Work Capability Assessment

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The Work Capability Assessment (WCA) is the test designed and used by the British Government's Department for Work and Pensions (DWP) to decide whether welfare claimants are entitled to sickness benefits.

The actual testing was delegated to private firms from the start — first to the Paris-based multinational Atos in October 2008 then, after Atos left early, to Maximus in March 2015. At an hour-long face-to-face assessment a healthcare professional — in most cases, a nurse — working for Maximus uses purpose-built software, their on-the-job training and their clinical experience to compile a report on the claimant's fitness for work. The US firm then sends the report to the DWP and charges it $260.[1] A civil servant uses this report, plus any other relevant information they have to hand, to decide on entitlement to Employment and Support Allowance or to an enhanced rate of Universal Credit, and on whether a successful claimant will be required to take part in "work-related activity".

The test was designed when Tony Blair was prime minister and introduced when James Purnell was Secretary of State for Work and Pensions. Citizens Advice said of it: "Bureau advisers have expressed grave concern at the number of people unexpectedly being found fit for work".[2] New eligibility criteria were drawn up over the course of 2009[3] and given legal force in 2011[4] by David Cameron's coalition government.

Despite the overhaul, the test remained the object of criticism — mainly for its inability to gauge the fitness for work of people with mid-range disabilities, especially where mental health was concerned (see the Criticism of the Work Capability Assessment page); the criticism intensified from 2011 onwards, after the test became the fulcrum for a reassessment of more than two million people receiving Incapacity Benefit and every disabled person on Income Support.[5]

In 2017 one of the designers of the WCA, Dr Paul Litchfield, told a parliamentary committee that the test was "imperfect" when it left the drawing board because the DWP had been "forced into rushing the design of the WCA" in order to "meet the legislative timescales of the Welfare Reform Act" — the act that paved the way for the deployment of the WCA during the financial crisis of 2007-2008.[6]

In February 2018 a former minister at the DWP, Baroness Altmann, said: "Disability benefits needed an overhaul — and of course we must not let people make bogus claims — but the extent of the appeals clearly indicates that something is seriously wrong with the system".[7] In the same month Polly MacKenzie[8], who was the Deputy Prime Minister's director of policy from 2010 until 2015, declared that "we need to think again about how we assess work capability" because WCA findings often failed to reflect the nuances of living with a disability; she also suggested that assessors had displayed a baked-in tendency to doubt the validity of claims, saying "capability assessors too often have a culture of disbelief about disability, especially mental illness".[9]

History[edit]

Between 1971 and 1995, the main out-of-work sickness payment from the National Insurance scheme was known as Invalidity Benefit. Entitlement to it was decided by a civil servant using information and advice provided by the claimant's doctor.

In 1995, the Department of Social Security abolished Invalidity Benefit for new claims and introduced Incapacity Benefit instead. The main difference was that the new benefit would only be paid if the claimant was unfit for any job, not just their old trade. The department then began to commission independent medical assessments using its new All Work Test. However, only a minority of fresh claims were actually assessed in this way; the rest were still gauged by a government official using information provided by the claimant's GP.

In 2000, five years after it was introduced, the All Work Test was replaced by the Personal Capability Assessment. This new test was used by government-approved doctors not only to assess some fresh claims but also to reassess some established recipients, at the behest of a government official.[10]

In its last term of office New Labour began to phase out Incapacity Benefit and replace it with Employment and Support Allowance. At the same time the Work Capability Assessment became the gateway to the new out-of-work sickness benefit. The policy objectives for the new test were: to accentuate the positive by "looking at what you can do, not what you can't do"; to take into account new disability legislation, changes in the workplace and developments in occupational health; to make the test more stringent; to assess most new claims in person rather than on paper; and, once the new test had bedded in, to use it to re-evaluate virtually every established sickness benefit recipient. To facilitate these last two objectives testing capacity was increased fivefold by employing nurses and physiotherapists to work alongside doctors, and a semi-structured interview technique based on a computer-generated template was used for the first time.[11]

The WCA went live in 2008, assessing only fresh claims, but the sickness benefit caseload went up — partly a consequence of the banking crisis and its effect on the economy and on jobs.[12] An overhaul of the test began soon afterwards and the new version was deployed in 2011 by the coalition government led by David Cameron. The WCA then became the fulcrum for a reassessment of all recipients of Incapacity Benefit and all disabled people on Income Support — a major Whitehall project that was supposed to save billions of pounds a year from the welfare budget, in a new age of austerity.[13][14]

Assessment process[edit]

The process is ultimately a legal one that uses social security legislation as its main reference point (which is why appeals are made to lawyer-led tribunals overseen by the Ministry of Justice). The standard of proof used is 'the balance of probabilities': a claim should be accepted if it is more likely than not that the claimant has a significant disability.

