Written evidence submitted by Darren Thomas
1. I am responding to your invitation for individuals
to submit evidence to your inquiry into Employment and Support
Allowance and the Work Capability Assessment.
2. The migration of Incapacity Benefit claimants
to Employment and Support Allowance is a matter of serious concern,
given the disastrous consequences the Work Capability Assessment
has already had. Due to the nature of the assessment, thousands
upon thousands of sick and disabled people have been passed as
fit for work when they quite clearly are not. Even the terminally
ill have been deemed fit for work. In my view, the reasons for
this are clear: the design of the assessment itself, and Atos,
the private corporation which administers it.
3. Firstly, the WCA itself is a farcical tick-box
exercise in the literal sense of that phrase. On the one hand
it is incredibly crude and superficial, on the other hand it is
outrageously harsh and unfair. I know from experience that any
attempt to explain to the Atos assessor the effects of how one's
illness or disability impacts on daily life is met with impatience,
the assessor instead asking such vital questions as "do you
watch films on TV?" and "when did you last go to a shop
to buy a CD?". The test is literally a series of questions
on a computer monitor, and the assessor is simply there to tick
the boxes. The idea that this pre-determined, one-size-fits-all
list of questions is enough to cope with the many and varied illnesses
and disabilities that an assessor will encounter, let alone give
a detailed picture of how illness or disability affects someone,
is intellectually risible, yet that is the system currently in
place.
4. Secondly, there is mounting and widespread
concern about the role of Atos in this process. Atos has a highly
lucrative contract with the DWP to carry out the WCA. Since Atos
assumed this role, a distinct trend has become apparent. Many
seriously sick and disabled people are deemed fit for work; they
then ask for a copy of the Atos assessor's report; and when they
receive it they find it bears little or no relation to what they
actually told the assessor. Organisations such as the Citizens
Advice Bureau will tell you that this is not just happening in
a handful of isolated cases - on the contrary, it is very common
indeed. It is widely suspected that Atos is incentivized to produce
reports which it knows will result in denial of benefit. Unfortunately,
all attempts thus far to obtain details of Atos' contract with
the DWP have been unsuccessful, with even Freedom of Information
requests turned down. For sick and disabled people subjected to
Atos' "assessments" this is an almost impossible situation.
A private corporation being offered financial incentives to produce
reports which it knows will result in denial of benefit is the
sort of thing which would never be permitted in a court of law:
it is like finding yourself on trial before a jury which has already
been offered money to find you guilty. In other words, whereas
even those accused of the most serious and heinous crimes, such
as murder, rape and child abuse, have the right to be considered
innocent until proven guilty, and the right to a trial by an impartial
judge and jury - and rightly so - the WCA assessments carried
out by Atos deny those rights to the sick and disabled, who are
considered guilty until proven innocent. Such is the Kafkaesque
nightmare to which the sick and disabled are subjected.
5. If Atos were providing an impartial, objective
and high quality service, one would expect the level of appeal
success to be very low. However, around 40% of appeals succeed
even when the claimant has no-one to represent them at their tribunal.
When they do have representation (for example, someone from the
CAB), that figure rises to around 70%. The fact that such a high
proportion of appeals are successful - and, therefore, that such
a high proportion of Atos assessors' reports are found to be wrong
- is surely proof that something is going very badly wrong; especially
as the appeals tribunals consist of independent people, in contrast
to those who conduct the WCA, ie Atos staff, who are working for
a company motivated by the profit motive. It is certainly amazing
how often the verdict changes when that profit motive is removed
from the equation.
6. Bearing in mind all of the above, one may
well wonder how on earth we have ended up with a situation in
which so many sick and vulnerable people are being put through
such suffering and misery at the behest of a private corporation.
I would strongly urge you to read the following article, which
answers this question in some detail. It only takes a few minutes
to read and is most illuminating: http://www.lwbooks.co.uk/journals/articles/rutherford07.html
7. The information in this article will come
as no surprise to anyone who has been on the receiving end of
Atos' tender mercies, but it is deeply disturbing nonetheless.
What it makes clear is this: the WCA now being run by Atos in
the UK is essentially the same as an assessment system which was
tried in an American court and found to be both corrupt and illegal.
