Sick? No you’re not!

This news item is worrying. Scary, in fact.  GPs should ‘not sign off long-term sick’ [BBC] I’ve quoted most of it here, with my responses.

People should be signed off for long-term sickness by an independent assessment service and not GPs, a government-backed review says.

Strange. The government trusts GPs to run the NHS but not to decide who is too sick to work. Yet they trust Atos and Group 4 who have a proven record of ignoring evidence and making wrong decisions. I wonder which company the government will outsource this “independent” assessment service to?

The review also suggests tax breaks for firms which employ people who suffer from long-term conditions.

This, I actually like.

It is estimated the changes would send 20% of those off sick back to work.

This is blatantly a move in favour of employers and against employees. Tories always side with people with money. Perhaps the government should instead ask why so many people are sick.

A Department for Work and Pensions spokesman said: “The government is committed to supporting more people with health conditions to work.”

Supporting? They mean forcing. Whether it’s what people need for their health or not.

Around 300,000 people a year are absent from work due to long-term sickness.

Perhaps there is some problem other than people pretending to be sick. Perhaps being forced to do too much work for too little pay is the problem. Perhaps employers should pay more and stop sacking people and then forcing other employees to do the work of more than one person.

The review also calls for a new government backed job-brokering service, to find work for people cannot stay in their current job because of their condition.

Great idea. But don’t force it on people that shouldn’t be working at all.

A survey suggested 77% of GPs had admitted they signed people off sick for reasons other than their physical health, the report authors told the BBC.

What, like MENTAL HEALTH? This is an absurd, biased statement that ignores a huge part of health care.

The government asked Professor Carol Black and the former head of the British Chambers of Commerce David Frost to consider radical changes to deal with the human and financial cost of sickness absence in the workplace.

Ah. “Deal with”. Because it must not really be sickness.

If the recommendations are accepted people who are signed off sick would also be put on to Job Seekers’ Allowance, instead of Employment Support Allowance, for a period of three months.

They would receive less money and have to prove they were looking for work.aul

This is outrageous. In fact, it’s evil. When someone has been signed off sick the last thing they need is to be forced to look for work. Being made to visit the job centre every fortnight can be very difficult and highly damaging to what little health remains. Looking for a more suitable job means being forced to leave the job you are in and abandon hope of going back which can be crushing. Even if there are jobs which a sick person could manage to fit around their problems, most employers would hire a healthy person, which means endless applications and rejections which cause stress, which in turn aggravates both mental and physical health problems. Sometimes a GP will sign a person off work because they need rest, both physical and mental, in order to recover from their illness.

The government’s new policy to deal with the costs of sickness in the workplace appears to be to pretend that people aren’t sick at all.

 

—Update—

As is pointed out by Paul Cotterill at Liberal Conspiracy, Atos founded the Commercial Occupational Health Providers Association (COHPA) which has seats on Dame Carol Black’s select committee for occupational health and the Council for Work and Health. COHPA boasts

COHPA has been active politically in trying to represent the interests of commercial OH providers to Dame Carol Black, Government and key bodies in the industry.

It seems likely that Atos will be well-placed to bid to carry out these assessments.

Conservatives: Protecting the vulnerable?

When I contacted my Conservative MP a year ago to express my concern about government policy towards sick and disabled people, he told me that “I see something different, I see the vulnerable protected.”

I still can’t see that.

Conservatives,

Your ministers and special advisers constantly give incorrect information to the press and in speeches. You give misleading statistics to the press, and you leak it in advance to press that are sympathetic to conservative policies. That leads to headlines that seriously harm those reliant on benefits. Your language is itself harmful. You talk of benefit cheats, and scroungers, and the benefit lifestyle, and yet you ignore your own official statistics which show how tiny the levels of fraud really are. You ignore the massive damage done to the vast majority of claimants by your portrayal of those forced to rely on benefits and your constant references to deserving and undeserving; genuine and fake. Rhetoric from conservatives and the press has led to an increase in hate crimes such as stoning of people in wheelchairs and verbal abuse against those who need to use crutches or walking sticks. That has directly led to many disabled people being terrified of leaving the house.

You legislate on the assumption that with mobility aids, disabled people are on an equal footing with everyone else when moving around. They aren’t. Shops have steps in their doorways. Pavements lack dropped kerbs, leaving those who are on wheels or cannot manage a change in level to make extended detours. Cars and vans are routinely parked blocking ramps and dropped kerbs. Bus drivers refuse to lower their bus to allow wheelchair users on, or pretend not to see them. Trains and buses allow only one wheelchair on the whole vehicle. Those who need an electric wheelchair for use outdoors are denied one because they have no need to use one at home. Others wait months or even years to be supplied with one.