The process starts with an assessment by a healthcare professional, after which an official from the DWP decides on entitlement to Employment and Support Allowance (or to an enhanced rate of Universal Credit). The process also decides whether a successful claimant is able to take part in 'work-related activity'. In this way, the process sorts claimants — broadly speaking — into three groups:[15]

  • Fit for work
  • Unfit for work, but fit for 'work-related activity' (the Work-Related Activity Group)
  • Fit for neither work nor 'work-related activity' (the Support Group)

In principle[edit]

The strength of a claim is largely determined by comparing the claimant's problem with a framework of set criteria, known as 'descriptors',[16] which are divided into 'functional' and 'non-functional' descriptors. The healthcare professional's main role is to select the most appropriate descriptor for each activity printed on the ESA claim form that the claimant has marked as being difficult for them in their day-to-day life. To do this, assessors draw on their training in the field of 'functional assessment' — a subspecialty concerned with gauging the practical impact of an impairment on a person's daily life and, in the context of the WCA, on their ability to work.

The healthcare professional also draws on their medical knowledge gained from working in a clinical environment earlier in their career to:

  • Answer factual questions that have a bearing on eligibility, such as: "Is the claimant receiving intravenous therapy?"
  • Explore the medical history
  • Deliver clinical judgements, such as on whether the claimant is at substantial risk or terminally ill
  • Estimate the date of any future recovery

Functional descriptors[edit]

Each functional descriptor comes with a 'score' of 6, 9 or 15 points that is intended to reflect the relative severity of the disability. A total score of 15 points or more will qualify the claimant for ESA. If the healthcare professional deems that none of the functional descriptors apply, the total score will be zero.

Descriptors are grouped into 17 activities. For example, the activity 'Manual Dexterity' – hand function – comes with the following descriptors for the assessor to choose from:

  • The claimant cannot use a computer keyboard or mouse (9 points)
  • The claimant cannot use a pen (9 points)
  • The claimant cannot pick up a small object (15 points)
  • The claimant cannot press a button or turn a page (15 points and a place in the Support Group)

Only one descriptor may be chosen for each activity, and it should be the highest-scoring option that still accurately describes the loss of function. Someone who can pick up a small object like a coin but cannot use a pen to make a simple mark will score 9 points for that activity.

If a claimant is capable – in narrow terms – of carry out a particular action but cannot do so reliably, repeatedly, in a timely manner, safely and without significant pain, they should be treated as being incapable of carrying out that action.

The physical functional descriptors cover these activities:

  • Mobilising
  • Standing and sitting
  • Reaching
  • Picking up and moving an object
  • Manual dexterity
  • Making yourself understood
  • Understanding others
  • Finding your way around
  • Continence
  • Consciousness

The mental functional descriptors cover:

  • Learning tasks
  • Hazard awareness
  • Planning and problem-solving
  • Coping with change
  • Getting about
  • Coping with other people
  • Behaviour

A 'top score' in one activity will usually qualify the claimant for the Support Group.

Non-functional descriptors[edit]

The non-functional descriptors have no points attached but instead have a simple 'yes' or 'no' answer:

  • Is the claimant unable to eat or drink?
  • Is the medical condition life-threatening and uncontrollable?
  • Will the claimant probably die within 6 months?
  • Would the claimant's health be at substantial risk if they were found fit for work or for work-related activity?

Other factors that might be taken into account here include:

  • The claimant is pregnant
  • There is a risk to others
  • Intravenous therapy is being administered
  • The claimant has cancer

Summary[edit]

The process uses fixed criteria and a system of points in an attempt to differentiate between people claiming ESA whose disability does not substantially affect their ability to work and those who do face significant barriers to employment. Within the latter group, the WCA tries to identify successful claimants who have one or more severe functional disabilities: they are not required to prepare for future work and will be placed in the Support Group rather than the Work-Related Activity Group.

A 'yes' answer to a non-functional descriptor question will usually lead to the claimant being treated as though they were in the Support Group.

