The whole ESA, WCA, DWP, JCPlus, Atos Healthcare debacle. You couldn't make it up! As with other parts of the public sector, you don't know what really goes on until you see it first hand.
Showing posts with label JCPlus. Show all posts
Showing posts with label JCPlus. Show all posts
Tuesday, 19 August 2014
ID-S Deception - only telling half of the story
Ian Duncan-Smith regularly claims to have overwhelming public support for his welfare reforms, which might well be true, but if it is these opinions have not been based on the full story. So of course you will elicit support if you just ask the following questions:
Q: Do you want to reduce the overall cost of benefit payments through improved efficiency?
A: Damned right I do.
Q: Do you want to focus on those with the greatest need?
A: Yes, they deserve it
Q: Do you want to stop benefit fraud?
A: As quickly as possible.
Q: Do you want to wheedle out those lazy so-and-sos who just don’t want to work?
A: Yes, it’s high time they pulled their weight.
Q: Do you want to see more efficient DWP administration?
A: What do you think?
Q: Well we have a plan that will do all of this, so do you want us to implement it?
A: With all possible speed!
But there will be consequences, which even if not thought through initially, are more than apparent now. So an open & honest supplement to the above would be:
Well, unfortunately the plan is a bit rough and ready so,
Q: Are you happy that we will make tens of thousands of decision errors and stop benefit payments whilst they are sorted out by HMCTS at huge cost to the taxpayer? This will create many months of financial hardship for those affected.
A: Hang on a minute; I don’t like the sound of this.
Q: Do you mind that in thousands of cases these errors will directly result in people’s health deteriorating and quite a few will die.
A: In that case, no sorry the plan is not good enough – think again!
I wonder how much of the support would fall away if he just told the whole story and made it clear what “price” he regards as acceptable – just how many deaths does would it take for him to change his approach? He really should be made to address this matter or state clearly that he thinks it is irrelevant. The end DOES NOT always justify the means.
Wednesday, 29 May 2013
The New Cost Effective Descriptors & "Remote Assessment"
The New Cost Effective Descriptors & "Remote Assessment"
Is has long been said that merely being able to get to a Medical Assessment Centre for a WCA indicates to Atos & DWP that one is fit to work. Although initially a somewhat cynical view, it has turned out to be far closer to the reality than I suspect whoever first coined the phrase imagined.
Little has changed since other than DWP has admitted to other “rules of thumb” that it feels are equally soundly based and provide a similarly reliable indication. These RAs (Remote Assessments) are of course highly cost effective and can be undertaken without any training whatsoever. They also have the distinct advantage of never having to meet the ‘customer’ who is simply a distraction and can adversely affect progress towards DWP’s organisational goals.
The accuracy rate however has not been tested, but this is probably unnecessary as even under the present methodology no attempt has been made to measure the right-first-time decision rate, so clearly it is not regarded as a KPI (Key Performance Indicator). As cost is evidently not an issue either, erroneous RAs can be corrected (as now) through the appeals procedure.
The RA criteria already implemented are as follows, others will no doubt be added as times goes on.
1) Eloquence (the ability to speak forcefully, expressively, and persuasively)
Although this is usually a function of one’s education and/or experience and is therefore accumulated over very many years, display too much of it and it will regarded as synonymous with good health. DWP finds this characteristic unsettling as it can undermine its intentions, challenge its philosophy and present information in such a way that it cannot be contested. It would be interesting to know how Stephen Hawking would fare.
Although none of the forms directly associated with ESA ask for exam results, claimant’s would be well advised to down-play their abilities in this area by using small words and short sentences, with little punctuation and the odd glaring spelling mistake. Expletives are unnecessary and should always be avoided.
DWP will deduce that a claimant has this skill if it receives any form of electronic communication and again if a claimant used this technology it will be assumed they able to hold down a job. It will not consider perfectly feasible, alternative scenarios, for example the email/letter has been typed or even composed by another person.
Advice to claimants is therefore to handwrite all communication and send by conventional post. This has the added advantage of being able to make it illegible which can be used to further demonstrate a lack of eloquence (see 1) above). If at all possible, have the letter written by a young child.
