Work Capability Assessment

People ask how we are coping financially while I’m unwell. The answer is that I’m on Employment Support Allowance (ESA). ESA is a benefit that provides financial help to people who are unable to work because of illness or disability, worth around £50 per week. I wrote about the complex application process back in this post. After claiming ESA we completed a questionnaire (limited capability for work questionnaire ESA50) asking about how my illness is affecting daily life and I regularly supply up to date medical certificates from my doctor, confirming that I am still unwell. In most cases the Department for Work and Pensions (DWP) request that claimants attend a face to face medical assessment, regardless of your GP’s or specialists’ judgement about your health. The report arising from this assessment, known as a Work Capability Assessment (WCA) is passed to a decision maker at the DWP who uses its findings to continue or stop your ESA benefit.

The prospect of having my health scrutinised by a Work Capability Assessment is a great source of anxiety, fear and stress for me as a depression sufferer. It is an experience I expect to find deeply uncomfortable, an event that I do not trust holds my best interests, and one I do not expect to be sensitive and understanding of mental health conditions and their impact on daily life. The prospect of this assessment is exactly the sort of thing my depression feeds on to hamper my recovery.

Atos Healthcare (a division of the Atos S. A., a private French technology corporation) conducts disability assessments for people claiming a range of disability benefits including Employment Support Allowance, Incapacity Benefit, and Disability Living Allowance. It’s a strange feather in the cap of this international giant with 2011 annual revenue of EUR6,812 million. Interestingly, Atos Healthcare came into being in London in 2007, months before the introduction of WCA and quickly dominated the provision of occupational health services to government departments and local authorities, as well as winning the contract to carry out disability assessments. In November 2010 Atos Healthcare was awarded a three year contract extension worth over £300 million by the Department for Work and Pensions (DWP).

Atos Healthcare recruits doctors, nurses and physiotherapists to disability assessment jobs, where they are known as disability analysts. They carry out over 800,000 face-to-face medical assessments for the DWP each year. Up to 40 per cent of all ESA claimants are claiming primarily because of mental health problems. Since the introduction of WCA in late 2008, these assessments have been a source of much controversy, much of which relates to the computerised script used by disability analysts and devised by Atos Healthcare.

Atos say: “The programme, called LiMA (Logic-integrated Medical Assessment), was developed by Atos Healthcare to improve and ensure consistency and quality of the reports.” However Baroness Sheila Hollins, past president of the Royal College of Psychiatrists, said in her 2011 address to the House of Lords: “There are real concerns about Jobcentre Plus and Atos assessing staff's knowledge and understanding of mental health conditions.” The Citizens Advice Bureau, an advocate for benefit claimants, expressed “grave concern at the number of people unexpectedly being found fit for work”. They said: “We still hear repeated reports of rushed assessments, assumptions being made without exploration, inaccurate recording and poor recognition of mental health problems.” The personal stories and campaigns are easily discovered by searching on Google, campaigning and personal blogs, and You Tube. I could link to them here but websites reporting on this have been taken down for a lot less.

Five days ago The Guardian reported the chief executive of mental health charity Mind, who also acts as a member of the panel responsible for monitoring the functioning of the work capability assessment, faced a moral dilemma.  This was: “should he continue to sit on a government advisory panel, charged with scrutinising a policy that his charity believes to be inhumane? Or should he resign, publicising his anger at the coalition government's refusal to listen to the charity's concerns, and remove himself from the room where improvements are being discussed?” He chose to resign, saying: “The DWP seems absolutely committed to pushing 11,000 people a week through a flawed system”.

In the DWP’s own July 2011 report it is confirmed that at least 390,000 people have gone to appeal since 2009; tribunal courts have been forced to open on Saturdays and to increase staff by 30% since January 2010, to deal with the backlog. Appeals are costing the government around £50m a year, in addition to the £100m it is paying Atos, to carry out the largely computer-led assessment.

Atos Healthcare was in the news again recently after The Guardian reported that medical staff assessing benefit claimants were told to sign the Official Secrets Act. Two doctors who work for Atos raised their concerns with the Guardian and online political blog Liberal Conspiracy after the company asked them to sign a document pointing out their obligations under the OSA. “Both doctors believed that signing the document would hinder people in the organisation from blowing the whistle on patient safety and issues around whether medical assessments were being carried out appropriately.”

Accessing information relating to the Work Capability Assessment continues to be a stumbling block. Wikipedia reads: “Attempts by advocacy groups, and even MPs, to secure access to LiMA in order to demonstrate its weaknesses have been refused on the grounds of commercial confidentiality”. In April 2011 Atos Healthcare sought to officially accredit disability analysts by teaming up with the University of Derby Corporate. The British Medical Journal reports that the University of Derby would not disclose its fees for hosting the course, and Atos would not disclose the course materials.

The difficulties surrounding Work Capability Assessments continue to be a concern to people like me, faced with attending one. From the collection of stories others have posted about their WCA experience, I expect to be asked how I travelled to the assessment, if I can make a hot drink, if I have pets, if I watch Coronation Street, all of which can be used to make extrapolated judgements about my mental and physical health. I have little choice but to put my faith in a system that others have found fault with, and that disregards the judgement of my own mental health team. It’s just me against the point scoring machine, LiMA – and everybody else that has been a part of helping me get better thus far can only watch from the sidelines.

Should you be unfortunate enough to be in the same strange position, I’ll leave you with a link to Rethink Mental Illness who provide advice in advance to attending a WCA.