Demonstrators at an anti-Atos protest. The company has since abandoned its contract with the DWP.
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How do we make the fit-for-work tests fit for purpose?

Maximus has just taken over the running of the controversial Work Capability Assessment from Atos. What’s broken and how can they fix it?

David waited nervously to see the physiotherapist who would judge whether his learning disability stops him from working, just as thousands like him do every month.

David already knows the answer – for him, it does. But he felt powerless.

Half a million other people are waiting for this assessment who, like David, want to live normal lives and just need a little help. Whether extra help to find a job, or support because they can’t work, the Work Capability Assessment (WCA) is the gatekeeper to a lifeline that millions of disabled people rely on. This lifeline, the out-of-work benefit Employment and Support Allowance (ESA), helps disabled people to live the kind of life that most people take for granted.

David lives independently with a carer - someone who helps him to shop, cook, manage his money and even get out of the house - things he struggles to do alone. They told the physio this, and more, in his scarcely 15-minute long assessment. Several months later, David got a letter telling him he’d been refused ESA and was ‘fit-for-work’.

His choice was to either go hungry or claim Jobseekeer’s Allowance (JSA). This would force him to spend 35 hours every week applying for jobs on a computer. He can’t use a computer or spend 35 hours per week looking for a job because of his learning disability. David would probably end up being sanctioned as a result and eventually go hungry anyway.

David and his carer couldn’t believe it, especially as the physio’s report didn’t reflect David’s needs at all. Like many people with a learning disability, David tends to agree with questions he doesn’t understand - something the assessor clearly wasn’t aware of. ‘Tick box’ is how many describe the assessments, designed by the Department for Work and Pensions (DWP) and carried out by a third party.

David couldn't see how badly the assessment had been, as he couldn’t read his own report; his carer had to. Bizarrely the DWP doesn’t provide alternative formats like ‘easy read’ for their disability benefit assessments.

When asked to reconsider their decision, the DWP maintained that David was fit-for-work and had to find a job. David now has to face a tribunal, represented by his 75-year-old dad, leaving him feeling even more powerless than when he walked into that assessment.

In 2012/13, £66m of taxpayers’ money was spent defending ESA tribunals like David’s, with just four in ten being upheld.

At the start of March, Maximus took over the running the WCA from Atos. Perhaps Maximus will improve the quality of assessments, the quality of training (which clearly isn’t adequate), and perhaps more people will get the right results.

Maximus could improve the assessment right now by matching claimants with more suitable assessors - ending the current lottery of whether you’ll get a doctor, nurse, physiotherapist or occupational therapist who may not understand your disability.

But Maximus can only change so much. It’s up to the DWP to fix the rest of the issues. Issues like the backlog of half a million people, the flawed ‘tick box’ interview, the refusal to provide information that disabled people can understand (here's an easy read sample – it’s not hard to make). Things like the rigid format of the assessments and the fact that people on ESA - no matter their condition - repeatedly undergo assessments, whether or not their condition has changed or even can.

We don’t know how Maximus will fare. We don’t know if the DWP will make those changes. We do know that changing the company conducting the assessment won’t fix a fundamentally flawed system.

We don't need a system that forces thousands of our society’s most vulnerable people, like David, to live in fear of the next letter dropping on their floor, the next ring of their phone, or the next knock on their door.

We need a fit-for-work test that is itself fit-for-purpose. 

James Bolton leads work on welfare and health policy at Mencap and is the co-chair of the Disability Benefits Consortium, a group of over 50 health and disability charities. James was an expert witness for the Public Accounts Committee’s investigation into Personal Independence Payments in 2014. He tweets at @JamesABolton.

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Wrists, knees, terrible rages – I felt overwhelmed when Barry came to see me

I teach my registrars to be aware how a consultation is making them feel: that can give valuable clues to the patient’s own emotional state.

To begin with, it seemed that Barry’s wrists were the problem. He told me about the pain he was experiencing, the pins and needles that came and went in his hands. I started to examine him. His palms were calloused, his fingers thick and stubby, veterans of the heavy work he’d undertaken throughout his 57 years. Even as I assessed this first problem, he mentioned his knees. I moved on to look at those. Then it was his back. I couldn’t get to grips with one thing before he veered to the next.

I teach my registrars to be aware how a consultation is making them feel: that can give valuable clues to the patient’s own emotional state. Barry was making me feel overwhelmed, the more so as I learned that he’d been experiencing all these problems for years.

“Why are you coming to see me about them now,” I asked, “rather than six months ago – or in six months’ time?”

“I need some time off, doc.”

There was something about the way he wouldn’t meet my gaze. And again, that feeling of being overwhelmed.

“What’s going on at work?” I asked him.

His tone hardened as he told me how he’d lost his temper a couple of days earlier. How one of the others had been winding him up, and something inside him had snapped, and he’d taken a swing at his workmate and landed a punch.

Barry had walked out and hadn’t been back. I tried to find out if he’d heard from his boss about the incident, if he knew what was likely to happen next.

He told me he didn’t care.

We talked some more. I learned that he’d been uncharacteristically short-tempered for months; his partner was fed up with being shouted at. Sleep had gone to pot, and Barry had taken to drinking heavily to knock himself out at night. He was smoking twice his usual amount. Men like Barry often don’t experience depression as classic low mood and tearfulness; they become filled with rage and turn in on themselves, repelling those closest to them in the process.

Depression is a complex condition, with roots that can frequently be traced right back to childhood experiences, but bouts are often precipitated by problems with relationships, work, money, or health. In Barry’s case, the main factor turned out to be his job. He’d been an HGV driver but at the start of the year his company had lost its operator’s licence. To keep the business afloat, his boss had diversified. Barry hated what he now had to do. He was now a “catcher”.

I didn’t know what that meant. Getting up at the crack of dawn, he told me, driving to some factory farm somewhere, entering huge sheds and spending hours catching chickens, thousands upon thousands of them, shoving them into crates, stashing the crates on a lorry, working under relentless pressure to get the sheds cleared and the birds off to the next stage of the food production chain.

“It’s a young man’s game,” he told me. “It’s crippling me, all that bending and catching.”

It wasn’t really his joints, though. Men like Barry can find it hard to talk about difficult emotion, but it was there in his eyes. I had a sudden understanding: Barry, capturing bird after panicking bird, stuffing them into the transport containers, the air full of alarmed clucking and dislodged feathers. Hour after hour of it. It was traumatising him, but he couldn’t admit anything so poncey.

“I just want to get back to driving.”

That would mean landing a new job, and he doubted he would be able to do so, not at his age. He couldn’t take just any old work, either: he had to earn a decent wage to keep up with a still sizeable mortgage.

We talked about how antidepressants might improve his symptoms, and made a plan to tackle the alcohol. I signed him off to give him some respite and a chance to look for new work – the one thing that was going to resolve his depression. But in the meantime, he felt as trapped as the chickens that he cornered, day after soul-destroying day.

Phil Whitaker’s novel “Sister Sebastian’s Library” will be published by Salt in September

This article first appeared in the 21 July 2016 issue of the New Statesman, The English Revolt