After hated Atos quits, will Maximus make work assessments less arduous? | TheGuardian.com | 18 January 2015

from TheGuardiam.com, 18 January 2015 (Story by Amelia Gentleman).

Bombarded with abuse and with its reputation tarnished, Atos has bought its way out of its £400m state contract to assess if benefit claimants are fit to work. A new company, Maximus, is taking over. Who is behind it – and will they do anything differently?

Shortly before Atos bought its way out of the contract to conduct the government’s controversial fitness-for-work testing scheme, the company briefed journalists about the scale of abuse its employees were facing. As well as periodic bomb threats to its testing centres, the company said managers had recorded about 163 incidents of assault or abuse against staff every month in 2013.

Online, the abuse was vitriolic. One Facebook post asked: “Know anyone who works for Atos? Kill them”; another described employees as “murderous scumbags”. In the past six years the company has been targeted repeatedly by protesters who picket its offices, waving placards that state: “Atos Doesn’t Give a Toss”, or more brutally: “Atos Kills.” To counter the heightened sense of alarm, Atos doctors and nurses were equipped with panic buttons, and the layout of the assessment rooms was changed so that health assessors could sit close to the door, allowing them to flee if necessary.

Last March, the company announced it was quitting its five-year £400m contract early, paying to escape prematurely with a “substantial financial settlement” to the Department for Work and Pensions. (“Atos declared not fit for work,” headlines noted.)

In March, a new, US company, Maximus, will take on the job of assessing whether claimants are eligible for sickness and disability benefits. To listen to ministers’ excitement about the switch, it is as though this moment heralds a beautiful new dawn for the most controversial scheme in the government’s welfare reform programme.

But how much better, or even different, this new dawn will be remains uncertain. Anyone who has followed the unhappy saga of Atos and the work capability assessment, through what has been one of the most troubled government outsourcing contracts in history, will be sceptical.

Shortly before Atos bought its way out of the contract to conduct the government’s controversial fitness-for-work testing scheme, the company briefed journalists about the scale of abuse its employees were facing. As well as periodic bomb threats to its testing centres, the company said managers had recorded about 163 incidents of assault or abuse against staff every month in 2013.

Online, the abuse was vitriolic. One Facebook post asked: “Know anyone who works for Atos? Kill them”; another described employees as “murderous scumbags”. In the past six years the company has been targeted repeatedly by protesters who picket its offices, waving placards that state: “Atos Doesn’t Give a Toss”, or more brutally: “Atos Kills.” To counter the heightened sense of alarm, Atos doctors and nurses were equipped with panic buttons, and the layout of the assessment rooms was changed so that health assessors could sit close to the door, allowing them to flee if necessary.

Last March, the company announced it was quitting its five-year £400m contract early, paying to escape prematurely with a “substantial financial settlement” to the Department for Work and Pensions. (“Atos declared not fit for work,” headlines noted.)

In March, a new, US company, Maximus, will take on the job of assessing whether claimants are eligible for sickness and disability benefits. To listen to ministers’ excitement about the switch, it is as though this moment heralds a beautiful new dawn for the most controversial scheme in the government’s welfare reform programme.

But how much better, or even different, this new dawn will be remains uncertain. Anyone who has followed the unhappy saga of Atos and the work capability assessment, through what has been one of the most troubled government outsourcing contracts in history, will be sceptical.

For many disability campaigners, the substitution of Maximus for Atos offers nothing new. They question whether the state should be paying global companies to make a profit out of performing such sensitive tasks, and whether it is right to continue to outsource the work when there have been such enormous problems with the current system.

It’s clear that Atos has no regret about washing its hands of this contract. The company was recently advised by a PR firm that it had extremely high brand recognition for all the wrong reasons. The company’s senior vice-president, Lisa Coleman, was asked during a select committee hearing a few months ago: “If you knew then what you know now, would you have bid for the contract in the first place?”

She replied: “Quite honestly […] probably not.” The rest of her answer indicated that the primary reason that Atos quit the contract was less to do with staff safety, and much more to do with the company’s image and bottom line. “I have shareholders and stakeholders who would not let me bid for a contract that would give rise to both the reputational and profitability issues we are facing now,” she said.

