A letter to the Atos CEO

Dear Ms Morgenstern

Re:  Medical Services Contract with the DWP

From your response to the National Audit Office’s recent report, (http://blog.atoshealthcare.com/2012/08/atos-healthcare-response-to-the-nao-review/), you clearly do not believe that their investigation was well conducted or objective and are highly disgruntled with the findings and this is your attempt to set the record straight.  It does however raise a number of important issues, so I feel compelled to do likewise.

I am not sure at which audience your blog is aimed – it is your actions to date that have determined who loves you and who hates you, so I don’t think this plea of mitigating circumstances will influence current opinion one way or the other.

You have been doing the job now for 4 years, so one has to ask how long it will be before you can genuinely sit back and say that you have achieved the required standard.  The WCA process has as you know been highly controversial since its inception and a significant reason for this has been the lack of clarity in a number of key areas.  Whilst this may serve a political expediency, “muddy water” only ever inhibits efficiency and real progress.  My aim therefore is to put a series of propositions to you which, in the main, you can answer with a clear ‘yes/no’ or ‘agree/disagree’ supplemented perhaps with whatever qualification/elaboration you feel necessary, but the latter is of little use without the former.  It is much better (in the interests of clarity) that you provide the ‘yes/no’ rather than leaving me to surmise.

 If you feel unable to address any point directly, I would much prefer you to say so rather than insult my intelligence with unsubstantiated claims and meaningless clichés, all of which I can guarantee I have heard before.  I am reasonably well-read over the whole WCA debacle, so there is no need for you to cut & paste the standard responses that appear elsewhere.  What I am seeking here for everyone’s benefit is something fresh, objective and honest.

Rarely are assumptions clearly stated, but my only one here is that there is no place for morality in private enterprise and I have not therefore commented on whether Atos has it or not – it most certainly is not one of my expectations.  If you feel this assumption is unfair on Atos, please say so.

I will try to deal with the issues in the sequence they arise in your blog.

1)        In your opening paragraph there is an implied criticism of the NAO for not “sharing” its findings with you.

Yes it has, at the same time as it did with everyone else.  It seems you think you were entitled to a sneak preview and presumably the facility to suggest alterations prior to final publication.  This is not how the concept of independent audit operates.  I suggest you read the information on the NAO website at http://www.nao.org.uk/about_us.aspx  where you will find that they have worked exactly within their remit.

The “confusion “appears to be over your understanding of independence.  The NAO uses the conventional definition that most people would understand.  Your interpretation is however different as demonstrated by the arrangements around the so-called “Independent Tier”, which do not comply with any definition of the word I can find.

You will no doubt wish to defend the independence of the IT despite the fact that it is appointed by and paid by Atos, its members are secret (as is the precise nature of their qualifications to fulfil this important role), it sits in-camera and the only access to it is through Atos.  The direct analogy would be a court case where the only access to the (secret) judge is through your adversary’s lawyer – I doubt you would regard this as a satisfactory arrangement let alone one modelled on objectivity and indeed independence. 

Any suggestion that objectivity and impartiality can only be achieved through secrecy not only denigrates the entire British legal system but also rather flies in the face of the basic democratic principles of public accountability & scrutiny and the Prime Minister’s own views about the “disinfecting power of sunlight” – something he talks about frequently. 

2)        You cannot have your cake and eat it too, by on the one hand claiming autonomy and discretion to improve the process and then dive behind the contract when things get a bit sticky.  This disingenuousness will not earn you respect or credibility.  If the contract requires you to do anything other than a comprehensive, sensitive and accurate job, you must say so unambiguously (setting aside the question of why you signed it in the first place).  The “I was only following orders” defence was exposed for what it is over 60 years ago. 

3)        Of course the task is “challenging” – whoever said it would be easy?  You are making recommendations that result in potentially life or death decisions.  It is all very well having an appeals process, but even if it took days rather than months to deliberate, the damage has already been done - the worry and trauma cannot be erased.