In particular, the article mentions the four areas of concern
identified by the multi-state review following the 2003 court
case: "excessive reliance on in-house professionals; unfair
construction of doctors' reports; a failure to properly evaluate
the totality of the claimant's medical condition; and an inappropriate
burden on the claimant to justify eligibility for benefit".
All of this will sound all too familiar to those with experience
of the way in which Atos operates. The fact that such a system
has been introduced here in spite of the scathing verdict of the
American authorities is profoundly shocking. In my view, the respective
roles played in this sorry and depressing saga by UNUM, Atos and
Mansel Aylward, as outlined in the article, ought to be a matter
of serious concern. This information deserves to be far more widely
exposed. As the article shows, the reason the WCA seems to be
skewed against the claimant is simple: it seems to be so skewed
because it actually is; and furthermore, it is meant to be. What
we have here is an ideologically driven assessment system whose
sole purpose is to make it as hard as possible for the sick and
disabled to qualify for the benefits they desperately need just
to keep their heads above water. As if that were not bad enough,
Atos is being paid huge sums of taxpayers' money to carry out
this morally bankrupt agenda. (It is also worth noting that there
appears to be no evidence that the ESA/WCA regime has resulted
in any increase in the numbers of sick and disabled people moving
into employment (let alone sustainable employment) - and yet that
was supposed to be the justification for the existence of this
regime in the first place.)
8. It can therefore come as no surprise that
so many people are being wrongly assessed as fit for work. The
WCA is deliberately skewed against the claimant, and the company
implementing it has a vested commercial interest in producing
as many reports as possible that it knows will result in denial
of benefit. Atos typically uses two arguments to defend its conduct,
neither remotely credible. The first is that decisions on who
is eligible for benefit are not taken by Atos staff, but by DWP
decision makers. This is true, but is, to put it charitably, very
economical with the truth. One of the most common complaints about
the WCA is that medical evidence from a claimant's GP and even
hospital consultant is simply ignored (by both the Atos assessor
and the DWP decision maker). It does not matter if one has medical
evidence from an eminent hospital consultant going back many years
- this is dismissed out of hand in favour of the crude 30 minute
tick-box snapshot gleaned from the WCA. In other words, the DWP
decision makers simply rubber stamp the Atos assessors' reports,
even though evidence from a hospital consultant will inevitably
be vastly superior and more authoritative in its level of expertise.
It is indeed extraordinary that the opinion of Atos assessors
- who are frequently not fully qualified doctors - is given greater
weight than the views of GPs and hospital consultants. (It is
worth noting in passing the irony of the Government's policy of
allowing GPs to control their own budgets, on the grounds that
"GPs know their patients best" - except, it seems, when
it comes to the WCA, in which case it is the often dubiously qualified
Atos assessor ticking boxes on a monitor who knows the patient
best!)
9. To counter this objection, Atos then deploys
its second argument: the WCA is not a diagnostic test, but a functional
test, and hence not a "medical assessment" in the sense
in which one would normally understand that phrase. The intellectual
vacuity of this argument is obvious: if the assessor does not
have a proper medical understanding of the claimant's illness
or disability, it is highly unlikely that they will have a proper
understanding of how the symptoms of that illness or disability
impact on daily life. (To give just one anecdotal example of an
Atos assessor's level of understanding: I read of one person who
was asked by the Atos assessor, "are you still diabetic?",
to which the bemused claimant responded, "I wasn't aware
a cure had been found".)
10. As if all this were not enough, even Professor
Paul Gregg, who designed a key element of Employment and Support
Allowance, has warned against extending the WCA to Incapacity
Benefit claimants until the serious problems with the WCA have
been rectified. He has stated that the assessment system "is
badly malfunctioning", and indeed is "a complete mess".
To quote him more fully: "We need to trial the new, proposed,
reformed system to check and prove that it works and avoids the
serious stress and misclassification of people that we have already
seen, before we start implementing it on a large and vulnerable
population… The test so far has caused a huge amount of anguish
to the people who have gone through it. We need to have something
that is working accurately before we apply it nationally. We shouldn't
roll this out until we have something that is working." The
Citizens Advice Bureau's verdict is equally damning: the WCA is
"not fit for purpose". Unfortunately we now know that
the Government has decided to go ahead with the migration of Incapacity
Benefit claimants to ESA anyway. In fact, it is even worse than
that: as of 28 March, a new version of the WCA has come into force
which is even more ludicrously harsh and unfair than the version
which has already caused so much suffering (and one must wonder
how much good the recommendations of the Harrington report will
do, given that Professor Harrington was examining the pre-28 March
version of the WCA, not the even harsher new version).
