In two weeks I have to undergo a Work Capability Assessment which will determine whether or not I will continue to receive Employment and Support Allowance while I am ill. I will be placed into one of two groups: the Support Group, who are judged sick enough to be left alone to receive ESA, or the Work Related Activity Group, who are thought able to attend several Work Focused Interviews and eventually to be able to work if pushed enough. If by some miracle I am suddenly cured, I could be declared fit to work and moved on to Job Seekers Allowance and classed as unemployed.
That all sounds OK, you might think. It sounds reasonable, we have to make sure that sick and disabled people receive support, and the the work shy are sent back to work. But there's a problem. It isn't my GP that will carrying out this assessment. Nor is it any hospital specialist. It's not even the Department of Work and Pensions that will carry out this test, even though they requested it. No, instead of any of these, it is a French IT company called ATOS that will decide if I am fit to work or not. Specifically, a division of ATOS called ATOS Healthcare that has been contracted by the DWP to carry out these assessments and provide "medical advice" at a cost of £100 million a year. "That's absurd!" you may say. What does an IT company know about health? Well, that doesn't matter, according to ATOS. They have developed a computer system called LiMA that records the patients answers given in an interview, and makes the decision based on points. It's all very straightforward. What could possibly go wrong?
Well obviously something has, because ATOS is the subject of strong protest. On twitter and on blogs anger against ATOS has been obvious, cropping up again and again. In the physical world campaigners have held extensive protests outside ATOS buildings, with signs and slogans like "ATOS kills" and "ATOS don't give a toss." ATOS recruitment fares have been targetted too. When sick and disabled people are scared and angry enough to picket a company, wheelchairs and crutches and all, there might just be something wrong. A commons select committee has been investigating the Migration from Incapacity Benefits to Employment Support Allowance, and while questioning senior executives from ATOS healthcare MP Stephen Lloyd said that Atos was "feared and loathed probably in equal terms" by the families and friends of disabled people. Lisa Coleman, a senior manager at ATOS, said that "fear and misunderstanding" could be blamed on claimants "not really understanding the role that Atos plays".
So what is the problem with ATOS? Well, for a start, the computer can only work with what it is told. And what it is told is keywords. The examiner asks questions about things such as walking, reaching, communicating and controlling the bowels. The answers don't really matter much, because the examiner stares fixedly at the computer screen and picks keywords and numbers from a list as they are mentioned and the computer assembles them into a sentence and fills in the gaps. This has often resulted in some absurd and misleading statements. Some genuine examples include "usually can do light gardening for 1 minutes" and "The client’s Amputation of Upper Limb is mild. They have seen a specialist for this problem." Another claimant stated that she pottered about all day; it was recorded as "Customer does pottery all day." After the questioning is complete there is usually a very short physical examination. The claimant may poked and prodded and instructed to stand up, raise their arms, pick something up, or make other movements. It is all very rushed and does not leave time or scope for much useful data to be gathered. In addition the examiner records observations about the patients ability to walk and talk while at the assessment.
This assessment is flawed for several reasons. Firstly, the data gathering process is inaccurate and rushed. Staff carrying out the assessment have strict targets and are expected to get through five assessments in a morning or afternoon session, which allows about 45 minutes per assessment at most. People that have been through the process complain that the examiner spent their time looking at the computer rather than paying attention to them.
Once the examination is over the examiner produces a report that may bear little resemblance to the patient's actual condition. The reports often fail to take into account the variable nature of many illnesses. What the patient can do on one day is by no means representative of what they can do the next, and for someone who is chronically sick or disabled, each task in itself may be achievable but exhaustion and pain can often prevent repetition or moving on to the next task.
An ATOS examiner might note that a person can sit at a computer, walk to the shops, cook a meal, and wash themselves. What they fail to note is that it might well only be possible to do one of those things on any given day! Being fit to work in an office, for example, involves a series of tasks - washing, dressing, commuting, sitting, talking, thinking, typing, holding the telephone, holding a pen, making decisions, defending those decisions, and much more. I could do any of those things, sometimes, maybe, but I could not do them all together, and I certainly could not make any guarantees about when I could do them or how long it would take, or even guarantee to do them at all. ATOS cares not. If you say that you can ever manage a task, it is assumed that you can do all of the tasks all of the time. They may well assume that because I could write and record this article, I could write for a living. They don't see that it took me several days to write including many hours of frustration as my body left me in too much pain or fatigue to think or type.
