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Monday, 30 July 2012

The Question of Targets Again

Undoubtedly DWP is playing its usual game with semantics over the word “target”.  If there are numbers involved, it is certainly smart enough not to document them for fear of what the FoI Act might reveal. But there doesn’t need to be . . . .
The message to Atos in leaning the results of a WCA in one direction has been clear from the outset.  One of the early jibes was that if you can get to a MAC, you must be fit enough to work and this has never been that far from the truth.  Having initially biased the results, you have then created biased “norms” against which you judge current performance and correct accordingly, so the whole cycle becomes self-perpetuating – cunning & subtle, but transparent.
This is not speculation or opinion.  Using the Government’s own declared philosophy, there is more than enough evidence around covering almost every aspect of the WCA process to demonstrate that the process has been deliberately influenced.
One of the biggest giveaways is that Atos admits to monitoring HCP results against historical norms [although it does not explain a) quite how they are calculated, b) what level of deviation is considered “acceptable” or c) how far it investigates cause & effect, i.e. one HCP’s results might just reflect a bias in the conditions they have been called up on to assess.].  It does not however adjust for appeal reversals, so never measures the true picture individually or collectively, adding more bias.
In any other area of science or management, these anomalies would have been ironed out to ensure the ultimate results are genuine and offer a sound basis for decision making.  The fact here that they have not been simply means that they are irrelevant to the Government’s overall intentions and it will continue to falsely claim all of its policies are evidence-based and supported by experts to try to maintain the charade. 
It is aiming for a pre-determined end point and this end justifies the means.  The amount of collateral damage caused along the way is just “unfortunate”.

Saturday, 28 July 2012

The real attitude to customer service

If you’ve attended a WCA, you will have seen this leaflet.
Two important issues are conspicuous by their absence from it:
1)      Why you might like to have your WCA recorded and how to go about organising it.
2)      To bring along all the information you have – letters from GPs/consultants, X-rays, scan results etc., etc. 

Minister Grayling frequently claims that he has taken up Harrington’s recommendations regarding help and support for claimants.  He also regularly blames ESA decision errors on not having all of the information available, but makes no attempt to ensure it is provided.  It rather looks like they don’t REALLY want to know.

The ongoing debate about targets and quotas

This is prompted by:

Quite right that we take every possible opportunity to point out the flaws, inconsistencies and errors in the Government’s welfare programme, but don’t forget how thick-skinned and lacking in integrity it is.  Grayling et al will attempt to argue the statistical toss here and their underlying altruistic intensions in their usual disingenuous manner until they back themselves into the inevitable corner at which point they will have no qualms about changing their tack completely.  They have recently done exactly this with WCA audio recording. 
Much of this is post decision rationalisation – they decided long ago what they wanted to achieve and since have desperately being trying to find a way of supporting it.  I have yet to find one single aspect of the changes they have implemented that is GENUINELY evidence-based.  If you take the trouble to look closely and challenge, the truth is that for example:
·         There is no evidence to support descriptor changes or the correlation they assume between ‘typical day’ activities and capability to hold down a job.
·         The research they rely on is at best inconclusive, at worst argues AGAINST their proposition.
·         The reports they quote usually start with a disclaimer, even when they have commissioned them : “ These views are those of the author(s), not necessarily . . . . .
·         The organisations and “experts” they cite may well have been consulted, but most certainly have NOT signed off the end result and do not therefore necessarily support it.
·         Etc.
It is of course a thinly veiled charade to hide what is nothing other than a political dogma – they will not say outright that we are all benefit scroungers, but will happily construct a regime based on the belief that we are.  If there was a genuine scientific basis for their approach, they would not have to approach it in such and underhand and deceitful way (the hypothetical wheelchair is an absolute classic!).  If they genuinely believe that I am able to work, want to work and the “system” is preventing me, why adopt such a heavy-handed, autocratic, prescriptive, we-know-best philosophy?  Why not just ask me what I’d like to do and help me do it?  Why not build a process based on early consensus rather than one based on conflict and intimidation?  It is obviously because you don’t trust me.
There do not have to be specific targets – the Government’s overall message is perfectly clear.  If in doubt declare FFW – you may be wrong, but we’ll sort that out later.  The end justifies the means and the amount of collateral damage along the way is perfectly acceptable!!

