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Wednesday, 28 December 2011

ESA/WCA - Government Philosophy

The fact that Atos has been passing large numbers of people fit for work when they are clearly not by any reasonable definition of both ‘sickness/disability’ and ‘work’ has understandably caused great upset and huge criticism.  Let’s just be sure however that it is directed appropriately. 
Atos can legitimately be held accountable for undertaking a WCA poorly, but just remember where the overall direction and guidance comes from – DWP!  There is a strong suspicion that Atos and/or their so-called HCPs are in some way financially rewarded for passing people fit when they are not, but I do not believe this is the case. 
Firstly, if it is despite the denials, sooner or later it would come to light and the Government would be crucified both for agreeing the practice and, worse still, lying. 
Secondly, there doesn’t need to be an overt incentive when the underlying message is so clear.  The quotation below is from a DWP document published in 2008 and it explains the Government’s position clearly.  Remember too who was in Government in 2008!
Employment and Support Allowance
Equality Impact Assessment
March 2008
“Linked to the overall objectives of the new benefit, the starting point for the assessment will be that the overwhelming majority of customers are capable of some work, given the right support. This will lead to better employment outcomes for disabled people. Treating people in line with their capabilities, instead of making assumptions based on their condition, will have a positive impact on the attitudes of others to disabled people.
This is a sea change in the way the social security system interacts with disabled people and people with health conditions, and will promote wider societal change in attitudes to disabled people and work.”

If you are wondering who the bloody hell the “customer” is, it is you.

There is of course the bit about "given the right support", but that is another story.  On the Government's own admission, without it the theory falls apart.  QED?

Saturday, 17 December 2011

Who Knows Best?

This article includes a couple of statements that appear frequently.  I have never really understood them, but they are important because they are used to justify much of what the Government is doing:
“The Government believes the system deters some patients from returning to work, even if they are physically able to do so and would find employment a helpful part of their recovery.
A report by Prof Malcolm Harrington, the government adviser on testing welfare claimants, said the “automatic entitlement” to the illness and disability benefit for cancer patients had been counterproductive, and led to patients becoming dependent on benefits, stigmatising cancer and causing employers to make poor decisions.“
·      Did the “old” system really deterred patients who can work and want to work from finding a job?
·      Have patients where working would be an important part of their recovery programme been denied the opportunity by “the system”?
·      Are there sick or disabled people who can work and want to work, but have allowed themselves unnecessarily to be sidelined and prevented from even trying to find a job?
·      Quite what “poor decisions” have employers been making and what would the “better decisions” have been?

To be honest, I don’t know, but I find it hard to believe. 
I’m sure by now that if there were droves of sick or disabled people wanting jobs but being denied the chance, it would have received far more publicity.  By the same token, it the current actions by the Government were striking a chord with these same people ( . . . . thank God they are at last doing something about it . . . ) we’d have heard much more support for the changes, when in fact I have seen nothing other than concern & criticism.
I have never trusted any unitary, highly prescriptive view of anything, as plausible as it may sound.  People are obviously not all the same and need individual consideration – one size does not fit all.    These sweeping generalisations are just a loosely veiled attempt by the Government to impose its will by convincing us it is in our best interests.  Thank you very much, but I’ll be the judge of that.
I have been through three WCAs and not once has anyone from Atos or DWP asked me what I would like to do.  Perhaps this would be a sensible first step in the right direction.

A view from the Atos CEO

I wrote a long letter to the Atos CEO about my experiences through 3 WCAs and the subsequent fall-out through the ridiculous "decision making " and appeals processes.  I also included a few tips through which he could improve the standing of his business in contraversial circumstances.

The first script below is his response, the second is my brief reply.

"Dear Mr xxxxxx

I am in receipt of you letter dated 9th December.  I am not aware and indeed nor should I be aware of your personal case but I appreciate from your letter that you have experienced the disability assessment process several times and are clearly dissatisfied with the whole process. You also comment that you consider our lack of interest in criticisms levied at us as being down to our view that the problem is wholly with the DWP.

