ERSA Response to: Work and Pensions Select Committee inquiry into Employment and Support Allowance and Work Capability Assessments

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1 ERSA Response to: Work and Pensions Select Committee inquiry into Employment and Support Allowance and Work Capability Assessments This paper has been developed by the Employment Related Services Association (ERSA), the representative body of the employment support sector in response to the Work and Pensions Select Committee inquiry into Employment and Support Allowance (ESA) and Work Capability Assessments (WCA). 1. Introduction: About ERSA 1.1 ERSA has 140 members ranging from large multinational providers through to small specialist organisations and spans the private, public and voluntary sectors. This submission has been developed following consultation with ERSA s membership. It does not address all of the points in the Committee s inquiry but focuses on those that are of most relevance to the employability sector. 1.2 ERSA has previously submitted evidence to Independent WCA inquiries run by both Professor Harrington and Dr Litchfield and has facilitated meetings between the WCA review team and ERSA membership. As part of its work to support the hardest to help ERSA previously created a sub-group of its Disability Employment Forum to look into ESA best practice and currently leads a group established with the Department for Work and Pensions to look at barriers, successes and best practice in support of ESA claimants participating in the Work Programme. 2. ERSA key messages 2.1 ERSA and its members are committed to supporting the long term unemployed towards and into work and to support them to progress once there. Providers deliver government commissioned employment programmes, including the Work Programme, which offers mainstream support to long term unemployed jobseekers and the specialist disability employment programme, Work Choice. 2.2 Figures from providers indicate that approximately 20 per cent of those on the Work Programme experience a disability or long term health condition and many have subsequently gone through the WCA before being referred on to the programme. Providers therefore have a strong interest in promoting and supporting best practice in delivering a customer centred and accurate WCA which is positive for the customer and promote employment, plus ensuring that the information gathered through the WCA is used to inform future care and support. 2.3 Current practice, despite recommendations made by both Professor Harrington and Dr Litchfield, are that WCA findings are not shared with providers. This has two implications. First, more vulnerable jobseekers who may not clearly understand the basis on which assessment conclusions have been made are likely to wish discuss the WCA with their Work Programme provider, who has no sight of it. Secondly, it means that assessments are then repeated a process which wastes resource and can be frustrating for customers. The DWP has confirmed that WCA information is now being shared with Jobcentre Plus, but it appears that legal agreement has still not been reached to share this information with outsourced service providers. 1

2 Summary of ERSA recommendations This paper makes recommendations for measures to improve the Work Capability Assessments (WCA) and better support those on Employment and Support Allowance (ESA). These are brought together below: Work Capability Assessment A Work Programme adviser should have access to their customer s WCA report During mandatory reconsideration, a basic rate benefit should be paid Clear guidance on requirements to support ESA customers awaiting an appeal of their WCA decision should be issued to Work Programme providers Healthcare professionals should be encouraged to provide additional evidence to the WCA where appropriate Providers should be given the discretion to decide whether a customer should be mandated onto the Work Programme whilst awaiting a decision on their appeal or be supported on a voluntary basis Improve the quality and speed of communications between the assessor and the customer Specialist health related support should begin immediately after the WCA to address a jobseeker s capability needs Establish a customer centred approach to delivering the WCA for more effective engagement at an early stage of the customer journey Given the current backlog of appeals and the length of time some customers are waiting to be assessed, JCP should offer some work related support four weeks (or similar) after the ESA application is made Time limit the length of the appeals process Employment and Support Allowance The incoming claimant commitment should be passed from JCP to Work Programme providers to ensure continuity of service for customers Introduce progress measures for ESA customers (particularly those in the 12+ month group) that are far from the labour market Remove the 12+ month prognosis group from Payment Group 6 on the Work Programme given its distance from the labour market and level of need. Place these in PG7 to allow greater funding in the system for this customer group. Retain attachment fees in relation to customers on ESA. This will particularly help voluntary sector organisations who will disproportionately provider services for these customers. Introduce greater flexibility in terms of the time an ESA customer has on employment support programmes in recognition of how far some customers are from the labour market. If a jobseeker on ESA is close to achieving sustainable employment through the Work Programme, for instance, allow them to continue on the programme for a longer period. 2

