List of conclusions and recommendations
In this List, conclusions are set out
in plain type and recommendations, to which the Government is
required to respond, are set out in italic type.
ESA claims process and outcomes
1. It
is too early to predict whether the current trends in ESA outcomes
will stabilise. However, we note the recognition within the ESA
system that a higher proportion of claimants than initially expected
are not fit for work and are therefore eligible for ESA, and that,
of these, many need the higher level of benefit and absence of
work-related conditionality which the Support Group provides.
Nevertheless, it is clear that many claimants still find the process
very stressful. Many find themselves in an outcome group which
does not reflect their health barriers to employment, because
the current system is not sufficiently sophisticated to cope with
the wide variety in prognosis and impact which arises from the
huge range of conditions which claimants present with. (Paragraph
16)
2. We
raise concerns about the current system and set out a number of
shorter-term changes which we believe will help ameliorate some
of its most egregious flaws. However, our overall conclusion is
that the design of the ESA benefit and assessment process is so
problematic, particularly in relation to the confusion and limitations
of the outcome groups, that its inefficiencies and the detriment
inappropriate decisions cause to claimants can only be resolved
in a fundamental redesign of the ESA claims process over the next
few years. (Paragraph 17)
Improving the claims process: DWP's
role
3. The
current ESA process is too long and complex. We agree with Dr
Litchfield that it would be improved if DWP itself, and not the
assessment provider, issued the ESA50 and decided whether a face-to-face
assessment and/or additional evidence was necessary. This would
both speed up the process and put the DWP decision-maker at the
heart of the process. We recommend that this change be implemented
when the new provider starts delivering the WCA.
(Paragraph 25)
Supporting evidence
4. As
part of this new process we recommend that DWP decision-makers
(DMs) proactively seek additional evidence, from both health and
social care professionals, rather than placing the onus to do
this on claimants (although claimants should retain the right
to submit evidence with their ESA50 if they wish to do so). DMs
are best placed to know whether additional evidence is necessary,
whereas claimants may not know what evidence would be most useful
or from whom to seek it, and may not be able to afford the significant
charges which some GPs and other professionals require. Although
this change may lengthen the decision-making period and may incur
some additional public expense, this is likely to be balanced
by a reduction in the number of appeals, which are expensive,
time-consuming and stressful for claimants. DWP should also make
clear guidance available to both professionals and claimants on
what evidence is most useful in the process. This guidance should
explain that supporting evidence needs to set out how a condition
affects a claimant's functional capacity. DWP might also wish
to explore options for providing training on this for GPs and
other professionals. (Paragraph
26)
Paper-based assessments
5. We
also recommend that DMs give much more careful consideration to
whether a claimant can be placed in the Support Group without
having to undergo a face-to-face assessment. Paper-based decisions
are quicker, cheaper and less stressful for claimants, and may
well be possible for a greater number of claims than is currently
the case. However, we do not believe that paper-based assessments
are appropriate for placing people in the WRAG, as can currently
happen with IB reassessments (but not ESA new claims), because
moving a claimant to a lower level of benefit should be based
on the widest available evidence, particularly given the additional
job-search conditionality which arises from being in the WRAG.
We recommend that DWP change this policy urgently so that IB claimants
are not placed in the WRAG without a face-to-face assessment.
(Paragraph 27)
Frequency of reassessments
6. We
acknowledge that reassessments are a necessary feature of the
ESA system, to ensure that claimants remain in the correct benefit
group with the right level of conditionality placed on them. However,
reassessments are occurring too frequently, particularly for claimants
with progressive conditions and ones which are unlikely to change.
They also often take place too soon after successful appeals.
Unnecessary reassessments are distressing for the claimant and
a waste of public money. We recommend that DWP implements the
recommendations of the independent reviewers on reassessment intervals
without further delay, and that it looks again at whether its
current reassessment criteria are in the best interests of claimants
and are a good use of public funds. A speedy decision on this
would assist the new contractor to plan its work.
(Paragraph 32)
Communication with claimants
7. We
welcome DWP's acceptance of Dr Litchfield's recommendation that
all ESA-related forms and letters should be reviewed. We recommend
that DWP improve the way it communicates with claimants, both
in writing and in telephone calls. It should ensure that forms,
including the ESA50, and letters are user-friendly and in plain
English; the language used should be clear, with explanations
of the more technical terms; and confusing legal explanations
should be in footnotes or annexes rather than the main text. The
terms "limited capability for work" (for those placed
in the WRAG) and "limited capability for work-related activity"
(for those placed in the Support Group) are very confusing for
claimants. We recommend that DWP finds more meaningful terminology
to use in explaining decisions on ESA claims to claimants.
