Work Experience has a some value.

http://www.telegraph.co.uk/finance/comment/9112078/Sainsburys-chief-Justin-King-Dont-let-work-experience-debate-destroy-its-real-value.html

Trainees of any kind in the work place are often seen by junior management particularly as annoying to say the least and a huge distraction.  There is no denying that to do the training job well, it takes a considerable amount of thought and time to put a programme together that allows the trainee to get the most out of it and sadly, many can’t be bothered.

The first manifestation is usually that the trainee turns up only to find they were not expected – rarely true, more commonly the case that the person who was notified just forgot to tell anyone else.  Not off to exactly the best start and it goes slowly downhill thereafter.  Much of the day ends up being spent with a broom in hand or doing whatever task is the perennial standby – that job that does not appear in any job description or on any work plan, but nevertheless has to be done from time to time.  By comparison, shelf-filing is most certainly one notch up, but only a small notch.

I would not therefore be at all surprised to find that the employers currently being criticised for using “slave labour” did not join the scheme with exploitation in mind and have been let down by the quality of the front-line implementation.  Yes, they are required to make a profit, but the net saving here is minimal in the overall scheme of things and the risk of damage is relatively high as they are now finding out.

Atos or DWP - who is to blame???

A great deal of criticism is levelled at Atos and a good proportion of it is actually misplaced.  How many times have you seen from any level within DWP the faintest hint of criticism?  To the contrary, Chris Grayling has written personally to all Atos HCPs thanking them for their efforts.  It is perfectly clear that Atos is doing exactly what DWP wants it to do in precisely the way it has asked them to do it.

·           All of the Atos processes in and around the WCA have been signed off if not designed by DWP.

·           All of the content of the WCA has been designed and approved by DWP.

·           All of the progressive tightening and/or removal of descriptors has emanated from DWP.

·           All of the manuals and handbooks used within Atos and DWP have been designed and signed off by DWP.

·           All of the trickery contained within an assessment (the invisible wheelchair for example) is there at the behest of DWP.

·           It is DWP that misrepresents the evidence-base it claims supports may of it decisions, by portraying what is at best consultation as if it were whole-hearted support.

·           It is DWP that selectively chooses the organisations with whom it “consults”.

·           All of the changes to the appeals process to make it harder are being orchestrated by DWP.

So answering the question “What improvements should Atos make?” is not as straightforward as it seems.

One area is undoubtedly to do with the rigour with which individual HCPs perform WCAs, but be careful what you wish for.  The fact that Atos HCPs often do not follow the procedures in their WCA handbook at least provides good grounds for appeal, but conversely if they did, this opportunity would disappear.  This would then leave just the content of the WCA (its real fitness for purpose) as a generalised basis for appeal, which is a far more subjective and therefore difficult issue to address and prove one way or the other.

Another might be to ramp up the qualifications needed to perform a WCA, but there is a deeper underlying issue that determines current Government thinking.

Occupational Health is not, as some would have us believe, a radically new branch of medicine that (ironically) does not need a wealth of medical knowledge to understand.  It is in fact based on well established principles viewed from a slightly different perspective, with slightly different priorities.

The DWP theory is that as OH has only limited medical/clinical content, it does not require in depth medical training and ultimately can be distilled down into an evidence-base that can be reliably interpreted by an administrator with no medical training whatsoever.  Any similar suggestion within the NHS itself would be ridiculed – rather like my GP’s receptionist having power of veto over his recommendations.

DWP cannot however answer how on this basis, it can accurately assess factors that cannot be observed fully within a WCA, notably task repeatability over a sustained period and MOST importantly CONDITION VARIABILITY – was the day of the WCAQ a good day or bad day?  The only person who can make such an assessment is someone who fully understands the diagnosis, the treatments that have been performed, surgical remedies and the statistical range of potential outcomes, medication, side effects et., etc., etc., not to mention the complexities of mental illness - with all due respect, this needs more than a midwife or physiotherapist and a DWP administrator.

 In addition, Derby University has accredited the Atos Disability Assessment training programme, so Atos can therefore claim some legitimacy for what it is doing and even how it is doing it.  Professor Harrington as far as I am concerned is only addressing symptoms not causes and is supporting the wrong model.  It is the politicians (Tory now, Labour previously) that are driving through these ill thought through injustices, nobody else.

CG PQ reply to JD-P 22/02/2012 with a comment

Dear Ms Doyle-Price,

I am afraid I cannot let Chris Grayling’s disingenuous answer to your question pass without correction – I say this based on experience of three sub-standard Work Capability Assessments and three successful appeals.  His answer at best describes the theory, most certainly NOT the practice.  Everything I say hear, unlike most DWP claims, is genuinely evidence-based.

