ESA: right principle, wrong method

 

The government has recently opened its fourth call for evidence on Employment and Support Allowance, to inform the fourth independent review that will be coming out later this year. So far the independent reviews have found that ESA 'is the right principle' but that it 'does not work as well as it should,' and a number of improvements have been recommended.

What is less clear is what Professor Harrington, the leader of the first three reviews, meant when he said that ESA is the right principle. Did he mean that having a form for the claimant to complete and a face-to-face assessment with a healthcare professional (HCP) followed by a decision from a DWP lay person was the correct way to assess an individual's ability to work? Did he mean that the form and the HCP ask the right questions to elicit the relevant information on which an accurate and valid decision can be made? Did he mean the descriptors defining who can and can't work are valid descriptors that reflect reality? Or did he mean that the idea of having a group in which those who could work with support are given that support, and a second group for those who cannot work, is the right type of benefit to have for people with health conditions that limit their ability to work?

 

This last position is the one that most people would agree is meant by ESA being 'the right principle.' The principle is that those who can work should, and those who can't should get unconditional support. I am not aware of anyone who disagrees with this principle. On the other hand a lot of people disagree that the means by which ESA is assessed are the right means, that the form and HCP ask the right questions, and that the descriptors used relate well to the requirements of real-life full-time work.

 

It is widely felt that an assessment by someone who has never met the claimant before is at best unnecessary and at worst actively misleading. The point of the 'independent' assessor is that he or she has no vested interest in or bias towards finding the claimant unfit for work, as the claimant and - as is presumed - the claimant's medical team do. The assessor corroborates or challenges the truth of what the claimant and any supporting medical evidence say by observation of the claimant and by looking for inconsistencies in what the claimant says. Despite what the government says to the contrary, this is a snapshot. It can provide only one picture of the claimant's abilities and state of health - one picture of the claimant making the effort to attend, one blood pressure or heart rate reading, one check of the claimant's range of movement.

 

What is needed is a series of pictures of how the claimant performs over time. Can the claimant repeatedly and routinely attend appointments, or did the assessment require special effort and lengthy preparation? Are the claimant's blood pressure and heart rate normal, or did the assessment fall on a good day? Is the claimant's range of movement adequate, or did he take extra painkillers today; can he repeat the movement; what knock-on effects will occur after the assessment which the assessor won't see?

 

The descriptors used also focus on a snap-shot. When the claimant is asked whether he or she can remain, either sitting or standing or a combination of the two, at a workplace for one hour there is little recognition that one hour once a day does not mean that the claimant can do so for eight hours five days a week. Who cares if the claimant can manage one hour if they can't manage eight? Who cares if the claimant can make a 'meaningful mark' with a pen or pencil if the claimant can't write? Who cares if the claimant can carry a large empty cardboard box if the claimant can't carry a lever-arch file or a brief-case or a tool-box?

 

The Careers Development Group say they can tell within 10 minutes of being sent an ESA claimant, through the Work Programme, if that claimant can't work. 42% of decisions appealed are successful, and 60% of these were originally awarded 0 points, not the 15 needed to qualify. The majority of people found fit for work are not in work 12-18 months later, unlike Jobseekers of whom the majority are in work within 6 months of starting on JSA. People supposed to be capable of work-related activity or work with the right support do not find work any faster than those deemed incapable of work-related activity.

 

So when the government says that ESA does not need major reform, on the basis that it is the 'right principle,' the government is being misleading. ESA is the right principle but it is the wrong method, and it is the method that needs reforming.

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