Tag: Atos

The government are challenging independent disability assessment appeal decisions

newton

In 2017, the then minister for disabled people, Sarah Newton, said that the Department for Work and Pensions (DWP) was “recruiting, training and deploying” approximately 150 presenting officers (POs) to attend Personal Independence Payment (PIP) and Employment and Support Allowance (ESA) tribunals “in order to present the Secretary of State’s case and support the first tier tribunal in arriving at the right decision”.

The question is the ‘right decision’ for whom? It’s certainly not disabled people.

Given that, at the point of appeal, the Secretary of State’s case has already been presented twice –  at the first DWP decision following assessment and again during the mandatory review – it seems that the government is using an incredibly oppressive and authoritarian approach to prevent successful appeal outcomes for ill and disabled people trying to access disability-related social security alone, without legal aid and support in the majority of cases. 

Last week I spoke to someone who won her PIP appeal following a reassessment which had resulted in the loss of her PIP award. After waiting two weeks for some communication from the DWP,  she rang to see when her award would be reinstated. She was informed that the DWP had requested the full written reasons for the tribunal’s decision, and that they were considering challenging the court’s decision. If the DWP decide to proceed with their challenge, they must apply for permission to appeal.

The application must be made within one month of the date of the tribunals’ written statement of reasons. So far, the claimant has been left without her award for 13 weeks, and she is very distressed. Having gone through mandatory review and appeal, she is utterly exhausted and the stress of the process has significantly exacerbated her illness – she has multiple sclerosis. Since her assessment, she has also needed treatment for anxiety and depression.

The claim for PIP was in relation to her physical disabilities, but she has become mentally unwell as a direct consequence of her extremely distressing experiences. The DWP will be permitted to appeal the tribunal’s decision only if it is considered that the decision resulted from an error of law. Once the tribunal have received the request the chair of the tribunal will provide a written statement to the claimant and the DWP explaining why they awarded PIP.  It can take up to 12 weeks for the written statement to be sent out.  

I co-run a support group online for people going through ESA and PIP claims, assessments, mandatory review and appeals. We are seeing a rise in the number of cases where the DWP are requesting written reasons for the decision of the tribunal, but quite often, it eventually emerges that they are not proceeding with an appeal. 

This leaves people waiting many months with the fear they may lose their lifeline award, causing a lot of additional and unnecessary distress. Furthermore, the DWP are not keeping people informed of their intentions in a reasonable and timely manner, which adds significantly to the distress and uncertainty that the whole awful process has created.

There are two people who have waited over 12 months after they won their appeal, while being told by the DWP that they are still awaiting the judge’s decision as to whether the DWP can proceed with a challenge. Meanwhile, the DWP refuse to discuss the details of the matter any further when people ask for details and an idea of a timescale.

One person told me he felt that the DWP are “intentionally playing mind games to demoralise and scare people”, and that leaving people feeling precarious was “a deliberate strategy” to undermine people’s expectation of support, and 

Someone else who won their PIP appeal has been left for four months without any payments, the DWP claim he owes them money for an overpayment, and refuse to release the money he is owed. However, he told me that he does not owe any money, and has never been overpaid, as prior to his relatively recent claim for PIP and ESA, he was in work and received no social security. He ahs also been forced to appeal the DWP’s decision not to award him ESA. 

The DWP were allocated £22m of public money to hire the “presenting officers” to “support” the DWP at disability benefit tribunals. Disability campaigners warn that these 180 presenting officers, rather than helping judges to make fair decisions about whether to overturn the DWP’s rejection of someone’s claim for benefits, will inevitably argue as forcibly as possible in the government’s favour. The aim is to cut the number of successful appeal outcomes for claimants. The reality is that PO’s are sent by the DWP to try to discredit claimants’ accounts and to argue forcibly for the DWP’s interpretation of the law to be accepted. 

A freedom of information request by Disability News Service resulted in them being sent forms that have to be completed by presenting officers after each tribunal they attend.

Included in the documents are the following questions for presenting officers attending ESA and PIP tribunals, respectively:

“PO impact – Was SG [support group] award averted”

“PO impact – was enhanced PIP award averted?”

DNS quotes a DWP insider, saying that presenting officers are being given the ‘target’ of stopping enhanced PIP payments and that this was placing ‘immoral pressure’ on presenting officers. (See the full article: ‘Truly appalling’ revelations ‘show DWP is subverting justice’ at appeal tribunals.)

The DWP outline says: “The PO must be confident that the decision is accurate and prepared to lapse appeals where this is not the case. They must highlight inconsistencies and take appropriate action when new evidence comes to light, including making a critical assessment of its validity.

But surely that is the role of an independent court.

At the time, Marsha de Cordova, Labour’s shadow minister for disabled people, described the DWP’s admission as “truly appalling”.

She said: “The idea that the ‘impact’ of DWP staff is being assessed on whether they managed to get ESA support group or enhanced PIP awards ‘averted’ is truly appalling.

“Presenting officers are supposed to be there to provide fair and balanced evidence of a claimant’s needs.

“In May last year [2017], freedom of information requests revealed that the DWP was setting targets to reject 80 per cent of social security appeals at mandatory reconsideration.

“They clearly haven’t changed their approach.”

She added: “The whole system is broken: from assessments where, for example, only eight per cent of claimants think assessors understood their mental health, through to appeals where judges are overturning over 67 per cent of initial ESA and PIP decisions.

“Labour will scrap the current PIP and ESA assessments, bringing an end to the Conservatives’ failed, privatised assessment system.

“Instead of enforcing a culture of distrust and cost-cutting, we will work with disabled people to ensure that they have personalised, holistic support to live full and independent lives.”

The assessment process, from beginning to end, is almost entirely about providing opportunities for assessors and DWP decision makers to manufacture as many far fetched ‘inconsistenciesas they can to prevent awards and deter as any higher rate awards as possible.

This means that PIP is not about meeting the needs of disabled people, it is about how little the state can get away with paying out from public funds, regardless of a person’s needs and entitlement.

It was acknowledged in my own PIP assessment report that I had cognitive difficulties because of my illness. The HCP said that I had difficulty focusing when asked questions and needed prompting. She acknowledged that I rely on a 7 day pill organiser to ensure I take my medication safely and correctly.

However, the report said that I had a degree (I graduated back in 1996), I had worked in a profession – as a social worker (until 2010, when I became too ill to work) and I had a driving licence in 2005 (I haven’t been able to drive since 2005 because of flicker-induced partial seizures). The assessment took place in 2017. I was not awarded a point for cognitive problems, and was just one point short of an enhanced PIP award. The reasoning behind not awarding the one point was unreasonable, irrational pretty thinly stretched, given that I cannot drive, I was forced to give up work in 2010, and I graduated in 1996. The decision at mandatory review was exactly the same, with the same woefully incoherent reasoning presented again.  

In November 2017, POs attended 23% of all first tier PIP tribunals, but the aim back then is to increase this to 50%.

It would seem likely that presenting officers are being used primarily to target claimants who are likely to be seeking enhanced rates of PIP or the support group of ESA. In which case their presence has nothing to do with improving decision making by feeding back to colleagues and everything to do with taking awards from disabled people, regardless of the high price disabled people have to pay in terms of loss of independence, loss of income to meet their basic and additional needs, placing them in unacceptable situations of severe hardship. 

A claimant who secretly recorded his personal independence payment (PIP) assessment and provided a transcript to a tribunal has won his appeal against a disability living allowance (DLA) to PIP transfer decision, the BBC has reported.

Nev Cartwright, 45, received DLA because of breathing difficulties caused by a lung tumour which led to his left lung being removed.

Last year he was told to attend a ‘medical’ to assess him for PIP instead of DLA. Because he had seen a programme the night before questioning the fairness of PIP assessments, Nev decided to secretly record the interview on his mobile phone.

As a result of the assessment Nev lost his higher rate mobility and had to return his Motability car.

When he read the PIP assessors report he realised that there was information missing and other details such as his peak flow reading, had been altered. The effect was to make Nev seem much more mobile than he actually was.

Nev had a professional company write a transcript of his assessment recording and asked to be allowed to submit it as evidence for his appeal.

The DWP tried to prevent the transcript being admitted by the tribunal, but they failed and the transcript was taken into account. As a result Nev won his case and now has his Motability vehicle again.

Given the very costly restrictions attempt to place on openly recording your PIP assessment, it is not surprising that some claimants turn to doing so covertly. Although we have had members who have used relatively inexpensive cassette recorders at their assessment.

It is not illegal to secretly record your assessment.

But if you are caught doing so and refuse to stop, the interview is likely to be ended and you will be held by the DWP to have failed to take part in the assessment with the result that you will not be awarded PIP.

This imbalance of power is most certainly subverting justice for disabled people. We often hear about the outright unfair methods the DWP uses to cut disabled people’s income when they have been held to account. But for every case we hear about where justice prevails in the end, there are many more that slip under the radar, because perhaps some of us are simply too ill, exhausted and disheartened to appeal alone, without any legal support, while the government spends hundreds of thousands of pounds of public funds to prevent us from having a fair and balanced assessment and hearing, and accessing the social security support that most of us have paid towards.