3) Prolificacy (producing ideas or works frequently and in large quantities)
DWP does not like lots of communication even though it may be the direct result of its own ambiguity and general lack of clarity in some areas. In keeping with this principle, DWP has of course not provided any figures for what level of communication it regards as normal or excessive – one a day? one a week? – who knows?
There is a similar risk if letters are too long, even if justifiably so. Unfortunately as DWP has not documented any of these processes, data is scarce and it is not possible to say categorically that fewer longer letters are better than a larger number of shorter letters, but the former appears to produce less of a reaction.
Although too late, claimants will often find out when they have stepped over this invisible line by being classified as “unreasonably persistent”. This classification is not embodied in any legislation, is unilaterally determined (by DWP itself) and has no appeals process. Nor is it in any way time limited and there is no process for having the determination reassessed and potentially reversed even after a period of “acceptable” behaviour, so potentially it lasts forever. There is a documented process, but it is not policed and compliance is optional. There are no repercussions for staff who deviate from it.
4) Persistence (the quality of continuing steadily despite problems or difficulties)
In society generally, this is normally regarded as an desirable and admirable trait, but not in DWP as it can quickly become a nuisance, particularly when combined with 1) above. This frequently presents claimants with a difficult dilemma when the information provided by DWP is not what was requested – do they: a) pretend it is and get by without what was needed or b) try again and risk being tagged as persistence (note within DWP persistence is by definition unreasonable). As with 3), DWP makes no allowance for the fact that it has overtly side-stepped the original question (perhaps on more than one occasion) and insists that it has answered it when it has not.
Being labelled as unreasonably persistent does have one particular consequence in the acronym SPOC. No, this is not the involvement of a half human, half Vulcan mind reading arbiter – it is a Single Point Of Contact in DWP through which all communication is channelled in both directions. Any communication sent almost anywhere within DWP will be forwarded to this one person to answer on behalf of the intended recipient. On a positive note, it can be regarded as a level of personal service unavailable elsewhere within the entire DWP hierarchy, but it is at liberty to “not comment” on any matter it chooses.
It is also worth noting that combinations of these characteristics can in DWP’s opinion justify legal action against the claimant although it cannot identify the laws that are being broken. In the same way that it has its own dictionary covering the use of certain words, DWP cannot always differentiate between policy & legislation and feels it has almost unlimited authority to do pretty much as it wishes. This is of course not the case and its employees collectively and individually as well as the Ministers/Secretaries of State have no more rights in common law than any other individual in the country.
It is worth remembering that DWP Decision Makers are encouraged to be imaginative & proactive when interpreting the information they have to make an ESA decision. They are able to make largely uncontrolled use of the internet, without tight controls on the websites they visit to ensure the information they extract is authentic. They can also develop their own personal RAs based on their individual beliefs again without any form of supporting evidence – e.g. being able to steer a car = being able to self-propel a manual wheelchair, rendering the entire wheelchair assessment procedure used within the NHS redundant [another huge cost saving!].
Note finally that according to DWP, regarding decisions that are subsequently changed as errors is not the right perspective as ALL decisions accurately reflect a Decision Maker's opinion at the time which makes them "right". Any subsequent adjustment simply reflects another person's opinion - it does NOT mean the first decision was wrong. This of course explains why real progress has been so slow.
Anon
Sunday, 11 November 2012
FROM THE Atos NEWS DESK
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Additional Information
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Atos Healthcare: What to expect from your Work Capability Assessment
Oct 08, 2012 17:05 BST
We know that if you have a face to face Work Capability Assessment (WCA) coming up you are likely to have lots of questions about the process. One of the most common questions is “what is the assessment like?”
This blog post aims to give you an idea of what to expect from your WCA.
Before the assessment
The health care professional you meet at your face to face assessment will always have prepared by looking through your file to ensure they’re familiar with all the details you’ve provided so far on your medical condition(s). This includes your completed ESA50 questionnaire, which you’ll have filled out and returned before the assessment, as well any further medical evidence, like a letter you’ve submitted from your GP for example.
Indeed they should do this, but don’t always bother. Take copies of everything you have submitted to the assessment and confirm item by item that they have read everything – make them say yes or no to each rather than sidestep the question.
