Review of the Work Capability Assessment year four

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An Independent Review of the Work Capability Assessment – year four

Dr Paul Litchfield

December 2013

Presented to Parliament pursuant to Section 10
of the Welfare Reform Act 2007

London: The Stationery Office £21.25

© Crown Copyright 2013

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An Independent Review of the Work Capability Assessment – year four 1

Foreword 4

Executive Summary 6

Chapter 1: Introduction – the Review outline 10

Chapter 2: Implementation of the years one to three recommendations 17

Chapter 3: Effectiveness of the WCA 31

Chapter 4: Perceptions of the assessment 36

Chapter 5: Decision making 46

Chapter 6: Simplifying the process 57

Chapter 7: Mental health 65

Chapter 8: Northern Ireland 71

Annex 1: List of recommendations 80

Annex 2: Review of year one to three recommendations 86

Annex 3: Acknowledgements 97


The Welfare Reform Act 2007 established the Work Capability Assessment (WCA) as a means of distinguishing between people who could not work because of health related problems from those who were fit for some work or could, with support, eventually return to the world of work. The legislation also provided for an independent assessment of the WCA in its first five years of operation. This is the fourth such review but the first that I have carried out. The first three reviews were conducted by Professor Malcolm Harrington to whom I am indebted for his wise counsel when I took over the baton.

I was appointed shortly before Easter in 2013 and, despite 35 years of having been engaged in the world of work and health, I was surprised at how much I had to learn about the benefits system and its special language. The system is enormously complex, probably unnecessarily so, and efforts to simplify it should be of benefit to all. Even the limited part of the system which is the WCA is complicated with multiple hand offs, each of which adds delay, expense and the potential for error. This complexity is compounded by an unusual use of language which is handled skilfully by officials and independent benefits advisers but which can be impenetrable to ordinary people trying to navigate the system, often at a time of particular vulnerability. It is, perhaps, therefore no surprise that the WCA remains highly controversial with a number of people expressing strong views about its perceived fairness.

That perception of objectivity is fundamental if the WCA is to survive in its current form and I was pleased that it was specifically called out in my terms of reference. I have been influenced strongly by the notion of organisational justice in my career as an occupational physician. People need to feel that they are being treated fairly when dealing with an organisation and it is their perception that drives attitudes and behaviours more than any objective assessment of what has happened. In the context of the WCA, it is not just people making a claim for benefit who need to feel that the assessment is fair but also the staff administering the system and the taxpayer that funds it. The distributive element of the WCA (who gets benefit and how much) is clearly a matter for others but I have tried to look at both the procedures and the communication with people through the lens of organisational justice.

Previous reviews have paid particular attention to the clinical assessment conducted by Health Care Professionals and have also focused on appeals against decisions. While I have looked at both these elements and made some recommendations relating to them, I felt that the core of the WCA in which DWP Decision Makers operate should be my main focus for this year. I also noted in an early examination of the data that the number of people being moved to the Work Related Activity Group (WRAG) by Decision Makers has been growing steadily and I have sought to understand why that might be.

Another area of particular focus for me in this review has been mental health. Mental health problems, unlike many other medical conditions, are common in every age group and feature large in people claiming Employment and Support Allowance (ESA). The impaired capability associated with mental health problems can be difficult to assess and this can be compounded by the stigma that still exists in relation to this group of conditions. Professor Harrington made specific recommendations about reviewing the WCA mental, intellectual and cognitive descriptors and I had hoped that the resultant Evidence Based Review would have been completed to inform my work; unfortunately this was not possible and I have not been able to comment on descriptors. Nevertheless, there are a number of other mental health related issues that I have been able to examine and I hope that the resultant recommendations will help in this often neglected area of health.

Much has changed since ESA was introduced. Professor Harrington made 49 recommendations in his three reviews, almost all of which were accepted, and I felt it appropriate to review how those had been implemented and to try and gauge their impact. There have, however, been many other changes made to ESA and the WCA over the same period and disentangling the respective impact of particular interventions has proved extremely difficult. Nevertheless, I have tried to assess whether recommendations have been fully or partially implemented and I hope that there is some useful learning that comes out of the exercise.

The WCA has evolved since its introduction and will continue to evolve as circumstances change. There remain those who call for its abolition but suggestions for what to replace it with are rarely forthcoming. No “test” is ever perfect but the WCA has been designed with considerable rigour and it is subject to a process of continuous improvement in which I hope this review may play a small part. Good work is good for the health of most people and a benefits system that helps people back into employment when they have been incapacitated must be the aim of a compassionate society. An effective WCA which is fair and perceived to be fair can contribute to that overall aim.

Paul Litchfield

December 2013

Executive Summary

  1. The Work Capability Assessment (WCA) is designed to determine eligibility for Employment and Support Allowance (ESA). It is a functional assessment based on the premise that eligibility should not be determined by the description of a person’s disability or health condition but rather on how their ability to function is affected, which may vary considerably between individuals with the same diagnosis.

  2. The WCA has now been in operation for five years. Earlier Independent Reviews carried out by Professor Malcolm Harrington concluded that the WCA is conceptually right but that more needed to be done to improve the system. As the fourth of five Independent Reviews and the first carried out by Dr Paul Litchfield, this Review provides an opportunity to reflect on the implementation of recommendations from previous years and to assess their impact. There have been many changes to the system since it was first introduced and it is therefore also appropriate to revisit the underlying design principles to determine whether the WCA continues to operate as originally intended.

  3. In conducting this Review, it has become apparent that the length and complexity of the process contributes to dissatisfaction and negative perceptions surrounding the assessment. People need to feel that they are being treated fairly when dealing with an organisation and it is their perception that drives attitudes and behaviours more than any objective assessment of what has happened. This Review therefore makes a number of recommendations which aim to simplify the process and improve the way people feel they are treated.

  4. Another area of particular focus in this Review has been mental health. Recommendations are made that seek to build on the foundation of Mental Function Champions and improve knowledge of mental health more broadly for Decision Makers and Healthcare Professionals (HCPs).

Implementation of recommendations from earlier Independent Reviews

  1. Professor Harrington made a total of 49 recommendations over three Independent Reviews. 35 of these were accepted in full by the Department and 10 more were accepted in principle with others falling outside the remit of DWP.

  2. Overall the Department has made good progress with implementing the recommendations and some notable improvements have been made, such as the way people with cancer are treated. Some recommendations have not yet been fully acted upon and the better sharing of information with Work Programme Providers should be a priority.

  3. A key recommendation of Professor Harrington was for a comprehensive review of the mental, intellectual and cognitive descriptors. A major programme with independent oversight has been undertaken but, unfortunately, the work was not completed in time to be included in this Review.

  4. A number of recommendations are made for how the Department could improve the way it implements changes in future. In particular, giving due consideration to the need for pilots and ensuring that any such pilots are designed with robust evaluation measures from the start. Both policy intent and practical matters should be considered and sufficient analytical input should be sought at the design stage to increase the chances of obtaining meaningful results.

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