In practice[edit]

The first step in a new claim for Employment and Support Allowance is for the claimant to ask their doctor for a certificate stating that they are unfit for work. This is a standard blank form that the DWP issues routinely to NHS GPs — it is the same form that NHS GPs normally use to issue a sick note or 'fit note' to their employed patients when they are off work because they are ill. Next, the claimant contacts the DWP. At this point, the DWP conducts a basic screen of the claim and then usually sends out a more detailed form for the claimant to fill in, called the ESA50. The claimant then enters the 'assessment phase' and will normally be paid 'assessment rate ESA' for at least the next 13 weeks, at the rate they would be paid if they were on Jobseekers Allowance. Despite the name, no assessment takes place during the 'assessment phase'; it is intended to allow people with medium term medical problems, such as a broken bone, to recover before any more detailed assessment is carried out.

The main assessment process starts as soon as can be arranged after 13 weeks from the initial claim, when a healthcare professional approved by the DWP scrutinises the ESA50 claim form and decides whether to seek further evidence from the claimant's GP or another appropriate source. If the evidence shows that, on balance, according to the legally-defined criteria of the test, the claimant could not reasonably be expected to work or prepare for work, then a face-to-face assessment should not be necessary, the claimant should be recommended for the Support Group, and the higher rate of ESA usually granted. Otherwise, the healthcare professional arranges a face-to-face assessment – usually in an examination centre, but occasionally in the claimant's home.

At face-to-face assessments, the assessors – who are nurses, doctors or physiotherapists – are guided and prompted by a computer programme, designed by Atos in conjunction with the DWP, called the 'Logic-integrated Medical Assessment' or 'LiMA'. A large amount of lifestyle data and some clinical information is obtained from the claimant and is entered into the computer by the assessor, mostly by selecting pre-determined 'one click' options from an on-screen menu. As the assessment progresses, LiMA tries to gauge both the impact of the disability on the person's daily life and the person's fitness for work – but while LiMA suggests options to the assessor, it is ultimately the healthcare professional who is responsible for making the recommendations.

As well as taking a clinical history and exploring the claimant's 'Typical Day', the healthcare professional will make general observations of the claimant's hearing, mobility and posture, etc. and there may be a short physical examination. The claimant's mental state will to a large degree become apparent as the interview progresses, but specific questions might be asked in order to elucidate any disordered thinking, abnormalities of perception or cognitive impairment.[17]

If assessors are unsure how to apply the test's criteria in specific cases, telephone advice is available.

During the face-to-face assessment, if it becomes clear that the claimant qualifies for the Support Group on the grounds of severe functional disability, the interview should be brought to an early close and the finding recorded as a short note on the claimant's file as a recommendation to the DWP decision-maker. Otherwise, after the interview and any examination the findings are summarised in free text using Standard English prose and the report, constructed mainly from the LiMA options selected by the assessor during the interview phase of the assessment, is sent electronically to the DWP. The whole report attempts both to record all the findings and to justify the recommendation on fitness for work.[18] It shows the total points score and ends with a statement on whether significant disability is likely or unlikely, and a prognosis.

The way the test has been carried out has been strongly criticised. The semi-structured interview style and the use of decision-making software led to a suspicion that the WCA was merely a Whitehall box-ticking exercise: a checklist of standard questions coupled with a 'computer says no' attitude to eligibility, leading to large numbers of disabled people wrongly being declared 'fit for work'.

Checks and balances[edit]

The recommendation from the outsourcing firm is not the final decision on benefit entitlement. There are a number of what the DWP has called "checks and balances" that can follow the core assessment.[19]

DWP decision-makers[edit]

When the assessor's report is sent by the outsourcing firm to the DWP it clearly indicates suitability — or not — for the Support Group, and it contains the assessor's points score and a statement on whether the disability is significant enough for the claimant to qualify for ESA, but it is an official who makes the final decision on which category the claimant falls into and on entitlement to ESA payments. This decision takes into account: the assessor's report; any other available medical evidence; and the aspects of social security legislation pertaining to entitlement to benefits.

Assessors should not supply "prescriptive advice" on benefit entitlement in their reports. However, the structure of the core WCA and the way reports are presented mean that assessors' opinions on fitness for work are obvious to decision-makers. Some claimants are unfit for work but nevertheless ineligible for ESA because they do not meet the non-medical criteria with respect to benefit entitlement.

