Well enough to work

Not a new article but very well reasoned and presented.

Well enough to work?                      Re: Health professionals' advice: the ethics   4 March 2011

“Dr Cooper points out that when an Atos doctor sees a claimant that claimant is not his/ her patient, and there is not therefore an explicit, or even implicit, duty of care.

He goes on to point out that the doctor's employer in this case is Atos, and then says that, "the first duty of the assessor is to supply, with the consent of the claimant, honest advice to the DWP on the most likely correct numerical score for the statutory descriptors in the test."

Here, I think, he is incorrect. The doctor's first duty is not to the DWP, but to Atos who are, as we keep on being told, is a private company with all the legal privileges and duties that involves. Atos are his/ her employers; Atos has a contractual obligation to the DWP, but the "assessor" does not. The assessor's duty must be to provide Atos with what Atos wants, and the assessor has agreed to supply.

It is in that lacuna in the evidence that some, at least, of the problem lies. The exact nature of Atos' demands on its "health care professional" (HCP) is unknown, since the content of their contracts - like so much else of Atos' business - is covered by heavy veils of secrecy.

Atos may not require an assessor to submit evidence which is the assessor knows, or believes, to be completely false. This, however, is not a very substantial safeguard of the truthfulness of the reports.

We know that the questions asked by the LiMA program are used to generate from one reply a whole chain of inferences. Such inferences may then be churned out by the final report which a rushed HCP may just glance at and then sign. What options, after all, do they have? They are not required to take responsibility for the accuracy of the inference chain, and are discouraged from entering any information which does not fit the parameters of the LiMA program.

There is a further point. A HCP who is "assessing a claimant" has no direct duty of care. Suppose then that the HCP has been told, "You are to take a sceptical approach to all statements made by the claimant, or their GP." A short period working there and a couple of reprimands for taking too long, and being "insufficiently rigorous" in their assessments, and  the HCP will get the point.

As the CAB pointed out in their report "Not Working", "Another common problem with WCA reports, is that conditions frequently appear to be downplayed. If a client's condition has been described by their GP as 'moderate' - based on tests, MRI scans, reports from consultants or other appropriate diagnostic tools - the HCP is very likely to describe it - based on a half hour interview - as 'mild'. If it is described by the GP as 'severe' it will be 'moderate' in the WCA report."

There are numerous other examples of bad experiences from the CAB, from Citizens' Advice Scotland, from other reports and from anecdotal evidence on the web. Answers are twisted, misunderstood or abbreviated, so that "yes, with a lot of help," becomes, "Yes".

I believe that the handbook for assessors says that claimants frequently underestimate things like distance. Someone who "goes round a supermarket" can therefore be assumed to be able to walk 800m. That distance is then entered into the report and the claimant's statement that they can walk 20m is ignored, as is their explanation that the "supermarket" is the corner convenience store.

These are instructions from the commercial firm employing the doctor or other HCP. They have to shape what they hear to fit the demands of the computer program, and the wishes of the boss. That the DWP is happy with the service being provided by Atos is evident from the renewals and extensions to their contract.

There are doubtless doctors out there providing the sort of assessment which the DWP describes, and which Dr Cooper postulates. That many of the Atos HCPs provide nothing like that sort of service is the conclusion of several reports and the experience of thousands of claimants.”

http://www.bmj.com/rapid-response/2011/11/03/rehealth-professionals-advice-ethics