A scheme to get claimants off long term disability back to work is turning into something of a PR nightmare for the government. The sight of disabled protesters and their growing number of supporters taking to the streets, after a widely acclaimed Paralympics, is one it might wish to avoid.

At the heart of this controversy is something called the 'Work Capability Assessment' (WCA) which determines if you are entitled to Employment Support Allowance (ESA). This benefit is paid to those with limited capability to work because of ill health or disability.

To many who have been through the contentious 'medical assessment', part of the WCA carried out by ATOS Healthcare on the Department of Work and Pensions' (DWP) behalf, it is a blunt instrument which, they argue, makes a mockery of their illnesses and can be demeaning.

Having to apply for ESA is causing unnecessary stress for some claimants who feel the extent of their disability speaks for itself. This is not how policy strategists see it, however.

The WCA is an integral part of the new system as is the more demanding medical assessment. But when up to 40%of appeals by unhappy claimants to overturn initial assessments were successful then something is clearly wrong, adding weight to concerns the process is more than simply flawed.

Indeed, rarely has implementation of any new policy caused so much outrage. Media is awash with reports of claimants dying after being declared fit to work, MPs on about the sheer injustice of it, olympic protests against ATOS, suicides and terminal cancer or even psychotic patients being told they are fit for work.

With the Universal Credit being rolled out in 2013 the distrust generated by the ongoing controversy over ESA won't help endear sceptics to another package that could, in spite of concerns about readiness, make life easier for many welfare recipients. Sorting out the Employment Support Allowance mess first might help.

Excepting those who clearly are too ill or disabled, the default premise of the present strategy introduced in 2008 appears to be that huge numbers on disability are able to do some work, and the onus is on them to show they can''t.

But a common grievance with the scheme is that it is work, not 'condition' oriented. It emphasises what you can, rather than what you can't do and makes a virtue of looking beyond your limitations, concentrating, unrealistically some feel, on your capabilities.

Claimants undergoing WCA fill a questionnaire some find confusing, even duplicitous. Such is the unfortunate level of mistrust trust surrounding the whole thing that support groups frequently tell their clients to consider how they respond to even informal, friendly queries like "did you come by car?"or "did you walk from the bus stop?" as these reveal snippets about the physical capabilities of the informant.

Many have a medical assessment which is nothing like the illness-orientated clinical exam they are used to when they visit their own doctor. This can be disconcerting for some more attuned to pouring hearts out to healthcare professionals they trust and know.

The focus of proceedings is very much on all that is right, like checking how long you can stand or sit for, if you can move your arms freely or pick something off the floor without too much discomfort. If you can complete these and other tasks, and pass basic clinical tests then you may be deemed fit to work and lose entitlement to ESA..

But many patients complain that distressing symptoms they intermittently complain of, or other illnesses they suffer from, appear to be ignored or are described as not being relevant when they bring them to an examiner's attention

Although the present strategy is justifiably framed to encourage those capable of work break the cycle of dependence many feel that the rigid, impersonal way it is implemented signals a divisive plan to slash social welfare spending by targeting those in no position to complain.

There is no doubt that some claimants, unable to withstand the bureaucratic onslaught conveniently fronted by what they perceive as a medical inquisition they do not comprehend, will succumb and give up without a fight. This, critics suggest, could be part of the agenda

If we are to challenge a decades-long 'culture of dependence' then we need to tread carefully, know its extent and not confuse 'dependence' with 'disability'.

An aggressive strategy aimed at helping the genuinely disabled unable to work which lumps many of them in with those who possibly can, on top of a very small minority of shirkers is bound to be problematic. Not recognising this is a serious failing in its own right.

It is the silent minority you don't see or hear complaining on social media, but who accept 'judgements' that they are 'fit to work' when clearly many are not and have little prospect of ever finding it, who are the hidden victims of a policy being implemented with the finesse and speed of a runaway freight-train.

An equitable system would help those who need assistance and challenge those - there are many - who don't. It will work if there is trust but won't if there is not. Certifying dubious cases - and this lies at the heart of the present debate - is nearly always a matter of clinical judgement. But it can be done fairly, effectively, authoritatively and with consensus.

A one cap fits all approach to a complex social issue involving disability is not ideal. Factors like opportunity, unemployment, discrimination, exploitation in the workforce or ongoing medical support simmer in the minds of many concerned about being forced back to work. And these concerns need to be addressed, not just talked about. That takes time and patience, something which is missing from the present debate.

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