Response to our open letter and Atos’s reply to the BMJ:

URGENT – REQUIRING IMMEDIATE ACTION – PLEASE SIGN THIS LETTER AND CIRCULATE – ALL SIGNATURES TO BE IN BY 5 PM TUESDAY 29TH NOVEMBER 2011

Any enquiries regarding this letter please feel free to phone John McArdle on 0777 831 6875

Black Triangle Anti-Defamation Campaign in Defence of Disability Rights info@blacktrianglecampaign.org

Benefit Claimants Fightback notowelfarecuts@yahoo.co.uk

Defend Welfare network

Disabled People Against Cuts mail@dpac.uk.net

WinVisible (women with visible and invisible disabilities)

And: 

Response to our open letter and Atos’s reply to the BMJ:

(https://blacktrianglecampaign.org/2011/09/27/atos-open-letter-to-the-bmj-and-rcn/)

Atos

Letter prepared by John McArdle and Dr. Stephen Carty, Black Triangle Anti-Defamation Campaign in Defence of Disability Rights and all of the above organisations together.

To the BMA, GMC , RCGP, RCN, NMC

Dear Sir/Madam, 

We are writing to you to express our concern at the injustice, discrimination and subsequent harm occurring to citizens with illness and disability as the result of the Work Capability Assessment and the contractual arrangements between the medical profession, the The Department of Work and Pensions(DWP) and ATOS.

The existing contractual arrangements between the medical profession and the DWP are not fit for purpose and we are now lobbying for this to be addressed. There appears to have been a complicity of silence on these matters. We would like to assert the following: 

The Work Capability Assessment (WCA) is not fit for purpose

The use of the Logic Integrated Medical Assessment (LIMA) software programme as a method of assessing a patient’s “capability for work” is an affront to both the medical and ethical standards of the medical profession. The LIMA assessment has systematically ignored the complex needs of individuals being assessed. It has shown disregard for patients’ medical issues and frequently omits assessment of significant problems.

There appears to have been a failure to gather sufficient information, particularly with regard to mental health conditions. 

It is now undeniable that the assessment process has resulted in direct harm to sick and/or disabled patients and that it has resulted in many tragic cases of self-harm and suicide. The reality of this is felt on a daily basis by all those upon whom the process has an impact: patients, family, friends, carers and the wider community.

Despite encouraging statements from the Government promising action on the findings of the Harrington report, little if anything has changed at the coal face. Why not ask General Practitioners? We have, and the following are some of our findings

Has the WCA and the proposed DLA/PIP reassessment régime been adequately risk-assessed? 

Significant Event Analyses (SEA) are required to ascertain if the ‘reforms’ to Incapacity Benefit (IB) and Employment and Support Allowance (ESA), coupled with the migration from Disability Living Allowance (DLA) to the Personal Independence Payment (PIP) fully comply with the ethical standards of the profession and do not breach equality and human rights legislation as applied to sick and/or disabled patients.

The recent GMC publication of Good Medical Practice 2012 states clearly that a Doctor must (overriding duty or principle) “take prompt action if you think that patient safety is or may be seriously compromised by inadequate premises,equipment or other resources, policies or systems.”

It is our view that all doctors have an overriding duty to take prompt action to address the inadequate WCA system which has seriously compromised patient safety.

We call upon all medical professionals to engage in Significant Event Analyses of cases where it is perceived that harm may have been done by the assessment process. These could be submitted in confidence and with consent to the GMC for investigation, review and analysis. Doing nothing is not an option: there is an overriding duty to ensure patient safety.

The WCA involves the administration of a battery of questions  contained in theLIMAcomputer programme that comprehensively fails to adequately and accurately assess a patient’s ‘fitness for work’. 

The operation of the assessment system has been universally condemned for failing to take into account the disproportionate medical, social and other barriers that sick and disabled people face in the the job market as a direct result of their disabilities.

Disabled people are deprived accurate representation through the assessment process. There is a substantial body of  evidence that adverse decisions made by the DWP, based  on the administration and outcome of theLIMAassessment, are having a devastating impact on  the lives of some of the most vulnerable members of our communities.

In addition to massive cuts to funding for advice agencies that have seen, for example, the Citizens Advice Bureau in Cardiff close; the DWP is now seriously considering suspending all the benefits to patients who launch an appeal to the Tribunals Service: We stand ready to launch a legal challenge to this also.

