Memorandum submitted by Mr B...

Abstract

The memorandum submitted for consideration by the Department for Work and Pensions in respect of the Work Capability Assessment call for evidence year 3 independent review July 2012.

This page is published in the public domain and is uncopyrighted. Feel free to copy. See Copyleft (http://www.gnu.org/copyleft/)


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/.

Memorandum submitted by Mr B...

This memorandum is submitted as written evidence for consideration by the Department for Work and Pensions who produced a document dated July 2012 entitled "Work Capability Assessment, A Call for Evidence: Year 3 Independent Review" (deadline for written evidence Friday 7th September 2012).

I am willing for this evidence to be published in full on all media channels providing that my personal contact details are kept confidential.

Questions and Answers

  1. Question 1a: Have you had more than one WCA?

  2. Answer 1a: No.

  3. Question 1b: Was your most recent WCA: a or b or c?

  4. Answer 1b: b.

  5. My most recent WCA, in July 2009, was a new claim for Employment and Support Allowance (ESA). My case is currently with the Independent Case Examiner. In Appendix A, I have listed my correspondence with the DWP and Atos.

  6. Question 9: Overall, how fair do you feel that the assessment was?

  7. Answer 9: The assessment was not at all fair. By all reasonable measures it was completely unfair. It was scandalously unfair.

  8. The decision that a face to face assessment should take place was made by a nurse when under the Contract between the DWP and Atos it should have been made by a doctor after consulting with my own doctors. The Nursing and Midwifery Council (NMC) found that the nurse failed to read and as this was easily remedied found no further action should be taken.

  9. The assessment by the Atos doctor, Dr Ludmila Semetillo, constituted an assault as she, under the terms of the Contract between the DWP and Atos, should not have carried the assessment as my medical condition was that I had an unstable brain tumour together with recent occurring intractable epilepsy, seizures and focal fits which were not controlled by anti-convulsant medication. She failed to consult my own doctor before the assessment. She failed to prevent the assessment taking place. She was negligent. See Appendix B for the Contract list of medical conditions and actions to be taken by Atos.

  10. During the assessment I experienced pain and was near to blacking out a couple of times. This Atos doctor, Dr Ludmila Semetillo, continued without regard to my health. At the end I was pushed out of the outer door despite my stumbling.

  11. The report produced by the Atos doctor, Dr Ludmila Semetillo, was a defamation by libel and a work of pure fiction. The specific breaches of the Contract between the DWP and Atos have been documented both in the Appendix A listed correspondence and in evidence submitted to previous WCA inquiries and reviews.

  12. The DWP wrote to me stating "You have been placed in the Work Related Activity Group". More letters arrived scheduling "Pathways to Work" meetings. More letters arrived scheduling more Atos assessments.

  13. The assessment caused increased costs to the NHS medical staff who had to provide unnecessary duplicate information that was ignored.

  14. The assessment caused increased costs to the NHS welfare advice staff.

  15. The assessment caused increased costs to my county council (Hertfordshire) who provide minimal welfare advice and refer most matters to the CAB and charities. The CAB have had their funding cut by my county council. These cuts cause great difficulty because their work has increased due to the failings of Atos.

  16. The NAO in 23 July 2008 published "Department for Work and Pensions: Handling Customer Complaints" (http://www.nao.org.uk/publications/0708/handling_customer_complaints.aspx) in which it describes the independent tier process. The DWP and Atos do not comply with the NAO recommended process. The Atos Independent Tier process is neither independent or fair. It is very selective in the evidence it considers.

  17. A quote from my Atos Independent Tier report follows: "... letters of complaint cover a broad spectrum of concerns. He has asked for a good deal of action from the Independent Tier to secure a deep investigation of general standards within Atos Healthcare. I can see the foundations of this request as he has identified much which is lacking in the management of his case. But I must confirm that a good deal of what he asks for is beyond the remit of the Medical section of the Tier. I do not consider that his complaint - based as it is on distressing personal experience - can be used as a starting point for full investigation of the principles applied in examination and assessment procedures and decisions on benefit entitlement..."

    See http://www.whywaitforever.com/dwpatosindependenttier.html.

  18. Question 10: Overall, how effective do you feel that the process was?

  19. Answer 10: Completely ineffective in both the processes that were attempted and the resources required by Atos assessors, the DWP Decision Makers, the DWP management, the DWP executives and myself. I cannot stress enough how difficult it is to try and work through this ESA "not fit for purpose" foolishness.

  20. My case is evidence that the process of "deny, delay, and defend (delaying claims will increase the likelihood that the claimant gives up)" that was created by McKinsey & Co. for disability insurance companies in the USA and implemented in the UK by the DWP, in line with the technical implementation advice given by Unum and Atos, is actively being pursued.

  21. As my July 2009 WCA continues to be processed by the DWP, the process is a farce and so is, self evidently, ineffective.

  22. The DWP confirmed in April 2012 my ESA has ended. The DWP appears to have mislaid or lost my case records. I provided copies of previous DWP correspondence. The DWP wrote to me in April 2012 to ignore all DWP correspondence. The DWP confirmed in 22 May 2012 my ESA has not ended.

  23. I have NOT received any notification on the current rates and ESA calculations after I provided information relating to changes in my personal pension. I do not know if the decisions and calculations of the DWP are correct. Previous experience suggests that they are not. Compensation from the DWP or Atos is like squeezing blood from stone.

  24. I have not received a response as to why I was not paid the Christmas ten GBP until I chased the DWP.

  25. Communications have deteriorated significantly from the previous very low standard.

  26. I am still waiting for either an acknowledgement or a reply to my letter of the 25 May 2012 from Ms Maggie Brown, DWP Customer Services Team Manager, Basildon BDC, Essex. The Luton BDC was closed at the end of 2011.

  27. My evidence suggests that the DWP claims to have improved but in practice the contrary is the case. The DWP is making it harder and harder to go through the ESA process.

  28. Independent reviews appear to be ineffective, mere window dressing for the DWP to hide behind, to obfusticate the failure of the DWP to comply with Statute and Regulations.

  29. Question 11: What one thing (if any) would you change about the WCA to make the system better for people claiming ESA?

  30. Answer 11: The Contract between the DWP and Atos should be terminated as soon as possible in line with the termination of Contract clauses for the primary reason that Atos has repeatedly failed to comply with the Contract between the DWP and Atos. The role of Atos prior to termination should be handled as in following clause.

