Follow by Email

Monday, 7 November 2011

WCA - Has Lord Freud been completely straight (or is the Pope a Catholic)?

The article above contains the usual excellent FullFact analysis, but there is more.  Comments here are based on a WCA in September 2011, which was in fact the poorest of three starting two years ago.
1.    Fluctuating conditions, pain & fatigue
Completely inadequately assessed.  The various guides produced for Atos HCPs and DWP Decision Makers recognise the issue and problem, but neither group shows the slightest practical interest in this difficult area.  In my own case, I went to great lengths to explain that I can do most things as long as I can choose when I do them – e.g. when pain is at a low ebb, but there was no reference on the ESA85.

In fairness, the guides do explain that performing a task once does not justify ticking the box, but again this is largely ignored.

There is also a more sinister aspect of pain assessment.  In a recent dialogue with a DM’s manager, he stated that DMs use internet research as an aid to decision making.  The ethics of this aside for the moment (as DMs are not medically trained and are given no guidance as to which websites can be trusted), on pain he explained their view is that generally, suffering pain is unnecessary – just take stronger pain killers.  So if you do claim to experience pain, it is your own fault and it can’t be that bad – no consideration of side effects, risk of addiction etc.  Unbelievable, but true!

The new descriptors do not mention “pain & fatigue” but do mention “significant discomfort or exhaustion” – more or less the same.

2.    Information to be considered
The requirement to consider all of the information available applies equally to Atos HCPs and DWP Decision Makers and is well documented, but largely ignored.  My HCP claimed to have read my ESA50, but it was nowhere in sight and although I presented a copy of my X-ray, the HCP barely glanced at it and did not reference it in the ESA85.  They knew that my GP had declared me unfit for work, but likewise made no mention of it in the ESA85 report.  The instruction is clear – they MUST list all evidence submitted.

In addition, the WCA manual recognises that a HCP could be faced with conflicting evidence between the ESA50 questionnaire and their own observations/conclusions at the WCA.  The instruction again is quite clear – the HCP MUST acknowledge the difference and explain with evidence why their conclusion is different – they CANNOT just say “in my opinion . . .”.

Exactly the same requirement applies to DWP DMs, but there is the same lack of interest and diligence.  Again, the rights and wrongs aside, at very least there is the internet research they apparently undertake routinely and the GP fit-note that they already have a copy of, but in reality often neither are used.

Following my last WCA, I raised a complaint with Atos before receiving the DWP decision and sent DWP a copy.  They admitted to having this letter at the time the decision was made, but not using it.  I pointed out that ignoring it suggested they thought it unjustified, which undermined my position with Atos.  They insisted that this was not the case.  So I pointed out that if they thought the complaint to Atos was justified, why had they acted upon an ESA85 that was unsound?  They could not answer.

The overall reality is that (as we all know) the ESA85 summary is translated into points almost through a look-up table and the decision making process is a myth.

The Government has forced itself into a corner – outsourced, private companies cannot be seen to be making benefit payment decisions directly, so the decision making job had to be created and then given some apparent substance to pad out the job description.

To demonstrate the absurdity through all of this, I have raised the following question under the FoI Act with DWP:

“At my last visit to Atos, the HCP was quite clear that she was only performing a medical assessment and the WCA is performed by a DWP Decision Maker. The WCA then dictates whether or not ESA is paid and at what level.   However, DWP015 ( states,
“The medical assessment may find that you are able to work”, which means the Atos HCP determines capability to work. 
Please clarify who actually decides whether or not I am able to work as it is this that determines ESA payments– Atos HCP or DWP Decision Maker?
 This is important due to the large error rate discovered at tribunal, often based on EXACTLY the same information that was available to both the DM and HCP – they may have additional information in some cases, but not always.”
It will be interesting to see how they answer.

Sadly audit routines in both organisations are poor and do not detect these shortcomings, so bad practice has become endemic.

At the end of the day, the decision regarding capability to work is far better made by someone who is suitably medically trained rather someone who has no medical training.

No comments: