Friday 8 July 2011

What's wrong with ATOS

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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

 

Related Links


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]

15 comments:

  1. Equally problematical is the deceptive nature of the questioning by ATOS, with an answer to 'Do you like watching TV?' of 'yes' being treated as meaning you are capable of working at a computer workstation for extended periods. Unless someone knows this they are unlikely to provide the necessary information to put that statement in context. I did know this going into my WCA and was able to insist, over the doctor's objections, that I would give a full answer, and that that answer was that I did like watching TV, but had to do it lying on my back as sitting is too painful. My assessment of the WCA questions is that their deliberate obfuscation and deliberate attempt to prevent a complete answer renders them immoral and that conducting the WCA in that manner places a doctor in violation of not just their professional oaths, but their legal duty of care.

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  2. I agree with all said above. I have mental health problems such as PD, depression,OCD, and social phobias. I went to my 'last' ATOS assessment end of feb and it almost killed me then last week low and behold I have another questionnaire through my door? My support worker rang up to say I had just had one of these only to be told one must be completed every 6momths!! Omg! The thought of having to go through this every 6 months is awful. What if the nxt person to assess me knows nothing about mental health?
    I feel they are just going to continually re-assess until they can kick me/you off of ESA
    I seriously don't know how long I can cope with this.

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  3. I went to be interrogated by ATOS early last year, I was doped up on medication and slept through most of the interrogation after trying to answer their first question, "What are my conditions" The words wouldn't come out so the person with me took over answering the questions. The HCP put on the report that I was fit for work & that I shouldn't go to work in the longer term, HOWEVER LONG THE LONGER TERM IS? I know by the letter they send out informing of benefits increases that they intend to assess me again in December this year.
    I am either asleep or unable to concentrate on anything after about 30 minutes of taking the meds. What I found weird about my interrogation was that the HCP scored me the most points on mental health, now if being asleep is a mental issue then the whole country should be on ESA as we all have to sleep.

    In a way I am looking forward to the interrogation as I intend to tell them what I WILL BE DOING at the interrogation and that is making an audio recording whether they like it or not as it will be mentioned in bold on any paperwork that has to be sent back to either DWP or ATOS

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  4. Did anyone know about For travel to an alternative (MEC), ATOS WILL PROVIDE TRANSPORT IF THE JOURNEY WOULD PRESENT THE MEMBER OF PUBLIC WITH EXCEPTIONAL DIFFICULTY”

    I never knew that one but found out just today.

    Has anyone ever been transported by Atos to an alternative assessment centre?

    http://victimsofatoscorruption.wordpress.com/

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    1. YES, I HAD INTERROGATION YESTERDAY MY DOCTOR FAXED ATOS
      THAT DUE TO LONG TERM MENTAL PROBLEMS AND SEVERE IBS AND IRRITABLE BLADDER I NEED A TAXI OR A HOME VISIT.

      ATOS DID SEND A TAXI FOR ME BUT I SHOULD HAVE TAKEN A FRIEND WITH ME AND DIDN'T I PUT MYSELF THROUGH TORTURE GOING ALONE AND I WAS THE ONLY PERSON THERE UNACCOMPANIED AND I KNOW IT WENT AGAINST ME. THE FINAL QUESTION THEY ASK IS HOW YOU GOT THERE AND IF YOU CAME ALONE. SO, PRESUMABLY THE FACT THAT I GOT THERE AT ALL MEANS I AM ABLE TO DI IT - BUT I AM NOT ABLE MANY DAYS TO EVEN LEAVE MY HOME AT ALL, EVEN THOUGH I HAD VALIUM IT WAS INORDINATELY DISTRESSING AND ON THE WAY BACK I WAS SHAKING , SWEATING, FEELING SICK AS I SLOWLY REALISED HOW I HAD BEEN TRICKED BY ATOS, IT WAS NOT A DOCTOR WHO SAW ME BUT A PHYSIOTHERAPST - I BELEIVE THEY SIMPLY EMPLY THE FASTEST TYPISTS THEY CAN FIND AND THEY JUST MAKE UP
      THINGS WHATEVER YOU SAY THEY ARE NOT LISTENING JUST THINKING OF THEIR BONUSES, AS THE MORE PEOPLE THEY GET THROUGH IN A DAY, THE MORE THEY GET.

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  5. Corrupt from start to finish is the DWP. Thought Thatcher was bad with the 'care in the community agenda' but Cameron... well why doesn't he just build a few concentration camps and shove all impoverished and the disabled down a pit after gassing them. I'm quite sure he and his cronies will then save enough revenue to spend even more on their mansions, and expensive holidays.

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  6. ATOS appear to have more evidence mounting against them every day. I don't know how long their position will be sustainable for.

