Every so often, when another strange case crops up of someone being declared fit as a fiddle for work who then dies a few days later, or who cannot walk, talk or feed themselves, questions are asked about how on earth the government could have got its fitness-to-work tests quite so wrong. These Work Capability Assessments run by ATOS Healthcare on behalf of the Work and Pensions department, are a cross-party mess: set up by Labour and continued by the Coalition. I’ve written before about the problems with their design and the contract between the DWP and ATOS, but another element that makes the test even messier has come to my attention this week.
The table below, leaked to Coffee House by a whistleblower, is produced by ATOS Healthcare to keep tabs on the centres that carry out the assessments (the DWP makes the final fitness-to-work decision based on the scores from these tests). It marks the centres against ‘statistical norms’ – a national average of the percentage of applicants for Employment and Support Allowance whose scores fit them into certain groups, such as the Support Group which entails the highest level of benefit.
Click on the image to view a larger version:
Centres scoring above average are highlighted in pink for each group, while blue cells denote an unacceptably low number of allocations.
Of course, there is nothing wrong with a company keeping tabs on the way its centres are performing, but the problem is that the norms could start to influence the scores that are awarded to claimants, rather than scores being awarded on the basis of the condition of the applicant who arrives at the test centre. Centres that are above average could still be awarding the correct test results.
ATOS denies that it is using these norms as targets. A spokesman says:
‘ATOS Healthcare does not have targets. Norms are used solely as a management and quality assurance tool and are not used to drive individual outcomes.
‘Audits will only ever be conducted by ATOS Healthcare on the WCA report itself, never the outcome of a benefit claim. Audits are always conducted by experienced clinicians. Reports are never changed in order to achieve an expected norm. Changes may be made following an audit if there are inconsistencies in the report, if the advice is not clinically reasonable or there is a lack of clinical justification.’
The DWP also emphasises that these are not targets. A spokesman says:
‘This is an “exception report” and not a set of targets. It helps to show where sites are above or below normal range on different indicators and in spotting trends so that we can better understand any variations.
‘Sites are not made to change their practice based on the information but instead, where relevant, report on reasons for the variation.
‘ATOS Healthcare does not have performance targets or incentives around the number of people qualifying for benefit and does not make decisions on benefit entitlement.’
What’s important here is that these tests are designed properly and carried out properly by ATOS and DWP. Norms cannot be used to pressure centres in any way. The fitness-to-work issue has become incredibly partisan, but given the WCA was designed by one party and continued by the other two, partisan bickering about whose fault the mess is isn’t all that helpful. There are clearly claimants who are fit for work who the tests should identify and enable support back into employment: leaving them on benefits is hardly compassionate. But it is important that the assessment process itself is something taxpayers can have confidence in: this contract is worth £112.4 million, after all.Tags: fitness to work, UK politics, Welfare, work capability assessment