A report published by the Department for Work and Pensions (DWP) reveals that decision makers (DMs) feel pressurised not to challenge the advice provided by Atos Healthcare Professionals (HCPs) in work capability assessment (WCA) reports, that decision makers only query or overturn HCP recommendations in 1 in 40 cases where the case is considered to be borderline, and that decision makers no longer have direct access to HCPs in Benefit Centres.

The report, “​Decision making on Employment and Support Allowance claims”​ (Research Report No 788) was commissioned to look at decision-making on ESA claims in general, but more particularly on claims involving ‘​borderli​ne’​ cases. The research aimed to: understand the types of cases that can be considered as borderline;​ examine how DMs deal with borderline cases;​ and provide recommendations and guidance for DMs reviewing borderline cases (para 1.1, p 6).

The research found that for most DMs the WCA was considered to be the main piece of evidence and that the advice given by Atos HCPs was followed by DMs in the majority of cases. The number of cases considered borderline and where DMs either sought clarification and guidance from Atos, or acted against the advice contained in the WCA was small, amounting to around 1 in 40 cases.

In spite of the recommendations made by Professor Harrington in the Harrington Year 1 Review of the WCA that DMs be empowered to make correct decisions on ESA claims, at the time of the research many DMs felt they had no control over decision-making. Some had been told expressly that they could not make a decision contrary to Atos advice without securing the agreement of Atos to do this. Atos were reluctant to provide such agreement (page 1). Where there was evidence that conflicted with the advice in the WCA some DMs felt they had to ‘​rubber-stamp’​ decisions where Atos did not agree with the DMs amendments to the recommendations made in the original medical report (page 2).

The report found that Atos HCPs felt it was reasonable for DMs to act against their advice without involving them where there was sufficient evidence to justify doing so. HCPs saw the role of DMs as independent assessors of evidence who should have the authority to make final decisions without seeking approval from Atos. HCPs viewed their role as “​subsidiary and advisory”​ (page 3).

The report looked at the impact the removal of HCPs from Benefit Centres had had on the decision-making process. Until recently HCPs had been present in Benefit Centres, enabling informal discussions of borderline cases to take place. The presence of HCPs in Benefit Centres appears to have generated greater discussion of borderline cases between DMs and HCPs, a practice that has since declined as DMs now only have access to the Atos helpline.

The full report can be found here


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