{"id":1594,"date":"2016-08-31T09:36:10","date_gmt":"2016-08-31T09:36:10","guid":{"rendered":"https:\/\/www.rethinkingincapacity.org\/?p=1594"},"modified":"2016-08-31T09:36:10","modified_gmt":"2016-08-31T09:36:10","slug":"mean-assess-work-capability-real-world","status":"publish","type":"post","link":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/2016\/08\/31\/mean-assess-work-capability-real-world\/","title":{"rendered":"How can we assess work capability in the \u2018real world\u2019?"},"content":{"rendered":"

This is a guest post by Elina Rigler<\/strong>,\u00a0who has\u00a0a background in research and – together with own experiences of\u00a0 the benefit system\u00a0– this\u00a0led her\u00a0to try to understand how we ended up with the current assessment model.\u00a0I’ve found her ideas really important and thought-provoking (not that I always agree!), and I’m really glad to be able to share them via the blog.<\/em><\/p>\n

 <\/p>\n

The Work Capability Assessment (WCA) determining someone\u2019s eligibility for Employment and Support Allowance (ESA) has been surrounded by controversy ever since it was introduced in 2008. For some time now, claimants themselves, disability organisations and academics such as Ekklesia<\/a> and Scope<\/a> have been calling for the WCA to be scrapped and replaced by a \u2018real-world assessment\u2019 (RWA).\u00a0 It is not always clear, however, what is meant by a RWA, and what factors should be included in such an assessment.<\/strong><\/p>\n

One view \u2013 including the Rethinking the WCA<\/em><\/a> report by Ben \u2013 is that incapacity for work \u201cis intrinsically<\/em> linked to employability\u201d; hence, a RWA should take into account an individual\u2019s age, education, work experience and other non-medical factors, while ignoring local labour demand.\u00a0 But a RWA can also be interpreted more narrowly to refer to the level of functional ability required in the modern workplace – i.e. it should take account of the nature of jobs and the adjustments generally available in the workplace, but ignore wider personal circumstances.<\/p>\n

In other words, the question is whether the main problem with the WCA is (i) that it focuses on the claimant\u2019s functional limitations rather than their wider ability to get a job, or (ii) that it fails to assess the kind of level of functionality required in real jobs. <\/strong><\/p>\n

What is interesting is that this is not a new issue, but was already raised during the parliamentary debates leading up to the introduction of standardised functional assessments in 1995. \u00a0The issue has never been resolved; and for more than 20 years, successive governments have been tinkering with the \u2018fit for work\u2019 test, while failing to address the more fundamental flaws in the assessment model.<\/p>\n

 <\/p>\n

The Incapacity for Work Act 1994<\/strong><\/p>\n

The scene was set for the current controversy in the 1990s when the All Work Test (AWT), a points-based functional assessment, was brought in to determine eligibility for Incapacity Benefit (IB), the new out-of-work disability benefit\u00a0 replacing Invalidity Benefit (IVB).\u00a0 The main justification for this reform was that the number of IVB claims had been steadily increasing over the years, and it was argued that a more affordable and sustainable system was needed. Peter Lilley<\/a>, then Secretary of State for Social Security, stressed that it was important to target those who were genuinely incapable of work, while those who were fit enough to do at least some type of work should receive the more appropriate benefit, Job Seekers Allowance (JSA), and be helped to find suitable employment.<\/p>\n

Eligibility for IVB was decided mainly by GPs, who considered not only the person\u2019s state of health but also factors such as age, education, and skills when determining their fitness for work. This old system was deemed too lax and subjective, and the AWT was introduced to provide a more rigorous and objective<\/em> assessment of capacity for work.\u00a0 The new test<\/a>, which was carried out by specially trained Benefit Agency doctors, ignored all non-medical factors, assessing the claimant\u2019s\u00a0 general ability to perform physical and mental functions (e.g. walking, lifting, hearing, coping with pressure and interacting with others), and not their fitness for any specific occupations.<\/p>\n

In the old system<\/strong><\/a>, the \u201coverriding consideration\u201d had been \u201cone of reasonableness\u201d<\/strong>, i.e. the claimant\u2019s capacity for work had been measured against jobs which \u201cexists in the real world\u201d, though not necessarily available in the local area. \u00a0Now the critical question was whether the claimant met the threshold of 15 points required to pass the AWT.<\/p>\n

