The Secret Cuts: Part Six, How are those with mental health problems treated by Atos?

With complaints about the failed Atos work capability assessment flooding in, Alan White and Kate Belgrave look at some of them.

Update 5 September 2013

This piece originally mentioned allegations that a client was charged £70 by an agency called Outlook South West for a letter outlining his mental health problems. They have been removed. A spokesman for the company has since told us: "We give patients access to their clinical records for free, including any print outs they may require. We have also spoken with the client in question (before the article was published) to reassure them that we could provide what they asked for free of charge and they were quite satisfied with this."

Update, 28 August 2013

In the article below, we talked about GPs being instructed by their Local Medical Committees to stop providing medical support information for disability benefit claimants appealing “fit to work” decisions. That decision by the Bro Taf LMC in Wales had sparked real concern among claimants and campaigners, as you’ll read below.

Now, the ante is being upped even further. GP magazine Pulse is reporting “that Local Medical Committee leaders are considering a ‘Just Say No’ campaign to support [GP] practices who refuse to take on unfunded work.” The story says that LMC leaders have: “already drafted a letter to help them turn down patient requests for support when appealing against their benefits being withdrawn.”

The magazine goes on to say that:

The campaign would be designed to back GPs who turn down requests for medical reports from benefit claimants and requests for work from secondary care. The LMC leaders from Lancashire and Cumbria have already come together to create a template letter for all GP practices to use in the area advising patients against personally asking for help from their GP. But they are also planning on taking forward a campaign to widen a "just say no" campaign to other areas of unfunded workload at its next meeting, including requests from hospitals and other parts of the NHS and social care.

Meanwhile, the Bro Taf local medical committee issued another statement which took an even harder line than the first: it says that “under their NHS contract there is no requirement for GPs to provide reports or offer an opinion on incapacity for work to anyone unless requested to do so by Jobcentre Plus" (you can read the whole statement here). This and the amounts of money that benefit claimants are being asked to pay for medical support information (see below) will leave many claimants in a very bad position - they’ll have trouble getting the information that they need to support their appeals and may be priced out of getting it even if their GPs agree to supply it. That’s an impossible situation and it can’t be allowed to continue.

Original Story

Tony Lea, who runs the Cornish benefit advice charity Bufferzone, wants to tell us about Jane. She suffered abuse from the age of 13. She never went to school and she can’t read or write. She’s 33 years old and has tried to kill herself before.

In February this year, the outsourcing company Atos carried out her Employment and Support Allowance Work Capability Assessment (WCA). She didn’t score any points on the mental health ability descriptors, and was placed in the ESA Work Related Activity Group – the group for claimants that the DWP considers to be capable of work at some point.

She was assigned a career adviser by a company called Prospects, which is contracted to find jobs for the unemployed under the Government’s Work Programme. Jane told this adviser that she had mental health problems. The adviser called her a liar and sanctioned her benefits. By June, Jane had got a job. She was in the job for three days before she tried to commit suicide by overdose.

On 2nd July, Tony told the Prospects career adviser not to contact her, and asked a mental health crisis team to carry out an immediate assessment. On the 29th of that month she tried to take an overdose again. Tony says this was because Prospects sent her a letter. She’d been receiving them for months, asking why she hadn’t been in contact with them. She can’t read and didn’t want them read it out to her, so she’d been storing them in a drawer: 18 of them in total. She recognised the company’s logo on the top, and that tipped her over the edge.

Tony made an official complaint. The DWP said it would not investigate the matter because Prospects has its own internal complaints procedure. On 5th August another Prospects worker phoned Jane. Tony believes “we’d have been looking at another suicide attempt,” had another mental health team not visited her.

When we contacted them, Prospects issued the following statement:

“Prospects strongly refutes the allegations made by Bufferzone which purportedly relate to one of our customers on the Work Programme in South West.

"Prospects takes its responsibilities to its customers and staff seriously. We have robust policies on safeguarding and data protection in place to ensure their privacy and safety is always maintained. With this in mind, it would be inappropriate for Prospects to comment on individual any cases.

"Prospects is currently helping more than 18,000 long term unemployed people in the South West to return to work through its innovative ASCENT model of delivery. Prospects works with customers to help them overcome barriers to employment through bespoke support and training to increase confidence and develop skills.”

***

You can see why there is such concern about the way that the WCA deals with people who have mental health conditions - and concern about the DWP’s commitment to a real overhaul. Here’s a reason to question that commitment: the Upper Tribunal recently ruled that the current WCA process is unreasonable to people with mental health conditions. That ruling came after an action against the DWP was brought by the Mental Health Resistance Network. Two claimants argued that Atos work capability assessments discriminated against people with mental health conditions. The courts agreed.

That decision would have put the onus on the DWP to source medical information for people with mental health conditions right at the start of their ESA applications. Unfortunately, the DWP is fighting that decision tooth and nail - and was recently granted leave to appeal it. "We already request claimants supply any evidence they feel will be relevant to the assessment in the ESA50 questionnaire," the department said in an email. The fact that the change could improve the experience for people who must go through the appalling work capability process appears to be neither here nor there.

