PIP INVESTIGATION: Assessment reports show widespread dishonesty by nurses

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Healthcare professionals who carry out face-to-face assessments of benefit claimants have lied, ignored written evidence and dishonestly reported the results of physical examinations, according to a two-month Disability News Service (DNS) investigation.

The investigation has compiled evidence from more than 20 disabled people who have contacted DNS over the last year or have commented on previous DNS news stories to claim that their assessors – usually qualified nurses – lied repeatedly in reports they produced for the Department for Work and Pensions (DWP).

The evidence compiled during the investigation suggests a far-reaching, institutional problem that stretches across DWP and the two private sector contractors – Atos Healthcare and Capita – that assess eligibility for personal independence payment (PIP) on its behalf.

The alleged dishonesty includes assessors: refusing to accept further written evidence from medical experts; wrongly claiming that detailed physical examinations had been carried out during the assessment; refusing to list all of a claimant’s medications; ignoring or misreporting key information told to them during the assessment; and reporting that a claimant had refused to co-operate with a physical examination, when they were unable to complete it because of their impairment.

Eight PIP claimants have given their permission to have their cases shared with DWP, Atos and Capita. Five of those cases concern Atos and three relate to assessments carried out by Capita.

DNS has also offered to send anonymous details of at least 15 more cases, but DWP, Atos and Capita have shown no interest in seeing that information.

DWP has made it clear that it does not believe there is any dishonesty at all among its PIP assessors, and its press office has confirmed to DNS that the department will take no action in response to the investigation, but that it was “committed to providing a high-quality, sensitive and respectful service by conducting fair, accurate and objective assessments”.

A DWP spokeswoman said: “Independent audit is in place to ensure advice provided to DWP decision makers is of suitable quality, fully explained and justified.” (See separate story, ‘Politicians call for action over widespread dishonesty by assessors’,  for more detail on DWP’s response.)

Both Capita and Atos refused to answer questions about the evidence DNS has compiled, and Atos refused to comment at all, although Capita produced a brief two-line statement, in which it said it expected “all assessors to behave in a way that meets both our high professional standards and those of their professions”.

But DNS has also received new figures released under the Freedom of Information Act by the Nursing and Midwifery Council which suggest that the regulator receives hundreds of complaints about nurses who carry out face-to-face benefits assessments every year (see separate story).

The assessment reports are used by DWP to decide eligibility for PIP, the benefit the coalition introduced in 2013 to replace working-age disability living allowance (DLA), as part of reforms aimed at cutting the benefits bill by at least 20 per cent.

As a result of the lies, misreporting, omissions and other dishonesty included in the reports, nearly all of those disabled people DNS has heard from saw the benefits they use to pay for the extra costs they face as disabled people reduced or removed completely by DWP, and had to rely on independent appeal tribunals to reinstate some or all of that support.

Nearly all of the assessors were nurses, although one was a paramedic.

Among the PIP claimants who have passed their details to DNS is Abbie Marshall, from South Yorkshire, who has described how the Atos nurse who assessed her wrote in her report that she had carried out a full physical examination – when no such test took place – and missed out all but one of her medications and a list of side-effects.

As a result of that report, Marshall was found ineligible for any PIP at all, when she had previously been receiving DLA middle rate care and low rate mobility.

Following an appeal, she was granted the PIP enhanced rate of mobility and standard rate of daily living (worth more than £110 a week).  

The brother of another PIP claimant, who recorded the home assessment carried out by Capita without the nurse’s knowledge, described how, although his sister explained that she had not been to her local shops since October 2013, the assessor wrote in her report that she visits her local shop every day.

The nurse also said in her report that the claimant spoke to family and friends on the phone every day, even though she does not possess a mobile phone or a landline.

As a result of the assessment, she was awarded zero points for both daily living and mobility, and therefore found ineligible for PIP by a DWP decision-maker.

It was only after her brother sent DWP a transcript of the assessment that she was awarded enhanced daily living and standard rate mobility for PIP (worth more than £100 a week).

The nurse who assessed Celia Cullum at an Atos assessment centre, again in South Yorkshire, described in her report how the claimant was lying down on a couch and then lifted her legs as part of an examination, even though there was no couch in the assessment room.

Cullum took her orthoses and prostheses and walking aids to the assessment, including an ankle foot orthosis (AFO) which wraps around her leg and has a carbon fibre plate that fits in her shoe to support her foot so she can walk.

