Migration to ESA

ESA 40

Written evidence submitted jointly by Centre for Mental Health, Hafal, Mind, Rethink, the Royal College of Psychiatrists and SAMH (the Scottish Association for Mental Health)

About Us

Centre for Mental Health

Centre for Mental Health is an independent, national charity that aims to help to create a society in which people with mental health problems enjoy equal chances in life to those without. We aim to find practical and effective ways of overcoming barriers to a fulfilling life so that people with mental health problems can make their own lives better with good quality support from the services they need to achieve their aspirations. Through focused research, development and analysis, we identify the barriers to equality for people with mental health problems, we explore ways to overcome those and we advocate for change across the UK.

Hafal

Hafal is run by its 1,000 members - people with a serious mental illness and their families and carers.  Every day our 160 staff and 150 volunteers provide help to over 1,000 people affected by serious mental illness across all the 22 counties of Wales.  The charity is founded on the belief that people who have direct experience of mental illness know best how services can be delivered.  In practice this means that at every project our clients meet to make decisions about how the service will move forward and the charity itself is led by a board of elected Trustees, most of whom either have serious mental illness themselves or are carers of a person with a mental illness. 'Hafal’ means equal. Our mission is to empower people with serious mental illness and their families to enjoy equal access to health and social care, housing, income, education, and employment, and to achieve a better quality of life, fulfil their ambitions for recovery, and fight discrimination.

Mind

Mind is the leading mental health charity in England and Wales. We work to create a better life for everyone with experience of mental distress by:

· Campaigning for people’s rights

· Challenging poor practice in mental health

· Informing and supporting thousands of people on a daily basis

A fundamental part of Mind’s work is provided though our network of over 180 local Mind associations who last year worked with over 220,000 people running around 1,600 services locally. Services on offer include supported housing, crisis help lines, drop-in centres, counselling, befriending, advocacy, and employment and training schemes. Over 30,000 people are supported by our national telephone help lines. Welfare reform is a key issue for many of the people Mind has contact with. We also work extensively with the Disability Benefits Consortium (DBC) on issues of welfare and benefits.

Rethink

Rethink Mental Illness, the leading national mental health membership charity, works to help everyone affected by severe mental illness recover a better quality of life. We help over 52,000 people each year through our services and support groups and by providing information on mental health problems.  Our website receives over 600,000 visitors every year. Rethink's Advice and Information Service helps almost 8,000 people each year and advises people daily with benefit claims.

Royal College of Psychiatrists

The Royal College of Psychiatrists is the leading medical authority on mental health in the United Kingdom and is the professional and educational organisation for doctors specialising in psychiatry.

 

SAMH (Scottish Association for Mental Health)

SAMH is the biggest mental health charity in Scotland, providing an independent voice on all matters of relevance to people with mental health and related problems and delivering direct support to around 3000 people through over 80 services across Scotland. SAMH provides direct line-management to respectme (Scotland’s anti-bullying service) and ‘see me’ (Scotland’s anti-stigma campaign).

1
Summary

 

1.1 Our organisations understand the motivation for moving claimants off existing incapacity benefits (IB), which is seen as a ‘passive’ benefit, onto Employment and Support Allowance (ESA), which is seen as more ‘active benefit’. Around 43 per cent of those people due to be migrated are claiming primarily due to a mental health problem, [1] and many more will have experienced mental distress. We welcome efforts to help people with mental health problems back to work, where appropriate and if done in a supportive and understanding manner. However, we are concerned that the process will not be fair; will cause substantial distress; and will lead to many people receiving inadequate support and being subject to inappropriate and potentially harmful requirements.

1.2 All of our organisations have received substantial feedback, from people with mental health problems who have experienced the WCA and from professionals who work with them, that the assessment is unsuitable for gauging the impact of mental health problems on an individual’s ability to work. Some of our organisations have also been involved in various stages of creating and reviewing the assessment, but have often felt that our perspectives and objections have been largely disregarded. We do not believe the assessment is working fairly and effectively and we do not think migration should go ahead until these issues are resolved.