Neither is the fact that sourcing people’s medical information at the start of their WCAs might improve things as far as the public purse goes – people found eligible for ESA from the start would not need to take their case through the wildly oversubscribed and costly appeals process. You’d also think the fact that the minister for employment, Mark Hoban, has been forced to admit there are problems with the assessments and the written reports that Atos produces (“an unacceptable reduction in the quality”) would give the DWP reason to pause when looking to overturn decisions which could dramatically improve the information available to Atos assessors. (Hoban has also brought in his former employers, PricewaterhouseCoopers, “to provide independent advice in relation to strengthening quality assurance processes across all its health and disability assessments.” Ahem).

And then Tony tells us about Claire. She has a history of depression and suicide attempts. The WCA said there was nothing to go on regarding her mental illness. But the mental health team and Tony told Atos and the DWP not to contact her because they strongly believed she had a paranoid schizophrenia condition.

When her case went to tribunal, Claire only had medical evidence that was over ten years old, because her GP refused to provide evidence. The DWP supplied no evidence to back up its case that she was in good mental health. The tribunal chair was deeply unimpressed with the stress to which she was being subjected, and demanded medical evidence from both the department and her GP. Now she faces another tribunal in six weeks’ time.

Tony will most likely win the tribunal. Last year he attended 104 tribunals with nine losses: a 93 per cent success rate. His overall rate of success is 98 per cent. As he says: “Atos are so bad they make my job easy.”

***

This whole scene is a catastrophe. The implosions are everywhere. A few weeks ago, disability benefit claimants and campaigners were shocked to read that GPs in south east Wales had been told by the Bro Taf local medical committee to stop providing support information for disability benefit claimants appealing “fit to work” decisions, because the work was an “abuse of resources”. We spoke to the Bro Taf LMC, which sent this statement (and they said they’d be issuing another one this week, so we’ll look out for that) to say that their problem was not with providing medical evidence for claims, but for the “increasing number of appeals [which] has resulted in more GP appointments being taken up to deal with such requests.”

None of which helps claimants and we’re looking for a legal view on that withholding of support information. Public Interest Lawyers’ Tessa Gregory says: "It can’t be right that claimants are left without vital medical evidence from their GPs to support them in their appeals against Atos assessments which are notoriously unfair. We are considering the position of both the DWP and the Local Medical Committee carefully to see whether a legal challenge can be brought to ensure that claimants get the assistance they require."   

The WCA’s systemic failures are causing complete havoc.

Only a day before the Bro Taf story appeared, industry magazine Pulse reported that “GPs were struggling to cope with a 21 per cent rise in requests to verify work capability since January [2013]” – saying that figures obtained by Pulse “showed the number of requests to verify claimants’ ability to work have increased by over a fifth since the beginning of this year.”

Note the anger in the comments on that story, with people arguing that they're doing the extra work for social security “reform”, while Atos makes the profit - “ATOS collects the money. GPs do the work. Welcome to the Tory vision of privatisation.”

As far as charging for medical information is concerned: it's not new for GPs and consultants to charge (there's a list of some charges here) – but the problem in the case of disability benefits is that cost could be pricing people out of vital information they need to support their claims and leave them with absolutely nowhere to go. What happens then? Around the country, people are being asked to pay £20, £30, £50 and more for medical evidence (you can see in the comments here that even last year, people were being charged upwards of £100 for support information and saying they couldn’t afford to pay it).

The Citizens Advice Bureau saw all this a mile off: they raised the issue of cost back in their January 2012 investigation (called Right First Time) into the accuracy (or otherwise) of ESA reports. The CAB observed then that: "In many cases, NHS doctors will charge an average of £30 (we have evidence of consultants charging £200 an hour) for medical evidence and few people on low incomes can afford to pay this much out of an income of £67.50 ESA (assessment phase rate) per week." That was over 18 months ago. As the number of appeals skyrocketed, this problem could only grow.

And it’s grown into a right disaster. When the Bro Taf story broke, the disability campaigner Sue Marsh wrote about Mark Hoban’s attempts to shift responsibility for the ever-burgeoning appeal rate: as she said here, Hoban has implied that the high rate of ESA appeals is at least in part because people don’t have enough medical evidence:

“DWP ministers have blamed the staggering 43 per cent ESA (Employment and Support Allowance) appeal rate on claimants not requesting and submitting enough medical evidence. As Mark Hoban claimed, “What’s happening too often is people are suggesting to claimants ‘oh, just leave the medical evidence until the appeal’ – there’s a shared responsibility here.”

In theory, within the claim process, Atos is expected to request evidence from a claimant’s doctor when the claimant is likely to be placed in the Support Group. For the year up to October 2012, Atos only requested such evidence (as an ESA113 form) in 27.2 per cent of all ESA referrals; 23.8 per cent of these were not returned by GPs.” The DWP would have us believe that extra sourcing of information is a robust part of the WCA process: when we asked why it was trying to overturn the Upper Tribunal decision on mental health claimants, the department said: “Atos healthcare professionals will continue to seek further medical evidence in accordance with the Department’s guidelines.” Doesn’t sound like that’s going too well.

Sue Marsh tells us that Hoban needs to sort it out. “The ESA50 clearly suggests that a claimant sends in medical evidence from a consultant or GP that knows them best. If those medical professionals are now withholding that vital support and Mr Hoban insists that it is necessary for an accurate WCA decision, he MUST act immediately to make sure that medical professionals cannot refuse to provide this evidence and that they are not allowed to charge punitive fees for obtaining it."

 

All Bufferzone client names have been changed

Atos. Photograph: Getty Images
Photo: Getty
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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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