Better Benefit ‘Work’ Tests

posted: 24/11/2010

The government has said it will overhaul its controversial medical tests to decide whether the seriously ill and disabled can claim long-term sickness benefits. An independent review found they were "impersonal, mechanistic and lacked empathy", leaving many claimants feeling unjustly treated and distressed.
 

The review, conducted by the academic Malcolm Harrington, an occupational health specialist, looked at whether the 'working capability assessment' was a fair system. There is mounting evidence that people with serious illnesses, like HIV, are being judged fit for work, when they are not. 40% of people who appeal, win their appeals.
 

Testing 94,000 people a month
The tests, first introduced in October 2008, mean 53,000 people are assessed a month for 'employment and support allowance'. The numbers being tested will balloon from next April as another 41,000 incapacity benefit recipients are re-assessed under the ‘work capability assessment’ every month.
 

Long-term ill and disabled somehow pass ‘work’ tests
Harrington found that the assessments, run by a French multinational, Atos Origin, which received £54m from the coalition government for the contract, failed people with mental illnesses and long-term disabilities.
 

‘Impossible’ 28 page form
One form which claimants needed to complete is 28 pages long and almost half the people "found the questionnaire difficult or impossible to complete".
 

Another problem is that people’s ability to work is measured by a computer questionnaire that uses "descriptors" - questions that are apparently unrelated to work. One example is that people are asked whether they had "loaded a dishwasher or washing machine" that day. "It does not bother to ask whether the claimant has a dishwasher or washing machine. That is the danger with computer systems and drop-down menus," said Harrington.
 

Another question asks if you sit and watch TV. Say yes and they assume you can sit for long periods in a chair.
 

"We want to rely much more on healthcare professionals and assessments., said Harrison..

He pointed out that 40% of those found fit for work by the system appealed and won – and added that most people who appealed provided "additional medical information".
 

Radical change needed
Harrington called for a radical overhaul, with jobcentre staff having to take into account health records, the Atos assessments and an individual's own testimony before making a decision about whether someone on sickness benefits should be forced back into work.
 

At present benefits staff rarely dissented from Atos's verdict, he said, and "a lack of procedural justice can lead people to feel embittered and for some this can lead to psychological distress with affects on physical and mental health".
 

Champions to help
The report also recommends the appointment of lay "champions" to guide claimants through the process, and detailed explanations of why a benefit has been refused.
 

Welcome for review
Many working with the poor and vulnerable welcomed the report, saying it was a long overdue recognition of the system's problems. Citizens Advice said its surveys showed a 41% increase in complaints from claimants in the past year alone.

NAT, National AIDS Trust welcomed the findings and recommendations. They say ‘we fully support the call for change to ‘improve the fairness and effectiveness of the WCA’ by improving transparency, empathy and communication within the assessment process for Employment Support Allowance (ESA)’. NAT were among the 400 organisations and individuals to contribute to the independent review, based on their research report Unseen disability, Unmet needs – A review of the impact of Work Capability Assessment on people living with HIV. Deborah Jack, Chief Executive of NAT (National AIDS Trust), said: ‘NAT supports the recommendations of the independent review and we were extremely pleased to see some of our concerns included in the final report.

Government to make all the changes

The government said it accepted Harrington's conclusions and would implement them in full. The work and pensions minister Chris Grayling said: "There were no targets or goals to get people off benefits. This is meant to be a fair process … we are dealing with claimants who we have had very little contact with."
 

Reform delay criticised

However, Harrington did criticise the government for failing to implement a key recommendation quickly enough: that of a "personalised summary of assessments in plain English" to be produced by Atos. The government could only promise that ministers "explored the feasibility of providing a summary" by the end of 2011. Given the planned expansion in the scheme next year, Harrington said, this "was just not good enough".
 

Charities said the "review pinpoints what is wrong with the system". Matthew Lester of the Papworth Trust, a disability charity, said the main concern now was how quickly the government would implement the report's main findings. "Even if they get the main points implemented by April that will mean another 250,000 people being assessed by a system that we already know is unfair."

NAT report

Source (adapted)

Well Enough to Work?

posted: 23/03/2010

People with HIV are among those getting a raw deal in assessments carried out for Employment and Support Allowance (ESA). A report launched today by national charity Citizens Advice, and supported by eighteen other organisations including National Aids Trust, highlights grave concerns about how sick and disabled people are being assessed for Employment and Support Allowance (ESA).
 

ESA was introduced in October 2008 and it replaces incapacity benefit for new claimants. It aims to give more help to those who might, with support, be able to work. Everyone already on Incapacity Benefit will soon begin to be transferred to Employment and Support Allowance, using the assessment methods criticised in this report.
 

 2 out of 3 sick and disabled people told - ‘fit for work’
Since ESA was introduced, advisers across the country have been reporting high numbers of seriously ill and disabled people being found ‘fit for work’ under the new Work Capability Assessment (WCA). Two out of three people having this assessment are found ‘fit for work’.

Examples of people in this situation include people with late stage HIV, Parkinson’s Disease and Multiple Sclerosis, people with severe mental illness, and some who are dealing with acute short-term health problems, such as awaiting open heart surgery.
 

"People with serious illnesses and disabilities who could not reasonably be expected to work are being found fit for work," the report states. "Many of these people are too ill to sign on, or are not eligible for any other benefit, and so are left with reduced incomes and no help or support to find work." Sue Royston, the author of the study, said "This is a systemic problem. Advisers up and down the country are reporting that very seriously ill people are being found fit for work." 

Time for full review
Citizens Advice are calling for a full review, a rethink that would reassess who should be eligible for the benefit, and study the accuracy of the medical assessments.
 

