15 November 2005

In what appears to be a trade-off for agreeing to close fewer medical centres than it originally wished, (see: 11 medical centre closures confirmed) Atos Origin has been given permission to begin using its own computer led private sector nurses to carry out DLA and AA medicals. In addition, Atos has been allowed start examining DLA and AA claimants at Medical Examination Centres (MECs) instead of at home and is to begin recruiting doctors from abroad to carry out incapacity for work medicals.

It is currently against the law to use anyone other than a doctor approved by the Secretary of State to carry out incapacity benefit medicals. However, the DWP has agreed to allow ATOS to use 'other Healthcare Professionals (HCPs) such as nurses' to carry out examinations 'in other benefit areas - provided that they follow appropriate EBM [Evidence Based Medicine] protocols and are supported by LiMA'. LiMA (Logic integrated Medical Assessment) is the software developed by Atos primarily to carry out incapacity for work medicals.

The DLA and AA nurses will begin work in early 2006. The most likely area of involvement is disability living allowance assessments for which LiMA software is already being piloted in the Bootle and Manchester areas. The DWP are making determined - and unlawful - efforts to keep the information on this software secret. What is clear, however, is that as with the LiMA incapacity software, the ultimate aim is to reduce most of the assessment to a series of easy to answer questions which require no medical knowledge. (For more on LiMA and its use for DLA assessments see: DLA winners and losers: leaked document reveals radical new assessment system)

Home visits cut
At the moment Atos claim there is no standalone version of LiMA which can be used on a laptop, so computer led nurses will only be able to carry out DLA and AA medicals in Medical Examination Centres.

In guidance to doctors on carrying out DLA examinations in Medical Centres, produced for pilots run in 2003 and available from the Benefits and Work members area, Atos list the 'Opportunity to develop computer-generated reports' as one of the reasons they wish to make the switch.

Atos ran the pilots on using MECs for DLA assessments in Birmingham, Bootle and Manchester between April and September 2003, and again in Leeds and Sutton between July and September 2004. Having had satisfactory results from the pilots, in October 2005 Atos began inviting claimants around the UK to be examined in a purpose built examination room where the facility exists.. At the moment attendance at such centres is voluntary but, given the potential savings, there will undoubtedly be pressure to make home visits the exception rather than the rule.

Covert observations
Another attraction for the DWP is that these type of examinations allow the doctor to observe the claimant when they may not be aware that the examination has already begun. As the pilot guidance explains:

"Examinations conducted in MECs will afford the Examining FTMAs [full-time medical assessors] an opportunity to see the claimant seated in the waiting room, to note their response to the doctor's call, and to observe them walking to the examination room, and then settling and sitting in the examination room."

No ordinary nurses
It should be noted that the computer led nurses will be no ordinary nurses, they will in fact be from Atos Origin's own pool of existing occupational health nurses. In other words, they will be full-time employees whose loyalties are entirely to Atos and who are accustomed to working towards getting employees of large corporations back to work. Claimants who are invited to attend at an MEC for a DLA or AA medical will need to think carefully about whether they should exercise their right to insist on a home visit. On the one hand Atos nurses will probably have very little experience of the benefits system or of working with claimants. On the other hand, computer led medicals carried out by Atos nurses may be easier to challenge at appeals, particularly if claimants have evidence from their own GP or consultant to put in its place.

There is an increasingly clear trend in the way that medical assessments are being carried out: cutting costs and increasing profitability is now a primary driving factor. But how will this impact on claimants?

Importing doctors from abroad may be cheaper, but will they have sufficiently good training and language skills to do the job effectively? The use of Atos' own computer controlled nurses in place of doctors, many of whom Atos currently sub-contracts from another company called Nestor, will also be much cheaper for Atos. But what happens then to Medical Services often repeated claim that Medical Examiners are expert doctors highly trained in disability analysis? Finally, cutting down on home visits for DLA and AA will undoubtedly cut costs but how many will claimants have disentitled themselves simply by managing to travel to the examination centre and sit in the waiting room?

Public private partnerships truly are a wonderful thing . . . for shareholders and government departments at any rate.


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