Civil Service Code of Ethics - worth the paper it is written on?

I stumbled across this today on a Goverment website:

The Civil Service Code, first published in 1996, sets out the core Civil Service values and the standards of behaviour expected of all civil servants in upholding these values.

• Integrity – putting the obligations of public service above personal interests
• Honesty – being truthful and open
• Objectivity – basing advice and decisions on rigorous analysis of the evidence
• Impartiality – acting solely according to the merits of the case and serving governments of different political parties

I wonder how many civil servants (and by implication politicians) have a) read it and b) give a toss?  I am thinking particularly of those associated with ESA/WCA etc. where patently none of these apparently preciously held values apply.

When outsourcing, particularly when the business partner has direct contact with the end user, it is de riguer to demand identical standards from the service provider, so this all applies to Atos too.

There is clearly an internal and external problem monotoring compliance!!!

Surreptitious Assumptions made by Atos/DWP in a WCA - BEWARE

I have posed the first part of this blog as a FoI Act request to DWP:

The answers given to a variety of seemingly innocent and innocuous questions posed within a WCA can have a very precise interpretation by Atos and/or DWP. Some quoted examples are:

·         Visiting a supermarket: ability to walk unaided, without pain or exhaustion for 800m+

·         Driving a car for 10 – 15 minutes: ability to self-propel in a wheelchair 200m+ without pain or exhaustion.

·         Walking 30m: ability to walk 60m on the basis of 30m outbound + 30m return journey

·         Use a bus: ability to stand in a queue for 30+ mins.

·         Watch films on TV: ability to sit continuously for 90+ mins.

·         Watch soaps on TV: ability to sit continuously for 30 mins.

·         Holiday to Cornwall: ability to sit for 3 hours at least.

·         Appointment 30 mins late: sat in the waiting room continuously for 30 mins.

1.       Are these 8 examples accurate and if not, what are the correct versions?

2.        Are there other instances where assumptions are applied within a WCA and if so what exactly are they – physical and mental?

3.        Where are they all documented?

4.        Is each and every one based on authenticated scientific evidence that is open to inspection or just based on opinion/hearsay albeit by so-called “experts”?

5.        How do you ensure that they are equally and consistently applied by all HCPs/Decision Makers in Atos/DWP to all WCAs?

6.       The Civil Service code of conduct emphasises the absolute need for integrity and honesty within the public sector. Do you regard the general approach of not declaring the full purpose of certain questions and extracting information in such a way as it may not be appropriately qualified by a claimant as complying with these requirements?

You must therefore make sure you explain fully all of the small but significant perspectives of your condition that affect your life and ability to work.  Do NOT assume that whoever you are talking to will know what you mean, be on your side and be prioritising your best interests.  It is far safer to assume precisely the opposite. 

Do not be rushed and do not allow what you describe to be heavily paraphrased to the point where it is no longer representative, but equally not exactly inaccurate – more incomplete.  Atos and DWP will at some stage fall back on what they claim you have said as recorded on the ESA85 whether it is true or not. It is very important to correct each error as it arises rather than have to backtrack subsequently, which can make it look like you are just changing your mind.

HCPs and Decision Makers are taught and encouraged to “read between the lines” on the assumption that this will get them nearer to the “truth”.  The associated assumption that they think justifies this underhand approach is that all claimants are potentially or actually fraudsters, so there is a need to trip them up, catch them out etc. to uncover the deception they are bound to be perpetrating.

Quite how this attitude fits with the Civil Service Code of Ethics requiring integrity and honesty is a mystery and just another of the contradictions and overt hypocrisy being demonstrated by DWP through its welfare reform plans.

WCA - Has Lord Freud been completely straight (or is the Pope a Catholic)?

http://fullfact.org/blog/lord_freud_work_capability_assessment-3097

The article above contains the usual excellent FullFact analysis, but there is more.  Comments here are based on a WCA in September 2011, which was in fact the poorest of three starting two years ago.

1.    Fluctuating conditions, pain & fatigue

Completely inadequately assessed.  The various guides produced for Atos HCPs and DWP Decision Makers recognise the issue and problem, but neither group shows the slightest practical interest in this difficult area.  In my own case, I went to great lengths to explain that I can do most things as long as I can choose when I do them – e.g. when pain is at a low ebb, but there was no reference on the ESA85.

In fairness, the guides do explain that performing a task once does not justify ticking the box, but again this is largely ignored.

There is also a more sinister aspect of pain assessment.  In a recent dialogue with a DM’s manager, he stated that DMs use internet research as an aid to decision making.  The ethics of this aside for the moment (as DMs are not medically trained and are given no guidance as to which websites can be trusted), on pain he explained their view is that generally, suffering pain is unnecessary – just take stronger pain killers.  So if you do claim to experience pain, it is your own fault and it can’t be that bad – no consideration of side effects, risk of addiction etc.  Unbelievable, but true!

