Fact-finding Visit
Good morning, everyone, and welcome to the 14th meeting in 2012 of the Welfare Reform Committee. I remind everyone to turn off mobile phones and other electronic devices, please.
Our first agenda item is a report back on a fact-finding visit to the Atos Healthcare assessment centre in Edinburgh, which was two weeks ago, I think. The committee agreed that Kevin Stewart should report back on behalf of the group that attended, which consisted of Kevin, Alex Johnstone and me. I will let Kevin take members through his impressions of the visit and then give Alex the opportunity to add comments. We will then have a discussion until we exhaust any questions and issues that come up in Kevin’s introduction.
Thank you, convener.
I thank the clerks for the note that has been provided on the meeting, which was very interesting. I am sure that the convener and Alex Johnstone will have a few bits and pieces to add to what I say.
It is sometimes very difficult to gauge what is going on in role-playing situations, but I pay due respect to the actress who played the part of the person who was being interviewed. She was very good, even though the room was crowded with Atos people and officials—which did not give us a great impression of what would happen.
A number of things were quite surprising to us and would, I think, have been even more surprising to members of the public. The key issue is the division of responsibility between Atos and the Department for Work and Pensions. Because of what they hear from the media and other sources, the general public seem to think that the Atos folk who carry out assessments are also the decision makers. They are not: the decision makers are officials of the Department for Work and Pensions. The fact that the person who makes the assessment is not the decision maker is probably one of the great weaknesses in the system. I will expand on that.
We got the opportunity to see exactly what the assessor wrote down; we saw the boxes that had been ticked and the comments that were written. I do not know whether the others who were on the visit would agree, but as we went through the tick-box exercise—if you like—it looked very much as though the person was fit for work, although you would have said that they were completely unfit for work if you had seen what happened. What may have swung things for the decision maker—we do not know what the decision maker would have done in the case—was the assessor’s ability to write a few bits and pieces. I mean “a few bits and pieces” because there is not a huge amount of room for manoeuvre in the writing. The interpretation of what the assessor has written is what can make the difference for the person who is being assessed.
The software system that is used is called LIMA, which stands for Logic Integrated Medical Assessment. As I said, most of that is based on box ticking. Professor Harrington has, of course, looked at the system in his reviews. I do not think that the system is quite right because many decisions are based on what the assessor has written and writing can be interpreted in different ways. When somebody asked me to describe the system, I suggested that it is like buying something over the internet based only on a description, so the thing that you have bought is a major disappointment. Description is open to interpretation, and I have a difficulty with a faceless bureaucrat basing everything on the writings of the person who has assessed the person in front of them.
During the course of the visit we found that healthcare professionals do not always co-operate fully with Atos; we were told that general practitioners fail to respond in about half of assessed cases. There is a great danger in that because GPs’ input to assessments could lead to different outcomes.
It is difficult to explain all the ins and outs to people who have not seen the process. The interaction between the assessor and, in this case, the actress, was extremely good, but I wonder whether every assessor handles everything in the same way. We met a couple of other assessors who seemed to be absolutely fine, too, but the reality is that we have seen only a snapshot. We require that a number of other things be clarified including throughput of claimants, changes that have been made to the assessment following the various Harrington reviews, and how many assessments are undertaken by each type of healthcare professional—doctors, nurses or others. The committee must see a copy of the initial DWP form and a copy of the ESA50 assessment form.
An issue that was raised was the increasing levels of violence in Atos centres. Obviously, as I said at the beginning, Atos folk are being blamed for making decisions that they do not make, so we need the figures for violence against staff.
The key thing is that it is all fair and well for us to have seen the Atos assessment folks in action, but we must talk to decision makers and find out how they interpret the information in assessments. At the end of the day, we must ensure that the general public are aware that the Atos assessors are not the decision makers and that that function lies entirely with the Department for Work and Pensions.
Convener, I am quite sure that you and Alex Johnstone will have things to add to that.
Thank you very much, Kevin. That was a fair assessment of what we saw.
I would not say much different, although I got the clear impression that Atos has been portrayed as the villain of the piece, when probably it is not. Although the process that Atos goes through is open to mistakes in individual cases, we saw it carry out a fairly robust process in a fairly objective manner.
