ESA: Work Capability Assessments, Mandatory Reconsiderations and Appeals: September 2020

Q: 3. Experimental data: Initial and repeat ESA WCAs for October 2013 to December 2019

Counts of cases going through the WCA , MR , appeals process for initial and repeat ESA WCA , October 2013 to December 2019 Of 4.7 million ESA WCAs started between October 2013 and December 2019: 66% had a completed assessment; WCAs for the remaining claims are either still in progress or were closed by the claimant 400,000 MRs have been registered in relation to the 3,100,000 completed WCAs 99.8% of these MRs have been completed, with the original decision revised 16% of the time 26% of assessments with a completed MR also went on to complete an appeal; of these 100,000 appeals, 34% of DWP decisions were upheld Note: numbers may not sum to totals due to rounding. See the methodology note for further details about this.

Question 1

1.  Main stories

Accepted Answer

The statistics show:

the majority, 117,200 (84%), of all ESA-WCA assessments completed in the latest quarter to March 2020 were repeat assessments
the number of completed initial WCAs in the latest quarter was 21,800
both repeat and initial WCA assessments decreased in the quarter to March 2020 compared with the previous quarter. Repeat WCAs fell by 14% and initials by 1%
the number of completed initial ESA WCAs fell by 47% when compared with the same quarter a year earlier, whereas complete repeat WCAs also fell but at a slower rate, a fall of 14% for the same period
the number of registered MRs has continued to fall in the latest year and in the latest quarter decreased from 1000 in April 2020 to 200 in July 2020
MR monthly median clearance time decreased to 3 days in July 2020
the median end-to-end clearance time for claimants completing their initial WCA remained stable at 73 days between December 2019 and March 2020

Question 2

2.  What you need to know

Accepted Answer

The sources of the statistics are:

DWP’s benefit administration datasets including MR data
healthcare provider assessment data
HM Courts and Tribunals Service (HMCTS) appeals data for completed appeals

Experimental cohort statistics enable us to publish information on the different stages of the ESA claim process and better understand the claimant’s end-to-end journey through claiming ESA to WCA, MR and appeal.

A typical customer journey for an ESA claimant is as follows:

Claimant registers for ESA – payment issued at assessment rate.
Claimant referred for WCA and issued the “Capability to Work” questionnaire.
Claimant completes and returns questionnaire.
Assessment Provider (AP) may conduct face-to-face assessment and provides recommendation to DWP.
DWP makes a decision based on the AP recommendation. Those found eligible for ESA are either placed in the WRAG, which offers support in preparing for work, or the SG if they are unable to work or complete work-related activity. Those not eligible are found Fit For Work (FFW).
If the claimant disagrees with this decision, then depending on the nature of the decision they will either (i) have to request an MR (before they can appeal); or (ii) be able to appeal straightaway.

Note: As a result of High Court decision in July 2020, MR has been discontinued for any claimant who, having been found Fit For Work following a WCA would, if they appealed, be paid ESA pending the outcome of that appeal. This is known as Payment Pending Appeal (PPA). Not all claimants qualify, and it applies only to Fit For Work disallowance decisions, not decisions such as disallowance due to Failure to Return a Questionnaire or Failure to Attend a WCA.

Rounding policy

Since March 2017, the following rounding policy has been applied to the statistical release. Please note that percentages shown within the release are calculated using figures prior to rounding.

From	To	Rounded to
0	1,000	10
1,001	10,000	100
10,001	100,000	1,000
100,001	1,000,000	10,000
1,000,001	10,000,000	100,000
10,000,001	100,000,000	1,000,000

Question 3

3.  Experimental data: Initial and repeat ESA WCAs for October 2013 to December 2019

Accepted Answer

Counts of cases going through the WCA, MR, appeals process for initial and repeat ESA WCA, October 2013 to December 2019

Of 4.7 million ESA WCAs started between October 2013 and December 2019:

66% had a completed assessment; WCAs for the remaining claims are either still in progress or were closed by the claimant
400,000 MRs have been registered in relation to the 3,100,000 completed WCAs
99.8% of these MRs have been completed, with the original decision revised 16% of the time
26% of assessments with a completed MR also went on to complete an appeal; of these 100,000 appeals, 34% of DWP decisions were upheld

Note: numbers may not sum to totals due to rounding. See the methodology note for further details about this.