Surprisingly, the fact that you might want the WCA audio recorded is not mentioned at all here. Best to ask for it in advance to give Atos time to arrange. If they will not, there are various options open to you to ensure you end up with an accurate record of what took place.
During the assessment
There are a number of different elements to the WCA. Unlike previous conversations you may have had with your GP and others which were focused on diagnosing and treating your condition(s), all elements of the WCA are about understanding how your condition(s) affect your day to day life.
How relevant this is to the practicalities of holding down a job is a source of great debate. The other difference is that it is safe to assume that whatever your GP recommends has been considered with your best interests at heart. Not so here. If the assessor thinks you can do odd jobs to look after yourself, you will almost certainly be declared fit for work. It has even been (cynically) suggested that the mere fact you have been able to get to an Assessment Centre means you must be fit for work.
1. Meeting your assessor and an introduction to the process
The health care professional who’ll be carrying out your assessment will meet you in the waiting room and accompany you to the assessment room. There, the first thing he or she will do is explain what’ll happen during the assessment, and what each section is for.
Not so. The assessment starts from the moment you enter the Centre. In fact the HCP is told to walk behind you so they can observe your mobility. You will need to be on your guard throughout.
They’ll also explain about the report they need to fill in during the assessment with your help and what information they’ll be gathering.
Not completely true. The HCP will be making assumptions about your capabilities well beyond what they will discuss with you without any scientifically supported evidence whatsoever. A trip to the supermarket means that you can walk at least 800 meters unaided. Also, your mobility assessment will be made by considering if you would be better off in a wheelchair even if you do not normally use one and even if your GP has specifically advised against it. Although formal Wheelchair Assessment is a medical discipline in its own right, the short cut taken here will not be openly discussed with you and may not be explicit in the final report either. If this judgement is made, you will not be given any help over what to do next, but if you pursue obtaining a wheelchair through the NHS, you will need a referral from your GP (if they agree with the principle), you will have to wait a while for an appointment and then of course you may fail the assessment.
This does mean that they’ll need to be typing as you talk during parts of the assessment, to make sure they don’t miss anything and that they’re making an accurate record of the information you’re providing. They’ll also explain what happens after the assessment.
Make sure the HCP acknowledges everything you say - if they look preoccupied or inattentive, say it again. Do not become pressured or rushed.
You’ll have a chance to ask any questions you might have at this point, and you’ll also be encouraged to ask any questions you have or raise any concerns as you go. It’s your assessment so the health care professional will do everything they can to make you feel at ease.
I have had three and this was not the case in any of them. You may be luckier.
2. Discussing your medical condition(s)
The health care professional will then ask you about your medical condition(s). A lot of this may be information you’ve already included in the ESA50 questionnaire you’ve filled in, but this will be a chance to talk about what may have changed since you completed the questionnaire.
They’ll ask questions to understand your current symptoms and how frequently you experience these. They’ll also ask about any medication you’re taking and any side effects you’re experiencing.
Be very clear about all of this. Your HCP may not be as fully trained as your GP and will not be as expert as your consultant (if you are under one) and so may not appreciate all of the aspects of your condition, although they may give the impression they are.
Next they’ll move on to chatting about your situation at home, such as who you live with and any accessibility issues you might have, like going up and down stairs. They’ll also be keen to hear about any work you’ve done in the past or are currently doing, and any difficulties you’ve experienced while doing them.
Again, be on your guard as seemingly innocent and incidental questions may be interpreted with a very precise meaning that may or may not be applicable to you.
3. The ‘typical day’ assessment
This is the main part of the assessment and will be the element the health care professional spends the most time on. They’ll ask you to talk about your daily routine in detail – what you can and can’t do due to your health problems, or what you struggle to do. This allows them to get a good understanding of your daily routine and how your condition affects you.
Many people have two typical days – a typically good day and a typically bad day, so make any variability in your condition VERY clear.
During this part of the assessment the health care professional may ask you some quite detailed questions about your daily life that you may not have been asked before by other health care professionals. This is so they can make the most accurate assessment of the impact of your condition and they’ll always be happy to explain why they’re asking if you have any concerns.