(Paragraph 36)
8. Communication
with contribution-based ESA claimants placed in the WRAG is particularly
important because they need to understand that their ESA will
terminate after a year. The consequences for claimants of the
12 month time-limit and the options available to request mandatory
reconsideration of the WRAG decision and to apply for income-based
ESA at the end of the time-limit should be clearly set out. We
recommend that DWP ensure that these claimants receive specific
and clear information on the implications of this claim outcome,
including when the time-limit starts and when it will end, both
in the decision letter and in the Decision Assurance telephone
call. (Paragraph 39)
Appropriateness of the WRAG for people with long-term
conditions
9. More
than 80,000 new ESA claimants and IB claimants undergoing reassessment,
many of them with progressive conditions, have been placed in
the WRAG since ESA was introduced, with a prognosis statement
that a change in their functional abilities is unlikely in the
longer term. The purpose of the WRAG is to provide work-related
support for people who are expected to be fit for work in the
short to medium term. Work-related conditionality accompanies
this designation. We believe that it is wholly inappropriate to
place people in the WRAG if they have a condition which is unlikely
to improve and which makes their prospect of returning to work
remote. We therefore recommend that DWP changes its practice so
that claimants with this prognosis are allocated to the Support
Group and not to the WRAG.
(Paragraph 43)
Design and application of the WCA descriptors
10. 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.
(Paragraph 58)
Future delivery of the face-to-face
assessment
11. Atos
has become a "lightning rod" for much public dissatisfaction
with the benefit decisions people receive. This is unlikely to
change if the WCA is simply "rebranded" by moving to
a new provider, who will inevitably face a huge challenge in delivering
the new contract. We recommend that the Government takes steps
to communicate clearly to claimants, the wider general public
and the media, that it is DWP which decides on benefit eligibility,
not the contracted provider of the WCA, and that the face-to-face
assessment is just one part of the decision-making process. (Paragraph
80)
Service standards and contract management
12. Although
some progress has been made, concerns remain about the accessibility
of Atos assessment centres, the overbooking of appointments, and
the manner in which some claimants are dealt with by assessors.
We recommend that DWP specifies exacting service standards relating
to these aspects of the claimant's experience of the WCA in the
new contract. The Minister made clear that the Government is willing
to pay more for a service that meets the standards that claimants
and taxpayers are entitled to expect. We welcome this acknowledgement
that, as assessments are to remain part of the welfare system,
they should be adequately funded.
(Paragraph 83)
13. If
claimant confidence in the process is to be restored, the new
contractor will need to demonstrate that its staff have the expertise
necessary to carry out effective assessments of claimants presenting
with the more difficult conditions, including those which are
progressive, fluctuating or relate to mental and cognitive health.
We support Dr Litchfield's recommendation that assessors should
have suitable and sufficient experience in mental health. We recommend
that this should be set out on the face of the contract and that
DWP extend this to other conditions which are acknowledged to
be difficult to assess. (Paragraph
84)
14. There
have been fundamental problems with the current WCA contract in
terms of meeting the requirements on throughput and quality. The
current backlog of 700,000 cases awaiting assessment is unacceptable.
People with health conditions and disabilities should not be left
for months with uncertainty about their benefit entitlement. The
fault does not lie with Atos alone; DWP has changed the contract
a number of times and its own forecasts of referral levels have
sometimes been inaccurate. DWP should also have done more to manage
the contract effectively, to prevent the problems which have caused
detriment to claimants occurring in the first place. (Paragraph
86)
15. The
new WCA contract needs to balance the quality of assessment reports
with specified levels of throughput of referrals which avoid backlogs
and delays to claimants. Achieving this balance will depend heavily
on DWP providing accurate forecasts of referral levels, as well
as the efficiency of the provider. To ensure transparency, we
recommend that DWP publishes the forecast levels of referrals
which will be specified in the new contract. These will need to
include different levels to take account of: the initial period
when the backlog is being cleared; the period when the IB reassessment
is being completed alongside new claims continuing; and then the
period when steady state is achieved and only ESA new claims and
reassessments of existing claims are being processed.
