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

4  Design and application of the WCA descriptors

44. To determine eligibility for ESA, claimants are assessed on how their condition affects their ability to carry out 17 different activities. In relation to each activity, there are a number of "descriptors", which set out a level of functionality. Each descriptor has a point score attached to it (either 15, 9, 6 or 0). Claimants are allocated points on the basis of which descriptor applies to them under each activity (if more than one descriptor applies, then the one that attracts the highest points is allocated). If a claimant is allocated 15 points across the 17 activities, then they will be considered to have limited capability for work and will be placed in the WRAG. If they also meet one of a further 16 "limited capability for work-related activity" descriptors, they will be placed in the Support Group. A full list of both sets of descriptors and a detailed explanation of the process is available in the DWP's Guide to ESA: the WCA.[68]

Effectiveness of the descriptors

45. It is obvious that achieving an appropriate WCA outcome for claimants, in terms of being found fit for work or placed in the WRAG or Support Group, is very heavily dependent on whether the assessment criteria are the right ones, and whether they are being applied properly. The effectiveness of the descriptors, especially for those with mental health or other fluctuating conditions, was criticised by a number of witnesses.[69]


46. There was particular concern amongst witnesses about the way in which the descriptors are applied to fluctuating conditions. Z2K argued that: "There is a tendency, during the WCA, to give undue focus to claimants' abilities on 'good days' […] with little or no attention given to what they are able to manage on a 'bad day'."[70] It may be possible for a claimant to fulfil a task once; but the assessment needs to establish whether they can do it consistently and safely. The National Rheumatoid Arthritis Society referred to an example of a claimant being asked to write their name during an assessment, and being told that it was not relevant that they could not write more than 40 words without it being too painful.[71]

47. The WCA Handbook for HCPs carrying out assessments makes clear that "even in cases where the descriptor does not specifically mention the concept of 'repeatedly and reliably', this must always be taken into account". It also specifies that HCPs must assess whether claimants are able to carry out the additional Support Group descriptors "reliably, repeatedly and safely".[72] James Bolton of DWP confirmed that the "repeatedly and reliably" requirement "has been an integral part of the assessment since the start. It is in the handbook; it is in the health professional training." He told us that there was a specific Atos training model on fluctuations, that assessors have to ensure they take account of fluctuations in producing the assessment report, and that it "forms a key part of the audit criteria and the standards to which we hold them".[73]

Review of the descriptors

48. The adequacy of the descriptors was considered in Professor Harrington's first review of the WCA.[74] The Government accepted the recommendation in his second review that a "gold standard review" of the descriptors be carried out.[75] The outcome of this "Evidence Based Review" (EBR) was published in December 2013. It compared the performance of the WCA against an Alternative Assessment (AA) devised by specialist disability representative groups. [76]

49. The charities involved in devising the AA made clear to us that the EBR was an opportunity to suggest changes to the WCA descriptors, rather than to create a completely different assessment.[77] The AA was similar in many ways to the WCA, with both assessments using a structure based on activity headings and descriptors, and the 15 point threshold applied in both tests. The AA included two extra activities in addition to the 17 included in the WCA: "maintaining focus" and "executing tasks". The AA required the HCP to record how often the claimant experienced a limitation denoted by a particular descriptor, with the intention of producing more accurate outcomes for those with fluctuating conditions. The AA also allowed 3 points to be allocated to a claimant in relation to some activities: under the WCA, claimants can only be allocated 6, 9 or 15 points in relation to a particular activity.[78]

50. The AA was tested on 600 claimants undergoing the WCA at two different centres, Newcastle and Manchester, between March and September 2013. Claimants were first assessed by an Atos HCP using the current WCA. A second HCP then asked additional questions and gathered further information to allow the AA to be carried out. On the basis of these assessments, the HCPs then chose the descriptors that they felt applied best to the claimant. To compare the two assessments, the findings of the AA and the WCA were compared against the findings of panels of medical experts.[79]

51. The EBR concluded that "The overall findings suggest that the WCA performed better than the AA—the WCA produced consistent results on the whole, and is an accurate indicator of work capability as compared with expert opinion." In 77% of cases, the WCA produced the same fitness to work outcome as the experts, compared to 65% of the cases assessed using the AA.[80]

52. DWP has concluded from the EBR that "there is no evidence that changes to the WCA descriptors would significantly improve the overall assessment."[81] However, the review also highlighted that "The AA did reveal some areas—namely the way in which limitations and their fluctuations are noted, and the style of assessment discussion—which have relevance for ongoing refinement of the WCA."[82] In this context, it is worth noting that Dr Litchfield recommended that HCPs "should avoid reporting inferences from indirect questioning as factual statements of capability".[83]

53. Professor Harrington told that us it was a "big mistake" by the Government to reject changing the descriptors to take account of fluctuations in a claimant's functional limitation, because "there is lots of evidence that fluctuation is very important in the prognosis for people's individual cases, and for their work capability."[84] The Minister told us that assessing fluctuation "is the next real area that we need to look at very carefully."[85]


