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

Written evidence submitted by A4e


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.


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].


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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Prepared 26 July 2011