We are generally silent when criticised in the press simply because we do not believe it appropriate or indeed beneficial to manage our business in the press, make public comments about our clients business or as in this case comment on Government Policy.   I’m sure you will share my view that the objective of newspaper journalists are not necessarily always to present an accurate representation of the facts.  We do respond to support groups and professional bodies as you would expect.

We also publish a "blog”, which you can access via  I would encourage you to look at the blog and hear what we have to say. I hope by doing so you will see that we certainly do care about the work we do and ensure that we maintain high standards of quality and professionalism.

As you note I am about to move on to a new post but I will certainly pass on your letter to my successor whom I am sure will respond to your queries either directly or via the blog.

Yours sincerely,
Keith Wilman
Atos, Chief Executive, UK and Ireland"

Wednesday, 14 December 2011

The trend with who is performing WCAs

Fresh from a FOI request.  There is a worrying but predictable trend here.  Nurses are clearly less experienced than doctors and DWP claims that their training acts as a leveller is a nonsense.  The membership renewal criteria for the Nursing & Midwifery Council are not exactly stringent.  However, on the basis that Atos pays less for a nurse than a doctor, the driving motivation here is clearly profit improvement.  No surprise as Atos is a private company with a responsibility to its shareholders and regardless of what we think, it must be fulfilling the conditions of its contract with DWP or they would boot it out.  So DWP is the real culprit, not Atos!  This is the way the private sector works - just look at the banking sector and closer to home, Southern Cross. 

Tuesday, 13 December 2011

Employment for the disabled – a fresh look at one aspect

I’m all for integration within the workplace but it is not always practical and the issues go far further than a few ramps and PIR operated doors.
The one thing most employers want is reliability.  There is an amount of work to get through in the day and they need to know that the requisite number of people will be available to complete it on time.  The trouble is that many disabilities are unpredictable – the intensity varies and there is no way of knowing when it will start and when it will subside.  It’s not that some form of work is not possible; it just has to be arranged around the disability – maybe totally.
The solution requires a much more open-minded approach that considers not just the design of the workplace, but the design of the work itself.    Modern technology offers all sorts of imaginative and flexible solutions, working at home (WAH) being an obvious example.
Our local council has decided its offices are largely uninhabitable and something new is needed.  There is an unavoidable gap when there is simply not enough office accommodation available and they have been surprised at how easy WAH has been to organise and their fears over control & productivity have turned out to be ill-founded.
Although it rather contravened the “integration” objective, Remploy had a place within all of this, but sadly the Government seems to have decided it will not continue.  Organisations like this are not an admission of defeat, but a recognition of reality – that with the best will in the world, some disabilities are impossible to integrate – I for one would find it hard to work alongside someone with extreme Tourette’s .
Ignoring the fact that there are currently no jobs available for anyone, the Government’s attitude is narrow-minded and unrealistic to say the least.  It ignores the flexibility needed and relies exclusively on the assumption that anti-discrimination legislation is both comprehensive in addressing all of the issues (which it is not) and has been universally adopted by employers regardless of industry and size (which it has not).
We will undoubtedly soon be faced with another failed initiative, a huge amount of wasted expenditure and much head-scratching before another initiative is conceived, which unless it defines the issues correctly, will also be doomed to follow the same path.

Harrington & Grayling keep promising more support from DWP, but where is it?????

I raised a complaint with Atos immediately after an appallingly badly performed WCA in Feb 2011, before I had even seen the subsequent DWP decision and I decided to pursue it regardless of the decision.

It was still unresolved in Sept 2011, when the next WCA came around.  I tried to get some help from DWP, based on the continual promises of better support from Messrs Grayling and Harrington, but guess what . . . . . . . . ????

Stuff like this ends up with a DWP Dept. called Commercial Management of Medical Services (CMMS), one of whose jobs it is managing the Atos contract.  Another is responding to FoI Act requests, so the style is predictable, generally evasive, non-committal and most certainly not unbiased and helpful.
Dear Mr xxxxxx,

Thank you for your letter dated 10th December, received today.

