The government has signalled an overhaul of its controversial medical tests to decide whether the seriously ill and disabled can claim long-term sickness benefits after an independent review found they were "impersonal, mechanistic and lacked empathy", leaving many claimants feeling unjustly treated and distressed.
The review, conducted by the academic Malcolm Harrington, an occupational health specialist, looked at whether the 'working capability assessment' was a fair system amid mounting evidence that people with serious illnesses are being judged fit for work when they are not. The tests, first introduced in October 2008, have been expanded to the extent that 53,000 people are assessed a month for 'employment and support allowance' – which pays £65 a week. This group will be joined next April by another 41,000 incapacity benefit recipients every month.
Harrington found that the assessments, run by a French multinational, Atos Origin, which received £54m from the coalition government for the contract, failed people with mental illnesses and long-term disabilities. One form which claimants needed to complete ran to 28 pages and almost half "found the questionnaire difficult or impossible to complete". Another problem was that people were characterised by "descriptors" within a computer system that relied on questions apparently unrelated to work. In one instance people were asked whether they had "loaded a dishwasher or washing machine" that day.
"It does not bother to ask whether the claimant has a dishwasher or washing machine. That is the danger with computer systems and drop-down menus," said Harrington. "We want to rely much more on healthcare professionals and assessments." He pointed out that 40% of those found fit for work by the system appealed and won – and added that 40% of people who went in front of a judge did so with "additional medical information". Harrington called for a radical overhaul, with jobcentre staff having to take into account health records, the Atos assessments and an individual's own testimony before making a decision about whether someone on sickness benefits should be forced back into work. At present staff rarely dissented from Atos's verdict, he said, and "a lack of procedural justice can lead people to feel embittered and for some this can lead to psychological distress with affects on physical and mental health".
The report also recommends the appointment of lay "champions" to guide claimants through the process, and detailed explanations of why a benefit has been refused. Many working with the poor and vulnerable welcomed the report, saying it was a long overdue recognition of the system's problems. Citizens Advice said its surveys showed a 41% increase in complaints from claimants in the past year alone.
The government said it accepted Harrington's conclusions and would implement them in full. The work and pensions minister Chris Grayling said: "There were no targets or goals to get people off benefits. This is meant to be a fair process … we are dealing with claimants who we have had very little contact with."
However, Harrington did criticise the government for failing to implement a key recommendation quickly enough: that of a "personalised summary of assessments in plain English" to be produced by Atos. The government could only promise that ministers "explored the feasibility of providing a summary" by the end of 2011. Given the planned expansion in the scheme next year, Harrington said, this "was just not good enough".
Charities said the "review pinpoints what is wrong with the system". Matthew Lester of the Papworth Trust, a disability charity, said the main concern now was how quickly the government would implement the report's main findings. "Even if they get the main points implemented by April that will mean another 250,000 people being assessed by a system that we already know is unfair."
