I assess if you are fit for work. I hate having to score your life this way

I’m the person who assesses whether or not your medical condition is stopping you from being able to work – and I have never felt so dejected by a job.

It’s my job to carry out work capability assessments to see if people qualify for Employment Support Allowance (ESA). For 18 months, I’ve been working for a private company to which the the Department for Work and Pensions (DWP) outsources this task.

I’m a healthcare professional who joined after being disillusioned with working in the NHS. I will be honest: for me, as for many of my colleagues, the salary, which is far higher than NHS pay, was a big draw. But like all healthcare professionals, we want to do a good job. We go into caring professions because we care.

But in this job I just don’t always have the time to be as sympathetic as I’d like to be or give people the time they need. We are under constant pressure to assess at least six claimants a day, spending 65 minutes on average with each.

If the company I work for fails to meet its assessment targets it can get fined by the DWP. So I often get a knock on the door to ask how much longer I will be and when I can pick up another case.

ESA is a contentious type of benefit and the people who walk into my assessment room are often anxious, angry, scared, pessimistic or resigned. Many have lost faith in the system and feel the government is abandoning them. We are often the sounding board for the people who come in. They confide in us about the horrific things that have happened to them.

About 80% of the people we see have mental health problems. I have assessed clients who were actively psychotic, in a manic bipolar phase, or severely depressed to the point where they couldn’t speak and a family member had to do the talking for them.

There has been a general improvement in reports since the company I work for took over the contract, but there still isn’t always the time to give full consideration to the complexity of cases. Some people have as many as 15 medical conditions and we have to document and obtain a history for every single one. When this happens, staff know it will take longer. It can lead to us rushing and missing things because we are so concerned about not seeing enough people during the day. It is relentless.

Most people I assess understand we are just there to do a job. But some people are very volatile and some do resort to verbal abuse, intimidation, and occasionally, physical violence. They’re angry at the system – and I can understand why.

As the face of that system, I am the one who bears the brunt of their ire. We all try to placate and soothe the people who come in as best as we can. But sometimes we just can’t. I have had to abandon cases and there have been countless times where the emergency services have been called. Sometimes I feel genuinely scared.

As we don’t make the ultimate decision, we never find out what happens in the end. When someone asks how they have done, it can be very difficult. I’m not allowed to tell them anything, but I know that if I have scored them little or no points, they will most likely lose their benefit and be expected to hunt for a job. It makes me feel so dishonest and I imagine their face when they’re hit with that letter or phone call, delivering the bad news.

It is most difficult with the ones who are trying their best to get by but just aren’t deemed bad enough to qualify for any support. Many claimants are older and underskilled, which makes it much harder for them to find work. I have cried on two occasions after an assessment because I felt so awful that I couldn’t help.

The job is incredibly demoralising and psychologically draining – by the end of the day I’m exhausted. I honestly don’t know how much longer I will last.

This series aims to give a voice to the staff behind the public services that are hit by mounting cuts and rising demand, and so often denigrated by the press, politicians and public. If you would like to write an article for the series, contact kirstie.brewer@theguardian.com

Talk to us on Twitter via @Guardianpublic and sign up for your free weekly Guardian Public Leaders newsletter with news and analysis sent direct to you every Thursday.

I assess if you are fit for work. I hate having to score your life this way

Salt campaign deserves partial credit score for fall in heart deaths

Typical daily salt consumption fell from 9.5g a day in 2003 to 8.1g a day in 2011. Photograph: Alamy

It is understandable that the authors of this research want to highlight salt’s position in lowering heart assault and stroke deaths. Professor Graham MacGregor, one of the three researchers, is the chairman of Consensus Action on Salt and Wellness (Funds), a lobby group that deserves credit score for exposing the dangers of additional salt in foodstuffs and element-shaming, portion-persuading producers to decrease it and government to oversee the process. Sonia Pombo-Rodrigues, an additional co-author, works for Cash.

Its function in encouraging the fall in average every day salt consumption from 9.5g a day in 2003 to 8.1g a day in 2011 is extensively acknowledged, and the ensuing well being benefits plainly significant. But exactly how much of the 42% drop in stroke deaths and forty% fall in ischaemic heart disease fatalities in the course of that time is due to declining salt consumption is not agreed. The paper states that that “is probably to be an critical contributor to the falls in blood pressure from 2003 to 2011 in England. [And] As a end result, it would have contributed substantially to the decreases in stroke and IHD mortality”. It mentions that declining costs of smoking and common cholesterol more than the very same years also played a component.

But these other factors are very likely to be accountable for much more of the falls. Certainly, the authors admit that the fall in systolic blood stress they attribute to less salt in our diet programs would most likely only produce eleven% and six% falls in the number of strokes and IHD respectively, a quarter and a seventh of the declines seen.

Whilst the research does not estimate the probably impact of the falls in smoking and cholesterol, Britain’s increasing disenchantment with cigarettes is vital. The British Heart Foundation lauds that as creating “a large contribution to the decline in cardiovascular illness”. While 41% of women and 52% of guys smoked in 1972, by 2012 just 19% of ladies and 22% of guys did so. The public smoking bans in 2006-07 helped hugely as, medical doctors hope, will plain packaging when it arrives.

There are also other causes why Uk deaths from cardiovascular condition much more than halved from 335,000 in 1971 to 161,000 two years ago. Greater remedies, each surgical and pharmacological, which includes statins, clotbusting medicines and the increasing use of principal angioplasty – the insertion of a stent to preserve open a previously-blocked artery – have improved survival for these who would previously have died. It is a far more complex, but also a lot more promising, picture than just the salt in our food we do not require but generally are not able to escape.

