What you need to know about Atos assessments.

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Courageous whistleblower and Scottish nurse, Joyce Drummond, who recently made a heartfelt apology to Atos assessment victims, has submitted evidence to the Scottish Parliament Select Committee on Welfare Reform.

Joyce forwarded some of her notes to me, containing this information about Atos assessments. I have edited where needed, organised the notes and added some information to the text. I’ve included the contents from Joyce’s notes in full. Both Joyce and I share this information in the hope that people going through Atos assessments will find it helpful.

Joyce told me: 

“I knew nothing about Atos when I joined, and left as soon as I realised that there was no way to fight from the inside.  I stated at my interview for the job that I believed in social inclusion and social justice.

I went for 4 weeks training in England. The training did not prepare me for what I was expected to do in real life.

The forms that are completed prior to assessment, I have recently found out, are opened by Royal Mail Staff. They are then sent for “scrutiny” where nurses decide whether or not a face to face assessment is required. I was not involved in this and do not know what criteria are used.  

 It is made clear throughout training and working that we are not nurses- we are disability analysts.  Also, we do not carry out “medical assessments” – we carry out “functional assessments”. We did not even need a diagnosis to carry out assessments. I had reservations around consent, as we were expected to assess patients – sorry, we didn’t have patients, we had ‘claimants’ – who appeared to be under the influence of alcohol or other substances. 

We were also consistently told that we did not make benefit decisions. The final decision was made by a DWP decision maker with no medical qualification. If our assessment was overturned at appeal we never knew about it. There was no accountability for assessments overruled.”

Please note that assessment starts on the day of your appointment with the Health Care Professional (HCP) reading the form you completed when you applied for benefit. Remember that every single question you are asked is designed to justify ending your claim for ESA and passing you as “fit for work”. That is what Atos are contracted to do by the Government.  This is not a genuine medical assessment, but rather, an opportunity for the DWP to take away the financial support that you are entitled to.

Things that are noted at this stage are:

  • Did you complete the form yourself
  • Is the handwriting legible
  • Are the contents coherent

These observations are already used in assessing your hand function, your cognitive state and concentration.

Further observations made:

  • Do the things you have written add up
  • Does your medication support your diagnosis
  • What tests you have had to confirm diagnosis. For example a diagnosis of sciatica is not accepted unless diagnosed by MRI scan
  • Do you have supporting medical evidence from your GP or consultants. If you do, it shows that you are able to organise getting this information

Joyce observes:

“This is also a hidden cost to the NHS. I believe that if ATOS request information there is a charge levied by GP’s. However claimants are expected to source medical evidence themselves. It uses valuable NHS time for medical staff to write supporting statements. 

There were no hidden cameras, at least in Glasgow, to watch people arriving for assessment or sitting in waiting room. This may not be true in other areas.”

When the HCP has read your form they input some data into the computer system. The assessment properly begins when they call your name in the waiting room.

At this point the HCP assesses:

  • Did you hear your name being called
  • Did you rise from your chair unaided, did the chair have support arms or not
  • Were you accompanied – assessing your ability to go out alone
  • Were you reading a paper while waiting – assessing your concentration
  • Did you walk to the assessment room unaided, did you use any aids correctly. Did you navigate any obstacles safely – assessing sight

The HCP will shake your hand on introduction – assessing your handshake, noting if are you trembling, sweating – signs of anxiety. The HCP carefully scrutinises everything you do and say. The HCP will often ask on way to waiting room:

  • How long you’ve been waiting – assessing ability to sit, physically, and appraising your mental state
  • How did you get here today – assessing ability to drive or use public transport

Formal assessment begins by listing medical conditions/complaints. For each complaint you will be asked:

  • How long have you had it, have you seen a specialist
  • Have you had any tests, what treatments have you had
  • What’s your current treatment. Have you had any other specialist input e.g. physiotherapy, CPN

The HCP will use lack of specialist input/ hospital admissions to justify assessing your condition as less severe. Medications will be listed and it will be noted if they prescribed or bought. Dates will be checked on boxes to assess compliance with dosage and treatment regime. Any allergies or side-effects should be noted.

