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

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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 …

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14 thoughts on “ESA, Broken Beyond Repair? A Suggested Framework for a Wholesale Overhaul #GE2015

  1. anon.

    I agree with much of what you say – just that there is surely NO place for a WRAG in disability benefits.

    Leaving aside the horror that almost half of claimants with degenerative (and thus incurable) conditions are vexatiously placed in WRAG currently – as well as people who already have a job to return to, should they recover) surely when someone is signed off from their regular job by their doctor, it is because they need to concentrate their time and energies on getting well.

    Tell a sick rat it is indulging in ‘illness behaviour’ and throw it in a treadmill and it will probably die – because in sickness and injury the body needs to divert its resources into repair and healing. Even thinking takes energy, which is why sick people are often lethargic and sleepy. And stabilised autoimmune patients with conditions such as MS can be triggered out of remission and into a destructive and debilitating flare by stress hormones. It is counterproductive and makes no economic sense to prolong a person’s illness by continually stressing them and denying them rest.

    In practice, WRAG generally means that a company such as Ingeus will claim the bounty money for adding a disabled person to their books, and then ‘park’ them for the entirety of their sentence because they have no resources to make that individual employable.

    WRAG is about bullying and harrassment, not help, and statistically it seems to be KILLING MORE PEOPLE THAN IT RETURNS TO WORK.

    The place for a true ‘wrag’ group, that offered genuine and realistic help (such as vocational guidance, occupational therapy and retraining to recognised qualifications) might be helpful to FORMER disability benefit claimants who have RECOVERED enough from their conditions to realistically contemplate a return for work (or disabled people who, probably wrongly, have been kicked on to JSA by Atos). Above all this would need to serve as an ‘amnesty group’ for vulnerable people forced to claim JSA, in which they could be exampted, for, say two years, from the sanctions-mill of conditionality that is used to crush and grind down fully able-bodied claimants.

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    • Thank you for your comments.

      I agree with the point set out in your second paragraph hence I would leave any Medical Assessment to at least six months after a new claim has started.

      I would not contract out either Medical or Employability Assessments. They should be conducted by qualified Civil Servants. Post EA support should start with a Disability Employment Adviser in a Jobcentre. Further specialist support should come from organisations with a proven track record in delivering bespoke support. There are plenty of them out there. I have worked with many such and there are a few, but not too many in the private sector.

      I would like to see the return of properly funded Jobclubs as well as greater awareness and use of Work Trials. More thought might be devoted to self employment, home working, Intermediate Labour Market models and the like.

      I stress I do not accept the current norms for determining who goes into the WRAG and the SP. I envisage more people in the SP and that MAs, after the initial one would lead to people moving into the SP as well as being determined to be fit for work.

      I envisage people whose conditions improve whilst in the WRAG opting in to the support that we both think that they should receive. I think a voluntary approach for all those within the WRAG will see enough people coming forward for help. No need, in my opinion for people to be forced to take up help after their DEA interview.

      I am horrified by the stories that I read about the application of JSA conditionality. The current guidelines for claiming JSA already allow for easements that reflect a person’s limitations with regards to their jobsearch. Limitations that include health, childcare, travel and so on. The current sanctions regime needs to be revised and, in future be applied in a proportionate way.

      The parking fee for the Work Programme is minimal and is expected to disappear in June this year. I take the view that WP has failed and should be scrapped.

      Finally, should there be a WRAG? I think yes, but a much smaller one than now. There was widespread support for the concept when ESA was being formulated. The implementation and delivery have most definitely not lived up to expectations.

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    • Which is really my point, they should not carry on with the set up that has been severely distorted by the Tories. ESA started on 27 October 2008 so most of the implementation and delivery has been under the Tories and their Tory Democrat allies. This chap makes some interesting observations on this aspect of ESA.

      The concept of ESA when first propounded, yes by Labour was widely well received amongst key stakeholders not just the Treasury. We can and should get ESA back to a situation where it works effectively and humanely for all involved. There is more than a year to get Labour to develop policy that does so.

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  2. I think a big problem with ESA and the WCA as it stands is the fact the contract was awarded to an IT Corporate as the LiMA software they use has no moral, compassion or understanding built in and thus it ends up being very callous as the assessors are guided by that software.

    Whilst computers and its software are a good thing they have there limits and thus much of these assessments must use the brain and paperwork too.

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    • I agree! My brother was assessed by a medical professional, not a computer when he was on Incapacity Benefit. The chap my brother saw felt that the treatment my brother was getting for his knees had put him in a holding pattern.

