Work Capability Assessment

The Work Capability Assessment (WCA) is the test designed and used by the Department for Work and Pensions (DWP) in the United Kingdom to determine whether disabled welfare claimants or those suffering from long-term illnesses are entitled to the main out-of-work sickness benefit: Employment and Support Allowance (ESA). The introduction of the WCA as the gatekeeper to ESA was a crucial part of the out-of-work benefit reforms of 2008[1] that the next government continued and developed.

The WCA aims to sort sickness benefit claimants into three groups: fit for work; unfit for work but fit for pre-employment training; or fit for neither work nor training. The DWP views this as the first step in a process that helps some disabled people "off benefits and into work" but the testing procedure has proved highly controversial, with concerns loudly expressed about inaccurate decision-making and the difficulties and delays faced by claimants when they launch an appeal.[2]

Atos Healthcare, part of the UK branch of the Paris-based multinational Atos, conducted the core assessment on behalf of the DWP from October 2008 until 1 March 2015, on which date the American firm Maximus took over.

Labour and the two former coalition parties all support the principle of ESA – to encourage work and thereby reduce welfare spending – but few observers now see the deployment of the WCA as a success, in economic terms or otherwise. More than seven years since it was introduced it is still not clear that the test will ever work as intended, and there is a persistent criticism of the leadership skills and integrity shown by government ministers and officials during the long attempt to launch what was once a flagship welfare reform.[3][4][5]

Evolution of the 'fitness for work' test

Before 1995, entitlement to the payment known as Invalidity Benefit was decided by an Adjudication Officer, based in large part on the opinion of claimants' own doctors.

In 1995, Invalidity Benefit became Incapacity Benefit (IB) and the now defunct Department of Social Security began commissioning its own medical assessments using its new 'All Work Test'.[6] From this point on, the testing process looked at the ability of the claimant to do a range of jobs, not just their previous trade.

In 2000, the All Work Test was replaced by the Personal Capability Assessment, which was used by DWP-approved doctors to assess new claims and to reassess some existing recipients.

In 2007 the New Labour government passed the Welfare Reform Act[7] which – for fresh claims, initially – would, the following year, introduce Employment and Support Allowance as the main out-of-work sickness benefit, with the new Work Capability Assessment acting as its gatekeeper. The aims were: to accentuate the positive by "looking at what you can do, not what you can't do"; to make the test for out-of-work sickness benefits more stringent; and to take into account new disability legislation, changes in the workplace and developments in occupational health. Testing capacity was increased by employing nurses and physiotherapists to work alongside doctors, and a semi-structured interview technique based on a computer-generated template was used for the first time.

In early 2011, the Conservative-Liberal Democrat coalition government began the planned expansion of the programme to reassess 1.5 million people whom previous governments had judged to be entitled to Incapacity Benefit.[8][9] At the same time the DWP revised the framework of the test, with the result that the eligibility criteria became even more stringent: most notably, the 03/11 version awarded no points when a claimant who had difficulty walking could overcome the disability by using a wheelchair, if reasonably practicable.

Official projections then envisaged most former recipients of Incapacity Benefit either moving onto Jobseekers Allowance or into a training programme and then into work.[10] As a result, a saving of at least £3 billion annually in the IB/ESA budget was anticipated by the end of the parliament.[11][12]

The assessment process

When the New Labour government introduced the 'fit for work' test, it contracted out the core medical component to its existing partner for disability assessments: Atos Healthcare, which was already conducting assessments on people claiming a range of other disability benefits, including Disability Living Allowance and Industrial Injuries Disablement Benefit.[13] On 1 March 2015, the US company Maximus[14] assumed responsibility for carrying out these assessments[15] through its subsidiary, the Centre for Health and Disability Assessments (CHDAUK), also known as the Health Assessment Advisory Service.[16]

The process starts with an assessment by a registered healthcare professional employed by the outsourcing firm, after which an official from the DWP first decides on entitlement to Employment and Support Allowance and then on whether a successful claimant is able to take part in 'work-related activity'. In this way, the process sorts claimants – broadly speaking – into three groups: fit for work; unfit for work but fit for work-related activity (the Work-Related Activity Group); or fit for neither work nor work-related activity (the Support Group). Technically, however, it is more nuanced: the test really tries to establish whether a claimant faces significant extra barriers to work because of their disability. In this way, someone can be classed as 'unfit for work' but still apply for jobs and get them without penalty.

In theory

The assessment process[17] is ultimately a legal one that uses social security legislation as its main reference point (which is why appeals are made to lawyer-led tribunals overseen by the Ministry of Justice). The standard of proof used is 'the balance of probabilities': a claim should be accepted if it is more likely than not that the claimant has a significant disability.

The strength of a claim is largely determined by comparing the claimant's problem with a framework of set criteria, known as 'descriptors', in a procedure that draws on occupational health theory, broad clinical knowledge, and the field of 'functional assessment' – a subspecialty concerned with gauging and validating the practical impact of a physical or mental impairment on a person's daily life and, in the context of the WCA, on their ability to work.

The descriptors[18] are split into 'functional' and 'non-functional' descriptors. The functional descriptors are then subdivided, depending on whether physical or mental function is affected. Each functional descriptor comes with a 'score' of 6, 9 or 15 points that is intended to reflect the relative severity of the impairment; the assessor's core role is to select the most appropriate descriptor for each activity printed on the ESA claim form that the claimant has marked as being difficult for them in their day-to-day life. If the assessor deems that none of the functional descriptors apply – despite what the claimant might have said on the claim form – the total score will be zero. A successful claimant will normally score at least 15 points in total.

For example, the activity 'Manual Dexterity' – hand function – comes with the following descriptors for the assessor to choose from:

Only one descriptor may be chosen for each activity, and it should be the highest-scoring option that still accurately describes the loss of function. Someone who can pick up a small object like a coin but cannot use a pen to make a simple mark will score 9 points for that activity.

If a claimant is capable – in narrow terms – of carry out a particular action but cannot do so reliably, repeatedly, in a timely manner, safely and without significant pain, they should be treated as being incapable of carrying out that action.

The physical functional descriptors cover these activities:

The mental functional descriptors cover:

The non-functional descriptors – which have no points attached but instead have a simple 'yes' or 'no' answer – apply when:

Other factors that might be taken into account include:

A 'yes' answer to a non-functional descriptor question or – for most but not all activities – a 'top score' in one area will usually qualify the claimant for the Support Group (but several scores of 9, for instance, will not).

The process also usually gathers a large amount of information about the claimant's day-to-day life, to build up a picture of what is officially termed their 'Typical Day'.

One criticism of the WCA is that there is nothing built into the core assessment to draw a distinction between disabilities that will never change and conditions that are known to change over time: the picture is only a 'snapshot' taken at the time of the assessment (although a prognosis is usually given after the main assessment, its accuracy will depend on the medical knowledge of the assessor, which varies according to their professional background and clinical experience).

In summary, the process uses fixed criteria and a system of points in an attempt to:

The healthcare professional:

And a face-to-face assessment will gather detailed information about the claimant's day-to-day life.

In practice

The process starts with a healthcare professional approved by the DWP scrutinizing the ESA claim form and deciding whether to seek further evidence from the claimant's GP or another appropriate source. If the evidence shows that a claimant probably has both limited capability for work and limited capability for work-related activity (in other words: the claimant would be likely to get a 'top score' for certain functional activities, or a non-functional descriptor would probably apply) then a face-to-face assessment is not normally required, the claimant is recommended for the Support Group and the higher rate of ESA is usually granted. Otherwise, the healthcare professional arranges a face-to-face assessment – usually in an examination centre, but occasionally in the claimant's home.

At face-to-face assessments, the assessors – who are nurses, doctors, physiotherapists or occupational therapists – are guided and prompted by a computer programme, designed by Atos in conjunction with the DWP, called the 'Logic-integrated Medical Assessment' or 'LiMA' (despite no longer carrying out WCAs directly, Atos is still paid by the DWP to operate LiMA because Atos owns the software, although the DWP owns the intellectual property rights). A large amount of lifestyle data and some clinical information is obtained from the claimant and is entered into the computer by the assessor. As the assessment progresses, LiMA tries to gauge both the impact of the disability on the person's daily life and the person's fitness for work – but while LiMA suggests options to the assessor, it is ultimately the healthcare professional who is responsible for making the recommendations.

