The Care Bill: The road to more private medical assessment injustice?

The Bill

At a time when almost one million carers, older, disabled and sick people are not receiving the care and support they need, the Care Bill is currently meandering its way through the chambers of Westminster. It is described as:

A Bill to reform the law relating to care and support for adults and the law relating to support for carers, to make provision about safeguarding adults from abuse or neglect, to make provision about care standards, to establish and make provision about Health Education England, to establish and make provision about the Health Research Authority, and for connected purposes.

The aims of the bill are:

  • Create a cap on care costs
  • Extend the current means test threshold for financial assistance
  • Ensure nobody has to sell their home in their lifetime to pay for residential care
  • It will merge sixty years of care and support law into a single Act, which according to the government will be “built around the person not the service”
  • Enshrine in law the right for carers in England to receive support from their local council
  • Ensure that people requiring care can be moved between local authority areas without fear that their care will be interrupted
  • Provide a new legal entitlement for everyone to a personal budget , which they can opt to receive as a direct payment to give them more control where desired
  • Clarify in law what protection will be put in place to ensure care is not disrupted if a care provider goes out of businesses
  • Establish Health Education England and the Health Research Authority as non-departmental public bodies, to give them the independence to carry out their roles

With the principle of introducing a capped cost social care partnership model set out in the Care Bill, the next step will be to resolve the Pandora’s box of issues that need to be resolved in time for April 2016. From then on, people’s qualifying social care costs could count towards reaching the cap of £72,000, after which the state will help towards the cost of the person’s care.

Concerns about the Bill

The heads of 38 leading charities including Age UK, the Alzheimer’s Society, Scope and the British Red Cross, have sent a letter to the Prime Minister warning that a change in how needs are assessed could strip 135,000 frail and vulnerable people in England of state-funded care on which they currently rely.

The charities have warned David Cameron that almost 900,000, who already have to pay if they want help with basic tasks such as washing and dressing, would not be able to benefit from a cap on the cost of care.

They say that the Care and Support Bill, which will usher in a cap on the cost of care to prevent people being forced to sell homes, should transform the system for future generations. But they add that they are now “seriously concerned” that when the final details of how the system is to be implemented are worked out, huge numbers of frail, elderly people will still be left without any help with their care.

Under the current system, only elderly people with assets, including their family home, worth less than £23,500 get help with the cost of care. Even then, only those deemed to have the greatest physical needs qualify.

Those are assessed on a four-point scale ranging from “low” to “critical” with just people above a threshold — decided by local social services – getting help.

In recent years, with funds squeezed, councils have tightened up criteria, meaning that in most areas only those deemed to have “substantial” needs qualify — usually meaning they can no longer live on their own.

Concerns about Assessments and the private providers

Another area of major concern is a part of the Bill introducing a national assessment framework to assess people’s eligibility for care, and also to have the associated costs count towards the cap. This gives local authorities the power to contract out the assessment process of people – to determine how bad their care needs are and what services they might need.

Over the last few years we have seen similar processes adopted via Work Capability Assessments (WCA) of the disabled and sick with contracts awarded to companies such as Atos. If you are aware of these assessments, no doubt, you will also be aware of the hundreds of accounts of people who are clearly unable to work due to health problems being declared “fit for work”.

Even if we are to take the giant leap of ignorance and put aside the obvious injustices suffered by many, many individuals, the use of companies like Atos being used to assess the needs of care raises many concerns, including:

Dr Greg Wood, a former Royal Navy doctor, resigned from Atos in May after working as an assessor for the company for two-and-a-half years. He said said the system was “skewered against the claimant”. He also stated that a number of the tests were staged in such a way as to find people fit for work and an excuse cutting their benefits.

Last year Atos – which in total earns £1.6billion in Government contracts – ‘won’ a government contact, worth £184 million, for London and the South of England on the promise of a tender stating that it had a network of 740 assessment sites across this area.

However the Department of Work and Pensions (DWP) has now admitted that Atos only has “up to” 108 centres available that meet its requirements.

