TV Channel 4 Dispatches - Britain on the Sick

Using undercover filming, reporter Jackie Long investigates the controversial processes used to assess whether sickness and disability benefit claimants should be declared fit for work.

Reporter (Jackie Long):

The man who said he needed a Wheelchair doing a jive! The man who said he could not cut his own food playing golf! The goalkeeper who said he had a bad back! All prosecuted for wrongly claiming disability benefits. The Labour Government decided enough was enough and the Coalition want to do more.

Prime Minister Cameron:

We simply need to do more to get to grips with the sick note culture.

Reporter (Jackie Long):

Two and a half million people are on disability benefit. It costs us thirteen billion pounds a year.

Now Channel 4 Dispatches has uncovered evidence that a tough regime of tests is secretly trying to push almost ninety per cent of these claimants off the sick to look for work.

We have been undercover in the company which is carrying out these tests.

Atos Trainer 1:

This is a very specific job. In my opinion it is frustrating! It is toxic!

Reporter (Jackie Long):

And we have discovered that people with major disabilities are being declared fit for work.

Atos Trainer 1:

As long as you got one finger and you can press the button you don't score anything for manual dexterity.

Undercover Doctor (Dr Bick):

You just need one finger.

Reporter (Jackie Long):

So just how tough should we be on the sick and the disabled.

This is Dr Stephen Bick for twenty three years a family practitioner. He is used to people wanting a sick note.

Undercover Doctor (Dr Bick):

Most of us can work those that can't need help from a caring society.

Reporter (Jackie Long):

Now Dr Bick is turning his attention to a new case that of the French multi-national company which is responsible for running the Government's disability benefit tests. The company is called Atos and it has been the subject of fierce controversy over the way it assesses claimants for the Department for Work and Pensions.

Britain's GPs have demanded the Government scrap the system which the company runs. And earlier this year the head of the mental health charity MIND stepped down from the official scrutiny panel calling the system "inhumane".

Reporter (Jackie Long):

So Dr Bick is going to go undercover for Dispatches inside Atos.

How are you feeling about the prospect of doing this actually as it is quite an undertaking isn't it?

Undercover Doctor (Dr Bick):

I am apprehensive. I have never done anything like this before.

We do need to properly assess people and detect people that are swinging the lead. On the other hand we do need to properly support people who are chronically unwell and who arn't actually capable of working.

Reporter (Jackie Long):

Dr Bick stood at the last election as a Labour candidate and it was Labour who first hired Atos, a French IT company, to work in the benefits system.

The Atos contract has since been extended by the Coalition. It is worth one hundred million pounds a year.

Critics say Atos are unduly tough on claimants and there is evidence to support this. Two out of every five decisions are appealed by claimants and almost a third of those appeals are successful.

Our undercover doctor will start his training at an Atos centre in Leeds. It will take sixteen days. Dr Bick will learn to assess how much someone's disability affects their capacity to work.

Atos Trainer 1:

I will be training you.

How do you do?

Undercover Doctor (Dr Bick):

How do you do?

Reporter (Jackie Long):

The trainer is a doctor from Eastern Europe. She explains that this wasn't her first choice of job.

Atos Trainer 1:

My specialty is not recognised in this country. So there is a bit of problem that I don't have much choice so I have decided to love Atos and marry Atos for some time and I have worked a long time now.

Reporter (Jackie Long):

Atos's job is to assess the two and a half million people who claim extra benefits because they are too sick to work. The Department for Work and Pensions, the DWP, uses the test to decide either to pay people the Employment and Support Allowance up to forty five pounds a week extra in benefits or to send them off to the JobCentre to look for work their disability benefits reduced or even withdrawn.

Reporter (Jackie Long):

Dr Bick has been training with Atos for a couple of days. His tutor says she does assessments herself and she warns that it is not an easy job.

Atos Trainer 1:

This is a specific job, in my opinion. It is frustrating. It is toxic. And that is why I don't do overtime. It is specific. You like it or hate it or you get crises ever so often at least I do.

