Assessment Centre's

When the DWP invite you for your Work Capability Assessment, they will tell you which assessment centre your assessment will take place at. Normally it will tell you which floor the assessment takes place on, too, but if your letter does not tell you this, and you do have access requirements, I suggest you contact the DWP using the phone number from your letter, to ask which floor your assessment will be on.

Using Google Maps, and the post code for the assessment centre, you will be able to have a look at the assessment centre and the surrounding area. You are looking to see how accessible it is:

• is there parking outside?
• is there parking nearby?
• is it in a no stopping zone?
• is it in a pedestrianized area?

If for whatever reason, the building looks inappropriate, explore the other centre's that you may be able to get to, in the same way until you find one you feel is suitable for your needs. You can use this document to identify other centres.

Once you have identified a centre that you would prefer, contact the DWP to make the request. A DWP telephonist may be helpful, but if they are not, make the request in writing. A letter from your GP agreeing with you that the centre is not suitable for you will be helpful.

What to expect from the Work Capability Assessment

When you apply for ESA, you may have to undergo what a lot of people colloquially refer to as 'the medical'.

The DWP call it the Work Capability Assessment (WCA). That's exactly what it's doing; assessing how capable you are of work, not assessing how ill or disabled you are.

Naively, when I first underwent this in 2003 I believed that they had my interest at heart (that our government looks after us), that they wanted to assess how ill I was, as opposed to how capable of work I was, and that when they referred to 'work' they were referring to the job I used to do. This is why I failed. Lack of understanding. So I advise to be prepared, and know what you're expecting and what is expected of you.

You will be sent a letter inviting you to attend the WCA. It will give you the date of the assessment, and the location. You may well find that the assessment centre they expect you to attend is over an hour's journey for you. They may have included a route for you to use to get there, using public transport, too.

If the assessment centre does appear to be in an unreasonable location for you, contact the DWP to discuss it. There may be one that isn't any nearer, but is more convenient for you to get to; the assessment may be able to be rearranged for you. You can view a list of assessment centres here.

If the date they have scheduled your assessment for is inconvenient, again, contact them to reschedule it.

If you are given a morning appointment, and you find morning's impossible to function (as many people with M.E. do), you might want to contact them and ask for an afternoon appointment. Make it clear why you are rescheduling. Then when you get to the actual assessment, again, make it clear, so that it is noted that you cannot function in the morning. On the other hand though; if an assessor can see how badly you function in the morning, it may help you to score more points on the assessment.

The public transport itineraries they send people are usually totally ridiculous. The one they sent me would have taken six hours, with a 40 minute wait at one station, and a walk across a city. None of it was at all possible. The public transport agenda is essentially their first way of tripping people up. A lot of assumptions are made if you are able to use public transport, for example that you have planning skills, you do not suffer from social phobia or anxiety, you can deal appropriately with people you do not know, etc.

Ideally you will arrange for someone to drive you to the assessment centre. The assessment centre may offer to pay a little towards the fuel. Otherwise you may be able to agree with the assessment centre for them to pay a portion of a taxi fee. If neither of these are possible for you, some areas have voluntary drivers; your Citizens Advice Bureau is most likely to have this list.

Of course, if you can drive, then you may drive yourself there. Again, the assessment centre may pay a little towards the fuel. There are a few things to consider in doing so though:

• Do you normally need to rest before and after driving that distance? - it will be assumed that you do not.
• Are you able to drive the same distance every day? - it will be assumed that you can.
• Are you able to fill your car with fuel, or does someone else usually do that for you? - it will be assumed that you have the manual dexterity and strength to lift the fuel pump nozzle.

Joyce Drummond, who worked for Atos for a while, has given a very insightful account of what to expect from the WCA. I highly recommend reading it for further observations that I may not have made here.

In Joyce's account she states that at the centre she worked in they did not use security cameras to assess people as they approached the assessment centre. However, we've heard so many accounts of people believing this has happened, that it's best to assume they do.

