Professor Harrington Speaks

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TX: 09.08.10 – Fit to Work PRESENTER: JULIAN WORRICKER

WORRICKER  How do you reorganise the welfare system so that it looks after people who can’t work but also gives a fair deal to the taxpayer? The work capability assessment is the system used to determine whether new claimants are fit for work or not. If not they qualify for the employment and support allowance, which used to be called incapacity benefit. Two point six million people are currently claiming incapacity benefit and they’re due to transfer to the new allowance by early next year, with a pilot in October. And this is all against the backdrop of the new coalition government saying the benefits bill is simply too high. But is the work capability assessment fair and accurate? Benefits claimants told they are fit to work as a result of this assessment have successfully appealed in 40% of cases. Enter Professor Malcolm Harrington, he’s been appointed by the government to carry out an independent review of the work capability assessment and he joins me now from Exeter. Professor, good afternoon.

 HARRINGTON Good afternoon.

WORRICKER Can you be appointed by a government and then entirely independent of it?

HARRINGTON I should jolly well hope so. I mean I’ve also got a scrutiny group, which is in some ways going to oversee what I do, consisting of people from the national clinical advisor from the Care Quality Commission, the chief executive of MIND and a couple of occupational health experts.

 WORRICKER But this is a government – as I hinted in the introduction – that wants to cut the benefits bill, can you realistically come up with a report that will make it far harder for them to do that? HARRINGTON I think my job is to look at this new process of assessment and to see whether it is fair and effective for the people who go through it. I know there are a number of people who have made complaints about whether in fact it is fair and effective and my job in the first of five annual reviews is to see whether in fact there can be – improvements can be made if things are going wrong and report to the Secretary of State before the end of the year.

WORRICKER Well as you know we’ve been hearing from our listeners on that very subject. So let’s hear from one of them. She is Sheila Murphy, she does believe that the test is unfair and she told me that the problem began at her initial assessment.

MURPHY The actual experience of going there was pretty bad. The healthcare professional that I saw didn’t appear to be listening to what I was trying to tell him, so I would answer his questions but then try and qualify my answer in some way but he was looking at the computer rather than at me and just seemed to want to move on to the next question, rather than dwell on anything overlong.

WORRICKER Was he taking notes, was he writing things down?

MURPHY Everything seemed to be computer based, so he would ask me something, turn back to the computer, tap, tap, tap – it did feel like it was some sort of tick box exercise that was taking place.

WORRICKER And how long did that interview process last?

MURPHY I think it was between 20 minutes and half an hour, so it was fairly protracted, there were a lot of questions but not much listening. For instance, one of the questions he asked was how far can you walk and because I didn’t answer immediately – because it’s quite difficult to say exactly how far you can walk – he said well can you walk round your local supermarket. Yes I can. What I didn’t say is yes I can, my husband is with me, he would be pushing the trolley, you know, as soon as I started trying to explain anything we’d moved on. It was – I just felt that there was no care in it either – here was a doctor in front of me and I didn’t feel any compassion or caring.

 WORRICKER So let’s move forward to the moment that the letter arrived which says you are, in their estimation, fit for work, what did you feel when you opened that envelope and read what it said?

MURPHY I just couldn’t believe it. At the same time in the same month I was given ill health retirement from the NHS pension scheme and the people who assessed my fitness for work were ATOS Healthcare, the same organisation that are used to assess work capability assessments.

WORRICKER So you decided to appeal on the basis of that decision over your benefit, tell me how you went about that process and what reaction you got.

MURPHY In order to appeal I decided to ask for a copy of the healthcare professional’s medical report. And that was the biggest shock – to actually read what he’d written about me. WORRICKER Why the shock?

MURPHY Well it actually wasn’t truthful because on the report he said that he’d given me a medical examination and he talked about how I had no trouble getting up on to the examination bed, he talked about examining my spine and my wrists etc., and he didn’t conduct any medical examination of me. And some of the comments that he’d made about me I could show not to be true because I have some scarring on my back from previous surgery that I’ve had that he wouldn’t have known about and yet he put on his report that my back was clear, that there were no abnormalities etc. etc. So I was – I was dismayed that anybody in that situation could write or almost fabricate a report on which my eligibility for benefit would be based.

WORRICKER So having read that copy and having immediately decided that what he said was untrue where does that leave the appeal process for you now?

MURPHY In parallel to my appeal I also made a complaint to ATOS Healthcare about the way the medical had been performed and eventually I got a letter off them apologising and stating that the medical was seriously flawed and as a result my appeal would lapse, I wouldn’t need to go to appeal, my benefit would be reinstated and then at some point in the future I would have to go for another medical. So I had my next medical probably about three months ago and that was a much pleasanter experience. And my benefit has continued, I’m now in the limited capacity for work group.

WORRICKER So you’ve outlined what happened, how do you reflect on the whole experience now?

 MURPHY It was all incredibly stressful for somebody with a heart condition. I mean I can only talk for myself but my condition isn’t obvious in that they are heart conditions. For any healthcare professional not to at least refer to those people who’ve been treating me just seems crazy. I mean my benefit’s sorted out now but an awful lot of people that I think that have been refused this benefit an appeal will just feel as if it’s beyond them.

WORRICKER Well that was Sheila Murphy and we asked ATOS Healthcare to comment on Sheila’s case but it declined, saying it’s their policy not to comment. Professor Malcolm Harrington when you hear a story like that how do you react?

