Archive for June, 2014
There are two studies I found, which appear to prove that it is a person’s usual general practitioner (GP) that is best placed for providing a reliable assessment on that person’s work ability, at least in the first instance, to provide a basis for further examinations and assessments:
‘Work ability assessed by patients and their GPs in new episodes of sickness certification’
Reiso H1,Nygârd JF, Brage S, Gulbrandsen P, Tellnes G.
Fam Pract.2000 Apr;17(2):139-44.
Sickness certification legislation demands that work ability is reduced due to disease or injury. Most sickness certificates are issued by GPs. Assessment of work ability might introduce conflict in the doctor-patient relationship.
The aim of this study was to compare the level of work ability assessments by patients and their GPs in new episodes of sickness certification, and to explore how medical conditions and work demands are associated with the assessments.
Forty nine GPs supplied data about 408 patients certified sick <8 days before questionnaires were filled in. A total of 268(66%) patients completed corresponding questionnaires. Patients and GPs independently answered the following question using a five-point scale: “To what degree is your (the patient’s) ability to perform your (his or her) ordinary, remunerative work reduced today?”
Work ability was assessed by patients as very much or much reduced in 66%, moderately reduced in 23% and not much or hardly reduced at all in 11% of the cases. Corresponding assessments made by GPs were 71, 27 and 2%. Patients and GPs agreed well on their assessments (+/- 1 answer category) in 81% (216/266) of the cases. The patients assessed work ability asmore reduced the more stressful or physically strenuous their jobs were, and the older their GPs were. The GPs assessed work ability as more reduced the more their assessments were based on clinical findings.
The agreement between work ability assessments made by patients and GPs was high, despite patients’ assessments being associated with work demands and GPs’ with medical conditions.
PMID: 10758076 [PubMed – indexed for MEDLINE]”
‘How primary health care physicians make sick listing decisions: the impact of medical factors and functioning.’
Norrmén G1,Svärdsudd K, Andersson DK
BMC FamPract. 2008 Jan 21;9:3. doi: 10.1186/1471-2296-9-3
The decision to issue sickness certification in Sweden for a patient should be based on the physician’s assessment of the reduction of the patient’s work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability.
Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians’ assessments of causes and consequences of the patients’ complaints,potential to recover, diagnoses and prescriptions on sick leave, and the patients’ view of their family and work situation and functioning as well as data on the patients’ former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed.
Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculo-skeletal diseases were partly similar to those for all diseases.
The strongest predictors for sickness certification were patient’s and GP’s assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient’s complaints were judged to be non-somatic the risk of sickness certification was enhanced.
PMID: 18208594 [PubMed – indexed for MEDLINE] PMCID: PMC2266928”
These are just summaries of the reports, which are available on-line and found via the provided links. But it appears sufficiently convincing that persons’ own GP’s medical reports and certificates should be relied on more than those from WINZ’s own chosen designated doctors, and clients’ own GP’s reports must also definitely be given due consideration besides of any reports from the newly contracted “work ability assessment” providers, who mostly seem to have a rehabilitation treatment focus.
ANOTHER STUDY OF SOME OTHER RELEVANCE TO WORK ABILITY ASSESSMENTS:
Here is another report from Sweden, presenting various issues that can arise when different professionals and officials are involved in the “work ability assessment” of sick and disabled social security benefit recipients:
‘Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System’
Christian Ståhl, Tommy Svensson, Gunilla Petersson and Kerstin Ekberg;
Christian Ståhl (corresponding author)
Linköping University Post Print
The following shows larger extracts from the study:
Purpose: Changes in the Swedish sickness insurance system shifts focus from return-to-work to labour market reintegration. This article analyses Swedish rehabilitation professionals’ perspectives on how the changed regulations affect practice, with a special focus on work ability assessments.
Methods: Two groups of representatives (n=15) from organizations involved in rehabilitation and return-to-work met at seven occations. The groups worked with a tutor with a problem-based approach to discuss how their practice is influenced by the changed regulations. The material was analysed inductively using qualitative content analysis.
Results: The new regulations requires developed cooperation between insurance, health care, employers and occupational health care; however, these demands are not met in practice. In work ability assessments, several flaws regarding competence and cooperation are identified. An increasing number of people previously assessed as work disabled are required to participate in labour market reintegration, which puts demands on professionals to engage in motivational activities, although this is perceived as hopeless due to the group’s lack of employability.
Conclusions: The possibility for employers to sidestep their responsibility has increased with changed regulations. The overall lack of cooperation between relevant actors and the lack of relevant competence undermine the ambitions of activation and reintegration in the reform.”
(See page 2)
In recent decades, policy development on disability and sickness insurance has converged in most European countries, and there has been a shift of focus from passive compensation to active work reintegration (1), a development actively promoted by international actors such as the European Union (EU) and the Organisation for Economic Co-Operation and Development (OECD) (2-5). As a consequence, the concept of work ability has become increasingly important, because the criteria for eligibility for sickness benefits are commonly related to remaining abilities rather than diagnoses. However, there are a variety of methods for assessing work ability in the different national settings, and there are differences in who is responsible for the assessments and the criteria for making assessments (6).
To be eligible for sickness benefits from Swedish sickness insurance, a person must have a medical condition that implies work disability. After an initial waiting day, the employer is responsible for paying sick-pay for the first two weeks, whereafter the cost is taken over by the Social insurance Agency. The agency assesses the worker’s work ability based on a medical certificate issued by a physician, most commonly in primary health care.
In 2008, the government introduced several changes to the sickness insurance system. The most prominent feature of the reform involve a fixed time schedule for work ability assessments (the Rehabilitation Chain) which describes how work ability should be assessed in increasingly broader terms as time passes (see table 1), which affect eligibility for sickness benefits. After 180 days, the process is shifted away from the employer to the labour market at large, i.e. from return-to-work to labour market reintegration. At this stage, the Public Employment Service assists the sick-listed worker with vocational guidance. An ending-point to sickness benefits was also introduced, where benefits after 365 days are only to be granted in cases of severe illness. Further, a system of temporary disability pension for people with more long-term diseases was abolished to direct the sickness insurance system more towards labour market reintegration. Sickness benefits have also been reduced from 80% to 77,6% of wages1.
[Table 1 about here]
The new time schedule have changed the conditions for sick-listing, and in particular work ability assessments. Before the changes, there were no set time limits in the system. A more narrow time perspective put higher demands of purposeful cooperation between relevant actors in the processes of rehabilitation and return-to-work. Therefore, it is of interest to study how officials (i.e. the gatekeepers) within the authorities that are responsible for these processes perceive that the changes affect their practice.”
(Pages 3 to 4)
The aim of this study is to explore how officials from different organizations involved in rehabilitation perceive that the changes in sick-listing regulations affect their practice and cooperation, with a special focus on work ability assessments. The study aims to answer the following questions:
* What factors are taken into account when work ability is assessed?
* How do the representatives perceive that the new sickness insurance regulations affect their cooperation in work ability assessments?
* How do the representatives perceive that the new sickness insurance regulations affect return-to-work and labour market reintegration?
In this article, the term cooperation is primarily used to indicate cooperation between professionals from different organizations, e.g. cooperation between health care workers and social insurance officials. The term is thus to be understood as referring to interorganizational cooperation rather than cooperation between professionals within a specific organization.
This is a qualitative explorative study in which the experiences and attitudes of representatives of officials from different public services are investigated. …”
(Pages 4 to 5)
The participants’ discussions in this study concerns two distinct phases in the sickness insurance system: the early return-to-work oriented phase, and the later labour market reintegration phase.
The return-to-work phase: work ability assessments as a public affair
Because work ability is a central concept for decisions on eligibility for sickness benefits, these assessments must be performed accurately. However, there are several ways of assessing a person’s work ability, incorporating a different number of factors (e.g. medical, psychological or social). Work ability assessments are performed by health care and the Social Insurance Agency, and different definitions of the concept may prevail.
At the initial phase of a sickness insurance case, a physician assesses the individual’s functional ability, most commonly in primary health care. In the medical certificate, the physician also suggests whether the functional disability will decrease the person’s work ability, for which the physician needs to have an idea of the characteristics of the person’s work tasks. The following quote illustrates how this may be complicated, because one occupation may have very different working conditions.
Health care coordinator: “That there is someone on the person’s surroundings who asks “describe your work, how is it done”, because you are surprised. We had one; this guy who filled a hundred kilos a day, and that was his only task as a painter. “What do you do as a painter?” “I fill.” And he filled this sand fill, a hundred kilos a day, and he had such terrible pain in his shoulder. Another guy who was a painter, “what do you do when you paint”, and “I only paint bases”. He was on his knees all day painting bases. Well, of course your knees hurt.”
This example illustrates how difficult it is for health care workers to assess whether a person is able to continue their work or not, based only on a short visit to a health care centre. Because the health care workers cannot observe the individual at work, the assessment is dependent on their ability to ask the right questions, and that they can trust the individual’s description of their working conditions.
In a strict sense, health care is only supposed to assess the individual’s level of functioning, which is then formally transferred into an assessment of work ability by the Social Insurance Agency. However, the physician’s medical certificate is the basis for this assessment. It is thus interesting to ask who has the competence to assess work ability. The following quote indicates that the Social Insurance Agency officials do not consider that they have enough competence to do so.
Social insurance official: “We have to translate this certificate to what work ability it generates. And it’s not sure that the physician, it’s not the physician’s task to describe that, it’s us who are supposed to consider on the basis of the certificate if there is a work ability or not. And it’s not easy for us laypersons to do.”
The official in the quote speaks of herself as a layperson in assessing work ability, and yet it is this person who has the formal task of performing this assessment. Apparently, the officials at the Social Insurance Agency are given a task they do not feel competent enough to fulfil.
Social insurance official: “As an official, I’m not supposed to ask the physician if the person has a work ability. I’m only supposed to ask, “what is the functional ability?”. Then it’s my role – because it says so in our profession – to assess on the basis of the physician’s description how it decreases the work ability. And it becomes, it gets ambiguous. Because I don’t really have the competence to assess work ability.”
More specifically, the officials at the Social Insurance Agency state as problematic their lack of knowledge of working conditions and how the different factors that limit work ability can and should be weighed. According to the regulations, the officials are to limit their assessment to medical factors as the only valid cause for limitations, although there may be other, more socially oriented factors that influence an individual’s situation. Since physicians in general tend to include a broader set of factors in their certificates, the Social Insurance Agency officials have to deal with sorting out the factors that permit or deny eligibility to sickness benefits. In doing so, they may consult insurance medicine counsellors, but they are in turn even further detached from the individual’s working conditions because they do not meet the individual.
Social insurance official: “… it’s tricky. Then you hope to get help from the insurance physician, the insurance medicine counsellor to clear it up, to help you find out what’s what.”
Tutor: “Is that where you go for advice?”
Social insurance official: “Exactly, when I want to get to the bottom of it, the medical and to be able to decide what to do.”
Tutor: “Help with not seeing all the other things?”
Social insurance official: “Exactly, yes.”
(Pages 9 to 11)
“Cooperation needs in the return-to-work phase
Since the sickness insurance system only focus on return to the previous workplace during the first 180 days, cooperation with employers and occupational health care is an important issue to make return-to-work possible within this time frame. However, these actors are perceived as disinterested as long as the public system cannot offer financial incentives for participation. There is a general view among the participants that employers can easily escape their responsibility for rehabilitation. Employers only need to state that they have no possibilities of returning their employee to work, after which there are no further opportunities for the Social Insurance Agency to act.
Social insurance official: “…it’s enough [for an employer] to state in a meeting that they’ve done what they can and that there’s nothing else, and then we can submit a note and that’s enough for us.”
Health care coordinator: “So the employer doesn’t need to declare what they’ve done?”
Social insurance official: “No, well, they probably do in the meeting, but they don’t have to. […]”
Employment service official: “My take on that is that it’s too easy for employers to get rid of people. You need a clearer, deeper account of what actually has been done to save someone’s job.”
Tutor: “Are there too little demands on the employers?”
Employment service official: “That’s my experience.”
Lack of cooperation between the public authorities and employers is perceived as the weak link in the process of rehabilitation and return-to-work, and possibilities of workplace adjustments are easily missed due to comunication failures. Similarly, there is a lack of communication between primary health care and occupational health services, where secrecy is perceived as a hindrance for cooperation.
Health care coordinator: “The problem is that the occupational health services don’t have physicians in the way they used to. If they [people on sick leave] have their certificates from [the occupational health service], then we [in primary healthcare] don’t have any information on them. And we’re also supposed to take those who come from psychiatry, and we have to refer them back since we don’t have access to their journals. There’s a level of secrecy that we cannot get around. …..”
(Pages 11 to 12)
“The labour market reintegration phase
After 180 days on sick leave, the worker’s work ability is to be assessed in relation to the labour market at large, which implies that the focus is shifted from return-to-work to labour market reintegration. In this phase, the earlier assessment of work ability may prove to have little in common with employers’ demands. Basically, this may be seen as a transfer from work ability to employability: employers may not want to hire a person, even though he or she has been assessed as able to work, if the person lacks relevant competence. Both these concepts are highly interrelated to the situation on the labour market; in bad times, there are fewer jobs, which makes the competition tougher.
Health care coordinator: “And then the development on the labour market. I’m thinking about those I’ve met who had been odd-jobbers more or less, in a workplace, sweeping the floors, carrying mail, watering flowers, this and that. And the social competence was perhaps not the best. But it worked there, in that small family business where you believed in them. But as soon as they got kicked out of there they were toast, because in our groups where we were to test their work ability, they really made a mess. […]”
Employment service official: “Yeah, I’m thinking about this with employability. I mean, it takes – an important thing is that there is an employer who is willing to pay for what this person can do. I think that’s where it’s at. If someone’s willing to pay me for standing on the street playing my lip, well then I guess I’m employable for that.”
Employability is a context-bound concept, depending on what employers need at a certain place at a certain point in time. This has little to do with how the Social Insurance Agency assesses work ability: when assessing work ability after 180 days, social insurance officials are expected only to consider the medical function and are not allowed to take age, education, place of residence or working life experience into account.
The ultimate goal for the rehabilitation process, according to policy, is that the individual shall return to work with full work ability within the time frame of the Rehabilitation Chain. However, the participants in this study expressed concerns about whether this is feasible for all individuals. Those who are not able to finish their rehabilitation in time lose their sickness benefits and are transferred to the Public Employment Service where they have to compete with people with full work ability. In addition, the policy changes were introduced shortly before the financial crisis of 2008, which resulted in a dramatically deteriorated labour market with increasingly tough competition over jobs. This situation causes the participants in the study to question the goal of the rehabilitation process.
Social welfare official: “…if there’s no job for this ability, then I feel that we’re fooling people, to fire them up and be positive and work with them, and then there’s no possibilities.”
The participants see few practical possibilities and no actual end point for rehabilitation of the more complex cases. In the quote above, the participant expresses that it feels like they are fooling the individual when arguing for a goal that is not possible to accomplish. This involves the risk of backlash, where the individual falls back into sickness.
Health care coordinator: “I have a man with a troublesome past, a drug addict who prior to that worked as a welder for twenty years and got a disk displacement, went to sick leave, alcohol abuse, depression following that. Then in some way he changed his life, got off his addictions and has found a 75% work ability. And he’s so proud of his job, he’s a wood worker, and enjoys it. So he’s really succeeded. But then there’s no employer to hire him, and what will happen to him? The last thing he told me was “the social welfare office, I’ll never set my foot there”. It was humiliating for him when being assessed as having a 75% work ability; he has no unemployment insurance, what will happen to him? He can tip back over night.”
Employment service official: “That’s a great example. That’s the biggest dilemma we have to face. […] There’s something missing, a “what happens next?”. […] When you come to this, when you’ve worked up an ability and motivation to pull from and you’re so close to the goal, you’re finally “normal”. Finally, but too bad. So close, but there was no employer to hire you.”
Most participants expressed that there are no alternatives for those who are not able to cope with the competition on the labour market. For instance, those who due to the changed regulations have had their temporary disability pension withdrawn generally have decreased work ability. The participants express a wish for more alternative employment structures, such as sheltered workshops or other forms of subsidized employment. The participants generally claim that the availability of these alternative forms of employment have decreased considerably in recent years.
Employment service official: “That’s a clash I’ve been thinking about since last time. When we assess sheltered employment, for instance. There’s no such thing. You’re put in a queue for something that’s not available, because you assess by old rules. Sometimes we get documents where someone has assessed sheltered employment, and the person has been waiting for fifteen years or something. But they will never get there, and we still get these indications to do these assessments, put them in line. It doesn’t feel realistic for me to do so.”