I am afraid you have not addressed the sole point in my original letter dated 30th October, to which Mr xxxxx first responded.  I am more than conversant with the way the Atos complaints procedure SHOULD work – my complaint to you was because it was failing and clearly whatever controls you apply were failing too. 

As you say, they should make an initial response to a complaint within 4 weeks – mine took 7 weeks and was incomplete.  I then spent the following 6 months trying to get straight answers to quite legitimate questions about my WCA which Atos continually sidestepped and in some cases referred them to CMMS as a FoI Act request when they were nothing of the kind.  This was all an elaborate plot to drag the process out as long as possible without admitting the errors that were apparent to pretty much everyone else.

In relation to the “controls” DWP apply, what exactly are they?  I would expect to see for example a “red flag” against any complaint
a)      Where the initial response had not been dispatched within 5 weeks, with a double red flag at 6 weeks and
b)      That overall had been running for more than 8 weeks, double red flag at 13 weeks.

A “red flag” is the point at which the customer (in this case DWP) gets involved to sort out the delay.  This is a very common arrangement in managing complaint handing and I am surprised that you do not have anything like this in place.  Professor Harrington’s two progress reports emphasise the need for DWP to provide greater support to claimants, but I cannot quite see where this forthcoming from you here.  As I said at the beginning, all you have told me is what should happen rather than help me through a process that has clearly failed.

The email issue is indeed now resolved – it was not at the time I wrote and I would like to think that you have admonished Atos for the childish stance they took – hardly becoming of a multi-national conglomerate – but I doubt you have.  You will never be able to provide the support Chris Grayling promises if you continually take the side of Atos against the claimant.

Although Atos has to this day not addressed the outstanding issues around my complaint about a WCA in February, I have dropped it for other reasons.

Finally, the Atos so-called “Independent Tier” will never have any credibility whilst it remains shrouded in secrecy.

Yours sincerely

Monday, 12 December 2011

12m limit to contribution-based ESA - a response to FoI Request on impact

“If this proposal takes effect in April 2012 as planned, how many claims are expected to cease on implementation a)completely and b)but switch to another benefit payment? Best estimates please.”

It is estimated that approximately 100,000 claimants will lose entitlement to contributory ESA in April 2012 as a result of the Government’s proposals to limit receipt of contributory ESA to one year for those in the Work Related Activity Group.   Of those 100,000, who may be affected immediately, an anticipated 60% are expected to be fully or partially compensated by income-related ESA so will retain entitlement to ESA. The remaining 40% will no longer receive ESA benefit payments, but will be able to retain National Insurance credits by becoming an ESA credits-only claimant. They may also see increases in other benefits such as tax credits and Housing Benefit. 

The Department published an impact assessment for this proposal, available at the following link:

Sunday, 11 December 2011

Evolution not revolution and not becoming too paranoid

The revolution needed to remove the vested interest that underpins the whole of society will not occur in my lifetime, so my approach is largely pragmatic and based on what buttons can be pressed and which nerves can be touched to at least edge things in the right direction.  The political regime in the UK may not be perfect, but I would prefer to be here rather than Syria. 
Whilst a huge conspiracy on a scale Dan Brown can only dream about has an intellectual and intuitive appeal, I have decided to set this aside, at least for the time being.  The purists amongst us will argue I am wasting my time as a fish decays from the head, but I am happy to climb the ladder one rung (or perhaps two) at a time.  I will try from this point on to avoid any more disgraceful metaphors.
My pragmatism is based on a belief in the “evidence-based” philosophy, so the potentially paranoid suggestion that the major charities et al have agendas that do not place the people they claim to represent at the very heart of what they do, needs some evidence to sustain it.  They clearly cannot do this every minute of every day, so we have to settle for something like “most of the time”.  We continually have to consider whether or not (despite their failings), we are better off with them than without them, or we will throw the proverbial baby out with . . . . . .(sorry, no more I promise).
Large conspiracies are very hard to arrange and require first class organisation and planning, which is usually absent from the very regimes we are accusing.  What looks like a concerted effort to do-down the needy is often therefore simply the result of well-meaning incompetence.
Of course the major charities need to consider self-preservation, which will force compromises from time to time, but at least for the time being, that’s the way the system works and to achieve any success in the short term we need to accept it and continue to exploit its weaknesses, which thankfully due to the poor organisation are not that hard to find.
The 12m time limit is something specific that needs to be challenged without doubt, but doing so does not imply anything other than a belief that it is wrong.  I don’t think for one minute that anyone wishing for its demise in any way regards people who have made no NI contributions any less worthy.