Reporter (Jackie Long):

The doctors are learning to carry out the work capability assessment to find out what each person can actually do rather than what they can't. So the assessors will measure seventeen different types of activities like; can you carry a cardboard box, can you raise your arms above your head, can you walk two hundred metres. And for each activity they assign a score fifteen for a maximum disability, zero for minimum. In most cases only people with at least one maximum score of fifteen will receive full benefits everyone else is declared fit for some kind of work or work related activity.

The DWP devised this system to replace an old incapacity benefit which wrote off too many people to a life on benefits without considering what work they could do. They say it is meant to protect the people who are really unwell and help get everyone else into work with differing levels of support but Dr Bick hears a bolder truth from his Atos trainer.

Atos Trainer 1:

You shall remember this new benefit Employment Support Allowance was meant to take people off the benefit.

Reporter (Jackie Long):

The class starts to learn how to allocate the points for each test. First one is siting and standing. If you can sit or stand in the same place for half an hour then you wont score maximum points because you could, in theory, work at a supermarket checkout.

Atos Trainer 1:

I will plead again the example of this lady in ASDA the checkout. She will tell you, oh I have back pain. I can't sit more than fifteen minutes. I have to standup, move about and sit down. She's not scoring anything. As long as she's capable of doing again scanning of the products. Fifteen minutes she's got tired. She feels better with her back. She can sit down. She sits down and she continues to scan the products. She is not scoring anything.

So it is difficult. This was specifically designed to take people off incapacity benefit.

Reporter (Jackie Long):

On the Kent Coast, Graham Smith has been declared fit for work. He has very serious back pain. He needs one hundred sixty milligrams of morphine a day. He had to leave his job as a lorry driver last year. He is appealing against his assessment. His family doctor can't understand how anyone can deem him fit for work. He says that Graham's current pain levels require so much medication that he is quite sedated.

Graham did not score enough points on the Atos tests. He got none at all for siting and standing disability. So he should in theory be able to work a checkout. Could he?

Wife of Claimant 2 (Graham):

Now that work, such a small shift, to be able to get up, move around and then come back or just he will just fall asleep because all the medication he is on they all say make you drowsy and of course all of them working together and he will just sit down sometimes and fall asleep.

Reporter (Jackie Long):

How do people who have serious problems getting around still fail to score enough points in these tests?

Atos Trainer 1:

Now for Employment Support Allowance we talk about mobilizing which means being able to transfer from point A to point B either by walking. Walking with aids which is crutches, walking sticks, Zimmer frame or using manual wheelchair so if someone has no leg but they have good hands they can sit and propel manual wheelchair they don't score anything. This is one of the toughest change.

Reporter (Jackie Long):

This rule applies even if the claimant has never actually used a wheelchair.

Atos Trainer 1:

We are thinking about hypothetical wheelchair. Could they use the wheelchair? They don't have to have it. So people are completely shocked when they get a letter and decision maker. They may phone them and they may tell them look you score nothing, you have arthritis of both knees I know, but your hands are OK and you could mobilize in the wheelchair. They say what the hell I have no wheelchair.

Reporter (Jackie Long):

Jenny McDonald was one of those people. She scored no points at her Atos assessment in April. In 2009 she was a ski instructor when a freak accident caused lasting damage to her knee.

Claimant 1 (Jenny):

What I have is called complex regional pain syndrome. Its a problem with the nerve endings in the leg where they are hyper sensitive. They will tell me that I am in pain constantly. Someone needs to be in the house just in case I am on a bad day. I stand up and I just drop because I can't get myself back up.

Reporter (Jackie Long):

You went from an incredible active job to effectively doing nothing?

Claimant 1 (Jenny):

It is very frustrating. Being someone who is so active to someone who can't even put a sock on.

Reporter (Jackie Long):

The Government is quite clear that this test is about finding what people are capable of rather than saying what they are not capable of.

