Disabled people and their organisations have long been worried that ESA is assessed to targets. This has been consistently denied by the DWP and Atos, as a requirement to keep within a certain limit is not a 'target' when it can be called a 'statistical norm.' But data released today shows what has been going on - and unsurprisingly, a badly managed norm is in practice a target.
We need an audit system to ensure that all assessors are capable of delivering accurate reports. But this would be done more appropriately by taking a random selection of reports from each assessor and checking them for accuracy. It would not be done by insisting that all assessors keep within 20% of a national average.
A national average means that assessors in inner-city Glasgow are expected to award ESA at a similar rate to assessors in a leafy Surrey suburb. It means that doctors, who see more severe and complex cases, are expected to award ESA at no higher a rate than a nurse or physiotherapist. And it means that if nationwide the majority of assessors are under-awarding ESA, then the ones who are audited are the ones giving the correct assessments, not the ones who are under-awarding.
Worryingly, there is a wealth of evidence indicating that assessors are under-awarding ESA on a national basis. The majority of reports contain errors, including omissions, incorrect inferences and mis-statements of fact. Physiotherapists are less likely to give points for mental health conditions, and nurses for physical conditions. At least 40% and potentially more than 60% of people told they are fit for work appeal that decision - and 42% win. So a decision made by a layperson (with no medical or legal training) and based on a report made by a doctor or, more usually, a nurse or physiotherapist following a 45 minute assessment results in an award of ESA less often than a decision made by a judge and a doctor working together to question the claimant and decide the outcome. And 60% of those winning their appeal were originally given 0 points, when 15 are needed to be given ESA - so it isn't even borderline cases that are appealing and winning, it's people who very definitely meet what are considered to be the harshest such criteria in the OECD yet have been given a very poor assessment.
It gets worse. You might think that 20% is enough leeway to cover variation in claimant health. But the national average for points is 2.1 for physical health conditions, and 3.6 for mental health conditions. Is this low average the reason why assessors report being trained to 'assume zero points' and 'award points begrudgingly'? If an assessor gives ESA to more than one third of the claimants she sees, then she is over the limit. But these are people who, in many cases, have already been signed off work for 28 weeks of Statutory Sick Pay and a minimum of 13 weeks whilst waiting for the assessment for ESA. In all that time, the GP could have recommended a return to work with amended duties or reduced hours, but hasn't. Is it really likely that 2/3rds are, contrary to the medical opinion of their GP, capable of work?
There is an additional safety measure, where claimants who don't meet the narrow criteria (things like being unable to make a meaningful mark with a pen, or hold an empty cardboard box) can get ESA if it is thought that work would make their health worse. But this is used in 0.1% of cases nationally. With such a tiny percentage, there is almost no leeway to use what ought to restrain the over-positive assessments.
Assessors report that the 20% norms do restrict their ability to assess objectively. One, cited in the report released today, says,
"I feel guilty for doing it but I need my job with Atos to pay my mortgage and feed my children. I have been overtly threatened with re-training and dismissal when my support group figures strayed above 20% - after I saw a run of very disabled people in a row one week. It is very depressing to be on 100% audit - it forces you to slavishly follow the rules, rather than being fair to genuinely disabled people."
Another assessor, Dr Greg Wood, left Atos after he was told to alter his clinical judgment in order to remain within the expected norms.
So far, there have been no reports of punitive auditing practices for being below the expected range. If it is national practice that assessors are more heavily penalised for being above than below target, then this will naturally drive down the national average, making it even more difficult to award the correct number of points.
The overall effect of this is that assessors can't assess people based on individual merit, but have to adjust based on the profile of the other claimants they have seen that day or week. Assessors in areas of poorer health have to adjust to be harsher in their assessment to remain within target. Alterations to ESA to improve accuracy in the most case mean more people (correctly) getting ESA, but with a tight auditing system making it difficult to award more points, the reality may take longer to catch up.
For the individual concerned, it is their own health that matters, not whether or not another person can sustain work. The Tribunals, who don't have prescribed norms, are free to base each case on individual merit. THe consequence is that the public pay for assessments to fit within norms, and then pay for those inappropriate norms to be corrected at high expense at appeal. Assessors should be free to make assessments without reference to what everyone else is doing and what other claimants the assessor has seen recently. If this were to be permitted to happen, perhaps the appeal system would not be so over-loaded and the public would not be charged twice for a decision that could have been made properly the first time.