We submit that the Work Capability Assessment system breaches human rights and equalities legislation prohibiting discrimination as applied to patients. We allege that both the policy and operation of the WCA system discriminates against patients with illnesses and disabilities. 

These unethical practices breach all the relevant domestic human rights and equalities legislation and also international treaties and conventions such as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

Patients are continually hounded by being continually reassessed after having won their appeals, up to three consecutive times See:

https://blacktrianglecampaign.org/2011/11/21/benefits-appeals-system-on-brink-of-collapse/

The constant reassessment of disabled people with chronic diseases amounts to an abuse of a patient’s fundamental human rights and constitutes a form of psychological torture in breach of human rights and equalities legislation.

We submit that doctors who participate in such a system are complicit in this injustice and are betraying the ethical codes and standards laid down by the GMC. We call upon the GMC to launch an immediate and full inquiry into these decision-making processes and the operation of the assessment system. 

We request that the GMC consider withdrawing the status of ATOS ‘Medical Assessment’ Centres as ‘GMC Approved Environments’ pending investigation into these gravely serious allegations.

It is our firm and settled view that the proposed reassessment of disabled people currently in receipt of Disability Living Allowance for the new Personal Independence Payment will follow a very similar format to the WCA and will repeat the same very same injustices as we are witnessing now. 

Indeed, the government has already stated that it expects the budget for disabled people currently in receipt of DLA to be slashed by 20%. It has offered no empirical scientific, medical evidence on which to base this assumption. 

It is our  view that these assessment systems are designed specifically to redefine the parameters as to what constitutes a disability for the purposes of qualifying for state support with the effect that many tens, perhaps hundreds of thousands of disabled people will have the reality of their disabilities and needs unethically and unlawfully denied. 

The result will be an increasing number of disabled people disproportionately affected by the cuts and will drive them further into poverty, squalor and despair. This is utterly unacceptable.  

The assessment process is flawed from start to finish

According to the BMA, “The claimant’s GP has a specific role in the process to provide a factual report based on information contained within the patient’s medical records.” We wish to point out that the contractual obligation GP’s are under is to provide information to the Department of Work and Pensions (DWP) for the purposes of Employment and Support Allowance (ESA) benefit claims free of charge.

We also wish to point out that the ESA form only has one half of a page of A4 allocated for the GP to enter the complete past medical history and include the details of significant diagnoses, investigations and treatment.

According to our research here in Scotland, there is a groundswell of helplessness amongst GP’s who have had their reports ignored for too long: they have to deal with the fall out from this at the coalface every day. This has led, we contest, to less effort and detail being provided on the grounds that it will be ignored anyway.

The appeal process is log-jammed and further reports for no fee are constantly sought from GPs from the various voluntary and other support agencies who are the only remaining advocates to put forward the patients case.

We appeal to the membership of the BMA to boycott this pseudo-scientific assessment pending a resolution of these issues through consultation with its members and formulation of a policy that truly reflects the views of medical practitioners. To out knowledge this has never properly been done and the BMA can hardly claim to represent its members if it has not first sought  their views on this issue of grave importance to their patients’ health and well-being.

In the first instance do no harm

The BMA states that “It is vital that GP’s are not asked to provide an opinion on their patient for the purposes of receiving the ESA – doing so could damage the relationship between patient and doctor.” 

We submit that far greater harm is at present being done to the future of the doctor-patient relationship in Britain by these existing arrangements, which we assert amount to a relationship of complicity between the medical profession, government and Atos/DWP.

The BMA states that “A key part of our role is to represent our members in negotiations for appropriate terms and conditions of service.” : Is it is not time for the BMA to take a lead and ask for its GP and Consultant members’ views on the evolving relationship between the profession, the state, the private sector and welfare benefit reform?”

This issue is of such importance that it must be put out to full consultation with all medical and allied health professionals. Not to examine these issues by putting them out to consultation would, we assert, constitute an abdication of the BMA and the profession’s ethical duties and standards and would form part of a breach of a duty of care to patients.

We submit that the current contractual arrangements between the DWP and General Practitioners are no longer fit for purpose.

If there was a consultation process with GPs before the LIMA system was introduced as a means of assessing claimants fitness for work we have not seen it, and nor we contest, have the majority of GPs.

