Fit for work. Who decides?

Speaking at this year’s Conservative party conference, David Cameron said that profit will never be “a dirty and elitist word” under his administration. Fair enough. It is reasonable to expect that a company making a profit will provide the best service.


ATOS is a French company appointed by the government to carry out what are known as a Work Capability Assessments – in other words they provide medical advice to the Department of Work and Pensions on whether people claiming sickness benefit are capable of working. Apparently, ATOS does not make a profit on work it does in the UK – which includes £100m worth  for the UK government. According to a report published by the National Audit Office, the company did not pay any corporation tax in 2012. A spokesperson explained that “ …due to significant investment in the UK to maintain our business here as well as pension contributions, we did not make enough profit last year to qualify for Corporation Tax.”


So is ATOS providing a good service? Not according to the beast of Bolsover. Dennis skinner was described as red-faced with anger when he urged the Prime Minister in the House of Commons “ abolish this cruel and heartless monster called ATOS – get rid of it”. Mr Skinner had raised the issue of one of his constituents who had died from cancer while waiting for an appeal to be heard against a decision that he was fit for work,


What happens in Waverley? In the last six months almost 3,700 issues were raised by clients who  contacted the four bureaux across Waverley district (that is, Farnham, Godalming, Haslemere and Cranleigh). Of these, over 150 were concerned with appeals by people who had previously received Employment Support Allowance (ESA) which is paid to people incapable of work as a result of sickness or long-term medical conditions.


Under new rules recently introduced by the government people who want to appeal against the outcome of a Work Capability Assessment will have to seek what is known as a Mandatory Reconsideration (in other words the Department of Work and Pensions will have another look). During the time the reconsideration is being made no benefits are payable. This could clearly cause hardship and anxiety to a significant number of people in Waverley as well as elsewere.  In April of this year it was reported that nationally, 37% of appeals against benefit decisions based on incorrect Work Capability Assessments were successful.


The situation has also proved difficult for GPs. People appealing against Work Capability Assessment decisions obviously require some medical view of their condition to support an appeal. This burden falls fairly (some would say unfairly) and squarely on GPs. Some doctors are seeking payment from people needing medical opinions as part of the appeal process and some are refusing to get involved. Supporting an appeal can take up a lot of time for GPs. It is understandable that they should feel aggrieved that they are being asked to undertake this work without being paid when they are not responsible for the underlying issue.


One GP has challenged the effectiveness of the Work Capability Assessment as a realistic measure of capability to work. Writing in the British Medical Journal a former Naval GP said that the assessment involved punching superfluous lifestyle data into a computer and that it cannot take account of long-term medical conditions where the symptoms vary unpredictably..


Responding to Dennis Skinner in the Commons, David Cameron acknowledged there is a case to answer.  “Everyone who has constituency surgeries and talks to constituents knows that we have to improve the quality of decision-making about this issue.”   While the Prime Minister’s awareness of the issue may be reassuring it is clearly not going away.


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