Claimant 1 (Jenny):

I would like to know what I am capable of but what job would take me on with the amount of hospital appointments I go to, with the amount of time I will need of, with the collapsing that I do and the fact that I can't get stressed. I struggle just to do simple jobs.

Reporter (Jackie Long):

Jenny was amazed when she received her decision letter.

Claimant 1 (Jenny):

If I use a wheelchair like most people would, I could lose a leg completely. I need to keep it motivated. I need to keep it moving. I need to keep weight on it. In the medical report she said I had no upper limb problems so would be able to work in a wheelchair. I spent quite a few years giving all my effort to stay out of a wheel chair. I am not going in one.

Reporter (Jackie Long):

Because you want to stay as mobile as possible.

Claimant 1 (Jenny):

I really want to keep myself going. I don't want to fall any further back than what I already am.

Reporter (Jackie Long):

Even losing a whole arm is not considered enough to qualify for significant disability points. The problem needs to be bilateral affecting both limbs.

Atos Trainer 1:

Even they have one problem, one frozen shoulder, one impingement[???] syndrome, one broken elbow, one hand problem, no limb, amputation. They may score a little. The problem has to be bilateral. It is almost unachievable.

Undercover Doctor (Dr Bick):

Even if it is your dominant arm.

Atos Trainer 1:

It does not matter any more. Can you imagine? It is a very very tough benefit.

Reporter (Jackie Long):

Dr Bick starts to question some of the rules.

Undercover Doctor (Dr Bick):

Can we just discuss this one arm two arms question? It does say cannot raise either arm.

Atos Trainer 1:

I know one thing. The problem has to be bilateral.

Undercover Doctor (Dr Bick):

Because a lot of jobs you do need both hands. Don't you. Like the checkout girl she can't just do it with one hand. Can she?

Atos Trainer 1:

Well they still consider one hand.

Undercover Doctor (Dr Bick):

Yes but you can't work a checkout with one hand. I don't think.

Atos Trainer 1:

But you are not thinking about specific job. You are thinking about being able to do any job and this is will be the business of personal advisor in Jobcentre Plus to find suitable job. I know it is Utopia in general. As long as you got one finger and you can press the button. You don't score anything for manual dexterity. I wish you could have a job just to press but we'll come to this in a moment.

Undercover Doctor (Dr Bick):

Button tester?

Atos Trainer 1:

Yes, yes. My speciality is not recognised in this country.

Reporter (Jackie Long):

We showed some of our undercover footage to experts in the issues of work and disability. Richard Hawkes is Chief Executive of the disability charity SCOPE.

Richard Hawkes:

This test is deeply flawed and we saw that in the clip and how people can determine whether or not somebody is fit to work by asking about whether their arm works or their leg works is simply outrageous to be honest. You need to look at a much wider perspective of an individual and determine whether or not they are capable of working and what kind of support they need.

Reporter (Jackie Long):

Professor Stephen Bevan (The Work Foundation) advises Governments and companies on work place policies.

Professor Bevan:

Work is a mechanism through which people get dignity and income and social connection and so on. It could be an incredibly positive thing and also better for people's health if they are working and they are all principles that underpin the policy. The danger is that you almost treating a person a bit like a car going through a MOT with a sort of tick list and I think that reduces people down to a set of physical symptoms rather than the whole person.

Reporter (Jackie Long):

Undercover Dr Stephen Bick is inside the benefits assessment system. He has been finding out that even the people who train him are uneasy about their work. The work capability assessments have been controversial. Last December the Government launched a review into the way people with cancer are treated, under pressure from the charities. Last month (June 2012) the Department for Work and Pensions insisted that they have already put in place changes that have increased the range of cancer patients who receive ongoing unconditional support. But on the ground, things look different.

Atos Trainer 1:

The one under special circumstances is chemotherapy.

Reporter (Jackie Long):

Dr Bick's trainer explained that under DWP guidelines there are still set rules about which cancer treatments count for automatic support and which don't.

Undercover Doctor (Dr Bick):

And is radio therapy covered by this?

Atos Trainer 1:

We are talking about chemo, only chemo and unfortunately all round cytotoxic therapies does not count for this. That is the problem.

