Saturday, 27 August 2011

Why are they doing it that way, anyway?

In this blog I am stepping outside my comfort zone, so if I have made any glaring errors, please be kind! But in following the various horror stories, screams of outrage and complacent comments of "I told you so" arising from ATOS's assessments of fitness to work, one thing puzzles me. Why on earth has the Government engaged an external company to do this work, no doubt in return for handsome remuneration, when it already has a huge workforce that is more than capable of undertaking these assessments?

I refer, of course, to GPs.

GPs have access to patient medical records - which ATOS don't. For those claimants who are actually sick, their GP will be the person who manages their condition, refers them to consultants, deals with any aftercare following hospital admissions, sees them for repeat medical checks. Some of this work may well be done by practice nurses or health visitors, but the GP has ultimate responsibility. For those claimants who are disabled rather than sick, the GP is still likely to know them well. Why on earth weren't GPs given the responsibility of assessing claimants to determine what work they could do?

Could it be that our Government doesn't trust GPs to assess claimants accurately? Oh dear. Not a great endorsement of our medical system.

Or could it be that the aim of the Government in outsourcing ESA and DLA claim assessments was not to ensure that those who really are sick and disabled get the money they need to live on, but to eliminate as many claims as possible to reduce the bills and keep Daily Mail readers happy?

A look at the ATOS website (occupational health section) is informative. Yes, they are involved in healthcare assessments for private companies too, so they are obviously experienced in this area. But these assessments are aimed at keeping workforces healthy, reducing absence due to sickness and facilitating rehabilitation back to work. Well, well. It couldn't be that this is what attracted the Government, could it?

Helping people back to work is a reasonable thing to do. But the way they are going about it doesn't make any sense. How can a tick-box assessment by a doctor, nurse or physiotherapist who has never met the claimant before be a better judgement of someone's fitness to work than a GP's report?

The Work Capability Assessment process conducted by ATOS has been seriously criticised by the Parliamentary Select Committee on Work and Pensions. Maybe it's time to replace it with something that really works for both claimants and Government?

12 comments:

  1. No glaring errors Frances, lol

    What's more, it really IS that simple. GP (or consultant even better if applicable) led assessments would be accurate (on the whole) and fair.

    Currently, the system is designed to deter and intimidate - from the forms through to the assessments.

    If they made the assessments fair, then literally millions more - not thousands - would claim. They are eligible.

    Your post is the first, most important, and most sensible question anyone looking into this farce asks. The answer is simple. Sadly and shamefully simple.

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  2. Frances, this article on the genesis of the current system might help ... New Labour, the market state, and the end of welfare http://wp.me/p1seqm-7y ALSO Unum explain their side of it Ask UNUM FAQ: Atos, WCA, CardiffU and Biopsychosocial Model http://wp.me/p1seqm-7N

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  3. I saw somewhere an argument that GPs do not want to be gatekeepers to benefits because it would change the doctor-patient relationship. However, I see no reason why the fit-for-work decision could not be made by actual doctors employed by the NHS and with access to medical records.

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  4. It's so easy and obvious that the only possible reason they DON'T do it is because more people would qualify.

    The idea is to take the medical out of the decision - they are quite clear about this. It is a functional test NOT a medical one.

    That's why.

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  5. In an ideal world, with a system geared entirely towards support and not cost saving the assessments would be performed by a panel including GP's, OT's, physio's, CPN's, occupational health, housing, social care, disabled advocates etc and consider needs in a holistic manner. However, that is unlikely to ever happen.

    Whilst there are obvious benefits to using GP's to do the assessments it's worth being cautious of the pitfalls. Does my GP know me? Yes. But does my GP know anything at all about my condition and it's impact on my life? No. Using GP's to do the assessments would work in the favour of those of us who have access to good, consistent GP care, but very much work against those unable to access such care, particularly in inner city areas.

    I'm not against outsourcing per se, but in this instance I think the most obvious solution is not to turn to GP's but to return to employing the assessing doctors directly through the DWP as was done in the pre Sema/Atos days.

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  6. I agree with Stephen & Sue have said but it's not a level playing field with GPs either. My GPs definitely have a bugbear about my "just a UK Resident" status... I have had a hard enough time as it is trying to get help for my needs here in Wales and there was no help from them at all all of the times I've had to deal with Atos for ESA & DLA. Unfortunately it took having private insurance for a year post-redundancy from the old employer to get referrals, tests, reports etc. Without that insurance and the intervention I had to enlist from old doctors in London to get the new GPs to listen in the first place, I would be dead now... and that is a matter of record and documented by the old team in London, the CMHT here and one of my Surgical Specialists. Unfortunately being disabled, housebound and on a limited income at the moment travelling further afield to find a new surgery is impossible. I'm at the mercy of people who treated me like a lying scrounger until all the reports were in hand. Now they simply argue with the Specialists and think they know better - while grilling me every time I set foot in the place about why I'm not returning to the States (same as the ESA WCA Doctor).

