Meeting with Dr Paul Litchfield, new independent reviewer of the Work Capability Assessment | 6 August 2013

August 9, 2013


I attended a meeting at DWP HQ on Tuesday 6th August with Dr Paul Litchfield, who has taken over the work of carrying out an annual independent review of the WCA from Professor Malcolm Harrington.

Also present were DWP officials, representatives from a small number of other medical and mental health charities, and Professor David Haslam, Chairman of NICE.

Thank you to everyone who passed on information about their DWP benefit claims earlier in the week following my request for feedback that could be taken to this meeting

Dr Litchfield was very keen to hear about the problems that people are still facing with all aspects of the claim procedures and appeals as well as to what extent the findings of the first three independent reviews had improved, or not improved, the situation

The discussion covered all aspects of the complicated pathway that claimants go through when claiming and being assessed for ESA and, where necessary, having to go to appeal>

In particular there was discussion on:

1 Problems that still remain with the ESA 50 application form, whether further information should be obtained, and what other modifications are required

2 Whether the current medical assessment for ESA is too heavily weighted towards medical evidence and whether more overall emphasis needs to be placed on collecting evidence relating to psychological, mental health and social factors – in other words taking a more biopsychosocial approach to medical assessments

3 The collection of all forms of supportive evidence – medical, mental health and social – including practical difficulties in obtaining this information from doctors; collecting evidence from other sources; and whether the DWP needed to be more proactive in collecting this evidence (yes!). Whether it might be helpful for people to have a face to face interview with DWP decision makers as well.

What does the DWP mean by fit for work? CS pointed out that the Australian Social Security Act 1991 clearly defines what it means by fit for work:

At least 15 hours per week of unsupported employment, at or above the minimum wage, and the person must be able to reliably perform such work on a sustainable basis without requiring excessive leave or work absences.

CS stated that the DWP should have an equally clear public statement for benefit claim purposes.

4 Problems relating to the WCA descriptors – including the over-emphasis on assessing disability and functional impairment and the fact that there is no active attempt to capture information on the disabling effects of symptoms such as fatigue, pain, low level cognitive dysfunction, sleep disturbance, just not feeling well that are often associated with chronic ill health

5 The situation and confusion regarding the ESA Amendment Regulations that were brought in at the start of the year and which sought to clarify the way in which physical and mental health descriptors could (or could not) be used together. We have previously discussed these concerns, along with other members of the FCG, with Dr James Bolton at the DWP in July

6 The way in which information about DWP decisions – telephone calls in particular – were conveyed to claimants

7 The role of Atos – including the inadequate time given to assessments; training of medical examiners, especially in relation to the assessment of complex conditions such as ME/CFS, mental health conditions and people with learning difficulties, and to what extent DWP decision makers are still ‘rubber stamping' Atos recommendations

8 Appeal procedures – in particular the enormous amount of money that is currently being wasted when people with perfectly genuine claims are initially scoring zero points but are then being successful at appeal. The cost could be significantly reduced by getting the decision right first time

This was a useful first meeting with Dr Litchfied where our concerns were carefully listed to and noted.

The next DWP meeting is on August 21st when members of the Fluctuating Conditions Group and Mental Health Group will be discussing the preliminary findings from the Evidence Based Review of our recommendations for changes to the WCA descriptors. The EBR is well underway and is currently due to finish in September.

Dr Charles Shepherd
Honorary Medical Adviser, The ME Association
9 August 2013.

5 thoughts on “Meeting with Dr Paul Litchfield, new independent reviewer of the Work Capability Assessment | 6 August 2013”

  1. On medical evidence: a reasonable person might suppose that providing a consultant’s report which states clearly the person being assessed is not fit for work and is unlikely ever to be, would be considered seriously as part of the assessment. I did provide one, the DWP completely ignored it and failed to include it with my appeal papers. When I queried this, they claimed not to have received it although I made sure the ATOS assessor had it.

    I then obtained and sent a new consultant’s report, concerned that the previous one might be too old. The DWP dismissed the new report as not being “new evidence” – presumably because it said much the same as the older one!

    What is the status of medical evidence if it can be so easily dismissed and the brief, functional assessment of a nurse, not remotely qualified to assess someone with a complex neurological condition, is taken as conclusive? The fact is, the WCA is not a medical assessment – it is designed to get people off benefits regardless of their real condition. I think this is appalling and should be addressed by any review into the WCA. Please feed this in.

    1. I am in no way supporting the current system, but the current WCA is not a test of a persons ability to work, it tests 18 discreet areas of a persons capabilities which are defined in legislation, it is only as a result of these test being completed that a claimant is considered to have Limited Capability for Work.

      A letter that says a claimant is unable to work or even that they will never be able to work is virtually useless in regard to the legal definitions.

      This is undoubtedly one of the fundamental problems with the assessment process where medical evidence as you would expect, uses medical terms and references and the WCA does not.

  2. I agree the WCA focuses mainly on scoring sufficient poinbts, but I found this in the guidance for the WCA. The Training & Development in the Revised WCA Handbook issued by Medical Services and provided on behalf of the DWP states –

    “The medical assessment process… entails bringing together information gained from observation, questionnaire, medical evidence and examination in order to reach an accurate assessment of the disability of a claimant and so to provide the information and the opinion which the Decision Maker requires.

    “The choice of the most appropriate descriptor in the functional category areas will depend upon:

    Consideration of all the medical evidence
    The interview with the claimant
    The medical assessment
    Your medical knowledge of the likely effects of the condition

    “The Atos Healthcare HCP will provide advice to the Decision Maker using all their skills as a Disability Analyst. They will review all the evidence on file and provide advice on likely functional implications of any medical evidence provided.

    “Any evidence brought by the claimant must be read and the report should make reference to the evidence that has been considered and justification provided if there is a conflict between the opinion of the HCP and the other medical evidence.”

    http://www.dwp.gov.uk/docs/wca-handbook.pdf

    If this advice is followed, medical evidence should be taken into account.

  3. RE:
    “What does the DWP mean by fit for work? CS pointed out that the Australian Social Security Act 1991 clearly defines what it means by fit for work:

    At least 15 hours per week of unsupported employment, at or above the minimum wage, and the person must be able to reliably perform such work on a sustainable basis without requiring excessive leave or work absences.”

    That’s such an important point and am very glad Charles raised it.

    Is it my imagination, or was there some government clarification recently that ESA assessment related to 16 hours of work a week. If so, that would mean that “reliably and repeatedly” could be interpreted in the context of 16 hours work a week. Or maybe I am dreaming here.

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