BMJ 2012; 345 doi: 10.1136/bmj.e5347
(Published 8 August 2012)
Cite this as: BMJ 2012;345:e5347
Margaret McCartney, general practitioner, Glasgow
Two recent television programmes made public what doctors and patients already know: fitness to work assessments being conducted in the UK by the private firm Atos are unfit for purpose and damaging.
Why are doctors involved in this farce, asks Margaret McCartney
Atos Healthcare carries out disability assessments on behalf of the Department for Work and Pensions.
When I tried I failed to find out about the content of assessments, their evidence base, and the training and auditing of assessors.1 2 I wanted to know basic things.
What medical criteria were used in assessments?
How could the assessor—having no access to medical notes, test results, clinical opinions, or history—make a valid decision about whether the person was fit, or not, to work?
Despite Atos’s services costing the taxpayer £100m (€125m; $155m) a year, commercial confidentiality is given as the reason why the veils are persistently and firmly drawn.
The general practitioner Steve Bick thwarted this tangled web by going undercover as a new recruit, filming his training sessions for Dispatches.
It made for painful viewing.
Incapacity benefit is being converted to employment support allowance, with the intention that every claimant would have a medical reassessment—the “work capability assessment.” This is a medical examination carried out by a nurse, physiotherapist, or doctor.
The tests—peak flow, limb movements, pushing a box around, pressing a button—are clearly unable to distinguish someone who can work from someone who can’t.
Points can be awarded in several categories and are forwarded to the decision maker, a Department for Work and Pensions assessor, for judgment. The box-ticking to achieve enough points to be granted employment support allowance was ludicrous.
The doctor who trained Bick explained the distinctions.
Oral chemotherapy or hormone therapy, say for prostate cancer, doesn’t get points; intravenous chemo does. When Bick asked why, he was told, “That’s the legislation.” Disabled claimants were assessed as though they were using a “hypothetical” wheelchair. Having one hand or one leg is not enough to generate points; you must have no use of either of a pair of limbs to get a tick. This was described as “almost unachievable.”
The assessment bears no resemblance to real life. Why are doctors involved in such a farce?
Atos has been allowed to take over the assessment of the most vulnerable people in society without proper scrutiny. The many successful appeals, which cost the taxpayer £50m a year to administer, shows the system’s failure, and we do not know how many others do not appeal. Why are we not acting on the human cost of stress and anxiety caused by the assessments?
One man was declared fit to work while awaiting heart surgery—and died shortly afterwards. No system will be perfect, but this system fails serially. Disabled people are left to deal with an often insensitive round of assessments, failures, appeals, successes, and then, in a circular fashion, reassessments. People who had worked all their adult lives feel humiliated in asking for benefits and then being turned down. This is no way to treat sick or disabled people. Yet we do.
Citizens Advice, which helps people with appeals, has had its funding cut by an average of 10% from local government and reported last year that it was able to help 7% fewer people.3 A video recently created by Her Majesty’s Courts and Tribunals Service for appellants, which gave tips that might increase the chances of success, has been withdrawn after Chris Grayling, employment minister, complained about the “tone.” Grayling went on camera for Panorama to deny that there were targets for assessment results, describing the push to get people off benefits as “tough love.”
So, how does this work with, say, assessments of people not working because of mental illness?
Panorama showed a man detained in hospital under the Mental Health Act who was pronounced fit to work. How do the assessors make judgments without recourse to notes or third party information, knowledge of stressors, patterns of illness, chronicity?
What evidence does Atos have to show that its assessments are fit for purpose? The variety of backgrounds of the health professionals doing the assessments means that some may have no clinical experience of mental illness. Their only training may be that from Atos. Is this enough?
Having professionals on board lends legitimacy to Atos’s process. Yet the potential for deprofessionalisation in this environment is overwhelming.
Malcolm Harrington has written three independent reviews of the work capability assessment for the government and has asked for substantive changes, including improvements in the assessment of mental illness and to transparency of the process. He told Panorama that the assessments needed human medical judgment to work.
At the Atos recruitment evening I attended we were told that there were no targets; there were, however, averages, and if you fell beyond these you should expect close auditing. This was confirmed by Dispatches, but the derivation of these averages is unknown. So there was no room for medical judgment or nuance. One health professional explained that she felt awful for scoring a man with prostate cancer as fit to work. No wonder Bick’s trainer explained that this was a “toxic” job: “That’s why I don’t do overtime.”