Reconsideration[edit]

If the claimant disagrees with the decision-maker's conclusion, the claimant can ask the DWP to review its decision (in October 2013, the DWP stopped claimants from appealing directly to independent tribunals; claimants must now first ask the DWP to reconsider the case — a process known as 'mandatory reconsideration' — whereas before October 2013, claimants could choose between asking for a reconsideration by the department or going straight to an external appeal).

In early 2014, more than 40% of 'fit for work' decisions undergoing reconsideration were overturned at this stage of the process. By 2015, the overturn rate at this stage had dropped to just over 10%.[20][21]

Tribunals[edit]

If the result of the reconsideration is unfavourable to the claimant, he or she can then appeal to an independent tribunal — consisting of a judge, a doctor and a layman — operating under the auspices of the Ministry of Justice. The tribunal takes oral and written evidence from the appellant and observes them during the hearing but the doctor on the panel does not physically examine them; otherwise, the tribunals use the same legal process and the same set of criteria as the DWP and its outsourcing partner.

Outcomes[edit]

The core WCA generated high volumes of 'fit for work' recommendations from its inception. As the reassessment programme gathered steam, the proportion disregarded by decision-makers grew: 8% of 'fit for work' recommendations were disregarded in 2012; this almost doubled to 15% in 2013 and then increased again in 2014 to 20%.[22]

With initial decisions, almost two-thirds of claimants were declared 'fit for work' by the DWP in 2009 and 2010. This dropped to around half once the reassessment programme got underway in 2011; by 2013, it was a third; by 2014, only a quarter of claimants were declared 'fit for work' by the DWP at the first stage of the decision-making process.[23] The DWP then overturned a sizeable percentage of its own decisions at the reconsideration stage, while independent tribunals overturned still more.

More recently, DWP data for the first quarter of 2016[24] showed that 9% of WCAs carried out at that point in time were reassessments of old Incapacity Benefit claims, while 21% were reassessments of successful ESA claims and the remaining 70% were new assessments of fresh claims. The outcomes, before any reconsiderations or appeals, were:

  • After Incapacity Benefit reassessments, 93% of claimants were found to be unfit for work
  • After ESA reassessments, 89% of claimants were found to be unfit for work
  • After assessments of new claims, 54% of claimants were found to be unfit for work

The Work-Related Activity Group[edit]

The Work-Related Activity Group (WRAG) is the cohort of successful ESA claimants whom the DWP thinks are likely to be able to find work in the future after receiving extra help. The WRAG generally contains people with less severe disabilities than those of people in the Support Group. However, the WRAG and the Support Group both contain people whom a disability analyst and the DWP have deemed to face significant extra barriers to work because of their ill-health or disability.

Those in the WRAG are required to take part in 'work-related activity' as a condition of their benefit. The DWP has not defined 'work-related activity' precisely but so far it has not involved applying for jobs, taking part in work placements or undertaking any form of provisional employment. The DWP says: "Claimants identified for this group will take part in work-focused interviews with a personal advisor and have access to a range of support to help them prepare for suitable work" and tells claimants their advisor will "help with things like job goals and improving your skills".[25] Pre-employment training was delivered through the Work Programme, which aimed to find people jobs within two years. However, in February 2017, the DWP decided to stop referring new claimants to the programme, which took effect on 1 April 2017.[26]

Members of the Support Group have fewer conditions placed upon them and receive a higher rate of ESA than people in the WRAG.

Modifications[edit]

Summary 
The most significant change to the WCA took place in early 2011 when the criteria for judging fitness to work were changed in law, after an overhaul carried out by medically-qualified civil servants. 
In a separate process, doctors who were not part of the civil service carried out reviews between 2010 and 2014. These reviews made recommendations for improvements to the end-to-end process, many of which were accepted in principle by the DWP. The key recommendations for the central (outsourced) part of the process were made in 2010, and some but not all of these were put into practice by the DWP and Atos in 2011.
In 2016, the DWP announced that it would try to avoid reassessing recipients with conditions that were not expected to improve — a move that took DWP ministers a year to partially implement.


In October 2008, the WCA was introduced for new claims.[27] Reformers were disappointed to find that the total number of people on sickness and incapacity benefits went up, largely as a result of the financial crisis of 2008 and the consequent rise in background unemployment. Plans were then made to tighten up the eligibility criteria still further. The Labour Welfare Secretary at the time, James Purnell, wrote that these and other changes would ensure that "only those who are genuinely incapable of work" would get full ESA.[28] The DWP's in-house medical experts piloted the new criteria in 2010 and parliament gave them legal force in March 2011.[29] Some of these changes would make it easier for some claimants with specific conditions to receive ESA, but most were intended to toughen up the test.