Clarity over where the biggest problems lie - fair's fair!

I am not at all sure that slagging-off every aspect of ESA & the WCA is most productive and we are better focussing our efforts – the old shotgun vs. rifle metaphor.  Yes, the overall ESA/WCA process is badly flawed at many levels, but it is nevertheless important to be clear where the biggest problems lie. 
For example, LiMA, the computer programme used by Atos HCP during a WCA comes in for considerable criticism and as it has let me down 3 times, I was not exactly its biggest fan, but having looked more closely at it ( is actually relatively comprehensive and more flexible than many would imagine.
The DWP has to have a standardised way of capturing WCA data for all sorts of legitimate reasons and it strikes me LiMA is as good a mechanism as anything else AS LONG AS IT IS PROPERLY USED, which points the finger elsewhere – attitudes, training etc.

Saturday, 10 December 2011

The ESA Saga: Dodgy Decision Making (it is not just Atos) - a long and detailed complaint

The ESA Saga: Dodgy Decision Making (it is not just Atos) - a long and detailed complaint
I'd have prefered to have said this to somebody's face, but the guilty parties are well protected. Likewise, I'd like to have seen him say what he said over the phone to my face without turning his head away in disgrace. It'll be interesting to see if I get a reply - nothing yet.

If you are faced with your first WCA, go well prepared and be on your guard. Their underhand and devious approach to this almost encourages dishonesty from claimants - what a way to run a business!!!

There's plenty of stuff here and on other sites to tell you more. Good luck, although ironically this is far too important to trust to luck.

Thursday, 8 December 2011

WCA - Atos Audio recording trial

I have seen a number of questions in various places asking what has happened with this.  The answer is:

·      A trial took place in the Newcastle-upon-Tyne Medical Assessment Centre
·      Started in March2011 finished May 2011
·      DWP is still after 6+ months “considering” and “trying to understand “the results and offers all sorts of pseudo-confidential reasons why the evaluation report cannot be published.
·      There is an implication that the results were not as expected, but no more clues.
·      Absolutely no commitment to a deadline.
·      I am trying to establish the nature of the trial.
What a way to run a brewery!

Monday, 5 December 2011

#ESA Appeals - clause 99 of the Welfare Reform Bill

Again, some propaganda from Chris Grayling, who we already know cannot be trusted.
However he tries to explain the motivation behind this clause and the limited use he has in mind, it gives DWP the authority to determine which appeals can be heard by the Tribunals Service, which is an infringement of the principles on which our legal system is based and should be resisted by all means possible.  Yes, some wholly spurious appeals reach the TS that waste time & money, but this is the small price we pay for democracy and basic human rights and something we should not give up.
In addition, some of what he says is not true:
1.       The current process already requires DWP reconsideration of a decision on appeal before it passes on to the TS.  Although sensible to filter out any obvious gaffs, the reality is that the second DM invariably comes up with the same decision as the first DM – what else would you expect?
2.       It makes sense to ask straight away for any more evidence if there is any, but I doubt if it will get a fair hearing within DWP and the original decision without it will simply be upheld.
3.       It would help to be more informative about what “additional evidence” could comprise and list it on the front page of the ESA50.  Do not regard a fit-note from your GP as in itself an indication of his opinion.  Better to have a letter from him/her explaining more fully why you are not fit for work if that is the case.
4.       Yes, sometimes the TS finds itself with more evidence than the DM had, but a LOT of the time this is not so – it is simply that whilst the DM had it, they decided not to use it.  I know this happens, because it happened to me and the DM admitted it.  This is not just hearsay – reports produced by the TS prove it is the case.

Sunday, 4 December 2011


For anyone who is progressing a WCA complaint through Atos and reached level 3 and the so-called “Independent Tier”, you might find the following notes helpful.