The participants in the study experience an increasing gap between the sickness insurance system and the labour market, especially concerning those with low work ability who are not work disabled enough to receive a disability pension. The participants expressed concerns that the introduction of the Rehabilitation Chain implies that these individuals will not be able to provide for themselves when they lose their sickness benefits.”
(Pages 13 to 16)
A prominent feature of the reformed sickness insurance regulations is the shift of focus from return-to-work to labour market reintegration. From a political perspective, the idea behind the reform was to speed up the return-to-work process and to promote activation through an earlier focus on job mobility. This study shows that employers are regarded as passive and non-contributing in this process. Employers have through the new regulations gained an opportunity to sidestep their responsibility for returning workers by staying passive for 180 days, after which the system has the full responsibility for the person.
The two phases in the rehabilitation process put different demands on all of the involved actors. The participants in the study raise a number of concerns regarding these two phases, where the most emphasized are the lack of competence to assess work ability, the lack of cooperation with employers and occupational health care, and the limited possibilities for work disabled people to compete on the labour market.
It is notable that the social insurance officials do not feel competent in assessing work ability. It is also notable that the officials do not make contact with employers or occupational health services, who could provide the information that is necessary to make reasonable assessments. Instead, they rely solely on physicians’ medical certificates, which are based on medical status rather than working conditions. Thus, the basis for decisions of eligibility for sickness benefits is weak, which is troublesome from a legal perspective.
As the OECD notes in a report, the sick-listing process focuses more on eligibility to benefits than on activation and return-to-work (13). The new policy framework, further, “requires good cooperation and continuous information exchange to continue” (13, p. 42); this study indicates that this is not the case with regard to the assessments in the return-to-work phase of sick leave. According to Loisel et al. (14-15), work disability management need to take into account the situation at the workplace as well as personal and medical factors and the compensation system for the return-to-work process to be purposeful. The sickness insurance reforms have primarily targeted the compensation system in controlling in- and outflow from sickness benefits, while the importance of involving the workplace arena has been disregarded.
What is disregarded in work ability assessments?
In current practice, work ability assessments are based on physicians’ initial assessment of functioning in medical certificates. This assessment is in turn based on the definition of functioning in the International Classification of Functioning (ICF) given by the WHO (16), which, as noted elsewhere (17), offers a broader definition than the one used by the Social Insurance Agency. ICF, for instance involves social and contextual factors which the insurance system are not expected to take into consideration. Because the definition of functioning, and subsequently work ability, differs between the actors, this is a possible cause for conflict within the process of assessing work ability.
The broader perspective on work disability suggested by Loisel et al. (14-15) is to a large extent in line with Nordenfelt’s analysis of work ability, in which he distinguishes between a number of factors that together make up a person’s ability to work on a specific task, such as personal competence, motivation and health status (18). Nordenfelt concluded that a person’s work ability needs to be assessed holistically, involving the context of sickness insurance as well as the person’s qualifications and the characteristics of the work task. The results of this study suggest that the biomedical perspective prevails in the sickness insurance system, which implies that other factors that may contribute to a person’s work ability are disregarded.
When comparing the Swedish sickness insurance regulations to those in other countries, the focus on medical factors for work disabilty is notable. As Hedborg notes, it is uncommon that a system disregards other factors as thoroughly as the Swedish does (19). The other Nordic countries (i.e. Norway, Denmark and Finland) permits long-term benefits for other reasons than strictly medical, where the possibilities for the indidivual are taken into account, including factors such as education, working life experience and age (19).
The return-to-work phase: is it possible to involve employers and occupational health care?
There is scientific evidence that well-functioning cooperation between health care, employers and the compensation system is effective for shortening the sick-leave period and for facilitating return-to-work (20-21). However, in the Swedish sickness insurance system there is a general lack of clarity regarding the responsibilities of the employers and occupational health services. This study highlights this ambiguity by elucidating flaws in the cooperation between the public system (the Social Insurance Agency and primary health care), employers and occupational health services in return-to-work due to the lack of regulations on employer responsibilities, which leaves them outside the cooperation domain. …”
(Pages 16 to 18)
“The labour market reintegration phase: a Sisyphean task?
As discussed, the current system promote a fast shift of focus from return-to-work to labour market reintegration. In the labour market reintegration phase, the relevant actors change, as does the relevant competencies and needs for cooperation. Where the return-to-work phase required communication with employers and knowledge of working conditions, this later phase put more demands on the officials’ therapeutic and motivational skills and their knowledge in vocational training and guidance. Here, the Public Employment Service replace the employers in trying to bring the sick-listed worker back to the labour market. In this phase, the officials at the Social Insurance Agency are not allowed to take into account the worker’s age, education or working life experience when assessing work ability, which implies that most people will be assessed as able to work and hence lose their benefits.
The participants in the study notes how the changed regulations imply that an increasing number of people who previously were considered work disabled now are required to look for jobs on the open labour market. Since the possibilities for placing these people in subsidized or alternative employments are scarce, the task of motivating these people is perceived as hopeless due to their lack of employability. Motivating them to look for jobs is not considered realistic, nor ethical.
One consequence of the changed regulations is that an increasing number of people reaches the new ending point in the sickness insurance system (365 days). In a report on where these people have gone, it is concluded that after six months only 2,5 % have a regular job on the labour market; 7 % have subsidized or supported employments; 41 % returns to sickness insurance after a waiting period, while the rest are either unemployed or not identifiable in the statistics (28). Taking this into consideration, it is reasonable to assume that the disenchantment expressed by the participants is valid.”
(Pages 20 to 21)
The Swedish sickness insurance system has undergone dramatic changes over the last years, with a shift of focus from return-to-work to labour market reintegration through a fixed time schedule as the most prominent feature. This study highlights how these changes put new demands on cooperation between social insurance, primary health care, occupational health care and employers, and that these demands are not met in practice. Employers are perceived as passive in this process, and the possibility for employers to sidestep their responsibility has increased.
An increasing number of people previously assessed as work disabled are according to the new regulations required to participate in a labour market reintegration process. This puts demands on professionals to engage in motivational and therapeutic activities for this group, although this is perceived as a hopeless task due to the group’s lack of employability.
The results of this study also show that officials at the Social Insurance Agency do not consider themselves competent in assessing work ability, which implies that decisions rely heavily on medical certificates issued by physicians. Because of a general lack of communication and cooperation between the public system (the Social Insurance Agency and primary health care), employers and occupational health services, these certificates are based on assumptions rather than actual observations of the individual at work.
In sum, the lack of cooperation between relevant actors and the lack of relevant competence undermine the ambitions of the reform.”
(Pages 22 to 23)
OWN COMMENTS ON THIS SWEDISH STUDY
Although this explorative and limited study based on participating groups of professionals and officials in Sweden may only have some limited value, because it is about social, health and employment service frameworks and settings in a different country, it does clearly present a range of serious issues relating to work ability assessments. The study shows how difficult it is to apply new systems and approaches in moving sick and impaired social security benefit recipients with disabilities into suitable work. At least some of the issues raised in the study are also relevant to the approaches tried by MSD and their department Work and Income here in New Zealand.
The Swedish study does not research and analyse particular medical conditions and under what criteria they may be considered as impairments affecting ability to work, thus leading to disability. It is rather focused on examining, analysing and making conclusions on general systemic approaches based on recent changes in how work ability assessments are increasingly being used to provide support to sick, injured and disabled into employment, whether back into positions the affected held before, or otherwise into alternative kinds of jobs on the market.
MSD and WINZ claim that they are not working with clients to rehabilitate and refer them into suitable work within tightly set time frames. But the started use of outsourced, contracted, private “mental health employment service” providers, same as some other similar service providers, does encourage the providers to deliver anticipated outcomes for clients within specified periods. The existence of contracts containing a graded fees structure does reward contracted service providers to place WINZ clients into jobs as soon as possible, at least within a 12 month period. That will of course mean, they will communicate expectations to the clients they deal with, and this will put great pressure on the beneficiaries that WINZ refer to them, to accept jobs that may be deemed suitable, whether they are or are not so. Hence there is a similar situation as to the one in Sweden, where sick and disabled beneficiaries are expected to make use of available rehabilitation and other services, and thus prepare themselves to take on previously held – or alternative work. If this does not result in (lasting) employment, and especially if they are seen as not being “cooperative”, they may lose benefit entitlements, or face other forms of sanctions.
There are clearly issues around appropriate, essential competency of professionals conducting work ability assessments, like who should be doing them, and how assessments should be done. There are separated responsibilities that professionals from the various groups have, that work with social security clients around assessment and rehabilitation. Medical practitioners play a role, so do rehabilitation professionals, and in a very different way administrators like case managers, who are working for state social security service agencies. A lack of cooperation and coordination between parties involved can create problems, and one must expect the same to happen here in New Zealand, as it did in Sweden.
Generally it will first and foremost be medically diagnosed sickness, injury and disability that will be crucial for any assessment. Some environmental factors and possibly psychological aspects will also be of varying importance. It is my firm view, that in general, the client’s long term medical practitioner (GP) will have the best ability to assess work ability, given the familiarity with the patient’s medical history and also social and other environmental circumstances. While specialists can provide more particular information on certain health conditions, they will often only see patients/clients for short periods. Any occupational or other rehabilitation therapist may be able to develop familiarity with the patient, but without prior assessment by a GP there will be risks of them failing to see the whole picture.
Traditionally WINZ case managers make the final decisions about a client’s work capacity in relation to benefit entitlement, and so forth, but they do follow recommendations by the Ministry of Social Development’s internal Regional Health Advisors and Regional Disability Advisors. They work under the supervision of the Principal Health Advisor (Dr Bratt!) and the less prominent Principal Disability Advisor. All these advisory professionals do again rely on either a client’s own GP’s or specialist’s medical diagnosis and certification, or on WINZ’s own “designated doctors”, and now also on new private “work ability assessment” providers.
WINZ case managers do usually not have any relevant medical, rehabilitation or other health qualifications, which may enable them to make their own assessments. So they will have to rely on the various other professionals involved in processes they have in place, and given the different focus on criteria for work ability, there will inevitably be differing assessments and recommendations. WINZ case managers and health and disability advisors will feel to have some extra “responsibility” to meet expectations by their employer (MSD), who of course has an interest to reduce benefit claimant numbers. Clients’ own doctors will feel that they know their patient best, but may also feel that they need to be extra careful, to avoid making risky or wrong assessments. Designated doctors and new work ability assessment providers will be paid by MSD and be bound by contracts they entered with the Ministry, so they can due to that not be seen as totally independent. There are forms of conflict of interest at play here.
It is clear that it is never easy for any sick and disabled beneficiary to compete with those without such handicaps on the competitive job market; hence they will always face extra challenges. Employers will mostly be hesitant to take on any new employee with lasting health conditions, injuries or disabilities, given the risks and potential costs associated with hiring and employing them. So in absence of any extra measures, to involve and “incentivise” employers, and to also offer alternative employment in special work-shops or on subsidised schemes (that will not exposed clients to the same market pressures), any measures to move sick and disabled into work will in most cases be difficult and risk prone endeavours.
Sadly it seems, with the flawed approach now adopted by MSD and WINZ in New Zealand, we have a huge experiment being conducted, that exposes many, particularly mentally ill, to some risks to suffer harm, due to potentially wrong, inappropriate, flawed assessments – and decisions based on them.
Christian Ståhl, Tommy Svensson, Gunilla Petersson and Kerstin Ekberg;
Linköping University Post Print
Link to download site:
“Swedish Rehab. Professionals WAAs Perspectives, 2011, FULLTEXT01, d-load 20.05.14.pdf” (601.23K):
See attached a PDF file containing the full study report mentioned above:
Title: ‘Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System:’
G). LEGAL ASPECTS AND IMPLICATIONS TO CONSIDER RE WORK ABILITY ASSESSMENTS
The involvement of contracted outside, private, work ability assessment providers is of great concern, because there are some major, significant legal implications in all this.
Firstly MSD and their department Work and Income (WINZ) will have finalised contracts with the work ability assessment providers (like with other providers), that will contain not only details about how the providers will have to operate and follow agreed practices and processes, they will also contain certain expectations in regards to meeting certain targets and achieving certain outcomes re the referred sick, injured and disabled clients they will work with. As these contracts will be deemed to be commercially sensitive, they will in all likelihood never be made publicly available. That makes it near impossible to examine and assess, how reasonable and realistic stated expectations may be, that WINZ may put into the providers meeting the contractual agreements.
As it appears to have happened with the designated doctors that WINZ have been using to varying degrees since 1995, it must be feared, that there will be particular “expectations” communicated by WINZ’s Principal Health Advisor Dr Bratt, and the various Regional Health and Disability Advisors, for the contracted assessors to deliver certain assessments on WINZ clients based on such criteria as recommended by “experts” like Mansel Aylward. This may be based on the approach of looking at what clients “can do rather than what they cannot do”. There may be expectations that assessors take an approach that unreasonably questions or discredits client’s own GP’s or specialist’s diagnosis, by applying a degree of scepticism and scrutiny, that may lead to biased conduct by the assessors. The claims by Aylward and some others, that much reported illness may simply be based on “illness belief”, and that certain musculoskeletal and mental health problems may simply rather be “common health complaints”, with “subjective symptoms”, having “psychosomatic” causes, which should not be taken too seriously, can lead to assessments being seriously flawed. One must only look at the presentations by Dr David Bratt, likening benefit dependence to “drug dependence”, to realise, that certain expectations and “standards” will be expressed and expected to be met.
This should strictly not happen and not be condoned, but the RHAs and RDAs have certainly regularly consulted client’s own GPs and other health practitioners, and there is no clear indication that such “cooperation” will not happen with the new WAA service providers.
The use of the now known work ability assessment providers, who are almost exclusively rehabilitation treatment service providers, and in some cases even employment placement service providers, must raise the valid question, why there is a need to even use them for assessments that can already be obtained elsewhere. They do hardly appear to be “independent” or without conflicts of interest, as they offer other services that they will have an interest in “selling” and providing to WINZ and their clients, namely rehab and job placement services.
In any case, the involvement of these particular rehabilitation service providers can only be justified, when earlier assessments will already have been made by clients’ own GPs, own specialists and perhaps in some cases designated doctors, who may have determined that there may be a potential work ability a patient or client has. Only then would it make sense to involve the providers now described as “work ability assessment providers” to perhaps provide additional, more specified assessments, with a focus on prospective rehabilitation. Only if there is a capacity to work, would it make sense to have this further clarified by rehab professionals, who may further determine what work ability there may be. There is no other sense for the involvement of these supposedly “independent” assessors, and the naming of them as being “work ability assessment” providers does seem somehow inappropriate.
That is unless WINZ does not have any faith in clients’ own doctors and even their own selected designated doctors, and therefore follows an ulterior agenda to simply set the bar higher than conventional medical and other health practitioners may have been doing, to simply find ways of moving more sick and disabled off benefit receipt into any kind of “suitable” work, whether it may actually exist or not.
Due to the separation of the assessing party from the commissioning party seeking assessments of clients, it is expected to provide services to; there are different areas of legal accountability, which do only partly overlap. The assessor will perform a role similar to an advisor providing reports and recommendations, which the commissioning party (WINZ) will use to base decisions on. This process of dealing with outsourced assessments has of course already been used with designated doctors that WINZ has been using since 1995.
The experience with designated doctors is, that if they conduct any examinations in a flawed or even illegal manner, for instance by not applying natural justice principles, by using forms of bias, by not basing reports and recommendations on professional, competent, objective analysis and fair judgment, they can hardly be held accountable for this. Designated doctors may be complained about by laying a complaint with the Health and Disability Commissioner (HDC), but as there appears to be a kind of memorandum of understanding between the HDC Office and MSD or Work and Income (like also with ACC), such third party assessments are not usually dealt with by the HDC. In some cases the HDC may look at a case, if it was a face to face assessment, and if other criteria were met, but as has been experienced, the HDC is likely to claim, that any issues with an assessment by a third party should be raised with and resolved by the agency that commissioned the assessment, or by the medical or health professional who conducted the assessment.
The Health Practitioners Competence Assurance Act 2003 will in all likelihood also offer no legal remedies to any aggrieved assessed client, as any practitioner registered by a professional authority like the Medical Council, will not face any investigation and possible disciplinary actions, unless the HDC refers a case to the authority covered by that Act. So clients that may feel they were assessed unfairly, will have little means available to address any issues with a designated doctor, and the same will inevitably apply also to the new work ability assessment providers and their staff.
An appeal may be possible under the Social Security Act on medical grounds to the Medical Appeal Board (or “Medical Board”), but again, that Board will only look at the medical and work capability information provided and used for an assessment, and never be able to address any conduct by an assessor, except for making a recommendation on the documentary and verbal evidence put before it, that may be different from the previous assessor’s recommendation.
