Tag Archives: atos

The rise of an out-dated healthcare model in Government decision making

UPDATE: 25/12/2012

Nassir Ghaemi has replied to my email saying that he will take some time to explore these links and then pass on some thoughts. He added:

“My initial impression is that this is quite an unwarranted vulgarization [sic.] of  an already out of date and oversimplified medical theory.”


I came across an editorial by Nassir Ghaemi MD MPH for BJPsych, “The rise and fall of the biopsychosocial model”, and read with great interest. [“The biopsychosocial model was valuable in its day as a reaction to biomedical reductionism, but its historical role has played out.”]

Let me try to give the background and explain my interest in the Biopsychosocial model, and why I contacted Nassir for his expert opinion on these matters. (This is an edited version of the email I sent him.)

I have been suffering with quite sever ME/CFS, together with fibromyalgia and depression, since 2005. Although it stopped my teaching career back then, it hasn’t stopped my determination to carry on living and learning.

There has been a long running saga in the UK over welfare reform, ‘work capability assessments’, the company ATOS, and welfare to work schemes. My research has turned up some interesting developments and evidence in these areas over the last 10-20 years.

Let me introduce you to the controversy surrounding the US Tennessee-based insurance company Unum, who are advocates of the Biopsychosocial (BPS) model. Due to a major class action, It admitted unfair business practices, investigations, and fines, and was called an “Outlaw Company” by the former California Insurance Commissioner, John Garamendi. [Gosselin, Peter G. (3 October 2005). “State Fines Insurer, Orders Reforms in Disability Cases”. Los Angeles Times. Tribune Company. Retrieved 27 December 2009. “‘UnumProvident is an outlaw company. It is a company that for years has operated in an illegal fashion,’ said California Insurance Commissioner John Garamendi.“]

Unum has been advising the UK government since 1994, and has been involved with the UK’s Welfare to Work Bill. [ http://www.corporatewatch.org.uk/?lid=2940 ] In 2003, the government brought in Atos Origin to conduct incapacity assessments, and in 2005 they started using a computer system they call ‘LiMA’ – ‘Logic Integrated Medical Assessment’. The Full Facts website [ http://thefullfacts.com/esa/forum/viewtopic.php?f=22&t=330 ] lucidly explains how the system works, and the issues and controversy surrounding it. It is in essence a ‘tick box’ automated assessment, and having seen the training manuals and comments from many surrounding this ‘training’, can attest to the computer programme being predominantly involved in the decision making, reducing the role of the health care professional doing the assessment merely to the status of ‘computer operator’. There is evidence that the system is fully based around the BPS model. The Black Triangle Disability Campaign have been at the forefront of the struggle against Atos and successfully lobbied  Scottish GPs  to denounce the testing regime, a move soon followed by the UK wide BMA.

The BPS model was recommended by Dame Carol Black in her report ‘Working for a Healthier Tomorrow’ (2008). [ http://www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf ] This report was commissioned by the DWP and used as justification for the Work Capability Assessment.  Lord Freud, the minister for state in charge of welfare to reform (who is also the Great-grandson of Sigmund Freud) made it plain that he wanted to implement this report in full, and that he fully supports the BPS model.

However, with Unum’s involvement as advisors to the government in these matters, it has concerned many that the BPS model has achieved such traction in government policy with regard to all illness, conditions and disabilities. ‘Disabled People Against Cuts’ are among many groups that believe that BPS intervention has been imported from a discredited background and become the defacto ideology behind the welfare reforms and back to work policies for disable and sick people. [ http://www.dpac.uk.net/tag/bio-psychosocial-model/ ] This constantly reaffirmed by ministers and government with a completely unqualified mantra of “work is good for you”.

