Botched tests deny the disabled their benefits | Daily Telegraph | 9 October 2012

From the Daily Telegraph, 9 October 2012 (story by Max Pemberton)

There are serious concerns about the way Atos makes its assessments for eligibility

It is roundly accepted that a society can be judged on how it treats its weakest members. Few would want to live in a country where those who were too ill to work were left to fend for themselves. Providing assistance to those in need is fundamental to a civilised society, and I’m pleased that in this country we have a long, rich tradition of this.

But there are finite resources available, and we need to assess who is eligible for help and in what circumstances. Deciding where the line falls isn’t easy. If the bar is set too high, it risks excluding people in genuine need. If it is too low, then too many people qualify who might be able to work, and that reduces the resources available to those in greater need.

At present, anyone who claims employment and support allowance because they are too sick or disabled to work must pass a work-capability test, designed by the Department for Work and Pensions but conducted by Atos, a French company. For some time, there have been concerns about the way this company makes its assessments, but a blistering light was shone on its practices after it sponsored the Paralympic Games.

In what will surely come to be regarded as a textbook PR disaster, the strength of feeling towards this company among those with disabilities, carers and medical professionals was beamed across the world when athletes at the opening ceremony were seen covering up the Atos logo on their clothing.

Atos has been dogged by controversy ever since it took over the Disability Living Allowance assessments, and the accusation – that it unfairly fails people, thus stripping them of their benefits and placing them under extreme stress and financial hardship – was given more weight last month when a nurse who had previously been employed to assess applicants claimed that she was forced to judge disabled people as fit for work.

The company denies her allegations and says that its staff – nurses, doctors and physiotherapists – simply apply government tests. Similarly, when concerns were raised by MPs this week, defenders of the scheme replied that horror stories of people being humiliated and unjustly denied benefits were anecdotal.

This is disingenuous. The statistics, sadly, speak for themselves. A third of all appeals against the assessments are successful. Even more worrying is that the success rate of appeals increases if the Citizens Advice Bureau is involved, implying that even more appeals would be won if everyone who appealed had proper representation. Which suggests that the tests currently used to decide who is eligible for support and who is not are not much better than flipping a coin.

This becomes truly tragic when you think that behind these numbers are human beings. The National Audit Office has investigated and reported that Atos is underperforming. The British Medical Association has called for the assessment system to be scrapped. Eight out of 10 doctors report having seen patients develop mental health problems as a result of the stress of the tests.

I find it incredible that these practices – the way the company determines which applicants should or should not be awarded benefits – are not open to scientific scrutiny. They are, after all, administering a test. With any other test in medicine, a basic requirement is that the test demonstrates suitable sensitivity and specificity – in this case, that it can accurately identify those who should be receiving benefit.

It is clearly failing. Because of “commercial sensitivity”, the exact details of the tests are shrouded in secrecy, which simply isn’t good enough. The tests are being administered on behalf of the taxpaying public, and we have a right to know how people are being judged worthy of receiving our money.

A huge number of my patients, the majority with severe and enduring mental illness, have been assessed by Atos, and the results are laughable. It’s not just that the assessments are excessively harsh, it’s that they appear so arbitrary.

Reporters have gone undercover and discovered bizarre criteria. Oral chemotherapy doesn’t get points, but intravenous chemotherapy does. A BBC Panorama investigation revealed that a man who had been detained under the Mental Health Act was deemed fit for work. Every doctor I have spoken to has a similarly ludicrous story of botched assessments. This is the tick-box culture at its most sickening.

Whether the fault lies with Atos for the way it administers the tests or the Government for the way it has designed them, they are not fit for purpose. The tests and criteria used must be open to scrutiny by researchers and academics, so that their effectiveness can be monitored, just as is expected of other tests administered in medicine.

If I developed a test for cancer that was no better than tossing a coin, it would be medically negligent for me to administer it. The same applies to these assessments. Given the stress and pressure they place vulnerable people under, it’s vital that we can rely on them to give clear, consistent and valid results. We need to halt this mess before more lives are ruined.