Tag: Atos

Doctors bribed with 70-90k salaries to join Maximus and “endorse a political agenda regardless of how it affects patients.”

maximus-logoYes, but which people?


The National Audit Office (NAO) scrutinises public spending for Parliament and is independent of government. An audit report earlier this month concluded that the Department for Work and Pension’s spending on contracts for disability benefit assessments is expected to double in 2016/17 compared with 2014/15. The government’s flagship welfare-cut scheme will be actually spending more money on the assessments themselves than it is saving in reductions to the benefits bill – as
Frances Ryan pointed out in the Guardian, it’s the political equivalent of burning bundles of £50 notes.

The report also states that only half of all the doctors and nurses hired by Maximus – the US outsourcing company brought in by the Department for Work and Pensions to carry out the assessments – had even completed their training.

The NAO report summarises:

5.5
Million assessments completed in five years up to March 2015

65%
Estimated increase in cost per ESA assessment based on published information after transfer of the service in 2015 (from £115 to £190)


84%
Estimated increase in healthcare professionals across contracts from 2,200 in May 2015 to 4,050 November 2016

£1.6 billion
Estimated cost of contracted-out health and disability assessments over three years, 2015 to 2018

£0.4 billion
Latest expected reduction in annual disability benefit spending

13%
Proportion of ESA and PIP targets met for assessment report quality meeting contractual standard (September 2014 to August 2015).

This summary reflects staggering economic incompetence, a flagrant, politically motivated waste of tax payers money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people. Some people are dying after being wrongly assessed as “fit for work” and having their lifeline benefits brutally withdrawn. Maximus is certainly not helping the government to serve even the most basic needs of sick and disabled people.

However, Maximus is serving the needs of a “small state” doctrinaire neoliberal government. The Conservatives are systematically dismantling the UK’s social security system, not because there is an empirically justifiable reason or economic need to do so, but because the government has purely ideological, anticollectivist prescriptions.

This is a government that claims social security is “unsustainable” and a “burden” on the public purse, yet has no problem with an extraordinary profligacy with public funds and dispossessing tax payers when it comes to implementing “cost-cutting” and draconian welfare “reforms.” Conservative anti-welfare dogma and prejudice are costing the UK billions of pounds.

In April 2014, Atos was forced to abandon their contract with the government because of a growing public backlash, but not before they had profited from very large sums of public money. Meanwhile, sick and disabled people have had their support callously slashed to the bone, people have suffered and some have died as a consequence of that. Yet our welfare state is being used as a sporting arena for big business profit-making, eating up public funds that were supposed to help people who have encountered difficulties meeting their basic needs through disability, losing their job or becoming ill.

The selling of our public services and lucrative contracting out of state functions to private companies who exchange public money for a notoriously poor service is a prominent feature of Tory “small state” Britain.

The Department for Work and Pensions uses the controversial work capability assessments to decide if people are eligible for benefits or to force those on long-term sick leave back into work. The assessment is conducted using a computer software package called Logic Integrated Medical Assessment (LiMA) application.

The assessments are heavily weighted towards finding people capable for work, regardless of the medical evidence presented by claimant’s own doctors. Patients with severe brain damage, kidney failure, cancer, multiple sclerosis and Parkinson’s Disease, amongst many others with seriously incapacitating illnesses, have been found fit for work. On 24 April 2013, a woman who was a double heart and lung transplant patient died in hospital only days after she had been told that her Incapacity Benefit was being stopped and that she was fit for work. There are many other instances of grave errors in the decision-making of the Department for Work and Pensions which are based on the work capability assessment.

Between April 2015 and March 2018, the Department for Work and Pensions expects to carry out around 7 million assessments which it estimates will cost a total of £1.6 billion.

The National Audit Office report on contracted-out “health and disability assessments” states that the cost of providing assessments is rising and providers are still struggling to meet expected performance standards, and that providers continue to struggle with hiring and training staff.

From the NAO summary:

“The Department continues, however, to struggle with setting targets and requirements with clear evidence and failed to adequately test bidders’ assumptions, for example about staff training, during the contract tender process. It does not yet have a clear strategy for contracting-out assessments and risks damaging market interest through tight procurement timetables, inflexibility towards critical assumptions and lack of transparency.

…For PIP, both providers have failed to meet targets for the quality of assessment reports since October 2013. The Department is paying more for assessments, caused in part by capacity shortages pushing up salaries.”

In the last month, recruitment website healthjobs.co.uk has added almost 100 job advertisements for “functional assessor” roles with Maximus, the US company contracted by the Department for Work and Pensions to conduct work capability assessments. Applicants are required to have two years post-qualification medical experience and are offered positions with whoppingly “incentivising” salaries that start at £72,000, with some roles attracting salaries of up to £98,000. The salary for a junior doctor working in the National Health Service (NHS) with two years of experience is approximately £30,000.

Junior doctors working within the NHS were forced to take industrial action recently – the first strike action for more than four decades – over the government’s proposed new junior doctor contracts, because of serious concerns about patient safety, the quality of doctor’s working lives and the lack of recognition regarding the strain of working long and unsocial hours.

The British Medical Association said:

“The biggest threat to patient care is the government’s insistence on removing safeguards which prevent junior doctors from being forced to work dangerously long hours without breaks, with patients facing the prospect of being treated by exhausted doctors.

“The government is threatening to impose contracts in which junior doctors have no confidence and which represents the first step in a wholesale attack on all NHS staff at night and over weekends. We want a contract that is safe for patients, fair for juniors and good for the NHS.”

Maximus offer substantially better working conditions and pay for junior doctors, but compromising patient safety is an inevitable consequence of the company drive to provide administrative solutions to improve the cost effectiveness … and efficiency of government-sponsored benefit programs.

One NHS doctor, Karl Norrington, noted on Twitter that despite Maximus’s company motto: “Helping Government Serve the People” – in reality Maximus is: “paying drs to medically endorse a political agenda regardless of how it affects patients.”

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Related

The disturbing truth about disability assessments

Why I blew the whistle on Atos fitness-for-work test

We can reduce the Welfare Budget by billions: simply get rid of Iain Duncan Smith

 

 

Government turns a blind eye to work capability assessment related deaths and expect the public to do the same

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Tory ministers are facing further pressure to reveal information about how many people have died after being assessed as “fit for work.” Labour MP for central Newcastle-upon-Tyne, Chi Onwurah, has joined over 120,000 people that have signed a petition to demand that the Government release the figures.

Many campaigners have been calling on the Department for Work and Pensions (DWP) to publish the figures since November 2012.

Mrs Onwurah, who led a Commons debate on welfare earlier this year, said: “One of the most powerful and distressing examples in my debate was of a man who had committed suicide.

“If someone dies after being found fit to work it doesn’t necessarily mean that being found fit to work had an impact in their death, so I can understand that the Government might fear the figures would be misinterpreted.

“But if the Government has figures then they should share those, and allow people to interpret them fairly.

“This isn’t just a matter of dry statistics. It is about about the health-affecting impact that having been found fit to work can have on claimants.

“And I know that because I see them in my surgery on a regular basis.

“When bad decisions are made I know they can have a life-destroying impact on vulnerable people. So it makes sense for the Government to share that data.”

It was in January of this year that Mrs Onwurah told MPs about a vulnerable constituent who had tragically committed suicide after being found fit for work. He was claiming Employment Support Allowance and incapacity allowance. He was being supported by Newcastle Welfare Rights, who told the DWP that after suddenly being found fit to work:

“.. he was acutely distressed; he struggled to talk, he was having thoughts of suicide, he had also started drinking alcohol to cope and had struggled to leave the house”

Despite supporting psychological assessments, other evidence, and an attempted suicide, the decision was not reversed and in January 2014 he was found hanged by his neighbour.

