Cross posted with the permission of the brilliant campaigner Kaliya Franklin, who wrote the report.
Why are so many sick and disabled people being failed by the Work Capability Assessment and who is to blame?
1. The contract between DWP and Atos Healthcare specifies all costs and solutions MUST be based around an artificially imposed ‘statistical norm’ for the Support Group of 11% (which has since been allowed to rise slightly). This ‘gears’ the whole WCA system to deliver that ‘desired result’.
2. The manner in which the audit system is used within Atos Healthcare, including whistle-blower evidence of ‘punitive auditing’, means there is insufficient latitude for assessors to freely use their professional judgement about an individual’s true fitness for work.
The Work Capability Assessment (WCA), used to determine eligibility for Employment and Support Allowance (ESA), which replaces Incapacity Benefit, has been dogged with problems since its inception. Department for Work and Pensions (DWP) ministers and Atos have always denied the existence of ‘targets’ for the WCA. Now, for the first time, evidence is presented that the WCA operates to a norm-referenced system. This is a de facto target system, since when ‘statistical norms’ are applied to a process such as the WCA they deliver the same outcome as targets. As Lord Boswell predicted in 2007, this use of statistical norms means “the test will, in effect, be geared to deliver that [desired] result”. Being able to consistently deny the existence of any targets has been crucial both for the Labour government who introduced the WCA, and the Conservative/Liberal Democrat Coalition government who have continued with its use despite evidence of significant faults in the process.
The media regularly feature stories of people even the Daily Mail would consider deserving of ESA who have been refused the benefit – people with sickness or disabilities as diverse as Huntington’s Disease, uncontrolled epilepsy, kidney failure or brittle bone disease – but until now there has been no completely satisfactory explanation for this misery and hardship.
Ministers, MPs, the DWP and campaigners point the finger at Atos, the company contracted to carry out these tests on behalf of the DWP. The DWP say Atos are at fault and that they will improve the system by breaking their monopoly and allowing other companies to bid for the contract. Labour have also announced that they will “sack Atos”. DWP ministers blame the civil servants and the civil servants seethe. It is a classic case of political, “it wasn’t me Miss, it was them”.
To explain what all this really means education analogies are helpful. Exams can be either ‘norm-referenced’, ‘criterion-referenced’ or a mix of both. A criterion-referenced exam system means students receive an objective grade based on their performance against a pre-defined marking scheme. A norm-referenced exam system sets ‘quotas’ which limit the overall proportion of students able to achieve each grade.
Originally ‘A’ levels were simply pass or fail, but in 1963 guidance was issued which limited the overall proportion of students allowed to receive each grade. This was a norm-referenced system which ensured that only a small proportion of students could achieve ‘A’ grades. This was widely perceived as unfair to students and during the 1980’s ‘A’ level marking systems were changed to remove quotas.
Why are so many sick and disabled people being failed by the Work Capability Assessment and who is to blame?
1. The contract between DWP and Atos Healthcare specifies all costs and solutions MUST be based around an artificially imposed ‘statistical norm’ for the Support Group of 11% (which has since been allowed to rise slightly). This ‘gears’ the whole WCA system to deliver that ‘desired result’.
2. The manner in which the audit system is used within Atos Healthcare, including whistle-blower evidence of ‘punitive auditing’, means there is insufficient latitude for assessors to freely use their professional judgement about an individual’s true fitness for work.
The Work Capability Assessment (WCA), used to determine eligibility for Employment and Support Allowance (ESA), which replaces Incapacity Benefit, has been dogged with problems since its inception. Department for Work and Pensions (DWP) ministers and Atos have always denied the existence of ‘targets’ for the WCA. Now, for the first time, evidence is presented that the WCA operates to a norm-referenced system. This is a de facto target system, since when ‘statistical norms’ are applied to a process such as the WCA they deliver the same outcome as targets. As Lord Boswell predicted in 2007, this use of statistical norms means “the test will, in effect, be geared to deliver that [desired] result”. Being able to consistently deny the existence of any targets has been crucial both for the Labour government who introduced the WCA, and the Conservative/Liberal Democrat Coalition government who have continued with its use despite evidence of significant faults in the process.
The media regularly feature stories of people even the Daily Mail would consider deserving of ESA who have been refused the benefit – people with sickness or disabilities as diverse as Huntington’s Disease, uncontrolled epilepsy, kidney failure or brittle bone disease – but until now there has been no completely satisfactory explanation for this misery and hardship.