MPs and peers opposing the introduction of the functional assessment argued that it was too formulaic and the cut-off point was arbitrary. \u00a0For example, Baroness Hollis protested that the AWT was a tick-box test \u201cwhich bears as much relationship to the capacity for work as an MOT certificate does to the ability of a driver to pass the driving test\u201d. She stated<\/a> that such a mechanical assessment \u201cmay test for disability\u201d, but being unable to measure pain, fatigue, and stress, \u201cit certainly does not test for sickness\u201d. Lord Swinfen agreed that people should be only considered capable of work which is realistically within their grasp. \u00a0He made the eminently sensible point that<\/a><\/p>\n

it should be the requirements of an average employer which is the yardstick; most employers\u00a0nowadays expect a flexible, reliable and adaptable workforce.\u00a0 People who could only work for\u00a0an ideal, altruistic employers, who is willing for staff to work when they feel up to it, should not\u00a0be regarded as capable of work\u2026 Individuals may be able to perform a specific function, but it\u00a0does not necessarily follow \u00a0therefore that they are capable of work.<\/em><\/p>\n

Some parliamentarians also questioned the assumption that a standardised test would be fairer or more accurate than a discretionary one. For example, Baroness Hollis<\/a> objected to the GP\u2019s role being marginalised in the new system, arguing that only the GP knew the patient\u2019s history and entire situation, <\/em>and was therefore in a position to make \u201ca proper qualitative judgement\u201d. \u00a0Likewise, the legal expert, Nick Wikeley<\/a>, <\/em>observed that the new test would \u201cremain subjective\u201d, but focus \u201con a narrower area of inquiry\u201d.<\/p>\n

A number of critics were especially concerned about the decision to exclude all non-medical factors from the test. For instance, the Labour MP Keith Bradley<\/a> complained that the one-dimensional functional assessment omitted other factors relevant to incapacity, such as \u201cage, education, work experience and skills\u201d. \u201cIt is nothing short of cruel\u201d, he added, \u201cthat people found to be capable of work on functional grounds should be expected to find employment when there is no work for them to do\u201d.<\/p>\n

 <\/p>\n

Why real-world factors were rejected in the 1990s<\/strong><\/p>\n

Ultimately, the proposal to include wider, non-medical factors in the test was rejected on the grounds that such an assessment would fail to distinguish between unemployment and incapacity for work.\u00a0 William Hague<\/a>, then minister for Social Security and Disabled people, argued that<\/p>\n

Non-medical activities, such as education, skills and experience, may affect the ability to get\u00a0a job, but they are not a cause of medical incapacity.\u00a0 It is the medical condition that distinguishes\u00a0the long-term sick from the unemployed.\u00a0 To include non-medical factors in the assessment\u00a0would reintroduce the problems of the current system.\u00a0 It would mean that incapacity benefit\u00a0would be paid to people because they are unemployed rather than incapable of work.<\/em><\/p>\n

Baroness Cumberlege<\/a> objected to the unfairness of the discretionary IVB assessment:<\/p>\n

The current system is subjective, and, despite its objective of \u201creasonable work\u201d, often produces unreasonable outcomes\u2026This blurring of employability and incapacity also leads to unfairness:\u00a0two people with precisely the same degree of incapacity may be treated differently because one\u00a0has retrained and the other has not, although both are equally capable of retraining. That\u00a0 is both unfair and nonsensical: someone who cannot work because he does not have the appropriate skills requires training, not a benefit for sick and disabled people.<\/em><\/p>\n

Despite Government\u2019s reassurances that the AWT would provide a fair and objective assessment of incapacity, opponents of the Bill<\/a> maintained that the new test was \u201cwrong in principle, unworkable in practice\u201d<\/em>, anticipating the criticisms that would be levelled at the WCA 15 years later.<\/p>\n

 <\/p>\n

Plus \u00e7a change? The same debates in recent years<\/strong><\/p>\n

It is noteworthy that the same complaints have been made about the functional assessments over and over again (e.g. compare this<\/a> to this<\/a>).\u00a0 One of the most common criticisms (e.g. in 1998<\/a> , 2006<\/a> and 2010<\/a>) has been that the mechanistic tick-box test is not able to adequately assess those with mental illness and other fluctuating conditions or to recognise the effects of pain and fatigue. The assessment process also continues to be something of a lottery: its outcome often depends on whether the claimant is lucky enough to be assessed by a sympathetic Health Care Professional or to have their claim processed by a decision maker who is willing to exercise a degree of common sense and discretion, instead of totting up the descriptor points mechanically.<\/p>\n

