WCA - A call for evidence - Year 3 Independent Review

The Work Capability Assessment – A Call for Evidence: Year 3 Independent Review – Questions

Question 1

a) Have you had more than one WCA?

YES

b) Was your most recent WCA:

(Please select only one)

·         A reassessment of an existing Incapacity Benefit (IB) award?

·         A new claim for Employment and Support Allowance (ESA)?

·         A repeat (second or third) WCA having already been awarded Employment and Support Allowance?

If you answered YES to Question 1a), please go to Question 2

If you answered NO to Question 1a), please go to Question 9

Question 2

Please tell us where you live in Great Britain

(Please select only one)

1.    South East England

2.    South West England

3.    North East England

4.    North West England

5.    Midlands

6.    Scotland

7.    Wales

Question 3

Were you assessed for:

(Please select only one)

1.    A mental, intellectual or cognitive condition or disability

2.    A physical health condition or disability

3.    Both

Question 4

What was the outcome of your award?

1.    Found fit for work (for the 3^rd consecutive time)

2.    Work related activity

3.    Support group

 

Question 5 (communications)

a) Thinking about the start of your claim, were there any changes in the telephone contact between you and DWP between your first and your most recent WCA?

(Please select only one)

·         There has been an improvement

·         It was not as good

·         There was no change – equally disinterested.

b)  Between your first and your last WCA, did you notice any changes to the written communications which DWP sent you?

(Please select only one)

·         There has been an improvement

·         It was not as good

·         There was no change – certainly not of any consequence.

c)  The ESA50 form has been amended; please can you tell us if you think:

(Please select only one)

·         There has been an improvement

·         It was not as good.  Changes to descriptors were completely unjustified and were simply intended to cut points.

·         There was no change

Please use this space to tell us anything that is relevant to communications during the WCA process

Frankly dreadful.  The DWP notification that my ESA had been stopped was slow coming and arrived AFTER I had obtained a copy of the ESA85, so I knew what was coming.  It effectively stopped my ESA retrospectively – i.e. 3 weeks before the date of the notification.

There was no phone call to explain the decision at any point and I had to chase DWP around to find out what was going on.  They admitted receiving but completely ignoring the detailed letter of complaint I had sent to Atos when making their decision.  It was only through pressing during these phone calls that I unearthed the “hypothetical wheelchair” deception used to assess mobility and the inconsistencies around it.  I was and still am staggered that this trick is deemed acceptable.

Question 6 (face to face assessment)

a) Was there a notable difference between your first and your most recent face to face assessment?

·         First was better – still not good, but better than the two that followed, primarily because it was a doctor not a nurse.

·         Last was better

·         There was no difference

Please use the space below us to tell us anything else that you think is relevant to the face to face assessment

For my last WCA, the HCP could not have been less interested.  She made not note of the information I had taken with me, had clearly not completed the file-work thoroughly and was not at all conversant with the consequences of my condition & treatment.

Through minimal research it became apparent that this was not her main source of income, which perfectly explained her overall approach and attitude.

She made no attempt to follow even the most basic instructions in the WCA handbook.

Question 7 (decision making)

a) Since your last WCA, did you notice a difference in the way in which the outcome of your WCA was communicated to you by a decision maker?

(Please select only one)

·         There has been an improvement

·         It was not as good.  Although the message was broadly the same, DWP staff were far more aggressive and dismissive in dealing with my challenges.

·         There was no change

b) If you provided additional evidence in support of your claim (e.g. from a GP, consultant or support worker), was this evidence taken fully into account by the decision maker?

(Please select only one)

·         Evidence was considered and it changed the original decision

·         Evidence was considered and it did not change the original decision

·         Evidence was supplied but not reconsidered.  She ignored it completely and did not even record that I had brought it with me.

·         Not applicable

Please use the space below us to tell us anything else that you think is relevant to the decision making process

See below.  You have to start by working out what the REAL decision points are and who is best qualified to make them.

There is not one single area where DWP claims to have made improvements that they can support with any hard evidence whatsoever – it is all just intuitively wishful thinking.

Question 8 (Organisations) – N/A

This section should only be completed if you are responding on behalf of an organisation. The call for evidence has been designed specifically with the experiences of the claimant in mind but the Department is aware that organisations may also want to contribute to the call for evidence. Please use this section to comment on the experiences that people you represent have been experiencing since the introduction of Professor Harrington’s recommendations. You are asked to describe each part of the process, using bullet points to summarise the individual parts of the process. Any further evidence should be given at question 11.

