Atos Healthcare replies to Greg WoodBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5584 (Published 18 September 2013) Cite this as: BMJ 2013;347:f5584
- Angela Graham, clinical director1
I wish to respond on behalf of Atos Healthcare to certain points raised by Wood in his recent article.1
Firstly, Wood talks about “five . . . rules of thumb” when referring to functions such as manual dexterity and the ability to mobilise and alleges that these take precedence over the work capability assessment (WCA) regulations.
I wish to make it clear that Atos requires all its healthcare professionals to take full account of all evidence gathered during each assessment.
As well as reviewing individuals’ claim forms, in which claimants give their opinion on their level of disability, practitioners record a clinical history of each condition, an account of the individual’s normal daily activities, a physical or mental state examination (as appropriate), and relevant observations made during the assessment. They also take account of any additional medical evidence that is present and consider the effects of variability, pain, and fatigue.
They then construct a report that offers a justified opinion on the level of disability present, using information from all these sources. All reports must fully comply with the Department for Work and Pensions guidance contained within the WCA handbook; all our practitioners are expected to be fully aware of this guidance and are responsible for ensuring the advice they offer complies with it.
The suggestion that simple “rules of thumb” should be relied on by professional practitioners, in preference to a balanced and justified consideration of the gathered evidence and DWP guidance, is inaccurate. All practitioners are fully responsible and accountable for the reports they produce, including the accuracy of information recorded and ensuring that each report contains sufficient detail to explore all the relevant disabilities claimed, as well as complying with DWP guidance in full.
Secondly, I wish to discuss the statement that Atos auditors “were in the habit of demanding that healthcare professionals change their reports without seeing the patient themselves.” Wood goes on to state that the General Medical Council advises doctors “should not alter reports if they think it would make a report less accurate, or would render it misleading to the body commissioning it.”
All Atos Healthcare auditors are experienced healthcare professionals themselves, who hold DWP approval for both the relevant benefit and their ability to audit appropriately and accurately. Like all our healthcare professionals, auditors have to comply with DWP guidance and the professional standards of their licensing body.
A practitioner will be asked to consider amending a report only if quality problems are identified. Such an example would be when advice given within a report is not consistent with the evidence gathered, or when the author has clearly not followed the guidance and standards appropriately. There is no ethical conflict in advising doctors that aspects of their work require further attention to meet the standards expected; indeed, ongoing quality audit and feedback are key to good medical practice, whatever the specialty.
However, it must be emphasised that an Atos Healthcare auditor will never ask for any of the evidence gathered to be altered in terms of the clinical history, examination findings, or observations made.
Finally, all reports that Atos Healthcare produces on behalf of DWP must contain a complete account of all the information gained by the practitioner during the assessment. Reports must also explain how the opinions have been derived and highlight how the practitioner dealt with any inconsistencies in the evidence.
Because the decision on the outcome of benefit claims is made by a decision maker within DWP who does not meet the claimant face to face, all the evidence used by practitioners in offering their opinion—including nuances of observed behaviour and mental state assessment—must be included within the report so that the decision maker can evaluate it fully and independently. As such, auditors will have access to all the relevant information in a properly completed report.
Wood suggests that practitioners who have seen an individual in person have access to additional relevant information that impacts on their function but is not contained within the report: this is not consistent with our practice or the DWP’s guidance.
I am grateful to have the opportunity to correct these inaccuracies.
Cite this as: BMJ 2013;347:f5584
Competing interests: AG works as the clinical director of Atos Healthcare.
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