Does Chris Grayling Have Any Idea What is going on (rhetorical)?

DWP recently admitted that it has not, does not and will not be tracking the critical success parameter right-first-time-decision-making.  It seems from this extract from Hansard that they have no inclination to measure the performance of any of their policies.  There is of course only one reason why they don’t want to know.

http://www.publications.parliament.uk/pa/cm201212/cmhansrd/cm120314/text/120314w0006.htm

Work Capability Assessment

Andrew Stephenson: To ask the Secretary of State for Work and Pensions what assessment he has made of the effect that people being found fit to work following a work capability assessment has had on the level of unemployment in the latest period for which figures are available. [98801]

Chris Grayling: No assessment has been made and to do so would incur disproportionate cost.

The Government do not believe that it is acceptable to write people off to a lifetime on benefits because they have a health condition or impairment. Many people with health conditions are able to sustain and progress in employment. Evidence points to the negative impacts of being without work and that appropriate work is generally good for people regardless of whether or not they are disabled or have a health condition.

Andrew Stephenson: To ask the Secretary of State for Work and Pensions how many people found fit to work following a work capability assessment are now working in the latest period for which figures are available. [98802]

Chris Grayling: These data are not routinely available.

However, DWP has commissioned research into this as part of the wider ESA evaluation.

More WCA dishonesty - FoI confession from DWP

When assessing mobility within a WCA, Atos HCPs are allowed to recommend the use of a wheelchair to improve mobility (if they think it will do this) for someone who does not normally use one.  They can do this without any specific discussion with the claimant or their GP.  They are not however allowed to recommend treatment – make sense of this if you can, but as unbelievable as it is, it is true.  Decision Makers are allowed to do the same thing, without specifically declaring it to claimants – all the claimant is told is that for mobility, they have scored (say) zero points.

This methodology was introduced in March 2011, presumably with the approval of Professor Harrington and is dishonest to say the least, as the claimant is not made aware of this trick before, during or after their WCA.

Through appeals, the courts have seen the injustice and dangers of DWP’s approach and have issued guidance.  From this FoI request, it appears that DWP thinks it is outside of the law and can ignore the advice.

http://www.whatdotheyknow.com/request/wheelchairs_assignment_by_dms_no

Brief Rejoinder to Michael O'Donnel

http://www.bmj.com/content/344/bmj.e1114?tab=responses

Re: Atos and changes to disabled people’s benefits

15 March 2012

I write to address several points raised in a recent article (Atos and changes to disabled people’s benefit (BMJ 2012;344:e1114) and your editorial column (Through Historians’ eyes (BMJ 2012;344:e1112).

Firstly, Professor Malcolm Harrington has examined the Work Capability Assessment (WCA) in two extensive reviews. All recommendations made to Atos Healthcare in the first review have been implemented. We are now working with the DWP to implement those made in the second review.

Not so – audio recordings of WCAs is not universally available.

Secondly, in his second review, Professor Harrington examined LiMA, the computer software used by Healthcare Professionals to construct assessment reports. He concluded that: “there does not appear to be any fundamental problems with the way in which the software operates” and noted that “many of the comments received ... appear not to be robust or evidence based.” As is now widespread in most healthcare settings, LiMA simply replaces paper as a recording tool.

Not so.  LiMA incorporates a diagnostic algorithm of doubtful reliability.  The WCA handbook specifically encourages HCPs to use only the drop-down options provided, although free-form text fields are available, but cannot be interpreted by the algorithm.

Thirdly, Atos Healthcare and DWP encourage people to submit additional medical evidence at any stage of the process for consideration as part of the claim. Our Healthcare Professionals ask for additional medical information from the claimant’s GP or other medical specialist when an individual’s completed questionnaire suggests that they may have a high level of functional loss, and as such may not require a face-to-face assessment. Unfortunately, these requests are not always answered.

Not so. The Atos appointment letter only tells you what to bring to identify yourself.  I have had 3 WCAs: one glanced at my questionnaire, one didn’t look at it and the latest didn’t even have a copy to hand.  None of them asked for any additional information and all of them ignored completely what I took with me.