Mrs Onwurah said: “My constituent was found hanged in his home by a neighbour. He was well known to Newcastle Welfare Rights, from which he had received considerable support in his dealings with the Department for Work and Pensions.

“He had been in receipt of employment and support allowance, and previously incapacity benefit, and he was engaging well with Newcastle Welfare Rights until November 2013, when he underwent a work capability assessment.”

The Department for Work and Pensions (DWP) insists it is irresponsible to suggest deaths which follow an assessment that claimants are fit to work were caused by the assessment.

The DWP originally published statistics in July 2012  after several of us submitted Freedom of Information requests (FOIs). The released statistics indicated that 10,600 people had died between January and November 2011 who had been claiming Employment Support Allowance (ESA), and where the date of death was within six weeks of the claim ending.

The DWP publication caused huge controversy, although many people disagreed over what the figures actually showed. Ministers subsequently blocked publication of any updated figures.

At the time, I made a statistical cross comparison of deaths, and the information released showed that people having their claim for Employment Support Allowance (ESA) stopped, between October 2010 and November 2011, with a recorded date of death within six weeks of that claim ceasing, who were until recently claiming Incapacity Benefit (IB) – and who were migrated onto ESA – totalled 310. Between January and November 2011, those having their ESA claim ended, with a recorded date of death within six weeks of that claim ending totalled 10,600. The DWP did not provide information regarding whether or not people had died before or after their benefit claim was ended, which complicated matters.

However, there is a very substantial and significant statistical variation over a comparatively similar time scale (although the 10,600 deaths actually happened over a shorter time scale – by 3 months) that appears to be correlated with the type of benefit and, therefore, the differing eligibility criteria – the assessment process – as both population samples of claimants on ESA and IB contain little variation regarding the distribution in the cohorts in terms of severity of illness or disability. 

Bearing in mind that those who were successfully migrated to ESA from IB were assessed and deemed unfit for work, (under a different assessment process, originally) one would expect that the death rates would be similar to those who have only ever claimed ESA.

This is very clearly not the case. And we know that the ESA assessment process has actually excluded many seriously ill people from entitlement because of the media coverage of individual tragic cases, when a person deemed fit for work by Atos has died soon after the withdrawal of their lifeline benefit, and of course, such accounts of constituents’ experiences and case studies, as evidence, informs Parliamentary debate, as well as the ongoing Work and Pension Committee inquiry into ESA, details of which may be found on the Hansard parliamentary record.

An official watchdog has also ordered the Government to release further information about how many people have died after going through the work capability assessment (WCA) which had resulted in a decision that they were fit for work, since the last publication in 2012.

The ruling was made after an appeal by Mike Sivier, a fellow campaigner, freelance journalist and a carer that runs the Vox Political blog who has himself been pushing for the figures to be published since the summer of 2013.

Being assessed as fit for work would mean that someone is expected to start looking for a job, take part in training designed to “prepare them for employment”, including workfare programmes – and would face the prospect of sanctions as part of the strict welfare conditionality regime – losing their lifeline benefits – unless they comply.

Mike also used the Freedom of Information Act to ask how many people who died between November 2011 and May 2014 had been found “fit for work”, or told they should move towards finding work.

But the Department for Work and Pensions refused his request, saying it was already preparing to publish the information.

Mr Sivier appealed to Information Commissioner, Christopher Graham, who ordered the DWP to publish the data within 35 days of his ruling on April 30, 2015.

But the Department of Work and Pensions has instead decided to appeal this ruling.

Campaigners now want to know what the government is trying to hide and the online petition demanding that Work and Pensions Secretary Iain Duncan Smith stop attempting to block publication of the statistics has been signed by more than 120,000 people on the website: www.change.org.

A spokeswoman for the DWP said: “We have been clear that we intended to publish these statistics – but we need to make sure they meet the high standards expected by the UK Statistics Authority before we do so.”

Many sick and disabled people have said that the constant strain, anxiety and stress of what they have described as a “revolving door process” of assessment, review, appeal and re-assessment, has contributed significantly to a decline in their health.

The previous figures from the DWP, and the marked contrast between the ESA and IB death statistics certainly substantiate these claims that the assessment process places a great deal of stress on people who are often seriously ill. Anyone with a chronic illness will tell you that stress invariably exacerbates their condition.

At a meeting in June 2012, British Medical Association doctors voted that the Work Capability Assessment (WCA) should be ended “with immediate effect and be replaced with a rigorous and safe system that does not cause unavoidable harm to some of the weakest and vulnerable in society”.

The vote has not been acknowledged by Atos or by the Government, although it was reported widely in the media at the time. On 22 May 2013, a landmark decision by the courts in a judicial review brought by two individuals with mental health problems ruled that the WCA is not fit for purpose, and that Atos assessments substantially disadvantage people with mental health conditions. Despite the ruling’s authoritative importance, the decision had a similar lack of real-world effect as it did not halt or slow down the WCA process: Atos and the DWP have ignored the judgement and its implications.

In mid-January 2012, there was a significant scandal as media were alerted to the fact that the WCA had found a man in a coma to be “fit for work”. Work Capability Assessments have found patients with brain damage, terminal cancer, severe multiple sclerosis, and Parkinson’s Disease to be fit for work. On 24 April 2013, a woman who was a double heart and lung transplant patient died in her hospital bed only days after she was told after a WCA that her allowance was being stopped and that she was fit for work.

In August 2011, twelve doctors working for Atos as disability assessors were placed under investigation by the General Medical Council because of allegations of misconduct in relation to their duty of care to patients. One doctor was forced to resign from Atos after being told to change a report about an individual, pointing out “the General Medical Council makes it clear that doctors must not change a report and risk being disciplined for unprofessional conduct if they do”.

There are many more well-documented problems with the Work Capability Assessment. It’s mired in controversy. Yet since 2010 the current government has continued to expand its role to reassess millions of  people that the DWP had already judged to be entitled to Incapacity Benefit. The government also made changes to the framework of the test to make ESA more difficult to claim.

Despite the controversy, the government continues to show a somewhat baffling and extremely troubling disinterest in the serious problems related to the increased means-testing and conditionality of sickness and disability benefits that they have introduced.

Another major area of concern is that there is a clear absence of impact monitoring, regarding the changes they have made to policy. I find it curious that whilst the DWP couldn’t state either way which side of a claim ending that the deaths happened, journalists and the government shrug the figures off, rather than actually INVESTIGATING the matter.

I have lost 3 friends during the past three years, who each died tragically just after being told they were fit for work, their lifeline benefit support was ended. Families who have suffered bereavement related to ESA claims consistently report that it is the stress of the assessment, the strain of being told they are fit to work when they are not, and the fact that chronically sick people then have to fight for their lifeline benefits that causes a further decline in their health, and the exceptional stress, caused by government welfare policy that is very punitive in nature, that is leading to some people dying.

It’s inconceivable that the government have failed to understand that placing very ill people in a position where their lifeline benefit is stopped so they have to fight for the means to meet their most basic needs – those of food, fuel and shelter – will potentially be very harmful, having a detrimental impact on their health, which may be fatal.

Further related reading:  Cross-party concerns raised in Parliament about Atos assessments, with evidence – presented cases studies of people who died AFTER their lifeline benefit was withdrawn – Atos comes under attack in emotional Commons debate

How many persons has Atos killed today? – Michael Meacher MP

Black Propaganda

What you need to know about Atos assessments

Clause 99, Catch 22 – State sadism and silencing the vulnerable

Labour would end this Government’s demonisation of benefits claimants – Chi Onwurah MP

Essential information for ESA claims, assessments and appeals

Remembering the victims of the Government’s welfare “reforms”

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Thanks to Robert Livingstone for his excellent pictures.

