Last week saw the publication of the fifth and final independent review of the Work Capability Assessment (WCA), the test for Employment and Support Allowance (ESA).*

I have spent five years looking at the impact of ESA and the WCA on people living with HIV who cannot work due to poor health - and advocating for change.  NAT has provided detailed submissions to each of the five independent reviews of the WCA, lead by Professor Harrington and Dr Litchfield.

In the first review of the WCA, Professor Harrington said he did “not believe that the system is broken or beyond repair.”  While I didn’t quite share his confidence there did seem to be room for optimism at this point, and that changes to implementation of the assessment could make a real difference.

But having reached the end of five years of work by independent reviewers, civil servants, charities and advocates, it is time to face facts: the system is broken and must be fundamentally reformed.

NAT has been campaigning for the same set of changes since the introduction of the WCA. These are the same points which we raised in our first report on HIV and the WCA - Unseen Disability, Unmet Needs – back in 2010:

 1. Any assessment must be able to take into account the impact of fluctuating conditions like HIV.

 2. So-called ‘functional’ assessments where people are asked about a ‘typical day’ are not suitable for  understanding the impact of complex conditions like HIV.

 3. Assessors and decision-makers need to have better training about HIV

We also advocated along the same lines while participating in the Evidence Based Review of the WCA, otherwise known as the EBR (sorry, there are a lot of acronyms in DWP – I mean, the Department for Work and Pensions).

NAT was invited to join a range of other charities who were recommending a similar approach for improving the way the WCA captured fluctuation and complexity.  The DWP tasked us with developing an ‘alternative assessment’, which was tested on 600 real-life benefits claimaints. 

One key different in our alternative assessment was a semi-structured interview approach to the face-to-face assessment.  This technique borrows from social research, where the interviewer keeps their questioning open-ended, to make sure they get the most and most relevant information possible.

So for example, in the current WCA, the assessor will ask questions about a typical day such as “Do you go to the shops?” or maybe, “Tell me about what you do when you are at home”.  The responses to these questions will help the assessor form a judgement about whether someone can walk a certain distance (e.g. around a large supermarket) or sit comfortably for a particular duration (e.g. while watching an hour-long television show).

Our semi-structured approach would be both more straight-forward and more flexible than this.  So to learn about mobility problems, the assessor would say simply something like:  “Can you tell me about any problems you have with getting around?”.  The rest of the conversation would be guided by the claimant’s answer and also by a set of prompts, to make sure the assessor asks for all the necessarily details about the severity and fluctuation of their difficulties.  

We think the process is simpler, more transparent and more accurate.  The assessors and claimants who piloted the alternative assessment seemed to agree.  But despite agreement from the independent review, DWP and Select Committee on Work and Pensions that the semi-structured interview approach had great potential, it has not yet been implemented -  over a year since the findings of the pilot were announced and the Government committed to  explore “the feasibility of healthcare professionals using prompts from a semi-structured topic guide for WCA discussions”.

Semi-structured interviews may not be the full answer to the problems with the WCA but they can and should be introduced immediately.

*Employment and Support Allowance (ESA) was introduced in 2008 to replace incapacity benefit as the income support available to people who are unable to work because of ill health and disability.  The introduction of ESA brought with it the Work Capability Assessment (WCA) – the assessment for the new benefit.   HIV is a complex, fluctuating condition. While those who are diagnosed and access treatment in a timely way can now expect their HIV to have a limited impact on their everyday health and ability to work, there is still a significant minority who live with long-term, HIV-related illness and disability.