  31. While Atos continues to carry out assessments, any assessment report produced by Atos should ALWAYS include:

    • The name and GMC number or NMC pin number of the individual who decided that a face to face assessment was required.

    • The team leader or manager (name and GMC number or NMC pin number) responsible for the individual who decided that a face to face assessment was required.

    • The name and GMC number or NMC pin number of the individual who carried out the assessment.

    • The team leader or manager (name and GMC number or NMC pin number) responsible for the individual who carried out the assessment.

    • The date, time and duration of the assessment.

    • The report, within ten days of production, should be sent by Atos to the claimant.

  32. ESA assessments after termination of the Contract between the DWP and Atos should be carried out as follows:

  33. The assessment should be carried out by a locum at the claimant's own GP with full access to the claimants medical records. The locum can request additional medical evidence from specialists such as physiotherapists etc. The results of the assessment, as now, should be sent to the DWP Decision Maker.

  34. My case reinforces the foolishness of assessing a claimant without full access to the claimant's medical records.

  35. If the claimant disputes the assessment of the first locum a second assessment can be made by a different locum at the claimant's own GP.

  36. The GP practice should receive a payment related to the work involved. This is likely to be far less than the payment to Atos for each report Atos produces. Appeal costs would be minimal. An appeal would be far less likely to succeed.

  37. If the claimant still disputes the assessment findings then the NAO recommended Independent Tier, the current DWP Independent Tribunal and the Independent Case Examiner processes can be requested by the claimant.

  38. Question 12: Is there anything else, relevant to the WCA, that you would like to tell us about?

  39. Answer 12: Since April 2009, my case has been processed by the DWP. It is now at the Independent Case Examiner stage. These delays are the results of the inabilities of the executives and senior managements to manage a failing situation and take a firm grip on the issues.

  40. In particular I would like to highlight the failings of Darra Singh (please read my published correspondence with the evasive Darra Singh on http://www.whywaitforever.com/dwpatos.html). Darra Singh was appointed Job Centre Plus head July 2009 and left the DWP in September 2011.

  41. Organisations reflect the qualities, or lack thereof, of their leader. The current state of the DWP is testament to all that needs to be said of the capabilities of Darra Singh. Hopefully, now that Darra Singh has left, new DWP executives will lead the DWP from the nadir it descended to between July 2009 and September 2011.

  42. No reimbursement or compensation has been paid by Atos to the DWP in respect of my case.

  43. As the years go by, the performance of the DWP and Atos has worsened.

  44. The Independent Reviews' findings are ignored or used to suggest that concerns are being addressed.

  45. The Government,of whatever complexion, in the main replies to each review in the same way "more training is needed" and "things are improving" and "patchy"!

  46. The fact that the Advertising Standards Agency (ASA) found "... We noted that Atos had not provided evidence to show that each year it processed over 1.2 million referrals for medical advice and completed over 800,000 face-to-face medical assessments, or that it had over 1700 healthcare professionals. We therefore considered that the claims had not been substantiated and concluded the ad was misleading...". The figures for Atos healthcare professionals reported to Parliament falls far short of this widely over the top figure of 1700. The shortfalls of G4S in the Olympics were clear to see and tackled. The shortfalls of Atos in terms of the numbers of staff they deploy and the quality of Atos staff has hardly been addressed.

  47. The Independent Reviewer has not highlighted the massive gap in staff that Atos has deployed and that Atos should deploy.

  48. On the 17 August 2012 the National Audit Office criticised the DWP for not seeking 'financial redress' for delays in carrying out tests and noted that the department had only collected ten (10) percent of possible penalties triggered by poor performance.

  49. The Independent Reviewer has not highlighted that the DWP failed to seek 'financial redress' from Atos for Atos multiple and repeated failings.

  50. The Independent Reviewer has not questioned the need for Atos staff to sign the Official Secrets Act. This increases the risk to whistle blowers who as whistle blowers are protected by Statute and Regulation.

  51. The Independent Reviewer has not questioned the need for parts of the Contract to be redacted for commercial confidentially reasons.

  52. The Independent Reviewer has not considered whether Atos enjoys a monopoly position which cannot be challenged by any possible rival because of Atos control of assets, intellectual property rights and other intangibles such as consultancy and training.

  53. The NAO report dated 28 May 2010 on the DWP entitled "Support to incapacity benefits claimants through Pathways to Work" includes the following clause: "27 The Employment and Support Allowance and the accuracy of the new medical assessment have, however, yet to be rigorously tested in practice. At the same time, not all claimants found capable of work following an assessment of entitlement to Employment and Support Allowance will actually find employment. Claims for Jobseeker's Allowance are likely to increase as is the proportion of such claimants with some level of disability or sickness."

  54. ESA has been rigorously and continously tested in practice since it was introduced in 2008. The ESA assessment by Atos has categorically failed by all criteria, key performance indicators and by vastly increasing the costs to all concerned. The Atos assessment is not fit for purpose. Atos has proved time and again that it is not fit to run such a programme.

  55. As the Atos "medically qualified" trainer in the recent BBC documentary put it "Atos is toxic". The UK did not recognise the medical specialism of the Atos doctor who was training prospective Atos assessors! Atos continue to use "medically qualified" staff whose English is inadequate for the role they are asked to carry out.

  56. In the recent BBC and Channel 4 documentaries, it was stated that over thirty (30) people die every week despite being declared by Atos fit for work shortly before their deaths. This is a scandal. If any organisation not protected by the DWP were a possible party in the death of over thirty (30) people a week, there would be a major outcry and inquiry. It is reasonable to conclude that Atos are responsible, in whole or in part, in that they deliberately, callously and cynically declare sick people fit for work. These high numbers of deaths MUST be explained. Coroners can only do so much.

  57. The recent BBC and Channel 4 documentaries covered targets for the numbers of people allowed into the Support Group. Atos trainers, from different locations all were quite clear that targets were in place and "mentors" enforced these targets. Everyone who has worked for a large organisation at senior level knows that many "contentious" issues, tactics to be deployed and targets/ KPIs are NEVER written down. Plausible deniability is widely used to protect those who issue the orders from those who carry out the orders. If those who apply these orders are found out, the answer is "more training". Off the record briefings and instructions are issued and passed down through an organisation. It is clear that this has happened at Atos. It cannot be coincidence that all Atos trainers, Atos mentors and Atos assessors know these targets and rigorously enforce them. The target for the people allowed into the Support Group is clearly under twenty percent and for the "best" assessment centres it is around twelve percent. The high levels of successful appeals by claimants who are subsequently transfered into the Support Group is more hard evidence of these targets. What other explanation can there be?

