The Department for Work and Pensions is getting far too many decisions wrong on claimants' ability to work. This is at considerable cost to the taxpayer and can create misery and hardship to the claimants themselves. This poor decision-making is damaging public confidence and generating a lot of criticism of the Department's contractor for medical assessments, Atos Healthcare - but most of the problems lie firmly within the DWP. The Department's view that appeals against decisions are an inherent part of the process is unduly complacent. Nearly 40 per cent of appeals are successful, with a third of those successful appeals involving no new evidence. The Work Capability Assessment process hits the most vulnerable claimants hardest. The one size fits all approach fails to account adequately for mental health conditions or those which are rare or fluctuating. While the Department has started to improve, the process is still too inflexible and too often is so stressful for applicants that their health simply gets worse. A key problem is that the Department has been unable to create a competitive market for medical assessment providers, leaving Atos in the position of being a near monopoly supplier. The Department is too often just accepting what Atos tells it. It seems reluctant to challenge the contractor. It has failed to withhold payment for poor performance and rarely checked that it is being correctly charged. The Department also cannot explain how the profits being made by Atos reflect the limited risk that it bears