Incapacity assessments (1) – crippling contracts
The assessment of people claiming benefits on the basis of disability, illness or injury appears fraught with difficulty. ‘Fit for work’ seems currently defined by media myopia, and benefits are awarded on the basis of points scored for unfitness not fitness. This first part of an examination of these assessments considers the Catch 22 created by the principles on which they are contracted.
At the heart of this challenging decision-point (which impacts so significantly on the lives of all involved) is the evaluation of when a person is or isn’t better off in work.
It is generally accepted now that in the vast majority of cases everyone is better off in employment – better off physically and psychologically and, if the system is working sensibly, financially. And, of course, the increased wellbeing of the individual raises the wellbeing of those around them in their family and community. At a societal level, we have more included individuals representing income rather than deficit on our shared balance sheet.
There are conditions, and times, however, when the individual is incapable of meaningfully participating in the world of work. It is a mark of the maturity of our society that we recognise the need to provide support in such instances.
The decision-point is presented, in the assessments currently administered, as drawing the right line between the bed-ridden, pain-racked person with a terminal illness, and the essentially able-bodied person playing the system. This is symptomatic of the media’s portrayal of the challenge and, perversely, drives the operation of an assessment tool that pulls in precisely the wrong direction.
An assessment seeking to identify the fraudulent claimant does not genuinely look to identify what you CAN do but attempts to identify whether you really CAN’T do certain things. The motivation of the assesse is demonstrating failure not success. In this negative deficit model, claimants are driven to score points for incapabilities. This mitigates entirely against any sort of system that is looking to identify your limitations but build on your capabilities to enable you to achieve your maximum possible wellbeing.
Of course, this is partly a result of the perception of the claimant that: success = incapacity benefit; failure = Jobseekers Allowance (and less cash). As far as the claimant is concerned, the fit-for-work assessment is an incentive to be unfit and demonstrate unfitness and a disincentive to seek employment. This perception is based on a number of factors, including:
- Someone’s ‘incapacity’ may be reinforced by contact with the medical profession, the medical model necessarily identifying things to treat rather than emphasizing elements of fitness;
- The more stressful, bureaucratic and complex the process for claiming incapacity benefit, the bigger success becomes as a prize;
- There is a considerable disconnect between the assessment and any back-to-work support – organisationally and temporally;
- There is competition for limited job vacancies and there are concerns about employer attitudes towards people with illnesses/disability.
Since 2008, all new claimants of sickness or disability-related benefits have been required to attend a Work Capability Assessment (WCA). Now all existing claimants must also attend an assessment as the new Employment Support Allowance (ESA) is phased in to replace Incapacity Benefit. All WCAs are currently administered, under contract to the Department for Work and Pensions, by Atos Healthcare.
It is claimed that these WCAs are assessments of what people can do – but ability to do something is actually synonymous with failure, in the Catch 22 of the design and delivery of this test.
As the new Personal Independence Payment rolls out in place of Disability Living Allowance, with outsourced assessment qualifying claimants in or out of eligibility, is there a way for these contracts to be structured and managed to create very different impacts? Clever, aligned contracting could be the answer.
Buying Quality Performance 
Dear God, has it not occurred to you that there is a huge fault with the report and its assumption that work is “Good for you”?
It had, in its original form a number of caveats – that the work had to be “good” work, that it had to be appropriate, that it had to not endanger the health of the worker, and the whole report concluded that this “Work is good for you ” assumed that there would be recovery and that the person was RETURNING to a job, not being parked on JSA, subjected to conditionality that they could not fulfill, and being sanctioned!
The report also pointed out that work would be bad for some people, and that some people with incurable and degenerative conditions may never return to work.
If you are going to quote, as many do, a report I suspect you havn’t even read (as you failed to reference it) then at least be honest that you are just repeating poisonous rhetoric to fill a space.
Many thanks for your comments. I am not actually referring to a report but discussing the ‘fit for work’ assessments. We also appear to be in violent agreement! If you go on to read the second in this duo of blogs, you will see I state that:
“The objective is leaving benefit for meaningful employment, not shifting to a benefit that costs the state less money. Simply forcing people from Incapacity Benefit or ESA onto JSA, or simply removing their Disability Living Allowance, apparently achieves a short-term saving but does nothing to address the social exclusion and concomitant long-term costs of long-term worklessness. Indeed, it may even exacerbate that exclusion and raise that cost.”