1.3 We are also concerned about the way in which the process will be communicated to IB claimants; the timescale of the migration; and the outcome of the process for those claimants reassessed.

2 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

 

2.1 It is clear that, in response to Professor Harrington’s Independent Review, the Department and Jobcentre Plus in particular is paying considerable attention to how the process of migration is communicated. We welcome recent innovations in the customer journey, such as additional phone calls during the process to ensure that the customer is kept informed and up-to-date.

2.2 However, we are keen that, throughout the process, customers are regularly reminded of their rights at each stage of the process around submitting additional evidence; being accompanied during the assessment; accessing their report from the assessment questioning the Decision Makers verdict; and appealing the final decision. We would be very concerned if any of the additional contact established with the customer resulted in a sense that it wasn’t worth questioning or appealing a decision that they were not happy with.

2.3 We are not confident that people feel well informed about the process of migration and we are concerned that uncertainty and anxiety about the process is having a detrimental effect on people’s health. In a recent survey on the Mind website of over 300 current IB claimants:

· 78 per cent did not feel well informed about the process

· Only 20 per cent had received their information from the Department (62 per cent had picked up their information from the media)

· 75 per cent said concern about the WCA had made their mental health worse and 51 per cent reported it had made them have suicidal thoughts

· 95 per cent do not think that they will be believed at their assessment and 89 per cent believe that they will be forced back to work before they are ready or able.

2.4 Although we understand that a huge number of people are due to be reassessed over a significant period of time, we do feel that it would be helpful if the Department could indicate to people when they are likely to be reassessed. The knowledge that you are due to go through a process that could have a profound impact on your life, along with the uncertainty of when this will occur in the next three years, is an unpleasant combination for those concerned. The ongoing anxiety this situation is causing may well worsen people’s mental health and could place them even further from the job market.

"I was due to be re-assessed for IB last September, nothing has happened yet except for a daily dread of brown envelopes"

"I dread the post coming each morning just in case there is a brown envelope with DWP printed on it and can no longer listen to news reports on the radio about anything to do with benefit changes." [1]

2.5 Informing people would not need to involve sending letters out to all those due to be reassessed, or even identifying specific dates. It could simply consist of a webpage where people can check the month or quarter when they are likely to be called in for reassessment. This webpage could be promoted to third sector organisations who could assist those without direct access to the internet. We feel that this would prove beneficial to a huge number of people.

3 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

 

3.1 Our organisations have, between us, worked extensively on the WCA: from involvement in the meetings that led to the creation of the assessment and two reviews of its functioning, to listening to the concerns of people with mental health problems going through the process and feeding these concerns back to government. However, we do not feel that the DWP or successive governments have been particularly responsive. We believe that the assessment is not fit for the purpose of gauging the impact of mental health problems on an individual’s ability to work.

3.2 Professor Harrington’s Independent Review in 2010 vindicated the vast majority of the criticisms of the WCA that we had been expressing. We do not go into detail here about all of these criticisms, as the majority are well known. However, we have summarised our concerns below and have also enclosed our joint submission to the Harrington Review, which explains these concerns in more detail:

· Many people with mental health problems that pose a serious barrier to them finding employment are being found ‘fit for work’ and that many of these people are scoring zero points

· A huge number ‘fit for work’ verdicts are being successfully overturned at appeal, suggesting that these cases are not initially being assessed fairly or effectively

· The process is impersonal and mechanistic and does not allow the applicant to express the extent of their impairments and the details of their circumstances

· Applicants often feel that they have been treated unfairly and that this can cause distress that can both worsen their mental health and put them further away from the job market

· The assessment does not take sufficient account of fluctuations in conditions, which is vital to understanding the impact of mental health conditions

· The assessors do not have adequate expertise or training to understand mental health problems and the impact they have on an individual’s ability to work

· Too much weight is given to the verdict of the assessment and not enough to the perspective of clinicians who have a more complex and nuanced understanding of the applicant’s condition

3.3 We are pleased that the Department has now taken some of these criticisms on board and is looking to implement Professor Harrington’s recommendations. We support these recommendations and believe that they should help to significantly improve the WCA for people with mental health problems. We are also pleased that Professor Harrington has been kept on to perform a subsequent review which will include monitoring the implementation and effectiveness of his initial recommendations.

