REED IN PARTNERSHIP: RESPONSE TO THE WCA INDEPENDENT REVIEW

REED IN PARTNERSHIP: RESPONSE TO THE WCA INDEPENDENT REVIEW About Reed in Partnership Reed in Partnership was formed in 1998 as the first private sector provider of New Deal employment services with an 8 million contract in London. Since then we have delivered and managed over 50 DWP and LSC contracts with a combined value of almost 400 million. We now manage large welfare to work and skills contracts across London, Yorkshire, Merseyside, Cambridgeshire, Suffolk and Scotland working with around 100 subcontractors, 2,000 partners and over 10,000 employers. Over the past twelve years, we have helped over 200,000 disadvantaged customers with improved motivation, skills, and jobsearch capacity, with over 105,000 finding employment. Our success is built on providing a personalised and responsive service to our customers and understanding the needs and requirements of the local labour market. Since the introduction of Employment and Support Allowance (ESA) in October 2008, over 40,000 ESA claimants have joined our Pathways to Work and New Deal for Disabled People programmes to help them secure employment. The majority of these customers join on a mandatory basis and meet with our advisers on a regular basis for 6 months or more. Due to the backlogs in Work Capability Assessments, the majority of these customers will not have been assessed before joining our programme. Key Recommendations The key recommendations contained within our response are detailed below: Recommendation 1: Allow examiners to tailor assessments to ensure a comprehensive examination is carried out and an accurate decision is made. This will allow the assessment framework to identify a wider range of health conditions. Recommendation 2: Ensure evidence from GPs and other health professionals form a significant part of the WCA. This will assist examiners in understanding fluctuating conditions and make claimants more accepting of the WCA outcome. 1

Recommendation 3: Ensure examiners are fully aware of the support available to customers via local providers and their partners. This information should also be available at the assessment centres to create a less daunting and more joined up service for customers as they make the transition into an employment programme. Recommendation 4: Contact all Incapacity Benefit claimants prior to the migration onto Employment Support Allowance to let them know of the support options available. This will capture proactive customers who may be willing and fit for work before the WCA stage is reached. Recommendation 5: Allow WCA examiners access to medical records if plans for an NHS database are continued. Our Research We welcome the independent review to evaluate how the WCA assesses limited capability for work and limited capability for work-related activity. To create our response, we surveyed over 80 Employment Advisers from our Pathways to Work and New Deal for Disabled People programmes. These Advisers regularly meet with Employment and Support Allowance claimants before and after their Work Capability Assessments. The customers who register on our programmes suffer from a wide range of health issues such as depression and limited mobility. Our Advisers have considerable experience of measuring what a customer can and cannot do in a working environment. A crucial part of our Advisers' role is to identify and understand the type and level of health condition of the customer. All of our Advisers receive mental health and disability training. In addition, our Advisers are also able to draw on the knowledge of our qualified inhouse Employment Therapists who operate our Condition Management Programme aimed at supporting customers to manage their disabilities and health conditions and move towards employment. Our response to the independent review draws on our experience of working with customers on health related benefits to help them move into the labour market. 2

Throughout the response we focus on the interplay between the WCA and how this relates to whether candidates can be supported into employment. Our Findings Question 1a: How effectively does the WCA correctly identify those claimants whose condition is such that they are unable to undertake any form of work related activity (the support group)? When asked, our Advisers were mixed about whether the WCA is correctly identifying those claimants whose condition is such that they are unable to undertake any work related activity. Based on the results of our survey, 47% of Advisers believed that decisions around who was placed in the Support Group were fairly or very inaccurate with 33% believing the decisions were fairly accurate and just 1% seeing them as very accurate. The results are based on the experience of Advisers who are seeing many candidates placed in the Work Related Activity Group who they consider should rightly have been placed in the Support Group. Some of the comments from our Advisers included: "I had a customer with cancer and AIDS fail the WCA. I also had a member with cancer, blackouts (including one in the WCA) and cataracts fail the WCA with 0 points" "Some of my customers are wrongly placed in WRAG with illnesses like terminal cancer, COPD and emphysema combined. Some have suffered strokes making walking and movement near impossible, severe mental illness, learning difficulties, down syndrome. Others have severe MS in later stages and even customers in wheelchairs with oxygen attached." "I have a customer with both legs amputated who lives in a basement flat and needs an ambulance and two people to lift him out of the flat placed in WRAG" 3

