Work Capability Assessment faces its own fit-for-work test

The controversial assessment of whether or not benefit applicants are medically fit for work has now been running for two years. A statutory independent review is currently considering claims that the system is resulting in many incorrect diagnoses.

On this page:
Greater "conditionality"
Box 1: The extent of incapacity
The Work Capability Assessment
Box 2: The DWP "discussion document"
Three in four applicants fail
Box 3: Assessment considerations
Charities concerned
Box 4: Hazards awareness
The Harrington review.

While the Government points out that the Work Capability Assessment (WCA) has resulted in large percentages of individuals either being assessed as fit for work or dropping their claim - with the unsaid implication that many of the claims were invalid or bogus - charities and other organisations that work with the claimants are voicing concerns that the WCA is resulting in many incorrect diagnoses. These fears are currently being examined as part of a statutory independent review but - regardless of whether or not they are substantiated - the implications for health and safety professionals of having to accommodate workers who are not fully fit for work are likely to prove increasingly significant.

Greater "conditionality"

The numbers of recipients of incapacity benefits have risen sharply for most of the past 20 years, at a considerable cost to the economy and loss to the individuals themselves and the country as a whole (see box 1 below). The last Labour Government long argued that work is "good" for people's mental and physical health and that benefit dependence had hindered or halted the efforts of many to find a job. In particular, it insisted, a large proportion of recipients of incapacity benefits were fit for work but had been failed by a welfare system that paid benefits but did little to help them back into work. It set in place a large number of initiatives, including Pathways to Work, which were designed to help welfare recipients escape what is often a poverty trap.

At the same time as offering such "assistance", the Government started to introduce greater "conditionality" into the benefits process, in which applicants, as a principle, have to do more to prepare themselves for work. Such conditionality may become more stringent in early 2011 when Iain Duncan Smith, secretary of state at the Department for Work and Pensions (DWP), announces his reaction to responses to a recent DWP "discussion" exercise (on the DWP website) on wider welfare reform (see box 2 below). There is considerable tension, however, between the cost-cutting priorities of the Treasury and Duncan Smith's approach, which although harsher than even that of the Labour Government, similarly recognises that a proper welfare-to-work system needs significant financial investment.

The Work Capability Assessment

By 2014, Employment Support Allowance (ESA) will have replaced the main incapacity benefits (see box 1 above) for people who are unable to work due to ill health or disability. All new applicants for ESA undergo a WCA within 13 weeks, while individuals who were receiving incapacity benefits before 27 October 2008 will undergo the assessment no later than March 2014 (originally 2013). Although Duncan Smith told his party's annual conference on 4 October 2010 that although the Government intends to replace nearly all welfare benefits - including ESA - with a single benefit, the WCA will continue.

The WCA focuses on what applicants can, rather than what they cannot, do. It replaced the "personal capacity assessment" on 27 October 2008 and differs in that it is a functional health assessment and not a diagnostic medical assessment (which will already have been carried out by the claimant's GP or consultant). The WCA is carried out by ATOS Healthcare, which is contracted by the DWP. The ATOS assessor makes a recommendation to the DWP as to which of three groups an applicant should be placed into, with the DWP taking the final decision.

The core of the WCA (PDF format, 204K) (on the direct.gov website) comprises 11 physical, and 10 mental, cognitive and intellectual, "activities" that the applicant is asked about, all of which could also be relevant to the ability of a person to perform a job without endangering the safety and health not only of themselves, but also of other workers and the public (see box 3 below). Each activity is supplemented by a list of "descriptors", which are actions that applicants must be able to perform.

Each descriptor scores one of 15, nine, six or zero points (with 15 representing the highest impediment); a score of 15 or more points would indicate that the person has limited capability of work and should be placed in either the support or work-related activity groups and receive ESA (see below); a score below 15 points indicates the individual does not have limited capability for work and is therefore not entitled to ESA. People in the work-related activity group will undergo a work-focused health-related assessment, which is a "discussion between the customer and the healthcare professional to identify potential barriers to work and any relevant health-related interventions". Box 4 lists the descriptors for one of the 21 activities - the applicant's awareness of hazards.

