Friday, 6 April 2012

"32" die a week after 'failing' ESA tests: Context please?

A story emerged on April 4th in the Mirror that, on first glance, sounds horrible. 32 people a week die after failing test for new incapacity benefit they say. This is derived, perhaps incorrectly, from the figure of 1,100 given to them through a freedom of information request for the 8 month period of January to August 2011. That 1,100 is those who have died after being told that they have *some* claim to benefits for a year, but need to still try to find work.

ESA, how it breaks down...

First of all, before we go any further it might be useful to clarify some things. First, those applying for ESA, Employment and Support Allowance, the new benefit that is to take the place of Incapacity Benefit (IB), are new claimants. They are people that after 2008 (when the new ESA benefit was introduced, by Labour) were "healthy" and needed not to take this kind of benefit, and are now applying again.

When you have applied for ESA several things could happen. First you could have a change of circumstances and no longer complete your claim, second you could be given the full benefits that are due to your inability to work, third you could be denied any benefit as you are deemed to be "fit for work", or finally you could be placed on an interim group, the Work-Related Activity Group (WRAG). This final group is the controversial one, as it states that you get a smaller level of benefits in return for seeking employment in a suitable field.

It's suitability here that is key. Those in the WRAG grouping are not expected to just find work, otherwise they would be given Job Seekers Allowance while looking for any work, they are expected to work with advisors to find suitable work. The theory is that, for example, someone with a heart condition may be able to work in a job that is not physically taxing.

I am not going to discuss the ins and outs of whether the ESA assessment and subsequent process is failing in following this theory, but it's good to know what the purpose of it all is.

In April this year (2012) the conditions of ESA change, and those in the WRAG grouping will not get any more contribution-related benefits after 12 months of benefits. Those who have received 12 months of benefits on 30th of April 2012 will be cut off from that type of benefit, and will have to rely, if they can, on income-related ESA instead.

However, as yet, they have not. It's important to remember this when talking about the Mirror's FOI findings, both because there is no question of having no benefits (WRAG claimants would get more in benefits than someone on JSA, for example), but also because there could be a greater risk of a heightened mortality rate amongst this group of people when their circumstances change for the worst.

Do 32 people die a week after failing the ESA test?

32 people dying a week is over 1600 people a year. The Mirror's FOI request states 1,100 people that have been placed in the WRAG grouping (not failed, as such, just have conditions) died within 6 weeks of being placed in that group, over an 8 month period. Extrapolating it out, a crude measurement that doesn't take in to account seasonal variation, the figure is reached for 32 people dying. However these people have not "failed" any test, they've just been determined to be fit enough to consider work in certain areas with, as yet, no pressure to take a job that doesn't suit them.

Those that have failed the test are not tracked by those that provided the response to the FOI request, so actually we have little idea from the Mirror's article how many people are dying after truly failing the ESA tests.

Isn't this evidence that people are dying at work after being told their fit to work?

Those that are in the WRAG grouping don't necessarily have to, or do, find work within the first 6 weeks of being assessed. It is an assumption, backed up by no data I have been able to find, to make the sensational claim that people are dying because they are essentially being pushed in to work that they are not physically fit to do.

What we need, to be able to see if people are being pushed beyond their limits, is data about deaths that extend beyond those 6 weeks, and are specifically broken up in to those that find work through the WRAG program, and those who don't. Even with that data we would have to be cautious about reading too much in to deaths that are caused by the underlying problem but NOT exacerbated by the type of work they undertake.

But still, if they're dying they can't be fit for work, can they?

Why not? In the article the quote given on this issue is...

Citizens Advice told us it has found "a number of cases" of people dying soon after being found fit for work.

"There seems to be a clear link between the cause of death and the condition they were suffering from that led to the claim," said Katie Lane, head of welfare policy.

This to me seems to be common sense. If someone has a heart condition that leaves them vulnerable to dying, then the chances are that their death with be linked to that condition, a condition that led them to apply for ESA.

It does not mean, as the Mirror seems to want to allude to, that the person would have survived any longer if they were not deemed fit for work. It is entirely possible for someone to be quite unwell, with a poor prognosis, but for them to still be able to work.

There are wider questions of course about whether we should begrudge those with only years to live with cancer, or serious heart failure, the ability to try and enjoy the time they have left, but with that must also come arguments that are backed up by data that show by putting these people through the process that the WRAG dictates worsens their prognosis.

Isn't it still a huge number of people dying though?

1,100 people dying in a 9 month period is something that I'm sure anyone would describe as "too high", is it comparatively high though? By contrast some 5,300 people, almost 5 times as many, die when they receive full benefit support. To put this in to context we can look at some figures we do have.

Caveats: This is data that is up to date, but only dates from 2008 until February 2011. An assumption is being made by me that the numbers of claimants is the same from January 2011 to August 2011 as they would be in the same period in 2010. The reason for this is that within a margin of around 2-5% the figures of claimants has been consistent and very slowly growing since it has started.

Around 650-700 thousand people apply for ESA every year. Over 120 thousand make it on to the WRAG grouping, while around 50 thousand make it on to full benefits. The rest, up to 500 thousand, either stop their claim or are deemed to be "fit for work" (though the Mirror claims that many appeal and many of them are successful).

This means that around 1.3% of WRAG grouping claimants died a year, while 16% of those successful on their ESA claims died in a year.

By comparison the UK death rate is around 1%.

Does this mean the number of people dying is "normal"

Even taking the crude comparison that those on the WRAG group, who should be more ill or unhealthy than the general populace, are dying at a similar rate as a group as the average population, it doesn't mean this is normal or not.

The real questions are this: How did the same people fare in previous years? Is 32 people a week a number that has increased amongst the WRAG grouping, decreased, or is it stable? Without a trend to look at it's hard to immediately assess if recent news of changes (and clear change of protocol that is leaving many more claims unresolved for too long) has had an affect on mortality.

Even then, such analysis is too general. Really we would want to know how the deaths of these people compare to those in a similar demographic. Gender, age, obesity, smokers, drinking habits, etc... to know if this statistic is "shockingly high" as someone described it to me, we'd need to know what the rate of deaths is for those not assessed but share the same traits/lifestyles.

The simple fact is that we don't actually have enough data put in front of us, as far as I can tell, to say if these levels of deaths are bad or normal in the grand scheme of things.

So what does it tell us?

Nothing, unfortunately. It doesn't tell us if these numbers of deaths are larger than usual, either for the demographics of the people involved, or for the level of incapacity the government determines people to have over a period of time.

I believe this article by the Mirror is trying to make a claim that this government has done something to make it more likely for people to die, however conditions outside of the length of time that it takes for claims to be processed since the 2010 election have not changed. Slightly more people are making it on to the WRAG grouping, however this is actually because LESS people are being told they are fit for work. Changes to benefits that would affect those who have been on ESA don't come in until the end of this month so statistics about January to August 2011 are unaffected by them.

It seems cynical and based in political ideology that the Mirror would choose now to make these claims when there is every chance that the same numbers could have been leveled, in proportional terms, at the Labour party. Without the context of how these numbers of deaths compare, the statistic of 32 deaths a week is worthless. Worst of all it seems to conflate the issue of being fit for work with being "in good health", which are ultimately two things that don't necessarily have to align with each other.