(Paragraph 87)
16. We
recommend that DWP takes all necessary steps to assure itself
that the new provider has the capacity to deliver both quality
and quantity of assessments. Performance indicators should be
challenging and transparent and financial penalties should be
applied if specified standards are not met. However, given the
extreme negativity around the existing contract, the WCA is unlikely
to appeal to the few private contractors with the necessary capacity
to take it on. DWP's willingness to offer incentives in the new
contract, as well as imposing penalties, is therefore welcome.
(Paragraph 88)
17. DWP
also needs to demonstrate that it has sufficient expertise and
capacity to manage a contract of this size and complexity, to
ensure value for public money and that claimants receive an acceptable
level of service. This does not appear to have been the case with
the Atos contract. If this capacity does not currently exist,
we recommend that it be developed as a matter of urgency, bringing
in expertise from other parts of Government if necessary. We welcome
the Government's plans, in the longer term, to bring in multiple
providers. This makes it even more important that DWP should develop
its contract management expertise. Once the new contractor has
been selected, we recommend that DWP make public the cost of the
contract to the public purse (and how far that differs from the
previous contract), the way payments will be calculated, and the
basic service standards, including the average number of assessments
to be carried out per assessor per day. Greater transparency on
such matters would avoid some of the controversy which has dogged
this benefit. The Government may also wish to take this opportunity
to consider whether, in the light of the negativity around the
delivery of the face-to-face assessment by a private provider,
it would be more appropriate for the assessment process to be
taken back in house. (Paragraph
89)
Mandatory reconsideration
18. We
have previously expressed concern about the high number of appeals
against ESA decisions. Appeals are both expensive to the public
purse and stressful for claimants and we welcome the introduction
of mandatory reconsideration (MR) as a step towards reducing the
number of unnecessary appeals. However insufficient information
is currently available to allow us to evaluate whether it is likely
to have this effect in the longer term. The reduction in the number
of DWP decisions, due to temporary operational changes, is likely
to have contributed to the significant reduction in appeals shown
in the latest statistics, rather than representing a long-term
change arising solely from MR. We welcome DWP's assurance that
an analysis of the reasons behind the reduction in appeals will
be undertaken. (Paragraph 97)
19. Mandatory
reconsideration will be a success if it results in a reduction
in unnecessary appeals to HMCTS. We are however concerned that
its introduction may deter claimants who were likely to have been
successful in their challenge from appealing, because the new
dual process is more onerous. We recommend that the Department
monitor claimant behaviour, to evaluate whether the policy is
having this undesired effect, rather than fulfilling its intended
purpose of ensuring a correct decision is reached more quickly
and without needing to go to appeal.
(Paragraph 98)
20. We
recommend that the Department works with the Office for National
Statistics to ensure that official statistics on the operation
of mandatory reconsideration are published as a matter of urgency.
These should include: volumes of reconsiderations received and
processed since the policy was introduced; the outcomes of these
reconsiderations; the overall impact on ESA outcomes; and the
length of time it is taking for reconsiderations to be completed.
(Paragraph 100)
21. We
acknowledge that DWP often needs to seek additional evidence as
part of the reconsideration process, which can be time-consuming,
and we agree that it is better for mandatory reconsideration to
take a little longer if this results in the correct decision being
made. However this should not be an open-ended process and we
do not accept that either of these factors preclude DWP from introducing
a reasonable time target for completion of reconsideration. The
introduction of a time target would also help to drive better
performance. We therefore recommend that DWP introduce and report
against a reasonable time target for the completion of mandatory
reconsiderations. (Paragraph
102)
22. We
believe that it is inappropriate that those who have been determined
by DWP to be fit for work and who have asked the Department to
reconsider the decision are ineligible for assessment rate ESA.
Although these people may be eligible to claim JSA, many are reluctant
to do so because of the accompanying conditionality requirements.
There has also been a problem with some Jobcentre advisers not
being aware of the flexibility to modify the attached conditionality
appropriately for these claimants. Assessment rate ESA and JSA
are the same amount of money, so there is no financial saving
for the Department from the policy, and it may in fact cost the
Department money due to the administrative burden of moving claimants
from assessment rate ESA to JSA during reconsideration, and then
back to assessment rate ESA if they decide to appeal. We therefore
recommend that claimants deemed fit for work following the WCA
process who have requested that the Department reconsider that
decision be paid ESA at the assessment rate until they receive
the reconsidered decision.