You constantly have to be alert to the underhand techniques being used so always ask why a question is relevant and what interpretation will be placed on the answer you give.
4. The physical examination
Depending on the nature of your condition, you might then be asked for your permission to carry out a physical examination. This is a simple and not at all intensive examination – it’s not meant to make a diagnosis but instead to look at how your condition affects you physically. At most you might be asked to remove outer clothing layers, but nothing else.
This examination isn’t like one you might have had at the GP where the doctor would have physically manipulated your joints for example. Here, the health care professional will ask you to control all of your movements yourself so you don’t exceed your limits or cause yourself pain.
This is the first reference to pain, so make the levels of pain you experience very clear and how you manage it. There is an assumption that drugs can remove pain and if you do not take enough, the pain cannot be that bad. Be very clear over side effects and remember that the long term effects of medication will be downplayed.
He or she may also carry out hearing, heart, breathing or sight tests depending on your condition. You won’t be forced to do anything that causes you pain and if you do feel uncomfortable you should tell the health care professional.
5. Summing up the process
Finally, the health care professional will explain again what happens next, and that you’ll be hearing directly from a Decision Maker at the Department for Work and Pensions (DWP) about the outcome of your claim. You’ll then be given another opportunity to ask questions or raise any concerns – the health care professional will be keen to make sure you don’t leave the assessment with any worries or unanswered questions. Once any queries you’ve raised are answered that’ll be the end of the assessment, and the health care professional will take you back to the assessment centre reception.
Always worth asking the HCP for their initial thoughts on your capability to work or otherwise, but unlikely you will receive a straight answer. The DWP Decision Maker may technically decide if you are to receive ESA or not, but as the medical expert is the only one is qualified to comment on your fitness to work, they must have an opinion.
After the assessment
Once you’ve left, the health care professional will fill in the rest of your report. They’ll do so straight after the assessment to make sure all the information is completely accurate, then send it, along with any other medical information you’ve provided, straight onto the DWP where a decision will be made about your claim.
We hope that this was useful. If you have any other questions, take a look at the FAQ section of our site, which has lots of useful information about all aspects of the assessment process.
How the Atos Healthcare health care professional assesses capability
Oct 30, 2012 17:13 GMT
Illnesses and disabilities affect people in different ways, and to different degrees, which is why the focus of the Work Capability Assessment is on capability, rather than diagnosis. Atos Healthcare health care professionals do not diagnose conditions or offer advice on their treatment, but review the information available about what each person is able to do.
This is not true. In deciding you are fit to work in the absence of the specific agreement of your GP, the HCP is affecting your treatment programme and they cannot say otherwise.
This emphasis on capability rather than diagnosis is a misnomer. The HCP sees you once and so cannot possibly see all of the variability that may exist with your condition. They can therefore only go by what you say and can only assess it objectively if they are familiar with the condition itself and its typical symptoms. Diluting the relevance of diagnostic and clinical knowledge is however necessary to allow the use predominantly of nurses and physiotherapists.
The aim of the Work Capability Assessment (WCA) is to assess the effects of an individual’s health condition or disability on their ability to carry out a range of everyday activities.
Note the careful avoidance of the word “work”. Note too that there is no definition of the word “work” as if it exists in only one generalised form. So you are been assessed to perform something that is not defined.
This includes areas of functional capacity such as mobilising, standing and sitting, learning tasks and awareness of hazards which are relevant to work. Illnesses and disabilities affect people in different ways, and to different degrees, which is why the focus of the assessment is on capability, rather than diagnosis. Our health care professionals do not diagnose conditions or offer advice on their treatment, but review the information available about what each person is able to do. This information may come from the claimant, as part of the questionnaire that is completed, or through discussion at a face to face assessment. It may also come from the claimant’s treating health care professional.
Note the surreptitious approach taken as described above – take nothing for granted and do not assume you will be given any benefit of the doubt. Note too that Atos has decided that bending and kneeling is no longer necessary in any job these days so your ability to do either/both is not even tested.
All of the people we employ to carry out WCA assessments are trained, fully registered doctors, nurses or physiotherapists.