GPs are now compromised by their indirect association with a profit-driven multinational company which is morally bankrupt but benefiting commercially to the tune of £100 million pounds per year. Appeals to the Tribunals Service are now reaching a cost £50 million a year. 

We submit that the evolving relationship between medicine, the state and the private sector has undermined the integrity of the profession and must be addressed as a matter of the utmost urgency.

The forms used, the structure of information provided and the process are inadequate and DWP Decision Makers never request any additional information.

Patients with mental health problems or addiction are frequently assessed by a midwife, physiotherapist or nurse with little or no training in these complex illnesses.

In our  opinion, the employment of doctors and other ‘medical professionals’ to carry out these assessments does little more than lend an aura of medical credibility to what is a thoroughly discredited pseudo-scientific creation of the American insurance industry, which we allege was expressly designed to deny patients of the support to which they are rightfully and lawfully entitled. The vast number of successful lawsuits against decisions made based on this utterly discredited system in the United States attest to this.

We utterly reject any assertion that this process can legitimately be termed “disability assessment medicine”. We furthermore firmly oppose and deeply regret its teaching as an academic subject, to be credited as part of nursing degrees in the UK. This may have come about as a result of commercial pressures and arrangements entered into between private companies and academic institutions desperate for cash.

We call on doctors and nurses to join with the University and College Union in condemning this alarming development as an unacceptable attack on the academic and ethical standards of their respective professions

These arrangements, as we understand it, have come about by stealth and without proper debate, due diligence or consultation with the memberships of any of the professional bodies.

Furthermore, we also cannot but express our grave concern that before taking up his role as Atos’s Chief Medical Officer, Michael O’Donnell was Chief Medical Officer for Unum Insurance at a time when the company was subject to a large number of successful lawsuits by disabled people in the United States.

It was held that these disabled people were unlawfully denied their disability claims using an almost identical computer programme (the precursor of LIMA) and administrative system to the one that is currently being used by Atos and which Unum pioneered.

A Federal judge condemned the company for operating disability denial factories and another branded them as a ‘rogue company’. They were subsequently banned from operating in many states as a consequence of their malfeasance. 

Evidence-based medicine

It has just been announced that the government intends to remove the role of the General Practitioner and Consultant from the process of deciding whether a patient is fit for work or not See:

http://www.independent.co.uk/news/uk/politics/workers-on-longterm-sick-leave-face-tougher-assessment-tests-6264610.html

“The move was welcomed last night by the British Medical Association.” GPs have a long-term relationship with their patients and it puts them in a difficult situation if they are being asked to tell a patient that they’re wrong and are fit to work,” it said. “GPs are often not best placed to assess what someone can and cannot do. It is far better if a trained occupational health doctor does that.”

https://blacktrianglecampaign.org/2011/11/20/margaret-mccartney-general-practitioners-and-sickness-absence/

We join with Dr. Margaret McCartney and express our horror at this statement which the BMA Executive have put out without first consulting with their membership.

Where is the evidence from ATOS that the LIMA system has any scientific rigour?

Modern medicine requires evidence based tools. A valid scientific tool ought to be both sensitive and specific.

ThisLIMAtool and its application is, we submit, both insensitive(sic) and non-specific.

We would like to see what, if any, evidence there is to support this assessment system having particular regard to  consistency, reproducibility and a low-level of inter-observer variability.

We suggest that a cohort of patients be put through through two processes in the format of a clinical trial: comparing  where the patient goes through aLIMAassessment, on the one hand, and then an independent occupational health assessment by a doctor with proper occupational health training.

We have many documented cases of employees having been declared ‘unfit for work’ by Atos Occupational Health Assessors, only to be declared ‘fit for work’ by Atos “Disability Assessment Advisers” whilst no objective change in their medical condition has been observed..

You will be aware that 70 % of patients appealing these decisions have them overturned at Tribunal when they are represented by a welfare rights adviser. In some areas of the West of Scotland the success rate is a high as 90%.

If there is so much inter-observer variability from initial assessment to appeal: leading to 0 points one day and 25 the next*, does this not demonstrate the subjective and objective weakness of the process?

We have always maintained that assessment companies are working to targeted calculations. 

