- SENSITIVVE DEPARTMENT FOR WORK AND PENSIONS RESPONSE TO REGULATION 28 PREVENTION OF FuTurE DEATHS REPORT ON MICHAEL BRENDAN O'SULLIVAN Introduction This report fulfils the Department for Work and Pensions' (DWP) duty to respond t0a Prevention of Future Death report made under the Coroners (Investigations) Regulations 2013. The request for the report has arisen following an inquest on January 2014, into the death of Mr Michael Brendan OSulllvan: Mr O'Sullivan was a former claimant of long-term sickness benefits, who took his own life on 24 September 2013. 2 The Department has a number of safeguards for Employment and Support Allowance claimants with mental health problems This includes a clear policy that further medical evidence in cases Where claimants report suicldal ideation in their claim forms which regrettably was not followed in this case. We will issue a reminder to staff about the relevant guidance.
3. The report is structured in three parts: The first describes the current system for assessing entitlement to Employment and Support Allowance including provisions for people with mental health problems: The second part explains what happened in Mr OSullivans case: The final part describes what systems the Department has in place t0 continuously improve the assessment of people with mental health problems: How the system works
4. Emplovment and Support Allowance (ESA) is a benefit paid t0 people of working age who have limited capability for work; It was introduced in 2008 in place of incapacity benefit and certain other benefits pald on the ground of incapacity and severe disablement ESA is designed on the principle that whole groups of people with health conditions or disabilities should not be written off as incapable of work on the basis of a diagnosis because of the costs of long-term inactivity to individuals and society. Research shows that worklessness is being

OFFICIAL - SENSITIVE associated with poorer physical and mental health and wellbeing,' while returning to work is associated with improvements in health.?
5. key feature of ESA is the Work Capability Assessment; or WCA: The WCA emerged from a process of review of the previous assessment for Incapacity Benefit; the Personal Capability Assessment ("PCA"), and refinement of the emergent assessment:
6. In 2006, DWP published Transformation of the Personal Capability Assessment: Report of the Physical Function and Mental Health Technical Working Groups' (September 2006), which reviewed the effectiveness of the PCA: The report recommended a revised set of physical and mental functional criteria that were "a fairer; more accurate, more robust assessment of entitlement to benefit" , a revised self-assessment questionnaire and a review of the process of gathering medical evidence: 7 _ In particular; the report proposed "an extensively revised mental function assessment; to address a current gap in assessment of cognitive and intellectual function, in conditions such as learning disability, autistic spectrum disorder; and acquired braln injury . It also proposed "a new scoring system for mental function; which addresses a bias in the current PCA against people with mental health probler (sic), as opposed to limitation of physical function". This entailed adding elements to assess a person's ability to learn and apply understanding and their interpersonal skills. These elements were lacking in the PCA but are central to assessing the capability to work of people with a learning disability or autistic spectrum disorder: 83 The new assessment; the WCA, responded to the recommendations of technical working groups, made up of leading experts in occupational and mental health; amongst others From the outset; the WCA was also developed with the input of a consultation group consisting of representatives from disability organisations including Mind, Mencap, Sane; the National Autistic Society and Rethink
9. In contrast to the PCA , the WCA was designed to be an assessment of an individuals functional ability, focusing on what they could do, rather than what could not: The assessment is not intended to be a measure of employability, but simply to measure how the clalmants ability to function is affected by their condition or disabilities: Waddel G and Burton K (2006) Is work good for your health and well-being? London:TSQ. McManus 8 atal (2012) National study 0f work-search and wellbeing: DWP Research Report 810 Transformation of the Personal Capabillty Assessment, a report of tha Physical Function Mental Health Technical Working Groups, commissioned by the DWP (2008) atp. 3 they and

