On 20th August this year Dr Greg Wood, the former naval doctor who resigned from his post as an Atos disability assessor and subsequently became a whistleblower by going to the press to expose the cruelty of the Work Capability Assessments, published the following article in the British Medical Journal (BMJ):-
I blew the whistle on the government’s disability assessments
Greg Wood former naval doctor and Atos disability analyst.
Greg Wood went to the media with concerns about the ethics surrounding tests for fitness to work—and eligibility for benefits—that the UK government outsourced to Atos
Actually, two whistleblowers went public before me, and several other doctors have raised concerns anonymously. I am a former general practitioner in the Royal Navy, where work related
assessments are bread and butter stuff. The UK Department for Work and Pensions (DWP) devised the work capability assessment (WCA) to judge whether people who receive out of
work sickness benefits could, in fact, cope with most forms of work. A more stringent test came into use in 2011, and the government made no secret of the fact that it hoped this would boost the labour market, improve people’s self esteem and personal income, and, of course, reduce government debt.
For many years the information technology and “business process outsourcing” company Atos has had a contract, now worth £100m (€116m; $155.4m) a year, to carry out several
social security benefit assessments, including the WCA, for the Department for Work and Pensions. In my view this risks tension between doctors’ professional concerns on the one hand and business imperatives on the other.
The WCA had a troubled childhood. From early on, claimants and disability groups were reporting problems. They felt the assessment was a box ticking process, where medical assessors spent most of their time punching superfluous lifestyle data into the computer. And the likely outcome as they saw it? Computer says no. In fact, the test, on paper at least, isn’t too bad, though it isn’t going to win anyone a Nobel prize. But it cannot adequately
take into account health conditions that fluctuate unpredictably, and it tries to include too broad a range of jobs. Driving, call handling, shelf stacking, data entry, and cleaning, for example, are all theoretically covered. And although the test is nominally a pre-employment medical test of sorts, it is really still about measuring the person’s level of disability.
In early 2013 the WCA was still causing a rumpus in public, despite a series of external reviews.
One problem that dawned on me over time was the widespread use of five ill conceived so called rules of thumb that were promulgated during the training of new assessors. On one,
manual dexterity, the guidance was just plain wrong. The training said that this all boiled down to an inability to press a button, whereas the regulations allow points to be awarded when there are difficulties forming a pinch grip, holding a pen, or operating a computer. The other “rules of thumb” showed a combination of discrepancies and questionable interpretations of medical knowledge—for example, moving from one room to another at home was supposed to be equivalent to moving 200 metres. The effect was to reduce a claimant’s likelihood of entitlement to financial help. Another concern was the absence of documentary evidence, which, in my experience, occurred in about a fifth of assessments. This was a simple failure to move important pieces of paper from one building to another but the assessment was expected to go ahead regardless. And my third concern was that there was an implicit assumption that the most likely outcome of an individual face to face
assessment was that the person would be found fit for work. Ihave no reason to believe that this was deliberate; it was probably more a question of wishful thinking and a misunderstanding of basic statistical principles. You can’t expect the proportions of claimants who are fit to work who are seen by an individual doctor to correspond to national trends. The general culture was one where, at the point when their file was
being opened for the first time by the assessor, it was broadly assumed that an individual claimant was more likely than not to be found fit for work.
My fourth concern was that Atos auditors, for quality assurance purposes, were in the habit of demanding that healthcare professionals change their reports without seeing the patients themselves. This seemed fairly reasonable if the amendment could be justified, but not so reasonable when the doctor who had seen the patient thought otherwise. For instance, auditors supposed that they could tell that a patient with a chronic and only part treated psychotic illness had adequate mental focus, despite not assessing the patient for themselves, and using solely a report.
The position of the General Medical Council is that doctors should not alter such reports if they think that it would make a report less accurate, or would render it misleading to the body commissioning it—that is, the DWP. I resigned from Atos primarily over this widespread interference with reports, which I felt encroached on my professional autonomy and crossed ethical boundaries. So I blew the whistle and found myself talking to
parliamentarians and journalists, and then making an appearance on BBC news. It was nerve wracking trying to choose my words carefully while keeping the message clear and simple. Obviously I worried about the repercussions, but what had tipped it for me was that the DWP had stonewalled on this for more than two years; medical knowledge was being twisted; misery was being heaped on people with real disabilities; and the cost to the
taxpayer of these flawed assessments and the subsequent successful tribunal appeals was going up and up. Three months after I blew the whistle, the DWP announced that all Atos assessors were to be retrained and that external auditors had been called in to improve the quality of the WCA. To others considering blowing the whistle, I would say this: if
it is important enough to you and you do not believe that the problem can be fixed by more conventional means; if you can back up your assertions with evidence; if you are prepared to risk alienating your colleagues; and if you are robust enough to deal with the slings and arrows that might come your way; then blow your whistle loud and blow it proud.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Not commissioned; not externally peer reviewed.