You continue the broken system of assessing people that was introduced by Labour. The concept of the Work Capability Assessment is broken in itself as the impact of most health problems cannot be assessed in 45 minutes by a health care professional who has no knowledge of the problems that the patient has. Atos continue to recommend that people go in the Work Related Activity Group and attend Work Focused Interviews at the Job Centre when they will be seriously harmed even by attending the Job Centre, IF they manage to do so, and never mind the fact that there are no available jobs that are suitable for them and competition for the unsuitable jobs is more than five to one and up against healthy people.

You are time-limiting contribution-based ESA with no regard for the actual length of time that a person will be sick for. The prospect of losing that income causes stress and seriously damages the mental and physical health of many of those people, leading to even longer recovery times.

You are introducing Personal Independence Payments to replace DLA, but apart from assessing people more often which is highly damaging to the health of those who are permanently sick or disabled, you are reducing the budget by 20%. The costs of being sick or disabled have NOT gone down by 20%!

Conservative cuts to council budgets have come directly out of budgets for personal care. People who can barely get out of bed have been left to shop and cook for themselves; others have been given incontinence pads and told to soil themselves rather than receive help to get to the toilet, and this despite having full control over their bowels but simply being unable to walk. Forcing people to lie in bed for hours in their own faeces and urine is now conservative policy.

You reassured me that the vulnerable would be protected. You were wrong. You are attacking the vulnerable. You are abandoning those in need. Your policies leave people more sick, more disabled, blamed for needing your help. You should be ashamed.

Welfare Reform Bill: Contact a Crossbench Lord

This guest post written by DarkestAngel and provided to me by Sue Marsh.

As you may be aware, the Welfare Reform Bill passed its second reading
in the House of Lords and has now moved onto committee stage.

Last Wednesday, Lords tabled a “highly unusual” motion to send the bill to
Grand Committee, which will take place in side rooms, rather than a fully accessible
public room. The motion was voted through, 263 votes to 211, and the bill will now
be sent to the Grand Committee.

The main difference between a Committee and a Grand Committee is that no
votes take place during a Grand Committee. Therefore, amendments will not
be voted on individually. There is also no public gallery and less room for all
peers to attend at once.

The reasons given for taking this step were that a bill of this complexity would
block up the chamber and delay other bills. Also, that too many people would
want to take part in the debate and it would take up too much time. However,
It now appears that the Main Chamber will actually be sitting empty during Grand
Committee

Several Lords have stated their objections to this:

“There is a great deal of consternation that is being expressed by disabled
people about this decision.
Noble Lords have received a number of e-mails. There is both a practical and
a symbolic significance to this decision. Disabled people feel that their democratic
right to observe the proceedings at the Committee stage is being severely curtailed
by any decision to take the whole of the Committee stage off the Floor of the House.
I think it is wrong . As well as this, we are now starting a week earlier than
previously announced – when some Lord’s may still be on holiday – this is because
the recess dates were changed late in the day. I’m concerned also about my
fellow peers who are wheelchair users. Apparently we may be meeting in a
committee room upstairs, which is larger than the Moses Room, though
still far from ideal. It had already been accepted on this side that some of the
Committee stage should be taken in Grand Committee, but there are clauses
in the Bill that are highly controversial. It is not just about experts coming in;
it is about people who feel that their lives or livelihoods are at stake. “

Baroness Lister

“I am very concerned that we are debating a bill that has many aspects which
are yet to be finalised. This is a most unsatisfactory situation which many
people have expressed concern about. Yesterday matters were made worse
by the Coalition Government insisting that the bill is discussed in Grand
Committee and not in the Chamber of the House of Lords. It will make
scrutiny more difficult and cause real problems for members of the public
who want to come and observe proceedings.”

Lord Kennedy

“I am seriously concerned about the ability of all noble Lords to participate
in the proceedings on this Bill. The noble Baroness has rightly drawn attention
to the shortcomings of the Moses Room. Those shortcomings are just as
apparent on the Committee Corridor. Several colleagues have told me in
clear terms that the rooms upstairs are not much better and that a lot of
furniture will need to be moved to facilitate those who have difficulty with
mobility and to enable lobby groups and those who are interested in the Bill
to participate and observe proceedings.”