You will get the impression that rather like the Tribunals Service, there is a panel of experts who adjudicate in some form of hearing.  Apparently not so – it just involves two individuals: one who looks just at the way the complaint has be handled by Atos, the other looks just at the medical exactitude of the WCA.  They work independently and never meet.  Any suggestion that the hearings can be observed is therefore fallacious and gives the impression of a much more substantial arrangement than really exists.

It is absurd to insist on the fact that they are independent when, on Atos’s own admission:

1)      AH know who they are and I do not.  I am not even sure DWP knows.
2)      “AH will determine whether a referral to the Independent Tier is appropriate” (a quote from the Atos complaints manual).
3)      “The (AH) Team Leader will determine the nature of any corrective action appropriate”  from IT conclusions. (ditto).
4)      “The Independent Tier will not provide views or judgements to any person outside AH” (ditto).
5)      “IT results will be published in an approved format”, but nowhere does it say approved by whom or what this format is.
6)      Only the AH convenor can communicate with IT and arrange any contact or obtain additional guidance (paraphrased).
7)      DWP says it has no idea what (if any) contractual or commercial arrangements exist between AH and the IT.  Any costs associated with use of the IT are not directly charged to DWP so must affect Atos profit margins – undoubtedly an incentive to use it as little as possible.
8)      There is no competitive tendering process for selection of the IT – Atos appoint who they like.
9)      DWP will not even disclose the nature of the IT’s business and so cannot demonstrate they have any qualifications, experience or credentials to adjudicate in this area.
10)   Because of the secrecy, DWP cannot conclusively prove that any of the processes it describes actually exist.
11)   There are no detailed documents listing the exact criteria the IT assesses so it is impossible to judge what job they are doing let alone how effectively they do it.  The Atos Complaints manual refers to the IT checking against “agreed processes”, but NOT what they are.  There is a very detailed WCA manual giving guidance to HCPs, but there is no confirmation in anything you have sent me that even this forms part of the IT’s ToR when investigating a complaint.   There must be some form of template to ensure consistency.
12)   Following on from 11), the only reference to service levels requires AH to acknowledge complaints within 2 working days and fully answer complaints within 4 weeks, but the latter is only a “hope” rather than a firm commitment.  What does the IT judge against?  What about the fact that for me they took well over 4 weeks and even then did not address all of the points I had raised?  What about all of the correspondence with Atos since – what response times must they adhere to with these?
13)   Although DWP says claimants receive copies of everything Atos provides to the IT, nobody can independently prove this is the case.
14)   Likewise, nobody can prove that IT adjudications are not edited prior to publication.
15)   Informal contact between Atos and the IT is perfectly possible.

The second disgrace is over the secrecy which is a far bigger issue than many might imagine.  CMMS has indicated two reasons:

1)      The Atos/DWP contract apparently requires the identity of the IT to be kept secret and DWP claims there will be commercial implications (unspecified) if they breach this clause.  Obviously very stupid to allow this to be in the contract and it should be renegotiated to allow disclosure.  Carefully done there is no reason why it should have any financial consequences, so this is just a smoke-screen.  
2)      DWP continues to insist that in principle that the IT’s impartiality is only secure through anonymity, which is hugely worrying in a democratic society, supposedly built on transparency and the principle of public accountability.  The Tribunal & legal systems work OK in the open, so why not the IT too? I’m sure they can see the contradictions and outright hypocrisy, but will not budge.

For 2), I can accept the contractual constraint as a short term barrier, but nothing else.  CMMS will hide behind the FoI Act for ever so this needs something more direct.  Personally, I’m not convinced there is any deliberately established bias going on here and it is more a case that DWP is embarrassed by how flaky the whole IT arrangement is – a couple of blokes sifting through piles of papers whilst watching telly over the weekend??????

This secrecy nevertheless should be a great worry to all political parties except perhaps any hard line communists and fascists.

UK Government to withdraw work capability assessments from Cancer patients Petition

<a href=" UK Government to withdraw work capability assessments from Cancer patients Petition | GoPetition</a>

Friday, 2 December 2011

Atos HCP or DWP DM - who decides what????