In theory yes, but there is no foolproof system place to make sure that registration is ALWAYS up to date.
In addition to their existing clinical expertise, they have all received specific training to become disability analysts, to provide WCAs in accordance with Employment and Support Allowance (ESA) legislation. Following training, each healthcare professional must demonstrate their competency to the Department for Work and Pensions before gaining their approval to produce WCA reports.
Atos Healthcare: All about your Work Capability Assessment report
Oct 03, 2012 15:31 BST
Most people applying for Employment and Support Allowance (ESA) will need to attend a face-to face assessment – the Work Capability Assessment or WCA – with a trained Atos Healthcare professional.
If you are asked to attend a face-to-face assessment, the healthcare professional you see will fill out an assessment report setting out the details of your condition(s) and how it affects you.
This blog post provides further information on the report and how it’s used.
What is your assessment report?
The report is split into two halves. The first part will be completed by the healthcare professional whilst you are talking together. It will include information about all the conditions you’ve been diagnosed with, how you feel these affect you and details of what you do in a typical day. They will take account of symptoms that are not the same every day. The report will also cover what medication you’re on and any side effects you may be experiencing from that, as well as noting any findings from the simple physical examination that may be required in some cases. You will notice the healthcare professional is noting this information as you talk together to make sure the report is accurate.
When your assessment itself is over, the healthcare professional continues to work on the second half of the report. Here, the healthcare professional will set out their view of how you’re affected by your condition(s), using all the information from your conversation with them as well as any other medical information present. They will base their assessment on a set of criteria known as “functional descriptors” – actions and capabilities that may be affected by your condition. These “descriptors” take account of physical, sensory and mental health problems. The healthcare professional must use these criteria as they have been defined by the DWP within the legislation relating to ESA. The healthcare professional will summarise the information present.
We then send the report, along with any other information you’ve provided, such as further medical evidence, to the DWP. A Decision Maker at the DWP will then use all of this, and any other information they have, to make a decision on your claim.
The healthcare professional that carries out your WCA doesn’t make any decision about your benefit entitlement, and won’t know the outcome of your claim.
So if they get it wrong they will be none the wiser and will make the same mistakes over and over again.
How can you get hold of a copy?
You’re entitled to see a copy of your assessment report. If you’d like to get a copy, you just need to get in touch with the Jobcentre Plus office that is dealing with your claim.
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]
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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:
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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
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“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
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Reply/
conclusion
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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. |
Saturday, 8 September 2012
WCA - A call for evidence - Year 3 Independent Review
The Work Capability Assessment – A Call for Evidence: Year 3 Independent Review – Questions
Question 1
a) Have you had more than one WCA?
YES
b) Was your most recent WCA:
(Please select only one)
· A repeat (second or third) WCA having already been awarded Employment and Support Allowance?
If you answered YES to Question 1a), please go to Question 2
If you answered NO to Question 1a), please go to Question 9
Question 2
Please tell us where you live in Great Britain
(Please select only one)
5. Midlands
Question 3
Were you assessed for:
(Please select only one)
2. A physical health condition or disability
Question 4
What was the outcome of your award?
1. Found fit for work (for the 3rd consecutive time)
Question 5 (communications)
a) Thinking about the start of your claim, were there any changes in the telephone contact between you and DWP between your first and your most recent WCA?
(Please select only one)
· There was no change – equally disinterested.
b) Between your first and your last WCA, did you notice any changes to the written communications which DWP sent you?
(Please select only one)
· There was no change – certainly not of any consequence.
c) The ESA 50 form has been amended; please can you tell us if you think:
(Please select only one)
· It was not as good. Changes to descriptors were completely unjustified and were simply intended to cut points.
Please use this space to tell us anything that is relevant to communications during the WCA process
Frankly dreadful. The DWP notification that my ESA had been stopped was slow coming and arrived AFTER I had obtained a copy of the ESA85, so I knew what was coming. It effectively stopped my ESA retrospectively – i.e. 3 weeks before the date of the notification.