3 3. Overview: An employability perspective 3.1 The following section provides an overview of the current experience and interaction between providers of employability programmes and ESA customers and the WCA. 3.2 The WCA is different to the employability assessment undertaken in employment support provision. Getting both assessments accurate is crucial in effectively designing the most appropriate support services for each individual customer. 3.3 Providers estimate that approximately 20 per cent of those on government commissioned employment programmes are impacted by disability or a long term health condition, the most common of which are mental health issues, musculoskeletal conditions and drug and alcohol dependencies. 3.4 Providers also report that a significant number of those referred to them have an inaccurate assessment (one provider estimated this was 25 per cent), many of whom will go on to appeal a WCA decision. Individuals can appeal against their WCA assessments and the WCA assessment phase can sometimes be protracted. So while ERSA considers the specialist design of the WCA and indicators itself to fall outside its remit, it considers it crucial to support future employability activity that improvements are made to get the assessment right first time. 3.5 During the initial mandatory reconsideration period individuals will no longer receive benefits, unless they apply for JSA, which many do not do. Members report that this approach can cause undue stress and create a negative beginning to someone s experience on an employment programme, which will impact their entire journey. 3.6 There is a growing backlog of Atos assessments which is affecting the Work Programme. In some parts of the country it is reported that the backlog is over six months, meaning that ESA claimants are six months further from the labour market once referred to a provider. Until this backlog is resolved, it is felt that JCP could offer some form of work related support or information in the meantime, potentially at the four week point after an application for ESA is made. This could include mention of the opportunity to volunteer for the Work Programme. 4. The effectiveness of the WCA in indicating whether claimants are fit for work, especially for those claimants who have mental health, progressive or fluctuating illnesses, including comparison with possible alternative models. 4.1 The WCA is assessing whether someone is capable of working; this is separate from the focus of assessment undertaken by ERSA members, which is on how employable someone is when looking for work. These assessments should complement each other. Where a capability assessment finds someone fit for work it should be followed by an employability assessment to identify what needs they have or barriers they face to becoming employed. 4.2 ERSA s view is that the vast majority of people with mental health issues want to work and that employment can greatly improve confidence and mental wellbeing, as well as enhancing skills 3

4 and offering a route out of poverty. However, it is also clear that a person s mental health needs and the potential barriers to work that these can present must be recognised at the assessment stage and adequately inform the outcome of that assessment. 4.3 Members report particular concerns that individuals with substantive mental health conditions are being inappropriately referred to employment support provision, specifically the Work Programme, both on JSA and ESA payment groups. Members report that these inappropriate referrals are attributable to both a lack of specialist understanding of mental health conditions amongst assessors and underlying problems with the suitability of the assessment itself. 4.4 Instances reported by providers of inaccurate referrals include those with psychopathic conditions, such as severe schizophrenia. In these instances referrals place undue stress upon these individuals and can potentially undermine progress already achieved by health practitioners. Inaccuracies may also mean that an individual will lose out on extra support to which they should be entitled and their circumstances may mean they are not be able to cope with a programme of mandatory work related activity. 4.5 One provider estimated that 75 per cent of customers are fit for work by the prognosis date set out in the WCA, leaving 25 per cent who will require additional support and resource in order to get back into work. ERSA therefore believes that assessments should recognise and reflect the complexity of barriers that individuals can face when preparing for and then seeking work. Accurate assessments help to ensure that individuals are referred to the correct support programmes and providers are allocated the correct level of resources, enabling them to offer the intensive and specialist support that people may need. 4.6 A high proportion (around 40%) of those on ESA referred to the Work Programme are or have been appealing their Work Capability Assessment (WCA), which providers report has a direct impact on their attitude to participation in the scheme. 4.7 Providers also raise concerns that some individuals referred to them following a WCA report having very negative experiences of the WCA, including that their views were not listened to during the assessment or that they felt disbelieved during the assessment process. 4.8 Many ERSA members believe that the length of time it takes to go through the WCA process is too long. Providers report that it is not uncommon for this process to take six months or longer, by which time the ESA claimant can become more disconnected from the employment routine and individuals may begin to develop additional barriers to work. Addressing this issue could prevent future instances of long term and entrenched worklessness linked to disability and ill health. 4.9 ERSA is also concerned by reports from providers that some ex-incapacity Benefit customers are transferred to the ESA WRAG group without an assessment. These customers are therefore receiving no initial assessment of their capability and subsequently it is impossible to ensure that they are being offered the right support to meet their individual needs. 4

