Rethinking Incapacity https://www.rethinkingincapacity.org create a better system of incapacity assessment Mon, 10 Jul 2017 12:21:16 +0000 en-US hourly 1 https://wordpress.org/?v=4.8.4 85178669 What effect do sanctions & conditionality have on disabled people? https://www.rethinkingincapacity.org/disabled-sanctions-research/ https://www.rethinkingincapacity.org/disabled-sanctions-research/#respond Mon, 10 Jul 2017 12:20:45 +0000 https://www.rethinkingincapacity.org/?p=1655 There are times that policy runs ahead of academic knowledge. Indeed, this is often the case, for policies must first be introduced before social scientists can study them – and if policymakers were restricted to policies that had been tried and tested, then policy innovation would be impossible. Yet such innovation can come with considerable […]

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There are times that policy runs ahead of academic knowledge. Indeed, this is often the case, for policies must first be introduced before social scientists can study them – and if policymakers were restricted to policies that had been tried and tested, then policy innovation would be impossible. Yet such innovation can come with considerable risks, as new policies can be introduced and widely imitated, only for social scientists – after some delay – to show that such policies are difficult to implement, can fail to achieve some of their aims, and may even have unforeseen and harmful consequences.

In a new special issue of the Journal of Poverty and Social Justice, we focus on one area where this might be happening: sanctions & conditionality for sick and disabled social security claimants. While historically disabled benefit claimants were largely exempt, high-income countries from Australia to Norway have increasingly required disabled claimants to take steps towards work, under the threat of financial penalties. The conventional wisdom repeated by bodies such as the OECD is that this is a necessary step towards reducing high benefit claim rates, and moreover helps improve the finances, health, and social inclusion of disabled people themselves.

However, there are several challenges to this story. By any principle of justice, claimants cannot reasonably be required to perform actions that they are incapable of doing, but it is difficult for benefits agencies to know exactly what someone can or can’t do. If they get this wrong, conditionality for disabled people can create injustices, and inflict considerable stress on disabled people. Moreover, conditionality may move disabled people further away from work, by both undermining their relationship with their employment support caseworker, and making them less willing to take risks in performing tasks that they are not sure they are capable of doing.

Two conflicting stories – but what does the evidence say?

Until now, there has been very little published research trying to establish which of these accounts is correct. This is the aim of the special issue, which includes four research papers looking at experiences from around the world. In the UK, Aaron Reeves looks at on the impacts of conditionality for disabled people claiming unemployment benefit. In Denmark and Sweden, Sara Hultqvist & Iben Nørup look at the different forms of conditionality implemented for young disability benefit claimants. In Germany, Patrizia Aurich-Beerheide & Martin Brussig look at the (failed) implementation of conditionality for disabled people in Germany. And my own paper (see below) brings together these papers with a wider review of evidence and practice, to come to some initial conclusions about what we know so far.

The special issue also includes four further, slightly more unusual papers about the UK, perhaps the country where these issues have become most hotly contested. Indeed, conditionality for disabled people has been the subject of an award-winning film (I, Daniel Blake) and an award-winning play (Wish List), both of which are reviewed in the special issue (by Alison Wilde and Kim Allen respectively). Jed Meers covers a recent Supreme Court judgement about the ‘bedroom tax’ in the Supreme Court. And we felt it was important to convey the lived experience of conditionality, so a team from the Welfare Conditionality project describe two real-life stories of people who took part in their research.

Conditionality is not easy to implement

So at the end of this, what do we know? In my (open access) review paper, I summarise the evidence into four ‘stylized facts’:

  1. Requirements for disability benefit claimants are common, but sanctioning is rare (particularly outside of the UK and Australia).
  2. Assessment and support are critical in making conditionality work on the ground, and can be combined into ‘passive’, ‘supportive’, ‘demanding’ or ‘compliance-based’ systems.
  3. The limited but robust existing evidence suggests that sanctioning may have zero or even negative impacts on work-related outcomes for disabled people.
  4. Individual case studies in ‘compliance-based’ systems suggest that sanctioning in the absence of other support can lead to destitution, and that conditionality can harm mental health.

While we need to know more, it is already clear that we cannot assume that conditionality for disabled benefit claimants is easy to implement, nor that it will have purely positive consequences. Policy may have run ahead, but research is now starting to catch up. It is crucial for the wellbeing of disabled people around the world that deeper knowledge and more informed policy go hand-in-hand from this point.

This is an edited version of the (open access) introduction to the special issue, and is simultaneously being posted on the Policy Press blog and my own Rethinking Incapacity blog. The full special issue can be accessed here.

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Do you want to give your thoughts on the WCA? https://www.rethinkingincapacity.org/want-give-thoughts-wca/ Tue, 14 Mar 2017 09:32:26 +0000 https://www.rethinkingincapacity.org/?p=1636 Would you be interesting in sharing your views on the WCA and conditionality, to help the Rethinking Incapacity project? As part of my research, I’m speaking to different groups of people about what they think of the current system, and how they think it should be changed – including disabled and non-disabled members of the public, […]

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Would you be interesting in sharing your views on the WCA and conditionality, to help the Rethinking Incapacity project?

As part of my research, I’m speaking to different groups of people about what they think of the current system, and how they think it should be changed – including disabled and non-disabled members of the public, Maximus assessors, welfare-to-work providers, charities & think-tanks, and politicians. This will feed into my upcoming final Demos report to be sent to policymakers, as well as later academic & wider publications.

As part of this I’m keep to speak to DPOs and other disability campaigners, who are obviously a crucial voice to hear strongly. I am therefore holding a small group discussion on Friday 24th March:

  • The discussion will include up to 12 people.
  • We will be talking about your views of the current WCA & conditionality regime, how a few hypothetical people should be treated, and how the system should be reformed more broadly
  • It will be at 12-3pm in central London (I’ll pass on the venue for people who are confirmed attendees).
  • We will pay a per diem of £60, as well as reasonable travel costs within London.

