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Picking up the pieces

There can hardly be a GP in the land who has not noticed the mess that we are being invited to mop up over the Government’s work capability assessments.

The programme to reassess whether people on benefits are fit for work – as contracted out to the French technology company Atos at a cost of £100m a year1 – is creating distress in patients and additional workload for practices as many people are told to ask their GP for a letter to try and support their claim.

We are asked to fill in cursory forms that give space only for confirmation of the diagnosis; barely any space to describe the impact of illness on a patient. A doctor recently wrote in the BMJ about how difficult she found the process; how much worse is it for patients who are unused to form filling and bureaucracy?2

The fall-out for ordinary people is immense. Many people who have worked all their lives and who feel guilt and shame at being ‘burdens’ on the state find the process of claiming benefits humiliating and degrading.

There are multiple harms created for citizens that are going unmeasured – the ongoing stress of the uncertainty of the process has profound impacts on many people’s health.

The costs of this are not being borne by the company running the scheme; the NHS is bearing the brunt of them.

Earlier this year, the LMCs conference called for the process to be scrapped, saying it should be replaced with ‘a rigorous and safe system that does not cause avoidable harm to some of the weakest and most vulnerable in society’.

It is not a fair system (and there is copious evidence of its unfairness) and its failings will be borne by the most vulnerable. The stress caused by its inadequacies will be pushed on to the NHS.
Of the many people who appeal, some 38% win.1 People who have the help of agencies such as Citizens’ Advice are more likely to be successful at appeal – suggesting that the process does not favour people unfamiliar with the system.3

In October, Margaret Hodge MP, chair of the Public Accounts Committee, described the Government’s contract with Atos as ‘unacceptably loose and (permitting) loopholes that can all too easily be exploited by contractors’.4

Let’s hope the £400m contract Atos won in August to reassess people for the new Personal Independence Payment, which will replace the Disability Living Allowance, is not also full of similar ‘loopholes’.

I believe this will be a recurring problemas large Government contracts with the private sector become more involved in healthcare. Why on earth are we franchising out the care of our most ill to a profit-making system? We need to pull the plug on these contracts.

Dr Margaret McCartney is a GP in Glasgow


1 National Audit Office 2012, Contract management of medical services HC627. Published Oct.

2 BMJ 2012, It is too difficult for ill people to claim benefits. Published 30 Oct

3 BMJ 2012, UK Government’s contract with Atos is ‘unacceptably loose’, MPs say. Published 22 Oct

4 Public Service 2012, Hodge: DWP management contract is ‘easily exploited’. Published 22 Oct