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Thursday, 25 October 2012

We don't know (care) how many people have died

“Tom Greatrex: To ask the Secretary of State for Work and Pensions pursuant to the answer of 27 June 2012, Official Report, column 1098W, on work capability assessment: appeals, how many people found fit for work under the work capability assessment have subsequently died within (a) three, (b) six and (c) 12 months of the assessment decision in (i) Scotland and (ii) the UK. [122403]
Mr Hoban: The information requested is not available.  Data on the number of ESA claimants that have died following a Fit for Work decision are not available, as the Department does not hold information on a death if the person has already left benefit.”


One would have thought that prior to the WCA implementation a full risk assessment would have been undertaken and likewise for every major change to it since.  It was not.  There have been odd RAs since in odd areas, but they have all (deliberately?) omitted the greatest risk of all.  Risk assessment and impact analysis sit side by side and one is looking for combinations of risk & impact that are high – they do not both individually need to be high. 
Amongst a variety of risks is the obvious risk of getting an assessment wrong (it will never be 100% accurate).  However small the risk was perceived to be, the subsequent impact could be momentous – someone dies, so on any scale using any criteria or any management philosophy this possibility would appear high on the risk management matrix.  The only theoretical situation where is would not be the case is where the risk of a wrong assessment could be genuinely judged as zero.
Having comprehensively assessed the risk, good management practice would then evolve a plan to mitigate it, both in the sense of minimising both parameters ongoing, together with a contingency plan to ensure ‘failures’ are dealt with effectively.  To do this one does of course need the appropriate information, most particularly the feedback on ‘failures’, so that causes can be identified and the process adapted to avoid repetition.  This is simply learning from one’s mistakes which is apparently a cornerstone philosophy of both the DWP service charter and the Civil Service Code.  In the private sector, this approach is regularly taken when there is just a few quid at stake let alone lives.
However, not necessary here it seems.  A person dying is bad enough, but the Government’s demonstrable lack of concern or interest is the real indictment and undoubtedly an unforgivable dereliction of duty.  This is what they must answer for.

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.

Wednesday, 10 October 2012

The Misnomers around Evidence Evaluation within Decision Making

Government Ministers and DWP frequently talk about Decision Makers (DMs) applying weightings to each piece of evidence they have to derive their conclusion.  This sound very scientific and objective, so it is worth understanding quite how it works and in particular:
1)      On a case by case basis, how does a DM appropriately weight each of the pieces of information in front of him/her, particularly as the nature and amount of it will vary?
2)      Are the weighting decided upon recorded for audit/Quality checking purposes case by case?
3)      Are the weightings “fixed” for a given assortment of information – e.g. for all cases where only the ESA50 & ESA85 are available, will the respective weightings always be the same across ALL DMs? If not, what features of either/both could bring about variations in weightings?
Through FoI requests, it appears there is no information covering any of these questions, so something is clearly not right.  It boils down again to “spin” and using words that exaggerate the reality of what is taking place.  A prime example is over Atos’s “Mystery Shopping” activities which are no longer a mystery and little more than an admin check – there is certainly no intention to simulate a claimant’s experience.
Here there is what you might generously regard as confusion, not so generously a deliberate attempt to mislead. There is a big difference between:

1)        Weighing up the evidence – applying judgement to the significance and credibility of each piece of evidence to form an overall view, which by definition is subjective and difficult to audit and replicate.
2)        Weighting the evidence – attaching a numerical value to each piece of evidence representing its importance and credibility with a formula to aggregate into a final decision. With sufficiently detailed guidelines this is much more objective, auditable and reproducible.
In the absence of the information to support the existence of b), the methodology employed is obviously a). This would explain the high appeal rate and large number of decisions reversed at tribunal.

In addition, a number of worrying admissions arose:
1)        DWP will retrospectively under the guise of “clarification” provide Atos with the opportunity to amend a report. This would partly explain why claimants say there are parts of the ESA85 they cannot recall or recall differently. No such opportunity is afforded to the claimant.
2)        There is no audit trail for the decision made – i.e. no record of the weightings attached to each piece of evidence and how they were derived to reach a decision.
3)        There is a requirement to assess a “customer’s needs” (DWP’s words), which given the high rate of appeal cannot be regarded as successful.

There is nothing here that will directly help with preparing for and getting through a WCA, but you are hopefully now more aware of what really goes on in the background and better able to understand why the result was not as you expected.