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This website provides information on how Atos runs its business, extracts from the Contract between the DWP and Atos including the MEDICAL CONDITIONS that mean a face to face medical assessment is not always necessary, ASSESSMENTS AND POINTS, the breaches of Contract that occurred in my case, my unsound medical report and the correspondence showing how difficult it is to obtain justice or advice.
The Government is inviting the public to submit petitions. Search epetitions.direct.gov.uk for "DWP" or "Atos" or "disabled" to list relevant petitions including Stop and review the cuts to benefits and services which are falling disproportionately on disabled people, their carers and families (http://epetitions.direct.gov.uk/petitions/20968).
Other ongoing petitions are Petition against constant vilification of sick and disabled claimants and Petition to "Sack Atos Immediately" .
The DWP occasionally consults the public http://www.dwp.gov.uk/consultations/.
This page contains extracts of the information that I provided in the ESA50 form. It contains the unsound medical advice ESA85 form that Atos Healthcare provided to the DWP Decision Maker. It contains the breaches of Contract that occurred in my case.
The "medical" examination was undertaken on 24 July 2009. It should have started at 15:30 and started 45 minutes late. After many letters and emails, including two letters to the Secretary of State for Work and Pensions, a printed copy of the ESA85 advice to the DWP Decision Maker was received on 25 November 2009. This came without a cover letter. It is not yet clear whether this is an authorised copy or not.
The facts and observations are disputed.
Please note the grammar, spelling and tardiness. This is supposed to be a professional document. I do not accept errors such as using "She" instead of "He" is ever acceptable. I do not accept the use of the plural form "their" when "his" should be used. Professional documents should be checked and rechecked especially where life, death and finances are involved.
Atos Healthcare are happy with the quality and professionalism of the "Registered Medical Practitioner" who produced this report as they passed it to the DWP.
It should be noted that the phrase "side affect" is used when the phrase "side effect" should have been used. There has been a recent medical case when notes were passed from one doctor to another, who took over as part of a shift change, and effects were misreported as affects with fatal consequences.
The following sentence might enlighten.
"Her poor performance did not affect me at the time because I knew the incompetence of Atos Healthcare personnel would have had no effect on my prior decision to keep accurate records.
It is surprising as a layman that so much medical information can be gleaned in a 10 minute examination. I would not accept this in my field of expertise and find it more difficult to accept in the field of medicine. I found the "Registered Medical Practitioner" had difficulty with spoken English. She did not know what intermittent meant and so did not include the word in the report. I do think it is important to record whether a symptom is constant or intermittent.
I was amazed at the sweeping conclusions that this "Registered Medical Practitioner" felt able to make. None of the specialist consultants who have seen me can state when my condition started and yet this "Registered Medical Practitioner" can boldly state on page 2 "The condition started 8 years ago".
As an engineer, I am not the best qualified to comment on grammar. Nevertheless there are tools, such as grammar check, which can be useful. I suggest this is another example of the inferior quality of the IT Services supplied by Atos Healthcare.
The following is an extract of the information that I provided and which was stamped as being processed 15 June 2009. It took days to complete by hand as I was shaking and twitching. The hand writing is very poor despite the force of will to stop the shakes.
...any special help you would need if you go for a medical assessment.
My ant-fit medicine makes me very tired. My right knee fails at times so I use a stick for support. There is no transport from H... to Q... Hospital which is the closest place for neuro-surgery. If I am strong, I can use public transport to go to Q... Hospital. My wife takes me to my local hospital.
Tell us about any times or dates in the next 3 months when you cannot go to a medical assessment.
August MRI scan and assessment at Q... Hospital.
Please tell us about your illness or disability
I have primary brain tumour, consultant ..., patient no: ..., ref: ..., medicine: ...
Anti-fit medicine makes me very tired (2000mg per day) ...bad handwriting.
Can't use PC for any length of time. TV can be tiring. Rest many times a day. Short walks difficult.
Are you receiving care ...
None
Are you having any hospital or clinical treatment?
Yes
What do you attend the hospital or clinic for?
Tumour investigation
Have you been in hospital as an in patient in the last 3 months?
Yes emergency admitted 15 April 2009 discharged 24 April 2009
Please tell us what you were in hospital for ...
Emergency admission due to fit. Suspected stroke. Scan revealed brain tumour. Referred to Q... Hospital. Stroke unit: ...
Do you expect to be admitted to hospital as an in-patient in the next 3 months?
Yes
Tell us what you are going into hospital for ...
Brain surgery. Biopsy or surgery and or radio therapy.
Are you pregnant?
No
Do you think any of your health problems are linked to drug or alcohol misuse...
No
1. Walking and using steps
Can you walk on level ground?
Yes
Can you walk at least 200 metres (about 220 yeard) before you need to stop?
It varies
Use this space to tell us how far you can walk...
Sometimes OK. Sometimes 10 mins then rest. Hills (slight) can be difficult.
Can you go up or down two steps, if there is a rail...
Yes
2. Standing and sitting
Can you remain standing up...
Yes
Use this space to tell us more about standing and sitting...
It is getting worse symptoms worse 10 days ago so follow up MRI scan moved earlier.
Can you sit in a chair?
Yes
Can you stay sitting on a chair...
Yes
Can you get up from a chair...
Yes
Can you move from one seat to another right next to it...
Yes
3. Bending and Kneeling
4. Reaching
Sometimes not right as tumour on left.