Meanwhile, Atos and Capita have come under fire for the reported mishandling of as many as a third of the PIP assessments they carried out. The firms received a raise for their efforts last year, raking in more than £250 million each for the controversial disability welfare checks, despite Parliament’s Work and Pensions Committee recently suggesting vulnerable people had been “pushed to the brink of destitution” by the contractors’ handling of the scheme.

That’s because the private companies are contracted to do precisely that by the government.

pip-esa inhumane

 


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A man with multiple sclerosis lost his PIP award after assessment report was dishonestly edited during ‘audit’

 

DWP

A man with multiple sclerosis and mental health problems had his personal independence payment (PIP) stopped after officials tampered with the assessor’s original report.  The man only discovered the ‘audited’ version of his health assessment report when he asked for copies to make an appeal.

He said that no one spoke to him or the nurse who carried out the assessment before the report was altered and his PIP was stopped.

The man had been in receipt of the basic level of support for two years when he was summoned to be re-assessed for PIP, which is non-means tested and designed to help with the extra cost of living with debilitating conditions.

Private companies Atos and Capita carry out the tests across the UK, but Atos contractor Salus do much of the work in Scotland.

His local SNP MP, Marion Fellows, said: “The tampering of a health assessment report by someone who wasn’t even in the room is utterly disgraceful and deceitful.

“It shows that, for many people, the system is rigged against them and the outcome is a foregone conclusion.”

An approved nurse at Salus Glasgow carried out the assessment in September last year. The Daily Record has seen the original and ‘audited’ versions of the man’s report.

The original document said the man, diagnosed with multiple sclerosis (MS) last year, has “regular specialist input”. The ‘audited’ version says he does not.

The original report outlines the patient’s MS, depression and anxiety and tells of his difficulties with tasks including cooking, dressing and washing. The nurse noted his clothes were dirty and his top inside-out. The ‘auditor’ had removed the second point.

The ‘auditor’ changed a part which said the man needed supervision or prompting to wash or bathe, and a section on preparing food. The original said he “needs prompting” but the ‘audited’ version said he could prepare and cook a simple meal himself.

An ATOS assessment form which Marion Fellows MP claims was altered by officials (Image: Daily Record)

While the original report said that the man had “regular specialist input” and took regular medication for mental health, the altered report stated that he “has no regular specialist input”.

The man, who is from Motherwell, said: “They didn’t ask me any more questions, they just decided to go back and change the document. I’d say this can’t be a one-off situation.

“It’s disgusting. It’s picking on the weak.”

Fellows, MP for Motherwell and Wishaw, wrote to Atos and the Department for Work and Pensions (DWP) in August about the ‘audit’.

Atos, who now call themselves Independent Assessment Services, told her they did not choose which reports were audited. They wrote in an email: “This happens on a random basis. However, independent DWP audits are a DWP process.”

The DWP wrote in their reply to the MP: “If a health professional’s advice is of poor quality which could result in an incorrect decision, the case will fail the audit activity.”

Fellows said that in every section of the report where the man scored points towards his  PIP award, the ‘auditor’ had reduced his score to zero.

She added: “It is outrageous.

“It isn’t even clear who carried out the audit, as Atos say it was the DWP and the DWP say it was someone independent from them.

My constituent is now going to tribunal.

“This sums up the Tories’ austerity-driven welfare regime, which attacks the most vulnerable.

“There needs to be a complete halt to these audits, and an inquiry so that whoever is responsible is held to account.”

The government guidance document for PIP assessments (section 3.4 onwards) says that “audit processes are in place for auditing the quality of assessments through:
• DWP Lot-wide audit (random sample); and
• The provider – Approval-related audit (for trainees).

And: “Audit has a central role in ensuring that decisions on benefit entitlement, taken by DWP, are correct. It supports this by confirming that independent Health Professional advice complies with the required standards and that it is clear and medically reasonable. It also provides assurance that any approach to assessment and opinion given is consistent so that, irrespective of where or by whom the assessment is carried out, claimants with conditions that have the same functional effect will ultimately receive the same benefit outcome.”

It goes on to say: “The DWP Independent Audit Team carries out lot-wide audit, which is an audit of a controlled random sample from across each contract Lot, feeding in to routine performance reporting for DWP.”

Where a report is deemed ‘unacceptable’: “Any changes made to forms should be justified, signed and dated. It should be made clear that any changes are made as a result of audit activity. Where necessary a new report form should be completed.”

The government guidelines also say that: “Any challenge to the reason DWP has returned a case to the Provider for rework must be made via the nominated rework Single Point of Contact (SPOC).”

In the event of a dispute regarding a request for an assessment report to be changed, “the final decision on whether the case requires rework rests with DWP and not the assessor.” 

So ultimately, an official at the DWP who was not present when a person was assessed, may decide that the assessment report is ‘reworked’, and use non-transparent criteria to change the facts established and recorded during the assessment.

This means that the person making the claim has no opportunity to challenge the changes made to ‘reworked’ reports before the decision is made regarding the claim. 

There is increasing evidence that disability benefits are being removed on flimsy and fabricated grounds. Disability News Service (DNS) has been carrying out an investigation into claims of widespread dishonesty in the disability benefit system, with more than 250 PIP claimants alleging assessors repeatedly lied, ignored written evidence and dishonestly reported the results of physical examinations. It’s a regular occurrence for disabled readers to read the reports of their benefit assessment, and find a statement, of an event or comment that never in fact happened.

The government produced guidelines that says assessors must look for ‘inconsistencies’ in disabled people’s accounts. For example, if a person says that they cannot bend because of spinal problems, but they have a pet, such as a cat or dog, a decision will be made that the person making the claim can bend to feed the pet. I

In my own PIP assessment report last year, it says that the HP had to prompt me several times because of my lack of concentration. She also acknowledged that I needed aids to remember to take my medication. Yet the report is riddled with inconsistencies and inaccuracies. It was concluded that there is no evidence that I have ‘cognitive difficulties’ because I have a degree (from 1996), and worked as a social worker (before I became too ill to work in 2010.) It was also mentioned that I had a driving licence as further justification for removing a point, but the report failed to mention I have not been able to drive since 2005 because of flicker-induced seizures, even though I made that clear. I therefore lost one point – which meant I was not awarded the enhanced rate.

As well as widespread allegations of fabricated reports, secret filming has produced claims of a culture of targets, in which assessors are allegedly monitored to ensure they don’t find excessive numbers of disabled people eligible for benefits, and mounting evidence of toxic punitive measures. As one former jobcentre adviser put it when describing her role with benefit claimants, there were “brownie points for cruelty.

Last year, figures released by the government indicated that neither Atos nor Capita – the private companies contracted by the government – paid more than £500m to assess people for Personal Independence Payments (PIP) – are actually meeting the target of 97% of assessments conforming to standards. 

The government released the data to the Commons Work and Pensions Committee, which was due to take evidence from Atos and Capita regarding the assessments.

While private companies carry out the assessments, it is the DWP that makes the final decision on whether to award people financial support. However, those decisions are informed by the contents of reports that privately contracted ‘health professionals’ write during the assessment process.

One of the current performance measure – which sees an independent team pick cases at random – was launched in March 2016. Under the previous method, the private providers audited assessments themselves. 

The NAO found last year that the number of completed ESA assessments were below target, despite an expected doubling of the cost to the taxpayer of the contracts for disability benefit assessments, to £579m a year in 2016/17compared with 2014/15.

The NAO said that nearly 1 in 10 of the reports on disabled people claiming support were rejected as below standard by the government. This compares with around one in 25 before Atos left its contract. The provider was not on track to complete the number of assessments expected last year and has also missed assessment report quality targets.

The proportion of Capita PIP tests deemed ‘unacceptable’ reached a peak of 56% in the three months to April 2015.

For Atos, the peak was 29.1% for one lot in June 2014. 

More than 2.7million people have had a DWP decision regarding PIP since the benefit launched in 2013 – this suggests that tens of thousands went through an ‘unacceptable’ assessment.

However, it’s difficult to acertain what ‘unacceptable’ actually means, in light of the fact that the DWP orders some reports are ‘reworked’. This editing may – and undoubtedly has – result in grossly inaccurate final reports which in turn inform a fatally flawed and unjust decision-making process, aimed at declining disabled people’s claims for lifeline support.

Related

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

Thousands of disability assessments deemed ‘unacceptable’ under the government’s own quality control scheme

 


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Devastated mother whose children were murdered fears eviction due to cut benefit

Image result for pip esa inquiry

 

A mother of two children who were murdered by her husband says she fears being made homeless, after the heartless Department for Work and Pensions stopped her disability benefit support, despite being aware of the severe trauma she had experienced and the devastating impact it has had on her mental health.

June Martin, who has been diagnosed as suffering with post traumatic stress disorder (PTSD) and depression, was considered by the Department for Work and Pensions (DWP) to be ineligible for Personal Independence Payment (PIP), following an assessment by Independent Assessment Service – formerly known as Atos Healthcare.

June has challenged the accuracy and fairness of the PIP assessment process. She told the Sunday Post that the assessor only “wanted to know if I could spell ‘world’ backwards and hold my arms above my head.”

She said I’ve been treated like some kind of scrounger and put on trial, although I’ve done nothing wrong.

“My former husband, who murdered our children, doesn’t have to worry about keeping a roof over his head or where his next meal is coming from but now I do.

She added, tragically:I’ve been made to feel a burden on society. Maybe it would be better if I wasn’t here.”

On Saturday, May 3, 2008, June walked into her home in Buckhaven, Fife, and found the bodies of disabled Michelle and her little brother Ryan while their father, who had stabbed them 26 times, lay on his bed, pretending to be dead. June’s former husband, Rab Thomson, was found guilty of stabbing 25-year-old Michelle and 7-year-old Ryan and given a life sentence in 2008. 

However, despite her struggle to cope with the terrible trauma, the benefits assessment report describes her mental state examination as “unremarkable”.

She said: “I’m now terrified I will lose my rented flat because I can’t keep up the £35 a week I have to find to make up the difference to housing benefit.

“I must have moved over a dozen times because I haven’t been able to settle somewhere I feel safe.

“Just when I finally found a little peace and somewhere I can feel safe, I fear it’s all going to be taken from me now.

“I’ve tried far too many times to take my own life because I just feel there is nothing for me to live for and this has left me feeling like that again.”

MP Patricia Gibson described the case as “shocking” and said: “This is yet another example of the DWP letting down vulnerable people when they most need support. Those living with mental health challenges are poorly understood by DWP assessor and this has to change.”

Left bereft, extremely distressed and suicidal, June has struggled to rebuild her life. She has never recovered from her ordeal, which is absolutely understandable. She had been in receipt of £55.10 a week in disability benefits before being reassessed for PIP.

However, an independent tribunal has unbelievably upheld the DWP decision. 

A spokesperson said: “Whilst the tribunal accepts Ms Martin has mental health problems and balance problems, the nature and extent of the resulting limitations are insufficient to score the required number of points.

“As a result Ms Martin does not qualify for either component of Personal Independent Payment.”

That someone who has faced such a deeply traumatic event as the murder of her children has to then “score a required number of points” to be considered eligible for lifeline support indicates just how profoundly dehumanising and utterly unfit for purpose the disability benefit assessment process is.

June said “Neither the assessor or the tribunal last week seemed to want to know about the trauma I suffer daily reliving finding my children posed as if they were asleep in their beds, or pulling back the covers to find them stabbed to death,” she said.

“I’ve battled so very hard to try and go on, but I’ve had to accept I’ll never get over finding my babies murdered, their blood on the walls and over their toys and teddy bears.

“My disabilities are invisible. They cannot be tested by spelling a word backwards or holding my arms above my head.

“Questions were thrown at me, one after the other. I couldn’t think straight to answer them properly. I’m a mess. I don’t stand up well to questioning. I just blurt things out and I panic.

“I’d written on the official forms that my children were murdered and I found them, but I don’t remember being questioned about that or my inability to live anything like a normal life.”

June also said that the assessor and DWP failed to take into account how her mental health fluctuates from day to day.

June continued: “I don’t know from one day to the other how I will feel, sometimes from one hour to the other”, she said.

“I can get up and go to the supermarket for a loaf of bread one day, but if I hear a child crying it takes me back to the murder scene.

“A smell, a song, someone laughing like my Michelle used to laugh, brings it all back and I have to run away from it.”

A DWP spokesperson offered the usual meaningless and standardised platitudes, saying: “This is a sensitive and distressing set of circumstances and our thoughts remain with Ms Martin.

“We will continue to ensure Ms Martin is receiving all the benefits she is entitled to and gets the support she needs.”

The support that June needs is the reinstatement of her Personal Independence Payment, and an adequate level of support to meet her housing costs, not gaslighting from the DWP. 

We live in an age of ubiquitous measurement, where our health and eligibility for support is defined and decided by metric based judgments, and our behaviours and expectations are expected to conform to the government’s notion of an overarching competitive model of the market. In this horrifically cruel, impersonal and dehumanising neoliberal world, eligibility for support depends on whether you score enough points that measure arbitrary criteria of what the state thinks should be measured.

Can you say a “world” backwards? Can you touch your knees? Can you raise an arm? This framework of meaningless tick box criteria bears little resemblance to the many actions and decisions you have to make during your everyday life, and it doesn’t show anything of how someone copes or doesn’t cope. It doesn’t indicate if someone has a network of support, help from other agencies, or if they are completely isolated.

It tells us nothing of whether or not someone can consistently perform one of these prescribed and contradistinctive tasks at an assessment for lifeline support in real life. The more of these meaningless and detatched-from-everyday-living tasks you are perceived as able to perform, the less points you are awarded. If you fail to score enough points, you aren’t considered ‘eligible’ for support, regardless of how much you happen to need it. 

The accounts presented in disability assessment reports based on the rigid, inadequate point scoring system and the actual realities of disabled people’s lives are incommensurable.

The Commons Work and Pensions Committee said earlier this year that it had an “unprecedented” response when it asked members of the public to get in touch with their experiences of being assessed.

Some people said reports of their assessments included the results of physical examinations that hadn’t happened. Some reports left out crucial information provided during the interview, and some seemed to refer to entirely different people. Publishing their findings, the MPs said the number of ‘mistakes’ taking place, and the number of decisions eventually overturned on appeal, had created “a lack of trust in both benefits” and led to fears the system is deliberately rigged against claimants.

It is. The system is rigged to disallow social security awards to disabled people who need support.

Stephen Brown, head of North Ayrshire Council’s health and social care partnership, said: “The benefits system often fails to recognise the impact of trauma and its long-term debilitating nature. Our psychologists, psychiatrists and social workers have known this for years and much of their time is spent supporting people to rebuild their lives.”

To rebuild lives, we must first ensure people can meet the costs of their basic living needs – such as for food, fuel and keeping roof over their head.

 

Related

Please let’s help Peter to maintain his mobility and independence

The PIP & ESA inquiry report from the Work and Pensions Select Committee – main recommendations

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

Thousands of disabled people have already lost their specialist Motability vehicles because of Conservative PIP cuts and many more are likely to be affected.

PIP and the Tory monologue

Government plans further brutal cuts to disability support

Consultation as government seek to limit disabled people’s eligibility for Personal Independence Payment

Second Independent Review of Personal Independence Payment assessment

 


I don’t make any money from my work. I am disabled because of illness  and have a very limited income. But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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The revolving door of disability assessments and appeal is still killing people who are chronically ill

 

Sandra Burns

Sandra Burns

Social security was originally designed to ensure that everyone was protected from the worst ravages of unfettered capitalism. To say that we have regressed as a society since then is an understatement. 

‘Behavioural economics’ are currently embedded within our current welfare system. This is a technocratic solution to essentially politically created problems. It addresses social problems by simply shifting the blame and responsibility from state to individual. This has led to an increasingly punitive social security system, aimed at pushing people into employment, regardless of whether or not they are able to work. ‘Nudge’ is increasingly being used by an authoritarian Conservative government to ensure citizens behaviours are aligned with neoliberal ideology and policy outcomes.

People who are chronically ill are suffering terribly because of the government’s anti-welfare ideolology. Yet most of us have paid tax and National Insurance to ensure that we have access to social security if or when we need it, only to find that the hostile environment created by by the government has made claiming support an ordeal. 

Back in 2013, I wrote about the terrible impact of  stressful, continuous work capability assessments on disabled people, particularly those with chronic illness. It’s long been understood that stress exacerbates the symptoms of illness. 

Many people have described a “revolving door” process of endless assessment, ceased ESA claim, (based on an outcome of almost invariably being wrongly “assessed” as fit for work), appeal, successful appeal outcome, benefit reinstated, only to find just three or four months later that another assessment is required.

The uncertainty and loss of even the most basic financial security to meet the bare necessities to survive that this process creates, leading to constant fear and anxiety, is having a damaging, negative impact on the health and wellbeing of so many. It’s appalling that in a first world so-called liberal democracy, sick and disabled people are being punished for being ill and disabled by a system that was originally intended to support them in meeting their most basic living costs.

Five years on, nothing has changed. People are still dying because of a system that is fundamentally flawed and not fit for purpose. The government are not listening to us. 

I write all too regularly about disabled citizens who have been treated brutally because of Conservative policies, many who have died as a consequence of a system that is intentionally designed to punish people for their need. 

I’m saddened to report that disabled woman has died from a heart attack after she was repeatedly refused vital financial support following disability assessments carried out by a private benefits firm, Atos, over a five year period. 

Sandra Burns, who lived in Luton, was found dead at the bottom of the stairs at her home on 16 April. She was surrounded by letters from the Department of Work and Pensions (DWP) and overdue utility bills, having suffered what is believed to be a massive heart attack. 

Sandra’s brother, Ian, told Luton Today: “She was found dead at the foot of her stairs, apparently of a massive heart attack. 

“She was surrounded by letters informing her that the gas, electricity, water, telephone and television were all in danger of being cut off.” 

“This debt and anxiety lay all around her on the floor”.  

Ian also said that the stress of the process had a degenerative impact on Sandra. He says that the work assessments were “punitive” and that they “ignored the comments of her GP”.

“These appeals would take six to eight months. Every single time, she won the appeal and got a backdated payment. But in that period, she would get into debt and lose her credit rating. 

“And then she’d get back on an even keel until the next year, when the same thing would happen,” he added.

Sandra, who was 57, had worked in retail for 30 years before severe back pain caused by five fused vertebrae in her spine forced her to give up working. She had failed a number of work capability assessments over a five year period but had successfully challenged each decision at appeal. 

The disability assessments were carried out at the time by Atos, on behalf of the DWP, who withdrew from a contract to carry out assessments for Employment and Support Allowance (ESA) following widespread failures and mounting criticism. 

Each time she failed an assessment, Sandra found herself looking at a growing mountain of debts while she fought to have the harsh decisions overturned at appeal.

In a letter sent to the DWP before her death, Sandra wrote: “I am old school and would still be working if I could do it. Do you think I would be silly enough to do this? I have always worked.”

Why do they think it’s ok to treat me like this? It’s not acceptable”.

Her Brother Ian said the difficulties of living with a chronic health condition, coupled with having to repeatedly fight for the benefits she desperately needed, caused her health to deteriorate. 

He says that Atos “based their assessment on the fact she could walk the five or six steps of the stairwell to the interview room”.

“She could walk small distances and couldn’t stand for long”, he said.

Every time ATOS assessed her, they judged her fit for work.”

“She described how one man said, ‘I’ve been watching you walk from the waiting room and as far as I’m concerned, you’re fit for work’.”  

Ian Burns, who lives in Denmark, said his sister had become reclusive during the last year of her life, adding that he had last spoke to her on 3 April.

Having not heard from his sister for some time, Ian asked a friend and neighbour to check up on her. 

He said: “They knocked on the door and went around the back. Through the kitchen window, they could see piles of dishes.

“The police came quarter of an hour later. They got through the back door and found her at the bottom of the stairs.”

Ian came to his sister’s home the following day. “I came the next day … all around the sofa was a pile of letters and debts.

“It was terrible heartbreak and I just feel it could have all been avoided… everyone is treated as cheats or maybe the DWP have an agenda.

“Whatever it is, it’s putting people like Sandra under incredible amounts of stress.”

A DWP spokesman, offering the usual discordant platitudes, said: “Our thoughts are with Ms Burns’ family. We are absolutely committed to ensuring that people get the support they’re entitled to. 

“Assessments are carried out by qualified healthcare professionals who look at how someone’s disability or health condition impacts them on a day-to-day basis.”

Disabled people protesting about the punitive disability assessments in Parliament

 

If you have been affected by the issues raised in this article and need support, please contact the Samaritans free on 116 123 (UK).

Related

What you need to know about Atos assessments

Thousands of disability benefit assessments deemed ‘unacceptable’ by the Government’s own quality audits

Atos’s PR company director wants me to phone him about one of my articles

The connection between Universal Credit, ordeals and experiments in electrocuting laboratory rats

The ESA ‘Revolving Door’ Process, and its Correlation with a Significant Increase in Deaths among Sick and Disabled People

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

Disability Income Guarantee abolished under Universal Credit rules – a sly and cruel cut

 


 

I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Atos’s PR company director wants me to phone him about one of my articles

Image result for atos healthcare controversy

Atos don’t provide medical assessments for disabled people needing to claim support: they provide ‘functional’ assessments, as ‘disability analysts’, who ‘focus on what you can do, rather than what you can’t.’

I wrote an article recently, which was published by Welfare Weekly, about the Work and Pensions Committee inquiry into Personal Independence Payment (PIP) and Employment and Support Allowance (ESA) assessments. 

The editor of Welfare Weekly, Steven Preece, forwarded an email to me regarding my article, marked ‘high importance’. It said:

Subject: Atos FAO Sue Jones
Importance: High

Hi there, 

Please could you ask Sue Jones to give me a quick ring on 0141 221 0707 re the article in the link below. We represent Atos and I’d like to have a quick chat about a couple of point in the article which are inaccurate.

http://www.welfareweekly.com/thousands-of-disability-benefit-assessments-deemed-unacceptable-by-the-governments-own-quality-audits/ 

Apologies for the email but I couldn’t find any numbers to call Sue directly. 

Regards

Lindsay McGarvie

Firstly, having been through 3 Atos assessments and a subsequent tribunal, I think it’s absolutely priceless to be lectured about ‘inaccuracies’ from a ‘representative’ of Atos. 

Secondly, I never ring people I don’t know, regardless of the reasons they may give me to do so. I did some research regarding who the person that wants to contact me actually is.

The email was from someone working with a PR company called 3X1. Atos are one of their clientsLindsay McGarvie was political editor at the Sunday Mail, and reporter for the Daily Mail, before moving into PR in 2005. He’s now a director of 3X1.

So, the director of Atos’s PR company wants to discuss my articles that are critical of Atos. The one in question was written while I watched the work and pensions select committee’s evidence session, then I read two articles in the Mirror. I wonder if Mr McGarvie has contacted the Mirror, too. After all, their two articles on the inquiry combined said pretty much the same as mine.

According to his LinkedIn profile, McGarvie’s specialisms include:

– Strategic public affairs counsel
– Reputation management
– Devising and implementing proactive PR and public affairs campaigns
– Media Training
– Digital communications

PR practitioners build and protect the reputation of their clients, whether they are individuals or organisations. Companies whose profits or reputation have been damaged can claim for ‘defamation’. Non-trading corporations can also claim where they can prove that their fiscal situation has been affected, or their property damaged. However, Atos’s reputation was damaged long before my article was written. That is because of  widespread  criticism of their ethics, standards and performance, not because of writers such as me.

3X1 is not the only PR company referring visitors to read my articles.

PR is concerned with persuasion, selling products, persons, governments and policies, corporations, and other institutions. In addition to marketing products, PR has been variously used to attract investments, influence legislation, raise companies’ public profiles, put a positive spin on policies, disasters, undermine citizens campaigns, gain public support for conducting warfare, and to change the public perception of repressive regimes.

Edelman Intelligence and Westbourne, for example, are engaged in rebuttal campaigns and multimedia astroturfing projects to protect corporate interests:

“Monitoring of opposition groups is common: one lobbyist from agency Edelman talks of the need for “360-degree monitoring” of the internet, complete with online “listening posts … so they can pick up the first warning signals” of activist activity. “The person making a lot of noise is probably not the influential one, you’ve got to find the influential one,” he says. Rebuttal campaigns are frequently employed: “exhausting, but crucial,” says Westbourne.” From The truth about lobbying: 10 ways big business controls government

Edelman Intelligence is among the world’s largest PR companies and either their staff or their clients have been quietly visiting my own WordPress site over this last year, the link shows they were referred to my site from Edelman’s own social media monitoring command centre. I’ve contacted the company to ask why, but have yet to receive a response. I’m not a paying client so it’s highly unlikely that the visits are in connection with promoting my best interests.

Cision are another PR company that provide social media ‘monitoring’ and I have had visits to my site from theirs. The company offers three web-based packages: the ‘CisionMarketing Suite’, the ‘Public Relations Suite’ and a ‘Government Relations and Political Action Committee Suite’. The Cision ‘Public Relations Suite’ allows users to distribute press releases, access a database of bloggers and journalists, and monitor and analyze news and social media sites. Designing responses to influential critical voices and general ‘image management’ is one of the things that PR is all about. 

The company’s ‘Government Relations Suite’ manages government contacts, analyzes lobbying activity, facilitates communication with elected officials and provides PAC compliance software for filing reports to the FEC and state elections commissions (US).

Some PR organisations claim that critical bloggers are ‘bullies’

“I often wonder what it is about social media that makes people anti-social. Perhaps the empty dialogue box creates a discomfort similar to silence in a crowded room. Maybe it is the need for instant gratification and peer recognition that comes from outing a company’s poor service. Or, it could be that the Internet provides a safe venue for bullies to vent with minimal repercussions. Whatever the reason, people talking badly about companies create a lot of drama and headaches for corporate leaders.”

As a public interest writer with a strong interest in social justice, equality, imbalances of power relationships, policy, human rights and as a strong advocate of democracy, I believe that ‘outing’ a company’s poor service is necessary to prevent citizens from suffering distress and harm and to hold those with power to account. I’m not motivated by profit – I don’t earn anything from my work. However, I’m motivated by a strong sense of ethical duty and solidarity with my fellow citizens. I want to see big businesses (and governments, for that matter) act in a socially responsible manner. I think it’s a reasonable public expectation that companies actually earn their profits by providing a service which does not cause harm to anyone.

My experience of ‘bullying’ comes from the other direction, from the top down – from powerful business groups and organisations that simply want to silence lone critical voices. Now THAT is bullying. Furthermore, our responses to being bullied are also being micromanaged.

Calling critics ‘bullies’ is a PR stunt in itself.

It’s an oppressive tactic commonly used (by bullies) over recent years by those in positions of power, from the top down. 

I won’t apologise for writing critical articles or holding my informed opinions. I always research and produce evidence throughout the articles I write. That’s not to say I never make mistakes. However, if there is an injustice being done, I will say so.

And I will keep on saying so. 

I have written more than one critical article about government policy aimed at cutting the lifeline support of disabled people, and of Atos, who are employed by the state to implement the cuts via the Work Capability Assessment. Because there is a significant and catastrophically damaging injustice being done to disabled people.