Finally, for chronic and fluctuating conditions, we use the same techniques as other clinicians to depending on what question you ask. variability of symptoms, and a detailed functional history ensures the effects of variability on an individual’s abilities are addressed.

DWP cannot make up its mind how much clinical & diagnostic expertise Atos HCPs need depending on what question you ask – supported by FoI requests.  Harrington’s reports specifically highlight shortcomings with assessing condition variability.  There is a standing joke that if you can get to a WCA, you must be fit enough to work – not as much of a joke as many might think I’m afraid.

All our 1,400 doctors, nurses and physiotherapists, are registered with their relevant professional body and are individually approved by the DWP. Atos Healthcare is also a GMC Approved Practice Setting. We want those who are called for a face to face assessment to understand that they will be well treated and properly assessed and by highly professional and dedicated practitioners.

Perhaps, but there are fundamental issues over qualifications needed to do this job, too complex to go into here.

Finally, Harrington himself is far from objective and most certainly NOT independent.  (What happened to Prof Paul Gregg his predecessor?)

There is a view of “disability” that pervades the Health Insurance industry, private sector health service providers and the Government – it is dogma not science as we are led to believe.

There is more at http://tia-junior.blogspot.co.uk/2012/03/reasoned-and-coherent-way-forward-stage.html

Professor Michael O’Donnell
Chief Medical Officer, Atos Healthcare

Competing interests: I am the Chief Medical Officer of Atos Healthcare

A reasoned and coherent way forward - stage 1

The Tory Government is simply doing what Tory Governments do – no surprises there.

If the intention is to unseat them at the next election, the first thing to consider is what would come next, but that’s a thought for another day.  Just be careful what you wish for.

There needs to be a plan, which I think starts with unravelling all of the spurious claims they are making and exposing their policies for what they are.  Personally, I believe the step by step, logical approach will be more productive than “Nazi bastard” vilification.  Whilst this usefully winds up some emotion, it is at risk of alienating the very large proportion of people who are prepared to be sympathetic if than can see the issues in a clear and honest light.

The view of disability that causes greatest upset is the one that regards it as just another form of unemployment, or perhaps more accurately, under-employment.  This is clearly part of the Government’s thinking.  It suggests that there is an absolute formula that can differentiate between those that can work and those that cannot.  It has been allowed to drift and all they are doing now is resetting it to where it should be.  They imply that this new level can be independently and scientifically determined, so their approach is unchallengeable.

This of course is not true.  The cut-off is part of one’s dogma – religious, political, whatever.  The Coalition believes that the bar should be set considerably lower (so fewer are allowed past it) which is their ‘prerogative’, but let’s not lie about its basis.  One way or another, it has formulated an estimate of how many people need to be moved from one side of the line to the other.

Closely linked to this is the “Arbeit Macht Frei” philosophy, so not only is working good for society, it is good for you individually too – it will broaden your outlook, enhance your self-esteem, and improve your health and probably your longevity too.  It will do this both directly and indirectly through you being financially better off.  It is a little vague on how all the wealth created is distributed, but at least everyone gets some.

With such a strong belief in the work panacea, not surprising that one would accept a fair degree of collateral damage as undoubtedly the ends justifies the means.   The horrendous fit-for-work errors that crop up frequently are not personal, nor particularly deliberate: they are just seen as part of the price one has to pay.  The points to get across therefore are firstly that this is not the case and secondly if it were, this price is too high.  The current process is flawed on two counts:

1.       It produces  too many errors

2.       It produces far too many extreme errors

The consequences of both are massively compounded by a very long and convoluted remedial process that has no feedback loop to generate at least some progressive improvement.