That means that these new contracted, private, outside work ability assessment providers will be able to operate with too little scrutiny, except for that which will be placed upon them by Work and Income, as part of contractual agreements. Of course the medical and health professionals employed by the providers will be bound by the Code of Ethics of the medical profession, but with the present setup of the law, there is very little that can be done to effectively hold the staff accountable for any wrong actions – including incorrect assessments they provide.
As the ‘Legislation Advisory Committee’ already stated in their submission to the Social Security (Benefit Categories and Work Focus) Amendment Bill, the Chief Executive of MSD and Work and Income now have such wide ranging powers of discretion, which include deciding about the work ability of clients, that most decisions will inevitably and ultimately be made by WINZ staff acting under the authority of the Chief Executive. This is a major concern, and it basically invites the same kinds of problems that occurred in the UK, during the use of ATOS Healthcare as an outside assessor for the DWP. Recommendations are made, whether correct or not, passed on to WINZ, and the RHAs, RDAs and case managers will generally accept them and base decisions on them.
The individual staff members working for the contracted work ability assessment providers will be bound by probably individual employment contracts and confidentiality clauses, so they will not be encouraged to divulge any sensitive information that may expose any provider for any shortcomings or wrongdoings that may have occurred. Only in extreme cases may some use special legislation protecting whistle-blowers, if very severe cases of misconduct, misdiagnosis and so forth may happen. The risk will always be dismissal, and that in itself will force staff to “tow the line” and also cover each other’s backs.
Naturally the private providers will also NOT be bound by the Official Information Act 1982, so the public will have no means to scrutinise their operations and actions in any way. They will be bound by the Privacy Act 1993, but that will only allow affected, assessed clients to seek information relating only directly to their information that was provided and handled in relation to their assessment. It will limit access to any information to individual case scenarios. As few clients will want to share their personal medical records with media or the public, few will dare raising any issues that will arise.
At least there will not be the same problem as with the outsourced “Mental Health Employment Service” providers, who will be motivated by earning as many rewarding fees as they can, in order to meet at least certain targets to cover costs and achieve at least some profits. That “reward system” can in itself have negative, harmful consequences for clients those providers are supposed to offer “wrap around services” and get into employment. With a flat fee of $ 650 per assessment though, the only motivator the WAA service providers have will be, to do as many assessments as possible. Only if they have after that also the prospect of WINZ perhaps also paying for rehabilitation services for clients, then they may be extra motivated to find more clients “fit for work”, even where there may be questions whether they really are, simply to get more “business” that way.
While I am not in a position to give any proper, professional legal advice to any WINZ clients on how to deal with private, outside WAA service providers, I would nevertheless advise affected persons to be extra careful and cautious, and to prepare well for these assessments. As it has been suggested re assessments with “designated doctors”, it will be wise to have a support person to serve as a witness, or if that may be a problem, to perhaps record the conversations of the 1-hour interview with an assessor. I would recommend that affected clients ensure they have up to date medical and other record with them, when they go there, and present what needs to be presented, to provide evidence of medical diagnosis, of treatment and what else may matter. It may be a good idea to have the assessor sign a statement re what documents they were presented. Most certainly it will be important to state clearly and correctly what sickness, injury, disability, health conditions and impairments a person has, and to stress the very aspects that prove that certain work is not an option.
The Social Security Act provides for harsh sanctions if the attendance of such assessments is refused or failed without good, sufficient reason, so it is no option to not cooperate, unless good reasons exist. I would also advise affected to ask the assessor for their qualifications, whether they are registered with a particular medical or health professional authority and of course what their full name is, that is if they do not provide the information themselves. I would also ask about whom else will be involved in preparing the final report and recommendations. If no recording is made, I would afterwards make detailed notes about what was asked and what was answered and discussed during the assessment interview. I would make a list of documents provided, and I would ask for a copy of the assessment report once it has been sent to WINZ, as WINZ will certainly have to provide the information under the Privacy Act.
If the recommendation appears unreasonable, unfair and based on irrelevant information, I would certainly request a review of decision if WINZ have relied on such a flawed assessment report and recommendation, and if a review will not bring the desired result, I would seriously consider making and appeal to a Medical Appeal Board.
These new providers and new processes are new territory for clients and WINZ staff to work on, so it pays to follow also media and other reports on how other persons fare with them. It pays to read up on Mansel Aylward, Dr David Bratt, and what these persons represent in regards to “medical opinions”, as what they propagate can hardly be based on sound science and research. This must be raised again and again, and the medical profession and scientific community must be challenged to address the issues that have repeatedly been raised about Professor Aylward and his like-minded colleagues.
H). CLOSING NOTES AND FINAL CONCLUSIONS
It is with great disappointment, but should not surprise, that the government and Social Development Minister Paula Bennett show no signs of wanting to review or even reverse the draconian, largely punitive welfare reforms, as the following news-media report reveals. It appears they are hell-bent on pushing on with this agenda, to drive sick and disabled into jobs and off benefits, without the proper support and fair, respectful treatment that clients should be able to expect. In view of that, it is a duty of those of us, to use our remaining capabilities to continue raising the very serious issues that remain.
Paula Bennett and WINZ are clearly not intent on changing anything
‘Bennett: No changes at Work and Income’, ‘Stuff.co’, ‘Nelson Mail’, 02 May 2014:
“Social Development Minister Paula Bennett says she is proud of Work and Income’s 4500 staff and won’t be making changes as a result of a campaign by Nelson woman Sarah Wilson.
Wilson has said the department is inhumane, and that dealing with it is frustrating, depressing, anxiety-inducing, dehumanising and debilitating. Her complaint about her treatment as a beneficiary led to an apology from the Nelson office.
But Bennett, who visited the Nelson office yesterday, said while there she had been approached by a woman tearfully complimenting the work of two staff, and had been shown letters and notes received from people who disagreed with Wilson.”
“With 295,000 people on welfare, she had much more to think about than Wilson, she said, and she saw no need to make changes as a result of what Wilson had said.
Although there were some mistakes, Work and Income staff cared about the people they dealt with and wanted to help them – that was why they worked there.
“I’m really proud of them,” Bennett said. “I stand not just beside them, I stand in front of them and I’m happy to take any flak for the policies, but I think the work that they’re doing is outstanding.” “
Comment: SOME NEVER LEARN!
Best wishes –
Quest for Justice 09 May 2014
(This series of posts was first published via ACC Forum, and has been published here with the permission of the author)
A further link to an earlier article in the ‘Nelson Mail’ on 24 March 2014:
‘Sick writer fights for beneficiaries‘, by Stacey Knott
Links to Sarah Wilson’s ‘Writehanded’ blogs:
Contents of Study
Part A) WORK AND INCOME INTRODUCES “INDEPENDENT” WORK ABILITY ASSESSMENTS PROVIDED BY PRIVATE, OUTSOURCED CONTRACTORS
Part A.1.: Introduction and Background Information
Part A.2.: Social Security Act changes facilitating the new, draconian measures introduced as part of the major welfare reforms
Part A.3.: Aylward’s “UNUM-sponsored” “research” adopted by the AFOEM
Part A.4.: A.4.: Sundry information on medical certification and work ability assessments – in forms and relevant publications
Part A.5.: The use of Designated Doctors to conduct examinations / assessments
Part A.6.: Media reports on the changes in the area of work ability assessments
Part B) ACC’S APPROACH AND PROCESSES IN REGARDS TO WORK CAPABILITY ASSESSMENTS AND REHABILITATION
Part B.1.: Legislation: The Accident Compensation Act 2001
Part B.2.: Information on assessments from the ACC website
Part B.3.: Critical reports and submissions on ACC processes and practices
Part B.4.: Media reports on ACC and their questionable practices and failures
Part B.5.: Comparison between the WINZ / MSD approach and the ACC approach to work ability and related assessments
Part C) WORK AND INCOME’S CONTRACTED WORK ABILITY ASSESSMENT (WAA) PROVIDERS
Part C.1.: New Zealand Doctor publishes details of WAA contractors
Part D) RADIO NZ INTERVIEW WITH MSD’s SANDRA KIRIKIRI
Part D.1.: A revealing interview by Radio New Zealand’s Kathryn Ryan with MSD’s ‘Director of Welfare Reform’, Sandra Kirikiri, on the expansion of a new WINZ scheme using “intensive case-management” and outsourced, private service providers, to place sick and disabled beneficiaries into jobs
Part D.2.: Analysis, conclusions and comments on that Radio NZ interview
Part D.3.: Some links to websites offering relevant media reports
Part E) OFFICIAL INFORMATION ACT REQUESTS AND ANSWERS RECEIVED FROM MSD
Part E.1.: Official Information Act (O.I.A.) request from 16 Jan. 2014, re “Mental Health Employment Services’ and ‘Work Ability Assessments’, with answers received (in italics) from Debbie Power, Chief Executive, dated 24 April 2014:
Part E.2.: Own Conclusions and Comments on the O.I.A. response by MSD dated 24 April 2014:
Part E.3.: Earlier O.I.A. request and replies from MSD
Part F) THE NEW WORK ABILITY ASSESSMENT PROVIDERS WINZ HAS ENTERED CONTRACTS WITH – A CLOSER LOOK
Part G) LEGAL ASPECTS AND IMPLICATIONS TO CONSIDER RE WORK ABILITY ASSESSMENTS
Part H) CLOSING NOTES AND FINAL CONCLUSIONS
Final Part) Contents of Study
F) THE NEW WORK ABILITY ASSESSMENT PROVIDERS WINZ HAS ENTERED CONTRACTS WITH – A CLOSER LOOK
a) APM Workfare – http://www.apm-nz.co.nz/
Information from their website:
“New Website Under Construction”
“APM Workcare delivers a wide range of services designed to transform lives.”
“APM Workcare provides assessment, vocational rehabilitation and employment assistance services across New Zealand. If you have an injury as a result of an accident, we deliver comprehensive and quality assistance in the following areas:
→ Stand alone work place assessments
→ Stay at work services
→ Work ready services
→ Job brokerage services
→ Job search services”
“Vocational rehabilitation services are aimed at assisting adults who have sustained an injury achieve their maximum level of function, and safely return to work and activities of daily living. Assessments are designed to obtain objective information regarding an individual’s abilities and limitations, in order to determine functional capacity, and rehabilitation and return to work potential. Services are structured, goal-oriented, and promote positive functional outcomes.”
“APM Workcare uses a client centred approach, recognising that every person and setting are unique, and strives to find the best solution for each situation. The consultants at APM Workcare share a dedication to ongoing education and training, have experience working in a variety of occupational settings, and are sensitive to many workplace issues such as safety, productivity demands and current legislation.”
“APM Workcare and Integrated Care are New Zealand companies that originate from Advanced Personnel Management, an Australian owned company which commenced in Western Australia in 1994 and has steadily grown to provide services internationally. In Australia, APM is the largest private sector provider of Australian Government funded Vocational Rehabilitation Services and Disability Employment Services.
APM Workcare opened in New Zealand in 2011 and began delivering services in March 2012. Our track record and knowledge of what works for rehabilitation management will add value to solutions offered under the new Vocational Rehabilitation Services framework contracted by ACC.”
Our priority is to contain the human and financial cost of a disability, injury or illness and advance the quality of working life.”
“Interested in ACC Vocational Rehabilitation Services? Partner with APM Workcare”
“We welcome the chance to work in partnership with innovative, high performing organisations who share our mission to contain the human and financial cost of a disability, injury or illness and advance the quality of working life.
We particularly welcome those organisations who can offer an area of specialism and ask that you contact us with your interest.
For ACC Vocational Rehabilitation subcontracting opportunities please complete our online Expression of Interest Form. Alternatively, we can be contacted on 0800 967 522.”
Address given on website:
APM WORKCARE LTD, Rosedale Office Park, Unit 7D, Suite A, 331 Rosedale Road Albany,
Just looking at their limited website information, it becomes clear, that APM Workcare, a subsidiary of the Australian parent company, is not so much an “independent” assessment provider, but has so far rather provided assessments only to prepare clients or customers for vocational rehabilitation and for employment placement purposes! Their “Mission” clearly states their goal to “contain” costs due to disability, injury and illness. It is beyond belief that this new contracted service provider that WINZ are using is supposed to be “independent”, while paid by WINZ, and expected to deliver services with clear outcome target expectations, namely to put persons they assess into rehabilitation, employment or both. As the same company has also entered contracts with MSD to provide “Mental Health Employment Services”, and probably similar services for other client groups, there is a certain conflict of interest in this supposedly “independent” “Work Ability Assessment” provider.
An independent assessor should not be allowed to have an additional or ulterior interest in “earning” extra fees from providing additional (rehabilitation and referral) services to the persons assessed.
They have already been operating in New Zealand since 2012, and have also provided “vocational rehabilitation services” for ACC! It can be expected that they will bring in their experience from working with ACC.
b) Catapult Employment Services Trust – http://www.catapult.org.nz/
From their website:
“Catapult is a source of good workers
Catapult is a source of good workers, who may have had time out of work because of a disability, trauma or illness.
There are many things that put people out of the workforce for months, even years. It can be a personal trauma, or it can be a disability that you are born with, It can be the result of a bad accident, or it can be a long run of really bad luck…
Catapult is an organisation that helps such people who now want to get back into work and as a result, employers are finding people who get the job done, do it with pride, and tend to stay with the job longer.”
“A free supported employment service for both employers and jobseekers
The Catapult Employment Services Trust is made up of a range of people from various backgrounds and professions (see Staff page). The Board comprises professional business people to reflect Catapult’s ideal of setting itself alongside other progressive businesses in Canterbury.
Catapult was developed to support people into work who, by virtue of condition, illness, impairment or disability are marginalised from open employment. It is contracted to Government and receives financial support from philanthropic organisations and grants.
What sets Catapult apart is the extent to which it matches the right people with the right jobs… and then can stay involved for as long as required. This helps maintain a long term satisfying employment relationship for both employer and employee.”
A look at their ‘staff’ tells us this (current on 03 May 2014):
“Kevin Blogg FRCSA | Director | Contact Kevin Ph: 03 929 0780
The combination of life’s experiences. either good or challenging, is what Kevin brings to supported employment. With experience in business, employment and marketing, Kevin has developed strong business networks over the years which enables him to move easily amongst all people involved in the employment placement industry. His commitment is to secure sound employment and career development for all his clients, and to encourage employers to value the concept of investing in a diverse workforce. Kevin was recently accepted as Fellow of the Recruitment and Consulting Services Association Australia and New Zealand.
Alison Brown | Assistant Director | Contact Alison Ph: 03 929 0781
Alison has eighteen years of experience in assisting people to find work, in negotiating, administering and monitoring supported employment contracts between employers and workers, in building partnerships with employer groups, training providers, and work placement agencies, and in developing career plans and writing CVs She has a strong network of contacts in the private and not-for-profit sectors in Christchurch and holds a degree in Psychology.
Haylee Powell | Office and Systems Administrator | Contact Haylee Ph: 03 929 0786
Holding a qualification in Business Administration and Computing, Haylee began working at Catapult in January 2004 as an Office Assistant and has progressed into her current role as our Office & Systems Administrator.
Brent Trethewey | Senior Employment Consultant | Contact Brent Ph: 03 929 0782
Brent has an extensive history in working as an Employment and Vocational Consultant. He began working at Catapult in September 2004 and has established remarkable relationships with clients and employers, Brent is considered a valuable asset in our commitment to providing quality service to all people we come in contact with.
Greg Chilton-Smith | Employment Consultant | Contact Greg Ph: 03 929 0783
Greg has an extensive background, ranging from farming to owning his own business. This experience along with Marketing and Management qualifications, sees Greg well equipped to work in assisting people into the workforce.
Joe Maxwell | Employment Consultant | Contact Joe Ph: 03 929 0785
Joe has worked in the employment consultancy and learning disabilities fields for over ten years, the last seven of which were in the UK. Included in his working career, are periods of voluntary work, social work, along with sales and marketing. In Joe’s experience of working with jobseekers who face personal challenges, he has gained and appreciation of just what people can achieve.
Maree Stachel-Williamson | Employment Consultant | Contact Maree Ph: 03 929 0784
Maree is our newest member of staff joining the team in November 2013. Maree has worked in a wide range of fields both employed and self employed. She has been supporting clients to reach their goals since 2004, and is experienced in helping people problem solve and map out action plans. Maree has a Diploma in Counselling and is a Master Practitioner in NLP (Neuro Linguistic Programming).
Kevin Kirner | Job Coach |
Kevin joined Catapult as our Job Coach in June 2011. Having a background in management and the supervision of staff along with skills in grievance and problem solving enables Kevin to liaise effectively with our clients and employers achieving and sustaining positive outcomes for all parties involved.”