Last year, the United Nations verified that the UK  government have systematically violated the rights of disabled people. Resistance to the injustice of austerity cuts that are targeted at disabled people disproportionately – and among them, at some of our most vulnerable citizens – begins at the raw, weary and often fearful front lines of those impacted first and impacted the hardest: disabled people. 

Disabled people have been forced to pay nine times more than the average citizen to reduce the budget deficit and people with high or complex support needs have been forced to pay 19 times more. From the despotic Bedroom Tax, cuts to Employment and Support Allowance and the closing of the Independent Living Fund, it has been a relentless political assault on one of the most disadvantaged social groups.

The government have contracted private companies to deliver the cuts.

The UK has become the first country in the world to use the United Nations Convention on the Rights of People with Disabilities to be investigated forgrave and systemic violations’ of disabled peoples’ rights and it is telling that the government has since denied the findings of the inquiry, refused to make public the findings and refused to listen to the accounts of disabled citizens.

I was among those involved in contacting the United Nations in 2012 and have submitted evidence regularly since, regarding the impact of government policies on disabled people. 

Atos have played a part in these events and have made a hefty profit from their role. No amount of PR work will convince me that Atos have disabled people’s best interests at heart. I have experienced 3 assessments delivered by Atos, myself. I was told I was ‘fit for work’ after I had taken the painful decision to leave a profession that I loved because I was much too unwell to work. I then had to face a Tribunal. The stress of that exacerbated my illness. I won the appeal. However within 3 months following the successful Tribunal I was sent by the Department for Work and Pensions for another Atos assessment. I collapsed during the subsequent interview. Even the doctor whocarried out the re-assessment stated that I should never have been made to go through it gain so soon after winning my appeal. It’s very difficult to believe that this kind of ordeal is unintended.

People have died within a short time after being told they are fit for work. They clearly weren’t. My friend and fellow campaigner Karen Sherlock is among those people who are simultaneously ‘fit for work’ and dead. She died in fear and despair because the system failed her – because a cruel government refused to listen and powerful men and women refused to act.

My friend Lottie Ryan had a brain tumour. The Department for Work and Pensions sent her a letter demanding that she attend a work related interview or face having her lifeline support cut. She couldn’t even feed herself at this point in time because of the advanced stage of her cancer. She was dying, but that didn’t stop the government from trying to coerce her into work. Now THAT is more than bullying. It’s despotic, savage state persecution.

There are many more disabled citizens’ accounts like these.

I don’t need repressive tactics or ‘reputation management’ strategies flung at me. My aim (and that of many other fellow campaigners) is to ensure that people recognise the systematic political oppression of some social groups in the UK. It’s real. Disabled people are living in fear of a bureaucratic brown envelope arriving through their letterbox. They live in fear every time the government claims they want to ‘help’ and ‘support’ them into work – by cutting their lifeline support even further. 

So, I will continue to criticise. I will continue to speak out and to do my best to raise public awareness of what is happening in what was once a civilised and democratic society. 

I’m far from alone. Atos have been the subject of widespread criticism in the media, among campaign groups, charities, the National Audit Office, Atos ex-employees and whistle blowers, and opposition MPs. Must be hard work having to contact all of those people about ‘inaccuracies’. 

If I’ve made a couple of points that are ‘inaccurate’, then there is a comments section beneath the article in question to accommodate some transparent debate and dialogue. Leave your comment and evidence there, Mr McGarvie. 

My phone number is reserved for my friends, family and people who I trust not to intimidate me.  

Update

I have had four visits to my site today originating from Edelman Intelligence. I know this because on my site’s stats page, referrers are listed, such as Facebook, Twitter, search engines and so on. You can click on the link provided and it shows you were site visitors have come from

Additionally, a listed app called meltwater showed up. Outside Insight is Meltwater’s  Media Intelligence and Social Media Monitoring tool. Their site describes this service: ‘PR professionals lean on Meltwater’s product suite to help them boost their brand’s position and demonstrate their ROI (Return on Investment).

One of the most valuable things that legitimate criticism tells companies is that they have an audience that cares. The worst outcome in public relations isn’t mismanaging criticism or anger; it’s apathy and indifference. Criticism tells you that something is wrong, if you have enough visibility to warrant feedback.

It’s important not to lose sight of the fact that PR is located within local, social, political, cultural, economic and historical contexts. PR approaches often lack critical thinking and analysis needed to improve ethics and societal impact.  

Companies need to understand and listen to audiences as well as evaluate the results of campaigns, in order to identify more ethical, sustainable and socially beneficial ways of practising public relations. However, in the UK, there are few regulations that govern PR firms. That is why public feedback is so important.

In democracies, publics need and demand information about what companies, organisations and governments are doing. Inequities in power and influence, lack of transparency, or negative or harmful societal impacts affect every citizen, potentially.

However, provided it is conducted ethically, public relations may be a legitimate part of free speech which fosters diversity of viewpoints and facilitates democratic dialogue in society.

In short, PR companies and their clients need to listen to ordinary citizens like you and me, rather than simply refusing to accept a viewpoint. One of the most oppressive tactics that has arisen this past few years is the now habitual political dismissal of citizens’ experiences and accounts, as ‘anecdotal evidence’ of the harm that government policies are inflicting on people. Instead of denying the experiences of others, and engaging in techniques of neutralisation, the corporate sector and government need to engage with us using an open and dialogic approach to resolving the growing conflict of interest presented by the private sector profit incentive and the need for ensuring public safety and democratic inclusion.

Related

Reputation launderers: the London PR firms with their own image problems

What you need to know about Atos assessments

 


I don’t make any money from my work. I am disabled because of illness and have a very limited income. But you can help if you like, by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

DonatenowButton

 

 

 

PIP assessments are dehumanising, degrading, very distressing and potentially harmful

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I co-run a support group for people going through Employment and Support Allowance (ESA) and Personal Independent Payment assessments and appeals. I have heard many people’s harrowing experiences of these assessments, I have written about them, and I’ve written critically about the assessment process itself. However, it isn’t until you experience one of these assessments for yourself that you may fully appreciate just how utterly distressing, surreal, degrading and dehumanising the process actually is. Or how potentially harmful.

I had my first ever Personal Independence Payment (PIP) assessment today. I have systemic lupus and pulmonary fibrosis, among other problems, all of which affect my mobility and capacity to live independently, day-to-day. My consultant is a rheumatologist and more recently, I have been seeing a pulmonary consultant. Other specialists I sometimes need to see are a neurologists, opthalmologists, physiotherapists and haematologists.

After a bout of pneumonia and sepsis earlier this year, which almost cost me my life, a follow-up scan found further lung problems, which have probably been ongoing for some time. Fibrosis can happen as a result of connective tissue illnesses like lupus, scleroderma or rheumatoid arthritis. It can also happen to people whose conditions have been treated with a chemotherapy called methotrexate – which I was given from 2012 onwards. My mother, who had rheumatoid arthritis, died suddenly of pulmonary fibrosis in 2009. The coroner said it was a complication of her illness, not because of a treatment. She was never given methotrexate.

The interview part of the assessment seemed okay, initially. I provided further evidence regarding my recent assessment, undertaken by my local council’s Occupational Therapy Service, which led to the prescription of aids and appliances in my home. The assessment report was quite clear about my basic medical conditions and day-to-day mobility limitations. I was asked about medication. I explained that following my second appointment with my new rheumatologist, I was prescribed some new medications, including one for secondary Raynaud’s syndrome, which has arisen because of my having lupus, as a complication.

A recent thermal imaging and microvascular study shows that this condition has got worse over time, and so my rheumatologist prescribed a treatment called Amlodipine. It concerned me that the Health Care Professional looked confused and skeptical when she asked for a list of my medication, and she said that this is a treatment for high blood pressure, she seemed to disbelieve what I had told her. I explained that I don’t have high blood pressure, and that calcium channel blockers such as Amlodipine are used for more than one condition, such as certain types of angina – which I also don’t have – and secondary Raynaud’s syndrome, which I do have. 

I was asked about the impact of my illnesses on my day-to-day living. At one point I explained that I find preparing and chopping food difficult because of the tendonitis in both wrists. I have been diagnosed with De Quervian’s Tenosynovitis, which makes putting any weight or strain on my wrists very painful.

I was also concerned that I was then asked if I have had my wrists splinted. This shows a lack of understanding about my condition. I have had splints but it did not make any difference to my wrists. I was diagnosed with De Quervain’s syndrome by my rheumatologist and a physiotherapist in 2011, but had the problem for considerably longer. As my physiotherapist pointed out, my wrists are not injured or strained through overuse and so won’t get better with rest or splinting. This is because they are damaged by a chronic systemic inflammatory disease process that is ongoing, and he told me it is medication rather splinting that is needed to try to manage the level of inflammation in my body as a whole.

Splinting my wrists is akin to putting a plaster cast on a knee affected by rheumatoid arthritis, or a plaster on cancer. It won’t help at all. That the HCP didn’t seem to understand the difference between the chronic inflammatory symptoms of connective tissue disease and curable strain and injury related conditions bothered me.

