FROM THE Atos NEWS DESK

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 Atos Healthcare: What to expect from your Work Capability Assessment

Oct 08, 2012 17:05 BST

http://www.mynewsdesk.com/uk/pressroom/atos-healthcare/blog_post/view/atos-healthcare-what-to-expect-from-your-work-capability-assessment-15093

We know that if you have a face to face Work Capability Assessment (WCA) coming up you are likely to have lots of questions about the process. One of the most common questions is “what is the assessment like?”

This blog post aims to give you an idea of what to expect from your WCA.

Before the assessment

The health care professional you meet at your face to face assessment will always have prepared by looking through your file to ensure they’re familiar with all the details you’ve provided so far on your medical condition(s). This includes your completed ESA50 questionnaire, which you’ll have filled out and returned before the assessment, as well any further medical evidence, like a letter you’ve submitted from your GP for example.

Indeed they should do this, but don’t always bother.  Take copies of everything you have submitted to the assessment  and confirm item by item that they have read everything – make them say yes or no to each rather than sidestep the question.

Surprisingly, the fact that you might want the WCA audio recorded is not mentioned at all here. Best to ask for it in advance to give Atos time to arrange.  If they will not, there are various options open to you to ensure you end up with an accurate record of what took place.

During the assessment

There are a number of different elements to the WCA. Unlike previous conversations you may have had with your GP and others which were focused on diagnosing and treating your condition(s), all elements of the WCA are about understanding how your condition(s) affect your day to day life.

How relevant this is to the practicalities of holding down a job is a source of great debate.  The other difference is that it is safe to assume that whatever your GP recommends has been considered with your best interests at heart.  Not so here.  If the assessor thinks you can do odd jobs to look after yourself, you will almost certainly be declared fit for work.  It has even been (cynically) suggested that the mere fact you have been able to get to an Assessment Centre means you must be fit for work.

1. Meeting your assessor and an introduction to the process

The health care professional who’ll be carrying out your assessment will meet you in the waiting room and accompany you to the assessment room. There, the first thing he or she will do is explain what’ll happen during the assessment, and what each section is for.

Not so.  The assessment starts from the moment you enter the Centre.  In fact the HCP is told to walk behind you so they can observe your mobility.  You will need to be on your guard throughout.

They’ll also explain about the report they need to fill in during the assessment with your help and what information they’ll be gathering.

Not completely true.  The HCP will be making assumptions about your capabilities well beyond what they will discuss with you without any scientifically supported evidence whatsoever.  A trip to the supermarket means that you can walk at least 800 meters unaided. Also, your mobility assessment will be made by considering if you would be better off in a wheelchair even if you do not normally use one and even if your GP has specifically advised against it.  Although formal Wheelchair Assessment is a medical discipline in its own right, the short cut taken here will not be openly discussed with you and may not be explicit in the final report either.  If this judgement is made, you will not be given any help over what to do next, but if you pursue obtaining a wheelchair through the NHS, you will need a referral from your GP (if they agree with the principle), you will have to wait a while for an appointment and then of course you may fail the assessment.

This does mean that they’ll need to be typing as you talk during parts of the assessment, to make sure they don’t miss anything and that they’re making an accurate record of the information you’re providing. They’ll also explain what happens after the assessment.

Make sure the HCP acknowledges everything you say - if they look preoccupied or inattentive, say it again.  Do not become pressured or rushed.

You’ll have a chance to ask any questions you might have at this point, and you’ll also be encouraged to ask any questions you have or raise any concerns as you go. It’s your assessment so the health care professional will do everything they can to make you feel at ease.

I have had three and this was not the case in any of them.  You may be luckier.

 2. Discussing your medical condition(s)

The health care professional will then ask you about your medical condition(s). A lot of this may be information you’ve already included in the ESA50 questionnaire you’ve filled in, but this will be a chance to talk about what may have changed since you completed the questionnaire.

They’ll ask questions to understand your current symptoms and how frequently you experience these. They’ll also ask about any medication you’re taking and any side effects you’re experiencing.

