Public Accounts Committee Report on the DWP AtoS Contract management of medical services

Will the PIP assessments repeat the 'mistakes' of the notorious WCA?
Will the PIP assessments repeat the ‘mistakes’ of the notorious WCA?

Atos Contract Killers

Stethoscope08 February 2013

Public Accounts Committee publishes the Department for Work and Pensions: Contract management of medical services: Twenty-third Report of Session 2012-13. 

The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:

“The Department for Work and Pensions is getting far too many decisions wrong on claimants’ ability to work. This is at considerable cost to the taxpayer and can create misery and hardship to the claimants themselves. 

This poor decision-making is damaging public confidence and generating a lot of criticism of the Department’s contractor for medical assessments, Atos Healthcare – but most of the problems lie firmly within the DWP.

The Department’s view that appeals against decisions are an inherent part of the process is unduly complacent. Nearly 40 per cent of appeals are successful, with a third of those successful appeals involving no new evidence.  

The Work Capability Assessment process hits the most vulnerable claimants hardest. The one size fits all approach fails to account adequately for mental health conditions or those which are rare or fluctuating. While the Department has started to improve, the process is still too inflexible and too often is so stressful for applicants that their health simply gets worse.

A key problem is that the Department has been unable to create a competitive market for medical assessment providers, leaving Atos in the position of being a near monopoly supplier.

The Department is too often just accepting what Atos tells it. It seems reluctant to challenge the contractor. It has failed to withhold payment for poor performance and rarely checked that it is being correctly charged. The Department also cannot explain how the profits being made by Atos reflect the limited risk that it bears.

There needs to be a substantial shake-up in how the Department manages this contract and in its processes for improving the quality of decision making.”

Margaret Hodge was speaking as the Committee published its 23rd Report of this Session which, on the basis of evidence from Citizens Advice, Disability UK and the Department for Work and Pensions, examined the contract management of medical services.

The Department for Work and Pensions (the Department) relies on medical assessments to help its decision makers reach an appropriate decision on a claimant’s entitlement to a range of benefits. Work Capability Assessments are used to assess new applications for Employment and Support Allowance and to reassess existing recipients of Incapacity Benefit. This is damaging public confidence and generating much criticism of ATOS, but most of the problems lie firmly within the DWP. The Department has outsourced this work since 1998 and in 2011-12 paid its contractor, Atos Healthcare, £112.4 million to carry out 738,000 assessments. From April 2013, a new medical assessment will be introduced for the Personal Independence Payment.

The Work Capability Assessment process is designed to support a fair and objective decision by the Department about whether a claimant is fit for work, but in far too many cases the Department is getting these decisions wrong at considerable cost to both the taxpayer and the claimant. The Department’s decisions were overturned in 38% of appeals, casting doubt on the accuracy of its decision-making.

Poor decision-making causes claimants considerable distress, and the position appears to be getting worse, with Citizens Advice reporting an 83% increase in the number of people asking for support on appeals in the last year alone. We found the Department to be unduly complacent about the number of decisions upheld by the tribunal and believe that the Department should ensure that its processes are delivering accurate decision-making and minimising distress to claimants.   

The Work Capability Assessment process has a disproportionate impact on the most vulnerable claimants. The standardised “tick-box” approach fails to adequately account for rare, variable or mental health conditions and this can lead to greater inaccuracies in decision-making for these particular claimant groups. We welcome the efforts made to improve the process and encourage the Department to continue to review the operation of the work capability assessment for vulnerable groups.

The Department does not know the full cost of the overall decision-making process. Its processes have financial effects across government, for example, in the National Health Service, and high levels of appeals increase the Department’s own administrative costs yet it has not assessed the overall cost to the taxpayer. Without this information the Department will be unable to assess the value for money of its decision-making processes.

The Department is currently dependent on one supplier to undertake all medical assessments. In the 14 years since the service was outsourced, the Department has never awarded the contract to a new supplier; it has only ever changed hands due to a company takeover. The inability of the Department to develop a competitive market for medical assessment providers has left it vulnerable, with limited leverage to remedy poor performance.

The Department is not using all the mechanisms it has at its disposal to manage the contract for medical assessments effectively. We saw no evidence that the Department was applying sufficient rigour or challenge to ATOS given the vulnerability of many of its clients, the size of the contracts and its role as a near monopoly supplier. We are concerned that the profitability of the contract may be disproportionate to the limited risks which the contractor bears.

The Department’s evidence was not always consistent with the views expressed by our other witnesses. We heard different interpretations of statistics such as the proportion of successful appeals, the accuracy of decision-making and on whether overall contract performance is improving.

As a result the Committee was unable to arrive at a clear conclusion about whether the overall performance is improving and we recommend that the National Audit Office should provide a further report focussing on up-to-date performance data.

