ESA: Work Capability Assessments, Mandatory Reconsiderations and Appeals: September 2021

Question 1

1.  Main stories

Accepted Answer

The statistics show:

the number of completed ESA WCAs with a DWP decision in the latest quarter to March 2021 is 38,000, compared with 43,000 in the previous quarter
of the total number of ESA assessments completed in the latest quarter to March 2021, half were initial WCAs (19,000) and half were repeats
DWP decisions for initial WCAs for the latest quarter to March 2021 show the majority (68%) resulted in a Support Group (SG) outcome, followed by 18% Fit for Work (FfW) and 14% Work Related Activity Group (WRAG)
the number of monthly registered MRs relating to an ESA WCA decision has remained below 400 since May 2020 and in the latest month to July 2021 the number registered is 280
the median time taken to clear MRs in the latest month, July 2021, is 8 days
the median end-to-end clearance time for initial ESA WCAs, that is from the date the claim was registered to the date of the DWP decision, is 113 days in March 2021. This marks the highest time recorded since November 2016

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

Information is only available for claims that began at least 6 months following the assessment date, or 9 months following the date of claim. This is because of the time required for the customer journey to end and for the information recorded to be as complete as possible.

All figures in this release have been rounded according to DWP rounding policy, as detailed in section 10.

COVID-19 operational easements

Figures for this release reflect the disruptions caused by the Coronavirus (COVID‑19) pandemic, which has led to changes to operational procedures. Such changes were necessary to process claims and ensure people in need of financial help could access benefits, while keeping customers and staff safe.

DWP temporarily suspended face-to-face health assessments from 17th March 2020. however, paper based assessments continued and telephone assessments were introduced from 7th May 2020 and video assessments from November 2020. For more information of operational easements see the background information note.

The typical customer journey, prior to the COVID-19 easements, is detailed below:

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 or paper-based 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 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 that as a result of High Court decision in July 2020, MR has been discontinued for any claimant who, having been found Fit for Work (FfW) 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.

Question 3

3.  Assessment volumes and outcomes: ESA initial and repeat assessments

Accepted Answer

Initial and repeat assessment volumes for all outcomes this quarter remain low, with a slight decrease of 12% compared to the previous quarter.

ESA and WCAs were introduced in 2008. Claimants who had previously been on Incapacity Benefit (IB), or who claimed ESA, would receive an initial assessment. If they remained on the benefit, they might then get repeat assessments to ensure they were still receiving the appropriate amount of support.

All completed assessments by quarter, December 2008 to March 2021

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

There were equal numbers of initial and repeat assessments completed in the latest quarter to March 2021.

Since the introduction of ESA numbers and types of assessments have changed over the years. At first many assessments were initial and many of these related to claimants who were migrated from IB. Numbers of repeat assessments gradually increased, with these usually taking place between 3 months and 3 years after the previous assessment. From January 2014 until there was a period in which repeat assessments were supressed in order to focus on initial WCAs and manage the number of cases awaiting a decision, but numbers of repeat WCAs began to increase again when they were re-introduced in December 2015.

The number of completed ESA WCAs increased to reach a peak of 270,000 in March 2017 but has fallen since to stand at 38,000 in the latest quarter to March 2021.

The introduction of UC for most income-related new claims from December 2018 has greatly changed volumes and types of ESA-WCAs. This, together with the suspension of face-to-face assessments in March 2020 in response to the COVID-19 pandemic, has resulted in an overall downward trend in numbers of completed assessments.

Albeit the overall number of assessments is still lower than pre-COVID levels, initial assessments have been following a steadily increasing trend after the sudden drop in March and April 2020. The drop can be likely attributed to the COVID-19 pandemic causing changes to the assessment process. Starting in May 2020, initial assessment volumes started to increase and numbers are now, in the latest quarter to March 2021, comparable to pre-COVID levels.

Initial and repeat assessment outcomes, December 2008 to March 2021

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

Of the 19,000 initial assessments completed in the quarter to March 2021, 16,000 resulted in ESA entitlement.

Since April 2016 quarterly volumes of completed repeat WCAs have always been greater than initial WCAs, however in the latest quarter to March 2021 both initial and repeat assessments accounted for 50% each of the total WCA’s completed, both standing at 19,000.

In recent years, the long-term trend for initial and repeat WCAs is that numbers have been falling. However, looking at the latest quarter to March 2021, initial WCAs increased by 5,000 to reach similar numbers to pre-COVID levels.

On the contrary, the numbers of repeats continued to fall, decreasing by 9,000 compared to the previous quarter.

The overall decreasing trend in the number of initial assessments in recent years can be attributed to UC replacing most income-related new claims to ESA from December 2018 following the national rollout.

Percentages of assessment outcomes for ESA initial assessments by date of decision, December 2008 to March 2021

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

Outcomes of both ESA initial and repeat assessments for the latest quarter show the majority of ESA claimants are assigned to the Support Group (68% and 84% respectively).