Nobody expects a foolproof process that never makes a minor error of judgement – there is too much inherent variability involved and inevitably an element of subjectivity.  What we do expect is a process that recognises these characteristics and adapts appropriately to them.  Nobody has the right to irresponsibly gamble with my health and well-being except me – and the medical lawyers would contest even that.  You therefore have to show compassion and err on the safe side rather than take a risk – the stakes are too high.  We expect any errors to be only at the margins and quickly corrected.  We do not expect errors at the extremes.  Can you guarantee categorically that a claimant’s overall long-term health and well-being is your primary consideration – yes or no?

 A number of the extreme assessment errors are well documented, together with the irreparable consequences – yes, people have literally died and one is one too many.  However, you have never once commented on any of your errors or indeed apologised, so you cannot now expect sympathy, respect or even a “fair hearing” as that is not what you have provided to many of the people you have assessed.  The end does not always justify the means and the amount of collateral damage you have created is simply unacceptable.

The stakes could not be higher – my health and possibly my life, so I expect you to be conservative, cautious and err on the safe side.  I do NOT expect you to be cavalier on the basis that it will all get sorted out sooner or later by someone else.  You do not give the impression that you accept this – in fact rather the opposite. 

4)        You refer to the high standards you set yourselves – easily said, but what exactly are they? 

5)        You mention in a number of places WCA improvements for which you should receive credit and it is worth being clear as to quite what this means – there have undoubtedly been changes over the past 3 – 4 years but their effects are debatable in the absence of clear evidence one way or the other.

I am sure you are familiar with the old management cliché that says in essence, “If you don’t measure it, you can’t manage it”.  What quantifiable measures do you have to support this claim of ongoing, continual improvement? 

Everyone talks about the critical importance of right-first-time classification (fit for work or otherwise).  Why then don’t you make any attempt to track it over time?  Improvements would then be self-evident and instantly quell criticism.  It may be a bit difficult to measure accurately, but NOT impossible and its value is beyond dispute, so well worth the effort. 

6)        You may be able to technically claim that you have implemented all of the Harrington recommendations, but have you really addressed the underlying issues?  Take for example the matter of audio recording WCAs.

Yes, you arranged a trial (albeit it was an extremely poorly conceived and managed project which meant accurate interpretation of results was impossible) and you made clear recommendations to offer the facility widely, recognising as long ago as Spring 2011 that there was rapidly increasing demand.  By contrast, you now only offer the service on a ‘best endeavours’ basis, which could in the extreme mean not at all, or at best on some sort of unpredictable, random basis.  I cannot see how this is tenable and indeed fair to claimants.

It is rarely discussed, so you may wish to comment on the justifiable lack of trust in the process that brought this suggestion about in the first place– even Professor Harrington could see it and you clearly agreed, hence your recommendation.  There are only two possibilities given the current situation:

·         Either you believe the underlying problem has been resolved, in which case what specific evidence do you have to show this is the case?  Or

·         The underlying problem still exists (and increasing demand for audio indicates it is getting worse), so what is your alternative plan to get rid of it? 

7)        Returning to the difference between change & improvement, descriptor amendments were implemented around March 2011. One of these was to remove all references to bending and kneeling within the WCA on the basis that neither is relevant to the workplace any longer.  I am sure I do not need to point out to you that:

·      Every single warehouse in the country (if not world), stores stock down to floor level.

·      Every single self-service retail outlet in the country (if not world) stores merchandise down to floor level.

·      4-drawer filing cabinets are still widely in use and I believe the vast majority of offices still use the bottom drawer.

There have been suggestions that this change was ‘evidence-based’ but in fact relies upon unproven assumptions about compliance with certain equality legislation – in fact one quoted report says precisely the opposite.  The truth is that it was a thinly veiled ruse to cut points and bias assessment in the desired direction.  Nobody has been fooled.

 

8)        You suggest an error rate of “only” 9%.  9% may not sound too bad, but just consider it against:

·           GPs making a wrong diagnoses

·           Surgeons undertaking unnecessary operations

·           The transfusion service wrongly classifying blood types

·           And even cars that are unsafe but are passed through an MOT.

In all of these areas, such an error rate would cause outrage.  