5 4.10 Recommendations Data sharing: following the recommendation made in year two of the Harrington Independent Review into the WCA, and reiterated by Dr Litchfield in last year s Fourth Independent Review, a Work Programme adviser should have access to the WCA report of the referred client. This can contain advice as to how best to deal with the individual referred. The JCP Adviser holds this report, but currently this is not routinely shared with providers. Immediate support with health needs: Specialist capability support (namely health treatments) should begin immediately after the WCA findings are determined if not already in place. In the current provision model some people are waiting for up to two years for a mental health referral to come through. Without adequate treatment for underlying health problems it is less likely that individuals referred to employment support will engage with the programme, find employment or sustain in work. Encouraging additional and collaborative evidence from healthcare professionals: Claimants should be made aware as a matter of course that additional evidence from doctors and healthcare specialists can be submitted. Health professionals should be given adequate time to provide this at the first stages of the assessment process and sufficient weight given to its content. Importance of the customer approach: Treating individuals as partners is important as the first steps of engagement in the customer journey. A negative experience early on can significantly impact upon how engaged an individual will be throughout their time on an employment programme. The WCA is the first step for many in this process and therefore the assessment should be done with them, not to them. 5. The process and criteria for procuring new providers of the WCA 5.1 ERSA believes that the WCA s purpose should be to establish a person s capability to work connected to their physical and mental wellbeing not their overall employability in today s labour market. Getting an accurate assessment of both capacity and of employability is fundamental to developing the most appropriate support packages for unemployed people. 5.2 The criteria for assessing bids should be weighted towards quality and accuracy of assessment and evidence that the provider will put in place a customer-orientated approach which supports the individual on their journey into employment. ERSA understands that the government will be looking for value for money. However, the implications of incorrect assessment and the impact on individual claimants is so serious that ERSA believes this should be a secondary consideration. The expected unit cost of assessment will need to take into account the resource intensive nature of the assessment, given many customers present with multiple health needs which will require a breadth of expertise to assess accurately. 5

6 5.3 Recommendations ERSA recommends that DWP runs a consultation on how the commissioning of future WCA contracts can ensure the highest degree of accuracy in assessment using the learning from previous assessment programmes. The criteria for awarding contracts will need to ensure that providers are able to offer sophisticated assessments able to cater for both physical and mental health conditions. 6. The ESA entitlement decision-making process and the reconsideration and appeals process 6.1 ERSA members, who deliver the government commissioned Work Programme, can often find it difficult to actively participate in the appeal processes of their customers. Members may therefore signpost those considering an appeal to seek advice from support services including the Citizens Advice Bureau. 6.2 In terms of demographics, members report that approximately 25 per cent of customers referred to the Work Programme on ESA seriously consider appealing the decision, although far fewer actually initiate a formal appeal. 6.3 Once someone on an employment programme decides to initiate the WCA appeals process the provider then has to make a decision on next steps for the individual. There is no official process for how an individual should be dealt with at this stage. Usually, the customer is no longer focusing on their work search, but on their appeal, and providers report it can be extremely challenging to engage and motivate a customer with their work related activity. 6.4 Time during a customer s appeals process will still count towards an individual s time on their employment programme, which can mean that a protracted appeal can significantly reduce the time someone is fully focussed on their employment related actions and subsequently lower their chances of finding employment. This also has an impact on overall performance rates. 6.5 Providers take different approaches to how they interact with those individuals who are going through an appeal while assigned to an employment programme. These can include: Making an individual s status or participation on the Work Programme voluntary. For example an individual on appeal may be invited to attend one to one sessions with their adviser. Include the option for an individual to be accompanied by a family member or support worker to all activity. Carry on the usual delivery model by discussing their specific needs and creating an appropriate Action Plan. 6.6 Providers report that some individuals appealing a WCA can have very complex and complicated lives and to mandate activity while they are in the process of appeal may place added strain at an already stressful time. Providers report that when given the option of voluntary activity during this period customer will most frequently decline, for these reasons. In addition mandating activity at this stage may also impact upon future client relationships should the appeal be unsuccessful. 6

7 6.7 Work Programme ESA WRAG customers may be called for a WCA whilst on the Work Programme and if they are found fit for work and wish to appeal this decision will have to go through the mandatory reconsideration process. This will mean customers will be without their benefit allowance for that period unless they claim JSA. Customers report feeling they cannot do this due to the conditionality attached. Therefore providers may need to provide customers financial support for duration of their reconsideration process. This will have cost implications for providers and use valuable resources on financial supporting customers financially when the money should be spent on addressing their barriers to work. 6.8 Recommendations Improve the quality and speed of communications between the assessor and the customer Introduce flexibility around participation for customers on the Work Programme and making WCA appeal In particular, the clock should be stopped for a customer s time on the Work Programme during the appeals process. Claimants should be able to volunteer for activity however during this period. Place a time limit upon the length of the appeals process: Currently members report that this can take a significant amount of time (often 9-12 months). A time limit would enable more efficient and effective support where someone is found fit for work following an appeal. 7. The impact of time-limiting contributory ESA 7.1 More is now known about the profile of jobseekers on ESA than was available at the Work Programme s commissioning. Many of the jobseekers now on the programme had not been subject to previous welfare to work type interventions; it therefore follows that for this customer group a significant proportion are a long way from the labour market. 7.2 Some individuals require focused support to first address their, often severe, health issues and other capability related needs before they are able to undertake employability activities. In particular, the Committee should note that, since November 2012, those with a 12+ month prognosis according to their WCA, have been referred to the Work Programme in Payment Group 6. Evidence from prime contractors is that this group is far further from the labour market than those with a 3-6 month prognosis. It should also be noted that the performance targets for PG6 customers were not adapted to reflect the inclusion of this new prognosis group. 7.3 In addition, ERSA members report the importance of building trust between the client and advisors to develop engagement and confidence in their own ability. This process takes time and cannot be rushed. 7.4 The time-limiting of contributory ESA to one year risks increasing anxiety and stress for individuals and worsening any existing mental health issues they are experiencing. For individuals with multiple needs the time-limiting does not necessarily offer an incentive to find work because such individuals are facing a number of barriers to work and can take considerably longer than one year to achieve progress. 7