Question 4

4.  Assessment volumes and outcomes: ESA initial, repeat and Incapacity Benefit (IB) reassessments

Accepted Answer

All completed assessments by quarter, December 2008 to March 2020

Initial and repeat assessment volumes for all outcomes have decreased this quarter.

Source: Stat-Xplore: ESA Work Capability Assessments under ESA WCA by Completed Assessment.

The majority (84%) of completed ESA WCA assessments in the latest quarter were repeat assessments.

At the end of 2013, repeat ESA WCA completed assessment volumes dropped substantially as the focus moved to clearing new claims. During this period, claimants could still request a repeat assessment due to a change of circumstances, such as the development of a new condition or deterioration of the existing one.

After almost 2 years, processing was re-introduced for repeat assessments in December 2015. The numbers of repeat assessments have risen substantially from 35,000 in the quarter to December 2015 to 190,000 in the quarter to March 2019. Since then, numbers have gradually fallen to 120,000 in the latest quarter to March 2020.

In the quarter to March 2020, only 16% of completed assessments were initial ESA claims and less than 1% were IB reassessments.

After peaking in the quarter to December 2015, there was a downward trend in the number of completed initial ESA assessments. The number of completed initial ESA assessments continued to decrease over the past year, but have stabilised in the most recent quarters.

Initial assessments in the quarter to March 2020 have reached the lowest figure (21,800) since the introduction of ESA. This decrease is a result of the introduction of Universal Credit (UC) replacing most income-related new claims to ESA. The introduction of UC has greatly changed the volume and composition of new claims to ESA.

ESA initial and repeat assessment outcomes, December 2008 to March 2020

Source: Stat-Xplore: ESA Work Capability Assessments under ESA WCA by Completed Assessment.

Of the 21,800 initial assessments completed in the quarter to March 2020, 18,000 resulted in ESA entitlement.

Assessment outcomes for ESA initial assessments, December 2008 to March 2020

Source: Stat-Xplore: ESA Work Capability Assessments under ESA WCA by Completed Assessment.

ESA and IB completed assessment outcomes for the latest quarter show sizable differences across claim types.

Assessment outcomes for ESA initial assessments

ESA Initial	Percentages
Support Group	63%
Work Related Activity Group	17%
Fit For Work	20%

Assessment outcomes for ESA repeat assessments

ESA Repeat	Percentages
Support Group	84%
Work Related Activity Group	13%
Fit For Work	3%

Assessment outcomes for IB reassessments

IB Reassessment	Percentages
Support Group	94%
Work Related Activity Group	6%
Fit For Work	0%

The proportion of ESA repeat assessments assigned to SG has decreased from 86% last quarter to 84% this quarter, while the proportion found FFW has remained stable at 3 percentage points.

The process of migrating IB claims onto ESA is almost complete. As a result, there were less than 100 IB reassessments completed in the latest quarter. Of these, the proportion assigned to SG increased by 5 percentage points since last quarter to stand at 94% in March 2020. The small change may be due to the low number of IB reassessments taking place.

The majority of ESA repeat and initial assessments are assigned to SG (84% and 63% respectively).

Initial ESA assessments, when compared to ESA and IB repeats, show the largest FFW proportion (20%). This is expected as initial WCA claimants don’t have a known functionally-limiting condition.

Question 5

5.  ESA WCA Mandatory Reconsideration registrations, clearances and clearance times

Accepted Answer

MR registrations have followed a downward trend since the 22,000 peak in March 2017, to reach a record low of 200 in July 2020.