  • A brief note is made of how you feel each condition affects your life
  • A brief social history will be taken – who you live with, if have you stairs in your house or steps outside your house
  • Employment history taken – asking when you last worked, what you work entailed, reason for leaving employment

Your typical day – this is the part of the assessment where how you function on a day to day basis is used to justify the HCP decisions. Anything you say here is what is most likely to be used to justify you failing your assessment and being passed as “fit for work”. Along side this, the HCP records their observations.

Starting with your sleep pattern, questions are asked around your ability to function. This will include:

  • Lower limb problems – ability to mobilise to shops, around the house, drive, use public transport, dress, shower
  • Upper limb – ability to wash, dress, cook, shop, complete ESA form
  • Vision – did you manage to navigate safely to assessment room
  • Hearing – did you hear your name being called in waiting room
  • Speech – could the HCP understand you at assessment
  • Continence – do you describe incontinence NOT CONTROLLED by pads, medication. Do you mention its effects on your life when describing your typical day
  • Consciousness – Do you suffer seizures – with loss of continence, possible injury, witnessed, or uncontrolled diabetes
  • HCP observations include – how far did you walk to examination room, did you remove your coat independently, did you handle medications without difficulty, did you bend to pick up your handbag

Formal examination consists of simple movements to assess limited function. Things the HCP also looks at:

  • Are you well presented, hair done, wearing make-up, eyebrows waxed
  • Do you have any pets – this can be linked with ability to bend to feed and walk
  • Do you look after someone else – as a parent or carer- if you do, this will be taken as evidence of functioning
  • Any training, voluntary work, socialising – this will be used as evidence of functioning
  • Do you watch TV – this may be used as evidence of being able to sit unaided
  • If you wear jewelry it will be assumed you have sufficient dexterity to open the clasps on chains and so on

This is not a comprehensive list, but it gives you an idea of how seemingly innocent questions are used to justify HCP decisions to pass you as “fit for work.” For example, “Do you watch soaps on TV?” is translated as “Can sit unaided for at least half an hour” on the report.

Mental Health:

  • Learning tasks – Can you use a phone, computer, washing machine
  • Hazards – Can you safely make tea, if claiming accident, there must have been some emergency services involvement, e.g. fire service. Near miss accidents do not count

Personal Actions:

  • Can you wash, dress, gather evidence for assessment
  • Do you manage bills

Further observations made by the HCP – appearance and presentation:

  • Coping with assessment interview – any abnormal thoughts, hallucinations, confusion
  • Coping with change – ability to attend assessment, attend GP or hospital appointments, shopping and socialising

More HCP observations:

  • Appearance, eye contact, rapport, any signs/symptoms that are abnormal mood/thoughts/perceptions. Any suicidal thoughts
  • Coping with social engagement/appropriateness of behaviour – any inappropriate behaviour must have involved police to be considered significant
  • Ability to attend assessment, engage with assessor, behave appropriately

Again, this is not an exhaustive list, merely some examples.

Further information: 

At present to qualify for ESA you need to score 15 points, unless the Exceptional Circumstances Regulations apply to you. The 15 points can be a combination of scores from physical and mental health descriptors.

To qualify for the Support Group you must score 15 points in one section. As long as you are claiming income-based ESA then your award can be renewed at each assessment, if you gain 15 points.

You may also qualify without meeting the 15 points criterion, even if you don’t score any points, because of Exceptional Circumstances (Regulation 29 and Regulation 35, (or 25 and 31 for Universal Credit – see link at the foot of article) if there would be a substantial risk to your mental or physical health if you were found not to have limited capability for work. Regulation 29 is about exceptional circumstances for being assessed as having limited capability for work (WRAG) , and Regulation 35 is about  being assessed as having limited capability for work-related activity (Support Group).

Special cases – exemptions from assessment include those people having:  terminal illness, intravenous chemotherapy treatment and danger to self or others if found fit to work.

Contribution-based ESA lasts for 1 year only, unless you are in the support group. After 1 year in the work-related activity group, you may only get income-based ESA if your household income is below a certain threshold. It makes no difference how long you have previously paid National Insurance.

Joyce told me:

“For clarity, as far as I know in the real world, doctors carry out medical assessments, nurses carry out nursing assessments and physios carry out physiotherapy assessments. In the world of Atos, each of these separate professions are employed as disability analysts, carrying out functional assessments.

Nurses are employable for these posts if they have been qualified for at least 3 years, are registered to practice with the NMC, and have basic computer skills.