  58. To understand how this ESA "not fit for purpose" assessment arose seems to be an aspect that the Independent Reviewer should revisit. Professor Mansel Aylward introduced the, discredited in the US, Unum assessment to the DWP. When Professor Mansel Aylward left the DWP he became director of a Unum funded research department at Cardiff University.

  59. Alphonse (Al) Hemond was VP of Reengineering and Claims for Unum. It is believed that he was the most senior Unum man who took the McKinsey & Co approach used at Alstate and reengineered Unum. It is believed that he was responsible at Unum for the discredited process.

  60. In July 2008, the American Association for Justice (www.justice.org) published a document "The Ten Worst Insurance Companies In America: How They Raise Premiums, Deny Claims, and Refuse Insurance to Those Who Need It Most". Allstate was the worst and Unum was the second worst.

    See http://www.justice.org/docs/tenworstinsurancecompanies.pdf

  61. Memorandum submitted by the New Beginnings Advisory Group (EDP 35) 
    
    THE ROLE OF THE PRIVATE SECTOR AND EMPLOYERS 
    
    12. Most members of the Group believe greater communication of best practice
    will create a wider trickle down effect across the country.
    Job Centre Plus might be the best mechanism to co-ordinate such activity.
    UnumProvident has worked together with the Department for Work and Pensions
    and Job Centre Plus to create "The Knowledge" a best practice guide for employers.
    New Beginnings would like to see more of this kind of activity. 
    
    MEMBERS OF THE NEW BEGINNINGS ADVISORY GROUP INCLUDE:- 
    
    B&Q                              Business in the Community 
    CBI                              The Cooperative Bank 
    Disability Alliance              Disability Rights Commission  
    Employers Forum on Disability    HSBC  
    The Institute of Directors       Scottish Power  
    The Shaw Trust                   Swiss Re 
    UnumProvident                    Barclays Bank
    
    15 April 2003 
    
    www.publications.parliament.uk/pa/cm200203/cmselect/cmworpen/401/401ap27.htm 
    
  62. In 6 May 2006 Unum submitted a document "Supplementary memorandum submitted by UnumProvident following the publication of the Welfare Reform Green Paper" which included:

    "3. We endorse the name of the benefit being changed to the Employment and Support Allowance. We have long argued for this change as it sets the tone for how the benefit is perceived." and

    "24. At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working with our partners at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University to better understand what places people at risk of long-term or chronic illness. Further information about this model can be made available to the committee."

    See www.publications.parliament.uk/pa/cm200506/cmselect/cmworpen/616/616we37.htm.

  63. In March 2007 Professor Malcolm Hooper submitted evidence (NICE 07) which included:

    "4. The incidence of ME/CFS is rising alarmingly. In order of insurance costs, one of the major medical insurance companies (UNUM Provident) reported in 1993 that ME/CFS came second in the list of the five most expensive chronic conditions, being three places above AIDS. In August 2004 the same company issued a Press Release reporting a 4,000% (four thousand) increase in claims for symptom-based syndromes, including ME/CFS. No other disease category surpassed these rates of increase. UNUM's "CFS Management Plan" states: 'UNUM stands to lose millions if we do not move quickly to address this increasing problem...'" and

    "14. The advisors upon whom NICE relies have been shown to have undeclared vested interests: These psychiatrists and their adherents are heavily involved with the medical insurance industry, including UNUM Provident, Swiss Life, Canada Life, Norwich Union, Allied Dunbar, Sun Alliance, Skandia, Zurich Life and Permanent Insurance, as well as the re-insurers Swiss Re, at which Peter White is Chief Medical Officer. For the way in which these psychiatrists deal with ME/CFS claims, see www.meactionuk.org.uk/Notes_on_the_Insurance_issue_in_ME.htm. For an exposition of their commercial conflicts of interest in relation to the Department of Work and Pensions, see www.meactionuk.org.uk/Obs_on_DLA_ Handbook_for_Gibson.html."

    See www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/503/503we79.htm.

  64. Professor Mansel Aylward is a director of a company Health Claims Bureau that sells assessments to employers to minimise the amounts employers' have to pay to employees who become sick or disabled.

  65. It is believed Alphonse (Al) Hemond assisted in setting up Health Claims Bureau and may retain an interest.

  66. The Chairman and Managing Director of Health Claims Bureau is James (Jim) Harris from James Harris Investigations.

    • He was a Police Officer in the British South African Police (Rhodesia).

    • It is believed that he was awarded a medal by Rhodesia: "Meritorious Conduct Medal (MCM) Harris, JW (No. 18049S) Field Reservist on 07-Dec-1979".

    • He has extensive knowledge and experience of investigating disability claims.

    • It is believed that he has an excellent track record in disproving claims.

  67. Health Claims Bureau website states "Our assessment requires a different mindset from clinical medicine".

  68. In evidence submitted to Parliament dated 6 May 2006 Unum stated: "At UnumProvident we have a non-medical, enabling model of rehabilitation and we are working with our partners at the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University to better understand what places people at risk of long-term or chronic illness. Further information about this model can be made available to the committee."

    See http://www.publications.parliament.uk/pa/cm200506/cmselect/cmworpen/616/616we37.htm

  69. Unum and Atos were part of the DWP Technical Working Groups that defined the details of the "non-medical" model assessments

  70. In the UK, Unum sells disability insurance to employers and it is presumed will use companies such as the one Professor Mansel Aylward is a director of, to carry out assessments. Unum launched a major publicity campaign to sell direct to the UK public but has withdrawn from this market due, it is believed, to adverse publicity.

  71. It is widely believed that US healthcare and US disability insurance companies want to undermine the confidence of the UK public both in the NHS and in the UK welfare and social net so that they can sell more of their products in the UK.

  72. Current and past MPs and Senior Government officials seem to be very interested in the possibilities. Government has short time periods; up to the next election. Major companies plan for the short term two to five years, the medium term five to ten years and the long term over ten years.