On their website page for ‘Employers’ it says:
“Catapult works by this three-step process…
Stage 1 is the assessment process.
It identifies jobseekers’ career possibilities, generic work skills, interests, stamina, etc., ensuring they are matched to a satisfying position that will allow the worker to perform to his or her maximum efficiency. This gives us a clear idea whether we have a candidate suited to you.
Stage 2 is working alongside the jobseeker
to apply for and secure appropriate work.
Stage 3 is our ongoing support
which enables the worker to maintain high levels of performance, and a longer
term of employment. Support can be provided for the supervisor and co-workers as well as the worker.
For ‘Jobseekers’ it says:
“We help you find a job, and we’re there long term to ensure everything goes well
Working with a Catapult consultant, jobseekers identify appropriate work and together we develop an employment plan to access the desired type of work. Once employed, we develop a support plan together to help maintain long term satisfying employment. Catapult can keep providing support for the entire duration of the employment if required.
We endeavour to provide an individual client-driven service, so we actively encourage jobseekers to communicate their needs and wishes throughout the process.
Catapult does not generally offer a list of vacancies from which jobseekers can choose. It does, however, have access to a diverse range of employers and job banks.
Who can access the service?
Any person who identities having a condition, illness, disability or impairment which may impact on his/her ability to find suitable employment, along with a commitment to finding and keeping a paid job.”
“How do jobseekers access the service?
Catapult has a referral process. A jobseeker can be referred by either a doctor, Work and Income Case Manager or Work Broker, or another service provider/agency. The referrer must complete a referral form and this can be done online or by downloading the referral form, filling it out and returning it to us”
Address of Catapult on website:
478 Barrington Street, Addington, PO Box 33368, Barrington, Christchurch 8244
So what have ‘Catapult’ to offer in the way of a supposed “independent” Work Ability Assessment provider, I ask, as they are clearly an employment service provider, and have NO appropriately qualified medical or rehabilitation staff at all to offer?! Given their strong focus on job placements and consultancy, they will as a future “assessor” have a very strong interest in getting business to refer clients into jobs, which makes them have a vested interest in declaring clients from WINZ as “fit for work”. As the information on the website shows, they have apparently already worked with Work and Income. I would expect an “independent” provider of “Work Ability Assessment” services to have at least medical AND possibly rehabilitation staff with the appropriate qualifications to assess “work ability”, and not primarily serve as an “employment service”.
c) Company Medic – http://www.companymedic.co.nz/
From their website:
As a market leader covering Northland and the greater Auckland area, we have the skills, expertise and talent to assist your business.
From full turn-key Health and Safety solutions across multiple high risk workplaces through to single service solutions such as workplace vaccinations or pre-employment testing we can meet your specific needs.”
“Our Services Include
● Pre Employment Testing
● Health Monitoring
● Drug and Alcohol Testing
● Post Employment Testing
● Injury Management
Under ‘Services’ it says this:
“Taking a manageable approach to working with you we can ensure your company and employees know where to start in respect of legal obligations, but also more importantly how to ensure your company is and continues to remain a safe workplace.
Our aim is simple; using our expertise we will take care of your legislative requirements and implement the necessary systems (or single need solutions) to mitigate a contingency risk that has the ability to significantly damage your brand, reputation and company profitability. Our staff includes leading experts in the fields of – Specialist Occupational Medical Practitioners, Occupational Health Nurses, Safety Systems Advisors and Health and Safety Advisors.”
Under ‘Pre-Employment Testing’ the website informs:
“You need new employees. How do you know if they are fit to do the job?…or even if they are fit, that they won’t become ill from exposures to chemicals or processes in the job? Are you fearful that by asking questions you many be abusing some right under law?
There is a way through this. We know and understand all the relevant legislation (Health and Disability, Privacy, Employment Relations Acts etc) and will create a process for you that is legally acceptable.
Company Medic can devise processes from simple questionnaires through to extensive medical examination and testing based on your workplace and the work your people do there. Such systems ensure you minimise and understand the risks of employing a particular individual. This will give you a sense of security whilst meeting your Health and Safety obligations.”
Under ‘Second Opinion Medicals’ it says:
“Your employee has been certified as unfit to work as a result of a workplace accident. It concerns you to think that you have gone to great lengths to ensure that good alternative duties are available and encouraged. You also need to consider that this injury may cause you to miss some Health and Safety goals you have set. You have the right to ask for a second opinion from a doctor you nominate.
Company Medic’s doctor is prepared to take on this role and ensure that workers are given the best chance of a quick recovery through appropriate treatment and returning to appropriate duties. Company Medic can help you develop relationships and systems of communication to reduce the chance of such events occurring. We can be involved with any long-term rehabilitation to ensure best outcomes.”
Under ‘Rehabilitation’ they inform:
“The cost of a worker off sick or injured from your work place can be extreme. Covering a skilled worker costs overtime, training costs and often decreased productivity and quality.
Good rehabilitation will reduce the costs and the downtime. Research has proven that people get better quicker and have less long term effects when actively rehabilitated following injury or illness. This saves employers money.
Company Medic has very experienced staff in this field that can work with you the employer, the injured person and ACC to ensure safe effective early return to work. We can ensure that your staff get the support they need to get back to their jobs quickly regardless if the absence is created by work injuries, non-work injuries or sickness.”
Under ‘Profiles’ they introduce their staff and management:
“Dr Jim Mcleod, MBChB Dip Occ Med, Dip Occ Health Practice
“Founder And Director”
Jim graduated from Auckland University with a Bachelor of Human Biology, Bachelor of Medicine and Bachelor of Surgery. He subsequently achieved a Diploma of Occupational Health Practice (Otago) 1997, Diploma of Occupational Medicine (Akld) 1999, Certificate in Hyperbaric Medicine (Akld) and Certificate in Teaching (Northland Polytechnic).
He has held a number of positions including Hospice Medical Director, Department Medical Practitioner and General Practitioner. He has provided Project Management and Consultancy services to a number of organisations including Northland District Health Board. Subsequently he was a Medical Advisor for HIH Insurance before forming his own Occupational Health Company in 2000.
Jim is currently a medical advisor to such clients as The New Zealand Refinery Company, and Shell New Zealand. He is an Accredited Provider for Accident Compensation Corporation.”
“State registered Nurse, Midwife, BSc Hons. Community Nursing MSc Practice Education. Certificate in Occupational Health.
Susie has some 30 years experience in a wide range of fields from Accident and Emergency, midwifery, Community Nursing and union representation as well as lecturing in nursing in UK. Susie has specialized in Occupational Health in recent years, completing the certificate in Occupational Health in 2009 at Otago.”
“Susie has a role in recruitment, induction, ongoing training, professional development, appraisal and supervision.”
“Beth Swarbrick” (Office Manager)
“Beth is the face of Company Medic. Usually the first person you will see if you come down or the first person who answers the phone when you call; her role is entirely to make sure that your needs and expectations are met.
After working her whole life with children in both Early Childhood settings and primary level, Beth decided on a change of career and did Legal Studies at Northland Polytech, gaining her Legal Executive Diploma.
Beth then worked in an accounts department, becoming Dr Jim McLeod’s Personal Assistant before moving into the role of Office Manager for Company Medic.”
“Julie Reynolds” (Client Liaison)
“Julie has recently returned to work for Company Medic where she takes on the role of Marketing/Client Liaison.
Her working background includes 6 years working as the Operations Manager for a large occupational health and safety company. She resigned from this role in 2007 to become full time caregiver for a close family member. In this role of Operations Manager she managed the day to day running of the company including a team of Nurses, Health and Safety Advisors and Technicians. She provided a consistent and quality service to clients.
Prior to working in this role Julie worked as a Case Manager at ACC for 3 years, where she worked alongside claimants, employers and health professionals to provide an in-depth rehabilitation service.
Julie also has several years experience as the Manager of a large retail outlet in Whangarei employing up to 26 staff at any one time.”
“Pip Bennett” (Occupational Health Nurse)
“Pip is a New Zealand registered nurse with many years’ experience in many different settings. Having worked in several hospitals gaining experience in most types of nursing, Pip moved in to general practice nursing. Moving to Whangarei, Pip ws self employed in health screen consultancy work and worked in a nurse lead health centre at North Tec.
Pip now works solely for Company Medic as an Occupational Health Nurse. She is studying a Post Graduate Diploma in Occupational Health.”
“Maureen Evans” – (Occupational Health Nurse)
“Hi my name is Maureen. My nursing qualification is a Bachelor of Health Science (Nursing) I have experience mostly in general surgical nursing and emergency department nursing. My first introduction to Occupational Health Nursing was helping a colleague for 1 to 2 hours weekly to complete annual monitoring for members of the many volunteer Fire Stations throughout Northland. I thoroughly enjoy the work of occupational health nursing and am currently completing Post Graduate Occupational Health qualifications.”
“Jas Futter” – (Occupational Health Nurse)
“Jas first trained as a Maternity Nurse at St Helens Hospital in Wellington and loved nursing so much she continued on to do her General and Obstetric Nursing Training at Middlemore Hospital in Auckland. After graduation she disappeared overseas and worked as a nurse in several countries including a 5 year stint at St Stephens Hospital Intensive Care Unit in London and a year at the International General Hospital in Paris.
On returning to New Zealand Jas went back to Middlemore Hospital and worked in Intensive Care completed the Intensive Care Certificate and then decided she had had enough of patching up unpatchable people and headed off to work in the Occupational Health Field at Winstone’s NZ where she learnt the ropes for Occupational Health Nursing and has been in the field ever since. Jas then went to New Zealand Post Office and New Zealand Post for 14 years and during this time she completed her Diploma in Occupational Health Practice at Otago University.
In 1997 after being secure in full time work Jas took the big leap and became an Independent Contractor.
As a contractor Jas has worked in a wide variety of roles and is now in a permanent contract position for a large forward thinking company managing their Occupational Health Programme from Health Monitoring through to their Drug and Alcohol Testing and Intervention Programme.”
“Jed Beney” – (Accountant)
After studying for two years, Jed returned to Whangarei and spent some time working in one of Northland’s largest Accountancy firms, which proved to be a good experience, both in a professional development sense and also in a lifestyle sense.
In 2007 Jed made the move to a commercial role for an Occupational Health and Safety Provider before making the move in to a contracting role for Company Medic, looking after some of the more complex issues faced by the business.”
Address for ‘Company Medic’ on their website:
51 Port Road, Whangarei 0140, New Zealand
Company Medic staff and management do certainly have qualified medical, health care and rehabilitation staff needed to be able to provide “work ability assessments”, but again, their services have to date been delivered with a strong focus on assisting employers, by offering them work place and staff examinations and assessments, all with the goal to minimise risks and to provide options for rehabilitation and assistance in hiring new staff. They have apparently also worked for ACC, but their existence as a business is hardly in an “independent” work ability assessment provider role, as they will have vested interests in serving their employer clients before the referred WINZ clients.
They have so far specialised in pre work testing of workers, work place assessment, consultancy services, injury management and training. I presume they have worked with rehabilitation service providers, but do not seem to be such themselves. With such a strong focus on serving employers, I question their “independence” as “Work Ability Assessment” providers. It may be presumed that they want to develop that new specialist type of activity.
d) ECS Connections Ltd – No website found!
PO Box 269, New Plymouth 4340, Taranaki
‘ECS CONNECTIONS LIMITED’
“Registered Address: 16 Puketotara Street, Highlands Park, New Plymouth 4312 NZ”
“Shareholder name Shares Percentage
Grant Burfield LANGLEY 500 ~ 50.00%
Faye Emily LANGLEY 500 ~ 50.00%”
Director Grant Langley on LinkedIn:
Managing Director at ECS Connections Limited
Employment Advisor at New Zealand Employment Service
Outplacement Consultant at Business & Management Services
Medical Department Manager at Glaxo New Zealand Limited
BSc(Psych) PGDipRehab(Distinction) DipCareersGuid PMCDANZ MNZPsS”
“Grant Langley’s Experience”
ECS Connections Limited
1997 – Present (17 years)
New Zealand Employment Service
1996 – 1996 (less than a year)
Business & Management Services
1994 – 1995 (1 year)
Medical Department Manager
Glaxo New Zealand Limited
1992 – 1994 (2 years)
Clinical Research Manager
Glaxo Group Research, UK
1991 – 1991 (less than a year)
Medical Development Manager
Glaxo New Zealand Limited
1988 – 1990 (2 years)
Pharmaceutical Development Officer
Glaxo New Zealand Limited
1985 – 1987 (2 years)
Medical Research Assistant
Pfizer Laboratories Limited
1984 – 1984 (less than a year)
Palmerston North Public Hospital
1981 – 1984 (3 years)
Department of Rehabilitation and Rheumatology
Palmerston North Public Hospital
1980 – 1980 (less than a year)
Trainee Medical Laboratory Technologist
Taranaki District Health Board
Government Agency; 1001-5000 employees; Hospital & Health Care industry
1975 – 1976 (1 year)”
This is obviously a small business owned by Grant Langley and his partner, and the Managing Director has a science degree in apparently psychology, plus qualifications in rehabilitation, and is member of two professional organisations. Grant Langley only worked for a few years in lab and research positions, and also only shortly as a psychologist, and then followed a career in the pharmaceutical industry (Pfizer and especially with Glaxo). Only briefly did he work for the former New Zealand Employment service (less than a year), and he started his own employment agency EPS Connections Ltd in 1997, which he has since headed as director.
Again we have a business agency that is primarily active as an employment placement and consultancy operation, with NO track record of providing “independent”, medical type work ability assessments. The agency currently only has a P.O. Box address in public listings, and there is NO information about staff and other details. It is a peculiar contractual involvement that MSD have entered here. So at best we must presume, they want to set up new services to deliver to WINZ, with so far no indication what kind of staff to employ for this.
e) EnableWorks Ltd – http://www.enableworks.co.nz/
Information found on their website:
“Welcome to EnableWorks”
“EnableWorks partners with employers and insurers to lower the cost of worker injury & illness, resulting in improved performance & productivity”
“We tailor services for employers; small, medium and large businesses; and insurers
○ Injury Prevention
○ Early Intervention
○ Work Rehabilitation”
“Our programmes and processes are robust, our results are quantifiable”
“EnableWorks is the licensee of two international injury prevention and rehabilitation processes:
○ We can confirm a person’s physical capability to perform specific job requirements with WorkSTEPS Pre and Post Employment Functional Tests”
○ “We manage acute pain and prevent chronicity (chronic pain) through Abilita coaching, preventing delayed recovery for the injured or unwell worker”
Under ‘About EnableWorks’ we find:
“We utilise evidence based, international best practice for injury prevention, early intervention and work rehabilitation.
Our services are based on our underpinning philisophy “Work is central to wellbeing”
EnableWorks offers a full range of services that are objective, targeted and tailored to meet the worker’s needs as well as employer and insurer requirements.
The recent integration of WorkSTEPS and Abilita licensed rehabilitation programmes ensure objectivity and consistency. EnableWorks can offer both of these programmes nationwide.
Our team works in partnership with all parties to achieve a positive outcome for the employer, insurer and client”
Under ‘Work Rehabilitation’ they inform:
“INJURY ILLNESS DISABILITY”
“EnableWorks endorses International Best Practice. We provide a full range of inter-disciplinary services to assist people to return to work:
EnableWorks uses a range of assessments and standardised tests to identify physical, psychological and social barriers impacting on return to work.
EnableWorks exclusively offers:
WorkSTEPS Fit for Duty Test – objectively defines functional readiness for return to work
Abilita Assessment – identifies and quantifies psychosocial barriers to return to work
EnableWorks Programmes are designed and tailored to overcome physical, psychological and psychosocial barriers, utilising a self-management approach.”
At the bottom of that page some further information is offered under:
“Please click here for a referral form to access any of our services.
○ Psychological Services
○ Vocational Services
○ Pain Management Services
BUT, by clicking any of the links, no additional information is offered!
Address for ‘EnableWorks Ltd’ on their website:
61 Mandeville Street, Riccarton, Christchurch
While EnableWorks do clearly offer assessments and testing to persons facing employment challenges or difficulties due to disabilities, injuries and illness, there is no detailed, transparent information on who they employ to do the testing and assessing. It appears that they are yet another employment service agency, which offers some prevention and basic rehabilitation services. It is mystifying as to why they have been contracted by MSD to provide “independent” assessments, as their focus has to this date again been to primarily serve employers and insurers by offering rehabilitation for persons.