The question of how we got ourselves into this mess is one thing. How we get ourselves out is another. Fear of losing their jobs, and the confidentiality agreements, means that few Atos Healthcare staff speak out. Bick was told, by a doctor who assessed a patient he had never met, to alter his examination findings. This should be intolerable. The BMA’s conference of local medical committees in March passed a motion saying that the work capability assessment was unfit for purpose.
The evidence for the processes that Atos uses needs immediate public scrutiny, and the harms of this system must be examined urgently. We should support and protect health professionals who work for Atos and want to speak out. We have allowed medicine to be made responsible for a dreadful process. We need to work together to make it clear that it cannot be.
Cite this as: BMJ 2012;345:e5347
Disabled or Faking It?
A Panorama programme first shown on BBC Two on 30 July 2012
Britain on the Sick
A Dispatches programme first broadcast on Channel 4 on 30 July 2012
McCartney M. Well enough to work? BMJ2011;342:d599.
McCartney M. Atos and changes to disabled people’s benefits. BMJ2012;344:e1114.
Citizens Advice. Cuts in CAB funding leaving thousands with nowhere to turn for help. 6 Sep 2011. www.citizensadvice.org.uk/press_index/press_20110906.htm.
16 thoughts on “‘The disturbing truth about disability assessments’ by Dr. Margaret McCartney RCGP (Glasgow) ~ British Medical Journal”
yes but they will noy get rid of them neither will ed at thwe moment hes saying not to much on atos only oh look theres tony blair he help us ,but hes been warned by hooking up with this laughing shitte he be outside looking in again so atos the killers of the sick an disabled cutting benefits when mps should be looking in their house for cuts but that is to much to ask jeff3
Ed Milliband has said that Labour will sack ATOS, When /if Labour win the next election,
Here are two links. Please read them in the order they are given. They may go some way towards explaining the social cleansing policies that this government is employing.
I do not believe the first link is anything to do with so-called “conspiracy theorists.” The article quotes a member of the Agenda 21 project and what he says is quite chilling and ties up with what’s being practiced here in the UK against disabled people.
Whether or not our government is signed up to Agenda 21, and that will be for you to make your own minds up on, the fact that it has been exposed at the same time that they are progressing their policy of benefit stripping from the UK’s most needy does mean the question of their complicity or not has to be raised now.
The second link is distressing, but shows how the Agenda 21 project would be (already is being?) applied.
We just have to continue fighting and not give up. As long as I have amazing heroes like Dr Stephen, who would give his last breath for his patients and John, dedicated and always there battling by our side I have hope. If I give up now and just lay down and wait to not wake up anymore, the criminal government has won and I cant not let that happen. Thank god for those who fight for us, us who are not able mentally and or physically to fight daily for the human rights of those left without any resort! I am so grateful and I will not give in into despair.
ATOS are criminals and the government are party to one of the greatest crimes against the British people in history. This must be stopped and NOW !
Most people forget that tomorrow it could be them ! It can go very very quickly and you go from being an active person enjoying life and work to being what you what never would have thought in your worst nightmares. It can hit ANY person at ANY time ! Why are all the people out there so so SURE that it will not hit them, their wife, husband, mother, father, son, daughter, sister, brother..how has this society become so shortsighted? Do they really think it could never happen to them? What is wrong with this society… I can not understand it ! Tomorrow YOU could be the one whose life is shattered by an illness, an accident…something you would NEVER have expected. How can this go on without society being outraged ? People say: how could Hitler get away with all his atrocities with no one stopping it? THAT IS HOW. NO ONE CARED, no one wanted to stand up and say: stop it now.
this government have lied on and on saying they would help the most vulnerable in society it has not it has brought in a company from america to access a severally disabled person as capable of work so that a big american company can profit..out of taxpayers. i for one was accessed back in the 70,s as incapable of work due to severe birth disabilities..i know have other illnesses i am also deaf.as i said earlier for the sun comments …this government are immorilising disabled peoples rights. taking away benefits is not a cause to government reforms it is a controversy to all sick and disabled ..we are not scroungers..we are genuinely sick people who seek justice from an unfair government using tactics to reform benefits on those who genuinely need help..we are not in the thities and forties of modern hitler society seeking a revenge on those who can and cannot work.this government are wrong bringing in an american company to access british welfare to sick and disabled.if i was an active disabled person i would be able to work do most activities a normal person would do.judgement should not be an accessment…if all medical records and hospital records were read by these so called hired accessors..this country would not be in a mess.no one can blame disabled people for a governments mistake on reforms .taking away benefits would destroy a disabled persons quality of life.this government do not realise on day it could be one of them struck down by illness and disability and hardship.
i made a mistake in two words in my comment ..thities ..should be thirties , know should be now.please can you amend these two words in my comment.thankyou.c.f.
