Intended for healthcare professionals

Feature Medical Work Assessments

Well enough to work?

BMJ 2011; 342 doi: (Published 02 February 2011) Cite this as: BMJ 2011;342:d599
  1. Margaret McCartney, general practitioner
  1. 1Glasgow
  1. margaret{at}

Increasing numbers of people previously deemed medically unfit to work are being taken off state benefits after assessments by a doctor. Margaret McCartney investigates the ethics and fairness of the system

A medical degree can open all sorts of doors. One is the brown and tinted glass entrance of the Atos Healthcare offices in Glasgow, where I checked that my name was on the list held by the security guard at the desk. This recruitment evening was for doctors, nurses, and physiotherapists interested in working with this French information technology firm, which is subcontracted to the Department for Work and Pensions to provide work capability assessments.

In November last year Atos announced a three year extension to its contract with the department, worth £300m (€350m; $480m), to “support the UK government’s welfare reform agenda.”1 Atos is the sole contractor, and the medical reports it generates are used to make decisions about eligibility for employment and support allowance. This benefit, which has been replacing incapacity benefit and income support since 2008, is paid to people who are medically unfit to work because of illness or disability. The weekly allowance, once the claim has been verified with an assessment of capability, is worth up to £96.85. The government estimates that 2.5 million UK citizens receive sickness benefits at an annual cost of around £12.6bn to the taxpayer.2

A quick glance at internet discussion forums suggests widespread dissatisfaction from people who have been assessed. The adverts for Atos, however, consist of smiling, badged professionals saying, “Getting home on time has become part of my daily routine.”1 The lack of on-call duties and the 9-5 office hours were also the major advantage plugged at the evening, where nurses and doctors working for Atos helped to promote joining the company.

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But what …

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