If you would be interested in taking part or have any questions about this, then please get in touch with me (b.b.geiger@kent.ac.uk) ASAP – and many thanks in advance for your help!

Ben Baumberg Geiger

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The Green Paper & I, Daniel Blake https://www.rethinkingincapacity.org/green-paper-daniel-blake/ https://www.rethinkingincapacity.org/green-paper-daniel-blake/#comments Tue, 01 Nov 2016 09:42:06 +0000 https://www.rethinkingincapacity.org/?p=1625 After a year of false starts, three Secretaries of State, and a change of colour from white to green, the Work, Health & Disability Green Paper has finally come out. By a strange quirk of fate, these delays have meant it has come out barely a week after the launch of Ken Loach’s film I, Daniel Blake, perhaps the first […]

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After a year of false starts, three Secretaries of State, and a change of colour from white to green, the Work, Health & Disability Green Paper has finally come out. By a strange quirk of fate, these delays have meant it has come out barely a week after the launch of Ken Loach’s film I, Daniel Blake, perhaps the first screen polemic against the way that disability is treated in the benefits system. And even more surprisingly, I want to argue that the Green Paper can be seen as providing answers to one of the key issues in the film – at the same time as raising new questions that need to be answered. 

The iron cage of bureaucracy

At the start of the film, as the credits flash in front of us, we hear a conversation between Daniel Blake and an assessor for the Work Capability Assessment (WCA). I can’t do it any justice, but it’s one of the most memorable scenes of the film; the WCA questions seem bizarre and irrelevant, and you hear Daniel Blake wittily, angrily trying to make his way through the tick boxes that don’t seem to fit him but which he is forced to jump through all the same.

The film is many things, but it is perhaps most of all a picture of how an ill man is failed by an iron cage of bureaucracy. Daniel Blake is found fit-for-work by a WCA that asks a series of meaningless questions without focussing on his heart condition. He can’t appeal the decision until he gets a phonecall from a ‘decision maker’, for which he waits while already having his benefit cut off. He’s forced to try to to apply for unemployment benefits online because the system is ‘digital by default’, even though he can’t use a computer. And he’s then required to spend 35hrs/wk looking for work, which he then can’t take because he’s too ill.

The Secretary of State’s response is to question the accuracy of the film – a debate I’ll come back to at another point. But what he could equally have said is that this is the very situation that Universal Credit is designed to avoid. Rather than putting people into a box with standard rules labelled ‘Jobseeker’s Allowance’ or one of the two boxes called ‘Employment and Support Allowance’, it tailors the conditionality (i.e. the things people are required to do, and the penalties for not doing them) to the person. Indeed, the word ‘personalised’ appears 31 times in the Green Paper:

“In order to realise our ambition to ensure individuals can access personalised support while still receiving the additional financial help they need, we need to consider whether the Work Capability Assessment is the right vehicle for deciding access to personalised employment support…[Under a new system,] work coaches could have full discretion to tailor any employment support to each individual claimant. This approach would be truly responsive, allowing the work coach to adjust requirements and goals dependent on changes in a person’s condition or circumstances.”

While there are some aspects of this that are new (previously people who the WCA saw as incapable of work-related activity had no conditionality in ESA or UC ), this can also be seen as a logical extension of the idea of Universal Credit, which was all about personalised support and conditionality. So the Green Paper is obviously not a direct response to I, Daniel Blake – this is the whole direction that ‘welfare reform’ has been moving for the last few years, not the last few days.

The dangers of discretion

We are therefore moving away from the dangers of an iron cage of bureaucracy – but this introduces a new danger, the danger of discretion. As various experts (including Mind and Neil Crowther) have already highlighted, the extension of conditionality to nearly all disabled benefit claimants includes considerable risks. One of these risks is about the effectiveness & fairness of conditionality & sanctions for disabled people in general – I am currently reviewing the evidence on disability & conditionality and commissioning an attitudes survey to see what the public think, so I’ll be regularly returning to these issues on the blog.

The other risk that the Government has to manage, though, is that discretion could mean that people will be required to do things they aren’t capable of. Yet this is not the main issue that’s raised by I, Daniel Blake. If anything, it’s the lack of discretion available to Jobcentre staff that’s raised as an issue (one of the Jobcentre staff is told off for trying to help him in ways that contravene procedure). In the call to arms at the end of the film, Daniel Blake writes:

“I am not a client, a customer, nor a service user… I am not a national insurance number, nor a blip on a screen… My name is Daniel Blake, I am a man, not a dog. As such I demand my rights. I demand you treat me with respect. I, Daniel Blake, am a citizen, nothing more, nothing less.”

To the extent that the Green Paper is all about personalisation, it’s about treating people as human beings rather than bureaucratic categories, just as Ken Loach was calling for. But to the extent that it’s about extending conditionality, it also introduces considerable new risks – perhaps a topic for Loach’s next film, if he decides to make one.

The future of the WCA

As a final aside, it’s worth noting what’s happened to the WCA in the Green Paper. Over the weekend, the news trailed that the WCA was going to be overhauled. What this means is that the WCA will no longer set conditionality, or indeed which benefit people are on (because Universal Credit combines ESA and JSA, or at least the non-contributory versions of them). And in many ways this is the aspect of the WCA that troubles people the most.

Still, disabled people will get a higher level of benefit, and this will still need a separate assessment. The consultation is open to changing this – one of the questions is, “What other alternatives could we explore to improve the system for assessing financial support?” – but it doesn’t have any fixed ideas on what to change it to. The Green Paper merely says any new assessment should use existing medical & social care evidence as far as possible, and “should still focus on the impact that an individual’s health condition has on them”. So this is something else to think about, and I’ll return to this on the blog in the coming months as well.

