Friday, 4 January 2013

The unfairness of ATOS WCA assessments

Accurate, objective, consistent and transparent assessment that looks at people as individuals. This is the description given by the Department for Work and Pensions of its disability assessment criteria.  It sounds good doesn't it? Objective; accurate, consistent.

 In a previous article I made the case that a dispassionate calculated assessment made by ticking boxes is unlikely to be fair because it takes little or no account of the real circumstances of the person assessed. Similar physical or mental abilities obtained either from a form filled in by the applicant or from face-to-face assessment can present different problems depending on context and circumstance. When the assessor is more concerned with inputting data into a computer than with engaging with the applicant then it is difficult for the applicant to make clear how their condition affects them in their daily life. When the assessor seeks to be disengaged, then there can be little informative narrative. 

“Each time I tried to explain fully my conditions and how they affected my every day life he would interrupt and go on to the next question”, Ms T in evidence to the 3rd Annual Review of WCA. 

And peoples' lives are a narrative. They are not disjointed bits of data. Disability isn't simply a problem confined to the individual as a physical being but also as a social being.  The social condition can have as much of an impact as any measure of 'disability'; circumstances can be disabling. How any particular condition affects a person's capabilities may vary with time, with geography and with other physical or mental conditions. In short the way in which any condition can be disabling is complex. Sometimes it is the very complexity that is disabling. Disabilities are often multifaceted. 

This is certainly true for mental health. It beggars belief that those making the assessments for the WCA have the necessary expertise and experience to make an assessment of how any particular mental condition impacts on the life of the claimant. It takes many years of training and several years of experience. So I really doubt the efficacy and ethics of an assessment process by Decision Makers who have no such expertise.  Yet it is acknowledged that the Decision Makers employed by  ATOS have very little appropriate training for such assessments. And this is a major concern for mental health organisations and mental health care professionals. 

In evidence presented jointly to the 3rd yearly review of WCA  mental health organisations said:

“We believe that, without expertise in the causal conditions, healthcare professionals are not sufficiently equipped to understand why and how function may be impaired or to elicit the relevant information from an  applicant who may have… difficulties in reporting their condition” (joint response from the Centre for Mental Health, HAFAL, the Mental Health Foundation, Mind, Rethink Mental Illness, the Royal College of Psychiatrists and SAMH )

This opinion,  based on all the credentials and experience of these organisation, was dismissed in a complacent 3rd year report as having 'little evidence to support it'.  It really makes you weep doesn't it? In fact there is buckets of evidence. Would anyone want their house rewired by a worker without appropriate training, experience and accreditation? Would they want work done by a cowboy electrition? I doubt it. Then why on earth would anyone conclude that we don't need expertise and experience to assess mental health? Cowboy heath professionals.

Performing a Google Scholar search for assessment of mental health capacity I found over 500,000 scholarly articles on the subject. Of course I didn't read them all, but the ones I did read (oh yes I read some. I have a degree in neuroscience too so I found it fascinating) were all considering the difficulties of assessing capacity. It is something so obvious that it beggars belief it could be dismissed. 

Yet there are enough signs in the report to warn us that the system isn't working, particularly in relation to mental health. 

"Worryingly," it said "there continues to be a percentage of ESA claimant who do not engage with the process initially; and a significant percentage of those failing to comply with the requirements are claimants with mental, intellectual or cognitive conditions."

Between 26 and 30% fail to attend their face-to-face assessments. Up to 44% failed to send in their assessment form. This should ring alarm bells. It should make us sit up and, yes, worry! What it means is that many are not getting the kind of support necessary for them to deal with the process. For those with mental health issues this is worrying! 

You would think also that particularly for vulnerable people ATOS healthcare professionals would seek advice from the claimants chosen health care advisor. But in too many cases this is not done unless "they believe it would help the process or avoid an unnecessary face-to-face assessment."  It isn't clear how they make that judgement. For any legitimate assessment it would be necessary to have all the necessary documentation and advice before a decision was reached. But in so many cases this is not the case. Indeed it was a recommendation of the 3rd annual report that 

"Decision Makers should actively consider the need to seek further documentary evidence in every claimant’s case. The final decision must be justified where this is not sought. " Currently it is not done. The previous annual report also recommended this but it wasn't done. DWP and ATOS clearly aren't working.

Estimates vary on the percentage of 'ft to work' decisions reversed on appeal. Those overturned when appeals are made with help from the CAB can be as high as 80 to 90%. Clearly something is awry that so many decisions could be judged to be wrong. It appears that a major factor in decisions being overturned by tribunals is the presentation of documentary evidence that was not considered or was largely ignored in the assessment. 

“Very difficult process when you have letters from GP, Psychologist, Neurologist etc. informing DWP that they consider you unfit to work, but as these professionals have a limited knowledge of [the] system these letters were not considered useful as the terminology they used did not cover the descriptors used”, Ms B in evidence to the 3rd Annual Review. 

The annual review makes the point that for this to improve ATOS would need to work with the health care professionals. But the BMA have voiced their concern that this might ethically compromise the patient's health care professional.  

"It is not." They warn, "the GP’s role to provide any opinion on the patient’s capability to work as part of this  process. It is vital that these two roles are kept separate and that GPs are not asked to provide opinion on their patient for the purpose of receiving Employment and Support Allowance (ESA); doing so could damage the doctor-patient relationship” British Medical Association evidence to 3rd Annual Review. 

The BMA have clearly expressed their concern that the process may compromise their members whose duty it is to act in the best interest of their patients. It also points out there is no funding for the support GPs might give to their patients in the appeal process. The Citizens Advice Bureaux have also expressed concern that they cannot give the level of support to all claimants in the appeal process and access to such help varies across the country. 

If you are concerned about the WCA and how it is affecting people's lives there are two petitions you might consider signing:

Exclude vulnerable severe & Enduring Mental Health Sufferers from DLA Assessments in 2013 and The Wow Petition

Postscript

Many 'fit to work' decisions are overturned on appeal. As explained in the article a key factor in decisions being changed on appeal is documentation provided that was not considered in the ATOS assessment and DWP decision. It is clear that the DWP decision makers rarely (less than 0.1%) request further information from ATOS before decisions are made. This is disturbing as it demonstrates lack of diligence and an assumption that the ATOS assessment has covered sufficient ground. 



2 comments:

  1. The WCA works very well. It does what it's supposed to do and that's deny people benefits. Until you accept this is malevolent, it's design not accident or incompetence, you aren't facing the reality here. Ugly, isn't it? Googling for Unum scandal gives the whole game away, it's a takeover of this backward little country by the giant American insurance company.

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    1. Yes I take your point well Bill. Perversely they may not be succeeding even in that malevolent objective, or at least not to the extent they intended. I suspect they will next target the tribunals to reduce the numbers of decisions being reversed.

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