Atos and changes to disabled people’s benefitsBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1114 (Published 14 February 2012) Cite this as: BMJ 2012;344:e1114
- Margaret McCartney, general practitioner, Glasgow
The Welfare Reform Bill stutters through parliament. It proposes changes to housing benefit, caps to benefits, and changes to the disability living allowance. This allowance is currently paid with two components, for mobility and care. Claimants must have a severe disability, which means that they need help with basic personal care or require supervision to avoid danger. Mobility allowance is paid to people who are bilateral amputees; are unable or virtually unable to walk without severe discomfort or are at “risk of endangering life”; need guidance or care most of the time; or have severely impaired sight. The bill seeks to replace disability living allowance with “personal independence payments,” making a 20% cost saving in the process. The peer Tanni Grey-Thompson sought two crossbench amendments. She wanted to make it obligatory for assessors of eligibility for personal independence payments to seek evidence from the claimant’s healthcare professional. She had also tabled amendments for a trial period and an independent review. Neither amendment was passed (www.guardian.co.uk/society/2012/jan/17/welfare-reform-bill-amendment-blocked).
What kind of medical examination is reliable in these circumstances? Who should do it? And how should it be done? These issues, together with a discussion of the evidence, seem to have slipped under the radar. The BMA has made no official comment on the Welfare Reform Bill, and nor has the Faculty of Occupational Medicine. An exception is the Royal College of Psychiatrists, which has raised serious concerns. Its former chairwoman, Sheila Hollins, speaking in the House of Lords last year, said, “There are real concerns about Jobcentre Plus and [the contractor] Atos assessing staff’s knowledge and understanding of mental health conditions” (www.rcpsych.ac.uk/pdf/13%20Sep%202011%20Hollins%20Speech%20III.pdf). The college has also co-signed a statement, with mental health charities, describing “serious danger” for patients of the “shortsighted” proposal and expressing the likelihood of a “negative knock-on impact” on the health of claimants. However, this medical opinion has been scarcely reported in the press.
Currently, assessments for disability living allowance do not always include a medical examination. When they do, they are contracted to Atos, a private French technology company, the sole contractor for the Department for Work and Pensions’ medical examinations of benefit claimants. The department says that these assessments are “not to diagnose or discuss treatment” but to “assess how your condition affects you.” The government plans to have all people of working age who receive the disability living allowance to be reassessed before they are allowed personal independence payments (www.dwp.gov.uk/docs/pip-briefing-managing-claims.pdf).
Already this has caused distress among disabled recipients, who have little faith in the present medical assessments done by Atos. Currently these are carried out by doctors, nurses, or physiotherapists and are reported through a computer. However, Atos has not published the assessments or evidence it uses, impeding peer review and open discussion. The University of Derby’s corporate training and development division has “teamed up” with Atos to offer “a certificate of achievement—disability analysis,” which gives credits towards a nursing degree. In 2011 Atos said that 300-400 nurses would be expected to complete this each year. Atos told me that the training was “designed by Atos Healthcare and reviewed and approved by the Department of Work and Pensions.” The University of Derby would not disclose its fees for hosting the course, and Atos would not show me course materials.
There has been little media discussion of the need for medical evidence in producing fair assessments. Malcolm Harrington, emeritus professor of occupational health at the University of Birmingham, has written two independent reviews for the government on the work capability assessment performed in part by Atos. He has made many recommendations for its improvement and is clear about its failings. “I still don’t know what Atos stands for,” he says.
He’s concerned that the proposed change from disability living allowance to personal independence payments will mean a lot of medical examination, done with the computer program, which may not be able to deal appropriately with disabled people. “I don’t think a computer system on its own will ever be good for assessing chronic fluctuating conditions,” he said. This is also a problem in the current use of the Lima software that Atos uses to do work capability assessments. “The Department of Work and Pensions’ response has been that asking questions about severity, frequency, and fluctuation would make the assessment difficult and complex. But these are difficult and complex conditions.” Professor Harrington thinks that the civil servants who make the decisions about benefits on the basis of Atos’s medical assessments would be able to take these factors into consideration. “Decision makers do have the will, and they are audited,” he said, “but there is a danger that middle management will just say, ‘It’s all too complicated.’” Although there is the potential for Atos healthcare professionals to use information about the patient gathered from elsewhere, in Professor Harrington’s experience of sitting in on assessments this isn’t done: “Other information is just ignored.”
Meanwhile the media have focused on “benefit scroungers” and have taken little time to examine the concerns raised by the Royal College of Psychiatrists. Nor has the role of Atos been examined closely enough: after all, benefits for the most vulnerable people in society have been franchised out to an opaque system that is remote from the care in the NHS. More medical organisations should be making their voices heard.
Cite this as: BMJ 2012;344:e1114