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The return of the stricter WCA? https://www.rethinkingincapacity.org/return-stricter-wca/ https://www.rethinkingincapacity.org/return-stricter-wca/#comments Wed, 21 Sep 2016 10:30:08 +0000 https://www.rethinkingincapacity.org/?p=1599 The Work Capability Assessment (WCA) has for several years now been widely felt to be a harsh and unfair assessment of incapacity, as I’ve explored elsewhere. But what escaped some people’s notice was that it became a much more lenient assessment over time. Whereas two-thirds (67%) of those having an initial assessment in mid-2009 were […]

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The Work Capability Assessment (WCA) has for several years now been widely felt to be a harsh and unfair assessment of incapacity, as I’ve explored elsewhere. But what escaped some people’s notice was that it became a much more lenient assessment over time. Whereas two-thirds (67%) of those having an initial assessment in mid-2009 were getting found fit-for-work, this dropped to merely one-quarter (25%) in Nov 2014. Conversely, only 10% in mid-2009 were being allocated to the Support Group, compared to over 60% in Nov 2014. (The remaining people were allocated to the Work-Related Activity Group or ‘WRAG’, which is means-tested and in which people can be sanctioned to some degree).

However, the latest figures suggest the WCA is starting to become stricter again, as Disability News Service reported last week. The chart below looks divides the WCA outcomes by when the assessment takes place (rather than when the claim is made). In March this year, 48% of people were found fit for work, the highest figure since Feb 2013, while only 33% were found eligible for the Support Group. To the extent that the WCA became more generous in recent years, we now seem to be seeing a return to the WCA of 2013 – a time before the final two reviews of the WCA by Paul Litchfield, before the Work and Pensions Select Committee’s influential report, and a time when Atos still did incapacity assessments (and was roundly criticised for it).

Figure 1: Outcome of completed assessments (initial assessments before appeals, by month of assessment)

Figure-1-Outcome-of-completed-WCAs

 

EXPLAINING THE WCA TRENDS

Yet there has been no policy change in the WCA – no change in the functional descriptors that make up the assessment, no ‘cut’ announced as part of Budgets or Spending Reviews – so what exactly is going on here?

One possible explanation – raised on Twitter by Declan Gaffney – is around the backlog of WCAs. Anecdotally, it seems that in the later days of Atos, they were doing more ‘easy’ paper-based WCAs of severely disabled people (which ended up in the Support Group), while the backlog was growing for people who were more marginal decisions who needed a face-to-face assessment. If Maximus have started clearing the backlog of (more marginal) face-to-face assessments, then this would lead to a fall in the number of people going into the Support Group, and a rise in those found fit-for-work. Yet as far as I can tell, this cannot explain the apparent increasing strictness of the WCA.

If we try and estimate the backlog from the WCA data1, it looks like there were nearly 300k pending initial assessments at the peak in mid 2014, which has since declined to 185k. The rate of decline has recently increased (70k in the last quarter, vs. 35k in the quarter before that), which is quite substantial within the total of 100-130k initial assessments per quarter. However, the main statistics allow us to look at outcomes by month of claim, and if we focus on people claiming in the most recent 3 months of each release (which admittedly involves putting together lots of spreadsheets), then we can ensure that we are ignoring the backlog. The results of this are shown below – and show exactly the same trend: in claims made in Apr-Jun 2015 (as of the Mar 2016 data release), 61% were allocated to the Support Group and 10% to the WRAG, but in claims made in Oct-Dec 2015 (in the Sep 2016 release), only 40% were allocated to the Support Group and 17% to the WRAG.

Figure 2: Ignoring the backlog: outcome of initial assessments for latest 3mths of claims (by most recent month of claim in each successive data release)

Figure-2-WCA-outcomes-ignoring-the-backlog

 

Another explanation is that this is something to do with ‘Regulation 35’ (as Ken Butler of Disability Rights UK and Anita Bellows of DPAC argued in the Disability News Service report), in which people can be allocated to the Support Group because of a risk to their health, even if they do not have enough points from the functional descriptors assessment. (They can also be allocated to the WRAG due to the parallel ‘Regulation 29’). The DWP have changed the guidance around this in deliberate response to the massive expansion in the use of what was meant to be an ‘exceptional’ circumstance – by mid 2015, over 30% of all completed assessments resulted in someone being assigned to the Support Group on these grounds, noticeably greater than the 20% relying on the actual functional descriptors. The final Litchfield review made clear that this was regarded as something that had to change, so we have been expecting DWP to do something in this area.

The revised guidance to healthcare professionals was released in July 2016 – you can compare the relevant sections to the 2015 guidance in this document I’ve created here. (You can also see the guidance in 2015 and 2016 appendices: the 2016 version is effectively brand-new. The 2015 updated version to DWP Decision Makers is here). While the detailed message of what has changed is complex, the basic message is clear: assessors are discouraged from saying that there is a substantial risk to the claimant’s health if they are found capable of work (or work-related activity). There are three aspects to this: ‘the focus on suicide has been reduced’ (as the DWP put it), the bar for ‘substantial risk’ has been raised, and the DWP has emphasised that “claimants must not be asked by DWP to do anything that is unrealistic or could put their health at risk” – hence they argue that it would be rare for work-related activity to cause difficulties for claimants.

So can this explain the changing WCA outcomes? The guide to healthcare professionals nots that “the Revised Substantial Risk Guidance was issued by the DWP in 2015 and implemented early 2016”, so we should just be about to see the impact of it now.  And we do. From claims begun in Jun-15 to Dec-15, people allocated to the Support Group due to Reg35 dropped from 30% of completed assessments to merely 12%. In contrast, Support Group allocations for other reasons stayed basically the same (reducing from 26% to 24% of claims).