11. The consequences of this are easy to predict.
Even greater numbers of people will be deemed fit for work even
though they are not (at which point they may have no option but
to try claiming Job Seekers Allowance, even though that benefit
is simply not designed for the sick and disabled); the level of
appeals will rise even further; GPs and hospital consultants will
have to try to pick up the pieces of their patients' physical
and mental health deteriorating even further as a result of having
to go through the extremely daunting and lengthy appeals process
(and indeed the financial hardship resulting from having their
benefit cut) - and meanwhile, Atos will continue to pocket vast
sums of taxpayers' money, safe in the knowledge that it doesn't
matter how often their assessors' reports are found to be wrong
by independent tribunals, or how much misery they cause to the
sick and vulnerable; they still pocket the cash anyway, and they
are of course utterly unaccountable. (Incidentally, one result
of even more people appealing will be an increase in the length
of time it takes for an appeal to be heard - and it already takes
so long that, by the time an appeal is heard, even if the appeal
succeeds, the successful claimant sometimes finds themselves called
in for another WCA by Atos within a matter of weeks of winning
their appeal, thus setting the whole extremely stressful process
off again. Atos should not be allowed to subject someone to another
WCA so soon after their own assessor's decision on the previous
WCA has been found to be wrong).
12. I do not think it is unreasonable to suggest
that when an independent tribunal finds an Atos assessor's report
to be wrong, and the claimant's appeal is successful, it is Atos
themselves who should be made to foot the bill for the cost of
that tribunal. The taxpayer should not have to pay for Atos' failings;
and since the profit motive appears to be the only thing to which
Atos pays any attention (few would suggest that a philanthropic
concern for the sick and vulnerable forms any part of their motivation
for conducting the WCA), being made to foot the bill for successful
appeals might just force them to get their act together.
13. This, however, would be simply an attempt
to make the best of a very bad job. It seems to me that the ideal
solution to this whole sorry business is to return to the assessment
system used for Incapacity Benefit. Those assessments were carried
out by properly qualified doctors, and, as they were not working
for a private corporation, there was no question mark over the
integrity of the system due to the presence of the profit motive
(thus, returning to the Incapacity Benefit system would have the
enormous advantage of getting rid of the likes of Atos - if they
were sent packing, there would be precious few tears shed by the
sick and disabled people of this country). That assessment was
also far more medically rigorous than the superficial nonsense
of the WCA, and it also took medical evidence from GPs and consultants
into account. Nor can this system be said to have been lax: the
article to which I have provided a link mentions that in 2003
the OECD described Britain's benefits gateway as "one of
the toughest in the world", and indeed audits conducted by
successive governments, including those actively trying to remove
as many people from Incapacity Benefit as possible, regularly
found the level of fraud to be remarkably low.
14. Bearing in mind all the points I have raised
in this e-mail, I hope you will do whatever is in your power to
try to improve the current appalling situation for the sick and
disabled. Chris Grayling has attempted to defend going ahead with
the migration of Incapacity Benefit claimants to ESA as a process
of continuous "refinement" (despite the fact that this
national migration is starting virtually immediately following
the end of trials in two areas of the country - quite how those
trials can be properly evaluated when no time is being allowed
for that evaluation is, to put it mildly, not immediately apparent).
However, the whole point of refinement is, at least in theory,
to improve the system, not make it even worse. The new version
of the WCA is certain to achieve the seemingly impossible feat
of inflicting even more widespread suffering and misery on the
sick and disabled than the pre-28 March version, especially with
Incapacity Benefit claimants forced to go through this new version
along with new claimants. There have already been anecdotal reports
of people being denied benefit, driven into poverty and despair
as a result, and tragically, in some cases, even suicide. The
new version of the WCA can only cause an increase of such cases.
This is surely not morally tolerable: if a society is judged by
how it treats its' most vulnerable members, we are in a poor state
indeed.
April 2011
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