Government fitness for work test is making disabled people more sick

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In January, 2012, I wrote an article: The ESA ‘Revolving Door’ Process, and its Correlation with a Significant Increase in Deaths amongst the Disabled and I discussed the distress and harm that the current government work capability assessment is causing disabled people. I said:

Many claimants have described a “revolving door” process of endless assessment, ceased Employment Support Allowance (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 3 months later another assessment is required. The uncertainty and loss of even basic security that this process creates, leading to constant fear and anxiety, is having a damaging, negative impact on the health and well-being of so many.

A significant proportion of those required to have endless assessments have very obviously serious illnesses such as cancer, kidney failure, lung disease, heart disease, severe and life threatening chronic conditions such as multiple sclerosis, lupus, myalgic encephalomyelitis, rheumatoid arthritis, brain tumours, severe heart conditions, and severe mental health illness, for example. To qualify for ESA, the claimant must provide a note from a doctor stating that the person is unfit for work. There can be no justification for subjecting people who are so ill to further endless assessments, and to treating us as if we have done something wrong.

Marginalising and stigmatising sick and disabled people, amongst whom are some of our most vulnerable citizens, via propaganda in the media, using despiteful and malicious terms such as “workshy” and “feckless” is a major part of the Government’s malevolent “justification” to the public for removing the lifeline of support from the sick and disabled. We are climbing Allport’s Ladder

In addition to very justified anxieties regarding the marked increase in disability hate crime that the Tory-led propaganda campaign has resulted in, many sick and disabled people have also stated that they feel harassed and bullied by the Department of Work and Pensions and Atos. Many talk of the dread they feel when they see the brown Atos envelope containing the ESA50 form arrive through the letter box.

The strain of constantly fighting for ESA entitlement and perpetually having to prove that we are a “deserving” and “genuine” sick and disabled person is clearly taking a toll on so many people’s health and well being. Many families of those who have died have said that the constant strain, anxiety and stress of this revolving door process has contributed significantly to their loved ones’ decline in health and subsequent death. The figures from the DWP, and the marked contrast between the ESA and IB death statistics certainly substantiate these claims.

Leonard Cheshire, a charity that works with disabled people, surveyed 350 people who had been through the workplace capability assessment, which is used to establish whether benefit claimants are well enough to return to work.

More than six in 10 (65 per cent) of those who had gone through the process said they had ended up with more pain afterwards. Almost three quarters (72 per cent) said they found the assessment had a negative impact on their mental or physical health, or both. The same number described the face to face appointment as very stressful.

A teacher who was medically retired in 2011 due to progressive rheumatoid arthritis, said she left her appointment “feeling absolutely awful and suffered a lot of pain in the following days”. She went on to suffer a stroke a few weeks later, and believes the experience of undertaking a work fitness assessment was a contributing factor.

Andy Cole, campaigns director for Leonard Cheshire, said:

“This isn’t acceptable and no test should put someone through something that makes their condition worse.

We have known for a long time that this is an important issue. We had anecdotally hear this information but, [getting] it quantified in this way in quite such significant numbers, we were really surprised to see that it was this sort of figures.”

Harm may be caused by assessors because they did not have sufficient information about patients’ conditions. Less than half (42 per cent) said their assessor had evidence of their condition prior to the meeting. Only 21 per cent agreed with the statement:

“The assessor let me explain how my condition [or] disability affects me differently on different days or at different points during the day.”

Two thirds disagreed with the outcome of their assessment.

Mr Cole added:

“Some of the conditions are well documented through medical data going back decades. If that was used better there wouldn’t be a need for a test in the first place. It’s worth remembering that the test was fundamentally supposed to be about a benefit that helped people back into work. There are lots of issues around the test about whether it’s been able to achieve that.”

The research relates to the period during which the private company Atos was responsible for carrying out the assessments. Its work has ended after it pulled out of a government contract to manage disability claims early, and the American company Maximus has taken over delivery of the assessments from 1 March 2015.

The charity is calling on Maximus to take the findings of its survey into account when redesigning the fitness for work assessment process. It wants to see staff trained in specific medical conditions, (as most Atos assessors are non-specialised nurses or occupational therapists,) physical examinations restricted to cases of absolute necessity and for claimants to be aware they can say no to an examination if it will cause them pain.

However, a spokesman for the Department of Work and Pensions said:

“Healthcare professionals always take consent for any physical examination and ask claimants to tell them if any movement is uncomfortable. Examinations are not completed if they cause pain. Sufficient information is usually obtained through discussion, observation and a limited physical examination to assess the effects of disability.”

We know this to be untrue because of the high numbers of people needing to challenge wrong decisions.

One such person is Sharon Majek, 57, from Rugby, who has been unable to work since her mid-thirties after suffering a serious injury at work. She stopped an elderly patient from falling out of bed badly hurting her back. She was diagnosed with osteoarthritis, degenerative disk disease and fibromyalgia, leaving her in constant joint pain and with limited sensation in her hands.

She described her assessment as “traumatic”. She said:

“The doctor never made eye contact with me once, and that made me feel very uncomfortable. I was awaiting a knee replacement. He asked me to bend my knees. When I said I couldn’t he pushed it back. I was sweating with the pain. It swelled up later that day.”

Ms Majek was found fit for work so she asked to see a copy of her report, which she and her husband described as unrecognisable from the meeting they had attended. The decision was overturned at appeal. This is a very common and unacceptable experience amongst people claiming ESA.

 

Further reading:

What you need to know about Atos assessments.

Black Propaganda

Essential information for ESA claims, assessments and appeals

Clause 99, Catch 22 – State sadism and silencing the vulnerable

 

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Thanks to Robert Livingstone for the memes

Essential information for ESA claims, assessments and appeals

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Essential Information for claims, assessments and appeals. 

There are three essential ideas to keep in mind when claiming Employment Support Allowance (ESA) because of the nature of the ESA50 form, and the fact that Atos are seeking to deny benefits, and NOT assess disability: this will not be a fair investigation of your health issues.

This information needs to be shared widely so people are made aware of them, and can use them when claiming ESA or appealing.

These very helpful ideas are:

  •  Reliably, repeatedly and safely
  •  Exceptional circumstances – Regulations 25 and 31, 29 and 35
  •  Atos assessments and pitfalls – how they try to deceive you

1. Reliably, repeatedly and safely. 

‘Lord’ Fraud made this statement in the House of Lords:

“It must be possible for all the descriptors to be completed reliably, repeatedly and safely, otherwise the individual is considered unable to complete the activity.”

You might be able to go up three steps once – but if cannot do it “reliably, repeatedly and safely”, in Freud’s own words you CAN NOT do it at all.

Apply the phrase “reliably, repeatedly and safely” all through your ESA50 or appeal form, use it on each of the descriptors. Make sure you state clearly which activities you can not do reliably, repeatedly, safely and in a timely manner, because Atos will otherwise assume you are consistently capable of them all.

2. Exceptional Circumstances – Regulations 25 and 31 for Universal Credit and Regulations 29 and 35 for current and ongoing ESA claims and Contribution-based ESA.

Regulations 25 and 31 will replace the old Special Regulations 29 and 35 from April 2013 for Universal Credit. This is in preparation for the abolishment of income-related ESA only, and not contribution-based ESA.

However, the old Regulations 29 and 35 still apply to ongoing cases that are not yet affected by Universal Credit, and will remain in place indefinitely for all Contribution-based ESA. So there are two sets of Regulations in place for Exceptional Circumstances.

