Work capability assessment
17. Before we decide if we should investigate a complaint in more detail, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any signs something went wrong regarding CHDA’s decision to ask Mr U to come in for an assessment.
18. Mr U was in receipt of ESA. This is a benefit DWP pays that people can apply for if they have a disability or health condition that affects how much they can work. The Employment and Support Allowance Regulations, 2008 are the legislation behind this, and Part 5 ‘Limited Capacity for Work’ is the relevant aspect here. Section 23(1) of this explains a claimant may be called for a medical examination to decide if they have limited capability for work. The claimant must co-operate with this examination, unless they fit one of the specific criteria outlined in the legislation. This does not apply in Mr U’s case.
19. These examinations, or WCAs, are designed to find out a claimant’s functional ability - that is how their medical conditions affect their ability to carry out everyday tasks and their capability for work and work-related activities.
20. CHDA carries out WCAs on behalf of DWP, when DWP has referred a claimant, so it can get a medical review of the claim. DWP uses the reports CHDA produces after an assessment to help it decide which category of benefit a claimant is entitled to if they have said they cannot work or would need support to work.
21. CHDA does not always do face-to-face assessments. Where it feels the claimant has provided enough information for it to be able to decide about their capability it may do a paper-based assessment of their functional ability. If CHDA feels more information is needed, it may carry out a telephone assessment or do this face to face. We will consider the assessment method later in this report.
22. In 2017, Mr U had a paper-based assessment for his claim, which was successful. He says when DWP wanted to review his functional ability again in 2019, he gave CHDA enough evidence for another paper-based assessment. CHDA did not agree, explaining there was not enough clear medical evidence to support Mr U’s claimed level of disability, so he would need an assessment. CHDA says its decision to do a paper-based assessment in 2017 was influenced by information from Mr U which showed he had started on medication for his heart condition. It noted that once this treatment was underway, there may have been an improvement in Mr U’s health.
23. DWP asked CHDA to consider Mr U’s 2019 claim. Having done so, it felt there was not enough evidence available to support the level of disability claimed. As ICE explained to Mr U, CHDA considered all the evidence provided in reaching this decision and still considered this necessary.
24. We understand Mr U felt he had given enough information and evidence for CHDA to make a paper-based assessment, but CHDA did not agree and it provided a plausible explanation for why it needed to see him this time around. In these circumstances, it was entitled to ask him to be assessed further and it did so. Although we understand why Mr U disagrees, we think this was a reasonable decision.
25. When Mr U provided CHDA with his information and evidence in 2019, he asked for any assessment to be done at his home. He explained this was because he would become very anxious if he had to go to an assessment centre.
26. CHDA refused this request and Mr U went for an in-person assessment in May 2019. Mr U went to hospital by ambulance before the appointment started after having an angina attack outside the building and then in the reception. Mr U explains this was because of the enormous amount of stress and anxiety CHDA’s demand that he attend the assessment caused him. We do not want to minimise the experience Mr U has told us about, as this was clearly very frightening and distressing. But, it is important that before we consider any potential impact, we first establish whether CHDA acted incorrectly.
27. Section 10.3 of the Guidelines details the organisation’s process for doing a home assessment. This explains the preferred option is for an assessment at one of its assessment centres, but there are times where this is not possible. Guidance is set out to allow CHDA to consider whether this is necessary, while recognising it cannot account for all eventualities.
28. The Guidelines do, however say the following should be considered when a home assessment is requested:
• Does the claimant have a medical condition that precludes them from travelling to the assessment centre?
• Has there been medical verification of the severity of the condition that precludes them from attending for assessment in the assessment centre?
• Are there health and safety implications?
29. The Guidelines provide further information, saying CHDA ‘must ensure that there is medical confirmation of the condition, providing the reason why the claimant cannot travel on the grounds of health.’ They suggest looking at whether the request is based on medical fact rather than opinion in doing this and provide an example of a GP stating, ‘My patient has severe agoraphobia and cannot leave the house’ rather than ‘I feel my patient would benefit from an assessment at home’ or ‘My patient tells me they are unable to travel to the assessment centre.’ This is among other considerations CHDA should weigh up.
