Do Atos mental function champions really make WCAs “better”?
In anticipation of tomorrow's debate on mental health in parliament, we're publishing this story about Atos work capability assessment mental function champions (MFCs). We're hoping that questions that our group has put forward to MPs about Atos MFCs will be asked in the debate.
Update Thursday 16 May: Kevan Jones raised the issue of Atos mental function champions, the difficulty our group has had finding any information about any "real" impact of the role on WCAs for people with mental health problems and the lack of reporting information in parliament today at the mental health debate. It really is appalling that this "initiative" is thought to be good enough for people with mental health problems, particularly as neither the DWP nor Atos will show anyone any evidence of it producing results. You can read Kevan Jones' comments at the end of this article.
In 2011, Atos introduced Mental Function Champions into the ESA work capability process to "improve" assessments for people with mental health problems. A group of us have spent six months trying to find out exactly how this MFC role works, if MFCs have “improved” work capability assessments for people with mental health problems and if anyone at Atos or the DWP can prove that the role has had any impact for people who must go through WCAs.
We've had very little luck. We did manage to get a meeting with Atos, someone who said he was an MFC and the DWP on the topic, but that was not particularly satisfactory, as you'll see:
For months now, mental health service users and campaigners from the voluntary sector consortium group Mental Health Northeast (MHNE), Newcastle user-led mental health support group Launchpad and False Economy have been trying find out more about the work done by Atos Mental Function Champions.
Mental Function Champions are the mental health support and advice “experts” that Atos supposedly introduced into the ESA work capability assessment process in 2011 (Malcolm Harrington recommended the creation of this “role” in his early WCA reviews). The aim of this exercise was, according to Atos, to “spread best practice and provide advice and coaching to healthcare professionals at any stage in a case” where an ESA claimant had a mental health illness, learning difficulty or cognitive impairment.
Actually, he hadn't. When our group chased that up, the DWP told us that there were 60 MFCs across the country and that they largely worked a phone advice line – to “provide advice and support to Atos assessors, spreading best practice, and building links with appropriate stakeholders in their area,” whatever that meant. We decided that we wanted to know more.
And with good reason. MHNE and Launchpad were extremely surprised to hear that best practice was being spread through the WCA process for people with mental health problems. As far as they were concerned, the opposite was true and WCAs were having an extremely detrimental effect on people with mental health problems (and they're far from the only ones who think that, to say the least):
As MHNE says:
“MHNE and many other VCS organisations are continuing to experience high demand for support and help from distressed members of the public and mental health service users, who are experiencing either an exacerbation of their existing mental health problems, or in some cases developing mental ill health following Atos/DWP WCAs and ESA appeals. This is happening at a time when funding to both statutory and voluntary services is being reduced due to austerity measures and unfair cuts to services. Many of the calls we receive are from members of the public who are suicidal either because they can't face going through a WCA, or ESA appeal, or because they have been unjustifiably found fit for work by Atos and the DWP. The increase in demand for support is such, that all MHNE staff have had to undertake suicide prevention training so that we can deal with these types of calls.”
As we say, MHNE and Launchpad weren't and aren't the only ones with doubts. According to Harrington's third review: “some representative groups claim that awareness of the champions is low and that those who are aware of them believe they have little or no impact on the quality of mental function assessments. The review asked Atos to report on the effectiveness of their mental health champions. They said that their healthcare professionals found the champions to be ‘a great resource’ and that they were of ’great use to put any uncertainties into perspective’.”
Saying that MFCs were a great resource and of use to put uncertainties into perspective is one thing. Proving it is quite another.
We've been trying for six months, but our group (MHNE, Launchpad and FE) has not been able to find any concrete evidence of performance measurements or reporting for the MFC role at all. Despite repeated requests, the DWP could not produce that information and finally admitted that Atos "did not report back to the DWP on things like that."
Which wasn't too good. We wanted to know exactly what impact the MFC role was having on WCAs for people with mental health problems, but nobody would give us anything definitive.
This is extraordinary. The MFC role is an important formal concession that the DWP and Atos have made to the monumental concerns raised about the WCA experiences of people with mental health illnesses - but the DWP wasn't formally monitoring it. ESA claimants did not see MFCs and were not assessed by them: MFCs were there to advise and support Atos assessors only. It's all very well saying that MFCs were "a great resource" but how would anyone know that for a fact? How would the DWP? How would we? Let's not forget that coroners and GPs have reported that people are committing suicide or attempting suicide because of their experiences with work capability assessments. It doesn't get much more serious than that.
Trying to set up a meeting with an Atos MFC
To pin Atos and the DWP down on details of the recruitment, training and performance of MFCs, MHNE, Launchpad and FE tried for about six months to get Atos to agree to set up a meeting with us and several MFCs. It was clear that Atos did not want such a meeting: we sent emails and made calls and Atos kept saying that it would set a meeting, but didn't. So we'd call again and email again and nothing would happen. Our group kept the pressure up, though, and a meeting was finally set up for the first week of April – only for Atos to cancel it at the last minute. They said they wanted to arrange another time when the DWP could also attend.