5. Picking up and moving things on the same level
Can you pick up and move a litre (two pint) carton full of liquid...
It varies
Can you pick up and move a half-litre (one pint) carton full of liquid...
It varies
Use this space to tell us more about picking things up...
Right weak as tumour on left of brain.
Can you use both hands together to pick up and move something big but light, like an empty cardboard box?
Yes
6. Manual Dexterity (Using your hands)
Can you use your hands to do things like ...
It varies
Use this space to tell us more...
Handwriting poor getting worse as right handed and tumour on left of brain.
7. Speech
Can you speak?
Yes
If yes, can you speak clearly enough for a stranger...
Yes
Use this space to tell us more...
Slur sometimes.
8. Hearing
Can you hear?
Yes
If yes, when someone is talking to you in a busy a street, can you hear what they are saying?
It varies
Use this space to tell us more...
Tumour related.
9. Seeing
Do you have any useful sight?
Yes
Can you see well enough to recognise a friend 15m (just over 15 yards) away ...
Yes
Do you have any other problems with your eyesight?
It varies
Use this space to tell us more...
Tumour related.
10. Controlling your bowels and bladder
11. Staying consious when awake
While you are awake, do you have fits or blackouts?
Yes
If you have a problem with fits or blackouts, do you get a warning that it is going to happen?
Sometimes
Use this space to tell us more...
Anti-fit medicine was doubled 10 days ago. Emergency MRI Scan.
12. Learning or comprehension in the completion of tasks
Can you learn how to do a simple task as long as someone shows you what to do?
Usually
Can you understand and remember how to do a more difficult task?
Usually
13. Awareness of hazard or danger
Can you manage your daily life safely?
Usually
14. Memory and concentration
Can you remember to do your usual daily routine?
Usually
Can you concentrate on your daily routines?
Usually
15. Execution of tasks
Do you have difficulties finishing routine daily jobs?
It varies
Use this space to tell us more...
Not if too tired (most mornings).
16. Initiating and sustaining personal action
Can you organise yourself to start and keep on with routine jobs?
It varies
Do you need encouragement...
It varies
Use this space to tell us more...
Tumour related.
17. Coping with change
18. Going out
19. Coping with social situations
20. Propriety of your behaviour with other people
21. Dealing with other people
Other information
My symptoms got worse 10 days ago. Consultant wanted me to be emergency admitted. GP agreed I could be treated at home as H... hospital can do nothing for me except treat symptoms. Doubling anti-fit has treated problems for now. Will receive analysis of MRI scan next week.
....too tired
12% survive 5 years. I am not optimistic (question to Parliament 2007 about Primary Brain Tumour)
...I am 52. I have had a reasonable innings. The doctors and hospitals have been excellent.
If you need more, talk to them or ring me if I am strong enough to answer.
The printed report was scanned as images, converted to text and sensitive information removed. There have been minor format changes to improve the layout. This is a true copy of the actual report.
Each page contains the following:
Report on ... completed by Dr Ludmila Semetillo on 24 July 2009 Ref: ...
Surname ...
Other Names ...
National Insurance Number ...
Date of Birth ...
Time Examination and Interview Started 16:13
Time Examination and Interview Ended 17:53
Time Report Complete 18:06
Date of Examination 24 July 2009
Place of Examination HIGHGATE MEDICAL EXAMINATION CENTRE
Healthcare Professional's Name Dr Ludmila Semetillo (Registered Medical Practitioner)
Client Interview Medical Conditions and Treatment 1. Medical Conditions Conditions Medically Identified Brain Tumour Cardiovascular Problem Other Conditions Reported Client states no other problems 2. Medication Levetiracetam 500 mg Atenolol (for blood pressure taken regularly. Ramipril (for vascular disease) taken regularly. Simvastatin (for cholesterol) taken regularly. 3. Side Effects Due to Medication The client experiences drowsiness as a result of their epilepsy medication. 4 Description of Functional Ability Having considered whether the condition is likely to vary during the average week and if the function can be carried out regularly and repeatedly taking into account, fluctuation, pain, fatigue, stiffness, breathlessness, balance problems etc, the description of functional ability is as follows: Condition History Brain Tumour The condition started 8 years ago. He was unconscious for 20 minutes, he had grand mal fit with big pain. Last admitted to ... hospital 3 months ago. Stayed in hospital for 10 days. He was put in stroke unit with symptoms of stroke. Has had MRI scan for Brain Tumour and the result confirmed an abnormality. Since October 2008 he had 4 fits including 4th in April when he was admitted to hospital. I past 6 months 3 fits.
Description of Functional Ability He had to submit his driving license. She suffers with fits, cramps, problem with walking, balance, shaking, visual problems, tiredness, migraines and anxiety. He was put on anticonvulsive treatment. Currently attends the neurosurgeon out-patient clinic at ... hospital every 3 months. The treatment started 3 months ago. He was offered immediate surgery, watch and see or biopsy with radiation. They decided to wait and see. He had another MRI scan 10 June and there was no change. He is referred to neurologist. Sees GP at the surgery for this condition. Cardiovascular Problem The condition started 8 years ago. It has been getting worse over the last 3 years. Troubled by headaches and lightheadedness which happens most days. Sees GP at the surgery every 1 month for routine check up for this condition. Social History The examination was carried out in an examination centre. Came by tube here today, which took about 119 minutes. Came to the examination centre alone. Lives with their wife. Lives in a house. Occupational History Last occupation: IT manager. Stopped work 10 months ago. The main reason for leaving work was redundancy. Not currently working or studying, The client is right-handed. Description of a Typical Day Client states that: Usually gets up at about 6 am. Usually sleeps well. Usually needs to lean on something to get out of bed due to pain and stiffness. Usually goes to bed at about 10 pm. Poor sleep at night causes moderate fatigue and napping during the day. Has no problems in the bathroom. Has no problems with dressing. Often needs someone's help to make meals due to weakness and poor concentration.