A medical and scientific analysis of the number of people declared ‘fit for work’ taking into account demographic differences, we submit, would not give rise to the kind of consistency of ‘fit for work’ decisions based on the findings of the WCA nationwide.

Considerable damage has already been done. The lives of sick and/or disabled patients are being devastated anew every single day. Urgent action is required. We appeal to you, as members of the caring professions, to assist us in arresting this harm immediately and to work with us in repairing this damage.

The motto of the Black Triangle anti- defamation campaign in defence of disability rights is:

“Disabled people fighting for our future, custodians of our past.”

It is time for us all to again time to re-learn the lessons of history. 

There have been many shameful episodes in our recent modern history as disabled people where the medical profession was either actively complicit in attacks on the lives and welfare of disabled persons or where it failed miserably to react whilst the attacks and oppression was taking place.

As disabled people ourselves we call upon you all directly not to look the other way today.

We have not fought for liberation and equality for 70 years to have it destroyed in one parliamentary term by Ministers who have labelled us as “unsustainable”! 

It is now time for the British medical and nursing professions and those of professions allied to medicine to stand full square in solidarity with sick and/or disabled people in our communities.

We hope to make further representations, at your earliest convenience.

Yours, etc.

Copy to Pulse.

Dr. Stephen Carty

Dr. Margaret McCartney

References

https://blacktrianglecampaign.org/2011/09/27/atos-open-letter-to-the-bmj-and-rcn/  

https://blacktrianglecampaign.org/2011/10/05/gps-face-gmc-duty-on-%E2%80%98back-to-work%E2%80%99-drive/  

https://blacktrianglecampaign.org/2011/10/07/health-and-social-care-bill-must-be-withdrawn-or-substantially-amended-bma-tells-peers/  

https://blacktrianglecampaign.org/2011/10/03/scrap-nhs-reforms-doctors-tell-lords/  

https://blacktrianglecampaign.org/2011/09/22/terminally-ill-patients-told-their-benefits-may-be-cut/  

https://blacktrianglecampaign.org/2011/09/12/nhs-reform-bill-must-be-resisted-leading-doctors-tell-royal-colleges/  

https://blacktrianglecampaign.org/2011/09/05/citizens-advice-cuts-threaten-the-most-vulnerable/  

https://blacktrianglecampaign.org/2011/07/26/the-medical-absolute-joke/  

https://blacktrianglecampaign.org/2011/07/26/work-capability-assessment-assessed-lacking/  

https://blacktrianglecampaign.org/2011/10/06/through-the-eyes-of-a-benefits-adviser-a-plea-for-a-basic-income/  

Further Information:

Employment Support Allowance & the Work Capability Assessment 

Concerns have been mounting about how the Work Capability Assessment (WCA) for Employment Support Allowance (ESA) has been implemented.  

A Citizens Advice Scotland (CAS) report found that ESA has been the most concerning issue for its advisers over the last 2 years.

There have been 400,000 appeals against WCA decisions. Almost 40% of appeals are upheld. The proportion of successful appeals rises to 70% when the disabled person is represented by CAB. 

Since the new WCA was introduced around two thirds of new ESA claimants have been found fully fit for work and made to claim JSA or been moved off benefits altogether.

Disability Living Allowance & the Personal Independence Payment

The Government intends to reduce the amount of DLA paid out by 20%. For Scotland this will lead to benefit losses of £268 million p.a.  

As the new assessment tests are restricted to claimants of working age, at least 1 in 3 disabled people aged 16 – 65 would need to lose ALL of their current entitlement to achieve the necessary savings.

The Personal Independence Payment (PIP) will replace DLA in 2013/14. Under PIP there is no equivalent to the Lower Rate Care component for DLA. All working age recipients of Lower Rate Care, 60,000 Scottish disabled people are almost certain to lose their entitlement, saving £60 million p.a. 

This means that many thousands more Scots disabled people currently on higher rates of DLA will also have to lose entitlement to make the additional +£200 million in savings that the Coalition Government wants to make. 

Other Potential Losers:

The Mobility component of PIP is to be taken away from all disabled people living in residential care. This will save £135 million a year. The mobility component is: £18.95 (lower rate); £49.85 (higher rate).