With regards to my condition, I have been positively diagnosed twice by a consultant  in neurology and by a consultant in rheumatology, both saying very similar things about my condition. However, currently, the government allows psychiatrists to give the majority of advice for ME/CFS although there are more than 5000 research papers showing ME to be physical, not psychological. Advice on ME needs to be given by experts specialising in areas of the disease pathology, such as neurology and immunology.This is the subject of a petition to the government currently, calling for the government to get “Advice on ME needs to be given by experts specialising in areas of the disease pathology, such as neurology and immunology… [and not from] psychiatrists, psychologists, or anyone working in an unrelated area” [ http://epetitions.direct.gov.uk/petitions/37117 ].

Are we right to be worried by the prevalence of the BPS model at the heart of government decision making, what are the true motivations behind these decisions, and ultimately is the BPS model is of any value whatsoever?

Atos Healthcare: Still profiting from misery

By Nathan Akehurst and Amy Dunne
Original article published:

Whilst the Olympic opening ceremony, quite fairly, glorified our National Health Service, it is nonetheless worth remembering the real state of affairs for a significant number of Britain’s sick. In April of this year, around 3400 people in Oxford and 10,000 in the county of Oxfordshire were subsisting on Incapacity Benefit (the allowance for those physically unable to work, which ranges within the modest bounds of £88-£105 weekly. Of that number, roughly two in three were told they were fit to engage in some sort of work. Employment Minister Chris Grayling would hail the figures, calling the current system ‘a waste of human life’- supremely ironic given that an average of thirty-two people nationally died every week after failing the new incapacity benefit tests in 2011. Between January and August 2011, 1,100 claimants in the ‘work-related activity group’ alone died. Clearly, mistakes are being made (and have been made since New Labour let the likes of assessors Atos Healthcare loose on the disabled community). In Oxfordshire, when the cases finally reach a full appeal, around nine out of ten benefit removals have been rejected. Nationally, the figure is 40% (hitting 70% when advocacy groups are representing the claimants.)

The question then remains, why on earth do Atos continue to be able to handle vulnerable people, with a failure rate of almost forty per cent? Why do Atos assessors have to complete courses in disability healthcare a mere eight or seventeen days long, and are not required to have any prior experience in that field? What’s more, they are actively encouraged by government to aggressively remove people from the benefits system, along with a program of direct assaults from the state. Their tests are based on ticking boxes (a frequent complaint is the refusal of assessors to make eye contact with claimants) that distil complex issues into black and white statements, and the experience even for those who do not lose the money they subsist on is degrading and disablist. For instance, the Department of Work and Pensions are appealing against a court ruling which stated (from the June edition of Inside Housing) that ‘The Housing Benefit Regulations 2006, which restrict housing benefit for private renters according to property size, were found to be discriminatory because they do not allow benefit for an extra room where two children cannot share because of disabilities.’ In short, they are defying the courts for the right to make vulnerable people homeless.

In April, I was involved in a flash occupation of the Atos assessment centre on St Aldate’s in Oxford. Despite making every effort possible to minimise distress to those undergoing Atos’ draconian ‘assessments’, the administrator there had the gall to accuse us of potentially causing harm to the disabled people in the office- as if that is not what their organisation exists to do. Extensive criticism of the role of assessors has originated from the medical community, with doctors claiming (quite correctly) that the position is one incompatible with the medical duty of prioritising the patient. Meanwhile Atos made £102m in profit in the first half of 2012, and their poor decisions turned over at appeal, leaving aside physical distress to patients, has cost the British taxpayer £60m. Yet statistics and the national picture, whilst gritty and relevant, somewhat obscure the personal stories, and the impact they have on real people. Thus I present the story of one victim of Atos, told by the patient’s niece (Amy, a nineteen-year old woman due to start at Ruskin College in Oxford in 2012.)

“I’m going to begin this story with a question. There’s a person with severe dyscalculia, dyslexia, cerebral palsy, arthritis and a club foot: what job could this person possibly do? Neither manual labour nor service or administration work would be viable. I came to the conclusion that there were absolutely no jobs available that could be suited to her- however, this is not what that Atos decided at their assessment.