HARRINGTON Well I think it’s very sad and it’s quite unacceptable. It’s unfortunately not the only occasion I’ve heard of people going into these rooms, it’s a stressful examination for anybody, and then people say they’re not listened to and they just look at a computer. And then the report is not accurate. Well that’s quite unacceptable.

WORRICKER And also as we looked through the correspondence we’ve had not only has that issue arisen again but the issue of, for example, the tick box approach, that’s arisen several times among people listening to this programme – that’s not the right way to approach this is it?

HARRINGTON Well this isn’t a medical examination as such, it’s an ability or a disability assessment, and the way in which it’s structured is to look to see in the end how many points people will score on certain things and because it’s computer organised/generated there is the tendency that it looks like a tick box thing. But there’s plenty of opportunity during the examination for supplementary questions to be asked, for supplementary answers to be given and for other evidence to be provided by the patient to help in their case.

WORRICKER But you heard Sheila Murphy’s frustration at that very point – when she wanted to qualify something she didn’t feel able to.

HARRINGTON Well she should feel able to. I’ve been to one and I’m going to – that was laid on for me down here in Exeter – and I’m going to do some random visits as well but certainly the one I saw there was no doubt that the opportunity for supplementary answers was taken and given.

WORRICKER Even as we speak I’m reading an e-mail that’s come in literally in the last few moments which makes that point about box ticking. “I had a work fitness examination in late June…” writes Steve, “… it was a case of ticking boxes as are all government schemes, not at all helpful in discriminating between genuine and the abusing benefit seeker.” How do you respond to that?

 HARRINGTON I respond to that by saying I’m going to look at this in great detail and I want to try and come up with some practical recommendations for improvement and change. And because we’ve put out this call for evidence there is an opportunity for your listeners to please write to us and let us know about these experiences. But also – as I’ve said to a number of charities I’ve spoken to – don’t just tell us that it’s wrong, tell us how you think it could be improved, that would be very helpful indeed.

WORRICKER When you look at the wider statistics, which I mentioned in the introduction, 32% of decisions currently are being appealed, 40% of those appeals are successful – what does that say to you about the way the system is currently working?

HARRINGTON It says several things to me, it says one of the things I think is that it’s not working effectively, there shouldn’t be so many overturned decisions, if you like. I’m also going – talking to the tribunal service to see how they operate because then I’ve talked with the decision makers inside the DWP and they would like a much closer liaison to see what is going wrong in a number of cases, it appears to me, the tribunal service have the opportunity to review evidence that was not available to the decision maker and that doesn’t seem right to me.

WORRICKER I mean I’m interested at this stage in the review process, which of course is ongoing, that even now you’re prepared to say publicly in some cases it simply isn’t working, the system is at fault.

HARRINGTON Well I wouldn’t say the system is at fault, it could be that the people who administer the system are not doing it in a way which is meant to be done, so it’s not being done in the spirit in which it’s meant to be done. As I say my personal experience is very limited of going to these interviews but it’s not the experience that your client, your reader, had but in fact she is not alone and so I want to find out whether these are isolated examples or whether in fact there’s something systemically wrong with the system and that’s what I want to try and do.

WORRICKER Can I ask you about your timetable and how that compares with the government’s timetable? I mentioned that 2.6 million people who are currently on incapacity benefit are due to be transferred onto the new allowance and there are going to be pilots in Burnley and Aberdeen in October this year, which is before you are due to report, does that make any sense?

HARRINGTON It’s due to report the first of five yearly reports and I think the decision was taken – not by me – the decision was taken we would go ahead with this because it’s in primary legislation that these independent reviews have to be done and have to report within a particular year. And as there are going to be other reports in other years there will be plenty of opportunity for me or whoever does the other reviews to look at how this migration, so called, is taking place for the larger group of people on incapacity benefit.

 WORRICKER But would it not make sense for those pilots to at least be delayed until after the review of your work emerges at the end of this year or the start of next?

HARRINGTON Well there’s already been an – there’s already been an internal review suggesting changes to the scheme already and so the feeling was that it’s not all going to be solved in one year by me. And so why not allow the programme to continue, it already was established long before I was appointed, in fact I was only appointed in July to do this, so the first report is going to be relatively short – unfortunately. But there is an opportunity to see how this goes in subsequent years and so I don’t think – I think the decision was that we would not change the timetable and that doesn’t affect what I intend to do.

WORRICKER Right so you’re comfortable with those pilots going ahead in those two places in October?

HARRINGTON It’s not my decision to do that, my responsibility is to review the work capability assessment scheme with or without the pilots and so I will do this one report before the end of the year to the Secretary of State and there will be other reviews in subsequent years.

WORRICKER And just to clarify, as you hinted a moment ago, you are keen to hear from people listening to this programme as part of your review process?

HARRINGTON Absolutely, we need to know what is going wrong with this scheme, if it’s going wrong, and then we want to try and fix it if that is the case. WORRICKER Thank you very much for coming on the line Professor Malcolm Harrington. And if you do want to get in touch the details of the consultation document are on our website. You can contact the Department of Work and Pensions directly or you can e-mail via our website and we’ll pass on your comments by the 27th August. And you can hear more on this subject this Thursday evening on Radio 4 in The Report, that’s at 8 o’clock.