The new descriptors do not mention “pain & fatigue” but do mention “significant discomfort or exhaustion” – more or less the same.

2.    Information to be considered

The requirement to consider all of the information available applies equally to Atos HCPs and DWP Decision Makers and is well documented, but largely ignored.  My HCP claimed to have read my ESA50, but it was nowhere in sight and although I presented a copy of my X-ray, the HCP barely glanced at it and did not reference it in the ESA85.  They knew that my GP had declared me unfit for work, but likewise made no mention of it in the ESA85 report.  The instruction is clear – they MUST list all evidence submitted.

In addition, the WCA manual recognises that a HCP could be faced with conflicting evidence between the ESA50 questionnaire and their own observations/conclusions at the WCA.  The instruction again is quite clear – the HCP MUST acknowledge the difference and explain with evidence why their conclusion is different – they CANNOT just say “in my opinion . . .”.

Exactly the same requirement applies to DWP DMs, but there is the same lack of interest and diligence.  Again, the rights and wrongs aside, at very least there is the internet research they apparently undertake routinely and the GP fit-note that they already have a copy of, but in reality often neither are used.

Following my last WCA, I raised a complaint with Atos before receiving the DWP decision and sent DWP a copy.  They admitted to having this letter at the time the decision was made, but not using it.  I pointed out that ignoring it suggested they thought it unjustified, which undermined my position with Atos.  They insisted that this was not the case.  So I pointed out that if they thought the complaint to Atos was justified, why had they acted upon an ESA85 that was unsound?  They could not answer.

The overall reality is that (as we all know) the ESA85 summary is translated into points almost through a look-up table and the decision making process is a myth.

The Government has forced itself into a corner – outsourced, private companies cannot be seen to be making benefit payment decisions directly, so the decision making job had to be created and then given some apparent substance to pad out the job description.

To demonstrate the absurdity through all of this, I have raised the following question under the FoI Act with DWP:

“At my last visit to Atos, the HCP was quite clear that she was only performing a medical assessment and the WCA is performed by a DWP Decision Maker. The WCA then dictates whether or not ESA is paid and at what level.   However, DWP015 (http://www.direct.gov.uk/prod_consum_dg/...(http://www.direct.gov.uk/prod_consum_dg/...) states,

“The medical assessment may find that you are able to work”, which means the Atos HCP determines capability to work. 

Please clarify who actually decides whether or not I am able to work as it is this that determines ESA payments– Atos HCP or DWP Decision Maker?

 This is important due to the large error rate discovered at tribunal, often based on EXACTLY the same information that was available to both the DM and HCP – they may have additional information in some cases, but not always.”

It will be interesting to see how they answer.

Sadly audit routines in both organisations are poor and do not detect these shortcomings, so bad practice has become endemic.

At the end of the day, the decision regarding capability to work is far better made by someone who is suitably medically trained rather someone who has no medical training.

Compassionate capitalism with a social conscience – unfortunately not possible.

J K Galbraith is arguably the most insightful economist we have ever seen, best shown through his quotations, which appear a few times here.

Capitalism is just economic Darwinism and certainly reflects its main postulation.  In the same way that it is difficult (and some would say dangerous) to tamper with nature, it is difficult to modify (permanently) the capitalist model which will always eventually revert to type.  The people who have the power to instigate change are the people with (as they would see it) most to lose and vested interest will always win the day.  Put cynically:

“The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness” (JKG#1).

 A good example is over attitudes to tax legislation.  There is generally a fairly clear intention with a new law – to raise more tax from a particular source – but the very first reaction of those affected is to try to find a loophole and a way round it.  This is largely seen as acceptable as it is within the law, but the letter rather than the spirit.  The moral approach would be to accept the intentions of the law and pay up willingly, but will that ever happen?  Capitalism permeates downwards as crumbs fall off a table: sometimes the crumbs become larger, but at the very first sign of a famine they will stop falling altogether.

“People of privilege will always risk their complete destruction rather than surrender any material part of their advantage. Intellectual myopia, often called stupidity, is no doubt a reason.” (JKG#2)

As was admirably demonstrated by Colonel Gadhafi. 

For a noticeable and sustained improvement in social equality something more radical is needed, but unfortunately the traditional alternatives are no more attractive:

“Under capitalism, man exploits man. Under communism, it's just the opposite (JKG#3)         and
“Liberalism is, I think, resurgent. One reason is that more and more people are so painfully aware of the alternative.” (JKG#4)

Personally, I believe there is a concept of “enough” – a more than adequate level of reward that can be applied to any form of investment, financial or otherwise.  Once this threshold is reached, all subsequent returns are spent on general welfare.  It will take some thought, but there is a formula that serves this purpose.  I may be prepared to agree to allowing Wayne Rooney to live in extreme luxury as a reward for the talent he possesses, but am I really prepared to extend the same level of generosity to every generation of Rooneys in perpetuity – given I have a problem with the first proposition, I most certainly would not vote for the second!

