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Saturday, 17 March 2012

Brief Rejoinder to Michael O'Donnel

Re: Atos and changes to disabled people’s benefits
15 March 2012
I write to address several points raised in a recent article (Atos and changes to disabled people’s benefit (BMJ 2012;344:e1114) and your editorial column (Through Historians’ eyes (BMJ 2012;344:e1112).
Firstly, Professor Malcolm Harrington has examined the Work Capability Assessment (WCA) in two extensive reviews. All recommendations made to Atos Healthcare in the first review have been implemented. We are now working with the DWP to implement those made in the second review.
Not so – audio recordings of WCAs is not universally available.
Secondly, in his second review, Professor Harrington examined LiMA, the computer software used by Healthcare Professionals to construct assessment reports. He concluded that: “there does not appear to be any fundamental problems with the way in which the software operates” and noted that “many of the comments received ... appear not to be robust or evidence based.” As is now widespread in most healthcare settings, LiMA simply replaces paper as a recording tool.
Not so.  LiMA incorporates a diagnostic algorithm of doubtful reliability.  The WCA handbook specifically encourages HCPs to use only the drop-down options provided, although free-form text fields are available, but cannot be interpreted by the algorithm.

Thirdly, Atos Healthcare and DWP encourage people to submit additional medical evidence at any stage of the process for consideration as part of the claim. Our Healthcare Professionals ask for additional medical information from the claimant’s GP or other medical specialist when an individual’s completed questionnaire suggests that they may have a high level of functional loss, and as such may not require a face-to-face assessment. Unfortunately, these requests are not always answered.
Not so. The Atos appointment letter only tells you what to bring to identify yourself.  I have had 3 WCAs: one glanced at my questionnaire, one didn’t look at it and the latest didn’t even have a copy to hand.  None of them asked for any additional information and all of them ignored completely what I took with me.
Finally, for chronic and fluctuating conditions, we use the same techniques as other clinicians to depending on what question you ask. variability of symptoms, and a detailed functional history ensures the effects of variability on an individual’s abilities are addressed.
DWP cannot make up its mind how much clinical & diagnostic expertise Atos HCPs need depending on what question you ask – supported by FoI requests.  Harrington’s reports specifically highlight shortcomings with assessing condition variability.  There is a standing joke that if you can get to a WCA, you must be fit enough to work – not as much of a joke as many might think I’m afraid.
All our 1,400 doctors, nurses and physiotherapists, are registered with their relevant professional body and are individually approved by the DWP. Atos Healthcare is also a GMC Approved Practice Setting. We want those who are called for a face to face assessment to understand that they will be well treated and properly assessed and by highly professional and dedicated practitioners.
Perhaps, but there are fundamental issues over qualifications needed to do this job, too complex to go into here.
Finally, Harrington himself is far from objective and most certainly NOT independent.  (What happened to Prof Paul Gregg his predecessor?)
There is a view of “disability” that pervades the Health Insurance industry, private sector health service providers and the Government – it is dogma not science as we are led to believe.

Professor Michael O’Donnell
Chief Medical Officer, Atos Healthcare
Competing interests: I am the Chief Medical Officer of Atos Healthcare

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