A key recommendation from the first external review of the testing process in 2010 by Professor Malcolm Harrington was that Atos should select assessors to be 'mental function champions', who would provide mainly telephone advice to other assessors on mental health issues as they related to the WCA's criteria.[30] At the DWP's behest, Atos did this in 2011. The other legacy of his tenure was the introduction in 2011 of the 'personalised summary statement'. This was intended to be a written explanation to the claimant in plain English of how the assessor's recommendation had been reached, but the DWP decided not to send them to claimants; instead, the department sent a 'decision-makers justification' written by a civil servant.[31] Nevertheless, the DWP insisted that assessors still write summaries, saying that decision-makers found them helpful when trying to understand the main reports. Professor Harrington also asked MIND, Mencap and the National Autistic Society to "provide recommendations on refining the mental, intellectual and cognitive descriptors". Professor Harrington would listen to their ideas and then make recommendations to the DWP, once the recommendations had also been considered by an independent scrutiny group. However, the DWP's medical experts were not convinced by the evidence presented: they did not agree that the existing descriptors were not working properly; they saw no evidence that the proposed system would be any better; and they felt that the changes would make the assessment unnecessarily complicated.[32] The DWP decided to set up an 'evidence-based review' — overseen from start to finish by Professor Harrington and to run in parallel with his annual reports for Parliament — to look at the proposed changes to the mental health criteria used in the WCA. But in his third and final report, Professor Harrington lamented that "the evidence-based review has unfortunately taken longer to develop than is ideal". One reason it had taken longer to develop was that the scope of the review had been broadened to cover the physical descriptors as well, and had mutated into an evaluation of an entirely new assessment. This 'evidence-based review' did not publish its findings until December 2013 — three years after it had originally been conceived — by which time most of the Incapacity Benefit reassessment programme had been completed. The review concluded that the proposed alternative assessment was less accurate than the WCA and that "the WCA produced consistent results on the whole, and is an accurate indicator of work capability as compared with expert opinion".[33] DWP ministers decided to replace Professor Harrington once he had submitted his final report in 2012 (although he maintained an oversight role with the evidence-based review that he had suggested be set up in 2010 and that published its findings at the end of 2013).[34] [35] As his successor they appointed Dr Paul Litchfield, another occupational health specialist and one who had played a key part in designing the WCA's mental and cognitive function descriptors in 2006.[36]

In October 2016, the government published a Green Paper, which included the possibility of another "overhaul" of the WCA in the future.[37][38] In the same month, the recently-appointed Work and Pensions Secretary, Damian Green,[39] said:

If someone has a disease that can only get worse then it doesn't make sense to ask them to turn up for repeated appointments. If their condition is not going to improve, it is not right to ask them to turn up time after time. So we will stop it.[40]

In a later statement, he revealed that the policy change would not be formalised before the end of 2017. Medical and operational factors had not been worked out and the "IT changes needed" prevented it from happening sooner — although Green did say: "In the meantime, we will be working to ensure that people with these conditions are not reassessed unnecessarily".[41] Green was asked by the Scottish Parliament's Social Security Committee if there was a list of conditions that would be exempt from reassessment by WCA. He replied:

It's not the condition. Well, I mean, we know which conditions degenerate or which conditions don't improve. I think the - but the key is, it's got to be individualised. It all fits in with that pattern: that there will be people who, at some stages of having, say, multiple sclerosis can work and at some stage it may get to the point where they can't work. What I'm saying is that, If they've got to the point where they've been assessed as being unable to work, then with a condition like that, there is no point calling them back in two years time saying we're going to reassess you because we know it won't have got better.[42]

A year after the policy was announced, the DWP said that henceforth claimants placed in the Support Group after their WCA who have a "severe, lifelong disability" (as judged by the DWP) "will no longer need to be reassessed".[43]

Credibility[edit]

Reliability of decisions[edit]

Between 2011 and 2013 around 40% of claimants found 'fit for work' appealed to a tribunal and around 40% of those appeals were successful.[44] The total number of external appeals dropped markedly over the course of 2013, although most appellants who reach the tribunal stage now see their 'fit for work' decision overturned.[45][46]