As well as taking a clinical history and exploring the claimant's 'Typical Day', the healthcare professional will make general observations of the claimant's hearing, mobility and posture, etc. and there may be a short physical examination. The claimant's mental state will to a large degree become apparent as the interview progresses, but specific questions might be asked in order to elucidate any disordered thinking, abnormalities of perception or cognitive impairment.

During the face-to-face assessment, if it becomes clear that the claimant qualifies for the Support Group on the grounds of severe functional disability, the interview should be brought to an early close and the finding recorded on the claimant's file.

After the interview and examination the findings are summarised in free text using Standard English prose, and a typed report – largely, apart from the summary, constructed from modified pre-set LiMA options – is sent electronically to the DWP. This report attempts to describe the claimant's 'Typical Day' and to justify the recommendation by comparing and contrasting the disabilities described by the claimant against the criteria – the descriptors – constituting the legal framework of the test[19] (as well as considering the other factors, such as whether there would be a substantial risk if the claimant were declared fit for work). This report normally concludes with the points score intended to reflect the level of disability together with a final recommendation on fitness for work and a work-related prognosis. If the assessment is carried out in the claimant's home, the report is usually written by hand and is substantially shorter (normally, only doctors are authorised to write reports by hand, i.e. without using LiMA).

If assessors encounter practical difficulties or are unsure how to apply the test's criteria in specific cases, telephone advice is available.

These assessments[17] have been criticised for their repetitive impersonal style, while the reports have been criticised for several aspects of their overall quality as well as for the accuracy of their recommendations.[20][21] Poor evidence-gathering before an assessment, a 'computer says no' attitude to eligibility, and a reluctance to recommend successful claimants for the Support Group are perceived as historic faults in the system. The reliability of LiMA in gauging disability has never been independently demonstrated.

The decision-maker

The task of the DWP official is to establish from the evidence whether or not the claimant has 'Limited Capability for Work' i.e. whether they are entitled to ESA at all; if they are, officials then have to decide on whether the disabled person has 'Limited Capability for Work-Related Activity' i.e. whether they are capable of taking part in 'work-related activity' (usually interpreted to mean pre-employment training). If the person qualifies for ESA but is deemed not to have limited capability for work-related activity, they will be placed in the Work-Related Activity Group (WRAG) and will take part in mandatory training; they will also receive less money than those selected for the other category – the Support Group – where training is not compulsory (in the July 2015 Budget, it was announced that new claimants put into the WRAG after April 2017 will receive no more money than if they were on Jobseekers Allowance).[22]

People in the Support Group usually, but not invariably, have more severe disabilities than those in the WRAG: a 'top score' for one functional activity or the application of a non-functional descriptor is almost always the reason why a claimant is put in the Support Group (but someone with multiple problems who scores 9 for several activities would not normally qualify for the Support Group; on the other hand, someone with little apparent disability in their day-to-day life will normally go into the Support Group if their health would be at risk if they were declared fit for work).

Surprisingly, there is little in the core test that separates successful claimants who are likely to be able to work at some point in the future from those who are not (people in the Support Group can and do apply for, and get, full-time jobs).[23] Furthermore, the claimant's ability to cope with work-related activity is not even specifically evaluated on an individual basis within the core assessment: the architects of the WCA took the view that a severe problem in one functional area – such as being unable to point a finger under 'Manual Dexterity' – would make employment-related training too difficult, whereas a less severe problem in the same functional area – such as being unable to form a pinch grip with the index finger and thumb – would not.

For these reasons, the assertion that there is a clear distinction between the two categories of ESA claimant is difficult to sustain.

In practice, when the assessor's report is sent by the outsourcing firm to the DWP it already contains the assessor's opinion on fitness to work and on suitability for the Support Group, but it is an official that makes the final decision. This decision takes into account: the assessor's recommendation; any other available medical evidence, e.g., a sick-note or another DWP report, for example one from a previous Disability Living Allowance assessment; and the legal aspects of social security regulations pertaining to entitlement to benefits.

In 2014, 20% of fit-for-work recommendations from assessing healthcare professionals were overruled by a DWP decision-maker[24] (up from 8% in early 2013).

The independent tribunal

If the claimant disagrees with the decision, he or she is entitled to ask the DWP to formally reconsider, though the onus is on the claimant to initiate this. If the result of this formal review is unfavourable to the claimant, he or she can then appeal to an independent tribunal – consisting of a judge, a doctor and a layperson – operating under the auspices of the Ministry of Justice. The tribunals take evidence from appellants and observe them during the hearing but the medical member of the panel does not physically examine them; otherwise, the tribunals use the same legal process and the same set of criteria as the DWP and its outsourcing partner, but they do not use LiMA nor set out to delineate the claimant's 'Typical Day'.

At the reconsideration stage the DWP reverses 20–25% of its own fit-for-work decisions, while a further 15% are reversed later by tribunals. Looking at the overturn rate based on the rulings from independent legal hearings, since mid-2013 most appellants who have got as far as a tribunal have seen the DWP's decision overturned by that tribunal.[25][26]

The work-related activity group compared to the support group

The WRAG generally contains people with less severe disabilities than those in the Support Group.

However, the WRAG and the Support Group both contain people whom a disability analyst has deemed to face significant extra barriers to work because of their ill-health or disability. Members of both groups have been accepted by the DWP as being entitled to ESA, though those in the WRAG are required to take part in 'work-related activity' as a condition of their benefit. The DWP has not defined 'work-related activity' precisely but so far it has not involved applying for jobs, taking part in work placements or undertaking any form of provisional employment. The DWP says: "Claimants identified for this group will take part in work-focused interviews with a personal advisor and have access to a range of support to help them prepare for suitable work" and tells claimants their advisor will "help with things like job goals and improving your skills".[27]

The clinical prognosis (an indication of whether the impairment is expected to improve or worsen - or stay the same - and over what timescale) has no bearing on whether the claimant is placed in the WRAG or the Support Group (except when the claimant is terminally ill). At the end of a WCA, the assessor gives an estimate of the timescale for return to work, but again this prediction has no bearing on whether the claimant goes into the Support Group or the WRAG – it is used by the DWP to decide when to review the claimant again.

In practice, people almost always go into the Support Group because one of the following applies: they have one or more relatively severe restrictions of function, such as being unable to move over more than a short distance by themselves; their health would be at risk if found fit for work; they are receiving intensive treatment as an out-patient; or they are terminally ill. But at first, the DWP envisaged that the two categories of ESA would contain people with few differences in their level of disability. At the planning stage, the intention was to use the WCA to identify claimants who, though their underlying condition was not necessarily expected to improve, might nevertheless become more employable through some of the following: focussed rehabilitation, such as learning Braille; the use of an aid, such as a walking frame; or an adaptation to the workplace, such as a bespoke computer keyboard built around the disability. But in practice, the help given to people in the WRAG has been predominantly delivered through the generic Work Programme. As a report produced for the mental health charity MIND concluded, it would be wrong to suggest that people in the WRAG are 'fit to work'; that their impairments are expected to improve any more rapidly than those of claimants in the Support Group; or that the barriers they face are primarily a lack of relevant work experience or the need for advice on how to apply for a job.[28]

As an illustration of the difference in health between those in the WRAG and general jobseekers, figures released by the DWP in August 2015 showed that people in the WRAG have nearly four times the mortality rate of people on Jobseekers Allowance.[29]

The Incapacity Benefit reassessment programme

At first, the WCA was only used to gauge fresh applications and to reassess some successful post-2008 claims. The plan to expand the programme to retest long-term recipients whose sickness benefit claims had begun before 2008 - a plan that had been a key component of ESA from the very beginning - was expected to be put into practice at some point after 2010.

