These are my brief notes on the FMG (Forward ME Group) meeting at the House of Lords on Tuesday 25th October to discuss problems relating to PIP (personal independence payments) with two representatives from Capita:
- Dr Ian Gargan, Chief Medical Officer for Capita (UK and NI)
- Ms Rebecca Papanicolas, Communications and Stakeholder Manager at Capita
Dr Ian Gargan CV:
https://www.materprivate.ie/consultants/dr.-ian-gargan/index.xml
A more detailed report on the meeting will appear in the Forward ME Group (FMG) Minutes for the meeting
Dr Gargan introduced himself by stating that he was new to the CMO post at Capita - he had only started work there in August 2016 - and is consequently on a "steep learning curve" at the moment
He has a rather unusual medical CV in that he started medical work as a psychologist, then went into forensic psychology, then became a medical doctor and went into orthopaedic surgery before entering disability medicine at Capita
He has a keen interest in MUS (medically unexplained syndromes) and regards ME/CFS as an MUS - rather like irritable bowel and fibromyalgia
When asked about his position on the WHO (neurological) classification of ME/CFS, he did not appear to be in favour of classifying ME/CFS as a neurological disease
More information on medically unexplained syndromes:
http://www.healthcareconferencesuk.co.uk/userfiles/1/Simon_Heyland_and_Carolyn_Chew-Graham.pdf
After introductions, we covered quite a lot of ground. The discussion was largely based on real life problems that people are having with PIP assessments - so thank you once again to everyone who sent me details prior to the meeting
We were not able to deal with every case or issue but we did cover a number of common complaints
Overall, Dr Gargan agreed that most of the examples of bad practice that were being raised should not be happening and went on to explain what should be happening instead in each case
Health assessors:
Capita does not employ many doctors to carry out DWP medical assessments for PIP, most of this work is now being done by nurses, OTs, physios etc
CS note: This is a matter for considerable concern because in our experience nurses, OTs and physios are often in a position where they have received little or no education on ME/CFS or have an practical patient experience in ME/CFS. Some also have very inaccurate or unhelpful views about both the cause and management of ME/CFS
The role of the health assessor:
Dr Gargan stressed that the job of Capita health assessors is NOT to make subjective judgements about the cause of ME/CFS, or to pass unfavourable/unhelpful comments about any aspect of ME/CFS (which would be unethical)
Equally, they are not there to dispute the need for things like a wheelchair (the subject of one specific question) or disability aids if the person says that these are required to assist with their care or mobility
Their job is assess - based on formal and informal observations on the day along with the interview - how a person is functioning as a result of their ill health and/or disability and how this relates to the way in which eligibility for PIP is decided on the DWP point scoring system
So the assessor should recording what the patient is saying about their health, disability and functional capabilities and not trying to assess or dispute the accuracy of what is being reported
The assessor should then be producing a fair, accurate and objective assessment in the report for the DWP
Decisions on eligibility for PIP:
Capita are not there to make a decision on eligibility for PIP. The assessor's job is to produce a factually accurate report for the DWP decision maker - who then assesses all the evidence that has been obtained and makes a decision
In reply to my question on the subject of further/supportive medical evidence (FME), Dr Gargan said that if it would be helpful to have FME from a health professional then Capita should request it and that Capita would pay the doctor for providing it. Patients should not be paying for these reports
Other questions
Relating to questions about the times of appointments, Dr Gargan confirmed that people can request to be seen at an assessment centre after 12 noon if this was going to be more helpful, especially where they are not functioning very well in the morning
Training on ME/CFS
There were several questions on how the medical assessors receive their training and education about ME/CFS at Capita
Dr Gargan explained that Capita is currently training materials on a range of conditions, including ME/CFS, and that he would welcome input from the FMG
Myself and Dr Paul Worthley (formerly
at Burrswood Hospital in Kent) agreed to help with this and I will now be sending copies of the MEA purple book to start this process moving
By the end of the meeting the two representatives from Capita were left in no doubt that many people with ME/CFS are having significant and unacceptable problems with their medical assessments for PIP at Capita
And as I pointed out, there is something seriously wrong with an assessment system where a significant number of people with ME/CFS are being told they are not eligible for PIP but then go to appeal and win their case - sometimes achieving enhanced rates for care and/or mobility components of PIP
We will continue to carefully monitor the situation at Capita
And if you feel that something has gone wrong with your assessment, it is very important to contact Capita, preferably in writing, to inform them about what has happened and what action is going to be taken as a result
Dr Charles Shepherd
Hon Medical Adviser, MEA