I will not have been the first person to attend a WCA with difficulty walking only to find that the Atos HCP decides, contrary to my medical advice, that I'd be better off and therefore more able to work if I had a wheelchair.  My HCP's wording on the ESA85 was a little ambiguous, but not enough for the DWP Decision Maker to question it, so I was deemed fit for work etc.

Although I was aware that descriptor wording had changed, I did not for one minute imagine the references to wheelchairs was for anyone other than those people who regretably use one all of the time.  I was of course very "uncomfortable" about the principle of a DWP administrator contradicting expert medical advice.  I was also staggered at the suggestion that my life would be better in a wheelchair rather than not!!!!!!

The DWP DM had claimed just to have followed the Atos "recommendation", but as the HCP's statement was not a clear recommendation, I decided to first pursue this through Atos to clarify quite what it was the HCP was saying.  This is all part of being crystal clear about who is deciding what and therefore finally who is ACCOUNTABLE for what.  My question was:

"Could you please confirm that Ms XXXXXXX (the HCP) felt that my work capability would be enhanced being in a wheelchair, so it in fact amounted to a recommendation?"

The answer from the Atos Customer Relations Medical Adviser was:  

"The health care professional (HCP) merely advises the DWP Decision Makers of their opinion as to which of the mobilising descriptors might apply according to the descriptor definitions as laid down in the legislation and as summarised in the ESA handbook. This advice to the DMs is not in any way a suggestion or a recommendation to the claimant as to which aids, appliances or adaptations he may or may not benefit from, or may or may not consider using.
The HCP cannot provide advice to claimants about treatment or aids they may wish to deploy to help their specific medical condition, and it is not within their remit to provide advice about adaptations for possible employment.  That is for other health care professional who are involved with the customer's medical care."

Have you ever seen such an absurb contradiction? - watch this space, it will be interesting to see how DWP squirms around this one!.


DWP & Vested Interest - UNUM or anyone else - FoI Act request

2 December 2011
Dear Department for Work and Pensions,

You will be aware of widespread public concern over private companies who are invited to advise the Government or attend consultative meetings, but have a vested commercial interest in one or more of the potential outcomes. One such company is UNUM, whose website states (

“With an unprecedented budget deficit to tackle, the government is cutting back on public spending, which includes welfare support.  While the government steps back, employers are being asked to step forward to take on more responsibility for their employees’ welfare in times of illness and injury.”

Q1: Does the Government accept that is must maintain a very clear and visible distance from this and similar private companies to ensure there can never be any  accusations of impropriety?

Q2: To what extent have representatives from UNUM had any contact with Government, civil service or any other public services employees to date?

Q3: The Government’s declared policy makes it clear that it will still provide support to individuals who need it. The UNUM statement above however indicates that the Government will be cutting welfare payments to claimants who do still need support, but will be expecting employers to take on the welfare cost responsibility. Is there any truth in the UNUM statement and if so, how will this manifest itself to employers and will their compliance be mandatory (i.e. encapsulated in law)or optional?

Yours faithfully,

Contribution Based ESA - 12 month time limit impact assessment

The published IA is on the link

There are a few issues over its rigour:

Quote #1:
“It was never intended that ESA for those in the Work Related Activity Group (WRAG) should be paid for an unlimited period to people who, by definition, are expected to move towards the workplace with help and support.”
Who says so?  This needs to be supported by a clear policy statement elsewhere

Quote #2
“Government intervention is required to help ensure that ESA is paid for a temporary period for those placed in the WRAG, thereby encouraging a return to work and stopping people being trapped on benefits for a lifetime”.
The WCA determines who is and who isn’t fit for work and the frequency with which an individual attends allows their return to work in line with their recovery.  This does not cause them to be “trapped” (whatever that means) and there is therefore no justification to apply an arbitrary time limit other than simply to
a)      Save money
b)      Create a financial “back-stop” because the WCA is not working effectively.