Thursday, 26 July 2012

Well enough to work

Not a new article but very well reasoned and presented.
Well enough to work?                      Re: Health professionals' advice: the ethics   4 March 2011
“Dr Cooper points out that when an Atos doctor sees a claimant that claimant is not his/ her patient, and there is not therefore an explicit, or even implicit, duty of care.
He goes on to point out that the doctor's employer in this case is Atos, and then says that, "the first duty of the assessor is to supply, with the consent of the claimant, honest advice to the DWP on the most likely correct numerical score for the statutory descriptors in the test."
Here, I think, he is incorrect. The doctor's first duty is not to the DWP, but to Atos who are, as we keep on being told, is a private company with all the legal privileges and duties that involves. Atos are his/ her employers; Atos has a contractual obligation to the DWP, but the "assessor" does not. The assessor's duty must be to provide Atos with what Atos wants, and the assessor has agreed to supply.
It is in that lacuna in the evidence that some, at least, of the problem lies. The exact nature of Atos' demands on its "health care professional" (HCP) is unknown, since the content of their contracts - like so much else of Atos' business - is covered by heavy veils of secrecy.
Atos may not require an assessor to submit evidence which is the assessor knows, or believes, to be completely false. This, however, is not a very substantial safeguard of the truthfulness of the reports.
We know that the questions asked by the LiMA program are used to generate from one reply a whole chain of inferences. Such inferences may then be churned out by the final report which a rushed HCP may just glance at and then sign. What options, after all, do they have? They are not required to take responsibility for the accuracy of the inference chain, and are discouraged from entering any information which does not fit the parameters of the LiMA program.
There is a further point. A HCP who is "assessing a claimant" has no direct duty of care. Suppose then that the HCP has been told, "You are to take a sceptical approach to all statements made by the claimant, or their GP." A short period working there and a couple of reprimands for taking too long, and being "insufficiently rigorous" in their assessments, and  the HCP will get the point.
As the CAB pointed out in their report "Not Working", "Another common problem with WCA reports, is that conditions frequently appear to be downplayed. If a client's condition has been described by their GP as 'moderate' - based on tests, MRI scans, reports from consultants or other appropriate diagnostic tools - the HCP is very likely to describe it - based on a half hour interview - as 'mild'. If it is described by the GP as 'severe' it will be 'moderate' in the WCA report."
There are numerous other examples of bad experiences from the CAB, from Citizens' Advice Scotland, from other reports and from anecdotal evidence on the web. Answers are twisted, misunderstood or abbreviated, so that "yes, with a lot of help," becomes, "Yes".
I believe that the handbook for assessors says that claimants frequently underestimate things like distance. Someone who "goes round a supermarket" can therefore be assumed to be able to walk 800m. That distance is then entered into the report and the claimant's statement that they can walk 20m is ignored, as is their explanation that the "supermarket" is the corner convenience store.
These are instructions from the commercial firm employing the doctor or other HCP. They have to shape what they hear to fit the demands of the computer program, and the wishes of the boss. That the DWP is happy with the service being provided by Atos is evident from the renewals and extensions to their contract.
There are doubtless doctors out there providing the sort of assessment which the DWP describes, and which Dr Cooper postulates. That many of the Atos HCPs provide nothing like that sort of service is the conclusion of several reports and the experience of thousands of claimants.”

Monday, 23 July 2012

WCA Audio Recording - the plot thickens, but the truth becomes clearer.

