An important study reported by Global Research.
An important study reported by Global Research.
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.
In yesterday’s Observer Iain Duncan Smith once again boasted about how proud he was of his precious welfare reforms. Instead of addressing the very real and totally legitimate criticisms of his performance so far he pointed to the fact that the DWP had delivered their programme of torture on time:-
… we already have a proud record of achievement… We promised a benefit cap and it began, on time, in April in four London areas. It will be completely rolled out by September. We introduced the new personal independence payment as planned and on time. Automatic enrolment started last year, and now 1 million people have been registered into a workplace pension. People are using our Universal Jobmatch website for more than 5m job searches a day. Our Work Programme has launched and the industry tells us that so far 321,000 people have found a job through it.I am proud of this record.
How any decent, sane human being can ignore the thousands of lives that have been devastated by his policies or refuse to acknowledge the deaths and suicides that can be directly linked to his actions is totally beyond my comprehension. Why a newspaper like the Observer gave him the space to make those comments is also a mystery to me. And his refusal to undertake an impact assessment of the effect he’s had on the lives of disabled people simply shows that he doesn’t want to know. The only conclusion you can draw from this is that he’s irresponsible, unprofessional and should never be allowed to ‘serve’ as a politician again.
But as usual the odious Mr Smith is not giving us the true picture about the DWP’s performance when it comes to the progress of Universal Credit. There are huge problems with it. Two aspects stand out here. The first is to do with their badly thought through devotion to ‘digital by default’. This report from Public Net published today shows that the DWP have overestimated the number of people who will be able to claim the benefit online. The potential for chaos is tremendous.
UNIVERSAL CREDIT PILOTS REVEAL CHALLENGES FACING BENEFIT CLAIMANTS
Headlines: July 29th, 2013
Many benefit claimants will struggle to meet the requirement of the new welfare arrangements which are due to be introduced from October 2013 with the launch of universal credit. Pilot schemes started last year by councils have revealed the scale of the difficulty many claimants will experience.
Universal credit will require all claimants to submit claims on line. Although 86 per cent of the UK population have access to the internet, the pilots have found that in the case of benefit claimants it is closer to 60 percent. Theoretically claimants can use facilities in libraries to submit claims, but they don’t visit libraries and they need support to cope with the technology and with the benefit processes. Some pilots are experimenting with providing access points in council premises and with staff on hand to support the claimants. Other pilots are exploring various approaches to improving access but have found it difficult to encourage take up.
Universal credit will roll up all benefits into a single payment which will be made directly to the claimant. This will meant that currently where some housing benefit is paid to landlords, in future it will be paid directly to the claimant. The pilots have revealed that many social housing tenants have problems with debt and rent arrears which might compound possible problems with personal budgeting.
Some councils have found a reluctance from customers to take part in budgeting and financial training in group sessions. It is thought the reluctance is due to the stigma of engaging in sessions which may highlight personal debt and rent arrears issues. The uptake of group financial education sessions in some authorities has been so low that sessions have been cancelled. This evidence is mirrored in the Direct Payment Demonstration Pilot areas.
Different approaches are being used to support personal budget management. They include sessions in smaller community groups and collaborating with partner organisations. Changing the welfare culture, which universal credit seeks to achieve, is a mammoth undertaking and it raises issues which must be addressed to bring success. While solutions to the problems are available, they will need time and funding on a scale which has probably not been foreseen in the implementation plan.
The second report is potentially more damaging since it concerns the IT system that’s being developed to allow Universal Credit to be calculated. Because it combines all previous benefits into one package claimant information has to be gathered from HMRC systems and the system used by local authorities to calculate Housing Benefit. It seems they’ve messed up and now need to start from scratch. With the next roll out due in only two month’s time (October) its looking increasingly unlikely that even the six centres that are earmarked for the next stage will be able to cope. These computing problems were highlighted earlier in the year but in typical IDS fashion our SoS shrugged them off and refused to acknowledge that his ‘baby’ wouldn’t be born on time. Again Public Net have the story:-
UNIVERSAL CREDIT AMBER RED-RATING VINDICATED
Headlines: July 15th, 2013
Last year’s Government review conclusion that the Universal Credit project should be rated as amber/red because its successful delivery was in doubt and urgent action was needed, has been proved to be correct. Current trialling of the system with simple claims has revealed failings and there is to be a new design for dealing with the more complex claims.
Universal Credit will simplify the benefits system, improve work incentives and reduce fraud and error. It will replace income-based Jobseeker’s Allowance; income-related Employment and Support Allowance; Income Support; Child Tax Credits; Working Tax Credits and Housing Benefit.
