In the wake of increasing privatization of parts of the U.K.'s National Health Service, the dismissal of Atos Healthcare – the private company commissioned by the Department of Work and Pensions to assess whether or not existing or potential claimants of disability benefits are fit for work – has sparked fresh debate about the efficiency of subcontracting vital healthcare services.
In April, the DWP announced that its contract with Atos would terminate early, finishing at the beginning of next year rather than in August. (A previous memo leaked in February had already hinted at the decision.)
The move came following intense fury from campaigners and politicians who said that Atos's rigorous, one-size-fits-all testing process had wrongly assessed too many people as being “fit for work,” leading to a spate of deaths. Atos staff were reported to be receiving threats, including death threats, as a result.
At the end of last month, further revelations about Atos's substandard service emerged, with official figures showing that only a quarter of all Atos claims were being processed within the government's 13-week target. However, the government plans to replace Atos with another private company, and many fear this will not bring any significant improvement.
Fit, or Not, to Work
Colin Traynor, 29, suffered from grand mal epilepsy from the age of 14 months. Deemed “fit for work” by Atos and stripped of his benefits, the stress of waiting in poverty for his appeal to be scheduled triggered a seizure which killed him. A fortnight after he died, the DWP informed his parents that he should never even have been assessed in the first place.
Despite suffering from a severe degenerative lung condition which rendered him unable to walk or breathe properly and reduced his weight to seven stone, Larry Newman was also assessed fit for work. He died from his condition while waiting for an appeal date. The last thing he said to his wife, through a ventilator, was: “It's a good job I'm fit for work!”
Cases like these are common. Atos testing for mental health disorders has been a particularly controversial issue, with many insistent that the tests simply disregard these conditions as they don't feature a physical component. Mark Wood, 44, suffered severe depression and died of starvation – weighing just 78 pounds when his body was found – after his benefits were stopped.
These are just a few of the many victims of Atos's test procedures. Government figures released at the start of last year suggest that 1,300 people died after being told they were fit for work, and a further 2,200 died waiting for their assessment to be completed.
Following the announcement about the termination of the contract with Atos, a spokesperson for the DWP said: “I am pleased to confirm that Atos will not receive a single penny of compensation from the taxpayer for the early termination of their contract; quite the contrary, Atos has made a substantial financial settlement to the department."
Atos's statement simply said: “We are pleased to have reached an agreement with the government to allow us to exit this contract early and we remain committed to delivering essential services to the U.K. government as a strategic supplier.”
Atos declined to comment. However, Occupy.com managed to speak to two Atos clients, both with mental health conditions, who won tribunals against the company. Jenni Crisp suffers from bipolar disorder.
She was assessed as “fit for work” by Atos, after which she took them to court and won. She told Occupy.com: “I rapid cycle, which means I go from a manic high to a depressed low without a noticeable calm break between the two. I have a cycle of about eight to 10 weeks where I become manic for about a week, then depressed for about two weeks, then I even out for about six or seven weeks and then it starts all over again. I generally have about six or so episodes like this a year.”
Crisp has had significant difficulty getting work because “not many employers will hire someone who will probably have to take three or four weeks off every couple of months because they are either bouncing off the walls or incapable of getting out of bed.”
She has been assessed by Atos three times since 2010. “I was asked the same questions as they put on their application form,” Crisp said. “The majority of these were about my mobility, which is fine, not my mental health issues.”
Crisp felt a significant level of concern over the fact that the assessor did not seem qualified to make the assessment. “On the first occasion I was assessed I asked the person interviewing me if they were a doctor specializing in mental health,” she recalls.
“After a bit of wrangling it was established that the person was not a doctor and had no medical training at all. I questioned the validity of a medical assessment conducted by a non-medical interviewer but I was told that most cases were dealt with like that.
“The second assessment had the same result. The third assessment stated that the doctor interviewing me did not believe I was bipolar and recommended that I had my benefits withdrawn,” she said.
A shocked Crisp lodged an appeal against the decision.
“We walked into the court room but before we could even sit down the judge handed us a piece of paper and said, 'That is the confirmation that your appeal has been upheld. I am sorry you had to go through this, it is obvious that you are unfit for work and you should never have been told otherwise'. So now I am on the permanently unfit for work section, which technically means that Atos should leave me alone.
"But will they? More to the point: what happens when ATOS goes? Will everyone in the 'permanently unfit for work' section have to go through it all again? I bet they do.”
Sarah Johnson suffers from depression and anxiety as a result of childhood sexual abuse. She also found Atos testing to be inadequate for mental health conditions.
“I got through my first assessment, I was asked to come back in six months, then at this second interview they said I hadn't scored enough points,” Johnson explains. “You had to get 15 points. I sat down with a friend of mine, who was also a long-term Atos user, and we prepared a defense – bringing up things such as the fact that 'masking' is a common tactic for survivors of abuse. We can hide our distress well and present as a being stable when we're not. The fact that I was neatly dressed, articulate and not rocking back and forwards with distress was another thing which lost me points.”
Johnson's tribunal was successful and her score “went from 0 points to 30,” although she was asked to return every six months for assessment.
“I know I don't fit into their boxes so I have to adjust my answers to fit into their boxes, which makes me feel like I'm lying,” Johnson sighs. “And it's only going to get worse. They are now talking about introducing a new system where you are assessed online without ever seeing a real person!”
So what does this very public failure say about the future of the main source of increasingly privatized healthcare, the National Health Service? John Lippetz of the Keep Our NHS Public campaign, says, “Atos, Serco, G4S – all these types of organizations have been proved to be inadequate in many ways. The outsourcing that goes on to these types of organizations is there to provide them with profit. That's all they're interested in.”
Despite both G4S and Serco being implicated in a catalogue of malpractice – including fraud scandals, allegations of mistreatment of refugees and prisoners and, in Serco's case, severe understaffing of the health services which they run – the government still continues to grant them contracts.
“The NHS currently has over £10m of privatization contracts,” Lippetz continues. “Privatization means the priority becomes getting financial returns on the contracts, rather than doing what's best for patients. If the Transatlantic Trade and Investments Partnership – a proposed free trade agreement between the U.S. and the U.K. which would mean governments have less power to regulate markets according to public need rather than profit – goes ahead, this will put corporations in charge.”
Lippetz is adamant that privatization offers nothing in the way of improved service. “Doctors and consultants who see private patients as well as NHS patients get a lot of extra money,” he says. “But the reality for patients is that the public service gives a better service overall.”
In Lippetz's view, the threat of moving towards a U.S. model of healthcare is very real.
“Before the NHS came in, people were frightened to go to the doctor because they couldn't afford it. The danger is we're moving towards payment for services.”
It remains to be seen, then, if lessons will be learned from Atos's failure – or if the race towards a profit-based model in U.K. healthcare will continue regardless.
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