If WINZ want to contract with rehabilitation services to help clients improve health conditions and reduce disability and impairments, they should openly state this. To call this kind of operation an “independent” “Work Ability Assessment” provider seems to be somewhat inappropriate. Only time will tell what they will actually deliver, in whatever form.
f) Linkage Limited (Wise Group) – http://www.linkage.co.nz/
From their website:
“Welcome to Linkage”
“Linkage is here to help you access information and support for your wellbeing – at the right time, in the best way. Here’s more about what we’re doing to help strengthen the wellbeing of people and communities.”
Services offered include:
‘Webhealth’ – “Our online directory that helps you find a health or social service for your unique needs”
‘My Linkage’ – “Where people, whanau and organisations sign in to make and save lists of wellbeing providers”
‘ACC advocacy’ – “Free and independent service that helps quickly resolve issues with ACC claims”
Under ‘Linkage services’ this can be found on assessments:
“Work ability assessments”
“Identifying strengths and the right supports can make a world of difference for people who may be facing barriers to realising their employment dreams.”
“Linkage’s work ability assessment service is available for people who receive support from Work and Income. To break down any barriers to help a person achieve their employment dreams, there may be times when Work and Income needs additional information. This could be about a person’s strengths and aspirations, the type of work they might be looking for and the supports and services they might need.
When Work and Income refers a person to Linkage, a registered health professional will meet with that person to talk about their employment journey so far. The registered health professional will discover what the person needs to find and keep employment that is meaningful to them. Based on the discussions from this meeting, Linkage will inform Work and Income how the person can build on their strengths and access the right services and support, to help them find work that fits best.
Meetings are held in Linkage offices closest to where the person lives.”
“Integrated mental health care involves primary and secondary services connecting and sharing resources so people get the best care possible.”
Important to note is that ‘Linkage’ is part of the Wise Group:
And part of the Wise Group is also ‘Workwise’, a separate company, which MSD has also contracted with, to provide “mental health employment services” and the likes:
Workwise is an employment agency that provides evidence-based support to help people facing personal or health challenges to find and keep paid employment. Our philosophy is based around a holistic approach to employment. We know that having a paid, meaningful job plays a crucial role in helping people live happy, healthy lives. http://www.workwise.org.nz”
Under ‘About Us’ on their website it says:
“Workwise is an employment agency for people facing personal or health challenges in their lives.
Workwise is a unique agency. Our employment consultants work alongside people, supporting them on their journey to find and keep meaningful employment.
Employers value our services, as we go above and beyond a usual recruitment agency. Our focus is on sustainable employment – keeping people in jobs long-term. That’s why we work hard to match the right people with the right jobs. It’s better for them and it’s better for employers.
People returning to work value our support, as we don’t just place people in a job and walk away. We help them find meaningful employment that matches their skills and aspirations, and we provide ongoing on-the-job support to help make them great employees.
We know that having a paid job is a key part of helping people maintain wellbeing. Our aim is to help people into decent, lasting jobs, and to help everyone get the best from the employment relationship.”
“Workwise can help if you are:
• an employer looking to employ a new staff member
• someone looking to return to work after experience of mental illness
• a clinician or case manager looking to refer someone who needs help returning to work
• anyone looking for information about mental health issues in the workplace.
Workwise is a member of the Wise Group – a family of non-government organisations operating in New Zealand’s mental health sector. Read more about the Wise Group here.”
Under their ‘NEWS’ column they offer this:
“Effectively integrating employment support
Presentation 1: Combining our expertise, effectively integrating employment support
Helen Lockett, strategic policy advisor, the Wise Group
Download presentation as a PDF (1.3MB)”
“The science of mental health and employment, an evidence based alternative to signing sickness certificates
Presentation 1: Helen Lockett, strategic policy advisor, the Wise Group
Download presentation as a PDF (1.1MB)
Presentation 2: Heather Kongs-Taylor, researcher, Te Pou
Download presentation as a PDF (790KB)”
The ‘Strategic Policy Advisor’ for ‘Workwise’ is Helen Lockett, originally from the UK:
See her LinkedIn page:
“Helen Lockett’s Overview
Strategic Policy Advisor at The Wise Group
February 2011 – Present (3 years 4 months)
Director of Programmes and Performance at Centre for Mental Health”
University of Bradford
University of Cambridge”
“University of Bradford
Masters in Business Administration
2008 – 2010”
“University of Cambridge
social and political sciences, social and cultural psychology
1990 – 1993”
There used to be more information on Helen Lockett on the ‘Workwise’ website, as there is now!
Of particular interest is that Helen Lockett sat on the so-called “Health and Disability Panel” that advised MSD and Paula Bennett on health and disability related matters (and measures to introduce) on the welfare reforms, which have resulted in her employer now getting “rewarding” contracts!!!
See also this information:
‘Linkage’ and ‘Wise Group’ job advertisement (from February 2014):
‘Registered health professional – work ability assessment’
“About Linkage and the Wise Group”
“The Wise Group is one of the largest non-government providers in New Zealand. We’re a family of charitable entities, and we’re all linked by a common dream. We believe in creating fresh possibilities and services for the wellbeing of people, organisations and communities.
We’re not like other organisations. For us it’s about people, not awards, it’s about caring, not headlines.
Linkage Limited operates as a subsidiary charitable company of the Wise Trust and supports people across New Zealand to access community services that meet their most urgent needs with the right information, at the right time, in the right way. Since 1998 Linkage has been providing free, professional and confidential support and information services to help people navigate their way through the health and social service system.
Our spirit is – together we make a difference. This is not just a slogan on the wall for us, we all live this every day and as individuals and as an organisation we work hard to stay connected with each other and our communities to inspire hope through choice.”
Details extracted from a comprehensive table in the position description:
“Registered health professional – work ability assessment”
“Reports to: Clinical Leader”
* To complete work ability assessments which place people at the centre and effectively identify the strengths they bring that enable them to find and keep employment which is meaningful to them
* To write reports that accurately reflect each person and the supports that will break down any barriers which may exist to working and living their lives well
* To build and maintain relationships with regional health and disability advisory teams that ensure Linkage is the provider of choice for work ability assessment referrals for people who experience mental health concerns
* To contribute to Linkage’s reputation for connecting people with the right information, at the right time, in the right way to address their most urgent needs.”
“Relationships (internal): Wise Group employees, Linkage employees”
Work and Income clients, regional health and disability teams, Work and Income case managers, relevant government and non-government agencies, local health and social services, community groups”
Build positive and engaging relationships
Assess strengths and break down barriers
Tracking and reporting
Meet key performance indicators
Be your very best
Be committed to safety and wellness in the workplace” (not detailed below)
“Provision of other related duties within capability“ (not detailed below)
“Activities (Build positive and engaging relationships):
Develop and maintain effective functional relationships with regional Work and Income health and disability teams
Work collaboratively with clinical, support, and other health and social services in planning and coordinating seamless service delivery
Communicate regularly and share relevant information and updates to ensure consistent messaging about the work ability assessment and its purpose
Develop effective relationships with the Linkage team to support the work ability assessment process”
“Activities (Assess strengths and break down barriers):
Provide a high trust environment where people feel safe, comfortable and encouraged to speak honestly about their journey
Conduct effective work ability assessments that uncover each person’s unique situation, dreams, strengths and needs
Use appropriate questions to accurately understand each person’s true barriers to meaningful employment
Develop and maintain a broad knowledge of the range of services available in each region to identify and connect people with the right supports”
“Activities (Tracking and reporting)
Write work ability assessment reports which clearly and accurately reflect each person’s strengths, abilities and dreams, and identify the supports they need to achieve employment goals”
“Activities (Meet key performance indicators)
Ensure referrals are managed to completion
Maintain knowledge of contractual obligations
Achieve all outcomes in line with the timeframes for completing a work ability assessment”
“Activities (Be your very best)
Plan regular uninterrupted times to meet with your manager to review your 90 day plan and seek feedback on your performance
Willingly undertake training opportunities if applicable to an activity (e.g. health and safety)
Role model a healthy lifestyle that includes a good work/life balance”
“Outcomes (Build positive and engaging relationships):
* Ongoing long term relationships are established with the regional health and disability teams
* Linkage is the provider of choice for work ability assessment referrals for people who experience mental health concerns
* Registered health professionals have broad networks and great relationships to deliver the best possible work ability assessment outcomes
* Linkage has a reputation for being an organisation that works collaboratively with others to get the right information, at the right time, in the right way to meet peoples most urgent needs
* Knowledge within the Linkage team is accessible
* Effective communication ensures confident journeys”
“Outcomes (Assess strengths and break down barriers):
* Work ability assessments are consistently delivered in line with Linkage’s policies, processes and values
* People who attend work ability assessments report feeling listened to and, instantly at ease and able to speak candidly about their ability to work
* Registered health professionals gather rich and meaningful data that best informs their recommendations for supports which enable people to find and keep a job that is the right fit
* Valuing people and listening builds trust”
“Outcomes (Tracking and reporting):
* People who attend a work ability assessment believe each report is a good representation of them on the page and understand what information will be provided to Work and Income
* The health and disability team accept all work ability assessment reports on first submission and accurately interpret the information provided to achieve positive outcomes for the people they support”
“Outcomes (Meet key performance indicators):
* All work ability assessment referrals are managed within the necessary timeframes
* Registered health professionals demonstrate robust knowledge of contractual obligations and consistently meet required outcomes”
“Outcomes (Be your very best):
* You demonstrate behaviour that is consistent with equitable practices
* Evidence of Treaty of Waitangi principles are reflected in everyday practice and future organisational planning
* Each working week is manageable and balanced”
“Practical and technical knowledge”
* A relevant health professional qualification
* Membership to a profession which is regulated by the Health Practitioners Competency Assurance Act 2003
* Full drivers licence
* Experience with Microsoft Office Suite
* Comprehensive understanding of relevant legislation including The Privacy Act, Mental Health Act, Human Rights Act and Treaty of Waitangi Principles
* Proven ability to build successful relationships with health and social service professionals and community organisations
* Sound knowledge of supports and services needed to support people to find and keep meaningful employment
* Knowledge and understanding of the barriers that could affect a person’s employment and how these can be addressed
* Excellent interpersonal skills
* Excellent time management and organisation
* Proven critical thinking and problem solving skills
* Proven ability to work independently”
* Extensive working knowledge of mental health and/or disabilities sector”
* Mental health and addiction or social work experience, particularly needs based assessment and condition management
* Understanding of vocational assessment in the context of an identified health condition, injury or disability
* Proven ability to accurately review and interpret medical, health and employment information
* High attention to detail, particularly in written communication
* Ability to produce professional, clear, accurate and timely reports
* Provide cultural safe clinical practice
* Ability to work in partnership with specialist health services, primary health services, government and non-government health and social services, and community organisations
* Effective learner and keen to try new approaches and develop new skills”
* Ability to quickly learn new computer programmes and skills
* Understands the recovery principles and has the ability to demonstrate this in practice
* Ability to utilise motivational interviewing techniques and the strengths model in practice
* Enjoys engaging with people from various cultures and backgrounds”
* Financial – Nil
* Operational – Nil”
To enable people to exceed their best and become a Peak Performer we believe it’s essential to be clear on what success looks like for every role in the organisation. We need to know what to aim for to truly realise our potential. So it’s not just about what we achieve, it is also how we achieve it that sets us apart and adds the inspiration for our journey.”
Under the headings ‘Description’ and ‘Positive indicators for the role’ detailed aspects of expectations are listed – in addition to the description above under “How to”). Areas covered are:
Adhering to principles and values
Working with people
Creating and innovating
Delivering results and meeting customer expectations
Adapting and responding to change
Writing and reporting
Planning and organising
Relating and networking
This comprehensive ‘Position Description’ gives an insight into what qualifications, experience, personal attributes and other skills and prerequisites an assessor working for ‘Linkage’ is expected to have. While there is talk about a “registered” health professional, the question arises, whether this position is for a senior or ordinary assessor position. One must presume that the targeted group of professionals will be a nurse or rehabilitation professional with relevant skills and experience.
Address for ‘Linkage’ on their website:
Kakariki House, 293 Grey Street, Hamilton 3216
The ‘Linkage’ website offers very little in the way of information about assessments that they quite evidently are providing to Work and Income and for their clients. There is NO information on staff employed, on any qualifications they may have, and what exactly they will be doing in detail, to assess referred persons. In that regards the “position description” from the “Wise Group” offers some insight into what kind of staff they will employ for work ability assessments. It is surprising that they advertised in February 2014 for a “registered health professional”. It is unclear whether all their assessors will have to be registered, and what exact qualifications they will hold in the end.
The description of Linkage’s ‘work ability assessment’ service seems like the language that Work and Income would use, and the service appears to be a mere “extension” of what WINZ would provide as a “service” to motivate persons facing “barriers” into employment. It clearly sounds like there will be certain expectations put into clients sent to these assessments, that they will already be considered as “fit for work” from the outset, and that ‘Linkage’ are only being consulted to clarify what needs to be done to “assist” clients into employment. Apart from that we get slogans, lots of photos and graphics, and nothing else. This is again NOT quite what we could call an “independent” work ability assessment provider, it is simply a service intended to “guide” clients sent there into other services preparing to work, or into some form of employment referral service directly!
It is a disturbing fact that we have ‘Linkage’ now commissioned by WINZ to do supposedly “independent” work ability assessments, and ‘Workwise’ commissioned to place sick and disabled WINZ clients into employment. This does mean, that ‘Linkage’ will of course have a vested interest in finding clients as “fit for work”, as they can then refer them on to the other ‘Wise Group’ company, to get paid for referring them into work! Also disturbing is the clear conflict of interest that Helen Lockett had, when she advised MSD and the government on welfare reforms, and on possible measures to introduce (e.g. outsourcing specialised services), which now has resulted in her employer gaining benefits in the form of service contracts from the welfare reforms. So much for “independence”, one must conclude!
g) Mana Recovery Trust – http://www.manarecovery.org.nz/
From their website:
“Welcome to Mana Recovery Trust”
“Mana Recovery values working together, recognising and respecting individual differences while supporting people to make positive changes in their lives.
Our purpose is to provide opportunities for our trainees to develop their social and work related skills in work based environments that focus on resource recovery, recycling and sustainable living.
To provide rehabilitation and vocational training services for people with mental health needs, with a sustainability focus.
To lead social and employment outcomes for people with mental health needs in the Porirua and Wellington region, through business partnerships which help our environment and support our community.
Originally known as Mana Community Enterprises, our non-profit organisation based in Porirua, was established in 1996 to provide vocational rehabilitation programmes to people with mental health needs, after the closure of the long-stay wards at Porirua Psychiatric Hospital.
After identifying that there was great difficulty for the people that we support (our trainees) to move beyond our programmes into paid employment, Mana Recovery developed a range of small business initiatives in partnerships with the Porirua City Council and local businesses, focused around sustainability. Through these initiatives, Mana Recovery offer services that assist our trainees to develop socially, gain employment skills and work ethics, building confidence and the opportunity to rehabilitate back into the community.
Today Mana Recovery has extended the concept of community care far beyond the original activity programme. Up to 100 people per day participate in a variety of training programmes and Mana Recovery now employs more than 25 people with mental health needs in full or part time positions within the organisation.
Providing meaningful community services through business initiatives that increase employment opportunities for our trainees and also benefit our environment is a recipe of success for Mana Recovery. With the partnering and support of our local council, businesses and the community, together we are paving the way to a truly sustainable future.”
Their “Services” are covered here:
“Our Products + Services”
“You can help our non-profit organisation by using our services and products or by recommending them to others!”
“ All proceeds go back into the organisation to provide further training and employment outcomes for our trainees. We can offer:
“Our services are provided via three separate locations, all of which are based in the Porirua region:
Business Recycling Collection
ReV Bags, Cushions, Footstools + Aprons
Grounds Maintenance, Gardening and Lawn-mowing
Second Hand Goods + Electrical Goods
Inorganic Collection + Donated Goods Drop off
E-Waste Metal Recycling
Resource Recovery Educational Tours”
The only “service” in the form of some kind of “rehabilitation” they offer is this:
“RIVERSTONES @ Mana Recovery”
“Riverstones aims to develop self confidence, personal achievement and a sense of self worth”
“Riverstones are the foundations on which our rivers flow, collecting rich nutrients on their way to nourish our oceans. Riverstones is the name of our vocational and rehabilitation training programmes, designed to provide our trainees with the necessary social, living and work related skills that they will require for their journey forward.”
“Our trainees are assessed for performance at regular intervals, with a range of course modules on offer:
Promotion of Individual Interests
Large and Small Task Performance”
“Providing hands-on work programmes is a key developmental step for our trainees, they gain valuable work ethics and skills that will help them in a real workplace environment. We are very grateful to the local businesses that willingly support our Riverstones training programme.
Riverstones programmes are conducted from each of our three locations – Oranga, Vailima and Trash Palace.”