You carefully refer to this as decision errors rather than assessment errors – ok, so what is the assessment error rate bearing in mind those FFW recommendations from Atos that are corrected by DWP before an appeal is raised?  Somewhat higher I presume.

You are assuming (without evidence) that the absence of an appeal means the FFW recommendation was correct, which is of course not necessarily so.    This percentage is no more meaningful than me suggesting to you that the true overall assessment error rate is more likely to be 40%, based on Tribunal data.  I would not do this as I understand the limitations of the data and you should do likewise.  “Spin” will prove to be the scourge of the 21^st Century.  All this does is again highlight the overriding need for universally agreed, objective performance measures.

 The frequent suggestion that DMs and Tribunals have more information than HCPs is a myth and confirmed by analyses from the TS itself.  Even if it was true, you have only yourselves to blame – you go to great lengths to tell claimants how to prove who they are, but do nothing to ensure they bring all the medical information they could to help the assessment.  It is as if you don’t want to know. 

·          Do you regard this figure of 9% as acceptable, at least for the time being? The answer can only be yes or no.

·         Do you make any attempt to track assessment error by seriousness – clearly there is a fundamental difference between extreme and marginal mistakes.

·         What is your target error rate (accepting it will never be 0%) and when will you reach this figure?  If you don’t have one, how will you know when you have reached the end-point?  There is no value in looking for improvements that are in reality unachievable – an expensive waste of time.

·         How can you be sure that the current model and process is capable of reaching this target?   

9)        Whilst in theory the WCA is only part of the decision process, it without doubt carries the greatest weight by a long way – and quite right too - it is disingenuous of you to suggest otherwise.  If its significance is understated, it will reduce the urgency to get it right on the false assumption that there are adequate checks and balances further down the line.  DWP DMs have no medical training.

10)     You mention the training given to your staff, but you do not have a foolproof mechanism that guarantees their qualifications are always up to date.  This has been confirmed by DWP through FoI Act requests.

11)      Where are these independent reviews that confirm high standards of service?  You claim they are accurate, impartial and statistically sound, but given previous misrepresentations (spin), this is hard to believe. 

Your “Mystery Shopping” programme is in fact no more than a site/admin audit and does not touch (as one would expect) on the WCA itself.  These audits no doubt have a place, but call them something else that accurately describes their content.  Similarly, the audio recording trial in Newcastle was approached in such an ill-thought out, haphazard manner, none of the conclusions it drew could be treated with any credence, which in part explains the chaos around the principle now.   

12)     You are clearly complicit in the deception and dishonesty within the process and support the ‘benefit scrounging’ philosophy - if you did not, you would approach the task in a far more open and honest manner. The hypothetical wheelchair mobility evaluation sums this up perfectly, not to mention all of the unsupported assumptions made elsewhere (a visit to a supermarket means you can walk unaided and without pain for at least 800m – where on earth did that come from?).  You cannot expect respect by attempting to defend the indefensible. 

Yours sincerely

#WCA #ESA Government Duplicity and their real intensions

http://www.dailymail.co.uk/debate/article-2149854/Oh-dear-Dave-Now-GPs-turned-Time-exit-strategy-disabled-perhaps.html?ito=feeds-newsxml

The way the Government has implemented and managed the ESA/WCA process is not just a sign of poor judgement or incompetence, it reflects a dogma based on contempt for the sick and disabled, a belief that they are an avoidable drain on society and the sooner they stop it the better.  If they will not pull themselves together and sort themselves out, we (the Government) will have to do it for them.  Society only has room for those that make a net positive financial contribution measured by the standards dictated by a capitalist elite.  We might just feign a little compassion for some of the more seriously ill, but only under sufferance and against our better judgement.  Sorry, this may sound harsh, but this is just Nature at work, first summed up by Charles Darwin many years ago and it is wrong to meddle in the process that God himself probably intended – our attempts at intervention in the past have created the current mess and we do not want that all over again do we?  They don’t put it quite this way, but when you look at what they have allowed to happen (in fact engineered), this is precisely the overall plan and indeed it is going quite well.