She told DNS: “I can’t wear it for too long as it is too uncomfortable for the sole of my foot and causes diabetic foot ulcers.”

But the assessor failed to mention any of this in her report and wrote instead that she was able to dress and undress unaided, even though she needs to use the AFO, an orthotic insole or a prosthetic foot to be able to wear shoes.

The nurse also wrote in her report how Cullum, who has a part-amputated right foot, crouched down to the floor and then stood up as part of a physical examination.

But she said she was never asked to do this, and that it is an action she is unable to do because of the amputation.

She told DNS: “I was shocked when I read a copy of my assessment at so many things left out and things made up. I thought it was dishonest.”

She had previously been receiving PIP standard daily living and enhanced mobility, but as a result of the assessment, she lost all of that support. When she appealed to a tribunal, she was awarded standard rate daily living but no mobility support.

When she complained to Atos, she said, the company admitted that “some errors occurred in regards to documenting accurate information and this will be fed back to [the nurse]for future professional development”.

Another PIP claimant, Mary*, who had a home assessment carried out by Atos, said her assessor “lied about almost everything” in her report.

The nurse claimed that Mary had had no contact with the specialist NHS service she receives treatment from for three years, whereas she had had at least 16 contacts with that service during that time, as a result of severe and debilitating ME.

When she tried to explain this, the nurse “dismissed anything I tried to say” and cut her off when she was speaking.

The nurse described Mary’s appearance as “well kempt” and wrote that she had been wearing “soft trousers, top and a cardigan”.

In fact, she had been unable to wash her greasy, straggly hair for over a week, and was wearing pyjama bottoms, a vest she wears in bed and an old cardigan that was two sizes too small and had two buttons missing (having had to spend much of the last three years in bed she has put on weight, so few of her clothes now fit her, and she is rarely well enough to do any clothes shopping, even online).

Mary said: “Almost the entire Atos report is lies. Or things being twisted. Wilfully misunderstood. 

“I have so much anger from the way I was treated by this process. The ‘nurse’ from Atos should be struck off from working in any sort of healthcare job.

“She was very fast and hurried. I couldn’t keep up – and kept telling her this.”

She said the nurse was “bullying and heavy-handed” and “kept twisting things and putting words in my mouth”, and “dismissed anything I tried to say”.

She was found ineligible for PIP and had intended to appeal but “overwhelmed by the level of detail requested by DWP” and its impact on her impairment, she conceded defeat last summer.

Patricia Wohl’s husband, Gerhard, witnessed the PIP assessment carried out on his wife by a Capita nurse in their home in Bridgend.

When his wife was asked to stand up, he said, she “struggled to get up, she needed help from her walking stick and the arm rest of the settee, then she needed to stand for a time (30 seconds to a minute) to find her balance, then after two steps she fell forward to the right against the stone wall in our living room.

“I jumped up to stop her falling to the floor because I expected something like this.”

When his wife tried again, the same thing happened, but in the report the Capita assessor said she had risen and walked six metres in a straight line without any help.

She had previously been claiming the higher rate mobility and lowest rate of care under DLA, but lost all support under PIP as a result of the assessment report. A tribunal eventually awarded her standard PIP rates for both mobility and daily living.

Peter’s* wife has told DNS how both she and her husband told the Atos nurse who assessed him several time that he needs someone with him when he leaves the house, because he becomes confused and can easily get lost, but this information was omitted from her report.

When Peter was asked to stand and make various movements, he was unable to do so, and fell against the wall. But the assessor stated in her report that Peter had a full range of movement in both his upper and lower limbs.

His wife said: “Her levels of honesty in compiling the report were, on a scale of 0 to 10, 0.

“She came across as very helpful and trustworthy, approachable and friendly. No reason not to trust her, until we saw the report, which I did initially think was someone else’s.”

Peter had previously claimed middle rate care and higher rate mobility under DLA, but now receives standard rates for both with PIP. Their appeal was unsuccessful. They say the tribunal ignored their claims that the assessor had lied in her report.

Another claimant, Fazliabbas Raffiq, was assessed by Atos in his home in London, but in her report, he said, the nurse ignored his visual impairment, his fibromyalgia and his depression.

He told the nurse that he has to take 23 different medications every day, and handed her a repeat prescription form to prove it, but she referred only to five in the report.

He had previously received the highest rate of care and mobility under DLA, but following the assessment he was awarded just the PIP standard rate for both daily living and mobility.