During 2012, Parliament's Office of Science and Technology analysed the WCA's performance and found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process". In the same year, a parliamentary committee heard evidence from welfare advisors that, in nearly two out of three successful appeals to tribunals against fit-for-work decisions, appellants were seeing their points rise from zero in the original assessments — meaning that the original WCA had detected no relevant disabilities at all — to at least 15 points after the tribunals had independently assessed their claims.[47]

A 2012 study of 28,000 tribunal hearings analysed the reasons for overturning the DWP's decisions:

  • In almost two-thirds of successful appeals, the tribunals found the appellants' descriptions of their difficulties, given in person on the day of the tribunal, sufficiently convincing for them to be awarded the benefit — known as presenting "cogent oral evidence" in legal jargon. By implication, in these cases, the tribunal found the oral evidence more persuasive than had the assessor who had conducted the original face-to-face assessment
  • In nearly a quarter of successful appeals, the tribunals agreed with the DWP on the facts of the case but decided that the DWP had come to the wrong conclusion based on those facts
  • In 13% of cases, documentary evidence was provided that had not been available at the initial assessment
  • In under 1% of cases, the assessment report was found to contain important technical errors.[45]

In 2013, the Work Programme firms responsible for training people in the Work-Related Activity Group said that, despite the modifications that had been made to the test since 2008, they still had "ongoing concerns about the accuracy of the WCA".[48]

Outcome targets[edit]

Professor Malcolm Harrington, the first external reviewer of the operation of the WCA, was asked by a parliamentary committee whether he had ever found any evidence that Atos assessors had been put under pressure to reach targets. He replied:

They say not, and whenever I have gone anywhere, they say not. This is purely anecdotal, but there was one Atos assessment centre I went to where the bosses walked out and I was left with a couple of assessors having a cup of coffee at the end of the session, and they told me they were under pressure.[49]

In 2012, a GP posed as a trainee Atos assessor and recorded undercover video footage that was later broadcast by Channel 4's investigative current affairs programme Dispatches. In the film, trainers warned the NHS doctor that if, on average, he were to recommend more than one claimant per day for the Support Group (out of the eight he would be expected to see each day) he would be subject to an increased level of management scrutiny through a mechanism known as "targeted audit".[50] The undercover doctor was told:

If it's more than I think 12% or 13%, you will be fed back 'your rate is too high'

An assessor on "targeted audit" would have all their reports scrutinised before they were sent to the DWP and would no longer be allowed to recommend any claimants for the Support Group without asking for permission first. When the doctor asked an experienced assessor where these rules had come from, she replied: "DWP".

Both the DWP and Atos categorically denied ever having had any target for getting claimants off sickness benefits. However, both eventually admitted that Support Group "norms" were being used nationwide,[51] though they both denied that the purpose of "targeted audit" was to limit the number of claimants placed in the Support Group. Atos said that the audit process triggered by the breach of a "norm" was intended to ensure consistency across the firm's UK team: if the assessor's reports met the DWP's expectations, the healthcare professional would not be asked to change their recommendations.[52]

Between October 2008 and November 2010, only fresh claims for ESA were assessed. Figures obtained by the Daily Mail in July 2011 showed that in this period, the percentage of claimants placed in the Support Group after undergoing a WCA was 11%.[53] Soon afterwards, a "norm" of 1 in 8 or 12.5% was in use as the benchmark for targeted audit during the Incapacity Benefit reassessment programme, suggesting that the DWP was expecting a very similar proportion of claimants to be recommended for the Support Group overall. However, Professor Harrington has described the set of people making fresh claims as "a completely different group of people" from long-term recipients, who generally have a significantly higher level of disability than new claimants. Moreover, studies of long-term Incapacity Benefit recipients carried out by the DWP before the 'roll out' of the Incapacity Benefit reassessment programme suggested that 31% of established recipients - almost 1 in 3 - would be suitable for the Support Group.[54] Despite this, the "norm" does not appear to have been adjusted upwards to reflect the more severe disabilities experienced by the people being tested from 2011 onwards.