Image: iStockphoto

Parliament 

Comments
  • jeffery davies February 8, 2013 at 7:42 pm

    all the lying gits belonging to atos and dwp d/makers should be sacked ids grayling should have to answer to the courts of this as every wk more die because of atos dwp but then will they i think not trying to save all making the sick atos whip so that they render to it nah do the decent thing get rid jeff3

  • Justin Thyme February 8, 2013 at 10:03 pm

    “This report completely fails to recognise the considerable improvements we have made to the work capability assessment since coming to power in 2010.” Mark Hoban, Employment Minister

    that’s his card marked then, bastard!!

  • Sam February 11, 2013 at 3:50 am

    Reference the standardised ‘tick-box’ mentioned in the report. Was there any mention of a widely-reported practice by ATOS HCPs of making assertions which were not based on interviews or evidence provided?

  • steve davies February 11, 2013 at 11:54 am

    So what is going to happen now or in near future ? or do we have to wait for more deaths and suicides . It will , in my opinion, only change when the ConDems are voted out of office.

  • owen uptwit February 11, 2013 at 3:57 pm

    Some way towards justice. I want to know if those who have list lived ones or have experienced health deterioration are to sue DWP. I hope they can and do.

  • Sam February 11, 2013 at 4:28 pm

    I’m afraid steve davies is too optimistic about an election – it was, after all, the last government which introduced us to ATOS. And if UKIP were to be part of the government, we might be begging to have IDS back! When our damaged soldiers, who have more public sympathy than the simply disabled, start being treated better, THAT’LL be a good sign.

  • Sam February 11, 2013 at 6:20 pm

    Note to owen uptwit: if I can find the resources, I plan to do exactly that – I think I may have grounds including 2 laws broken. I shall post progress on a blog, but I ought to ask this site’s permission before naming my site…

  • nikki February 11, 2013 at 11:03 pm

    ATOS drove me to the brink of wanting to commit suicide with an assessment and report which took me from high rate both DLA components to Nil . Severe complex mental health problems is just one of my illnesses ,of which i have had to have 12 sessions of electric shock treatment for in the past after attempting to take my life and as you may know ECT is a last and final resort .I blame this government as they are setting ATOS targets at whatever cost to sign the sick and vulnerable off benefits . My mental health is very fragile and now I am awaiting also for the decision of my ESA ,I have severe pain throughout my body and also have narcolepsy ,incontinence problems ,sever derealization syndrome ( I constantly feel the world is unreal and I am not a part of things . But ATOS cured me in a 30 min assessment with a report that painted me in a bright light ,the stress of appealing has made me ill and the loss of my mobility vehicle which was the only way i could be taken out on short journeys by my partner due to my sever anxiety disorder .The dr from ATOS described me as well built ,and intelligent ,all because i could tell him how i feel on a day to day basis .I cant eat or sleep as a result of what has happened .This system is a total disgrace and to treat human beings in this way should be unlawful .My family are also ill due to this with the worry of my mental health state .Financial worries as a result of my dla removed ,christmas was aweful and my sons 18th birthday due to the withdrawal of my dla ,as i still have the pay expenses to family and friends who help care for me .I have a solicitor to fight my appeal. I dont know how they sleep at night

    • Anne Byrne February 15, 2013 at 12:59 pm

      They sleep at night because YOU do not exist to them YOU do not move in their circles and if you were a family member YOU would be the secret they hid in their attic or the wing of the house that only one servant was allowed to use !
      I would probably be there with you as I have a deformed spine. Didn’t you know this world is only for the perfect people who share their views and are born into a life of riches. The rest of us are just something unpleasant to be stamped out and now their little pet dog ATOS has been muzzled they need to find another one.
      I will go out fighting. I am currently waiting for a re-decision and then no doubt an appeal. My benefits ceased on 8th Feb as yet nothing has been awarded, DWP say I should hear before my next payment would have been received which is 22/02/13 so they still have 1 week to let me know if I can continue to eat.
      Sending you and the thousands of others in this appalling position a *hug* it sometimes helps just to know you are not alone.

  • Ange KRUMS March 5, 2013 at 12:04 am

    This government is worse than communist USSR. They should be booted out.
    I never voted for them, I never voted for a con/lib government. ATOS should be investigated, there practices and assessments need to be scrutinised by some sort of independent body. It all amounts to gross abuse of vulnerable people in our society. It is intimidation. These ATOS doctors intimidate the out come of all the assessments they carry out. They manipulate the reports they write, to benefit the DWP, Medical services, the Government, and finally
    ATOS as a company, to increase there own profits. What the government pay’s ATOS as a company should alternatively be paid to our sick and vulnerable society.
    Anybody who let an ATOS doctor physically examine them should not let them do this. They are only suppose to ask you 20 questions. Nothing else.
    I would suggest that if they try or do physically examine any one it should amount to assault.

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