Be very clear about all of this.  Your HCP may not be as fully trained as your GP and will not be as expert as your consultant (if you are under one) and so may not appreciate all of the aspects of your condition, although they may give the impression they are.

Next they’ll move on to chatting about your situation at home, such as who you live with and any accessibility issues you might have, like going up and down stairs. They’ll also be keen to hear about any work you’ve done in the past or are currently doing, and any difficulties you’ve experienced while doing them.

Again, be on your guard as seemingly innocent and incidental questions may be interpreted with a very precise meaning that may or may not be applicable to you.

3. The ‘typical day’ assessment

This is the main part of the assessment and will be the element the health care professional spends the most time on. They’ll ask you to talk about your daily routine in detail – what you can and can’t do due to your health problems, or what you struggle to do. This allows them to get a good understanding of your daily routine and how your condition affects you.

Many people have two typical days – a typically good day and a typically bad day, so make any variability in your condition VERY clear.

During this part of the assessment the health care professional may ask you some quite detailed questions about your daily life that you may not have been asked before by other health care professionals. This is so they can make the most accurate assessment of the impact of your condition and they’ll always be happy to explain why they’re asking if you have any concerns.

You constantly have to be alert to the underhand techniques being used so always ask why a question is relevant and what interpretation will be placed on the answer you give.

4. The physical examination

Depending on the nature of your condition, you might then be asked for your permission to carry out a physical examination. This is a simple and not at all intensive examination – it’s not meant to make a diagnosis but instead to look at how your condition affects you physically. At most you might be asked to remove outer clothing layers, but nothing else.

This examination isn’t like one you might have had at the GP where the doctor would have physically manipulated your joints for example. Here, the health care professional will ask you to control all of your movements yourself so you don’t exceed your limits or cause yourself pain.

This is the first reference to pain, so make the levels of pain you experience very clear and how you manage it.  There is an assumption that drugs can remove pain and if you do not take enough, the pain cannot be that bad.  Be very clear over side effects and remember that the long term effects of medication will be downplayed.

He or she may also carry out hearing, heart, breathing or sight tests depending on your condition. You won’t be forced to do anything that causes you pain and if you do feel uncomfortable you should tell the health care professional.

5. Summing up the process

Finally, the health care professional will explain again what happens next, and that you’ll be hearing directly from a Decision Maker at the Department for Work and Pensions (DWP) about the outcome of your claim. You’ll then be given another opportunity to ask questions or raise any concerns – the health care professional will be keen to make sure you don’t leave the assessment with any worries or unanswered questions. Once any queries you’ve raised are answered that’ll be the end of the assessment, and the health care professional will take you back to the assessment centre reception.

Always worth asking the HCP for their initial thoughts on your capability to work or otherwise, but unlikely you will receive a straight answer.  The DWP Decision Maker may technically decide if you are to receive ESA or not, but as the medical expert is the only one is qualified to comment on your fitness to work, they must have an opinion.

After the assessment

Once you’ve left, the health care professional will fill in the rest of your report. They’ll do so straight after the assessment to make sure all the information is completely accurate, then send it, along with any other medical information you’ve provided, straight onto the DWP where a decision will be made about your claim.

We hope that this was useful. If you have any other questions, take a look at the FAQ section of our site, which has lots of useful information about all aspects of the assessment process.

How the Atos Healthcare health care professional assesses capability

Oct 30, 2012 17:13 GMT

http://www.mynewsdesk.com/uk/pressroom/atos-healthcare/blog_post/view/how-the-atos-healthcare-health-care-professional-assesses-capability-15472

Illnesses and disabilities affect people in different ways, and to different degrees, which is why the focus of the Work Capability Assessment is on capability, rather than diagnosis. Atos Healthcare health care professionals do not diagnose conditions or offer advice on their treatment, but review the information available about what each person is able to do.

This is not true.  In deciding you are fit to work in the absence of the specific agreement of your GP, the HCP is affecting your treatment programme and they cannot say otherwise. 

