.
4.3 This lack of understanding has resulted in
a number of customers resigning from working age benefits—some
of which were in the process of work-related activity through
the voluntary element of Pathways and New Deal for Disabled People.
An A4e customer in the Surrey and Sussex area resigned
from benefits due to a significant increase in her levels of stress
and anxiety. This resulted in the customer losing the opportunity
to accept a job under the Permitted Work Rules. Although she took
up the part-time job, the loss of support through the condition
management element of Pathways contributed to an escalation of
her mental health condition and she left the job after a few weeks.
She is now back to square one, but without any benefit support.
4.4 A4e Recommendation
Communication and explanation should be simplified
and made available in a variety of formats, including easy-speak.
Customers should have access to Advisors who emphasise the positive
aspects of welfare reform and who work to change the mindset of
customers are assessed by Work Capability Assessment as being
fit for work. This should be framed as a positive event. DWP needs
to ensure strong reinforcement of the message that work is generally
good for people; contributing to longevity and increasing life
opportunities.
The Work Capability Assessment: assessment criteria;
service provided; suitability of assessment centres; and customer
experience
5.1 Customers' experiences of the Work Capability
Assessment seem to be inconsistent. In Surrey and Sussex, many
customers have claimed that although they attended the assessment
centre, the assessment was not conducted as the Assessor was not
present. Some claim that they had waited for up to two hours and
were then told that the centre had no record of their appointment.
When assessments have taken place, customers have claimed that
they are rushed, sometimes taking 10 minutes or less, with some
elements completed in their absence.
5.2 In Wales, Pathways Advisors have reported
that they have to spend considerable time dealing with negative
"fall-out" from the assessments, rather than being able
to concentrate on effective work-related activity. Customers are
feeding back answers are limited to "yes" or "no",
but their conditions are not so binary. They claim that the Health
Professionals conducting the assessments are generally unwilling
to listen to a more detailed explanation of the impact of their
fluctuating condition. General customer feeling is that assessments
are rushed and they often see mistakes and anomalies in their
written feedback.
A customer in Wales noticed that in her written feedback
the Assessor had reported that she had a colostomy bag. When the
customer suggested that she had received the wrong feedback as
she did not have a colostomy bag, she was assured that, despite
this obvious inaccuracy, this was indeed her assessment.
5.3 Feedback has not been wholly negative. Advisors
in West Cornwall have noticed that recently more customers are
scoring enough points to "pass" their Work Capability
Assessment and that there has been a significant reduction in
customers contacting the office for advice after being notified
that they had "failed". Additionally, the number of
customers wishing to complain about the process has significantly
reduced in recent months.
5.4 However, some customers have commented on
a lack of flexibility in agreeing a location that is more suitable
for them.
Two customers from Cornwall expressed their annoyance
at being requested to attend a medical assessment in Plymouth.
The customers telephoned to request a change to Truro and were
informed that they would be considered to have failed their assessments
if they failed to attend their appointments in Plymouth.
5.5 The Work Capability Assessment remains overly
focussed on physical capability. The accuracy of the assessment
is contingent on the customer accurately expressing their condition
and readiness to undertake work or work-focussed activity. The
assessment format is not transparent and assumptions are made
on performance based on broad questions such as "how did
you get here today"; and simple tests such as can the customer
lift their arms. The assessment contains only a small number of
questions focussed on mental health.
A customer in Wales has a severe anxiety condition.
When asked if she was comfortable in crowds she reported that
she found it very stressful and would avoid it whenever possible.
The Assessor went on to ask if she had been in a social situation
in the last six months. The customer answered honestly and said
that she had been to a family celebration. The next question was
"had she collapsed or urgently needed to leave the event?"
The answer was no, but that she was very uncomfortable and was
relieved when it was time to go home. As a result of these answers,
the Assessor entered in his report that the customer was fine
with crowds, therefore, not accurately reflecting her condition.
5.6 Little attention appears to be paid to GP
or Health Consultants notes and work or condition history.
Customer S.T. has a degenerative eye condition, which
means that he has gradually lost his sight and is now registered
as blind. He has reports from specialists confirming that his
sight will not be restored. He recently attended his Work Capability
Assessment and was amazed to receive a report of his assessment
claiming that he had stated that he would "recover"
from this health condition in the next three months and he would
need to attend another WCA. The customer has written a strong
letter of complaint about his assessment.
Feedback on the assessment centres themselves has
been broadly positive.