All a bit of a pipedream, so the current debate on the steps of St Pauls may be an interesting intellectual pastime, but I am afraid rather pointless.  You simply cannot be a banker and a true Christian!

Derby University must accept what its association with Atos means

Derby University has accredited the Atos disability training course that “qualifies” Atos staff to perform WCAs for the DWP.   It was organised by the university’s Head of Corporate Relations and it would be surprising if the university did not receive some form of recompense for their cooperation.

It is important that Derby Uni appreciates the full context of their association with Atos and the broader consequences of providing the WCA with a level of credibility & integrity it ill-deserves.

A statement from Derby Uni is below, but it hedges some key issues.  As attempts to take this further with departmental heads have failed, a request under the FoI Act might at least stimulate some interest and a response.

If you would also like to express your views, contact details are on their website

http://www.derby.ac.uk/marketing/main-contacts/contacts/peter-gallimore

1.    Do you believe in principle it is possible to perform a WCA without a definition of what “work” means, i.e. the minimum capabilities it requires?

2.    In accrediting the training, do you regard the WCA itself as fit for purpose, i.e. it is a reliable discriminator between people who are fit to work and people who are not?  I cannot imagine you would endorse a qualification that was below par.

I of course accept that you have no way of knowing how well every WCA is undertaken by a healthcare professional, but I am assuming that you are in effect saying that everyone who successfully completes the training is perfectly able to discriminate accurately.

  

3.    This being the case, in your view what possible explanations could there be for the fact that a significant number (40%) of WCA outcomes are overturned on appeal?  Do you feel that this high failure rate reflects at all on the training you have accredited and/or the WCA the training underpins?

University of Derby Statement:

In April (2011) the University’s business-to-business arm, University of Derby Corporate (UDC), publicly announced it had teamed up with healthcare services provider Atos Healthcare to officially accredit the company’s own disability analysis training for healthcare professionals

Part of UDC’s business involves accrediting training that an organisation already provides internally; assessing that this is well structured, of high quality and promotes employees’ development at work through meeting specific learning outcomes at a recognised academic level. If a company’s training meets all these criteria it can be linked to a formal qualification, which the employee can then add to their CV and use to improve their career development.

This was the case with regard to Atos Healthcare.

UDC was able to accredit the company’s nurse training within an existing academic framework. UDC is not involved in delivering this training but provides quality assurance and moderates the award of a Certificate of Achievement for staff. 

Atos Healthcare’s nurse training programme, and the learning materials used in it, are the sole property of its contract holder, the Department for Work and Pensions (DWP). Any queries on the nature of nurses’ training and the learning materials they use should therefore be directed to Atos Healthcare or the DWP. Atos Healthcare can be contacted on email enquiries@atoshealthcare.com 

From next year (2012) UK nurses will need an undergraduate degree in order to successfully qualify in nursing. UDC’s accreditation of Atos Healthcare’s training will enable existing nurses to put credit points from that qualification towards studying independently for a full degree if they wish, increasing their knowledge and patient care skills.

Atos Healthcare’s own disability analysis training for its nurses has been shortlisted in the 2011 National Training Awards (run by the Department for Business, Innovation and Skills), which is a further endorsement of the training UDC has accredited.

Ends

FoI Act Request - Who makes what decision?

5 November 2011

Dear Department for Work and Pensions,

At my last visit to Atos, the HCP was quite clear that she was only performing a medical assessment and the WCA is performed by a DWP Decision Maker. The WCA then dictates whether or not ESA is paid and at what level. However, DWP015
(http://www.direct.gov.uk/prod_consum_dg/...(http://www.direct.gov.uk/prod_consum_dg/...)
) states, “The medical assessment may find that you are able to work”, which means the Atos HCP determines capability to work.

Please clarify who actually decides whether or not I am able to work as it is this that determines ESA payments– Atos HCP or DWP Decision Maker?

This is important due to the large error rate discovered at tribunal, often based on EXACTLY the same information that was available to both the DM and HCP – they may have additional information in some cases, but not always.

Yours faithfully,

Dear Mr Osborne - give it a break!

George Osborne has made his loathing of the sick and disabled plain enough since he has been in office, but now he is trying to cast his net even wider.

The rule is that annual inflationary increases to benefit payments are based on the September figure - 5.2% and barely in line with inflation.  OK, so it is higher than he would have liked and what he feels he can afford, but a promise is a promise. 

In previous years when the Semptember figure was lower than inflation, out of a sense of fairness, did he bump it up - NO HE DID NOT.  So, Mr Osborne you have no need to make your intentions any clearer, but this time if you do have a shortfall, find it elsewhere - the area within the MoD that thinks it is fine to pay £26 for a light bulb would be one place to start.

http://www.pensioncalculator.org/12158/news/state-pension-pensioners-to-dodge-govt-benefit-cuts/