17 March 2011

Benefits and Work has obtained a copy of the guidance being used to train Atos health professionals to carry out the new work capability assessment.

We have discovered that claimants with mental health conditions face the possibility of being found fit for work on the grounds of being able to carry out the most basic of  activities.  In fact, if you can simply:

make a cup of tea; and
travel to the medical examination on your own

then there’s a real chance that you will already have scored zero for six of the seven mental health activities.

The mental health test is made up of activities 11 to 17 of the limited capability for work assessment. Below, we go through them in order to see how that simple list of activities may affect your chances of scoring enough points to be eligible for ESA.

Activity 11: Learning tasks
Claimants who can reliably learn how to do moderately complex tasks score no points for the ‘Learning tasks’ activity.

The guidance for Atos health professionals tells them that moderately complex tasks may include:

“Using a microwave oven
Making a cup of tea including filling kettle, putting tea bags in teapot, pouring into cup and adding milk and sugar
Playing CDs on a stereo
Using a Playstation
Using a computer for basic activities such as playing a game.

“More complex tasks should also be considered such as driving should be detailed [sic] and any previous tasks learned in training and employment should be considered.”

So, the ability to reliably make a cup of tea can be used as evidence that you should not score points for this activity.  If you also listened to a CD whilst enjoying your morning cuppa then there’s even less chance of scoring points.

Activity 12: Awareness of hazard
In relation to ‘Awareness of hazard’, health professionals are told to look at your ability to cope with potential hazards, such as:

“Ability to cope with road safety awareness
How they manage if they live alone
Ability in the kitchen
Awareness of electrical safety
Responsibility for children/pets”

So, once again, your ability to make a cup of tea and to travel to the MEC alone without having an accident may make it difficult for you to score points for this activity.

Activity 13:  Personal action
This activity looks at whether you can initiate or complete at least ‘two sequential personal actions’. 

Atos health professionals are told that this activity is about the “ability to understand how to co-ordinate actions in the correct sequence such that they successfully complete any personal actions in a logical order for example washing before dressing.”

They are also told that:

“The concept of 2 sequential tasks could include showering, and getting dressed to go out.”

In addition, they are told that ‘personal action’ may include:

“ability to get up, washed, dressed and ready for work in the morning.”

They are also told that the sort of daily living activities they should look at include:

Making travel arrangements
Writing shopping lists
Organising finances
Planning a simple meal
Getting washed and dressed
Ironing clothes for the next day
Caring for children: preparing clothing, lunches etc.

The guidance is not entirely straightforward, however.  At one point it explains that:

“Similarly, if a person perhaps with bipolar illness manages to wash and dress but then goes out and spends all their money on non essential activities, giving no consideration to issues such as bills, rent, food etc, they would not be considered to be initiating effective personal action.”

Nevertheless, it is clear that being able to get washed and dressed and travel to the medical examination centre can be used as evidence that no points should be scored for this activity.

Activity 14:  Coping with change
The ability to cope with planned and unplanned change is another activity that claimants can score points for.  However, Atos health professionals are told that:

“It would seem unlikely that a claimant who manages to attend the medical examination centre alone would meet the level of severity of functional restriction for anything other than CC(d) to apply.”

CC(d) is the zero scoring descriptor for ‘Coping with change’.  So, once again, if you manage to get to your medical on your own, your chances of scoring points for this activity are very slim.

Activity 15: Getting about

This activity is about your ability to get to a specified place. If you can’t do it at all you get 15 points.  If you need someone with you then you score 9 points if it is in relation to somewhere with which you are familiar and 6 points if it is somewhere unfamiliar.

Atos health professionals are told that the way you travel is not considered, so that if you cannot get somewhere by public transport but could get there ‘by other means’ then you will not score.

Although it is not specifically stated in the guidance, it is likely that someone who can travel to the medical examination centre unaccompanied will struggle to score any points for this activity.

Activity 16: Coping with social engagement
This activity is about engaging in social contact with unfamiliar people.  Your problems have to be more than ‘mere shyness or reticence’.

Atos health professionals are told that:

“It would seem likely the person would require a companion to attend at the MEC due to the level of anxiety/communication restriction that this descriptor would normally be expected to reflect.”

In other words, once again, if you attend alone your chances of scoring points for this activity are very slight.

Activity 17:  Appropriateness of behaviour with other people.
The final activity in the mental health test is less likely to be affected by your ability to wash, dress, make a cup of tea and travel to your medical alone.

You score points for “uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.”

Astonishingly, however, Atos health professionals are told that:

“The descriptors relate to behaviour that would be considered [unacceptable] in an average workplace such as a call centre as this provides a more general concept rather than applying “reasonable” to one person’s standards as this may be subject to considerable variability. It is likely that the behaviour would extend beyond verbal aggression for the descriptors to apply.”

It may well be that Atos are quite happy for their call centre staff to display verbal aggression towards claimants or towards each other.  But in virtually every other workplace in the country, verbal aggression is regarded as entirely unreasonable and is likely to be a disciplinary offence.  Indeed, in some circumstances verbal aggression constitutes a criminal offence for which a custodial sentence can be imposed.

To advise health professionals that they should not generally allocate points where, due to a mental health condition, someone is verbally aggressive is extraordinary. 

Simplistic and unreliable
And that’s it.  Every mental health activity bar one potentially undermined by simply being able to wash, dress, make a cup of tea and attend a medical appointment unaccompanied.  And the only activity left appears to involve a requirement that you physically attack someone or behave very bizarrely.

Of course, it may not always  be that straightforward.  There are issues such as your ability to carry out the activities repeatedly and reliably to be taken into account.  And, in the case of some activities, the guidance is so imprecise that a range of different points may be possible. 

But one thing is not in doubt:  tens of thousands of claimants with genuinely debilitating mental health conditions will soon be found found fit for work on evidence that many people would consider flimsy, simplistic and highly unreliable.


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