And every now and again the issue of a real-world assessment has raised its head again. For instance, the following exchanges, which took place during the Work and Pensions Select Committee\u2019s inquiry into the IB reassessment in 2011<\/a>, <\/em><\/strong>echoed the 1994-5 debates:<\/p>\n

Anne Begg (Chair of the Committee) voiced her concern that \u201cthe WCA does not ask questions about real life chances\u201d of someone getting a job, or \u201ctake into account labour market conditions in the area, educational ability or ability to retrain\u201d, while the then Employment Minister Chris Grayling declared himself \u201cabsolutely, unreservedly and implacably\u201d opposed to introducing such a real-world test, stating that it would do \u201ca huge disservice to those people – some of whom have health problems \u2013 who are on JSA\u201d.<\/p>\n

At this point, Dr Gunnyeon (DWP Chief Medical Advisor) pointed out that many people didn\u2019t think of it as being about employability, but about whether \u201cthe assessment is really properly determining people\u2019s suitability for work\u201d. <\/em>Right at the end of the session, Anne Begg got to the heart of the matter, stating that: \u201cEmployers are reluctant to employ disabled people\u201d, <\/em>and therefore \u201cthey are always going to be disadvantaged in the labour market\u201d<\/em>.\u00a0 Grayling glossed over this inconvenient truth, giving\u00a0 a typical ministerial response involving empty rhetoric (\u201cbreaking down barriers\u201d),\u00a0 and an anecdote about one<\/em> disabled claimant who had found a job.<\/p>\n

The confusion about the meaning of \u2018real-world assessment\u2019 seems to remain.\u00a0\u00a0 Moreover, policy makers seem to assume that since there may be good reasons for excluding non-medical factors from the assessment, they can continue to ignore the fact that the current WCA does not assess people\u2019s fitness for the type of jobs that exist anywhere in the labour market.<\/p>\n

 <\/p>\n

The time for tinkering is over<\/strong><\/p>\n

It should be obvious by now why the WCA is not working, and, more to the point, why such an assessment will never work. The decision to exclude all non-medical factors from the assessment may be understandable; the problem is that, contrary to DWP\u2019s claims<\/a>, the \u2018fit for work\u2019 test has never reflected \u201cactivities and functional capability that a reasonable employer would expect of his workforce\u201d.<\/p>\n

It may also be that \u201creal-world incapacity is intrinsically linked to employability\u201d.\u00a0 But then the old questions remain:\u00a0 What employability factors should be taken into account; and how they should be weighted in the assessment? How to combine the benefits of a standardised test (e.g. consistency) with those of a more discretionary approach (e.g. personalisation)? And, above all, how to implement such a system without discriminating against some groups of claimants, especially those on JSA?<\/p>\n

Despite this, it should be possible to replace the WCA with some form of real-world assessment \u2013 at the very least, based on the kind of level of functionality required in real jobs.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

This is a guest post by Elina Rigler,\u00a0who has\u00a0a background in research and – together with own experiences of\u00a0 the benefit system\u00a0– this\u00a0led her\u00a0to try to understand how we ended up with the current assessment model.\u00a0I’ve found her ideas really important and thought-provoking (not that I always agree!), and I’m really glad to be able […]<\/p>\n","protected":false},"author":131,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[13,16],"tags":[52,64,67],"class_list":["post-1594","post","type-post","status-publish","format-standard","hentry","category-blog-post","category-featured","tag-incapacity-assessment","tag-real-world-assessment","tag-uk-policy-developments"],"acf":[],"_links":{"self":[{"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/posts\/1594","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/users\/131"}],"replies":[{"embeddable":true,"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/comments?post=1594"}],"version-history":[{"count":0,"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/posts\/1594\/revisions"}],"wp:attachment":[{"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/media?parent=1594"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/categories?post=1594"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/research.kent.ac.uk\/rethinkingincapacity\/wp-json\/wp\/v2\/tags?post=1594"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}