The news that Atos Healthcare are in negotiations to withdraw from their contract with the Department of Work and Pensions to carry out fitness-for-work tests has been welcomed by many, especially those who oppose the way the current assessment regime works. Images of protestors with Socialist Worker placards - never terribly helpful to my mind - and reports of death threats against Atos staff demonstrate the passion with which groups have fought against the way things are done. But I can't help feeling that Atos are the symptom, rather than the cure, and that simply replacing them will make little difference, and might even make matters worse.
Without a sight of the contract, one must presume that Atos are obliged to carry out their assessments at a specified price, agreed in advance with the DWP. They are then free to order their affairs in such a way as to deliver the contract within that cost, maximising profit as far as they can. The profitability of the contract is, it appears, less of a concern than their competence.
But what incentive is there to do the job so poorly as to attract such a high rate of successful appeals as, presumably, Atos have to meet the cost of dealing with them, and the Ministry of Justice have to resource the tribunals - presumably what is driving consideration of levying charges against appellants. It appears to make little sense.
Perhaps it is the Key Performance Indicators (KPIs) that are part of the problem. What targets might you set as part of a contract to deliver fitness-to-work tests? A simple throughput incentive would provide little or no incentive to do the job properly, as the service provider could just pass everyone as being unfit to work. A target rate for failures would incentivise towards failing claimants regardless of whether that is merited.
How flexible is the assessment regime? The application of discretion would suggest that those people with long-term, incurable conditions need assessing less frequently, if at all, after an initial assessment, whereas others might benefit from a more frequent assessment. Does the current system allow that, and what is the impact of assessment on those who feel that they should strive, when tested, to demonstrate the limits of their capabilities, and thus give a falsely optimistic test result?
There is, of course, an underlying problem, that of who should qualify as being in need of support, and how do you ascertain whether or not an individual applicant meets the criteria set. Indeed, what should those criteria be, and what should be paid? And those questions drive the design of any assessment process.
So, unless we answer some of these questions, make relevant changes and discuss them properly, the chances are that, whoever takes the work on, be it a private supplier or by taking it back inhouse, little will change as far as those being assessed are concerned, as I find it hard to believe that Atos are any more heartless or inept as any other similar provider,. And, in any case, the staff who carry out the assessments will probably come from the same pool or have their contracts transferred over to any replacement provider.
There are some short-term solutions, however. Not charging people for appeals would be a good first statement of intent, as it indicates an acceptance that the assessment process is not without flaw - even the best system will have marginal cases. And yes, you may want to consider a means of dissuading frivolous appeals, assuming that they are significant in number, but not in such a way that puts at risk the genuinely vulnerable.
Publishing the terms of the contract as far as is possible would be the right thing to do, especially the Key Performance Indicators. Yes, some of the details will be covered by commercial considerations, but transparency when spending public money is, generally speaking, a good thing, likely to engender greater trust.
Ensuring that any new contract allows for sufficient time to carry out a proper assessment on applicants is important too. The appeals process is stressful, expensive and time consuming, an unnecessary waste of finite resources. Its impact upon those genuine borderline cases, and on those evidently mis-assessed, is traumatising and damaging. So, anything that increases the accuracy rate of assessments is beneficial to all of us.
Other issues, if you like, the bigger ones, require more reflection. Questions of who, how much, and to what end, need a more public debate, which is not shorthand for exchanges of abuse and death threats. If Atos have recorded an average of 163 death threats against their staff per week, that's either going to drive out those who genuinely care, or harden the hearts of those that don't, assuming that any of their staff are so heartless.
But there will always be a need for assessment of some kind, and a requirement for someone to carry out such assessments. There will always be error, and marginality, because the decisions are taken by humans about humans, and as even the Pope doesn't claim to be infallible, there will need to be a right of appeal. We should build compassion and humanity into those processes, whilst understanding that, for some people, compassion has a limit, and our humanity is not there to be abused.
Great post. I would say, though, that while nobody should ever have to be threatened and abused at their work, I spent years being so abused in various jobs and my heart didn't grow hard. You need to understand where those people are coming from. That, probably, is why I would never, ever get a job working for ATOS or anybody like it. But it is probably a reason why I should.
ReplyDeleteCaron,
ReplyDeleteIt takes great integrity and a lot of resilience to withstand such treatment and still care, and these cases are emotionally draining, a bit like interviewing asylum seekers, I guess. To do a really good job, you need to engage properly, and that does mean opening yourself up a little. And in an environment where public debate is so vitriolic and personalised, that leaves you vulnerable.
My job isn't any like as near to life and death as fitness-to-work tests or asylum applications, but it does involve an impact on individuals whose eyes I have to look into and give bad news. It doesn't get any easier after twenty-seven years.
Firstly Mark you are correct - no it will not make any difference.
ReplyDeleteMy own experience with regard to time is that they can be flexible as my assessments take about 50 minutes but some can be done in 20. The current system states everyone unless they have an illness that normally leads to death shall be assessed every year. However it seems that the appeal tribunal can extend this time.
My beef with Atos is that they don’t record the assessment. Atos do not make the decision nowadays (I am not sure about the past). A decision maker at the DWP does. (Atos do not have to meet any extra costs as it is the DWP who provides a written case for their decision.) I have had three assessments and within the Atos reports there have been inaccuracies but the decision makers in the guidance are told to believe the report and not the clamant (if I have read it correctly). If the assessment was audio recorded then the decision maker could check the recording for what was really said. (You can’t tape it yourself either, unless you employ someone to do it and can provide two tapes one for them and one for you.) If the medical assessor informed the claimant what they were entering on the computer then the claimant could if there was a misunderstanding explain again until the assessor understood what the claimant was saying.
One of the descriptors is about getting to an unfamiliar place. My last visit was my fourth but still the assessor stated I had said I was unfamiliar with the route to get there. (I made notes and it was clear from my notes that I had said it was my fourth visit. When you take notes they inform you that they can’t be used in any appeal, which is not exactly correct because you can use them to check what you said but you can’t send them to the DWP as proof of what you said.) When I appealed I added that while I don’t live in that town my sister does and I regularly visit it, but not only that but I had a girlfriend who I visited who lived near the assessment centre. The third decision maker (on this last decision) dismissed what I had written and quoted the medical report as if what I had stated was false.
The descriptors need revising as does the guidance. However what would also help would be if everyone who got any points at all were entitled to the benefit and not judged to be fit for work as those who scored no points. It might help if the new provider of the assessments didn’t get paid if their report was questioned by the claimant in their appeal until the appeal was decided and if the claimant won the appeal the provider was only paid some of the fee for the assessment. This would give the provider an incentive to ensure that the assessment was accurate.
Amalric,
DeleteThank you for sharing your story, and for explaining some of the process. Things like the bar on using contemporaneous notes at appeal are very troubling, as that puts into question the motives of those coming up with such restrictions.
And your suggestions sound entirely, so I hope that they are conveyed to those who can do something to address them.
Perhaps you could mention my suggestions to those parliamentarians you know and to any members of the manifesto writing team and hopefully they are people who can do something to address them.
ReplyDelete