      The Doctor recommended a number of exercises my brother could undertake and wrote to my brother’s consultant with his recommendations. My brother acted upon his recommendations and his health returned to normal. He was subsequently able to find and get a job.

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  3. Reassessments need to be done regularly only on people who can get better, the rest of the people should be left alone for at least 3 years and in all probability longer. The stress of an assessment has already been the cause of some deaths, even the courts have recently recognised this issue as being factual. Assessments in the first place should only ever be done by Doctors never by the euphemistically named ‘medical professionals’ [i.e. some bastard they took off the streets who has a warped right wing view of the world and thus will diligently carry out their vile orders to cull the numbers any way they can].
    Also each assessment is utterly individual – no illness even the same illness is equal in its effects on everybody… only your own Doctor who knows you and your condition can truly understand most of what a person goes through, and even then they are missing daily hourly data about how a person copes with their disability.

    In my opinion ESA PIP are a disaster designed to fail. I think the evidence shows that the Politicians wanted to scourge the poor and disabled because they are all basically misanthropes who hold onto this generational rich man’s ideology that poor people are scabbing their taxes off them… it is the criminal blaming the victim for the crime syndrome.

    I could go into a lengthy explanation of all the political perfidy that has gone on but it is a huge topic and I have done this elsewhere… needless to say the bottom line is .. leave the disabled alone… they have enough to deal with minute to minute, hour to hour, day to day. They do not need extra stress or vilification by a right wing Political extremists like the Tories and their equally right wing extremist news media.

    They have money for everything except the people…

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  4. I don’t agree that people should be sorted into groups. Some obviously have ailments and illnesses that will not last long, and others have chronic and degenerative condtions that will never get better. The problem is that too many people with chronic illness are being placed in the work related activity group and if their partner works to the minimum wage they lose entitlement to the benefit after 365 days regardless of whether they have recovered or not. This also excludes them from accessing JCP “support”. Financial support should be given as long the person remains sick. I appreciate that this is because the assessment is utterly flawed and HCPs are jumping to bizarre conclusions about prognosis and likely recovery times. However, when people are sick, they’re sick. They should be allowed to recover (or not) at a pace that’s best for them and their health. The pressure they are under to find work whilst in the WRAG is unjustified, sick people are not comparable to someone who is fully fit and seeking work and they cannot compete at an equal level due to symptoms, barriers and employer discrimination. Forcing people onto the work programme whilst they’re in mental distress or physically unfit is just plain wrong.

    I’m not sure that further delaying the medical assessment is a good idea? People roll onto and off the benefit within the 13 weeks assessment phase, say if they have an injury or short term illness. Some people are waiting much longer than that to be assessed anyway. Though the idea of an employment assessment further down the line is plausible. It depends on what conditions are attached.

    The work programme is a dire and I agree that it needs to be scrapped. I can only really speak from the perspective of someone with a mental health conditon. I explained in detail on the ESA50 that I couldn’t get out without support and that my condition was long-term, treatment resistent and had a poor prognosis. The HCP still advised that I’d be cured (by some miracle) within 12 months and I ended up in the WRAG. Almost immediately I was mandated to attend the work programme and told to join a group placement. Given that it would have triggered panic and distress and I would have needed my mum to take me and stay with me, it was ridiculous, if not cruel to force me to do this. I appealed and eventually, when my medical records were eventually read the decision maker agreed to put me into the support group. Now the problem for me is that I just cannot deal with any changes to routine and the anticipatory anxiety of appointments. I don’t even answer the phone if I don’t know who’s calling. People with MH conditions need to be treated much more sympathetically and with greater care. Many sufferers of common conditons don’t get access to treatment at all, and when they do, therapy courses are for a limited time and all support ends even when there is no positive outcome. It feels like abandonment. If the system was being rewritten then I would ask for long term MH support and therapy before even thinking about work. The ability to take baby steps without small progress being used as an excuse to find you completely fit and ready. I’d like to further my education, but I can’t because the agoraphobia prevents me from attending college. I feel trapped and very frightened by my future. If support meant relearning social skills lost to years of isolation then great. That might include assisted education, a like-minded group who could meet for a chat, or for a swim, some exercise, a leisure course, life skills come before work. All of the emphasis is that “work is good for you”. Actually, I think it might have been the stress of work that pushed me over the edge in the first place. When you’ve lost your life to an illness, employment, employment, employment, is not always the best place to start to get it back.

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