Ministers, MPs, the DWP and campaigners point the finger at Atos, the company contracted to carry out these tests on behalf of the DWP. The DWP say Atos are at fault and that they will improve the system by breaking their monopoly and allowing other companies to bid for the contract. Labour have also announced that they will “sack Atos”. DWP ministers blame the civil servants and the civil servants seethe. It is a classic case of political, “it wasn’t me Miss, it was them”.
To explain what all this really means education analogies are helpful. Exams can be either ‘norm-referenced’, ‘criterion-referenced’ or a mix of both. A criterion-referenced exam system means students receive an objective grade based on their performance against a pre-defined marking scheme. A norm-referenced exam system sets ‘quotas’ which limit the overall proportion of students able to achieve each grade.
Originally ‘A’ levels were simply pass or fail, but in 1963 guidance was issued which limited the overall proportion of students allowed to receive each grade. This was a norm-referenced system which ensured that only a small proportion of students could achieve ‘A’ grades. This was widely perceived as unfair to students and during the 1980’s ‘A’ level marking systems were changed to remove quotas.
The audit system as controlled by the DWP can be seen as a teacher, and Atos the poorly performing pupil. The teacher punishes the pupil, focusing on reprimanding him when he smudges his ink (deviates from the ‘norms’ imposed in the contract) whilst ignoring the content of his answers or his behaviour. The teacher blames the pupil for not learning and the pupil blames the teacher for everything. Before anyone should feel too sorry for the pupil, it’s important to note, this pupil is more Harry Flashman than Harry Potter; the real victims are those affected by their combined bad behaviour.
The test for the old Incapacity Benefit – the Personal Capability Assessment – was a criterion-based system. People were awarded points based upon how they scored against certain criteria – for example, those who could walk less than 50 metres were awarded more points than those who could walk less than 200 metres. If the person scored the number of points, across all the criteria, necessary for benefit receipt, they would be entitled to the benefit.
However, the WCA is a norm-referenced system. People must both score the number of points required for benefit receipt and fall within the proportion of people the norms system will allow to receive the benefit. In practice this means there is a finite number of claimants the assessment system will allow to be awarded the benefit, regardless of the number of people who objectively meet the criteria for benefit eligibility.
New evidence gleaned from the original contract between Atos and DWP, testimony from Atos employees and Freedom of Information requests, clearly indicates that the outcomes for individual sick and disabled ESA claimants are not driven solely by the severity of their condition or the nature of their disability. On the contrary, as Lord Boswell warned in 2007, the imposition of statistical norms onto the WCA gears the outcome of the whole system to achieve the desired result: in effect a cap on the overall number of people the system will permit to be granted eligibility for ESA.
Evidence shows that Atos uses a ‘management information tool’, based on the ‘statistical norms’, to ‘manage’ the behaviour of individual assessors. Although officially the audit of assessments is not supposed to be punitive, it’s clear from whistle-blowers that in many regions there are negative consequences for assessors if they do not restrict the number of points they award to claimants to comply with the norms. This makes it difficult, for example, for them to award a high point score to every claimant who, in their clinical judgement, has a serious condition affecting their ability to work.
There is therefore a serious risk that the overall outcome for the claimant – whether they are placed in the Support Group and given unconditional support because they are unable to work, placed in the Work Related Activity Group on the basis that they are likely to be able to return to work in the future, or denied ESA altogether and expected to actively seek employment – may be driven as much by the severity of other claimants’ conditions as their own, particularly those claimants assessed on the same day by the same assessor!
So is removing Atos actually a solution to the problems with the WCA? The answer is no. As long as the WCA remains a norm-referenced system of assessment, removing Atos is the political equivalent of fiddling while Rome burns.
It is clear, and in the light of this evidence totally unsurprising, that this iniquitous system is causing immense distress, hardship and increased ill-health for the very people who most need support, whilst at the same time costing the taxpayer many millions of pounds in unnecessary assessments and appeals.
This evidence and analysis must be understood by politicians of all parties, since only a cross party solution can fix this cruel, wasteful, immoral system and prevent more unnecessary suffering. If sick and disabled people are to receive the support they need – and which a civilised, compassionate Western society is expected to provide – this new report, published by The Centre for Welfare Reform, “Investigating the real reason for the misery of ‘fit for work’ assessments”, is essential reading for both Parliamentarians and the public alike.
