Migration to ESA

ESA 45

Written evidence submitted by Advice Network on behalf of Advice Centres for Avon (ACFA)

1 Introduction & 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 fifteen-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 0 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 0 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.

2.5 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 0-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