The assessor will ask you where you parked. Your answer will be used, in part, to assess your mobility (how far you can walk). Most centre's do not have parking available nearby. I personally choose to be dropped off outside - even if there are double yellow (or red) lines there. I cannot walk far reliably, repeatedly or safely, so I don't want to mislead them into thinking that I can.

The buildings vary, but most of them do not have the assessment centre on the ground floor. One of my experiences was thus:

I arrived at the assessment centre. Two security guards watched me get out of my partners car. One made notes. After I had reached the door and presented my papers I was asked whether I could use the stairs. I said that I could not, and asked to use the lift. I was told that if I could not use the stairs then I could not go up to the assessment centre in case there was a fire. I started to panic, so the other security guard rephrased, asking whether I'd be able to push myself to use the stairs in case of a fire. So that I could get to the centre, I said that if there was a fire I'd have no choice, even if it meant going down on my bum. I was assessed as being able to use stairs, on the basis of that conversation.

That was a dirty trick. At the time I knew no better. If anyone plays a trick like that on you, don't fall for it. If you can use the stairs fair enough, but if you can't, don't be forced to put yourself in a position that causes you pain and/or discomfort. If they prevent you from going upstairs, they are forfeiting the assessment, not you. If you've mentioned on your ESA50 that you have a problem using stairs then they should not have scheduled you to be assessed at a centre that is inaccessible to people who cannot use stairs. What I should have done was ask my partner if he could go up to the centre and explain the situation. I believe I could have insisted upon an assessment downstairs, even if that meant rescheduling it for another date and location.

And that is one of the keys for the whole of the assessment; don't do anything that causes you pain or discomfort. As soon as you feel anything tell them - because they cannot know if you don't do so.

Once you arrive at the assessment centre you need to go to reception to book yourself in and prove you are who you say you are. At my last assessment they played another dirty trick here; three receptionists sat behind the desk giggling and gossipping while a queue built up. I sat on the floor to start with (if you have Orthostatic Intolerance too, you'll understand why), but moved to some chairs after five minutes, to lie down.

If there is a queue when you arrive, I recommend you take a photo of your watch, or preferably a clock on their wall; a screen print of your phone if necessary. The reason I suggest this is because that half an hours queue at the reception desk made me late for the assessment. They later used this as an excuse to send me home without the assessment. Not turning up for an assessment can result in your benefit being revoked.

At the desk they ask you for three forms of ID. I totally forgot to take any one time, so just emptied my entire purse at the lady, which she accepted. So I believe that several things with your name on will be fine. If you usually have trouble remaining standing, you can request a seat while you're at the desk.

If you accept the expenses form, bare in mind that they will be assessing your manual dexterity when you fill it in, and how legible your handwriting is. If you have to submit it in another room, they'll also be assessing your mobility. As such, if your condition is fluctuating, make sure that the assessor knows (once you meet them) what the difference is between these actions and how they would be when you've become fatigued.

Everything you do and say is being watched. From the moment you step into the assessment centre the type of chair you choose to sit in is noted, how you sit in it, whether you fidget, rock, talk to yourself, etc, is all being noted. If you stand or pace, your mobility is assessed. If you use your phone or have brought a book to read, or a book of puzzles, your manual dexterity and concentration are being assessed. Judgements are made according to what you are wearing, and how well groomed you are (not particularly correctly in my experience). Joyce Drummond mentioned that they even make note of whether someone's eyebrows are waxed. I couldn't help wondering how they know.

For most people it isn't particularly unfair that their actions in the waiting room are assessed. The problem for people with M.E. and similar conditions is the fact that our conditions fluctuate. For some of us they fluctuate on a hour by hour basis, others it can be month by month. So, until we actually speak to the assessor to explain where we are in our fluctuations, judgements really should not be made. I've heard of people's assessments not taking place though, because of observations that have been made in the waiting room. (To be fair, though, in these cases the decision has gone in the claimant's favour).

Usually you will be expected to wait a while before you meet your assessor. You may be assessed by a nurse, a physiotherapist or a doctor. Technically speaking the rules state that neurological conditions should be assessed by a doctor. Despite NICE and WHO recognising M.E. as being a neurological condition, the DWP and Atos do not. If your personal condition has been recognised as being neurological you can therefore insist upon being assessed by a doctor. Personally, since we're not seeking treatment from these people, I don't really see that it makes a difference.

