Views & Reviews Review

The disturbing truth about disability assessments

BMJ 2012; 345 doi: (Published 08 August 2012) Cite this as: BMJ 2012;345:e5347
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}

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, …

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