The boss of Atos, Thierry Breton, has been awarded a £280,000 pay rise after his firm helped to heap misery on thousands of disabled people who are deemed fit for work. His total package of pay, bonuses and perks is now £2,329,250. For the same period in 2011, Breton received £2,049,250.

The parent company of Atos is American based “Unum Provident”, a company that makes its cash selling sickness insurance policies. Their “medicals” have been declared illegal in the states and branded “disability denial factories”.

Part of the WCA process is that people are allowed to seek advice and take another person with them to the interview. However there have been numerous accounts that this right is often challenged or refused at Atos centres. At an assessment centre in Liverpool recently, Atos staff called the police to remove a demonstration that was “threatening and upsetting people”. It subsequently transpired the ‘demonstration’ consisted of 2 Councillors handing out leaflets giving advice to people attending assessments and the Atos staff also refused to carry out an assessment after a person being assessed requested one of the ‘demonstrators’ to attend the ‘medical’ with them.

We all need to ask ourselves, would we entrust the determination of our own care needs, or those of our parents, to companies such as Atos? And at the same time we must remind ourselves, and make everyone aware, that hundreds of thousands of disabled and sick people have already had this inflicted upon them and suffered the utter despair and injustice that goes with it.

Sources:
Care Bill [HL] 2013-14 – Parliament.uk
Million ‘at risk’ from Care Bill – Telegraph
DWP finally reveals ‘shocking’ number of Atos PIP assessment sites – The Fed Online
Fury as boss of Atos gets £280k pay rise while thousands of Scots are plunged into poverty by their benefits assessment tests – Daily Record
Queen’s Speech 2013: Care bill – Politics.co.uk
Police called after welfare experts offer advice to disabled ahead of Atos sickness benefit assssments – Liverpool Echo

Related links:
Stop Atos Work Capability Assessments
Video – Filming of an ESA Assessment Carried Out by French Firm ATOS
Video – Simon Hickmans Atos assessment
The Hardest Hit
How To Deal With Benefits Medical Examinations
Victory as judges rule controversial disability benefits procedure is unfair

How To Deal With Benefits Medical Examinations

welfare-wrongs

Never Face Them Alone

This article describes how claimants for disability benefits can deal with the medical examinations by medical professionals, which for many claimants are central in deciding whether or not you are entitled to disability benefits.

Before The Examination

The examinations are run by Medical Services (MS) which is operated by the private profit making company ATOS on behalf of the Department for Work and Pensions (DWP). Before a MS examination your own GP sends info to the DWP. It is important that this info is as full as possible and states clearly whether or not in their medical opinion you are fit for work at that time and in the foreseeable future (at least 6 months ahead).

It is frequently the case that people with a long-term illness gradually minimise in their own minds the effect of their illness on their everyday lives and develop survival strategies to cope on a daily basis in an attempt to lead as normal a life as possible.

This can cause a problem as this habit when taken into a medical examination does not present a true picture of the illness and could be misleading. It might be helpful to discuss the reality of your illness and the limitations it imposes on your life with someone who knows both the illness and yourself well. The reality of your illness is what must be presented to the MS medical professional and to the DWP.

If you have a Medical Services examination, either at the MS office or at your home, always have someone accompany you. This is your right. We have often done this. They cannot refuse you this right – if they try then just insist you need someone with you.

To obtain benefits you are legally required to attend this examination, and the information obtained at the examination is used, within a legal framework, to decide on your benefit entitlement – it is therefore vital to make sure your legal rights are protected.

If the date for the examination is not suitable, eg your accompanying person cannot make it on that date, you can get the date changed. If you are unable to travel to the examination you can ask for a home visit instead. If you change the arrangements over the phone write to confirm the changes. You have the right to be seen by a medical professional of the same sex.

Meet the accompanying person beforehand to discuss what’s going to happen. Before the examination you should be clear that:

  • The examination can be halted to allow you to go to the toilet, have a glass of water, take a pill, or if you feel faint or ill.
  • The examination should only proceed if you feel happy to continue.
  • You should refuse to do anything that hurts or distresses you.
  • The person accompanying you should take a pen and paper and also a watch.
  • If possible, take a tape recorder. Take your medicines, and any aids you use, such as a walking stick or crutches.
  • You can claim travel expenses for going to the examination – but if you need to take a taxi you must contact the MS beforehand.

