Appliance of science

Talk to most social workers and advisers and you could get the impression that decisions on disability living allowance and attendance allowance are almost randomly arrived at, with many who seem cast-iron certainties refused while others sail through. 

Due to some excellent detective work by an organisation called Benefits and Work, making full use of the Freedom of Information Act 2000, some light can now be shone on the rather murky processes that these doctors are now using.

The doctors are employed by a company called Atos Origin to undertake Examining Medical Practitioner (EMP) visits on behalf of the Department for Work and Pensions. It seems that these EMPs are trained to decide whether the claimant is “genuinely living the life of a disabled person”.

The method, a “bio-psychosocial assessment”, was referred to in the July 2005 edition of Decision Maker’s Exchange, the monthly newsletter for DWP staff who decide on claims. A scientist wrote: “People with ‘medically unexplained symptoms’ – conditions for which there is limited or no recognised pathological basis, such as chronic fatigue, fibromyalgia, chronic low-back pain – feature regularly in disability assessments for state benefits. Why is it that in disability assessment medicine we see two individuals, of the same age and with the same illness or pathological condition, but with very different resulting levels of disability?”

The answer lies apparently in the adoption of the bio-psychosocial model of disability, developed by a psychiatrist in 1977.

Whatever the philosophy behind the model, EMPs are taught to look for evidence by judging “consistency of disability in a typical day; a history involving chronic pain management; use of home adaptations and adaptations to daily living; and appropriate intervention from a carer.”

In theory, such an assessment could help some claimants, and it would be more thorough than some of the perfunctory, poorly performed and badly recorded EMP visits that claimants have experienced.

In practice, however, the new style of assessment may well simply be used to dismiss a large part of a claimant’s needs as “psychosocial” rather than physical and genuine. There has always been a history of EMPs (and decision-makers and tribunals) querying the extent of a person’s disability, of course, but the new method gives that attitude a quasi-scientific veneer.

Benefits and Work has already seen one EMP report involving a disability living allowance claimant with chronic fatigue syndrome. The doctor who visited him recorded that he had “applied the bio-psychosocial model”. He went on to state that the claimant’s condition was 40 per cent physical and “60 per cent psychosocial: dependence on family members, depression and pain”.

Armed with that report, the decision maker concluded the higher rate of the allowance (mobility) was no longer appropriate, as the primary reason for the difficulty in walking was psychosocial.

As the Benefits and Work website says, the bio-psychosocial model enables claimants to be blamed for the degree of their impairment and could deprive them of benefits as a consequence.

Gary Vaux is head of money advice, Hertfordshire Council. He is unable to answer queries by post or telephone. If you have a question to be answered  please write to him c/o Community Care

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