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Thursday, 11 October 2012

Underhand wheelchair assessment by untrained staff

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A recent FoI request exchange with DWP:

Question:
The WCA Handbook consistently instructs HCPs to use an evidence-based approach, not to leave anything to chance and avoid ambiguity. This is obviously important to a DWP DM who has no formal medical training.

However, in complete contradiction of this basic principle, HCPs are allowed to speculate over ways in which an individual’s mobility might be improved by the use of mobility aids, even though the individual may not have used them before and the individual’s GP has specifically advised against them. P 26 of the WCA Handbook
(
http://www.dwp.gov.uk/docs/wca-handbook....) states:

a)        “......... the HCP should consider whether a person could potentially use a wheelchair regardless of whether or not they have ever used a wheelchair. In considering this issue, as above, upper limb function and cardio respiratory status must be taken into account.” and
b)         “A manual wheelchair may be considered any form of wheelchair that is not electrically driven.”

Note the use of the word “potentially”, i.e. they do not need to make a definite recommendation, just suggest there is a possibility without even having to qualify it with “good”, “slight” etc.

If the HCP is of this opinion:

1) Are they required to discuss the proposition openly with the individual during the WCA to make sure nothing relevant is overlooked?

2) Are they required to state the recommendation clearly on the ESA85? Not being medically trained, it would of course not be possible to leave a DWP DM to draw their own conclusion.

3) What (if any) limitations are there on the aids they can consider – specifically, could they consider a powered mobility scooter? If not, why not?

4) If there are limitations, on what are they based? If there are no limitations and individual HCPs can act as they see fit, how do you ensure fairness & consistency?

5) Assessing a patient’s need and suitability for a wheelchair is in itself a highly technical and complex issue requiring specific education and training. (See for example
http://healthcare.remploy.co.uk/_assets/.... Furthermore, the NHS
website (
http://www.nhs.uk/NHSEngland/AboutNHSser...) states: “The people who assess you (for wheelchair use) will all be health professionals, such as GPs, occupational therapists or physiotherapists, and should include a "rehabilitation engineer" (someone who specialises in wheelchairs and seating). There is no one-size-fits-all policy, which means you will be assessed according to your individual needs. The assessment should take into account your physical and social needs, as well as the environment in which you live and work.”

6) Are all HCPs performing WCAs fully qualified to consider all of these factors relevant to wheelchair use, notably rehabilitation engineering, before making their recommendation? If they are so qualified, why can’t they make the recommendation openly in the best interests of the patient?

Finally,
7) Can a DWP DM decide to award zero points for the mobility descriptor based on what might only be a remote and unproven possibility?

8) What steps must the DM take to eliminate the uncertainty left by the Atos DM?

Please note that none of this information is contained within the WCA handbook.

DWP Response
“The role of the FoI Act is about the supply of recorded information held by the Department
rather than providing an explanation to, or confirming whether the assumptions made by the author of the questions are correct or not.” – not exactly helpful

Reply/
conclusion
We have a document (the WCA Handbook) written by Atos approved by DWP that instructs HCPs to undertake what amounts to a wheelchair assessment
·      knowing they are not adequately trained.
·      without providing the support stipulated for this assessment
·      surreptitiously, without discussion with the claimant
·      potentially without all of the relevant information available.

This is followed by a DWP decision making process that can reach a conclusion that uses this assessment again without any prior discussion with the claimant or consideration of the consequences.  It does not even declare what it has done, let alone provide the claimant with any help in pursuing the proposal. The ultimate dishonest insult is that Atos/DWP then admit that they are not able to prescribe treatment and deny that they have stated that a wheelchair would be in the person’s best interests when this is EXACTLY what they have done – they have categorically said that the person’s ability to get a job is better with a wheelchair than without one.

Despite the significance of this conclusion there is no other information available within Atos or DWP that explains this series of contradictions or indicates it has ever been considered. This is clearly either a serious dereliction of duty, or a deliberate deception.

It is quite clear what I am trying to establish here and in the light of your response, I would remind you of certain features of FoI legislation as described on the ICO website:

·      “The main principle behind freedom of information legislation is that people have a right to know about the activities of public authorities, unless there is a good reason for them not to. This is sometimes described as a presumption or assumption in favour of disclosure.”
·      “The Act covers all recorded information held by a public authority. It is not limited to official documents and it covers, for example, drafts, emails, notes, recordings of telephone
conversations and CCTV recordings.”
·      “FOIA applies to official information held in private email accounts (and other media formats) when held on behalf of the public authority”
·      Your obligation under the Act to “publish certain information proactively”.
·      The principle of “voluntarily giving information . . . . . outside the provisions of the Act”
·      "Public authorities should be flexible in offering advice and assistance most appropriate to the circumstances of the applicant. “

As you can see, you are required to do somewhat more than rebuff a request just because it is awkward to answer, although in doing so, you do of course send a very clear message – we (DWP) know what we are doing isn’t right, but we are going to carry on doing it anyway even though it cheats some people out of their legitimate entitlement to ESA.

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