Salt campaign deserves partial credit score for fall in heart deaths

If NHS was a country it would "barely have a credit score rating", says BMA

“The NHS is struggling just to preserve tempo. A increasing and ageing population, public well being issues like obesity, and continual advances in remedy and technology are all contributing to push NHS charges nicely above general inflation.”

Dr Porter extra: “The numbers total are so poor that if the NHS had been a country, it would barely have a credit rating at all. The Nuffield Trust has estimated that if the NHS price range continues only to preserve tempo with basic inflation, there will be a shortfall of in between £44 billion and £54 billion in England by 2021-2022, unless there are productivity gains.

“But even with a 4 per cent productivity achieve every yr, the funding gap would nonetheless develop to as considerably as £34 billion. It would consider savage cuts to even commence to discover this considerably funds out of even more ‘efficiency’ savings.”

He mentioned that NHS staff have “borne the brunt” of the Government’s NHS efficiency drive – the well being service has been charged with producing £20 billion in efficiency savings by 2015.

“The Nationwide Audit Workplace explained the NHS had produced the ‘easiest’ cost savings very first,” he said.

“They were surely not simple for the medical doctors and other healthcare personnel who were created to bear the brunt. And it was not simple for the individuals and personnel every time a vacancy is not filled, a ward is closed, or a clinic is cancelled.”

He explained that “fundamental adjust” to the service is needed but added: “Even though not necessarily the sort of alter most of us would want. A senior NHS leader warned not too long ago at a policy gathering that efficiency financial savings would not be sufficient in the years ahead, and that the NHS would have to ‘take out capacity’. That translates as cutting companies to patients.”

And since the Government’s NHS reforms, which came into force in April this 12 months, individuals functioning across the NHS in England are unsure of who is in charge.

“A main dilemma, in England at least, in that in a submit-Well being and Social Care Act planet no-1 actually understands who is in charge,” he said.

“As well often, service adjust decisions are driven by a mishmash of political and financial imperatives, alienating the regional communities that the providers are meant to serve.”

Dr Porter also created a dig at feedback created by Jeremy Hunt, the Wellness Secretary, about the role of GPs in exacerbating difficulties at overstretched accident and emergency departments.

Mr Hunt said earlier this year that alterations to the way GPs provide out-of-hours care had had a “enormous affect” on accident and emergency solutions.

Responding to the Health Secretary’s remarks, the BMA chairman of council said: “You will don’t forget what happened when politicians made inaccurate and demoralising feedback blaming GPs for the pressures on emergency care, and we must be alert to these sorts of attacks on our professionalism and integrity, and fight them with information.”

If NHS was a country it would "barely have a credit score rating", says BMA

If NHS was a country it would "barely have a credit score rating" - BMA

“The NHS is struggling just to hold pace. A expanding and ageing population, public health troubles like obesity, and continual advances in treatment method and technology are all contributing to push NHS expenses properly above common inflation.”

Dr Porter added: “The numbers overall are so undesirable that if the NHS were a country, it would barely have a credit rating at all. The Nuffield Trust has estimated that if the NHS price range continues only to keep pace with common inflation, there will be a shortfall of between £44 billion and £54 billion in England by 2021-2022, except if there are productivity gains.

“But even with a four per cent productivity achieve every yr, the funding gap would nevertheless develop to as considerably as £34 billion. It would take savage cuts to even get started to find this a lot income out of further ‘efficiency’ financial savings.”

He stated that NHS workers have “borne the brunt” of the Government’s NHS efficiency drive – the wellness services has been charged with producing £20 billion in efficiency financial savings by 2015.

“The Nationwide Audit Office said the NHS had produced the ‘easiest’ savings 1st,” he mentioned.

“They were surely not easy for the physicians and other healthcare personnel who have been produced to bear the brunt. And it was not effortless for the individuals and personnel each time a vacancy is not filled, a ward is closed, or a clinic is cancelled.”

He mentioned that “basic alter” to the services is needed but extra: “However not always the type of change most of us would want. A senior NHS leader warned not too long ago at a policy gathering that efficiency savings would not be enough in the years ahead, and that the NHS would have to ‘take out capacity’. That translates as cutting services to sufferers.”

And considering that the Government’s NHS reforms, which came into force in April this 12 months, folks operating across the NHS in England are uncertain of who is in charge.

“A key difficulty, in England at least, in that in a publish-Wellness and Social Care Act globe no-a single really is aware of who is in charge,” he stated.

“As well usually, services adjust selections are driven by a mishmash of political and monetary imperatives, alienating the neighborhood communities that the providers are meant to serve.”

Dr Porter also made a dig at feedback manufactured by Jeremy Hunt, the Health Secretary, about the function of GPs in exacerbating issues at overstretched accident and emergency departments.

Mr Hunt stated earlier this year that alterations to the way GPs give out-of-hrs care had had a “massive effect” on accident and emergency providers.

Responding to the Overall health Secretary’s remarks, the BMA chairman of council mentioned: “You will bear in mind what happened when politicians created inaccurate and demoralising feedback blaming GPs for the pressures on emergency care, and we have to be alert to these kinds of attacks on our professionalism and integrity, and battle them with information.”

If NHS was a country it would "barely have a credit score rating" - BMA