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Agoraphobia - unable to get to ATOS PIP assessment. Doctor charging £20 for letter. Any other options?
Hello,
I have a client who has severe longstanding Agoraphobia. Has all his appointments at home including GP, Optician, Dentist etc. Has had this for 40 odd years.
ATOS have given him a PIP assessment at an assessment centre. His Doctor has said it will cost him £20 for a letter stating he will need a home visit. His dentist has refused to write a letter. Only other vaguely medical professional is the Optician who he hasn’t asked yet. He can’t afford £20.00.
I know this is a fairly common problem, has anyone had any success challenging this? ATOS basically usually just say - no doctors letter = no home assessment, they seem to have got much more strict on this over the past few months. They also refuse to contact the doctor themselves.
Any other options? Any case law? I want to avoid him having his claim closed but there is no chance of him getting to his assessment.
Thanks
EDIT: quick update, gave ATOS all the details and they have put through a request for a home visit without a Dr’s letter, I am not holding out much hope as I haven’t had much success with this in the past.
[ Edited: 8 May 2017 at 10:58 am by JAS1 ]Don’t ask for letters; ask for records under the Data Protection Act; especially if a dentist is doing home visits; I’ve never heard of that before.
They might charge a tenner but ATOS would be hard pushed to refuse a HV with evidence that other professionals are visiting at home. I’d be reaching for the dentist’s records first and chatting up the GP’s secretary as they can usually print off a consultation history pretty easily and might do it free of charge.
Thanks Dan. Good advice. I have actually told people to get print outs of medical records before and you are right it seems much easier to get (obviously takes a lot less time so makes sense). I think you are right, using the word letter means someone actually creating a document rather than just pressing print.
I will see what ATOS say and if they refuse I will go down the route you have suggested.
I’d be scrambling to get that evidence before the AP ASAP; once they’ve refused to do a HV it will be a steeper hill to persuade them to change their mind rather than their conceding one’s necessary at the first pass.
and it’s only £10 to get the records for an individual who asks in person (as opposed to getting their rep to ask, which would run to £50). the full computer printout should have all the info needed.
and, i should have thought, his previous DWP records should have all that info as well? and that’s free .....
(as opposed to getting their rep to ask, which would run to £50).
Would it ??? I can’t see any distinction depending on who’s requesting them… nor can I see any distinction in the regs
(as opposed to getting their rep to ask, which would run to £50).
Would it ??? I can’t see any distinction depending on who’s requesting them… nor can I see any distinction in the regs
possibly not. but every time i as a solicitor ask for records it’s £50; if i get client to do so, it’s £10. i think you’d find an invoice for £50 would arrive….
Just spoke to ATOS and they have granted the home visit in this instance. The client’s optician had actually just agreed to do a letter but this is no longer needed.
I am still glad I posted this thread despite this issue resolving itself as the replies have been useful for future clients as this issue crops up a lot and ATOS aren’t always so agreeable.
Thanks all
Might seem obvious but make sure your client is observant on the day on the day of the home appointment, to avoid anything like this happening as well.
Oh dear, yes Paul wouldn’t want anything like that happening.
Not sure if it is the same in other parts of the country but we get a time slot that has a range e.g. assessor will arrive between 09.00 - 10.30 am. I understand why, but it makes it a bit tricky if someone wants me to be there for the appointment too!
By the by but I have had considerable success as follows, especially with ATOS.
1) Get client to record all recent home visits and the last time they went out to the GP, dentist etc. The one client I had with a dentist who did HVs always followed up the phone agreement to do so with an appointment letter. You then have a decent, credible history and if you can expand it with more evidence then great. If not, it’s not the end of the world.
2) Write detailed letter advising of the above plus the fact that the client will be covered by EA 10 and therefore entitled to specific reasonable adjustments, starting with a home-visit. Make it clear we’re making a formal EA 10 request and that, if ATOS et al are going to refuse then of course we will require them to detail which one of the 5 legitimate grounds for refusal they think applies.
3) Ask for a copy of the ATOS complaints process to be included with their decision on whether to grant a HV. Make it clear that we’re not just asking for a HV. We’re asking for it to be confirmed in writing under EA 10. Latter of course means that it will need to be recorded against the clients record and acted upon every single time the client comes back for assessment.
One has some sympathy with GPs about charging for evidence.
They are not paid for doing so as it is not part of the contract they work under, yet ATOS, Capita and Maximus are getting enormous sums of public money to do work ostensibly in part, to save time for GPs and NHS employed staff. GPs and other NHS staff are working with reducing resources and excessive demand. But because ATOS, Capita and Maximus do so many dreadful assessments and put up unreasonable barriers, such as needing medical evidence for home visits, NHS staff are constantly having to give up clinic time to write reports and letters to counter the defects. One can see why so many GPs and NHS staff are reluctant to help.
On the substantive point, surely insistence by any of the assessment providers to consider a home visit without medical evidence is fettering of their discretion and also a possible breach of their duty to make reasonable adjustments for a person with a disability as required by the Equality Act 2010? The latter is probably the most fruitful line of attack by instructing solicitors with an LSC contract to do such work? One probably one has to have one such success to have a wider impact.