Of course, Ministers and the PM fiercly deny that this is the case, but the evidence speaks for itself.  Most telling is the fact that way back in 2008, no risk assessment was undertaken prior to WCA introduction.  If you have not come across the expression before, RA is simply a standard feature of good management practice when changing something whereby you think about all the things that could happen as a result of the change you are making (good, bad & indifferent), assess their likelihood & consequences and put together a prevention strategy, i.e. a proactive plan designed to keep the likelihood of unintended events arising to an absolute minimum, particularly if these events have devastating consequences .

The current Government blames this omission on the previous Government, but it is never too late, so they could easily have initiated an RA once they were in office.  They do point out that they did undertake an RA following the so-called Internal Review in 2011, but don’t mention that it is incomplete - it misses completely the potentially dire consequences of an incorrect fit for work decision resulting in a deterioration in someone’s health.

To be fair, the best assessment process in the world would contain some small risk of an occasional mistake which could never be eliminated completely, but at least one has the comfort of knowing that the risk was recognised and every attempt was made to minimise it.  Not so with the WCA.

Of course there is a risk of error with potentially monumental consequences, but the Government chose to ignore it.  They cannot have been so naive to believe that the WCA process was perfect and would never make a mistake, so the only conclusion one can draw is that they simply don’t care – so what if some people die along the way, one cannot after all make an omelette without breaking eggs, the end always justifies the means and a bit of collateral damage is a small price to pay.

What every voter in the country needs to understand that this philosophy will not be limited to the sick and disabled – it will manifest itself through every Government activity from NHS Reform to motorway speed limits.

More specifically, much criticism is directed at LiMA (the computer system used by Atos), but at the end of the day there needs to be a standardised database for all sorts of good reasons and properly used, this is probably as good as any.  The mischief lies in the simplistic diagnostic algorithm it contains and the way in which it is manipulated to produce the desired results.

The DWP knows this (of course it does), but as long as LiMA/Atos is “doing its job” (designating large numbers as FFW whether they are or not) they do not care.  Its own Decision Makers are perfectly able to rectify an unsound recommendation from an Atos HCP, but rarely do – why should they when they can hide behind the pseudo-intelligence of LiMA – sorry, the computer, it says no.  If DWP had the will, it could change this attitude overnight.

So yes, have a go at LiMA and Atos, but don’t forget who is really driving the “agenda”.   Anyone who has suffered at the hands of a WCA will understand all of this and most politicians do not care, but there is a huge group of people in between that needs to know the true colours of our politicians.  My hope is that we can get the message to them through posts like this, so they know the truth, not the illusion painted in the mass media.

Harrington & Grayling keep promising more support from DWP, but where is it?????

I raised a complaint with Atos immediately after an appallingly badly performed WCA in Feb 2011, before I had even seen the subsequent DWP decision and I decided to pursue it regardless of the decision.

It was still unresolved in Sept 2011, when the next WCA came around.  I tried to get some help from DWP, based on the continual promises of better support from Messrs Grayling and Harrington, but guess what . . . . . . . . ????

Stuff like this ends up with a DWP Dept. called Commercial Management of Medical Services (CMMS), one of whose jobs it is managing the Atos contract.  Another is responding to FoI Act requests, so the style is predictable, generally evasive, non-committal and most certainly not unbiased and helpful.

======================================================================================

Dear Mr xxxxxx,

Thank you for your letter dated 10^th December, received today.

I am afraid you have not addressed the sole point in my original letter dated 30^th October, to which Mr xxxxx first responded.  I am more than conversant with the way the Atos complaints procedure SHOULD work – my complaint to you was because it was failing and clearly whatever controls you apply were failing too. 

As you say, they should make an initial response to a complaint within 4 weeks – mine took 7 weeks and was incomplete.  I then spent the following 6 months trying to get straight answers to quite legitimate questions about my WCA which Atos continually sidestepped and in some cases referred them to CMMS as a FoI Act request when they were nothing of the kind.  This was all an elaborate plot to drag the process out as long as possible without admitting the errors that were apparent to pretty much everyone else.

