Citizens of the United Kingdom probably take it for granted that the quality of debate in the House of Commons is usually very high (Prime Minister’s Questions being the dishonorable exception) and that all the questions raised in that place receive an answer.
How sad to see that this is a comfortable lie.
The Minister of State at the Department for Work and Pensions, Mark Hoban, directly answered only 10 questions, among the dozens that were put to him at the debate on Atos’ handling of the Work Capability Assessment (WCA) for Employment and Support Allowance on Thursday.
He added a handful of ‘answers’ that were not related to specific questions, and left a great deal of very important issues hanging.
It is interesting that Mr Hoban was the minister who attended the debate. Here in the UK we do, in fact, have a minister dedicated to the needs of disabled people. At the moment, that minister is Esther McVey. Where was she on Thursday afternoon and why did she not take part in this important debate?
Let’s have a look at the questions that were graced with responses. I think we’ll see the reasons for Mr Hoban’s choices very quickly.
“We are, in effect, trying to put a sticking plaster on a gaping wound,” said Labour MP Ian Lavery (Wansbeck). “Atos and the WCA are not fit for purpose. Does the hon. Gentleman agree that we should bin them both, and start again with the idea of looking after disabled people, rather than the opposite?”
Mr Hoban did not. “Much has been said about employment and support allowance not working—that is untrue,” he said. “What we are seeing is people coming off ESA and getting into work. The number of working-age people on ESA and incapacity benefit in February 2012 was 2.56 million—the lowest level since the introduction of IB in 1995. Early estimates to September 2012 suggest that overall numbers for this benefit are falling and will for the first time be below 2.5 million.”
So his yardstick for success was the number of people who have been cut off from benefit. That’s very revealing.
“Professor Harrington [Malcolm Harrington, who was hired by the DWP to lead three independent reviews of the assessment system] has made it quite clear that the WCA, designed as a first positive step for work, is the right concept for assessing people who need our support. There is a need to improve it. No one doubts that, which is why we have implemented Professor Harrington’s recommendations. The assessment we inherited needed refinement. That is why we accepted and have largely implemented more than 40 of his recommendations over the past two years. That is why twice as many people have gone into the support group in comparison with when ESA was introduced.”
His colleague, Charles Walker (Con, Broxbourne), did not seem to share Mr Hoban’s glowing opinion of these improvements to the system. He asked: “Does my hon. Friend share my fear that the reputation of Atos may be so damaged that it can never really be effective? Perhaps the time has been reached when we need to park Atos and move on in a different direction.”
In response, the minister said: “Let me deal with the issue of Atos’s capability. Atos deals with 100,000 cases every month and it consistency meets the quality thresholds. Only 3.6 per cent of assessments are below standard compared with a threshold of five per cent. It receives complaints about only 0.6 per cent of assessments. DWP decision makers return to Atos assessments that are inadequate for reaching a decision in only 0.2 per cent of cases.”
Note that we are not told what these quality thresholds may be, so let’s turn to the question from Natascha Engel (Lab, North East Derbyshire), who said: “The proportion of original Atos decisions that are overturned is shocking—it is about 30 per cent or 40 per cent. I would be grateful if the Minister replied to that point. Precisely how many people deemed fit for work by Atos have their decisions overturned on appeal and are signed off work?”
Get ready for a shock because this is where Mr Hoban departed from the script with which we’re all familiar: “Let me be clear about the rate of successful appeals. Of all the fit-for-work decisions taken by the Department, only 15 per cent are overturned on appeal. Only 15 per cent of all the decisions we take, then, are overturned on appeal, which I think demonstrates that while we need to ensure that there is a proper appeals process, we should not be bandying around figures that misrepresent the level of successful appeals.”
Only 15 per cent? Where did he get that figure? Other MPs quoted the 40 per cent figure in the debate, including some who had received it as a reliable figure in committee. Perhaps Channel 4’s FactCheckers should get onto this one!
Look, here’s Austin Mitchell (Lab, Great Grimsby) making that exact point: “As our Committee was told, 38 per cent of the cases that go to appeal—I advise all my cases to go to appeal—are successful in reversing the verdict. That demonstrates its inadequacy and the enormous cost in the reassessment process at appeal, a cost that is not taken into account in the Government’s estimates of the savings produced by the system. [We’ll come back to those costs later, although we won’t get an answer to that question] Those reassessments are usually done with the help of the patient’s own doctor, so I do not see why their doctor’s view cannot be invoked and used at an earlier stage in the process. After all, the Government are giving more power to the doctors and claiming that they represent the patients. The doctors know the long-term conditions—they are treating the patient—so why are their views not taken into account by Atos at the start?”