Mandatory reconsiderations registrations and clearances, October 2013 to July 2020

Source: Stat-Xplore: ESA Work Capability Assessments under Mandatory Reconsiderations – Registrations and Mandatory Reconsiderations – Clearances.

When the MR process was first introduced, the number of MR clearances was lower than the number of MRs registered. As the MRs became established, clearance volumes started increasing and became comparable to registration volumes in recent years.

The number of ESA WCA MR registrations should be seen in context with the decrease of ESA claims as UC is rolled out, the changing composition of assessment outcomes and the effect of the COVID-19 pandemic.

Mandatory reconsiderations median clearance times, October 2013 to July 2020

The median MR clearance time peaked at 16 days in January 2020, but has fallen since then to stand at 3 days in July 2020.

Note: The MR average clearance times is derived using calendar days by calculating the median of the time taken from the date the Benefit Centre (BC) has decided the MR to be valid, having considered any new information, until the date the decision is cleared by the decision maker at the Dispute Resolution Team (DRT). These dates are obtained from the DWP Decision Making and Appeals Case Recorder (DMACR) reporting system. The total clearance time therefore includes the time taken to transfer the case to DRT.

Source: Stat-Xplore: ESA Work Capability Assessments under Mandatory Reconsiderations – Clearances.

Question 6

6.  ESA WCA Mandatory Reconsiderations outcomes

Accepted Answer

For the 200 MRs completed in the quarter to July 2020, 64% of decisions were revised. This is a decrease of 18 percentage points when compared with the quarter ending in April 2020.

ESA WCA Mandatory reconsideration outcomes, October 2013 to July 2020

When MRs were first introduced the majority of decisions were upheld, with the proportion of revised decisions between March 2015 and January 2018 being consistently below 17%. Since then the proportion of revised MRs has increased to 27% in April 2019, 48% in January 2020 and 64% in the latest month, July 2020.

Although the proportions of MRs revised each month has been generally increasing, there are monthly fluctuations which can be seen from the unusual monthly sharp increase to 82% revised in April, but then falling to 63% revised in May 2020.

The increase in the proportion of revised decisions since 2019 should be seen in context alongside the decrease in the number of MRs registered as well as the changing composition of WCA decisions caused by a number of factors. These include the introduction of UC replacing most income-related new claims to ESA, and new operational approaches to gather additional oral and written evidence at the MR stage.

Source: Stat-Xplore: ESA Work Capability Assessments under Mandatory Reconsiderations – Clearances.

The number of MR decisions has fallen from 5,500 from July 2019 to stand at 200 in July 2020, a fall of 96%. This reflects the pattern in the falling number of MR registrations.

Mandatory Reconsiderations – Decisions by type for the quarter to July 2020

Decisions Made	Percentages
Customer failed to attend WCA, provide medical evidence or return questionnaire	8%
Customer disputes FFW decision	26%
Customer disputes ESA group allocations	66%

The majority of ESA WCA MR raised in July 2020 were made on disputes about FFW and ESA group allocations.

Approximately 26% of MR decisions in the quarter to July 2020 were made on disputes about FFW assessment outcomes. Of all MR decisions made in the latest quarter, 8% were on disputes where the claimant had not followed the claim procedures correctly.

These reasons include failing to return the initial questionnaire, failing to provide medical evidence or not attending the assessment. Of these disputes, 82% were revised in the latest quarter. FFW disputes follow with 65% resulting in a revised decision.

Mandatory Reconsiderations – Decision Outcomes for the quarter to July 2020

Decision Outcomes	Revised	Not Revised
Customer failed to attend WCA, provide medical evidence or return questionnaire	82%	18%
Customer disputes FFW decision	65%	35%
Customer disputes ESA group allocations	62%	38%

Question 7

7.  Appeals clearances and outcomes to June 2019

Accepted Answer

The number of appeals heard on initial FFW decisions continues to fall, reaching the lowest figure since the introduction of ESA in 2008.