The notion of ‘good’ work which you raise is an interesting and important point, particularly now. Though unemployment is falling (slowly but hopefully surely) as the economy’s green shoots emerge, there is some concern that employment for many people is increasingly temporary or otherwise fragile – at the same time as increasing pressure is exerted on all unemployed people to take such work.
The percentage of people, for example, who leave the Work Programme for a job are sustaining that first job at a much lower rate than previous programmes. Many of these people do go on to achieve 26 weeks of employment (the payment trigger for the contractors) but it is achieved through multiple jobs with gaps in between. An optimistic interpretation would be that the contractors are enabling the individual to progress through ‘better’ and ‘better’ employment towards ‘good’ long-term work. Or, this succession of short-term jobs could be indicative of a fragile labour market, with a brittle edge of working poverty, the Work Programme participant cycling between employment and unemployment, interspersed with periods of worklessness during which no benefit can be accessed.
Gordon Waddell and Kim Burton, Is Work Good for your Health and Wellbeing?, The Stationery Office 2006.
This is the report that was used.
Sadly the bias introduced is deliberate – one of these two miscreants works at the Unum sponsored dubious “Biopsychosocial research” centre at Cardiff – hardly an independent paper, as it was also commissioned by the DWP.
So a DWP commisioned paper, funded by a Unum sponsored body – effectively its a sales brochure, that was used to promote a new welfare system.
It was also designed for people who were in work – and for people who had private insurance, to reduce the payout time and get people back to work quickly.
These are not people who have life long and life limiting conditions – it was written for common conditions, such as a curable back injury, or a broken leg.
It was the wrong product in the wrong market – but has been subsumed into general thinking that work is good for you, when for the majority on long term sickness benefit the exact opposite is true.
The whole system has been built on terrible foundations i.e. that one single report.
Further insult is added by the targets, or norms, which was based on a report by Fothergill and Beatty, where a very small group of sick and disabled people where asked their opinions on work.
Now 65% said they WANTED to work full time, not that they could work full time, just they had the desire.
And who doesnt have the desire? We would all love to cast off our impairments, be free from the fear and pain of our illnesses, stop staring death in the face on a daily basis.
Perhaps you could refrain from using statements such as “It is generally accepted now that in the vast majority of cases everyone is better off in employment – better off physically and psychologically and, if the system is working sensibly, financially.”
Its a weak and unproven statement, loaded against the many who are genuinely incapable of work, and certainly incapable of the type of work that Governments and society see as “real” work.
Many thanks for your comments. I am not actually referring to a report but discussing the ‘fit for work’ assessments. We also appear to be in violent agreement! If you go on to read the second in this duo of blogs, you will see I state that:
“The objective is leaving benefit for meaningful employment, not shifting to a benefit that costs the state less money. Simply forcing people from Incapacity Benefit or ESA onto JSA, or simply removing their Disability Living Allowance, apparently achieves a short-term saving but does nothing to address the social exclusion and concomitant long-term costs of long-term worklessness. Indeed, it may even exacerbate that exclusion and raise that cost.”
The notion of ‘good’ work which you raise is an interesting and important point, particularly now. Though unemployment is falling (slowly but hopefully surely) as the economy’s green shoots emerge, there is some concern that employment for many people is increasingly temporary or otherwise fragile – at the same time as increasing pressure is exerted on all unemployed people to take such work.
The percentage of people, for example, who leave the Work Programme for a job are sustaining that first job at a much lower rate than previous programmes. Many of these people do go on to achieve 26 weeks of employment (the payment trigger for the contractors) but it is achieved through multiple jobs with gaps in between. An optimistic interpretation would be that the contractors are enabling the individual to progress through ‘better’ and ‘better’ employment towards ‘good’ long-term work. Or, this succession of short-term jobs could be indicative of a fragile labour market, with a brittle edge of working poverty, the Work Programme participant cycling between employment and unemployment, interspersed with periods of worklessness during which no benefit can be accessed.