The closest I could find to a response was in fact an answer to a question from Sheila Gilmore (Lab, Edinburgh East): “When we asked judges why they overturned DWP decisions, they said that an error in the Atos assessment was the primary reason for an overturn in only 0.3 per cent of cases. However, although it happens very rarely, I agree with her on one point: I would like to get more information from the judges.” [I was later told that the prime reason for overturns is medical evidence from claimants’ doctors that was ignored by the Atos assessors and DWP decision-makers]
Moving on to specific issues, of the seven questions asked by Michael Meacher (Lab, Oldham West and Royton), Mr Hoban answered only one. That in itself should tell you how selective the responses were, and how little real information was in fact released. Mr Meacher asked: “Will the Minister accept that the current criteria and descriptors do not sufficiently—or even at all—take into account fluctuating conditions, especially episodic mental health problems? How will he rectify that?”
“That is not the case,” said Mr Hoban. “It gives people with a fluctuating condition the opportunity to explain how their condition varies over time. It is not a tick-box assessment, as some have suggested. There is a discussion between the health care professional and the person making the claim for ESA to determine how their condition varies over time. The questionnaire that customers are sent has been redesigned for that purpose, and people are now asked to give more details about how their fluctuating condition affects them as an individual. If a person cannot carry out a function repeatedly and reliably, they will be treated as unable to carry out that function at all. We all recognise that the capacity of people with a fluctuating condition can change, and it is important that proper regard should be given to that fact.”
How interesting, then, that Stephen Timms (Lab, East Ham) asked when changes to the descriptors for fluctuating conditions and mental health conditions, which were recommended months ago by the disability organisations, would be implemented!
Mr Hoban said: “We have committed to a review of the descriptors for fluctuating conditions, and we are working closely with charities on that. We also need to ensure that any new descriptors are as good as, or better than, the existing ones, for the purpose of assessing someone’s condition. That work is going on at the moment.”
So either people with fluctuating conditions already have a glowingly redesigned new questionnaire to help them make their condition understood, or it is being reviewed at the moment. Which is it?
Former Welsh Secretary Cheryl Gillan (Con, Chesham and Amersham) picked up on the mental health issue with some questions of her own. Firstly: “More than 2,000 people have signed a National Autistic Society petition to Atos, which was launched following the ‘Dispatches’ and ‘Panorama’ investigations, with which many of us are familiar, into the company last year. The programme claimed that Atos was working to internal targets on the numbers of people being put into the work-related activity group, the support group or as being fit for work. Atos has indicated that it is open to working with the National Autistic Society and other charities, including in the context of this petition, but I have a specific question for the Minister. Will the Minister provide assurances that no such targets are in place?”
He did: “Several hon. Members suggested that Atos had targets for finding people fit for work or placing them in a particular group. Let me be absolutely clear—let nobody in or beyond the House be in any doubt—there are no such targets. There are no targets for who should be put into which group. Instead—hon. Members would want this—there are quality-control checks.”
I do not believe this. I saw the ‘Dispatches’ programme mentioned by Mrs Gillan and it was stated loud and clear by an Atos trainer that there are targets, and they are harsh. A statement to the contrary by a representative of a government that has been more than economical with the truth? That’s not going to cut any ice with me.
Mrs Gillan went on to address the work of new ‘mental and cognitive champions’ employed to advise Atos assessors: “How many of the mental and cognitive champions currently operating at Atos assessment centres have specific autism training? Do WCA assessors receive autism-specific training? If so, of what does it consist?”
Mr Hoban’s response: “I can assure her that that is the case.” But he avoided details.
She asked how he will monitor the effectiveness of the introduction of those mental and cognitive champions, but Mr Hoban slithered away from that question: “It is not for me to dictate the work that Professor Harrington’s successor will undertake as part of the fourth review, but I think that that is a good suggestion. We need to look at the effectiveness of the recommendations that Professor Harrington has made.”
Picking up on the mental health issue, Madeleine Moon (Lab, Bridgend) asked: “We are told that specific support staff for mental health will be provided. Are they in place? Are they aware of the trauma of post-traumatic stress disorder?”
