Litchfield WCA Review Year 4

Sharing information from the WCA on capability for work with Work Programme Providers should be addressed as a priority.

The guidance on companions should be made clearer and applied consistently.

The person being assessed should be able to see what is being written during the assessment.

The Department should update documentation and training to ensure that: • There is clear differentiation between the purpose statements for HCPs and Decision Makers. • A simple narrative explaining the differences is used consistently internally and externally. • The distress that people can experience when things go wrong is recognised and acknowledged appropriately by staff.

The ESA50 and all letters and forms are comprehensively reviewed with the input of the Behavioural Insights Unit at the Cabinet Office, to ensure that: • all letters and forms meet Plain English standards. • information is presented at the right point in the process. • the person making a claim is clear about their rights and responsibilities at each stage of the process. • decision letters set out clearly what the outcome means for the person concerned ideally in the opening section: the period that will elapse before the receive the benefit; what they will need to do to continue to receive the benefit; and what they will not need to do

Apply any Tribunal recommendations on review periods as the default and should only be altered where there is strong justification.

Consider a minimum period (e.g. 6 months) between a successful appeal decision and a recall notice unless there are good grounds for believing that an earlier review is indicated.

Give greater clarity about the role and parameters of Decision Makers with a particular focus on the meaning of "empowerment".

Review the QAF so that existing strengths in process adherence are supplemented by measures to examine other elements of Decision Maker quality. In particular, the outcome of decisions and the logic underpinning them should be monitored more closely.

Build a better relationship between HCPs and Decision Makers to engender more team spirit and to help Decision Makers view HCPs as their trusted advisers.

Improve Decision Maker training to recognise the strengths and weaknesses of further medical evidence and other information on capability to supplement the HAP report.

The Evidence Based Review and the actions taken by the Department as a result of its findings should be evaluated as part of the Year 5 Independent Review.

Re-engineer the case mix for the two levels of Decision Maker so that more senior staff consider "borderline" cases (e.g. 6 – 21 points) and more junior staff process all others.

Ensure the provider batches cases into point bands when they send to the Department to save departmental admin/processing time.

Review the place of Decision Assurance Calls and apply them only in "borderline" cases handled by Band C Decision Makers who should be up-skilled to make the intervention more effective.

Review the guidance on the preparation of Reasoning and audit completed documents on a regular basis to further improve quality.

Monitor overturn rates on an individual Decision Maker basis. Investigate exceptionally high and low rates as part of performance management.

DWP continues to work with BMA to develop and co-design a revised electronic ESA113 with the aim of simplifying the process for GPs and improving the quality of evidence available.

The Department carries out a full impact assessment on an alternative process whereby DWP Decision Makers triage cases; • DWP, rather than the HAP, issues the ESA50 and reviews the response with any supporting evidence supplied; • the Decision Maker determines (with the help of decision support materials) whether further evidence is required and, if so whether to obtain that by face to face assessment or other means; • where suitable and sufficient evidence is available on paper and a face-to-face assessment would provide no additional value, the Department should make a decision without referral to its HAP; • where a person is found Fit for Work on paper without a face-to-face assessment and subsequently disagrees with the decision, a second Decision Maker then reconsiders the need for a face to face assessment as part of the new mandatory reconsideration process.

The Department should carry out a full impact assessment on the feasibility of a DWP Decision Maker being collocated with the HCP undertaking a face-to-face assessment and either seeing the person making a claim jointly or separately.

The Department strengthen its requirements for HCPs working on the contract to have suitable and sufficient previous experience of dealing with people with mental health problems so that they can contextualise their findings at assessment.

The current training in mental health that HCPs receive should be reviewed to ensure that it is adequate and the evaluation results for these and other key modules should be considered by the Department before approving any individual HCP. Approvals should be reviewed on a periodic basis and reaccreditation should be dependent upon effective refresher training in key subject matter areas.

The Department should build on the improvements for people with cancer by amending page 20 of the ESA50 to make it clear that Clinical Nurse Specialists and consultants may also complete that section of the form.

Mental Health training for Decision Makers should include dealing on the telephone with distressed people, interpreting warning signs of potential self-harm and signposting to appropriate sources of help

The ESA50 is redesigned to make it clear that evidence, particularly in mental health cases, from CPNs, Support Workers, Carers etc is valuable and giving guidance on the functional aspect that will help Decision Makers.

Consideration is given to a new reassessment period extending to 5 years in the Support Group for people who have very severe incapacity resulting from brain disorders that are degenerative or which will not realistically improve.

Review the terms of reference, role profile and job description of the HAA with input from a senior occupational health professional to maximise the value of the position.

Capture and monitor data on Decision Maker overturns of HAP recommendations to track future trends to give the Department a valuable source of management information.

Extend the feedback loop to ensure that learning is communicated to the HAP as well as to Decision Makers.

Maintain the arrangement whereby a Mental Function Champion is available to Decision Makers via the advice line.

Give careful consideration to both the public perception as well as the objective evidence relating to understanding of mental health issues before agreeing to any further adjustment of the HCP skill mix.

Give due consideration to whether piloting is required for interventions and, if so, to design pilots with particular attention to the means of evaluation. There should be suitable and sufficient analytical input to any pilots at the design, implementation and evaluation stages.

Ensure that proposed adjustments to accepted recommendations are fully considered in advance by both policy officials and operational staff so that policy intent and practical considerations are harmonised.

The Department reviews its use of WCA scores, places less emphasis on the final number attained and uses the calculation simply to determine whether the threshold for benefit has been reached.

Any further changes to the descriptors, as a result of the EBR or otherwise, should be considered in the light of their overall impact on the effectiveness of the WCA in achieving its purpose of discriminating between the different categories of people assessed.

The Department should specify an assessment format that facilitates better rapport, such as the HCP and person being assessed sitting side by side.

The assessor should avoid reporting inferences from indirect questioning as factual statements of capability.