Question 1b: How effectively does the WCA correctly identify those claimants whose condition is such that they are currently unable to work due to illness or disability (the limited capability for work group)? Our research found that the accuracy of the WCA when placing claimants who are currently unable to work due to illness or disability in the Work Related Activity Group could be substantially improved. Almost 70% of our Advisers thought the WCA decisions made to place claimants in the Work Related Activity Group were fairly or very inaccurate. Some of the typical comments included: "One of my customers has severe MS and is receiving chemotherapy amongst other regular treatments. She is at Kings hospital 2-3 times weekly, and her husband is her primary carer. It is unlikely she will ever return to work, her illness is progressive and she was placed in the Work Related Activity Group." "Generally, I see people who have serious long term health conditions including Pulmonary Hypertension, Rheumatoid Arthritis, Heart Failure and Ankylosing Spondylitis being judged fully fit for work with no detrimental impact from their health condition on their ability to gain and maintain employment, the conditions I believe in place for eligibility to the WRAG". Question 1c: What are the main characteristics that should identify claimants for each group, where these may differ from the current assessment? All of our findings reflect the difficulty of using an identical assessment for each claimant. Our experience indicates that health conditions are too varied in their symptoms and effects to be able to not personalise the assessment. Although it may be useful to think of a fair assessment as one that treats all customers the same way, we believe there needs to be more awareness and direct questioning which relates health conditions back to practical work related issues. We believe that the assessments should be delivered from a core script but with greater freedom for examiners to personalise questioning around the impact and effects of particular health conditions. This process should be carried out with a common sense approach that doesn't rely solely on a list of generic questions. 4

Based on our experience the main characteristics that should identify claimants for each group is how illnesses and disability relate to the capacity for people to engage in work related activity and indeed move into the labour market. To achieve this, we believe that examiners need more awareness of what work related activity actually involves and how the health condition will impact on the ability of people to move into employment. Question 2: What evidence is there to suggest that any issues with the operation of the WCA are as a result of the policy design, and what evidence is there to suggest that they are a result of the delivery? There is much evidence to suggest that there are problems with both the design and the delivery of the WCA. The most commonly reported issues are below and show a combination of both delivery and policy design issues. o The examiner's report did not give a true reflection of their assessment For example, an Adviser reported that a "Member was asked to touch their toes, as they were in a wheelchair they could not reach. Their result for this part of the exam was reported as "refused to comply"". o Medical examiners do not recognise the claimant's health issues Our research has shown examples of Customers with cancer, severe arthritis, wolfram syndrome (life expectancy 30 years) and those in later stages of Multiple Sclerosis that have been found fit to work. o Mental health issues are not taken into account Comments from Advisers included: "Mental health illnesses seem not to be recognised by ATOS. People with severe depression always get under 15 points." "The most common situation is where mental health problems are completely disregarded". Another adviser reported that "almost all customers with schizophrenia, depression and anxiety fail their WCA, appeal, and win their appeal." o Fluctuations in health not considered An example of comments from our Advisers included: "One of our customers claimed for ESA after their employment was terminated because of the health 5

and safety risk connected to their heart, breathing problems and stress which led to blackouts. However, as these did not occur at the medical assessment, they were disallowed access to ESA." The full list of issues related to the WCA and the number of Advisers citing this particular issue as a problem are listed below. The second tier issues are more related to the operational delivery of the WCA including candidates not being aware of appointments, being unable to book appointments and assessment centres being too far from their home. If your customers have reported problems with the WCA process, please select the issues they have reported Issues Reported Response Percentage Medical examiner didn't recognise their issues 98.6% Examiner's report did not give a true reflection of their assessment 91.4% Mental health conditions were not considered 85.7% Fluctuations in health not considered 82.9% Unaware of appointments being booked and benefits being stopped 54.3% Process is upsetting 52.9% Didn't understand the questions 37.1% Assessment centre was too far from their home address 37.1% Unable to book appointments with the phone system 35.7% These problems are, in part, a result of the design of the assessment, in particular the questions which are not able to identify an entire range of health conditions, especially mental health conditions. Sometimes customers have reported that the full list of questions has not been asked. Also, the level of knowledge required by the examiner is not currently sufficient to effectively assess conditions which are less common or which require a deeper understanding of how this will impact on the ability of the candidate to engage in work related activity. The delivery of the assessment is also of concern. From our research we have found that over 50% of our Advisers have heard from a customer that their benefits were stopped as they missed a medical assessment they were not aware of. Our Advisers have also commented on situations where the examiner themselves did not speak adequate English to administer the assessment properly. This is likely to create real 6