Another flaw is that the ATOS assessment process can often be harmful in itself. For example, I could usually raise my arm above my head when asked. It would result in pain and fatigue which the examiner would not see. It would also be harder to do a second time, and after a few goes I would be unable to do it at all. The ATOS examiner would simply note that I could manage it the first time and would take no account of whether or not I could do it again or what price I paid for doing it.
More problems occur because at least a fifth of ATOS medical centres are not wheelchair accessible. Only one third of the centres have onsite parking, while visitors are required to walk from car parks several minutes away for other centres, and just one has a parking space for disabled people. 30 of the centres are not on the ground floor some don't even have lifts! Considering that people only visit these buildings when they are sick or disabled and a huge number of them will be using walking sticks or wheelchairs, this is ridiculous.
For many people, just getting to the ATOS medical examination centre can be a major challenge. In a letter sent out to notify me of my impending assessment I was helpfully sent a suggested journey plan. It included bus, train and 17 minutes of walking. I do understand that the journey plan is a standard item sent out to all claimants, and this is why they have suggested that I walk despite them being fully aware that I cannot stay on my feet for more than a couple of minutes. But I can't be the only one that would have trouble with that journey. In fact, I would suggest that a majority of people that claim ESA would find it difficult. Whether that be through inability to stand or walk, or pain, or fatigue, or because of a lack of accessible buses, or through mental health problems that get worse when around other people or attempting a task such as travelling. The problem is that many people will attempt and complete the journey at great cost to their own health, purely because they feel that they have to. Again, ATOS would merely note that the journey had been completed, and not what it cost in terms of pain, fatigue and recovery time.
It is not just the people subject to the tests that are unhappy with the situation. As I mentioned above, a commons select committee has been investigating the Migration from Incapacity Benefits to Employment Support Allowance. In February, Dr Margaret McCartney attended a recruitment evening with ATOS Healthcare and reported back in the British Medical Journal. She noted that apart from doctors, ATOS also recruit nurses and physiotherapists for the same role, and that patients often would not be examined by anyone with knowledge of their health conditions. She reported that ATOS said "You are not in a typical caring role. This isn’t about diagnosing." and "We don’t call them patients . . . We call them claimants." She said that "Throughput is a clear focus" and that "from the recruitment evening it was clear that the medical examination consisted of a computerised form to be filled in by choosing drop down statements and justifying them. For example, you could say “able to walk with ease” if you witnessed this or the patient told you this." Even Professor Paul Gregg, who was involved in designing the test has said "The test is badly malfunctioning. The current assessment is a complete mess."
Since ATOS have taken over the assessments for ESA, both ESA and the contract with ATOS originating from our last government, by the way, the number of people being judged fit for work has risen substantially but high numbers of those go on to appeal with a 40% success rate at overturning the decision. That rises to 70% of cases overturned when representation is provided. This has caused alarm to a great many people with groups such as Citizens Advice Scotland reporting "Our evidence has highlighted the cases of many clients with serious health conditions who have been found fit for work, including those with Parkinson’s disease, multiple sclerosis, terminal cancer, bipolar disorder, heart failure, strokes, severe depression, and agoraphobia." In fact there have been several recent cases where people have died soon after being judged fit for work and while waiting for their appeal. In one case the patient died IN the ATOS building after his assessment. On the day of the funeral his family received a letter notifying them that he had been declared fit for work.
Clearly, the Work Capability Assessment needs a rethink. Actually, the whole system by which benefits are controlled needs a rethink. Government insist that GPs can be trusted to take over administration and budgeting of the NHS from Primary Care Trusts, and yet they do not trust GPs and specialists to say whether or not their patient is capable of work or needs to rest at home. The current arrangement for ATOS to assess patients does not and cannot provide for accurate assessment and proper care.
This article has been cross-posted from Tentacles of Doom
Margret McCartney reports for the BMJ: Well enough to work?
The Guardian: New disability test 'is a complete mess', says expert
ESA and how the Lima computer system says "NO"
The Guardian: 'The medical was an absolute joke'
MP asks Atos bosses why their company is ‘feared and loathed’
Disability activists demonstrate against Atos Origin - London
3 more assessed "fit for work" by ATOS die
BBC Ouch: ATOS assessment centres not accessible
Commons Select Committee: Migration from Incapacity Benefits to Employment Support Allowance
Disabled People Against Cuts: Atos don't give a toss!
DPAC - Debbie Jolly: The Billion Pound Welfare Reform Fraud: fit for work?
PCS - Welfare: an alternative vision [PDF]