The plot thickens.  From the latest letter from DWP it would appear that the fact that recording is a waste of time has been known since the completion of the pilot in June 2011.  Interestingly, this has only just come to light and frankly everything that has taken place since has been designed as a palliative to keep us all happy and quiet.  Why Mr Grayling has not made this clear in the House of Commons is a mystery. 
It is worth noting that this is completely at odds with Atos’s own conclusions & recommendations, although both organisations used the same data.  Unfortunately, no supporting information or supplementary reports have been produced by DWP, it is not possible to see or understand the basis for DWP to take the decision it has.
This is based on the following text from JCP:
The results of the pilot showed that audio recording of Atos assessments would not improve the quality of assessments and there was only limited evidence of improvement in the customer experience for some individuals. 
·         Less than half consented to having their assessment recorded and a tiny proportion, less than 1%, requested a copy of their assessment. .
·         Some claimants felt intimidated by having their assessment recorded and others decided not to have their assessment recorded once they arrived at the assessment centre.
·          There was no difference between the quality of recorded and non-recorded assessments.
Rolling out audio recording for all assessments would be extremely costly with no apparent substantial benefit or improvement in assessments. As a result, DWP has not implemented universal recording of assessments.
DWP has instead asked Atos Healthcare to try to accommodate requests for audio recording where a claimant makes a request in advance of their assessment.
The announcement, however, of the availability of audio recording was at a time when only small numbers were expected and since that time, the number of requests has increased significantly. This has put pressure on the ability to provide sufficient capacity to meet all requests. The dual CD machines required for audio recording are a specialist item; there is only one manufacturer and machines need building on demand.  Consequently, there is a lead in time of 4 to 10 weeks. There has been an order for additional machines, but a large-scale purchase of machines in the absence of an evaluation of the process is not effective use of public money, Although there have been increases in requests these still represent only a small percentage of overall Work Capability Assessments.
In the meantime, whilst Atos will do all that they can to accommodate requests for audio recording there may be times when the service cannot be offered, for example where it has not be possible to get access to recording equipment on the date/time of the WCA.  In these circumstances, Atos will inform claimants in advance that they are not able to meet their request for recording.
You will need to submit a Freedom of Information request for documents relating to this announcement.”

My response has been as follows and I am waiting for a reply:

“Thank you for your letter dated 20th July 2012 and I will take up your FoI suggestion separately using your letter as the point of reference.
I know you have to toe the party line, but some of the information you are being provided with is duplicitous literally beyond anything I have ever encountered previously.  It appears the author has no memory, no sense of integrity and most certainly no shame, but the ability to deny history.  Your latest statements will cause a stir as it means that not only have your FoI colleagues deliberately provided false responses to requests for information, but Chris Grayling has lied to MPs in the HoC, which I am sure they will want to take up when they see what you have said here. 

The beauty of having no evidence of course is that you can say what you like with impunity and change your mind day to day as you wish.
I really do have to correct the content of your last letter to remove the ‘spin’ and concentrate on the facts.  Perhaps you would pass this on to the individual responsible for the misrepresentation.
1.       The audio trial was a fudge, just to allow you to  say something had taken place:
a)   There are standard techniques for establishing meaningful sample sizes, none of which were used – 500 was totally arbitrary.
b)   The explanation offered to potential participants was deliberately worded to discourage them from taking up the facility.
c)    No information is available as to how the 500 were selected and nobody can therefore show that there was no bias.
d)   No information was gathered regarding the participants’ previous WCA experiences – clearly something that would have a major impact on attitudes to the pilot – nor their conditions, not even physical or mental.
Nobody therefore has the faintest idea as to whether the sample was representative or not and has no sound basis for making any decisions whatsoever as a result.
2.       Despite 1b), over two-thirds of the sample expressed interest and this only ultimately dropped to 46% due to assessments that for a variety of reasons did not take place.  It is dishonest to imply as you have that over half were not interested.  Some of those who wanted recording were pressured to change their minds on arrival.  Anyway, 46% may not technically be a majority, but it is most certainly a substantial minority too large to be ignored.   David Cameron would be delighted with 46% of the vote at the next General election.
3.       The JCP pre-project internal briefing made it clear that recording would not be seen as part of the decision making process and that there was no reason why claimants should need a copy unless for reconsideration and/or appeal, in which case it would be there if required.  As this thinking was incorporated in the offer made to the 500 participants, it is surprising that any at all asked for a copy there and then – the 1% you quote therefore means nothing.

4.       On your own admission, demand has well exceeded your “expectations”, so why quote figures you know are understated?

5.       You have stated “......    there was only limited evidence of improvement in the customer experience for some individuals.”  There is nothing to support this – by contrast a couple of quotes from the Atos report:
·         “The majority (85%) of surveyed customers thought recording was a good idea”
·         “Overall, the HCPs felt the experience had been positive and that the recording would support them in potentially difficult cases . . . . and the resolution of subsequent complaints”
6.       You have stated that there was no improvement in the quality of assessments, which is a claim you simply cannot make:
·         No quality measure was defined.
·         The Atos report simply refers to report “grading” NOT overall quality.
·         There was no follow up on decision errors, reconsideration or appeals.