Figure 3: Reason for being allocated to Support Group, completed assessments after appeals by month of claim

Figure-3-Reasons-for-WCA-Support-Group-allocations

To my mind this is all pretty convincing – it has become harder to get allocated to the Support Group from the start of 2016, because the DWP has made it harder for assessors to make judgements on the grounds of a a risk to people’s health.

 

A CRISIS IN 2017?

Does this mean that we are returning to the old days of the WCA circa 2013? Time will tell if the recent figures are the new normal. But there are reasons to believe that a reversion to the 2013 WCA severity may actually cause more of a crisis than previously:

  • ESA reassessments are now being re-introduced. ESA reassessments were suspended in Jan 2014, reaching 1m suspended reassessments by Aug 2015 (NAO report #1.12). But these now seem to have resumed, with 31k reassessments in Mar 2016 (up from about 10k/mth for most of 2015) – so more assessments are happening than usual while the backlog is cleared.
  • There are extra hurdles in appealing WCA decisions. With the introduction of mandatory reconsideration in late Oct 2013, it is harder to put in an appeal against a WCA judgement – with the result that appeal levels fell through the floor. (For claims starting in most of 2012, there were 6-7k appeals per month, which dropped to 1k/mth after mandatory reconsideration was introduced. Before MR successful appeals were 2-3k/mth; afterwards it was less than 1k/mth). If the initial WCA returns to its previous levels of severity initially, then the final level will end up being more severe, because fewer people will appeal (and therefore fewer people will overturn the initial decision).
  • The benefit in the ESA WRAG group is getting substantially cut. WRAG claimants will get a £30/wk benefit cut in April 2017, which I previously argued will considerably increase the pressure on the WCA.

Obviously this might not happen – confidently predicting the future is a mug’s game, as the last two years’ of elections (and most of human experience) have shown – and hopefully the current version of the WCA will work much better than previously, even if it is similarly difficult to get. But this is just a hope, and the possibility of a ESA/WCA-related crisis seems higher in 2017 than it has done for some time.

 

[Added note 22nd Sep: @KayleyHignell also noted that Citizens Advice have seen a sudden rise at the start of 2016 in people coming to them with ESA issues, as shown below (from this p17):

citizens-advice-caseload

 

Footnote
1 DWP do not provide regular updates of the WCA backlog. I have created these figures by looking at the number of assessments marked as ‘in progress’, which obviously includes a certain number that are still within the target wait of 7 weeks. These numbers do not precisely match the number that the DWP report as the ‘backlog’, which they seem to estimate as the pending claims minus the ‘expected outstanding volume’ of 1.5 x the latest month’s claims, and which seems to include claims not yet referred to Atos/Maximus, and possibly also some reassessments that have been put on hold. However, the estimated backlog of 280k in Aug 2015 is similar to the ‘in progress’ WCAs for initial and repeat assessments using my method. (The official backlog is also reported as 500k Mar 2015 and 110k Oct 2015; see the NAO report #1.12 and Maximis General Manager Leslie Wolfe at this Select Committee Evidence Session).

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How can we assess work capability in the ‘real world’? https://www.rethinkingincapacity.org/mean-assess-work-capability-real-world/ https://www.rethinkingincapacity.org/mean-assess-work-capability-real-world/#comments Wed, 31 Aug 2016 09:36:10 +0000 https://www.rethinkingincapacity.org/?p=1594 This is a guest post by Elina Rigler, who has a background in research and – together with own experiences of  the benefit system – this led her to try to understand how we ended up with the current assessment model. I’ve found her ideas really important and thought-provoking (not that I always agree!), and I’m really glad to be able […]

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This is a guest post by Elina Rigler, who has a background in research and – together with own experiences of  the benefit system – this led her to try to understand how we ended up with the current assessment model. I’ve found her ideas really important and thought-provoking (not that I always agree!), and I’m really glad to be able to share them via the blog.

 

The Work Capability Assessment (WCA) determining someone’s eligibility for Employment and Support Allowance (ESA) has been surrounded by controversy ever since it was introduced in 2008. For some time now, claimants themselves, disability organisations and academics such as Ekklesia and Scope have been calling for the WCA to be scrapped and replaced by a ‘real-world assessment’ (RWA).  It is not always clear, however, what is meant by a RWA, and what factors should be included in such an assessment.

One view – including the Rethinking the WCA report by Ben – is that incapacity for work “is intrinsically linked to employability”; hence, a RWA should take into account an individual’s age, education, work experience and other non-medical factors, while ignoring local labour demand.  But a RWA can also be interpreted more narrowly to refer to the level of functional ability required in the modern workplace – i.e. it should take account of the nature of jobs and the adjustments generally available in the workplace, but ignore wider personal circumstances.

In other words, the question is whether the main problem with the WCA is (i) that it focuses on the claimant’s functional limitations rather than their wider ability to get a job, or (ii) that it fails to assess the kind of level of functionality required in real jobs.

What is interesting is that this is not a new issue, but was already raised during the parliamentary debates leading up to the introduction of standardised functional assessments in 1995.  The issue has never been resolved; and for more than 20 years, successive governments have been tinkering with the ‘fit for work’ test, while failing to address the more fundamental flaws in the assessment model.

 

The Incapacity for Work Act 1994

The scene was set for the current controversy in the 1990s when the All Work Test (AWT), a points-based functional assessment, was brought in to determine eligibility for Incapacity Benefit (IB), the new out-of-work disability benefit  replacing Invalidity Benefit (IVB).  The main justification for this reform was that the number of IVB claims had been steadily increasing over the years, and it was argued that a more affordable and sustainable system was needed. Peter Lilley, then Secretary of State for Social Security, stressed that it was important to target those who were genuinely incapable of work, while those who were fit enough to do at least some type of work should receive the more appropriate benefit, Job Seekers Allowance (JSA), and be helped to find suitable employment.

