Atos? Dept. of Social Protection is considering outsourcing medical review services

iptba

This story was covered in the Sunday Business Post (page 6, news, August 11), but their articles require a subscription.

The Department of Social Protection have placed a notice on eTenders about this.

Short description of nature and quantity or value of supplies or services:

The Department of Social Protection (DSP) is considering contracting providers of medical services to supplement DSP's existing medical review and assessment service capacity. Doctors within DSP's medical service undertake assessments / reviews (both face to face with customers and/or on files and reports) so as to provide medical opinions in respect of claims for illness, disability and caring welfare schemes. The service also comprises associated administrative tasks (e.g. scheduling appointments, written and phone communications with customers etc.) It is estimated that the number of cases contracted out could range from 25 000 to 75 000 per annum.

http://ireland-tenders.eu/1404_Provision_of_medical_services_medical_opinions_2013_Dublin

Some people may be familiar with the situation in the UK where a company called Atos has been contracted to provide such assessments, with a lot of people unhappy.

L1011

You would hope they would actually contract it out to a qualified medical service, rather than the disastrous UK system.

More reviews are definitely needed, as during the Tiger era little consideration was given to the awarding of disability allowance - whereas we've possibly gone too far out the other side now.

Godge

MYOB wrote: »

You would hope they would actually contract it out to a qualified medical service, rather than the disastrous UK system.

More reviews are definitely needed, as during the Tiger era little consideration was given to the awarding of disability allowance - whereas we've possibly gone too far out the other side now.

http://www.davidmcwilliams.ie/2013/04/04/the-mystery-of-disability


David McWilliams seems to think it has gone the other way, now he has got other things wrong but it might be worth checking.

rasper

Mot on the slash welfare brigage however always felt disabilty psyments were by far over subsvribed and the recipients have totally wrtitten off ever working again ,
Talking about adicts and people with depession etc not physical disabilities

Cody Pomeray

Interesting, from that chart in Godge's link, to compare the 'flight to disability' between this recession and the 1980s recessions and cutbacks



Because of the duration of the increase, it's unlikely that it can be ascribed to the fairly recent welfare conditionality announcements.

It might be a case that people who were in some physical or emotional distress found the marginal value of work too good to stay at home during the boom, their disability notwithstanding.

And now, the same marginal gains no longer exist. There isn't much to lose by applying for the welfare that was always there for them.

There's also a possibility that the recession has aggravated underlying emotional and psychological disorders.

So while the recession might be playing a part, I think it's necessary to ask why the recession is playing a part.It's possibly not as cynical as it appears at first glance.

murphaph

What changed in 1996? That's as dramatic a change as you'll find.

iptba

One big change in Ireland in the last few decades is women working. Previously, housewives/homemakers would have contained lots of people, from people in full health, to people with disabilities and disabling chronic physical and/or mental illnesses. So in the past, a lot of disability and disabling conditions weren't noted.

johnnyskeleton

iptba wrote: »

This story was covered in the Sunday Business Post (page 6, news, August 11), but their articles require a subscription.

The Department of Social Protection have placed a notice on eTenders about this.



http://ireland-tenders.eu/1404_Provision_of_medical_services_medical_opinions_2013_Dublin

Some people may be familiar with the situation in the UK where a company called Atos has been contracted to provide such assessments, with a lot of people unhappy.

I'm sure a lot of people would be unhappy if their bogus claim for disability was found out, but it would be a different matter if the complaints are from genuinely disabled people unfairly cut off.

Nodin

johnnyskeleton wrote: »

I'm sure a lot of people would be unhappy if their bogus claim for disability was found out, but it would be a different matter if the complaints are from genuinely disabled people unfairly cut off.

...that's what seems to have happened. Quotas, agendas etc are bad enough pushed by the civil service, but when your profit and jobs depend on reaching and pushing them, its legitimate cases that will suffer.

spank_inferno

No harm. The review process as it is, is quite easy to get through and is just done annually.

murphaph

There must have been some policy change in 1996 that meant people who previously were on unemployment benefits were "switched over" to disability or something. There were no dramatic changes in our economic fortunes in 96. Things were steadily (actually quite rapidly) improving with unemployment tumbling. Perhaps to "accelerate" this fall in unemployment a certain government decided it would be good to push the lifers onto disability so they could claim even more heroic feats of economic management? I can't imagine what else could cause such change in trend in such a dramatic fashion.