This emphasis on capability rather than diagnosis is a misnomer.  The HCP sees you once and so cannot possibly see all of the variability that may exist with your condition.  They can therefore only go by what you say and can only assess it objectively if they are familiar with the condition itself and its typical symptoms.  Diluting the relevance of diagnostic and clinical knowledge is however necessary to allow the use predominantly of nurses and physiotherapists.

The aim of the Work Capability Assessment (WCA) is to assess the effects of an individual’s health condition or disability on their ability to carry out a range of everyday activities.

Note the careful avoidance of the word “work”.  Note too that there is no definition of the word “work” as if it exists in only one generalised form.  So you are been assessed to perform something that is not defined.

This includes areas of functional capacity such as mobilising, standing and sitting, learning tasks and awareness of hazards which are relevant to work. Illnesses and disabilities affect people in different ways, and to different degrees, which is why the focus of the assessment is on capability, rather than diagnosis. Our health care professionals do not diagnose conditions or offer advice on their treatment, but review the information available about what each person is able to do.  This information may come from the claimant, as part of the questionnaire that is completed, or through discussion at a face to face assessment.  It may also come from the claimant’s treating health care professional.

Note the surreptitious approach taken as described above – take nothing for granted and do not assume you will be given any benefit of the doubt.   Note too that Atos has decided that bending and kneeling is no longer necessary in any job these days so your ability to do either/both is not even tested.

All of the people we employ to carry out WCA assessments are trained, fully registered doctors, nurses or physiotherapists.

In theory yes, but there is no foolproof system place to make sure that registration is ALWAYS up to date.

In addition to their existing clinical expertise, they have all received specific training to become disability analysts, to provide WCAs in accordance with Employment and Support Allowance (ESA) legislation. Following training, each healthcare professional must demonstrate their competency to the Department for Work and Pensions before gaining their approval to produce WCA reports.

Atos Healthcare: All about your Work Capability Assessment report

Oct 03, 2012 15:31 BST

http://www.mynewsdesk.com/uk/pressroom/atos-healthcare/blog_post/view/atos-healthcare-all-about-your-work-capability-assessment-report-15026

Most people applying for Employment and Support Allowance (ESA) will need to attend a face-to face assessment – the Work Capability Assessment or WCA – with a trained Atos Healthcare professional.

 If you are asked to attend a face-to-face assessment, the healthcare professional you see will fill out an assessment report setting out the details of your condition(s) and how it affects you.

 This blog post provides further information on the report and how it’s used.

 What is your assessment report?

The report is split into two halves. The first part will be completed by the healthcare professional whilst you are talking together. It will include information about all the conditions you’ve been diagnosed with, how you feel these affect you and details of what you do in a typical day. They will take account of symptoms that are not the same every day. The report will also cover what medication you’re on and any side effects you may be experiencing from that, as well as noting any findings from the simple physical examination that may be required in some cases. You will notice the healthcare professional is noting this information as you talk together to make sure the report is accurate.

 When your assessment itself is over, the healthcare professional continues to work on the second half of the report. Here, the healthcare professional will set out their view of how you’re affected by your condition(s), using all the information from your conversation with them as well as any other medical information present. They will base their assessment on a set of criteria known as “functional descriptors” – actions and capabilities that may be affected by your condition. These “descriptors” take account of physical, sensory and mental health problems.  The healthcare professional must use these criteria as they have been defined by the DWP within the legislation relating to ESA. The healthcare professional will summarise the information present.

We then send the report, along with any other information you’ve provided, such as further medical evidence, to the DWP. A Decision Maker at the DWP will then use all of this, and any other information they have, to make a decision on your claim.

 The healthcare professional that carries out your WCA doesn’t make any decision about your benefit entitlement, and won’t know the outcome of your claim.

So if they get it wrong they will be none the wiser and will make the same mistakes over and over again.

 How can you get hold of a copy?

You’re entitled to see a copy of your assessment report. If you’d like to get a copy, you just need to get in touch with the Jobcentre Plus office that is dealing with your claim.

The WCA - DWP exposed in their own words (as it were)

This is constructed from a series of FoI requests of DWP.  The main thread is referenced below, but there are a few others.  The first part of this blog is the final annotation left on that thread.

I have closed this FoI Act request, but will leave a summary here to hopefully save other people time.

This is actually a very important issue and the reality is self-evident to anyone who has been through a WCA.  The difference here is that the indictment is based on DWP’s own responses to a series of connected questions.

1)      Although DWP “has no recorded information”, it is still insistent that GPs are not equipped to assess capability to work.  It can produce no evidence to support this and cannot see that it is at best ‘opinion’, certainly not fact.

2)      It has now to maintain this unsubstantiated position otherwise it undermines the whole outsourced HCP/DM concept.  It is not well known for admitting mistakes.

3)      It says this despite the fact that GP training includes this very subject and the BMA promotes the occupational health skills of its members to industry, the result being that many GPs are retained by companies for exactly this purpose.

4)      The clue is maybe in the DWP phrase “according to legislation”, which tends to imply that it has been drafted to sit outside of a GP’s expertise.  Firstly, I do not think this is the case – GP’s are perfectly well qualified.  Secondly, if you can teach it to an HCP in a few weeks, you could teach it to GP’s too in probably less time with must better results.

5)      GPs engaged for occupational health advice will become very familiar with the working environment of their clients and be able to meaningfully compare individual capabilities with known work situations.  By contrast DWP believes that there is something called “general work” although it cannot define what it is or define its characteristics.  It can however deem people fit to do it without knowing what “it” is.

6)      DWP still disingenuously maintains that a DM only makes an administrative decision over ESA payments.  It has to say this because DMs have no medical expertise.  It also cannot allow Atos to be seen to be making benefit decisions, so it has created a hole for itself.  The ESA decision is a direct result of ability to work – once you have established the latter, the former is obvious.   So who decides fitness for work – DM? (not medically equipped) or HCP? (outside of the public sector).   DWP talks around this question, but cannot/will not answer it.

7)      It (DWP) will not state that its overriding priority is patient well-being.  This is a grave concern.  It tries to suggest that the ESA decision means the same thing, but of course it does not.  This is precisely the difference vs. The NHS.

8)      It will not admit it has a duty of care.  In countermanding my GPs opinion, the DM must assume the responsibility my GP accepted and never contested i.e. for my health & well-being.  If my health suffers as a result of the DM’s decision, he/she is culpable, without doubt.7

9)      It also disappears up its own backside over the issue of clinical expertise.  Depending on what question you ask, an HCP need it or not.  Physios (with all due respect) have limited clinical expertise, so DWP has to say that its process doesn’t need much.  If you ask about complicated conditions, medication cocktails and side-effects, HCPs suddenly become qualified to make assessments comprehensively.  Sorry DWP, again, you cannot have it both ways.

In conclusion, the fact that DWP will not make clear statements speaks for itself.  The ONLY interpretation (they cannot suggest another) is that they are driven to reduce welfare costs come what may and will continually manipulate the rules to achieve whatever £  maximum it has in mind.

It knows that working from the bottom up with patient health as top priority might exceed its spending target, so it has to construct a process under its own control that it can be sure will not.

It will no doubt continue to try to convince us all otherwise in the same transparent manner.

http://www.whatdotheyknow.com/request/the_role_of_gps_in_the_wca_proce

More WCA dishonesty - FoI confession from DWP

When assessing mobility within a WCA, Atos HCPs are allowed to recommend the use of a wheelchair to improve mobility (if they think it will do this) for someone who does not normally use one.  They can do this without any specific discussion with the claimant or their GP.  They are not however allowed to recommend treatment – make sense of this if you can, but as unbelievable as it is, it is true.  Decision Makers are allowed to do the same thing, without specifically declaring it to claimants – all the claimant is told is that for mobility, they have scored (say) zero points.

This methodology was introduced in March 2011, presumably with the approval of Professor Harrington and is dishonest to say the least, as the claimant is not made aware of this trick before, during or after their WCA.

Through appeals, the courts have seen the injustice and dangers of DWP’s approach and have issued guidance.  From this FoI request, it appears that DWP thinks it is outside of the law and can ignore the advice.

http://www.whatdotheyknow.com/request/wheelchairs_assignment_by_dms_no

A reasoned and coherent way forward - stage 1

The Tory Government is simply doing what Tory Governments do – no surprises there.

If the intention is to unseat them at the next election, the first thing to consider is what would come next, but that’s a thought for another day.  Just be careful what you wish for.

There needs to be a plan, which I think starts with unravelling all of the spurious claims they are making and exposing their policies for what they are.  Personally, I believe the step by step, logical approach will be more productive than “Nazi bastard” vilification.  Whilst this usefully winds up some emotion, it is at risk of alienating the very large proportion of people who are prepared to be sympathetic if than can see the issues in a clear and honest light.

The view of disability that causes greatest upset is the one that regards it as just another form of unemployment, or perhaps more accurately, under-employment.  This is clearly part of the Government’s thinking.  It suggests that there is an absolute formula that can differentiate between those that can work and those that cannot.  It has been allowed to drift and all they are doing now is resetting it to where it should be.  They imply that this new level can be independently and scientifically determined, so their approach is unchallengeable.

This of course is not true.  The cut-off is part of one’s dogma – religious, political, whatever.  The Coalition believes that the bar should be set considerably lower (so fewer are allowed past it) which is their ‘prerogative’, but let’s not lie about its basis.  One way or another, it has formulated an estimate of how many people need to be moved from one side of the line to the other.

Closely linked to this is the “Arbeit Macht Frei” philosophy, so not only is working good for society, it is good for you individually too – it will broaden your outlook, enhance your self-esteem, and improve your health and probably your longevity too.  It will do this both directly and indirectly through you being financially better off.  It is a little vague on how all the wealth created is distributed, but at least everyone gets some.

With such a strong belief in the work panacea, not surprising that one would accept a fair degree of collateral damage as undoubtedly the ends justifies the means.   The horrendous fit-for-work errors that crop up frequently are not personal, nor particularly deliberate: they are just seen as part of the price one has to pay.  The points to get across therefore are firstly that this is not the case and secondly if it were, this price is too high.  The current process is flawed on two counts:

1.       It produces  too many errors

2.       It produces far too many extreme errors

The consequences of both are massively compounded by a very long and convoluted remedial process that has no feedback loop to generate at least some progressive improvement.

They claim their approach is based on need rather than financially driven (bottom up, not top down), but this is splitting hairs if they continually redefine “need” to fit a financial target, which is precisely what we have now.  Cleverly, if WCAs are not producing the required ratios, they manipulate WCA content to make sure they do. Proof is through the descriptor changes made in March 2011

The complementary side of this is of course is the nature of work itself – not how much of it is available, but what characteristics it has.  Quite obviously, if you move the bar downwards, you need to re-specify what work is so that it can accommodate people with what is now a wider range of abilities.  The Government in effect argues that it has already done this and is now just catching up by modifying descriptors accordingly.

This claim is based on the way in which employers of all types have positively responded to equality legislation over the years, to the point where in the typical workplace, disabled employees are no longer at any disadvantage when compared to fully able employees.  This is not just about wheelchair access, but literally every aspect of every work environment.

This is the argument DWP used to substantiate its descriptor changes in March 2011.  It argued that the changes were legitimised by clear scientific and impartial evidence which is simply untrue.  The report on which they mostly rely was indeed commissioned by DWP.  However, its results are far from conclusive and in places diametrically opposed to the Government’s proposition.  Also and somewhat absurdly, the report includes a disclaimer whereby DWP points out that it does not necessarily agree with the authors.  I can only assume that when they quote evidence to support their strategy, they hope that nobody will ever check it out.

It is also worth considering causes and effects as they are often wrongly assigned.  The Government regularly falls back on the proportion of claimants initially found FFW following a WCA.  If they lump together FFW + WRAG, they can quote proportions of around 70%.  This, they say justifies the process they have set up.  What they conveniently forget however is that this is precisely what they have designed the process to do, so it is rather a self-fulfilling prophesy.  In fact, one could argue that given this, the results are actually quite disappointing from the Tory viewpoint – ONLY 75%, when they would like it to achieve something higher.

One final general point and that is over the meaning of “independence”, which in reality is often very hard to achieve.    Most commonly it requires features such as:

·         not controlled by another

·          free from the authority, control, or domination of somebody or something else, especially not controlled by another state or organization

·         able to self-govern

·         Financially independent, not forced to rely on another for money or support.

The prevailing view from most quarters, campaigners included is that much hangs on the infamous Professor Harrington – if they were only to implement all of his recommendations properly, everything would be ok.  NO IT WOULD NOT and this is why.

One of the biggest issues has been around decision making errors, subsequently corrected.  Logically therefore right-first-time decision rates would be an important KPI to monitor.  DWP has not, does not and will not however be using it.  Nor will they declare a target that they are aiming for.  This is just politicians for you – keeping the water muddy, but where is Malcolm setting the target and insisting they meet it sooner rather than later – all conspicuous by its absence.

Secondly, how independent is Malcolm?  Just run through the tests above and make up your own mind.  He has done little more since involvement began than “urge patience”. He has also said:

“My take on things is that [the Department for Work and Pensions] DWP and [Jobcentre Plus] JCP (in collaboration with Atos where appropriate) are energetically implementing all of my recommendations.” and

“In some cases I believe the JCP staff responsible have actually improved on what I had proposed in light of practical experience. I see real progress and am even more confident of improvements than I was in my interim report to the Minister in May. “

I would simply ask

·         What evidence does he have to support any of this?  A few examples would be really helpful.

·         Does anyone who has had repeat dealings with WCA/Atos over the past three years agree that things have changed very much for the better?

It is ironic to say the least that the venerable professor wants to “collect robust evidence about what is and isn’t working, moving, where possible, away from anecdotal reports.”,  when DWP does exactly the opposite.

If you go back to Professor Harrington’s first report in 2010, there are other things conspicuous by their absence, notably a comprehensive PDD (Project Definition Document).  This is very much standard management practice and can be constructively applied in almost any ‘change’ situation to define the scope of the work, its boundaries, its objectives, success criteria, assumptions, inclusions, exclusions etc.  It then provides the key reference point for subsequent work for the duration of the project and I would say it is impossible to manage well without one.  There were some general terms of reference at the outset, but all rather vague – unprofessional or deliberate – who knows?  There was no well-reasoned argument for example that explained why NHS services had been excluded from consideration.  Nothing of this nature has appeared since and his subsequent work just follows the same path.

So we need to reconsider Professor Harrington’s so-called independent role in all of this and if there is a conspiracy, judge if he is part of it.

Inequality in the Welfare State? [CIRC Report]

Inequality in the Welfare State?

Report written and produced by Clydebank Independent Resource Centre, 627 Dumbarton Road, Dalmuir Clydebank G81 4ET 0141 951 4040: info@irc-clydebank.co.uk: www.irc-clydebank.co.uk:  Registered charity no. SCO37670. November 2011

http://www.oxfamblogs.org/ukpovertypost/wp-content/uploads/CIRC-Equality-Act-Report.pdf

A  few supplementary thoughts.

Prof Harrington has never challenged the basic premise that fit for work (FFW) decisions can be distilled into a set of parameters that can be adequately assessed by a DWP administrator, “supported” by no more than a lowly-trained medic operating under their direction. 

In addition the question of whether condition variability and task repeatability can ever be adequately assessed in a single short WCA has not been sensibly addressed.

Prof Harrington himself does not pass all of the tests to establish his “independence” from DWP & Coalition dogma and a cynic would argue that his vested interest in certain outcomes makes this impossible.

