Further Medical Evidence

One of the main issues with the WCA as it stands is that Atos staff and DWP Decision Makers are working on assessments without taking full account of documentary medical evidence from professionals familiar with claimants’ conditions such as GPs or social workers. I am concerned that this is partly due to the application form – the ESA 50 – failing to make it clear that such evidence can be submitted. The DWP’s ESA Stakeholder Information Pack – updated in November 2012 – suggests that improvements have been made:

Claimants are able to provide medical evidence to support their claim to DWP at any point during their claim. This includes when a person goes to their face-to-face assessment.

To improve this part of the process, we have changed the ESA50 to encourage claimants to send any relevant medical evidence when they return the form.

The Information Pack also says:

Any evidence given by a claimant’s GP, consultant or health care adviser is very important. There are processes in place to make sure this evidence can be requested and this information is fully considered.

However I’m concerned that the changes don’t go far enough. In particular there’s only one small section on additional written evidence and the importance of submitting such evidence isn’t emphasised throughout. The section merely reads:

2. Send us any medical information you want us to see

It is important that you give us as much information as possible as this helps us to deal with your claim.

If you have any medical information from your doctor, consultant or health care professional, or any other information which you wish us to see, please send us a copy with this questionnaire.

You do not have to see your GP or health care professional to ask for a specially written report. You may be charged if you do this.

Bizarrely the former Minister Mark Hoban was quoted as suggesting that claimants had been actively witholding additional evidence. I pushed him to withdraw this remark at DWP Select Committee on 21 November 2012 but he chose not to do so.

The former Minister Chris Grayling proposed changes to the ESA 50 as a short term alternative to rewriting the descriptors for the WCA (an issue which I cover in detail here). Unfortunately in an answer from 24 April 2012 Grayling admitted that no work had yet been agreed on the form, and that his officials had failed to contact one of the most relevant stakeholders – the Disability Benefits Consortium. His contribution to the debate on 19 June suggests this is still the case.

I’m concerned that DWP are not making enough effort to obtain further medical evidence that might allow for better informed decisions as to whether claimants are fit for work. This is reflected in a letter from June 2013 from the British Medical Association to the former Minister Mark Hoban.

Dr Greg Wood claims here and here that Atos rarely request further medical evidence because they don’t have time, given the two week target they have to work to.

In 2013 the Court of Appeal found that the Government has a responsibility under the Equality Act to ensure Decision Makers actively consider whether they should seek out further medical evidence when dealing with applications from people with mental health conditions. This is known as Professor Harrington’s Evidence Seeking recommendation. Bizarrely in the response to Dr Paul Litchfield’s fourth independent review of the WCA, the Government says:

A recommendation about collection of further evidence in Professor Harrington’s third independent review of the WCA has, unfortunately, been delayed due to ongoing legal action against the Government.

In chapter six of the fourth independent review of the WCA, Dr Paul Litchfield recommended that better use should be made of further medical evidence. He suggests improving the ESA113 form and making it electronic so that claimants don’t have to gather evidence for any subsequent appeal. In chapter seven he calls for the ESA50 to be redesigned so as to encourage submission of further medical evidence from Community Psychiatric Nurses, Carers, and Support Workers etc, arguing these people are better placed than GPs to comment on claimants’ functional capabilities.

In response the Government said:

The Government accepts the Reviewer’s recommendation in full and will continue to work with the BMA to further investigate ways of improving the way in which supporting evidence is collected during the WCA process.

They went on to say:

DWP currently review the ESA50 twice a year – we will incorporate these changes as part of the review which will be completed in October 2014. As with all changes to the ESA50, where appropriate we will work with representative groups to agree this new wording. DWP is also reviewing the contents of the letter sent with the ESA50 – the ESA51 – to ensure this information is contained in the letter.