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10.As well as basing the new WCA on the fIndings of the technical working group that assessed the PCA, the DWP continued to keep the assessment under expert review to ensure that it was fulfilling its purpose, namely accurately and consistently assessing people t0 the appropriate level of benefit A DWP-led review of the assessment; which engaged with both independent experts and specialist disability groups, led to a report and addendum in March 2010: The review found that generally the WCA was accurately identifying individuals for benetit; but it also made recommendations for improvements, including simplifying the language, making greater provision for those awaiting chemotherapy: widening the criteria for support in relation to people s mental function; and taking greater account of people"s adaptation t0 their disability or health condition; These recommendations were taken forward in the Employment and Support Allowance (Amendment) Regulations 2011 which were laid before Parliament on 10 February 2011 and came into force in March 2011_ Legal framework for ESA
11.Section 1 of the Welfare Reform Act 2007 sets out the conditions a claimant must meet in order t0 be entitled to ESA There are a number of conditions which must be met; including financial conditions However; the primary condition is that the claimant must have "limited capability for work". Section 1(4) sets out that a person has "limited capability for work" if their capability for work is limited by their physical or mental condition, and the limitation is such that it is not reasonable to require them to work 12 Sections 8 and 9 of the Welfare Reform Act set out the legislative framework for the assessment to determine whether a clalmant has limited capability for work (section 8) or limited capability for work related activity (section 9) The ESA Regulations 2008 (S.1 2008/794) set out the scheme of assessment in more detail in regulations 19 to 39. The Regulations are made by statutory instrument and any changes must be approved by Parliament Claimant groups
13. The WCA allows three groups of people to be distinguished: those who would be capable of work in spite of any health problems: This group is commonly called 'fit for work' those who with additional support could eventually return to work (the Work- Related Activity Group) btellwwdwogovukldocslwork-capabilitv-assessment-reviewpdf; htto dwpgov Ukldogelwonk-Capa bllity-assessment-revew-addendunpdf

OFFICIAL - SENSITIVE those with the greatest impairments or disablements who would not be able to work (the Support Group)
14.The Support Group comprises claimants whose conditions mean that they have limited capability for both work and work-related activity (LCWRA) as measured against descriptors' set out in Schedule 3 t0 the ESA Regulations These are claimants who are most seriously affected by their disabilities or conditions and they are not expected to do anything to receive their benefit (regulation 34): However they can engage in work-related activity on a voluntary basis if wish
15. The Work Related Activity Group (WRAG) comprises those claimants whose conditions mean that they have limited capability for work (LCW), as measured against descriptors contained in Schedule 2 to the ESA Regulations, and it is considered that they should be able to return to the work place in due course
16. The descriptors are functional descriptors and each carries a score. A claimant must score at least 15 points - either against a single descriptor or by scoring against multiple descriptors where points are added together to meet the criteria for limited capability for work and be placed in the WRAG (regulation 19) These claimants are generally expected to engage in work-related activity in order to receive their benetit: The claimant is also given a prognosis which reflects the length of time the DWP believes it will take the claimant to be ready for a return to the labour market.
17.Claimants in both groups are periodically reassessed to determine whether their functional capability has changed for the better or worse since the previous assessment; In addition, from October 2010, all claimants entitled to Incapacity Benefit; Severe Disablement Allowance or Income Support on the ground of Incapacity for work are belng reassessed to see whether the award qualifies for conversion for ESA:
18. The 'point is that the WCA is more sophisticated than previous systems of assessment, more tailored to identifying the particular needs of the individual;, in particular the impact of mental health conditions, learning disabilities and autistic spectrum disorder: The process tor applying tor ESA
19.For those making a new clalm for ESA, an application is made using form ESAT. This collects information of the claimant's personal details, details of the claimants illness or disability, including the name and contact details for their bttpJlwww legislatlon gov uklukds12013/97801.11531872lcontents they key "