8 7.5 Recommendations Flexibility in time limitations for ESA claims Time limitation should be adapted to individual circumstances or based on a scale related to the intensity of support a customer requires. Introducing progress measures This approach would enable providers to demonstrate that customers from the hardest to help ESA groups are moving closer to the labour market. These could include recognition of addressing health needs and also employability barriers such as skills. 8. Outcomes for people determined fit for work or assigned to the WRAG or the Support Group 8.1 ERSA does not hold or collect information related to outcomes for WRAG or ESA Support groups. Outcomes for those customers placed within the Work Programme are included within the subsequent payment groups. Many of those customers found fit to work will be then become an ESA customer on the Work Programme. However, ERSA has been working with providers to analyse information relating to those customers within Work Programme ESA groups. In particular, the Committee is asked to note that: - As of end December 2013, according to ERSA collated statistics, 11% of jobseekers in PG6 (15,111 in total) had started work whilst on the Work Programme. Given the time lag to Job Outcome not all of these are yet contained within the Work Programme s official statistics. - Sustainment levels for the PG6 group are consistently higher than other payment groups. The performance differential between the 3-6 month prognosis and 12+ month prognosis groups on ESA reflects a greater level of need for the 12+ month group. - The 12+ month prognosis group have far higher needs than the 3-6 month prognosis group. 8.2 ERSA has also been collating demographic information from across prime contractors as to the characteristics of jobseekers on ESA on the Work Programme. This information is showing that: Jobseekers with a longer prognosis tend to have been out of work far longer than other jobseekers. Providers report that over 50% of those with a 12+ month prognosis have been out of work for at least six years. Those on ESA tend to be older. Nearly 40% of those with a 12+ month prognosis in PG6 are 55+. The following table again shared by one provider provides a helpful and broadly representative view of information shared with ERSA. Across ESA customers, between 33%-40% report mental health as a primary condition, with around 10%-15% reporting it as a secondary condition % report muscular skeletal problems as a primary condition, with a further 5-15% reporting it as a secondary condition 10-17% of heart/breathing/stomach problems reported as a primary condition 8.3 The consequence of this level of need is that ERSA believes that, without additional resources becoming available, the 12+ month prognosis group, in particular, on the Work Programme are unlikely to find work in significant numbers as the barriers to work are far higher. In order to address this, ERSA believes that: 8

9 The 12+ month prognosis group should be removed from Payment Group 6 and placed in Payment Group 7. Attachment fees for providers for customers on ESA should be retained in order to increase the money in the system to support these customers, many of whom need to be supported by specialist subcontractors in the voluntary sector. A proportion of the Adults Skills Budget should be ringfenced for those on ESA as there are disincentives in the system for colleges and training providers to take on customers who they may judge are less likely to complete qualifications. Progress measures should be introduced to recognise distance travelled during the journey to work. 8.4 Recommendations Continuity of Claimant Commitment The incoming claimant commitment should be passed from JCP to Work Programme providers to ensure continuity of service for customers Increase resourcing for ESA customers. In particular, re-classify 12+ month prognosis group on the Work Programme, keep attachment fees for ESA customers and introduce distance travelled measures to reflect distance from the labour market. Remove the 12+ month prognosis group from PG6 and place in PG7 in order to aid transparency of performance and to reflect the greater needs of this group and increase funding in the system for ESA claimants, including through keeping attachment fees for these jobseekers. 9. Conclusion ERSA believes that if implemented the recommendations included within this paper will improve the delivery of the WCA and facilitate more joined up support to ESA customers following the assessment. In particular ERSA would like to emphasise the importance of an assessment being delivered, that is, for the vast majority of customers, right the first time and, for those who do then appeal, that their needs are appropriately catered for during what is likely to be a difficult and stressful time. In addition ERSA believes there would be a real benefit to the customer through implementing the Harrington recommendation to share the WCA with employment support providers. 10. Contact Details For further information please contact: Maeve McGoldrick ERSA, Director of Policy and Communications Maeve.mcgoldrick@ersa.org.uk