Assessment outcomes for ESA initial assessments for the quarter ending in March 2021

ESA Initial	Percentages
Support Group	68%
Work Related Activity Group	15%
Fit For Work	18%

Assessment outcomes for ESA repeat assessments for the quarter ending in March 2021

ESA Repeat	Percentages
Support Group	84%
Work Related Activity Group	15%
Fit For Work	1%

Note that percentages may not sum to 100% due to rounding.

The latest trends for DWP decisions on WCA outcomes are impacted by the operational changes implemented in response to the COVID-19 pandemic, such as the temporary suspension of face-to-face assessments. Also from March 2020 the focus was on initial assessments, however reassessments already present in the system were processed alongside those related to changes in circumstances, where possible. When telephone assessments were first introduced in May 2020 only SG decisions could be made, however this was extended to include WRAG decisions from September 2020.

The proportions found FfW for both initials and repeat WCAs have remained low since last quarter. However, there was an increase from 10% to 18% for initial WCAs, while repeats remained relatively stable at 1%.

Question 4

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

Accepted Answer

The number of monthly MR registrations remains low and stands at 280 in July 2021.

By the end of July 2021, a total of 850,000 MRs have been registered. Of these, 99.6% had been cleared. The number of MR registrations and clearances within each month fluctuate over time:

the number of MR registrations and clearances gradually increased between April 2013 and March 2017 as volumes of ESA customers increased
the number of monthly MR registrations peaked in March 2017 at 22,000 but have since followed a downward trend
since June 2020 the number of MRs registered and cleared each month has remained below 400
there were 280 MR registrations and 300 MRs cleared in the latest month, July 2021

The number of ESA WCA MR registrations and clearances should be seen in context with the decrease of ESA claims as UC is rolled out, the changing composition of assessment outcomes, the effect of the COVID-19 pandemic and that, in some circumstances, MR has now been discontinued and claimants can appeal straightaway.

For the purpose of these statistics, all reconsiderations occurring after the WCA are counted as MRs. For more information on the definition of MR see section 10 of this release and the methodology note .

Mandatory reconsiderations registrations and clearances, October 2013 to July 2021

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

In July 2021 the monthly median clearance time for ESA-WCA MRs was 8 days.

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.

Immediately after the introduction of MRs, in October 2013, the median average time taken to clear MRs had sharply increased to stand at 37 calendar days in May 2014. MR clearance times have significantly decreased from their peak in May 2014, and have been quite volatile since, with peaks in September 2016 (15 days), August 2018 (16 days) and January 2020 (16 days). Since January 2020 the monthly median clearance times have fluctuated but remained below 10 days. It should be noted that they are also based on very low numbers of MR clearances.

Mandatory reconsiderations monthly median clearance times (calendar days), October 2013 to July 2021

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

Question 5

5.  ESA WCA Mandatory Reconsiderations outcomes

Accepted Answer

In the latest quarter to July 2021 65% of ESA-WCA decisions were revised as a result of an MR outcome.

From October 2013 to October 2019, the majority of requests to reconsider ESA WCA outcomes were not revised at MR stage. Since then, the proportion of assessment outcomes where the award changed after the MR gradually increased, with some fluctuation. The proportion of MR decisions resulting in a change in award rose from 53% in February 2020 to 81% in April 2020, reflecting the new operational approaches as well as COVID-19 impact.

Since May 2020 approximately two thirds of MR decisions led to a change in award. In the latest quarter to July 2021, 65% of ESA-WCA decisions were revised as a result of an MR.

Percentage of ESA WCA Mandatory Reconsiderations by outcome, October 2013 to July 2021

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

The increase in the proportion of revised decisions since 2019 should be seen in context with the large reduction in MRs, the new operational approaches to gather additional oral and written evidence at the MR stage, as well as the changing composition of WCA decisions influenced by a number of factors. These include the COVID-19 pandemic and the introduction of UC replacing most income-related new claims to ESA.

Mandatory Reconsiderations – Decisions by type for the quarter ending in July 2021

Decisions Made	Percentages
Customer failed to attend WCA, provide medical evidence or return questionnaire	9%
Customer disputes FFW decision	13%
Customer disputes ESA group allocations	79%
Others/Unknown	0%

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

Mandatory Reconsiderations – Decision Outcomes for the quarter ending in July 2021

Decision Outcomes	Revised	Not Revised
Customer failed to attend WCA, provide medical evidence or return questionnaire	70%	30%
Customer disputes FFW decision	29%	71%
Customer disputes ESA group allocations	70%	30%

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

Note that percentages may not sum to 100% due to rounding.

The majority of ESA WCA MRs cleared in the quarter to July 2021 were made on disputes about ESA group allocations.

In the quarter ending July 2021 approximately 79% of MR decisions were made on disputes on ESA group allocation, followed by 13% against FfW decisions. The remaining 9% related to disputes where the claimant had not followed the claim procedures correctly.