Comments
  • Rachel Gordon-Smith on Facebook November 21, 2011 at 10:28 pm

    where is their response? I could only see your letter

  • Angela Mitchell on Facebook November 21, 2011 at 10:46 pm

    DITO is there a response yet? The letter was very comprehensive and what I would want them to know myself.

  • Sue Rees November 21, 2011 at 10:47 pm

    I really hope that this letter is taken seriously and acted upon. In many places it reflects the issues I have had to deal with in helping my son in his transfer from IB to ESA. The process has left me feeling that we no longer live in a civilised democratic society.

  • Thanks for pointing that out Rachel Gordon-Smith and Angela Mitchell – we are working to resolve that on the post immediately

  • We are having technical difficulties momentarily

  • Will be resolved by the morning (JJ)

  • Motm Dwg on Facebook November 21, 2011 at 10:54 pm

    A truly exceptional letter indeed. I am sure you will post up the response soon .

  • Rachel Gordon-Smith on Facebook November 21, 2011 at 10:56 pm

    that is utter pants

  • What is pants Rachel Gordon-Smith?

  • Rachel Gordon-Smith on Facebook November 21, 2011 at 10:57 pm

    the reply from atos

  • Sue Izzard on Facebook November 21, 2011 at 11:09 pm

    Great letter to GMC and ATOS, I agree the reply is pants.

  • The BMJ didn’t even take a position – I guess they are waiting fot this response. Please ask everyone you know to sign this including the local vicar and Occupy Camp! 🙂

  • Angela Mitchell on Facebook November 21, 2011 at 11:37 pm

    The ATOS reply was incredible. Why aren’t they medically trained? I got a visit from an ATOS assessor who took my peak flow reading as I have asthma. It was 300 when it is usually 450. He replied it is probably because you are being interviewed by a stranger that it is so low! I knew what it meant. As shortly after I had an asthma attack. This shows that the medical should be carried out by health professionals as clearly they do not know how to react when faced with an emergency or worse. Pure negligence is my view. What if I did not know what to do instinctively?

  • Joe Kane on Facebook November 22, 2011 at 12:26 am

    The open letter is simply stunning.

  • Bill Kruse on Facebook November 22, 2011 at 3:07 am

    Well I’m pleased about that at least as I’ve been entirely sure for pretty much all my life we didn’t live in anything like a democracy. They’ve been pretending we do, allowing us small things, because if you can make people think they’re in a society of their own it’s easier to control them but that’s all breaking down noiw. The reality is we are a beaten people, essentially invaded by the banks and their rich chums and we work forthem, they rule. The gloves are coming off lately, they aren’t even bothering to pretend what we live in is fair any more.

  • bridgetdprice November 22, 2011 at 7:10 pm

    I think I may be a bit slow!
    1 your letter is a bit long it took me a while!
    2 I can not see any correlation between it and the ATOSser reply. (Perhaps they got a bit of LiMA like software to do an automated reply based on key words but with no overall sense) For example: ‘The services are provided to all required professional standards as set out under the services contract with customers, as stipulated by any applicable professional standards and as provided by statute and regulation’. This gobbledygook is all well and good but it does not address the issues of concern that were raised.

  • Bill November 24, 2011 at 7:49 pm

    Do you really think these FAT CAT jobs-worth’s will do ANYTHING? You really are DELUDED if you think so. What planet are you on?

  • Tia junior November 24, 2011 at 8:54 pm

    The reality is that Atos itself is “protected” by the contract with its customer (DWP) exactly as it describes – this is the nature of outsourcing. Everything it does and how it does it has been approved by DWP, including the professional, legal and ethical standards to which it operates. The one thing DWP cannot outsource (although it pretends it can) is accountability for the service it has defined. Contractually, Atos does not have to change anything unless DWP requests it and even then there will probably be a cost. DWP motivation is clear and are happy with the way things are going, so if there are legal loopholes, DWP cannot be relied upon to spot them. There is a stong arguement that DWP itself is not complying with the general Civil Service Code of Conduct & Ethics, but I am not clever enough to take this forward. For all of these reasons I believe DWP should be the prime focus of attack. the Atos contract was to run to 2014, but has ALREADY been extended by one year. Clearly DWP has no intention of ending the relationship and it seems from more recent declarations, give Atos more work rather than less. Describing Atos as “independent” is the greatest absurdity of all.
    Personally I do not regard Occupational Health Assessment as a new branch of medicine that requires an entire educational infrastructure to support and promote it – it is just a slightly different view of a patient’s capabilities. We have more than enough expertise and capacity in the NHS to do a far better job at far lower cost.