7.       The increasing demand was highlighted by Atos in their report so there is no excuse for not having dealt with it 12 month later – it was certainly not the surprise you have indicated.
8.       Atos recommends that recording become routine.
9.       Your statement regarding the cost/benefit of recording assessments is completely unsubstantiated as no overall analysis (that for example considers the impact on tribunal costs) has been undertaken – it is pure guesswork.
10.   The Minister’s statement was unconditional - he categorically stated it would be available to anyone who wanted it.
11.   Your concern for effective use of public funds is a surprise and hard to believe given that decision errors result in a somewhat larger bill through the Tribunals Service. 
12.   You have said “..... a large-scale purchase of machines in the absence of an evaluation of the process is not effective use of public money”, which is of course true.  But equally if as you also say recording adds nothing to the assessment process and you have known this since the end of the pilot, why even buy 11 – surely this in itself is a waste of public money?  Have you told Professor Harrington he was wrong and there is no need for recording?

13.   You try to discourage claimants making their own recording by telling them it is illegal.  It simply is not and likewise you cannot stop a claimant taking notes.  If the HCP refuses to procede that’s their problem – as the Government continually tells us, if they have nothing to hide they have nothing to fear.

14.   You are quite happy to allow Atos to provide the facility on a best-endeavours basis, without any controls on how this might develop - if they mismanage the machinery, so no recordings can be made, so be it.  Amazing!!!

So in summary, DWP’s position on this all stacks up as follows.  You haven’t exactly said this I know, but this is a straightforward logical interpretation of what you have said.

“Although there is no justification or benefit in audio recording WCAs, we will fund the provision of 11 recording machines and all of the administration etc. required to support them.  We do not however regard this as value for money or as a waste of money either (please do not ask me to explain this contradiction).  We have no plans to increase or reduce this number and have no interest in how many may be available for use at any point in time.  We have instructed Atos to do their best to comply with recording requests, but if they feel they can’t or don’t want to record, they will not have to.  If claimants are upset, so be it – tough luck.  As far as we are concerned, in the absence of a plan to the contrary, this situation will continue indefinitely at whatever level of cost happens to arise.  We will continue doing all we can to prevent claimants from making their own recordings.”

Yours sincerely

Friday, 20 July 2012

WCA Audio Recording - Important (& disgraceful) update

I put this contradiction to a JCP District Manager as follows:
“You are no doubt aware of the controversy and delays around the facility to audio record WCAs.  In terms of the availability of equipment and the impact this might have on WCA scheduling, DWP has been quite clear that if a claimant wishes a WCA to be recorded, Atos must comply.  It has further stated in direct response to a FoI request:
“……..if a claimant is unable to attend their WCA because Atos Healthcare are (sic) unable to comply with the request the postponement will not be attributed to the claimant.”
We will make every effort to accommodate requests for this service and hope that we will be able to meet demand. However, under the terms of our contract with the Department, we cannot postpone an assessment on the basis of audio-recording.” 
I would like to know:
1)      Who is right and who is wrong?
2)      Assuming it is Atos, who authorized this posting on their website?
3)      How quickly will it be corrected?
4)      Who will now contact any claimants who have been wrongly advised by Atos and rearrange their appointments as necessary?
I would like a clear, point by point answer.”