Communications

Face to face assessment

Decision Making

Fairness and Effectiveness

 

Question 9

Overall, how fair do you feel that the assessment was?

The latest was totally unfair as shown by a successful appeal, now three times over.  They did not even take the trouble to check my WCA case history and learn from previous mistakes.

Question 10

Overall, how effective do you feel that the process was?

Totally ineffective.  Setting aside whether or not the WCA is fit for purpose, it application and control is poor, which is why there are so many mistakes.  Everyone talks about right-first-time decisions, but nobody troubles to measure it – ridiculous.  HCPs don’t follow the handbook. Atos managers/auditors are unable/unwilling to see when this is the case.

Looking forwards

Question 11

What one thing (if any) would you change about the WCA to make the system better for people claiming ESA?

You have to look at a person’s ability to survive in employment and hold down a job, NOT just their ability to do random pieces of work.  All employers depend on staff reliability and this is precisely the thing that many disabled people struggle to guarantee.  The concept of “general work” is meaningless. Change the name WCA to J(ob)CA.

Please use the space below to give us your comments.

Question 12

Is there anything else, relevant to the WCA, that you would like to tell us about?

Please use the space below to give us your comments.

Much of this is simply good management practice.

·      If GPs haven’t provided quite the right perspective on capability to work, retrain/re-educate them so they do, don’t take it out of their hands altogether, if only on the grounds of cost.  What better place could there be to conduct my assessment than at my GP’s practice – he has EVERYTHING to hand – even a second opinion if he needs it.  10,000 practices, 40,000 GPs – you do the math – a handful of WCAs per week on average:  Barely noticeable in relation to workload.

·      DWP should at least be open and honest with claimants.  Their whole approach is born out of the belief that we are all benefit scroungers and are intent on fraudulently obtaining money.  They therefore have to employ a variety of underhand tricks and subterfuge to establish the ”truth” – or the truth as they would like it to be.  The hypothetical wheelchair scenario when assessing mobility is shameful.

The picture here appears in a DWP publication and says it all.  The document contains 8 images with 17 faces portrayed, which carefully ensure all races are represented.  Given the high correction cost, documents like this are always very diligently proof-read and checked in great detail prior to mass production.  Of the 17 faces, the one on the left here is the ONLY one with a sad expression.  It was not therefore an accident or oversight, but done this way for a reason.  There are only two possible interpretations of the message they are attempting to convey:

1.    All claimants are on the fiddle and this one knows they have just been found out

or,

2.    This claimant knows the assessment is wrong and they will now have their benefit stopped and will have to fight for a year to get it back.

DWP would hardly promote its own errors, so option 1 here is the logical interpretation

The fact that I occasionally visit a supermarket does NOT prove I can repeatedly walk 800m and the fact I can drive for 15 mins does NOT mean I can propel a wheelchair.  They suggest that there is scientific evidence to support both propositions, but this is a lie.

·      Why on earth does nobody measure the right-first-time rate when it is by a long way the most important performance measure?  What would you prefer – a wrong decision communicated sensitively, or a right decision communicated a bit abruptly?  It’s all about priorities!  The old cliché “if you don’t measure it, you can’t manage it” is true.

There are standard statistical techniques to measure the success of any discrimination process, most of which have a valuable place here with the WCA.  It is a long way from rocket science – just good management practice.

·      What is regarded as an acceptable error rate – 1 in 10? 1 in 100?  We need to know and agree what we are aiming for.  Until we do, we cannot be sure that current process is capable of delivering it and even if we do, we’ll never know and there is no point in continuing to seek something that is unattainable.

·      You cannot proactively manage anything if you have to wait 9 months to be sure your data is correct.  Quickly get the Tribunal queue down to see more clearly where the problems are and be in a position to act quickly and see the results of any changes quickly.

·      The Paralympics recognises that in many cases sports have to be modified or indeed created to allow disabled people give of their best.  What’s so different about the job market?  We must place the horse before the cart – be sure that suitable jobs are available first.

·      If DWP can legitimately countermand my GP’s recommendation it MUSTR accept full responsibility for my health and well-being thereafter, which includes the consequences of a wrong decision whatever they might be.  Authority without corresponding accountability is a well know recipe for disaster.

