A fairly innocuous parliamentary question to Chris Grayling, brings an important issue to the surface again:
The requirement under 4.1.2.8: “ . . .fully clarifying any contradictions in medical evidence” is extremely significant and in fairness to DWP & Atos, this is stated in the WCA Handbook.
What is means in practice is that if the Atos HCP feels there is inconsistency or between what they are observing during the WCA and other evidence (notably the ESA50 questionnaire completed by the claimant in advance), they must
a) acknowledge it and
b) adapt the assessment so that they can resolve the dilemma based on some degree of evidence, even though in the end they may have to base their conclusion on the balance of probabilities.
They categorically cannot just base their reported conclusion on their unsubstantiated “opinion”.
This is a perfectly reasonable approach to a difficult situation. It does however introduce certain associated issues:
1) The HCP must have all the relevant information in advance with sufficient time to study it in detail. DWP however does very little to explain the importance of this to claimants ahead of a WCA. The Atos appointment letter for example concentrates only on means of identification.
2) It significant expands the clinical expertise needed to perform a WCA. It requires a far greater understanding of diagnosis, treatment options etc. which will often be beyond the experience of a nurse or physiotherapist. It is all very well claiming that for a WCA, diagnosis and history are largely irrelevant, but they most certainly are not in this context.
The problem is that:
1) Atos HCPs do not fully understand this requirement. This is down to Atos to ensure it is adequately emphasised to its staff.
2) Atos internal QA does not understanding it either so would not detect such a flaw in an ESA85 report.
3) DWP Decision Makers do not understand it either. Despite the fact that they have no medical training, they should still be able to spot reporting omissions of this nature.
If the dilemma is not properly resolved DURING the WCA, it cannot be dealt with retrospectively. The only fair action to take therefore is to:
· Reject the report and do not pay Atos for its production + add a penalty for such a fundamental, inexcusable omission – it would then quickly be sorted out.
· Apologise to the claimant and rearrange another WCA asap.
· Leave ESA payments unaffected until the results of the repeat WCA are known.
· If finally the Atos error caused any additional cost of any kind to taxpayers it should be recharged to Atos. This could include ESA payments made that prove to have been unnecessary. We certainly would not want to pay them twice for the same job.
All perfectly reasonable and “do-able”, if of course there is the will !!!! in the meantime, grounds for appeal without doubt.
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