RCN Congress and Exhibition Liverpool 21-25 April 2013

1. Disability assessments

Inner North Central London Branch

(R) That this meeting of RCN Congress believes that the current process of disability assessments in the UK is discriminatory and unfit for purpose and urges Council to campaign for a review

Dominic Walsh, from the RCN Inner North Central London Branch, asked Congress delegates to endorse the view that the current process of disability assessments in the UK is discriminatory and unfit for purpose. As he urged Council to campaign for a review, he acknowledged that in his own field of work (palliative care), this is an issue he did not previously have to personally address. However, since moving to community work, he said he was increasingly seeing people who had been struggling for years to get access to welfare support.

He said the “shocking” percentage of successful appeals – 38 per cent – and the 89 per cent increase of requests for help at the Citizens Advice Bureau have served to highlight the severity of the problem.

As a professional union, it was time for the RCN to highlight the problems of the assessment process, he said. 

The resolution was seconded by Linda Bailey from the Public Health Forum who said this “disgraceful treatment” of vulnerable people should not go unchallenged. She said the current process resulted in mental stress which some people cannot cope with.

David Baker, who works in substance misuse, backed the argument, saying that the stress of being assessed as fit, when they are not, can jeopardise a patient’s recovery. Tom Bolger gave delegates a description of the “fairly threatening” environment in which Atos Healthcare assessments take place.  He added that he did not just fear for patients’ health, but also for the Nursing and Midwifery Council registration of nurses undertaking the assessments.

More delegates took to the stand with descriptions of the negative impact the assessments had on vulnerable patients. Christina Sosseh paraphrased Edmund Burke, reminding RCN members that for evil to exist, it only takes good people to do nothing; and Vivienne Ferris, former Chair of WING, told delegates that the “horrendous changes” were causing serious problems for RCN members.

RCN Deputy President Cecilia Anim summarised her attack on the system saying it was based on the simplistic notion that if you can walk and talk, you can work.  This, she said, was nonsense.

The resolution was passed with an overwhelming majority.


The resolution was passed.

For: 97.51% (431)
Against: 2.49% (11)
Abstain: (4)

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Debate report


More than 15,000 people go through disability assessment in the UK each week.

There is concern that the current system is not fit for purpose, and the RCN has been alerted to a number of cases by members, raising concerns about the pressures placed on them to declare people fit for work, despite the findings of their professional medical assessment.

Reports in the media talk of having to meet targets for how many applicants are deemed as fit for work. This indicates that if targets are to be met, some applicants may be incorrectly categorised, and being declared fit to work when they are not able to.

Of equal concern is the distress that has been caused to individuals and families where the capability work assessment processes have led to perverse judgements. This includes RCN members whose disability is related to a serious accident or incident that occurred in the workplace, who have also been incorrectly assessed.

In September 2012, the Labour Party called for a "fast and radical" overhaul of the system, admitting the policy it introduced when in government was not working. And the Department of Work and Pensions (DWP) stated in October that: "The work capability assessment is under constant review to ensure it is both fair and effective, and it is in everyone's interest to get the system right."

In Scotland, the private company contracted by the DWP to carry out medical assessments of people claiming benefits subcontracted these activities to the NHS in Scotland (led by NHS Lanarkshire). This is an unusual example, and one which has prompted questions from government ministers about whether outsourcing represents value for public money if services are, in turn, subcontracted to the public sector.

Nursing expertise can be helpful in assessing people's conditions and their potential to work, but it is essential that the clinical judgements of those making those assessments are not swayed by any other pressures and are set within an effective framework.

The rigidity of assessments makes it difficult for the professionals involved to make valid and reasonable judgements and consequentially, the appropriate risk assessments.

The RCN has no objection to the principle of ensuring that spending on welfare is responsibly managed and goes to those who need it most. However, it maintains that the process of making this judgement should be open to scrutiny, affecting as it does some of the most vulnerable people in society.

References and further reading

Gentleman A (2012) Get ready for work: what woman who needs constant care was told, Guardian, 3 October [online]. Available at: www.guardian.co.uk/society/2012/oct/03/work-woman-care (accessed 12/03/13) (Web).

Gentleman A (2012) Atos calls in public sector to take on outsourced medical assessments, Guardian, 10 October [online]. Available at: www.guardian.co.uk/business/2012/oct/10/atos-outsource-medical-assessments (accessed 12/03/13) (Web).

Parliament Commons Select Committee (2013) Report on the Department for Work and Pensions: Contract management of medical services, London: Parliament. Available at: www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/contract-management-of-medical-services/ (accessed 12/03/13) (Web).

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