Eligibility for IVB was decided mainly by GPs, who considered not only the person’s state of health but also factors such as age, education, and skills when determining their fitness for work. This old system was deemed too lax and subjective, and the AWT was introduced to provide a more rigorous and objective assessment of capacity for work.  The new test, which was carried out by specially trained Benefit Agency doctors, ignored all non-medical factors, assessing the claimant’s  general ability to perform physical and mental functions (e.g. walking, lifting, hearing, coping with pressure and interacting with others), and not their fitness for any specific occupations.

In the old system, the “overriding consideration” had been “one of reasonableness”, i.e. the claimant’s capacity for work had been measured against jobs which “exists in the real world”, though not necessarily available in the local area.  Now the critical question was whether the claimant met the threshold of 15 points required to pass the AWT.

MPs and peers opposing the introduction of the functional assessment argued that it was too formulaic and the cut-off point was arbitrary.  For example, Baroness Hollis protested that the AWT was a tick-box test “which bears as much relationship to the capacity for work as an MOT certificate does to the ability of a driver to pass the driving test”. She stated that such a mechanical assessment “may test for disability”, but being unable to measure pain, fatigue, and stress, “it certainly does not test for sickness”. Lord Swinfen agreed that people should be only considered capable of work which is realistically within their grasp.  He made the eminently sensible point that

it should be the requirements of an average employer which is the yardstick; most employers nowadays expect a flexible, reliable and adaptable workforce.  People who could only work for an ideal, altruistic employers, who is willing for staff to work when they feel up to it, should not be regarded as capable of work… Individuals may be able to perform a specific function, but it does not necessarily follow  therefore that they are capable of work.

Some parliamentarians also questioned the assumption that a standardised test would be fairer or more accurate than a discretionary one. For example, Baroness Hollis objected to the GP’s role being marginalised in the new system, arguing that only the GP knew the patient’s history and entire situation, and was therefore in a position to make “a proper qualitative judgement”.  Likewise, the legal expert, Nick Wikeley, observed that the new test would “remain subjective”, but focus “on a narrower area of inquiry”.

A number of critics were especially concerned about the decision to exclude all non-medical factors from the test. For instance, the Labour MP Keith Bradley complained that the one-dimensional functional assessment omitted other factors relevant to incapacity, such as “age, education, work experience and skills”. “It is nothing short of cruel”, he added, “that people found to be capable of work on functional grounds should be expected to find employment when there is no work for them to do”.

 

Why real-world factors were rejected in the 1990s

Ultimately, the proposal to include wider, non-medical factors in the test was rejected on the grounds that such an assessment would fail to distinguish between unemployment and incapacity for work.  William Hague, then minister for Social Security and Disabled people, argued that

Non-medical activities, such as education, skills and experience, may affect the ability to get a job, but they are not a cause of medical incapacity.  It is the medical condition that distinguishes the long-term sick from the unemployed.  To include non-medical factors in the assessment would reintroduce the problems of the current system.  It would mean that incapacity benefit would be paid to people because they are unemployed rather than incapable of work.

Baroness Cumberlege objected to the unfairness of the discretionary IVB assessment:

The current system is subjective, and, despite its objective of “reasonable work”, often produces unreasonable outcomes…This blurring of employability and incapacity also leads to unfairness: two people with precisely the same degree of incapacity may be treated differently because one has retrained and the other has not, although both are equally capable of retraining. That  is both unfair and nonsensical: someone who cannot work because he does not have the appropriate skills requires training, not a benefit for sick and disabled people.

Despite Government’s reassurances that the AWT would provide a fair and objective assessment of incapacity, opponents of the Bill maintained that the new test was “wrong in principle, unworkable in practice”, anticipating the criticisms that would be levelled at the WCA 15 years later.

 

Plus ça change? The same debates in recent years

It is noteworthy that the same complaints have been made about the functional assessments over and over again (e.g. compare this to this).  One of the most common criticisms (e.g. in 1998 , 2006 and 2010) has been that the mechanistic tick-box test is not able to adequately assess those with mental illness and other fluctuating conditions or to recognise the effects of pain and fatigue. The assessment process also continues to be something of a lottery: its outcome often depends on whether the claimant is lucky enough to be assessed by a sympathetic Health Care Professional or to have their claim processed by a decision maker who is willing to exercise a degree of common sense and discretion, instead of totting up the descriptor points mechanically.

And every now and again the issue of a real-world assessment has raised its head again. For instance, the following exchanges, which took place during the Work and Pensions Select Committee’s inquiry into the IB reassessment in 2011, echoed the 1994-5 debates:

Anne Begg (Chair of the Committee) voiced her concern that “the WCA does not ask questions about real life chances” of someone getting a job, or “take into account labour market conditions in the area, educational ability or ability to retrain”, while the then Employment Minister Chris Grayling declared himself “absolutely, unreservedly and implacably” opposed to introducing such a real-world test, stating that it would do “a huge disservice to those people – some of whom have health problems – who are on JSA”.

At this point, Dr Gunnyeon (DWP Chief Medical Advisor) pointed out that many people didn’t think of it as being about employability, but about whether “the assessment is really properly determining people’s suitability for work”. Right at the end of the session, Anne Begg got to the heart of the matter, stating that: “Employers are reluctant to employ disabled people”, and therefore “they are always going to be disadvantaged in the labour market”.  Grayling glossed over this inconvenient truth, giving  a typical ministerial response involving empty rhetoric (“breaking down barriers”),  and an anecdote about one disabled claimant who had found a job.

The confusion about the meaning of ‘real-world assessment’ seems to remain.   Moreover, policy makers seem to assume that since there may be good reasons for excluding non-medical factors from the assessment, they can continue to ignore the fact that the current WCA does not assess people’s fitness for the type of jobs that exist anywhere in the labour market.

