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Govt response to WCA fourth review

27 March 2014

Government's response to the year four independent review of the Work Capability Assessment

The Department for Work and Pensions (DWP) appointed Dr Paul Litchfield to undertake the fourth independent review of the Work Capability Assessment (WCA), as required by section 10 of the Welfare Reform Act 2007

The call for evidence asked respondents to comment on:

  • the overall effectiveness of the WCA as a discriminator;
  • the impact of earlier independent reviews;
  • the way that mental health conditions are considered in the WCA; and
  • the biopsychosocial factors that influence capability for work.

You can view the Government's response at https://www.gov.uk/government/publications/government-response-to-the-work-capability-assessment-independent-review-year-4

ou can view our response to the fourth independent review here. - See more at: http://disabilityrightsuk.org/news/2013/july/work-capability-assessment-...

You can view our response to the fourth independent review here.

Below is the Annex A summary from the report.

List of Recommendations: Government’s response

Implementation of the year one to three recommendations

1. Sharing information from the WCA on

capability for work with Work Programme Providers should be addressed as a priority.

Accepted subject to the outcome of further work

on feasibility.

DWP is currently investigating how information from the WCA might be shared with Work Programme providers.

The findings from the detailed feasibility work undertaken will help to inform future decisions on how or if to proceed with recommendation.

2. The Evidence Based Review and the actions taken by the Department as a result of its findings should be evaluated as part of the Year 5 Independent Review

Accepted.

The findings of the Evidence Based Review were published on 12 December 2013 and can be accessed through the following link - https://www.gov.uk/government/publications/work- capability-assessment-evidence-based-review

The findings indicate that overall, the WCA is a valid assessment relative to expert opinion about people’s fitness for work.

The findings and implication of the Evidence Based Review are discussed in Chapter Three.

3. The Department should build on the improvements for the people with cancer by amending page 20 of the ESA50 to make it clear that Clinical Nurse Specialists and consultant may also complete that section of the form

Accepted and will be implemented in spring 2014.

DWP will make the recommended change as part of the updated ESA50 which will go live in spring 2014.

4. Give due consideration to whether piloting is required for interventions and, if so, to design pilots with particular attention to the means of evaluation. There should be suitable and sufficient analytical input to any pilots at the design, implementation and evaluation stages

Accepted.

DWP will assess whether there should be a pilot of any measures intended to change the WCA. With contributions from appropriate analytical experts, the most appropriate design, implementation and evaluation of any pilots will be considered to ensure robust findings.

5. Ensure that proposed adjustments to accepted recommendations are fully considered in advance by both policy officials and operational staff so that the intent and practical considerations are harmonised

Accepted.

DWP will build on its existing practice of joint working between Operational and Policy staff to further strengthen our capacity to identify the implications of any recommendations and design appropriate changes or measures in response to them.

Effectiveness of the WCA

6. The Department reviews its use of WCA scores, places less emphasis on the final number attained and uses the  calculation simply to determine whether the threshold for benefit has been reached.

Accepted subject to the outcome of feasibility work that will also address recommendation 13.

DWP will review how it explains scores when communicating decisions to claimants. This will involve examination of the intended behavioural effects of any potential changes as well as our obligation to make transparent decisions.

7. Any further changes to the descriptors as result of the EBR or otherwise should be considered in the light of their overall impact on the effectiveness of the WCA in achieving its purpose of discriminating between the different categories of people assessed.

Accepted.

DWP will explore practical improvements to the assessment process in light of the EBR findings, in particular the feasibility of healthcare professionals using prompts from a semi-structured topic guide for WCA discussions.

DWP will also explore the scope to further review healthcare professional training and guidance on considering and recording fluctuation during assessment discussions without placing undue burden on claimants.

On the whole, the EBR results do not suggest that changes to the descriptors would improve the effectiveness of the WCA.

Perceptions of the assessment

8. The Department should specify an assessment format that facilitates better rapport, such as the HCP and person being assessed sitting side by side.

Accepted in principle.

DWP agrees that building a better rapport between the healthcare professional and person being assessed will help to improve the perception of the WCA.

We will work with our health assessment provider to ensure that seating arrangements used during assessments aim to put the individual at ease.

9. The assessor should avoid reporting inferences from indirect questioning as factual statements of capability.

Accepted as part of work to examine the possibility of a semi-structured interview approach to assessment discussions to address recommendation 7.

DWP will work with its health assessment provider  to examine how further improvements might be made to ensure best practice in healthcare professionals conduct and write-up of discussions. A consideration of the feasibility of using semi- structured interview prompts will be a key part of this work.

10. The guidance on companions should be made clearer and applied consistently.

Accepted.

DWP will work with its health assessment provider to review communications and guidance around companions at assessments to ensure clarity of the policy and consistency of practice.

11. The person being assessed should be able to see what is being written during the assessment.

Accepted in principle.

DWP believes it is paramount that assessment reports are an accurate reflection of the issues explored during discussions.

We will work with our health assessment provider to ensure that seating arrangements used during assessments are appropriate and engender trust in the process.