Income-based ESA will be replaced by Universal Credit, as (or if) it is rolled out, but there will be the same additional financial components added as we currently have for ESA – you will be able to claim either the work-related activity or the support component.

The contents of both sets of Regulations are essentially the same. They are applied in the same way. 25 and 29 are for those who are not capable of work, and would usually be placed in the Work-Related Activity Group, and 31 and 35 apply to those not capable of work-related activity, and would normally be placed in the Support Group.

Because of the tick-box nature of the ESA50 form, it is likely that people will fall below the number of points required to be declared incapable of work – it doesn’t take into account variable illnesses, mental illness, or the effects of having more than one illness.

However, the Exceptional Circumstances Regulations may cover us – they both state that the claimant should be found incapable of work (Regulation 29 for ongoing ESA claims, 29 for Universal Credit) or work-related activity (Regulation 35 for ongoing ESA claims, 31 for Universal Credit) if:

  • they have an uncontrolled or uncontrollable illness, or “the claimant suffers from some specific disease or bodily or mental disablement and
  • by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work/work-related activity”.

If you feel this reflects your circumstances, then we suggest adding something like this, where you put “other information” on the ESA50:

“If the scoring from my answers above is insufficient, then I believe applying the Exceptional Circumstances Regulations would be appropriate due to the severity and interaction of my conditions, and my inability to reliably, repeatedly and safely encounter work-related situations and/or safely perform work-related tasks.

I am taking all available and appropriate medication as prescribed by my doctor(s), and there are no reasonable adjustments to a workplace which would mitigate my medical condition(s).

Therefore I believe being placed in the Support Group would be appropriate, because there would be a serious substantial risk to mental and/or physical health if I were placed into a workplace environment or in the work-related activity group.”

You can word it yourself, of course. Please change the wording to fit your situation, delete “mental” or “physical” if appropriate, leave both in if necessary. If your illness cannot be controlled at all, or medication can’t be used to control it, add that instead.

Regulations 29 (for ESA) and 25 (for Universal Credit) cover people who might be put in the Work-Related Activity Group (WRAG), which has work-focused activities, sometimes it has workfare placements, and sanctions may apply, while Regulations 35 (for ESA) and 31 (for Universal Credit) cover people who are not well enough for any kind of work activity. This is for people who might be placed in the Support Group. There are no conditions placed on you for getting your ESA, such as workfare, if you have limited capability for work-related activity.

You can ask your doctor to support you with this claim, as it is stated in the regulations:

“(b) evidence (if any) from any health care professional or a hospital or similar institution, or such part of such evidence as constitutes the most reliable evidence available in the circumstances” may be presented to support your case. 

You can ask for copies of any communication from your consultant to your GP. You can also ask to be copied into any further correspondence between your doctors. 

Here are some links so you can download and print off documents to give to your GP to support your claim or appeal. You ought to submit copies of these to the DWP as soon as you can. (Make sure that you keep a copy).

In some cases, this may mean that your case will be reconsidered in your favour without having to wait for a tribunal hearing.

These templates are for ongoing ESA claims and Contribution-based ESA:

(CLICK)   Cover letter for your GP

(CLICK)   ESA Appeals Letter for your GP

(CLICK)   Legal Advice of Counsel for GPs: Prevention of Avoidable Harm Interpretation and Application of ‘Substantial Risk’ ESA Regulations 29 & 35

With many thanks to the Black Triangle Campaign for these extremely helpful links and templates.

Please remember: Regulations 29 and 35 still apply to all ongoing ESA claims, and will remain in use for contribution-based ESA claims.

Regulations 25 and 31 apply to Universal credit when that is rolled out. If you are one of the few currently claiming Universal Credit in one of the pilot areas, and if you are not eligible for contribution-based ESA, Regulations 25 and 31 apply now. You may amend the print off documents for your GP, as they cite the Regulations most likely to be applicable at the moment.

The full text of the legislation appears at the end of this article (Appendix A).

3. The Atos assessment and what you need to know.

You have a right to ask for your assessment to be recorded. You will need to request this in advance, but it’s worth making sure you use this opportunity to gather evidence on record because in doing so, you make it much more difficult for the Health Care Professional (HCP) to disregard what you tell them and write “inaccuracies” in their assessment report. We would strongly recommend you exercise this right.

It’s also worth knowing that Atos don’t conduct “medical” assessments,  they conduct “disability analysis“. You are not a patient to Atos, you are a “claimant”.

Bear in mind throughout the assessment that your answers to any apparently innocent questions, such as:

  • Do you watch television
  • Do you read
  • Do you use the internet 

These may be translated into phrases for the assessment report such as:

  • Can sit unaided and unsupported for at least half an hour. 
  • Has no problems with concentration and focus
  • Has no visual problems

Assessment starts on the day of your appointment with the HCP reading the form you completed when you applied for benefit. Remember that every single question you are asked is designed to justify ending your claim for ESA and passing you as “fit for work.” That is what Atos are contracted to do by the Government. This is not a genuine medical assessment, but rather, an opportunity for the DWP to take away the financial support that you are entitled to.

Things that are noted from your form:

  • Did you complete the form yourself
  • Is the handwriting legible
  • Are the contents coherent

These observations are already used in assessing your hand function, your cognitive state and concentration.

Further observations made:

  • Do the things you have written add up, is there consistency
  • Does your medication support your diagnosis
  • What tests have you had to confirm diagnosis. For example a diagnosis of sciatica is not accepted unless diagnosed by MRI scan
  • Do you have supporting medical evidence from your GP or consultants. If you do, it shows that you are able to organise getting this information

When the HCP has read your form they input some data into the computer system. The assessment properly begins when they call your name in the waiting room.

At this point the HCP assesses:

  • Did you hear your name being called
  • Did you rise from your chair unaided, did the chair have support arms or not
  • Were you accompanied – assessing your ability to go out alone
  • Were you reading a paper while waiting – assessing your concentration
  • Did you walk to the assessment room unaided, did you use aids correctly. Did you navigate any obstacles safely – assessing sight

The HCP will shake your hand on introduction – assessing your handshake, noting if are you trembling, sweating – signs of anxiety. Note that you are under constant scrutiny. The HCP will often ask on the way to the assessment room:

  • How long you’ve been waiting – assessing your ability to physically sit, and appraising your mental state
  • How did you get here today – assessing your ability to drive or use public transport

Formal assessment begins by listing medical conditions/complaints. For each complaint you will be asked:

  • How long have you had it, have you seen a specialist
  • Have you had any tests, what treatments have you had
  • What’s your current treatment. Have you had any other specialist input e.g. physiotherapy, CPN

The HCP will use a lack of specialist input/ hospital admissions to justify assessing your condition as less severe. Medications will be listed and it will be noted if they are prescribed or bought. Dates will be checked on boxes to assess compliance with dosage and treatment regime. Any allergies or side-effects should be noted.

  • A brief note is made of how you feel each condition affects your life
  • A brief social history will be taken – who you live with, if have you stairs in your house or steps outside your house
  • An employment history taken – when you last worked, what you work entailed, reason for leaving employment

Your typical day – this is the part of the assessment where how you function on a day to day basis is used to justify the HCP decisions. Anything you say here is most often used to justify the HCP “failing” you and assessing you as “fit for work”. The HCP records their observations.