·      DWP’s standards of integrity can be demonstrated by its approach to the audio recording trial.  Never have I seen such a poorly managed project progresses under such obvious sufferance.  Clearly DWP doesn’t want it and has been doing its level best to scupper the idea since ‘Day 1’.  The present tactic it to deliberately suppress demand so that it can kick the idea out on the basis that there isn’t any and the whole thing is not cost effective.  Even Atos could see the reality, but let’s not forget that this need is a result of justifiable mistrust which needs to be eliminated NOT accommodated.

·      Where is the original risk analysis – the one that examined in detail the potential consequences of making wrong decisions?  There is not one – again shameful.  The ends DO NOT always justify the means and the level of collateral damage we have seen is simply not acceptable – people have died.  Imagine the outcry if the same cavalier approach was taken in the justice system – the huge downside risk is the very reason we do not have capital punishment – we do not say that killing the odd person wrongly is the price one has to pay . . . .

The best processes achieve consensus early on, so everyone has the same objective thereafter.  Being borne out of mistrust, the current WCA process is highly adversarial which inevitably generates conflict, misunderstandings, errors and cost.  It the HCP has done a fair and thorough job and can genuinely say that their recommendation is in my best interests, why can’t we discuss the result BEFORE I leave and sign it off?  Of course not as easy as it sounds, but worth thinking about. 

Any suggestion that it is not in my best interest raises a whole host of questions . . . . .

·      The confusion over quite who can & should do what between an Atos HCP & DWP DM in itself causes errors through confusion.  The DM decides if I am to receive ESA or not – on the surface purely an administrative decision.  But, it is a direct result of me being deemed fit for work or not, so who makes that decision?  It can’t be the DM as the DM has no medical training and the assessment is largely medically based.  It can’t be the HCP otherwise they are in reality determining my benefit entitlement.  So who?  The current attempt at job definitions fudges the issue and creates a DM role that is not really necessary if you have trust and confidence in the HCP – easier if they are public rather than private sector employed.  Sadly, in 2008 we through the baby out with the bathwater.

·      Outsourcing is hardly a new commercial concept, but DWP does not yet understand that whilst you can outsource the service itself, you cannot outsource or side-step the accountability for successful delivery.  It cannot even guarantee that at the time of a WCA the Atos HCP’s qualifications are wholly up to date, despite stating that this is an absolute prerequisite for approval.

There are many other side issues too numerous to list here.  Everything I have said is (unlike the equivalent DWP claim) genuinely evidence-based, largely through the use of FoI requests.  What DWP cannot say is often as revealing as its confessions.

WCA Audio Recording - an enquiry to Atos

To:  Atos Customer Services

Dear Sir,

In your “Pilot Evaluation Report”, you state:

“The results of the pilot indicate that there are (sic) a significant proportion of clients who would welcome the opportunity to have their assessment recorded”  and

“There is increasing demand for recording of assessments and currently there is no easy process to offer this and we estimate AH receives around 1-2 requests / day. Therefore is a need to make recordings more readily available on request. “

And finally, “Our recommendation would be that recording should be become routine as it is in a call centre or for example – NHS direct. “

However, on your website you now state: “Due to minimal take-up during the pilot, we only have a limited number of recording devices available”.

Why are you now misrepresenting the results of the trial and why have you so drastically changed your position on the usefulness of the facility to the point where you now only offer it on a hit and miss basis?  Surely this will result in discrimination – some claimants will have the benefit of a recording, others will not, which if they decide to appeal the DWP decision, places them at a huge disadvantage.

I look forward to hearing your explanation.

Yours faithfully

Duplicity begets dupicity

Hypocrisy and the use of double-standards are not acceptable characteristics in any situation and there are never mitigating circumstances.  However, through its ill-thought out policies and procedures in many areas of Welfare Reform DWP regularly demonstrates both in abundance.  Increasingly it is important to publicise each example that arises so that is can accumulate the credit it so rightly deserves.  It has yet to understand the vicious circle into which it has manoeuvred itself where its hypocrisy and dishonesty simply begets more hypocrisy and dishonesty.