Quote #3 – Policy Objectives
1.       “To ensure that ESA is paid for a temporary period thereby creating a culture that does not allow people to stay permanently in the WRAG, that they are expected to move towards work or into the Support Group if there is deterioration in their functional impairment.”
This can be automatically achieved through an effectively managed WCA programme – see above.

2.       “Simplification of the benefit system, better alignment of contributory ESA rules with contributory Jobseeker’s Allowance in the run up to the introduction of Universal Credit.”
There is no logic or sound basis for “aligning” ESA with JSA.  Being ill is NOT the same as being jobless.
[As an aside for ESA aficionados, UNUM quite openly declare they believe that sickness and disability are both hidden forms of unemployment.]

3.       “Reductions in social security spending to ensure that money is targeted on those most in need will help the UK's challenging fiscal position.”
Ah, so at last we have the real reason!

Quote #4 - What policy options have been considered? Please justify preferred option
1.      “Do nothing.
2.      Time limit contributory ESA for those in the WRAG to one year. “
Options around the coverage and length of the time limit were considered. One year was selected as the best balance between providing people claiming contributory ESA in the WRAG with enough support and reducing the cost of contributory ESA. It was decided to exclude customers in the ESA Support Group on the basis that they are the most severely disabled or terminally ill and therefore least likely to move into work.”
As you can see, there is no evidence-based information to support a 12 month limit, so it is completely arbitrary.
This section of the IA requires the preferred option to be justified.  The paragraph above does not constitute justification.  It does not, for example, explain why say 18 months is a poorer option.

Thursday, 1 December 2011

Decision Making Errors - the myth as to why.

It is well know that about 40% of ESA fit-for-work decisions made by DWP (note DWP not Atos) are reversed on appeal.  Worrying, but DWP has convinced itself that it is not its fault as in 65% of reversals, the Tribunal had additional information, so it not concerned about the error rate as there is a convenient and plausible explanation, despite the devastating impact it can have on a disabled person’s life.
This 40% figure is authenticated by reports issued by the Tribunals Service, but as long ago as 2009.  However, DWP fails to mention that the same reports also point out that it is not always the case that the DM does not have the information, more that they tend to ignore it.  The TS says:
“The 65% figure for the production of additional evidence suggests that an important source of information is being overlooked in the decision-making process. There continues to be a tendency on the part of decision-makers to discount oral evidence received from the appellant in the process of evidence gathering prior to the decision and then in the preparation of the appeal, and not to seek out new evidence to verify the facts where the decision has been challenged. Where a decision is challenged it is the duty of the decision-maker to review the initial decision, satisfy themselves that the facts are correct, ensure that there is no further evidence that might lead to a review and where they do not accept evidence or doubt it explain why, making this explicit in the submission to the tribunal.”
One would imagine that in the interests of effective staff performance management, DWP collates TS outcomes by Decision Maker as the basis for re-training etc. but NOT SO.  The strong and clear recommendation above has just been ignored for the past 2 years!!!

The Culpability of a DWP Decision Maker - not as simple as it seems

If DWP pressures an individual to work despite the concerns of the GP/individual and their health suffers as a result, who in DWP is culpable?
DWP “Answer”:
Individuals who are allowed Employment and Support Allowance cannot be asked to work, instead those in the work-related activity group are asked to prepare for work and those in the Support Group are provided with unconditional support.
Dear DWP Adelphi Freedom-of-Information-Request,

Thank you for this, but your response does not address the important issue here.

There have already been many cases where a DM has judged people fit for work when their GP has felt otherwise. If doctors do not exercise due diligence, they can be held culpable, which is perhaps
why they might be inclined to err on the "safe" side. Whether they like it or not, in altering the GP's judgment, a DM unavoidably assumes the same responsibility. You cannot sidestep this when you
have placed the individual in such a potentially invidious position. If a DM judges someone fit for work and they are wrong and their error has serious repercussions, they must face the consequences. They cannot assume the authority without also assuming the accountability.

Do they document a risk assessment for each case they judge? If not, do you think they should? If something goes wrong and there has been no risk analysis, the legal consequences are well
established through H&S legislation.