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  7. this was a very interesting read because of what i experienced this week!

    a few weeks ago my surgery called me to arrange a twenty minute appointment relating to my esa50 form (i have m.e and fibromyalgia plus other problems)which atos had sent him, i made for 19 sept.
    after a further phone call from my gp it turns out the form is an esa113 which states...

    ''The Social Security Agency may ask GPs to complete a factual ESA113 report (currently an IB113) on their patient. GPs can complete this form from their records. There is no need to carry out a separate examination of the patient.The Social Security Agency will only ask a GP to complete an ESA113 if:•it could result in the patient’s entitlement to additional financial support being confirmed on paper evidence, without need for a face to face assessment, or •if, in the case of reassessing the patient’s continuing entitlement to Employment and Support Allowance, it could result in ongoing entitlement being confirmed without need for another face to face assessment.''

    http://www.dsdni.gov.uk/index/ssa/ssa-projects-and-initiatives/ssani-esa/esa-healthcare-professionals.htm


    last week atos phoned to make an appointment and she would only give me the 12th sept which we had previously informed them we would be away. well she kept on so we agreed and resigned ourselves to coming home a day early.

    after gathering some information from forums my OH called a number to arrange another date~one after i had seen my gp re the form, otherwise its wasting everyones time~the chap was very insistant (also denying they sent the form then later saying i did not have to see my gp for it!)that he could not and tried to give us other dates before the 19th and when we were away (turns out they wrote the wrong dates down) then he accused us of 'deliberately making ourselves unavailable'. my OH hit the roof demanding to speak with a supervisior. they were all apparently in a meeting and we were told one would phone us within the hour.
    45 minutes later the phone rang twice and then stopped so my OH rang the number straight back. it was the young chap on the other end and OH told him that someone had called to which young chap replied 'oh so you missed the call'~'no we did not miss the call it rang twice and stopped as i answered' young chap brushed this off but was much less confrontational and informed us they would cancel the appointment and call up at a later date to arrange an appointment after i had seen my GP.

    it seems to us that they are trying very hard to see me before they get the report from my gp

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  8. Frances, you miss the point of the 'testing'. In my view it's a scam, nothing to do with welfare reform at all, that's just the cover for transferring hundreds of millions from the public purse to the private sector where it can be shared out later by the crooked businessmen and corrupt politicians involved. It's a giant raid on the public purse, nothing else. Look at it from that point of view and suddenly it all makes sense, no? The way very ill people are repeatedly, routinely and wrongly declared fit to work, the breakneck speed at which welfare reform has been pushed though the house (did you know it's now in the public domain that the figures presented to parliament to support welfare reform were wrong and the DWP actually knew this but kept quiet till after the consultation period was over?), the way the designer of the test himself Professor Grigg has said it's a train-wreck (my words) but has been ignored)... it all makes sense when you understand they're just trying to get as much money out of the public purse as they can before they get rumbled and the milking has to stop.

    BB

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  9. Thanks Frances for posting this view after we spoke of the real benefit to the NHS of an extra 100 million a year, and hardly any systematic changes being needed - should this exercise be undertaken within existing health structures.

    That seems WELL overlooked by many decision makers.

    As for Doctors being Gatekeepers to benefits? Were they not always that? Issuing Original and Confirmation of renewal of sick notes etc?

    The Harassment of assessees and non contractual compliance of carrying out the assessments is felt and documented across the interweb, and noted by professionals and Governmental Scrutiny panels.

    My question is simple. WHY is this farce not stopped now.

    Its wrong on every level.

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  10. I think my GP is pretty good, that's why I've stuck with her through 2 decades of disability, but that doesn't mean she actually knows much about my disability. The details are too amorphous and out of the ordinary for her to really involve herself deeply. Instead we trust each other that I'll only ask for what is needed and she'll refer me to where I can get it. Involving my GP in the process wouldn't really help. Nor could rheumatology,or the spinal surgeon I've been seeing really help, I've tried to get them to look at the big picture without success, in fact rheumatology have told me they don't have anyone qualified to look at the entirety of my spinal problems.

    My pain management consultant, OTOH, and his team, know exactly how I'm disabled, and how that limits me, so he's the one I would need to get involved. But he's said in the past that it's almost impossible to get a doctor who isn't a specialist in pain management to understand how disabling chronic pain really is.

    What this all boils down to is needing the process to consult the specific doctor nominated by the patient, and for the evidence to be examined by a doctor who has the necessary specialism, not a nurse or physio with 8 days of training. Anything less simply isn't fair to us.

    (How we deal with the situation where there are very limited numbers of specialists in a condition I don't know, I know that potentially affects at least a couple of us in this thread).

    The other change needed is a complete change of approach in the structure of the questioning, people need to be asked (for example) if they have trouble sitting, not if they like to watch the TV, obscuring the question denies people the opportunity to give a precise and informed answer.

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