Many readers will have heard it said that the computer programme used to put together WCA reports is less a useful tool than a fundamental part of the problem with the assessment process. I used to be quite sceptical about this idea, but something an expert on disability benefits said to me last week, and a read of the Atos Annual Report 2012 sent to me via Twitter yesterday, have made me think again.
I am by no means an expert on IT and I have no special knowledge of this subject from my time at Atos - I was too far down the totem pole to be told anything about wider company strategy. But the more I've thought about the idea, the more it seems to hold water, because it might answer the question of why a giant IT company is interested in a not-all-that-profitable (by their standards) disability assessment process.
A short history of benefit agencies
Before outsourcing was even a twinkle in Margaret Thatcher's eye, disability assessors were fully paid-up civil servants, albeit with medical degrees; then they found themselves working for the Benefits Agency, rather than a government department. After that their role was outsourced to a private company and as medically-qualified civil servants retired from practice, the new doctors who replaced them were taken on as employees of that private company, a company which could be bought and sold on the open market.
Until 2003 the company that employed these disability assessors and also contracted GPs to do that work was Schlumberger, an engineering company normally operating in (naturally enough) the oil, gas and mining industries - the name sounds German because the founder was from Alsace, the historically-disputed and culturally German region of France, but it is actually a French multinational.
In 2001 Schlumberger acquired Sema Group after the dotcom crash and renamed it SchlumbergerSema. Prior to that, Sema had been an Anglo-French IT company with a background in mid-level software development. SchlumbergerSema began to develop the programme that is still used to carry out WCAs. Atos now owns this software, not the DWP.
A short history of UK healthcare IT systems
After New Labour was re-elected in 2002, the stop-cocks of NHS spending were turned on. But the Department of Health also fancied a national computer system (even though few clinicians felt the need for one that ran beyond their own region and that was conceived primarily as a giant data hoover for the bureaucrats in Whitehall).
SchlumbergerSema was the favourite to win choice contracts at the heart of the 'National Programme for IT in the NHS' at the time when it was bought by Atos in 2003.
As we now know, this grand project turned out, because of unrealistic aims set by the DoH, to be a multi-billion pound disaster which the Coalition, to their credit, finally killed off in 2011.
So Atos bought the company that looked like it was going to be a big hitter in NHS IT, which also happened to run the (then) uncontroversial assessments for claimants of medical benefits.
Healthcare and information technology
Rarely a week goes by without a news story on how robots will soon be performing heart surgery or how nanobots will monitor our bowel flora from the inside and send the findings to our iPads, and we already have a plethora of websites that tells us about which countries pose a malaria risk, etc. There are some where you type in your symptom (a dry cough) then answer some supplementary questions and it tells you the most likely diagnosis (anthrax). Large organisations like NHS Direct employ something like this, but it is so risk-averse that the answer is too often 'see your GP', 'go to A+E' or 'dial 999'.
The challenge for software designers is to take this decision-making software and make it reliable. Then it could, in theory, be used by patients to self-triage and by healthcare workers to make some clinical decisions, particularly by those professionals who are not comfortable about making a decision without getting some sort of top cover first.
Social security and information technology
One of the major themes of the Universal Credit project is to get claimants to provide the details of their claim online. The ultimate aim must be for an algorithm to then calculate the level of entitlement, in a similar way that self-assessment for income tax operates already.
But what if the algorithm could also assess your level of disability at the same, using the date you've punched in yourself? Think of the manpower costs that could be saved - no disability assessor and no DWP decision maker!
The 2012 Atos report
This claims that:
- The public sector is facing an unprecedented challenge to think more creatively and pioneer new methods.
- There needs to be better engagement with external stakeholders based on increased online delivery.
- Changing demographics mean an ageing population and a corresponding increase in chronic disease, which will have a massive impact on healthcare planning and provision.
- Atos has 3000+ business technologists worldwide specializing in healthcare.
- From the Atos perspective, an exciting new age for the public sector is starting, in which healthcare will be more customizable.
- The future is likely to involve technology without barriers.
What does this have to do with the WCA?
As is widely acknowledged, the WCA involves the computer sitting perched on the desk while a harried assessor and a frustrated claimant try to feed more and more unprocessed data into its open beak. Why?
- The DWP - I suggest - has been conducting an undeclared trial of a self-administered disability assessment, with the assessor acting as a data-entry clerk on behalf of the claimant.
- Atos - I reckon - saw an opportunity to further develop its expertise with decision-making software.
Here's the twist
As the computer software and its usefulness to both parties' future ambitions brought the DWP and Atos closer together, will it also drive them apart?
In July the DWP accused Atos of furnishing it with unsatisfactory reports of unacceptably low quality. Yet it claimed in a press release that if a report is graded 'unsatisfactory' it does not mean necessarily that the assessment was wrong in its recommendation as to the claimant's fitness for work; it might just be that the report lacked "the level of detail demanded by the DWP". Since the whole purpose of a report is to make a recommendation on work capability, this explanation sounds bizarre, if taken at face value.
If Atos sees the software as an early example of their expertise in designing decision-making software, it is not going to take kindly to this criticism. Atos would probably only see the need to gather enough information - which importantly includes findings from the examination and observations - to allow the software to make a suggestion to the assessor on the claimant's eligibility, while the DWP in this context seems only to be preoccupied with mining masses of data from the 'Typical Day' history.
Has this dichotomy proved the fault-line in their relationship?
