Fact-finding Visit (Report)
Our second item of business is a report back on the fact-finding visit to meet Department for Work and Pensions decision makers at the Bathgate benefits centre. I went on that visit, along with Annabelle Ewing and Alex Johnstone. I invite Annabelle Ewing to report back on the visit, and Alex and I will offer any additional comments, if that is necessary.
Last week, we went to the DWP office in Bathgate and met the site manager, the group manager and three decision makers. They felt it appropriate to go through three case studies—with the names and addresses deleted—to demonstrate how they go about handling various elements of their case load.
The decision makers were clearly making decisions within the parameters that are set by the rules that are applicable to them. They stressed that they were not required to meet any quota of cases that are allowed or disallowed. We also dealt with the issue of points being placed in the medical report forms by Atos, further to the medical examination, with regard to various elements of the work capability assessment. We tried to get to the bottom of the question of whether Atos awards points or not, and the answer that we were given is that the medical report form includes points by way of recommendation, but those points are not the end of the story. The decision makers consider all of the information before them, which includes the information from the applicant, the medical report form from the individual in Atos and, where it exists, information from the GP or further medical evidence. They were at pains to say that they consider all the information, and that the points that appear on the form that they receive from Atos are simply recommendations, not the final decision.
The decision makers also indicated that, following the Harrington reviews, they have changed some of the procedures in terms of the number of call-backs that they make to reach an applicant by phone when they need further information. They say that they call back at least twice. They also say that the Harrington reviews have led to the inclusion within the work capability assessment documentation of a personalised summary relating to the applicant or client.
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The decision makers also provided some information to the effect that the procedure now is that if, within one month of the applicant or the client receiving notification of the decision maker’s decision, they provide further information that is relevant and compelling, the decision maker can change their decision, absent going through the appeal process. That was quite an important piece of information to extract, because that is something that we can, in turn, pass on to our constituents.
One case study concerned someone who was receiving treatment for cancer and was put into the support group. That was a clear-cut case, where certain obvious conditions were met.
The second case was in more of a grey area. The applicant had provided information, and the Atos recommendation was six points for mobility, which meant that the points were not high enough to secure support group status. The decision makers said that they considered that case and all the information that was before them and decided to raise the points that were awarded for mobility. That was an example of a case in which the decision makers went against the recommendation from Atos.
The third case concerned a situation in which the points were not sufficient for an award to be made. I guess that that case seemed fairly clear-cut as well.
Certain issues arose from our visit. I am sure that the convener and Alex Johnstone will want to make some points, but I would like to make some first.
At least in the three case studies that we saw, the medical report form says on its front page who carried out the assessment and what their status or level of qualification is—we do not have the papers because they took them back, notwithstanding the fact that they had deleted the salient information relating to identity; they had a belt-and-braces approach to confidentiality. One of the papers was by a doctor, another was by a nurse, and I am not sure whether the third one mentioned who had conducted the assessment.
In a whole series of categories in the form, Atos awards zero points. I asked the decision makers whether, when they say that they consider the whole of the information again, they mean that they also conduct a detailed consideration of all the zero categories because, if someone suddenly had points in one of those many categories, they could find themselves in a completely different position. They stressed that they did that. However, my feeling is that, the minute you have something on paper, that is a presumption, and changing that is akin to changing the status quo, which involves a slightly different psychological approach.
There was an issue about the descriptors and what possible relevance they could have to the world of work. We had a discussion with regard to the second case, which involved an applicant who was capable of sitting for more than an hour. What relevance that would have to their ability to carry out an eight-hour shift at work was not clear. To be fair, that is not an issue for the decision makers, but I wish to make that observation.
Before the medical assessment forms were taken back, I noted the headings that are used when someone mentions depression or a mental health issue in their initial application. One of those headings was, “THOUGHTS”. That was followed by:
“Does not ruminate (recurrent or persistent thoughts, involving complex sequences and internal debates, that enter the mind despite efforts to exclude them)”
and
“No obsessive ideas (distressing repetitive thoughts)”.