The work capability assessment (WCA) was launched for new claimants by the Labour government in 2008. The policy was aimed at cutting the benefits bill – the scheme was set to save around £1bn over five years. Officials won’t admit it, but the money-saving aspect of the scheme lay in fundamentally redefining the nature of disability. When people who had been receiving the old incapacity benefit were retested to see if they were eligible for the new employment and support allowance (ESA), the initial assumption was that 23% of people who went through the test would be found fit for work. “This increases the estimated net savings,” an official document from 2010 notes.

But in human terms, the change meant that large numbers of people who had previously been classified as ill or disabled enough to qualify for benefits were suddenly and unexpectedly being told that they were well enough to find a job.

Initially, the test was so faulty that people with terminal cancer were being found fit for work and denied the extra financial support (at £108 a week, employment and support allowance – ESA – is about £30 more than jobseeker’s allowance). But despite its flaws, the assessment was rolled out in 2010, starting the process of retesting around 1.5 million incapacity benefit claimants.

Crudely, there were two ways of looking at the test – either it was a long-overdue reform that stopped people from getting a benefit to which they were not entitled (the Daily Mail described it as a “tough new test to weed out the workshy”), or it was a cruel, cuts-driven measure, saving money at the expense of the country’s most vulnerable.

People such as Larry Newman were declared fit for work, despite the fact that they were profoundly unwell. Newman, who had worked all his life and who was dying of a respiratory condition, was so upset by the test’s conclusion, and – as he saw it – the suggestion that he had previously been lying to get a benefit, that one of the last things he said to his wife, as doctors put him on a ventilator, was: “It’s a good job I’m fit for work.”

Anger stemmed in part from the way that the tougher new programme to find people fit for work mirrored a growing government rhetoric suggesting that people who tried to claim sickness benefits were skiving, simply unwilling to work. “We are ending the something-for-nothing culture,” became a familiar slogan in ministers’ speeches.

By 2012, hundreds of thousands of shocked people were going to tribunal to appeal their fit-to-work assessment. Courts had to open on Saturdays, new judges had to be hired, and the cost to the Ministry of Justice was estimated at £60m a year. On average, around 40% of those refused the benefit go to tribunal, of whom 40% are subsequently granted the benefit.

In a commons debate in 2013, MPs revealed that 1,300 people had died after being told they should start preparing to go back to work. MPs from all parties described meeting constituents who had been made more unwell by the “humiliating and demeaning” process.

Throughout this period, Atos, which was previously a low-profile, French IT firm, was the focus of rising public anger. When Atos sponsored the Paralympics, hundreds of protesters visited its headquarters (again) to show their anger.

The decision to leave the contract does not appear to have been a hard one. In any case, the company has plenty of other fish to fry; it received £700m in public sector and UK central government revenue in 2012-13, according to the National Audit Office, and can afford to drop this one (worth around £80m a year). Despite the scandals, Atos was awarded a separate contract to perform a different disability benefit assessment scheme – for personal independence payments – another reformed benefit, designed to cut 20% from the bill. This separate testing process, launched in 2013, is already behind schedule and causing widespread unhappiness.

Disability campaigners were affronted by the company’s decision to cast its decision as a response to abuse from claimants. John Pring, of the Disability News Service, wrote that the “Atos claim that its staff were regularly being assaulted by benefit claimants was an attempt to shift the blame”.

In the Maximus temporary headquarters, in a shared, shabby building by Victoria station in London, (where everyone is so new that they struggle to find the exit), there is a determinedly upbeat atmosphere, with staff outlining how the new regime will be characterised by a new compassion. Leslie Wolfe, the Canadian programme director of the company’s fitness assessment programme, is smiley and soft-spoken, wears her hair in a hippyish side pony-tail and talks about how her staff will have more time to listen. Did the endless UK headlines criticising Atos’s performance make the company nervous about the potential for brand damage to Maximus? Wolfe and her press adviser answer simultaneously and their response is confusing. He says: “No.” She says: “Yes.”