Professor Harrington

Section 10 of the Welfare Reform Act 2007[30] states that:

The Secretary of State for Work and Pensions shall lay before Parliament an independent report on the operation of the assessments under sections eight and nine [the 'limited capability for work' and the 'limited capability for work-related activity' assessments - the two parts of the WCA] annually for the first five years after those sections come into force.[31]

New Labour submitted no review of the first full year of the WCA's deployment in 2009. In June 2010, the Conservative Secretary of State for Work and Pensions asked Professor Malcolm Harrington, a doctor and an expert in occupational health, to review the performance of the WCA.[32] Professor Harrington was assisted by a small team from the DWP and his work was overseen by an Independent Scrutiny Group that included the National Clinical Adviser to the Care Quality Commission and the Chief Executive of the mental health charity MIND.

In November of that year he published his first report.[33][34] The Guardian summarised Professor Harrington's opinion as being that the test was "impersonal", it "lacked empathy" and it was too reliant on "computer systems and drop-down menus".[35] In the executive summary of his report, he wrote:

I 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...[but] I do not believe 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 changes can have a positive impact on the process.

He made 25 recommendations. The changes he advised to the core assessment were:

As Professor Harrington was conducting his first annual review, the DWP's in-house medical experts were in any case changing the physical and mental descriptors and toughening up the test. The new criteria were piloted in late 2010 and a rolling programme of one-day conversion courses for assessors began soon afterwards. In February 2011, Professor Paul Gregg, an economist and one of the original architects of ESA, warned that the WCA was "badly malfunctioning" and urged further pilot studies before the more stringent 03/11 version was used as the default assessment.[36] Nevertheless, the mammoth Incapacity Benefit reassessment programme got underway in the spring of 2011, using the new version of the test.

The evidence-based review of the mental health criteria.
In his first annual review published in November 2010, Professor Harrington asked MIND, Mencap and the National Autistic Society to "provide recommendations on refining the mental, intellectual and cognitive descriptors". Professor Harrington would listen to their ideas and then make recommendations to the DWP. He did this in April 2011, once the initial recommendations had also been considered by an independent scrutiny group. The following month, six experts in mental health - including the chief executive of MIND - warned in a letter to The Guardian that the WCA was "deeply flawed".[37]
The DWP's in-house medical experts were not convinced by the evidence presented: they did not agree that the existing descriptors were not working properly; they saw no evidence that the proposed system would be any better; and they felt that the changes would make the assessment unnecessarily complicated.[38]
The DWP decided to set up an 'evidence-based review' - overseen from start to finish by Professor Harrington and to run in parallel with his annual reports for Parliament - to look at the proposed changes to the mental health criteria used in the WCA. But in his third and final report, Professor Harrington lamented that "the evidence-based review has unfortunately taken longer to develop than is ideal". One reason it had taken longer to develop was that the scope of the review had been broadened to cover the physical descriptors as well, and had mutated into an evaluation of an entirely new assessment.
This 'evidence-based review' did not publish its findings until December 2013 - three years after it had originally been conceived - by which time most of the Incapacity Benefit reassessment programme had been completed.
The review concluded that the proposed alternative assessment was less accurate than the WCA and that "the WCA produced consistent results on the whole, and is an accurate indicator of work capability as compared with expert opinion".[39]

At the end of 2013, The Guardian quoted Professor Harrington as saying: "I would have preferred to do a roll-out [the IB reassessment] in the second year [2012]" and as having told the DWP this before the Incapacity Benefit reassessment programme began. The DWP told the newspaper: it had no record of a warning of this kind being given; Professor Harrington had not raised the speed of the roll-out in his interim report to ministers in May 2011; and his "remit was to assess the effectiveness of the Work Capability Assessment, not whether to reassess Incapacity Benefit claimants". [40] Furthermore, the minister responsible for the WCA when the scheme was expanded had said in Parliament in 2012 that beforehand Professor Harrington had told him: "I believe the system is in sufficient shape for you to proceed with incapacity benefit reassessment".[41]

When asked later about this discrepancy, Professor Harrington replied:

Can I clarify this once and for all? In my first year - before the first report, that is - I said to [the minister] that, left to my own devices, I would prefer it if they would postpone the IB migration until I had got at least one review in, so they could just deal with the new claimants and would not be confused by another group of people coming in - a completely different group of people, as you well know. He did not say no; it was just obvious that it was a political done deal and they were going to go ahead and do the IB migration whatever.[42]

2011

From March 2011, the WCA was used to reassess more than a million established recipients of ESA's forerunner Incapacity Benefit and some people on Income Support; until that point, none of these recipients had undergone a WCA (some had undergone a Personal Capability Assessment or an All Work Test between 1995 and 2008, and all had been declared 'unfit for work' by previous governments, according to the criteria in use at the time). Although, technically-speaking, claimants were now being evaluated for transfer onto a new benefit with different and more stringent eligibility criteria than before, the purpose of the process was not made clear to the people going through it – nor to the wider world, where it was often assumed that when an application for ESA from an established IB claimant was unsuccessful, it meant that there had never been anything really wrong with the claimant in the first place.[43] As a parliamentary report that was compiled at an early stage of the 'migration' of IB claimants onto ESA concluded: "It has caused controversy because some people previously considered disabled and entitled to invalidity benefits are now being found fit-for-work".[44]

The test was criticised over its ability to deal with mental health problems.[45] To address this, in 2011 Atos trained selected assessors to be 'mental function champions' who provided mainly telephone advice to other assessors on mental health issues as they related to the WCA's criteria[46] – a response to one of two key recommendations made by Professor Harrington. The other legacy of his tenure was the introduction of the 'personalised summary statement'. This was intended to be a written explanation to the claimant in plain English of how the assessor's recommendation had been reached, but the DWP decided not to send them to claimants; instead, the department sent a 'decision-makers justification' written by a civil servant.[47] Nevertheless, the DWP insisted that assessors still write summaries, saying that decision-makers found them helpful when trying to understand the main reports. The summarisation process introduced in 2011, although time-consuming for Atos assessors, made little discernible impact on the level of criticism of the WCA.

Professor Harrington declared in November that "The WCA has, in my view, noticeably changed for the better".[48]

2012

The WCA received more criticism in Parliament[49]and it continued to trigger protests outside Atos headquarters in London and elsewhere.[50] Pressure was applied by parliamentarians of all parties – but particularly by Michael Meacher, Tom Greatrex [51] and Sheila Gilmore – for improvements to the 'fitness to work' assessment. Meanwhile, Parliament's Office of Science and Technology analysed the WCA's performance and found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process".

In the same year, The Independent reported that 43 complaints against Atos doctors and nurses were being investigated by the General Medical Council or the Nursing and Midwifery Council[52] but Atos later countered that the number of formal complaints was small in comparison to the total number of assessments. At a meeting in June, British Medical Association doctors voted that the WCA should be ended ‘with immediate effect and be replaced with a rigorous and safe system that does not cause unavoidable [sic] harm to some of the weakest and vulnerable in society’.[53]

DWP ministers decided to replace Professor Harrington once he had submitted his final report in 2012, although he maintained an oversight role with the evidence-based review that he had suggested be set up in 2010 and that published its findings at the end of 2013.[54] [55] As his successor they appointed Dr Paul Litchfield, another occupational health specialist and one who had played a key part in designing the WCA's mental and cognitive function descriptors in 2006.[56]

2013

There was more criticism of the WCA: in Westminster,[57] by the Catholic Church,[58] by the medical profession,[59] by welfare rights advisers,[60] and by disability organisations and protest groups.[61]

The Public Accounts Committee of MPs chaired by Margaret Hodge heard evidence that over the previous financial year, Atos had been paid £112 million to carry out 738,000 assessments. At that point in time, 38% of appeals to tribunals were successful and the committee's view was that too many wrong decisions were being made, only for the decisions to be overturned later (while Atos was paid by the DWP, it was the Ministry of Justice that paid for the tribunal appeals, with £500 million being the potential cost of these appeals over ten years).[62] Hodge said that the DWP got "far too many decisions wrong on claimants’ ability to work...at considerable cost to the taxpayer" and added that this can "create misery and hardship to the claimants themselves". She also remarked: "We saw no evidence that the Department was applying sufficient rigour or challenge to Atos given the vulnerability of many of its clients, the size of the contract and its role as a near monopoly supplier. We are concerned that the profitability of the contract may be disproportionate to the limited risks which the contractor bears"[63] and concluded: "The Department's got to get a grip of this contract!".[64]