The meeting finally took place on 23 April. MHNE and Launchpad met with the DWP and Atos in Newcastle (Atos did not want False Economy journalists to attend). One of the two members of the Atos contingent was, it was said, an MFC.
As MHNE and Launchpad say, the meeting was far from reassuring.
The DWP confirmed at the meeting that it didn't formally collect data from Atos on MFC performance. The North Durham MP Kevan Jones has been asking Mark Hoban questions about this on our group's behalf in parliament and been told the same: “There are no formal performance measures around the role of the mental function champion and no separate data is held on the specific performance of mental function champions.”
In the meeting, Atos said that it kept records of calls to MFCs and logs of questions raised with MFCs by Atos assessors – but that it wasn't prepared to make any of that information public. Which is entirely useless, as our group has said time and time again. What's the point of this role if nobody can see whether it works or not, or what sort of questions Atos assessors are asking of people in it? How can people with mental health illnesses be reassured that their issues are being understood by their Atos assessor if they have no idea what sort of advice MFCs give, or what sort of questions Atos assessors ask MFCs before, during, or after assessments?
Our group would like Atos and the DWP to commit to complete public transparency around this. This is too serious a role and too serious an issue to take place behind closed doors.
Other points of note/concern that came out of the meeting:
* Atos and the DWP were unable to provide any specific information on how MFCs were recruited (which seemed bizarre in a way, given that one of the Atos representatives at the meeting was an MFC)
* MFCs are not required to have formal qualifications in mental health. The minimum requirement is that they have some postgraduate experience in mental health. This is vague and in effect, it would be possible to have a practitioner with a few weeks' postgraduate experience in mental health as an MFC. Atos said that some will have a specific formal qualification and that they didn't want people to think that just because there are no minimum criteria for formal qualifications, that doesn't mean that a significant number of MFCs don't have them. They say that all MFCs are already approved "disability analysts" and have been through the basic assessor training which covers mental function and mental health assessment.
Our group has asked what proportion of MFCs have some sort of formal qualification in working in mental health. We have yet to hear back.
* To train for the MFC role, Atos HCPs take a two-day Atos inhouse self-facilitated training course.
* The DWP does not think that the tribunal service gives enough information about the reasons why it overturns decisions.
* And as we say - MFCs are not accountable to the DWP. They do not report to the DWP and there are no performance measures in place to monitor their effectiveness.
Your right to ask an Atos assessor to call an MFC at your WCA
One other vital piece of information that our group uncovered at the meeting was that anybody who undergoes a WCA has the right to request that their Atos assessor calls on the assistance of an MFC during their assessment - if they feel that their assessor does not understand how their mental health problems affect their lives and daily activities. Previously, the DWP has told us that the MFC role is to advise Atos assessors and not claimants - that is certainly the impression that you get from reading Atos' advice on MFCs on its website.
At the meeting, however, Atos said that claimants could take a proactive role in ensuring that assessors made contact with MFCs then and there if they wanted that.
One of our group members asked if a “a claimant could request that an HCP seeks advice from an MFC if they feel that the assessor does not adequately understand the illness?"
The Atos representatives responded that they would have no problem with that and that although it was not something that was generally advertised, there was no reason that an individual couldn't ask.
That at least would give people the option to find out what the MFC role does for them. That's what we want - transparency and robust public reporting of this role.
Mental Health Northeast will release a full report on the meeting and its experiences supporting people with mental health illnesses through WCAs soon. We're hoping that Kevan Jones will have a chance to ask questions about the MFC role in the debate tomorrow.
Update 16 May:
Kevan Jones: Professor Harrington’s review of the process put forward the idea of mental function champions. The Government spun that idea out a bit, as though it was the big answer to the problem, and I actually fell for it at the beginning, thinking that those people would be the ones who would carry out the assessments. That was not the case, however; they are there to give advice to the Atos assessors. So we still have assessors with no mental health qualifications.
Representatives of the charity Mental Health Matters (MHNE), a good advocacy charity in the north-east, have just met Atos to ask about the champions, and a number of questions have been raised. Atos would not tell them how the champions were recruited, and there is no indication that they need any formal qualifications. I understand that they are given a two-day Atos in-service training course, but they do not interact with any of the royal colleges or other outside bodies. Remarkably, they are also not accountable to the DWP. I put it to the Minister that he needs to tell the DWP that this must be looked at again. The process is not only causing a lot of heartache and difficulty for many of our constituents; it is actually not a good use of public money. People are failing the tests and going to appeal. At least one of my constituents has been affected in that way. They sometimes go through the process and end up in a residential hospital for a month, which must cost more than the amount of benefit that might have been saved.
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