From The Guardian, 28 October 2009
Critics of new medical tests aimed at getting claimants off benefits and into work say they are target-driven measures that penalise genuinely ill people. By Melissa Viney.
Had Anna Wood realised that by bending down to pick up an object off the floor she would be deemed fit to work, perhaps the 33-year-old former academic would have thought twice. Wood, who had been forced to give up a prestigious fellowship position at Strathclyde University last year after developing severe ME, was made to perform the exercise as part of a medical test that all claimants of the new sickness benefit for ill and disabled people have to undertake.
"The doctor came and asked me lots of questions and filled in a form," she recalls. "I then got a letter saying, ‘You've only got 12 points. We need 15. You don't qualify.' He had asked me to bend down and pick something off the floor and I did it. The point is I can't do it repeatedly, and I don't see how that can mean I can work. There was nothing in the test that related to my stamina and energy.
"How any normal person could read my medical report and think, ‘Oh yes, she can work', is absolutely beyond me."
Wood points out a section in the report that states: "The healthcare professional opined that Dr Wood is likely to have significant instability regarding walking, standing and using stairs. She cannot hoover, wash dishes, make a bed and struggles to stand in the kitchen and needs to hold onto the rail using stairs … due to fatigue and pain."
This tough medical test, called the work capability assessment (WCA), is at the heart of controversial changes to sickness benefit that were introduced last October when employment support allowance (ESA) replaced incapacity benefit (IB) for new claimants.
The test contains a series of questions, called "descriptors", that relate to physical and mental functions, and from which claimants score points. The test fails to include questions relating to energy, stamina, illness and malaise. Instead, it focuses on specific physical functions, such as reaching, bending and continence. In some cases, the "descriptors" are the same as they were in the IB test, but are now awarded fewer points, making the test harder to pass.
As a result, claimants who "risk losing control of their bowels or bladder" (six points) and also "need verbal instructions as to how to carry out a simple task" (six points) will not gain the 15 points required to pass the test, so they will be found entirely fit for work and placed on jobseeker's allowance (JSA). Of those who do pass, a third are not expected to work, but two-thirds will be expected to prepare for finding a job with help from a personal adviser employed by Jobcentre Plus.
Critics of the medical test, conducted by doctors and nurses supplied by ATOS Healthcare, a private company contracted by the Department for Work and Pensions (DWP), say it is so stringent and heavy-handed that it raises the bar too high and fails to determine those who are genuinely ill.
Since its introduction a year ago, only 5% of ESA claimants have scored enough points to be deemed unable to work and to receive benefits of up to £108.55 a week, while 36% have been placed on JSA, where they will receive just £64.30.
A further 11% of ESA claimants have been found eligible for the "work related activity group" at a weekly rate of £89.80 per week. Here they receive tailored help and attend compulsory work-focused interviews. If they do not comply, their benefit is liable to be stopped. Under the previous medical test, up to 83% of IB claimants were found unfit for work.
The remainder of ESA claimants either stopped claiming benefits before the assessment was completed or were still being assessed at the time the statistics were being compiled, between October 2008 and February 2009.
Mark Baker, chair of the Disability Benefits Consortium, an umbrella organisation representing more than 25 national disability groups, says it is extremely worried about these statistics. "They show quite clearly that the ‘work capability assessment', the gateway to ESA, is extremely tough. We believe, as we said all along, that it would lead to people being put on to other inappropriate benefits where they don't get the support or help they need, and don't get the extra money that people who are out of work for longer periods of time need."
He accuses the government of refusing to acknowledge its concerns. "We believe it's been the government's intention to dramatically reduce the numbers of people on disability benefits. When this new work capability assessment was designed a couple of years ago, we felt throughout the process that our concerns were ignored and, at the end of the process, we said that the report did not reflect our input, did not reflect our concerns, and was not representative of the organisations invited to take part."
Although the DWP claims that the WCA assesses whether the person can "carry out an activity reliably and repeatedly the majority of the time", this is not borne out by the experience of claimants such as Wood and many disability organisations.
Daniel Berry, head of policy and campaigns at the MS Society, says: "MS symptoms can change by the day or even by the hour, so it's vital that benefits assessors are trained to understand fluctuating conditions. Many people risk losing the financial support they need if they are inaccurately assessed."
Tim Greenaway, a Manchester GP with patients who have failed to get ESA, describes the new medical test as "insensitive" and "clumsy" and failing to "acknowledge the role of doctors in providing a valuable opinion about their own patients". He says: "It seems to be driven by targets and the need to get people back to work."
Welfare benefits officers working for the DWP also have grave concerns about the new test. One specialist benefits officer for sick and disabled people, and who wishes to remain anonymous, says: "What I'm seeing at ground level is that there are some people who do want to work but who are so ill and physically disabled that they can't, and they're being forced to go into the work-related group of ESA and to jump all these hurdles in order to get the benefit."
She challenged the case of one client who has a cognitive impairment. "Someone from the jobcentre visited my client and I went along. I asked her why she didn't accept the [medical] evidence I was submitting from medically trained people. I asked her if she was a doctor herself. During the interview, she accepted that my client would have to go into the ‘support group.'"
Based on current figures, both main political parties anticipate saving £600m by reassessing existing IB claimants and putting many on JSA at a lower rate. Should they gain power, the Conservatives are also committed to introducing penalising JSA benefit cuts for "non-participation at all stages" or for turning down a reasonable job offer. One job refusal will result in a one-month benefits cut, two jobs refused will mean a three-month cut, and those who refuse three jobs will be excluded from receiving benefit for three years.
Steve Webb, Liberal Democrat work and pensions spokesman, says: "The rhetoric sounds great – ‘We're going to focus on what you can do and not what you can't do' – but we all know that what that really means in practice is getting tougher and setting the bar higher." He adds: "What worries me is the idea of a future Tory government going further, faster down this track and already budgeting for millions of savings, saying there's obviously people who don't need this money."
Wood eventually won an appeal at tribunal against her initial medical assessment and is now receiving the higher rate of ESA as someone who is unable to work. She is one of the luckier ones. So far, of those who have appealed – and the complexity of the process has meant appeals are only just starting to filter through – only 29.3% have been successful, in comparison with 51.2 % of IB claimants.
However, the DWP insists that the work capability assessment is "a fairer medical assessment, looking at what people can do, not only what they can't." A DWP spokesman says: "This is not about making it harder for people to get benefit. It's about creating a fairer and more accurate assessment of an individual's functional capability, and will ensure that people who are able to undertake some work-related activity get the benefit that is right for them and receive the support they need to help them prepare for a return to work."
As people on JSA will not receive extra support that is tailored towards getting sick and disabled people back to work, disability campaigners point out that it will further decrease the already slim chances of such claimants finding suitable work.
Baker fears that the consequences will be dire. "I think the majority will end up at the feet of informal carers or local last-ditch charities," he says. "People will effectively drop out of society."