Benefit delivery Contents

4Legacy benefits

48.This chapter considers potential improvements to the DWP’s delivery of the benefits it intends to replace with UC over the coming years. As set out in the previous chapter, some claimants will be in receipt of these benefits until at least 2020–21.

Employment Support Allowance

49.Employment and Support Allowance (ESA) replaced incapacity benefits (IB) for new claimants in 2008. Since 2010, existing IB claimants have been undergoing reassessment through Work Capability Assessments (WCA) as they migrate to ESA. WCAs are conducted by contracted healthcare professionals who produce an assessment report on the claimant’s functional capability for work. The report is used by the DWP to make a decision on the claimant’s eligibility for ESA.94

50.The DWP’s original intention was that the entire IB caseload of around 1.4 million people would be reassessed for ESA by April 2014, but the process has been dogged by delays. Five independent reviews, and reports published by our predecessor Committee and others, have sought to improve both the efficiency and accuracy of the WCA.95 The previous contracted provider, Atos Healthcare, was replaced by Maximus in 2015, with a view to improving efficiency and clearing the backlog of WCAs.96 However, in May 2015 there were 86,500 people still in receipt of IB and some 600,000 WCAs, including new ESA claims, outstanding in total. Maximus completes between 6,000 and 10,000 assessments per week.97

51.Several organisations told us they remained concerned about the length of time claimants were waiting for WCAs.98 The DWP aims to complete WCAs within 13 weeks of a claim. During this period claimants receive ESA at the “assessment rate” (£73.10 per week, for claimants aged 25 and over). If found eligible for ESA they could currently receive either £102.15 per week or, if their functional capability is more severely limited, £109.30 per week.99 The Community Housing Cymru Group emphasised that, despite DWP assurances that average waiting times are down, “there are still people who have been waiting for over a year to be assessed and to receive the additional money”.100

52.Citizens Advice Scotland reported that Maximus had admitted to a local CAB that “the 13 week target for assessments has not applied for ‘about a year’”.101 This seems to reflect the casework of Members of Parliament, who are often asked to step in when their constituents experience lengthy waiting times (see boxes 1 and 2 below). The caseworker for Gisela Stuart MP told us that “in August 2015, Maximus confirmed to us they were 2 years behind in processing and still dealing with 22nd June 2013 cases”.

Box 2: Casework—Jeremy Lefroy, MP for Stafford, Delay in ESA assessment

I am writing as your constituent about my ongoing difficulty applying for Employment and Support Allowance (ESA), and to ask that you intervene on my behalf.

I have Parkinson’s and received contributory ESA from August 2014, but the benefit stopped automatically after 365 days because I was not reassessed.

The reason the support has stopped is not because of anything I have done (or not done), but because of an apparent lack of resource in the system on the part of Maximus (the contractor doing Work Capability Assessments) and/or DWP.

My wife and I asked for an assessment and sent in plenty of supporting evidence but I was told I would have a long wait.

A local Parkinson’s UK advisor contacted the DWP and Maximus to make a complaint.

This resulted in a letter and phone call to say that I was not even near the front of the queue, and that there are people in the Birmingham and Bristol areas who have been waiting for an assessment since 2013, because Maximus can’t (or hasn’t) recruited enough doctors in these areas! This particularly affects people with Parkinson’s as we (rightly) need to be assessed by a doctor, rather than a nurse, under DWP guidelines.

As a result of the complaint the DWP has “fast-tracked” me for an assessment but this only means I will get an appointment letter with an assessment date on it. They cannot say what the timescale for the appointment may be, and this could be several more months.

Box 3: Casework—Gordon Henderson, MP for Sittingbourne and Sheppey, Delay in ESA assessment

1. One constituent applied for Employment and Support Allowance in June 2013, however, she was only referred by the Department for Work and Pensions in November 2014 and did not receive her assessment until March 2015. This is a total waiting time of 21 months.

2. Most recently I have dealt with a constituent who has finally received assessment date after a wait of 20 months.

53.Since 2012, the DWP has dropped targets for average actual clearance time for ESA and replaced them with a target to process 85% of assessments within 16 days. As the 15% of assessments that take the longest to clear are not monitored as part of the assessment, there is a danger of particularly long delays not being tackled.

54.We have been unable to determine exactly how many people with health conditions or illnesses have been subject to protracted ESA assessment delays. Church Action on Poverty highlighted that “no more recent information is available, nor is there any published information on how long claims falling outside of this [16 day] target took to be processed”.102 Individual Members of Parliament have asked the Department to provide figures but it has either been unable to provide answers or refused to answer on the grounds of “disproportionate cost”.103

55.The lack of available data on ESA and WCA clearance times is unacceptable. The DWP cannot properly monitor Maximus’ performance, make clear policy decisions or effectively support claimants without it. We recommend, where applicable, the Department publish quarterly official statistics on ESA clearance times, including data on time from claim to completion of WCA; time from WCA to decision; and time from decision to payment of benefit, showing not only averages but a breakdown of the ranges of clearance times. We further recommend that in addition to the current average claim processing time target, the Department set a target time within which ALL claims should be processed.

