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Thursday, 19 April 2012

The WCA – GPs are not well enough trained it seems (2)

This post is a continuation of http://tia-junior.blogspot.co.uk/2012/04/wca-gps-are-not-well-enough-trained-it.html as my reponse to the latest feedback is too long to post as a "comment"
Thanks for the comment and my apologies for the lengthy response.
Basically I agree.  My own belief is that GPs are perfectly capable and best able to assess work capability with at best a slight change in the way they approach it, at worst a tiny amount of “training”.  There are as you have touched on a number of relevant issues that HAVE to be addressed for this to work effectively from everyone’s point of view that the Government has so far avoided.
·         I accept that some GPs may have been a bit “soft” in the past, but they have had no real guidelines to work to and there have been no consequences to this approach.  They are paid a great deal of money and adopting the view that the only answer it to place the task elsewhere just adds to cost and reduces effectiveness – there has been no corresponding saving through taking this away from GPs and like it or not, cost-effectiveness whilst not the first consideration is still A consideration.
·         To devise a WCA without defining the “W” is ridiculous. The only commercial analogy I can think of is a QA test for light bulbs that only checks they light up, rather than to the correct brightness – inconceivable that such a meaningless test would be deployed.  Am I being passed fit as a steeplejack or bank clerk – absurd to say it is irrelevant!
·         It is the general demands of working that is so seriously missing from the WCA – being forced into the same daily disciplines when one’s condition is highly variable, perhaps hour to hour as well as day to day.  If there was a good supply of work that recognised the inevitable constraints of a disability, the situation would be different.  So not only has the Government placed the cart before the horse (introduced the test, before providing suitable jobs), it has taken a further step backwards in its approach to Remploy.
·         The issues of condition variability and levels of pain are without doubt the hardest areas to accurately assess in a single session, whether it lasts 10 mins or 10 hours.  There are also other complex issues to do with the ‘cocktail’ effect of multiple prescriptions as well as their combined side effects.  These can ONLY be evaluated by a HCP who has adequate clinical training an experience, which means a doctor, not a nurse or physio (with all due respect to both).  The assessor should be familiar with the full range of treatment options, risks and potential outcomes so that they can at least establish if a person’s condition falls within a generally accepted range and if not, through the assessment establish why.  Again, beyond the experiences of nurses and physios.
·         Then there is the matter of one’s career or profession.  The Government pretends it recognises this but does not with its concept of “general work”.  I believe that they should first consider a return to one’s profession if at all possible, but could quite reasonably put a time limit on it.  If one’s heath (sadly) will not allow a return, quite reasonable that alternatives need to be considered and this is where support would be of real help.
·         As an aside, the Government’s justification for dumping people who are less than fully able into the “normal” job market is also rubbish.  It claims that equality legislation has been so effective that they are no longer at any kind of disadvantage in the workplace or when applying for a job.  This hugely flawed theory has also allowed them to manipulate/eliminate descriptors using the same assumption, when clearly the only motivation has been to cut points.
·         [Of course this is all doubly compounded by the fact that we are in a recession]
Finally, the BMA should out of principle be fighting hard to get this work back in the hand of GPs.  They should regard it as a huge insult to suggest they are incapable or hide behind the “patient trust” nonsense.
·      If working is in my best interests, my GP should be telling me – he has signed the Hippocratic Oath for Christ’s sake.  If I disagree, we will have a debate and reach the best answer – one of us will convince the other or we will sensibly compromise.  The point is that we AGREE.  By contrast, the current system is adversarial being based on mistrust so hardly surprising it generates conflict.  Conflict requires resolution = delay + cost that adds no “value”.  At no stage does anyone currently ask me what I would like to do.  Far better to reach agreement early on then everything afterwards runs smoothly.  Substitute the concept of ‘appealing ‘with the occasional need to seek a second opinion – quite easy in my GP’s surgery – he just has to ask the bloke next door.
·      If my GP explains why working would be good for me, I am far more likely to accept it than when it comes from a DWP administrator I will never meet and who will not entertain a debate.  The trust between me and my GP is an advantage to build on, not a disadvantage to steer around.
DWP has to split hairs over who does what and introduce spurious levels of demarcation not because they are justified, but simply to support the ‘model’ it has adopted. 
1.    Atos cannot be seen to make ESA decisions – they are not within the public sector.
2.    Decision Makers cannot be seen to be making medically based decisions because they are not medically trained.
So my as yet unanswered question to DWP is:
“My ESA payments are wholly dependent on my ability to work – if I am deemed fit to work the payments stop, if I am not they continue.  So the REAL decision is about FFW which then dictates ESA or no ESA.  So who decides if I am FFW (which is of course a medically based decision)? 

which takes us straight back to the dilemma between 1) & 2) above. 

DWP will not relinquish power easily, but it is less of an issue for everyone if it is to public sector colleagues in the NHS rather than an outsourced private outfit – at least that’s my view.

2 comments:

Anonymous said...

One more thing. Before ESA was introduced, the DWP should have carried out large-scale surveys among different claimant groups and asked them about their specific barriers to work and the kinds of adjustments they would need to be able to work. And then, before declaring hundreds of thousands people fit for work, the DWP should have made sure that employers were willing and able to make these adjustments.

Indeed, Labour had a wonderful opportunity to overhaul the formulaic assessment process and to devise a truly work-related assessment that recognised an individual’s special employment needs. Instead, having learnt nothing from past mistakes, they introduced an even cruder functional test.

Tia Junior said...

Absolutely agree with both posts.

The glaring omission from the consultation programme is employer reps. You will no doubt have noticed that the bending/kneeling descriptor disappeared about a year ago. DWP insisted it was justified on the basis that it was no longer an issue in the modern workplace and poited to a research report as evidence. The trouble was that a) this is NOT what the report concluded and b) it opened with a disclaimer from DWP ( views of the authors not necessarily us), even though they had commissioned it. What is one meant to think?

DWP also “confuses” consultation with support and assumes the former means the latter, so I was delighted to see the stance of MIND but withdrawing from what is clearly a meaningless exercise.

Despite what it says, it is areas like this that reveal the true attitude to claimants = benefit scroungers, so processes are designed on the basis of mistrust despite this being the minority situation. This underlying assumption influences absolutely every approach to every issue. Again, an analogy would be John Lewis creating its customer service policy on the assumption that all customers are shoplifters. I wonder how different the end result would look if they did?