Although many WCAs are poorly performed by Atos, DWP claims to have rigorous quality and audit procedures in place and that Atos routinely achieves its contractual KPIs.  Either this is not true, or they do not work, at least to the standards most would assume.  The fact is that they satisfy only the standards DWP has set – DWP has not on thanking them for their efforts.

Without doubt and despite its protestations to the contrary, the Government largely subscribes to the “benefit scrounging” school of thought.  This can easily be seen in some of the imagery it uses in key publications.

The Government has singularly failed to offer any definition of the work it is glibly passing people fit to perform.  It relies on the concept of ‘general work’ (sic), without even describing its basic characteristics.

DWP has severely criticised the historical contribution of GPs to this process to the point where it has effectively challenged their professional integrity.  Rather than tackle this unsubstantiated proposition directly, DWP has adopted a costly strategy that progressively removes them (GPs) from the process altogether.  It still however claims they (GPs) play an important role to play, albeit from a remote and mistrusted position.  This is one of many contradictions within DWP’s assurances and it is both surprising and disappointing that their representative organisations have not taken great issue with this implication – or is it just a case of same money, less work?

The comments on p15 are not quite correct.  Whilst the Atos HCP does not have direct access to medical records etc, they are required to consider and log ANY evidence a claimant brings to a WCA.  What is missing is a comprehensive briefing for claimants (and their reps) to ensure that they present their situation at the WCA as comprehensively as possible.  The WCA invitation letter covers little more than being able to prove who you are!

The WCA handbook is quite clear (and reasonable) over how a HCP must deal with an apparent contradiction between claimant evidence and their own observations to produce an acceptable report.  It states that the HCP cannot simply rely on their ‘opinion’ and must support any conclusions with evidence of one kind or another – this could take the form of a specifically tailored examination and/or Q&A.  It is therefore vital that the claimant takes everything they can to the WCA or any contradiction might not be apparent – the HCP must not be left in the position where they can (legitimately) say that they were unaware of something relevant to the way the assessment should be performed.

The report rightly highlights DWP’s progressive tightening of descriptor definitions, notably in March 2011.  DWP insists that they are justified based on objective evidence, but this is not confirmed within the documents they themselves rely upon.  In fact in some cases, the reports contain explicit disclaimers where DWP states that it does not necessarily share the views and conclusions of the authors – how absurd it that?

In addition, the joint DWP/Atos process contains a number of surreptitious ‘correlations’ whereby very specific interpretations are placed on the answers to seemingly innocent questions.  A visit to a supermarket for example means being able to cover 800m comfortably and would attract no points.

Worse still, in Mar 2011, ‘walking’ was substituted with ‘mobilising’ again on the surface for legitimate reasons but has given rise to the “invisible wheelchair”.  This allows the HCP & Decision Maker to make the mobility assessment with the claimant in a wheelchair even if they do not normally use one, even if their GP has advised against it and they do not even have to declare that this is what they have done.  All the claimant sees is no points.   The invisible wheelchair can be deployed selectively in that it might appear for mobility assessment on level surfaces, but be abandoned when steps are involved.

DWP insists that a declaration of fit for work does not mean they do not believe you are ill, just that the illness is not severe enough to stop you working.  This is of course (as explained above) despite the fact that ‘work’ is not defined.  Furthermore, it insists that people who find themselves on the job market through this route are at no disadvantage relative to other fully fit job seekers.  It bases this assurance on reports in which it has incorporated a disclaimer (see above) and/or completely contradicts its proposition and universal compliance with long standing disability equality legislation.  The reality is that there is no real evidence to support any of this.

Atos or DWP - who is to blame???

A great deal of criticism is levelled at Atos and a good proportion of it is actually misplaced.  How many times have you seen from any level within DWP the faintest hint of criticism?  To the contrary, Chris Grayling has written personally to all Atos HCPs thanking them for their efforts.  It is perfectly clear that Atos is doing exactly what DWP wants it to do in precisely the way it has asked them to do it.

·           All of the Atos processes in and around the WCA have been signed off if not designed by DWP.