 

The time for tinkering is over

It should be obvious by now why the WCA is not working, and, more to the point, why such an assessment will never work. The decision to exclude all non-medical factors from the assessment may be understandable; the problem is that, contrary to DWP’s claims, the ‘fit for work’ test has never reflected “activities and functional capability that a reasonable employer would expect of his workforce”.

It may also be that “real-world incapacity is intrinsically linked to employability”.  But then the old questions remain:  What employability factors should be taken into account; and how they should be weighted in the assessment? How to combine the benefits of a standardised test (e.g. consistency) with those of a more discretionary approach (e.g. personalisation)? And, above all, how to implement such a system without discriminating against some groups of claimants, especially those on JSA?

Despite this, it should be possible to replace the WCA with some form of real-world assessment – at the very least, based on the kind of level of functionality required in real jobs.

 

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Does the WCA really penalise poorer people? https://www.rethinkingincapacity.org/wca-really-penalise-poorer-people/ https://www.rethinkingincapacity.org/wca-really-penalise-poorer-people/#comments Wed, 10 Aug 2016 15:06:36 +0000 https://www.rethinkingincapacity.org/?p=1588 Yesterday the Guardian posted an article with the headline ‘‘Biased’ fit for work tests penalise poorer people’, based on a soon-to-be-released piece of research. This seems to have caught a few people’s eye – but sadly this is one of those times that I think the media has got it wrong (much as it’s written […]

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Yesterday the Guardian posted an article with the headline ‘‘Biased’ fit for work tests penalise poorer people’, based on a soon-to-be-released piece of research. This seems to have caught a few people’s eye – but sadly this is one of those times that I think the media has got it wrong (much as it’s written by the usually excellent Frances Ryan). In this post, I’ll explain why the headline goes way beyond the evidence.

First, a quick recap. The paper uses publicly available data on WCAs for people moving from the old Incapacity Benefit to the new benefit ESA, and looks at which areas were most likely to find people fit-for-work. Its key finding is that current Incapacity Benefit claimants were least likely to be awarded ESA in areas with more poverty and lower educational achievement. Hence the claim (in the words of the Guardian piece) that “the controversial work capability assessment [WCA] is disproportionately removing benefits from people in more deprived regions”.

Before disagreeing with this completely, it’s worth flagging three good points here. Firstly, the newspaper article does accurately reflect the paper. Secondly, the article still isn’t out yet, but the author Jonathan Hume helpfully shared a draft to his Twitter followers yesterday. (Jonathan unusually isn’t an employed academic, but has an article in the journal Radical Statistics – this is a journal for leftwing statisticians whether in academia or outside of it, and it sometimes has really thought-provoking articles; I should mention that I know some of the people on the editorial board). And thirdly, the paper itself is well-written enough that I’ve managed to replicate the analysis in it, and it holds up.

Showing bias

Yet I still think the article and Guardian piece are wrong. The author’s key assumption here is that if the test is fair, then the rate of finding people fit-for-work during their benefits assessment should be constant across different areas (as he said explicitly on Twitter). But I see no reason whatsoever for this to be true.

Put simply, some disabled people find it easier than other disabled people to find and keep work. If Stephen Hawking had previously worked for Primark rather than as a theoretical physicist, then he would have stopped working much sooner. While everything obviously depends on the individual, generally people with genuine but less severe disabilities  are more likely to be working if they have higher qualifications and live in areas with more jobs. If people have more severe disabilities, then their chances of working get much smaller, even if wider advantages probably still help (I’m currently doing research on this as part of the Rethinking Incapacity project, so watch this space – but for the time being, see this and the studies cited in the paper behind it).

So my guess is that the average incapacity benefit claimant in a poorer area is less severely disabled than in the average claimant in a richer area. (It would be possible to check this out using different data such as Understanding Society – I’ll try and do this later in the year)And if you make it harder to claim incapacity benefits (such as the transition from Incapacity Benefit to ESA), then what you would expect to see is a greater proportion of people failing to get the new benefit in poorer areas. Hence this would explain the pattern that Jonathan Hume sees, without any unfairness at all in the WCA.

Does controlling for life expectancy in that area help? Well, probably not. The issue is about the health selectivity of the benefits system in different areas – i.e. not about whether people in the area are healthier or not on average, but how likely unhealthy people are to be claiming benefits. So to my mind, what the paper shows is a pattern that you would expect to see, and one which doesn’t (in itself) show there’s anything wrong with the WCA (though see my final words below on this).

I just don’t think the study can justify the very strong claim that “it has been established that there are significant biases in the WCA”. Showing bias is a tricky task where you need to have information on people’s actual eligibility for benefits, which would need a completely different type of study, backed up by supporting evidence. The study does show an interesting pattern for researchers to go away and look at, but it wasn’t predicted, there’s no other supporting evidence, etc – the study just isn’t strong enough to justify this kind of headline.

[Note: I edited this shortly after putting up the original post, when my wife pointed out that I hadn’t really explained it very well first time round…]

Fairness and the WCA

It’s worth clarifying a couple of things here:

  • Overall, incapacity benefits are disproportionately claimed by lower-qualified people in more deprived areas (see e.g. the maps by Tina Beatty here). I find it very strange that this isn’t mentioned in either the research paper or the newspaper report. And the Government’s decision to means-test ESA for less-disabled people after a year further pushes the benefit away from less more deprived people.
  • The DWP is right to say that the paper “makes a huge leap in attributing local variation in work capability assessment outcomes to ‘bias’”. If you want to criticise the DWP’s response to research, then it’s better to use e.g. the DWP’s dismissal of the excellent paper by Ben Barr et al on the WCA last year.

Despite all this, at heart I agree with Jonathan, Frances and others that the WCA is a disaster and needs to be changed. Indeed, I’ve detailed a lot of the problems with it (and how it could be changed) here, and will keep writing about this over the next 12mths. But if anything, I think this makes it even more important to criticise the WCA for the right reasons, so that the many deficiencies of the WCA can’t reasonably be denied by anyone.