In relation to the “controls” DWP apply, what exactly are they?  I would expect to see for example a “red flag” against any complaint

a)      Where the initial response had not been dispatched within 5 weeks, with a double red flag at 6 weeks and

b)      That overall had been running for more than 8 weeks, double red flag at 13 weeks.

A “red flag” is the point at which the customer (in this case DWP) gets involved to sort out the delay.  This is a very common arrangement in managing complaint handing and I am surprised that you do not have anything like this in place.  Professor Harrington’s two progress reports emphasise the need for DWP to provide greater support to claimants, but I cannot quite see where this forthcoming from you here.  As I said at the beginning, all you have told me is what should happen rather than help me through a process that has clearly failed.

The email issue is indeed now resolved – it was not at the time I wrote and I would like to think that you have admonished Atos for the childish stance they took – hardly becoming of a multi-national conglomerate – but I doubt you have.  You will never be able to provide the support Chris Grayling promises if you continually take the side of Atos against the claimant.

Although Atos has to this day not addressed the outstanding issues around my complaint about a WCA in February, I have dropped it for other reasons.

Finally, the Atos so-called “Independent Tier” will never have any credibility whilst it remains shrouded in secrecy.

Yours sincerely

THE ATOS “INDEPENDENT” (Ho ho) TIER

For anyone who is progressing a WCA complaint through Atos and reached level 3 and the so-called “Independent Tier”, you might find the following notes helpful.

You will get the impression that rather like the Tribunals Service, there is a panel of experts who adjudicate in some form of hearing.  Apparently not so – it just involves two individuals: one who looks just at the way the complaint has be handled by Atos, the other looks just at the medical exactitude of the WCA.  They work independently and never meet.  Any suggestion that the hearings can be observed is therefore fallacious and gives the impression of a much more substantial arrangement than really exists.

It is absurd to insist on the fact that they are independent when, on Atos’s own admission:

1)      AH know who they are and I do not.  I am not even sure DWP knows.

2)      “AH will determine whether a referral to the Independent Tier is appropriate” (a quote from the Atos complaints manual).

3)      “The (AH) Team Leader will determine the nature of any corrective action appropriate”  from IT conclusions. (ditto).

4)      “The Independent Tier will not provide views or judgements to any person outside AH” (ditto).

5)      “IT results will be published in an approved format”, but nowhere does it say approved by whom or what this format is.

6)      Only the AH convenor can communicate with IT and arrange any contact or obtain additional guidance (paraphrased).

7)      DWP says it has no idea what (if any) contractual or commercial arrangements exist between AH and the IT.  Any costs associated with use of the IT are not directly charged to DWP so must affect Atos profit margins – undoubtedly an incentive to use it as little as possible.

8)      There is no competitive tendering process for selection of the IT – Atos appoint who they like.

9)      DWP will not even disclose the nature of the IT’s business and so cannot demonstrate they have any qualifications, experience or credentials to adjudicate in this area.

10)   Because of the secrecy, DWP cannot conclusively prove that any of the processes it describes actually exist.

11)   There are no detailed documents listing the exact criteria the IT assesses so it is impossible to judge what job they are doing let alone how effectively they do it.  The Atos Complaints manual refers to the IT checking against “agreed processes”, but NOT what they are.  There is a very detailed WCA manual giving guidance to HCPs, but there is no confirmation in anything you have sent me that even this forms part of the IT’s ToR when investigating a complaint.   There must be some form of template to ensure consistency.

12)   Following on from 11), the only reference to service levels requires AH to acknowledge complaints within 2 working days and fully answer complaints within 4 weeks, but the latter is only a “hope” rather than a firm commitment.  What does the IT judge against?  What about the fact that for me they took well over 4 weeks and even then did not address all of the points I had raised?  What about all of the correspondence with Atos since – what response times must they adhere to with these?

13)   Although DWP says claimants receive copies of everything Atos provides to the IT, nobody can independently prove this is the case.

14)   Likewise, nobody can prove that IT adjudications are not edited prior to publication.

15)   Informal contact between Atos and the IT is perfectly possible.