Of interest are some of their “sponsors”:
Thank you to MSD for providing funding for employment opportunities for our trainees and providing funding for the Skills for Industry Retail Training courses.”
So third from the top, after the Capital Coast DHB and Porirua City Council they list MSD as one of their “sponsors”!
Addresses given for the ‘Mana Recovery Trust’ on their website:
Oranga @ Mana Recovery, 3 Hall Rd, Porirua
Vailima @ Mana Recovery, 2A Upper Main Drive, Porirua Hospital Grounds, Porirua
Trash Palace @ Mana Recovery, Broken Hill Road, Porirua
The Mana Revocery Trust may be doing excellent and commendable work in the areas they list, but there is NO information to be found on them offering anything in the area of medical and rehabilitation type work ability assessments, nor is there any information on the staff they employ. Given the information on their services, I feel I can confidently say that they do not have much in the way of medical or other health professional assessment staff. That means it will need to offer new services, which it has never delivered before. Of concern is also, that one of their “sponsors” is MSD, so how “independent” would this provider be? Having a sponsor send clients to a “sponsored” service provider for supposedly “independent” Work Ability Assessments does not sound convincing!
h) OTRS Group Ltd – http://www.otrs.co.nz/index.php
From their website:
“Welcome to OTRS”
“Organisation of Therapy and Rehabilitation Services
When life’s a challenge, OTRS can help you with a wide range of therapeutic and practical solutions to make your life easier. Our team will work with you to help achieve the independence and productivity needed to lead a satisfying and stress-free life.
A thriving, community-based private company, OTRS has operated successfully in the Waikato, Bay of Plenty, Coromandel and King Country regions, since 1999. Since then the services have expanded to include Auckland. Our directors, Jenny Oxley and Barbara Brook, both Occupational Therapists, are proud of the OTRS team’s ability to provide quality medical rehabilitation services following an injury or as the result of a medical condition or disability.
We are recognised as one of New Zealand’s leading providers in the specialist area of driver and passenger rehabilitation. In addition, we are the only organisation in the region with specialists who can carry out medical driving assessments.
Our team consists of occupational therapists, nurses, physiotherapists, psychologists, counsellor, speech language therapist, social worker and office and accounts managers.”
Under ‘Services’ they offer this:
• Occupational therapy driver and passenger rehabilitation
• BrainAction cognitive rehabilitation training
• Workplace wellness
• Case Management
• Progressive Goal Attainment Programme
• Mobility Scooters
• FUNdamentals Development Programme
• Occupational therapy
• Speech language therapy
“Driver and passenger rehabilitation”
“OTRS is your specialist organisation in the Waikato, Bay of Plenty, Coromandel and Auckland for driver and passenger rehabilitation. Using the unique driving simulator, we evaluate your driving capability in a safe and non-threatening environment.
A drive in your own car or the modified assessment car checks your road safety.
Advice will be given on your physical and cognitive (thinking skills) function as it relates to driving.
For both drivers and passengers information will be provided on suitable vehicles and modifications, including seating, driving controls wheelchairs hoists.
A driving assessment is appropriate for:
• Anyone who has a medical condition or injury and needs to determine their ability to drive safely and/or advice on vehicle modifcations
• Older persons who have lost confidence or noticed a deterioration in their driving skills
• Learner drivers who are unsure of their potential to learn to drive, due to their disability or medical condition
• Learner drivers who require the use of a vehicle with modifications to compensate for any physical limitations
• Commercial class drivers who require medical fitness to drive”
Their ‘Team’ consists of:
Managing Director, NZ Registered Occupational Therapist, Post Graduate Certificate in Occupational Therapy Driver Assessment Training, Certificate in Advanced Driving Competence, Certificate in Adult Teaching, EMS Accredited.
Managing Director, NZ Registered Occupational Therapist, Post Graduate Certificate in Occupational Therapy Driver Assessment Training, Certificate in Advanced Driving Competence, PGAP, FIM and EMS Accredited.
And they also list a number of occupational therapists, physiotherapists and nurses, one psychologist (Veronika Isler) and a speech therapist.
For ‘Contact’ they give this address:
OTRS, PO Box 4138.Hamilton, LIFE Unlimited Building, 20 Palmerston Street, Hamilton 2540
OTRS Group appear to have at least some staff that are needed to provide something like “Work Ability Assessments”, and they seem to also offer certain support and rehabilitation services. I see no reference to staff with a medical practitioner background, but they have at least a psychologist and a number of occupational therapists and physiotherapists and nurses.
As a private business with a focus on rehabilitation and support services to refer clients/patients into employment, there is again a kind of focus, which goes far beyond of what I would call simple, independent “Work Ability Assessments”. So it seems again, to be a contract, where more than just assessments will be expected to be delivered. Hence the impression is that WINZ are not simply going to expect “Work Ability Assessments”, and actually want the provider to deliver more, which raises questions about the true purpose of this new outsource assessment service they talk about.
They offer the specialty of driver and passenger rehabilitation.
i) PhysioACTION Ltd – http://www.physioaction.co.nz/
From their website:
“Welcome to PhysioACTION”
PhysioACTION aims to provide a first class Physiotherapy Service for all clients. Clients should find that their treatment or rehabilitation gives them the best recovery or function for them to carry on their day to day activities.”
“What we provide:
General Physiotherapy Services
We achieve this through:
Manipulation or mobilization
Deep and Soft Tissue massage
Pre/post surgery rehabilitation
Lifting and Back care
“NB: Please note that PhysioACTION is an ACC contracted provider for these rehabilitation programmes and that the programmes do require the prior approval of ACC.”
PhysioACTION will be the location where clients choose to have their treatment or rehabilitation because of the professional, friendly and welcoming environment that is provided. Clients will experience the best possible level of care and respect whilst receiving our services.
PhysioACTION staff will be client focussed at all times.
Honesty, integrity and confidentiality.
Respect and dignity for all individuals.
Service excellence – pride in what we do.
Accessibility of services to a diverse range of clients.
Innovative Physiotherapy services”
PhysioACTION has a team of qualified and skilled Physiotherapists, supported by competent administration staff. All Physiotherapists involved in treatment have sound knowledge of musculo-skeletal conditions whether the onset be on the sports field, at work, from a road traffic accident or at home.”
The only services they list are under ‘physiotherapy’ and ‘exercises’:
Addresses for ‘PhysioACTION’ on their website:
PhysioACTION Glenfield, 418 Glenfield Road, Glenfield
PhysioACTION ShoreCare, Sovereign House, Smales Farm, Takapuna
PhysioACTION Birkenhead, 165 Mokoia Road‚ Birkenhead
PhysioACTION Panmure, 2 Clifton Court‚ Panmure
(2 further addresses in Auckland are listed)
Again this is primarily a rehabilitation service provider, and the website gives only information that they employ physiotherapists with their relevant qualifications and experiences. There is no mention of any medical practitioner or other practitioner staff outside the mentioned area. Any assessments they will have so far provided, will have been done for planning and preparing rehabilitation measures they offer for clients/patients. They may well offer mere “Work Ability Assessments”, but that will likely only be done following earlier assessments done by GPs and so, certifying a basic ability to do some forms of work. They have done work for ACC, so any services provided to WINZ are likely to be of the same or of a similar type as offered to the Corporation.
j) ProActive Rehab – http://www.proactiverehab.co.nz/
From their website:
We provide our clients with holistic solutions that focus on long-term recovery. Our treatment deals with you as a whole person, rather than simply treating your injury. Whether you are a corporate, insurance or private customer, we can help you recover.
We recognise an injury can really put a stop to not only that working part of the body, but to all aspects of your life. We have a spectrum of services aimed at kick starting your recovery and providing you with the ability to reclaim independence!
ProActive not only provides acute Physiotherapy, we also provide Specialised Musculoskeletal Exercise Rehabilitation services, Pain Management services, Return to Work programmes and occupational solutions. Workshops we provide include: injury prevention and educational workshops, nutritional workshops, stress management workshops, Corporate OOS, Wellness programmes , manual handling workshops and expertise in exercise prescription for work fitness and safe work practices.”
With the changes in physiotherapy funding under ACC we asked our clients what they were looking for and what they needed. There was a variety of acceptable co-charges and expectations for these, which has led us to develop a tiered service structure as well as four specific packages that give more value to our clients and to the referrer.”
You do not need to see your GP first to be eligible so you can quickly access injury treatment. The earlier you get on to your injury, the more likely you will make a full recovery. ProActive complied to accreditation criteria and meets best practice standards across all of its services. Consumables are not covered by ACC, so a small fee will be charged to cover these if required. Failure to attend appointments will also incur a surcharge of $20.00.”
Under ‘Case Managers’ they publish this:
“ProActive provides health and disability insurers a true multidisciplinary team service to ensure best practice intervention and outcomes for your clients. ProActive’s spectrum of services includes a full range of assistance, including physiotherapy treatment, reconditioning programmes, pain management, vocational rehabilitation, wellness programmes and injury prevention workshops.”
Under ‘Medical Professionals’ you find:
“When referring patients for injury care, all professionals want a genuine, quality, outcome focused organisation to link with. You can be sure that if your patient is treated at ProActive, we will do our very best to provide premium high quality care”.
“As mentioned in the services section of this website, we provide an all encompassing holistic approach to injury care, that focuses on long-term recovery. Whether the patient is participating in one or several of our services, our treatment deals with a client as a whole person, rather than simply treating one aspect of the problem.”
“ProActive strives to deliver an outcomes based client centric service. Working hard with our clients to ensure their engagement and ownership of their rehabilitation programmes, ProActive staff have demonstrated the ability go out of their way to help clients achieve goals.”
Addresses given for ‘ProActive Rehab’ on their website:
c/o Les Mills Extreme, 52-70 Taranaki St, PO Box 6074, Marion Square, Wellington
c/o Les Mills Hutt City, 7-15 Pretoria St, Hutt City
c/o City Fitness, Coastlands Shopping Centre, Paraparaumu
c/o Te Rauparaha, Arena Health & Sports Med, 17 Parumoana Street, Porirua
‘ProActive Rehab’ are again primarily a rehabilitation provider, offering physiotherapy, specialised musculoskeletal exercise rehabilitation services, pain management services, return to work programmes and occupational solutions. They appear to be located in various fitness centres. They are also an ACC “subsidised” service. Yet on their website there are no professional qualifications listed for the staff they employ. For “Work Ability Assessments” they seem to have taken on new, additional service delivery for WINZ clients, as they are not really set up to simply deliver assessments to third parties. The fact that they are again primarily a rehabilitation service provider, raises again the question what the true intentions of MSD and WINZ are with using these services.
k) Southern Rehab – http://southernrehab.co.nz/
From their website:
“SouthernRehab is a leading South Island interdisciplinary rehabilitation health centre situated in Sydenham, Christchurch. SouthernRehab is a pioneer in the development of interdisciplinary rehabilitation and continues to be the largest private community provider of rehab services in Canterbury.
SouthernRehab also provides Vocational Rehabilitation Services throughout the entire South Island via a network of specialised clinics and practitioners. Please select the Vocational Rehabilitation Service tab above to access a further description of these services and to find a list of South Island Providers.
SouthernRehab assists people to manage all aspects of their condition. Examples of the types of conditions and rehabilitation services that SouthernRehab provides are: musculoskeletal and persistent pain assessments and rehabilitation programmes; orthopaedic injury – including pre and post surgical treatment; brain injury and concussion assessment and rehabilitation; psychological assessment and treatment; spinal cord injury rehabilitation; and vocational rehabilitation, including return to work following an injury.
The SouthernRehab team includes rehabilitation and musculoskeletal physicians, physiotherapists, occupational therapists, clinical psychologists, career practitioners, nurses and speech language therapists.
SouthernRehab’s interdisciplinary provision reflects the current evidence that persistent pain and disability following injury is a combination of interrelating physical, psychological, social and occupational factors. We combine the skills of our clinicians to integrate the journey of care around the needs of our Client.
People can be referred to SouthernRehab for their injury rehabilitation through a variety of means including self-referral, GP referral, ACC and Health insurance.”
Under ‘About Us’ we find this:
Our aim is to be a nationally recognised Centre of Excellence for the provision of Interdisciplinary Rehabilitation Services
Clinical Excellence in an Interdisciplinary team environment is the cornerstone of our philosophy:
SouthernRehab is an Interdisciplinary team, which “goes across” the discipline boundaries depending on the particular problems of the Client, the specific skills of each of the team members and the goals for the rehabilitation programme. Our approach is characterised by Client-centered goal planning with recruitment of individual team members and groups of team members to achieve specific tasks towards those goals.
SouthernRehab recognises the complexity underpinning persistent disability, and that effective rehabilitation brings together the skills of different clinicians to assist the Client towards their goals. An integrated rehabilitation programme fosters self-management and supports more normal function. Benefits include restored quality of life and independence.
We understand that timely delivery of services is also a key part of providing effective rehabilitation solutions and recognise the importance of efficient process and attention to detail for our Clients. We believe in investing in the development of business and administrative systems to support our clinicians to meet critical time-frames.”
‘Vocational Rehabilitation Service’
“SouthernRehab provides Vocational Rehabilitation Services throughout the South Island, through ACC’s Vocational Rehabilitation Services contract. These services include :
NB: The following names and descriptors are consistent with ACC’s Vocational Rehabilitation Service but non-ACC Clients, medical practitioners, private case management/insurance companies/personnel are welcome to use the same structure or customise our services to their requirements.”
Under Services they list a number of assessments or evaluations they offer:
“Functional Capacity Evaluations (FCE)
An FCE is used to determine a person’s safe physical limitations for performing work. The FCE referral can target simple, complex or task specific information. It is a systematic process of measuring, recording and analysing a Client’s ability to perform purposeful activities in response to broadly defined work demands, activities of daily living or projected vocational status. The assessment usually takes around 3 to 3.5 hours to perform.
SouthernRehab uses the Workhab programme or ErgoScience FCE Physical Work Performance EvaluationTM as the assessment tool.”
“Initial Occupational Assessment (IOA)”
“The IOA is an ssessment with a Vocational Consultant to establish work types that a Client is able to pursue after an injury when they are unable to return to their pre-injury work. The assessment takes into account the Client’s skills, education and experience. After the assessment a report including the selected job types is sent to the Case Manager.
The IOA assessment usually takes 60 to 90 minutes of face-to-face time and the appointment is usually followed up by a phone call to inform the Client of any outcomes. The IOA forms the basis of job options that ACC may consider for use in the Client’s rehabilitation journey.”
“Vocational Independence Occupational Assessment (VIOA)”
“This assessment is carried out by a Vocational Consultant to review the vocational services provided to a client and consider the suitability of types of work previously identified for the client in the Initial Occupational Assessment (IOA). People are eligible for a VIOA when they are no longer able to work in their pre-injury role and have been deemed by ACC to have received all necessary rehabilitation services.”
Under ‘Services’ they list a range of rehabilitation services for primarily physical disabilities, and only this for “psychological services”:
“Psychological Services (Psych)
After an injury there are often challenges to adapting to ongoing symptoms and changes in lifestyle. Sometimes there are emotional problems relating to the experience of the accident. Clinical Psychologists help to identify any difficulties in adjusting to the injury and help Clients to address these. Problems such as anxiety, depression, stressful thinking patterns and interpersonal difficulties are addressed. With a Psychology team of four, SouthernRehab is one of the larger providers of psychological services in Canterbury.
Psychological Services may be provided independently of, or to complement other programmes like the Functional Reactivation Programme. Clients may receive Psychological services after a recommendation from another assessment, or Clients may be referred directly by their Case Manager.”
This website page lists all their South Island providers:
Also be aware of criticism here:
“Empathy” commented there on 12 Nov. 2012 (02:44 pm):
“Be very very careful and record assessments. They tell lies and and work together to exit you once your quota is up. They are not interested in your recovery and rehabilitation just the Range Rover or Lexus in the drive compliments ACC.”
Also see comments info on this post:
Address for Southern Rehab given on their website:
Level 1, 29 Byron Street, Sydenham, Christchurch, 8240
Southern Rehab offer assessments and evaluations by a number of providers across the South Island, whose qualifications are not provided in detail, but appear to be appropriate. Their team includes rehabilitation and musculoskeletal physicians, physiotherapists, occupational therapists, clinical psychologists, career practitioners, nurses and speech language therapists, the website tells us. Some areas will be served better than others, due to geographic limitations.
They are primarily physical rehabilitation experts, but apparently also deliver psychological services. They have been doing work for ACC, and some of it seems to have been commented on critically by persons affected. Again we have experts in rehabilitation and that almost exclusively physical rehabilitation, and one must ask, what “independent” work ability assessments will they provide, as the focus is clearly on establishing work ability for the purpose of employment, with probably insufficient direct medical practitioner input by the provider, apart from offering rehab professionals look at work ability.