I multiple posted this comment by mistake , sorry. But if it makes me scream even louder I might be forgiven. JJ, xxx back, without my knights in shining amour I would not know why and how to go on. I am not sure if the fighters for us always know what a huge difference they make but it is honestly a difference between life and death. HOPE is the air that keeps me alive and without someone out there battling for me, there would be none.
If Ican not sleep at night or panic and get lost throughout the day the thought of me not being in this on my on is the greatest comfort of all. I will never be able to explain how much the support keeps me going. And now I will shut up and go to sleep.xxx
Darren I am shocked that this has shocked me. It’s no more than I have come to believe but it has shades of Nazi Germany 1939 “Aktion T4”
The Practice of Medical and Health Care is a Service and Not a Business
The Evil Demonic and Cruel Persecution of the ” Useless Eaters ” and ” Work Shy ”
by the Demonic National Socialist Regime has Parallels with the Persecution of
the Poor and Vulnerable by the Con Dem Regime of ” Democratic ” Britain even
if in our Supposedly ” Green and Pleasant Land ” People Think that Tyranny
and Oppression has Nothing to do with the UK when it Clear as Crystal with
CCTV Cameras Slave Driving Bosses and the Un Equal Distribution of Wealth in
the Land does
Namely that the Weak the Sick and those at the Bottom of the Pile are Singled
Out for Victimisation with the Help of Below the Gutter Tabloids and ” Quality
We Need an Instant Change for the Better in Government Policy with Regards
to the Sick Disabled and Vulnerable and Public Accountibility for Health Care
Cut the Billions Wasted upon Nuclear Weapons and the War of Aggression in
Afghanistan and Put part of that towards Welfare Spending
Welfare Spending is about Helping People whereas Warfare Spending is More
to do with Harming People
I’ve undergone two ‘assessments’ with ATOS, on both occasion I was seen by the same person, a GP. At my first meeting he told me he would ask for further information from my GP and a few weeks later when I checked with my surgery they had not received a request from him.
As he told me he was a GP and gave me his full name I was able to check on the GMC website and found he was not on the GP register but on the specialist register as a obstetrician and gynaecologist. I’m confused as I’m a cancer patient and was supposed to be seen by a GP and my cancer was in my tonsil, not in the ‘southern region’.
He also confessed that he had only met one patient in the past with tonsil cancer during his 50 years of practice..strange he said 50 years as he looked like in his mid50’s so must have qualified in his toddler years
I have no trust in ATOS nor the DWP and it will never change!
This government says they will ‘help’ people but instead they are killing people off fast..
Can I draw people’s attention to something rather disturbing i discoverd recently. A friend with multiple health problems including mental health ones, had been sent a letter with a date for medical from atos. He was worried sick but prepared to go when I asked if he had filled in an ESA50. He had never even received one ! To cut a long story short, after making phone calls on his behalf I was told it is Atos POLICY, if they have not received back the ESA50 that they will ASSUME, if the person is flagged as having mental health problems, that they have simply been unable to fill it in and will call straight to medical. They will not bother finding out whether they have made a mistake and the form hasn’t even been sent. You can imagine what would happen if someone took their word that a form was not needed and attended the medical without the examiner having the completed form to even refer to. It needs to be understood that this is Atos and DWP policy towards people with mental health conditons and people need to know that they must ask for another form if they haven’t received one before they are called for medical. I was astonished that this could happen; they are relying on people not being aware of the proper procedure.
I am confused trying to read sues note. What exactly happened? What other form ???????
Hi Christina, the problem was that you are meant to have received an ESA50 and returned it before they call you for medical. My friend had not even received one but, because he has mental health conditions they thought he simply hadn’t known how to fill it in and set a date for medical. This is contrary to the procedure they are meant to follow and if he had just turned up for medical there’s a chance he would have been found fit for work as the face to face assessment is not good for assessing mental health issues. They even tried to say to me that they were doing him a favour by calling him straight to medical as the ESA50 itself, they said, is difficult for people to fill in if they have mental health problems. So they used the language of opposition to the whole process to excuse the fact they hadn’t followed correct procedure. I thought it was a one off error but was later told that this is their policy now for people with mental health conditions if they don’t get the ESA50 back. Sorry if I didn’t explain it very well.