Starting with your sleep pattern, questions are asked about your ability to function. This will include:

  • Lower limb problems – ability to mobilise to shop, around the house, drive, use public transport, dress, shower
  • Upper limb – ability to wash, dress, cook, shop, complete the ESA form
  • Vision – did you manage to navigate safely to the assessment room
  • Hearing – did you hear your name being called in the waiting room
  • Speech – could the HCP understand you at assessment
  • Continence – do you describe incontinence NOT CONTROLLED by pads, medication. Do you mention its effects on your life when describing your typical day
  • Consciousness – do you suffer seizures – with loss of continence, possible injury, witnessed, or uncontrolled diabetes
  • The HCP observations include noting how far you walked to the examination room, watching to see if you removed your coat independently, did you handle medications without difficulty, did you bend to pick up your handbag

Formal examination consists of simple movements to assess limited function. Things the HCP also looks at:

  • Are you well-presented, hair done, wearing make-up, eyebrows waxed
  • Do you have any pets – this can be linked with ability to bend to feed and walk
  • Do you look after someone else – as a parent or carer – if you do, this will be taken as evidence of functioning
  • Are you doing any training, voluntary work, do you socialise – this will be used as evidence of functioning

This is not a comprehensive list, but it gives you an idea of how seemingly innocent questions are used to justify HCP decisions to pass you as “fit for work.”

Mental Health:

  • Learning tasks – can you use a phone, computer, washing machine
  • Hazards – can you safely make tea, if you claim you have accidents, there must be emergency services involvement, e.g. fire service. Near miss accidents do not count

Personal Actions:

  • Can you wash, dress, gather evidence for assessment
  • Do you manage bills

Other observations made by the HCP – appearance and presentation:

  • Coping with assessment interview – any abnormal thoughts, hallucinations, confusion, suicidal thoughts
  • Coping with change – ability to attend assessment, attend GP or hospital appointments, shopping and socialising

More HCP observations include:

  • Appearance, eye contact, rapport, any signs/symptoms that are abnormal mood/thoughts/perceptions. Any suicidal thoughts
  • How you cope with social engagement- appropriateness of behaviour – any inappropriate behaviour must have involved police to be considered significant
  • Your capacity to cope with the assessment, overall responses and level of engagement with the assessor

Again, this is not an exhaustive list, merely some examples.

Additional information:

Special cases: exemptions from assessment include – terminal illness, intravenous chemotherapy treatment and regular weekly treatment of haemodialysis for chronic renal failure; treatment by way of plasmapheresis; regular weekly treatment by way of total parenteral nutrition for gross impairment of enteric function.

At present to qualify for ESA you need to score 15 points. This can be a combination of scores from physical and mental health descriptors.To qualify for the support group you must score 15 points in one section. As long as you are claiming income-based ESA then your award can be renewed at each assessment, if you gain 15 points.

Remember that you may also qualify without meeting the 15 points criterion, even if you don’t score any points, because of Exceptional Circumstances (Regulations 25, 29 and 31, 35) if there would be a substantial risk to your mental or physical health if you were found not to have limited capability for work and/or work-related activity respectively.

Contribution-based ESA lasts for 1 year only, unless you are in the Support Group. After 1 year, in the Work-Related Activity Group (WRAG), you may only get income-based ESA if your household income is below a certain threshold. It makes no difference how long you have previously paid National Insurance. 

Further information:

Lord Freud – “Reliably, repeatedly and safely”  – Source: Hansard, column 326, paragraph 4.

*There are Judges who interpret the law and where applicable, set precedent. There are Ministers who set policy. With specific reference to the use of repeatedly, reliably, safely, and in a timely manner, this is the result of Upper Tribunal judges interpreting the law and setting precedent through case law.*

Exceptional Circumstances: Employment and Support Allowance Regulation 25
Exceptional Circumstances: Employment and Support Regulation 31
Employment and Support Allowance: 2013 Regulations in full
Explanatory memorandum to all benefits 2013: Full legislation document
Recommended – Implications of the changes and advice: Employment Support Allowance claim update: Exceptional Circumstances – Regulations 25 and 31 and Universal Credit
Recommended – The Black Triangle Campaign: How to Gain Exemption from DWP/Atos ‘Fit for Work’ & WRAG decisions by Applying ESA Regulations 29 and 35 (see note for 25 and 31)
The new Work Capability Assessment 2013: DWP Guide
The Employment and  Support Allowance Regulations 2008 (as amended) – judiciary.gov.uk

Appendix A: 

Regulation 25

25.—(1) A claimant who does not have limited capability for work as determined in accordance with the limited capability for work assessment is to be treated as having limited capability for work if paragraph (2) applies to the claimant.

(2) Subject to paragraph (3), this paragraph applies if—

(a) the claimant is suffering from a life-threatening disease in relation to which—

(i) there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and

(ii) in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; or

(b) the claimant suffers from some specific disease or bodily or mental disablement and, by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work.

(3) Paragraph (2)(b) does not apply where the risk could be reduced by a significant amount by—

(a) reasonable adjustments being made in the claimant’s workplace; or

(b) the claimant taking medication to manage the claimant’s condition where such medication has been prescribed for the claimant by a registered medical practitioner treating the claimant.

(4) In this regulation “medical evidence” means—

(a) evidence from a health care professional approved by the Secretary of State; and

(b) evidence (if any) from any health care professional or a hospital or similar institution,

or such part of such evidence as constitutes the most reliable evidence available in the circumstances.

*Regulation 25 outlines exceptional circumstances in which a person will be treated as having limited capability for work, but may be capable of work-related activities. People in these circumstances are placed in the ESA work-related activity group (WRAG)

However, there are further exceptional circumstances in which a person  will be treated as having limited capability for work-related activity in addition, and will therefore be placed in the ESA support group. These are outlined by Regulation 31.

Regulation 31 

31.—(1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;

(b) the claimant is—

(i) receiving treatment for cancer by way of chemotherapy or radiotherapy;

(ii) likely to receive such treatment within six months after the date of the determination of capability for work-related activity; or

(iii) recovering from such treatment,

and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity;

(c) in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity; or

(d) the claimant is entitled to universal credit and it has previously been determined that the claimant has limited capability for work and work-related activity on the basis of an assessment under Part 5 of the Universal Credit Regulations 2013.

(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 30(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.

For all ongoing cases where Universal Credit does NOT apply, and for ALL Contributions-based ESA claims:

Regulation 29

29.—(1) A claimant who does not have limited capability for work as determined in accordance with

the limited capability for work assessment is to be treated as having limited capability for work if:

paragraph (2) applies to the claimant.

(2) This paragraph applies if—

(a) the claimant is suffering from a life threatening disease in relation to which—

(i) there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and

15(ii) in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by

a recognised therapeutic procedure; or

(b) the claimant suffers from some specific disease or bodily or mental disablement and, by reasons of

such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work.

Regulation 35

35.—(1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;(b) the claimant is—

21(i) receiving treatment by way of intravenous, intraperitoneal or intrathecal chemotherapy; or

(ii) recovering from that treatment and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity; or

(c) in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity.

(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 34(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.

Appendix B

Most Atos HCPs are not doctors, they are usually nurses or occupational therapists. You can demand that a qualified doctor or specialist conducts your assessment under some circumstances. I’ve gathered the following list from various Freedom of Information responses from the Department for Work and Pensions.