They claim their approach is based on need rather than financially driven (bottom up, not top down), but this is splitting hairs if they continually redefine “need” to fit a financial target, which is precisely what we have now.  Cleverly, if WCAs are not producing the required ratios, they manipulate WCA content to make sure they do. Proof is through the descriptor changes made in March 2011

The complementary side of this is of course is the nature of work itself – not how much of it is available, but what characteristics it has.  Quite obviously, if you move the bar downwards, you need to re-specify what work is so that it can accommodate people with what is now a wider range of abilities.  The Government in effect argues that it has already done this and is now just catching up by modifying descriptors accordingly.

This claim is based on the way in which employers of all types have positively responded to equality legislation over the years, to the point where in the typical workplace, disabled employees are no longer at any disadvantage when compared to fully able employees.  This is not just about wheelchair access, but literally every aspect of every work environment.

This is the argument DWP used to substantiate its descriptor changes in March 2011.  It argued that the changes were legitimised by clear scientific and impartial evidence which is simply untrue.  The report on which they mostly rely was indeed commissioned by DWP.  However, its results are far from conclusive and in places diametrically opposed to the Government’s proposition.  Also and somewhat absurdly, the report includes a disclaimer whereby DWP points out that it does not necessarily agree with the authors.  I can only assume that when they quote evidence to support their strategy, they hope that nobody will ever check it out.

It is also worth considering causes and effects as they are often wrongly assigned.  The Government regularly falls back on the proportion of claimants initially found FFW following a WCA.  If they lump together FFW + WRAG, they can quote proportions of around 70%.  This, they say justifies the process they have set up.  What they conveniently forget however is that this is precisely what they have designed the process to do, so it is rather a self-fulfilling prophesy.  In fact, one could argue that given this, the results are actually quite disappointing from the Tory viewpoint – ONLY 75%, when they would like it to achieve something higher.

One final general point and that is over the meaning of “independence”, which in reality is often very hard to achieve.    Most commonly it requires features such as:

·         not controlled by another

·          free from the authority, control, or domination of somebody or something else, especially not controlled by another state or organization

·         able to self-govern

·         Financially independent, not forced to rely on another for money or support.

The prevailing view from most quarters, campaigners included is that much hangs on the infamous Professor Harrington – if they were only to implement all of his recommendations properly, everything would be ok.  NO IT WOULD NOT and this is why.

One of the biggest issues has been around decision making errors, subsequently corrected.  Logically therefore right-first-time decision rates would be an important KPI to monitor.  DWP has not, does not and will not however be using it.  Nor will they declare a target that they are aiming for.  This is just politicians for you – keeping the water muddy, but where is Malcolm setting the target and insisting they meet it sooner rather than later – all conspicuous by its absence.

Secondly, how independent is Malcolm?  Just run through the tests above and make up your own mind.  He has done little more since involvement began than “urge patience”. He has also said:

“My take on things is that [the Department for Work and Pensions] DWP and [Jobcentre Plus] JCP (in collaboration with Atos where appropriate) are energetically implementing all of my recommendations.” and

“In some cases I believe the JCP staff responsible have actually improved on what I had proposed in light of practical experience. I see real progress and am even more confident of improvements than I was in my interim report to the Minister in May. “

I would simply ask

·         What evidence does he have to support any of this?  A few examples would be really helpful.

·         Does anyone who has had repeat dealings with WCA/Atos over the past three years agree that things have changed very much for the better?

It is ironic to say the least that the venerable professor wants to “collect robust evidence about what is and isn’t working, moving, where possible, away from anecdotal reports.”,  when DWP does exactly the opposite.

If you go back to Professor Harrington’s first report in 2010, there are other things conspicuous by their absence, notably a comprehensive PDD (Project Definition Document).  This is very much standard management practice and can be constructively applied in almost any ‘change’ situation to define the scope of the work, its boundaries, its objectives, success criteria, assumptions, inclusions, exclusions etc.  It then provides the key reference point for subsequent work for the duration of the project and I would say it is impossible to manage well without one.  There were some general terms of reference at the outset, but all rather vague – unprofessional or deliberate – who knows?  There was no well-reasoned argument for example that explained why NHS services had been excluded from consideration.  Nothing of this nature has appeared since and his subsequent work just follows the same path.