Mr Hoban chose to wax lyrical for a moment: “It has also been said that the work capability assessment does not take full account of mental health conditions. Let me say a bit about that important issue. We have sought to improve the process and the support for the health care professionals who are undertaking the assessments. All Atos health care professionals receive specific and additional training in assessing mental health conditions—Atos has 60 mental health function champions in place to spread best practice.”
Mr Hoban also went on to answer questions that were not, in fact, raised directly in the debate. Perhaps he has a guilty conscience! Let’s look at them briefly.
“It has also been suggested that Atos health care professionals make decisions on benefit entitlement. They do not. Those decisions are made by DWP decision makers.” We know from the previously-mentioned TV documentaries that DWP decision-makers just rubber-stamp the Atos assessors’ recommendations in the vast majority of cases. This is not a reassuring answer.
“It has been suggested that GPs should make the assessment. The British Medical Association has been prayed in aid. Let me quote what the BMA said about that idea: ‘However, it is not part of the GP’s role to provide any opinion…on the patient’s capability to work as part of this process. It is vital that these two roles are kept separate and that GPs are not asked to provide an opinion on their patient for the purpose of receiving the Employment and Support Allowance; doing so could damage the doctor-patient relationship.'” The BMA has already been approached to repudiate that remark; or at least to provide an explanation of what it meant.
“My hon. Friend the Member for Stafford [Jeremy Lefroy] talked about quality. The tribunal service can refer substandard reports back to Atos as an appeal for further action. It has exercised that right only 23 times in the past year. Rigorous checks are in place to ensure that quality applies.” But this number does not include the amount of appeals that they allowed without reference back, of course.
Now here’s his summing-up, with a few things he wanted to shoehorn in but didn’t have the opportunity anywhere else: “Overall, the proportion of people with mental health conditions being awarded ESA has risen from 33 per cent to 49 per cent. We are seeing improvements and more will be introduced later this month on the categories of cancer treatment that allow people to go straight into the work-related activity group. These changes are happening. We should recognise that change is important and that it is happening.
“This is the right approach,” he said in conclusion. “Demonising the work capability assessment does not help our constituents and does not address their concerns.”
If you weren’t shocked by that last sentence, you haven’t been paying attention to the Atos debate. The whole point is that it is the Work Capability Assessment that does not help our citizens or address their concerns. Demonising it (he’s stealing the word from protestors, who have been using it to describe the government’s attitude to the sick and disabled it is persecuting) is the only way to fight what is happening. But I refer you to the Skwalker blog for a detailed analysis of that statement.
Those were all the questions that were answered by the minister. He did his best to paint a rosy, “nothing’s wrong” picture of the system. But he did so by ignoring important statistics and questions raised by them.
Perhaps he hoped that nobody would notice – or that we would not be cheeky enough to put him on the spot.
Too bad. If that is the case, I intend to misbehave! In this spirit of mischief, let’s look at the questions for which Mr Hoban had no answer, starting with those raised by Mr Meacher:
“How can pursuing with such insensitive rigour 1.6 million claimants on incapacity benefit, at a rate of 11,000 assessments every week, be justified when it has led, according to the Government’s own figures, to 1,300 persons dying after being put into the work-related activity group, 2,200 people dying before their assessment is complete, and 7,100 people dying after being put into the support group?” (NO RESPONSE)
“Is it reasonable to pressurise seriously disabled persons into work so ruthlessly when there are 2.5 million unemployed, and when on average eight persons chase every vacancy, unless they are provided with the active and extensive support they obviously need to get and hold down work, which is certainly not the case currently?” (NO RESPONSE)
“It is true that Harrington has produced minor adjustments—implemented at a glacial place—but the underlying system remains largely undisturbed. The BMA and the NAO have therefore called for a thorough, rigorous and transparently independent assessment of the suitability of the work capability assessment. Will the Minister now implement that?” (NO RESPONSE)
“Will the Minister provide full and transparent details of the Atos contract? They should not be hidden by specious claims of commercial confidentiality when Atos is the sole provider of what is clearly a public service. Better still, given that Atos has failed so dramatically, why does he not in-source the work back into the NHS?” (NO RESPONSE)