“Nervousness is probably not the right word. There was an awareness of how high the public profile of this contract is,” the press adviser says. “That’s probably a better way of putting it,” Wolfe agrees.

Maximus has had its own experience of negative headlines already. As soon as the government revealed that Maximus was to take over, offering a “fresh approach”, disability campaigners here unearthed a stream of problems with Maximus contracts in the US. In 2000, an audit showed Maximus had billed the state of Wisconsin almost $500,000 since 1997 in improper or questionable expenses; the company paid back $500,000 and made another payment of $500,000 as a show of good faith. In 2007, the company settled a Medicaid fraud lawsuit – centring on whether it falsified tens of millions of dollars of Medicaid claims – with a payment of $30.5m.

The company describes these issues as “historic”, and not something that will impact on its ability to deliver a good service here.

Aware that Atos’s global reputation took a savaging from its association with the fitness-for-work programme, the new firm will not be substituting its own company logo for Atos’s on the letters sent to benefits claimants. Instead, it will brand the business with a more “neutral name”, Wolfe says, likely to be the Centre for Health and Disability Assessments. “I was surprised that there was so much criticism of Atos as a company … We’re not used to British press,” she says. She believes that much of the coverage of Atos has been “unjustifiably negative” because the company had become synonymous in people’s minds with a very unpopular government programme.

What startled Wolfe and her colleagues goes to the heart of the strangeness around popular loathing of Atos. Over the years, the company has become a convenient lightning rod for public unhappiness. Much of the criticism might more accurately have been directed at the government. “The DWP are responsible for setting the policy and making the decision. If the assessment is conducted correctly, I don’t think the supplier should be criticised. That’s the part we found disconcerting … It seemed that they were being criticised beyond their responsibilities,” Wolfe says.

From next March, there “will be more touch, more communication”, she says. Things will instantly improve, she adds, “if we can reach out and make people understand the process they are going through … if we can reduce some of the anxiety … if we can schedule more intelligently … if we can speak to people rather than just sending letters. Those are some of the differences … We believe if we do it right, we should be able to do this in a good way.”

But beneath the new veneer how much will things have changed? The government’s policy of a much tougher eligibility test for sickness benefits, designed to cut the overall benefits bill, remains. Maximus must carry out the same test, assessing claimants’ capacity to work, according to the same rules that Atos used. It inherits the same much-distrusted computer program to do so; assessors will still ask people a series of oblique and sometimes apparently irrelevant questions (“do you have a pet?”; “do you regularly watch a soap on television?”) that build up a picture of someone’s ability to work. Claimants accrue points according to (among a long list of criteria) their ability to walk certain distances, pick up a coin or bend over; those who collect 15 points or more may be eligible.

At the heart of the programme, very little will be different. Most of Atos’s staff will be given the option to transfer to the new company. Some of the senior managers have already left Atos to join Maximus.

Privately, staff admit it was becoming difficult for the company to recruit new doctors and nurses. “If you get invited for a job interview, the first thing you do is Google the company. That does put a lot of people off,” an Atos source says. The struggle to recruit staff meant that backlogs mounted. Because claimants were coming into their assessments feeling terrified, staff were spending longer trying to reassure them. “You see people who are vulnerable, who don’t think they are going to get a fair hearing, who have read that you are evil. It’s really difficult to manage as an organisation,” an Atos source says.

Although there’s a logic to the defence that it was merely carrying out a hated policy, Atos has not been faultless in its execution. There have been mistakes and, increasingly, there have been huge delays as the company struggles to assess the people it is contracted to see.

The government has carried out five annual reviews and made improvements; several of these reviews criticised Atos’s performance. Claimants describe doctors barely making eye contact as they type information into the computers. There were complaints over the fact that several of the testing centres have no disabled access (Atos says this was not its fault, because the buildings are owned by the DWP, and it seems that this is a problem that remains for Maximus to resolve). There were reports of inaccuracies in the information logged; Cecilia Anim, for example, was unhappy that her daughter Ruth, who needs constant one-to-one care, was classed as someone who would be capable of finding work in the near future, but she was also extremely angry that Ruth had been described as a “male client” in the Atos report.

