Atos is "black and white" on fitness and disability

One man's experience of successfully appealing a Work Capability Assessment ruling.

One man's experience of successfully appealing a Work Capability Assessment ruling.{C}

I'm one of the 39 per cent. I appealed against a decision by Jobcentre Plus that, despite being five months into recovery from a stroke, I was not entitled to sickness benefit. On Tuesday, I won. The overturned decision was based on the infamous work capability tests carried out by French IT company Atos. The accuracy of the tests has been described as "worryingly low" by Citizens Advice. I know why.

In the summer of 2010 I suffered a brain haemorrhage and subsequent stroke. In comparative terms the stroke was mild, but felt devastating. My balance was shot to pieces (getting from A to B involved going via C, D sometimes S), my speech so badly slurred I could barely be understood and I developed double vision. My cerebellum had been damaged; the part of the brain that is temporarily impaired if you get blind drunk. I spent three weeks in hospital. At 40-years-old I was a relatively young, but told that recovery would take time.

After a long struggle of contending with doctor's notes that mysteriously disappeared when posted, during which time I felt that the universe personally hated me, I eventually received £65.45 a week Employment and Support Allowance. In November that year I was told by my Jobcentre Plus adviser that I would have to attend a "medical" to confirm my condition. What followed was a distinctly "unmedical" procedure to demonstrate that I was capable of work, when I obviously wasn't.

I arrived at a former driving test centre on a cold Saturday morning in December 2010. I sat alone in the waiting room. The test had been postponed from the previous week because -- you have to admire the irony -- the doctor was sick.

The test lasted no more than 20 minutes. I was asked various questions by a "healthcare professional" sat behind a desk about whether I prepared my own meals, did my own shopping, walked to friends' houses nearby. The answer, in all cases, was a "Yes, but . . .". But as the computer keyboard rattled in response to my answers, I realised that there were no conditionals in the Atos universe.

The "but" was all the difference in the world, both to me and any potential employer. I could perform "tasks" as the pre-assessment form put it; but if done repeatedly, as real jobs tend to demand, they would soon result in chronic fatigue, and the deficiencies of my damaged brain would come to the surface. My speech would become incomprehensible, my dexterity would collapse, I'd have to squint to see properly, I wouldn't be able to walk in a straight line and concentrating would become an insurmountable achievement. Besides the loss of balance, I have a permanent sense of slight dizziness. I pointed this out but had the feeling no one was listening.

The Atos doctor ploughed on with the test. I was asked to touch my fingers, just once, above my head. I'm still not sure what this proved. The doctor then shook hands and asked if I was satisfied. As I left I could feel his eyes in the back of my head as I walked, slowly, down the corridor.

In employment terms, at that stage in my recovery I was useless. I knew I was unemployable, my Jobcentre adviser knew I was unemployable. But Atos -- and the Department for Work and Pensions -- thought otherwise.

Two weeks later, I was phoned by the Jobcentre and told I had been found fit for work. I received the test report through the post. My disabilities had been minimised and frozen in time: if I could do something once, I could do it, period. Unhesitatingly, I appealed against the decision.

Atos says it is focussed on high standards and its customer satisfaction ratings exceed 90 per cent. Also, it works under contract -- worth £100m -- from the Department for Work and Pensions. The government ultimately decides what level of incapacity has to be shown to qualify for benefit.

I was plunged into a horribly unfair struggle to prove what I knew what wrong with me; all the time aware of the irony that if I applied for an actual job then my real abilities, or lack of them, would be glaringly exposed. It was cruel. With the government "unreservedly and implacably opposed" to letting the "real world" impinge on the work capability test, the cruelty and colossal expense, estimated at £50m, of thousands of sick people appealing against the injustice, will go on. I hope it never happens to you.

Mathew Little is part-time freelance journalist.

CREDIT: PETER DAZELEY/PHOTOGRAPHER’S CHOICE
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The overlooked aspect of patient care: why NHS catering needs a revolution

The NHS performs so many miracles every day – in comparison, feeding the sick should be a doddle. 

A friend recently sent me a photo from her hospital bed – not of her newborn baby, sadly, but her dinner. “Pls come and revolutionise the NHS” the accompanying text read, along with a plaintive image of some praying hands. A second arrived the next morning: “Breakfast: cereal, toast or porridge. I asked for porridge. She said porridge would be ‘later’. Never arrived. (sad face).”

Contrast this with the glee with which another friend showed me his menu at a Marie Curie hospice a few weeks later. He seemed to have ticked every box on it, and had written underneath his order for syrup sponge and custard: “extra custard please”. It wasn’t fancy, but freshly cooked, comforting food that residents looked forward to – “like school dinners”, he sighed, “but nice”.

To be fair, though budgets vary significantly between hospital trusts, a reliable estimate suggests £3.45 per patient per day as an average – only slightly more than in Her Majesty’s prisons, though unlike in prisons or schools, there is no legally enforceable set of minimum standards for hospital catering. As Prue Leith writes in the foreword to a 2017 report by the Campaign for Better Hospital Food, “this means hospital food is uniquely vulnerable to a race to the bottom in terms of food quality, and patient care”.

Plate after plate of disappointment is not only demoralising for people who may already be at a low ebb, but overlooks the part food has to play in the recovery process. Balanced, appetising meals are vital to help weaker patients build up strength during their stay, especially as figures released in February suggest the number of hospital deaths from malnutrition is on the rise. According to Department of Health findings last year, 48 per cent of English hospitals failed to comply with food standards intended to be legally binding, with only half screening every admission for malnutrition.

The Campaign for Better Hospital Food’s report, meanwhile, revealed that only 42 per cent of the London hospitals that responded to its survey cooked fresh food for children – even though the largest single cause of admissions in five-to-nine-year-olds is tooth extraction. Less than a third of respondents cooked fresh food for adults.

Once the means to produce fresh meals are in place, they can save trusts money by allowing kitchens to buy ingredients seasonally, when they are cheaper. Michelin-starred chef Phil Howard, recently tasked by the Love British Food organisation to cook their annual lunch on an NHS budget, explained that this, along with using cheaper cuts and pushing vegetables centre stage, allowed him to produce three courses rather than the two he’d been asked for. Delicious they were, too.

Andy Jones, a chef and former chair of the Hospital Caterers Association, who was there championing British food in the NHS, told me the same principles applied in real healthcare environments: Nottingham City Hospital, which prepares meals from scratch, saves £6m annually by buying fresh local ingredients – “I know with more doing, and voices like my small one shouting out, we will see real sea change.”

Unusually, it’s less a question of money than approach. Serving great hospital food takes a kitchen, skilled cooks and quality ingredients. But getting every hospital to this point requires universal legal quality standards, like those already in place in schools, that are independently monitored.

Nutrition should be taken as seriously as any other aspect of care. The NHS performs so many miracles every day – in comparison, feeding the sick should be a doddle. 

Felicity Cloake is the New Statesman’s food columnist. Her latest book is The A-Z of Eating: a Flavour Map for Adventurous Cooks.

This article first appeared in the 18 April 2018 issue of the New Statesman, Enoch Powell’s revenge