Lord Bassam, Opposition Chief Whip

Some also stated their approval:

“I would prefer that every bill were considered in Grand Committee. It avoids
votes at an early stage of examining the bill, the atmosphere is more intimate
and business-like and we can spend more time on the detail. It feels to me
like a more normal less stilted way of discussing an issue. The Education Bill
was on its 10th day in committee yesterday for example whereas in the Chamber
it would be rushed through more quickly. There is room to spread out one’s
papers on a table in front of the speaker, the Minister has his support team
of bill experts immediately behind him to consult and because it is not televised
there is usually precious little grand-standing and posturing. It is easier to
interrupt to question without it seeming rude. A technical bill like the Welfare
Reform Bill in particular is best examined outside the Chamber. Then it
returns to the Chamber for the important Report Stage when the
important votes are taken.”

Baroness Murphy

We have three main concerns regarding this development:

• Firstly, access is poor. We are concerned that wheelchair users in particular
will be affected by this, not to mention members of the public who wish to attend.

• Secondly, we are still unsure if live streaming will be available allowing
campaigners like us and the general public to follow debates and scrutinise
them properly and democratically.

• Thirdly, amendments will not be voted upon in Grand Committee, all
amendments must be agreed upon unanimously. Just one objection can
prevent any attempt to fix the faults of this bill.

We would like to urge you all to contact crossbenchers in the House of
Lords (details below) to express your own concerns over this development.
We suggest asking for live streaming so that we can at least see events as
they happen, not 3 hours later and, of course, raising your objections to
the bill so that the Lords understand how it will, as it currently stands, affect so many of us.

We made a difference last time. We can make a difference this time.

Contact details for crossbench peers in the House of Lords

Continue reading “Welfare Reform Bill: Contact a Crossbench Lord”

Good news for those on ESA, bad news for the NHS

Liberal Democrat conference voted on Saturday for a motion criticising employment support allowance and Atos work capability assessments. In addition they passed an amendment to the motion which contained much more interesting statements. Page 20 of Conference Extra [PDF] gives details of amendment one for motion F6.

This amendment means that LibDems oppose limiting ESA to one year for those that have made national insurance contributions, demand that people with “serious and uncontrollable life-threatening conditions” are given unconditional support instead of having to attend work-focussed interviews, and are in favour of giving legal help to those appealing against being declared fit to work. They also want Atos to be forced to improve their performance, and in future, for the role of assessing people as fit for work or not to be carried out by government or non-profit groups.

While this has come late in the day, the Welfare Reform Bill has not yet been passed by the House of Lords and so now that the LibDems have adopted this motion and amendment I am hopeful that LibDem peers might oppose aspects of the bill that conflict with it and either amend the bill or send it back to the house of commons to start again. I don’t know how binding this motion is on the LibDem peers but their previous stance does not have the backing of the party. In fact, when this motion was voted on there were very few people that voted against it at all.

There were some excellent speeches in favour of this motion and amendment and I have uploaded some of the best to Youtube – see further down. You can also view the whole afternoon’s proceedings on iPlayer for a limited time. The motion was originally written by George Potter who contacted a few different people for help. In his speech he used Sue Marsh of Diary of a Benefit Scrounger as his main example.

However, it’s not all good news. Many LibDems wanted to debate the governments plans for the NHS in the Health and Social Care Bill, also waiting to pass through the Lords. They held a vote on whether or not to debate and vote on the bill during the conference. The vote was 235 in favour of debating it versus 183 against, but unfortunately they needed a two thirds majority to win and so the bill will not be debated. This means that the Health and Social Care Bill will still go through the house of Lords with LibDem support although it might just about be possible to stop it if all the cross-bench peers vote against.

Nick Clegg and Simon Hughes spoke during the opening of the conference and talked about opposing ruthless and extreme right-wing policies that the Conservatives are pushing through. They seem to think that they can win back support by opposing the Tories. I think they are wrong. The biggest things that they needed to stop were the cuts to welfare and the massive changes to the NHS, and before that, the scrapping of funding for universities and the introduction of huge tuition fees. I think it’s too late for the LibDems. They don’t seem to have noticed.

 

Videos from the Liberal Democrat Conference 2011 Continue reading “Good news for those on ESA, bad news for the NHS”

Atos: Why are we campaigning?

The Stream – a programme on Al Jazeera English – are covering the protests against Atos in their show this evening at 19:30 GMT. They asked me what I thought should be included.