My interview consisted of:

  • Face to face interview with medical director and nurse team leader.
  • A written paper assessing a scenario, in my case someone with back pain
  • A 10 minute basic computer test

“In order to be approved as disability analyst I had to complete 4 weeks Atos disability training, reach a certain standard of assessment reports – as decided by audit of all cases seen (don’t know what criteria was) and finally approval to carry out Work Capability Assessments  (WCA) from the Secretary for Work and Pensions.

In my opinion the money given to Atos and spent on tribunals should be given to NHS GPs. They are best placed to make assessments regarding patients work capability. They have access to all medical reports, past history, specialist input and know their patients. My concern would be what criteria the DWP would impose on GPs risking the doctor/patient relationship. GPs already assess patients for “fit notes”, which have to be submitted to DWP during assessment phase of ESA.

While I worked at Atos, sessional medical staff were being paid £40 per assessment, as far as I am aware. I have no idea of wages of permanent medical staff. Nurses were on a salary, which based on 10 assessments a day (Atos target) equalled around £10 per assessment. These are approximate figures but may give a clue as to why Atos are employing nurses rather than doctors.”

Appendix

Most Atos HCPs are not doctors, they are usually nurses or occupational therapists. There are some conditions that will mean you need to be assessed by a qualified specialist nurse, or a doctor and you can ask for this.

List of conditions judged suitable for assessment by neuro trained nurses/any health care profession:

Prolapsed intervertebral disc
Lumbar nerve root compression
Sciatica
Slipped disc
Lumbar spondylosis
Lumbar spondylolisthesis
Lumbar spondylolysis
Cauda equina syndrome
Spinal stenosis
Peripheral neuropathy
Neuropathy
Drop foot
Meralgia paraesthetica
Cervical spondylosis
Cervical nerve root compression
Cervicalgia
Nerve entrapment syndrome
Carpal tunnel syndrome
Trapped nerve
Paraesthesia
Tingling
Numbness
Brachial plexus injury
Polyneuropathy
Dizziness
Vertigo
Essential Tremor
VWF
Alzheimers

List of conditions judged by the DWP and Atos Healthcare as suitable only for assessment by doctors:

Stroke
Head injury with neuro sequelae
Brain haemorrhage/Sub Arachnoid Haemorrhage
Brain tumour
Acoustic Neuroma
Multiple Sclerosis
Motor Neurone Disease
Parkinson’s disease
TIAs
Bulbar Palsy
Myasthenia Gravis
Muscular Dystrophy
Guillain-Barre Syndrome
Amyotrophic lateral sclerosis
Syringomyelia
Neurofibromatosis
Spina bifida
Polio
Fits (secondary to brain tumour)
Learning difficulties (with physical problems)
Nystagmus Myelitis
Bells Palsy
Trigeminal Neuralgia
Paraplegia
Quadriplegia
Huntington’s Chorea
Huntington’s Disease

Further information:

Special exemptions from the 15 points criteria: The New Regulation 25
Useful updated information about Regulations 25 & 31: Exceptional Circumstances and Universal Credit.
Exceptional Circumstances:
Employment and Support Regulation 31

Employment and Support Allowance: 2013 Regulations in full
The Amendments to ESA Regulations: as laid before Parliament
Clause 99 and important changes to the appeal process: Clause 99, Catch 22 – The ESA Mandatory Second Revision and Appeals
Questions you may be asked at assessment: dwpexamination forum 
How to deal with Benefits medical examinations: A Useful Guide to Benefit Claimants when up against ATOS Doctors
More support and helpful advice here: How to deal with Benefits medical examinations

Essential information for ESA claims, assessments and appeals

Previous related articles: 

Joyce’s campaign:  The Daily Record 
Joyce Drummond and Sue Jones:  After Atos

Further reading:

Targets in Atos contract

7 out of 8 targeted to lose ESA

Amnesty condemns erosion of human rights of disabled in UK

Whistleblower says Atos Work Capability Assessments are unfair

377683_445086432227557_1770724824_n (1)Many thanks to Robert Livingstone for his excellent artwork. Many thanks to Joyce for the information she has provided, and for her courage and integrity, which is so strongly evident in her outstanding campaign work.

236 thoughts on “What you need to know about Atos assessments.