  73. Alan Milburn reported receiving payment through his company for his role as a Member of Lloyds Pharmacy's Healthcare Advisory Panel. The former Labour MP, who stood down at the 2010 election, has also been reported as a consultant to Pepsi and Bridgepoint. He served for five years in the Cabinet, firstly as Chief Secretary to the Treasury from 1998 to 1999, and subsequently as Secretary of State for Health until 2003.

  74. In April 2011 the Boston Consulting Group announced they have hired former Labour MP, James Purnell, as a "Special Advisor to their Public Sector Group". He has previously served in the Cabinet as Secretary of State for Work and Pensions.

  75. It is believed former Health Secretary, Patricia Hewitt, has worked with Boots.

  76. David Blunkett, the former Secretary of State for Work and Pensions, has worked for A4E, a leading employment and training firm that bids for multi-million pound contracts awarded by the DWP.

  77. Ernst & Young has appointed Darra Singh as an Executive Director within its Government and Public Sector team.

  78. The "cash for questions" and other investigations raise questions about the relationships between the objectives of individuals whilst working in the public sector and their promoting the objectives of the companies who have employed them having left the public sector. The case of Professor Mansel Aylward and his relationship with Unum is one that could be an interesting case study.

  79. The Independent Reviewer should address whether public confidence in the DWP the ESA assessment as carried out by Atos has improved or declined.

  80. The Independent Reviewer should address whether the level of private disability insurance has increased and what regulation is in place to protect individuals who have purchased disability insurance from these private companies. These private companies such as those Professor Mansel Aylward is a director of, are likely to be engaged to carry out assessments.

  81. If the "not fit for purpose" ESA assessment is allowed to be used by the DWP surely it can be used outside regulatory controls by private companies to minimise payments made to the insured. The inevitable large number of claims made by employees against their employers will add significant costs to UK companies to the detriment of the UK economy.

  82. The UK economy will become an unregulated cash cow for companies such as Unum and Health Claims Bureau. As the Atos trainer put it in the recent Channel 4 documentary: "...I will emphasise that we are only giving advice but the final decision belongs to the Decision Maker ... Just to push, kind of, the guilt from yourself ...".

  83. The winners are Unum, Atos, Health Claims Bureau and others. The losers are the DWP, DWP claimants, UK employers, UK employees and the UK Government. It is believed that the legal costs of company civil cases are deductible. Additional costs means lower profits, means lower payments to the UK Government and lower payments to shareholders.

  84. Three years has past. This is more than sufficient time for improvements to have been implemented and the results revealed. It is clear improvements were and are not possible for a "not fit for purpose" process.

  85. Consider phrenology which is the study of the elevations and depressions of the skull, based on the belief that they indicate a person's character and mental capacity. Phrenology cannot be improved with more training. Phrenology is "not fit for purpose". History judges most harshly those who were in a position to take a stand against this pseudoscience and took no action. The Atos assessment is one "phrenology" of this age. The future will look back at this time and judge us harshly.

  86. It seems obvious but needs stating, pseudoscience, such as the Atos assessment, cannot be improved.

  87. I tend to agree with critics that say the Atos assessment was designed to take money away from the public and put it into the hands of companies and those who awarded the contract to Atos, gave protection to Atos and left to work for companies that benefit from Atos undermining the confidence of the UK public in the Welfare State.

  88. The DWP paid Atos over £147 million in the financial year 2010-2011. The DWP paid Atos over £142 million in the financial year 2011-2012. The cost to the DWP of appeals due to Atos cases has been reported as over £50 million each financial year. See http://www.whywaitforever.com/statistics/index.html which collates the data from http://data.gov.uk/dataset/financial-transactions-data-dwp.

    Please note that the DWP pays Atos through differently named accounts:

                                                   AMOUNT     TRANS
    2010 - 2011
    
        ATOS ORIGIN IT SERVICES UK LTD         33,437,945       525
        ATOS ORIGIN IT SERVICES UK              5,965,632        11
        ATOS ORIGIN MEDICAL SERVICES          108,310,468        80
                                              -----------
                                              147,714,045
    
    2011 - 2012
    
        ATOS HEALTHCARE                       104,795,327       182
        ATOS ORIGIN IT SERVICES UK LTD         24,679,649       416
        ATOS ORIGIN IT SERVICES UK              4,320,987         7
        ATOS ORIGIN MEDICAL SERVICES            9,103,535        17
        ATOS ORIGIN                                83,570         2
                                              -----------
                                              142,983,068
    
  89. If a request by an MP or other interested party is made into how much "Atos Healthcare" was paid in 2011-2012 the answer is under 105 million GBP. If the request was clarified as what is the amount paid to Atos through all Atos related accounts the figure is 142 million GBP. The difference is significant! It does seem strange that MPs and the press use the lower over 104 million GBP figure rather than the over 142 million GBP figure. A reasonable person might suspect that there is evasiveness at work here.

  90. Each payment transaction is broken down into cost centres, sub-cost centres, and type of work. Taking these into account the payments seem to all fall into very similar categories. It seems that the work paid for in the "near budget" account is very similar to the work paid for in the other accounts. At the lowest cost centre level work has to be accounted correctly. If this were not the case the whole accounting system would be open to gross errors. This suggests that at executive level amounts from cost centres are being reallocated to different accounts for reasons that are not obvious, have not been published and thus are not open to scrutiny. It is unusual in accounting for an account to be set up to be around the budget amount and additional payments to be made to variants of the account name.

  91. What is the difference between "ATOS ORIGIN IT SERVICES UK LTD" and "ATOS ORIGIN IT SERVICES UK" and "ATOS ORIGIN"? What is the difference between "ATOS HEALTHCARE" and "ATOS ORIGIN MEDICAL SERVICES"? This makes no sense and does not seem to be in line with accounting practice. It is for the Independent Reviewer to consider whether the DWP is being disingenuous and if it is for what reason.

  92. The Atos assessment appears to be similar to the Unum assessment that failed in the US. In the US, Unum had to pay a fortune in compensation In the US, Unum had to repeat vast numbers of assessments. The Independent Reviewer has not reviewed the differences between the failed Unum assessment and the Atos assessments. Critics believe that any differences are minor and omit the changes that the US Government forced Unum to make.