At The Examination

You should be aware that the examination begins on entry to the examination centre and does not end until you leave the centre. An evaluation of your medical condition does not only take place when you are in front of the examining doctor, but also potentially on your way into the building, in the waiting room, and on your way out. They could note the length of time you can sit without apparent discomfort, how you pick up your bag, etc..

At the examination the medical professional should:

  • Be courteous and considerate.
  • Spend some time explaining the purpose of the examination.
  • Ask if you are willing to be examined.
  • Ask you and give you time to explain YOUR OWN VIEW of how you are affected by your condition, including how it affects your ability to do day to day tasks like shopping, cooking, cleaning and so on.

The examining medical professional should not attempt to ‘manipulate’ parts of your body.

During the examination you should:

  • Make sure the medical professional realises the full extent of your illness/ disability, including any other conditions/ illnesses you may have. Remember, unlike your GP, this medical professional does not know your medical history.
  • Describe how you feel on a “bad day”, rather than on a “good day”.

If you are accompanying the claimant you should:

  • Write down the name of the medical professional, the place of examination, the time of starting and finishing the examination.
  • Take notes on everything the medical professional and the claimant say, what the Doctor asks the claimant to do and what happens. Especially note any aggressive attitude or manner adopted by the medical professional. Note the exact words spoken.
  • Intervene and ask for the examination to be halted if the claimant becomes unwell or distressed. The claimant should have a break until they feel well enough to continue.
  • Object to and stop any attempt by the medical professional to have the claimant do exercises which could injure or distress them.
  • You should have the examination stopped if the claimant is becoming ill or distressed for any reason. If the claimant is not fit to continue then the examination should be postponed until another day.
  • If the claimant’s distress is due to mistreatment by the medical professional, stop the interview, then say that you will be making a complaint with a request for an examination at a future date with a different medical professional.
  • Time the length of the examination and any breaks taken (some medical professionals have been known to exaggerate the length of time of the examination to make it appear more thorough than it was).
  • At the end of the examination ask the medical professional to read back their notes, to check that they have made an accurate record. If the medical professional refuses, then note that together with the reason given for refusing. If there seem to be any inaccuracies in the medical professional’s notes, check with the claimant, then if necessary ask the medical professional to change their notes. If they refuse then make a note of that, writing down exactly what they said.

After The Examination

If the medical professional did anything wrong, then as soon as possible afterwards write a letter of complaint to DWP – don’t wait for the decision to come through. The letter should be signed by both the claimant and the accompanying person.

How You Can Be Found Incapable Of Work Even If You Don’t Score Enough Points

Even if you don’t score enough points under the personal capability assessment – the medical test to decide if you’re incapable of work – you may still have a chance of being found incapable of work either at claim or appeal stage. This is because of the little known ‘exceptional circumstances’ rules.

There are a number of these, but probably the most important is regulation 27(b), which states that you will be found incapable of work if:

  • “There would be a substantial risk to the mental or physical health of any person if he or she were found capable of work’’

This regulation could apply to you on physical health or on mental health grounds.

For example, if you experience severe anxiety attacks and might harm yourself or somebody else if placed in a situation you find threatening, then this might be grounds for applying regulation 27(b).

Or you may have a lung condition which is made much worse by stress and, in the past, such situations have led to a serious deterioration in your health and perhaps hospitalisation. If you would find being found capable of work, having to sign on for Jobseekers Allowance (JSA) and take part in training or work experience very stressful, then that may be grounds for declaring you incapable of work under the exceptional circumstances regulations.

However, neither doctors nor decision makers are quick to identify people who might be covered by these clauses. And very few claimants even know they exist.

ATOS And The Bigger Picture

atos2

ATOS are currently recruiting more staff to help meet Government targets to force more people off disability benefits to reduce the public debt problem caused by banks gambling in the financial markets. The process is driven by cost cutting not objective medical opinion. The most vulnerable in society are being made to pay for the greed of others and the inevitable booms and busts of capitalist economics.