On 22 May 2013, a tribunal carrying out a judicial review ruled that the WCA process was unfair to people with cognitive impairment and other mental health issues: the upper tier tribunal said that such claimants were at a disadvantage when gathering and presenting evidence in support of their claims.[65] The DWP disagreed.[66]

In the same month, a Freedom of Information request by Reading councillor and Chair of Reading Borough Council’s Access & Disabilities Working Group, Pete Ruhemann, revealed that: "28 of the 140 medical assessment centres, or 20 percent, do not provide wheelchair access," and, "[m]any, including the larger centres, are on the second or third floor". Furthermore, the "great majority do not have associated parking".[67] The councillor characterised this national situation as, "a disgrace".[67]

Also in May, a doctor who had resigned from Atos after refusing to downgrade his rating of the disability of a mentally ill claimant blew the whistle on biases in the testing process to the BBC and said: "These assessments need to be done independently, impartially, considering all the evidence and with proper use of medical knowledge – and that's just not happening at the moment. Pressure is being put on healthcare professionals in many cases to come up with a particular outcome, really regardless of the facts of the case" and accused the DWP of "pulling strings behind the scenes" to boost the number of fit-for-work recommendations being made by the outsourcing firm. The news report drew attention to unduly harsh interpretations of the criteria for awarding points, on key abilities such as mobility and mental concentration, that the former mental health lead had claimed were being taught to WCA assessors[68][69][70] – to which Atos replied that it was the DWP that was responsible for setting the training curriculum, not Atos.[71] Tom Greatrex MP wrote to the Prime Minister to bring to his attention the whistleblower's allegations that the core assessment was "skewed" against the claimant. Downing Street made no reply but simply passed the letter back to the DWP, which issued a non-specific statement. Greatrex described the response as "woefully inadequate".[72]

Mandatory retraining of assessors

On 22 July 2013, the DWP announced that it had put in place a 'quality improvement plan'. The DWP claimed the move followed an audit of reports produced in the six months to April 2013, when Atos had furnished more than 300,000 recommendations on fitness for work, in which the DWP said it had found 164 reports - around 1 in 1800 - where the department had given the report a 'C' grade for its quality. The DWP went on to say: "A ‘C’ grade report does not mean the assessment was wrong, and the recommendation given in a ‘C’ grade report may well be correct, but, for example, their reasoning for reaching that recommendation may lack the level of detail demanded by the DWP."[73]

Retraining

The 'quality improvement plan' amounted, almost entirely, to the retraining and re-evaluation of every Atos WCA assessor. The retraining began in June 2013. The handbook used by assessors was revised in-house, although the update was not made public until 2015. The redrafted guidance had a new focus on how to gauge mobility, continence, vision, mental health and risk, and included specific advice on how to assess claims from people suffering from motor neurone disease.[74]

The immediate impact of the retraining was an increase in the average time taken to carry out a face-to-face assessment - from around 50 minutes to about 80 minutes - and an increase in the already-high attrition rate of Atos assessors (this more rapid loss of assessors was at least partly voluntary). In the second half of 2013, a long-term trend emerged: the number of people on ESA stopped falling and began to rise.[75]

Report quality

The major criticism of the reports written by WCA assessors up to that point was that their recommendations were often inaccurate: people were being declared fit for work when they weren't, while others who were entitled to ESA were being recommended for the Work-Related Activity Group when they belonged in the Support Group.

Other comments on the quality of the reports came from several sources:

Atos quits the contract

In the middle of 2013, the government called in the audit firm PricewaterhouseCoopers to investigate problems with the DWP's 'quality assurance processes' for its disability assessments[73][78] and in the autumn the Prime Minister ordered the incumbent of the ministerial post with responsibility for the WCA to return to the backbenches.[79] In December, in a statement to the Work and Pensions Committee, the new Disabilities Minister criticised the test and blamed the Labour government which introduced it, describing the assessment process as a "mess" that the Coalition had been obliged to pick up when it came to power.[80]

Meanwhile, Atos called in its own firm of auditors and began to secretly negotiate an early exit from its £500m WCA contract with the DWP in London (but not in Belfast, where the contract with the DWP's devolved Northern Irish counterpart - the Department for Social Development - remained intact).[81][82] In February 2014 the French firm went public, citing death threats to its staff, criticism from Labour MPs and its own opinion that the WCA was "not working" as the reasons why it wanted to quit.[83] At the same time, the company removed the 'Atos Healthcare' branding from its occupational health division and rebadged it as 'OH Assist'.

In March 2014, when responding to Dr Paul Litchfield's review of the WCA's performance in 2013 – in which the 'quality improvement plan' was barely mentioned – the Disabilities Minister poured more scorn on the WCA process and once again blamed the previous Labour government. The minister said: "...the system we inherited from the previous administration was not fit for purpose. The process was riddled with problems..." and declared that DWP officials had been trying to fix the process for several years. At the same time, the minister told Parliament that the contract with Atos was in the process of being brought to a premature close, with Atos paying a "substantial financial settlement" to the DWP as part of a mutual agreement to terminate the WCA contract early (but which was erroneously represented by some media organisations as Atos being 'sacked').[84][85]

The DWP continued to employ the French firm to assess most new claims for the Personal Independence Payment (PIP).[86] The Veterans Agency had voiced no concerns about the work of Atos doctors in the assessment of claims for War Pensions made by former members of the UK's Armed Forces.

In the summer of 2014, the BBC reported a backlog of more than half a million new ESA claims caused by longer assessments and a dearth of WCA assessors – unintended consequences of the 'quality improvement plan' begun the previous year.[87]

Maximus and the health and disability assessment contract

At the end of October 2014, the DWP announced that the US firm Maximus – trading as the Centre for Health and Disability Assessments and the Health Assessment Advisory Service – would take over the contract from Atos in March 2015, only five months short of its natural end point.[88][89] Maximus would be paid around £595m ($900m) to carry out Work Capability Assessments and a small number of other disability assessments over a period of three and a half years (equivalent to approximately £170m ($250m) per annum, although the exact amount depends on how close the firm gets to the DWP's target of a million WCAs a year: if the firm underperforms, it will earn less; if it exceeds the target, it will earn more).

On signing the contract, Maximus said that it would improve evidence-gathering prior to a face-to-face assessment, introduce specialist assessors for particular types of disability and communicate more effectively with claimants.[90] However, concerns were expressed about whether this was truly the start of a new chapter when it emerged that, because it was the DWP that owned or leased most of the real estate, the assessments would continue to take place in buildings that were often difficult for disabled people to access. Some disability groups were alarmed to discover that key former senior staff from Atos and the DWP were going to transfer to the new provider, along with most of Atos's remaining assessors.[91]

The president of the new outsourcer's health services division acknowledged that hundreds more healthcare professionals would have to be recruited in order to clear the backlog of ESA claims and boost capacity in the future.[92] One strategy adopted by the firm was to raise the top pay offered to new nurses to almost £40,000 a year. In September 2015, anonymous healthcare professionals complained to Private Eye that they had been "lured" from secure NHS jobs by the prospect of a substantial pay rise, only to find themselves unemployed when they either didn't pass the exacting tests set for newly-recruited disability assessors by the DWP or they otherwise failed to complete their probationary period with the US firm.[93] In response to the news report, Maximus said: "Inevitably, some people do not meet the required standard or voluntarily exit".

At the end of October 2015, the DWP's director-general of finance assured a parliamentary committee that the backlog of claims would eventually vanish altogether, saying: "The arrears figure...is probably nearer to 600,000 [sic] now...we are confident that [Maximus] will over-achieve the amounts of work over and above the forecast that was set".[94]

At the start of November 2015, in a quarterly conference call with investors, the CEO of Maximus said that the backlog had fallen by a third since March.[95] But Maximus's senior management team warned its shareholders that:

On the same day, the price of shares in the company fell sharply, losing more than 20% of their value.[96]

In January 2016, the National Audit Office (NAO) published its evaluation of the DWP's health and disability assessment contracts. It said:

The NAO also implied that the target set by the DWP of one million assessments a year - which, once the backlog had been cleared, would allow the DWP to order hundreds of thousands of reassessments of people who had already undergone a WCA and been granted ESA - was too ambitious, saying: "One experienced bidder withdrew from the process because it could not meet the required number of assessments". The next month, the most senior official in the DWP told a parliamentary committee that of all the bidders for the £595m WCA contract, only Maximus and one other unnamed firm had submitted bids "above the line" that anticipated hitting the DWP's target of one million assessments per year.