The assessor will come to the waiting room and call you by name. They will be assessing, at first, how well you hear them, then they'll assess whether you make eye contact and to some extent your manual dexterity and social behaviour when they offer to shake you by the hand. As you walk with them to the assessment room they are assessing your mobility from whether you walk straight, stumble, bump into doorways, etc.

If you usually use a walking aid or wheelchair, take it with you. The assessor may ask you if they were prescribed or if you bought them. Whichever is your answer, make sure you explain clearly what your reasons are for using it. If there are other aids or appliances you use at home that you believe may help the decision, you could bring them in, or take a photograph to add to the evidence.

You can take someone in to the assessment with you. This person can make notes on the assessment, provided that you allow the assessor to make a photocopy of these notes before you leave. You can have the assessment recorded by prior arrangement. If you want your assessment recorded, you simply phone the DWP and request it. There are not many recorders available throughout Atos as an organisation, so making this request can cause the date of your assessment to be postponed. You can also have home assessments recorded, again, by prior arrangement.

Once you're in the assessment you will be invited to sit down. If the type of chair you are given to sit in is one you are normally uncomfortable in, make sure you mention this to the assessor. If they offer you another chair, don't be fooled into carrying it across the room if it will cause you any discomfort or pain, whether that would be immediate or later.

To every question you are asked, understand that they are making various judgements. For example:

• how much do you need to move around for whatever the question was in reference to.
• how much do you need to move your hands?
• how much do you need to walk?
• how much responsibility does it require?
• how much prior organisation?
• how much social interaction does it require?
• how much social interaction with strangers?

For example, they ask you whether you have any pets. If you simply answer 'yes', it will be assumed that you have a cat or a dog. From that they assume that the animal is fed on the ground, so you must be able to squat (bend the knees) and open a tin (manual dexterity). They will also assume you walk the dog daily. Even if you specify that your pet is not a cat or dog, an amount of responsibility and organisation is assumed, since you will assumably be feeding and watering the animal every day. They do not ask you how many pets you've accidentally maimed or killed. As such, if you have a pet in your household, which you are not responsible for, either do not tell them that it is your pet, or tell them who takes care of it.

You can find a list of the questions you 

may be asked at the assessment, here.

There is also a physical section to the assessment. You will be asked to perform certain movements, some of which you will need to get up onto a couch for. If anything the assessor asks you to do, including climbing on to the couch, causes you discomfort or pain, or usually would, make it absolutely clear to them. If you know that something will cause you discomfort or pain, you can refuse to do it. If they try to talk over you (as one of my assessor's did continuously), say it to them again afterwards.

Once the assessment is over, you should hear what the result is within 4 to 6 weeks. If it seems to be taking forever, phone the DWP to find out what is why. 

Under some circumstances you may be able to arrange for the medical assessment to take place in your home, usually by a visiting doctor. The two scenarios I know of this happening are:

1. By submitting a letter from your GP or a specialist stating that attending the WCA will be detrimental to your health, or that of someone else.
2. When the medical assessment has been cancelled at your detriment, they may offer you a home assessment instead. (This happened to me).

Getting the DWP to agree to a Work Capability Assessment at home is infamously difficult. Simply requesting one yourself rarely works, no matter how hard you state your case. To illustrate how difficult it is; a close friend of mine was in hospital in a neurological unit when she was called for re-assessment. The DWP refused to give her a home/hospital assessment, so she was taken to the assessment centre in an ambulance, and carried in on a stretcher.

The home assessment is very similar to that performed in the assessment centre's. You are asked very similar questions. You are still asked to perform certain movements. The main difference is that the assessor can see for themselves the evidence around your home as to your state.

Useful Links

A comprehensive look at the WCA questions and how to answer them, written by Michelle.

A list of the questions you'll be asked in the WCA.

Work Capability Assessment Centres

The following two documents contain a list of the UK assessment centres, as of April 2013.

The spreadsheet you can sort in order to find the centre you're looking for more easily.