We learned that Atos is just a link in the chain and that there may be a problem in how it connects to neighbouring links in the chain. At the front end, there is an issue about who is called in for an Atos assessment. We were told that some applicants are called in for assessment because they have put very little information on their form, which makes it difficult for Atos to interpret the information. However, as Kevin Stewart said, the biggest problem for Atos is that 50 per cent of calls to GPs for information result in no response. When there is no response from a GP, it often leaves no alternative but to call the person in for an interview. There is no other way of getting the information. There is an obvious opportunity to tighten the process up there.
The difficulty seems to be at the other end of the Atos process. Although the information that Atos provides may be objective and accurate, we have no way of knowing how that information is used once it has been passed on. The key issue for me is that there needs to be robust quality control in the system to ensure that, in using the information, decisions are not being made that would not meet with the approval of the person who did the assessment in the first place. There has to be continuity and checks that would give us confidence that Atos’s input is being properly used as it moves through the process.
Thank you.
I agree about the issues that Alex Johnstone and Kevin Stewart have identified. When I left the meeting, my biggest concern was the structural weaknesses in the system. Clearly, Atos had put on its best bib and tucker for us; a very senior person carried out the assessment, who had a nice bedside manner and who took us through the process clearly and concisely. However, I am, as Kevin Stewart is, concerned about the division of responsibility. So few GPs providing information at the outset means that when people turn up to assessments, the assessor has very little knowledge on which to base their questions. It could be that we need to ask the health service what it can do to improve the level of response from GPs. It was made absolutely clear to us that whether a person is called in for an assessment can depend on the information that is provided by the GP at the outset. If the GP does not respond—
It is virtually certain that the person will be called in.
That means that Atos has to call the person in. Atos is making assessments based on very little information. One of the statistics that struck me was that 15 per cent of people who are called in for assessment appeal the outcome and 40 per cent of those decisions are overturned by the tribunal. Of that 40 per cent, 90 per cent are overturned on the basis that information that was not available at the outset has become available to the tribunal. That shows me that there is a structural weakness in the system; people are getting to the end of the process and it is only then that the information on which the assessment was based becomes clear.
We are talking about Atos, but we could talk about any generic health assessor because whoever was doing the job would have the same problem. We need to get GPs to inform the assessors so that the assessors have the best information before they take people through the process. That is one of the structural weaknesses in the system.
Another weakness is that the information from the assessment, wherever it is collected, is passed to a civil servant, who makes a decision on the basis of that limited information. There is no direct communication between the assessor and the decision maker. The assessors make it clear that they have no knowledge of the outcome of assessments and decisions that are made.
09:45
The third thing that concerns me is the level of violence that is being reported. People are turning up in anticipation of there being a problem; they are carrying that morning’s newspaper with the latest headline against Atos and expecting it to be ready to strike them off their benefits. That culture has started to develop and is becoming quite a cause for concern. We have to raise that issue.
It might be appropriate for us to contact the Cabinet Secretary for Health and Wellbeing to ask whether something can be done within the national health service to get GPs to engage with the process, because I think that that would help. However, Atos needs to do a lot of work on its public relations to try to clarify exactly where it sits in the system.
I open the meeting up to colleagues who want to ask questions.
On your point about whether something can be done to make the system a bit better by removing structural weaknesses, I am aware—as you are, convener—that NHS Lanarkshire will do some of the work for Atos. Would it be worth our while making contact with that health board to find out how it intends to approach the situation and—in the background—whether it is enabled to do anything differently or whether it will be forced to follow the same procedures that Atos uses?
I can partly answer that. A couple of weeks ago—I know that you were unable to attend—the Lanarkshire MSPs met the health board, and a representative of Salus was at the meeting to answer our questions. It struck me that that representative said that it is going to do things differently—it will input to the decision-making process and so on. When we turned up three or four days later to meet Atos, it told us exactly the same as what Salus had said; the impression that has been given is that Atos is the decision maker, which even Salus believed. Salus has been told that it will be able to give input and that it will be able to talk to the DWP and try to inform the decision-making process—Atos told us exactly the same thing—but in reality it will not.