The second disgrace is over the secrecy which is a far bigger issue than many might imagine.  CMMS has indicated two reasons:

1)      The Atos/DWP contract apparently requires the identity of the IT to be kept secret and DWP claims there will be commercial implications (unspecified) if they breach this clause.  Obviously very stupid to allow this to be in the contract and it should be renegotiated to allow disclosure.  Carefully done there is no reason why it should have any financial consequences, so this is just a smoke-screen.  

2)      DWP continues to insist that in principle that the IT’s impartiality is only secure through anonymity, which is hugely worrying in a democratic society, supposedly built on transparency and the principle of public accountability.  The Tribunal & legal systems work OK in the open, so why not the IT too? I’m sure they can see the contradictions and outright hypocrisy, but will not budge.

For 2), I can accept the contractual constraint as a short term barrier, but nothing else.  CMMS will hide behind the FoI Act for ever so this needs something more direct.  Personally, I’m not convinced there is any deliberately established bias going on here and it is more a case that DWP is embarrassed by how flaky the whole IT arrangement is – a couple of blokes sifting through piles of papers whilst watching telly over the weekend??????

This secrecy nevertheless should be a great worry to all political parties except perhaps any hard line communists and fascists.

Decision Making Errors - the myth as to why.

It is well know that about 40% of ESA fit-for-work decisions made by DWP (note DWP not Atos) are reversed on appeal.  Worrying, but DWP has convinced itself that it is not its fault as in 65% of reversals, the Tribunal had additional information, so it not concerned about the error rate as there is a convenient and plausible explanation, despite the devastating impact it can have on a disabled person’s life.

This 40% figure is authenticated by reports issued by the Tribunals Service, but as long ago as 2009.  However, DWP fails to mention that the same reports also point out that it is not always the case that the DM does not have the information, more that they tend to ignore it.  The TS says:

“The 65% figure for the production of additional evidence suggests that an important source of information is being overlooked in the decision-making process. There continues to be a tendency on the part of decision-makers to discount oral evidence received from the appellant in the process of evidence gathering prior to the decision and then in the preparation of the appeal, and not to seek out new evidence to verify the facts where the decision has been challenged. Where a decision is challenged it is the duty of the decision-maker to review the initial decision, satisfy themselves that the facts are correct, ensure that there is no further evidence that might lead to a review and where they do not accept evidence or doubt it explain why, making this explicit in the submission to the tribunal.”

One would imagine that in the interests of effective staff performance management, DWP collates TS outcomes by Decision Maker as the basis for re-training etc. but NOT SO.  The strong and clear recommendation above has just been ignored for the past 2 years!!!

The Culpability of a DWP Decision Maker - not as simple as it seems

Question: 

If DWP pressures an individual to work despite the concerns of the GP/individual and their health suffers as a result, who in DWP is culpable?

DWP “Answer”:

Individuals who are allowed Employment and Support Allowance cannot be asked to work, instead those in the work-related activity group are asked to prepare for work and those in the Support Group are provided with unconditional support.

Dear DWP Adelphi Freedom-of-Information-Request,

Thank you for this, but your response does not address the important issue here.

There have already been many cases where a DM has judged people fit for work when their GP has felt otherwise. If doctors do not exercise due diligence, they can be held culpable, which is perhaps
why they might be inclined to err on the "safe" side. Whether they like it or not, in altering the GP's judgment, a DM unavoidably assumes the same responsibility. You cannot sidestep this when you
have placed the individual in such a potentially invidious position. If a DM judges someone fit for work and they are wrong and their error has serious repercussions, they must face the consequences. They cannot assume the authority without also assuming the accountability.

Do they document a risk assessment for each case they judge? If not, do you think they should? If something goes wrong and there has been no risk analysis, the legal consequences are well
established through H&S legislation.

FoIA link at http://www.whatdotheyknow.com/request/support_group_associated_risks#incoming-232178

Atos feedback through their website

Again, no need to be rude.

http://blog.atoshealthcare.com/2011/11/update-on-harrington/#comment-327

Tia Junior says:

Your comment is awaiting moderation.

November 26, 2011 at 8:49 pm

You cannot expect to have any credibility when the third stage of your complaints process is shrouded in secrecy. As the Government itself has said “Anonymity breeds complacency”.