Medical professionals, including physiotherapists, with no experience of mental health problems, for example, are only given a matter of days training before making assessments of claimants. They are paid substantially more than NHS doctors and nurses for leaving their ethical concerns at the door. ATOS claim that they do not make the decision as to whether someone can work and have their benefits reduced, but that the decision is made by the DWP from their report and that performance targets are based simply on the number of claimants seen in a day. However they admit that if a medical professional passes all claimants for disability benefits it will not go unnoticed.

This information has been reproduced from The Crutch Collective formerly Anti Benefit Cuts Glasgow

Please contact BPACC if you require any further information, support or advice. We are not experts in this field but will always show solidarity and try to help in whatever way we can.

Related links:
How to prepare for a ESA Tribunal Hearing – The Crutch Collective
ESA Internal Handbook via The Crutch Collective (pdf)
How points are awarded in ESA assessments via The Crutch Collective (pdf)
Links to factsheets relating to benefits, debt and mental illness – Rethink
Personal Independence Payment – Our free guide to making a claim – Disability Rights UK

underattack

Photos of demo against Atos & WCA 28th Aug

As part of DPAC‘s week of action “The Atos Games” a protest was held outside the Atos Work Capability Assessment centre in Bournemouth. Click here for information about Atos, WCA and for helpful links.

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The Atos Games

As part of a national week of action against Atos, there will be a demonstration in Bournemouth:

Date: Tuesday 28th August
Time: 12noon – 1.30pm
Location: Atos Healthcare assessment centre at Jobcentre Plus, Tamarisk House, 1 Cotlands Road, Bournemouth BH1 3BG

Poster for event: PDF JPG
Leaflet for event: A4 A5
Facebook event page: Atos demo
Further info and links: Stop Atos Work Capability Assessments

Even if you are unable to attend, your help in sharing the details of the local event would be appreciated and please check out the following details of the week of events being organised by Disabled People Against Cuts:

DPAC – Our Atos Games

We are calling on disabled people, disabled activists, families, colleagues, friends and supporters to come together and fight back against Atos’s attacks. Atos represents as dangerous an opponent as any government, law or barrier the disability movement has faced in its long history. It’s not just welfare, but our very identity and our place within society that is under attack.
And we are asking the whole of the anti-cuts movement to join us in our opposition to the company most responsible for driving through the government’s brutal cuts agenda. Let’s make it Games over for Atos!
“We’re not against the Paralympics or the people taking part in it. We’re highlighting the hypocrisy of Atos, a company that soon may be taking disability benefits from the people winning medals for Team GB.

Ever since George Osborne announced he was slashing £18 billion from the welfare budget, the government has paid Atos £100 million a year to test 11,000 sick and disabled people every week, then decide whether they’re ‘fit for work’.

Atos uses an inhumane computer programme to do the testing, and trains its staff to push people off benefits. The government has admitted the tests are flawed, and the British Medical Association wants them to end immediately.

But Atos continues to devastate people’s lives. Many have committed suicide because of its testing programme, and over 1,000 people have died of their illnesses soon after being found ‘fit for work’.

We won’t let them get away with murder, so join in The Atos Games however you can – online, on the phone, or on the streets!

  • Monday 27th: We’ll hold a spoof Paralympic awards ceremony, hopefully with some very special guests…
  • Tuesday 28th: Pay a visit to your local Atos office – and maybe even take your protest inside!
  • Wednesday 29th: A coffin full of your messages about Atos will be delivered to its doorstep.
  • Thursday 30th: Phone jam! Let’s flood Atos with calls, and generate a Twitter-storm they can’t ignore!
  • Then on Friday 31st, join us in London where we’re teaming up with UK Uncut for the Grand Finale – an audacious, daring and disruptive action. Last time we shut down Oxford Circus, this time we will be performing miracles…!

Over the next few weeks we’ll give more details about each day of action. We’ll make sure that DPAC members and disabled people who can’t travel will be able to take part in different and accessible ways.

We’d really like YOU to make this week of action a great success! Let’s come together and show this monstrous company that we’re stronger than them. They’re the vulnerable ones and they know it.