·     Decision Makers (DMs) often do not consider all of the information they have.  The high Tribunal decision reversal rate is attributed to the fact that they have more information than the DM.  Perhaps true in some cases, but reports produced by the Justice Dept. prove that frequently DMs do not use all they have – most certainly true in my case.  Of course, with an 8 month long Tribunal queue a lot can change, so wonder the situation moves on. 

·     DMs can request information from GPs etc. but rarely do and the response rate is around only 50%.  Needless to say DMs do not chase.  Ironic here is that having denigrated the ability of GPs to assess capability to work, they are asked just this question here.  There is no point in the GP/consultant returning anything too technical as the DM has no medical training.  One has to ask what the point is and the strong inference is that DWP plays lip-service to the process and largely disregards the results.

·    We have here an administrator in DWP supposedly evaluating complex and potentially contradictory medical information with no more than a phone call or Google to help. Mmmmmm!

·    There are aspects of what takes place in a WCA that are at best surreptitious bordering on dishonest that are NOT explained to claimants in advance.  They are therefore in no position to complete the ESA50 as comprehensively as they should.

·    Everyone talks about improvement – what has been done to date and what is imminent, but the reality is that it is all speculative.  Without doubt right-first-time decision making is the acid test and DWP

o   Has never defined an “acceptable” error rate (no process is perfect and there are a variety of techniques that allow totally objective, measurable parameter to be defined).

o   Does not know what is now or what it has been historically.

o   Has set itself no targets of what must be achieved by when.

o   Has nothing in place as we speak to monitor

There is so much more that I could explain to you about the truth of what is going on and would if the opportunity exists.  I have no particular political axe to grind – I accept the need for a WCA and even the need to move the line a bit between fit for work and not fit for work, but as I have said several times, delivery to date and the path DWP is on is unnecessarily costly and will not reach the right end point.

Welfare Reform - Overall Plan

Getting it right first time

Getting it right first time - such an obvious objective

http://www.telegraph.co.uk/news/politics/9084292/The-state-needs-to-get-it-right-first-time.html

The reason it usually doesn't is that it can’t distinguish between cause & effect or means & ends.  It therefore inevitably only ever addresses symptoms, which by their very nature reappear.  Its preferred approach to problem-solving is not to solve at source, but to create another function to put right the errors.  If it too makes mistakes, we end up with another tier and so on.  And they wonder why public sector costs are so high . . . . . .

For the #WCA, right-first-time decisions is supposedly top of the priorities but the Government has set itself no targets and does not routinely measure its performance against this obvious mark of success.  The problem of course with indisputable measures of success, is that they are also indisputable measures of failure. 

ESA Appeal Tribunal Results - Preston, Jan - Oct 2011

Only a small regional sample but in line with others showing an appeal success rate of around 35%

Outcomes of ESA & DLA appeals at Preston tribunal venue Jan-Oct 2011
	Number of cases cleared at hearing	Number of DWP decisions upheld	% upheld	Number decided in favour of appellant	% in favour	Other	% other
ESA	561	365	65%	191	34%	5	1%
DLA	267	168	63%	96	36%	3	1%

Source: http://www.theyworkforyou.com/wrans/?id=2012-02-08a.93522.h&m=40250

Mobilisation - the invisible hypothetical wheelchair

I will assume that if you are reading this you know in principle what it is about.  The WCA descriptor changes were surreptitiously introduced around March 2011 and since they came to light (they were not exactly well publicised for obvious reasons), I have been pursuing the justification and logic through a series of FoI requests to DWP.  The one I have in part reproduced here is available in full at where it can be downloaded as a zip file too.

http://www.whatdotheyknow.com/request/limited_capability_for_work_acti#incoming-253469

This extract is just my final annotation following DWP’s last “answer”.  They will say no more, so the request is closed, but I have a funny feeling this will crop up again . . . .

See also http://tia-junior.blogspot.com/2011/12/atos-hcp-or-dwp-dm-who-decides-what.html?showComment=1324999446974#c8712299517901923476 and the useful comments that have been added and for the supporting detail:

http://benefits.tcell.org.uk/forums/2011-ukut-449-aac-ce-1217-2011-whether-tribunal-right-assess-claimant-though-he-normally-used