It seems that for WINZ “Work Ability Assessments” are really about REHABILITATION, and work preparation measures, rather than independent, standalone assessments.
l) Te Oranganui Iwi Health Authority – http://www.teoranganui.co.nz/
From their website:
“Welcome to Te Oranganui Iwi Health Authority
Te Oranganui Iwi Health Authority is a leading Health Care provider delivering a quality service contributing to the mana motuhake of whanau, hapu, iwi and other peoples.”
Under ‘Services’ for ‘Pahake / Adults’ they offer:
“Mental Health + Addictions Support”
“Mental Health and Addictions
Te Oranganui Mental Health and Addictions Service provides a range of services from home-based care, support for youth and their families, a 24hr oncall support service, community support, rangatahi and adult counselling, intervention and prevention strategies, education awareness to whanau, referrals to external services and can provide support in the courts.
Our service views the whanau as being central to the well-being of Tangata Whaiora, which means that the whanau must be actively involved in Tangata Whaiora care and management.
We work with whanau, preparing the way for reintegration of Tangata Whaiora back into the whanau and wider community. Once connection has been established, we maintain contact to monitor development and to provide support when and where needed. This is an essential component for fostering ongoing wellness.”
Under ‘Disability Support Services’ they offer:
The role of Disability Support is to facilitate improved access to information and services.
The Disability Support Service facilitation receives referrals from internal and external agencies, accepts self-referrals and whanau referrals. Contact with the client is made by the Disability Support Officer, an appointment is set and a full assessment is completed. If a person is deemed eligible for Support for Independent Living Service by Access Ability, a referral is sent through to Te Ara Toiora to provide this service.
The Disability Suport Service facilitator’s role is then to monitor the processes that are put in place for the client.”
Under ‘Vocational Services’ they offer:
We provide a vocation programme for people with disabilities. Each participant is empowered and supported to develop their own plan and are supported to achieve their dreams and aspirations.
The main aims of our vocational service is to support perople with disabilities to:
Access and take part in activities in the community
Develop skills to participate in the community
Acquire the skills needed to obtain employment
Gain and/or retain employment
Participants enjoy daily social interaction whilst learning key living skills and interacting with the local community. Karakia, waiata and mihimihi play an integral role in the holistic provision of this vocational service.”
Address for ‘Te Oranganui Iwi Health Authority’ on their website:
57 Campbell Street, Whanganui
There is no information on the website stating that the Trust offers any proper medical or even occupational type assessments that may be conducted by professional, qualified medical or other health practitioner staff. So far they appear to have worked with other separate providers that offer additional services. Besides of mental health and addiction counselling there seem to be only community support programs they offer. Disability support services are geared to some form of preparation for employment, amongst other things.
It appears they have been contracted only under a condition to expand their services to include proper “Work Ability Assessment” services. As a likely new provider, they so far seem to be insufficiently prepared to deliver such services.
m) WALSH Trust – http://walsh.org.nz/
From their website:
“Supporting people in Waitakere communities who have an experience of mental ill health or disability.”
“WALSHtrust stands for West Auckland Living Skills Homes Trust Board.
We offer support services that promote recovery for people whose lives have been affected by an experience of mental health that has been personally challenging or a barrier to participating in work or the community.
We nurture hope and new possibilities through communicating people’s worth and potential so clearly that they are inspired to see it in themselves.”
Under ‘About Us’ the website says:
“A Leader in Community Based Mental Health Services”
“West Auckland Living Skills Home Trust (WALSHtrust) is a non-government organisation located in Henderson, West Auckland.”
“We are an independent charitable trust, with funding coming from contracts with the Ministries of Health and Social Development and the Department of Work and Income, and charitable donations from organisations and individuals.
WALSHtrust Support Services:
Residential Housing & Recovery – seven houses across west and central Auckland with 39 clients receiving 24 hour support.
Mobile Community Support – to 155 people living in Waitakere in their own homes.
EmploymentWorks! – supported employment service placing and maintaining 100 people per year in open employment.
independent ENDEAVOURS – psycho-education service designed to address barriers to participation in the community, for 75 people.
jigsaw Peer Support Service – a team of people who live with their own experience of mental health issues, connecting with others who live with similar experiences.
Older Persons Service – residential care for older adults with 24 hour care and five beds with the option of a sixth, to be used for respite.”
Under ‘EmploymentWorks’ they publish:
“Exceptional Recruitment Solutions”
“”The biggest mistake people make in life is not trying to make a living at doing what they most enjoy.” Malcolm S Forbes
We believe people can, and do, recover from challenging health conditions. Appropriate employment is often a key factor in the recovery journey, and can make a dramatic difference to people’s lives – how they see their world, how they see themselves, how they see their future.
How supported employment works
See information for employers
See information for job seekers
See information about ACC Supported Employment”
Their newsletter for Summer 2014 had the title ‘Employment Works! Great Jobs for Great People’ and referred to a new contract with MSD:
“Employmentworks have been successful in securing another employment focussed contract from the Ministry of Social Development, this new contract enables us to work with job seekers for up to 6 months to find permanent sustainable employment and once successfully in work, to support them to retain their employment for another year.
We are now able to offer employers a larger pool than ever before of potential candidates keen and ready to start work now!
This new contract has seen us welcome on board 2 new staff members. Both Adam Hindley and Deidre Doyle bring with them a wealth of experience and personal qualities that have seen them complete their first 3 months in fine form and with some great results.“
Also under ‘EmploymentWorks’:
“ACC Supported Employment / Employment Placement Service”
“The ACC Supported Employment service is for job seekers who have been referred to EmploymentWorks! from ACC, through the National Serious Injury Service (NSIS) or Recover Independence Service(RIS) Teams throughout the Auckland Region, and it is for job seekers who have experienced a serious injury such as brain injury or spinal injury.
Our professional team of employment specialists will support each individual using a partnership approach to pursue their employment goals for as long as it takes; this is not sheltered work, nor work preparation, but ‘real jobs for real pay’.
The service has had excellent results in supporting those who have experienced a serious injury to either re-access the workforce in a similar career or start something entirely new. Either way, this supports the individual with a renewed confidence to get back on a career pathway and start moving forward towards independence once more.
WALSHtrust is a member of the Advisors for Supported Employment in New Zealand (ASENZ) and is actively involved in forums, conferences and training within the employment support sector.”
Under ‘For Jobseekers’ we read:
“For Job Seekers”
“We support job seekers in finding, getting and keeping work, remaining healthy to fully participate, and continue to develop in their chosen career. The service also works with employers, to ensure both parties are supported to ensure successful, ongoing employment.”
“The service is free for adults aged 17 and over:
• Whose ability to participate in employment has been affected by the experience of mental ill- health or ACC injury.
• Who want to get a job, or require support to retain their current job.
• Who are residents of Waitakere City.”
Re their “team” we find out this:
“We have 8 full-time and 3 part-time employment specialists, with a combined total of 20 years experience as supported employment practitioners.
We work together closely, and are passionate about supported employment, and committed to providing both employees and clients with a quality professional service.”
Under ‘About Mental Illness’ they write:
“One In Four People Affected At Any One Time”
“A recent New Zealand mental health survey shows nearly half (46%) of New Zealanders will experience a mental illness and/or an addiction at some time in their lives, with one in five (20%) of people affected at any one time.
Around 3% of those people – adults, young people and children – have serious ongoing and disabling mental ill health requiring treatment from specialist mental health, alcohol and drug services. The remaining 17% experience less severe, moderate and milder ill health and problems, which usually do not need treatment from specialist mental health services.
WALSHtrust’s philosophy is based on the fundamental belief that people can recover from mental ill health. Recovery is defined in the Mental Health Blueprint as the ability to live well in the presence or absence of one’s mental ill health – or whatever people choose to name their experience.”
Their address is on their website given under “contact us” as:
Physical Address: 8 Hickory Avenue, Henderson, Waitakere City 0650
The website clearly points out that the Trust receives funding from the Ministry of Health AND the Ministry of Social Devlopment, i.e. Work and Income! So how “independent” is it then, as a supposed future provider for “independent” work ability assessments, for which they so far seem to be very ill prepared to deliver such services?
Going by the numbers Walsh Trust present on their website re the numbers of mentally ill in the population, and then looking at those mental health sufferers that have to resort to claim benefits from Work and Income, and basing calculations on the whole population and the percentage of those needing longer term or ongoing treatment, it is clear, that most of those on benefits are there for good reasons, and not the ones that are simply suffering “common mental health conditions” (as Professor Aylward likes to claim).
Apart from “peer support services” and efforts the Trust makes to work with community providers, I see NO treatment or rehabilitation program they offer, and I see NO information on assessments they provide, certainly nothing about medically qualified health professionals.
It is primarily an employment and community support service for those that suffer mental illness and / or injuries. Their focus is on helping those client groups into employment, and any “Work Ability Assessment” services seem to be something new that they are expected to deliver.
n) Wayne Hudson Physiotherapy Ltd – no direct website found!
Some relevant information found on websites:
Rehabilitation Services Manager
Mobile: 021 616 356
“About Work Recovery”
“Established in 2011, Work Recovery is a provider of rehabilitation and vocational services to those in the Eastern Region of the North Island, covering Hawkes Bay, Chatham Islands, Gisborne (Tairawhiti) and Wairarapa. Service provision is focused on rehabilitation and vocational training following an accident, where the goal is a a return to the workforce.
Work Recovery is a joint venture partnership between Plus Rehab @ the workplace & Accomplish Vocational Services who have been providing both rehabilitation and vocational services in both the public and private sectors for over ten years.
Plus Rehab @ the workplace has specialised in the delivery of rehabilitation and return to work programmes in the Hawkes Bay region, which has included: Workplace Assessments, Ergonomic Assessment, Activity Based Programmes, and Return to Work Programmes.
Accomplish Vocational Services, with branches in Hawkes Bay, Gisborne (Tairawhiti), Wairarapa, and Bay of Plenty have delivered a range of tailored vocational training programmes which have included: Curriculum Vitae Preparation, Ergonomic Assessments, Workplace Assessment, Pre-employment Preparation Training, Work Preparation Programmes, Work Experience, Computer Skills Training, Literacy/Numeracy Skills Training, Job Placement, Career Guidance, Initial Occupational Assessments and Vocational Independence Occupational Assessments.
The dynamic team at Work Recovery bring specific skills and strengths across a range of disciplines, which include: Occupational Therapists, Physiotherapists, Support Trainers, Psychologists, Vocational Consultants, Computer Trainers, Literacy Trainers and Recruitment Consultants. Working as a close multi-disciplinary team we are committed to providing a client centred service, targeted to the specific needs of the client to achieve a return to work outcome”.
WAYNE HUDSON PHYSIOTHERAPY LIMITED
3 Ormond Road, Hospital Hill, Napier, NZ
Shareholder name Shares Percentage
Rachel Louise HARRIS, Wayne Noel HUDSON, WTR TRUSTEE SERVICES LIMITED 998 ~ 99.80%
Wayne Noel HUDSON 1 ~ 0.10%
Rachel Louise HARRIS 1 ~ 0.10%
Companies Office entry:
‘Wayne Hudson Physiotherapy’ or ‘Work Recovery’ again seems to be primarily a rehabilitation and vocational service deliverer, rather than an “independent” work ability assessor. There is talk of training, workplace assessments and job placement services. Yet they seem to offer initial occupational assessments and vocational independence assessments, which I presume are mostly provided to ACC claimants working on rehabilitation plans. There is a lack of other information on the staff they employ, and how they operate. As with so many other providers, the focus again seems to be on delivering additional services to prepare persons to work, and one must wonder, how sick, injured and disabled on WINZ benefits, who have so far been assessed as unable to work, will be fit enough to use these services and return to work. With those on the Jobseeker Support benefit only supposed to be suffering short term illness (which is not the case for all former sickness beneficiaries), this may make sense for some. But the suspicion remains, that this is all part of the greater plan, to reset the criteria for illness and disability, based on Aylward’s teachings, to usher more sick and disabled into jobs.
It does not generate trust in the whole scheme, as the mere talk of independent “Work Ability Assessments” is misleading, as it all seems to have further reaching goals that WINZ want to achieve.
o) WorkRehab Ltd – http://www.workrehab.net.nz/
From their website:
„Getting you back to work
At WorkRehab we have qualified staff who you can depend on to get you back where you want to be.”
“The team consists of Occupational Therapists, Physiotherapists, Career Practitioners and other health professionals who provide a fully integrated service.
Vocational rehabilitation services assist injured workers to achieve their optimum function to safely return to work. The service involves a structured and solution focussed approach aimed at optimising independence. WorkRehab offices are located South Island wide.”
Under ‘Services’ the website shows:
Standalone Workplace Assessment
Undertaken at client’s workplace to gather information about their pre-injury work tasks.
Stay at Work (SAW) Level 1 Service
For clients with simple rehabilitation needs who require brief assistance to return to their pre-injury work.
Stay at Work (SAW) Level 2 Service
For clients who require more intensive input to achieve a full return to work.
Stay at Work (SAW) Level 3 Service
For clients who require more intensive input to achieve a full return to work and may also require a physiotherapy functional programme to assist in achieving their return to work goals.
Stay at Work Level 4 Tailored Service
For clients with more complex rehabilitation needs who require longer rehabilitation.
Work Readiness Level 1 Service
For clients who are unable to return to their pre-injury employment and require assistance to prepare for new employment.
Work Readiness Level 2 Service
For clients who are unable to return to their pre-injury employment and require assistance to prepare for new employment and also require a work trial.
Work Readiness Level 3 Tailored Service
For clients who are unable to return to their pre-injury employment and require intensive assistance to prepare for new employment. The service may also include a work trial and physiotherapy functional programme.
Job Brokerage Services
For clients without employment who are work ready with transferable skills who are provided assistance with accessing the job market.
Job Search Service
For clients without employment who have been referred following a vocational independence assessment. The aim of the service is to assist with seeking and securing employment.
Functional Capacity Evaluation (FCE)
A structured assessment to determine an individual’s safe physical capacity following injury.
Initial Occupational Assessment (IOA)
The IOA is an assessment to establish work types that a client is able to pursue after an injury when they are unable to return to their pre-injury work. The assessment takes into account the individual’s skills, education and experience.
Vocational Independence Occupational Assessment (VIOA)
Assessment carried out to review the vocational services provided to a client and consider the suitability of types of work previously identified for the client in the IOA.
Training for Independence – adults with traumatic brain Injury
A integrated service for adults who have sustained a traumatic brain injury to help them develop life skills and increase their independence.
HEALTH AND SAFETY:
WorkRehab provides health and safety services tailored to your individual requirements. Services include”
Their ‘team’ is listed as:
“Heather started with WorkRehab late last year and works two days a week in the accounts department.”
Maria graduated from CIT, Wellington with a Diploma in Occupational Therapy in 1987. Since this time she has worked in a wide range of areas. This includes Mental Health, Community Occupational Therapy, Orthopaedics, Stroke Rehabilitation, Gynae-oncology and Maternity.” “Maria has worked in Vocational Rehabilitation since 2007.”
Paul has significant experience of working in vocational rehabilitation working for Workbridge and more recently for Scott Vocational Services Dunedin. Paul has an extensive rural teaching and management background and has lived and worked in the Otago, West Coast, Marlborough and Nelson regions. He recently completed a Diploma in Career Guidance. Paul particularly enjoys working with practical people.”
Bridget enjoys working with people in transition helping people identify realistic goals, develop a plan to achieve these goals and motivate them to achieve positive outcomes. She draws on her expertise as a vocational consultant and counselor, and previous experience within the horticultural, education, food manufacturing and IT fields. Bridget has a Masters degree from Canterbury University and is an Associate member of CDANZ.”
Ali has come to WorkRehab after a varied career as an Occupational Therapist working with children in both acute and primary care settings. More recently she has been working in community rehabilitation with adults and children with a range of injury related difficulties including chronic pain, traumatic brain injury and musculoskeletal problems.”
I am originally from Dunedin and graduated in 2010 at Otago Polytechnic. I have spent the last 3 years in Timaru working in older person’s rehabilitation and the community setting. I really enjoy working in rehabilitation and am looking forward to working in vocational rehabilitation in the South.”
Robyn graduated from CIT in 1978 and has worked as an Occupational Therapist in many settings since. She completed a Post Grad Diploma in Health Sciences in 2003 and a Pain Management paper in 2005 and Ergonomics Analysis paper in 2009. She has worked in vocational / health and safety roles since 2001. Robyn also enjoys working with people with disabilities.”