Godge

Nodin wrote: »

...that's what seems to have happened. Quotas, agendas etc are bad enough pushed by the civil service, but when your profit and jobs depend on reaching and pushing them, its legitimate cases that will suffer.

Link please?

The only statistics to date show the opposite, numbers have been rising faster than the population.

That means

(1) The criteria are more not less generous than before
(2) We are an increasingly unhealthy country

So how can you say legitimate cases are suffering?

iptba

Disability Allowance (the means-tested payment) used to be called Disabled Person's Maintenance Allowance and was paid for by the health boards. It was switched to the Dept of Social Protection in 1996*. So perhaps that might explain some or all of the sudden change in the figures.

*Sample reference:

In the past, people with disabilities had most of their needs addressed within the ambit of specialist disability services which were generally funded by the health sector. For example, up to 1996 the Disabled Persons Maintenance Allowance was administered by the former Health Boards. The Commission on Disability welcomed the transfer of this scheme (which was renamed Disability Allowance) to the Department of Social Welfare in 1996 as it was "the agency responsible for mainstream income maintenance payments"

http://www.dohc.ie/publications/fulltext/disability_sectoral_plan/health_sectoral_plan_08.html

Nodin

Godge wrote: »

Link please?

The only statistics to date show the opposite, numbers have been rising faster than the population.

That means

(1) The criteria are more not less generous than before
(2) We are an increasingly unhealthy country

So how can you say legitimate cases are suffering?

If you look at the context, you'd see I was referring to Britain.....
http://www.theguardian.com/society/2012/mar/19/sickness-benefit-try-avoid-paying

Godge

iptba wrote: »

Disability Allowance (the means-tested payment) used to be called Disabled Person's Maintenance Allowance and was paid for by the health boards. It was switched to the Dept of Social Protection in 1996*. So perhaps that might explain some or all of the sudden change in the figures.

*Sample reference:

http://www.dohc.ie/publications/fulltext/disability_sectoral_plan/health_sectoral_plan_08.html

That would explain the above-trend jump from 1996 to 2002. Either our social welfare system was more efficient or more generous than the previous health board system. However from 2002-2007 the increasing trend matched the increase in population. Since 2007 there has been another unexplained increase with the number of disabled once again rising faster than the population.

Nodin wrote: »

If you look at the context, you'd see I was referring to Britain.....
http://www.theguardian.com/society/2012/mar/19/sickness-benefit-try-avoid-paying

Fair enough but the UK may well have had the same problem as us - disability increasing faster than population which just doesn't make sense.

iptba

One thing I notice about the graph is that its cut off at 90 which can give a misleading impression.ETA: I've been told y-axis represents percentages

The other point that I mentioned was gender. If you were a married/cohabiting woman in the 1980s, there's a good chance you wouldn't have qualified for a disability payment. Disabled Person's Maintenance Allowance (now Disability Allowance) is a means-tested payment based on your and your spouse's income, so most married women won't be able to avail of it. The other type of disability payment requires PRSI contributions, which again are less likely in women who hadn't worked outside the home for a long time. So my guess is quite a lot of the change is to do with this. Also, more single people/single parents mean they are more able to get means-tested payments.

Anyone have a gender breakdown?

murphaph

iptba wrote: »

One thing I notice about the graph is that its cut off at 90 which can give a misleading impression.

What? It starts off at 100% in 1986 and goes from there. Population generally increased by about 30%, those on disability almost doubled!! It's an incredible graph really.

iptba wrote: »

The other point that I mentioned was gender. If you were a married/cohabiting woman in the 1980s, there's a good chance you wouldn't have qualified for a disability payment. Disabled Person's Maintenance Allowance (now Disability Allowance) is a means-tested payment based on your and your spouse's income, so most married women won't be able to avail of it. The other type of disability payment requires PRSI contributions, which again are less likely in women who hadn't worked outside the home for a long time. So my guess is quite a lot of the change is to do with this. Also, more single people/single parents mean they are more able to get means-tested payments.