4. Description of Functional Ability
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Climbs and descends the stairs every day by holding on to the rail.
Always unable to go to the local shop, alone or with someone else because of weakness,
poor balance and blackouts.
While taking the anticonvulsive medicine 1 hour later as a side affect he feels
extremely tired.
Able to walk 100 metres at a slow pace to the shops occasionally.
Can travel as a passenger without significant difficulties.
Experience no difficulties queueing.
Usually has difficulty using a computer for web surfing due to their poor concentration.
Listens to music most days.
Reads books most days.
Usually finds taking part in leisure activities such as watching TV difficult,
due to their problem with mood disturbance.
Usually has difficulty doing light gardening due to their poor balance.
The client speaks to their friends most days,
Has no difficulty communicating with others.
Is usually able to use a mobile phone for keeping in touch with others.
Always unable to deal with own correspondence due to upper limb problem and poor dexterity.
Requires help from wife.
Always able to begin and continue to complete getting washed and getting dressed
without any help.
Has not suffered any serious accidents or near misses recently.
Does not drink alcohol.
Is able to manage any changes in their daily routine and continue their day to day activities.
Experiences no difficulties finding their way to both a familiar and unfamiliar location.
Medical Opinion - Physical I have considered the possible ESA activity outcomes and my advice is that the following apply: Lower limb - Activity Outcomes Activity 1 - Walking with a walking stick or other aid if such aid is normally used We - Cannot walk more than 200 metres on level ground without stopping or severe discomfort Activity 2 - Standing and Sitting Sg - None of the above apply Activity 3 - Bending or Kneeling Bd - None of the above apply Lower Limb - Supporting Medical Evidence 5. Prominent features of functional Ability Relevant to Daily Living Client states that: Has no problems in the bathroom. Has no problems with dressing. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Climbs and descends the stairs every day by holding on to the rail. Always unable to go to the local shop, alone or with someone else because of weakness, poor balance and blackouts. Able to walk 1OO metres at a slow pace to the shops occasionally. Usually has difficulty doing light gardening due to their poor balance. 6 Behaviour Observed During Assessment Client was able to sit on a chair with a back for 65 minutes. The client rose twice from sitting in an upright chair (with chair arms) without physical assistance from another person. The client was able to bend to the floor and get up again to pick up an item without assistance. Stood independently for 5 minutes without difficulty. The client walked 35 metres normally to the examination room.
6 - Behaviour Observed During Assessment Gait observed to be broad-based and I found this consistent. Was able to get onto the couch without assistance, Did not appear to have any difficulty using a step to get onto the couch. 7. Relevant Features of Clinical Examination Abnormal Findings: Relevant Normal findings: Right Leg Power in the right leg was slightly reduced Reasons for loss of function: Pain, Stiffness, Neurological Problem Blood Pressure Slightly raised sitting blood pressure Other findings: No other significant findings from the lower limb examination noted. No other significant findings from the cardiac examination noted. No other significant findings from the vascular examination were noted. 8. Summary of Functional Ability Examination findings suggest mild disability due to functional loss of the lower leg, which is consistent with the typical day and observations.
Upper Limbs - Activity Outcomes Activity 4 - Reaching Re None of the above apply Activity 5 - Picking up and moving or transferring by the use of the upper body and arms Pd None of the above apply Activity 6 - Manual Dexterity Mj None of the above apply Upper Limbs - Supporting Medical Evidence 9. Prominent Features of Functional Ability Relevant to Daily Living Client states that: Has no problems in the bathroom. Has no problems with dressing. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Always unable to go to the local shop, alone or with someone else because of weakness, poor balance and blackouts. 10. Behaviour Observed During Assessment Had difficulty with removing coat but was able to manage unaided. 11. Relevant features of Clinical Examination Abnormal Findings: Relevant Normal Findings: Right Upper Arm Neck Muscle power in the right arm is significantly No neck tenderness reduced No grating felt on neck movements Reasons far loss of function: Pain, Stiffness, Can touch chin to front of chest Neurological Problem Full upward neck movement Can look over left shoulder Can move left ear towards shoulder Can look over right shoulder
11. Relevant features of Clinical Examination Can move right ear towards shoulder Left Upper Arm Left shoulder turns outwards normally Can put left hand fully behind neck Left hand can reach fully behind back Can raise left arm away from side as normal Can fully bend left elbow Muscle power in the left arm was normal Right Upper Arm Right shoulder turns outwards normally Can put right hand fully behind neck Right hand can reach fully behind back Can raise right arm away from side as normal Can fully bend right elbow Muscle tone in the right arm was normal Left Forearm Left wrist turns inwards as normal Left wrist turns outwards as normal Left wrist bends backwards as normal Left wrist bends forwards as normal Left hand - thumb and index finger grip normally Left fist grips normally Right forearm Right wrist turns inwards as normal Right wrist turns outwards as normal Right wrist bends backwards as normal Right wrist bends forwards as normal Right hand - thumb and index finger grip normally Right fit grips normally Other Findings: No other significant findings from the upper limb examination were noted. 12. Summary of Functional Ability The client's Brain Tumour is mild. They have seen a specialist for this problem. The medication used is average strength.