·           All of the content of the WCA has been designed and approved by DWP.

·           All of the progressive tightening and/or removal of descriptors has emanated from DWP.

·           All of the manuals and handbooks used within Atos and DWP have been designed and signed off by DWP.

·           All of the trickery contained within an assessment (the invisible wheelchair for example) is there at the behest of DWP.

·           It is DWP that misrepresents the evidence-base it claims supports may of it decisions, by portraying what is at best consultation as if it were whole-hearted support.

·           It is DWP that selectively chooses the organisations with whom it “consults”.

·           All of the changes to the appeals process to make it harder are being orchestrated by DWP.

So answering the question “What improvements should Atos make?” is not as straightforward as it seems.

One area is undoubtedly to do with the rigour with which individual HCPs perform WCAs, but be careful what you wish for.  The fact that Atos HCPs often do not follow the procedures in their WCA handbook at least provides good grounds for appeal, but conversely if they did, this opportunity would disappear.  This would then leave just the content of the WCA (its real fitness for purpose) as a generalised basis for appeal, which is a far more subjective and therefore difficult issue to address and prove one way or the other.

Another might be to ramp up the qualifications needed to perform a WCA, but there is a deeper underlying issue that determines current Government thinking.

Occupational Health is not, as some would have us believe, a radically new branch of medicine that (ironically) does not need a wealth of medical knowledge to understand.  It is in fact based on well established principles viewed from a slightly different perspective, with slightly different priorities.

The DWP theory is that as OH has only limited medical/clinical content, it does not require in depth medical training and ultimately can be distilled down into an evidence-base that can be reliably interpreted by an administrator with no medical training whatsoever.  Any similar suggestion within the NHS itself would be ridiculed – rather like my GP’s receptionist having power of veto over his recommendations.

DWP cannot however answer how on this basis, it can accurately assess factors that cannot be observed fully within a WCA, notably task repeatability over a sustained period and MOST importantly CONDITION VARIABILITY – was the day of the WCAQ a good day or bad day?  The only person who can make such an assessment is someone who fully understands the diagnosis, the treatments that have been performed, surgical remedies and the statistical range of potential outcomes, medication, side effects et., etc., etc., not to mention the complexities of mental illness - with all due respect, this needs more than a midwife or physiotherapist and a DWP administrator.

 In addition, Derby University has accredited the Atos Disability Assessment training programme, so Atos can therefore claim some legitimacy for what it is doing and even how it is doing it.  Professor Harrington as far as I am concerned is only addressing symptoms not causes and is supporting the wrong model.  It is the politicians (Tory now, Labour previously) that are driving through these ill thought through injustices, nobody else.

I trust my GP - please don't spoil it.

#DWP rejects using GPs for #WCAs because they are ‘too soft' (I prefer the words ‘sensibly cautious’).  They fear they will damage the 'relationship' and trust that exists between GP & patient.

Firstly, I do trust my GP.  I trust him to always advise in my best interests.  That that would include returning to work if that is what he thought.  After all, this is what the Hippocratic Oath is all about.

Secondly, I also respect my GP.  If therefore he thought I’d be better off working, I’d expect him to hold his ground despite my protestations.  This too is what the Hippocratic Oath is about.

Thirdly, my ‘relationship’ with my GP is professional only and based on hopefully mutual trust and respect.  He is not my best friend.  Having a sensible debate about whether or not work is a good idea is no less than I would expect.

I am absolutely confident that we would quickly reach agreement.  This does not mean he just gives in; otherwise he loses the trust and respect.

Not all GPs would be prepared to display this degree of integrity, but appropriate direction and monitoring from their highly influential professional bodies would soon bring transgressors into line.

PS

Sadly, this could all go for a ball of chalk if they press on with this rather greedy objection to a small cut in pension payments.  That have done very well thank you over the past decade in the face of the general economic difficulties.  They will do even better if the Government gets its way with NHS reforms.  The pensions of many are so large that they will still be in the ‘top earners’ group (over £65k p.a.).  Surely a modest reduction is not unreasonable?