The occupational health expert chosen by the government to review its much-criticised “fitness for work” test appears to have suggested that the assessment should be scrapped and replaced with a radically different process.
Dr Paul Litchfield, who led the fourth and fifth reviews of the work capability assessment (WCA), said the Department for Work and Pensions (DWP) had been “forced into rushing the design of the WCA”, before it was introduced by the New Labour government in 2008.
Litchfield, BT’s chief medical officer, was giving evidence to the Commons work and pensions committee for its inquiry into the assessment processes for personal independence payment and employment and support allowance (ESA).
He was speaking just days after new figures, published by Disability News Service, showed that the proportion of people claiming out-of-work disability benefits who had attempted suicide at some point in their lives doubled between 2007 – the year before the WCA was introduced – and 2014.
Litchfield (pictured, giving evidence), who was not asked about the figures by the committee, said there had been attempts to improve the WCA, but he warned: “There have been efforts to adjust it and improve it over time, but when it starts from a position which is designed as imperfect, you’re lucky if it gets more perfect, it is just as likely to get more imperfect as you adapt it.”
Litchfield told the committee: “The philosophical basis of what we do as a society does need to be revisited.”
He claimed that “the thinking that went into creating the current assessment” dated back at least to the early 1980s in the United States, and the WCA was simply an “evolution” of the previous assessment, the personal capability assessment.
He said the WCA was designed “very quickly to meet the legislative timescales… so it wasn’t a radical redesign of a system, it was an adaptation of what was there already”.
Litchfield said that the nature of work had “changed dramatically over that period” and it was now necessary to “think about as a society… how we want to distribute benefits to those who can’t work for whatever reason, and whether we want something which is specifically based on their health condition and their disability.
“If we do want that we need to think about how we would design that in the context of the modern workplace and the shifting demographics and the shifting disease profile that we are seeing in the population, so I think there does need to be that fundamental thinking that goes on but that inevitably is a 10, 15-year process and you can’t rush it.”
Despite those comments, disabled campaigners who have been calling for years for the WCA to be scrapped and replaced – because of its links to relapses, anxiety and distress among those with long-term health conditions, and the loss of many lives – are likely to be bemused by other remarks made by Litchfield to the committee.
He suggested that much of the reason for the failure of the WCA was that it was based on a “medical model” understanding of disability, which he said was now “largely discredited”.
He said that many experts were now more in favour of a “biopsychosocial model” approach.
But campaigners and researchers have previously pointed out that the biopsychosocial (BPS) model crucially underpins ESA and the WCA and also played a significant role in the tightening of eligibility criteria for ESA and other disability benefits by the coalition and Tory governments.
Research published last year by Professor Tom Shakespeare and Professor Nicholas Watson, and fellow academic Ola Abu Alghaib, argued that the BPS model was riddled with inconsistencies, misleading statements and “unevidenced” claims.
The BPS model was developed by Dr Gordon Waddell, an orthopaedic surgeon, and Professor Sir Mansel Aylward, who was DWP’s chief medical officer from 1995 to 2005.
Key to the BPS model, the three authors said last year, is the idea that “it is the negative attitudes of many ESA recipients that prevent them from working, rather than their impairment or health condition”, essentially branding many benefit claimants “scroungers”.
This allows supporters of BPS – including a string of New Labour and Tory government ministers – to draw a distinction “between ‘real’ incapacity benefit claimants, with long-term and incurable health conditions, and ‘fake’ benefit claimants, with short-term illness”, with the model responsible for a “barely concealed” element of “victim-blaming”, they said.
