Professor Malcolm Harrington, who carried out the first three independent reviews of the work capability assessment told the work and pensions committee last week that he 'did not trust Atos', that the DWP team set up to implement his recommendations was 'disbanded' and that the system was 'wrong at every stage'.
Professor Malcolm Harrington and Dr Paul Litchfield gave evidence to the Work & Pensions Committee on 14 May 2014 about the Work Capability Assessment and the outcomes and progress on recommendations in their respective reviews.
Professor Harrington made it clear that the principle of having a process of assessment was not wrong, rather that there was something wrong at every stage of the process.
“I thought it was impersonal, mechanistic and lacked transparency and there was poor communication, both between the parties taking part in the assessment and to the claimant.
“You have to have some system of assessment, but it has to be more humane and more individual-focused.”
Both Professor Harrington and Dr Litchfield have made comments that the decision maker should be central to the process and that this works better when they have direct contact with the medical assessors.
“When they all knew each other and talked to each other and it seemed to work a lot better.”
Harrington says, however, that although those “people working inside the Department made a serious effort to improve the way in which they did their bit… I did not trust Atos to get a sufficiently good assessment done, but the fact that there seems to be no improvement at all, I find very disappointing.”
Professor Harrington also raised concerns about the quality of personnel employed by Atos to carry out the assessments:
“You are asking supposedly highly qualified people to do a very boring job and some of them admit that they are not actually looking at these people—they are not caring for them, they are processing them. The danger is that the quality of the people who do that will not be of the optimum.”
He went on to say: “I think we ought to look seriously at alternatives to the private contractor. I talked to Kate Green (Shadow Minister for Disabled People) a bit about this, just kicking around ideas about whether the provident associations and the charities, with their medical advisers and a process of triage, could not actually get a better job done than we currently have with a private contractor doing it.”
Professor Harrington made further comments about how the system appeared to work well in the pilot areas when incapacity benefit claimants were reassessed (migrated), which he puts down to the decision makers having more time to make decisions, without the pressures of targets. This failed to work well when they were told they had to make 10 – 12 decisions a day.
He stated that the process for reassessment for certain conditions is flawed:
“I think the frequency of reassessments is illogical. They are not looking at individual cases. Some of those people come back for another assessment when it is clear that they don’t need one.
“Some are going to be in a deteriorating condition, like Parkinson’s, and are never going to work, so why don’t we just make that decision now and give them the support they need?”
And for groups of people with particular health conditions: “Doing it the way the DWP are doing it at the moment, using outside contractors and a computerised system, does not work well.
“I think.. you would have to have semi-specialised individualised to deal with some of the groups, like people with mental health and learning disabilities. Those assessors ought to have some degree of training specifically in that.”
He found that, despite his reports being welcomed, there were no resources to be able to make the necessary changes:
“The dedicated team I had in Leeds that was driving a lot of the recommendations was disbanded or downgraded or something, so that sort of the disappeared and that momentum went as well.”
He also raised concern that no alteration has been made regarding fluctuating conditions:
“As you know, some of these conditions vary greatly from month to month, or week to week, and quite dramatically. One week you might be able to work, and another week you cannot work at all. For the Government to say that there is no need to change the descriptors for fluctuation is wrong.
“The Government have also missed a trick over introducing a sliding scale, as I would call it, for the points.”
As he rightly states: The government fails to look at “the employability aspect as opposed to… work capability. The problem then is the real world test.”
Dr Litchfield took on the mantle of carrying out the fourth review of the WCA, publishing his report in December 2013.
He agrees that: “Co-locating health professionals and decision makers would encourage joint working and make for better decision making”.
He also raised concerns about the rate of overturned decisions:
“When we looked at the data, the rate of overturn was well over 50%. Paying money to a health care professional to give you an assessment if you are going to overturn that decision in more than 50% of cases does not seem terribly logical.”
He made specific comments about how the assessment is carried out with claimants who have learning disabilities:
“I think it is absolutely critical for that group that questions are framed in a way that they are likely to understand, that testimony from those who know them best is taken fully into account and…that inferences are not drawn on the basis of oblique questioning... First, I think that, particularly with that group, that can lead you into errors. Secondly, I think that if you draw conclusions in that way, it undermines trust—people think you are trying to catch them out.”
In support of the recommendation that decision makers should be central to the whole process, he feels they should be sending out the ESA50 before deciding on the need for a face to face assessment:
“It also strikes me that it helps to simplify the whole process. One of the problems I think that we have in the current system is that it has become over-complex. Stripping out some of that complexity would help in speeding things up. If you are not going for as many face-to-face assessments, you are speeding things up.”
Read the full transcript from the oral evidence session here