Employment and Support Allowance and Work Capability Assessments - Work and Pensions Committee Contents


Summary

Employment and Support Allowance (ESA) is the benefit paid to people who are unable to work because of ill health or disability. Concerns about the operation of ESA, and in particular the assessment used to help determine eligibility—the Work Capability Assessment (WCA)—have grown steadily since it was introduced by the previous Government as a new benefit in 2008, and were first examined by this Committee in 2011.

The current Government has made some welcome adjustments to the WCA as a result of the four independent reviews which have taken place since 2010. But problems with the ESA process persist, and many claimants continue to report a stressful and anxiety-provoking experience.

The scale and complexity of the challenge in determining eligibility for an incapacity for work benefit which is claimed by millions of people, with a vast range of conditions and disabilities, which affect them in very different ways, cannot be under-estimated.

Weaknesses in the operation of ESA

The WCA itself is flawed in that it frequently fails to provide an accurate assessment of the impact of the claimant's condition on their fitness for work or work-related activity. However, the problems with ESA are wider than this: it is also failing to fulfil its intended purpose of helping those claimants who can do so to "achieve their full potential through work" through an accurate assessment of the health-related employment barriers which an individual faces and, crucially, linking this directly to tailored employment support.

The outcomes of the ESA claims process are too simplistic. Claimants can be found "fit for work" and are then ineligible to claim ESA. Claimants found to have such limited functionality that that they cannot undertake any work-related activity are placed in the Support Group, where they are subject to no work-related conditionality. This leaves a large and disparate middle group of claimants who are not yet fit for work, and may even have a deteriorating condition, but who are required nonetheless to undertake activity which is meant to help them find work in the longer term. These claimants are placed in the Work-related Activity Group (WRAG). The WRAG covers too wide a spectrum of claimants with very different prognoses and employment support needs.

Contract for the WCA

Concerns about the WCA have culminated in the Department for Work and Pensions (DWP) negotiating an early exit from the contract with the private sector provider, Atos Healthcare.

The re-letting of the contract provides an opportunity to address some of the problems with the WCA itself and with the wider decision-making process for which DWP is responsible. The Government must ensure that this interim re-letting of the contract is used to improve the service to claimants and to build confidence in the fairness of the claims process.

The re-let contract needs to set robust and transparent service standards for the new provider including on: accessibility of premises; appointment systems; quality of assessments; timely delivery of reports; and level of training for assessors on mental and cognitive conditions and those which are progressive and/or fluctuating. The Government has acknowledged that the re-let contract is likely to cost more. This can be justified so long as DWP monitors it rigorously to ensure service standards are met. It will need to ensure that DWP staff have the necessary level of contract management expertise to exercise this role effectively.

Redesign of the WCA and ESA end-to-end process

The flaws in the existing ESA system are so grave that simply "rebranding" the WCA by taking on a new provider will not solve the problems: a fundamental redesign of the ESA end-to-end process is required, including its outcomes, and the descriptors used in the WCA. This will be time-consuming and complex but the redesigned ESA assessment process needs to be in place by the time a completely new contract, involving multiple providers, is tendered in 2018.

This redesign needs to focus on what the purpose of ESA is—helping people move back into work where this is possible. It should ensure that the health barriers to employment that an individual faces are properly identified, and that employment support needs are effectively evaluated. Work-related conditionality and employment support should then be matched to the identified employment barriers and tailored more closely to individual circumstances.

As part of this process, DWP should reintroduce an assessment of health-related employment barriers now, and then incorporate this type of assessment into the redesigned ESA process.

Shorter term improvements

In the meantime, a number of steps need to be taken to ensure claimants receive an improved service and outcomes. These include:

·  DWP taking overall responsibility for the end-to-end ESA claims process, including sending out information-gathering forms to claimants, and deciding whether they need a face-to-face assessment, rather than this being the role of the contracted assessment provider.

·  DWP deciding whether "supporting evidence" on the impact of a claimant's condition or disability on their functional capability is needed and, crucially, it proactively seeking it, rather than leaving this to claimants, who often have to pay for GPs to provide it. Where evidence is identified as necessary, it should be sought from the most appropriate health and other professionals, such as social workers, and occupational therapists, rather than relying on GPs.

·  Greater use of paper-based assessments to place people in the Support Group.

·  Unnecessary reassessments should be avoided, and decisions on reassessment intervals should be made in the best interests of claimants and be a good use of public funds.

·  An acknowledgement that the "descriptors" used to assess functional capability in the WCA are imperfect; accompanied by a more sensitive and common-sense application of them in the WCA and benefit decisions.

·  Clearer communication with claimants throughout the process, including on what the decision on eligibility means for them in practice, in terms of the amount of money they will receive and for how long; the work-related conditionality associated with the level of benefit awarded; and their right to ask for reconsideration or to appeal the decision.

Mandatory reconsideration and appeals

A high percentage of ESA decisions are challenged at appeal and a significant proportion of these decisions are overturned by tribunals. Fewer cases being taken to appeal would be a positive development, both in terms of public cost and stress for claimants. Mandatory reconsideration (MR) by DWP of challenged outcomes before they go to tribunal, which was introduced in 2013, therefore has the potential to be beneficial.

However, DWP needs to set a reasonable timescale for the MR process, rather than this being left open-ended. The current illogical arrangement whereby claimants seeking MR are required to claim Jobseeker's Allowance (JSA) instead of ESA should be abolished. Official statistics showing the impact of MR on the number of appeals and on outcomes for claimants should be published as a matter of urgency.

Where cases do go to the appeal stage, DWP and the contracted provider need to learn from the process by ensuring that the reasons for overturned decisions are disseminated to decision-makers and assessors and properly considered. The introduction of provision of summary reasons for decisions in tribunals is welcome and DWP should set out how it plans to use this feedback effectively.



 
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Prepared 23 July 2014