List of conditions judged suitable for assessment by neuro – trained nurses/any health care profession, so make sure that you are seen by a qualified HCP: 

Prolapsed intervertebral disc
Lumbar nerve root compression
Sciatica
Slipped disc
Lumbar spondylosis
Lumbar spondylolisthesis
Lumbar spondylolysis
Cauda equina syndrome
Spinal stenosis
Peripheral neuropathy
Neuropathy
Drop foot
Meralgia paraesthetica
Cervical spondylosis
Cervical nerve root compression
Cervicalgia
Nerve entrapment syndrome
Carpal tunnel syndrome
Trapped nerve
Paraesthesia
Tingling
Numbness
Brachial plexus injury
Polyneuropathy
Dizziness
Vertigo
Essential Tremor
VWF
Alzheimer’s

List of conditions judged by the DWP and Atos Healthcare as suitable only for assessment by doctors:

Stroke
Head injury with neuro sequelae
Brain haemorrhage
Sub Arachnoid Haemorrhage
Brain tumour
Acoustic Neuroma
Multiple Sclerosis
Motor Neurone Disease
Parkinson’s disease
TIAs
Bulbar Palsy
Myasthenia Gravis
Muscular Dystrophy
Guillain-Barre Syndrome
Amyotrophic lateral sclerosis
Syringomyelia
Neurofibromatosis
Spina bifida
Polio
Fits (secondary to brain tumour)
Learning difficulties (with physical problems)
Nystagmus
Myelitis
Bells Palsy
Trigeminal Neuralgia
Paraplegia
Quadriplegia
Huntington’s Chorea
Huntington’s Disease

Further reading:

More on questions you may be asked at assessment: dwpexamination forum 
How to deal with Benefits medical examinations: A Useful Guide to Benefit Claimants when up against ATOS Doctors
More support and advice here: How to deal with Benefits medical examinations
Step by step guide to appealing a ESA decision: Good Advice Matters

Important update

Clause 99, Catch 22 – The ESA Mandatory Second Revision and Appeals

Additional support:

The LawWorks Clinics Network is a nationwide network of free legal advice sessions which LawWorks supports.Clinics provide free initial advice to individuals on various areas of law including social welfare issues, employment law, housing matters and consumer disputes – List of LawWorks  clinics

V-STARTU

Thanks to Robert Livingstone for his valuable contributions.

With many thanks to Joyce Drummond for contributing such valuable information about the Work Capability Assessment.

With many thanks to The Black Triangle Campaign for sharing their work on the GP support letter template, and covering legal and explanatory documents


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

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What you need to know about Atos assessments.

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Courageous whistleblower, Scottish nurse and ex-Atos employee, Joyce Drummond, who recently made a heartfelt apology to Atos assessment victims, has submitted evidence to the Scottish Parliament Select Committee on Welfare Reform.

Joyce forwarded some of her notes to me, containing this information about Atos assessments. We had some dialogue about the content. I have edited where needed, organised the notes and added some information to the text. I’ve included the contents from Joyce’s notes in full.

Both Joyce and I share this information in the hope that people going through Atos assessments will find it helpful.

Joyce told me: 

“I knew nothing about Atos when I joined, and left as soon as I realised that there was no way to ‘fight from the inside.’  I stated at my interview for the job that I believed in social inclusion and social justice.

I attended 4 weeks training in England. The training did not prepare me for what I was expected to do in real life.

The forms that are completed prior to assessment, I have recently found out, are actually opened by Royal Mail Staff. They are then sent for “scrutiny” where nurses decide whether or not a face to face assessment is required. I was not involved in this and do not know what criteria are used.  

 It is made clear throughout training and working that we are not nurses – we are disability analysts.  Also, we do not carry out “medical assessments” – we carry out “functional assessments”. We did not even need a diagnosis to carry out assessments. I had reservations around consent, as we were expected to assess patients – sorry, we didn’t have patients, we had ‘claimants’ – who appeared to be under the influence of alcohol or other substances. 

We were also consistently told that we did not make benefit decisions. The final decision was made by a Department for Work and Pensions (DWP) decision maker with no medical qualification. If our assessment was overturned at appeal we never knew about it. There was no accountability for assessments overruled.”

Please note that assessment starts on the day of your appointment with the Health Care Professional (HCP) reading the form you completed when you applied for disability support. Remember that every single question you are asked is designed to justify ending your claim for ESA and passing you as “fit for work”. That is what Atos are contracted to do by the Government.  This is not a genuine medical assessment, but rather, an opportunity for the DWP to take away the financial support that you are entitled to.

Things that are carefully noted at this stage are:

  • Did you complete the form yourself?
  • Is the handwriting legible?
  • Are the contents coherent?

These observations are already used in assessing your hand function, vision, your cognitive state and concentration.

Further observations made:

  • Do the things you have written ‘add up’? Are there any ‘discrepancies’?
  • Does your medication support your diagnosis?
  • What tests have you had to confirm diagnosis? For example a diagnosis of sciatica is not accepted unless diagnosed by MRI scan.
  • Do you have supporting medical evidence from your GP or consultants? If you do, it shows that you are able to organise getting this information

Joyce observes:

“This is also a hidden cost to the NHS. I believe that if ATOS request information there is a charge levied by GP’s. However claimants are expected to source medical evidence themselves. It uses valuable NHS time for medical staff to write supporting statements. 

There were no hidden cameras, at least in Glasgow, to watch people arriving for assessment or sitting in waiting room. This may not be true in other areas.”

When the HCP has read your form they input some data into the computer system. The assessment properly begins when they call your name in the waiting room.

At this point the HCP assesses:

  • Did you hear your name being called?
  • Did you rise from your chair unaided, did the chair have support arms or not?
  • Were you accompanied? – assessing your ability to go out alone
  • Were you reading a paper while waiting? – assessing your concentration
  • Did you walk to the assessment room unaided, did you use any aids correctly? Did you navigate any obstacles safely? – assessing sight.

The HCP will shake your hand on introduction – assessing your handshake, noting if are you trembling, sweating – signs of anxiety. The HCP carefully scrutinises everything you do and say. The HCP will often ask on the way to waiting room:

  • How long you’ve been waiting – assessing ability to sit, physically, and appraising your mental state
  • How you got to the appointment – assessing ability to drive or use public transport

Formal assessment begins by listing medical conditions/complaints. For each complaint you will be asked:

  • How long have you had it, have you seen a specialist?
  • Have you had any tests, what treatments have you had?
  • What’s your current treatment? Have you had any other specialist input e.g. physiotherapy, CPN?

The HCP will use lack of specialist input/ hospital admissions to justify assessing your condition as “less severe”. Medications will be listed and it will be noted if they are prescribed or bought. Dates will be checked on boxes to assess compliance with dosage and treatment regime. Any allergies or side-effects should be noted.

  • A brief note is made of how you feel each condition affects your life
  • A brief social history will be taken – who you live with, if have you stairs in your house or steps outside your house
  • Employment history taken – asking when you last worked, what you work entailed, and the reason for leaving employment.

Your typical day – this is the part of the assessment where how you function on a day to day basis is used to justify the HCP decisions. Anything you say here is what is most likely to be used to justify you failing your assessment and being passed as “fit for work”. Along side this, the HCP records their observations.

Starting with your sleep pattern, questions are asked around your ability to function. This will include:

  • Lower limb problems – ability to mobilise to shops, around the house, drive, use public transport, dress, shower
  • Upper limb – ability to wash, dress, cook, shop, complete ESA form
  • Vision – did you manage to navigate safely to the assessment room
  • Hearing – did you hear your name being called in the waiting room
  • Speech – could the HCP understand you at assessment
  • Continence – do you describe incontinence NOT ‘CONTROLLED’ by pads, medication. Do you mention its effects on your life when describing your typical day
  • Consciousness – Do you suffer seizures – with loss of continence, possible injury, witnessed, or uncontrolled diabetes
  • HCP observations include – how far did you walk to the examination room, did you remove your coat independently, did you handle medications without difficulty, did you bend to pick up your handbag.