  93. The Independent Reviewer should state categorically that the Atos assessment is an "outlaw" process, it is pseudoscience and as such is not capable of improvement. The Atos assessment does not comply with the Statute and Regulations that it purports to implement. The Atos assessment ignores the rights of the dying, the sick, the disabled and their carers. There should be a moratorium on future Atos assessments until such time as the Contract with Atos is terminated. The period of the moratorium should be used to create a medically sound assessment that is subject to and has passed the rigours and testing used to validate any other new medical procedure.

My Personal Situation

  1. I was emergency admitted to hospital in April 2009 and was diagnosed with a brain tumour the size of a squash ball. I was inoperable but treatable. The tumour grew to the size of a small orange. In October 2010, I was an acute admission for a biopsy. The diagnosis was anaplastic oligoastrocytoma (WHO grade III), epilepsy, focal fits, intractable painful partial seizures and right hemiparesis. I had an extended stay in hospital to address my symptoms with high doses of anticonvulsants and other medicines. These I continue to be prescribed. These are debilitating in their own right. These medicines are not suitable for taking over long periods of time.

  2. The treatment was radical radiotherapy 54.9Gy in 30 fractions over six weeks completed 22 December 2010. The treatment reduced the intensity and size of the tumour. I have a MRI scan every four months. My current status is "stable appearance". After my next four monthly MRI scan in September 2012 I hope, if still stable, to be able to be moved to six monthly MRI scans.

  3. I am inoperable. I am fortunate not to have required chemotherapy. Chemotherapy for brain tumours is problematic due to the blood-brain barrier.

  4. There are periods when I had to be house bound and bed ridden. My right leg and right arm became ice cold at times. Heating needed to be both kept on longer and at higher temperatures. More heating plus extra clothes plus wearing coats in doors plus blankets were necessary at times and this did not mean that the discomfort was fully addressed.

  5. I take medicines twice a day at 08:00 and 20:00. My waves of tiredness are not predictable. In the evening it is unusual if I am up after 22:00.

  6. As I understand the situation at any time my tumour could rapidly grow or it could remain as it is and in either case I could just drop dead. My brain tumour will not shrink without further treatment and while the tumous is stable no further treatment is expected.

  7. I am fortunate that I do not suffer the anxieties and mental torment that can occur in some cancer patients. During epileptic episodes, seizures and focal fits I have experienced such extreme pain that my mind appeared to disassociate from my body. My mind felt no pain and everything was getting brighter and brighter.

  8. I was revived by a paramedic after around 20 minutes. The paramedic arrived in a fast car before the ambulance. I believe I am only alive now because of the incredible speed of response. I am not concerned about death. My lack of concern may be because I am an atheist or because I was so close to death and survived. The "wear down" tactics of the DWP and Atos do take their toll... brown envelope after brown envelope, repeated request for yet another Atos assessment.

  9. In contrast to the excellent treatment I have received from the NHS, the treatment I have received from the DWP and Atos reveals them to be an inept, incompetent bunch of clowns. The DWP appears to use the case of Sisyphus as a model for dealing with patients. The DWP tactics are to delay, to defer and to deny. Even if after months and months the DWP concedes, within a couple of weeks, a new ESA 50 form appears and so it goes on ... and so it goes on ... and so it goes on...

  10. The doctors and consultants involved in my case include my GP, neurologists, neuro-surgeons, neuro-oncologists, neuro-psychologists, physiotherapists and occupational therapists. At times my condition has been described as acute. My biopsy had to be scheduled for the first available bed. Because of my condition I was pushed to the top of the list for surgery. All regard my ongoing condition as very serious.

  11. The Atos doctor thinks this medical opinion is worthless and states that I am capable of work related activity. She is a liar. The DWP and Atos have taken no action against this Atos doctor. She is free to lie and lie again.

  12. I had major mobility issues which physiotherapy exercises recommended to me by the hospital helped to address. I returned my driving licence to the DVLA in May 2009. Occasionally I had other issues related to vision, memory and conceptual thinking.

  13. It was the little things that were so difficult and painful; getting up from a chair, putting and taking off clothes, putting on shoes, tieing shoe laces, washing, toilet, dropping things and picking them up ... always trying to minimise pain ... cutting nails (impossible), losing balance, the camber of pavements, buying a rail ticket while holding a stick, stairs and public transport.

  14. It was difficult to go to sleep knowing an extremely painful focal fit and seizure could happen at any time (no longer taking diazepam or phenytoin). I am pleases I no longer anticipate the extreme pain I used to experience night after night and in the daytime. Nevertheless even now any minor muscle twitch or twinge might be the start of an episode.

  15. In breach of the Contract between the DWP and Atos I was forced to attend a face to face assessment. The assessment constituted an assault and resulted in injuries. The doctor, who had little command of English, defamed me by libel.

  16. The Government in the form of the DWP and their contractor Atos found me capable of work related activity. Is it suggesting that I should only state to a prospective employer that I am work capable and not elaborate on my medical condition? Is it suggesting I should withhold information about my medical condition on the grounds that it is not pertinent to the considerations of an employer? Is it suggesting the DVLA should return my driving licence because I have been found work capable? Is it suggesting I could be placed in a position that would make me responsible for other people's lives such as a bus or train or tube driver? ESA is a fraud and a farce and continues to be "not fit for purpose" as the Atos trainer states "toxic".

  17. I was offered physiotherapy and occupational therapy at home on completion of the radiotherapy treatment. This I declined as I hoped my physiotherapy exercises would improve my physical condition. Fortunately this has been the case.

  18. Multiple daily focal fits and seizures for over two years meant my right arm and right leg muscles shrunk. It is now in August 2012 that the strength of my right side is back to 90 percent of what it was prior to initial focal fits in spring and summer 2008. I am right handed and I still use my left hand in preference when strength is required. My writing has improved. I tire less easily.

  19. In early autumn 2008 I was asked to manage an IT development team (previously I had managed major IT development projects) at the company where I was working as a developer, I declined as I was not well. Every working day I would collapse at home, have a bite to eat and then sleep. Every weekend I was a little stronger. Originally I accepted a developer position as I knew something was not right. When I declined the management role, I was made redundant and the team I was due to set up was eventually set up in a different location.

  20. I have worked at a senior level in IT with responsibilities for recruiting teams. I know I would not hire myself. I still receive a stream of job vacancy notices as my IT expertise is highly valued. If I could work I would work. I am not work capable now. I am unlikely to ever be work capable while the tumour remains and my body is declining due to the medication I must take.