OFFICIAL - SENSITIVVE doctor; and claimants are asked to provide a copy of their medical statement if It is required in their circumstances: This information can be provided over the phone_
20.When a claim is accepted; the claimant enters what is known as the "assessment phase" which is intended to end no later than thirteen weeks after the claim begins or the date on which a determination as to LCW or LCWRA is made. It is during this assessment phase that the WCA process takes place;
21. Once it is determined that the claimant meets all the basic criteria for ESA, such as right to reside in the United Kingdom and financial conditions, then the award of ESA is made and payment begins. 22In a case where a claimant entitled to IB, severe disablement allowance or income support on disability grounds is reassessed on to ESA?, no new claim is required but the clalmant goes through a WCA in the same way as a new claimant; as detailed below but no medical statement is required: Assessment process 23 The DWP makes a referral t0 its medical services provider; which is currently Atos Healthcare; The referral includes, in the case of a new claim, the diagnosis from the medical statement and other relevant information, In a case where ESA or IB has been paid previously, the referral Includes such relevant Information in respect of the previous decisions as Is still held on file. The case is transferred to Atos by means of.an IT platform, the 'Medical Services Referral System' (MSRS), which holds the relevant case details and information about the claimants medical condition: Where the claimant has a MHP, a #lag' is added to signpost that fact:
24.At Its heart; a simple process Is used to assess the claimant which usually follows the following steps: A questionnaire; the ESASO, is issued by Atos Healthcare t0 claimants, requesting them to provide further Information about their disabilities and health conditions with particular reference to how these affect their ability to function: Claimants have 28 in which t0 return this form: i) When the ESASO is returned; a healthcare professional employed by Healthcare will review the file and all documents held; to decide whether further medical evidence should be obtained. will also determine whether the claimant should be called for & face-to-iace assessment or whether LCW or LCWRA can be decided on the basis of the information Some 1.5 millon People who have previously qualified for these benefits to be reassessed for ESA from April 2011 any very days Atos They began

OFFICIAL - SENSITIVE already provided; The majority of claimants will be called for a face-to-face assessment and this is conducted by an Atos healthcare professional: il) The Atos healthcare professional will make a report of their finding either following the review or aiter the face-to-face assessment; and the file will be returned to DWP. iv) A DWP Declsion Maker will review the tile and make the final determination on whether the claimant has LCW or LCWRA or is considered "fit for work" The claimant can request that the decision be reconsidered (by a different Decision Maker) or can appeal the decision if applicable. Further medical evidence
25.In every case; healthcare professionals have to consider the information and evidence available to them on the system, determine whether further evidence is required (including the need for further medical evidence (FME) andlor a face-to- face assessment) and then provide reasoned advice to a DWP decision maker on the functional limitations imposed by a claimants illness or disability: In doing s0, they follow the guidelines set out in the Training & Development ESA Filework Guidelines' (Version 9, 24
2013): 26 These guidelines are prepared by Atos, and are then quality assured and signed off by the DWP medical team: They are subject t0 annual review and refreshed with updates agreed with the DWP during the course of the year: Updated versions published on the Atos intranet for HCPs to access
27. The Guidelines state that 'Where, In the scrutinising practitionars judgement; there is a clear possibility that an examination may be avoided they should make reasonable attempts to seek further evidence:" (p14)
28.In other words, it is already the case that FME should be obtained where it is likely to make a face-to-face assessment unnecessary. The Guidelines also make clear that: "FME should always be requested before calling for assessment clalmant who is noted t0 have an appointee: Where there is evidence of previous suicide attempt, suicidal ideation Or self-harm expressed in the ESASOIESASOA , the HCP must request FME: (p15)" May ' are

OFFICIAL - SENSITIVVE Making a decision & decision on entitlement
29. The Welfare Retorm Act 2007 , which introduced ESA provides that the decision on entitlement to benefit must be made by the Secretary of State This is a power that cannot be delegated to anyone else and under the Carltona" principle such decisions are made by DWP Decision Makers.
30.Decision Makers review the papers in the case including the healthcare professlonals report and any Other medical evidence that may have been obtained or provided and will then apply the legal tests as set out in primary and secondary legislation and interpreted by the case law in order to come to a decision Decision Makers are civil servants, employed by the DWP and trained t0 made decisions on benefits in accordance with the law. The independent reviewer of the WCA has suggested that "it is inappropriate for Decision Makers to have detailed medical training but it is prudent to provide a foundation level of knowledge o the Impact that most common conditions (such as mental health) are likely to have".
31.A decision that a claimant does not have LCW or LCWRA is colloquially referred to as a decision that the claimant is 'fit for work' However; what this actually means is that the claimant does not meet the functional descriptors set out in the ESA Regulations for LCW or LCWRA It does not represent a finding on whether or not the claimant is employable or whether the claimant will be able t0 find work 32It is a common misconception that the role of the healthcare professional is to make the decision on beneiit entitlement: It has always been the case, in relation to every benefit where an assessment was required; that the final decision on benefit entitlement is taken by a DWP Decision Maker, acting on behalf of the Secretary of State for Work and Pensions The role of healthcare professional is to provide specialist medical advice on how the diagnosis (If there is one) affects the claimant's ability to perform certain functions.
33.If a claimant is found fit for work, then the payment of the ESA basic rate is terminated, Before this occurs however, the DWP Decision Maker will make up to two attempts to make telephone contact with the claimant to explain the decision and ask if the claimant has additional information that ought to be taken into account:
34.If the claimant is placed in either the WRAG or the Support Group- will receive a back payment of the component to which they are entitled; payable Aprinciple that permits civil servants t0 act %$ the Secretary of State. The principle Was recognised by the courts in Carltona v Commissioner of Works [1943] 2 All ER 560 htps:llwWgovuklgovemmentpublicationslwork capabitv-assessment-independentreview-vear _4 p7O. file; the they -