One of the criteria was changed, because Atos was feeding information back—I think that it was on cancer patients. Atos told us that, when it sees issues arising, it feeds information back to the DWP, which is exactly what Salus said it would be doing. The position remains that the DWP draws up the questions and the assessments, and both Atos and Salus will do their work according to the criteria that are set by the Department for Work and Pensions.
When I met the official from Salus, I suggested to him that he might receive an invitation from us to come here and give evidence. Salus will not start doing assessments until the middle of next year and we will probably need to wait for a while to see how they are rolled out, but we will need to get Salus here at some point.
Although Salus will not start to do assessments until the middle of next year, it will be making preparations now. It would be interesting to hear what those preparations are. Also in that vein, it might be useful to get the British Medical Association back to discuss the issue.
In your report back, convener, you mentioned the involvement or otherwise of GPs and the relationship of that to the success or otherwise of appeals. Irrespective of whether there is input from GPs, how can the questions be so out of kilter with individuals’ actual situations? That is an important question to bear in mind. The DWP sets the questions, but is any differentiation made as to whether, in a particular case, there is input at the start from a GP? Does that determine which suite of questions is proceeded with? I think that there are further investigations that we can helpfully make here.
I will give a personal opinion, convener; it may well be that you and Alex Johnstone will disagree with me. In my view, some of the tick-box questions are pretty irrelevant—for example, the ones that ask how the person has presented themselves, whether they are clean and tidy and all the rest of it. The assessor said to us afterwards that he has to dig below the tick-box answers to find out whether such situations are the norm. Obviously, we met someone who was probably one of the organisation’s top-notch assessors. There are probably other folk—I am just guessing here—who, on a bad day, might just tick the box and leave it. One wonders about the relevance of such questions anyway. There are others that I could pick out.
A lot of what we saw involved the assessor trying to dig below the questions. As I said, he was probably one of the better ones—I do not know whether they all do that. A lot of the original tick-box questions are pretty irrelevant anyway, and we do not know how the current questions compare with the questions before the first and second Harrington reviews. There is an on-going review, but we do not know whether there will be any massive changes, or a move away from the tick-box exercise towards much more of a script-based exercise so that the decision maker has a real idea about what is going on.
I thank the convener, Kevin Stewart and Alex Johnstone for the useful and worthwhile feedback that they have given us from the visit. An obvious issue relates to GPs. I heard what the members said and I think that it would be worth our while to have Salus appear before us after it has done some of the work. Annabelle Ewing may be right to say that it would also be useful for Salus to come to the committee before then so that we can hear about its preparations.
I was also at the briefing that the members attended. If we take at face value what Salus has told us, it seems that its work will be quite innovative, so it would be as well to get that on the record. Perhaps we can invite Salus back after it has begun the work, and invite the BMA and a panel of representatives from that sector to the committee so that we can ask them about the issues that have been identified.
That brings us back to the fact that Atos has a contract with the DWP, which sets the terms. We must keep in contact with the DWP and pursue it to appear before the committee. I think that a letter has gone to the Secretary of State for Work and Pensions. He will, I hope, be a bit more positive in his latest response.
We should definitely follow up the GP issue. It seems to be pretty important and it is an area for which the Scottish Government—if only at arm’s length—is responsible.
Kevin Stewart said that a decision maker who had not seen the assessment that he saw but had seen only the output would think that the person was fit for work, whereas if the decision maker had watched the assessment and seen the person—or rather, the character who was being played—their view would have been that the person was not fit for work. What were you alluding to in that regard? Was there a problem with the assessment, or were the wrong questions being asked? That seems to me to be pretty fundamental to the question of whether or not the system is delivering the proper outcomes.
I will clarify what I said about the tick-box situation. If you watched—as we did—the assessor ticking the boxes, you would probably have come to the conclusion that the person was fit for work. However, the doctor’s written responses in the limited and small spaces that were available began to sway the decision the other way; that would have changed your mind and made you think, “Maybe not.” It was difficult, because there were three of us around one screen because of technological problems.