3.4 However, we do have some remaining concerns about the assessment that were not fully addressed by Professor Harrington’s Review:

3.4.1 We do not feel that there has ever been a rigorous evaluation of whether the WCA is both valid (i.e. it correctly measures what it is intended to measure) and reliable (i.e. it provides consistent and reproducible results). The high rate of successful appeals suggests that there is poor reliability and validity. We recommend that a thorough and scientifically rigorous evaluation of the WCA is undertaken, with a view to a more scientific approach to redesign if necessary.

3.4.2 We are concerned that the format and content of the current descriptors drives the behaviour of assessors in terms of only requiring them to seek a minimal amount of information from an applicant before assigning them to a particular category. The descriptors tend to try and measure complex impairments with multiple dimensions on a linear scale and we believe this fundamentally undermines their capacity to assess mental health problems. An example of this would be the descriptor on ‘coping with social situations’ which primarily measures the frequency of this impairment but doesn’t treat severity or duration as a variable. Professor Harrington has asked Mind to make proposals on improving the descriptors along with Mencap and the National Autistic Society. These proposals have been submitted to Professor Harrington and should go before Ministers around June 2011. We believe that these proposals would help to alleviate the limitations of the current descriptors but nonetheless call for fundamental review of assessment format.

3.4.3 The Government recently began implementing the recommendations of a previous, internal review of the WCA. Our organisations have significant concerns about both the process of this review and the outcomes. We are particularly concerned about the reduction in descriptors around mental, intellectual and cognitive function from ten to seven and we believe that this will render the assessment even less fair and effective for gauging the impact of mental health on an individual’s ability to work.

3.4.4 We believe that the guidance given to assessors compounds the problems with the descriptors by suggesting that they should look for sufficient cause to disqualify the applicant rather than rigorously assessing for reasons to qualify them. For example, there are a number of descriptors where simply turning up alone for the assessment is seen as cause for scoring zero points for the area impairment. This is particularly problematic for mental health where the impairments may not be obvious from appearance or even behaviour and where people’s condition as presented on the day of assessment may not be representative of their usual or worst states of fluctuation. The guidance often cites the most extreme example of impairment, rather than providing suggestions around more borderline cases which may allow assessors to make more balanced decisions. For example, descriptor 15 (execution of tasks) has the following guidance:

"The pattern of typical day activity should really reflect a person who should struggle to get through the basics of a day due to their mental disablement as a result of tasks taking so long to complete that they would be unable to cope with work due to the length of time required for basic tasks. For example those who have severe and continuous disabling anxiety where they struggle to even get out of their bedroom may come into this category".

By citing such an extreme case, it can overshadow less extreme, but still serious, cases and may lead to people being ‘under-assessed’.

4 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. 

 

4.1 As stated in our joint submission to Professor Harrington (see attached) we believe more weighting should be given to the professional opinion of those clinicians in contact with the individual making the claim. This would help not only to reduce the number of people erroneously judged to be ‘fit for work’ but would assist in dealing with some of the problems of fluctuating conditions and symptoms and of combined mental and physical disorders. These clinicians would also have a greater understanding of how the condition affects the individual and how it might impact on their ability to work. The process would be more transparent if DWP Decision Makers were obliged to explain to the applicant why they had contradicted the opinion of the clinician, where relevant.