OFFICIAL - SENSITIVE from the fourteenth week of their claim and going forward they will receive the basic rate plus the additional component: Appealing a decision
35.Any claimant who is either unsuccessful in their application for ESA,,or who believes that should have been placed in the Support Group rather than the WRAG is entitled to make an appeal against that decision to an independent Tribunal Service. The Tribunal Service is a part of HMCTS and appeals against a Decision Maker's determination are made to the First-tier Tribunal (Social Entitlement Chamber) : The First-tier Tribunal consists of a judge and a medical representative. It is a free to access service, funded from the public purse.
36.The right to appeal such decisions is a fundamental part of the social security administration process in the United Kingdom and is enshrined in primary legislation?. Safeguarde tor clalmants with mental health problems
37.A number of safeguards were built into the Work Capability Assessment (WCA) from the outset;, and we have introduced further improvements to ensure the process deals with potentially vulnerable people fairly and accurately: However, It must be acknowledged that assessing risk in a disability assessment setting is likely to be inaccurate, given evidence from clinical risk assessments. For example, according to the Royal College of Psychiatrists clinical risk assessments are relatively poor predictors of suiclde because it is a multi-factorial issue:
38.Only one health condition related to the claim is recorded in the administrative system used for ESA claims. Figures for the caseload of ESA claimants to August 2013 show that mental and behavioural disorders were the most common health problem among ESA claimants (46%) followed by musculoskeletal problems 10 (13%): Adjustments t0 process
39.If someone with a mental health problem does not return their ESASO within the four week period their case is still considered by Atos Healthcare, instead 0f being returned to DWP for a Decision Maker to consider whether the benefit should be terminated; as is usually the case Soclal Security Act 1998, sections 12 to 15 Employment and Support Allowance Caseload (Thousands): IB ICD (disease) summary codebv Gender of claimant; August 2013. DWP , Information Govemance and Security, Work and Pensions cgdtudigaSiudoOpifa-llacdlomniccsexa carate Idgpsumm 9ccser_aug13html tooldwp they :

