Government Inflicts Misery on the Sick

First published in Shifting Grounds: 1st August 2013

The decision by the government to bring in other providers to work alongside ATOS Healthcare in delivering the Workplace Capability Assessment (WCA) for Employment and Support Allowance (ESA) claimants has come as little surprise to those who have consistently campaigned against the company and the assessment in recent years. ATOS has been repeatedly labelled as the unscrupulous executer of the Government’s policy to move people off sickness benefit and onto Job Seekers Allowance (JSA). Tragic stories of who have died whilst awaiting appeals against benefit reclassification decisions have been few in number, but they have horrified those who feared the worst following the announcement of Ian Duncan Smith’s benefit reforms.

ATOS has enjoyed a fruitful, if controversial relationship with the government over the past 15 years. In 1997, the Labour government asked Mansel Aylward, a senior health professional, to devise the Personal Capability Assessment (PCA) a test designed to identify what individual clients were capable of and how they could be supported back into work. The contract for delivering the assessment eventually found its way to ATOS Origin, who administered the assessment through a Logical Integrated Medical Assessment tick box program. These evaluations were proved unreliable by the number of successful appeals against decisions, and in 2003 they were dropped in favour of the ‘Pathways to Work’ scheme, in which claimants were mandated to attend appointments with an advisor, with a view to returning to the jobs market.

Following the passage of the 2012 Welfare Reform Act, the return of assessments has yielded much the same result. Yet this time, both the DWP and the Coalition government are as much to blame. Though ATOS performed poorly in its recent audit – it was accused of providing inaccurate information and substandard reports to the Job Centre – witnesses have stated that the company has faced sustained pressure from the DWP to provide evidence that supports the government’s tough stance against benefit claimants. A recent investigation by The Guardian exposed the pressure its staff were under to edit reports so they were less favourable to ESA claimants, and to award points ‘begrudgingly (15 points are required to qualify for ESA). Responsibility, they claimed, lay with the DWP, who were responsible for the training of ATOS assessors. Over 80% of the 35% of successful appeals were lodged by clients who scored six point or less on their assessment. The WCA consists of a series of broad questions about clients personal lives and their health condition, with the answers building up a report of their capability to hold down work.

Government pressure appears to have been applied at every stage of the process. The WCA  consists of a series of broad questions about their personal lives and their health condition, with the answers building up a report of their capability to hold down work. The WCA, composed by the DWP in consultation with the American insurance company Unum Provident, has been criticised for containing questions that are deliberately oblique, with little indication given as to their individual importance to overall test score.  It is based on the diopsychosocial model, which incorporates psychological and social influences, in addition to biological influences, into insurance assessments of a claimants healing process, the idea being that once identified they can be neutralised. It is interesting to note that the Director of the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University is Mansel Aylward, knighted in April 2010 for his services to medicine.

Once completed, the questionnaire results are compiled into a report for the assessor to approve, which is then sent to the Job Centre, where an advisor makes the final decision on whether a claimant is eligible for ESA. With the Job Centre under considerable pressure from the DWP to reclassify clients – Dr Steven Bick claimed in a Dispatches expose that the Government expected seven out of eight claimants to be reclassified – it is not unreasonable to assume that both ATOS and the Jobcentre Plus were pressurised to make this statistic a reality. Consistent with the diopsychosocial approach, it is interesting to note that many successful appeals were lodged by claimants with progressive ailments such as Parkinsons, and ailments with few outward physical symptoms, such as Chronic Fatigue Syndrome (CFS) Chronic Pain, Multiple Sclerosis and Irritable Bowel Syndrome (IBS).

The picture that emerges of the situation is one of inadequacy and moral corruption. There is no doubt that there are a number of people who are currently in receipt of ESA who could hold down a job, and that these clients should be offered help in establishing a routine of job searching and reskilling to make them job ready. But as long as the Government places pressure on ATOS and Jobcentre Plus to reclassify claimants as being fit for work, it will bring misery on the sick. A true Workplace Capability Assessment would take into consideration all aspects of a claimant’s health condition, with an emphasis on biological barriers. The current click through system is over simplistic. A more nuanced Workplace Capability Assessment is required, with more emphasis based on actual health history. The current assessment, and the atmosphere it is conducted in, is an insult to human decency and compassion.

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