[blackbirdpie id=”108923075919216640″]

These are the key points that I think are the problem.

  1. That Atos staff and Lima system do not adequately assess whether patients fit the descriptors as set by government, instead asking their own questions to fit their tick boxes then trying to make the answers fit the legislation set out by government. (Found at http://www.legislation.gov.uk/uksi/2011/228/made)
  2. That Atos as a private contractor is not accountable in the same was as gov, e.g. FOI requests
  3. That the whole concept of assessing patients as fit for work or not is flawed, this cannot be tested in a 45 minute session as Atos does not draw on medical history, variation from day to day, etc.
  4. Atos judge a person’s ability to walk, stand, concentrate, communicate etc on what they look like in one 45 minute session which can be very different from other times.
  5. In making the decision Atos ignore impact of work on state of health and they don’t account for the health impact of doing many things in sequence to work, just ability to do any one of those things in isolation!
  6. Asking trick questions to catch people out.
  7. Having “Medical Centres” that are not fully accessible, including centres with no lifts, no disabled car parking bays, or sometimes no parking at all, and unsuitable chairs in their waiting rooms.
  8. Frequently keeping patients waiting hours for their appointment, and observing them in the waiting room for behaviour that might mark them as liars.
  9. Having assessments carried out by staff other than fully qualified doctors.

I would particularly like to know why Atos do not ask the questions as set out by legislation, instead asking their own random questions, including trick questions to catch people out. For example, “Do you watch Eastenders?” if answered with yes is taken as proof of ability to set in one place for an hour, and to concentrate fully. “Do you have any pets?” is used to determine that the patient is capable of feeding, cleaning and caring for the pet and therefore themselves. “How did you get here?” is another trick, since it can be taken as proof of being fully able to use public transport, when in fact the journey might have caused considerable deterioration in health for the patient but was undertaken out of fear of losing benefits.

This list is just what I can think of in a few minutes, I am sure there are other problems too.

 

Godwin’s law must die

On the internet we have a rule. It is called Godwin’s law. Godwin’s law states that “As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1 (100%).”

In the 21 years since Godwin first made this observation, it has been quoted whenever anyone has mentioned Nazis, as a way of saying “You have mentioned Nazis, therefore your argument is ridiculous, therefore you have lost the debate.”

The use of Godwin’s law to end and win an argument by default has been helpful in keeping arguments from straying into ridiculous comparisons but it also brings a risk; the danger that when a comparable situation does arise, it will be ignored because the comparison cannot be made in argument. Godwin’s law has power because of the idea that nothing as bad as the Nazis and the holocaust will ever happen again because we have learnt from what happened in the past. I think that this assumption is foolish and dangerous. Of course such atrocities will happen again. Throughout history we have had bloodthirsty power-hungry leaders of pure evil, over and over again. Pol Pot, Pinochet, Mao, Stalin, Saddam Hussein, and many other leaders have killed thousands, even millions each. Genocides are an relatively frequent occurrence. Groups have been singled out and slaughtered for many different reasons over the centuries, and others will be in the future.

My point here is important so I will state it again. Atrocities of this sort are not rare, have happened and will happen again, and to ridicule anyone making a comparison with the Nazis is to dismiss warnings in a very dangerous way.

Godwin’s law and disability rights

I and many other disability rights activists abandoned Godwin’s law some time ago. I believe that sick and disabled people in the UK are under attack and are the subject of a government and media smear campaign with the aim of turning public opinion against them. Although the Nazis ran a eugenics programme to eradicate all incurably sick and mentally ill people, (Called Action T4) the comparison that I am drawing is mostly with the propaganda element of that programme and the attitude behind it.

Nazi Euthanasia Propaganda
English translation: 60000 RM - this is what this person suffering from hereditary defects costs the Community of Germans during his lifetime. Fellow Citizen, that is your money, too.

The poster seen here speaks of the cost of caring for the disabled person depicted, the same message that is echoed in the cries of “this is taxpayer’s money” that we hear from indignant right-wing tabloid papers today. Papers like the Daily Mail and the Express routinely publish every “benefit cheat” story that they can find, with big front page splashes about people with houses and multiple cars. Headlines claim that just 1 in 14 are unfit for workWe even have “Saints and scroungers” from the BBC spreading the hate. Otherwise nice people are being convinced that there are legions of benefit cheats faking their inability to walk or the horrendous pain that makes every activity torture. (Apart from me. For some reason they never mean me.) All of these politicians and journalists seem to be adept at twisting the facts and lying through omission just for the public outrage that they feed on. They also ignore the realities of illness, of having good days and bad days, of choosing to push through pain to have a good day out, or just to pretend to your family that you are having a good day out so as to keep them happy. As Sue Marsh said, by their standards, we are all benefit cheats now.