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40.Claimants who cannot manage thelr own affairs are entitled and encouraged to allow someone trust an appointee _ to manage their affairs and contact the DWP on their behalf, 41,Where informs a DWP Decision Maker that a claimant has failed t0 attend a face-to-face assessment the Decision Maker will normally proceed to take a decision on entitlement, after giving the claimant an opportunity to explain why they failed to attend (known as establishing good cause): However; where the claimant is known to have a mental health problem he or she may be considered "vulnerable" and; if 50, attempts will be made to contact the claimant by telephone and, if appropriate; to arrange a "safeguarding home visit" before a decision on entitlement is made.
42. There are also several means available to claimants via DWP to help them complete the paperwork needed for an ESA claim, particularly the ESASO, including: transcription services, either on the telephone or face-to-face; audio versions of the forms; and online versions of the forms which are compatible with accessibility computer software Collection of further evidence
43.As described at paragraph 28, the policy is that further medical evidence should be requested in every case where a claimant reports sulcidal thoughts. Data for October 2012 show where a paper-based assessment was made Of the claim, without meeting the claimant face t0 face, further medical evidence was requested for around 27 per cent of all new ESA claims and 42 per cent of IB reassessment claims. Data for October to December 2011, show that further, where medical evidence was requested; it was eventually provided only in around 71 per cent of cases overall: Moreover, even when FME was provided upon request; it was provided within the requested two-week period only in some 37 per cent of cases"1 _ Substantial risk provisions
44. There is provision in the ESA regulations for claimants t0 be placed in the WRAG Or Support Group where there is evidence that there would be substantial risk to the physical or mental health of any person if they Were found fit for work:
45. These provisions, in Regulations 29/2)(b) and 35(2)(b) of the ESA Regulations, broadly reflect measures in the previous Personal Capability Assessment for IB and act as a net for certain vulnerable claimants. The provisions are note that these data are taken from Atos Healthcare Management Information and have not been quality assured t0 Official Statistics publication standard: should be approached with in mind: they ' Atos that; safety Please They that

OFFICIAL SENSITIVE intended to cater, on a discretionary basis, for a limited number of claimants whose conditions or incapacity cannot be measured by a functional assessment: They are expected apply in exceptional circumstances where, for example, among those claimant who might be placed in the WRAG no workplace adjustments or other interventions, as medication; could be put in place to significantly reduce the risk of harm: Training for healthcare professionals
46.As the risk of suicide is never easy to predict; we are committed to ensuring that all HCPs undertaking assessments are suitably trained and we have been working t0 continually enhance the training that HCPs receive in this area: We have worked with expert Psychiatrists to develop guldance for HCPs on assessing suicidal risk. An initial trial of the guidance proved positive and we are now looking to roll it out nationally: Monitoring issues
47.Data on cause of death are not routinely collected In the benefit system as only information on the fact of death is required for benetit administration: This means that it is not possible to measure whether the rate 0f suicide among those who have applied for ESA is higher than might be expected in a similar population where mental health problems are prevalent:
48.Nonetheless, the Department takes its responsibilities to ensure the protection of claimants at increased risk of harm very seriously: In the unfortunate event that we are notified that claimant has committed suicide following a WCA, we will carry out a full investigation to see what lessons can be learned: This will allow us to make appropriate changes where required: Action if an individual has suicidal or self harm plans
49.For Decision Makers and other DWP staff who work with claimants, the Department has a six-point plan for managing suiclde and self harm declarations from customers where the ideas are expressed face-to-tace or over the phone. In the event; the staff member should: Take the statement seriously remain calm and Iisten carefully 2 Summon a colleague to act as a support partner 3 Gather information to gauge level of risk Provide referral advice ~ if situation is non-urgent; e.g: general distress but no immedlate plans or means to attempt suicide or self harm 10 such

OFFICIAL - SENSITIVVE 5 Summon Emergency help ~ if customer is distressed, at serious risk or in immediate danger Review - discuss incident with line manager and record Mr O'Sullivan's case
50.Mr OSullivan had anxiety and depression. He had been a recipient of income support (IS) on grounds of disability since July 2000. On 30 March 2012, he was notified that the conversion phase had begun for him to see whether he would qualify for ESA: Decision on conversion
51.He attended a face-to-face assessment on 17 August 2012. The opinion of the healthcare professional in their report was that Mr O'Sullivan did not meet any descriptors dealing with Limited Capability for Work On 13 September, the decision maker decided that Mr OSullivan's IS award did not qualify for conversion to ESA and the award was stopped from 18 October 2012, 52 Mr OSullivan than appealed to DWP on the approved form on the ground that he felt the questionnaire did not deal with his problems so he could not express himself. The decision of 13 September was reconsidered by a DWP Decision Maker on 28 November 2012 but not revised, Re-application
53.Mr O'Sullivan then made a new claim for ESA in November 2012. He completed an ESASO (claimant questionnaire) which said he was being investigated by his Community Mental Health Team, and within which he expressed suicidal thoughts, However; further medical evidence was not requested In line with the stated policy (outlined at paragraph 28) where the claimant has referred to suicidal ideation:
54.He attended a second face-to-face assessment on 13 March 2013. On 28 March 2013 Decision Maker decided he did not have limited capability for work.
55.Mr OSullivan subsequently claimed Jobseekers Allowance from March 2013, for around six months without sanction before he; unfortunately, took his own life in September 2013.
56. The fact that he did not incur any sanctions during this period means that he was maintaining his obligatlons under the Jobseekers Agreement to be both available for and actively seeking employment on a weekly basis: 11