Something like this wouldn't cause the sudden upswing in 1996. I think the cause may well have been identified in the switch to the DSP from the Health Boards. Looks like NOBODY was watching this or simply didn't care. It seems to have gotten out of control. It is time a harder line was taken and yes that should include undercover observation of claimants from time to time. A claimant out of work because of a back injury shouldn't be found out on his hands and knees doing a spot of weeding in his front garden, for example. I think the disability payments are among the most abused in fact, but that's just my hunch.

iptba

murphaph wrote: »

iptba wrote:

One thing I notice about the graph is that its cut off at 90 which can give a misleading impression.

What? It starts off at 100% in 1986 and goes from there. Population generally increased by about 30%, those on disability almost doubled!! It's an incredible graph really.

I'm talking about the y-axis, the important axis, on the variable being measured.

murphaph

iptba wrote: »

I'm talking about the y-axis, the important axis, on the variable being measured.

I don't know what you mean. Can you explain your problem with the graph exactly?

iptba

murphaph wrote: »

I don't know what you mean. Can you explain your problem with the graph exactly?

The index score doesn't start at 0, it starts at 90. It's an issue brought up in the book "How to lie with statistics" (for example): this practice tends to give the impression the change is more significant than it is.

Godge

iptba wrote: »

I'm talking about the y-axis, the important axis, on the variable being measured.

The y axis?

OK in 1986 the index for population is set at 100 and the index for disability claimants is set at 100.

The graph is then set to measure how disability claimants changes vis-a-vis population. It shows that between 1986 and 1996 disability claimants grow slower than the population, in fact it would appear that the number of disability claimants fell as the 1996 figure appears to be below 100.

From 1996 we see a different scenario. The numbers of disability claimants relative to population significantly increased until around 2002. This has been explained earlier in the thread by the switch from health to social welfare in the administration of the payments. This may have been because social welfare was more generous, health had been too mean in the past, health had not been as efficient in managing the system, social welfare has greater coverage of the population or the fact that social welfare claimants could see there was such a benefit created a culture of claiming it. Anyway, those are historical issues and could be studied by someone - probably have somewhere in a thesis or something else.

From 2002 to 2007 a new equilibrium appears to have been established whereby the growth in population was mirrored by the growth in disability claimants. This suggests that the system at the very least was operating consistently in how it treated disability.

From 2007 something seems to have gone wrong as the growth in the number of claimants has exceeded the growth in the population. Nobody has yet pointed to any evidence for a credible reason for this. Potential reasons include:

(1) The Irish population is more disabled now than in the past (has there been an increase in accidents at work to support this?)
(2) The Irish population has aged significantly (more older people, more disability?)
(3) There are more fraudsters desperate for money claiming on small pretence?
(4) The system has become overly generous (either GPs taking a more lenient approach or social welfare officers relaxing the criteria?)

I don't know which of the above is correct but it is clear something is going on. Setting up an independent appeals system is one way of finding out so the tender by social welfare seems like an appropriate policy response.

Godge

iptba wrote: »

The index score doesn't start at 0, it starts at 90. It's an issue brought up in the book "How to lie with statistics" (for example): this practice tends to give the impression the change is more significant than it is.

The index score starts at 100 for both population and disability claimant. It is not an index based on absolute numbers which is the issue referred to in the book.

This is normal for tables such as these as the starting point is 100. In fact, if the number of disability claimants had always risen and not dropped, there would have been no reason to include 90 on the table at all.

iptba

Godge wrote: »

The index score starts at 100 for both population and disability claimant. It is not an index based on absolute numbers which is the issue referred to in the book.

This is normal for tables such as these as the starting point is 100. In fact, if the number of disability claimants had always risen and not dropped, there would have been no reason to include 90 on the table at all.

So this represents percentage increases? Oh, ok, I tend to read data in other fields where graphs tend to be used differently.

iptba

Just because a new regime might be tougher doesn't mean it is better, if deserving people don't get payments who should.

In medicine, one might talk about specificity and sensitivity: a disability system that is specific (i.e. few people who shouldn't get a disability payment) isn't necessarily good if it's not sensitive i.e. quite a lot of people who should be getting a payment, don't.

There have been complaints about the quality of Atos' assessments in the UK.

Godge

iptba wrote: »

Just because a new regime might be tougher doesn't mean it is better, if deserving people don't get payments who should.