In early February, the general manager in charge of the WCA contract at Maximus told Parliament's Public Accounts Committee:

In the same month, the WCA process attracted more negative headlines when reassessment proceedings were initiated against a military veteran in the advanced stages of Alzheimer's disease[99] and the most injured survivor of the London terrorist bombings of 2005.[100]

A key performance 'metric' that shapes whether the outsourcer will meet its volume target for the year is the number of assessments the typical assessor is able to do each working day. At its peak, Atos expected its assessors to aim for eight assessments a day; this dropped to five a day following the retraining programme that took place in the second half of 2013 (because the DWP then insisted on receiving much longer reports that contained a full description of how the claimant spends their day, as well as containing a detailed justification of the recommendation on fitness for work). The average duration of an assessment then increased from around 50 minutes to around 80 minutes. In March 2016, an experienced assessor who had left Maximus in 2015 told The Guardian newspaper that the new company was expecting its assessors to carry out six face-to-face assessments a day.[101]

During a quarterly conference call in early May, the CEO of Maximus disclosed that the DWP had lowered both its total annual target for completed WCAs and the target for the number of assessments that had to be done face-to-face.

Credibility of the 'fit for work' test

Professor Harrington, the first external reviewer of the operation of the WCA, was asked by a parliamentary committee whether he had ever found any evidence that Atos assessors had been put under pressure to reach targets. He replied:

They say not, and whenever I have gone anywhere, they say not. This is purely anecdotal, but there was one Atos assessment centre I went to where the bosses walked out and I was left with a couple of assessors having a cup of coffee at the end of the session, and they told me they were under pressure.[102]

Professor Harrington then immediately added: "That does not prove anything".

In 2012, another committee in Parliament heard evidence that, in nearly two out of three successful appeals to Ministry of Justice tribunals against fit-for-work decisions, appellants were seeing their points rise from zero in the original assessments – meaning that assessors and DWP decision-makers had registered no relevant disabilities whatsoever – to at least 15 points after the tribunals had independently assessed their claims.[103]

Also in 2012, a GP posed as a trainee Atos assessor and recorded undercover video footage that was later broadcast by Channel 4's investigative current affairs programme Dispatches. In the film, trainers warned the NHS doctor that if he put more than one in eight successful claimants into the Support Group (rather than the Work-Related Activity Group), he would be subjected to an increased level of management scrutiny through a mechanism known as "targeted audit".[68] Both the DWP and Atos later admitted using "norms"[104] to set the rate at which they expected assessors to recommend that claimants be put in the Support Group but they denied that "targeted audit" meant that there was a target for getting people off benefits, or that the norms artificially suppressed the number of claimants ultimately placed in the Support Group; Atos explained that the process merely detected outliers and was intended to ensure consistency across the firm's nationwide team of assessors: if an audit showed no cause for concern, no action would be taken against the healthcare professional.[105]

In 2013, the Work Programme's training providers - outsourcing companies who coach and train people in the Work-Related Activity Group - complained about the process to Parliament: the firms had "ongoing concerns about the accuracy of the WCA"; they rated earlier improvements to the WCA as only "4 or 5 out of 10"; claimants who were "clearly unfit for any type of work-related activity" were nonetheless being put in the Work-Related Activity Group; and even "claimants with terminal cancer, whose life expectancies were shorter than the work-ready prognosis" had been referred to them for pre-employment training.[106]

Charities have perennial questions about the wisdom of trying to rehabilitate people who suffer from diseases that are only going to get worse.[107][108]

In 2014, an MP asked the UK Statistics Authority to analyse and explain the high overturn rate of fit-for-work decisions by independent tribunals, as well as by the DWP itself at the pre-tribunal 'Reconsideration' stage.[109] The MP's request was passed back to the DWP, after which nothing more was heard. The DWP has elsewhere[73] suggested that this high overturn rate demonstrates the effectiveness of the system's checks and balances; critics say that it demonstrates the unreliability of the core assessment.

When, in early 2014, Atos gave its reasons for seeking to exit the contract to carry out the core assessment, the firm announced that it had come to the conclusion that "in its current form, the WCA is not working for claimants, for DWP or for Atos Healthcare".[110] But at the end of 2014 the DWP-appointed reviewer of the WCA – who viewed the test as "by no means perfect" but nevertheless adequate – declared that "we have taken the WCA about as far as it can sensibly go in terms of modification and adjustment" and warned that "there is no better replacement that can be pulled off the shelf".[111]

In February 2015 during the 'long campaign' to fight the General Election in May, the Prime Minister proposed using WCA findings to earmark people suffering from conditions that might respond to further intervention and then require them to undergo treatment or lose their entitlement to social security benefits.[112][113] The Conservative MP Sarah Wollaston – a former GP and the chair of Parliament's select committee on health – described the plan as "unworkable" and "illegal".[114] It soon emerged that similar ideas had been considered and rejected by the DWP before;[115][116][117] no more was heard of the Prime Minister's proposal[118] until the story resurfaced five months later, seemingly unworked on in the interim.[119] Professor Dame Carol Black had been asked to study the proposal in February and the request was re-announced through official channels in July. She was then expected to report back by the end of 2015; by January 2016, no report had been published.

In October 2015, the Work and Pensions Secretary joined in the criticism of his department's own test, calling the WCA "unbelievably harsh".[120] Iain Duncan Smith blamed the Labour Party for building in "perverse incentives" that could pressure people with disabilities into accentuating their problems and complained that the system gave doctors a "binary choice", not an opportunity to deliver a more nuanced opinion on claimants' fitness for work.

In April 2016, the new Welfare Secretary said that the WCA had "never worked as intended. The WCA was a mess, it didn't recognise mental health issues and other types of disability".[121]

Has the WCA caused otherwise avoidable deaths?

The DWP accepts that being found fit for work and therefore no longer eligible for long-term benefits can, in some circumstances, harm a recipient's physical or mental health. For this reason, one of the WCA's eligibility criteria - the non-functional descriptor Substantial Risk - applies where there is, on balance, more than a small risk of harm if the claimant were to be declared 'fit for work'. In these circumstances, the at-risk person should continue to receive their sickness benefit.

Inquests and media reports

There have been several media reports of unexpected deaths after assessments where the claimants seem to have been at risk of harm if found fit for work.

Mark Wood was receiving Incapacity Benefit and Disability Living Allowance because of long-term mental health problems, including an eating disorder characterised by a "phobia" of food and overvalued concerns about its freedom from contamination. He had been losing weight for many months before his WCA. He died, weighing 35kg, after he was declared fit for work and his Incapacity Benefit and Housing Benefit were stopped (the DWP continued to pay him Disability Living Allowance). His family believe that the stress of the WCA contributed to his death. The coroner delivered a narrative verdict, in which he gave the cause of death as "unascertained" but found no significant evidence of neglect, self-neglect, suicide or unlawful killing. The DWP admitted that the decision to declare him fit for work was wrong but the department denied that its decision had contributed to his death.[122]

In response to the case, Tom Pollard of the mental health charity Mind said:

Unfortunately this tragic case is not an isolated incident. We hear too often how changes to benefits are negatively impacting vulnerable individuals, who struggle to navigate a complex, and increasingly punitive, system. We know the assessment process for those applying for employment and support allowance is very stressful, and too crude to accurately assess the impact a mental health problem has on someone's ability to work. This leads to people not getting the right support and being put under excessive pressure which can make their health worse and push them further from the workplace. We urgently need to see a complete overhaul of the system, to ensure nobody else falls through the cracks.[123]

Other unexpected deaths where the person seems to have been at risk include:

Epidemiology

A study published in the Journal of Epidemiology and Community Health in November 2015 found an independent correlation between the deployment of the Incapacity Benefit reassessment programme in England and an increase in reported mental health problems, higher levels of antidepressant prescribing and 590 additional suicides.[131] The DWP responded by pointing out that association does not imply causation: the rise in mental health issues when the WCA was deployed after 2010 could just have been a coincidence. The researchers said they had found no other explanation for the rise.

