ESA, Broken Beyond Repair? A Suggested Framework for a Wholesale Overhaul #GE2015

I think the Labour Party needs to seriously ask itself how a social security reform that attracted widespread support at its inception has reached its current nadir.  My party needs to recognise that the process is broken beyond repair.  And that no tinkering with it will make it function both effectively and humanely.

I am not going to speak about the damage the current process has caused and is still causing.  There are many people better placed than I to describe the emotional and financial distress resulting out of the system as it is today.  My experience of it is, at most second hand.  I do, however, recognise that the system is failing some of the most vulnerable in our society.  It offers them neither hope nor social security.

My background is primarily in the area of support for those seeking work (and seeking to find workers) as well as economic and social regeneration.  You cannot do either effectively without some understanding of the social security and tax systems, a bit of economic theory and appreciation of the importance of effective management processes to inform decision making at all levels.

I take the view that the Work Capability Assessment is not fit for purpose or good Value For Money.  The WCA is expected to perform two quite different functions, assess entitlement for Employment and Support Allowance and evaluate an individual’s potential employability.  Curiously, it appears that one, often relatively unqualified person is capable of carrying out both tasks with a high degree of competence within a 45 minute period, if I get the timings right.  Has this target, sorry norm ever been met in its entirety, both quantatively and qualitively?

The focus of a WCA has become almost solely the assessment of entitlement to ESA which assuming, that the target, sorry again norm expectations are true has become more than a bit of a lottery.  In fact, why bother with WCAs at all?  Would not a random allocation computer program, with the norms set as parameters be good VFM?  After all, Atos is at its core a computer company.

I have seen a few WCA assessment reports and the employability advice within them is no basis on which to move someone closer to the labour market, let alone into work.

Separate Out the Initial Entitlement Process from the Employability Assessment

Firstly, I would put the onus on the Department for Work and Pensions to accept a claimant’s medical evidence at the start of a new claim to ESA.  Only in rare cases should such evidence be challenged.  Perhaps a norm might be developed over time to monitor how this part of the process is working, particularly to ensure that challenges do not become the rule.

Secondly, I would use the claimant’s medical evidence at new claim stage to determine whether an individual goes into the Work Related Activity Group, Support Group or has no entitlement.  I would back date the additional resulting monies to the claimant’s date of claim.

Thirdly, I would allow those placed in the WRAG to have access to an independent Medical Assessment, if they feel they should be in the SG.  I would apply the same approach to those deemed to be ineligible to receive ESA.  If the MA finds against the appellant in either case then I would provide them with access to an independent appeals process.  DWP should at all stages pro-actively seek out medical evidence from the third parties treating the appellant.

Six Monthly MA and EA

I would suggest MAs for all those claiming ESA six months after the date that they began to receive ESA at the WRAG or SG rate.  These assessments would require use of medical evidence supplied by claimant’s treatment providers and would have to be carried out by qualified specialist medical assessors and not, as now generalists.  MAs would take place in convenient locations, including, where necessary the claimant’s home.

The findings of the MA should then be used to determine ongoing eligibility to ESA with an appeals process where a claimant disagrees with the decision.  All appellants would remain on WRAG or SG levels of payment whilst an appeal was going through the system.

If someone was ultimately found ineligible for ESA then there would be a transitional phase, say three months to allow them to adjust to a lower level of social security payment.  They would continue to receive payment at the higher rate throughout the period of the transitional phase.

You will note I have said nothing about an EA.  Such assessments should take place at the six monthly stage, but only after the MA has taken place and not on the same day.  All parties to the EA need to have had a chance to study the results of the Medical Assessment well before an EA takes place.

EAs would be mandatory for all those in the WRAG and an option for those in the SG.  They would also be an option for anyone in the first six months of their claim as would access to back to work support.

The report from an EA would form the basis for tailored support from a revamped Disability Employment Adviser service based in Jobcentres.  Support and advice related not to an abstract concept of the labour market, but one firmly based on existing conditions in the claimant’s own local area.  They would have access to the current range of support, but not the Work Programme, and a revitalised package of support based on the New Deal for Disabled People and its successor, Pathways to Work.  This new programme would be contracted directly out to experts in the field and not via sub contracts arranged through the usual suspects.  This arrangement has patently failed under the Work Programme.  In fact, I would scrap the Work Programme completely.  Its black box stopped transmitting years ago.  And the box has never contained a Condition Management Programme, a work-focused rehabilitation provision developed in conjunction with the National Health Service.