Another thing that bothered me is that I was asked about the frequency of my periods of severe illness and how that impacts on my ability to manage things like personal care. She wanted an actual number of days, which of course is impossible to give with any precision when you have a fluctuating condition. Sometimes I struggle getting dressed and spend days on end in my pyjamas, and the HCP asked me “how often”? I tried to give an average number of days per month, but because the acute flares of my illness vary so much from month to month, week to week, that was very difficult to do. She also seemed impatient that I struggled to try and work out an average. I have cognitive problems as a result of my illness.

Another problem is that I struggle with washing my hair sometimes, and she demanded to know how often I need assistance with that task. The best I could do was to explain that when I have no help, I can go up to two weeks at a time with matted, unwashed hair. I felt embarrased and ashamed enough in having to discuss these personal difficulties with someone I have never met, but it was made to feel somehow like a confict, that part of the discussion. I felt that if I didn’t provide precise and quantified “evidence”, the qualitative details – my experience of my disability – would not be taken seriously by the HCP. 

Another problem with the assessments that worries me is that there was nowhere near enough time to discuss the complex impact of all my complex medical conditions and wide-ranging symptoms on my day-to-day life.

The ‘examination’

After discussion of my conditions and how my illnesses impact on upon my day-to-day living, I was asked to do some tasks during an examination, which have left me in a huge amount of pain. I also felt stripped of dignity, because I struggled to manage the exercises and felt very anxious and distressed. I was shocked at some of the tasks I was asked to do, and also shocked at the fact I couldn’t actually undertake a number of these tasks. My shock turned to anger later, as I had to leave in significantly more pain that I had arrived with at the start of the appointment. I was also asked to do each of the unfamiliar tasks and exercises in quick succession, which made assessing any likely pain and potential damage difficult before trying to do them.

It is also a traumatic experience to suddenly discover that your illness has insidiously robbed you of a degree of mobility that you previously assumed you had. That is always a shock. 

Last year, my GP was carrying out a standard examination and smear, when my hips locked painfully, as I tried to move my legs. She couldn’t completeher examination and the procedure as my egs would not move. After this, she told me to not get up for a while, and she described the experience – discovering that my mobility had been painfully restricted by my illness – as “traumatic.” It was.

I have, among other problems, very painful inflammatory arthritis and tendonitis in my knees, hips, spine, Achilles’ tendons and ankles. Because the inflammation and damage is bilateral and symmetrical – affecting both knees, both hips, both ankles and both Achilles’ tendons equally, and across my lower spine – it leaves me unable to compensate for pain, stiffness and weakness by shifting my weight and balance onto another limb, as that is also weak, stiff and painful. It leaves me unsteady. I often use a stick to stop me falling over, but as an aid for walking, it’s pretty useless generally, because my shoulders, elbows and wrists also won’t take any of my weight.

The inflammation process causes marked stiffness as well as severe pain, and so restricts my mobility. I was asked to “squat down” at the start of the examination. I refused, and told the assessor that I couldn’t do that. It would have certainly caused me severe pain and possibly an injury. As I can’t support weight on my shoulders and wrists – I also have osteoporosis in my wrists and hands –  had I tried and fallen backwards, I may have easily ended up with a fractured bone. I was horrified at being asked to do that. I struggled to equate the “health care professional” with what I had been asked to do, and felt confused and shocked that she had asked me to do something that may have been harmful.

I also felt that the HCP may have misconstrued my comments that I couldn’t undertake this task as an unwillingness to cooperate, as she looked unhappy about it. She did ask why, and I explained. I felt that trying some of the other tasks she set, which looked to be less dangerous, would at least demonstrate that I wasn’t being uncooperative, and most looked like they wouldn’t inflict any damage at first glance, when she demonstrated them.

However, other exercises I tried to do resulted in my neck locking and severe pain when I was told to turn my head to look over my shoulder – and couldn’t. I have neck problems through longstanding inflammation there and an upper spine injury involving a displaced vertebrae, which is sometimes very painful. In addition, the problems in my shoulders also contributed significantly to the level of pain when I turned my neck, and my neck clicked painfully at the base of my skull. 

I was asked to put my hands and wrists in positions that looked impossible to me. I tried, though. I was asked to line the backs of my wrists up with my hands flat, which I couldn’t do, and it hurt me a lot to try this.

Phalens-maneuver
This is called Phalen’s Manoeuvre. I was asked to do what is actually a provocative diagnostic test for carpal tunnel syndrome – which entails compression of the median nerve. The test provokes the symptoms of carpal tunnel problems, in the same way that the painful Finkelstein test provokes symptoms of severe pain in people with De Quervain’s. I have never been diagnosed with carpal tunnel problems, but I do have more than one diagnosis of bilateral De Quervian’s Tenosynovitis, as stated previously.

I tried to do this manoeuvre, even though it isn’t applicable to my condition (though I didn’t know that at the time, I have since researched the test, as I wanted to know why I couldn’t perform it). I couldn’t even get close to managing it, it hurt my shoulders a lot when I tried to align my elbows at right angles with my dropped finger tips, and I couldn’t drop my wrists fully due to an incredible pain and stiffness that I had not expected. The backs of my wrists simply painfully refused to meet.

I do struggle with pain when putting any weight on my wrists, but didn’t realise how much they had stiffened up, restricting their movement. Not being able to perform this movement doesn’t mean I actually have carpal tunnel syndrome. Nonetheless, I feel that given my previous concrete diagnosis, I was put through this painful and traumatic series of medical tests for no good reason. 

This is the problem with a short assessment of complex conditions. Many of my problems and diagnoses go back years, and only some of them are summarised neatly on my consultant’s report. My relationship with my new rheumatologist started in April, my old one moved in 2015. My new rheumatologist decided to “challenge” the previous diagnoses of two former rheumatologists. Her report to my GP was woefully inaccurate because she had not read my notes or listened to what I told herLong story short, she re-diagnosed me, inaccurately, with fibromyalgia, she didn’t read my notes, she sent me for tests and scans I had already had previously, whilst suspending my treatment pending results. The scans and tests took months. That resulted in a serious lupus flare, which culminated in a bout of pneumonia and sepsis. During the time I was in hospital, I was re-diagnosed with lupus following abnormal test results. My having lupus is thought to be the key reason why I had got so ill – unfortunately, lupus leaves me very susceptible to serious infections like pneumonia, kidney infections and sepsis. I now have a new rheumatologist who says I definitely have lupus.

Atos say they won’t carry out ‘diagnostic tests’ but they did.

In the appointment letter from Atos, it says: “The Health Professional will talk to you about how your health condition affects your daily life”. Much of this was covered with the council’s initial care plan report, but I did discuss my health issues and barriers to independence at length during the assessment.

The letter from Atos then says: “This will not be a full physical examination or an attempt to diagnose your symptoms.” 

My neck and shoulders are stiff, painful and I currently have limited mobility in them, yet I was asked to put my hands behind my head, raise my arms and so on. Loud joint cracking, popping, creaking and gasps of pain and my screwed up face didn’t stop the demands of what I felt was the impossible. I was actually sweating and trembling with the effort and pain, and still she did not stop the “examination”. I felt I couldn’t say no, as I would have seemed somehow unreasonable. I kept thinking that if I tried, gently, I was at least showing willing, and that would be okay, but unfortunately I wasn’t. 

It’s difficult to equate these artificial manoeuvres with day-to-day activities, and therefore it is also difficult recognise the impact it would have on my mobility limits before I tried them and to gauge how much a movement in isolation is going to hurt. 

Immediately following the examination/tests, my left calf has inexplicably swollen to twice its normal size, I could feel the uncomfortable tightness in it, and the swelling was visible through my jeans, whilst still with the assessor, and I commented on it.

My pain level has significantly increased everywhere. I had no groin or neck or elbow pain when I arrived until I was asked to do activities that were beyond my capability and that caused me a good deal of needless pain. I felt undignified trying to do those tasks, shocked and dazed at the pain, and sometimes, at how limited my movements have become. It was an extremely distressing and dehumanising experience. I was also shocked at how the effort made me tremble and sweat, and at how my clear distress was completely ignored by a so-called “health care professional”.

Of course I am going to make a formal complaint about this. It shouldn’t cause people so much pain and distress to be assessed for support. And any examination part of the assessment ought to take your medical conditions and descriptions of mobility constraints fully into consideration without such a grueling and painful examination regime.

It is worth bearing in mind that in addition to my own account, medical evidence from my rheumatologist was submitted in advance, and a report of recent assessments by a council occupational therapist who prescribed aids and adaptations, which clearly outlined my mobility difficulties, following two assessments, was also submitted. This was a report written by a qualified professional and was based on her own examination of my level of functionality and mobility while I tried to perform directed tasks in my home, such as climbing stairs, preparing food and using a bath board in my bathroom.

The fundamental difference between the assessments is that the one for my care plan allowed me to undertake tasks at my own pace, with dignity, and the Atos assessment did not. The former also felt like it was a genuine assessment of my needs, with support being the aim, whereas the latter felt like some sort of skeptic’s test to see if a way could be found to claim my account and those of my doctors were somehow incorrect. The Atos assessment was so horrifying because it felt like it was about reluctantly providing support for maintaining my independence as a very last resort only. 

According to the government’s PIP handbook, for a descriptor to apply to a claimant they must be able to reliably complete an activity as described in the descriptor. Reliably means whether they can do so:

 safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity.

