[1]The Public Accounts Committee of MPs chaired by Margaret Hodge heard evidence that over the previous financial year, Atos had been paid £112 million to carry out 738,000 assessments.
She also remarked: "We saw no evidence that the Department was applying sufficient rigour or challenge to Atos given the vulnerability of many of its clients, the size of the contract and its role as a near monopoly supplier.
[6] Furthermore, because many more claimants than forecast were being placed in the Support Group, the government's fiscal watchdog raised its estimate for spending on ESA from 2014 by one billion pounds a year.
[8] This was intended to clear the backlog and then allow the department to order hundreds of thousands of reassessments of people who had already been granted ESA, in the belief that many would have recovered from their illness and so could be taken off benefits.
At the end of October 2015, the DWP's director-general of finance was bullish about hitting this higher target when he appeared before a parliamentary committee, saying: "We are confident that [Maximus] will over-achieve the amounts of work over and above the forecast that was set".
[9] But at the start of November, Maximus's senior management team warned[10] its shareholders that certain performance metrics, most notably volume targets, were not being met and the challenges with the WCA contract resulted in reduced earnings outlook for fiscal year 2016.
[14] Professor Malcolm Harrington, the first external reviewer of the operation of the WCA, was asked by a parliamentary committee whether he had ever found any evidence that Atos assessors had been put under pressure to reach targets.
This is purely anecdotal, but there was one Atos assessment centre I went to where the bosses walked out and I was left with a couple of assessors having a cup of coffee at the end of the session, and they told me they were under pressure.
[15]In 2012, a GP posed as a trainee Atos assessor and recorded undercover video footage that was later broadcast by Channel 4's investigative current affairs programme Dispatches.
In the film, trainers warned the NHS doctor that if on average he were to recommend more than one disabled person per day for the Support Group, he would be subject to an increased level of management scrutiny through a mechanism known as "targeted audit".
[16] The undercover doctor was told: If it's more than I think 12% or 13%, you will be fed back 'your rate is too high'An assessor on "targeted audit" would also no longer be allowed to recommend a claimant for the Support Group without asking an authorised colleague for permission to do so.
Atos said that the audit process triggered by the breach of a "norm" was intended to ensure consistency across the firm's UK team: if the assessor's reports met the DWP's expectations, the healthcare professional would not be asked to change their recommendations.
A 'norm' of 1 in 8 or 12.5% was in use as the benchmark for targeted audit during the Incapacity Benefit reassessment programme, suggesting that the DWP was expecting a very similar proportion of claimants to be recommended for the Support Group overall.
[22] Conversely, Dr Paul Litchfield, who advised the DWP on the performance of the WCA in 2013 and 2014, described the test he had helped to design as "by no means perfect" but nevertheless adequate.
[25] In 2015, Iain Duncan Smith complained that the system gave doctors a "binary choice", not an opportunity to deliver a more nuanced opinion on claimants' fitness for work.
[28] In late October 2016, when appearing on Question Time, the president of the Liberal Democrats, Baroness Sal Brinton, described the WCA as "not fit for purpose", adding "this process absolutely fails" and "we need to get rid of it".
[29]In September 2016, Damian Green, the latest welfare secretary, was asked by the BBC's Andrew Marr about the deaths of specific benefit claimants:[30] You know these cases, they must be on your desk, you've been [at the DWP] over the summer, when you look at them, are you completely satisfied yourself that the government has done this right in the past?
[34] Parliament's Office of Science and Technology analysed the WCA's performance and found that "the number of fit-for-work decisions being overturned on appeal has led to questions about the reliability of the assessment process".
A 2012 study of 28,000 tribunal hearings analysed the reasons for overturning the DWP's decisions: In May 2013, a doctor who had recently resigned from Atos blew the whistle on biases in the testing process, telling the BBC: These assessments need to be done independently, impartially, considering all the evidence and with proper use of medical knowledge – and that's just not happening at the moment.
An Atos executive interviewed by the BBC acknowledged that the guidance referred to "might seem somewhat odd" but said it had been "taken out of context" and was part of a much bigger set of questions considered during assessments.
[36] The Employment Minister was asked by the BBC about the allegations of bias but he replied with a general explanation of the principles underpinning the Incapacity Benefit reassessment programme.
In response to the article's description of auditors instructing assessors — at the point when a report of a face-to-face assessment had been written, but had not yet been sent to the DWP — to alter their reports and reduce the number of points awarded, Atos said: There is no ethical conflict in advising a doctor that aspects of their work require further attention to meet the standards expected[38]Some assessors with several years' experience of carrying out disability assessments were chosen by Atos to audit the work of their colleagues.
[40]The reassessment programme was dogged by problems: handling of the contract was criticised by the National Audit Office[41] and by the Public Accounts Committee,[42] which described the DWP's project management style as "complacent";[5] the overhaul of the WCA by medically-qualified civil servants produced what seemed to be a more stringent version of the test, but outside experts warned it was flawed; thousands of appeals were launched each month, swamping the tribunals service and leading to long delays;[33] in 2013, accusations of bias, questions about quality and a contractual dispute caused the process to stall; and the DWP's attempts to restart the reassessment programme in 2015 were hampered by a shortage of healthcare professionals willing and able to carry out the test.
At inquests, coroners have raised concerns about information-gathering prior to face-to-face assessments, and there is epidemiological evidence to indicate that the 'roll out' of the WCA has been associated with hundreds of deaths.
[44] An independent review undertaken by occupational heath expert Professor Malcolm Harrington, a small team from the DWP, along with an Independent Scrutiny Group that included the National Clinical Adviser to the Care Quality Commission and the chief executive of the mental health charity MIND, gave a negative report of the WCA's usability, with The Guardian summarising Professor Harrington's opinion as being that the test was "impersonal", it "lacked empathy" and it was too reliant on "computer systems and drop-down menus".
"[46][47] He made 25 recommendations, with his changes he advised to the core assessment being: The DWP accepts that being found fit for work and ineligible for sickness benefit can, in some circumstances, harm a recipient's physical or mental health.
She died days after the DWP upheld its decision to declare her 'fit for work' (neither the assessor, the first decision-maker nor the second official who reviewed her case had deemed her to be at substantial risk of harm).
His family believes that the stress of his forthcoming WCA and then afterwards the loss of the bulk of his income damaged his already fragile mental state, worsened what the DWP called his "eating disorder" and so contributed to his death.
[54]Michael O'Sullivan had long-term depression and anxiety and was receiving sickness benefit in the form of Income Support until it was stopped by the DWP following a WCA.
[56]The case had many similarities with an earlier death following a WCA, where a coroner had also written to the DWP about the lack of an attempt to contact the psychiatrist who had been treating a person with mental health problems who went on to commit suicide.