Vision, Speech, Hearing - Activity Outcomes Activity 9 - Vision including visual acuity and visual fields, in normal daylight or bright electric light, with glasses or other aid to vision if such aid is normally worn Vg None of the above apply Activity 7 - Speech SPe None of the above apply Activity 8 - Hearing with a hearing aid or other aid if normally worn He None of the above apply Vision, Speech, Hearing - Supporting Medical Evidence 13. Prominent Features of Functional Ability Relevant to Daily Living Client states that: Has no problems in the bathroom. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Usually has difficulty using a computer for web surfing due to their poor concentration. 14. Behaviour Observed During Assessment Had no difficulty negotiating doorways and furniture within the examination centre. Had no difficulty reading small print on medicine label and a letter. 15. Relevant Features of Clinical Examination Visual acuity was 6/6 using both eyes with glasses. Visual field testing was normal in both eyes. 16. Summary of Functional Ability There was no evidence of significant physical disability affecting vision from the condition history, typical day history, physical examination findings, observed behaviour and medical knowledge of the condition.
Continence (Other than Enuresis) - Activity Outcome Activity 10a - Continence other than enuresis (bed wetting) where the person does not have an artificial stoma or urinary collecting device Ch None of the above apply Continence - Supporting Medical Evidence 19. Summary of Functional Ability Client has no problem with this activity.
Consciousness - Activity Outcome Activity 11 - Remaining conscious during waking moments Fc At least twice in the six months immediately preceding the assessment, has had an involuntary episode of lost or altered consciousness, resulting in significantly disrupted awareness or concentration Consciousness - Supporting Medical Evidence 20. Prominent Features of Functional Ability Relevant to Daily Living Client states that: Always unable to go to the local shop, alone or with someone else because of weakness, poor balance and blackouts. Has no problems in the bathroom. Able to walk 100 metres at a slow pace to the shops occasionally. Had to give up driving due to problems with fits. 21. Relevant Features of Clinical Examination Neurological examination revealed moderate weakness in the right leg. 22. Summary of Functional Ability The customer's fit result in infrequent episodes of altered consciousness during waking hours, which result in significantly disrupted awareness or concentration. They have seen a specialist for this problem. The medication used is average strength. The client's medication does improve their level of function.
Medical Opinion - Mental, Cognitive and Intellectual Function Understanding and Focus - Activity Outcomes Activity 12 - Learning or comprehension in the completion of tasks LTf None of the above apply Activity 13 - Awareness of Hazard AHd None of the above apply Activity 14 - Memory and Concentration MCc Frequently forgets or loses concentration to such an extent that overall day to day life can only be successfully managed with pre-planning, such as making a daily written list of all tasks forming part of daily life that are to be completed. Activity 15 - Execution of Tasks ETe None of the above apply Activity 16 - Initiating and sustaining personal action IAe None of the above apply Understanding and Focus - Supporting Medical Evidence 23. Prominent features of Functional AbiIity Relevant to Daily Living Client states that: Has no problems in the bathroom. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Always able to begin and continue to complete getting washed and getting dressed without any help. Has not suffered any serious accidents or near misses recently. Experiences no difficulties finding their way to both a familiar and unfamiliar location. Usually has difficulty using a computer for web surfing due to their poor concentration. Always unable to deal with own correspondence due to upper limb problem and poor dexterity. Requires help from wife.
24. Relevant Features of Clinical Examination Abnormal findings: Relevant Normal Findings: Appearance Looks tired Behaviour Was restless Cognition - General Needing prompting at interview Poor concentration on examination 25. Summary of Functional Ability Mental state examination suggests the client's Brain Tumour causes mild disability with their concentration, which is consistent with the condition history, typical day history and medical knowledge of the condition.
Adapting to Change - Activity Outcomes Activity 17 - Coping With Change CCd None of the above apply Activity 18 - Getting About GAe None of the above apply Activity 19 - Coping With Social Situations CSd None of the above apply Adapting to Change - Supporting Medical Evidence 28. Summary of Functional Ability Client has no problem with these activities.
Social Interaction - Activity Outcomes Activity 20 - Propriety of Behaviour with Other People IBg None of the above apply Activity 21 - Dealing with Other People DPg None of the above apply Social Interaction - Supporting Medical Evidence 31. Summary of Functional Ability Client has no problem with these activities.
Exceptional Circumstances Non-Functional Descriptor The Non-functional descriptors were not considered for this case as curtailment applied.