  • John McArdle November 25, 2011 at 12:56 am

    We await the response of all those of goodwill and conscience

  • Peter Maxwell November 29, 2011 at 4:17 am

    Good work but I think the wording seriously needs tightening-up: there are very strong points in there but the thrust of your arguments get lost in wordage.

    More importantly, who do you want signing this letter and how would one go about signing it?

  • Mo Stewart December 2, 2011 at 1:27 pm

    Just seen this and not yet viewed the Atos reply, and probably won’t bother as I can guess what it says… They believe they are untouchable.

    Please be advised that the BT letter is extremely long and winding and could have been edited to make a much greater impact.

    Do not expect the BMA to react as they cannot get involved in what are viewed as ‘political decisions’ and that is their get-out clause.

    Furthermore, this IS a DWP legally binding contract that Atos breach on a daily basis, the DWP have confirmed in writing that the contract NEVER has been ‘audited’ as claimed in the Commons by the PM, and the threatened and totally unnecessary ‘review’ of everyone on long-term or permanent DLA to convert to PIP is likely to be conducted by a DIFFERENT company other than Atos according to Bill Gunnyeon, the DWP CMO….. Wait and see who they get to conduct that one….

    Even more sinister, our profoundly disabled War Pensioners, who’ve already had a gvt medical to be awarded a War Pension, will STILL have to have one of these assessments to retain DLA/PIP…. What a waste of resources. So now we could get into a ludicrous situation where disabled veterans with 70% disability war pensions, or higher, may be re-assessed for DLA/PIP and fail to qualify??!! Let’s hope that the veterans groups will feel the need to do something about that before it becomes a reality?

    Following two years of research, and with failing health, the exposure of the two UNUM memorandums to gvt, in 2002 and 2006, are the natural conclusion to my research. I’m taking a break now till the New Year and should have more time to view BT and other disability rights support groups via their websites.

    Well done everyone but, please understand, this fight cannot be won but can only ever be adjusted. The fact is that the population are living decades longer than in the past. The last generation didn’t expect to live longer than 15 years post retirement age, now it isn’t at all unusual for people to live into their 90’s- to 100 plus and the DWP don’t have the cash.

    This has impacted on all funding, hence these destructive and savage funding via insurance, following the American idea of health support, masquerading as welfare reforms. Given the exposed evidence, it is inevitable otherwise they’d never promote an unelected former government adviser to his own ministry, with apparently no limitations on his interpretation of ‘disability’ which means that any of us who are not yet in a persistent vegetative state must be challenged… The global financial crash has just given Freud more power to keep going to reduce the welfare costs and, if you watch the last debate in Grand Committee in the Lords, you will hear Freud claim that “we will adopt powers to permit this to be achieved” so, if they don’t have laws to permit what they want to do, they’ll give themselves new laws….

    http://www.parliamentlive.tv/Main/Player.aspx?meetingId=9526 refers.

    This debate lasted for 5 hours…..!!

    As for Dame Carol Black and her so called ‘well notes’ she needs to get a life…

    Our GPs are now in an impossible position and are very angry but feel powerless to stop what is government impossed medical tyranny.

    Labour MPs claim to be outraged but it was a Lobour gvt who brought this in….. and the coalition gvt have just increased how savage it will be.

    One final thought…. I have exchanged a number of letters with Prof Harrington who has always thanked me for my research and invited me to keep him informed. One has to wonder therefore why, quite unexpectedly, I received a letter from the Professor claiming that he didn’t ‘endorse’ my work when no-one has ever claimed that he had. All I did claim was that he’s invited me to keep him informed and that he was happy to accept future research. Regarding his first report, the Professor wrote to invite my permission to use my report, so one must wonder if someone has had a word…. 🙂

    I am advised by a secure source that I am refered to as “that bloody woman” in gvt circles, and it tends to give me a warm feeling inside…..

    Meanwhile, it will probably take me another two years to do the filing…

    Take care of each other and keep up the great work.

  • cable December 7, 2011 at 9:12 pm

    I thought mobility allowance was saved?

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