54. We were keen to ascertain why the AA was trialled by adding it on to the existing WCA, rather than as an entirely separate assessment. Professor Harrington, who had chaired the EBR steering group, told us that a separate assessment had been "plan A" but the scrutiny group had decided that it would be difficult, "in practical terms, or even in ethical terms", to require claimants to complete two separate assessments, and that they had feared that there would a high drop-out rate if this were the case.[86]

55. The charities involved in the EBR pointed out that they had had to design the AA to DWP's timetable "without any financial or statistical assistance and without the opportunity to consult widely, pilot and refine the AA before the DWP commenced the testing." The study also assumed that the expert panel came to the correct conclusion about a particular claimant's fitness for work even though they did not meet the ESA claimants they were assessing. [87]

56. The charities also raised concerns about the definition of fit for work used by the expert panels. In oral evidence, Mind highlighted that the expert panel identified that 83% of claimants deemed fit for work would need "on average, two or three" adjustments; 50% would need flexible working hours; and 24% would need a support worker.[88] The charities commented that it seemed that the WRAG would be more appropriate for claimants requiring this level of support and argued that this level of support is unlikely to be available.[89] We discuss the implications for employment support of the EBR findings in Chapter 7.

57. We put the charities' reservations about the EBR to DWP. James Bolton, Deputy Chief Medical Adviser, pointed out that the independent steering group had "signed up to the findings; they signed up to the methodology; they worked with us throughout; and they signed up to the conclusions and findings at the end."[90]

58. We welcome the Evidence Based Review as a step towards evaluating the effectiveness of the WCA descriptors. However we do not believe that the Review was sufficient in itself to lay to rest concerns about the descriptors. There were factors both in the way the Alternative Assessment was piloted, and in how its outcomes were compared with those of the WCA, which limit its value as a comparative test. To help address the limitations of the descriptors in the short term, we recommend that DWP remind both Atos assessors and its decision-makers that they must take proper account, in coming to a decision, of the claimant's ability to undertake an activity reliably, repeatedly and safely. Clear guidance should be issued to HCPs to avoid reporting inferences from a claimant's responses as factual statements of capability (as recommended by Dr Litchfield), and instead to use follow-up questions to ensure that they fully understand the impact of a health condition or disability on a claimant's functionality. In the longer-term, DWP should reconsider the effectiveness of the descriptors as part of the redesign of the system that we recommend in Chapter 8.

68   DWP, A guide to ESA - the WCA, (ESA 214), January 2013. See pp 18-28 for descriptors. The guide also sets out on pp 10-12 circumstances in which the claimant may not be allocated 15 points or meet one of the limited capability for work-related activity descriptors but will nonetheless be placed in the WRAG or Support Group. Back

69   See for example Crohn's and Colitis UK, (WCA0100), paras 1.1 - 1.18; National Association of Welfare Rights Advisers (WCA0116), paras 9-11; and Royal College of Nursing, (WCA0143), para 4.3 Back

70   Z2K (WCA0019) paras 21-25 Back

71   National Rheumatoid Arthritis Society (WCA0174), paras 3.5 - 3.8 Back

72   Revised WCA Handbook, March 2013, paras 2.3.1 and 3.2.1 Back

73   Q430 Back

74   Professor Harrington, An Independent Review of the Work Capability Assessment - year one, Chapter 8, paras 2 - 9 Back

75   Professor Harrington, An Independent Review of the Work Capability Assessment - year two, Chapter 3, para 63; Government's Response to Professor Malcolm Harrington's Second Independent Review of the Work Capability Assessment, November 2011, p 16 Back

76   DWP, Evidence Based Review of the Work Capability Assessment, December 2013 Back

77   Charities involved in the Evidence Based Review of the WCA (WCA0170), para 13 Back

78   DWP, Evidence Based Review of the Work Capability Assessment, December 2013, pp 11-13 Back

79   DWP, Evidence Based Review of the Work Capability Assessment, December 2013, Chapter 2 Back

80   DWP, Evidence Based Review of the Work Capability Assessment, December 2013, pp 8 - 9 Back

81   Government's response to the year four independent review of the Work Capability Assessment, March 2014,Chapter 3, para 14 Back

82   DWP, Evidence Based Review of the Work Capability Assessment, December 2013, p 51 Back

83   Dr Paul Litchfield, An Independent Review of the Work Capability Assessment - year four, December 2013, Chapter 4, para 40 Back

84   Q210 Back

85   Q429 Back

86   Q211 Back

87   Submission from charities involved in the Evidence Based Review of the WCA (WCA0170), paras 20 and 37 Back

88   Q12; Submission from charities involved in the Evidence Based Review of the WCA (WCA0170), paras 38 and 39 Back

89   Submission from charities involved in the Evidence Based Review of the WCA (WCA0170), paras 36-40 Back

90   Q426 Back

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Prepared 23 July 2014