Limited Capability for Work-Related Activity 34. Evidence to support the opinion that the person does not meet any of the descriptors for limited capability for work-related activity Terminally Ill: There are no conditions reported that are likely to result in death within 6 months. Chematherapy: From the available evidence, the client is not receiving or recovering from chemotherapy administered via an intravenous, intraperitoneal or intrathecal route. Pregnancy Risk: Male client. Substantial Mental or Physical Risk: There is no indication of any condition that would lead to a substantial mental or physical risk if the client were found capable of work related activity. Watking or moving on level ground: Although the client has some limitation walking, the history, examination, observed behaviour and medical knowledge of the condition suggest they would be able to walk more than 30 metres. Rising from sitting and transferring from one seated position to another; The evidence does not support that the client has a significant problem rising and transferring, therefore they should be able to rise from sitting and transfer themselves independently. Picking up and moving or transferring by the use of the upper body and arms, reaching and manual dexterity: The evidence does not support that they suffer from a physical condition severely affecting the trunk or upper limb function. Therefore, they should be able to use a star-headed tap, reach up to the top pocket of a coat or jacket, pack up and move a O.5 litre carton full of liquid and pick up a £1 coin or equivalent. Continence where the client does not have an artificial stoma or urinary device: The evidence does not support a significant continence problem, therefore it is unlikely the client would lose control every week of full bladder emptying or full bowel evacuation. Maintaining personal hygiene: The evidence indicates that the client's physical and mental function is at a level which would allow them to clean the front of their own torso independently. Eating and drinking: The evidence does not support that the client cannot eat and drink independently. Learning or comprehension in the completion of tasks and personal action:
34. Evidence to support the opinion that the person does not meet any of the descriptors
for limited capability for work-related activity
The evidence does not support that there is either a severe mental health problem or
impairment of cognitive ability which would prevent the client being able to learn
or understand how to undertake a simple task, or to initiate and sustain basic
personal action.
Communication:
There is no evidence to support that the client has significant difficulty interpreting
or using any of the usual forms of communication.
Prognosis 35. Expected Change Functional Problems: I advise that a return to work could be considered within 6 months. 36. Reasons for the Opinion Given The client's level of disability would be expected to improve with time and appropriate treatment.
Medical Examination Findings The information contained in this section uses medical terminology and is intended for a reader with medical training. All relevant findings are explained in non-technical terminology in the appropriate sections earlier in the report. 37. General The details of the physical examination were explained to the client, who gave consent for the process to proceed. 38. Lower Limb Lower Back Spinal Curves: Are normal Palpation: There is no tenderness or muscle spasm Forward flexion to: Mid shin Squat and rise: Is Full Left Leg Hip flexion is: 130° (normal) Knee flexion is: 120° (normal) Knee extension is: Full External hip rotation: 45° (normal) Tone: Normal Power: Normal Straight leg raising is: Normal (more than 70°) Right Leg Hip flexion is: 130° (normal) Knee flexion is: 120° (normal) Knee extension is: Full External hip rotation: 45° (normal) Tone: Normal Power: Slightly Reduced Straight leg raising is: Normal (more than 70°) Reasons for loss of function: Pain, Stiffness, Neurological Problem No other significant findings from the lower limb examination noted. 39. Upper Limb Neck Neck tenderness: None
39. Upper Limb Neck crepitus: None Chin to chest: No gap Neck extension: 80° or more (normal) Left Neck rotation: 80° or more (normal) Left Ear towards shoulder ; Yes Right Neck rotation: 80° or more (normal) Right Ear towards shoulder: Yes Left Upper Arm Shoulder external rotation: 70° (normal) Hands behind neck: fingers overlap mid-line Hands behind back: finger to mid scapula Shoulder abduction: 170° (normal) Elbow flexion: 130° (normal) Power: Normal Right Upper Arm Shoulder external rotation: 70° (normal) Hands behind neck: fingers overlap mid-line Hands behind back: finger to mid scapula Shoulder abduction: 170° (normal) Elbow flexion: 130° (normal) Tone: Normal Power: Significantly Reduced Reasons for loss of function: Pain, Stiffness, Neurological Problem Left Forearm Wrist pronation: 70° - 80° (normal) Wrist supination: 70° - 80° (normal) Wrist dorsi-flexion ; 30° or more Wrist palmar-flexion: 30° or more Pinch-grip: Normal (thumb to index finger) Power-grip: Normal Right forearm Wnst pronation: 70° - 80° (normal) Wrist supinatian ; 70° - 80° (normal) Wrist dani-flexion: 30° or more Wrist palmar-flexion: 30° or more Pinch-grip: Normal (thumb to index finger) Power-grip: Normal No other significant findings from the upper limb examination were noted.