So we need to reconsider Professor Harrington’s so-called independent role in all of this and if there is a conspiracy, judge if he is part of it.

WCA Improvement - no real measures after all

THIS SPEAKS FOR ITSELF:

Thank you for your Freedom of Information request of 13 March 2012

In your request you stated:

Messrs Grayling & Harrison are agreed that the overriding priority is to ensure that WCA decisions are right first time and it is normal business practice to establish the parameters through which progress can be objectively measured.

You requested the following information:

1) Long term, once the process has settled, what error rate does DWP regard as acceptable and by when?

2) What are historical and current error rates?

3) What milestone dates has DWP set itself to reach the long term acceptable error rate?

At present, DWP does not collect data in relation to WCA Decision Making. It is not therefore possible to provide current or historical information.

As part of a wider quality improvement programme, a Quality Assurance Framework (QAF) was introduced to monitor and improve standards of decision making. The QAF focuses on providing detailed feedback to decision makers to ensure that they give due consideration to all of the available evidence. In the longer term this may involve introducing a measurable error rate however there are no current plans to do so.

Inequality in the Welfare State? [CIRC Report]

Inequality in the Welfare State?

Report written and produced by Clydebank Independent Resource Centre, 627 Dumbarton Road, Dalmuir Clydebank G81 4ET 0141 951 4040: info@irc-clydebank.co.uk: www.irc-clydebank.co.uk:  Registered charity no. SCO37670. November 2011

http://www.oxfamblogs.org/ukpovertypost/wp-content/uploads/CIRC-Equality-Act-Report.pdf

A  few supplementary thoughts.

Prof Harrington has never challenged the basic premise that fit for work (FFW) decisions can be distilled into a set of parameters that can be adequately assessed by a DWP administrator, “supported” by no more than a lowly-trained medic operating under their direction. 

In addition the question of whether condition variability and task repeatability can ever be adequately assessed in a single short WCA has not been sensibly addressed.

Prof Harrington himself does not pass all of the tests to establish his “independence” from DWP & Coalition dogma and a cynic would argue that his vested interest in certain outcomes makes this impossible.

Although many WCAs are poorly performed by Atos, DWP claims to have rigorous quality and audit procedures in place and that Atos routinely achieves its contractual KPIs.  Either this is not true, or they do not work, at least to the standards most would assume.  The fact is that they satisfy only the standards DWP has set – DWP has not on thanking them for their efforts.

Without doubt and despite its protestations to the contrary, the Government largely subscribes to the “benefit scrounging” school of thought.  This can easily be seen in some of the imagery it uses in key publications.

The Government has singularly failed to offer any definition of the work it is glibly passing people fit to perform.  It relies on the concept of ‘general work’ (sic), without even describing its basic characteristics.

DWP has severely criticised the historical contribution of GPs to this process to the point where it has effectively challenged their professional integrity.  Rather than tackle this unsubstantiated proposition directly, DWP has adopted a costly strategy that progressively removes them (GPs) from the process altogether.  It still however claims they (GPs) play an important role to play, albeit from a remote and mistrusted position.  This is one of many contradictions within DWP’s assurances and it is both surprising and disappointing that their representative organisations have not taken great issue with this implication – or is it just a case of same money, less work?

The comments on p15 are not quite correct.  Whilst the Atos HCP does not have direct access to medical records etc, they are required to consider and log ANY evidence a claimant brings to a WCA.  What is missing is a comprehensive briefing for claimants (and their reps) to ensure that they present their situation at the WCA as comprehensively as possible.  The WCA invitation letter covers little more than being able to prove who you are!

The WCA handbook is quite clear (and reasonable) over how a HCP must deal with an apparent contradiction between claimant evidence and their own observations to produce an acceptable report.  It states that the HCP cannot simply rely on their ‘opinion’ and must support any conclusions with evidence of one kind or another – this could take the form of a specifically tailored examination and/or Q&A.  It is therefore vital that the claimant takes everything they can to the WCA or any contradiction might not be apparent – the HCP must not be left in the position where they can (legitimately) say that they were unaware of something relevant to the way the assessment should be performed.