“How will the Minister ensure that the medical expertise of disabled persons’ doctors and related professionals is fully taken into account before assessments are completed?” (NO RESPONSE)
“I want to provide a full dossier to the Secretary of State so that he fully understands what is being done today in his name, and to bring a small delegation to see him from some of the excellent organisations of disabled people who have heroically battled to highlight and tackle the distress and pain caused by Atos. Can I please be assured that the Secretary of State will see such a delegation?” (NO RESPONSE)
Mrs Gillan asked: “What steps will the Government take to ensure that Atos collects existing evidence relating to a claimant’s capability to work, which would create a more cost-effective and streamlined system?” (NO RESPONSE)
Natascha Engel asked: “How many people deemed fit for work who do not take their cases to appeal then find work?” (NO RESPONSE)
“Is it really for the best to sign people as fit for work when there are no jobs to be had?” (NO RESPONSE)
“How many of them are getting a job, and how many of them are just being signed over to destitution?” (NO RESPONSE)
Pamela Nash (Lab, Airdrie and Shotts) said: “The Minister’s predecessor, the right hon. Member for Epsom and Ewell [Chris Grayling], made it clear in a Westminster Hall debate last September that he felt that Atos “should make recording available on a voluntary basis”. However, not a single constituent of mine who has come to see me about work capability assessments has told me that they have been offered the prospect of having it recorded. In fact, one constituent told me that she had asked for her assessment to be filmed, following her previous assessment, which resulted in a report that bore little resemblance to that assessment. On that occasion she was found fit for work, but she subsequently won her appeal. She was informed that recording would indeed be possible, but that she would have to pay for a private, independent company to come in to record her assessment. Equipment was not made available to her. She had hoped to take a family member in to film the assessment, but was told that this would not be allowed or appropriate. How on earth is a person living on benefits—living on the breadline—supposed to be able to afford to pay a private company to record their assessment?” (NO RESPONSE)
“Will Atos reschedule an assessment date if the person concerned is told that equipment is not available on the original date?” (NO RESPONSE)
“In the event that a claimant refused to go through with an assessment without a recording, would they be sanctioned in terms of their benefits?” (NO RESPONSE)
Debbie Abrahams (Lab, Oldham East and Saddleworth) asked: “Why does the hon. Gentleman think the Department for Work and Pensions and Atos have been unable to accept the recommendations of the British Medical Association and the Royal Colleges for more specific diagnostic tests that would make the assessments more appropriate?” (NO RESPONSE)
Kevan Jones (Lab, North Durham) asked: “The first contract with Atos was introduced by the previous Government, but why did the present Government renew and extend that contract even though they knew about all the problems that he and others have raised in the House?” (NO RESPONSE)
“The system is also costing the taxpayer money, not only through the additional health care provision for those with mental health conditions but through the extra work load on GPs, the tribunal system, which is at breaking point, and the reassessment system. The other week a 60-year-old nurse with osteoporosis, who has spent 38 years in the NHS, came to see me. She failed the work capability test. She is 61 in April and is now being told that she will be retrained for a new career until she is 62, when she gets her pension. What on earth is the point in wasting money on individuals like that?” (NO RESPONSE)
“There are also cases such as the 21-year-old young lady who ended up in the local psychiatric hospital because she failed the Atos interview. What is the cost of that to the NHS?” (NO RESPONSE)
Kevin Brennan (Lab, Cardiff West) asked: “The head of Atos was recruited from Unum in the United States. Is it not disturbing that the lieutenant governor of California has stated that Unum was operating ‘claims denial factories’ for working men’s compensation?” (NO RESPONSE)
Mrs Moon asked: “Atos received £112.8 million in 2010-11 for its DWP services. About 60 per cent of all claims are judged fit to work; 41 per cent of those people appeal, and 38 per cent of those appeals are successful. Last year, appeals cost £54 million. How can that be seen as value for money? How can this be seen as evidence of a supportive and caring Government in action?” (NO RESPONSE)
“Is sensitivity training available, because it has certainly not been made available to the ex-GP who works as an Atos assessor in my area?” (NO RESPONSE)
“Has the DWP looked at the cost—to Members, to citizens advice bureaux and to welfare rights organisations—of fighting this iniquitous system?” (NO RESPONSE)
Jeremy Lefroy (Con, Stafford) asked a couple of real questions, besides the non-existent one that Mr Hoban answered. They were: “There are cases in which people have had to wait for up to a year before winning appeals and then immediately face another work capability assessment, so the whole process starts again. Why cannot such people be given at least a considerable period of grace?” (NO RESPONSE)
