Medical examinations to assess welfare benefit claims have become notorious among claimants with disabilities and those supporting and advising them. Experiences of clients and advice workers include client mistreatment and economy with the truth in written medical reports. These are followed by barely credible negative decisions where the Department for Work and Pensions (DWP) decision-maker has unquestioningly followed the recommendation in the report.
Problems with medical assessments are being highlighted more widely because it is becoming more common for people to be required to attend an assessment in connection with a claim for certain welfare benefits. Decisions on a claimant’s entitlement to Personal Independence Payment (PIP) and Employment and Support Allowance (ESA) are commonly, although not always, based on the results of an assessment with an Independent Healthcare Professional (HCP).
The biggest controversy about the effects of the Work Capability Assessment (WCA) – used to determine entitlement to ESA – occurred last year when the government was forced to publish the number of claimants who died shortly after failing their WCA and being deemed ‘fit for work’. A large proportion included claimants who took their own lives.
The government has contracted work assessments on behalf of the DWP to various private firms, many of which work in various industries, as well as areas like occupational health. These include Maximus, Capita, and Atos Healthcare (which does PIP assessments but gave up doing WCAs, now done by Maximus).
The examinations are carried out by an HCP employed by the assessment providers. They state that all their assessors are medically qualified in their fields and that they all undergo a thorough programme of training and close supervision and quality-checking of their medical assessments.
The professional could be a doctor, nurse, physiotherapist or occupational therapist. But the examiner is unlikely to have specialist knowledge of, or experience in, assessing or treating people with learning disabilities (unless by coincidence). The limited case law on this issue establishes that legally there is no problem with a non-specialist HCP (for example, one who is qualified as a physiotherapist) in carrying out medical benefit assessments on a claimant with learning disabilities or mental health problems.
On a more fundamental level, there is no evidence available to suggest that the HCPs have any specific training in dealing with clients with cognitive impairments, or in the special approach that such clients often require. Jobcentre Plus was involved in creating the ‘Hidden Impairments Toolkit’ for helping job centre staff, and potential employers, to identify and give appropriate support to people with impairments that may feature communication problems, such as autistic spectrum disorders and ADHD. However, it is not apparent that the HCPs are given this resource to assist them in dealing with and assessing such clients.
Even the WCA Handbook, used to guide HCPs in completing ESA assessments, contains little advice on how to approach a WCA for a claimant with learning disabilities, other than the following: “Companions will be able to give useful information… In individuals with a learning disability or cognitive impairment the role of the carer may be essential to establish their functional capabilities.”
While this guidance contains a low expectation of the ability of a claimant with learning disabilities to explain their condition and how it affects them, it also indicates that the examiner should be willing to take information from a third party if necessary.
It may be important for carers and professionals to attend benefit-related medical examinations with a disabled claimant when possible as the client may need help to get to the venue and may be very anxious or even reluctant to attend.
Most crucially the client may need some support and prompting in adequately answering the examiner’s questions. Certainly some people with learning disabilities will have a willingness to please or to say the ‘right thing’. This may mean, for example, the client admitting to doing more than they are capable of doing, or forgetting the prompting and encouragement or physical assistance that they may require to do certain tasks.
It is a good idea for clients and any workers supporting them to try to get an idea of what to expect during an assessment. There is lots of advice online about this from advice providers and disability support groups.
A top tip is that the HCP will be assessing the client from the moment they meet. Seemingly innocuous questions will always be asked for a reason. For example, “Do you have a mobile phone?” If the client answers yes, this is taken as an indicator that she is able to verbally communicate and stay in touch with friends.
Thankfully, not all of our clients will have a difficult experience when attending a PIP examination or a WCA. But it is helpful if professionals can be ready to advise their clients in preparing for, and even to attend when necessary, the assessments.
Charlie Callanan is a welfare rights adviser with over 16 years experience in the statutory and voluntary sectors.