  21. I have not applied for or receive DLA though I would have been eligible. My intention was to apply for DLA after the ESA process was completed. My ESA process is not completed. I did not receive Carers Allowance or Attendance Allowance. I have applied and been found eligible for free prescriptions, a disabled bus pass, a disabled car parking pass and have purchased a disabled rail card.

  22. Two company pension schemes, due to exceptional medical circumstances, have agreed to pay me a pension (from September 2011). These would normally be paid at the state retirement age. The companies' doctor contacted my consultant and confirmed the seriousness of my medical condition. I presume further support for this action is based on actuarial grounds.

  23. My case is with the Independent Case Examiner who wrote 23 July 2012 "...an Investigation Officer has been assigned...".

Annex A - Correspondence

  1. The following correspondence, 135 items listed, is with the DWP and Atos. There were additional items not listed. Documents such as the ESA 85 and ESA 50 reports arrived without cover letters.

    2009       
    
      1 12 May Letter From Atos Healthcare, Request for ESA50 ESA Questionnaire to be completed. 
      2 10 Jun Letter From Atos Healthcare, Request again for ESA50 ESA Questionnaire. 
      3 18 Jun Letter From Atos Healthcare, Request to telephone Atos. 
      4 24 Jun Letter From Atos Healthcare, Appointment for medical assessment. 
      5 28 Jun Letter To Atos Healthcare, Before the medical examination. 
      6  3 Jul Letter From Atos Healthcare, Appointment for medical assessment. 
      7 10 Jul Letter From the DWP, Asking for a medical certificate from my GP. 
      8 29 Jul Letter To Atos Healthcare, Complaint after the medical examination. 
      9 29 Jul Letter From the DWP, ESA payment approved, benefit of £89.90 per week. 
     10  8 Aug Letter From Atos Healthcare, Work Focused Health Related Assessment. 
     11 11 Aug Letter To the DWP, After assigned to Work Related Activity Group. 
     12 11 Aug Email  To Atos Healthcare, Complaint failed to acknowledge. 
     13 12 Aug Email  From Atos Healthcare, Acknowledge receipt. 
     14 12 Aug Email  To Atos Healthcare, Request for the Independent Tier. 
     15 13 Aug Email  From Atos Healthcare, Refrain from sending emails. 
     16 13 Aug Letter From Atos Healthcare, Apologies and meaningless promises. 
     17 14 Aug Letter From the DWP, Wrong date wrong fact. 
     18 15 Aug Letter To the DWP, Repeat request for copy of medical report. 
     19 16 Aug Letter From Atos Healthcare, New Highgate appointment. 
     20 18 Aug Email  To Atos Healthcare, Request to cancel appointment. 
     21 18 Aug Email  From Atos Healthcare, Refusal to cancel appointment. 
     22 18 Aug Email  To Atos Healthcare, Indignation at refusal to cancel appointment. 
     23 20 Aug Letter From Atos Origin, Travel expenses cheque. 
     24 22 Sep Letter From Atos Healthcare, Rambling apologies and more errors. 
     25 24 Sep Letter To Atos Healthcare, Complain over new appointment. 
     26 28 Sep Letter To Atos Healthcare, Repeat complaints request for Independent Tier. 
     27  2 Oct Letter From JobCentrePlus, Pathways to Work appointment. 
     28  5 Oct Letter To JobCentrePlus, Request to cancel Pathways to Work appointment. 
     29  6 Oct Email  To Atos Healthcare, Request for progress report. 
     30  6 Oct Letter From Atos Healthcare, Acknowledge request. 
     31  7 Oct Letter From Atos Healthcare, New issues more delays. 
     32  8 Oct Letter To Atos Healthcare, Request to hear within 20 days. 
     33 12 Oct Letter From JobCentrePlus, Pathways to Work threat bullying. 
     34 13 Oct Letter From Atos Healthcare, Confirm FOI request forwarded. 
     35 14 Oct Phone  From JobCentrePlus, Apologies...of course did not have to attend. 
     36 14 Oct Letter To JobCentrePlus, Confirm JCP had made mistake. 
     37 11 Nov Letter From Atos Healthcare, More delays. Can't find ESA50. 
     38 18 Nov Letter To Atos Healthcare, Request for names and the Independent Tier. 
     39 25 Nov Letter From the DWP, Opinion Poll request to take part. 
     40 25 Nov Letter To the DWP, Opinion Poll response agree on terms. 
     41 26 Nov Letter From Atos Healthcare, More delays. Independent Tier refused. 
     42 26 Nov Letter From the DWP, A new FOI request. Why?!? 
     43 28 Nov Letter To the DWP, Clarify FOI request. 
    
