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.