Written evidence submitted by Advice Network
on behalf of Advice Centres for Avon (ACFA)
1. INTRODUCTION
AND SUMMARY
1.1 We are extremely concerned about the hardship
and destitution that is highly likely to be the outcome of the
migration from IB to ESA for many thousands of severely sick and
disabled people. Our member agencies are already dealing with
the fallout for new claimants who go through the WCA, which is
not fit for purpose, has been largely disowned by the academics
involved in its design, and has been the subject of numerous damning
reports.
1.2 We agreed with our members to focus on the
Work Capability Assessment, as the most urgent aspect of ESA that
we hope will be addressed, and to provide narrative evidence providing
examples of individual client's experiences. Examples of poor
practice were supplied by advice workers who specialise in Welfare
Benefits law from a range of agencies.
1.3 Our member agencies see clients' everyday
who are clearly not fit for work being assessed as such due to
poor quality WCA reports. Common causes of this include (but are
not limited to):
— Insufficient
medical knowledge of specific conditions on the part of examining
medical professionals.
— Inappropriate
interviewing techniques by examining medical professionals.
— Failure
to accurately record statements made by claimants.
— Leading
questions, and suggested answers, by the examining medical professionals.
— Failure
to deal appropriately with clients with mental health issues.
1.4 We would therefore call for a complete overhaul
of the WCA and the examination procedure prior to the roll-out
to existing IB claimants, as this inappropriate test and its unprofessional
application are leading to destitution and severe hardship for
thousands of extremely vulnerable people with long-term health
problems and people with disabilities, as well as costing the
state huge amounts of money in appeal and tribunal processes.
2. THE ASSESSMENT
CRITERIA
2.1 The problems with the basic assessment criteria
are well reported and include, but are not limited to, a failure
to fairly assess variable conditions; a complete failure to adequately
explore the needs and problems of people with mental health issues;
a failure to recognise the cumulative effect of having several
functioning problems; and the failure to consider recovery times,
ability to repeat functions, or the pain and discomfort experienced
while carrying out a function.
2.2 Our members reported significant and specific
problems with the way the assessment is carried out for claimant
who have mental health issues.
2.3 One adviser, who states she has several cases
every week of claimants being awarded zero points based on an
Atos medical report who subsequently are awarded f15-plus points
at Tribunal, reports:
"There seems to be a general tendency for the
questioning to lead clients into positive responses, so that they
agree they are able to do things that are in fact extremely difficult
or impossible for them to achieve.
A client with addiction and severe anxiety issues
was awarded zero points under the WCA based on the medical professionals
report. This was increased to 15 points by the tribunal who heard
her case, who placed her in the Support Group without even asking
her to go into the tribunal hearing room.
When I asked her about her medical she told me that
when she came out of the medical examination she believed she
could do anything 'as the man had told her she could'".
2.4 The same adviser expressed her fears about
the new descriptors for mental health issues:
"I fear that the new descriptors will make it
even more difficult [for vulnerable claimants] and require an
even greater level of competence from Atos examiners, who appear
to have little training or insight into mental health or addiction".
2.5 Advisers have also reported clients with
severe mental health problems being told that their Support Worker
would not be allowed into the examination. In this case the client
was unable to articulate themselves, the medical examiner seemed
to take no notice of the condition the client was in, and zero
points were awarded based on the examination report. This was
subsequently overturned at appeal, but at great cost—both
in terms of money for the process, and extreme mental distress
experienced by the claimant who was suddenly destitute. As the
adviser states all of this could have been avoided by allowing
the Support Worker to stay with the client to help them express
their difficulties to the examiner.
2.6 We have multiple reports of poor medical
assessments leading to an incorrect refusal of benefit, including
cases where the debilitating effect of HIV-medication was ignored
by the examiner, cases where clients have received the notification
that they are fit for work on the very same day they undergo emergency
heart-surgery for the heart defect that prompted the claim, and
cases where a zero point score based on the medical examination
becomes a 24-point score based on a brief yet meaningful examination
of the clients severe mental health problems by the tribunal.
3. ASSESSMENT
CENTRES
3.1 When asked about the suitability of assessment
centres one agency reported having advised on cases where the
accessible route into the building was unavailable, yet the claimant
was told they would be deemed to have not attended if they failed
to make it into the building and to the second floor.
3.2 The agency reported that:
"The client struggled to the examination room
up several flights of stairs, with large amounts of help from
their partner. The medical examiner reported that the claimant
had been able to climb stairs and gave no points for restricted
mobility. This decision was unsurprisingly overturned at appeal,
but caused huge amounts of problems for the family."
3.3 One agency reported several cases where interpreters
had been requested for the examinations of clients who had limited
English, yet interpreters had not been provided. These examinations
unsurprisingly resulted in claimants being incorrectly deemed
to be fit to work, due to their difficulties in expressing themselves
fully to the examining Healthcare Professional.
4 SERVICE PROVIDED
BY ATOS
STAFF
4.1 Our members reported several extremely concerning
client experiences, particularly around the assessments of the
most vulnerable clients.
4.2 One welfare benefits specialist stated that
Atos staff seem to have little recognition of the possibility
that aggressive and insensitive questioning of claimants suffering
from Post-Traumatic Stress Disorder can "trigger" debilitating
episodes for those claimants. She states:
"I have had two clients where PTSD, depression
and substance dependency arising from past sexual abuse and assault
are key factors. Both experienced insensitive interviews where
the assessor had little or no understanding or awareness of the
relevant issues and no concern as to how the questioning would
affect the clients after the interview ended".
4.3 The same adviser also reports repeated use
by Atos of male assessors for female clients who are victims of
sexual abuse/assault.
4.4 Other agencies report difficulties for clients
caused by a superficial approach to questioning, with no reference
to pre-existing medical notes to guide questioning. For example
one agency reported a client with severe and debilitating Carpal
Tunnel Syndrome, who also has great difficulties expressing themselves,
being assessed as having no problems with their hands or arms.
The assessment report stated that the client had no problems washing,
bathing, dressing, cooking, or carrying out many other functions,
despite, in reality, being unable to do any of these things. When
asked by the adviser why they hadn't told the examiner about these
problems the client replied that the examiner had rushed through
the assessment and that the client didn't feel confident enough
to ask them to slow down, repeat questions, or to correct answers
suggested by the examiner that were then recorded as fact.
5 CONCLUSION
The WCA is clearly failing in its primary function:
to identify claimant's who are unable to work. Reform of the test
is therefore urgently needed to halt the ongoing damage that is
being done to some of the most vulnerable people in society through
its failure to provide a means by which those people unable to
work can still have sufficient income to feed themselves, clothe
themselves and secure a roof over their head.
April 2011
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