If the so-called Independent Tier is truly impartial it has nothing to fear from being open to public scrutiny – just like the Tribunals Service.

The suggestion that impartiality can only be achieved through secrecy is the exactly opposite principle to the one on which the entire UK legal system is based.

Promise over payments during ESA appeal?

http://www.ifaonline.co.uk/cover/news/2124531/esa-appeals-benefit-stoppage

Good to hear, but can he be trusted to keep the promise?  Answers on a postcard . . . . .

Unfortunately again confusing cause and effect.  Sort out the WCA so it does what it should effectively and appeals will obviously fall. Organise it properly and all you would need is a second opinion from time to time.

Tampering with the Tribunals Service would be a big worry.  It is currently the last hope of justice, which Messrs Duncan-Smith and Grayling would trash if they could.

ESA Appeal to DWP - from a poor WCA by Atos

ESA Decision - Appeal

This letter is intended both as an appeal and a complaint about the way the decision was handled.

The comments below are largely a result of a telephone conversation with your Mr Wrong on 27^th October 2011.

1.    ESA214 states “To be entitled to Employment and Support Allowance, claimants must be found to have limited capability for work which means that their current health condition or disability restricts their ability to work”.

You scored me zero points, which is the lowest score possible and a score that would be given to, for example, a professional athlete.  You therefore think that my ability to work is completely unrestricted, which is simply not the case.

2.    ESA214 states Decision Makers (DMs) must consider ALL of the information available and mine did not, having completely ignored my letter of complaint to Atos dated 8^th October.  The only reason for the delay from my WCA on 23^rd September was the time it took to get a copy of the ESA85 to confirm my suspicions.  Note that it was so poorly conducted that I raised the complaint before knowing the ESA decision.  The complaint explains that some information I provided was omitted from the ESA85, so that could not have been considered by the DWP decision maker either.

ESA214 confirms that information from a doctor is relevant, but Mr Wrong said it is irrelevant and was not considered.  The Atos HCP also brushed it aside on the same basis.

3.    A DWP DM is charged with validating the quality of the ESA85 and referring it back to Atos if it is in any way unsatisfactory.  Mine was and even with my letter of complaint to assist no action was taken.  My belief is that the DM looked at the Atos summary and did no more than convert it to points, which is a serious dereliction of duty.

4.    Mr Wrong said that he agreed with no points for Activity 1 on the basis that I could mobilise over 200m in a self-propelled wheelchair, even though none of the NHS team involved with my condition has ever suggested a wheelchair would be beneficial to my recovery.  In fact, my orthopaedic surgeon has advised precisely the opposite. 

This was not mentioned during my WCA although the Atos HCP included a statement on the ESA85.  The only discussion about my upper body capability was in the context of light domestic activities.  I did not raise this matter in my complaint to Atos as I did not at the time appreciate its relevance.

I am still considered to be recovering from the major surgery I had in 2010 and have yet to reach the point where no further improvement is likely.  It would be fundamentally wrong and inhibit my recovery to rely on a wheelchair at this point.  I have attached a copy of an X-ray to demonstrate the point.

I do not believe or accept that this is the correct or intended interpretation of this activity and it is therefore a completely spurious basis on which to make a decision.  You are effectively saying that my capability to work is improved by being in a wheelchair over not being in a wheelchair.  The decision is clearly unsound.

5.    Mr Wrong said that the conclusion that if in a wheelchair I could self-propel at least 200m was based on the fact that I can drive a car for 10 minutes.  He admitted that this “assumption” is not based on any evidence or included in any of the WCA/ESA manuals and guides, but something him and some, but not all, DMs would use.  When I pointed out the problems subjectivity and inconsistency cause to claimants, Mr Wrong indicated that both are inevitable as the decision making process is very subjective.

The assessment must consider repeatability (within reasonable timescales), discomfort and exhaustion.  When I asked where these featured, Mr Wrong was unable to answer – because they had not been.   

In the absence of any foundation for any of these assumptions, they can only be treated as irrelevant and any decision relying on them must be wrong.