The initial interview with a DEA would be built around WETCHA; Work, Education, Training, Circumstances, Health and Aspirations.  A discursive interview, including the MA report should result in information under all six headings.  Only then might one look at how best someone might move closer to the local labour market.  I stress more closer to rather than start looking for a job.  Other avenues might need to be explored, perhaps quite extensive before beginning to try and find work.

As an aside, when I was going through my lengthy process of Management Attendance with DWP I kept getting the refrain about how work is the best cure.  Setting aside the small matter that it was work that was making me ill, I would contend that it is activity (and through it maintaining good social networks) that is what contributes towards good mental health.  And activity which would of course encompass more than paid employment.

I am now going to be very heretical.  I think all three elements, MA, EA and DEA interview should be repeated at regular interviews and be mandatory.  However, any further steps, beyond the initial DEA interview should be voluntary.  I strongly suspect that adopting such an approach would yield better results than the current ‘sheep dip’ policy.  Develop and deliver a good three stage process and you will not want for willing, well motivated volunteers.  I can only speak for NDDP and P2W here in Birmingham, but once word on the street gave it the thumbs up then there was no need to seek people for the programmes to help out.  People were queuing up outside the doors to find out what was on offer.

I would not impose a target on DEAs to keep X number of people engaging with them after the initial interview.  I would monitor the quality of their work to ensure that they were providing advice appropriate to the needs of individual clients.

 Intervals between Assessments

I would be interested to know the view of others as to whether or not six months would be the best point at which to start assessments.  Also, I am not best placed to say how one would decide upon the timing of successive assessments.  I would certainly not advocate standard time periods between them.  However, I would recommend giving people the option to ask for an assessment before they are due one.  My preference would be for such assessments to involve all three stages, unless there was compelling evidence to do otherwise, for example the worsening of a condition qualifying someone to move from the WRAG to the SG.

MAs could result in up ratings from WRAG to SG and down ratings as well.  I was intrigued by the view, expressed by a Tory MP in the WOW Debate that going on ESA was almost a panacea so down ratings were more likely than up ratings.  On a par, it seems with recovering from Alzheimer’s disease after a spell in an open prison.  Google Guinness Trial and all will become clear.

From Whence is the Money to Come?

For example, is assessing every person in the first six months of an ESA claim good Value For Money?  How many people cease to claim ESA within the first six months of making a new claim?  Also, the new claim group includes people whose Statutory Sick Pay has run out and so they have no choice, but to claim ESA.  Such claimants are, more likely than not to have a job to which to return.  Is it really necessary to assess most people in this particular group?  They and their employers should, however, be offered EA support to aid in any return to work.

There are also broader social and economic savings to be made from reforming the current system.  These savings would, for example come from:

• fewer, but more effective assessments, both medical and employability

• administrative savings resulting from fewer wrong decisions and appeals.  DWP has outsourced a sizeable chunk of the financial and social costs resulting from the current process to various other bodies, including the Ministry of Justice, Citizens Advice Bureaux, the National Health Service, the police and local authority social service staff

• a reduction in the emotional and financial distress experienced by claimants as well as their friends and families

•  increased tax revenues as more people go into work with the help of bespoke back to work support and an increase in aggregate demand leading to increased economic growth (and job creation).  Yes, guilty as charged, I am a Keynesian

• a genuine reduction in the ESA bill, both payments and ongoing administration of same.

I am sure others could easily add to this list.  I bet the Treasury, if it put its mind to it could commission an economic assessment of the costs, sorry benefits of the ESA ‘reforms’ to date in order to determine the savings from a proposal like this.  If not, then how have they determined the ‘savings’ used to justify the current ‘reforms’?

The ideas I have sketched out above need underpinning with evidence.  I am a great fan of Total Quality Management which is by definition an evidence led approach.  You cannot improve the quality of a service or good if you do not correctly identify to whom you are providing it and, in doing so endeavour to understand their particular needs.  The adoption of TQM across Government would make it possible to achieve savings not make cuts whilst at the same time maintaining, if not improving the quality of the services being provided.  ESA is ripe for a bit of TQM.

Finally, is the current ESA process primarily for those claiming it or has it been designed to pander to the likes of Daily Mail editorial writers?  I think those claiming and receiving ESA are its key stakeholders, then the taxpayer (in the guise of the Government) and after them, wider society.  If you agree with me then any redesign of ESA should involve those with direct experience of its current delivery, DWP front line staff as well as ESA recipients.  Why no one from Atos?  It is surely time to bring that contract back in house.  As a consequence, DWP front line staff would include medical professionals.

Dr Deming will see you now …