Black Triangle Campaign recently received an email referring to comments on their forum making comparisons with the past as “dangerous and extreme”. The email said: “I am not interested in extreme, left wing politics. I am trying to bring attention to government funded medical tyranny, copied from America, and such extreme comments are a distraction from what’s happening at government level. (…) you are playing a very, very, VERY dangerous game with desperate peoples’ lives by posting such extreme comments relating to past war time atrocities that belongs in the past. I DO understand why people feel like this but there are many, many very frail people out there and this will cause harm.

I disagree with the author of that email. I’ve talked before about how government ministers are spreading these stories and lying about the facts and how party special advisors are feeding the media frenzy in a previous blog post. No one here is suggesting that anyone be killed, but our government is focussed on ruthlessly cutting benefit costs along with healthcare and services, all while smiling and announcing that “the most vulnerable will be protected.” Well the most vulnerable are having their benefits cut, being told to shit themselves rather than receiving help to get to the toilet, being told to find jobs when they can barely leave the house, losing their homes, and committing suicide. Many of those that aren’t in that situation expect to be soon and many have talked of suicide. The policies of this government and the relentless abuse coming from newspapers have people living in fear – if what they fear hasn’t already come to pass. In Nazi Germany the killing of sick and disabled people was at first kept well hidden away from any chance of public opposition. What plans are our politicians hiding from us? Is it their intention to force all sick and disabled people out on the streets where they will helpfully freeze to death? Quite honestly, I think that they don’t even care as long as it’s not their problem. I think it is completely fair to compare this demonisation of the sick and disabled to the start of the Nazi attack on the same.

References

Daily Mail: Callous judges have sentenced Elaine to life without dignity (Daily Mail link. Yes, I was surprised too.)

DPAC: Elaine McDonald case: Court puts prisoners before the disabled

Purple noise: The beginning of the end (Warning, discusses suicide.)

Guardian: Jobcentre staff ‘sent guidelines on how to deal with claimants’ suicide threats’

 

 

 

Atos moves to shut down criticism

Atos are the French IT outsourcing company whose Atos Healthcare arm have been running Work Capability Assessment for the Department of Work and Pensions.

Lots of people are unhappy about Employment Support Allowance, about the assessments, and about the way that Atos run them. There have been protests outside Atos offices using slogans such as “ATOS kills” to express their feelings. Lots of people have explained why they are unhappy with Atos in blogs, on social networks, and in support forums.

It seems that Atos don’t like this. They have started issuing legal threats, and they have succeeded in shutting down some of their opposition. Various websites and forums have spoken out against ATOS and collected personal stories about them. After ATOS first received a take down request in May 2011. Atos lawyers recently threatened legal action against Paul Smith who runs the “Atos Register of Shame” website, accusing him of libel and claiming that “This is a direct attack on Atos and the name of the website in and of itself is implying that Atos carries on its business in a manner which is shameful.” You can see a take-down letter from Atos here.  http://issuu.com/atosvictims/docs/legal_letter_from_atos?mode=a_p

They have also shut down a support forum for carers, CarerWatch, by contacting their server host directly and having it taken down. This has removed a vital support network from many carers, presumably because of private discussions about Atos in members only parts of the forum. Apparently people are not even allowed to talk about Atos now, despite needing to do so to support each other when going through tests administered by Atos.

Following this action against them, CarerWatch have published their reply to Atos, which I reproduce here. (I hope they won’t mind.)

21st Aug 2011

FAO  – ATOS Legal Department

CarerWatch is an internet forum for sick and disabled people and their unpaid family carers. This is a private forum and only members are allowed to make/read posts.

We understand from the organisation that hosts our forum that they received a letter from your solicitors threatening to sue us for libel. The provider immediately closed our site down.

We have many members who are very fragile and the sudden disappearance of a support group has caused a lot of distress and fear. Some are ringing us in tears. We cannot get in contact with all of them though as we have lost their contact details through the closure.

All this distress could have been avoided if you had had the courtesy to contact us first and tell us what had been posted on our site that you considered libellous. Obviously if any post was possibly libellous we would have removed it and all this distress could have been avoided.

