The Harrington Review of the Work Capability Assessment November 2010

An Independent Review of the Work Capability Assessment
Professor Malcolm Harrington

“Executive Summary


1. We know that, for the vast majority of people, work is good for you. Similarly, we know that many disabled people or people with a health condition want to work. As a civilised society, we need to enable as many people as possible to take advantage of the positive aspects of work while at the same time providing support for people who cannot work.

2. The Work Capability Assessment (WCA) was designed to focus on a person’s capability rather than their incapacity. It distinguishes between those people who could work; those people who could work at some point with the right support (the Work-Related Activity Group); and those people cannot work (the Support Group). In essence, the WCA was designed to be a first positive step towards work for most people.

3. However, I have found that the WCA is not working as well as it should. There are clear and consistent criticisms of the whole system and much negativity surrounding the process. There is strong evidence that the system can be impersonal and mechanistic, that the process lacks transparency and that a lack of communication between the various parties involved contributes to poor decision making and a high rate of appeals.

4. I do not believe that the system is broken or beyond repair. I am proposing a substantial series of recommendations to improve the fairness and effectiveness of the WCA. If adopted, I believe these recommendations can have a positive impact on the process – making it fairer and more effective, changing perceptions so the WCA is seen as a positive first step towards work, and reducing the rate of appeals. I also set out a future programme of work indicating areas that subsequent reviews should examine.

Key findings

5. The review has considered a wide range of evidence to reach its conclusions. Over 400 responses were received to a Call for Evidence and the review met with around 100 key organisations including disability organisations, providers, representative groups, unions and employers. Data was also gathered from DWP/Jobcentre Plus, Atos and the First-tier Tribunal to assist with the review.

6. This evidence has consistently and regularly highlighted problems with each stage of the WCA process, which limit both the assessment’s fairness and effectiveness.

The key findings are:

  • Claimants’ interactions with both Jobcentre Plus and Atos are often impersonal, mechanistic and lack clarity. As a consequence, many people who are found fit for work feel an injustice has been done and are more likelyto appeal, rather than being receptive to other support available;

  • The Jobcentre Plus Decision Makers do not in practice make decisions, but instead they typically ‘rubber stamp’ the advice provided through the Atos assessment. They often do not have or do not appropriately consider additional evidence submitted to support a claim for Employment and Support Allowance (ESA). This results in the Atos assessment driving the whole process, rather than being seen in its proper context as part of the process;

  • Some conditions are more difficult to assess than others. This appears to be the case with more subjective conditions such as mental health or other fluctuating conditions. As a result, some of the descriptors used in the assessment may not adequately measure or reflect the full impact of such conditions on the individual’s capability for work; and

  • Communication and feedback between the different agencies and organisations involved is often fragmented and in some cases non-existent. For example, if a claim goes to appeal, Jobcentre Plus and Atos are not provided with the reasons for the subsequent decision.

 

Key recommendations

7. The review has set out a substantial series of recommendations to improve the fairness and effectiveness of the WCA. They are based on evidence that just procedures and processes lead to a fairer overall assessment. They aim to reposition the WCA as a positive first step towards work for most people and ensure people who cannot work are given support. To do this they will ensure that individuals going through the WCA are treated with respect, are listened to and are able to get their case across, and are able to understand and recognise the reasons behind the decision that is reached.

The review’s key recommendations include:

  • Building more empathy into the process with Jobcentre Plus managing and supporting the claimant. This includes speaking to them to explain the process, to explain their result and to explain the support that is available after the WCA;

  • Improving transparency of the Atos assessment by ensuring each report contains a personalised summary of the Atos healthcare professional’s  recommendations; sending this summary to all claimants; and piloting the audio recording of Atos assessments;

  • Accounting for the particular difficulties in assessing mental, intellectual and cognitive impairments by ensuring Atos employ “mental, intellectual and cognitive champions” in each Medical Examination Centre to spread best practice and build understanding of these disabilities;

  • Empowering and investing in Decision Makers so that they are able to take the right decision, can gather and use additional information appropriately and speak to claimants to explain their decision; and Independent Review of the Work Capability Assessment 11

  • Better communication and feedback between Jobcentre Plus, Atos and the First-tier Tribunal to improve the quality of decision making on all sides.

A programme of work for year two

8. This review is the first of five annual Independent Reviews into the WCA. It has examined the whole WCA process from end-to-end in a short timescale. As a result, some questions have remained unanswered and some pieces of work have remained uncompleted. The review has set out a proposed programme of work to look in more detail at these issues during the second review.

9. This programme focuses on: the descriptors, particularly in assessing fluctuating conditions; what happens to people who go through the WCA; and assessing whether the WCA could also provide a more rounded picture of a person’s readiness to work.

10. The review has already set up a task group to look at the mental, intellectual and cognitive descriptors and they will report back in late-November. The Independent Reviewer will assess this report and after consulting with a wide range of experts will make recommendations to Ministers.

11. In year two the review should also monitor the implementation of those recommendations in the year one report which have been adopted by the Government.

Costs and benefits

12. The recommendations of this review, if adopted, will improve the fairness and effectiveness of the whole WCA process. Some will have up-front costs associated with them, for example additional training for Decision Makers to create a cadre of skilled professionals who are better equipped to weigh-up
decisions independently.

13. However, seen in the wider context, these changes are likely to be cost saving in the medium-term by decreasing the rate of appeals and ensuring that the correct decision is made in the first instance.

14. This will enable the WCA to become a positive first step on the way back towards work for most people and ensure that state support is truly focused on those who cannot work.”

 

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One thought on “The Harrington Review of the Work Capability Assessment November 2010

  1. Yes and we can fairy’s and Jesus is in heaven and guess what Tony Blair is a saint.

    The WCA might be OK if it went back to the PCA approach, telling somebody without hands can you lift a cup with your stumps is getting a fit far is it no. Telling somebody in a wheelchair it’s OK we know you can sit down all day because you already do it. and it’s obvious you can move your own chair we watched you.

    I was asked about my catheter who adjusts this I said either my wife or a nurse, ah thats OK then you do not need to do it your self, I asked but for it to be alright then I should be able to adjust it in case of an emergency, he left the room to come back asking can you adjust it your self I said nope it has to be a trained person, they said well thats OK then no points.

    I think the WCA misses the point it’s about whether I can adjust my catheter in an emergency if not and a nurse has to be called then it’s not under my control is it…

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