Deaths after WCAs

In response to a campaign using the Freedom of Information Act, the Information Commissioner ordered the DWP to disclose the number of people who had died in the 12 months after their WCA since May 2010[132] – the DWP had sought to withhold this information, arguing variously that it was too time-consuming, the department was about to publish it anyway or it would not be in the public interest because the data might be misinterpreted. But in August 2015, the DWP was forced to reveal that between December 2011 and February 2014, 2,380 claimants had died after being declared fit for work. However, as Dr Ben Goldacre has explained, an imprecise question in the original FOI request and an unhelpful DWP response – which Goldacre characterised as "essentially a PDF and an excel spreadsheet full of red herrings" – meant that no firm conclusion could be drawn from these figures alone about whether the death rate of people found fit for work is any higher or lower than expected.[133][134][135][136]

Deaths after sickness benefit claims ended

DWP figures show that, between January and November of 2011, 10,600 sick and disabled people died within six weeks of their benefit claim ending;[137] many disability campaigners believe that these deaths occurred after – and even because – the claimants were declared fit for work. The Daily Telegraph has questioned this: it posits that the 10,600 deaths include people who happened to die from natural causes, after which their benefit payments ceased. The newspaper said that when the DWP states "within six weeks", this "does not mean 'within the following six weeks': it means 'within six weeks either side'. What that means is that the large, presumably overwhelming, majority of those 10,600 people died, and then their claims ended because they were dead."[138]

Economic effectiveness and welfare reform

A government follow-up study of 1,100 former incapacity benefits claimants who had been declared fit for work – the results of which were obtained through a Freedom of Information Act request in 2012 – found that more than half of the people in the study reported being without a job and without any income of their own; nearly a third were on Jobseekers Allowance or a similar benefit and only one in eight had found work.[139]

More recently, the National Institute of Economic and Social Research analysed the effectiveness of the WCA process in reducing the combined Incapacity Benefit (IB)/Employment and Support Allowance (ESA) claimant count.[140] It found that the broad downward trend since 2004 in the number of people claiming these benefits accelerated in 2011, only for the trend to abruptly reverse in the second half of 2013.[141]

In October 2014, the government's fiscal watchdog found that between 2010 and 2014 no savings at all had been made in the IB/ESA budget, which remained at more than £13 billion a year.[142] Six months later, the Office for Budget Responsibility raised its forecast for spending on IB/ESA by a further one billion pounds a year, because more claimants than before were being placed in the Support Group.[143]

Jonathan Portes, former Chief Economist at the Cabinet Office, has described the botched Incapacity Benefit reassessment programme as "the biggest single social policy failure of the last fifteen years".[141]

But after the General Election in May 2015, the new Conservative government declared that welfare reform was actually about creating "a complete shift in the welfare culture"[144] and pointed to the large number of jobless people who had found work during the economic recovery that began in 2013 – a trend which had brought unemployment down to a level not seen since the early phase of the 2008 recession; as part of this trend, the number of people claiming Jobseekers Allowance (JSA) had fallen back dramatically to prerecession levels[145] and a saving of up to one billion pounds a year was hoped for in JSA costs.[146]

In January 2016, overall unemployment fell to its lowest level since 2005.[147] New data also showed that the IB/ESA caseload had fallen by 12,000 in one month, although the total number of recipients was still around 2.5 million - only slightly less than in 2011 when the IB reassessment programme was launched.

