Work Capability Assessment
The Work Capability Assessment (WCA) is the test designed and used by the Department of Work and Pensions (DWP) in the United Kingdom to determine the entitlement of disabled welfare claimants to Employment and Support Allowance. Atos Healthcare, part of the multinational company Atos, will continue to conduct this highly controversial disability assessment until March 2015. The test has been criticised for the high proportion of those tested being found 'fit for work'.
Background to the 'Fit for Work' Test
Up to 1995 medical entitlement to Invalidity Benefit, though made by an Adjudication Officer, were largely based on the opinion of a claimant's own general practitioner. But clinical tests cannot themselves determine functional incapacity. The ultimate obstacle to work lies in the subjective experience of the claimant. Pain and fatigues are not susceptible to objective measurement. In 1995 that benefit was replaced with Incapacity Benefit and the Department of Social Security began commissioning its own medical assessments of claimants to determine eligibility using the new Personal Capability Assessment (PCA).
In 2007 the Welfare Reform Act 2007 heralded the replacement of Incapacity Benefit with Employment and Support Allowance (ESA) and the PCA with the WCA. The aim was to make the medicals more stringent and to take into account new disability legislation, changes in the workplace and developments in occupational health. However, the WCA programme did not gather pace - nor significant news coverage - until 2010 when the incoming Conservative-Liberal Democrat coalition government expanded its role to reassess the 2.5 million people that the DWP had already judged to be entitled to Incapacity Benefit, as part of an outsourcing contract that would cost more than £500m over the next five years. The Conservative-led Coalition also made lawful changes to the framework of the test to make ESA even harder to obtain.
The WCA was then held up as one of the DWP's primary driving mechanisms for getting people "off benefits and into work".
When the Labour government introduced the 'fit for work' test in 2008, it contracted out the medical to its existing partner for disability assessments: Atos Healthcare, which was already conducting assessments on people claiming a range of other disability benefits including Disability Living Allowance and Industrial Injuries Disablement Benefit.
For the WCA, Atos healthcare professionals scrutinize the benefit claimant's paperwork before deciding on the need for a face-to-face assessment. If one is deemed necessary, an appointment is booked - usually in an Atos examination centre, but occasionally in the person's home. At face-to-face assessments, the assessors, who are doctors, nurses or physiotherapists, use a computer-based points system and a semi-structured interview technique - designed in conjunction with the DWP - in an attempt to gauge the impact of the disability on the person's daily life and to assess the person's fitness for work. There may also be a short physical examination and general observations of the claimant's mobility, speech, hearing, etc. are made. After the interview a report is sent electronically to the DWP that concludes with a points score purporting to reflect the level of disability, together with a recommendation on fitness for work.
These assessments have been criticised for their repetitive impersonal style, while the reports have been criticised for several aspects of their overall quality and for the accuracy of their recommendations.
A medically-unqualified junior DWP civil servant - the 'decision maker' - then makes the final decision on eligibility for ESA (though in no more than 20% of claims is the Atos recommendation overruled at this stage).The decision is not a medical decision but is designed to be a weighing up of all the available evidence of their capability for up to 17 types of physical or mental activity (for example Moving Around and Using Steps, Reaching, Communicating with Other People, Learning How to Do Tasks, Dealing with Other People).
Criticism of the WCA
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. 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.
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 in the media at the time.
In 2013 the 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."
Also in 2013, the 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 claims, where the claimant might simply have recovered, with established claimants coming up for reassessment. Therefore, Shapps had no conclusive evidence to back up his assertion.
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.
Around the same time a doctor who had resigned from Atos after being told to change a report about an individual blew the whistle to the BBC, pointing out that in certain circumstances "the General Medical Council makes it clear that doctors must not change a report and risk being disciplined for unprofessional conduct if they do". He also drew attention to widespread and unduly harsh misinterpretations of the assessment's system for awarding points, on key abilities such as mobility and manual dexterity, that were promulgated through the training programme for new WCA assessors - to which Atos replied that it was the DWP that was responsible for setting the curriculum for new assessors, not Atos.
On 22 July 2013, the barrage of criticism of the Work Capability Assessment appeared to be vindicated when the DWP announced that it had directed Atos to put in place a "quality improvement plan" - as part of which, all WCA assessors would be obliged to undergo complete retraining - and said it would be bringing in new providers to carry out assessments, at this point supposedly in addition to Atos. The move followed a retrospective audit of 400 Atos reports produced over a six month period in which the DWP claimed that it had found 164 that were unsatisfactory - yet the DWP said that these "unsatisfactory" reports had nevertheless come up with the correct recommendation on fitness to work.
At the same time, the Coalition's attitude towards the WCA underwent a sea-change. PricewaterhouseCoopers were called in to audit undisclosed quality issues and in the autumn reshuffle the Prime Minister ordered the incumbent of the ministerial post with responsibility for the WCA to return to the backbenches. In December, in a statement to the Work and Pensions Committee, the new Disabilities Minister criticised the test and blamed the Labour government which introduced it, describing the assessment process as a "mess" that the Coalition had been obliged to pick up when it came to power - a mess so vast it was "astronomical".
Meanwhile Atos abruptly backtracked on a promising arrangement to carry out the WCA on the Isle of Man and began to secretly negotiate an early exit from its contract - worth half a billon pounds - on the mainland, later publicly citing death threats to its staff, criticism from Labour MPs and Atos's own opinion that the WCA itself was "not working" as its reasons for wanting to leave.
In March 2014, when responding to Dr Paul Litchfield's review of the WCA's performance for the DWP published the previous year, the Disabilities Minister poured more scorn on the WCA process and once again blamed the previous Labour government. The minister said: "...the system we inherited from the previous administration was not fit for purpose. The process was riddled with problems..." and declared that as well as extending the testing process to the 2.5 million people already on Incapacity Benefit, ministers had been trying to fix the assessment since coming to power.
At the same time, the Minister told Parliament that the contract with Atos was in the process of being brought to a premature close, with Atos paying a "substantial financial settlement" to the DWP (in what was officially described as a mutual agreement but which, by the time it reached the press, had been 'spun' to give the false impression that Atos had been sacked owing to the poor quality of its reports). 
Over the summer, it emerged that there was a growing backlog of hundreds of thousands of ESA claims.
At the end of October, the DWP announced that the US firm Maximus would take over the WCA contract from Atos - but not until March 2015, only five months short of the planned termination date of the five year Atos contract.
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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