In 2013, the Work Programme's training providers - outsourcing companies who coach and train people put into the Work-Related Activity Group after their WCA - complained that claimants who were "clearly unfit for any type of work-related activity" were nonetheless being put in the Work-Related Activity Group rather than the Support Group, and that "claimants with terminal cancer, whose life expectancies were shorter than the work-ready prognosis" had been referred to them for pre-employment training.[48]

Years later, after much upheaval in the testing process, a Green Paper provided more evidence that a de facto outcome target had been in operation during the first part of the Incapacity Benefit reassessment programme. In 2016, the government conceded that:

At the time Employment and Support Allowance was implemented in 2008 it was assumed that less than 10% of those having a Work Capability Assessment would go into the Support Group and that, as a result of [the extra help to find work given to people in the Work-Related Activity Group], there was an aspiration that one million fewer people would be on incapacity benefits by 2015. In practice, over the last 12 months, we have seen on average 50% of people going into the Support Group.[55]

In December 2016, the DWP released data on outcomes covering the first quarter of that year: then, for the small number of Incapacity Benefit recipients undergoing a WCA for the first time, the percentage being placed in the Support Group after their assessment was 87%, while 39% of new claimants qualified for the Support Group immediately after their WCA.[24]

Expert opinion[edit]

Professor Dame Carol Black advised the government on back-to-work policy between 2006 and 2016. She said of the WCA: "I don't think anyone thinks it has been a success".[56]

Conversely, the DWP has said that a group of experts — a professor of psychiatry, a consultant psychiatrist in learning disability, a professor of rheumatology, and an expert in human resources — reviewed the WCA in 2013 and concluded that "the WCA produced consistent results on the whole, and is an accurate indicator of work capability compared with expert opinion".[57] But in the year that the study was published, the firms running back-to-work training for people on ESA said they had "ongoing concerns about the accuracy of the WCA".[48] And in 2014, Atos announced that it had come to the conclusion that "the WCA is not working for claimants, for DWP or for Atos Healthcare".[58]

In November 2016, the United Nations Committee on the Rights of Persons with Disabilities published its report on the situation facing disabled people in the United Kingdom. Of the WCA, it said:

Despite several adjustments made to the Work Capability Assessment, the assessment has continued to be focused on a functional evaluation of skills and capabilities, and puts aside personal circumstances and needs, and barriers faced by persons with disabilities to return to employment, particularly those of persons with intellectual and/or psychosocial disabilities.[59]

Dr Paul Litchfield helped design the WCA and he later reviewed its performance for parliament.[60] He told a parliamentary committee in December 2017 that the test was "imperfect" when it left the drawing board because the DWP had been "forced into rushing the design of the WCA" in order to "meet the legislative timescales of the Welfare Reform Act".[61]

Political assessments[edit]

In 2015, Iain Duncan Smith complained that the system gave doctors a "binary choice", not an opportunity to deliver a more nuanced opinion on claimants' fitness for work.[62] In April 2016, the new Welfare Secretary, Stephen Crabb, said that the WCA had "never worked as intended. The WCA was a mess, it didn't recognise mental health issues and other types of disability".[63] Later the same year, the Shadow Secretary of State for Work and Pensions, Debbie Abrahams, said the test her party had described as "tough but fair" in 2010 had been "discredited".[64]

In late October 2016, when appearing on Question Time, the president of the Liberal Democrats, Baroness Sal Brinton, described the WCA as "not fit for purpose", adding "this process absolutely fails" and "we need to get rid of it". On the same BBC programme, Kier Starmer QC, a former Director of Public Prosecutions, said:

It is time for a real review of how these assessments are actually working.[65]

In September 2016, Damian Green, the latest Welfare Secretary, was asked by the BBC's Andrew Marr about the deaths of specific benefit claimants:[66]

You know these cases, they must be on your desk, you've been [at the DWP] over the summer, when you look at them, are you completely satisfied yourself that the government has done this right in the past? Do you want to look again at any of these cases and think again about the way disabled people are assessed for work?

In reply, the Secretary of State acknowledged that "obviously there are individual cases where it looks as though the system is not working". Marr asked once more: "Are you going to look again at the way people have been assessed generally to see if it has been as fair and humane as [...] you would like it to be?" Green replied:

I am permanently looking at all these systems. And of course, there are tens of thousands of these assessments going on all the time. There will, I dare say, be individual cases that are wrong and as they are brought to the attention of ministers we look at them

In February 2018 Baroness Altmann, a former minister at the DWP, said:[67]

The extent of the appeals clearly indicates that something is seriously wrong with the system

In the same month Polly MacKenzie[68], who was the Deputy Prime Minister's director of policy from 2010 until 2015, declared: "We need to think again about how we assess work capability" because "capability assessors too often have a culture of disbelief about disability, especially mental illness".[69]

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