An important feature, spotted here.
- Mental health sufferers assessed by physiotherapists
- Assessors forced to retrain if they pass too many people
- “Rude” assessors ignoring government guidelines
- Over half of all initial ‘fit-for-work’ decisions appealed against are being overturned
“My doctor knows my situation. My bones are crumbling, like arthritis. That only started when I began to lift the heavy things at M&S.”
Barbara Johnson, 52, lives alone on Colehill Road, Fulham. Her medical problems began after a botched operation on her right foot in 2006. She can now barely walk, due to numbness that has spread up her calf.
This has caused her to collapse in the street several times. “They’ve had to take me straight to hospital,” she says.
Incredibly, Barbara was declared “fit-for-work” by an independent assessor in 2011, despite sending doctors’ certificates to the Department for Work and Pensions. Her Employment and Support Allowance (ESA) was cut, leaving her with no income, without notice.
The DWP forced her to take a work placement at M&S: “I was carrying heavy trays that didn’t have handles — I had to bear the weight on my hands. My right side is so weak, yet they just wanted to put me in the workplace”, she says.
As well as aggravating her feet problems, the placement caused permanent damage to her wrists, for which she now requires steroids.
Her problems did not end there. When I met her in late October, her ESA had just been stopped once again.
How was Barbara declared fit-for-work, when her doctor and GP observed that she was not? How could she receive ESA one month, then be “fit-for-work” another?
Moreover, why are society’s most vulnerable still at the mercy of what has been criticised as an unpredictable and erratic assessment process?
These questions are as relevant as ever. In August the Department for Work revealed that, in 2012–14, 2,380 people had died shortly after being declared “fit-for-work”.
For the 8,000 Hammersmith and Fulham residents like Barbara— and the many more across the country — dependent on Employment and Support Allowance for survival, repeated assessments, rudeness from assessors, and the threat of benefits being withdrawn without notice, have been the norm for many years.
Applying for Employment and Support Allowance — which has been phased in to replace Incapacity Benefit, and Severe Disablement Allowance since 2008 — can take months.
After filling in the “ESA1” claim form, applicants are usually given the basic allowance of £73.10 per week until they complete the process.
The next step is the ESA50 medical questionnaire. Tom Kenny, who works for Action on Disability in Fulham, has helped thousands of prospective claimants with the form. “It’s not fit for purpose,” he says.
The ESA50 asks 18 questions split into Physical, Mental, and Eating and drinking capabilities. It also states a list of “Things we’d like to see, if you already have them”, including GPs’ and doctors’ reports and medical scans. “Don’t ask or pay for new information,” it stresses.
Critics argue that this deceives claimants into thinking that they stand a chance without including medical information. Tom Kenny finds this particularly misleading: “We would never send off an ESA50 without medical evidence, and we also do a covering letter. We have a high success rate with them but that’s only because of the time we put into them.”
After the ESA50, most claimants attend a face-to-face “Work Capability Assessment” (except in extreme circumstances, such as terminal illness — although in 2012, a man with terminal brain cancer was deemed “fit-for-work”). The assessor sorts claimants into “fit-for-work”; “fit for work-related activity”; or fit for neither (the “Support Group”).
The face-to-face assessment is the most controversial part of the process. French firm Atos held the contract for the assessments from 2008, but walked away in 2014 after “negotiations” with the DWP. They had become one of the most hated companies in Britain; employees received death threats.
American firm Maximus took over from Atos in March 2015. They refused to acknowledge my request for comment.
There have been plenty of shocking stories about the face-to-face examinations, and one case that Kenny dealt with springs to mind:
“We had a young man who was examined at home because they accepted that he was too ill to travel to the assessment centre. He had a commode, and was in a wheelchair. Yet they turned up at his house and failed him.”
The face-to-face assessment is supposed to test 17 areas of physical and mental capability. For each question, the claimant earns zero, six, nine, 12, or 15 points — the fewer the points, the “fitter-for-work” the claimant is.