Undercover Doctor (Dr Bick):

It has got to be injection?

Atos Trainer 1:

IV whatever. All round cytotoxic does not count. Remember write it down.

Undercover Doctor (Dr Bick):

At the end of the day it is still chemotherapy. I mean it is not as severe as the intravenous.

Atos Trainer 1:

That is the legislation. That is we have to fill in a form. That is the DWP. Please remember. Oral does not count.

Reporter (Jackie Long):

The DWP told Dispatches. It is working on new proposals to improve in this field. In Dr Bick's final week of training he discovers that the chemotherapy only rule is still in place. Another Atos trainer said she is worried about one recent claimant but she knows she has to follow guidelines.

Atos Trainer 2:

I have recently had someone with prostate cancer. But of course that is not traditionally treated with chemotherapy. So I gave him no points and I could not do anything else. Same with breast cancer the hormonal treatments do not count. So he was given no points. I felt very uncomfortable doing it. I did not like doing it. But I had no way of scoring him. So chemotherapy is the only time when you say yeah they are about to have something.

Reporter (Jackie Long):

Atos told us their assessments are carried out in accordance with detailed guidelines set by the DWP. They added "We invest time and resource in training and reviewing the work of our medical professionals to ensure that those assessed are treated professionally and sympathetically".

One of the last things the doctors learn is that they'll have to judge how well people with problems hearing and seeing can deal with the world. If people can lip read or use braille then they'll be fit for work. But they don't have to be that good according to another of the Atos trainers.

Atos Trainer 3:

Just to make you aware that reading braille we don't think about fluency. It is like reading 'fire', 'escape' 'run away' something like that simple comments. The same lip reading. OK. Most people can lip reading like fire. This sort of comments.

Reporter (Jackie Long):

Throughout his training Dr Bick has been reminded how tough it is to assess people's fitness to work. Officially though it is not the Atos doctors who make the final decision. Dr Bick reports will be sent to a Decision Maker at the Department for Work and Pensions who can also look at evidence from the claimant's own doctors. But our undercover doctor is told that the Atos verdict is usually decisive.

Atos Trainer 1:

I will emphasise that we are only giving advice but the final decision belongs to the Decision Maker and I will always emphasise you will say that to the clients. Just to push, kind of, the guilt from yourself that is how I say because really they wait for our advice. But officially according to the procedure guidelines final decision is made by the Decision Makers.

Reporter (Jackie Long):

In practice the DWP agrees with the Atos medics ninety four percent of the time. What the assessors put in their reports is usually final. More than two in every five claimants appeal against the assessments, a process which is costing forty five million pounds a year.

But Dr Bick and the other trainees are told they don't need to worry about the appeal tribunals at all.

Atos Trainer 1:

Good thing for us is that even if you make the wrong decision because you have no evidence. You don't see xrays. You don't see ECG. You just only see the person so you can be wrong but you never go to the tribunal. This is a good think. You never go to the tribunal. So you won't be blamed.

Reporter (Jackie Long):

The DWP say that they are trying to reduce the number of appeals by improving the initial decisions and asking appeal judges to explain their reasons for overturning them. Critics of the system have alleged that the Atos assessors have targets for the number of people taken off benefit.

The Government has insisted that there are no targets attached to work capability assessment outcomes. Even a Government commissioned review of the system found categorically it is not the case that the DWP or Atos have targets implicit or explicit.

The Dispatches undercover doctor discovers that Atos assessors are given a target. It is the percentage that they can find eligible for the top rate of disability benefit. The category Atos calls the Support Group.

Atos Trainer 1:

Also you are being watched carefully for the rate of Support Group. If it is more than I think twelve or thirteen percent you will be fed back. Your rate is too high.

Undercover Doctor (Dr Bick):

How do they know only twelve percent need the Support Group?

Atos Trainer 1:

How do you know?

Undercover Doctor (Dr Bick):

Yes. Why do they say only twelve percent.