40. Cardiac, Respiratory, Vascular General Cyanosis: Absent Clubbing: Absent Face Arcus Senilis: Absent Xanthelasmata: Absent Malar Flush: Absent Butterfly Rash: Absent Plethoric: Absent Hands Nicotine Stained: Absent Temperature: Normal Sweaty: Normal Tremor: Absent Splinter Haemorrhages: Absent Radial Pulse Pulse Rate: 65 bpm Rhythm: Regular Left Radial Pulse: Normal Volume Blood Pressure Sitting: 140 / 100 Arm Used: Left arm used Left Leg Peripheral Circulation Ankle oedema: None General Appearance: No evidence of significant peripheral vascular disease Dorsalis pedis pulse: Normal Popliteal Pulse: Normal Capillay return: Normal Bandaging: Absent Arterial Ulcers: Absent Scarring: Absent Hairlessness: Absent Venous Ulcers: Absent Varicose Veins: None Pigmentation: Absent Varicose Eczema: Absent Thrombophlebitis: Absent Lipodermatosclerosis: Absent Temperature: Normal
40. Cardiac, Respiratory, Vascular Right Leg Peripheral Circulation Ankle oedema: None General Appearance: No evidence of significant peripheral vascular disease Dorsalis pedis pulse: Normal Popliteal Pulse: Normal Capillary return: Normal Bandaging: Absent Arterial Ulcers: Absent Scarring: Absent Hairlessness: Absent Venous Ulcers: Absent Varicose Veins: None Pigmentation: Absent Varicose Eczema: Absent Thrombophlebitis: Absent Lipodermatosclerosis: Absent Temperature: Normal Heart Sounds Character: Normal Lung Sounds Crackles amount: None No other significant findings from the cardiac examination noted. No other significant findings from the vascular examination were noted. 41. Vision, Speech, Hearing Visual acuity was 6/6 using both eyes with glasses. Visual field testing was normal in both eyes. 42. Consciousness Neurological examination revealed moderate weakness in the right leg. 43 Continence
44. Mental State Appearance Tired: Looks tired Build: Average build Grooming: Well kempt Dress General: Casually dressed General health: Well Tremulous: Present Increased sweating: Present Complexion: Looks flushed Behaviour Activity Rocking: Absent Facial expression: Normal Activity General: Restless Coping at Interview: Some difficulty coping at interview Arousal: Tense Rapport: Adequate Eye Contact: Adequate eye contact Speech Amount: Was talkative Rate: Rapid Volume: Normal Content: Normal Mood Ideas of Self Harm: No ideas of self harm Demeanour: Confident Thoughts Delusions: No delusions Ruminations: Does not ruminate Obsessions: None Perceptions Illusions: Does not experience illusions Depersonalisation: Experiences no depersonalisation Derealisation: Experiences no derealisation Hallucinations: None Cognition - General Orientation: Orientated in time, place and person Prompting: Needed Prompting General Memory: Adequate
44. Mental 5tate Concentration: Poor Insight Insight: Good Awareness of Danger: Adequate No other significant findings from the mental state examination were noted. 45. Observed Behaviour Lower Limb & Back Client was able to sit on a chair with a back for 65 minutes. The client rose twice from sitting in an upright chair (with chair arms) without physical assistance from another person. The client was able to bend to the floor and get up again to pick up an item without assistance. Stood independently for 5 minutes without difficulty. The client walked 35 metres normally to the examination room. Gait observed to be broad-based and I found this consistent. Was able to get onto the couch without assistance. Did not appear to have any difficulty using a step to get onto the couch. Upper limb Had difficulty with removing coat but was able to manage unaided. Sensory Had no difficulty negotiating doorways and furniture within the examination centre. Had no difficulty reading small print on medicine label and a letter.
Declaration This form has been completed by a healthcare professional approved by the Secretary of State for Work and Pensions. I have completed this form in accordance with the current guidance to ESA examining healthcare professionals as issued by the Department for Work and Pensions. I can confirm that there is no harmful information in the report other than indicated. Healthcare Professional's Name Dr Ludmila Semetillo (Registered Medical Practitioner) Approved Disability Analyst Date 24 July 2009
The Contract provides strong evidence that, in my case, Atos Healthcare has both acted illegally and have on a number of occasions been in breach of the Contract. In breaking the law, in my case, Atos Healthcare have claimed that they have acted "in good faith". In my view the illegal actions of Atos Healthcare has caused me actual harm, the advice Atos Healthcare gave to the DWP is a libel and has caused the DWP to apply a procedure that has caused me further harm. Atos Healthcare have been given many opportunities to put right the harm they have caused. They have, as yet, not chosen to do this. My rights as a patient have not, as yet, been protected by the DWP.
Atos Healthcare and the company SEMA under which they previously traded has been used by the DWP to supply healthcare services since 2000 and before. If you feel Atos Healthcare has acted illegally or has been in breach of the Contract you should contact the DWP in the first instance and then your MP for redress. You may be entitled to compensation from Atos Healthcare. The DWP are legally obliged to ensure that the Contract is complied with. Even if you feel you have obtained the correct result but you do not know if a qualified medical advisor was used to decide on whether a face to face meeting was necessary, you should find out from Atos Healthcare. Many are sick and unable to do this but if you can, please find out from Atos Healthcare if not for yourself but then for others less fortunate than you.
You should email to Atos requesting in writing who decided that a face to face assessment was necessary and the medical reasons for the face to face assessment. Point out you may wish to check with the GMC prior to the assessment.
You might want to include some of the following in your email. You may want to copy the email to your MP and ask why the DWP does not enforce the Contract between the DWP and Atos.
The key question as I see the matter is as follows.
Given the ESA information supplied. Please can Atos supply the medical reasons in writing why "Further Medical Evidence" is not required in deciding whether a face to face assessment is necessary and if an assessment is necessary why "Further Medical Evidence" is not required for the assessment. You would like to see if the GMC agrees with the Atos medical reasons.
You could go into more details.
The ESA50 is a lay opinion of the patient's medical condition and thus does not constitute
medical evidence. A medical advisor is required in those medical conditions listed.
"Further Medical Evidence"
means medical evidence obtained from a third party such as, but not exclusively,
a general practitioner or a hospital practitioner and includes, but is not limited to,
written factual reports, hospital case notes including radiological and pathological
investigations.
