Migration to ESA

ESA 17

Written evidence submitted by RNIB

1. About us

As the largest organisation of blind and partially sighted people in the UK, RNIB is pleased to have the opportunity to respond to this consultation.

We are a membership organisation with over 10,000 members who are blind, partially sighted or the friends and family of people with sight loss. 80 per cent of our Trustees and Assembly Members are blind or partially sighted. We encourage members to be involved in our work and regularly consult with them on government policy and their ideas for change.

As a campaigning organisation of blind and partially sighted people, we fight for the rights of people with sight loss in each of the UK’s countries.

During the next five years we want to tackle the isolation of sight loss by focusing on three clear priorities:

1. Stopping people losing their sight unnecessarily;

2. Supporting blind and partially sighted people to live independent lives; and

3. Creating a society that is inclusive of blind and partially sighted people.

We also provide expert knowledge to business and the public sector through consultancy on improving the accessibility of the built environment, technology, products and services.

Question 1

The Department’s communications to customers going through the assessment and whether the information, guidance and advice provided by the Department and Jobcentre Plus is effective in supporting customers through the process.

1.1 The main requirement for visually impaired people is the provision for alternative formats, if initial contact with customer is made via inaccessible measure (standard letter) renders the process will be flawed.

Recommendation 1

Throughout the assessment process information should be available and supplied to visually impaired claimants in an accessible format.

Question 2

The Work Capability Assessment including: the assessment criteria; the service provided by Atos staff; the suitability of assessment centres; and customers’ overall experience of the process.

2.1 Despite the fact that blind and partially sighted people have a different impairment, face a different challenge in adjusting to their impairment, and require different aids and equipment the regulations conflate sight loss and hearing impairment within a single descriptor.

2.2 Activity 7 refers to both verbal means and non-verbal means. RNIB interprets this to mean that you may not obtain 15 points as long as you could communicate by one or other of these means. Consequently with respect to the first descriptor - "Cannot understand a simple message due to sensory impairment" a claimant may not obtain 15 points if they could hear a message even if they couldn't see it or if they could see a message even if they couldn't hear it. The ATOS guidance for health care professionals implementing the WCA makes it clear that this descriptor is aimed at the deaf blind community or people who have a hearing impairment.

2.3 Page 82 of the guidance states, "A person who is deaf who cannot hear a shout at beyond 1 metre (80db loss) with macular degeneration to the extent that their vision is moderately impaired such that they have 6/24 vision, and can only read N16 print with a magnifying glass is likely to have "significant" problems. A person who is deaf (80db loss) and has 6/24 distance vision but can read N16 print with their normal spectacles is likely to have "some" problems."

2.4 The only descriptor specifically linked to sight loss (in the ATOS guidance) is the activity "Navigation and maintaining safety, using a guide dog or other aid if normally used - Activity 8." This descriptor too is unworkable in practice.

2.5 Descriptor 8(a) "Unable to navigate around familiar surroundings without being accompanied by another person due to sensory impairment" raises the problem that if the surroundings are familiar to a claimant it is likely that such a person could already navigate them and thus would not qualify for 15 points.

2.6 The descriptor 8(b) "cannot safely complete a potentially hazardous task such as crossing the road without being accompanied by another person due to sensory impairment" raises the problems of the fact that the descriptor is likely to be taken very literally in assessments. If the road has a formal crossing, has audio signals that would have met the Best Value Performance Indicator and other standards for accessibility it might not be a problem to cross. Alternately if the crossing is being dug up, there is rat running traffic or there are no accessibility features then it might be a very large problem indeed. It may be safe to assume that only the blind or partially sighted person concerned is the appropriate judge of whether a task is hazardous or not.

2.7 In respect of the descriptor 8(c) "Unable to navigate around unfamiliar surroundings without being accompanied by another person due to sensory impairment there are no points currently inserted though the implication is that 9 is the score.

2.8 Many blind and partially sighted people's vision is affected by the light condition and consequently their ability to see fluctuates through the day. Our own experience of the ATOS assessment is that people are being assessed for being able to complete the minimum level of activity only once and in the optimum of conditions.