5.7 A4e Recommendation
De-generalise the Work Capability Assessment by including
open questions and introduce more flexibility in timescales and
the location of the Assessor.
How can the decision-making process be improved
so that customers are more confident in the result of their assessment?
6.1 Customer confidence appears to be primarily
affected by the perception that the whole process is rushed, much
too reliant on generalisations and significantly lacking in focus
on mental health and learning disabilities/difficulties. Customers
also expressed concerns around the level of errors/inaccuracies
in their report.
Many customers in all areas consulted reported that
when they received their copy of their assessment report, they
genuinely believed that they had received another person's report
in error.
6.2 The decision-making process is based on a
report generated from a single assessment visit. Much concern
centres around this single assessment and all areas and practitioners
sampled have suggested moving to two or more assessments when
the situation is unclear. This may sound timely and expensive,
but could negate the necessity for so many appeals and periods
of inactivity and uncertainty during those lengthy periods of
upheaval caused by the appeal process.
6.3 Frequently, the decision-making process does
not allow for varied recovery/acclimatisation times from operations,
new or worsening conditions, bereavement and fluctuating conditions.
It depends too much on generalisations round a snapshot in time.
6.4 Additionally, feedback has highlighted many
cases of customers who are terminally ill, or who are awaiting
serious operations but are being placed into the Work Related
Activity Group.
6.5 GPs questioned suggested that very little
attention is paid to their input regarding the customer's readiness
for work or work-related activity. They believe that they are
best placed to comment on a customer's health condition as they
have usually been involved with the customer over a longer period
of time.
6.6 A4e Recommendation
Widen the decision-making process to allow additional
evidence to be submitted and taken into consideration—especially
evidence provided by Health Professionals who are aware of the
customer's condition history.
The Appeal process
7.1 The opinion of most people and agencies questioned
in A4e's survey is that customers deemed to have "failed"
a Work Capability Assessment generally either lodge an appeal
or drop out of the working age benefit system. This, of course,
does not include the high percentage of claimants who drop out
of the system before the process has reached completion.
7.2 Of people who made a claim for ESA between
October 2008 and November 2009 and who were found fit for work
at assessment, 33% to date had an appeal heard by Tribunals Service.
The customer's appeal has been upheld in 40% of cases. These results
are generally considered by the customer group as an indicator
of a fair and consistent appeal process, but an ineffective Work
Capability Assessment and initial decision-making process. This,
of course, is based on the first full year of ESA. Little evidence
is available to allow comment directly related to the IB migration
period so far.
7.3 The only negative comments regarding the
appeal process is the time taken for an appeal to be ratified—a
period that is often very prolonged.
7.4 A4e Recommendation
The appeal process should be reviewed periodically
to ensure it is kept as efficient as possible.
The outcome of the migration process: different
paths taken and reaction to contribution-based ESA being time
bound for 12 months
8.1 Although evidence and feedback is limited
due to relatively low numbers going through the migration process
so far, a clear picture is emerging that many decisions regarding
the question of "fit for work" or fit for "work-related
activity/support" are inaccurate.
8.2 As of 22 March 2011, 1,626 decisions had
been made on whether a customer's claim qualifies for conversion
to ESA. 32% were found fit for work and so not entitled to ESA;
30% were placed in the support group and 38% were placed in the
Work Related Activity Group.
Customer JK was diagnosed with Multiple Sclerosis
and been informed by Health Professionals that this is a chronic
illness from which she will not recover. She failed her Work Capability
Assessment and this decision was upheld at her tribunal. She was
informed she should contact Jobcentre Plus to apply for JSA. Upon
doing this, JK was told that she was not eligible for JSA as she
was too ill to do job search and could not accept any work due
to her current health condition.
8.3 A4e Recommendation
Maximise the opportunities that will be available
through the Work Programme—ie eligibility to services being
dependant on need rather than benefit status. The Work Programme
is an excellent vehicle to ease the journey from an expectation
to be involved in work-related activity to an expectation to actively
seek work in exchange for benefit.
Timescale and capacity for national roll-out of
the migration process
9.1 Until very recently, the pilots were based
on manual systems and, as shown above, had only migrated 1,626
claimants. With an expectation of around 10,000 customers a week
going through a relatively untried software system, the timescale
seems ambitious and could lead to errors, which will in turn further
hamper the system due to a resulting high rate of appeal.
9.2 A4e Recommendation
We recommend DWP consider whether a more accurate
and controlled migration which may mitigate against high levels
of customers appealing against the outcomes of their assessment.
April 2011
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