Improvements planned
Responding to the report, the Department for Work and Pensions said the medical assessment system was being adapted and changes would soon be announced that would make it more sensitive to the needs of cancer sufferers, people with learning disabilities and autism, and those with fluctuating conditions (such as HIV).

Part of the problem is that the questions only allow yes and no answers so people can’t describe how their ill-health affects them, but must simply say yes or no to whether they can stand, or sit, or walk a certain distance. What do you say if you have some good days and some bad days, some days when you can, some days when you can't?

Mental ill-health, pain, exhaustion

The report also points out that the system pays little attention to the impact of mental ill-health on the ability to work, and warns that it does not properly recognise the effects of pain and exhaustion.
 

"Seriously ill and disabled people are being severely let down by the crude approach of the Work Capability Assessment. A much more sophisticated approach is needed, that not only looks at a person's ability to undertake a certain task on the day of the test, but considers supporting medical evidence and other aspects, such as the variability of a person's condition," David Harker, chief executive of Citizens Advice said. "We are very concerned about the 69 per cent of people assessed who are refused ESA."

Medicals are a one-size-fits-all production line
The report 'Not working - CAB evidence on the ESA Work Capability Assessment’ outlines the limited effectiveness of the assessment. Claimants undergo a medical test, which should assess what they can do, but the evidence shows that the test doesn’t deal with the complexities of many illnesses and disabilities.
 

Citizens Advice has numerous reports of hurried medicals, where medical examiners miss vital details,
make unjustifiable assumptions and don’t place enough emphasis on the impact of mental health issues on the ability to work.
 

Not working shows how failing the WCA can have an enormously detrimental effect. By being told they must find work, people face further hardship by either having to claim Job Seekers Allowance, which has strict rules and is less money, or, in many cases, no benefit at all.
 

The stress of having the assessment, and the prospect of fighting unfavourable decisions at a tribunal adds to the considerable pressure on people who are sick or disabled. The harm caused makes it even more likely vulnerable people will not be able to make a good return to working.
 

HIV and variable conditions
David Harker, Chief Executive at Citizens Advice said: “The current test to determine eligibility for ESA isn’t working. We are seeing cases where the Government’s aim of moving people into work is being totally undermined. Seriously ill and disabled people are being severely let down by the crude approach of the Work Capability Assessment. A much more sophisticated approach is needed, that not only looks at a person’s ability to undertake a certain task on the day of the test, but considers supporting medical evidence and other aspects, such as the variability of a person’s condition and the external barriers they face in finding work.
 

“We are very concerned about the 69 per cent of people assessed who are refused ESA. Some should never have been subjected to the work capability assessment, and we believe that if someone is seriously ill, more information should be gathered from their doctor before this decision is made. Undoubtedly, there are some people ready and able to go back to work at the time of their assessment, but our evidence shows that there are many more people who, by being moved off the benefit and away from any further support, are effectively being written off.” He concluded:
“Citizens Advice calls on the Government to address the problems outlined in the report, which are causing hardship to seriously ill people at a time when they most need support.”
 

HIV assessments
George House Trust, like other HIV organisations, have seen many bad examples. With Manchester Advice (who provide our expert benefits advice and represent people living with HIV at appeals) and with National AIDS Trust, and the help of people living with HIV, we are now gathering evidence about how these work capability assessments affect people with HIV. NAT plans to produce a report late this year and we will use the evidence to press for a better deal for people with HIV.
 

Citizens Advice press release
Citizens Advice report
More reporting
 

Two-thirds don’t get new sickness benefit

posted: 14/10/2009

The loss of Incapacity Benefit, or much lower weekly benefit, hangs over many people living with HIV, within the next 2-3 years. This is the lesson from a report into the workings of Employment and Support Allowance which will replace Incapacity Benefit for everyone. 

More than two-thirds of people who apply for the new sickness benefit fail in their claims. This suggests that many of the 2.6 million existing incapacity benefit claimants will be forced on to a lower level of benefit when they are assessed over the next two to three years. Only 5% claiming the new employment and support allowance now get the full £108.55 a week.
 

The findings come in research published today by the Department for Work and Pensions into the impact of a tougher medical assessment for the employment and support allowance (ESA), introduced in October. 36% of claimants have been refused because they are fit to work – more than double the rate of refusals under the old medical test.
 

The study of nearly 200,000 claims suggests the government will make big savings from its tougher approach to welfare, despite growing unemployment.
 

The results
Overall, the research found only 5% of those seeking ESA were totally incapable of work and so entitled to the full benefit of £108.55. A further 11%, were potentially capable of work, and put on a rate of £89.80 a week, and are expected to co-operate with efforts to ready themselves for work. A third of the initial claimants dropped out before completing their claim, and a further third were decided as fit for work.
 

The new assessment, the work capability assessment, focuses on the work claimants could do rather than what they can’t do. Based on these findings, substantial government savings could be made between 2010 and 2013, the existing 2.6 million people on incapacity benefit are tested using the new tougher assessment.
 

Expect a quarter of a million refusals a year
On this basis the number of sickness-related benefit claimants likely to be rejected in a year will top 250,000.
 

The work and pensions secretary, Yvette Cooper, did not pass judgment on the findings. She said: "In the 80s and early 90s, the number of people claiming incapacity benefit rose by a million. Too many people ended up on long-term sickness benefit without help to get back to work. That must never happen again."
 

George House Trust comment

This study makes clear that many people living with HIV who are now on Incapacity Benefit will either lose that completely (and need to claim Job Seekers Allowance) or face a cut in the amount paid under Employment Support Allowance.

It's better to be ahead of the curve - and start talking and thinking about a new future - rather than waiting for things to happen. The future could include training, education, finding other ways to increase income and cut spending, and dealing with debts and money problems. Our services team and specialist advisers can help.

Source