Saturday, 27 July 2013

The Pitfalls Behind Medical Assessments For Welfare

Today's post from (see link below) refers to the current situation in the UK regarding claiming benefits if you're too ill to work. It may be in a British context but the way people are assessed here will resonate with many people all over the world. You shouldn't have to convince private assessment firms that you are ill and in pain; your doctor's word and medical history should be enough but unfortunately in times of cuts and savings all over the world, welfare bills are being slashed. Chronic pain sufferers are easy targets, especially if the guidelines are continually being changed and tightened so that you have to be practically dying before you are entitled to social benefits. Of course there will always be people who want to unfairly take advantage of social benefits but these are always a tiny minority. You should never exaggerate your condition but you should be aware that the assessors are trying to catch you out in ways outlined below. Be prepared, is the motto and always try to have the support of your doctor or specialist in these situations.

What you need to know about Atos assessments.
April 18, 2013 Kitty Jones

(Atos healthcare carries out ability to work assessments on behalf of the Department for Work and pensions in the UK.)

Courageous Scottish nurse Joyce Drummond, who 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. 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.
“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 carried out Incapacity Benefit assessments, these were the forerunner to Employment Support Allowance (ESA) assessments. I stated at my interview for the job that I believed in social inclusion and social justice.
I went for 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 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 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.”
Assessment starts on the day of your appointment with the Health Care Professional (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 assessment, but rather, an opportunity for the DWP to take away the financial support that you are entitled to.
Things that are 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, your cognitive state and concentration.

Further observations made:

Do the things you have written add up

Does your medication support your diagnosis

What tests you have 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
“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 way to waiting room:

How long you’ve been waiting – assessing ability to sit, physically, and appraising your mental state

How did you get here today – 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 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, 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 assessment room

Hearing – did you hear your name being called in 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 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
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 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 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 (WRAG) , 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 danger to self or others if found fit to work.

Contribution-based ESA lasts for 1 year only, unless you are in the support group. After 1 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.

“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, 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 disability analyst I had to complete 4 weeks Atos disability training, reach a certain standard of assessment reports – as decided by audit of all cases seen (don’t know what criteria was) and 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, past history, specialist input and know their patients. My concern would be 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.”

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
Slipped disc
Lumbar spondylosis
Lumbar spondylolisthesis
Lumbar spondylolysis
Cauda equina syndrome
Spinal stenosis
Peripheral neuropathy
Drop foot
Meralgia paraesthetica
Cervical spondylosis
Cervical nerve root compression
Nerve entrapment syndrome
Carpal tunnel syndrome
Trapped nerve
Brachial plexus injury
Essential Tremor
List of conditions judged by the DWP and Atos Healthcare as suitable only for assessment by doctors:
Head injury with neuro sequelaeBrain haemorrhage
Sub Arachnoid Haemorrhage
Brain tumour
Acoustic Neuroma
Multiple Sclerosis
Motor Neurone Disease
Parkinson’s disease
Bulbar Palsy
Myasthenia Gravis
Muscular Dystrophy
Guillain-Barre Syndrome
Amyotrophic lateral sclerosis
Spina bifida
Fits (secondary to brain tumour)
Learning difficulties (with physical problems)
Nystagmus Myelitis
Bells Palsy
Trigeminal Neuralgia
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

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