The Universal Credit project is being tested in 2 areas of the north-west, with another 2 starting later this month. The pathfinder trial is restricted to new claimants who are specially selected. Despite this narrowing of usage, it is understood that significant manual input by officials is required to verify accuracy and deal with other problems.
This assessment of the pathfinder is supported by the announcement that the next stage of development in October will be restricted to 6 additional job centres. The original project plan was for all new claims for out-of-work support to be treated as claims to universal credit from October 2013.
A potentially more serious aspect of the project is how the system interacts with Real Time Data System which includes information about earnings of claimants from HMRC. It appears that this element of the system design has been scrapped and it is now ‘back to the drawing board’. The official line about this re-think is that there is a need to explore enhancing the IT for Universal Credit working with the Government Digital Service.
The need for a re-think is unsurprising, because the universal credit system design was completed prior to the emergence of the Real Time Data System. Pressing on with the system design without knowing what the final integration requirements would be, involved many assumptions. This was a high risk strategy which proved unsustainable.
Re-writing this element of the system will take time and the trialing of in work claims cannot start until it is possible to use information from the Real Time Data System. Getting the IT system to perform effectively is only one of the major risks to the success of the project. The cultural transformation involving claimants moving to a digital service will be difficult to achieve. In a move to promote this transformation 20,000 Job centre Plus advisers will be involved in a training scheme and ten pilots will test how to best encourage claimants to progress in work.
Mr Smith’s plans to get everyone including the terminally ill and profoundly disabled working to make Cameron’s pipe dream of winning the ‘global race’ come true seem to be nothing more than pie in the sky. The tragedy is by pursuing their hopeless policies this government are causing misery and death.
The Baron cracks his feudal whip once again. He’s determined to keep us poor . Is this the reason why I wonder http://wp.me/p3mYc5-88
Like so many others I’m sickened by the lies and spin that seem to characterise Iain Duncan-Smith’s DWP public statements about welfare benefit recipients. What’s worse is the way certain sections of the news media, notably the Daily Mail and the Sun reinforce this ‘dog whistle’ politics with aggressive content designed to turn public opinion against the poor. I was appalled to read recently that even Labour supporters were beginning to believe all this evil bullshit.
In view of this, I was more than a little heartened yesterday when I came across an excellent recent report published by The Joint Public Issues Team from the Baptist Union of Great Britain, the Methodist Church, the Church of Scotland and the United Reformed Church which identifies six myths propagated by the Coalition government about the nature of the UK’s poor families.
The report entitled “The lies we tell ourselves:ending comfortable myths about poverty” is a thoroughly researched piece and exposes the ideological agenda of a morally bankrupt government in no uncertain terms. In the Executive Summary of the report the Joint Public Issues Team say:-
“The myths exposed in this report, reinforced by politicians and the media, are convenient because they allow the poor to be blamed for their poverty, and the rest of society to avoid taking any of the responsibility. Myths hide the complexity of the true nature of poverty in the UK. They enable dangerous policies to be imposed on whole sections of society without their full consequences being properly examined. This report aims to highlight some comfortable myths, show how they have come to prominence and test them against serious evidence…The reputations of society’s most disadvantaged families became collateral damage in the rush to defend a new policy. Perhaps we are not surprised by this but we should be appalled.”
The full report can be found here
In order to publicise their findings and challenge the perceptions of the public which are being fed by the Tory press the Joint Public Issues Team actively encourage people to share their findings and provide a number of graphics which totally blow apart the false picture of families living in poverty which has been painted by the likes of IDS and George Osborne who recently tried to claim that the UK was full of dysfunctional families like the Philpotts who were the products of a ‘benefits lifestyle’. The graphics appear below. Click on each image to amplify. Please share them widely.
The Welfare Benefits Up-Rating Bill is currently going through parliament and a wide spectrum of church leaders have been lobbying for the government to protect benefits that affect children. As Paul Morrison, a Joint Public Issues blogger said on 13th April:-
“Churches and church leaders, including the Archbishop of Canterbury, have asked the Government to reconsider and exempt the benefits targeted at children. The Government response to these challenges has been aggressive but failed to address the substantive points or the underlying issues. More troublingly the response is grounded not in robust evidence but in the popular myths about those in poverty and receipt of benefits.”
I’ve been an atheist for many years and will continue to be one, but I’m impressed that these churches are at last standing up publicly against the government in defence of the many thousands of vulnerable people whose lives and reputations have been torn apart by the pernicious lies emanating from Westminster. Please give them your support.