SCHEDULE 4 SECTION 4.1 PART 2
4.5 Basis of Medical Advice
4.5.1 The CONTRACTOR shall ensure that wherever possible all medical reports and
medical advice:
4.5.1.1 is evidence based, that is, there is a consensus of critically evaluated,
published medical evidence in support of the advice provided by the
CONTRACTOR;
4.5.1.5 is based only on documents that are consistent with one another as to
the evidence they contain;
4.5.1.7 takes full account of and records the effects of pain, fatigue and
medication on the Claimant's functional capacity or care needs;
4.19.1 When obtaining Further Medical Evidence, the CONTRACTOR shall make it clear to
the author of that evidence that all evidence may be given to the Claimant and that
the only information that can legally be withheld from the Claimant is that which may
be harmful to the Claimant's health.
11.1 The CONTRACTOR shall, within twenty four (24) hours of completion of their required action,
use reasonable endeavours to despatch to the AUTHORITY all required documentation,
including all Referral documentation, any Further Medical Evidence gathered and the
appropriate output form(s), unless specifically requested to dispose of any documentation by
the AUTHORITY.
Atos confirms that my medical assessment was unsound.
(http://www.whywaitforever.com/dwpatosletters.html#AH20100108F)
Dr Bruecker has advised that the pathology of your condition is not clear
from the available evidence and in order to establish whether your case falls
within the support group he has arranged for a request to be issued to your GP
to provide further information.
Our National Customer Relations Manager, Mr Pepper, has provided his comments
in response to the other numbered points you have raised:
1. He confirms that an assessment of capacity was undertaken which is different
to a diagnostic consultation. There is no requirement to have NHS medical
records available for the assessment. When it is considered appropriate by
the Healthcare Professional (HCP), further medical evidence can be requested
from the customer's medical carers.
Atos confirms to the HSE what an assessment comprises of.
(http://www.whywaitforever.com/dwpatoslettersgov.html#HSE20090929F)
The Centre assesses people's functional ability through consultation, discussion
and simple physical tests (e.g. reflex).
Thus if "consultation, discussion and simple physical tests" alone is insufficient
to provide "sound" medical advice "Further Medical Evidence" is required
as defined in the contract (as above).
Letter from the Right Honourable Jonathan Shaw MP, Minister for Disabled People
http://www.whywaitforever.com/dwpatoslettersgov.html#MIN20091028F
... may be pleased to learn that we already screen the information provided by
customers before deciding whether a face to face examination is required.
The precise circumstances for exemption are prescribed in the regulations and
include terminally ill people who are fast-tracked onto the higher rate of benefit.
Every effort is made to identify potentially exempt cases by liaising with the GP
or specialist before contacting the claimant. This ensures that where at all possible,
severely ill people are not troubled by the assessment and in particular do not
have to undergo a medical examination unnecessarily.
This approach has some successes. This is a comment from "Josie" on the the Fibro Myalgia forum. This lady, like I, knew that a patient in a medical should be seen by an expert in the condition with full access to the medical history.
Had a appointment some time ago for a home visit for a medical and the doctor rang me on route to ask if he could come earlier, I asked him on phone if he had knowledge of my medical condition and he told me he had no knowledge, he said he would refer it back to them.
Got appointment for this morning between 9am and 10.30am and he turned up late, 10.40, came in and sat down, explained that he would ask me some questions and then do a medical, I asked him if he had knowledge of condition and he said no. He then looked at notes and said they should of sent some one with knowledge and said he would refer it back and get a doctor with knowledge to attend otherwise I would not be having a fair assessment.
How can the Department for Work and Pensions give you a fair assessment when they have no knowledge of the condition, that's crazy, they are meant to have knowledge of chronic conditions and he had no knowledge, I now have to wait for a third appointment. Has anyone else had this type of service from them and I won an appeal for DLA for personal care and passed my medical with 15 points on the grounds of having this condition, its crazy they don't use commonsense, you might say that the rules for Incapacity Benefit are different but I passed with 15 points on the grounds of having this condition so why do I have to see a doctor at home who has no knowledge and wants to do a medical. Its crazy.
http://www.fibromyalgia-associationuk.org/community/index.php?topic=30132.msg472897
My case provides the following examples of Atos Healthcare being in breach of Contract.
The Minister was assured by Atos Healthcare that a qualified healthcare professional reviewed the information provided prior to deciding that a face to face meeting was necessary. Initially I was told that a a nurse or midwife reviewed the information. The "Atos" Independent Tier could not identify who made the decision. A medical advisor did not review the information. No qualified medical advisor reviewed the information provided prior to the decision that a face to face meeting was necessary.
As I have cancer, a medical advisor must be a GMC registered doctor. Because I have a primary brain tumour, the medical advisor should have specialist neuro-science and neurology knowledge or should have contacted my GP and or consultant.
Breach of the Contract - Appendix 1 of Schedule 4 Section 4.12 Final Version - 15 March 2005
This lists cancer as a medical condition that must be referred to a Medical Advisor (GMC registered) for advice. The breach of contract has been confirmed by Atos doctor Dr Bruecker and by the "Atos" Independent Tier.
The medical assessment should not have taken place. The appointments clerk despite being asked to consider the medical situation refused to do so. If a medical assessment were to have taken place, after taking advice from my GP and Consultants, it should have been carried out by a medical advisor with specialist neuro-science and neurology knowledge.