2.9 The wider problems with all the descriptors affecting people with sight loss are that they are supposed to be assessing impairment functionality in the workplace but none of the descriptors apply to an actual work environment. The descriptors assume that the problem for people with sight loss is simply travelling to work and whether they constitute a safety hazard to themselves or others once there.

2.10 There is an implied assumption that all employers have enlightened attitudes to the employment of disabled people and have also made all reasonable adjustments to their policies, premises and equipment, this is unlikely because the disability discrimination legislation is reactive and not proactive in the responsibilities it places on employers.

2.11 The previously used descriptors correlated with work based activities e.g. visual acuity (reading & communication), field of vision (navigation, orientation & safety) and ability to recognise people/workmates (expressive and receptive communication). The tabled regulations contain proposed descriptors that do not correlate with a work setting. This leads to the inevitable conclusion that when taken into account with the suspension of the Work Focused Health Related assessment the system has been reduced to a medical and not social model of disability.

2.12 There has been considerable support for those people like ourselves who are critical of the WCA descriptors. Professor Harrington's first review identified the need to "look at "improvements that could be made" (p 630, The Social Security Advisory Committee referred to particular groups "being poorly served by the design and operation of the WCA" (paragraph 1.2). Finally the Merits Committee wished to see "fully appropriate" descriptors brought forward.

Recommendation 2

We welcome DWP's recent offer of improved guidance with respect to the interpretation of the descriptors on communication and navigation and in order to reflect the challenges faced by blind and partially sighted people.

The RNIB Group would also wish to see either the retention of the existing descriptors or the impact of sensory loss reflected in new descriptors.

2.13 In addition to our concerns regarding the nature of the assessment we also have some specific concerns relating to the service provided by ATOS staff. Our staff has reported instances of blind and partially sighted clients enduring some spectacularly bad assessments, these have prompted us to complain on several occasions to ATOS senior management.

Recommendation 3

In particular we are concerned that systemic failures occur because lessons learnt from the appeal process are not fed back into the assessments or the process for conducting the assessments via JCP decision-makers. Consequently we recommend that ATOS be asked to report on how their work is modified to redress poor practice identified by the appeal process.

2.14 All the ATOS assessment centres should be expected to be fully accessible to disabled people. Many assessment centres are not fully accessible for example our staff in Exeter have reported one WCA having taken place at a customers home as the assessment centre was not wheelchair accessible. In addition our staff have reported that even the signing in process is on occasion not accessible. The absence of disabled parking spaces at the centre in Stockport sparked media coverage, see http://menmedia.co.uk/stockportexpress/news/s/1417282_blue-badge-row-hits-new-centre

Recommendation 4

These reports lead us to question whether ATOS have audited their centres and procedures to ensure consistency of provision for disabled people's access. In order to demonstrate that they meet their obligations under equality legislation ATOS should be asked to make publicly available access audit reports for all their assessment centres.

Question 3

The decision-making process and how it could be improved to ensure that customers are confident that the outcome of their assessment is a fair and transparent reflection of their capacity for work.

3.1 ATOS medical reports are often erroneous; our staff reports one example where a visually impaired and diabetic customer's report stated that he had had the pulse in his feet tested. His GP was astounded, as he has not tested for a pulse in patient's feet for many years. This case is currently pending appeal.

3.2 Available evidence from staff supporting blind and partially sighted claimants suggests that many decisions are absurd and illogical. For example a service user registered blind, diabetic and also a double amputee in a wheelchair was found not to have ‘limited capability for work’. Following a lengthy appeal process the customer was placed in the support group. During this process the claimant moved from a position of securing less than 15 points to scoring 59 points.

Recommendation 5

We are supportive of the recommendations that emerged from Professor Harrington's review. We recommend that given that the Government has indicated its support for these recommendations that a timetable for their introduction is now published and made publicly available.

In addition we recommend that the DWP decision making standards committee be asked to independently review the customer journey through the WCA.

Question 4

The appeals process, including the time taken for the appeals process to be completed; and whether customers who decide to appeal the outcome of their assessment have all the necessary guidance, information and advice to support them through the process.

4.1 Appeals are taking many months and in some cases over a year, for example one customers appeal process lasted 16months. During this appeal no advice or guidance was provided by DWP. Our staff has reported that only at appeal is specialist medical information such as a certificate of visual impairment being taken into account.