And: “Do the health care professionals employed by Atos always take account of the fact that people have to get to work in the first place, or that, while they may be able to perform an action once, they may not be able to perform it repeatedly when it causes severe pain?” (NO RESPONSE)
Andrew Stunell (Liberal Democrat, Hazel Grove) asked: “Would not speeding up the appeal process also relieve stress and bring about certainty much more quickly?” (NO RESPONSE)
Sarah Newton (Con, Truro and Falmouth) (Con): “Does my hon. Friend agree that we must make Atos understand that in remote rural constituencies such as those we both represent some people have to travel long distances? That problem is leading to a lot of no-shows at the Truro Atos centre, which in turn is leading to lots of delays in assessments, thereby causing a great deal of anxiety.” (NO RESPONSE)
Ian Mearns (Lab, Gateshead): “The Minister for disabled people, the hon. Member for Wirral West (Esther McVey), told this House that by October 2015 560,000 claimants will have had their assessments, and 160,000 will get a reduced award, 170,000 will get no award, and 230,000 will get the same support. How can we know the assessments are valid when we have had such a prediction?” (NO RESPONSE)
Iain McKenzie (Lab, Inverclyde): “What does the Minister think of Citizens Advice’s detailed year-long study “Right first time?” on the controversial work capability assessment run by Atos, which has revealed evidence of widespread inaccuracies in the medical reports that help to determine whether individuals are eligible for sickness benefits? Citizens Advice also tracked a group of people through the process of claiming employment and support allowance and looked at how their claims were handled. The report’s conclusions are stark: 37 individuals were tracked and had their reports examined, with serious levels of inaccuracy revealed in up to 43 per cent of the reports. That level is significant enough to have an impact on the claimant’s eligibility for benefits—surely our sick and disabled deserve better than this.” (NO RESPONSE)
“Is it not better to have an accurate, fair and just system of medical assessment, one that claimants know will treat them fairly and with the humanity they deserve, rather than a system that is, frankly, unfit for purpose and that uses a company, Atos, that instils fear and loathing in people, resulting in a system where people are continually appealing against decisions? We have already heard that the success rate against the decisions is about 60 per cent.” (NO RESPONSE)
Heather Wheeler (Con, South Derbyshire): “When someone drops down dead within three months of being assessed as being perfectly capable of going back to work, what is the review process for Atos?” (NO RESPONSE)
Julie Hilling (Lab, Bolton West): “Why are Atos and the Department for Work and Pensions cruelly finding people fit for work or putting them in the work-related activity group when they are clearly unable to work?” (NO RESPONSE)
“People being placed in the work-related activity group is the next scandal. When people score 15 points and are found not fit for work, but are put in the work-related activity group, they will lose their benefit after 365 days. Is that another way of saving money, but one that also puts disabled people into abject poverty and causes them terrible stress?” (NO RESPONSE)
“Why do the assessors give more weight to work capability assessment descriptors than to professional medical assessments?” (NO RESPONSE)
“Why do they reassess people who have just won their appeal?” (NO RESPONSE)
“Why do they not record the number of people who die through illness or suicide when being rejected for disability benefit?” (NO RESPONSE)
“Why do they not track people who have been found fit for work and people who no longer receive benefit?” (NO RESPONSE)
“How much do all the botched assessments cost us?” (NO RESPONSE)
And Sheila Gilmore asked: “Research commissioned by the previous Government, which I understand is not being continued by this Government—the Minister might reassure us on that—found that 43 per cent of those found fit for work were neither in work nor in receipt of an out-of-work benefit a year later. We must ask where they are. What is happening to them?” (NO RESPONSE)
The conclusion? This is a government that is perfectly happy with a system that is throwing thousands of sick and disabled people to the wolves. It has made – or is making (Mr Hoban wasn’t all that clear) – cosmetic changes in the hope of diverting our attention. As long as the claimant figures are coming down, they will be happy.
As long as claimant figures are coming down.
Yesterday, in my article The High Street implosion is just beginning, I advocated the ‘constructive dismissal’ of the Coalition government by making its work so difficult that it couldn’t go on. If I was feeling mischievous, in the light of the evidence, I think I would suggest that we all ruin that drop in claimant figures by going out and filling ESA50 forms of our own – whether we deserve the benefit or not.
Clearly this government intends to keep Atos in work, so we may as well make it work hard!