Lord Mike German writes…ATOS contract scrapped, two requests for its replacement

stethoscopeThe previous Labour Government’s 2005 contract awarded to Atos Healthcare has been a long term thorn in the side of the policy of fairly assessing people on Invalidity Benefit for transferring to Employment and Support Allowance. The contract has been dogged by decisions taken which have been overturned on appeal, and longer and longer queues as people wait for their assessments.

At the root of the problem was Labour’s decision to award the contract to a single supplier for the whole of Great Britain. Now, we know Labour loves monopolies and centralising power – and this contract was no exception. Vesting so much public money and effort in a single provider meant the present government had almost no room for manoeuvre when making adjustments or seeking changes to the contract.

It was no surprise to me that this single provider contract has failed. I live in Wales under a  Labour government and centralising decisions is almost a watchword for all public services.  This mantra has meant our health and education services lag far behind those in England.

So the first message I want to send to our coalition government is to ensure that any new replacement contract is split – so that the government can turn to an immediate alternative when performance falls. This contract utilises a huge number of healthcare professionals – doctors, occupational therapists, mental healthcare specialists and the like. With a common assessment test in place it is the quality of the provision which is at stake. And that needs people with the right qualifications.

This government has put in place a set of independent on-going reviews of the assessment test – the Work Capability Assessment  – under both Professor Harrington and now Dr Litchfield. This has assisted government thinking on changes but much more can be done. What customers need now is certainty – certainty that their full conditions are taken into account, and certainty that the assessors are appropriately qualified. That’s my second message to our government.  People deserve fairness and accuracy. This new contract, to be up and running next year, is a chance to put both of these in place.

* Mike German is a Liberal Democrat member of the House of Lords. He was Party Treasurer from 2015-2021.

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  • They’re about to make the same mistake with the single contract approach for the health at work service….

  • This is welcome news for many sick and disabled people up and down this country who have been treated appallingly by ATOS and the DWP.
    Now this contract is up for renewal this government must ensue that the whole process is reformed to make it fit for purpose. I suggest that.
    1) The DWP must be responsible for contacting the claimants GP for an up to date medical report, they should also make this report available to the assessor before the assessment takes place.
    2) The DWP should contact other healthcare providers involved in the patients care i.e Specialists, therapists etc for statements.
    (At present the DWP does not do 1&2 because they will not foot the bill for medical reports. It is actually the claimants responsibility to gather the medical information and foot the costs, which is deeply unfair a financial burden that most can not possibly afford, on top of that the stress which is caused especially to people with mental health)
    3) The government must ensure that whoever takes over the contract has adequate staff levels who are trained in the field of medicine of the claimant who they are assessing.. Patients with mental health disabilities must be assessed by someone with the appropriate qualifications, ie Psychologist, Psychiatrist, Psychiatric Nurse. It is not right that at present ATOS has staff who have only received a few weeks basic training in mental health before being allowed to assess people sometimes with very complex mental health disabilities that requires specialist knowledge.

    4) There should be a provision for a “tell us once policy” for certain claimants i.e those who have from suffered mental trauma. It is not right that at present, some claimants are having to relive this experiences over and over again by constantly having to fill in forms giving harrowing details of their past. It is very traumatic for many vulnerable people.

    5) If the Minister in charge of the department is having catastrophic failures where up to 45% of claimants who are refused benefits go onto successful appeals in the tribunal, that Minister should be forced to resign. No other government department would be allowed to get away with those such shocking statistics and I fail to see why The DWP Minister should be exempt from this. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/289342/tribunal-stats-oct-dec-2013.pdf
    “Social Security and Child Support (Tables 2.6 and 2.7)
    Of the 144,000 SSCS cases disposed of in October to December 2013;
    64% were for ESA;
    14% for JSA and
    11% for Disability Living Allowance.
    In October to December 2013, 84% of all SSCS cases were cleared at a
    hearing, slightly higher than last year. Of these the overturn rate was
    40%, i.e. 40% had the initial decision revised in favour of the claimant.
    This has increased from 38% in October to December 2012.
    The overturn rate varies by benefit type with
    45% of ESA cases,
    42% of Disability Living Allowance
    and 17% of JSA cases
    that were cleared at hearing having the original decision revised in favour of the claimant.”

  • A Social Liberal 27th Mar '14 - 6:38pm

    The problems the DWP have do not stem from who they hire to do the assessments, it is that they hire external companies to do that which should stay in house. The problems are exacerbated by insisting that these external agencies are paid by results – not by the amount of clients assessed, but by how many of those clients are found fit for work.

    And please, correct me if I am wrong, but wasn’t payment resulting from those found fit for work the construct of this coalition government?

  • The way these contracts go is that the name at the top might change but a large proportion of staff are transferred to the new contractor. ATOS have said this up front – “We will be transferring our infrastructure and employees to ensure consistency of service to those going through the process.” Claimants might not be happy to be told “There will be no change for those applying for Employment and Support Allowance.” As matt says, a redesign of the service is required, but it’s likely to be restricted to tweaks on the contractor side, since extra work on the DWP side would require extra money. (Quotes taken from the BBC report)

  • The problem was not necessary ATOS. It is the computerised questionnaire, the criteria and the guidance given. Hopefully we wouldn’t start from here and we believe that the whole system has to be reformed to take account of the person’s chances of finding employment.

    However as Liberals we could address the powerlessness of those who have to go through the process. This could be done by ensuring that the medical professional does not write anything without telling the claimant what they are writing so the claimant can help remove misunderstandings and remove errors that often happen during the medical process. If the claimant disagrees with what is written this should be reported as well. The provider should audio record the medical if requested to do so (and only if requested to do so) by the claimant. The guidance which tells the decision maker to believe the medical report over what a claimant states must be changed so there is no bias against the claimant.