30. In Mr U’s case, he told CHDA he attended appointments at his diabetes clinic and hospital appointments. He provided CHDA with correspondence from his GP which said a home assessment would be ‘more suitable’ to ‘reduce the distress’ an in-person assessment at a centre would cause him. Extra correspondence from his GP said, Mr U ‘finds travel stressful and this can trigger panic attacks.’ The GP asked if CHDA would ‘bear this in mind when assessing his application’ and said he ‘wondered whether’ it would ‘consider’ a home visit.
31. We have no reason to doubt what Mr U or his GP report. But objectively, the information (including what Mr U provided in his claim) says Mr U has variable difficulty outside the home. He may well have trouble attending appointments, but the fact he does so in other situations suggests he is not unable to attend. Also, his GP asked for a home visit to be considered – they did not say Mr U would not be able to go to a centre. So, CHDA decided Mr U’s request was not medically necessary.
32. Also, there is a health and safety implication with Mr U having a home visit. His file has a PV or, what is now called an unacceptable claimant behaviour (UCB) marker. It is DWP that applies a UCB marker to a claimant’s file, not CHDA. CHDA can ask for this to be done, but it is DWP that makes the decision.
33. Mr U’s file has a UCB marker, which he explains is because of him disclosing that some of his medication can make him aggressive.
34. CHDA’s ‘Unacceptable Claimant Behaviour Guide’ explains that when a claimant with an UCB marker asks for a home assessment, an Area Quality Lead Assurance member of staff should consider this. They should review the request from a clinical perspective and, if a home visit is medically needed, CHDA should ask DWP to consider if it is appropriate.
35. We can see an Area Quality Lead Assurance member of staff did review Mr U’s request, but did not find this to be medically needed.
36. We consider CHDA acted as it should have done. Although it could have agreed to a home visit, if DWP agreed this was appropriate, this was not something it should have done. So, CHDA’s decision to demand a face-to-face assessment at one of its assessment centres was reasonable.
Keeping evidence
37. Mr U complains CHDA did not keep evidence of what happened when he had an angina attack while attending an assessment in May 2019. He considers, had it done so, it could and should have used this information in its report to DWP. But instead, he says CHDA called him back for another assessment.
38. Mr U has also asked why the assessment centre nurse who helped him said she did not record his blood pressure readings and then ‘changed her story and said she did record them and gave them to the ambulance staff, when in fact she didn’t.’
39. There is no dispute Mr U had a medical episode when he was at the assessment centre in May 2019. Mr U explains this started while he was outside the building, where he collapsed. He then made it into the building and asked for help at reception, where a registered nurse assisted him.
40. The nurse took Mr U’s blood pressure, pulse, advised him to take his angina spray and called an ambulance. Again, there is no dispute about this.
41. Mr U believes CHDA should have used this information in its report to DWP rather than calling him back for another assessment. He feels its failure to keep the information stopped this from happening.
42. When an assessment does not go ahead, as in this case, CHDA explains there is no specific guidance that says information must be kept on the customer’s file about the reason. We have seen, after the incident in May 2019, CHDA referred Mr U’s case to one of its medical advisers (a doctor) for their opinion on whether it was necessary for him to still be assessed in person. The adviser looked at the extra evidence Mr U sent after his overnight hospital admission, plus the rest of the information available and Mr U’s comments about the incident.
43. The adviser said, ‘I note the resulting hospital discharge summary. This seems to show that the event was simply an episode of angina with an overlay of anxiety, which is what is written in the ‘Primary/Actual Diagnosis’ section, and not an MI or hypertensive crisis.’ They went on to say they noted ‘the comment of ‘chest pain on exertion’ and ‘limited mobility and movements’ but this is not enough to be able to robustly advise without seeing the claimant since it is not at all clear what ‘exercise’ means in this context or how limited the movements are, in relation to the WCA activities as currently defined.’
44. Although there is no evidence from CCTV or notes written by the nurse who helped Mr U, this has not had an adverse impact on Mr U or his case with CHDA or DWP. As we have said, there is no dispute the incident happened. It is also clear CHDA considered this before deciding Mr U still needed to be seen in person. It is more than likely the same decision would have been made if this information had been kept.
45. As to why the nurse ‘changed her story’, we have not seen any evidence of this being the case. The nurse reported ‘giving’ the ambulance crew the information about Mr U’s episode, including details of his blood pressure readings. We have not seen anything to suggest she claimed to have written this down and consider it entirely possible this was part of her verbal handover to the crew.
46. We have therefore decided to take no further action. We fully recognise that going to the assessment was incredibly upsetting for Mr U, and our decision in no way intends to detract from that.