The reply was as follows:
“Thank you for your e-mail of 17 July. You ask for a point-by-point answer, but this may not be necessary in view of this reply, taken from the latest published guidance agreed between DWP and Atos.
We requested Atos to attempt to accommodate requests for audio recordings made in advance of the assessment. We introduced a limited facility to audio record at a time when we anticipated only small numbers of requests. Since that time, the number of requests has increased significantly and this has put pressure on Atos' ability to provide sufficient capacity to meet all requests. We have agreed with Atos that they can inform claimants when a recording cannot be made, and in these circumstances, that the WCA process should continue.
We are currently looking at ways to improve the availability of audio recording in the short term and Atos have indicated that it remains committed to assist us in the evaluation of the audio recording of Work Capability Assessments later in the year.”
My response has been:
“Thank you for your prompt reply dated 17th July - you have certainly fuelled an already raging fire in what you have said.  Perhaps you can point me to where I can find a copy of the publication you mention. 
It is of course totally wrong that claimants should be made to suffer the consequences of the appalling way in which this project has been organised and the ineffective way it is being managed now.  Atos only has 11 recording machines to service 141 MACs, so the logistical problems would be self-evident from the outset.  Add to this the fact that anything up to 10 of them have been out of commission on occasions and you have effectively removed the facility altogether.
Remember, the trial took place early last year & Atos published its report in June 2011, although you chose not to release it for 12 months whilst it was “under consideration”.  One of the obvious considerations, best in the form of a risk analysis (standard management best-practice) would have been “what if we have underestimated demand?” and you would have devised a contingency plan according.  From what you have said, the “contingency” is to refuse the facility as and when you think it appropriate on a random basis.  This of course allows Atos a free hand to refuse, whether equipment is available or not – we cannot check and you will not be policing.  You cannot possibly offer the facility to some and not to others.  You will no doubt then use this highly suppressed & distorted level of demand to support the underlying strategy, which I have to say is pretty transparent.
There has been an obvious plan in DWP to do all it can to falsely engineer down demand, so that at some stage the exercise can be deemed cost ineffective and abandoned.  It rather looks like the plan has backfired and DWP has egg on its face again.  Would you consider recording a session with your GP?  Of course not, so why then with an Atos HCP?  It is of course a simple matter of trust, confidence and integrity all of which have clearly fallen a long way short of what is acceptable.
I do not wish to question your authority, but as you have directly contradicted your FoI Act colleagues and the statement Chris Grayling made in the HoC (recorded in Hansard), how can you authenticate what you have said here?  Certainly the MP who extracted the statement from the Minister in the HoC will be interested to know that he has been lied to.  The Minister promised the facility to anyone who requests it.”
I will post the reply I receive next.

Tuesday, 17 July 2012

GPs performing WCAs - why not?

As far as I can make out, whilst DWP criticises GPs for being too soft (or inappropriately focussed etc. as they would put it), it has not stated categorically that they cannot perform a WCA – they have just not provided them with the wherewithal to follow the “process”.  I do not believe Atos has been granted absolute exclusivity.
Many GPs undertake occupational health assignments in the private sector without any additional training and the BMA actively promotes its members’ expertise in the area.  There can therefore be no question that GPs are adequately qualified.
So, as long as he follows the DWP format and produces an ESA85, why can’t my GP perform my WCA in the somewhat more relaxing environment at his own surgery?  One (minor) issue is that he does not have ready access to the LiMA computer system, but nor does an Atos HCP undertaking a home assessment, so there must be an easy answer to this problem if a system link is not possible.
I'll post the answer when I get it.

WCA Audio Recording - Take note if you intend to use.

There has been considerable prevarication by DWP and general controversy around the facility to audio record WCAs following the trial in 2011 .  Whilst there are legitimate concerns over the whole way this project has been approached (despite being a recommendation from Professor Harrington), in terms of the availability of equipment and the impact this might have on WCA scheduling, DWP has been quite clear - if a claimant wishes a WCA to be recorded, Atos must comply.  It has further stated in direct response to a FoI request:
“……..if a claimant is unable to attend their WCA because Atos Healthcare are (sic) unable to comply with the request, the postponement will not be attributed to the claimant.”
We will make every effort to accommodate requests for this service and hope that we will be able to meet demand. However, under the terms of our contract with the Department, we cannot postpone an assessment on the basis of audio-recording.”
The questions now sitting with DWP are: 
1)      Who is right and who is wrong?
2)      Assuming it is Atos, who authorised this posting on their website?
3)      How quickly will it be corrected?
4)      Who will now contact any claimants who have been wrongly advised by Atos and  rearrange their appointments as necessary?
It again appears that right hand and left hand are unconnected. 

Answer will be posted as soon as it arrives.  If you want a recording, don't be put off - insist on it.

Throughout this saga, even pre-trial, it is pretty clear DWP has not wanted to provide this facility as it could undermine their intentions with the WCA.  DWP has repeatedly emphasised how small the take-up was in the trial, but did nothing to ensure that demand levels were representative - in fact it can legitimately be accused of doing all it can to engineer the impression of low demand for the trial and since.  It is then hoping it can discontinue the facility on this (false) basis.

Enough people through appeals have shown that the Atos output from a WCA is often not just a minor error of judgement, but a deliberate attempt to misrepresent the evidence, so the audio recording facility is vital - in fact, many would argue that all WCAs should be recorded routinely rather than only on request.

True to form, DWP is treating the symptoms and doing little to address the cause, so let's keep focused on why audio recording is seen as a necessity.  By comparison, would you think about recording a session with your GP?  I doubt it.  It is simply a matter of trust, integrity and confidence.