issues when examiners are dealing with claimants who also struggle to communicate in English. There have also been many incidents when a claimant is accused of 'refusing to comply' if they are unable to complete a task and examinations are regularly completed in 5-10 minutes. Question 3: What is the best way to ensure that the effect of fluctuating conditions is reflected in the recommendation of the WCA? We believe that the best way to improve this situation is to give more weight to the evidence supplied by health professionals who are able to monitor the progress of the claimant over a longer period of time. This could also be improved if the examiners were given access to the proposed NHS database of medical records, which may give a more accurate view of the customer's long term health issues. Another, more costly option, is to decrease the amount of time between assessments for those in the Work Related Activity Group, who may be eligible for the Support Group, or may not be eligible for ESA. Question 4: What is the best was to ensure that the effect of multiple conditions is reflected in the recommendation of the WCA? Are there specific conditions that should be regarded as contributing to or adding additional weight to others, where both are present? We do not feel adequately qualified to fully answer this question from a medical perspective. We believe it needs to be aimed at health professionals who have a better understanding of the affects of multiple conditions. However, we are able to comment on our experience of working with a large number of customers on health related benefits and those who have been moved to JSA. This has allowed us to identify trends and patterns in health conditions and how they impact on the ability of people to move into employment. In our experience, the most common contributor to poor health, where another condition is present is depression. Many of our customers develop depression as an addition to their original health conditions. This is exacerbated by spending more time out of the labour market and suffering further social exclusion. We would recommend that the examiners focus more clearly on how multiple conditions can impact on the ability of people to actively look for work. 7

Question 5: What is the best way to give adequate weighting to additional (or initial) evidence outside of that gathered through the WCA? How can any changes be achieved without placing a burden on GPs and health care professionals, and without compromising their relationship with their patients? Many of our claimants already gather this evidence from consultants, GPs and other healthcare professionals before attending their WCA but have reported that these are largely ignored. Therefore, the burden is unlikely to be heavily increased by asking for written evidence. Furthermore, the 32% of claimants who appeal after failing their WCA will pressure GPs and other professionals to supply this evidence for their appeal. Our Advisers have also suggested that the WCA examiners research the conditions faced by the claimants before or during their visit to gain a better understanding of some conditions that are less common or well known. The apparent tendency for examiners to wrongly assess a claimant is likely to be closely connected to the length of time the examiner spends with the claimants. Although claimants are told to allow up to 90 minutes for their appointments they regularly take between 5 and 10 minutes, which suggests there are issues with the delivery of the WCA. This is not adequate for an accurate assessment and often serves to upset and frustrate the claimant further. Question 6: Is there any evidence to show that there have been particular problems with the WCA for any specific groups? These groups may include, but are not limited to, men and women, people from black and minority ethnic backgrounds, or people from differing age groups. Our research has shown that there is little or no evidence to show that particular groups are facing issues with the WCA. Of the 12% who did report issues, all identified that those with mental health issues were not being fairly represented in the assessment criteria. The process does not appear to make smaller groups suffer, but actually appears to be unfair for a large proportion of claimants due to the static and inflexible questions and the time pressures on the staff implementing the assessments. 8

Question 7: Do you have any suggestions for how the WCA process could be improved to better assign people with health conditions to the most appropriate part of the benefits system. As previously discussed, a large number of Advisers, when asked how the WCA could be improved, believed that the examinations and decision making process should place more importance on the evidence provided by health professionals, such as GPs and specialists. By incorporating this evidence, customers may also be less resistant and more accepting of the findings. There is a need for the WCA to become a more detailed medical examination which can bring together medical expertise with an awareness of how conditions impact on the ability of an individual to work. There is also a need to move away from the idea that asking every claimant the same list of questions represents a fair assessment. The WCA can be an upsetting process, and over half of our advisers have had this reported by their Customers. The assessment needs to be more personalised to ensure that the health conditions and abilities of the claimant are understood and addressed in a process that recognises the individual nature of health conditions and a person's ability to manage that condition. Furthermore, the amount of information offered to customers throughout the WCA process is inadequate. With more informed examiners and better resourced assessment centres, the customer would be able to gain a more accurate and more holistic picture of the options open to them. When customers are aware of the support available, the WCA process may act as a positive step on a customer's journey to employment where possible. Conclusions It is not only important to ensure that the WCA becomes a more effective tool for assessing the level of health conditions, but also that the current process becomes less daunting and upsetting for the claimant. The WCA is a hugely important part of the process of supporting people from ESA into work, and an attitude shift needs to be supported by a more compassionate process. By entering the Work Related Activity Group or being found fit for work, claimants should feel empowered that there is faith in them finding and sustaining work to make 9

them better off. Currently the process encourages claimants to believe they are being cheated out of something that is owed to them. This only serves to create further barriers to engaging with the welfare to work process positively and places claimants further away from the labour market. Another major problem created by inaccurate assessment is the length of time it takes to appeal these decisions. As shown it the WCA call for evidence, many claimants will win their appeals and will be entitled to Employment Support Allowance. However, by this time the customer has often missed out on 3 months of support from their Employment Adviser and the stress of the appeals procedure will often move the claimant further away from the labour market than before the WCA process started. This is very common with claimants who have mental health issues. As the process gets under way for all IB customers to transfer to ESA, the WCA process will need to be robust. Examiners will need to identify those who have been wrongly placed on a health related benefit, many for over a decade, and ensure these people are signposted properly to the support they will desperately need to change the direction of their lives. 10