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BSA: an update on British attitudes https://www.rethinkingincapacity.org/bsa-british-attitudinal-update/ https://www.rethinkingincapacity.org/bsa-british-attitudinal-update/#respond Wed, 20 Jul 2016 14:35:18 +0000 https://www.rethinkingincapacity.org/?p=1579 The latest version of the bible of public opinion, the British Social Attitudes (BSA) survey, came out recently – perhaps to less fanfare than usual given the deluge of other news. Still, buried away in the chapter on attitudes to benefits is an intriguing finding about changing attitudes to disability benefits over time that I thought deserved more attention. […]

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The latest version of the bible of public opinion, the British Social Attitudes (BSA) survey, came out recently – perhaps to less fanfare than usual given the deluge of other news. Still, buried away in the chapter on attitudes to benefits is an intriguing finding about changing attitudes to disability benefits over time that I thought deserved more attention.

The question itself asks people if they want more or less spending on six different types of benefits, including ‘benefits for disabled people who cannot work’. (The full wording is at the bottom of this post). As previous BSA chapters have shown (including mine), people generally want more spending on ‘deserving’ groups of claimants like ‘disabled people who cannot work’. (I’ll come back in future posts to how far they think this applies to all incapacity benefit claimants).

What’s surprising, though, is how this has changed in the last couple of years. The trend is shown in the table below (taken directly from Liz Clery’s chapter in this year’s report):

BSA 2015 Table 1

We’d already seen that there was a fall in support for more spending from 2008 to 2011 – perhaps unsurprisingly given all the talk of austerity, debt and deficits. However, this isn’t anything specific to benefits for disabled people – support for more spending on all benefits fell similarly (if anything, the fall was highest for benefits for retired people, which I wrote about elsewhere).

What’s new, though, is the rise in support for more spending on benefits for disabled people between 2013 and 2015 (from 54% to 61%). What’s more, this rise seems to be greater for disabled people’s benefits than for other benefits (much as there seems to be increasing support for more spending for other benefits too; the number of people thinking benefits for unemployed people should be cut fell from 49% to 45% for example, as shown in the full BSA chapter).

It’s always hard to read public opinion, and it’s particularly hard to read it on the basis of a single question in a single survey. Still, I think this shows more of the public are probably becoming aware of cuts to disability benefits, and their attitudes are changing as a result. This may have increased further (since the BSA fieldwork in Aug-Oct last year), given IDS’ resignation over disability benefit cuts earlier in 2016. And while smart social scientists don’t make predictions – the future is unpredictable, however fancy our statistics are – but if I was going to rashly make a prediction, it would be that this trend will continue into 2017 as the impact of the impending cut to the ESA WRAG group starts to bite.

To be clear – there has been no wholesale shift in public attitudes to disability benefits since 2013. But there are signs that attitudes are starting to change, and it will be interesting to see if this continues in the coming months and years.


Full question wording:

“Some people think that there should be more government spending on social security, while other people disagree. For each of the groups I read out please say whether you would like to see more or less government spending on them than now. Bear in mind that if you want more spending, this would probably mean that you would have to pay more taxes. If you want less spending, this would probably mean paying less taxes.

Firstly, benefits for unemployed people: would you like to see more or less government spending than now?

(Would you like to see more or less government spending than now on …) … benefits for disabled people who cannot work?

Etc.

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The disability & employment agenda in 2016 https://www.rethinkingincapacity.org/the-disability-employment-agenda-in-2016/ https://www.rethinkingincapacity.org/the-disability-employment-agenda-in-2016/#respond Mon, 04 Jul 2016 08:45:05 +0000 https://www.rethinkingincapacity.org/?p=1568 I’m now back after my brief time in DWP – and it’s great to be able to blog freely again! So much has happened since last autumn, that I thought I’d return to blogging by putting together a list of links of things that link to the Government’s aim of halving the disability employment gap (I’ll try […]

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I’m now back after my brief time in DWP – and it’s great to be able to blog freely again! So much has happened since last autumn, that I thought I’d return to blogging by putting together a list of links of things that link to the Government’s aim of halving the disability employment gap (I’ll try to keep this updated as the debate develops):