    A copy of the medical report should always be sent out with the decision. If the claimant asks for the decision to be reviewed then the second decision maker must take account of the disputes raised during the medical and later and if there is an audio recording then the second decision maker must listen to it.

    Hopefully these changes would reduce the number of appeals because the second decision maker would be more likely to make the correct decision if the first one failed to do so.

  • A Social Liberal 27th Mar '14 - 11:36pm

    No Amalric, this is not true. There are reports of ATOS and to be fair, the others, ignoring evidence when recommending that clients are fit for work. Yes, the questions are flawed and ignore many illnesses, but interviewers are recording answers to the questions on the form wrongly.

    Of course, it doesn’t help that the government changed several criteria to get a skewed view of a persons ability.

  • @ A Social Liberal – “No Amalric, this is not true. There are reports of ATOS and to be fair, the others, ignoring evidence”

    I wrote that there could be misunderstandings and errors in the medical report. The reason I said this is because there are lots of reports of there being errors when looking for evidence and in my experience of these medicals (having had three) is there are always errors or mistakes. In my last one, one of the misunderstandings was whether the medical centre was a place I knew or not (I said I knew the place as it was my fourth visit to it and I was familiar with the area of the town as well). To me it seems that it is the decision maker who ignores evidence and the reason is because of the guidance which states the decision maker (a DWP employee) must believe the medical report over the evidence of the claimant.

    If the medical professional records answer incorrectly then ensuring that the second decision maker listens to the audio recording would enable them to discover the correct answer, which was one of the points I was making.

  • The opening paragraphs of this article are highly disingenuous, ignoring as they do that the coalition renewed the Atos contract in 2010 & tightened eligibility for benefit at the same time – ignoring medical evidence at the expense of the claimant.

    I understand LDs desire to blame everything on Labour but seriously, the coalition need to start realising just how ridiculous it looks to us that you only take credit for the good stuff & blame all the less good on Labour. It will be your turn to face this in 2015 & I suspect you won’t find it very pleasant. Stones, glass houses and all that !

  • Let’s not forget also that Atos have been awarded the contract to deliver the coalition governments new child care scheme…….

  • I don’t think Labour are responsible for Atos enforcing Coalition policy.

  • And ATOS are currently helping DWP to screw up the PIP process.

  • The software that was designed by ATOS “LiMA (Logic Integrated Medical Assessment)” needs to be scraped.

    The tick box assessment is wholly inadequate for assessing someones medical conditions.
    The arbitrary point scoring system has been highly skewed to deny as many people access to benefits as possible.

    The questions are inappropriate and do not give a fair assessment or allow the claimant to give a fair account of how their disability affects them.

    For example, some of the questions asked
    3 (a) Cannot raise either arm as if to put something in the top pocket of a coat or jacket. 15 points.
    3 (b) Cannot raise either arm to top of head as if to put on a hat. 9 points.
    3 (c) Cannot raise either arm above head height as if to reach for something. 6 points.
    3 (d) None of the above apply. 0 points.

    4 (a) Cannot pick up and move a 0.5 litre carton full of liquid. 15 points.
    4 (b) Cannot pick up and move a one litre carton full of liquid. 9 points.
    4 (c) Cannot transfer a light but bulky object such as an empty cardboard box. 6 points.
    4 (d) None of the above apply. 0 points.

    5 (a) Cannot either: (i) press a button, such as a telephone keypad or; (ii) turn the pages of a book with either hand. 15 points.
    5 (b) Cannot pick up a £1 coin or equivalent with either hand. 15 points.
    5 (c) Cannot use a pen or pencil to make a meaningful mark. 9 points.
    5 (d) Cannot single-handedly use a suitable keyboard or mouse. 9 points.
    5 (e) None of the above apply. 0 points.

    11 (a) Cannot learn how to complete a simple task, such as setting an alarm clock. 15 points.
    11 (b) Cannot learn anything beyond a simple task, such as setting an alarm clock. 9 points.
    11 (c) Cannot learn anything beyond a moderately complex task, such as the steps involved in operating a washing machine to clean clothes. 6 points.
    11 (d) None of the above apply. 0 points.

    13 (a) Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions. 15 points.
    13 (b) Cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions for the majority of the time. 9 points.
    13 (c) Frequently cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions. 6 points.
    13 (d) None of the above apply. 0 points.

    These questions are not “guide lines” or examples. These are the questions that are asked which you must give answers to, which decides on your eligibility for benefits.
    You must score 15 points in order to be successful in your claim for ESA.
    It is ludicrous to have questions like can you push a button or move an empty box.

    Individuals are unique as are medical disabilities, 2 people suffering from the same condition do not necessarily suffer from exactly the same symptoms. Thats why I feel this arbitrary point scoring system is unfit for purpose.

    The test also does not take into account the consequences for someone who might have to undertake these tasks throughout the day.
    For example, there are people with mobility issues, pain and fatigue. These conditions can mean that the more activity they do one day, the more pain and discomfort , fatigue they will be in the following day. People with fluctuating conditions like MS, who have good days and bad days.

    In my opinion these medical assessments should be carried out within the NHS through the use of GP’s. It does not necessarily even have to be with the patients own GP. However a GP would have “full access” to a patients medical records and would have a better understanding of the claimants medical conditions and how they affect them.

    The only reason I can think of why the Government does not want GP’s carrying out these medicals is because a GP has signed a Hippocratic oath to put the welfare of the patient first above all else and that does not suit the governments agenda to kick off and deny as many people as possible access to sickness benefits. People who are genuinely are sick and disabled and vulnerable.

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