OFFICIAL - SENSITIVVE Refining the system
57. Formulating; developing and reforming any benefit system will always be an extremely challenging process The welfare system for those who are long-term sick in the UK is of considerable scale; we spend around 13.3bn annually on sickness benetit payments: 12 There are currently around 1.8m claimants of ESA and some 100,000 assessments are conducted each month. While the Department Is committed to continuously improving processes for this group wherever possible, with such a large numbers of people involved in thls system there will inevitably be instances where processes are not conducted in line with the stated policy:
58. To ensure that the process itself is as etficient and accessible as possible, the DWP engages with external stakeholders when revising aspects of the WCA such as some of the forms used by applicants: An example of this is the ESA5O; the claimant questionnaire completed by individuals making an application for ESA (referred to in paragraph 52 above): This was designed with input from technical working groups including Mencap, Forward ME, Arthritis Care and the National Autistic Society: Every effort was made to ensure the form has a properly structured series of questions which guide a claimant to provide a full explanation of how their illness or disability affects them: Independent Revlews of the WCA
59. The UK Government's determination to implement a non-discriminatory system which facilitates as full and effective participation in society as possible led to it statutorily committing to independently review the WCA annually for the first five years 0f its operation. Section 10 of the Welfare Reform Act 2007 states the "ItJhe Secretary of State shall lay before Parliament an independent report on the operation of the assessments under section 8 and 9 [limited capability tor work and limited capability for work-related activity] annually for the first 5 years after those sections come into force"
60. The annual independent review engages with stakeholder groups of all kinds as well as individuals who wish to participate. For each review there is a 'call for evidence' where anybody is able to submit evidence to the Independent Reviewer to be considered as part of their latest report All review materials are Issued in accessible formats such as Braille, British Sign Language and audio.
61.The review process, and in particular the evidence gathering process, Is a robust practice. It involves a call for evidence, stakeholder meetings and seminars, visits Health at Work - an independent revlew of sickness absence, 2011, https JIwWw goV uklgovernmentuplcadsisystemfuploads/attachment_data/iile/181o80/health-at work 12 'pdf

OFFICIAL - SENSITIVVE t0 Benefit Delivery Centres where claims are processed and Decision Makers consider cases (including unannounced visits) , interviews with managers and Decision Makers about changes already underway, dialogue with DWP ministers and senior officials;' visits to Atos assessment centres and a training centre; access to Atos management information and ongoing dialogue with Tribunal judges and private providers charged with delivering the Governments Work Programme. 62 The first such review of this kind found that generally the WCA was accurately identifying individuals for their entitlement to benefit but it also made recommendations where improvements to the assessment could be made; Recommendations from the reviews to date have included simplifying much of the language used throughout the assessment process, making greater provision for individuals awaiting chemotherapy treatment and widening the criteria for support in relation to people's mental function; The Government has implerented; or is in the process of implementing; over 50 recommendations from the first three reviews. The fourth independent review was published in December 2013, and the Department has accepted or accepted with certain caveats all but one of the 32 that fall within it scope. 63 Already this practice %f review and refinement has yielded quantifiable changes for those going through the WCA process to assess entitlement to ESA. For instance; the proportion of claimants with mental health conditions who are awarded ESA has been increasing: Shortly after ESA was introduced 33% of people claiming with a mental health condition were successful in their application where as latest statistics published in 2013 show this figure has risen to 44%.13
64.More information on the Independent Reviews can be found here: Year httpsllwwagQV uklgovernmentpublicationslwork-capabilityv: assessment-independent-review-vear 1 Year 2 - httpsllw GOv_uklgovernmentipublicationsIwork-capa bility: assessment independent-review-Year:? Year 3 httpsllwww gov_uklgovernmentpublicationslwork-capability: assessment -independent-revew-vear < Year 4 _ bttpe ILwww gov Uklgovermentlpublicationslwok-capa assessment independent-review-vear 4 Source: bttpsllw GovL uklgovernmentpublicationslemplovment-and-supportal Illowance-work: capablit assersment- outcomes-by phvslcak and menlalheain-condition and httpsltgov uklgovernmentpublica ionclemplymentand support alowance-statistics-on: reassessments-ol-Incapacity-beneits july 2012 13 July` bilitx