(Paragraph 109)
Appeals process
23. We
welcome the introduction of more extensive feedback from appeals
through the provision of summary reasons by tribunal judges. However
it is critical that this feedback is used effectively by the Department
to improve the initial decision-making process. We recommend that,
in response to this report, the Government set out how it plans
to handle the volume of information it is now receiving through
summary reasons, and how it will analyse and use it to improve
the initial decision-making process. We further recommend that
feedback from summary reasons is also shared with the new provider
of the face-to-face assessment, so that it can be used to evaluate
how assessments could be improved.
(Paragraph 113)
24. We
welcome the efforts to streamline and speed up the appeals process
by increasing the capacity of the Tribunals Service, and introducing
direct lodgement and a target time for DWP to submit its case
to the tribunal. We were, however, surprised to learn that documentation
is exchanged between DWP and the Tribunals Service in hard copy
through the post, given the Government's emphasis on the benefits
of using the internet for public services. There is clearly further
scope for increasing efficiency and improving the service for
claimants making an appeal by introducing an online appeal application
form and enabling electronic transfer of documents between DWP
and the HMCTS. We appreciate that there will be an initial cost,
but the return in terms of speed and efficiency would be worthwhile.
We recommend that the Government set out the action it intends
to take in this respect in response to this Report.
(Paragraph 119)
Interaction between ESA and employment
support
25. There
is a gap in the current system which means that a claimant's employment
support needs are not being properly assessed as part of the ESA
claims process. In particular, claimants should not be found "fit
for work" where they would only be able to enter employment
if significant adaptations and support were provided. We recommend
that DWP urgently reassess where in the process an assessment
of health-related employment barriers could most appropriately
take place—either by reintroducing the Work-focused Health-related
Assessment (WFHRA) as a second stage of the WCA, or at a later
stage as an extended version of the Work-focused Interview once
the claimant is referred to Jobcentre Plus (or to the Work Programme).
In the meantime, we endorse the recommendation made by both independent
reviewers, that information obtained through the WCA process should
be shared with Work Programme providers and JCP employment advisers.
(Paragraph 136)
Redesign of the ESA and WCA process
26. We
agree that an assessment of work capability of some sort is necessary
for an out-of-work benefit paid on the basis of ill health and
disability, and that eligibility should be based on functionality
and not diagnosis. We also agree that this assessment should seek
to distinguish between claimants who are unlikely to be able to
return to work in the long-term, and those who, with the right
support, could return to employment. Nor do we under-estimate
the scale of the task involved 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
may change over time and which affect individuals in different
ways. (Paragraph 144)
27. However,
the current ESA system is not working as well as it should, particularly
in terms of achieving the intended employment objectives for claimants.
The ESA outcome groups are too simplistic: the WRAG has become
a "catch-all" group for those claimants who do not meet
the narrow criteria for being placed in the Support Group, but
who are not fit for work. The conditionality attached to the WRAG,
and the focus on moving into work in a relatively short period
of time, means that this group, as it currently operates, is not
appropriate for many of these claimants. Nor does the current
WCA provide an accurate assessment of a claimant's individual
health-related employment barriers, or their distance from the
labour market. (Paragraph 145)
28. We
recommend that the Government undertakes a fundamental redesign
of the structure of ESA outcomes. This should focus on identifying
changes to the assessment process, to ensure that the health barriers
to employment that an individual faces are properly identified.
For claimants in the WRAG, proper account needs to be taken of
where they are on the spectrum of readiness for work. Work-related
conditionality should be matched to the identified employment
barriers. The support made available to help the individual move
closer to work should be tailored more closely to their individual
circumstances. It may be possible to use the different prognosis
periods for when a claimant is expected to be fit for work as
the basis for varying the conditionality and accompanying support.
The redesign process will require a considerable amount of research,
and will take time, but sufficient resources should be devoted
to it to ensure that a new design is in place before the new multi-provider
contract is tendered in 2018. The redesign will also need to take
account of the implications for ESA of the introduction of Universal
Credit. (Paragraph 146)
29. The
descriptors used in the WCA, and the way they are applied in the
current points-based assessment, are not producing accurate outcomes
of functional capacity in the workplace in many cases. The Evidence
Based Review was a useful process, but more needs to be done to
evaluate the effectiveness of the descriptors and to make them
more responsive, particularly for claimants with progressive and
fluctuating conditions, and those with mental, cognitive and behavioural
difficulties. We recommend that the redesign of the ESA process
includes a fundamental reassessment of the effectiveness of the
design and application of the descriptors used in the Work Capability
Assessment. (Paragraph 147)
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