References

  1. ↑ Editorial. "The benefits of welfare reform outweigh the risks | Comment is free". The Guardian. Retrieved 2015-09-07.
  2. ↑ "New benefit system dogged by 'endless appeals' – Channel 4 News". Channel4.com. 2011-11-21. Retrieved 2015-09-07.
  3. ↑ National Audit Office (October 2012). "DWP Contract Management of Medical Services" (PDF).
  4. ↑ The Committee Office, House of Commons. "House of Commons – Contracting out public services to the private sector – Public Accounts Committee". Publications.parliament.uk. Retrieved 2015-09-07.
  5. ↑ "BBC Radio 4 – Analysis, Inside Welfare Reform". Bbc.co.uk. 2014-11-02. Retrieved 2015-09-07.
  6. ↑ Morris, Jenny (2015-08-13). "Jenny Morris: The end game of welfare reform". Jennymorrisnet.blogspot.co.uk. Retrieved 2015-09-07.
  7. ↑ "Welfare Reform Act 2007". legislation.gov.uk. Retrieved 27 February 2014.
  8. ↑ "75% of incapacity claimants are FIT to work: Tough new benefits test weeds out the workshy". Daily Mail (London). 26 October 2010.
  9. ↑ Amelia Gentleman (2011-02-22). "New disability test 'is a complete mess', says expert | Politics". The Guardian. Retrieved 2015-09-07.
  10. ↑ "Nearly 2 MILLION on sickness benefits for years could be fit to work (including this karate teacher who claimed £30,000)". Daily Mail (London). 10 February 2011.
  11. ↑ "Office for Budget Responsibility Data » Office for Budget Responsibility". Budgetresponsibility.org.uk. Retrieved 2015-09-07.
  12. ↑ "Welfare savings and incapacity benefits". niesr.ac.uk. Retrieved 14 September 2015.
  13. ↑ McCue, Andy (16 March 2005). "Atos Origin wins £500m government BPO deal". silicon.com (CBS Interactive). Archived from the original on 3 April 2012.
  14. ↑ "Independent Health Assessments | MAXIMUS United Kingdom". Maximusuk.co.uk. Retrieved 2015-09-07.
  15. ↑ "ESA Claimants". Atos Healthcare. 2015-03-01. Retrieved 2015-09-07.
  16. ↑ "Health Assessment Advisory Service". Chdauk.co.uk. Retrieved 2015-09-11.
  17. 1 2 "Work Capability Assessment handbook: for healthcare professionals". www.gov.uk. 19 March 2013. Retrieved 26 October 2015.
  18. ↑ "ESA – descriptors to determine whether you have 'Limited Capability for Work' – Sense". sense.org.uk. Retrieved 26 October 2015.
  19. ↑ "ESA – descriptors to determine whether you have 'Limited Capability for Work'". Sense. 2014-03-05. Retrieved 2015-09-11.
  20. ↑ The Committee Office, House of Commons. "House of Commons – Employment and Support Allowance and Work Capability Assessments – Work and Pensions Committee". Publications.parliament.uk. Retrieved 2015-09-11.
  21. ↑ Added by: Graham Clews (2013-08-29). "CSP submits view on controversial disability benefits assessments | The Chartered Society of Physiotherapy". Csp.org.uk. Retrieved 2015-09-11.
  22. ↑ Baumberg, Ben (2015-07-08). "Why the Budget's cut to ESA may backfire". Rethinking Incapacity. Retrieved 2015-09-11.
  23. ↑ "Judas! Left's rage as benefits activist joins 'other side' for £75k". Daily Mail (London). 19 January 2015.
  24. ↑ "Work Capability Assessment independent review – year 5 – Publications". GOV.UK. Retrieved 2015-09-11.
  25. ↑ "ESA reconsideration decisions and appeals from Apr 2010 to Oct 2013 – Publications". GOV.UK. 2014-08-27. Retrieved 2015-09-11.
  26. ↑ The Committee Office, House of Commons. "House of Commons – Employment and Support Allowance and Work Capability Assessments – Work and Pensions Committee". Publications.parliament.uk. Retrieved 2015-09-11.
  27. ↑ "Employment and Support Allowance (ESA): What you'll get". www.gov.uk. Retrieved 30 January 2016.
  28. ↑ Catherine Hale. "Fulfilling Potential? ESA and the fate of the Work-Related Activity Group" (PDF). www.mind.org.uk. Retrieved 18 December 2015.
  29. ↑ DWP. "Mortality statistics: out-of-work working age benefit claimants" (PDF).
  30. ↑ "Welfare Reform Act 2007". Legislation.gov.uk.
  31. ↑ "Section 10 of the Welfare Reform Act 2007". Legislation.gov.uk.
  32. ↑ "Professor Harrington Speaks | Carer Watch's Blog". Carerwatch.wordpress.com. Retrieved 2015-09-07.
  33. ↑ "Harrington Review 2010" (PDF).
  34. ↑ "Government response to 2010 Harrington Review" (PDF).
  35. ↑ Ramesh, Randeep (23 November 2010). "Incapacity benefit tests face overhaul after damning report". The Guardian. Retrieved 12 April 2015.
  36. ↑ Amelia Gentleman (22 February 2011). "New Disability Test is a Complete Mess". London: Guardian. Retrieved 30 January 2012.
  37. ↑ "Fatal consequences of benefit changes". The Guardian. 31 May 2011.
  38. ↑ "Harrington review 2011" (PDF).
  39. ↑ "Evidence-based review of the WCA" (PDF). gov.uk. December 2013.
  40. ↑ Patrick Butler (16 December 2013). "Ministers 'ignored advice on inhumane fit-for-work tests'". The Guardian.
  41. ↑ "work capability assessments". Hansard. 1 February 2012.
  42. ↑ "Professor Harrington: evidence to work and pensions committee". 14 May 2014.
  43. ↑ Hennessy, Patrick (18 November 2012). "Long term "sick" found to be fit for work in new benefits drive". The Daily Telegraph (London).
  44. ↑ "Research Briefings – Assessing Capacity for Work". parliament.uk. Retrieved 14 September 2015.
  45. ↑ Cooper, Edward S (22 February 2011). "Letters: Getting welfare to work: Health professionals’ advice: the ethics". BMJ 342: d1155. doi:10.1136/bmj.d1155.
  46. ↑ "Mental Function Champions « Atos Healthcare blog". atoshealthcare.com. Retrieved 14 September 2015.
  47. ↑ "Government response to the WCA independent review - year two" (PDF).
  48. ↑ "Harrington review 2011" (PDF).
  49. ↑ "Government attacked over 'disastrous' medical assessments". Democracy Live. 4 September 2012.
  50. ↑ "Atos protest groups: Disability rights groups target firm". BBC News. 31 August 2012. Retrieved 12 April 2015.
  51. ↑ Crichton, Torcuil (10 May 2013). "Bungling Atos rake in £500million of taxpayers' cash from botched fitness-to-work tests". Daily Record.
  52. ↑ Nina Lakhani (29 August 2012). "Paralympic sponsor engulfed by disability tests row". The Independent (London). Retrieved 26 October 2015.
  53. ↑ "News from the BMA Annual representative meeting: Scrap Work Capability Assessment, doctors demand". British Medical Association (BMA). Retrieved 12 April 2015.
  54. ↑ "Harrington review 2012" (PDF).
  55. ↑ "Reviewer of fitness-to-work benefit tests to stand down". BBC News. 30 July 2012.
  56. ↑ "Hoban – committed to further improvements to the Work Capability Assessment – Press releases". GOV.UK. 2013-02-26. Retrieved 2015-09-07.
  57. ↑ Gentleman, Amelia (15 January 2013). "Atos comes under attack in emotional Commons debate | Society | guardian.co.uk". London: Guardian. Retrieved 15 January 2013.
  58. ↑ Taylor, David (7 June 2013). "Archbishop Tartaglia joins chorus of protests against Atos assessments which 'trample on human dignity'". Daily Record. Retrieved 12 April 2015.
  59. ↑ Pilkington, Anna (4 January 2013). "This brutal new system': a GP's take on Atos and work capability assessments". The Guardian (London). Retrieved 12 April 2015.
  60. ↑ Mary O'Hara. "The welfare rights adviser on a mission to shame Iain Duncan Smith". the Guardian. Retrieved 14 September 2015.
  61. ↑ "38 Degrees – Stop Benefits Despair: Fine Atos when it fails". 38 Degrees. Retrieved 14 September 2015.
  62. ↑ Ted Jeory. "£500m bill for appeal battles over benefits". Express.co.uk. Retrieved 14 September 2015.
  63. ↑ "Department for Work and Pensions: Contract management of medical services". UK Parliament. Retrieved 14 September 2015.
  64. ↑ "MPs criticise disability benefits tests". BBC News. 8 February 2013.
  65. ↑ Gentleman, Amelia (22 May 2013). "Fitness-for-work tests unfair on people with mental health problems, court says". The Guardian (London). Retrieved 12 April 2015.
  66. ↑ "DWP responds to today's tribunal ruling on the Work Capability Assessment". www.gov.uk. Retrieved 14 September 2015.
  67. 1 2 Ruhemann, Pete. "Disabled adaptations at Reading Medical Assessment Centre are welcome, but the national picture is dire". Reading & District Labour Party website. Retrieved 25 May 2013.
  68. 1 2 Amelia Gentleman. "Atos assessors told to keep disability benefit approvals low, film suggests". the Guardian. Retrieved 14 September 2015.
  69. ↑ "Disability benefit assessments 'unfair', says ex-worker". BBC News. 16 May 2013.
  70. ↑ Gentleman, Amelia (31 July 2013). "Why I blew the whistle on Atos fitness-for-work test". The Guardian. Retrieved 12 April 2015.
  71. ↑ Ramesh, Randeep (16 May 2013). "Atos benefit claimants face biased medical assessments, doctor alleges". The Guardian. Retrieved 12 April 2015.
  72. ↑ David Clegg (5 July 2013). "Iain Duncan Smith blasted for ignoring the warnings of an Atos whistle-blower who quit in protest at controversial welfare tests". dailyrecord. Retrieved 14 September 2015.
  73. 1 2 3 "Hoban – taking action to improve the Work Capability Assessment". www.gov.uk. Retrieved 14 September 2015.
  74. ↑ "Work Capability Assessment handbook: for healthcare professionals". Department for Work and Pensions. 19 March 2013. Retrieved 21 January 2016.
  75. ↑ "ESA:outcomes of WCAs" (PDF). September 2015.