The report rightly highlights DWP’s progressive tightening of descriptor definitions, notably in March 2011.  DWP insists that they are justified based on objective evidence, but this is not confirmed within the documents they themselves rely upon.  In fact in some cases, the reports contain explicit disclaimers where DWP states that it does not necessarily share the views and conclusions of the authors – how absurd it that?

In addition, the joint DWP/Atos process contains a number of surreptitious ‘correlations’ whereby very specific interpretations are placed on the answers to seemingly innocent questions.  A visit to a supermarket for example means being able to cover 800m comfortably and would attract no points.

Worse still, in Mar 2011, ‘walking’ was substituted with ‘mobilising’ again on the surface for legitimate reasons but has given rise to the “invisible wheelchair”.  This allows the HCP & Decision Maker to make the mobility assessment with the claimant in a wheelchair even if they do not normally use one, even if their GP has advised against it and they do not even have to declare that this is what they have done.  All the claimant sees is no points.   The invisible wheelchair can be deployed selectively in that it might appear for mobility assessment on level surfaces, but be abandoned when steps are involved.

DWP insists that a declaration of fit for work does not mean they do not believe you are ill, just that the illness is not severe enough to stop you working.  This is of course (as explained above) despite the fact that ‘work’ is not defined.  Furthermore, it insists that people who find themselves on the job market through this route are at no disadvantage relative to other fully fit job seekers.  It bases this assurance on reports in which it has incorporated a disclaimer (see above) and/or completely contradicts its proposition and universal compliance with long standing disability equality legislation.  The reality is that there is no real evidence to support any of this.

The Government's REAL attitude towards sickness and disability

This is a small, but very significant demonstration of the Government’s philosophy behind its Welfare Reforms.

This picture appears in the following DWP publication specifically about cancer sufferers. 
http://www.dwp.gov.uk/docs/work-capability-assessment-cancer-treatment-consultation-er.pdf
Thankfully I am not one, but I was struck by the sad face on the left and started to wonder why sad?  I think there are only two possible interpretations:

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.

So I posed the question to Dr Bill Gunnyeon, Chief Medical Advisor to the DWP who was the chap who finally signed off the document for publication.

Initially he tried to blame someone else (the “experts” he uses for advice in imagery) and pointed out that they would “never portray individuals with health conditions or disabilities as 'benefit scroungers' . . . . “, but he would say that wouldn’t he?

He also tried to suggest that it was not significant and I had misread his intentions by not considering the image with the associated text.  So I pointed out:

·      The document contains 8 images with 17 faces portrayed.  

·      He had been diligent enough to consider racial representation in these images, so they were clearly checked in some detail. 

·      Of the 17 faces, the one I have highlighted is the ONLY one with a sad expression.  It was not therefore an accident or oversight, but done this way for a reason. 

In response he suggested a third interpretation as follows:

“The picture merely reinforces the text in that the person is being told that she needs to look for work, whereas she could or should be in the Support Group and therefore not required to look for work (although our proposals would obviously mean that she could if she wanted to and felt well enough to work). So, she looks sad because she thinks she is being made to look for work when she, in fact, doesn’t need to.”

Make what you can of this. It seems to confirm option 2 above and at best represents an unforgivable communication cock-up.

The DWP character is smiling, so the news he is conveying is presumably good (at least from his own point of view), so why would the claimant look sad - only because the news is not good from their point of view of course.  No suggestion in the text that the speech bubble could be wrong.

I have worked in several organisations that publish brochures on a massive scale, so I know how much thought goes into the design and how much care goes into checking the final version before publication.  At very least, the risk of misinterpretation would have been identified and the image changed accordingly to avoid it.  No, it is clear here that a very specific message and the thinking behind it were intended. This is no accident, but reveals an attitude many have long suspected and is now undeniable.