Interaction between ESA and JSA

56.The problems for claimants caused by delays can sometimes be compounded by the interaction between ESA and JSA. For example, if an individual claims ESA but is found “fit for work”, then they can only claim JSA during the Mandatory Reconsideration stage of challenging that decision, or receive no benefit support.104 One reason the claimant might choose not to claim JSA is that they believe their health condition or disability would prevent them from meeting JSA’s very stringent work-related conditions. The Government acknowledged this in response to a report by our predecessor Committee and said that it had issued guidance to Jobcentre staff “to improve awareness of how the JSA regime can be varied to take account of the claimant’s physical or mental health condition”.105

57.We heard evidence that, contrary to the guidance, Jobcentre staff were not varying JSA conditionality for claimants with health conditions who had been found fit for work, and that some claimants had been sanctioned as a result.106 Problems can also arise because claimants found fit for work remain ineligible for ESA for six months, unless they can demonstrate a worsening of their health condition. The example below describes an instance where a claimant fell into “the gap between ESA and JSA”. Despite Jobcentre staff acknowledging a deterioration in her condition to the extent that she no longer met the conditions for JSA, she was refused ESA on the grounds that her condition had not deteriorated significantly enough. In effect, she was considered by DWP to be too ill to claim JSA but not ill enough to be eligible for ESA.107

Box 4: Example from written evidence—interaction between JSA and ESA

In July 2015 this client had gone six weeks without any money at all.

She had been on ESA suffering stress, but the award had been stopped after an unsuccessful appeal in mid-2014 (of which the claimant appeared to be unaware).

She claimed Jobseeker’s Allowance and was sanctioned for not doing sufficient to seek work. The Welfare Rights Service had sought a Mandatory Reconsideration, as health problems caused the failure, and the sanction was dropped.

However, the claimant’s health became worse—she was permitted three months’ ‘sick leave’ under new JSA rules but after this her JSA stopped as she was deemed incapable of work and not eligible for benefit.

She re-claimed ESA on the advice of Jobcentre staff.

ESA was refused on the grounds that the claimant had not shown that she had a new health condition, or that her existing condition was significantly worse.

This claimant was therefore too ill for JSA, but not ‘ill enough’ for ESA. She qualified for no benefits at all.

58.There is a growing consensus that the Work Capability Assessment needs to be reviewed. Our predecessor Committee found that it “frequently fails”.108 Phil Reynolds, a member of the Disability Benefits Consortium, told us that the “quality of assessments is generally not what it should be […] there are big problems in terms of understanding people’s conditions.”109 The Secretary of State said that “there is a fundamental problem at the heart of this benefit itself, which is this binary choice that you have to be too sick to work or you can work.” He said that he had announced a review of whether a partial capacity assessment would be feasible and asked for “interchange” with the Committee to see whether it was possible.110

59.We welcome both the Secretary of State’s intention to review the nature of the Work Capability Assessment and his commitment to engage with us in this work. However, people with significant health conditions who have been found “fit for work” and who are currently struggling to meet JSA conditionality cannot wait for a more nuanced assessment to be designed and implemented. They require immediate action to prevent them falling in the gap between JSA and ESA. We agree with our predecessor Committee that it is inappropriate for those challenging ESA decisions to claim JSA as some claimants are refused JSA due to being “unfit for work”. We recommend that assessment rate ESA be paid to claimants throughout reassessment of their claim, not only once an appeal is lodged.

94 See Work and Pensions Committee, First Report of Session 2014–15, Employment and Support Allowance and Work Capability Assessments, HC 302

95 See, for example, Dr Paul Litchfield, An independent review of the Work Capability Assessment, November 2014

97 ESA benefit caseloads from DWP Tab Tool; Oral evidence taken on 28 October 2015, HC (2015–16) 507, Q83 [Mike Driver]

98 Church of England and Oxfam (BFD0190), Caritas Social Action Network (BFD0165), Citizens Advice Scotland (BFD0158), Z2K (BFD0148)

100 Community Housing Cymru Group (BFD0185)

101 Citizens Advice Scotland (BFD0158)

102 Church Action on Poverty (BFD0133)

103 See Written answer 228323 (24 March 2015) and 228623 (25 March 2015)

104 If a claimant disagrees with a decision about their benefit claim then they must request a Mandatory Reconsideration before appealing to tribunal.

105 Ibid

106 Z2K (BFD0148)

107 Derbyshire County Council (BFD0181)

108 Work and Pensions Committee First Report of Session 2014–15, Employment and Support Allowance and Work Capability Assessments, HC 302

109 Q124 (Phil Reynolds)

110 Oral evidence HC 507, Q89

© Parliamentary copyright 2015

Prepared 18 December 2015