Atos Trainer 1:

I do not know who set the criteria. That is what we are being told.

Undercover Doctor (Dr Bick):

So if we put too many, twenty percent in, we get picked up on.

Atos Trainer 1:

Yes

Undercover Doctor (Dr Bick):

They would then come back at you and have a review of the case.

Reporter (Jackie Long):

Dr Bick is surprised by the idea of assessing people to a target. So he asked other trainers if this was true.

Undercover Doctor (Dr Bick):

In Leeds they said about twelve percent in the Support Group.

Atos Trainer 3:

Yes

Undercover Doctor (Dr Bick):

Is that about right?

Atos Trainer 3:

Yes

Undercover Doctor (Dr Bick):

Where did the twelve percent come from?

Atos Trainer 3:

DWP.

Undercover Doctor (Dr Bick):

Yes. They have said that?

Atos Trainer 3:

Yes.

Reporter (Jackie Long):

His main trainer explains the importance of sticking to the rules. She tells the trainees that they will be constantly audited to make sure they do. It makes her feel uncomfortable.

Atos Trainer 1:

Sometimes you feel awful because you can't do anything for people. But that is the job. You can't. You know. You can't feel sorry and just give them the money because you feel sorry for them. You go on targeted audit.

So just being overlooked, checked and you have your own mentor and they will deal with you. So you have no really freedom with giving out benefit or giving advice.

Reporter (Jackie Long):

When we asked Atos about targets they said "We can state categorically we have never been given or received targets for the number of people assessed as fit to work." They said they would be investigating our finding. The DWP also insists that the Atos contract does not contain targets. "If individual Atos assessors record results considerably outside the average, their work may be audited to ensure quality." They also say that of the first group to be assessed twenty nine percent were put into the Support Group declared unfit to work.

Reporter (Jackie Long):

After training, Dr Bick spends two days as an Atos assessor before handing in his notice.

Undercover Doctor (Dr Bick):

I actually did eight real cases and followed what I had been taught and examined people and made what I thought were fair conclusions using common sense or my medical opinion and they went through those cases and in four of them they bounced them back and told me to take the points off and even instructed me to change my examination findings.

Reporter (Jackie Long):

Perhaps their view was that you had not done it properly.

Undercover Doctor (Dr Bick):

Well if they want to redo the case with another practitioner and claim that I have not done it properly, let them. But this was just a case of a doctor on the phone from eighty miles away looking at what I had done and deciding it did not apply.

Reporter (Jackie Long):

The Department for Work and Pensions declined to give Dispatches an interview and expressed concerns about Dr Bick political past.

Reporter (Jackie Long):

They said that "In two thousand and ten the Work Capability Assessment was not entirely fit for purpose. But since then it has been significantly improved".

They said the system can be flexible and people who don't score enough points may still be supported if there is a substantial threat to their well being.

They told us that they have been working with the BMA, charities and leading experts on how to improve the system and have accepted the recommendations of two independent reviews adding "The most recent one reconfirmed that the Work Capability Assessment remains the right process".

Atos said the reviews had confirmed they were providing a high standard of service but it was their duty to look for ways to improve.

For the last two years critics have been claiming that the system run by Atos is too harsh. Our experts believe that Dr Bick secret filming provides crucial evidence.

Expert 1 (SCOPE):

I think there is a real worry that there is a presumption of malingering or some sort of dishonesty going on here which I think is a real shame because all our work shows the majority of people, often with severe or disabling conditions, really want to work and have got an amazing amount to contribute.

Expert 2 (Work Foundation):

The trainer in your clip described her role as toxic and I would say that this is an indication that the whole system is toxic. It needs to be reviewed.

Expert 1 (SCOPE):

This process should be a great way of connecting people back into the labour market and the real danger is it becomes seen as a sort of dead hand of the state somehow disqualifying people from benefits from which many of them may be entitled and that is a real concern.

Reporter (Jackie Long):

The Government is planning to put more benefit work out to the private sector and Atos is on a short list of ten firms to run another large disability testing program.