Formal examination consists of simple movements to assess limited function. Things the HCP also looks at:

  • Are you well presented, hair done, wearing make-up, eyebrows waxed
  • Do you have any pets – this can be linked with ability to bend to feed and walk
  • Do you look after someone else – as a parent or carer – if you do, this will be taken as evidence of functioning
  • Any training, voluntary work, socialising – this will be used as evidence of functioning
  • Do you watch TV – this may be used as evidence of being able to sit unaided or as evidence of being able to concentrate
  • If you wear jewelry it will be assumed you have sufficient dexterity to open and close the clasps on chains and so on.

This is not a comprehensive list, but it gives you an idea of how seemingly innocent questions are used to justify HCP decisions to pass you as “fit for work.” For example, “Do you watch soaps on TV?” is translated as “Can sit unaided for at least half an hour” on the report.

Mental Health:

  • Learning tasks – Can you use a phone, computer, washing machine
  • Hazards – Can you safely make tea, if claiming accident, there must have been some emergency services involvement, e.g. fire service. Near miss accidents do not count.

Personal Actions:

  • Can you wash, dress, gather evidence for assessment
  • Do you manage bills

Further observations made by the HCP – appearance and presentation:

  • Coping with assessment interview – any abnormal thoughts, hallucinations, confusion
  • Coping with change – ability to attend assessment, attend GP or hospital appointments, shopping and socialising

More HCP observations:

  • Appearance, eye contact, rapport, any signs/symptoms that are abnormal mood/thoughts/perceptions. Any suicidal thoughts
  • Coping with social engagement/appropriateness of behaviour – any inappropriate behaviour must have involved police to be considered significant
  • Ability to attend assessment, engage with assessor, behave appropriately

Again, this is not an exhaustive list, merely some examples.

Further information: 

At present to qualify for ESA you need to score 15 points, unless the Exceptional Circumstances Regulations apply to you. The 15 points can be from a combination of scores from physical and mental health descriptors.

To qualify for the Support Group you must score 15 points in one section. As long as you are claiming income-based ESA then your award can be renewed at each assessment, if you gain 15 points.

You may also qualify without meeting the 15 points criterion, even if you don’t score any points, because of Exceptional Circumstances (Regulation 29 and Regulation 35, (or 25 and 31 for Universal Credit – see link at the foot of article) if there would be a substantial risk to your mental or physical health if you were found not to have limited capability for work. Regulation 29 is about exceptional circumstances for being assessed as having limited capability for work (Work Related Activity Group), and Regulation 35 is about being assessed as having limited capability for work-related activity (Support Group).

Special cases – exemptions from assessment include those people having: terminal illness, intravenous chemotherapy treatment and those considered a danger to self or others if found fit to work.

Contribution-based ESA lasts for one year only, unless you are in the support group. After one year in the work-related activity group, you may only get income-based ESA if your household income is below a certain threshold. It makes no difference how long you have previously paid National Insurance.

Joyce told me:

“For clarity, as far as I know in the real world, doctors carry out medical assessments, nurses carry out nursing assessments and physios carry out physiotherapy assessments. In the world of Atos, people from each of these separate professions are employed as disability analysts, carrying out functional assessments.

Nurses are employable for these posts if they have been qualified for at least 3 years, are registered to practice with the NMC, and have basic computer skills.

My interview consisted of:

  • Face to face interview with medical director and nurse team leader.
  • A written paper assessing a scenario, in my case someone with back pain
  • A 10 minute basic computer test

“In order to be approved as a disability analyst I had to complete 4 weeks of Atos disability training, reach a certain standard of assessment reports – as decided by audit of all cases seen (I don’t know what criteria was) and was finally approval to carry out Work Capability Assessments (WCA) from the Secretary for Work and Pensions.

In my opinion the money given to Atos and spent on tribunals should be given to NHS GPs. They are best placed to make assessments regarding patients’ work capability. They have access to all medical reports, knowledge of past history, specialist input and they know their patients. My concern would be about what criteria the DWP would impose on GPs risking the doctor/patient relationship. GPs already assess patients for “fit notes”, which have to be submitted to DWP during assessment phase of ESA.

While I worked at Atos, sessional medical staff were being paid £40 per assessment, as far as I am aware. I have no idea of wages of permanent medical staff. Nurses were on a salary, which, based on 10 assessments a day (Atos target), equalled around £10 per assessment. These are approximate figures but may give a clue as to why Atos are employing nurses rather than doctors.”

Appendix

Most Atos HCPs are not doctors, they are usually nurses or occupational therapists. There are some conditions that will mean you need to be assessed by a qualified specialist nurse, or a doctor and you can ask for this.

List of conditions judged suitable for assessment by neuro trained nurses/any health care profession:

Prolapsed intervertebral disc
Lumbar nerve root compression
Sciatica
Slipped disc
Lumbar spondylosis
Lumbar spondylolisthesis
Lumbar spondylolysis
Cauda equina syndrome
Spinal stenosis
Peripheral neuropathy
Neuropathy
Drop foot
Meralgia paraesthetica
Cervical spondylosis
Cervical nerve root compression
Cervicalgia
Nerve entrapment syndrome
Carpal tunnel syndrome
Trapped nerve
Paraesthesia
Tingling
Numbness
Brachial plexus injury
Polyneuropathy
Dizziness
Vertigo
Essential Tremor
VWF
Alzheimers

List of conditions judged by the DWP and Atos Healthcare as suitable only for assessment by doctors:

Stroke
Head injury with neuro sequelae
Brain haemorrhage/Sub Arachnoid Haemorrhage
Brain tumour
Acoustic Neuroma
Multiple Sclerosis
Motor Neurone Disease
Parkinson’s disease
TIAs
Bulbar Palsy
Myasthenia Gravis
Muscular Dystrophy
Guillain-Barre Syndrome
Amyotrophic lateral sclerosis
Syringomyelia
Neurofibromatosis
Spina bifida
Polio
Fits (secondary to brain tumour)
Learning difficulties (with physical problems)
Nystagmus Myelitis
Bells Palsy
Trigeminal Neuralgia
Paraplegia
Quadriplegia
Huntington’s Chorea
Huntington’s Disease

Further information:

Special exemptions from the 15 points criteria: The New Regulation 25
Useful updated information about Regulations 25 & 31: Exceptional Circumstances and Universal Credit.
Exceptional Circumstances:
Employment and Support Regulation 31

Employment and Support Allowance: 2013 Regulations in full
The Amendments to ESA Regulations: as laid before Parliament
Clause 99 and important changes to the appeal process: Clause 99, Catch 22 – The ESA Mandatory Second Revision and Appeals
Questions you may be asked at assessment: dwpexamination forum 
How to deal with Benefits medical examinations: A Useful Guide to Benefit Claimants when up against ATOS Doctors
More support and helpful advice here: How to deal with Benefits medical examinations

Essential information for ESA claims, assessments and appeals

Previous related articles: 

Joyce’s campaign:  The Daily Record 
Joyce Drummond and Sue Jones:  After Atos

Further reading:

Targets in Atos contract

7 out of 8 targeted to lose ESA

Amnesty condemns erosion of human rights of disabled in UK

Whistleblower says Atos Work Capability Assessments are unfair

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Many thanks to Robert Livingstone for his excellent artwork. Many thanks to Joyce for the information she has provided, and for her courage and integrity, which is so strongly evident in her outstanding campaign work.


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 Tories are not simply “out of touch”, their policies are deliberate and malevolent

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It’s a common belief that Tory policies, which are inhumane to the core, and directed at taking money and support from the most vulnerable, have happened because of a kind of naivety, lack of experience, or a simple egocentricity of the privileged. Or general incompetence.