The descriptors at no point demand that a person completes the Phalen manoeuvre or squats. The brief and painful completion of raising your hands above your head does not demonstrate either a fluctuating ability to do so, or your ability to hold your arms up long enough to, say, wash your hair and rinse it, even on a good day. Nor does it adequately account for severe pain, profound fatigue, coordination difficulty and breathlessness that often impact on any performance of that task. I did point this out, and the fact that the activities had left me in a lot of pain.

It’s now the day after my PIP assessment. I am still in a lot of pain with my joints and tendons. I feel ill, anxious, depressed and I am still shocked and angry. I can’t even manage to wash today. I have also developed pain on the left side of my chest, which feels rather like pleuritis. I feel really unwell, profoundly tired and haven’t felt this bad since my bout of pneumonia. The assessment hasn’t made me ill – I was already seriously ill. But it HAS exacerbated by symptoms. 

No-one should be made to feel worse because of an assessment for support. The activities I was asked to do should have been stopped when it became clear I was struggling. I stated I was in pain, I was visibly sweating, trembling, weak and clearly in a lot of pain with the effort, and as a “health professional”, the assessor should have halted that examination. I am very concerned that unintended harm may be caused by assessors conducting examinations because they do not have qualification, sufficient information or understanding about patients’ conditions.

My condition, for example, has left a trail of individual symptom diagnoses and medical data that goes back many years. With such a complex array of joint and tendon problems, I felt that there was absolutely no consideration of the impact that, say, a hand and wrist manoeuvre may have on a person’s damaged shoulders and elbows, as well as their wrists, or how a neck movement may impact on an upper spine injury and inflammatory shoulder problems, as well as the neck.

Given the assessment report I submitted and medical evidence, in addition to my own account, I feel that such a painful physical examination ought to be restricted to cases of absolute necessity. I don’t believe those simple isolated movements I was asked to do can possibly demonstrate he complex limitations on my day-to-day independence, and how I manage (or don’t) to cope with domestic tasks and general mobility.

The fact I couldn’t do some of them was both traumatising and humiliating, as well as very painful. I am still in a lot of pain as a result. 

The shame of being there to explain to a stranger about your illnesses, the intimate details of your life, your vulnerabilities and why you need help, is difficult enough, without the added distress of being coldly assessed by someone who doesn’t understand your conditions and does not care that what they ask you to do may be traumatising, painful and potentially very damaging.

Image result for PIP disability

Related

What you need to know about Atos assessments

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’ 

Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

Tory MP says PIP should only go to ‘really disabled’ people, not those with anxiety ‘taking pills 

Disabled mum took fatal overdose after she was refused PIP

Fear of losing disability support led a vulnerable man to a horrific suicide

Theresa May euphemizes savage cuts to PIP when confronted by an angry disabled person demanding democratic accountability


 

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Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

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Thousands of disabled people have already lost their specialist Motability vehicles because of Conservative PIP cuts and many more are likely to be affected.

Personal Independence Payment is a non means tested benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these. It is an essential financial support towards the extra costs that ill and disabled people face, to help them lead as full, active and independent lives as possible.

The Department for Work and Pensions (DWP) have issued a guidance document for providers carrying out assessments for Personal Independence Payment (PIP), which was updated last month. It can be found here: PIP Assessment Guide.

The DWP Chief Medical Officer states that this is a supplementary guidance, in addition to “the contract documents agreed with providers as part of the commercial process, providing guidance for health professionals [HPs] carrying out assessment activity and for those responsible for putting in place and delivering processes to ensure the quality of assessments.”

Words like “fair”, “quality”,  “support”, “reform” and even “objective” have been given a very subjective, highly specific Conservative semantic make-over, to signpost and reference a distinctive underpinning ideology, and to align them with neoliberal and New Right anti-welfare discourse and outcomes, over the last five years.

There is some preemptive dodging of criticism and patronising get-out clauses in the document, for example: “It must be remembered that some of the information may not be readily understood by those who are not trained and experienced HPs.”

This comment is indicative of the lack of transparency in the terms, conditions and process of assessments, and how they are generally carried out. It also emphasises the professional gap between the “health professional” employed by the state to carry out the “functional capacity” assessments in the context of a neoliberal welfare state, and medical health professionals, whose wider work is generally not directly linked to the politically defined conditionality of welfare support.

If you fundamentally disagree with any of the approach outlined in the content of the document, or the policy, it’s because you “fail to comprehend it”, simply because you haven’t trained as a HP. 

I had no idea that HPs are the only people who can work out policy outcomes and who recognise government cuts, small state ideology and general cost-cutting measures for what they are, despite the thumping Orwellian semantic shifts and language use that is all about techniques of neutralisation (where the rhetoric used obscures or “neutralises” the negative aims and harmful consequences of the policy.)

Firstly, the HPs are not so much “health professionals”, but rather, “re-trained disability analysts.” Their role entails assessing the impact of illness and disability on the “functional capacity” of individuals in direct relation to justification or refusal of a PIP award only. Furthermore, it is the decision of the HP to “determine whether any additional evidence needs to be gathered from health or other professionals supporting the claimant.”

Often at the appeal stage, it turns out HPs frequently decide not to ask for further evidence.  The DWP must take all medical evidence into account when making a decision about PIP claims. Yet the DWP say: “In many cases, appeals are granted because further medical evidence is provided.” 

However, neither HPs nor the DWP decision-makers contact people’s GP or other professionals for more information about their health condition very often. This indicates that people are having to go to court, often waiting months for their appeal to be heard, because of deliberately under-informed, poorly evidenced DWP decisions. 

Furthermore, it says in the government guidance to GPs:  “Your patient should complete the forms to support their [PIP] claim using information that they have to hand, and should not ask you for information to help them do this, or to complete the forms yourself.” 

It seems that the DWP are determined to continue making ill-informed, medically unevidenced decisions as long as they can get away with it. 

The ‘functional’ assessment

From the document: “The assessment for PIP looks at an individual’s ability to carry out a series of key everyday activities. The assessment considers the impact of a claimant’s health condition or impairment on their functional ability rather than focusing on a particular diagnosis. Benefit will not be paid on the basis of having a particular health condition or impairment but on the impact of the health condition or impairment on the claimant’s everyday life.”

This process of assessment, however, is a very speculative one, with inferences drawn from seemingly unrelated questions and assumed circumstances, such as “do you have a pet?” This translates into “can bend from the waist to feed a cat/dog” on the HP’s report to the DWP.

During examination, people are asked to perform a series of movements, and inferences are drawn from these regarding the performance of day to day tasks. The movements bear no resemblance to ordinary day to day tasks, nor do they take into account the use of aids and adaptations that people may use to carry out daily tasks.

Furthermore, the person being assessed isn’t presented with the assumptions drawn from the examination and questions, which means they are not provided with an opportunity to verify any claim made by the HP, or to say if they can manage to feed their pet “reliably, safely and consistently”, or if their family have to feed the animal for much of the time. 

From the document: “The HP should check the consistency of what is being said by using different approaches, asking questions in different ways or coming back to a previous point. When considering inconsistencies, HPs should bear in mind that some claimants may have no insight into their condition, for example claimants with cognitive or developmental impairments.”

I know of a lady who wore a gold locket. It was simply assumed at her assessment that despite her extremely arthritic fingers, and information about her pain and the lack of movement in her hands from her GP, that she had sufficient dexterity to fasten and unfasten the clasp. Had she been asked, she would have informed the HP that she never took the locket off, even in the shower. 

This approach – “checking for inconsistencies” by using indirect questioning and assumption is NOT “objective”. It is a calculated strategy to justify a starting point of disbelief and skepticism regarding the accounts provided by ill and disabled people about the impact of their conditions and disabilities on their day-to-day living. As such, it frames the entire assessment process, weighting it towards evidence gathering to justify refusing awards, rather than being “objective”.

It’s simply a method based on side-stepping and discounting people’s own accounts and experiences of their disability, and any medical evidence submitted to verify that.

This approach is also mirrored in the Work Capability Assessment, reflecting Conservative cynicism and prejudice towards sick and disabled people. (See: What you need to know about Atos Assessments – it provides a good overview from a whistle-blower of how responses to seemingly casual observations and apparently conversational questions are re-translated into “inconsistencies” which are then used to justify refusing a claim.)

The introduction of PIP was framed by New Right anti-welfarism

Secondly, “PIP is replacing Disability Living Allowance (DLA), which has become outdated and unsustainable. The introduction of PIP will ensure the benefit is more fairly targeted at those who face the greatest barriers, by introducing a simpler, fairer, more transparent and more objective assessment, carried out by health professionals” [All boldings mine].

In other words, PIP is aimed at cutting welfare costs and support for people who would previously have been eligible for Disability Living Allowance (DLA). We are told that it’s no longer possible as a society to support all disabled people who need help with the additional costs that they face simply because they are ill and disabled, so the government propose to establish those “with the greatest need” by using a more stringent assessment process, which is claimed to be fair and more “objective”.

A recent review led the government to conclude that PIP “doesn’t currently fulfil the original policy intent”, which was to cut costs and “target” the benefit to “those with the greatest need.” That originally meant a narrowing of eligibility criteria for people formerly claiming Disability Living Allowance, increasing the number of reassessments required, and limiting the number of successful claims.