© BMJ Publishing Group Ltd 2013
Yesterday, 24th August, the BMJ published another article by GP Dr Glyn Phillips, written in response to Dr Woods’ piece. Dr Phillips helps claimants who are going to a Tribunal to appeal against the outcomes of their WCA and fully supports Dr Woods. Here’s what he had to say:-
Re: I blew the whistle on the government’s disability assessments
Glyn Phillips, GP
Greenhills Medical Practice, Greenhills Health Centre, East Kilbride,
24 August 2013
Dr Wood deserves to be thanked for his publicising of what lies behind the seemingly dark and at times Kafkaesque outcomes of Atos WCAs. Over the past few years I (and many others) have seen a growing number of patients becoming victims of mind-boggingly cruel and unfair assessments which have led to stoppage of their ESA payments.
How can a patient with a quite profound depressive illness somehow manage to score zero points at an Atos WCA but 27 in a PHQ-9 assessment in the same week? In their defence they would cite that they do not actually make that final decision, it is made by an adjudication officer, a clerical worker, back at the DWP. Thus they can sanitise their tainted and increasingly cruel and unfair judgements. Atos and the DWP seem to deny the existence of a target driven culture. However, their methods and tactics cannot be explained by any other logical reason.
In 1996 I spent 6 months doing two sessions per week with the then Benefits Advisory Medical Service. The assessment tool was the All Work Test, not totally dissimilar to the WCA. Available to assessors were two exclusion clauses for those occasions where a ‘client’ clearly would not achieve the magic score of descriptor points to retain their benefit but equally clearly was not fit for work. This facility remains present in the WCA assessment. This option to apply exceptions, without restriction from management, was what allowed latitude for commonsense, experience, empathy and compassion.
The recent marked increase in grossly unfair decisions by Atos/DWP is, in my view, solely due into the fact that doctors and nurses performing the assessments have had those four safety valve qualities blocked in an over-bearing and bullying fashion by their employer Atos. The DWP, as the commissioning public body, carries equal responsibility for this.
Atos employed doctors and nurses (especially those in managerial roles) should be examining their consciences in these matters. They should be reminded that the decision will be based largely, if not entirely, on their assessment. They are answerable to their governing body. They are also answerable to their ‘client’ who is our patient and therefore answerable to us. When they see somebody who has not scored enough descriptor points, but who they must know is not fit, it is their duty to apply an exception clause. It is their duty not only to our patient but also to their governing body.
This past year I have been involved with supporting appeals for increasing numbers of patients who have had their ESA stopped. One example is a significantly unwell man with complex multiple medical conditions including SLE and ‘shrinking lung syndrome’. He walks very slowly with difficulty and is significantly short of breath after just a few metres. I am convinced that a child would have come up with a more appropriate decision regarding his fitness.
Working with a like-minded local lawyer our success rate is currently 100%. There are more to come. This is a frustrating waste of time for me as it is so unnecessary. What is more frustrating is the total lack of transparency following such a successful appeal. The appeal is successful, the ESA is restored but there appears to be no other outcome. No acknowledgement of accountability on the part of Atos or its employee. The misery and extra unwelcome stress put upon our patient seem not to matter. Apologies do not exist. The tremendous waste of public money expended in dealing with the dramatic increase in levels of appeals is a disgrace.
Making unwell patients more unwell is a disgrace too
Competing interests: None declared
With the recent disturbing news that GPs are being urged by professional bodies to refuse to provide benefit claimants with the medical evidence they desperately need for their WCAs whilst the DWP and Atos refuse to do the job themselves, leaving disabled people in an impossible position, its good to read stories like these by doctors who put their principles and humanity before anything else.
We desperately need more health professionals who are or who have previously worked for Atos to come forward and speak out and put the powerful weight of their professions behind the people being criminally treated by Atos with the approval of their own government.