The company has been dogged by suspicion that it worked to targets to reduce the number of people who received the full benefit, although both the government and Atos have consistently denied this.

Given this profoundly hostile environment, why would Maximus want to take on such a risky contract?

First, there is more money in the programme, more than double what Atos was receiving for the contract, although it’s structured in a different way – the company is likely to receive between £590m and £650m over three years. Second, it’s a gateway for a large American company to expand into Europe. The company has a global staff of 14,000, with 10,000 in the US. “We have a presence in US, Canada, Saudi, but we didn’t have a UK presence,” says Wolfe.

The key thing the company will do differently is increasing the number of staff, by roughly an extra 1,000 people, bringing the total employed on the contract to around 1,500 to help clear the backlog of approximately 600,000 people waiting to be assessed and to allow them to treat claimants with greater sensitivity.

Currently, 40% of assessors are doctors, 40% are nurses and 20% are physiotherapists. Maximus will be reducing the proportion of doctors, and employing occupational therapists instead – which will be cheaper. The company promises to improve training around mental health, and conditions that fluctuate – two of the most problematic areas.

In meetings with the staff that Maximus will inherit, Wolfe has noticed their “weariness”. Staff have asked her how things will change. They have also asked whether security will remain strong; she has reassured them that personal alarms will be available, or someone who can walk them home at the end of the day.

In a shrewd move, the company announced at the start of the year that it was hiring the most vocal campaigner against the testing system, Sue Marsh – who has spent the past five years charting her unhappy experiences with the system and calling on her Diary of a Benefit Scrounger blog for the WCA to be scrapped. Her appointment as head of customer experience triggered a wave of online abuse, in which she was accused of “catastrophic betrayal”, but she says she hopes to introduce improvements. “I don’t feel comfortable saying I know who Maximus is yet. How is it going to go? Ask me in six months.” She says she will leave if she witnesses anything “utterly unacceptable”.

Mark Harper, minister for disabled people, is optimistic. “The WCA was introduced in 2008 and we know it wasn’t working as well as it should; we have made significant improvements to make it better, fairer and more accurate.”

In 2012, the National Audit Office found that the government had “not sought adequate financial redress for underperformance” in drawing up a contract with Atos. The DWP says the new contract contains “robust contract-management processes”, which allows the department to seek “financial compensation” if the supplier is “unable to meet our expectations”.

But analysts warn that the whole system has ground to a halt and is in danger of “falling over”. The Office for Budget Responsibility predicted in December that the backlog would take two years to clear, and that these delays to the process would eat into the savings the government hoped to see, by as much as £700m a year. The whole point of the scheme was to reassess incapacity claimants, and in doing so reduce the overall numbers getting disability benefits. That process was meant to have finished in March 2014, but to date another 490,0000 claimants are still waiting to be reassessed. In recent months there also seems to have been a dramatic softening of the policy, with more than 50% of people being tested being found unfit to work, and granted the full benefit.

Tony Wilson, policy director for the Centre for Economic and Social Inclusion, says: “The impact of those delays will cost £700m a year, which is huge, staggering. I think Atos have reached a point where this is not viable for them. Maximus think they can make it add up.”

But he is uncertain whether they will manage. “Maximus have an incredibly stretching target, to recover from a position where the WCA has almost fallen over. They have an absolutely huge job. The jury will be out for some time.”

Close observers of the process are not convinced that things will change much. John James McArdle, of the Black Triangle disability campaign group, says: “The staff won’t change. It’s just going to be rebranding.”

Anne Begg, chair of the work and pensions select committee, which has repeatedly grilled Atos management, says: “If the test is designed badly, it doesn’t matter whether it is done in house or by a private company.” The committee concluded last summer that: “The flaws in the existing ESA system are so grave that simply ‘rebranding’ the WCA by taking on a new provider will not solve the problems: a fundamental redesign of the ESA end-to-end process is required.”

Cathie Wood, whose vulnerable brother Mark Wood starved to death in 2013, four months after an Atos test found him fit for work, is not hopeful that things will improve much. “The DWP sets the policy. These companies just execute it and make money. It’s an industrial process in which people get squashed and my brother was one of them.”