We imagine this distress is unintended and hope you will work with us in looking at the problem and finding a solution.

Please note that this letter, and any reply received from yourselves, will be posted on our website. It is the only means left to us to reach some members and keep them updated.

It is vital we have our forum up and running again to reach those that are isolated.

Frances

On behalf of CarerWatch members

 

Obviously, I don’t want my website taken down. I have been careful to state only known facts here. These are the facts that I know.

  • Atos Healthcare carries out Work Capability Assessments for the DWP.
  • The contract is worth approximately £100 million per year.
  • There has been a sharp rise in people found fit for work
  • There has been a sharp rise in people appealing that decision
  • 40% of those that appeal, win, rising to 70% with legal representation.
  • Although the decision over “fit to work” lies with the DWP,a government review found that the DWP are institutionally incapable of overriding the Atos Health Care Professionals. The Atos recommendation is, in effect, the decision.
  • Atos employ Health Care Professionals to carry out the assessments. HCPs are a mix of doctors, physiotherapists and nurses. Only people with certain problems will definitely see doctors.
  • Atos use their own Lima computer system to record the patient’s answers. Lima has been widely criticised.
  • The HCP fills in Lima by choosing keywords and statements from a list and then justifying them.
  • An Atos recruiter said “We don’t call them patients . . . We call them claimants.”
  • Twelve Atos doctors are under investigation by the GMC over allegations of improper conduct.
  • Two Atos employees are under investigation after referring to patients as “parasites” and “down and outs”.
In the end, although there is much to criticise with the way that Atos carry out ESA WCAs, they may really only be doing what the government expects of them. The descriptors that are used to make the decision of whether a person is fit for work or not are set out in the by the government. (See The Employment and Support Allowance (Limited Capability for Work and Limited Capability for Work-Related Activity) (Amendment) Regulations 2011) I personally question whether Atos accurately records if a patient fits the descriptors or not, and their ability to do so given the way that Lima Works or the staff that are used. Even if they do make an accurate record in line with the government’s descriptors, it is questionable whether the descriptors are an accurate description of being fit for work or not. Even then, it seems that decision makers at the DWP are “institutionally incapable” of taking into account all of the relevant information for the case as they are supposed to, instead simply rubber stamping the recommendation made by Atos. It would seem that the appeals tribunals are making a fairer judgement on this issue than Atos or the DWP.

Twisting the facts, printing lies. How the DWP and tabloids are wrong about fit for work stats

 

Headlines claim that just 1 in 14 are unfit for work. Photo by @opinion8ed_dyke

The headlines today are screaming that a mere 7% of ESA claimants aren’t fit for work. The Daily Mail says that “Benefits Britain marches on: Just one in 14 disability handout applicants are too ill to work” while the BBC claim “Tests claim few benefit claimants unfit to work” These figures are grossly misleading. These actually come from a Department of Work and Pensions press release, 26 July 2011 – Work Programme provides tailored support as latest figures show people are being found fit for work. Those news stories haven’t actually mislead about the contents of the press release too much, the propaganda comes from the DWP. The Express, on the other hand, has gone for “Sick benefits: 75% are faking” which is just an outright lie.

Lets start with the figures from the DWP.

For all new ESA claims from 27th October 2008 to 30th November 2010, the result of the initial WCA is as follows

  • Support Group – 7%
  • Work Related Activity Group – 17%
  • Fit for Work – 39%
  • Claim closed before assessment complete – 36%
  • Assessment still in progress – 1%

These figures are true, but lie by omission. First of all, the figures given are for ALL that start a claim for ESA. As stated, 36% of people that start a claim drop out before they even get to their Work Capability Assessment. Some of these people will drop out because they perhaps shouldn’t have applied in the first place. Some might even have been trying it on and then realised that they would be caught. Some recover enough to find work, some find work that fits around their disabilities. Some, however, drop out because they are so ill that they cannot face the application and testing process. We don’t know, as no records are kept of reasons for dropping out, but I contend that many more than we know drop out because they are too ill to finish the process. Given that 36% of claimants are not tested, we cannot include them in the ‘fit for work’ category. That 7% of claimants is actually 11% of claimants who complete the process.

