DWP Decision Makers are meant to consider the advice from Atos along with other relevant information and declare a claimant Fit for Work or place them in either the Work-Related Activity Group or the Support Group.
At the heart of the process?
The first independent review of the WCA by Professor Malcolm Harrington concluded that Decision Makers were often simply ‘rubber stamping’ advice provided by Atos. He recommended that Decision Makers should be placed at the heart of the WCA process, and written answers from 28 February 2012 and 21 March shows that the number of decisions that contradict the advice given by Atos assessors is starting to rise. Following another answer from 9 July 2012 I produced a chart for the year 2010/11 that demonstrates this. I have updated this chart with written answers from 11 June and 1 July 2014 (a spreadsheet with the data can be downloaded here):
|Month||JCP decision differs from Atos recommendation||Total JCP decisions||Percentage|
(DWP have since published a document in response to a similar question from me but it’s actually a lot less helpful than the above as it includes decisions overturned on appeal – so we can’t look at Decision Makers on their own)
Some of the additional training being given to Decision Makers is detailed on page 15 of the WCA Stakeholder Information Pack.
In the fourth independent review of the WCA, Dr Paul Litchfield states:
The situation has been reached where decision makers move around 15% of people classified by HCPs as Fit for Work into the WRAG.
He actually implies that this change has gone too far in the other direction by suggesting that Decision Makers give “undue weight” to medical evidence that rarely describes capability and appears to skew the system towards awarding people ESA.
Still rubber stamping?
However evidence of rubber stamping still persists. For example see this post of the British Medical Journal website that reads:
Atos-employed doctors and nurses (especially those in managerial roles) should be examining their consciences in these matters. They should be reminded that decisions will be based largely, if not entirely, on their assessment.
This is further demonstrated by the fact that statistics on Decision Maker overturns is available, and that DWP use Atos’ advice when a final decision is not available when collating DWP’s quarterly statistical bulletin ESA: outcomes of Work Capability Assessments. The accompanying notes say:
The publication uses the final DWP Decision Maker’s decision, or the recommendation made by the ATOS Healthcare Professional, when the Decision Maker’s decision is not yet available.
Professor Harrington also recommended that Decision Makers call claimants found fit for work or placed in the WRAG and send them a short paragraph of prose justifying their decision. I’ve set out some concerns about the implementation of the recommendation on phone calls here.
Decision Makers and Healthcare Professionals
In chapter five of the fourth independent review of the WCA, Dr Paul Litchfield notes that a focus on time over outcomes means that Decision Makers don’t send back Atos reports for re-writing, and it is difficult to seek clarification (something that, as this question from 12 February 2013 shows, they are allowed to do). He also highlights the fact that DWP’s Quality Assessment Framework doesn’t consider Decision Maker overturn rates, and that both Decision Makers and assessors don’t receive adequate feedback.
In chapter five he also recommends that more senior staff should deal with borderline cases, and calls on the Government to consider basing Healthcare Professionals and Decision Makers in the same offices. In chapter six he suggests that responsibility for sending out ESA50s and deciding whether face-to-face assessments are necessary should be returned to Decision Makers so as to speed up the process and minimise unnecessary assessments (he suggests that there is a conflict of interest at present as Atos are paid per face-to-face assessment), and this is something that was picked up by the Work and Pensions Select Committee July 2014 report. I’m particularly supportive of this concept of ‘triage’ as it could potentially save significant sums of money.
In response the Government said they would consider giving borderline cases to more experienced Decision Makers, but stopped short of committing to co-location of Decision Makers and Healthcare Professionals.
In evidence to the Work and Pensions Select Committee, Judge Robert Martin highlighted the benefits of co-locations in the ESA appeals process, where judges and medical experts work together. While he acknowledged that this could be more expensive, if there were a system whereby more straightforward cases were dealt with separately, this could be of great help (see Q16 and Q81).