I wondered about the extent to which any assessment could be made by an average Atos examiner with no mental health specialism. What do those headings mean in practice? They do not mean a lot to me. I can think of a lot of people who may or may not have obsessive ideas, but that does not stop them proceeding with a host of things.
Those were the issues that arose for me in particular. Everybody was most helpful and sought to answer all our questions. The clear message was that they act within the parameters set. That probably brings us back to some of the broader issues that we have discussed before.
I will make one last point, if I may. At the end of the medical assessment form there is a declaration to be completed by the person who conducts the examinations. This is what they have to sign and swear to:
“I have completed this form in accordance with the current guidance to ESA examining health care professionals as issued by the Department for Work and Pensions.”
I asked whether the decisions makers had the document guidance referred to here, whether it is in the public domain, and whether we could have it. I have to say that the answers were not terribly clear. I suspect that we may have to go back to the DWP to try to get hold of that because it would be very interesting to see what guidance they are supposed to comply with in order to complete the medical assessment forms.
That is a pretty comprehensive account of the visit. There are a couple of points that I want to pick up. I am not saying that they have been left out, but they struck me when I was there because I had no expectations at all about the scale of what we were dealing with.
The scale of the centre in Bathgate is different from that of the Atos centre that we visited. Atos has facilities in different parts of Scotland whereas the decision makers centre in Bathgate is the only one for Scotland—and not only Scotland; it is also for the north-west of England. Two of the cases that we got were from the lake district. I was surprised by the scale of what goes on in the facility in Bathgate. I think that last year it had 44,500 cases to review. I do not know how many staff do that, but the scale of what happens there struck me as very significant.
We danced on the head of a pin at one point about what Atos actually does—whether it allocates, recommends or suggests points, or whatever. However, it became quite clear that the decision makers were not aware that the further medical information from general practitioners—which we have banged on about, and which has been lacking in so many of the assessments that have taken place—was a requirement. They just thought that it was a matter for Atos—whether it was able to get this information or not and whether it was helpful or not. They did not know that that information should be there and that it was part of the assessment.
That was very significant in one of the cases that Annabelle Ewing identified. Two of the cases were fairly clear-cut, either way. In the one in the middle, however, points were added to what was recommended when more information became available. That emphasised to me just how vital that additional information from the GPs or health centres is when it comes to making these decisions. Had the information been available to Atos or had Atos taken all the information into account, the person might not have had the recommendation.
When we were shown some examples of responses from medical professionals, it was quite noticeable that they were extremely poor.
Yes, and the level of the information was not particularly good. As Annabelle Ewing indicated, in one of the cases that she described, the person who carried out the Atos assessment was a nurse. The information on physical activity, movement and what have you was reasonably detailed, but, when it came to mental health, the descriptors were very, very limited. The contrast in the assessment between physical ability and mental health was quite stark.
When we visited the Atos centre some time ago, we were shown a worked example of a case that represented a mental health issue. Can you remember whether, at that time, we were told whether individuals with apparent mental health problems were treated any differently? Were they seen by people who had specialist knowledge or was it random?
My recollection is that it was just random.
When I heard that the forms were going to be taken back, I checked the language that was used in them and saw that they used different language when they dealt with issues that had more to do with mental health. The decision makers said that there was a difference in the headings in the forms because, in those other cases, a mental health issue had not been raised in the initial application form. The one that talked about rumination and obsessive thoughts concerned a person who had raised depression in their initial application.
It is clear that there is no differentiated approach to mental health. That is worrying, and it picks up on the points that were made in our earlier session about the impact on people, particularly those who are struggling with mental health issues.
I thank all of you for the information that you have given us about what sounds like an interesting visit. You might recall that, over the summer, I visited New Horizons Borders, which is the peer support group for folk who have had or have mental health challenges of various types. People there placed on the record their concerns about the types of questions that were being asked and the fact that the people who were undertaking the assessment did not have the requisite expertise. Your experience tallies with the experience of those who are going through the assessments.
I would like to make two comments. The first relates to a question that I posed to DWP officials in this committee. Do any of the decision makers have any medical experience?