The PDF contains more information.

Excel Spreadsheet.

PDF.

 

Work Capability Assessment described by Joyce Drummond

I worked as a HCP (nurse) for Atos for 5 months in 2009. I left because of the way I felt I was expected to trick sick and disabled people. I have not worked since. I have recently whistleblown on Atos.

I knew nothing about Atos when I joined, and left as soon as I realised that there was no way to fight from the inside,

I carried out Incapacity Benefit assessments, forerunner to ESA. I stated at my interview for the job that I believed in social inclusion and social justice. I went for 4 weeks training in England. The training did not prepare me for what I was expected to do in real life.

Firstly the forms that are completed prior to assessment, I have recently found out, are first opened by Royal Mail Staff. They are then sent for "scrutiny" where nurses decide whether or not a face to face assessment is required. I was not involved in this and do not know what criteria is used.

It is made clear throughout training and working that we are not nurses- we are disability analysts. Also that we do not carry out medical assessments - we carry out functional assessments. We did not even need a diagnosis to carry out assessments. I had reservations around consent as we were expected to assess patients - sorry we didn't have patients, we had claimants- who appeared to be under the influence of alcohol or other substances. We were also consistently told that we did not make benefit decisions. The final decision was made by a DWP decision maker with no medical qualification. If our assessment was overturned at appeal we never knew about it. There was no accountability for assessments overruled.

Assessment starts on the day by reading the form you complete when applying for benefit. Things that are noted are-

• did you complete the form yourself
• Is the handwriting legible
• are the contents coherent.

These things are already assessing your hand function, your cognitive state and concentration.

• Do the things you have written add up.
• Does your medication support your diagnosis.
• What tests you have had to confirm diagnosis. 

For example a diagnosis of sciatica is not accepted unless diagnosed by MRI scan.

• Do you have supporting medical evidence from GP or consultants. 

If you do it shows that you are able to organise getting this information.

This is also a hidden cost to the NHS. I believe that if ATOS request information there is a charge levied by GP's. However claimants are expected to source medical evidence themselves. It uses valuable NHS time for medical staff to write supporting statements.

There were no hidden cameras, at least in Glasgow, to watch people arriving for assessment or sitting in waiting room.

When the HCP has read your form they input some data into the computer system. The assessment proper begins when they call your name in the waiting room. At this point they assess-

• did you hear your name being called
• did you rise from your chair unaided, did the chair have arms or not
• were you accompanied - this addresses you're ability to go out alone.
• were you reading a paper while waiting - looks at your concentration.
• Did you walk to the assessment room unaided, did you use aids correctly. Did you navigate any obstacles safely - assessing sight.
• The HCP will shake your hand when inroducing herself - are you trembling, sweating- signs of anxiety.
• Often ask on way to waiting room how long you've been waiting - assessing ability to sit- physically and looking at mental state.
• How did you get here today - ability to drive, use public transport.

Assessment begins by listing medical conditions/complaints. For each complaint you will be asked-

• How long have you had it, 
• have you seen a specialist, 
• have you had any tests, 
• what treatments have you had, 
• what's your current treatment. 
• Have you had any other specialist input eg physiotherapy, CPN.

The HCP will use lack of specialist input/ hospital admissions to justify assessing your condition as less severe.

Medications will be listed, are they prescribed or bought. Dates will be checked on boxes to assess compliance. Any allergies or side effects should be noted. A brief note is made of how you feel each condition affects your life. A brief social history will be taken - who you live with, have you stairs in your house or to your house.

Employment history is taken asking when you last worked, what you worked as, reason for leaving employment.

"Typical Day" This is the part of the assessment where how you function on a day to day basis is used to justify the HCP decisions. Anything you say here is where you are most likely to fail your assessment. Along side this the HCP records their observations.

Starting with your sleep pattern, questions are asked around your ability to function.

