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Wednesday, 30 November 2011

DECISION MAKING ACCURACY & CONSISTENCY

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.
Q1
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?
Q2
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.
Q3
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?
Q4
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?
Q5
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?

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