In his column in the August issue of Pulse, Dr Phil Peverley let out a howl of pain on behalf of his readers - fellow GPs who feel ‘caught in the middle’ between their patients on Employment and Support Allowance (ESA) and the Department for Work and Pensions (DWP)’ proxy, the global outsourcing firm Atos.
But it was a cry from the heart, not from the head. He began by referring to a DWP press release, put out on 22 July (the day of the royal birth) about a hypothetical new contractor that might be invited to work alongside Atos on work capability assessments (WCA) some time next year.¹
In it, the Government also slipped the news that it has told Atos to improve the quality of its reports (a quality drive already underway on the day the royal baby was born).
The DWP also admitted that all Atos disability assessors were undergoing retraining. As if that wasn’t enough of a mea culpa, the DWP has called in external auditors, PricewaterhouseCoopers, to ‘strengthen quality assurance processes’ across its disability assessments.
Dr Peverley claimed that Atos ‘nearly always gets it right’ as far as so-called fitness-to-work assessments are concerned, but even the DWP admits that at least 15% of cases are appealed successfully.²
Furthermore, if you look at the findings of the tribunals that hear appeals against WCA decisions, the rate at which these decisions are successfully appealed is now running at 42%.3 Many would argue that the tribunals provide the clearest window into the accuracy of the WCAs, because an independent doctor and lawyer sit on them and because they are funded by the Ministry of Justice, not the DWP, and are thus free from the constraints written into the DWP-Atos contract.
Stephen Hawking’s WCA
Dr Peverley claims that ‘nearly everyone is capable of some form of work’. He’s right, in the sense that nearly all small boys are capable of going up chimneys. It is a common misconception that the WCA is a fitness-for-work test, a mistake encouraged by those with an anti-welfare agenda. In fact the test only sets out to establish whether a claimant has limited capability for work, and if so, whether they have limited capability for work-related activity.4 In this way, someone can be awarded ESA yet still apply for jobs: if they get one, great. No one would consider them a cheat for doing so.
As for using Stephen Hawking as an example: what was Dr Peverley thinking? Professor Hawking is of retirement age and way too rich to qualify for ESA, but if he wasn’t, he would obviously be eligible for the highest level of medical benefits. As Dr Peverley must know, motor neurone disease doesn’t affect cognitive function, which is why Stephen Hawking has been able to use his unique intellect to such good effect despite his physical impairments, which are of the utmost severity. Would Dr Peverley issue him with a sick-note if he were a postman, not a physicist?
Regarding letters of support, claimants are in a genuine Catch-22 situation. The DWP says that ultimately claimants - not the DWP or Atos - are legally responsible for providing any documents to be used in support of their claim, yet LMCs like Bro Taf have decreed that their GPs will only provide reports if asked to by Atos.5,6
Doing things differently
Atos has a £110 million-a-year deal with the DWP to conduct Work Capability Assessments, and the appeals process is costing half as much again.7 I would favour channelling some of that money towards GPs, in return for a willingness to write helpful reports which describe their patients’ functional limitations during activities of daily living, and which comment on any risks associated with them being found fit for work.
I propose we develop two kinds of sick-note: one for people in work, to give an indication to the employer of how long the employee is likely to be off sick; and another using a low standard of proof, simply recommending to the Jobcentre that the DWP pay the ESA, until a truly fair and truly independent assessment can be carried out.
Dr Greg Wood is a former GP and disability analyst for Atos, now a campaigner for WCA reform
1 Department for Work and Pensions (DWP). Hoban - taking action to improve the Work Capability Assessment. 22 July 2013.
2 Hansard. Work and Pensions Committee; Supplementary written evidence submitted by the Department for Work and Pensions. 29 January 2013.
3 GOV.UK. Tribunals statistics (quarterly) earlier editions. 27 September 2012.
4 DWP. A guide to Employment and Support Allowance - The Work Capability Assessment (ESA 214). January 2013.
5 DWP. Employment and Support Allowance claimant journey Stakeholder information pack. November 2012.
6 Pulse. GP support for benefit claimants is an ‘abuse of NHS resources’, LMC claims. 18 July 2013.
7 Hansard. Written answers. 17 July 2013.