• Lower limb problems- look at ability to mobilise to shops, around the house, drive, use public transport, dress, shower.
• Upper limb- ability to wash, dress, cook, shop, complete ESA form.Vision- did you manage to navigate safely to assessment room.
• Hearing- Did you hear your name being called in waiting room.
• Speech- Could the HCP understand you at assessment.
• Continence- Do you describe incontinence NOT CONTROLLED by pads,medication. Do you mention it's effects on your life when describing your typical day.
• Consciousness- Do you suffer seizures- with loss of continence, possible injury, witnessed, or uncontrolled diabetes.

HCP obsevations include- 

• how far did you walk to examination room, 
• did you remove your coat independantly, 
• did you handle medications without difficulty, 
• did you bend to pick up handbag.

Formal exam consists of simple movements to assess limited function.

Things HCP also looks out for- 

• are you well presented, 
• hair done, 
• makeup, 
• eyebrows waxed.

• Do you have any pets- looks at ability to bend to feed and walk.
• Do you look after someone else- parent or carer- if you do this will be taken as evidence of functiong
• Any training, voluntary work, socialising will be used as evidence of functioning.

This is not a comprehensive list, but gives you an idea of how seemingly innocent questions are used to justify HCP decisions.

Mental Health

• Learning tasks- can you use phone, computer, washing machine.
• Hazards- Can you safely make tea, if claiming accidents- must have had emergency services eg fire service. Near miss accidents do not count.
• Personal Actions- Can you wash, dress, gather evidence for assessment

Manage bills.
Observations by HCP= appearance and presentation, coping with assessment interview, abnormal thoughts, hallucinations, confusion.
Coping with change= Ability to attend assesment, attend GP or hospital appointments Shopping and socialising.
HCP observations- appearance, eye contact, rapport, no signs/symptoms abnormal mood/thoughts/perceptions. No suicidal thoughts.

Coping with social engagement/appropriateness of behaviour-
Inapproprite behaviour must have involved police

Ability to attend assessment, engage with assessor, behave appropriately.
Again this is not an exhaustive list, merely examples

There are some "special cases". Off the top of my head:-

• terminal illness 
• intravenous chemo
• danger to self or others if found fit to work

I am happy to speak to any politician, of any party- except BNP. I think it is telling that Atos have made no attempt to sue or silence me. They know I am speaking the truth. 

At present to qualify for ESA you need to score 15 points. This can be a combination of scores from physical and mental health descriptors. To qualify for support group you must score 15 points in one section. As long as you are claiming income based ESA your award can be renewed at each assessment, if you gain 15 points.

Contribution ESA lasts for 1 year only, unless you are in the support group. After 1 year, out with support group, you only get income based ESA if your household income is below a certain threshold. It makes no difference how long yoy have previously paid NI for.

For clarity, as far as I know in the real world, doctors carry out medical assessments, nurses carry out nursing assessments and physios carry out physiotherapy assessments. In the world of Atos each of these separate professions are employed as disability analysts, carrying out functional assessments.

Nurses are employable for these posts - if they have been qualified for at least 3 years, are registered to practice with the NMC, and have basic computer skills.
My interview consisted of-

• face to face interview with medical director and nurse team leader.
• a written paper assessing a scenario, in my case someone with back pain
• A 10 minute basic computer test.

In order to be approved as disability analyst I had to complete 4 weeks Atos disability training, reach a certain standard of assessment reports- as decided by audit of all cases seen (don't know what criteria was) and finally approval to carry out WCA assessments from the Secretary for Works and Pensions.

In my opinion the money given to Atos and spent on tribunals should be given to NHS GPs. They are best placed to make assessments re patients work capability. They have access to all medical reports, past history, specialist input and know their patients. My concern would be what criteria the DWP would impose on GPs risking the doctor/patient relationship. GPs already assess patients for "fit notes", which have to be submitted to DWP during assessment phase of ESA Re wages at Atos. 

While I worked there sessional medical staff were being paid £40 per assessment, as far as I am aware. I have no idea of wages of permenant medical staff. Nurses were on a salary, which based on 10 assessments a day (Atos target) equalled around £10 per assessment. These are approx, figures but may give a clue as to why Atos are employing nurses rather than doctors.

I hope this is of some help to your committee.
Please do not hesitate me for further clarification.
Joyce Drummond.