Appeals outcomes on initial FFW decisions, December 2008 to June 2019

Source: Stat-Xplore: ESA Work Capability Assessments under Appeal Outcomes by Claim Start.

Being found FFW at initial assessment is the primary reason for claimants disputing a decision. These figures focus on FFW appeals for initial assessments.

The total number of appeals heard on FFW decisions for initial assessments is very low compared to pre-2013 figures, when mandatory reconsiderations were introduced. Figures have remained lower than pre-2013 levels over the last 4 reporting years.

The low numbers of appeals over recent years may be partly due to the introduction of the MR process, among other factors.

The chart shows that in the latest quarter to June 2019, the number of appeals heard on FFW decisions for initial assessments has decreased from 300 in the previous quarter to 200.

Note: These figures are grouped by claim start date, therefore numbers could increase as more appeals are completed for claims started in the most recent months.

Approximately 64% of initial FFW decisions were overturned at appeal this quarter and 36% were upheld.

Appeal outcomes for disputes on initial FFW allocation

Appeal Outcome	Percentages
Upheld	36%
Overturned	64%

The proportion of decisions upheld at appeal has increased by 6 percentage points compared with the previous quarter (from 30% to 36%).

Question 8

8.  Health conditions and ESA group allocation for initial assessments

Accepted Answer

‘Severe functional disability’ is the main reason for SG allocation this quarter.

Main reasons for SG allocations for initial assessments, December 2008 to December 2019

Note: Recent falls in volumes across all groups are likely to reflect falls in ESA initial assessments as UC rolls out.

There was a notable decrease in allocations to the ‘Physical or mental health’ risk group for claims started from October 2015 onwards. Volumes in this group fell from 28,000 in the quarter to September 2015 to 17,000 in the quarter to December 2015. This should be seen in context with the updated guidance on the application of risk introduced at the start of 2016.

For claims started in the quarter to December 2019, volumes allocated to the ‘Physical or mental health risk” category decreased to 1,100.

Most claimants assigned to the SG, who started their initial ESA assessment in the quarter to December 2019, were allocated due to health conditions linked to ‘Severe functional disability’. This accounts for 55% of all SG allocations this quarter.

Source: Stat-Xplore: ESA Work Capability Assessments under ESA WCA by Claim Start

‘Terminally ill’ numbers remained relatively low, accounting for just under 2% of SG assignment reasons respectively for claims started this quarter.

Note: Since 29 September 2017, claimants in the ESA SG no longer need to be reassessed if they meet the Severe Condition criteria. Information on this can be found on Stat-Xplore

Main reasons for WRAG (15+ points) allocations for initial assessments, December 2008 to December 2019

‘Adapting to change’ and ‘Social interaction’ remain the main reasons for WRAG allocation (with 15 points or more) this quarter.

Receiving 15 points or more is the main reason for assignment to the WRAG at initial assessment, however claimants can also be assigned to the WRAG at reconsideration or after appeal.

Source: Stat-Xplore: ESA Work Capability Assessments under ESA WCA by Claim Start.

For claimants allocated to WRAG with 15 points or more, the most common categories for scoring points this quarter were ‘Adapting to change’ and ‘Social interaction’. Of these claimants, 87% had an ‘Adapting to change’ condition and 84% scored points in the ‘Social interaction’ group.

Note: Claimants can have multiple functional impairments, therefore appear in more than one category.

Other reasons for being assigned to WRAG (with 15 points or more) are less common (Upper Limb, Sensory, Continence, and Lower Limb).

Question 9

9. 	ESA WCA customer journey clearance times for initial claims (experimental statistics)

Accepted Answer

For initial WCA’s completed in March 2020 the median end-to-end clearance time has increased slightly, to stand at 73 days.