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  7. After filling out my medical form, the only contact I had from ATOS was an answer message on my phone informing me of the date and time of my appointment. I received NOTHING in writing or over the phone at all after that, and had to find out where the centre was and how to get there myself. And don't even get me started on the "assessment"

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  8. You could have been writing about my son. He is 20 next month. I have just completed the application for.esa and I await the medical questionnaire. he has no 'illnesses' but has a severe and complex learning disability. He can walk, talk etc but cannot process or retain information accurately. I am dreading his assessment. By becoming an adult the difference in the money I receive for.him as a child will drop.by £125 a week! Now with all the benefit changes I am really worried

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  9. Excellent article. This is always the problem with computer assessments. They cannot possibly know the nuances of life and the result is completely ridiculous. I have many clients who I can verify are unable to work, but would a computer questionnaire designed by people determined to cut costs represent that? I think not.

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  10. i have a mental illness.how can a doctor,or computer assess my state of mind ?.if i go to a assessment it should be with a mental health expert surely !.

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    1. I AGREE, I HAVE MENTAL HEALTH ISSUES AND IT WAS A PHYSIOTHERAPIST WHO SAW ME - IT IS SO RUSHED AND I BECAME SO PANICKED AND CONFUSED YET HE HAD NO CONCEPT OF IT AT ALL, I TRY TO CONTAIN IT - I WISH I HADN'T I WISH THEY HAD SEEN ME WHEN I GOT BACK HOME CRYING AND WAILING AT THE PRESSURE IN MY HEAD AND PERSECUTORY VOICES AND THE AWFUL REALISATION - THAT ATOS AND THE GOVERNMENT DO NOT CARE HOW DEEP ONE IS IN DESPAIR. IT IS ALL ABOUT MONEY - BILLIONS GOING TO ATOS AND THE GOVT. ROBBING THE POOR TO HELP THE RICH - THEY DO NOT KNOW WHAT IT LIKE - THEY ARE MILLIONAIRES - THERE ARE NO JOBS OUT THERE FOR YOUNG GRADUATES LET ALONE
      PEOPLE LIKE ME

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  11. I also have emotional problems as well COPD which is quite severe I can only walk a few yards without a black ring surrounding my vision. I went through the medical assessment in February this year (2012) as a result ESA was withdrawn, and my application for DLA was also refused on the strength of this assessment. Both of these decisions are now in the long convoluted process of the benefits of the benefits appeal system.

    Having read a lot of what is written here about ATOS I am rapidly coming to the conclusion that the best way of dealing with this company is going to be concentrated multiple lawsuits brought by everybody who has had an unsuccessful assessment by ATOS. I would recommend that everyone who's had an unsuccessful assessment and genuinely believes that this is wrong should in the first instance appeal against any detrimental benefit decisions (all of them) and secondly that perhaps at least the people who are still in receipt of benefit should also bring a county court action based upon the following against ATOS. I will calculate the amount by working out the potential total loss of benefit for the rest of the reasonable lifespan and then doubling it has punitive damages. This is what I intend to do.

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    1. I THINK THAT IS A GOOD IDEA - THE C.A.B. CAN HELP BUT THEY ARE SNOWED UNDER AND THE GOVT. KNOW ESPECIALLY PEOPLE WITH MENTAL HEALTH ISSUES, THAT THE STRESS OF GOING THROUGH WITH A COURT CASE PROBABLY BE TOO MUCH AND I EXPECT THEY WILL TRY TO HAVE CASES SLUNG OUT OR SUPPRESSED - MAKE IT DRAG ON AND ON - TILL YOU BREAKDOWN OR DIE - IT IS WICKED TORTURE - THEY ARE MAKING PEOPLE SUFFER FOR NOT BEING RICH - MONEY IS THE CAUSE OF ALL THIS - WHY CAN'T WE ALL HAVE SHARES OF THE LOTTO?

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  12. I wont go through my whole story on how the Government have let me down, but just to say ATOS insisted by phone that is, a so called human being, that I must attend the assessment on a certain day, I said I couldnt as this was only 5 days after my imminent triple bypass surgery and didnt know if I would be well enough as I was told by the surgeon expect to be laid up for a few weeks and on he mend up to three months or more, the lady from ATOS replied saying that dont I think I could attened with help, I questioned why she has asked me such a silly question, she said as they may now stop your benefits.. this was 2 days prior to the operation. By the way I was working and gat sacked for being ill!!! Different story but won Employment Tribunal..... ATOS are inhumane and I just hope none of them get ill. Still recovering and have many new job offers for when I am recovered, tomorrow I am having to attend a day on how to get a job!! I am 46 never been out of work and the young girl there, nice enough, but maybe the same age as my son..

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