Cracks starting to appear –
A few months ago a friend of mine received a letter from a company called Atos Healthcare instructing her to attend a medical assessment. “It is important that you attend,” said the letter. “If you fail to attend, your benefit may be affected.”
My friend (I’ll call her Janet) was receiving incapacity benefit. The medical she was called to attend was what is known as a personal capability assessment (PCA). That Janet was summoned for a PCA seemed strange. Both incapacity benefit and PCA are being replaced by employment and support allowance and the work capability assessment, meaning that even if Janet’s assessment concluded that she was entitled to continue to receive incapacity benefit, the benefit itself will soon cease to exist anyway. Then Janet will need to be reassessed for employment and support allowance. But if that seems a strange use of resources, it’s as nothing compared with Janet’s description of the medical itself.
First, a bit of background. Janet has been diagnosed with a major psychotic illness as well as a personality disorder and symptoms of post-traumatic stress, a consequence of the sexual abuse she experienced as a child. Janet has spent long periods in hospital, received ECT, and been sectioned under the Mental Health Act. She takes daily medication including antipsychotics and antidepressants. At one time Janet managed a day centre but, following a major breakdown a little over a decade ago, she has not been well enough to return to work.
Janet’s biggest concern (and that of her doctor) is that if she loses her benefits and is forced to seek employment, the stress is likely to trigger another breakdown. She may also end up homeless, as has happened in the past. I am telling you this in an attempt to convey just a little of Janet’s anxiety as she arrived for her appointment at the medical examination centre.
Janet was kept waiting for nearly an hour. The doctors were running late, she was told, because of “transport problems”. Finally, her name was called and she was taken through the locked security doors and into an assessment room. The doctor told her to take a seat and proceeded to work on his computer.
“I could tell he was clicking down a column of boxes. I could tell from the way he was moving the mouse.” The doctor said nothing more to Janet for “at least five minutes”. He then asked about her medication and also her physical health. And then – “I think it’s because I said I had piles” – he launched into the most extraordinary diatribe.
Janet was forced to sit and listen as the doctor described in graphic detail the physical damage men did to each other by having anal sex. “They’re everywhere!” the doctor said. “They’re running the government.” He would not allow his grandchildren to be brought up in a country run by homosexuals and paedophiles.
Janet, who is herself gay, said nothing. She found herself wondering if it was part of the test. The doctor went on to tell her that a lesbian couple had complained about him, saying that he had rejected their claim because he was homophobic. “I had to go to tribunal,” he said. “I could have lost my job. But they found against them and they lost their benefits.” The doctor then left the room without any explanation. Some minutes later he returned with a nurse and proceeded to examine Janet’s feet.
Now you don’t know Janet as I do, and it may be that you don’t believe her story. It’s easy enough to dismiss what she says; she’s mentally ill, after all. Atos says that regular surveys show more than 90% of customers are satisfied with the service they receive. But Janet is very far from alone in expressing concerns about Atos assessments and the quality of those employed to carry them out. A quick search through the internet forums reveals overwhelming dissatisfaction.
Last month, disabled people held protests at Atos offices across the country. Writing in the British Medical Journal, GP Margaret McCartney, who attended an Atos recruitment evening, questions the ethics of doctors performing assessments “separate from the NHS and without access to patients’ full medical records”.
Not everyone shares such concerns, however. Last November, Atos announced a three-year extension to its contract to “support the government’s welfare reform agenda”.
• Clare Allan is an author and writer on mental health issues.