12. DWP should update documentation and training to ensure that:

There is clear differentiation between the purpose statements for HCPs and DMs.

A simple narrative explaining the differences is used consistently internally and externally.

The distress that people can experience when things go wrong is recognised and acknowledged appropriately by staff.

Accepted.

Atos Healthcare already has a customer charter which clearly explains the role of healthcare professionals and is available in all assessment centres.

DWP will work with its health assessment provider  to ensure that both healthcare professionals and Decision Makers are able to communicate the distinction between the two roles with consistent and clear messages, and ensure that these messages are in turn communicated to stakeholders with an interest in the WCA where appropriate.

We will also review training and guidance to ensure that distress is appropriately recognised when the WCA process does not work as intended.

13.The ESA50 and all letters and forms are comprehensively reviewed with the input of the Behavioural Insights Unit at the Cabinet Office, to ensure that:

  • all letters and forms meet Plain English standards.
  • information is presented at the right point in the process.
  • the person making a claim is clear about their rights and responsibilities at each stage of the process.
  • decision letters set out clearly what the outcome means for the person concerned ideally in the opening section: the period that will elapse before the receive the benefit; what they will need to do to continue to receive the benefit; and what they will not need to do

Accepted.

We currently review the ESA50 twice a year and our letters are written in an easy to understand way.

However we will review our existing forms and letters to try and understand what changes we can make. We will undertake this review using Behavioural Insight techniques.

14. Apply any Tribunal recommendations on review periods as the default and should only be altered where there is strong justification.

Accepted in principle subject to the review of the policy.

DWP will review the current policy and amend guidance and training where appropriate to ensure clarity and consistency of review periods in line with the Her Majesty’s Courts and Tribunals Service recommendations.

15. Consider minimum period (e.g. 6 months) between successful appeal and recall notice.

Accepted.

DWP will consider the most appropriate minimum period between successful appeal and the recall notice.

Once policy considerations have concluded we will amend, if appropriate, DM guidance to ensure clarity of policy and consistency of practice.

Decision Making

16. Give greater clarity about the role and

parameters of Decision Makers with a particular focus on the meaning of “empowerment”

Accepted.

DWP is committed to ensuring Decision Makers are clear about the parameters of their role and are able to effectively use the current rework processes in place.

All training and products in place for Decision Makers are regularly reviewed, including communications, and there is specific training in place for Decision Makers on giving the appropriate weight to additional evidence provided by claimants.

DWP will continue to review the Quality Assurance Framework alongside its Learning and Development products for Decision Makers.

17. Review the QAF so that existing strengths in process adherence are supplemented by measures to examine other elements of Decision Maker quality. In particular, the outcome of decisions and the logic underpinning them should be monitored more closely

Accepted subject to scoping work on monitoring of specific quality outcomes.

The content of the Quality Assurance Framework is currently reviewed on a regular basis as part of the Department’s continuous improvement processes.

DWP recognises that this is a sensible suggestion and will undertake work on how best to monitor different aspects of quality.

18. Build a better relationship between HCPs and Decision Makers to engender more team spirit and to help Decision Makers view HCPs as their trusted advisers

Accepted.

Decision Makers are currently able to and encouraged to contact healthcare professionals through existing help lines. DWP that recognises further consideration of this area could improve the experience of the claimant and will work with its health assessment provider to strengthen existing work between Decision Makers and healthcare professionals.

19. Improve the Decision Making training to recognise the strengths and weaknesses of further medical evidence and other information on capability to supplement the HAP report.

Accepted.

DWP has done a considerable amount of work to improve training for Decision Makers, with a specific module on critical evaluation of evidence available. The content of existing training material is regularly reviewed to improve any weaknesses identified through the Quality Assurance Framework process.

The process for collecting further medical evidence during the WCA process is being reviewed by DWP.

Any changes introduced will be accompanied by relevant training for Decision Makers.

20. Re-engineer the case mix for the two levels of Decision Maker so that more senior staff consider “borderline” cases (e.g 6 – 21 points) and more junior staff process all others

Accepted subject to further feasibility work and future decisions on recommendations 26 and 27.

DWP recognises that there may be value in reviewing how work is allocated between different grades and the types of cases they are required to make decisions against.

DWP will consider the feasibility of re-engineering the grade mix of Decision Makers and the types of cases.

Any decision on whether to accept this recommendation in its entirety will only be made once this feasibility work, and work to consider recommendations 26 and 27, is completed.

21. Ensure the provider batches cases into point bands when they send to the Department to save the department admin / processing time

Accepted subject to further feasibility work and future decisions on recommendations 26 and 27.

DWP will assess the feasibility of implementing this recommendation and examine whether batching cases would achieve efficiencies.

A decision on whether to accept this recommendation in its entirety will only be made once this is completed.

22. Review the place of the Decision Assurance Calls and apply them only in “borderline” cases handled by Band C Decision Makers who should be up- skilled to make the intervention more effective

Not accepted.