The fact that DWP is very keen to explain what should perhaps be happening, but unwilling to explain what does is a common cause of disputes and indeed my latest spat, which began with a quite straightforward FoI request as follows:

“The WCA Handbook for Atos HCPs is quite clear that all of the evidence brought by the claimant must be considered and logged in their report. They must also consider the ESA50 and where appropriate use all of this to inform the way in which they approach the WCA, the questions they ask and the tests they perform. A comprehensive review of this information is vital to the success of the WCA.
If they fail to do this what action should a claimant take? Many claimants would not be able to raise this with the HCP at the time and it is not possible to "intercept" the ESA85 report before it arrives with DWP and a decision over ESA entitlement is made.”

This was borne from my own experience where the complaint I had raised with Atos before the ESA85 was produced and the ESA decision made was completely ignored by the Decision Maker although he admitting having it to hand at the time.  There is of course also the general backdrop of ongoing DWP & Ministerial promises to better support claimants through the process, but note that they are mainly about help AFTER the event – a personalised summary on the ESA85, a phone call to explain a decision etc. and I am a bit fed up with Prof Harrington continually telling me to be patient.

The best help to offer claimants is of course BEFORE the WCA takes place to better ensure it is right first time.  I would include in this specifically

·         A detailed list of all the information to bring along that might help – scans, X-rays etc.

·         An open offer to audio record the session if required and why this might help the claimant later.

As regards the former, the HCP cannot comprehensively construct the WCA correctly without it to rule out any contradictions that might arise.  It is therefore mandatory, not optional.  The WCA invitation letter makes no mention of this, just the need to identify yourself.  Perversely, DWP then blames its wrong decisions on not having all of the information available!!!  Amazing.  Also, sending it to DWP is sending it to the wrong person – it is the Atos HCP who needs it and is better placed to understand it as DWP Decision Makers are NOT medically trained.

The FOI response provided some useful information and quoted the theory, totally ignoring the thrust of the question (in theory of course this situation cannot arise), so I repeated it asking if all claimants are expected to read the sizable ESA Handbook, which was the source of much of the response – if no, where else are they told about this important area?

The second response insisted the question had been answered but included a bit more information, so I repeated the original question again as a second IR and posted the status at the time as follows:

“DWP has said it (rightly) does not expect claimants to read the WCA Handbook, but also that much of the information of use to claimants is NOT provided anywhere else.

DWP has accepted that only ID + medication is mentioned in the Atos letter – NOT ANY of the useful information that would help a claimant best present their situation.

It tries to tell us that it is doing all it can to help claimants through the process and to obtain the correct result first time, in line with the promises made by Chris Grayling – clearly on this evidence totally empty promises – it could do a great deal more if it wanted to.

The matter of what action a claimant should take HAS STILL NOT BEEN ANSWERED and is therefore the subject of a second IR request. “

Another month or two passed and I received a response that said little more than the previous one and stated that the onus is one the claimant to provide relevant information – perhaps technically so, but where has the help and support evaporated to?

My conclusions were therefore follows:

“What this second IR response confirms is that:

1) Chris Grayling’s promise of more help and support for claimants is a lie. What could be more valuable than making sure a claimant is prompted to take everything relevant to a WCA.

2) Alternatively, DWP has decided to ignore Chris Grayling’s promise and continue on its own merry way.

3) DWP offers no facility to claimants who experience a demonstrably poor WCA other than to allow “nature” to take its
course and fight the uphill battle retrospectively as an appeal.

4) DWP does not understand the meaning of the word “rhetorical”.”

Which I thought would bring matters to a close, but not so.  Quite unexpectedly I received a typically misplaced, partly erroneous and unnecessarily vitriolic attack on my question and me – clearly I had unwittingly touched a nerve.  Of course I HAD to respond:

“Dear DWP DWP Medical Services Correspondence,

I am of course at somewhat of a disadvantage as the person who has composed this latest response (24/08) is able to personalise their vilification of me from the shelter of their anonymity. I cannot describe the tone of it more eloquently and accurately than the annotations here have already. I will expose and respond to the broader issues it raises elsewhere and confine my comments here to FoI and the response itself, particularly as it is both logically and factually incorrect. I would use another vehicle if I knew what it is.

1.         My note dated Aug 9th was patently NOT a question or an IR request, so I am a wee bit miffed at being accused of raising one inappropriately. I am fully aware of the limitations of FoI legislation and the ideology behind the WDTK site. I know they do not like it to be used for debate, but I do feel entitled to respond to the latest DWP posting.

2.          Unfortunately, some sections of the public sector have become so steeped in duplicity that they have lost all ability to distinguish fact from fiction. I will not comment here on why this is the inevitable result of a certain style of management.

