Work Capability Assessment described by Joyce Drummond

I worked as a HCP (nurse) for Atos for 5 months in 2009. I left because of the way I felt I was expected to trick sick and disabled people. I have not worked since. I have recently whistleblown on Atos.

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 carried out Incapacity Benefit assessments, forerunner to ESA. 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.

Firstly the forms that are completed prior to assessment, I have recently found out, are first 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 is used.

It is made clear throughout training and working that we are not nurses- we are disability analysts. Also that 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.

Assessment starts on the day by reading the form you complete when applying for benefit. Things that are noted are-

• did you complete the form yourself
• Is the handwriting legible
• are the contents coherent.

These things are already assessing your hand function, your cognitive state and concentration.

• 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 GP or consultants. 

If you do it shows that you are able to organise getting this information.

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.

When the HCP has read your form they input some data into the computer system. The assessment proper begins when they call your name in the waiting room. At this point they assess-

• did you hear your name being called
• did you rise from your chair unaided, did the chair have arms or not
• were you accompanied - this addresses you're ability to go out alone.
• were you reading a paper while waiting - looks at your concentration.
• Did you walk to the assessment room unaided, did you use aids correctly. Did you navigate any obstacles safely - assessing sight.
• The HCP will shake your hand when inroducing herself - are you trembling, sweating- signs of anxiety.
• Often ask on way to waiting room how long you've been waiting - assessing ability to sit- physically and looking at mental state.
• How did you get here today - ability to drive, use public transport.

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 eg physiotherapy, CPN.

The HCP will use lack of specialist input/ hospital admissions to justify assessing your condition as less severe.

Medications will be listed, are they prescribed or bought. Dates will be checked on boxes to assess compliance. 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, have you stairs in your house or to your house.

Employment history is taken asking when you last worked, what you worked as, reason for leaving employment.

"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 where you are most likely to fail your assessment. Along side this the HCP records their observations.

Starting with your sleep pattern, questions are asked around your ability to function.

• Lower limb problems- look at 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 it's 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 obsevations include- 

• how far did you walk to examination room, 
• did you remove your coat independantly, 
• did you handle medications without difficulty, 
• did you bend to pick up handbag.

Formal exam consists of simple movements to assess limited function.

Things HCP also looks out for- 

• are you well presented, 
• hair done, 
• makeup, 
• eyebrows waxed.

• Do you have any pets- looks at ability to bend to feed and walk.
• Do you look after someone else- parent or carer- if you do this will be taken as evidence of functiong
• Any training, voluntary work, socialising will be used as evidence of functioning.

This is not a comprehensive list, but gives you an idea of how seemingly innocent questions are used to justify HCP decisions.

Mental Health

• Learning tasks- can you use phone, computer, washing machine.
• Hazards- Can you safely make tea, if claiming accidents- must have had emergency services eg fire service. Near miss accidents do not count.
• Personal Actions- Can you wash, dress, gather evidence for assessment

Manage bills.
Observations by HCP= appearance and presentation, coping with assessment interview, abnormal thoughts, hallucinations, confusion.
Coping with change= Ability to attend assesment, attend GP or hospital appointments Shopping and socialising.
HCP observations- appearance, eye contact, rapport, no signs/symptoms abnormal mood/thoughts/perceptions. No suicidal thoughts.

Coping with social engagement/appropriateness of behaviour-
Inapproprite behaviour must have involved police

Ability to attend assessment, engage with assessor, behave appropriately.
Again this is not an exhaustive list, merely examples

There are some "special cases". Off the top of my head:-

• terminal illness 
• intravenous chemo
• danger to self or others if found fit to work

I am happy to speak to any politician, of any party- except BNP. I think it is telling that Atos have made no attempt to sue or silence me. They know I am speaking the truth. 

At present to qualify for ESA you need to score 15 points. This can be a combination of scores from physical and mental health descriptors. To qualify for support group you must score 15 points in one section. As long as you are claiming income based ESA your award can be renewed at each assessment, if you gain 15 points.

Contribution ESA lasts for 1 year only, unless you are in the support group. After 1 year, out with support group, you only get income based ESA if your household income is below a certain threshold. It makes no difference how long yoy have previously paid NI for.

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 WCA assessments from the Secretary for Works 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 re 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 Re wages at Atos. 

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

I hope this is of some help to your committee.
Please do not hesitate me for further clarification.
Joyce Drummond.