Reporting on "fit for work" deaths isn't fit for purpose

"2,600 benefit claimants die within weeks of being ruled fit for work"

The Daily Mail, 27 August 2015

"More Than 4,000 Died Within Six Weeks Of Being Deemed 'Fit For Work', Reveal Government"

The Huffington Post, 27 August 2015

"Over a two-year period, 2,380 people claiming employment and support allowance (ESA) died within a fortnight of being told they were deemed able to work and so would lose the benefit."

The Times, 28 August 2015

Yesterday the Department for Work and Pensions (DWP) released data on the deaths of benefits claimants in Great Britain.

It was widely reported that thousands of people died within weeks of being found "fit for work" and losing their benefits.

This is wrong.

Within weeks of ending a claim, not within weeks of an assessment

The figures show the number of people who had been found "fit for work", and who died within weeks of their claim ending. They cover the period from late 2011 to early 2014. It's likely that in many of these cases, the person dying was why the claim ended.

A claim quite naturally ends when a claimant dies. The data being used here is collected every two weeks for Employment and Support Allowance (ESA) claimants and longer periods for other benefits.

If a claim ends between collection dates without the date of the end of the claim being recorded, then the DWP has to 'estimate' a date for the end of the claim between the two sets of records. If an ESA claimant died within 14 days of the estimated date, then they are recorded as a claimant who died and ended their claim for that reason.

In this case, the number of people dying within two weeks of a claim ending is not the same as the number of people who died within two weeks of being found "fit for work".

Before October 2013, someone could have been found fit for work, appealed the decision, and continued to receive ESA during the appeal process. There is no way of telling how long after the start of the appeal process those claims ended. (In October 2013, part way through the period the figures cover, the appeal rules changed so that ESA stops as soon as a decision is made and before people can appeal they have to go through a new stage of mandatory reconsideration by DWP. ESA is not paid again unless or until an appeal is lodged with medical evidence.)

Different outlets use different figures on the same topic

More than one set of figures was used in the press. The Mirror stated that 2,650 benefit claimants died shortly after being assessed as fit for work.

They reached this figure by adding the 270 people who died claiming Incapacity Benefit (IB) and Severe Disablement Allowance (SDA) after being assessed fit for work to the 2,380 people claiming ESA.

The Huffington Post stated that more than 4,000 people died within six weeks of being found "fit for work". This counts some people twice. The 4,000 figure takes the overall number of people found "fit for work", then adds the number with a completed appeal following a "fit for work" decision. But people who appealed their decisions are already included in the overall total and the two can't be added in this way. The "within six weeks" part of the story relates to claimants of IB and SDA.

Mortality rates matter

If 2,380 people on ESA were found fit for work from late 2011 to early 2014, and all 2,380 subsequently died in the process of challenging that decision, that would indicate that something was almost certainly going wrong in the assessment process.

But if 2 million people were found to be fit for work, there would be less concern that the assessment process was going wrong; one in 1,000 dying could just be the result of the 'normal' level of accident, misfortune and sudden illness.

If we want to know if people found fit for work are more likely to die than the general population, then age-standardised mortality rates would let us make that comparison while adjusting for differences in age and gender.

Unfortunately, the DWP has not published an age-standardised mortality rate for those found "fit for work". They may not be able to do so; publishing a mortality rate for people who were found fit for work would require information about people no longer claiming benefits who died during the time period in question.

What they might be able to do is find a mortality rate for people who left ESA and remained within the benefits system. However, this would miss the people who left the benefits system entirely. Using this figure to infer a mortality rate for the entire group found fit to work could be problematic if there are systematic differences between those who leave the benefits system and those that remain within it.

Correction 30 August 2015

The article orginally said that: "If someone is found fit for work, they can appeal the decision, and continue to receive ESA during the appeal process." That's true of some of the people in the figures, but after October 2013 an additional stage of mandatory reconsideration by DWP was added before appeal during which people do not get ESA, as is now explained above.

Update 30 August 2015

We added "on ESA" to the first paragraph of the section Mortality Rates Matter. The section was intended to be discussing ESA specifically, and it is mentioned in the last paragraph, but this wasn't clear.

Update 9 September 2015

This article was quoted by the Prime Minister at Prime Minister's Questions today.

For that reason, we have added the full, slightly technical, written explanation of the figures we obtained from DWP, which may be useful to others trying to understand them:

Once found FFW [Fit For Work] an ESA [Employment and Support Allowance] claim ends so anyone who died during a mandatory reconsideration period would not be classed as being in receipt of ESA at the time of death and should therefore not be included in the figures. If the claimant goes on to appeal the MR [Mandatory Reconsideration] decision then the ESA claim is reopened.

Therefore anyone who died during an appeal period (whichever stage of the appeal process they are in) would be classed as being in receipt of ESA at the time of death and would be included in the table 2.3 figures.

In response to your third question, yes it is possible that someone may not have appealed the FFW decision and due to time required to update the system they were still in receipt of ESA when they died.

It should also be noted that, as detailed in the publication, the data in tables 2.3 to 2.6 (and table 1) should be viewed with some level of caution as the figures are derived from unpublished information and have not been quality assured to National Statistics or Official Statistics publication standard.

I can confirm that the figures to which you refer include people who died up to 2 weeks after their ESA claim ended i.e. those where death is believed to be the reason for the claim ending, as specified in the publication. The FFW decision may have occurred at any point in the preceding period.

The weekend after publication we received feedback that the article had misunderstood who was included in these figures. Following our feedback process, the Director reviewed the article and research—including our exchanges with DWP—over the weekend and concluded that the article was accurate and accurately reflects what DWP itself told us and others that the figures meant. We sought this written confirmation at the end of the weekend, and received it later that week.