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]
APPLICATION OF THE DESCRIPTORS TO
FLUCTUATING CONDITIONS
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]
CONCERNS ABOUT THE TESTING OF THE
AA
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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