18 August 2011
Action for M.E.’s Sir Peter Spencer and representatives from the ME Association and BRAME were among 13 charities which met with Professor Malcolm Harrington, head of the independent Work Capability Assessment (WCA) review team, in London yesterday.
Sir Peter reports:
The meeting was billed as a seminar for stakeholders to meet with Professor Harrington and discuss:
- the implementation of the review’s Year 1 recommendations and the impact they are having
- what, if any, further work is required in future reviews and
- the face-to-face assessment.
Professor Harrington wanted to hear evidence about the specific problems that a range of client groups are experiencing and to establish if there are any common themes/problems and potential solutions.
There was a good turn out by the M.E. charities with Action for M.E., the ME Association and BRAME all present. The significance of this was not lost on Professor Harrington who appreciates the extent to which people with M.E. feel that the new welfare support system fails to comprehend their degree of disablement. Other charities present included the MS Society, Citizens Advice, Arthritis Care UK, several mental health charities and others.
Invited to give a broad impression of the impact the Year 1 recommendations are having, all charities stated there was little noticeable change.
Peter Spencer highlighted concerns expressed by people with M.E. that:
- they were being rushed through Atos interviews without being listened to
- Atos reports were factually incorrect
- there was little evidence of medical reports from people’s doctors being considered.
A limited amount of evidence from the Incapacity Benefit to Employment and Support Allowance migration pilots indicated that some assessments had used medical reports. It was generally agreed that there are inconsistencies across the Department for Work and Pensions (DWP) and need for best practice to be clearly explained, consistently implemented and closely monitored.
The point during the assessment process when medical evidence was consulted was a subject of some discussion. There is evidently confusion between Atos and the DWP about this point of detail.
Professor Harrington believes the DWP decision maker should refer to the medical evidence and, if none has been submitted, ask the claimant if they wish to provide any additional information before making a decision.
Peter Spencer made the point that whatever system emerges should not prolong the period of uncertainty and anxiety for claimants which for many will have an adverse impact on health. Inconsistencies in the availability of medical evidence also discriminates against:
- those with little money who may not be able to afford to pay GPs who insist on payment
- those who live in geographic locations without specialist secondary care services.
Dr Charles Shepherd gave a recent example of a person with M.E. being told not to bother to provide medical information because it would not be looked at.
Professor Harrington confirmed that the Government is highly motivated to improve the quality of DWP decision making because it is so costly to have so many appeals upheld. There was a strong push to get decisions right first time.
The general view was that for the system to work properly, claimants required a lot of help from welfare rights advisers in charities. Too many are slipping through the loop and these tend to be the most vulnerable.
Citizens Advice pointed out that 60% of successful appeals came from claims that were originally awarded zero points. This pointed towards major flaws in the decisions being made.
There was a spirited discussion about the Lima – the computer programme used by Atos assessors. It was stated that Atos are contracted to provide evidence on functionality and not fitness for work. The latter is the task for the DWP decision maker who should not limit the evidence considered to the content of the Atos report.
Nevertheless, Atos do recognise the need for their assessors to understand the impact on functionality of specific medical conditions. It was stated that Atos information on some conditions is out of date and inaccurate.
The discussion on descriptors for the WCA confirmed the view that fluctuating conditions such as M.E. and MS need more appropriate descriptors that explicitly reflect this characteristic. For many medical conditions the standard Atos question of describing a typical day immediately demonstrates a failure to understand that clients with such conditions don’t have typical days because their health varies so much.
Professor Harrington praised the work of the group who had examined fluctuating conditions, in which Dr Shepherd has played an influential part. In particular he highlighted their work on:
- a descriptor for fluctuating conditions
- the need to establish a descriptor that will reflect high levels of pain and fatigue
- the need for a proper definition of work and to establish whether the process of assessing someone as fit for work would be accepted by employers.
Peter Spencer pressed for the likely timescales in which year 2 changes might be expected. The reply was that changes reflecting more appropriate assessment of fluctuating conditions may not be rolled out until 2013. This prompted Peter to repeat the suggestion he has made before to DWP Ministers that WCAs should be put on hold for claimants with M.E. and other fluctuating conditions because the assessment process is known to be flawed and giving so many wrong decisions. Professor Harrington acknowledged that there is a case for this and suggested we include it in our response to the current consultation.
Peter also asked for DW P statistics on claims to be broken down into specific conditions with sufficient detail to check that specific patient groups are not being treated less fairly than the others. Again – another point to make in responding to the consultation.
Finally when asked for the most important changes that were needed now, the items identified by those present were:
- regular use of good quality medical information
- suspend assessments for those patient groups for whom the current process is acknowledged to be flawed
- training and understanding for Atos employees
- gold standard for mental health assessment – something which is being discussed elsewhere
- Atos to listen properly to all clients. especially those with complex medical problems.
Sir Peter concluded: “Professor Harrington agrees that there are big problems to solve but he is clearly managing expectations about how long this will take.
“The challenge is that change will cost money and the DWP and Treasury will demand to see the business case for devoting additional resources to making further changes to the WCA process. We will need to provide strong, current evidence to reinforce the personal case studies we have already provided.”