  1. hi all i just wanted to update you all that i had my medical in may and i was an extreme nervous wreck. suprisingly the woman was very nice to me. i managed to pass and ive been placed in the support group. i just wanted to give a massive thanks to everybody who wrote to me. i really appreciate it xxx

    Liked by 1 person

    1. Well done Claire, very glad to hear that. Not all of the assessors are so bad, the same thing happened to me back in 2012, after the previous assessment in 2011 had concluded I was fit for work. The report was rubbish and had little bearing on either my illness or what was actually discussed during the assessment. I had to appeal, of course, I won and got another assessment date just 3 months after winning the appeal… but the doctor I saw was very good, and assured me he’d recommend I was placed in the support group, he kept his word.

      Hopefully now, you will have a break from the revolving door of assessments and reassessments XXX

      Like

  2. my wife has her ATOS appointment in two weeks, she has dilated cardiomyopathy, raynauds syndrome and carpul tunnel syndrome.
    She is already very nervous about the appointment, she has heard so many horror stories about them, your advice will be welcome

    Like

    1. I know the situation is scary, and reading about people’s horrible experiences can add to the sense of trepidation, but knowing what to expect at the assessment, even though it’s unpleasant, can work in your favour, that’s why I write – to share these experiences so that people can use them.

      I wrote this a couple of years ago, but it is still pretty much up to date, and hope your wife will find it helpful. Best wishes – https://kittysjones.wordpress.com/2013/04/21/1560/

      Like

  3. esa pip and ATOS are definitely disgusting ..to actually think some1 we will only ever meet once in our lives and no nothing of our condition can over rule your own dr who has known seen and treated us week in week out for years and signed us off sick !!!! ABSOLUTELY DISGRACEFUL is all i can say 😦

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  4. Today I had my ESA review assessment, I suffer with bipolar disorder and paroxysmal artrial fibrillation. I was extremely nervous and of course the anxiety kicked in and I was a mess. My daughter who is my lifeline came with me, and was on hand to help with the questions and support. We explained my daughter helps with lots of my everyday tasks herself and my mum help with school runs for my youngest, we do get take always 2-3 times a week as sometimes it is just easier for me but my fridge is always full and plenty of fruit and fresh food, the assessor very loudly said “I AM VERY CONCERNED THAT U R NOT DOING ANYTHING FOR YOUR CHILDREN, YOU DONT LOOK AFTER YOURSELF HOW CAN U LOOK AFTER YOUR CHILDREN”….. At this point between tears and anger I explained that if I didn’t have the help from my family who knows where I would be, and who knows where my children would be, they may not even have a mother. I am so disgusted on how this man behaved as he doesn’t no me and my family and he doesn’t know how well looked after my children are. Good days or very bad days my children are looked after by their Family. Needless to say we will be putting in a formal complaint…….

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  5. Hi i went for an assessment on the 30 June I am a diabetic with type two diabetes I have complications with it 1 cold foot circulation problems I also have sicatica asthma high blood pressure high cholesterol bad back and a ulcer and my blood sugar levels never fall below 10 mmols I nearly set fire to my house twice as I forgot I had the cooker on with a pot on I also left my cooker on all night i was turns down for pip as they can’t assess the way way you live with your condition they need to reasses there criteria and look at your medical records to see your medical condition and not there one

    Like

    1. i also have sciatica, asthma and type 2 diabetes. tramadol helps with pain and asthma pumps help with asthma but if you cant control your sugar levels then you really need to be put on proper medication especially if you have high blood pressure too. that in itself wont qualify for PIP as its not seen as a disability. you can’t be looking after yourself with regular diabetic clinic and lifestyle changes.
      my dad didn’t take his diabetes serious and he has bad circulation and glycoma in both eyes. he also has a bad heart now too.
      seriously talk with your GP and get proper help and advice and if you are struggling (trust me its not an easy condition no matter what anybody else thinks), don’t be ashamed to admit it.
      a proper GP will support you and sit you with a nutritionist/dietitian for starters who can advice you on the diet part. i can understand you ain’t mobile enough to do exercise so with the right diet and medication atleast should help you because type 2 diabetes is very manageable when you know the in’s and out’s and how to look after yourself. it took me 2 years before i took my diagnosis serious. i only looked at my dad and that gave me motivation to change.
      good luck

      Liked by 1 person

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