Question 6

6.  Appeals clearances and outcomes for initial ESA claims started up to June 2020

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, for claims started December 2008 to June 2020

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 number of appeal outcomes for claims that started in the quarter to December 2018 fell below 1,000 for the first time and have continued to fall. In the latest period, for claims that started up to June 2020, there were very few appeals outcomes. The low numbers of appeals may be partly due to the decrease in FfW decisions and an increase in MR revision rates since late 2019, which are likely to affect the number of claimants going on to appeal.

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

Question 7

7.  Health conditions and ESA group allocation for initial assessments

Accepted Answer

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

Note that recent falls in volumes across all groups are likely to reflect falls in ESA initial assessments as UC rolls out

Most claimants assigned to the SG, who started their initial ESA assessment in the quarter to December 2020, were allocated due to health conditions linked to ‘Severe functional disability’. This accounts for 6,000 (66%) of all SG allocations this quarter.

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 2020, 1,300 cases were allocated to the SG due to ‘Physical or mental health risk’, while 1,400 were awaiting/recovering from chemotherapy/radiotherapy and 70 were terminally ill

Note that 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 SG allocations for initial assessments by claim start date, December 2008 to December 2020

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

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.

Note that claimants can have multiple functional impairments, therefore appear in more than one category.

Note that 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.

‘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.

Main reasons for WRAG (15+ points) allocations for initial assessments by claim start date, December 2008 to December 2020

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, 92% had an ‘Adapting to change’ condition and 90% scored points in the ‘Social interaction’ group.

Alongside these categories, in the latest quarter, claimants with impairments relating to consciousness and understanding accounted for 4% and 2% respectively of allocation to WRAG with 15 points or more.

Note that 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 8

8.  Experimental data: Initial and repeat ESA WCAs for October 2013 to December 2020

Accepted Answer

Of the 4.8 million ESA claims with a start date between October 2013 and December 2020:

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, following a completed WCA
99.7% of these MRs, which were raised after the WCA, have been completed, with the original decision revised 17% of the time
26% of claimants who raised an MR after the WCA went on to complete an appeal
of the 100,000 appeals completed, 34% had the DWP decision upheld at hearing while the remaining 66% were ruled in favour of the claimant

Counts of cases going through the WCA, MR, appeals process for initial and repeat ESA WCA, October 2013 to December 2020

Source: Data tables: ESA outcomes of Work Capability Assessments experimental cohort statistics for initial and repeat ESA assessments, by period of claim start, October 2013 to December 2020.

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. Not all claimants qualify, and it applies only to Fit for Work disallowance decisions.

Question 9

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

Accepted Answer

The median end-to-end clearance time is a measure from the claim registration date to the final DWP award decision.

The median end-to-end clearance times for initial ESA WCA claims is 113 calendar days for the latest month, March 2021. This marks the highest median time since November 2016.

After 2008, the median end-to-end clearance time generally followed an upward trend, reaching a peak of 192 calendar days in August 2014 falling to 70 days in September 2019. Since then, it has steadily increased.

One of the stages of the end-to-end process accounts for the time between the customer’s referral to the Assessment Provider (AP) and the AP recommendation. 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.

In March 2021, the median time between referral to the AP and their recommendation was 57 days.

Median clearance times for completed initial claims, October 2008 to March 2021

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

The median end to end clearance times have been following a mainly increasing trend since May 2020.

The increase in trend appears to be driven by the increases in times in the first and second stage of the claimant’s journey, that is the time between the claim being registered and being referred for assessment, and the following stage from referral to AP recommendation.

Since December 2011 until July 2020, the monthly median clearance time from claim registration to referral has remained under 10 days. However, over the last year it has steadily increased from 2 days in March 2020 to 25 days in March 2021.

There has also been increases in the stage from referral to AP recommendation over the past year, where the median clearance time has increased from 43 days in March 2020 to 57 days in the latest month, March 2021.

The median clearance times for this second stage have been impacted by the operational changes during COVID-19.

Median clearance times by stage for completed initial claims since the introduction of COVID-19 operational easements (March 2020), in days, to March 2021

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

Note that 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.

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 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. Due to operational practices performed within the DMACR system, some MRs are recorded on the source data as ‘reconsiderations’. Therefore, for the purpose of these statistics, all ‘reconsiderations’ occurring after the WCA (for reasons typically associated with MRs) have been included within the total number of MRs.
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.

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

Future developments

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.

IB reassessments information on Stat-Xplore

Information on Incapacity Benefit (IB) reassessments is now published via Stat-Xplore as well as via data tables. For future releases after September 2021, we will be releasing IB information only via Stat-Xplore.

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.

Contacts

DWP would like to hear your views on our statistical publications. If you use any of our statistics publications, we would be interested in hearing what you use them for and how well they meet your requirements.

For more information on these statistics, or to provide feedback on our publication, please email wca.statistics@dwp.gov.uk

For further enquiries, you can contact Press Office: 0203 267 5144

ISBN: 978-1-78659-355-9

ESA: Work Capability Assessments, Mandatory Reconsiderations and Appeals: September 2021

1. Main stories