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INSIDE TRACK: All not well in assessing claimants' fitness to work

Headlines about the recent Mental Welfare Commission (MWC) report looking into the death of a woman, known only as Ms DE, were about whether having her benefits cut had contributed to her taking her own life.

The report concluded that being told she should be able to work after a Work Capacity Assessment (WCA) had been a factor in her actions.

However, relatively unnoticed in the report was a survey the MWC also carried out of Scottish psychiatrists to gauge experiences of the system.

This was self-selecting (70 so-called Responsible Medical Officers from across Scotland's health boards replied, mostly consultants, roughly one in five). As evidence, that makes it flawed. Those with a poor experience of the system are perhaps more likely to have taken the time to respond to the survey. But the findings are interesting nevertheless.

Of those officers (56) who had seen patients go through the WCA process, 75% hadn't been asked by the Department for Work and Pensions (DWP) for their opinion at any point.

The DWP says it doesn't do this, because it doesn't want to overload doctors. But it is a thorny issue. Scottish GPs have certainly expressed frustration at the workload added by tasks such as letters in support of appeals to the benefits agencies.

There has also been controversy over whether decision-makers at the DWP are instructed to ignore the input of a patient's GP. Not being listened to is bound to make participation seem pointless.

But I suspect many psychiatrists would welcome the chance to clarify the position of a patient with a mental health problem if they thought it would make a difference.

Patients, on the other hand, had requested medical evidence and 95% of survey respondents said they had been asked by their patient to provide such evidence at some point.

It isn't surprising that 78% said some of their patients had lost entitlement to benefit, or that 80% said at least one of their patients had won an appeal. This tends to support common concerns that people with mental health problems are not well-served by the WCA. The DWP's system has been accused of being poor at assessing a person who may be very ill one day and healthy the next. We also know that the success rate at appeal is high.

Does the system actually make people with mental health problems more ill? Survey respondents seemed to say yes: psychiatrists said one or more of their patients had been distressed (96%) by the process or (93%) by the outcome.

Moreover, 85% said they had seen patients more often after a WCA test. In their opinion, 65% said, they had increased patients' medication, 40% had at least one patient who had self-harmed, 13% said a patient had attempted suicide and 4% had patients who had been sectioned, all as a consequence of the WCA.

So while it would be unwise to place too much weight on the statistics in the survey, it provides interesting context and views from people who probably don't normally speak out.

The report on Ms DE concluded that the system needs to change.

The withdrawal of the firm ATOS from delivering the testing provides an opportunity. Even out of context, the MWC survey suggests all is not well.

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