DWP figures on ‘unacceptable’ WCA reports cast doubt on decisions made on tens of thousands of ESA claims

Tens of thousands of “fitness for work” benefit claims could have been decided by civil servants on evidence from assessment reports that should have been rejected because their quality was “unacceptable”, government figures suggest.

The concerns about the way Department for Work and Pensions (DWP) decision-makers have decided employment and support allowance (ESA) claims follow last week’s revelations about similar concerns with personal independence payment (PIP) claims.

They are based on figures provided by the minister for disabled people, Sarah Newton (pictured), to Labour MP Grahame Morris.

The figures* show that the proportion of work capability assessment (WCA) reports sent back to DWP contractor Maximus** because they were found to be of “unacceptable” quality – following audits of small samples of the reports – was as much as 100 times greater than the proportion sent back by DWP decision-makers when making day-to-day decisions on ESA claims.

This suggests that DWP decision-makers are frequently deciding ESA claims based on “unacceptable” reports instead of sending them back to Maximus assessors to “rework”.

With Newton’s figures also showing that Maximus carried out more than one million WCAs and other assessments in 2016-17, and more than 1.1 million in 2017-18 – when only 625 reports were sent back by DWP to Maximus to be reworked because they were “unacceptable” – this suggests that tens of thousands of claims could have been affected every year.

DWP and Maximus yesterday (Wednesday) both denied that this was what the figures showed, with Maximus insisting that it was “inaccurate and misleading” to draw such a conclusion.

But disabled activists and researchers are deeply concerned by the figures and believe they are further evidence of the unfairness of the disability benefit assessment system, and of how tens of thousands of disabled people have been wrongly denied support through the social security system.

Maximus took over the WCA contract from Atos in March 2015.

The figures provided by Newton show that, in 2015-16, just 0.06 per cent of assessment reports were returned by DWP to Maximus for reworking because they were of “unacceptable” quality.

In 2016-17 this was 0.066 per cent (still far fewer than one in a thousand) and in 2017-18 it was just 0.056 per cent.

But when senior Maximus executives appeared before the Commons work and pensions committee in December, they told MPs that the audit process showed that the proportion of “C-grade” reports – those deemed “unacceptable” by auditors – was currently 7.3 per cent, more than 100 times higher.

In subsequent written evidence to the committee, Maximus told the MPs that C-grade reports were those “considered not to have met expected standards for a variety of reasons”, whereas A and B grade reports were those that were “fit for purpose” and where “a decision could be made on the case” by DWP.

Last week, DNS heard from a DWP civil servant who works on the PIP “frontline”, who said that DWP case managers have strict targets for the number of PIP claims they need to process every day, are quizzed by their superiors if they miss their weekly targets and are “instructed to act on the assessor’s report, given that they are the medical experts”.

This week, DNS has heard from a former DWP civil servant who worked on ESA and said she and her colleagues were also “strongly discouraged from sending back reports we felt needed to be reworked”.

She said: “I was told to leave it, continue with the decision.

“I was told there is probably something we don’t know about that the assessor did… so to leave it, no need to return it.”

Anita Bellows, a Disabled People Against Cuts researcher, said DWP again needed to explain the discrepancies in its statistics.

She said: “While the figures for reports deemed unacceptable and therefore needing ‘rework’ provided by disability assessors are low, the reports audited paint a different picture, one of disability assessors producing a huge number of unacceptable reports.

“But the discrepancies show something else. Statistics on the number of unacceptable reports are being manipulated and kept artificially low.

“It is unthinkable that the DWP did not notice these discrepancies. And this begs the question: how many claimants had their claim decided based on unacceptable reports?”

A DWP spokeswoman denied yesterday that the figures produced by the minister showed that civil servants had for years been making ESA claim decisions on the basis of reports of an “unacceptable” quality.

She said: “In order to provide the best possible service to our customers, rather than resending reports for re-work our decision-makers tend to call the health provider’s customer service desk to discuss and resolve problems they identify.

“Returning assessment reports for re-work extends the length of time taken to make a decision and delays payment to our customers of the benefit rate to which they are entitled.

“By discussing the case directly and immediately, issues can be solved quickly. However, in a minority of cases, this is not possible and the report needs to be returned for re-work as per our procedures.”

But campaigner John Slater, whose freedom of information work has previously produced crucial data about the DWP’s disability benefit assessment contracts, said: “It’s deeply worrying that the DWP admitted decisions are sometimes made on the basis of poor medical reports plus telephone calls with the health provider’s customer service desk.

“The flawed reports are not re-worked and there is every chance that no record of what is said during these telephone calls will be added to the claimant’s file.”

He said this could also mean that if the claimant requested a copy of their assessment report it might not be an accurate record of the information upon which the decision was based, which he said had “clear implications for the appeals process”.

A Maximus spokesman said that the latest figures from the audit process – through which DWP checks on more than 700 assessment reports a month – showed it was now meeting its target of less than five per cent of these being given a C-grade.

Maximus has also met its target of more than 70 per cent of assessment reports securing an A-grade in every month since the start of the contract, he said.

The Maximus spokesman said: “Since we took over the contract in March 2015, we have delivered year-on-year improvements across the service.

“We have met or exceeded all of our quality targets since January 2018.

“Separately, we have always exceeded the DWP’s target that over 99.5 per cent of reports comply with the department’s standards, enabling them to make a decision on ESA eligibility.

“These two measures are distinct and it is inaccurate and misleading to conflate them.”

*The vast majority of these assessments were WCAs but Maximus also carries out assessments for other disability benefits, including disability living allowance for under-16s and industrial injuries disablement benefit

**Referred to in Newton’s answer as CHDA (the Centre for Health and Disability Assessments), which is part of Maximus