Work Capability Assessment
The Work Capability Assessment (WCA) is test used by the Department of Work and Pensions in the United Kingdom to determine the entitlement of disabled welfare claimants to Employment and Support Allowance. These assessments are conducted by Atos Healthcare, the health division of the UK branch of the multinational company Atos. The test is controversial and has been criticised for the high proportion of those tested being found 'fit for work'.
Up to 1995 medical entitlement to Invalidity Benefit was established by a claimant's own General practitioner. In 1995 that benefit was replaced with Incapacity Benefit and the Department of Social Security began commissioning its own medical assessments of claimants using the new Personal Capability Assessment (PCA). In 2007 The Welfare Reform Act 2007 replaced Incapacity Benefit with Employment and Support Allowance and the PCA was replaced with the Work Capability Assessment. The aim was to ensure that the medicals assessments carried out to determine eligibility for the benefit would be more stringent. Nevertheless, the WCA did not gather significant pace, nor widespread national news, until after it was aggressively pushed by the incoming Conservative-Liberal Democrat coalition government in 2010/11. The coalition government held up the WCA as one of its primary driving forces to get people "off benefits and in to work". As verified in the Financial Times, Atos healthcare division "conduct[s] disability assessments for people claiming a range of disability benefits including Employment Support Allowance, Personal Independence Payment, Incapacity Benefit, and Industrial Injuries Disablement Benefit." They operate a computer-based points system based upon a questionnaire that is read to the sick person and their responses noted. Then there may be a short physical examination. These assessments have been criticised for their outcomes. In May 2013 UK Statistics Authority challenged Grant Shapps' claim that 878,300 benefit claimants dropped their claims rather than be assessed by Atos. Andrew Dilnot, chairman of UKSA, found that the figure appears to "conflate" new and old claims. Therefore, Shapps has no evidence to back up his claim and the evidence provided shows that he is wrong.
In 2013 a Public Accounts Committee made up of MPs and chaired by Margaret Hodge, revealed that in 2011/12 Atos was paid 112.4m to carry out 738,000 assessments. 38% of appeals against the Department for Work and Pensions (DWP) were successful. The Committee declared the Work Capability Assessments resulted in too many wrong decisions being overturned. Whilst Atos are paid to make the assessments, it is the government who pays for the tribunal appeals, with £500 million being the cost to the taxpayer for these appeals. "The Department's got to get a grip of this contract", concluded Margaret Hodge, saying "We saw no evidence that the Department was applying sufficient rigour or challenge to Atos given the vulnerability of many of its clients, the size of the contracts and its role as a near monopoly supplier. We are concerned that the profitability of the contract may be disproportionate to the limited risks which the contractor bears."
At a meeting in June 2012 British Medical Association doctors voted that the Work Capability Assessment should be ended ‘with immediate effect and be replaced with a rigorous and safe system that does not cause unavoidable harm to some of the weakest and vulnerable in society’. The vote has not been acknowledged by Atos or by the UK Government, although it was reported rather widely in the media at the time.
MPs didn't debate Atos Healthcare in relation to the Work Capability Assessment in Westminster Hall until 4 September 2012. Since then, there has been considerable pressure applied to Iain Duncan Smith, the minister for the DWP, by many including Michael Meacher and Tom Greatrex who have campaigned for the reform of the fitness to work assessment. Greatrex has also written to the Prime Minister to demand an investigation of allegations made by a former Atos assessor that Work Capability Assessments are biased against the claimant.
The Work Capability Assessment has been criticized in the media, in Parliament, by the Church, by the medical profession, and by protest groups regarding its disability programmes.
On 22 May 2013, a landmark decision by the courts in a judicial review brought by two individuals with mental health problems ruled that the Work Capability Assessments were not fit for purpose, and that they substantially disadvantage people with mental health conditions. Despite the ruling's self-evident importance, the decision had a similar lack of real-world effect as it did not halt or even slow down the Work Capability Assessment process; Atos seems to have ignored the judgement and its implications.
In the same month, a Freedom of Information request by Reading councillor and Chair of Reading Borough Council’s Access & Disabilities Working Group, Pete Ruhemann, revealed that: "28 of the 140 medical assessment centres, or 20 percent, do not provide wheelchair access," and, "[m]any, including the larger centres, are on the second or third floor". Furthermore, the "great majority do not have associated parking". The councillor characterised this national situation as, "a disgrace". It has been revealed that Atos has already made an out-of-court settlement with one user, "for disability discrimination […] over access." Again, despite this legal outcome, Atos appears to neither have engaged in public self-criticism nor to have moved its inaccessible assessment venues to more-accessible locations.
On 22 July 2013, the widespread criticism of Work Capability Assessments was vindicated by the Department of Work and Pensions announcing that it had directed Atos to put in place a performance improvement plan and it would be bringing in new contracting providers to carry out assessments. This followed a DWP audit which found that around 41% of reports produced by Atos following an assessment were graded C in a quality scale A-C.
One doctor resigned from Atos after being told to change a report about an individual, pointing out that "the General Medical Council makes it clear that doctors must not change a report and risk being disciplined for unprofessional conduct if they do."
In 2012, 43 complaints against Atos doctors and nurses were being investigated by the General Medical Council or Nursing and Midwifery Council. Criticism has been directed at Atos over the ability of its staff to deal with complex mental health problems and conditions whose symptoms vary with time. In August 2012, Atos Healthcare claimed they had appointed 60 Mental Function Champions to provide additional training.
Dangerous conclusions and deaths
Government statistics reveal that between January 2010 and January 2011, 10,600 sick and disabled people died within six weeks of being assessed. Government statistics also revealed that of those who had been put into the 'Work Related Activity Group' (which prepares claimants for future work), 1300 died within 6 weeks. Critics of ATOS allege that the number of deaths is far greater. In mid-January 2012, there was a significant scandal as media were alerted to the fact that the WCA had found a man in a coma to be 'fit for work'.
Work Capability Assessments have found patients with brain damage, terminal cancer, severe multiple sclerosis, and Parkinson's Disease to be fit for work. On 24 April 2013, a woman who was a double heart and lung transplant patient died in her hospital bed only days after she was told, after a Work Capability Assessment, that her allowance was being stopped and that she was fit for work.
In August 2011, twelve doctors working for Atos as disability assessors were placed under investigation by the General Medical Council because of allegations of misconduct in relation to their duty of care to patients.
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