OFFICIAL - SENSITIVE Evidence Based Review (EBR)
65. The Independent Review process is not the only mechanism for assessing and evaluating the impact and eftectiveness of the WCA. In line with DWP"s emphasis On evidence-based policy making; commitment to monitoring and adjustments to the implementation programmes where necessary, ESA is routinely the subject of analysis and research:
66. The Department has recently undertaken a systematic study - Evidence Based Review of the WCA t0 examine in detail how the WCA descriptors compared with alternative assessment proposals that were developed by a group of 14 disability representative organisations, Including leading mental health charities.
67.The study emerged from a recommendation In the second independent revilew of the WCA: It found that; overall; the WCA is a valid assessment relative to expert opinion about an individuals fitness for work As a result of the findings; the Department is considering how to make practical improvements to assessment, particularly the style of face-to-iace discussions and exploration of fluctuation in health conditions I5 The Government has also committed to seeing whether improvements could be made the assessment process in light of the study findings: Collection of Further Medical Evidence
68.It has been routinely suggested that DWP should obtain medical reports for individuals with a mental illness, learning disability or related condition who are beginning the WCA process:
69.This is currently the subject of litigation and we are therefore limited in what we can say on the issue. The Upper Tribunal has considered the question of whether the DWP should obtain further medical evidence for all ESA claimants with a mental health condition in an on-going judicial review case In their interim judgment dated 22 May 2013, the Upper Tribunal found that; at this stage, it would not be reasonable to make such a change.
70. This issue of further medical evidence has also been considered as part of the independent review process: The distinction drawn between the respective _ functions of HCPs and GPs is a element of the policy intent behind the WCA, and is supported by the British Medical Association: In its response t0 Professor Harrington"s call for evidence for his third independent review, the BMA said: jhtos Ihwwaov uklgovenmentoublcatioedroteranabllasonsetentevidencatabid-teview Mpsllwgov uklgovernmen oubllcationc/government response-jo the-! assessmenb independent-revew-vear__: See chapter 3. 14 key -

OFFICIAL SENSITIVE "Work Capability Assessments are carried out by health care professionals working directly for Atos Healthcare who are trained specifically to undertake this type of work The claimants GP also has a specific role in the process, t provide a factual report based on information contained within the patients medical record. It is not; however; the GP's role to provide any opinion on the patients capability to work as part of this process: It Is vital that these two roles are kept separate and that GPs are not asked to provide opinion on their patient for the purpose of recelving the Employment and Support Allowance (ESA); doing s0 could damage the doctor-patient relationship. It is also important to note that the majority of General Practitioners do not possess the correct training or knowledge in disability assessment medicine or in occupational medicine to be able to make such judgments; this is why specific health care professionals are trained by Atos to undertake these assessments "t8
71. We; of course, remain committed to keeping our processes for collecting further evidence under constant review and t0 improving these processes where possible. It remains important t0 retain a balance between the added value of further evidence in any claim for ESA and time demands on GPs and other healthcare professionals: Conclusion
72.As the information we have set out shows, the WCA process is under continual review and development; The mechanisms for retining the assessment approach include an Independent Review process and specific pieces of research to study how the assessment is working: This demonstrates the Governments recognition that the process should evolve as we learn lessons:
73.We have noted the Issues in this case and will continue t0 monitor our policies around assessment of people with mental health problerns while we await the outcome of related litigation (discussed at paragraph 68). We will also issue a reminder to staff about the guidance related to suicidal ideation that has been described in this report. BMA letter to Professor Harrington, 7 September 2012 15