This article titled “Disability assessment may be a farce, but it’s not French” was written by Zoe Williams, for The Guardian on Wednesday 28th December 2011 19.00 Europe/London

The biggest surprise of the whole breast implant scandal is, of course, how many women have had them, and naturally I disagree in principle with self-mutilation in the service of a bogus ideal. Yet what’s really struck me is how often it is noted that the implants were produced by a French company. Since the scandal originated in France, it’s natural to mention that. Often, though, the nationality of its head, Jean-Claude Mas, has been pointed out two or three times in one article.

The preponderance of French manufacturers in breast augmentation is a discernible global quirk – in Venezuala, where plastic surgery is very common, 84% of implants come from French companies. And I guess there is a subtextual observation about the notorious “perfectionism” (we call it “body fascism”, but that’s because we’re so fat and Anglo-Saxon) of the French, with their elaborate terror of ageing and phenomenal appetite for anti-cellulite products. But this story reminds me of the fact that, whenever there’s a conversation about the dark forces ranged around disability benefit, it is always pointed out that Atos is also a French company.

To recap: Atos assesses claimants for disability benefits, a contract that it was awarded in 2005, running for seven years and worth £500m. This contract should be up for renewal in 2012 and, given the large amount of public distress and anger at this company, coupled with the prospect of unemployment in the UK reaching 2.85m next year, it could be awarded to someone else – possibly, call me crazy, a company with more employees in the UK (although I think this is what’s called “protectionism”).

Also, Atos has just been awarded another huge contract for GP IT services, as well as a contract for the Olympics. So we’re staring down the barrel of one of those “procurement situations”, where all the commonsense solutions – a company closely connected to the area? a company that people don’t already hate with a passion? – have been rejected for reasons that you have to be in the government to understand.

The complaints against Atos are varied (the company calls itself global, by the way, but is listed on the French securities market). In the course of their computer-generated questionnaires, Atos assessors have been accused of rarely making eye contact with the patient, and taking no account of little things like the wide range of outcomes for the same disease, or the intricacies of mental illness. (“Can you pick up a pencil?” they’ll ask someone with terminal cancer, or bipolar disorder. “Yes? Well, back to work with you; back to one of those nonexistent jobs that you’ll never get.”)

These analysts have only six weeks’ training in “disability analysis”, and are not required to be experts in the field of the illness in question; yet their opinion takes contractual priority over that of the patient’s consultant – which is to say, it’s in Atos’s contract with the DWP, which I suppose makes sense from the point of view of the government department. There’s no sense blowing £500m on a service and then not listening to it. If only there were some other, meaningful opinions we could solicit freely, some kind of national health service …

The iniquity of this process will no doubt run and run. But increasingly, I find unsatisfactory the explanation that it’s the foreignness of these large corporations that is the major contributor to their shortcomings. It has become ever clearer, as money’s got tighter, that the entire business of commissioning out public services is a stitch-up to suck yet more money out of the public purse and into four or five private ones. So previously, when I heard that Geo (American) or Amey (French) was tendering for a government contract, my immediate suspicion was that a global company will not care enough about its end user; that the reason PIP made low-grade breast implants is the same reason an Atos representative won’t meet a cancer patient’s eye when they fill in the form: empathy is a function of proximity, and the further away you, as the company’s chief executive, are from your – well, let’s call them your “victim” for brevity – the easier it is to disregard them.

On a micro-level it’s perfectly logical: you’d do a better job for your next-door neighbour than for someone you’d never see again. But I think this is too easy an explanation to swallow, as opposed to the more problematic idea that it’s not a foreigner with a profit motive, but the profit motive itself, that distorts and poisons the relationships of healthcare.

Who speaks out when patient care suffers because of budget cuts? Not private doctors, nor “any willing provider”, but the BMA, the Royal College of GPs, the Patients’ Association – in other words, the public sector and the third sector. When profit is involved, something fundamental can happen to service providers: the danger is they become more attentive to the needs of the paymaster than the patient. This is about profit, not nationality.

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