There was no phone call to explain the decision at any point and I had to chase DWP around to find out what was going on. They admitted receiving but completely ignoring the detailed letter of complaint I had sent to Atos when making their decision. It was only through pressing during these phone calls that I unearthed the “hypothetical wheelchair” deception used to assess mobility and the inconsistencies around it. I was and still am staggered that this trick is deemed acceptable.
Question 6 (face to face assessment)
a) Was there a notable difference between your first and your most recent face to face assessment?
· First was better – still not good, but better than the two that followed, primarily because it was a doctor not a nurse.
Please use the space below us to tell us anything else that you think is relevant to the face to face assessment
For my last WCA, the HCP could not have been less interested. She made not note of the information I had taken with me, had clearly not completed the file-work thoroughly and was not at all conversant with the consequences of my condition & treatment.
Through minimal research it became apparent that this was not her main source of income, which perfectly explained her overall approach and attitude.
She made no attempt to follow even the most basic instructions in the WCA handbook.
Question 7 (decision making)
a) Since your last WCA, did you notice a difference in the way in which the outcome of your WCA was communicated to you by a decision maker?
(Please select only one)
· It was not as good. Although the message was broadly the same, DWP staff were far more aggressive and dismissive in dealing with my challenges.
b) If you provided additional evidence in support of your claim (e.g. from a GP, consultant or support worker), was this evidence taken fully into account by the decision maker?
(Please select only one)
· Evidence was supplied but not reconsidered. She ignored it completely and did not even record that I had brought it with me.
Please use the space below us to tell us anything else that you think is relevant to the decision making process
See below. You have to start by working out what the REAL decision points are and who is best qualified to make them.
There is not one single area where DWP claims to have made improvements that they can support with any hard evidence whatsoever – it is all just intuitively wishful thinking.
Question 8 (Organisations) – N/A
This section should only be completed if you are responding on behalf of an organisation. The call for evidence has been designed specifically with the experiences of the claimant in mind but the Department is aware that organisations may also want to contribute to the call for evidence. Please use this section to comment on the experiences that people you represent have been experiencing since the introduction of Professor Harrington’s recommendations. You are asked to describe each part of the process, using bullet points to summarise the individual parts of the process. Any further evidence should be given at question 11.
Communications
Face to face assessment
Decision Making
Fairness and Effectiveness
Question 9
Overall, how fair do you feel that the assessment was?
The latest was totally unfair as shown by a successful appeal, now three times over. They did not even take the trouble to check my WCA case history and learn from previous mistakes.
Question 10
Overall, how effective do you feel that the process was?
Totally ineffective. Setting aside whether or not the WCA is fit for purpose, it application and control is poor, which is why there are so many mistakes. Everyone talks about right-first-time decisions, but nobody troubles to measure it – ridiculous. HCPs don’t follow the handbook. Atos managers/auditors are unable/unwilling to see when this is the case.
Looking forwards
Question 11
What one thing (if any) would you change about the WCA to make the system better for people claiming ESA ?
You have to look at a person’s ability to survive in employment and hold down a job, NOT just their ability to do random pieces of work. All employers depend on staff reliability and this is precisely the thing that many disabled people struggle to guarantee. The concept of “general work” is meaningless. Change the name WCA to J(ob)CA.
Please use the space below to give us your comments.
Question 12
Is there anything else, relevant to the WCA, that you would like to tell us about?
Please use the space below to give us your comments.
Much of this is simply good management practice.
· If GPs haven’t provided quite the right perspective on capability to work, retrain/re-educate them so they do, don’t take it out of their hands altogether, if only on the grounds of cost. What better place could there be to conduct my assessment than at my GP’s practice – he has EVERYTHING to hand – even a second opinion if he needs it. 10,000 practices, 40,000 GPs – you do the math – a handful of WCAs per week on average: Barely noticeable in relation to workload.
· DWP should at least be open and honest with claimants. Their whole approach is born out of the belief that we are all benefit scroungers and are intent on fraudulently obtaining money. They therefore have to employ a variety of underhand tricks and subterfuge to establish the ”truth” – or the truth as they would like it to be. The hypothetical wheelchair scenario when assessing mobility is shameful.
1. All claimants are on the fiddle and this one knows they have just been found out
or,
2. This claimant knows the assessment is wrong and they will now have their benefit stopped and will have to fight for a year to get it back.