    2010
           
     44  8 Jan Letter From Atos Healthcare, Offer of £100 consolatory payment. 
     45 11 Jan Letter To Atos Healthcare, Independent Tier request. 
     46 14 Jan Letter From the DWP, FOI response. 
     47 19 Jan Letter From Atos Healthcare, Independent Tier referral (at long last). 
     48 20 Jan Letter To Atos Healthcare, Independent Tier referral response. 
     49 21 Jan Letter To the DWP, FOI response and request for full information. 
     50 23 Jan Letter From Atos Healthcare, Independent Tier does not accept evidence. 
     51 24 Jan Email  To Atos Healthcare, Independent Tier should use NAO procedure. 
     52 24 Jan Email  From Atos Healthcare, Atos Healthcare email system broken. 
     53 25 Jan Email  From Atos Healthcare, Atos Healthcare will comply with DWP procedure. 
     54 27 Jan Email  From Atos Healthcare, Does Atos try "spoof job" entrapment? 
     55 28 Jan Letter From Atos Healthcare, ESA50 form must be completed again, why? 
     56 31 Jan Email  To Atos Healthcare, Request copy of original ESA50 form. 
     57  1 Feb Email  To Atos Healthcare, Requesting serious complaint action. 
     58  5 Feb Phone  To DWP BDC, The DWP BDC is not aware of serious complaint. 
     59  5 Feb Email  To Atos Healthcare, Brian Pepper, Atos Healthcare tardiness. 
     60  9 Feb Letter From the DWP, Changes in benefits to £91.40 per week. 
     61 15 Feb Letter From Atos Healthcare, "Atos" Independent Tier investigations. 
     62 22 Feb Letter To Atos Healthcare, Independent Tier convened on unsound legal basis. 
     63 22 Feb Letter To Atos Healthcare, Complaint over new ESA50 request. 
     64 22 Feb Letter To the DWP, Unsound medical advice and request for action. 
     65 28 Feb Letter From Atos Healthcare, Threat to ESA50 form or lose benefits 
     66  3 Mar Letter From Atos Healthcare, Atos believes Independent Tier legal 
     67  4 Mar Email  To Atos Healthcare, Response and Atos breach the Contract again 
     68 11 Mar Letter From Atos Healthcare, Forgets that ESA85 was unsound 
     69 19 Mar Letter From the DWP, Provides ESA50 copy and request for new ESA50 
     70 22 Mar Letter To the DWP, Short shrift for new ESA50 request 
     71 24 Mar Email  To Atos Healthcare, Another complaint 
     72 24 Mar Email  From Atos Healthcare, Acknowledgement received within 20 minutes! 
     73 25 Mar Letter From Atos Healthcare, Ignores substantive points again! 
     74 26 Mar Email  To Atos Healthcare, Further complaint 
     75  7 Apr Letter From the DWP, FOI Response to 21 Jan 2010 correspondence. 
     76 12 Apr Letter From the DWP, DWP does not have jurisdiction over Atos. 
     77 21 Apr Letter From the DWP, FOI Additional to 7 Apr letter and copy of 7 Apr 
     78 28 Apr Letter From the DWP, Data Protection They retain no information. 
     79 29 Apr Email  To Atos Healthcare Asking for progress and where is the £100. 
     80  6 May Email  From Atos Healthcare, Confirm will pay initial £100. 
     81  8 May Letter From the DWP, Placing me in the ESA Support Group 
     82 11 May Letter To the DWP, Requesting copy of medical advice and money owed. 
     83 25 May Letter From Atos, Healthcare Letter and cheque of initial £100. 
     84 26 May Letter From the DWP, Responding to DWP Legal Group 10 Mar 2010 letter. 
     85 27 May Letter To the DWP, Requesting all matters be addressed. 
     86  1 Jun Letter From the BA DSS, Certificate of Pay and Taxable Benefit etc. 
     87 24 Jun Letter From the DWP, FOI Response 
     88 24 Jun Letter From the DWP, FOI Response ... more 
     89 29 Jul Letter From the DWP Chief Executive, Response following Independent Case Examiner 
     90 29 Jul IB59   From the DWP Chief Executive, Outstanding request (not written in English) 
     91  4 Aug Email  To the DWP Chief Executive, Response to his letter. 
     92  6 Aug Letter From the DWP Jobcentre Plus, Special payment of £75. 
     93 21 Aug Letter From the DWP, Remittance Advice of £75. 
     94 27 Aug Letter From the DWP, Acknowledge 4 Aug letter. 
     95  1 Sep Letter From the DWP FOI, GMC reference and HCP definition. 
     96  3 Sep Letter From the DWP CMMS, Claimant and customer. 
     97  6 Sep Letter From the DWP, Review all in order 
     98  7 Sep Email  To the DWP, FOI Response to 1 Sep letter. 
     99  9 Sep Letter From the DWP CMMS, Addressing the 14 points. 
    100 13 Sep Letter From the DWP CMMS, Addressing the 7 Sep FOI email. 
    101 13 Sep Letter From MP, Initial response from DWP CMMS. 
    102 29 Sep Letter To DWP BDC, Response to 6 Sep letter. 
    103  1 Nov Letter To DWP BDC, Informing hospital admission. 
    104  3 Nov Letter From DWP BDC, Apologising for delay. 
    
    2011       
    
    105  8 Jan Letter From DWP BDC,  Refusing to address any issue raised. 
    106  1 Feb Email  To DWP,   Requesting Darra Singh CEO DWP to review. 
    107  1 Feb Email  From DWP, Acknowledge receipt. 
    108  8 Feb Letter From DWP, Changes in benefits to £99.85 per week. 
    109 21 Feb Letter From DWP, Evasive answers from Matthew Nicholas, Director. 
    110 15 Mar Email  To DWP,   Response to Evasive Answers. 
    111 18 Apr Letter From DWP, Apology for delay claims replied to all issues. 
    112 23 Apr Letter From BA DSS,  Certificate of Pay and Taxable Benefit etc. 
    113 27 May Email  To DWP,   Request Atos to cease and desist harassment. 
    114 25 Jul Letter From DWP, Response to email. 
    115 31 Jul Email  To DWP,   Thanks for finally agreeing to comply with Contract. 
    116 12 Aug Letter From DWP, Agreeing to use "claimant", Atos falsehoods, compensation. 
    117 24 Aug Email  To DWP,   Responding to their letter. 
    118 26 Aug Letter From DWP, Change in allowance £10 Christmas Bonus. 
    119  9 Sep Letter From DWP, Apology for misleading information regarding Atos. 
    120 21 Sep Email  To DWP,   Accept apology. Repeat request to remove approval. 
    121 11 Oct Email  To DWP,   Company Pension details. 
    122 14 Oct Letter From DWP, ESA Change in rates £99.85 + £10.00 (Christmas). 
    123 17 Oct Letter From DWP, Company pension calculation. 
    124 17 Oct Letter From DWP, ESA change in rates £0.00 (company pension) + £10.00 (Christmas). 
    125 29 Dec Email  To DWP,   DWP failed to pay £10.00 (Christmas). 
    
    2012
           
    126  3 Jan Letter   From DWP, DWP computer system fault so Christmas £10.00 not paid. 
    127  9 April Letter From DWP, ESA is due to end! 
    128 12 April Letter To DWP,   Complaint about another DWP mistake. 
    129 15 April Phone Message From DWP, Luton Benefits Centre is closed. 
    130 21 April Certificate From BA/DSS, P60U Certificate for 2011 to 2012. 
    131 30 April Letter From DWP, "...disregard any further letters we issue..." 
    132 30 April Letter From DWP, Confirm ESA has ended. 
    133  4 May   Email To DWP,    Request confirmation still in Support Group. 
    134 22 May   Letter From DWP, Confirm ESA has NOT ended. 
    135 25 May   Email To DWP,    Ask for investigation report into my lost case records. 
    