Secondly, Annabelle Ewing said that there were two clear-cut cases and one in which the decision maker chose to move the person up by giving them additional points. In how many cases does the decision maker move someone down and thereby take them out of the equation?
We were told that, although it is not unheard of, it is extremely rare for people to be reclassified downwards.
And on the issue of the medical experience of the decision makers?
That was clarified. All the staff who conduct Atos assessments are health professionals.
I understand that, and I remember that from my visit. However, my concern involves the decision makers—the folk in Bathgate. The DWP officials were reticent on that issue, and my suspicion was that not many of the decision makers had any medical qualifications. Was that question asked? Did anyone give any indication of the situation?
It was made clear that the decision makers were civil servants. They were experienced in that role and had arrived in that role as a result of the experience that they had gained. However, they are civil servants. The medical knowledge and experience is on the Atos side.
To be clear, the latter pages of the medical assessment form are concerned more with issues such as the general appearance of the applicant—whether their clothes are clean, whether they have washed, whether they are unkempt. Those are things that can be observed by anyone. However, as I said, there were also questions about whether the applicant ruminated or had obsessive ideas. How would you know by looking at someone whether they are ruminating or not? There was no explanation about what questions had been asked to pursue that—that is to say, it seemed that none had been asked—and that person got zero points for that section. I have a real concern about that part of the form. It is completely meaningless. With respect, how could anyone who is not a mental health specialist make any progress with that kind of questioning?
For the record, I should say that we were accompanied by our excellent clerk Rebecca Macfie, who prepared the report. We thank her.
Thank you, Rebecca.
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I have visited Atos, I have visited the DWP and I have also sat here and heard about the experiences of individuals who have been through the system. While there is no part of this process that is foolproof—I doubt whether it would be possible to achieve that—I believe that I have seen a system that is broadly robust and that allows assessments to be made, reviewed and considered in a way that, as we heard from people who came forward as part of the your say initiative meeting, enables decisions to be reversed, following an appeals process. I believe that the combination of processes is largely robust. If there are members of the committee who believe that there is some kind of conspiracy afoot to achieve objectives that have not been declared, I say to them that I have seen no evidence to support that idea.
In fairness, I would concur with about 90 per cent of what you have said, Alex. My concern, which I raised at the meeting with the DWP decision makers last week, is that, even though they and the Atos healthcare professionals can be as professional as they want to be, if what they are looking for bears no relevance to someone’s practical experience of work, it makes no difference how thorough and professional those individuals are. You can assess 100 people on the basis that they can walk 50m, sit for an hour, move a box from one position to another or raise one of their hands above their head for a certain period of time and you might arrive to the same conclusion on every one of them. However, whether that makes someone capable of working an eight-hour shift for five days a week is a different question. For me, that undermines the whole process.
Regardless of how well someone at Atos or in the facility in Bathgate does their job, people will be taken off benefits because they are deemed fit for work when, clearly, that is not the case. The assessments from the DWP, which were devised to create that system, mean that people who need support from society because they are vulnerable are no longer going to get it. That undermines the whole process; it is nothing to do with the individuals who are carrying out the assessments.
If the system is so robust, why do so many people win their appeal when they produce more medical information? That is key to all of this.
With respect, I point out that I included the appeals process as being part of what makes the system robust. I am well aware that there are more appeals than we would like there to be, and that a lot of them are successful. However, nevertheless, the system seems to produce results that concur with the objectives of the system.
I disagree with that, convener.
So do I.
And so do I.
I think that there is a consensus around that, on the part of some members.
And your agreement was hardly 90 per cent, if I may say so, convener.
A bit of magnanimity from the convener never hurts.
I was trying my best.
Does anyone else want to raise any points on the report? It might be useful to collate all the information that we have gathered from our visits and so on into a document that we can refer to.
Yes. Also, there are a couple of questions that arose during our visit that we would like to pursue with the DWP or the UK Government directly.
We will have a look to see what they are and get a letter off to the appropriate people.
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Meeting continued in private until 12:31.