This recommendation does not align with DWP’s strategic direction for the Decision Assurance Call which is to maximise the number of successful claimant contacts. This will provide the claimant with additional opportunity to provide further evidence, discuss the proposed decision and manage a smoother transition to alternative benefits (where applicable).

DWP will trial a new process to the way in which Decisions Assurance Calls are made to ESA claimants. Early indications are that results have been promising: we therefore intend to formalise this initial start and consider alternative solutions, including introducing text messages prior to making the call in order to encourage claimants to answer their phone.

23. Review the guidance on the preparation of Reasoning and audit completed documents on a regular basis to further improve quality

Accepted.

As part of quarterly QAF reviews, reasoning is examined to ensure that it is robust. Where necessary, the findings are used to change guidance for Decision Makers.

24. Monitor overturns rates on an individual basis. Investigate exceptionally high and low rates as part of performance management

Accepted subject to further feasibility work

DWP will consider the feasibility of implementing this recommendation.

HM Courts and Tribunals Service (HMCTS), working closely with the Tribunal’s judiciary and the DWP, introduced on a ‘controlled start’ basis the provision of Summary Reasons in appeals against ESA decisions. The Summary Reasons take the form of written text which is incorporated into the Decision Notice issued by the Tribunal, which is provided to both the appellant and DWP. A wider roll-out of the provision of summary reasons for decisions made by the Tribunal is planned for the first half of 2014.

Any decision on whether to accept this recommendation in its entirety will only be made once this feasibility work is completed.

Simplifying the process

25. Immediately, the Reviewer recommends that:

DWP continues to work with BMA to develop and co-design a revised electronic ESA113 with the aim of simplifying the process for GPs and improving the quality of evidence available.

Accepted.

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.

26. In the medium term, the Reviewer recommends that:

The Department carries out a full impact assessment on an alternative process whereby DWP Decision Makers triage cases;

  • DWP, rather than the HAP, issues the ESA50 and reviews the response with any supporting evidence supplied;
  • the Decision Maker determines (with the help of decision support materials) whether further evidence is required and, if so whether to obtain that by face to face assessment or other means;
  • where suitable and sufficient evidence is available on paper and a face-to-face assessment would provide no additional value, the Department should make a decision without referral to its HAP; where a person is found Fit for Work on paper without a face-to-face assessment and subsequently disagrees with the decision, a second Decision Maker then reconsiders the need for a face to face assessment as part of the new mandatory reconsideration process.

Accepted.

DWP will carry out the recommended impact assessment to inform decisions about if and how triage of cases by Decision Makers might be implemented.

27. In the longer term the Reviewer recommends that:

The Department should carry out a full impact assessment on the feasibility of  a DWP Decision Maker being collocated with the HCP undertaking a face-to-face assessment and either seeing the person making a claim jointly or separately.

Accepted.

DWP will carry out the recommended impact assessment before making a decision about whether and how collocation of Decision Makers and healthcare professionals might be achieved.

Mental health

28. Strengthen requirements for HCPs to have suitable and sufficient previous experience of dealing with people with mental health problems so that they can contextualise findings at assessment.

Decision deferred until completion of further work to understand whether DWP would accept or reject the principles underpinning this recommendation.

All healthcare professionals receive training and Continuing Professional Development in mental health.

Further work is needed to understand exactly what Dr Litchfield means by ‘suitable and sufficient’ and how we would respond to his interpretation of this.

29. Current HCP training in mental health should be reviewed to ensure that it is adequate and the evaluation results for these and other key modules should be considered by the Department before approving any individual HCP.

Approvals should be reviewed on a periodic basis and reaccredidation should be dependent upon effective refresher training in key subject matter areas.

Accepted subject to the outcome of further scoping work on the overall effects of changing current approvals and training approach.

All training for healthcare professionals is reviewed on a regular basis, including modules related to mental health. External clinical experts have, and will continue to be, involved in this review process to ensure that materials are clinically sound and based on the latest available evidence.

DWP’s focus is on ensuring appropriate standards are maintained through regular auditing of performance across the contract, including on performance around mental health cases.

30. Mental health training for Decision Makers should include dealing with distressed people on the telephone, interpreting warning signs of self-harm and signposting to appropriate sources of help.

Accepted.

DWP has a range of learning products and guidance for DMs with clear focus on vulnerable customers, as well as Decision Maker training to facilitate conversations and deal with difficult or distressing conversations.

Nonetheless the Department recognises that a review of this package of training might suggest ways to further build Decision Maker capability to dealt with distressed people or those who may be at risk of self-harm.

31. The ESA50 is redesigned to make it clear that evidence, particularly in mental health cases, from CPNs, Support Works, Carers etc is valuable, and giving guidance on the functional aspects that will help Decision Makers

Accepted.

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.

32. Consideration is given to a new reassessment period extending to five years in the Support Group for people who have very severe incapacity resulting from brain disorders that are degenerative or which will not realistically improve.

Accept subject to the outcome of further scoping work.

DWP will ask Dr Litchfield to examine the Support Group criteria as part of the fifth independent review and consider what specific criteria might be applied to address this recommendation.