  • Government itself – the Conservative manifesto 2015 committed the Government to halving the disability employment gap, and the Budget 2015 promised a White Paper – a statement of planned Government policy – early in 2016. However, after IDS’ resignation, the new Secretary of State Stephen Crabb has signalled that this will instead be a Green Paper – a consultation on possible policies – to take place later in 2016 (probably in the autumn at the soonest). DRUK have warned that this might mean a watering down of possible actions, which was the same argument behind the Labour Party’s recent Parliamentary debate. While it’s too early to judge, it’s clear that the focus is likely to be on gaining knowledge rather than reducing the gap in the short-term – Stephen Crabb said (before being replaced by Damian Green) that his aim is that “by the end of the Parliament [in 2020] we will be pretty well advanced in terms of new policy thinking”.
  • Disability Rights UK (DRUK) have a number of reports in this area, particularly around peer support (where they have reviewed 50 practice examples alongside a Work Foundation report on their likely effectiveness), but also with their responses to various inquiries on disability and work. And the faith-based think-tank Ekklesia has a report on the WCA based on disabled people’s reported barriers by the excellent Stef Benstead – their grassroots consultation should be coming out soon.
  • Scope were one of the groups that pushed the Government to make their original commitment, and their most recent report has three sets of recommendations (also summarised here). Firstly, there should be much better employment support for disabled people (including personal budgets and an innovation fund for DPOs). Second, disabled people should be ‘connected to growth’ through local economic development strategies. Finally, more flexible workplaces need to be created by giving people the option of time-limited part-time sick leave – building on Finnish evidence on how it helps people return-to-work.
  • The Work Foundation launched a report in May 2016 that focusses on helping disabled people to find work. They include a series of detailed recommendations including better payments to subcontractors that reflect people’s actual barriers, expanding the availability of Work Choice, testing IPS approaches, and better local-level coordination. IPPR North also launched a report in July 2016 on the Work & Health Programme, suggesting that local joint venture companies should be set up on an ‘invest to save’ basis (and also suggesting personalised assessment).
  • The Resolution Foundation launched a report in June 2016 that (conversely) focuses on job retention and the role of employers, rather than getting people back into work. Their most striking recommendations are for a 1yr ‘right to return’ period for jobs after the start of sickness absence (building on maternity policy), and a rebate in Statutory Sick Pay for firms who help employees to return from long-term absence.
  • The think-tank Reform have been active in this area, partly led by Charlotte Pickles, a former special advisor to IDS. Their Feb 2016 report Working Welfare set out a range of interesting suggestions for incapacity benefits, though it is much more pro-conditionality than Matt Oakley’s SMF report that came out slightly later (and also his follow-up report). More recently, Reform released Stepping Up, Breaking Barriers, proposing a plan for outsourcing and devolution around the Work & Health Programme.
  • The Work and Pensions Parliamentary Select Committee is currently holding an inquiry on the Disability employment gap – the first session of collecting evidence begins later today.
  • The All-Party Parliamentary Group on Disability has a call for evidence out (deadline next Monday) on the disability employment gap, on the themes of business networks, self-employment, R&D grants, procurement, growth sectors, and organisational policies.
  • It’s also worth being aware that Citizen’s Advice are doing a major project in this area at the moment, of which this August 2016 infographic is a small taster. The TUC are doing analyses like this [added 11/7/16], and (as always) the Disability Benefits Consortium are being very active.
  • There’s also a huge range of other people and organisations with interesting things to say – just to take other people who submitted evidence to the Select Committee inquiry, there’s Inclusion Scotland, Inclusion London, Breakthrough UK, Macmillan, Mencap, Arthritis Research UK, Sense, the MS Society, the National Autistic Society, Rethink, Leonard Cheshire, Muscular Dystrophy UK, Parkinson’s UK, RNIB, Action for ME, the EHRC, the LGA, the Joseph Rowntree Foundation, the Learning and Work Institute, the TUC, Remploy, ERSA (including a joint submission with homelessness charities), Shaw Trust, the College for OTs, the Business Disability Forum and many more.

Given that the Rethinking Incapacity project is focussed on the WCA, I should also add that nearly everyone thinks that the WCA should be overhauled (this being particularly mentioned in the latest reports by Scope and the Work Foundation, but also mentioned by pretty much everyone in debates in the past few years).

As I said, this is an ongoing list, so if you think I’ve missed any major contributions to the debate then just let me know and I’ll add these ASAP!

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Are disability assessments associated with adverse trends in mental health? A longitudinal ecological study https://www.rethinkingincapacity.org/are-disability-assessments-associated-with-adverse-trends-in-mental-health-a-longitudinal-ecological-study/ https://www.rethinkingincapacity.org/are-disability-assessments-associated-with-adverse-trends-in-mental-health-a-longitudinal-ecological-study/#comments Mon, 23 Nov 2015 15:37:48 +0000 https://www.rethinkingincapacity.org/?p=1558 This is the title of a study that was recently published in the Journal of Epidemiology and Community Health (JECH) by Ben Barr and colleagues, which generated a considerable amount of press and political attention last week. Because I’m working with government at the moment I can’t really comment on the study right now, but rest assured I […]

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This is the title of a study that was recently published in the Journal of Epidemiology and Community Health (JECH) by Ben Barr and colleagues, which generated a considerable amount of press and political attention last week. Because I’m working with government at the moment I can’t really comment on the study right now, but rest assured I will in April when I’m back in my usual role again – and I have a loose agreement with the journal (JECH) to write a commentary on the piece too. In the meantime, the article itself is open access, and you can read it yourself here.

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A (temporary) change to the Rethinking Incapacity blog https://www.rethinkingincapacity.org/a-temporary-change-to-the-rethinking-incapacity-blog/ https://www.rethinkingincapacity.org/a-temporary-change-to-the-rethinking-incapacity-blog/#comments Mon, 26 Oct 2015 16:20:48 +0000 https://www.rethinkingincapacity.org/?p=1555 The blog is temporarily changing, and I thought it was important to be clear to people that read the blog (you!) about what’s going on. As of last month (Sep 2015), I am working part-time with the Department of Work and Pensions.  While I’m at the DWP, this means that I can’t publicly comment on […]

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The blog is temporarily changing, and I thought it was important to be clear to people that read the blog (you!) about what’s going on.

As of last month (Sep 2015), I am working part-time with the Department of Work and Pensions.  While I’m at the DWP, this means that I can’t publicly comment on issues around the WCA etc. Which will be a bit of a change! However, the blog will continue, focusing more on the latest policy-related research than on policy itself.

What this means, and what it doesn’t

There are two things that I thought were important to clarify about this.

Firstly, my silence on policy issues is purely temporary – once I’ve finished working with DWP in six months time, I’ll be back commenting on these issues exactly as before. (Indeed, my research is continuing part-time, and I’m planning to write a report and hold an event in the Spring, shortly after finishing at DWP). So watch this space.

Secondly, I know that there are some disability campaigners who have concerns about DWP policy (indeed, I blogged about reaction to the Duncan Smith’s recent speech here). However, having taken advice from various people that I trust (including some campaigners), I think that the best way for me personally to try to contribute to the independence and wellbeing of disabled people in Britain is to work with DWP.

So: for six months the blog will focus on policy-related research rather than my own views on policy itself, but after that, normal service will be resumed!

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