 and

http://www.osscsc.gov.uk/Aspx/view.aspx?id=3364

Just a final annotation for anyone reading this FoI Request This is of course not the way you would like your responses summarised, but this EXACTLY your position on this matter. You state that the “Decision Makers role is only to make decisions on benefit matters, nothing else”, but at the same time they can along the way decide (despite having no medical training) that a claimant’s capability to work would be improved by being in a wheelchair.  As Iain Duncan-Smith has stated that working improves one’s overall well-being, it naturally follows that you feel that the person’s overall well-being would be enhanced by being in a wheelchair and that my GP may well have overlooked this opportunity when planning my recovery programme. Moreover, you can draw the same conclusion even though my GP has specifically advised against using a wheelchair and despite the far reaching consequences of your decision, you feel under no specific obligation to discuss it first even with me, let alone my GP. You can do this and still claim that you are not in any way interfering with my treatment, even though you may be completely contradicting my GP’s opinion.  If I follow his advice rather than yours, I immediately run the risk of removing my right to claim ESA.  If I attempt to follow your line of thinking, you will allow me no time to arrange the necessary wheelchair assessment etc.  For however long it takes me to arrange a wheelchair (assuming I pass the test), you leave me in limbo – no longer entitled to ESA and being unavailable to work, not entitled to JSA.  If I fail this assessment, you will not automatically reverse your decision and you will leave me high and dry with no ESA and no way of getting a job. You do not accept that there are any contradictions in your position and, to repeat, you can decide to do all of this without any form of medical training.

WCA Audio Recordings - Extract from WCA Handbook

Training & Development, Revised WCA Handbook,  ESA (LCW/LCWRA) Amendment Regulations 2011

MED-ESAAR2011HB~001 Version: 4 Final 4th October 2011

4.1.3 Audio and video taping of examinations

At the present time, the DWP are considering their position on the issue of audio taping of assessments following the publication of the “Harrington Report” in 2010. In this report, one of Professor Harrington’s recommendations was that there should be a pilot and evaluation involving the audio taping of assessments.   Until this evaluation has taken place and further guidance is issued, should a claimant attend the assessment requesting permission to either audio or videotape the medical assessment you should politely refuse on the following grounds:

·         The Department for Work and Pensions does not require that a medical assessment for the purpose of advising on entitlement to state sickness or disability benefits be recorded on audio or videotape.

·         Such a claimant request can only be agreed with the prior consent of the examining practitioner, and then only if stringent safeguards are in place to ensure that the recording is complete, accurate, and that the facility is available for simultaneous copies to be made available to all parties present.

The recording must be made by a professional operator, on equipment of a high standard, properly calibrated by a qualified engineer immediately prior to the recording being made.

The equipment must have facility for reproduction so that a copy of the tape can be retained by all parties

The responsibility for meeting the cost of the above requirement rests with the claimant.

Any request by a claimant for an assessment to be audio or videotaped must be declined unless the above safeguards are in place. The claimant must instead be offered the opportunity of a rescheduled assessment in the presence of a companion or other witness. If the claimant refuses to avail him/her self of this opportunity and refuses to proceed with the assessment, the practitioner should return the file to the Department for Work and Pensions with an ESA 85A min explaining the situation.

Unauthorised taping

It is for Atos Healthcare, in conjunction with their legal advisers, to determine the action to be taken in the event of a claimant making an audio or video recording without the prior knowledge and consent of the examining practitioner, or without ensuring that the safeguards defined above are in place.

4.1.4 Taking of Notes during an Examination by Claimant or Companion

From time to time you may encounter a situation where the claimant is accompanied by a companion and either the claimant or companion may wish to take notes during the assessment.   Persons who are entitled to be in attendance are always entitled to take notes. This is because it is for their own purposes and not an official record of the process.

To attempt to deny the right to do so is likely to be contrary to Human Rights legislation.

To request a copy of the notes is unlikely to be helpful – it will place you in the position where you will be obliged to review the notes and comment on their reliability.

However, you should record in the medical report, the fact that notes were being taken. The following warning should also be given and the fact documented in the report. LiMA will offer the phrases as an optional addition. For any handwritten report, on the rare occasions when this is necessary, the report should be annotated on the front cover.

The form of words you should use has been clarified on legal advice. Please replace any copies of existing desk aids you hold with the one incorporating the following form of words:

“Where notes are taken by you, we consider it of assistance to both myself, as the examining practitioner, and yourself to point out the following:

1.       It is your right to take notes for your own use and benefit.

2.       The notes will not be included in the Report I make save for the fact that notes were taken and further, they are not accepted by myself or the DWP as an official record of this examination.

3.       If the notes are subsequently produced at any time for any purpose, such as part of an appeal process, I the Examining Practitioner, my employer and the Dept of Work and Pensions reserve all rights to challenge anything in the notes in the event we are asked to comment on the content of the notes at a future time.

4.       You are free to use your notes as you choose but if you chose to publicise the notes (other than in connection with correspondence with the DWP or under any appeal procedure) I would ask that you do not publicise my name. “