DWP would hardly promote its own errors, so option 1 here is the logical interpretation
The fact that I occasionally visit a supermarket does NOT prove I can repeatedly walk 800m and the fact I can drive for 15 mins does NOT mean I can propel a wheelchair. They suggest that there is scientific evidence to support both propositions, but this is a lie.
· Why on earth does nobody measure the right-first-time rate when it is by a long way the most important performance measure? What would you prefer – a wrong decision communicated sensitively, or a right decision communicated a bit abruptly? It’s all about priorities! The old cliché “if you don’t measure it, you can’t manage it” is true.
There are standard statistical techniques to measure the success of any discrimination process, most of which have a valuable place here with the WCA. It is a long way from rocket science – just good management practice.
· What is regarded as an acceptable error rate – 1 in 10? 1 in 100? We need to know and agree what we are aiming for. Until we do, we cannot be sure that current process is capable of delivering it and even if we do, we’ll never know and there is no point in continuing to seek something that is unattainable.
· You cannot proactively manage anything if you have to wait 9 months to be sure your data is correct. Quickly get the Tribunal queue down to see more clearly where the problems are and be in a position to act quickly and see the results of any changes quickly.
· The Paralympics recognises that in many cases sports have to be modified or indeed created to allow disabled people give of their best. What’s so different about the job market? We must place the horse before the cart – be sure that suitable jobs are available first.
· If DWP can legitimately countermand my GP’s recommendation it MUSTR accept full responsibility for my health and well-being thereafter, which includes the consequences of a wrong decision whatever they might be. Authority without corresponding accountability is a well know recipe for disaster.
· DWP’s standards of integrity can be demonstrated by its approach to the audio recording trial. Never have I seen such a poorly managed project progresses under such obvious sufferance. Clearly DWP doesn’t want it and has been doing its level best to scupper the idea since ‘Day 1’. The present tactic it to deliberately suppress demand so that it can kick the idea out on the basis that there isn’t any and the whole thing is not cost effective. Even Atos could see the reality, but let’s not forget that this need is a result of justifiable mistrust which needs to be eliminated NOT accommodated.
· Where is the original risk analysis – the one that examined in detail the potential consequences of making wrong decisions? There is not one – again shameful. The ends DO NOT always justify the means and the level of collateral damage we have seen is simply not acceptable – people have died. Imagine the outcry if the same cavalier approach was taken in the justice system – the huge downside risk is the very reason we do not have capital punishment – we do not say that killing the odd person wrongly is the price one has to pay . . . .
The best processes achieve consensus early on, so everyone has the same objective thereafter. Being borne out of mistrust, the current WCA process is highly adversarial which inevitably generates conflict, misunderstandings, errors and cost. It the HCP has done a fair and thorough job and can genuinely say that their recommendation is in my best interests, why can’t we discuss the result BEFORE I leave and sign it off? Of course not as easy as it sounds, but worth thinking about.
Any suggestion that it is not in my best interest raises a whole host of questions . . . . .
· The confusion over quite who can & should do what between an Atos HCP & DWP DM in itself causes errors through confusion. The DM decides if I am to receive ESA or not – on the surface purely an administrative decision. But, it is a direct result of me being deemed fit for work or not, so who makes that decision? It can’t be the DM as the DM has no medical training and the assessment is largely medically based. It can’t be the HCP otherwise they are in reality determining my benefit entitlement. So who? The current attempt at job definitions fudges the issue and creates a DM role that is not really necessary if you have trust and confidence in the HCP – easier if they are public rather than private sector employed. Sadly, in 2008 we through the baby out with the bathwater.
· Outsourcing is hardly a new commercial concept, but DWP does not yet understand that whilst you can outsource the service itself, you cannot outsource or side-step the accountability for successful delivery. It cannot even guarantee that at the time of a WCA the Atos HCP’s qualifications are wholly up to date, despite stating that this is an absolute prerequisite for approval.
There are many other side issues too numerous to list here. Everything I have said is (unlike the equivalent DWP claim) genuinely evidence-based, largely through the use of FoI requests. What DWP cannot say is often as revealing as its confessions.
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