3.         The FoI legislation offers one of the few opportunities to attempt to clarify this distinction. Yes, it focuses on recorded
information, but it is safe to assume within an organisation the size of DWP that anything NOT recorded is of no consequence and can be regarded as little more than hearsay or speculation – if it was material, it would most certainly be recorded somewhere.

4.         I doubt the author here has experienced a WCA whereas I have three times over, all wrong! I am therefore somewhat better placed to segregate the theory from the practice. I would happily have the debate face to face if there was such an opportunity as I am very sure of my ground and armed with indisputable evidence (unlike DWP) to support any assertion I make.

5.         The request here sought to define the truth behind a ministerial statement by offering DWP the opportunity to provide some supporting evidence, notably through their intentions behind what is undoubtedly the greatest manifestation of the support they could offer if indeed they are serious about the intention. As they are unable to do this there is only one conclusion that can be drawn – it is NOT an opinion, it is a logically deduced interpretation of the facts as presented by DWP. If there is an alternative interpretation they could have provided it and corrected my misunderstanding, but have chosen not to – clearly there is not one. (Although this too will be labelled as an opinion no doubt).  The evidence-based methodology is the one that DWP itself favours and they are therefore governed by its rules in the interests of avoiding accusations of hypocrisy.

6.         The statement over the proportion of GPs involved IS COMPLETELY FALSE. From its own statistics only around 25% of Atos FTE HCPs are registered with the GMC – the rest are nurses and physios. Also the proportion of WCAs performed by GP’s has been reducing, so clearly the overall expertise being applied is progressively diminishing. 

7.         The knowledge, expertise and rigour applied to maintain both are grossly overstated. DWP cannot even GUARANTEE that all HCPs have kept their registrations up to date and are therefore appropriately qualified at the time they undertake a WCA. It is absurd to state that a physiotherapist (with all due respect to all of them) has “vast experience” with mental disability. The last HCP I encountered whilst a registered nurse was attempting to make a living from a door to door Botox/collagen service and performing WCAs as an income top-up. This not in line with the picture painted here.

8.         The reply claims objectivity, but cannot describe against what standard – after 4 years there is still no definition of “work” nor is there any evidence to support some of the descriptor changes that have been applied, which are of course driven by political dogma which by definition is partisan. There are also no performance measures in place so any suggestion of improvement is pure speculation – even by ‘Lord’ Harrington himself.

9.         The picture it paints is one of a DWP DM sitting with a wealth of information about a claimant all of which is medically orientated, some of which could be highly technical and complex faced with making a decision when that individual has no medical training – how more perverse can one be?

10.      I have no political affiliations whatsoever. I would just like to see the DWP “doing what is says on the tin”. I would remind DWP that they have judged my ability to work wrongly not just once, but on three consecutive occasions. They assure me that I have not been victimised, so I should presumably regard my experience as par for the course. I am already gravely worried about the chances of the next one being right first time, I think with due cause. Perhaps DWP would like to promise me that this will not be the case – surely not too much to ask?

11.     They publicly accept they will make mistakes (by inference occasionally rather than my experience of 100%) and promise to explain why they did and how they will learn for the future. I have had no such explanation and my experience indicates nobody learnt anything. They did not even have the wit to demonstrably try harder third time round and assigned the least qualified, least interested HCP of the three.

12.     I would like to avoid a repeat of the trauma on my next WCA, so I am simply looking for clear signs that next time, DWP will in fact get it right first time. So when someone says something has improved, it is hardly surprisingly that I want to see some evidence as without it the claims are just so much hot air.

13.     My evidence is my own indisputable experience, so DWP, how can you match that??? Are you suggesting I’m making it all up? Just check your records.

14.      Finally I quite like the thought that DWP feels it has no obligation to reply to a (rhetorical) question that by definition, does not require an answer. That at least does make some sort of sense.

Yours sincerely,”

It also referred to the old chestnut about the extensive diagnostic skills needed by HCP – when you point out to DWP that that nurses/physios (with respect) don’t have them they tell you they don’t need them and a few weeks training with Atos is more than enough, but when you question the skills needed to perform a WCA, it appears they do have them.

The only point here is that despite the PR, sound-bites and often friendly tone, do not expect the help you really need to get through a WCA painlessly from Atos or DWP.  The good news is that there are website around that provide exactly this service, thank God.