I asked, at the visit, specifically whether Atos has a target. Atos made it absolutely clear that it has no target because it makes no decisions—it just carries out assessments. However, the DWP did not clarify whether or not it has a target. The decision maker might ultimately be saying “I have to get a certain number of people back to work.” Whether that is the case was never clarified, so it comes back to the point that Jamie Hepburn made: we will keep asking the ministers at the DWP to come before us because we have questions that we need to ask them.
The offer has been made for us to speak to officials from the DWP, which we should not rule out. We need to get answers from the DWP because the system involves the NHS in Scotland, which is working with a lot of service providers in relation to getting people back to work. Unless we can see where everything joins up, we will always be guessing about how the system is working. We must keep pursuing the DWP to get them before this committee, because we need to know how the system is working and how it can be better used to do the job that it is supposed to do.
I attended last week the cross-party group on armed forces veterans, which one official from the DWP attended. He had answers to some of the technical questions that were asked by veterans organisations, but the minute the questions strayed into policy, he said “I’ll have to take that higher up.” He was not trying to be obstructive; that was his position. We can get only so far by speaking to officials. The convener is quite right that in order to get to the bottom of some of the key elements, we need to hear from the secretary of state—or, failing that, the minister—here at committee, on the record, showing respect to this committee, as I believe they should be doing.
I will re-emphasise the importance of GPs in the process. It seems that GPs’ input is vital, whether in relation to the initial application or elsewhere. Failure of GPs to provide input is often a reason for people being assessed. As we have heard, the appeals process is often successful because of GP input at that stage. The lack of GP input is currently putting the system under unnecessary pressure at the sharp end.
We have overrun by a wee bit, but it is useful to give everyone the opportunity to make comments. We have a number of questions that we will pursue, but I will let Kevin Stewart pull it all together for us.
It is useful that we have overrun. One of the things that we need to find out is how much notice GPs are getting. It is all fair and well for others to say that half of GPs are not responding, but what kind of timescales are they being allowed in which to respond? We know that they are all very busy, so if they must respond within a week, for example, the system is bound to fall down. It is important to find out exactly what the timescales are.
Regarding the DWP and the fact that ministers continue to refuse to come to the committee, one of the most interesting things about the meeting that we attended relates to the folk who were in the room with us when the assessment took place. One of the ladies in the room said that she manages the contract. I asked her whether she manages the contract for Scotland and she replied that she manages it for the whole United Kingdom. Obviously the DWP is concerned that we are undertaking such visits before they have sent their top bods to keep an eye on us, if you like.
I thought that that was just the DWP showing respect.
I do not think that it was; if the DWP wished to show us any respect, Iain Duncan Smith or Lord Freud would have attended the committee by now.
Hear, hear.
10:00
If the DWP is willing to send a top bod up to attend that meeting, it should be sending those folks to this committee so that we can get the answers that we need from the decision makers. It is extremely important that we examine the whole process.
We have seen a bit of the process in terms of the assessment, but we need to get to grips with how the decision is taken and on what criteria folk are deemed to be fit or unfit for work. Until we get that information, we are still shooting in the dark. We are dealing with an aspect that has been taken out of context in terms of what the general public thinks because of the lack of information—or because of misinformation. Atos has taken a lot of flak, and the reality is that the folks who should be facing the flak have failed to show face at this committee.
I fully endorse your final comment.
We will invite Salus and the British Medical Association to come and talk to us at some point and we will write a letter on the GP issue to see whether we can get clarification of the points that Kevin Stewart has raised about timescales and so on.
I know, anecdotally, that there is an issue about GPs charging patients. Could you mention that in the letter on the GPs?
We could look back at the evidence that we have taken. There was representation from the BMA—
Was that before I joined the committee?
Yes.
To a small extent, we addressed the issue of whether there was a cost implication. We could revisit that.
Could we try to get some decision makers to visit the committee?
Why not?
Who will we write to in that regard?
We will write to Salus, the BMA and the national health service, and we will try to get clarification of the situation with regard to the Department for Work and Pensions’s decision makers. Is that agreed?
Members indicated agreement.
We will suspend for a couple of minutes.
10:02
Meeting suspended.
10:03
On resuming—