Controversially, the cuts to disability benefits (including the £30 per week cut from those claiming ESA in work related activity group) will fund tax cuts for the most affluent – the top 7% of earners. The chancellor raised the threshold at which people start paying 40p tax, in a move that will probably see many wealthier people pulled out of the higher rate of income tax. Osborne said he wanted to “accelerate progress” towards the Conservative’s manifesto pledge of raising the threshold for the 40p rate to £50,000 in 2020. 

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced. Of course the ever-shrinking category of “those with the greatest need” simply reflects a government that has made a partisan political decision to cut disabled people’s essential income to fund a financial gift to the wealthiest citizens. There is no justification for this decision, nor is it “fair.”

Fiona Colegrave, who is chief medical adviser, clinical governance and in charge of training for PIP at Capita, says: “As a disability assessor (DA), you are required to assess objectively how someone’s health conditions affect them and submit a report that is fair, reliable and can be justified with evidence because, if necessary, it may need to be scrutinised through an appeals process.

For these reasons, it is essential we equip DAs with the skills required to manage the assessment process, including: time management; questioning techniques; non-advocacy; collating all available evidence and identifying contradictions; and using an analytical but empathetic approach.

It is important for DAs to establish a rapport with the claimant, so that claimants feel like they have been able to express, in their own words, how their disability affects them and so they know that a DA will produce a report that accurately reflects their functional ability.”

Only “feel like”? Feedback from “claimants” says that DAs do NOT accurately reflect their “functional ability” in reports. And note the reductive use of the word  “claimant” – language use that places the other at a psychological distance from the author and administrators, objectifying them, as if people claiming PIP and other benefits are a homogenous group of people, bound by characteristics rather than circumstances, in a context of political decision-making.

It becomes easier to disassociate from someone you view “objectively” and to distance yourself from the impact of your calculated and target-led decision-making, constrained within a highly political framework. Such an objectification of a person or group of people serves to de-empathise us, which is a key characteristic requirement of neoliberal ideology, embedded in inhumane “small state” policy and extended via administrative (and outsourced, privatised) practices. It leaves us much less likely to relate to the circumstances, emotions or accept the needs and choices of others.

Surely a considerable part of our experience of being objectively diagnosed as ill and/or disabled, in any case, is a person’s subjective experience of it, rather than categories and counts; quantifiable, reductive and speculative statements about how we may perform highly specific tasks.

Quantitative medical evidence is important, because it does often give a general indication of conditions that would entail loss of function. But considering medical evidence isn’t a central part of the assessment process. Whether or not we can perform certain tasks, and inferences drawn from that are the central considerations for PIP eligibility.

Many conditions “fluctuate” – they vary so much that it’s difficult to assess performance of specific tasks consistently. Many conditions become progressively worse at a varied pace, often leaving little scope for a person developing coping strategies and adapting their everyday lives to the changes as they happen, such as a progressive loss of mobility, cognitive impairment, mood changes, anxiety, depression, sleep disruption and other psychological impacts, and the increasing pain and fatigue that they may experience.   

If the process were genuinely “fair, accurate and objective” then there would be no need for mandatory reviews and scrutiny through the appeals process. The introduction of the mandatory review – another layer of bureaucracy and a barrier to justice, where the DWP decide whether their first decision should be changed – has deterred many from appealing wrong decisions.

Those making the decisions about PIP awards are: “trained DWP staff who are familiar with the legislation governing PIP, but who do not have a healthcare background. The HP enables CMs to make fair and accurate decisions by providing impartial, objective and justified advice.

The PIP assessment is geared towards looking for “inconsistencies” in “functional limitations”. For example, if you say you can’t sit unaided for half an hour, but then say that you watch soaps on TV, it will be assumed you sit unaided for at least half an hour to watch TV, and that will be classed as a “discrepancy between the reported need and the actual needs of the claimant.”

The whole assessment is set up and designed to look for “inconsistencies.” In other words, the assessor is looking for any excuse to justify a decision that you are not among those in “greatest need” for a PIP award. The entire process happens within a framework of reducing welfare costs, after all. This makes a mockery of the government’s fondness for using the word “objective.”

What can we do to try to counter the state bias towards political cost-cutting, which is embedded in the assessment process? 

Well, we can use the guidelines and existing legislation to ensure that we are heard clearly. We can also raise awareness that, whilst most ill and disabled people tend to emphasise how well we cope, and remain positive about what we can do independently, and we often tend to understate our needs for support, in assessment situations, that tendency is likely to be used to trivialise the impact of our condition and disabilities on day-to-day “functioning.”

Reliability

The government says in the PIP handbook: “For a descriptor to apply to a claimant, they must be able to reliably complete the activity as described in the descriptor. Reliably means whether they can do so:

 safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity

 to an acceptable standard

 repeatedly – as often as is reasonably required, and

 in a reasonable time period – no more than twice as long as the maximum period that a non-disabled person would normally take to complete that activity.” 

If you cannot complete an activity reliably, safely and repeatedly, as outlined, then you must be regarded as unable to complete that task at all.  The reliability criteria are an important key protection for disabled people claiming both PIP and Employment and Support Allowance (ESA).

From the document: “Symptoms such as pain, fatigue and breathlessness should be considered when determining whether an activity can be carried out repeatedly. While these symptoms may not necessarily stop the claimant carrying out the activity in the first instance, they may be an indication that it cannot be done as often as is required.”

And: “The following situations highlight examples where an individual may be considered unable to repeatedly complete a descriptor in the way described due to the impact this would have:

A person who is able to stand and move 20 metres unaided, but is unable to repeat it again that day cannot do it repeatedly as you would reasonably expect people to move 20 metres more than once a day • A person who is able to prepare a meal, but the exhaustion from doing so means they cannot then repeat the activity at subsequent meal times on the same day. This means they cannot complete the activity repeatedly as it is reasonable to expect people to prepare a meal more than once a day.”

This also applies to people with mental health conditions, which may also impact on a person being able to carry out tasks reliably, repeatedly and safely.

Time periods, fluctuations and descriptor choices

The document says: “The impact of most health conditions and disabilities can fluctuate. Taking a view of ability over a longer period of time helps to iron out fluctuations and presents a more coherent picture of disabling effects. The descriptor choice should be based on consideration of a 12-month period.

This should correlate with the Qualifying Period and Prospective Test for the benefit – so in the 3 months before the assessment and in the 9 months after. A scoring descriptor can apply to claimants in an activity where their impairment(s) affect(s) their ability to complete an activity, at some stage of the PIP regulations.

 The following rules apply: If one descriptor in an activity is likely to apply on more than 50% of the days in the 12-month period – the activity can be completed in the way described on more than 50% of days – then that descriptor should be chosen.

If more than one descriptor in an activity is likely to apply on more than 50% of the days in the period, then the descriptor chosen should be the one that is the highest scoring. For example, if D applies on 100% of days and E on 70% of days, E is selected. Where one single descriptor in an activity is likely to not be satisfied on more than 50% of days, but a number of different scoring descriptors in that activity together are likely to be satisfied on more than 50% of days, the descriptor likely to be satisfied for the highest proportion of the time should be selected.

For example if B applies on 20% of days, D on 30% of days and E on 5% of days, D is selected. If someone is awaiting treatment or further intervention, it can be difficult to accurately predict its level of success or whether it will even occur. Descriptor choices should therefore be based on the likely continuing impact of the health condition or disability as if any treatment or further intervention has not occurred.

The timing of the activity should be considered, and whether the claimant can carry out the activity when they need to do it. For example, if taking medication in the morning (such as painkillers) allows the individual to carry out activities reliably when they need to throughout the day, although they would be unable to carry out the activity for part of the day (before they take the painkillers), the individual can still complete the activity reliably when required and therefore should receive the appropriate descriptor.”

Again, “fluctuating conditions” include many mental health conditions.

Risk and safety

“When considering whether an activity can be carried out safely it is important to consider the risk of a serious adverse event occurring. However, the risk that a serious adverse event may occur due to impairments is insufficient – the adverse event has to be likely to occur.”

Even if complex probability calculations were used – and I am certain HPs are unlikely to have been trained to use such formulae – there is no “objective” way of calculating risk of serious “adverse” events over time.

However, it is not such a big inferential leap to recognise that continually cutting essential lifeline support for sick and disabled people will ultimately lead to harm, distress, hardship and other negative consequences for individuals and will have wider social, cultural and economic “adverse” consequences, too.

dpac

“Making work pay” for whom?

See also:

PIP Assessment Guide A DWP guidance document for providers

Personal Independence Payment handbook

Government Toolkit of information for support organisations

Relevant:

PIP and the Tory monologue

Government plans further brutal cuts to disability support

Consultation as government seek to limit disabled people’s eligibility for Personal Independence Payment

Second Independent Review of Personal Independence Payment assessment


 

I don’t make any money from my work. I’m a disabled person with lupus, and I’m stuggling to get by. But you can help by making a donation and enable me to continue to research and write informative, insightful and independent articles, and to provide support to others going through disability benefit assessment processes and appeals. The smallest amount is much appreciated – thank you.

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