Three in four applicants fail

Government figures (PDF format, 74K) (on the DWP website) released on 27 July 2010 showed that three in four of the 686,500 WCAs carried out between 27 October 2008 and 30 November 2009 in mainland Britain resulted in the applicant either being found fit for work or withdrawing their claim for ESA before completion of the assessment process. Of the applicants:

• 39% (270,400) were designated as "fit for work", meaning their claim ceases, although they can appeal and they may be eligible for Job Seekers Allowance (JSA);
• 37% (252,800) stopped their application before the assessment could be completed;
• 14% (96,700) were placed in the "work-related activity group", in which they receive a higher rate of benefit than those on JSA and are mandated to engage with Pathways to Work, which offers them return-to-work assistance;
• 6% (40,100) were placed in the "support group", which means the DWP accepted that they have a severe disability and receive a higher rate of benefit and exemption from mandatory involvement with Pathways to Work; and
• 4% (26,500) had not completed the process. (The figures do not add up to the total because they are rounded and exclude "clerical" decisions made without the full medical assessment.)

Analysis of the 496,200 initial assessments that were completed by 31 May 2010 (ie excluding claimants who stopped their applications and assessments that were still in progress), shows the DWP designated:

• 10% (49,000) for the support group;
• 24% (118,800) for the work-related activity group; and
• 66% (328,500) as fit for work (again, the figures are "rounded").

Of the 166,500 individuals who applied for ESA between October 2008 and June 2009 and were assessed as fit for work, 32% (52,800) appealed, four in 10 (21,200) successfully. (Due to the length of the appeals proceedings, there are likely to be further appeals from the 166,500.)

Charities concerned

The Government had expected that half of the completed WCAs would result in the applicant being found fit for work, rather than the two-thirds that has been the case. The experience of organisations that deal with the individuals themselves is that the tests are producing incorrect diagnoses. A March report (external website) from the Citizens Advice Bureau (CAB), for example, expressed "grave concern at the number of people unexpectedly being found fit for work" under the WCA. CAB advisers, adds the report, have seen "high numbers of seriously ill and disabled people being found 'it for work'".

On 28 July, 36 organisations - charities representing people with disabilities and conditions, such as Mind and the MS Society, as well as organisations that specialise in getting people back to work, such as Remploy - formed a coalition to highlight their concerns about the assessment. "Charities," claims the Papworth Trust, which is leading the coalition, "are being overwhelmed by evidence showing the assessment to be inaccurate and often unfair to the nation's most vulnerable people. The assessment is too focused on physical capability, meaning that people with serious mental health issues, learning disabilities and fluctuating health conditions are often marked as fit to work." The WCA assessors, argues the trust, "have not been sufficiently trained to recognise the full range of disabilities, causing people dealing with serious health conditions to be reported as work ready".

The trust cites the example of "Wendy", a nurse manager suffering from stress who had a breakdown, tried to commit suicide and remained incapable of making even the simplest of decisions such as what to eat. Her WCA was carried out by a nurse, rather than a psychiatrist or psychologist, and, claims the trust, resulted in a "fit for work" determination because she "could wash, dress, walk and talk coherently".

Matthew Lester, the trust's work and learning director, says: "While we back the Government's aim to sort those who can work from those who can't, it is crucial that those genuinely unable to work continue to get the support they need. The current process causes massive uncertainty and stress for those already struggling with their health. We believe that people should be supported before, during and after the assessment, with advice available at every step."

The Harrington review

In September, the coalition submitted evidence to a government-commissioned independent review (PDF format, 103K) (on the DWP website) of the fairness of the WCA. The annual review, which is the first in a series of five that is required by s.10 of the Welfare Reform Act 2007, is being conducted by professor Malcolm Harrington, a distinguished occupational health academic, with the help of what the DWP calls "a small scrutiny group that will offer advice and challenge". The review called for evidence between 28 July and 10 September, and is scheduled to report by the end of the year.

The review's call for evidence speculates that the higher-than-expected number of people being assessed as fit for work may be due in part to changing attitudes to health and work, and that: "Under any new benefit system, particularly one where there is to be an objective assessment for capability, there may be problems with perceptions of fairness as people make the transition. This is particularly true of changes like the introduction of ESA, which may represent a significant culture shift for both healthcare professionals and claimants."

At the same time, however, the call for evidence also emphasises that it "is important to separate issues of perception from cases where the new regime or assessment is not accurately performing, either through problems with the design or delivery". HSB will return to the issue once Professor Harrington delivers his verdict.