Breach of the Contract - Appendix 1 of Schedule 4 Section 4.12 Final Version - 15 March 2005
This lists cancer as a medical condition that must be referred to a Medical Advisor (GMC registered) for advice. The breach of contract has been confirmed by Atos doctor Dr Bruecker and by the "Atos" Independent Tier.
The quality of the medical report in respect of the standard of written English is below the standard required in the Contract.
Breach of the Contract - Medical Requirements Schedule 4 Section 4.1 Final Version - 15 March 2005
4.5.1.9 is legible, presented to the AUTHORITY in the English language and understandable to those without medical qualifications....
In strict legal terms, the illegal medical assessment constituted an assault as the qualified medical practitioner was not qualified in neuro-science and neurology.
Breach of the Contract - Medical Requirements Schedule 4 Section 4.1 Final Version - 15 March 2005
4.3 Serious Complaints
4.3.2 For the avoidance of doubt the main types of complaint that are included in this category shall include but will be not be limited to:
a) assault as a consequence of examination
The medical assessment, the waiting time, the journey to and from the medical assessment exceeded the allowed time. This was the direct cause of actual injury to my person.
Breach of the Contract - Medical Requirements Schedule 4 Section 4.1 Final Version - 15 March 2005
4.3 Serious Complaints
4.3.2 For the avoidance of doubt the main types of complaint that are included in this category shall include but will be not be limited to:
b) injury as a consequence of examination
The medical assessment journey time exceeded the ninety minutes maximum allowed in the Contract.
Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version - 15 March 2005
5.5 The CONTRACTOR shall ensure that any Claimant is not required to travel for more than ninety (90) minutes by public transport (single journey) for an examination, ...
A forty minute waiting time exceeds the ten minutes maximum allowed in the Contract.
Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version - 15 March 2005
5.7 The CONTRACTOR shall use reasonable endeavour to ensure that examinations commence within ten (10) minutes, of their scheduled time, when Claimants arrive in time for their appointment.
The advice given by Atos Healthcare to the DWP was a defamation in writing and as such constituted a libel.
The libel was that I should receive the Employment and Support Allowance and that I should be placed in a "Work Related Support Group" and in consequence I am able to attend further face to face meetings. Atos Healthcare at the time did not admit that the medical assessment was invalid. I am pleased to note that at long last Atos Healthcare has admitted that both the original review of the information provided and the medical assessment were invalid.
The libel by Atos Healthcare caused the DWP to attempt to take action that may have caused further injury to my person as the DWP was obliged to require additional face to face meetings.
The months of delay in providing a copy of the medical contract exceeds the period set in the Contract.
Many complaints were not acknowledged within the two days maximum allowed in the Contract.
Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version - 15 March 2005
4.2.1 The CONTRACTOR shall acknowledge all complaints received directly from Claimants or their representatives within two (2) Working Days.
Many complaints were not resolved within the twenty days maximum allowed in the Contract.
Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version - 15 March 2005
4.2.2 The CONTRACTOR shall provide a full response to each Claimant or their representative within the required turnaround times as set out in Schedule 5 of this Agreement. This schedule defines the time as twenty (20) working days.
Customer relations refused to action a number of requests made by email. The Contract specifically lists email as an acceptable means of communications.
Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version - 15 March 2005
3.2.2 The CONTRACTOR shall ensure enquiries are accepted in any reasonable format, (e.g. by telephone, in writing, by facimile or e-mail) ...
Referral to the Independent Tier was not made in the time periods allowed in the Contract.
The Independent Tier operational details are not specified in the Contract but are covered by general clauses that require Atos Healthcare to comply with DWP procedures. Recently the NAO has defined for the DWP what should constitute an Independent Tier process. Once again Atos Healthcare have not acknowledged that they have been informed of this within the two days allowed in the Contract.
Breach of the Contract - Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version - 15 March 2005
See following section and the National Audit Office (NAO) procedure.
The Contract between the DWP and Atos Healthcare, Schedule 4 Section 4.1 PART 1 Final Version dated 15 March 2005 page 6 of 15 contains the following:
4.1.7 The CONTRACTOR shall ensure that its complaints procedure includes reference to and details of, a process that will give the Claimant or their representative the right to seek an independent review, by an independent tier, of their complaint should normal procedures not result in a satisfactory resolution.
4.6 Independent Tier
4.6.1 The CONTRACTOR shall implement a revised independent tier for complaints as agreed with the AUTHORITY.
The NAO (http://www.nao.org.uk/) published a document dated 23 July 2008 for compliance by the DWP (which covers the activities of Atos Healthcare). This procedure provides recommendations on the requirements that relate to the Independent Tier.
NAO for the DWP Handling Customer Complaints (http://www.nao.org.uk/publications/0708/handling_customer_complaints.aspx)
6. Since we last reported, the Department has made significant improvements to its complaints handling. It has extended the remit of the Independent Case Examiner (http://www.ind-case-exam.org.uk/) as an additional, independent tier through which customers can seek redress for complaints. In parallel it has clarified its three-tiered complaints resolution process and has made efforts to direct customers more clearly through this process. The Department is also taking steps to embed the Parliamentary and Health Service Ombudsman good practice principles across all the Agencies.
If you review the correspondence you may get the impression that Atos Healthcare is reluctant to follow the NAO procedure. It is hard to understanding the reasoning behind not using the agreed independent tier procedure for a procedure in which the party at fault makes decisions as to the procedure to be followed and selects the individuals who are to decide what matter is to be considered and how to weight that matter.