One of the cases that sparked the DNS investigation was the assessment of Sarah Goldstein, from Derbyshire.

The Capita nurse who assessed her wrote that Sarah could go to the shops and bring back shopping, when in fact she has to shop online, with help from her husband, who puts away the shopping when it is delivered.

As a result of the assessment, Sarah was found ineligible for PIP, a decision approved by DWP’s mandatory reconsideration process. When she appealed, a tribunal awarded her the standard rate for both daily living and mobility (more than £75 per week in total).

None of the facts above from the eight cases have been disputed by DWP.

There are further disturbing cases in which assessors have apparently lied in their reports, but the claimants have asked for their details not to be shared with DWP, Capita and Atos.

Neither DWP, nor its contractors, have shown any interest in seeing this anonymised information.

One claimant, Elizabeth*, who had been lying in bed at home during her assessment, said the Capita assessor had written in her report that she had been “observed to be able to sit down and stand up from a chair during the assessment without difficulty”.

Elizabeth said: “I have only the one chair in the living room and she was sitting in it!”

She told DNS that the assessor watched as she “took two to three steps from my bed to the foot of the bed… I was dizzy and held onto the foot of the bed and then I stumbled back into bed.”

This was translated by the assessor as having been “observed to be able to walk unaided at the assessment. Two to three metres at a slow pace but with normal gait… but stated she felt dizzy”, before concluding: “It is likely she can reliably stand and then move more than 200 metres aided for the majority of the time.”

Elizabeth previously received higher rates of DLA mobility and care, but as a result of the assessment now receives just the PIP standard daily living rate. A mandatory reconsideration by DWP upheld the original decision, and she is now appealing to a tribunal.

Another PIP claimant, a retired police officer, described how he twice tried to bend down and touch his toes during his assessment – watched by his wife – but was unable to do so; the Capita assessor then wrote in her report that he had refused the test.

He said: “The assessor refused to look at or take copies of my medical tests, which would have highlighted my disability.

“They continually prevented me from talking, saying that there was insufficient time.”

He added: “It was quite clear that the assessor had an agenda: to restrict or not award the benefit that my condition warranted.

“She told such blatant lies, left out all the evidence I mentioned and included things I didn’t say.

“She ‘constructed’ a dishonest report in which she told blatant lies and twisted words to suit their needs. Giving some information but not all that was discussed.

“It was a ‘cherry picked’ constructed report putting in what she wanted to go in and at the same time leaving out evidence on my behalf.”

Another case was that of a nurse, Mrs A, whose GP husband witnessed her assessment at their home in south Wales.

Their claims were reported by DNS in September, but they have asked not to be named.

Among their many concerns was that the assessment report stated that there was no evidence that Mrs A was wearing hearing aids, when a brief check would have shown they were in place behind her ears.

The report failed to mention her painfully swollen leg, and said that Mrs A refused to stand, when in fact the assessor had recognised she was in too much pain to stand and so did not ask her to do so.

Among many other concerns, the report failed to point out that Mrs A was clearly “distressed, in pain and anxious”, and failed to note the forgetfulness and slowness of thought she showed during the assessment.

Dr A said the report was “an absolute fabrication”, and added: “The actual examination was laughable. It took a few moments.

“My wife couldn’t even stand up… yet somehow she was able to infer that she could walk more than 50 metres but less than 200.

“How do you infer that from someone who wasn’t even able to get up out of the chair?

“She said she couldn’t see the hearing aids. She didn’t even look to see if the hearing aids were in place. How difficult is it to move a couple of hairs?”

He added: “It was appalling. Every single sentence in that report can be torn apart. “

Another female PIP claimant, who was assessed by Atos in Salisbury, was another who discovered the lies that had been told by her assessor after requesting to see a copy of the assessment report.  

She said: “He lied and said [I] had transferred from chair to bed independently when in fact I used my crutches and handed them to him and he had to give me them back when physical examination was completed.”

Another claimant said that his Atos assessor had described the strong medication he takes for both his physical and mental health conditions as “like Smarties”.

Other disabled people have told him how their reports included the same phrase.

He said: “Everything I said she ignored, even how I was breaking down in front of her, [she]even said ‘not suicidal’ when she never even asked. I was suicidal.

“She was dishonest on everything. Wrote down ‘mental health OK’ but said in front of me I need greater mental health support. She totally contradicted herself.”

*Not their real names

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