  76. ↑ "CSP submits view on controversial disability benefits assessments | The Chartered Society of Physiotherapy". Csp.org.uk. 2013-08-29. Retrieved 2015-09-11.
  77. ↑ "Government response to the WCA independent review - year two" (PDF).
  78. ↑ DWP (October 2013). "FOI request PWC audit" (PDF).
  79. ↑ "Fareham MP Mark Hoban tells of disappointment at losing job as work minister". Daily Echo. Retrieved 14 September 2015.
  80. ↑ "Work and Pensions Committee". parliamentlive.tv. 11 December 2013. Retrieved 14 November 2015.
  81. ↑ "Atos seeks early exit from fit-to-work tests contract". BBC News. 21 February 2014.
  82. ↑ Anne Walker (4 March 2014). "./foiextract20140304-12664-fkwywx-0" (PDF). whatdotheyknow.com. Retrieved 14 September 2015.
  83. ↑ "Outsource group seeks exit from UK £500m benefits contract after death threats". Financial Times. Retrieved 14 September 2015.
  84. ↑ "House of Commons Hansard Ministerial Statements for 27 Mar 2014 (pt 0002)". parliament.uk. Retrieved 14 September 2015.
  85. ↑ Franklin, Kaliya; Bourlet, Gary (27 March 2014). "For disabled people, and those with learning disabilities, the ‘sacking’ of Atos won’t change anything". The Independent (London). Retrieved 12 April 2015.
  86. ↑ "Personal Independence Payment (PIP) Assessment". atoshealthcare.com. Retrieved 14 September 2015.
  87. ↑ "Hundreds of thousands hit by benefits backlog". BBC News. 11 June 2014.
  88. ↑ "US firm Maximus 'awarded contract to assess fitness-to-work'". BBC News. 29 October 2014.
  89. ↑ "Health Programmes: Independent Health Assessments". Maximus Inc. Retrieved 20 June 2015.
  90. ↑ "MAXIMUS appointed to carry out health assessments for the Department for Work and Pensions". www.gov.uk. Retrieved 14 September 2015.
  91. ↑ Amelia Gentleman. "After hated Atos quits, will Maximus make work assessments less arduous?". the Guardian. Retrieved 14 September 2015.
  92. ↑ "Work capability assessments: One million disability checks planned". BBC News. 24 February 2015.
  93. ↑ "Private Eye". private-eye.co.uk. Retrieved 21 September 2015.
  94. ↑ "Work and Pensions Committee". parliamentlive.tv. 28 October 2015. Retrieved 14 November 2015.
  95. ↑ SA Transcripts (12 November 2015). "MAXIMUS' (MMS) CEO Rich Montoni on Q4 2015 Results – Earnings Call Transcript". Seeking Alpha. Retrieved 14 November 2015.
  96. ↑ Daniel Sparks (12 November 2015). "Why Maximus Inc. Fell 22% on Thursday". The Motley Fool. Retrieved 16 November 2015.
  97. ↑ National Audit Office. "DWP Contracted-Out Health and Disability Assessments" (PDF).
  98. ↑ Rajeev Syal (8 January 2016). "Maximus miss fitness-to-work test targets despite spiralling costs". The Guardian. Retrieved 14 January 2016.
  99. ↑ "Bed ridden Army veteran suffering from Alzheimer's sent back-to-work assessment by DWP". Daily Telegraph. February 2016.
  100. ↑ "Prove you're disabled: Government's demand of worst injured 7/7 survivor". The Sun. February 2016.
  101. ↑ "Maximus fit-for-work tests fail mental health patients, says doctor". The Guardian. 6 March 2016.
  102. ↑ "Professor Harrington: evidence to work and pensions committee". 14 May 2014.
  103. ↑ "Public Accounts Committee". parliamentlive.tv. 19 November 2012. Retrieved 14 November 2015.
  104. ↑ "How Norms Become Targets". centreforwelfarereform.org. Retrieved 14 September 2015.
  105. ↑ The Guardian (London) 9/12/2013 How Atos comes under pressure to declare disabled people as fit for work
  106. ↑ Can the Work Programme work for all user groups? (pdf) (Report). House of Commons Work and Pensions Committee. 15 May 2013. Retrieved 16 January 2016.
  107. ↑ "What next for the Work Capability Assessment?". mssociety.org.uk. Retrieved 14 September 2015.
  108. ↑ "Response to the Fourth independent review of the Work Capability Assessment" (pdf). Motor Neurone Disease Association. August 2013. Retrieved 11 January 2016.
  109. ↑ "Statistics – Reconsiderations". sheilagilmore.co.uk. Retrieved 14 September 2015.
  110. ↑ "Outsource group seeks exit from UK £500m benefits contract after death threats". Financial Times. Retrieved 14 September 2015.
  111. ↑ "Litchfield Review 2014" (PDF).
  112. ↑ "Go on a diet... or lose your benefits: PM to announce £500m clampdown". Daily Mail (London). 14 February 2015.
  113. ↑ "Diet Or Lose Your Benefits, Cameron To Tell Unemployed Obese". The Huffington Post UK. Retrieved 14 September 2015.
  114. ↑ McTague, Tom (16 February 2015). "Senior Tory slams plan to force fat people to go on a diet". Daily Mail (London).
  115. ↑ "DWP softens line on mandatory drug tests for benefit claimants". Community Care. Retrieved 14 September 2015.
  116. ↑ Kirkup, James (30 July 2012). "77,000 Drink And Drugs Addicts On Disability Benefits". The Daily Telegraph (London).
  117. ↑ "FactCheck: how many benefits claimants are addicts?". The FactCheck Blog. Retrieved 14 September 2015.
  118. ↑ "Iain Duncan Smith Restrains David Cameron's Plan To Strip Obese Of Benefits". The Huffington Post UK. Retrieved 14 September 2015.
  119. ↑ Holehouse, Matthew (28 July 2015). "Cost of obesity, drug abuse and alcoholism to be revealed". The Daily Telegraph (London).
  120. ↑ Nicholas Watt; Patrick Wintour (2 October 2015). "Iain Duncan Smith: ‘It is too easy to go out there and emote’ (interview)". The Guardian. Retrieved 9 October 2015.
  121. ↑ "Secretary of State for Work and Pensions Stephen Crabb on his new job, 'gay cure claims' and the bedroom tax". Western Telegraph. 8 April 2016.
  122. ↑ De Graaf, Mia (29 March 2014). "'We were wrong': Government admits it should not have axed disability benefits of Asperger's sufferer who starved to death just five months later weighing five-and-a-half stone". Daily Mail (London).
  123. ↑ The Guardian (London) 28/02/2014 Vulnerable man starved to death after benefits were cut
  124. ↑ "Atos Assessments: Widower claims system 'unfair'". BBC News. 30 May 2013. Retrieved 15 December 2015.
  125. ↑ "Atos Benefits Row: Transplant Patient Linda Wootton Dies After Being Judged 'Fit For Work'". The Huffington Post UK. Retrieved 14 September 2015.
  126. ↑ Craig McDonald (22 September 2013). "Heartbroken dad blames benefits axemen for driving his ill son to commit suicide". dailyrecord. Retrieved 14 September 2015.
  127. ↑ "Depressed man killed himself as a direct result of DWP's ‘fit to work’ ruling, coroner finds". The Independent. Retrieved 21 September 2015.
  128. ↑ BLG_admin. "Welfare benefits-related suicides". Benefits Legal Group. Retrieved 14 September 2015.
  129. ↑ Luke Traynor (28 December 2013). "Benefit cuts blind man committed suicide after Atos ruled him fit to work". mirror. Retrieved 14 September 2015.
  130. ↑ "Disabled Kinver man killed himself after being left "almost destitute" when his state benefits were axed". stourbridgenews.co.uk. Retrieved 14 September 2015.
  131. ↑ B. Barr; et al. (16 November 2015). "‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study". Journal of Epidemiology & Community Health. Retrieved 20 November 2015.
  132. ↑ "Freedom of Information Act 2000 (FOIA) – Decision notice" (pdf). Information Commissioner's Office. 8 June 2015. Retrieved 9 January 2016.
  133. ↑ BBC (London) 27/08/2015 More than 2,300 died after fit for work assessment – DWP figures
  134. ↑ The Guardian (London) 27/08/2015 Thousands have died after being found fit for work, DWP figures show
  135. ↑ "How DWP has confused everyone by releasing the right data for the wrong question on benefits deaths.". Storify. Retrieved 14 September 2015.
  136. ↑ Editorial. "The Guardian view on welfare reform: death and the benefit system". the Guardian. Retrieved 14 September 2015.
  137. ↑ "Incapacity Benefit: Deaths of Recipients" (PDF). Department of Work and Pensions, UK Government. 9 July 2012. Retrieved 12 April 2014.
  138. ↑ "The '10,600 people died within six weeks of being declared fit to work by Atos' stat is simply wrong". The Daily Telegraph (London). 9 July 2014.
  139. ↑ Ferguson, John (26 September 2012). "Atos Scandal: Benefits bosses admit over half of people ruled fit to work ended up destitute". The Daily Record. Retrieved 30 September 2012.
  140. ↑ "Retrenchment, Reform, Continuity: Welfare under the Coalition". sagepub.com. Retrieved 14 September 2015.
  141. 1 2 "Welfare savings and incapacity benefits". niesr.ac.uk. Retrieved 14 September 2015.
  142. ↑ "Office for Budget Responsibility". Office for Budget Responsibility. Retrieved 14 September 2015.
  143. ↑ Welfare trends report (Executive summary) (pdf). budgetresponsibility.org.uk (Report) (Office for Budget Responsibility). 2015. Retrieved 2 February 2016.
  144. ↑ "Iain Duncan Smith wins battle to complete his welfare reforms". Daily Mail (London). 10 May 2015.
  145. ↑ "Economy tracker: Unemployment". BBC News. 18 March 2015.
  146. ↑ "Office for Budget Responsibility". Office for Budget Responsibility. Retrieved 14 September 2015.
  147. ↑ "UK jobless rate at 10-year low but wage growth slows". BBC News. 20 January 2016. Retrieved 21 January 2016.
This article is issued from Wikipedia - version of the Saturday, May 07, 2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.