FoIA link at

Wednesday, 30 November 2011


FoI Act requests can be useful to establish an official view, particularly if you have hard evidence to the contrary - all part of exposing the flaws in the system.
It will be interesting to see what DWP comes up with in reply

Decision Making Accuracy
Dear Department for Work and Pensions,
The main principle of a WCA is that it concentrates on a claimant’s ability to work. It regards clinical condition/history as largely irrelevant and the WCA handbook instructs Atos HCPs to use drop-down menus and simplify condition/diagnosis wherever possible for the benefit of DWP Decision Makers (DMs) who are not medically trained. As part of the final assessment process, DMs consider a range of available information including information they might have researched on the internet.
How can a DM make an informed, accurate and robust decision if the condition they are researching has not been precisely recorded?  For example, a brain tumour may be recorded as "occasional headaches" and a serious spinal injury might be recorded as simply "back pain".
DWP Reply
Decision makers have to consider all the available evidence, not just the name of the condition. Healthcare professionals are required to take all information into account when providing advice to the decision maker. This includes the diagnosis, medication and history of the disabling conditions including relevant investigations, social and occupational history, a typical day history and relevant clinical findings. Healthcare professionals are required to list the medical conditions as accurately as possible. In addition, they are not restricted to the use of “drop down” menus and can enter the diagnosis as “free text”. It is therefore unlikely that a claimant with a brain tumour would have their condition recorded as "occasional headaches" and equally unlikely that a claimant with a serious spinal injury would have their condition recorded as "back pain".
I am afraid you are very wrong.  The WCA manual produced for Atos HCPs instructs them to simplify conditions for (non-medically trained) DMs.  My own WCA recorded a condition that required extensive surgery as “back pain” 3 times over.  Also the same manual positively discourages HCPs from using free form text in favour of the drop-down menus due to the diagnostic algorithm within Lima.
As quite clearly you laid down procedures are not being followed, what action will you be taking?
Given they are not medically trained, how can DMs interpret and understand information with which they are presented if it uses highly technical medical terminology?
DWP Reply
Atos Healthcare professionals are required to provide information in a non-technical manner, and explain any technical terms for the decision maker. This requirement was reinforced by the implementation of a recommendation contained within the first Independent Review of the WCA. Following this, all reports from Atos Healthcare now contain a personalised summary statement in plain English. In addition, if the decision maker does not understand any technical information within the report they are able to obtain clarification from a healthcare professional.
There is a contradiction here – providing information in a “non-technical “manner may well introduce inaccuracy.  See comments above, particularly regarding my own WCAs.
What is clear is that compliance is poor.
Would they be expected to interpret the following, which relates to a very well known condition: “The estimated rates of this complication are 0.3-4% after total knee arthroplasty and 3-13% after proximal tibial osteotomy.  Ischemia, mechanical irritation, traction, crush injury, and laceration can cause intraoperative injury to the peroneal nerve.”
DWP Reply
Decision makers would not be expected or required to interpret such information. They are able to obtain advice from a healthcare professional in order to interpret technical medical terminology.
Who & where are these HCP’s that DM use?  When a DM consults a HCP, where is the record of the conversation kept?  What records do you keep of this referral frequency?
Not all information on the internet has been fully authenticated and therefore cannot be regarded as reliable. To which websites are DMs therefore restricted and where is this "safe" list documented?
DWP Reply
Decision makers are instructed to use evidence-based guidance known as customer case management which has been developed in conjunction with relevant clinical experts. The guidance is intranet-based but a copy is available on the internet. They are able to obtain advice from a healthcare professional on individual cases.
I have in writing that DMs use websites on the internet liberally without any controls other than their supposed experience.  The risks are obvious.  What corrective action will you be taking?
In many cases medical opinion on a particular condition and its short/long term effects can be divided and revolve around some very complicated features of the complaint. How does a DM resolve such dilemmas?
DWP Reply
Decision makers are able to obtain advice from an Atos Healthcare professional for interpretation of medical evidence.
Atos HCPs vary widely in relation to medical experience.  How can a DM be sure the advice they receive is correct, particularly if medical opinion is divided?  Why in this area would a DM not use expertise within the NHS?