Recommendation 6

Claimants with a visual impairment should be invited to bring any additional medical evidence including a certificate of visual impairment with them to the assessment. The LiMA software used by Atos assessors should be altered to ensure that assessments are able to capture the significance of this additional medical evidence.

Recommendation 7

It shouldn't be necessary for claimants to have to write to DWP for a copy of their own assessment report. ATOS reports in suitable accessible format should be shared with claimants as a matter of course.

Question 5

The outcome of the migration process and the different paths taken by the various client groups: those moved to Jobseekers Allowance, including the support provided to find work and the impact of the labour market on employment prospects; those found fit for work who may be entitled to no further benefits; those placed in the Work Related Activity Group of the ESA, including the likely impact of the Department’s decision to time-limit contribution-based ESA to a year; and those placed in the Support Group.

5.1 The number of our clients likely to be migrated stands at 16,470 of whom 5940 are female, 10,530 are male and the remainder unknown. Our clients represent 0.77% of the total IB caseload. IB/Severe Disability Allowance caseload for working age - ICD categorisation diseases of the eye and adnexa, as of February 2010 (last available update).

5.2 With respect to ESA claimants the picture is as follows - (from Table 10 of 5.3 of "Employment and Support Allowance Work Capability Assessment by Health Condition and Functional Impairment" DWP, dated October 2010 using the same ICD classification).



Placed in the support group



Placed in the work-related activity group



Did not complete the assessment



Still in progress



Found fit for work



4200 of our clients in total

5.3 We are concerned firstly by the high proportion of claimants not completing the assessment and it is our hope that the reasons for this will be determined through Professor Harrington's next review. Secondly we are perturbed by the very high proportion of our clients that have been found fit for work with the possibility that these people will neither obtain work nor employment support to find work. These people will instead be placed on Job Seekers Allowance where they will face a tougher conditionality regime.

5.4 We are also concerned at the impact of the time limiting of contributory ESA for the people in the Work Related Activity Group. The Shaw Trust, a welfare to work provider, has stated that it doesn't help to rush ESA claimants or place unrealistic demands on them. Many blind and partially sighted people require longer term support. Recent analysis on the Pathways to Work Programme (January 2011) reveals that only 12% of clients with "diseases of the eye" were able to find employment within one year of joining the programme. Consequently we are concerned that many blind and partially sighted claimants will be affected by the time limiting of ESA. The effect will be to force them onto JSA where they will receive less support to find work and face a tougher regime of conditionality. The impact will be to reduce the income of many by up to a third and leave them with a significantly lower standard of living.

5.5 The RNIB Group recently obtained findings from research conducted by the University of Birmingham, into the impact of the recession on the employment rate of blind and partially sighted people. The research shows that since September 2008 there has been an 8% fall in their employment rate. This research highlights the vulnerability of our clients to the current recession and the challenges they face in obtaining and retaining work.

Recommendation 8

The proposal i9n the Welfare Reform bill to time limit contributory ESA for those in the Work Related Activity Group should be abandoned.

5.6 Finally we would highlight a gap in provision existing between the Pathways to Work Programme ending and the new Work Programme beginning. Disabled clients in the work related activity group would be left without employment support at a time of very high and rising unemployment.

Question 7

The time-scale for the national roll-out for the migration process, including the Department’s capacity to introduce changes identified as necessary in the Aberdeen and Burnley trials.

6.1 The Social Security Advisory Committee concluded in their own report that there was a mismatch between incorporating the improvements required to ensure fair treatment of claimants and the time planned for a national roll out of IB migration. We are aware that the Minister for Work and Pensions has indicated his willingness to introduce Professor Harrington's recommendations but is also aware that these changes will not all have been made prior to IB migration starting. Finally we are concerned that there may be an as yet unresolved dispute over Professor Harrington's recommendation that claimants should have the right to have additional medical evidence taken into consideration (such as a Certificate of Visual Impairment) and ATOS own willingness to modify the LIMA software to achieve this.

Recommendation 9

There ought to be consistency of treatment for all those being migrated and we would therefore endorse the SSAC recommendation that the IB migration be suspended until the WCA is fully revised and the LiMA software suitably modified to reflect this.

April 2011