Clearance times (in weekdays) for individual stages of the ESA WCA process

Clearance Type	Jan 20	Feb 20	March 20
Claim Registration to WCA Referral	2	2	2
WCA Referral to Assessment Provider (AP) Recommendation	44	45	42
AP recommendation to DWP decision	16	14	17
End-to-End ESA claim	72	72	73

Within this, the median time from the WCA Referral to Assessment Provider (AP) recommendation was 42 days in March 2020. This stage will usually involve a WCA assessment and includes the waiting time for the customer to complete and return the questionnaire. Multiple referrals are sometimes required before an assessment is completed and a recommendation received, as customers may not attend appointments or return questionnaires.

Note: The ‘end-to-end clearance times’ refer to time taken from claim registration to date of DWP decision. Claim registration date is the date the claimant has first contact with the department when making a claim to ESA. The DWP decision will include MRs where there is a completed decision.

Median clearance times for completed initial claims, October 2008 to March 2020

Source: Stat-Xplore: ESA Work Capability Assessments under Clearance Times for Initial Claims.

The end-to-end median clearance times (claim registration to final DWP award decision) for initial claims from October 2008 to March 2020, has been fairly stable, standing at 73 days for initial WCAs completed in March 2020. Prior to this, the median end-to-end clearance time generally followed an upward trend, reaching a peak of 107 days in July 2019. The end-to-end journey time will be affected by a variety of factors, including the completion of roll-out of UCFS and seasonal impacts. The end-to-end process accounts for the time between the customer’s referral to the AP and the AP recommendation.

In March 2020, the average time between referral to the AP and their recommendation was 42 days. The AP clearance times followed the same trend as the median end-to-end clearance times.

Question 10

10.  About these statistics

Accepted Answer

The UK Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Statistics. This badge does not currently apply to the experimental cohort figures or ESA clearance times.

Key uses of the statistics include:

providing the evidence base for assessing the potential effect of changes, monitoring and evaluation of DWP policy
answering Parliamentary Questions and Freedom of Information requests and Forecasting benefit expenditure (in conjunction with expenditure statistics)
policy development and evaluation by local authorities and other welfare to work and pensions stakeholders and providers

This release only includes ESA and IB WCAs.

This release does not capture:

UC WCAs
UC MRs
UC appeals

Recent trends in these ESA WCA statistics will be affected by the roll out of UC.

Terminology

Term	Definition
Registration	Claimant registers an application for a WCA, MR or appeal.
Clearance	DWP decision maker has determined whether the claimant should or should not be entitled to claim ESA.
Mandatory Reconsideration	Claimant wishes to dispute a decision made on their claim and requests DWP to reconsider the decision.
MR clearance time	The clearance time begins from the point the MR is raised on the DWP administrative system by the Benefit Centre as a valid MR, having considered whether they can initially change the decision in the light of any new information. The total clearance time therefore includes the time taken to transfer the case to the Dispute Resolution Team and the time taken for the decision maker to make a decision.
Repeat assessment	An existing claim that has been reassessed for ESA, as opposed to a new claim. A repeat assessment is the second or subsequent WCA undertaken on an existing, continuous ESA claim, usually between 3 and 24 months after the previous assessment. These claimants will have already been assessed as having a limited capability for work at their initial WCA and the repeat assessment will assess if their capability for work has changed.

Development of UC WCA official statistics

DWP are currently developing official statistics on numbers of UC claimants who go through a WCA and related outcomes. When the information will be robust and accurate enough for publication as official statistics, we will preannounce its release in the GOV.UK release calendar.

Where to find out more

See Stat-Xplore for more detailed breakdowns of the data covering Region, Local Authority and Westminster Parliamentary Constituency breakdowns available for WCA outcomes by claim start date and completed assessment date.

Read the methodology note for more detailed information on these statistics.

ESA: Work Capability Assessments, Mandatory Reconsiderations and Appeals: September 2020

Applies to England, Scotland and Wales

1. Main stories