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Friday, 7 October 2011

A Letter to my MP

Over the past two years, I have written to you on quite a few occasions about the absurdities, vagaries, inefficiencies, unfairness and cost of the current ESA/WCA/DWP/Atos based system.  Clearly my experiences are not unique and you don’t have to look very to find large numbers of people who suffer from illnesses far worse than mine (some terminal), who have been treated in much the same way and unceremoniously told they should stop messing about and get back to work.  Nor do you have to look too hard to spot a growing concern in both Houses about the way in which the Government is pressing on with its welfare reforms regardless of the consequences, upset and hardship it is causing.  This is wrong and it does not have the mandate to do it – everyone supports a more efficient system of benefits payments, but this is not what we will end up with by blindly following the path we are on now.

The Government has made a rod for its own back in taking the outsourcing route through Atos.  It knows it cannot let a private company directly say yes/no to benefits payments, so this decision has to stay “in-house”.  DWP has therefore had to create an internal role for a “Decision Maker” (DM) and create a full blown job description to make it plausible.  The trouble is of course is that DMs have no medical training, but are supposedly delving into complex and detailed medical conditions in parallel to the WCA from Atos and making a decision accordingly.  A DWP manager has even told me that they will even make a judgment over prescribed medication, based on what level of knowledge and understanding I dare not even ask.  When I challenged him over the complexities of drug “cocktails” and the risks of addiction/side effects, he was unperturbed.   The debate about what weight the medical element of a WCA should have has only arisen because it is performed outside of the public sector.  The truth is that it should represent 100% - my ability to work is exclusively dictated by the state of my health – but that means Atos decides and we cannot allow that – back to square one!

The effectiveness of any discrimination process is judged on the “false positives” and “false negatives” it generates – both in terms of the relative proportions and how far out the errors are.  The current process fails on all counts – 40% of Tribunal Service appeal hearings find in favour of claimants and there are numerous examples of people with long-term, serious, completely debilitating, sometimes life-threatening illnesses being glibly told they are fit to work, so the errors are often MASSIVE!  In any other sector a process that is so unreliable and so unfit for purpose would have been scrapped long before now.  Imagine the furore if the  if the quality assurance programme behind drug manufacture was so hit and miss?

In addition, Atos are paid per WCA, with no repercussions if they are subsequently proved to be wrong – so where would you expect their focus and priorities to lie?  They are in business for the sole purpose of increasing the value to shareholders through maximising profits.  It is not difficult to see what the combined effect of all this will be and the evidence bears it out.

Why on earth not use the NHS?  Atos performs 11,000 WCAs a week.  We have 10,000 GP practices (40k GPs) which is marginally more than one WCA each practice per week on average, so there is clearly no capacity problem.  It does not have to distract  GPs themselves as most have nurses, physiotherapists etc. on their payroll.  In fact my last WCA was such that my GP’s receptionist could have done it.  The (Atos) person who did do it primarily runs a  Botox/beauty service delivered to your own home and does WCAs as a fill-in.  Who am I likely to trust more?  Who knows me and my condition best?  Who has all of my records on hand to consult?  Who can turn to a colleague for a second opinion if necessary?  QED I think.

Atos costs £100m p.a.  TS costs are reported at up to £50m p.a.  Add to this the unnecessary ESA payments made whilst appeals are in the queue (12 months at present I am told) and the answer is obvious.  You can add to this the entire DM wage bill.  Get rid of the current adversarial system that only generates conflict (and then necessitates a process to resolve it) in favour of one designed to obtain consensus at the outset, after which everything runs smoothly.  The very word “appeal” indicates some awful wrongdoing has taken place, whereas perhaps a far less contentious “second opinion” for borderline cases is necessary occasionally with a commitment to resolve within 24/48 hours locally.

It is not a case of damaging the trust between GP and patient, it is  a case of building on it and using to best effect for everyone.  DWP says that an early  return to work often speeds  recovery.  They also admit that recovery is a GP’s primary aim.  So they both have the same objective and any attempt by DWP to suggest this is not the case relies on semantics, splitting hairs and a DWP’s desire to maintain the status quo come what may.  GPs are expected to responsibly issue “fit notes”; they will soon be expected to responsibly manage £m of NHS budgets, so why are they deemed incapable of administering the relatively trivial WCA task?

This new process is by definition open to public scrutiny (with appropriate confidentiality) and gets rid of the absurd secrecy around parts of Atos that are an affront to democracy and should be an embarrassment to every elected representative in the land.

On a broader note, as demonstrated by Southern Cross and others, the NHS is not safe in private hands.  Equally the NHS it needs to learn that better quality and service does not always mean more expenditure.

So please throw your weight overtly behind this and let’s stop the Atos farce now.

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