In medicine, one might talk about specificity and sensitivity: a disability system that is specific (i.e. few people who shouldn't get a disability payment) isn't necessarily good if it's not sensitive i.e. quite a lot of people who should be getting a payment, don't.

There have been complaints about the quality of Atos' assessments in the UK.

I have put forward a number of reasons why the numbers have changed. Your view is one but you have no evidence at all to support it. Neither have I seen any hard evidence or clear facts that it is fraud or doctors going easy.

The fact is an independent appeals system properly designed will sort it out. What do people have to fear from it if they are genuine recipients?

Nobody has said Atos will even compete for this tender. There are other companies such as Medmark which could compete too.

iptba

Godge wrote: »

Your view is one but you have no evidence at all to support it.

The point about more women working wasn't necessarily supposed to be a complete explanation. Something can be a factor without explaining all of a change. I don't accept there is no evidence at all to support the suggestion that more women may be availing of disability payments now than in the past when many more were long-term housewives/home-makers living with their partners and hence would often have been ineligible - I think it's close to being self-evident that more women are eligible now. It would be good if anyone has figures broken down by gender if they could post them.

Godge wrote: »

The fact is an independent appeals system properly designed will sort it out. What do people have to fear from it if they are genuine recipients?

Plenty of genuine people have got turned down in the UK.

---
For people with knowledge of disability and disabling conditions, it shouldn't be that hard to envisage that testing systems can be imperfect and can veer too much in one direction e.g. knocking people off which can include knocking off genuine people. 100% sensitivity and specificity is difficult to achieve. Testing done on the cheap could decrease accuracy. The ESA system introduced in the UK recently may have sounded good but is causing lots of problems.

nesf

iptba wrote: »

Plenty of genuine people have got turned down in the UK.

Wasn't there some whistleblower last year? A former psychiatric nurse working as an interviewer for the UK agency. She was saying she was having to deny payments for people because they fit the agencies criteria for not depressed where she thought you wouldn't find a doctor in the country who'd agree with that assessment. There was some nonsense about a person smiling during the interview meaning they weren't depressed.

iptba

nesf wrote: »

iptba wrote:

Plenty of genuine people have got turned down in the UK.

Wasn't there some whistleblower last year? A former psychiatric nurse working as an interviewer for the UK agency. She was saying she was having to deny payments for people because they fit the agencies criteria for not depressed where she thought you wouldn't find a doctor in the country who'd agree with that assessment. There was some nonsense about a person smiling during the interview meaning they weren't depressed.

All sounds familiar.

Here's a piece but may not be the same person:

Ex Atos Nurse Reveals The Real Inside Story….
http://atosvictimsgroup.co.uk/2013/01/31/ex-atos-nurse-reveals-the-real-inside-story/

Here's a doctor:

Disability benefit assessments 'unfair', says ex-worker

By Sophie Hutchinson

BBC News

16 May 2013 Last updated at 16:27 GMT

A doctor who worked for the private company which assesses people for disability benefits says its methods are "unfair".

Greg Wood, a former Royal Navy doctor, resigned from Atos earlier this month, after working as an assessor for two-and-a-half years.

He told the BBC the system was "skewed against the claimant".

continues at:
http://www.bbc.co.uk/news/uk-22546036

nesf

This is the one I was thinking of:

http://www.dailyrecord.co.uk/news/scottish-news/nurse-makes-heartfelt-apology-after-1340838

Sorry, it took a bit to find.

Fred Swanson

This post has been deleted.

iptba

Fred Swanson wrote: »

This post has been deleted.

Interesting. In the past, with a payment like disability allowance, the was generally an assessment by a doctor before a ruling was made. If an applicant was refused, there'd be another assessment by a doctor. Then if that was refused, there was a final appeal with a civil servant. I've been hearing of people recently being turned down on medical grounds (cf. on the means test) without having been assessed by a doctor.

iptba

Saw this today:

"The Atos offices in Glasgow are known as Lourdes given the amount of seriously ill/disabled people who go in and come out fit to work."

iptba

From this week's BMJ:

Personal View
I blew the whistle on the government’s disability assessments

Greg Wood went to the media with concerns about the ethics surrounding tests for fitness to work—and eligibility for benefits—that the UK government outsourced to Atos
http://www.bmj.com/content/347/bmj.f5009?tab=responses