4.2 We are pleased that Professor Harrington recognised the problems in this area and we hope that his recommendations on this issue are fully implemented. Since this will involve retraining Decision Makers and a culture-shift in their approach to balancing different sources of information it is likely to be a lengthy process.

4.3 We would also like to see applicants regularly reminded during the process that they can submit additional evidence; that they can request a copy of their report from the WCA to check for accuracy; and that they can ask for reconsideration of their decision or go to appeal.

4.4 To support this it would be helpful to have a named person from the DWP system to be responsible for each claimant’s benefits claim who could be contacted by the claimant or clinicians when queries are required and who can assist in guiding the claimant through the benefits system.

5 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

 

5.1 A number of Community Mental Health Teams (CMHTs) have reported that many of their service users have been winning their appeals. Under the old Incapacity Benefit system, the fact that they were using a CMHT would be an indicator of a severe mental health condition and so the benefit would be awarded. The fact that the WCA no longer has this feature increases the likelihood of people being assessed and placed in the wrong groups as well as the cost/ trauma of subsequent successful appeals.

5.2 We are also concerned that clients who have won their appeals are being reassessed through the WCA within a very short time frame. We have been in touch with a claimant who was initially declared ‘fit for work’, but overturned this verdict at appeal. He was sent an ESA50 form within months of the appeal being settled, and has now been called for a further medical assessment. This is causing him great distress and could potentially impact on his health, causing unnecessary expense for the NHS; particularly as he was assured it would be at least a year before he is reassessed.

5.3 Success rates for appeals are much higher when appellants are accompanied by an advocate or companion, suggesting that people appealing alone may not be able to adequately represent their case. People need to be encouraged to bring support to appeals.

5.4 We would like to see evidence from appeals being fed into the WCA system to ensure that those whom a tribunal has found to be eligible for ESA do not have to suffer the distress of presenting the same information to a different part of the system shortly afterwards, and that the DWP learns from these cases for future reference. This would also allow Decision Makers to understand why their decision was overturned, which should lead in time to a reduction in the need for appeals. At present, there is no systematic method for Decision Makers to learn from the decisions of Appeals Tribunals.

6 The outcome of the migration process and the different paths taken by the various client groups

 

6.1 1.6 million IB claimants will be migrated onto ESA by March 2014. We are concerned that many of these people may drop out of the benefits system due to the stress of the process or because they are not eligible for other benefits. Even if people are found to be legitimately ‘fit for work’, they will have been on benefits for many years, often without the right support to find paid work, and thus will take time to adjust to the demands being made of them and will in the interim face distress and hardship. As the current system of assessment is presently not sufficiently efficient they will be doubly disadvantaged. Policy will need adjusting to allow the long-term IB claimants who are found to be ‘fit for work’ to have a period of time on ESA before being moved to JSA.

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.

 

7.1 We have been aware for several years that the WCA is a flawed process and often denies people with mental health problems the benefits and support that they are entitled to. The Harrington Review has highlighted many of the problems in the process of assessment that contribute to this. The number and extent of the recommendations from this review demonstrate that the assessment is not functioning fairly and effectively. These recommendations need to be implemented in full, and their impact assessed to ensure they have had the desired effect, before the migration of existing IB claimants goes ahead.

7.2 We understand that it would be extremely complicated to halt new assessments of ESA applicants while reforming the assessment. However, there is no such imperative to begin migration at this precise moment. The average duration of claim for those due to be reassessed is nine years. We agree that it is hugely regrettable that so many people have been left for so long without active support, but it is absurd to claim that starting migration now should take priority over ensuring that the assessment process is fair and effective. A delay of a few months to ensure that the recommendations are implemented and have taken effect is clearly preferable to a more immediate migration with a flawed assessment.

APRIL 2011


[1] DWP Incapacity Benefits Migration: Customer Segmentation Programme Summary of Key Findings and Final Customer Segments, April 2010, Government and Public Sector Consulting

[1] Quotes taken from claimants who have contacted our organisations