These certainly may well contribute to the obvious lack of joined-up thinking, apparent when we step back to consider that the most vulnerable in our so-called civilised society are suffering and dying as a direct consequence of recent legislations and “reforms,” but it certainly doesn’t explain why the Tories persistently and historically CHOOSE to continue to ignore any other account of social reality but their own. That implies some intentionality, to me. Selective perception involves a certain degree of free will.

So we are now almost through the doorway to the “mad or bad” debate.

Tories also reduce every single human deed to an underlying motivation of greed for financial gain, no matter what the circumstances. They know the price of everything and the value of nothing. Some would argue that this is classic Freudian projection. But that doesn’t account for the fact that the Tories normalise and make a virtue of the financial gain principle, for the wealthy, big business and of course, the Tories themselves.

These motivations are held to be universal, and are translated into a vice when it comes to ordinary, everyday people, or in particular, poor and vulnerable people. That doesn’t hang together coherently at all, nor does it corroborate the view that the Tories are simply out of touch with everyday experience, since there is a deep and fundamental – and very apparent – contradiction here. It is a very significant flaw in their ideological grammar.

Human beings are not static, when it comes to ideas and beliefs: we are capable of learning, and in a variety of ways: though experience, through the experience of others, through historical accounts, evidence and so on. The Tories simply choose to overlook the need. They prefer, instead, to stay put, or regress, and simply insist that they know best. Challenge a Tory, and they often believe that simply talking louder, and over the top of you will somehow make what they are saying “right.” They are not called “Conservative” for nothing – they do like to maintain a status quo and resist change.

Well … notions of change apply only to their idea of how a society ought to be, hence the proliferation of legislation these past couple of years. The Conservatives are unravelling the progress we have made as a society, because they prefer the simplicity of basic feudal relationships. I’m not really joking here, unfortunately.

It’s as if the clocks stopped the moment the Tory-led Coalition took Office, and now we are losing a decade a day.

The truth is that austerity is NOT about deficit-cutting. It’s just the cover for Tory ideology. It is actually about shrinking the State and squeezing the public sector until it becomes marginal, then non-existent, in an entirely market-driven society. The banking crisis-generated deficit has been a gift to the Tories in enabling them to launch the narrative that public expenditure has to be massively cut back, which they would never have been able to get away with without the deficit-reduction excuse in the first place.

Austerity won’t benefit the economy: it will damage it further, since the cuts will reduce the income of those that spend proportionally the most money and add to the economy – the poorest. Taking more money out of an already struggling economy and impacting local economies will simply exacerbate the problem.

“We can safely abandon the doctrine of the eighties, namely that the rich were not working because they had too little money, the poor because they had too much” – John Kenneth Galbraith

Nope, that hasn’t happened, the Tories are still taking money from the poor and handing it to the wealthy. Why? Is it because the Tories are phenomenologically impoverished and incapable of learning, ever? No, I don’t think so.

I think it’s worse than that. I think that the Tories DO understand the consequences of their ideologically-driven policies, but they don’t care. Money for the wealthy has to come from somewhere, after all. The whole “out of touch/lack of experience” proposition overlooks the fact that the Tories refuse to listen, quite deliberately, they exercise authoritarian tactics to shut people up – such as excluding those people from debate who oppose their views – witnessed during the passage of the Health and Social Care Bill, for example. Then there is the monitoring” of the media for alternative political “biases.”

That is a quite deliberate narrowing down of experience, not naivety, based on a lack of understanding. That’s deliberate, calculated and certainly bears all of the hallmarks of authoritarianism. That’s the wilful imposition of a pre-moulded, dystopic Tory version of reality onto a largely unwilling population.

The propaganda regarding unemployed, sick and disabled people is not based on naivety either: it is deliberate, and calculated, a horrible and wicked attempt to justify their small state ideology and punitive approach to stripping welfare provision from the poorest, and from vulnerable citizens to redistribute funds from the public purse to the already wealthy.

David Cameron, Iain Duncan Smith and Chris Grayling have all contributed a selection of propagandic pieces of work to the press – largely the Sun and the Daily Mail. The language they use – words like “scrounger” “fraud” and “workshy” and the implied “burden on the state,” together with their knowledge that so-called benefit fraud was a mere 0.7% (and that includes DWP’s own errors, too) indicates clearly that the policies aimed at removing welfare provision, and the propaganda campaign that has led to an increase in hate crimes directed at sick and disabled people, are intentional.

10,600 sick and disabled people died last year between January and November, many within six weeks of their ESA claim closing. It’s very telling that the Department for Work and Pensions do not monitor or account for just how many of those were passed as “fit for work” by Atos, or awaiting Appeal.

Furthermore, this Government introduced targets which were written into the Atos contract when they renewed it in 2010: 7 out of 8 sick and disabled people to lose their benefits.

Bearing in mind that those targets exist BEFORE those sick and disabled people are assessed (and the Government have also redesigned the work capability assessment to make sure that there is a heavy bias towards withdrawing people’s support) then we can reasonably infer that the Government see those deaths – that have happened as a result of absolute poverty and extreme distress, some of our most vulnerable citizens have had their means of meeting their basic survival needs removed – as an intended outcome.

That the Government have not acted upon the high number of deaths associated with their welfare “reforms” is truly outrageous, and also indicates quite plainly, to me, that this “outcome” is not simply a by-product of their legislation, or incompetence, or lack of experience: it is calculated and intentional.

This is much, much worse than a little “Tory egocentricity,” incompetence, phenomenological ineptitude, or naivety: this is the deliberate, calculated and wholesale destruction of every State mechanism of support for the most vulnerable citizens as well as for the “ordinary” person. If people cannot meet their basic needs – food, shelter and so on, they die. That is common sense, everyone knows that.

Yet this Government are taking away people’s only means of support. Welfare, the safety net paid for by the tax paying public to ensure no-one dies of starvation or exposure. This Government have stolen our collective funds for social security, and blamed those they have stolen it from for their deed.

They blame the poor for poverty. They blame the unemployed for unemployment. But we know that the Government are to blame. Have you ever noticed that, historically, whenever poverty grows and inequalities become wider and deeper, look to the helm and lo and behold, we have a Tory-led Government steering the way. We need to put this Government out of our misery.

Every single “reform” has been about taking money away from the poorest and some of the most vulnerable people. The fact that the Legal Aid Bill has been timed for implementation next year, when the horrific consequences of the welfare cuts, the bedroom tax and the new council tax will become very apparent, as well as the Health and Social Care reforms, indicates quite plainly that these policies have been planned and coordinated for a long time.

The Legal Aid Bill means that challenging the Government regarding the reforms will be very difficult. Indeed, the Coalition have been steadily removing the essential democratic processes that safeguard our human rights and enable us to challenge effectively.

This is certainly an authoritarian Government.

We should hang their heads in shame.

How truly despicable. How utterly horrifying that they are getting away with it. There is an increasingly discernible taint of eugenics embedded in Tory ideology. This, and the propaganda, smoke and mirrors, media scapegoating diversions and theft from the poorest to handout to the wealthiest –  these actions are intentional, calculated and are being increasingly inflicted and administered, whilst the general population waits passively in the wings, shrugging off the blow by hammer blow accounts: more bad news of further Tory cuts, more devastating consequences.

Too many are finding temporary distractions, watching the idiot box, hoping quietly that those things they can see from the corner of their eye are not real.

Oh, but they are.

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Hanlon’s razor is an eponymous adage that allows the elimination of unlikely explanations for a phenomenon. It reads: “never attribute to malice that which is adequately explained by stupidity.”

However, I always considered malice and stupidity to be strongly correlated characteristics.