11% is still a very small number. That still casts 89% of claimants as cheats, doesn’t it? Well no. No it doesn’t. Not unless you are a tabloid writer. You see, 17% of total claimantss – or 26.6% of claimants that finish the process – are put in the Work Related Activity Group. Being put in this group DOES NOT mean that the claimant is fit for work! It means that there may be some job, as yet unknown, that the claimant could possibly manage to do, if they push themselves hard enough,possibly at high cost to their health, IF they receive the right support in terms of information, equipment, services and grants. People in this group must attend six interviews at the Job Centre over the course of a few months to try and determine just what this possible job could be, and the support that would be needed to do it. People in this group STILL RECEIVE ESA.

Adding those two together and leaving out the people that dropped out, that means that 37.5% of people tested were not fit for work. That still leaves 61% that were receiving ESA who were found fit for work. Are they all cheats? No. Here’s why.

The Work Capability Assessment takes place at the end of the assessment phase of the claim. That means the test can take place up to 14 weeks after the person started to claim ESA. 14 weeks is a long time, and it should also be noted that people are often sick for a long time before they even apply for ESA, either on Statutory Sick Pay for 28 weeks, or just unaware that they can claim. Those people could easily have been sick for 9 months before being tested. 9 months is long enough for people to recover or start recovering from many health issues, and so these people would have been correctly being given ESA while unable to work. Health issues change, and finding these people fit for work now would be correct, but does not invalidate their claim in the previous months. I think if the WCA correctly finds someone capable of work after many months of illness but heading towards recovery, this is usually a good thing.

Assuming that changes in health conditions account for a chunk of that 61%, let’s say a third, that still leaves the rest. Here’s the thing. The accuracy of the testing process has been found to be wrong, broken, inadequate, however you want to put it, by MPs, a house of commons select committee, many disability rights charities, and many many individuals and activists. Even a person involved in designing the test has said that it is not fit for purpose.

33% of people found fit for work between October 2008 and August 2009 appealed against that decision. 40% of those overturned that decision and were awarded ESA. That’s 27,500 people who were provably found fit for work when they were not. Many more people did not appeal, for many of the same reasons that may have caused people to drop out of the claims process.

Today the Commons Select Committee on the Migration from Incapacity Benefits to Employment Support Allowance released its 6th Report – The Role Of Incapacity Benefit Reassessment In Helping Claimants Into Employment. Among other things, that report criticised media coverage and stated that government had a duty to take more care when engaging with media.

5.  Sections of the media routinely use pejorative language, such as “work-shy” or “scrounger”, when referring to incapacity benefit claimants. We strongly deprecate this and believe that it is irresponsible and inaccurate. The duty on the state to provide adequate support through the benefits system for people who are unable to work because of a serious health condition or illness is a fundamental principle of British society. Portraying the reassessment of incapacity benefit claimants as some sort of scheme to “weed out benefit cheats” shows a fundamental misunderstanding of the Government’s objectives. (Paragraph 40)

6.  Whilst fully accepting that the Government, and this Committee, have no role in determining the nature and content of media coverage, we believe that more care is needed in the way the Government engages with the media and in particular the way in which it releases and provides its commentary on official statistics on the IB reassessment. In the end, the media will choose its own angle, but the Government should take great care with the language it itself uses and take all possible steps to ensure that context is provided when information about IB claimants found fit for work is released, so that unhelpful and inaccurate stories can be shown to have no basis. (Paragraph 41)

I disagree with part of this in that I think that consciously or not, Conservative ministers have an ideological motive to move people off of benefits, portraying them as cheats if necessary, with the help of special advisors. (SPADS.) I believe that ministers and SPADS have been feeding selected information to the press to create a national view that is biased against sick and disabled people that claim benefits, and the press have been only too happy to amplify this.

Related Links

Why won’t ATOS let us record our Work Capability Assessments?

As you will know if you have read my recent blog post “What’s wrong with ATOS“, there is often a large disparity between what is said during a Work Capability Assessment and what ATOS actually reports to the department of work and pensions. The reports take no account of context in answers (“I can do x IF…”) and often fail to note that an action or activity may be possible for a patient, but will have consequences for their health and may not be repeatable. As a result claims are often appealed and ultimately referred to a tribunal.

At that tribunal the patient must demonstrate that the ATOS report is not true for the above reasons.  It is permitted for the patient to be accompanied by a friend to witness the assessment, but an audio recording would be the ideal proof. Unfortunately ATOS have made it nearly impossible for anyone to record their assessment.

Many people have attempted to record their assessment using mobile phones, digital sound recorders or dictaphones. Nearly every time ATOS have halted the assessment and refused to continue while being recorded. On some occasions the patient has relented and stopped recording, on others they have been asked to leave and their report has stated that they did not attend their assessment, resulting in their benefit being stopped.