  2. The following correspondence is with the Independent Case Examiner.

    
    Independent Case Examiner
       5 Jul 2010 On line form To,   Complaining about the DWP. 
       9 Jul 2010 Letter From,       No action as final response has not been given by DWP. 
       6 Aug 2010 10:20  Email From, Requesting if action is now required. 
       6 Aug 2010 17:45  Email To,   Requesting postpone action for now (I am too ill). 
    
       3 Aug 2011 10:37  Email To,   Requesting to progress my case. 
       4 Aug 2011 Letter From, Confirm progressing my case. 
      11 Aug 2011 Letter From, Jobcentre Plus complaints procedure not yet exhausted. 
      16 Aug 2011 Email  To,   Asking clarification. 
      17 Aug 2011 Email  From, Confirmed allocated to Initial Action Team. 
      22 Sep 2011 Phone  From, Requested to discuss case. 
      29 Sep 2011 Letter From, Clarification of complaint elements. 
       2 Oct 2011 Email  To,   Provide clarification. 
      12 Oct 2011 Letter From, Clarification regarding the points raised. 
      13 Oct 2011 Email  To,   Accept clarification and ICE precedents. 
      20 Oct 2011 Letter From, Clarification agreed awaiting assignment to case worker. 
    
      25 Jan 2012   Letter From, Case notes have been received from DWP.
      27 April 2012 Letter From, Still awaiting an Investigation Officer. 
      23 July 2012  Letter From, Investigation Officer assigned. 
    

Annex B - Medical Conditions

  1. The following are listed the medical conditions and actions to be taken by Atos. Cancer is listed as "Reference to Medical Advisor required for advice".

Medical Conditions and Categories

For the purposes of administrative scrutiny of cases to determine suitability for inclusion in the DLA in Medical Examination Centre project, 5 categories of case have been devised:

In 2005 the Welfare Reform Bill, which introduced the Employment and Support Allowance (ESA), had not yet been enacted hence the reference to the Disability Living Allowance (DLA).

  1. Unsuitable for calling to a Medical Examination Centre.

  2. Reference to Medical Advisor required for advice.

  3. Tentatively invite to Medical Examination Centre.

  4. Invite to Medical Examination Centre.

  5. Any other Diagnosis.

For each category a list is attached.

1. Unsuitable for calling to a Medical Examination Centre.

Age >75 years      

Age <12 years
      
Both Blind and Deaf
Registered Blind (needs to be seen in own environment)
Cases accepted under the Special Rules defining Terminal illness.
Alzheimers
Amputation of both legs
Asperger's
Autistic Spectrum Disorder / Autism
Cerebral Palsy
Dementia
Hemiplegia
Huntingdon's Chorea
Korsakoffs Psychosis
Macmillan Nurse attending.
Motor Neurone Disease
On oxygen
Paraplegia
Quadraplegia
Renal Dialysis
Severe Mental Impairment
Severe Learning Difficulty
Spastic Diplegia
Tetraplegia
Total Parenteral Nutrition
Unstable Angina
Wernicke's Encephalopathy

2. Reference to Medical Advisor required for advice.

AIDS
Astrocytoma
Bone Marrow Transplant
Brittle Bone Disease
Cancer
Cystic Fibrosis
Dermatomyositis
Glioma
Guillane-Barre Syndrome
Hodgkin's Lymphoma
Leukaemia
Liver Failure
Mental Retardation
Mental Subnormality
Multiple Sclerosis
Muscular Dystrophy
Non Hodgkin's Lmphoma
On Morphine / MST
Osteogenesis Imperfecta
Parkinson's Disease
Poliomyelitis
Polymyasitis
Registered partially sighted
Respiratory Failure
Rheumatoid Arthritis
Schizoaffective Disorder
Schizophrenia
SLE
Spinal Injury
Systemic Lupus Erythematosis
Scleroderma
5evere Depression
Thallassaemia

3. Tentatively invite to Medical Examination Centre.

Agoraphobia (offer taxi)
Anorexia Nervosa
Ataxia
Bipalar Affective Disorder / Bipolar Disease Manic Depression
Burns
Cardiomyopathy
Cerebrovascular Accident / CVA
Cerebrovascular Disease
CFS
Chronic Fatigue Syndrome
Crohn's Disease
Diabetic Neuropathy
Eating Disorder
Fibromyalgia
Haemopphilia
Heart Transplant
Hemiparesis
Learning Difficulties
Leg Ulcers
Myalgic Encephalomyelitis / ME
Obsessive Compulsive Disorder
Peripheral Neuropathy
Phobic Anxiety
Sickle Cell Anaemia
Social Phobia
Spina Bifida
Stroke
Subarachnoid Haemorrage / SAH
Ulcerative Colitis
Varicose Ulcers

4. Invite to Medical Examination Centre.

Alcohol Dependence
Anaemia
Angina
Ankylosing Spondylitis
Anxiety
Arrythmia
Asthma
Atrial Fibrillation
Back Pain
Bronchiectasis
Bulimia Nervosa
Cardiac Arrythmia
Cervical Spondylosis
Chronic Bronchitis
Chronic Obstructive Airways Disease
Chronic Obstructive Pulmonary Disease
COPD
Coronary Artery Disease
Coronary Heart Disease
Depression
Dermatitis
Diabetes
Diverticular Disease
Diverticulitis
Dizziness
Down's Syndrome
Drug Dependence
Eczema
Endometriosis
Epilepsy
Hearing Impairment
Hernia
HIV
Hypertension
Hyperthyroidism
Hypathyroidism
Hysterectomy
Incontinence
Ischaemic Heart Disease
Irritable Bowel Syndrome / IBS
Joint Pain
Kyphosis
Kyphoscoliosis
Labyrinthitis
Liver Transplant
Lumbar Spondylosis
Meniere's Disease
Migraine
Myasthenia Gravis
Neck Pain
Osteoarthritis
Osteoporosis
Overactive Thyroid
Panic Attacks
Pelvic Inflammatory Disease
Peripheral Vascular Disease
Personality Disorder
Prolapsed Intervertebral Disc
Psoriasis
"Registered Alcoholic"
Renal Transplant
Rheumatic Heart Disease
Scoliosis
Slipped Disc
Underactive Thyroid
Valvular Heart Disease
Varicose Veins
Visual Impairment

5. Any other Diagnosis.

Not listed above should be referred to a Medical Adviser for advice

Mr B...

20 August 2012