After the examination to assess her claim, Atos declared my aunt perfectly fit for work, despite the fact she can’t count, read, write and can barely look after herself without support. She was informed that if she had not found a job within the next year, her Incapacity Benefit would be stopped and she would be forced to go on Jobseeker’s Allowance (starting at £55/wk) or be put on a ‘welfare-to-work’ course- the courses have been next to useless thus far. In any case, because my aunt was in no fit state to even understand how to challenge this decision, she would have been forced to accept it- she was only able to make the challenge because unlike others, she had supportive family members willing to fight the case.

When she told my father that her claim had been revoked, he immediately wrote to the Atos headquarters in Belfast to explain that his sister wished to appeal against her placement in the ‘working group’ –as it was called –and that she was indeed completely unfit to work. However, within six days of the letter being sent, a response from Atos came through saying that her appeal had failed. Whilst processing thousands of decisions, and taking into account mail from London to Belfast, this seems a ludicrously small amount of time (the subsequent tribunal wait took six months) and casts doubt upon whether the case was even read by Atos.) It fell upon her brother and sister to appeal through the courts and the case came to tribunal. During this time, she was expected to collect large amounts of evidence to prove she was indeed unfit to work, and this involved calling the relevant clinics at the relevant hospitals, a letter from her GP and numerous reports on her health and wellbeing from specialists. How, in her condition –a woman who cannot even spell her own niece’s name –is she expected to achieve all this when she can barely look after herself? The answer is, if she did not have the support of her brother and sister who were willing to take time out of their own busy lives and dedicate the time to making sure their sister had the relevant information to challenge this disgusting claim that she was perfectly fit to work from Atos, then she would be languishing on an insecure and tiny Jobseeker’s Allowance right now. During the time between the failure of the appeal to Atos and the tribunal, the mere stress of it caused my aunt to develop alopecia (symptoms include extreme hair loss). Perhaps due to the restructuring of the NHS under Lansley, the medical reports took some time to come through. Meanwhile my father had to dedicate considerable time going through the bureaucracy of chasing them up (since he wasn’t the claimant, stringent approvals and checks were involved, despite the fact my aunt had given express permission for her brother and sister to talk about her medical conditions on her behalf). Within a few hours of the deadline, the GP still had not written a letter backing up the claim that she was indeed entitled to incapacity benefits, and the letter had to be hand delivered to the court by my dad on his way to work.

The judge and attending physician at the tribunal was apparently fairly convinced that the Atos ruling was incorrect even before proceedings had begun, but they were nonetheless obliged to question my aunt, her twin and my dad in order to make sure they were right. Her responses during the tribunal made her unfitness to work patently clear –when asked a question, she answered what would seem to be a completely different question, and my dad and other aunt had to take over. My aunt was acquitted, and allowed the maximum period (24 months) on Incapacity Benefit before reassessment (six months of stress, illness, time-wasting and taxpayers’-money wasting later).”

It is shocking as a society to think that ordeals like this not only happen, but are a regular occurrence, and indeed even one of the milder ones. It compares (in 2011) 5,300 deaths of people who were put in the “support group” – which accounts for 22% of claimants – for the most unwell, who get the full, no-strings benefit of up to £99.85 a week. 1,600 people died before the completion of their assessment. Meanwhile repeated delays have led to claims the system is in “meltdown”, and in the largest twist of horrible irony, Atos are sponsors of the Paralympic Games. In 2010, Atos’ boss drew a salary of £800,000. This is nothing short of profiting from misery. The scandal of Atos, and the criminality of other firms which the government has outsourced welfare claimants to, has been allowed to exist not by chance but by the long-running structural demonization of benefit claimants. Decades of slander from the tabloids and politicians in all the main parties has led to the impoverished and disabled being stripped of their humanity, and led to a climate in which the behaviour of Atos’ assessors has become the mundane and commonplace. Britain should be thoroughly ashamed of itself.

Image credit: Socialist Worker