In a response to a Freedom of Information request made at the end of 2010 the Department of Work and Pensions provided the official guidelines to ATOS staff regarding recording of assessments. The most important parts are quoted here.

“Such a request can only be agreed with the prior consent of the HCP, and then only if stringent safeguards are in place to ensure that the recording is complete, accurate and that the facility is available for simultaneous copies to be made available to all parties present. The recording must be made by a professional operator, on equipment of a high standard, properly calibrated by a qualified engineer immediately prior to the recording being made. The equipment must have facility for reproduction so that all parties can retain a copy of the tape. The responsibility for meeting the cost of the above requirement rests with the claimant”

“It is for Atos Healthcare, in conjunction with their legal advisers, to determine the action to be taken in the event of a claimant making an audio or video recording without the prior knowledge and consent of the HCP, or without ensuring that the safeguards defined above are in place”

“If you suspect a customer of trying to film or record an assessment the following action should be taken

Advise the customer that such action is not permitted, explain why not, and ask them to switch the device off. If the customer refuses to comply:

  • The assessment should be suspended
  • Inform your site manager and/or medical manager immediately”

From this it is clear that recording by the patient will not be permitted, will result in the assessment being stopped and might result in legal action by ATOS. What is strange is the circumstances in which they will allow recording. It must be

  • Recorded by a professional operator
  • on professional equipment
  • immediately duplicated in front of ATOS staff
  • paid for by the patient

This is obviously impractical to arrange and priced far out of reach of the patient,  who is receiving Employment and Support Allowance to live on, at approx £60 – £100 per week.

In a court case in June 2008 a judge ruled on a patient who had been denied benefit and lost his appeal after ATOS reported that he did not attend because he attempted to record his assessment.   The judge ruled that he should be allowed to start his assessment process all over again, because he had not been advised that he could arrange for recording of the assessment in stricter circumstances. What is interesting is the other comments by the judge in his findings.

45. The appellant makes a number of good points in this context. He draws attention to the considerable (and probably prohibitive) cost that would be involved for an individual living on benefits in meeting the Department’s restrictive criteria. He rightly points out that those conditions (which include the presence of a qualified engineer) are actually stricter than those in place for police interviews with suspects. He might also have added that the Department’s own protocols for interviewing claimants under caution in the course of benefit fraud investigations do not require the presence of a qualified engineer (although dual-tape machines and sealed tapes are used).

Let me repeat that: ATOS’ requirements are stricter than those for police interviews, and stricter than their own interviews for benefit fraud applications.

So, we get to the really important question. Why do ATOS make it so difficult to record assessments?

There is one relatively good reason. They are worried that a single recording taken by the patient could be digitally altered and then presented before a tribunal as proof. They wish to counter this by having a duplicate recording in their own possession. This does seem a reasonable request, but their chosen methods are over the top and unnecessary.

ATOS also state that “Medical Services view unauthorised and secret recording to be an invasion of privacy.” Now, if this were a private conversation between two friends, that might be the case. But this is not. This is an assessment carried out on behalf of the government and with life-changing consequences for the patient.  It often starts a process which ends up in the legal system. In these circumstances, it is wrong to claim that recording is an invasion of privacy. In an assessment as grave and important as this, are they really saying that the assessor is going to say something which should not be reported, and that he won’t do so when officially being recorded? Because to me, that suggests that they think their staff might be unprofessional in their behaviour.

I think ATOS is clearly wrong to obstruct recording of Work Capability Assessments. At best, this is an uncaring attitude which shows lack of respect for the patient or of any concern over the outcome of their benefit claim. At worst, this is wilful obstruction of justice and a prevention of a proper outcome at a tribunal. There is a simple solution to this. ATOS should allow every patient to record their interview in any way that they wish to, openly so that their staff need have no concerns about privacy. If they are worried about a recording being altered to be used against them, then they should also record every interview themselves. They need not go to the expense of dual recording equipment if they allow patients to make their own recording.

Of course, they won’t do this. ATOS must be fully aware of the failure rate of their assessments and the large number of successful appeals against them. They know that if a large number of recordings were to be made, they would be shown up by the vast contradiction between what is said and what is recorded. They would be shown to be either incompetent or to have an agenda against benefit claimants.

What’s wrong with ATOS

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Cross posted at Disabled People Against Cuts

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.

 

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]