Tuesday, 18 February 2014

No rubberstamping? ATOS decides

The assessment process for Employment and Support Allowance (ESA), has been the subject of severe controversy and debate for a number of years.
The WCA (Work Capability Assessment) forms an integral part of the decision process and is administered by ATOS.
The WCA itself has come under attack with even the BMA calling for its suspension as far back as 2012.
It has been found in court to discriminate against people claiming on the grounds of mental health and despite some improvement since its initial implementation is said to continue to cause harm to many claimants.
Although ATOS is responsible for administering the test, the DWP has set its conditions and parameters. The DWP and ATOS have always denied that there are "targets" to meet as to how many claimants should pass the test. However it has become clear that "norms" have caused the same effect.

After administering the WCA ATOS staff issue a recommendation to the DWP as to whether the claimant should be assessed as Fit For Work, or put in the WRAG or Support Group.
The final decision rests with the DWP decision maker who we are told also has access to "further information".

Throughout the past few years the government has strenuously denied that ATOS decides who gets ESA. For example on July 22nd 2013 Lord Freud addressed the House of Commons and said:
"Assessment reports, such as those provided by Atos, form only one part of the WCA process, which has a number of checks and balances built in to ensure the right decision is reached for claimants. After the Atos assessment DWP Decision Makers make the final decision on claimants’ benefit entitlement based on all evidence provided during the claim."

It was therefore interesting to read this FOI request which gives the number of final DWP decisions compared to the number of provisional ATOS decisions.

A few short calculations reveal that the DWP follows the ATOS recommendations in 91% of cases.

This hardly seems to back up the claim that the ATOS process only forms a small part of the assessment process with plenty of "checks and balance". Instead it seems a rubber stamping exercise.

The fact is, for all intents and purposes, ATOS decide who is eligible for ESA at the WCA stage, with all the flaws mentioned above.

Notwithstanding this, there are some further troubling questions raised by the data.
Further scrutiny of the figures reveals that 98% of overturned decisions are in the claimant's favour, raising questions on whether ATOS are being too harsh in their assessments.

Furthermore, FFW recommendations are far more likely to be upgraded (16%) than a WRAG recommendation (4%). While this could partially be due to the structure of ESA itself, it also raises the possibility that DWP decision makers are concentrating more on FFW recommendations than WRAG.
Given that WRAG is time limited to one year for contribution based ESA, not to mention the requirements imposed on people in the WRAG including the threat of sanctions, this is a serious issue.

All of these issues: the potential over harshness of ATOS recommendations, the possible lack of investigation on the part of DWP decision makers and the possible concentration on FFW recommendations at the expense of the WRAG, should be investigated at the earliest opportunity.

Wednesday, 12 February 2014

Fibro and CFS, misunderstood disorders?


I originally wrote a blog post called "Fibro and CFS, mental disorders? WHO must rethink" in response to an article claiming that "The World Health Organisation (WHO) is due to "label Fibromyalgia and ME/CFS mental and behavioural disorders".

This article has since been withdrawn due to inaccuracies. WHO has clarified that there is no intent to classify these conditions as such in ICD 11. However an image of the article is still available here if you wish to read it.

WHO tweet: Fibromyalgia, ME/CFS are not included as Mental & Behavioural Disorders in ICD-10, there is no proposal to do so for ICD-11

It remains the fact though that a large part of the medical community believe that these conditions are primarily psychological in nature. They also have a particularly bad press with the general public. This is concerning due to the seriousness these conditions can have.

Rather than remove my blog post entirely I have therefore simply amended it by removing any references to today's inaccurate WHO article, as it is otherwise still relevant to these problems.


I am not an expert on fibromyalgia, ME and CFS and the differences between these 3 conditions. I am aware though that a great deal of research is currently ongoing and there is more and more evidence arising which suggests that these are physical illnesses (eg impaired pain receptors in fibromyalgia, SIBO and fibromyalgia, CFS may be autoimmune disease) These conditions have however have long been overlooked, misunderstood and more importantly dismissed by the medical profession and the public alike.

This dismissal is what has been the most damaging in my opinion. If the illness is not taken seriously then little research will take place. Without this research, medical knowledge and understanding will not advance and any possibility of proper treatment will remain out of reach. Furthermore patients will continue to be misunderstood and belittled by medical staff and the general public.

Sadly the feeling among the general public is that these are not "proper" illnesses on the same level, say, as MS, lupus or arthritis. Yet in my experience serious cases can be just as debilitating and require just as much support. This support is not just physical and practical but emotional too. Not receiving this and instead getting disbelief and even condemnation from friends, family, doctors, co-workers, acquaintances and the media is isolating and soul destroying.

A certain amount of bias also exists among medical professionals. While some doctors are sympathetic towards their patients, others are still very dismissive. Others still believe that these conditions are primarily psychiatric in nature. In some countries such as the USA the DSM 5 reclassification also makes these conditions particularly vulnerable to being classified as having a somatic symptom disorder.
There is nothing wrong with having a mental illness. However having a physical illness misdiagnosed as a mental illness is very wrong as it means that most patients will not get the treatment they need. Worse, they may be forced into unnecessary and inappropriate treatment. Imagine an MS patient being sent for CBT to alleviate their symptoms. Sounds barbaric? Not so long ago MS was also considered a psychosomatic disorder because the symptoms varied so much from patient to patient and doctors did not have a clear cut way to diagnose the illness. We now look back on this in horror. I believe one day we will do the same for fibro, ME and CFS.

I will admit to a certain level of personal bias. When I first got sick my symptoms fit MS. However this was unsupported by any test. Instead of delving deeper, my doctors in their wisdom decided that I had some form of psychosomatic disorder. Some went further and decided I was malingering. I was harrassed. One doctor went so far as to say "Think what you are doing to your family". I was sent to psychiatrists who found nothing wrong. This was ignored.
Eventually I was diagnosed with lupus (SLE). By then it was a little late. Permanent damage had already been done, not to mention 4 terrible years during which I began to believe I was an evil person for being ill! It took many years for me to shake the shame and guilt I felt. The psychological damage this caused cannot be emphasised enough.

I don't blame my doctors for not diagnosing lupus immediately. I was far from a textbook case. I do blame my doctors for reverting to a psychosomatic/malingering diagnosis when they couldn't find out what was wrong. It turns out that lupus is one of the most misdiagnosed disorders, known as "the great imposter" and many patients are told their symptoms are psychological.

This attitude of the medical profession must change. There is no shame in saying "I don't know". Medical research has only gone so far and doctors can only work with what they have. If something is unexplained it may simply be that medical research has not yet advanced enough to explain it. I strongly believe that this is the case with fibromyalgia, ME and CFS. More recent research tends to support this.

I can but hope that this research will continue to be well funded and shed light on what is really going on. Only then will patients receive the treatment they need and the stigma surrounding these illnesses finally disappear completely.