Given that the face-to-face test is supposed to test actions performed in the workplace, its format is alarmingly basic.
One of the questions asks if the claimant “Cannot raise either arm as if to put something in the top pocket of a coat”, for 15 points. Kenny explains: “Even the most severely disabled person can do that. What they don’t take into account is, can they do it repeatedly, all day long.”
A doctor, nurse, or physiotherapist will conduct the test. However, Kenny informs me that it is not uncommon for someone with a mental health problem to be assessed by a physiotherapist:
The lack of understanding of mental health has recently come into focus. In November, Oxford academics found evidence to suggest that every 10,000 Work Capability Assessments leads to about six suicides. The tests were also declared responsible for 279,000 extra cases of mental ill-health.
Francois Greeff, 56, suffers from bipolar disorder, attention deficit disorder, and autism. After spending four years on the streets of Hammersmith and Fulham, he now runs a charity, “Good4You”, devoted to helping disabled homeless people.
He recalls his 2011 assessment: “The guy said: ‘Do this [raise your arms], stand up, read the wall chart. You’re fit-to-work.’ I explained that I am bipolar, which he should have known if he read my medical records.
Firstly, the rudeness that Francois experienced is not uncommon. Barbara Johnson recalls being told that if she didn’t answer correctly, “you’re going to regret it.”
Secondly, mental illness simply should have been considered in the questions that Francois was asked.
A 2011 Statutory Instrument defines the prescribed structure of the test. For instance, section 12 states that having a “Reduced awareness of everyday hazards” which “leads to a significant risk of injury to self or others”, should earn the claimant 15 points.
In his current home in Merton, Francois points at his smoke alarm, which he has permanently disabled. “It’s kinder on the neighbours. I would leave something cooking and it would start smoking, and the alarm would go off. I’d just get distracted from cooking. That’s ADD (Attention Deficit Disorder).” Yet Francois’s assessor refused to consider this very real hazard to his daily life.
Why aren’t assessors following the guidelines laid out to them? For Tom Kenny, the problem is twofold: “Firstly, even qualified doctors aren’t following the guidance from the DWP.
“Secondly, there’s a subconscious culture of bashing benefit claimers.”
How does this culture manifest itself? “There’s no way that the DWP can say that they’ve got quotas of how many people they can pass. What we do know happens is that if an assessor is passing too many people, they go through a retraining period.”
Has this culture changed at all since Maximus took over from Atos? Although the DWP is publishes figures on the assessments, there is a nine-month backlog of information due to “processing of data”; the latest numbers are for ESA claims between January-March 2015. This means that there is no new data that enables us to compare Maximus’s pass rates to Atos’s.
The existing figures do reveal a sharp rise in successful tribunal appeals. Since 2008, 37% of all fit-for-work decisions have been appealed against. In January-March 2015, 54% of fit-for-work decisions that were appealed were overturned, compared with 37% in April-June 2013 — equating to an enormous number of wrong decisions.
Even at the tribunal, though, assessors have no accountability for their incorrect decisions. To Tom Kenny, changing this would present something of a solution.
“If doctors, nurses and physiotherapists could be brought before a judge to explain and justify their decisions, it would change the system radically.
“As far as I know, though, there are no plans to do this.”
What’s more, the benefits department of Kenny’s charity — Action on Disability – is in danger of closing before January, having not received funding from Hammersmith and Fulham council in six years. Residents will likely lose one of the few sources of support to guide them through the ESA process.
When I went back to see Barbara in November, she explained that her ESA had been resumed again, but now they were refusing to reimburse her for her month without benefits.
Reflecting on her perpetual difficulties with medical assessors, she insists: “I don’t keep having these problems because I’m particularly spiteful. I’m just angry that they’ve taken no responsibility. No care. No concern. Nothing.
“I thought they were meant to be doctors”, she says.