6.    Mr Wrong was unable to explain the obvious inconsistency in basing my potential mobility on being in a wheelchair and then ignoring it when it came to negotiating 2 steps.

7.    In other correspondence from DWP I have been assured that DMs assemble all the relevant information they can to ensure their decision is objective, informed and balanced.  This specifically includes routine research on the worldwide web.  Mr Wrong confirmed that in this case no information other than that on the ESA50 & ESA85 was considered, including the fit-note from my GP.  Contrary to what I have been told previously, Mr Wrong did not regard any of this additional information as relevant.  The missing/inaccurate information included in my complaint to Atos obviously has a bearing here.

The DM has clearly NOT fulfilled their responsibilities to consider all the information available.

8.    When discussing Activity 2, Mr Wrong acknowledged that just from the information that was available, 9 points would be more accurate than zero, but it was academic as the total would still be less than 15 and the ESA decision would remain the same.  DMs are required to calculate points accurately and have no authority to wrongly assign them regardless of totals or any other circumstances.

9.    ESA214 states that DMs and Atos HCPs are required to explain fully any conclusions they draw and decisions they make that are contradictory to the information on the ESA50.  Both the HCP & DM have failed to do this.

10. Neither the Atos HCP nor the DM considered the variability I described with my condition.  How this should have been dealt with is covered by my letter to Atos.  I emphasised to the HCP that this is the most significant aspect of my condition, but she has failed to convey the relevance in her report.

11. Neither the Atos HCP nor the DM considered the levels of pain and stress I described at the WCA.  I explained to the Atos HCP that I take the highest dosage possible to the point where the side effects become more serious than the pain itself.

12. Your letter informing me of the decision to stop paying ESA from 5^th October arrived on 27^th October, so the decision was retrospective by 3 weeks.  This is your fault not mine and I do not believe you should attempt to claim any payments back.

Finally, I have shown below an extract from your “Our Service Standards “booklet with further details of my complaint inserted in blue.

OUR SERVICE STANDARDS

Our responsibilities to you

We want to give you the best service we can. When you contact us, we want you to be happy with the advice we give you and the way we treat you.

Right treatment

We aim to treat all our customers in the same way. We will:

•         be friendly, fair and helpful

•          treat you with respect

•         behave professionally

I do not believe you have done any of this – certainly when you first told me my ESA had been stopped 3 weeks retrospectively.  Clearly such a decision was going to have a marked impact on my life, but all you saw fit to do was send me a rather bland letter with no explanation whatsoever.  II had to call you to find out what was going on. 

When we contact you

You can choose how we contact you – by phone or in writing. But to keep your personal details secure, we don’t include your personal details in replies we send by e-mail.

You have ALWAYS refused to use email despite my requests.

When we write to you

We aim for all letters to:

•         be typed, clear and easy to read

•         tell you if there is anything you need to do, and

•         give you contact details, like a person’s name and direct phone number.

When I asked for a name for correspondence, I was reluctantly provided with just a surname, not even an initial on the basis it is not mandatory.  Whether it is or not, this attitude is hardly compatible with a commitment to openness, honesty, help, support and customer service.

Right result

We aim to give you accurate information and the right advice to help you:

•         find a suitable job

•         get each of the benefits you’re entitled to

•         understand the conditions of receiving your benefit, such as attending interviews or looking for work

•         understand our decisions

•          decide what to do, and

•         access other support you may need, such as help to develop new skills or help with childcare or travel costs.

The way you informed me of the decision may have been “accurate”, but it was hardly considerate or complete.  At no stage did you indicate that consigning me to a wheelchair was a potential outcome or that this formed the basis of your decision – no straightforward and honest person would read this possibility into the descriptor definition, which I am sure is meant to be interpreted in relation to what is normal for an individual.

Being confined to a wheelchair is not only contrary to my medical advice, it obviously represents a massive change to my lifestyle, beginning with how I get one.  I have had no help from you over the other support I will now inevitably need.

So all in all, a pretty poor performance against the standards you say you are committed to.  It has never once felt like DWP has been trying to help me – totally the opposite in treating me as if I have not been honest and not once offering any benefit of the doubt.

Yours faithfully