Surely as staff working with “health professionals”, Capita, Atos and Maximus ought to have enough gumption to assess the case for a home visit without medical evidence based on history of the client’s conditions - for example, one does not have to be a consultant to realise that, for example, a wheelchair user might struggle with access to buildings or that someone with chronic agoraphobic symptoms would struggle to get out of their home. So, as a matter of law, why do they need evidence from the GP or whoever?
As per my earlier post, a focus on EA 10 and the public law principle of using what you already have should be enough.
I think the key word in your post Neil is “some” as in “some sympathy”. I don’t think any of it is especially clear cut.
On the one hand a step back to look at the sheer volume of stuff we request from medical professionals should periodically cause some soul searching. Our default position as advisers is often “medical evidence”, but why? Around 80% plus of claims which succeed do so without input from advisers. Of those 52% have no evidence at all and 48% have some evidence which may or may not be medical in nature. There’s very little evidence medical evidence swings anything. Now, that’s not to say I don’t recognise when it’s absolutely essential. I do think nowadays though that the gathering of “medical” evidence is a knee jerk thing in far too many cases. When one periodically looks at the tables or forms devised from advisers to make it easier for medical professionals one has to stifle a laugh. I’d charge if faced with that. Decide what is missing that can only be provided by a medical professional and ask the question!!!
The knock on from the lack of serious thought as to why we do what we do is that it starts to intrude into other areas and, as per this thread, it’s a little too easy to then buy into the narrative of ATOS et al that medical evidence is what swings things when it patently isn’t. Common sense and an attention to detail is mostly what does that but we have started to believe that medical evidence is everything. We are at least in part responsible for an upsurge in requests for evidence that most times simply isn’t needed. DWP and the Tribunals Service plus the likes of ATOS also undoubtedly contribute to this but we help the narrative along and perhaps need to be more proactive in stamping feet and saying “No”. Very easy to forget that DLA was about self-assessment and that the functional tests within ESA and PIP were designed to make it easier for claimants to articulate the practical consequences of an impairment without unnecessarily relying on a medical input.
The other side of this particular coin is that whilst we and others have contributed to the pressure on GPs etc. one also has to recognise that “saving” the NHS is a Sisyphean task hindered considerably by the fact that much of it has long since been privatised and incentivised toward profit dressed up as value for money. GP practices, like dental practices, increasingly don’t stand alone. They are often owned by a large parent company and actually the desire to monetise everything is built in from the ground up not as a reaction to time pressures.
As an illustrative aside to this my own GP (owned by a company covering much of NW England) so NHS in logo only from my perspective continues to have a policy whereby all letters requesting evidence get sent off site to the doctors who head the company. They write back saying they have personally never seen the client knowing full well this is disingenuous. True but disingenuous. Sure enough it triggers a second letter clarifying who it was the client did see at their local practice and… there is an instruction that the second response doesn’t get sent unless there is a charge agreed! Similarly they have started to reduce the number of services they offer through the GPs and the nurse and the decision making process on that has been wholly driven by what they can claim for and what things cost. It’s quite an eye opener.
I had a fascinating conversation with a lovely locum GP there who also works for CQC. They couldn’t wait to get them out of there because they kept on doing what was right for the patient not what could be monetised. It was apparently “more than (my) life is worth to give you x device from the stock within the practice so you can self assess. I am supposed to either offer to sell you this one or send you off to a pharmacy to buy one.” Patients being told that if they could afford private physio. (because they couldn’t get a GP appointment quick enough and because the NHS triage process adds 8 weeks to getting a physio. locally) then the practise wasn’t going to refer them to NHS physio. in future! That was equally “interesting”.
Pressure of time is absolutely not the main driver for charging for medical evidence.
Thanks Mike. You make some useful and interesting points.
We are driven to ask for medical evidence when faced with a poor assessments and a DM at DWP who is adhering to the conclusions like glue.
We are driven to ask for medical evidence when faced with a poor assessments and a DM at DWP who is adhering to the conclusions like glue.
exactly.
the only real way to counter poor/wrong assessments is proper medical evidence from people who know the person’s medical condition (combined, probably, with learned articles via google setting out the usual results of the relevant medical condition).
unless and until the people doing the assessments are allowed to (and trained to, and have the expertise to) do their jobs properly, then there will be a need for people’s medical records or whatever.
and one sometimes wonders about medical members of tribunals - since someone whose expertise is in one field of medicine is unlikely to have the relevant expertise in another which affects the claimant in front of them…
Really interesting posts, good points Neil and Mike.
Anecdotally, the only two PIP recons I have had success with recently both had very strong medical evidence with them. But I guess that is a different issue than evidence for a home assessment and/or evidence to go with the initial claim form. Evidence seems much more useful at the second stage of things.
Interesting you have both mentioned the Equality Act, I was thinking along these lines too.
As a side note, do ATOS/Maximum/whoever ever actually see what is written in the box on the PIP2 form about the help/needs the claimant may have at the face to face consultation? They never seem to be aware of anything I/the client specify.