Helen graduated from CIT in 1982 and have worked as an Occupational Therapist in a variety of settings. Her work has included periods of time in Australia and the UK, and has been interspersed with periods of travel and outdoor instructing.” “Helen works in the Central Otago region.”
Maria graduated from CIT, Wellington with a Diploma in Occupational Therapy in 1987. Since this time she has worked in a wide range of areas. This includes Mental Health, Community Occupational Therapy, Orthopaedics, Stroke Rehabilitation, Gynae-oncology and Maternity.” “Maria has worked in Vocational Rehabilitation since 2007”
Emily graduated with a Masters of Science in Applied Psychology from Canterbury University in 2003. Emily has over six years’ experience working in vocational rehabilitation in Christchurch, assisting clients on their pathway back to work after injury.”
Tracey is a new addition to WorkRehab and works alongside the Administration team at Reception.”
Hi my name is Tracy Kovacs, I live in a lovely little town called Waimangaroa, situated approximately 15km north of Westport on the very scenic West Coast. I have worked with WorkRehab since 2012 in the area of Vocational Consultant. My main scope of work is carrying out the Navigate to Work Programme through the MSD Contract and Job Search Services through the ACC Contract. Both contracts are highly motivational to me as I love working with people toward obtaining employment or increasing their qualifications through training.”
Jane Ryder-Foskett is an occupational therapist with 13 years’ experience in the areas of vocational rehabilitation, traumatic brain injury, paediatrics and mental health. Jane has spent a significant part of her career working with adults and young people to enable them to resume, enter and access employment and training environments successfully”
Neil graduated from Otago Polytechnic with a Bachelor of Occupational Therapy in 2011 and has worked in vocational rehabilitation ever since. He is completing post graduate study through AUT – currently pain management; and next year will study hand and upper limb therapy. His interest area is hand and upper limb rehabilitation. He completes regular observation at a local hand clinic and is an associate member of the New Zealand Association of Hand Therapists.”
Lorraine is a new addition to the WorkRehab team and works in the busy role of Administration. She takes care of all the day to day running of the reception area and is the voice on the end of the phone when you call.”
Lee started working with WorkRehab on a contract basis assisting with all the finance requirements of the company. Her skills however were quickly recognised and she became an employee 5 years ago. With the growth of WorkRehab Lee has now stepped up to the position of Financial Control Officer where she now oversees the financial management of the company, including carrying out more detailed analysis and budgeting.”
Ange joined WorkRehab in the very early days as a part time typist working from her home in Cromwell which fitted in with raising her two young children. Following her move to Christchurch she became more involved in the company, eventually coming on board full time as our administrator. With WorkRehab’s recent rapid growth, Ange has stepped up to the invaluable role of PA to the director, Lenny O’Connell.”
On Sarah’s return to the workforce after her youngest daughter started school, she joined WorkRehab as support for the financial team. She brings with her experience in the day to day Management of a Family Transport Business along with her excellent time management skills developed by being a busy working mother.”
Lenny is the Director of WorkRehab. He is an Occupational Therapist with a Masters in Health Science (Endorsed in Occupational Heath). Lenny has worked in Vocational Rehabilitation since he graduated and has developed the business into a fully inter-disciplinary service provider.”
Lisa graduated from Otago with a Bachelor of Occupational Therapy in 1998. As a new graduate she was involved in setting up a Mental Health Rehab Service in the North Island where she worked before travelling. Lisa then travelled to the UK and continued to work as an Occupational Therapist, with opportunities to work in both mental health settings and more recently in Vocational Rehab pilot schemes in Scotland. Returning to NZ Lisa has completed PGAP training (Progressive Goal Attainment Programme) which is a disability prevention program specifically designed to target psychosocial risk factors for pain and disability. She has worked in Vocational Rehabilitation for 6 years and enjoys the variety that the work offers and endless learning opportunities.”
Andy is a Physiotherapist with interests in rock climbing, diving and getting outdoors as much as possible. Andy has a particular interest in amputees and shoulder rehabilitation and is working with Orthopaedic Surgeon Mr Alex Malone on protocol development and research around Acromioclavicular joint injuries and Bicep tendon repairs. He is currently working on an amputee pathway for Osseointegration – a new procedure becoming available for lower limb amputees in New Zealand.”
Tricia’s focus is on clinical and service development and standardising clinical excellence across all WorkRehab sites in the South island. She is also responsible for ensuring WorkRehab’s Quality and Health and Safety standards are maintained during service delivery. Tricia’s Vocational Rehabilitation experience includes working with Injury, Disability, Mental Health and the ID populations. Her special interest include work cultures, Health and Safety (private companies), mediation and training.”
Kate Dyer completed her Bachelor of Occupational Therapy at Otago Polytechnic in her home town Dunedin. After graduation she moved to Hamilton to complete a new graduate mental health programme, including completing her Post graduate certificate in mental health at AUT on North shore of Auckland. After two and a half years in Hamilton including a year in supported employment she decided to move back to the South and move further into the field of vocational rehabilitation.”
Andrea graduated with a Bachelor of Physiotherapy from Otago University. Following graduation, Andrea went on to work in the musculoskeletal private practise field in Invercargill, as well as working with several sports teams. During this time Andrea graduated with a Post Graduate Certificate of Physiotherapy endorsed in Acupuncture. After gaining several years experience in private practise, Andrea decided to shift into vocational rehabilitation in 2011. She therefore brings a vast array of physiotherapy skills and knowledge to assisting the rehabilitation of Southland workers. Andrea has a special interest in exercise prescription for both home and gym based exercise programmes. She is a member of the New Zealand Society of Physiotherapists Occupational Health Special Interest Group.”
My name is Chris Harris. I came to Occupational Therapy later in life after various careers as a Chemist, Teacher and a self employed Carpenter / Joiner. This wide ranging vocational experience has been of great benefit in vocational rehabilitation. I chose to embark on an Occupational Therapy degree at AUT(Auckland) after spending time working with Occupational Therapists installing level access showers. It looked like the perfect profession for me and it hasn’t disappointed.”
The Head Office address for ‘WorkRehab Ltd’ on their website is:
10 Nazareth Avenue, Middleton, Christchurch
(further offices or branches are in Nelson/Marlborough, West Coast, South Canterbury, Otago and Southland)
The team of ‘WorkRehab Ltd’ consists of mostly occupational therapists, some physiotherapists, career practitioners and other health professionals who provide a fully integrated service, the website informs us. A long list of their team members is provided with introductory profiles. ‘WorkRehab’ offices are located South Island wide, we learn. They offer assessments for ACC related services and have a strong focus on rehabilitation by way of occupational therapy and physiotherapy.
The qualifications, experience and services mentioned appear convincing and good for the treatment areas covered. It can be fairly presumed that they can well conduct assessments such as those required by ACC and employers, potentially also for WINZ clients. There appears to be some shortage on psychologist and mental health experts, and as the focus at this provider is again primarily on treatment, it seems that “Work Ability Assessment” provision is in respect of WINZ meant to reach much further than simply asking such providers for an “independent” assessment of their clients.
WINZ and MSD appear to be rather dishonest about the actual scope of services they intend to send certain clients to. It remains to be seen, what “work ability criteria” will be used to assess clients, as the criteria that “experts” like Mansel Aylward recommend should be unacceptable in New Zealand.
E). OFFICIAL INFORMATION ACT REQUESTS AND ANSWERS RECEIVED FROM MSD
E.1.: Official Information Act (O.I.A.) request from 16 Jan. 2014, re “Mental Health Employment Services’ and ‘Work Ability Assessments’, with answers received (in italics) from Debbie Power, Chief Executive, dated 24 April 2014:
Transcript of MSD response:
Thank you for your letter of 16 January 2014, requesting, under the Official Information Act 1982, information related to the Mental Health Employment Service and Work Ability Assessments.
Mental Health Employment Service
The aim of the Mental Health Employment Service (“MHES”) is to support clients on jobseeker Support with mild to moderate mental health conditions to gain work and achieve sustainable employment. This is achieved through the provision of employment-related case management, placement and post-placement support that is integrated with the individual’s current clinical support.
This approach aligns with emerging best practice that points to improvements in people’s health and wellbeing where they are engaged in suitable employment.
I will address each of your questions about MHES separately.
1. Detailed information about the names, addresses and particular services offered by providers the Ministry of Social Development (MSD) has mid to late 2013 entered contracts with, to provide so-called “Mental Health Employment Services”. Also requested are details about the numbers of staff (incl. management) they employ, the particular qualifications held by the employees of those providers, the positions they hold and the roles and tasks they perform in dealing with so-called “moderate” mental health sufferers, who are considered suitable for accessing forms of employment.
Table one shows the names and addresses of MHES providers. You will note that MHES has not been implemented nationwide and that addresses listed show the office which holds the MHES contract, not where the service is provided.
The Ministry of Social Development does not hold details of external providers’ staff such as roles, numbers and qualifications. Therefore, your request for this information is declined under section 18 (g) of the Official Information Act. However, I can advise that providers were selected to deliver the MHES based on their demonstrated experience and ability to work with clients with mental health issues and provision of successful employment services.
2. Details about the fees payable by MSD, the agreed fee structure, the terms for payment of fees, the outcome expectations in the providers AND in the referred mental health sufferers on benefits – that were agreed to between MSD and the individual providers. This is also in consideration of established “particular service intensity categorisation”, and details about such categorisation would be appreciated.
Table two shows a detailed breakdown of the fee schedule including the service intensity categories. Please note that every client referred to a MHES provider is assigned a service intensity rating by Work and Income. These ratings relate to factors impacting on a client gaining employment and are based on age, gender and other circumstances.
The provider will carry out an individualised needs assessment for each client, to identify their skills, barriers to employment and the support required to overcome these. In conjunction with the client, the provider will develop a plan for the achievement of realistic and appropriate employment opportunities that align with the client’s goals and obligations.
3. Details about the “wrap-around services” that were mentioned in media reports, like for instance an article in the “Herald on Sunday”, dated 30 June 2013 and titled “Govt will pay to shift mentally ill into work”, that are intended to support the clients that Work and Income (WINZ) refers to such service providers. What kind of such services have been agreed on, who will pay for them, what are the roles and qualifications of those presumably external “wrap around service” providers offering what kinds of “support”? Information providing details on all this will be appreciated.
Changes implemented as part of the Welfare Reform programme mean that we now work more proactively with clients who receive Jobseeker Support and have a health condition or disability, to identify the type of support and services a person needs to help get them back into sustainable work. The ‘wrap around services’ referred to includes things such as our case managers having one-on-one conversations with a client about what they can do and what supports are needed and working with the client to formulate a plan. The MHES also provides a wrap-around service for clients.
4. Information on how MSD and WINZ do assess and decide on who as a “moderate” mental health sufferer in benefit dependency will be referred to “Mental Health Employment Services”, and what kind of input the affected are allowed to give, to apply any realistic, medically and otherwise justified, fair and reasonable measures, in order to achieve similarly justified, desired outcomes for them. If “independent” medical and work capability assessments were conducted, how many of them were conducted by WINZ designated doctors? Please supply available data on this.
To meet the initial selection criteria for the MHES a client will:
● be in receipt of Jobseeker Support
● have a common mental health condition as determined by their doctor (for example, clients with depression, stress and/or anxiety, who are cared for in a primary setting)
● be single or the primary client
● have part-time or deferred work obligations.
Clients who meet these criteria and reside in an area that offers a MHES will receive a call from a Work and Income staff member to advise them that it has services and options to assist people into employment. The client is asked to respond to a series of questions to determine if, with the right support, they would be willing to be involved in activities or a service that might help them to get into work.
If the client agrees to receive this support, they may then be referred to a service provider where capacity exists. If a client tells Work and Income that they do not want to participate, they will be removed from future referrals to MHES.
The Ministry does not centrally record the number of medical and work capability assessments carried out by a Work and Income designated doctor. This information is held on individual client files. Therefore, this part of your request is refused under section 18 (f) of the Official Information Act. This section allows me to refuse a request where substantial collation and research is required to find the information requested.
In this case, to research the information requested, the Ministry would need to manually access and collate a substantial number of individual client files. I do not consider this to be in the public interest as this would remove staff from their core duties and impact on the effective functioning of the Ministry.
5. Information on how many beneficiaries suffering “moderate” mental health conditions have to date been referred to such services, how many were approached to consider being referred, how many agreed to be referred, how many refused to be referred, how many have been successfully placed into employment, how many have had to terminate any efforts working with providers of “Mental Health Employment Services”, and of them, for what reason did they do so? Records on this are requested.
As at 27 January 2014:
● 2,930 clients were approved to participate
● 1,754 clients agreed to participate
● 1,176 declined to participate.
Sixty-five clients have achieved an employment outcome. This number continues to increase as clients work through the items on their plan.
Since the MHES started, 328 clients have ended their participation with a provider.
6. Information on whether any referred Work and Income clients with mental health conditions suffered any significant medical or psychological problems upon having been referred to such service providers as mentioned above, and what types of problems there were. Also in relation to this, if such cases occurred, what measures were taken by the provider and by WINZ, to offer support for the clients affected, and what records have been kept on this? Please provide the relevant details.
To date there have been no recorded incidents where a client has suffered significant medical or psychological problems having been referred to MHES. If this situation arises, the service provider will inform Work and Income, who will take the appropriate steps to support the client.
Work ability assessments
Work and Income is tailoring the support it provides to help people with a health condition or disability move into work. Following the July 2013 welfare reform changes, Work and Income is taking a closer look at the barriers some people face and the support and services they need to move towards sustainable employment.
From 24 February 2014, this involved referring some Jobseeker Support clients with a health condition or disability to a health or medical specialist to complete a Work Ability Assessment (WAA).
These people would have already been working closely with a case manager but WAA gives Work and Income a comprehensive assessment of their situation, strengths and what is needed to help them find and stay in work.
The WAA takes a holistic approach to the factors affecting a client’s ability to work and identifies the client’s ability to work, along with the supports and services required to enable them to secure sustainable work.
As a result of the WAA, Work and Income and participating clients have clearer information about clients’ strengths and abilities, the factors impacting on their ability to work, the types of work they can do, and recommendations for supports and services required to help them reach their employment goals.
Please note that WAA is not about benefit eligibility. Clients continue to receive a benefit as long as they meet criteria.
7. Details about the names, addresses and particular services to be offered, of contracted providers to perform outsourced work capability and/or medical assessments on beneficiaries (or applicants for benefits) that will commence providing services from February this year (2014). I refer to media reports in the ‘Otago Daily Times’ from 25 Oct. 2013, titled “Tests for disabled ‘flawed model’’’, and ‘Stuff.Co’, from 03 Nov. 2013, titled “Contractors to assess sick and disabled for work”, that mentioned some details on MSD entering contracts with such providers.
The Ministry has contracted 15 providers to deliver WAA. Table three shows the names and addresses of the WAA providers. You will note that the addresses listed show the office which holds the WAA contract, not where the service is provided.
8. Please provide also details on the number of staff (incl. management) that these providers will employ, what medical and other qualifications they will hold, what particular roles they will be expected to perform, and what direct interactions they will have with referred sick and disabled on benefits. Furthermore I seek information whether the medical staff will all be registered with particular professional registering authorities listed under the ‘Health Practitioners Competence Assurance Act 2003’.
The Ministry of Social Development does not hold details of external providers’ staff such as roles, numbers and qualifications. Therefore, your request for this information is declined under section 18 (g) of the Official Information Act.
I can advise you that it was a condition of the Request for Proposals for the provision of WAA that assessors proposed to carry out the assessments with referred clients belong to a profession regulated by the Health Practitioners Competence Assurance Act 2003.
The provider will be responsible for the delivery of an individualised assessment of each referred client to identify what types of work they can do and the supports required for them to achieve and retain employment. This will be carried out by a review of relevant information and face-to-face assessment.
9. Please provide details on the agreed fees payable, the fee structure agreed upon, any conditions placed on fees to be paid, the terms for such providers (that will be assessing sick and disabled clients of WINZ) when working with Work and Income to achieve specified outcomes. In this regard I appreciate details on the outcomes that are intended to be achieved under the contracts entered.
The provider will be paid $650.00 for the completion of the report.
10. What expectations will Work and Income place on referred sick and disabled on health related benefits, or applying for such, for them to meet obligations to attend external assessments for medical conditions and work capability, and what sanctions will be applied if a client objects to, or refuses to be examined by a medical or health professional she/he will not agree to. I appreciate your detailed response.
Clients on benefits have obligations, when asked, to attend the following external assessments:
● Specialist Assessment – this is used to determine medical eligibility for a Supported Living Payment at either application or medical review. The assessments are sought when the performance and/or severity of a client’s condition/s cannot be established using information already obtained by Work and Income. Additionally, specialist assessments provide information that cannot be obtained elsewhere, including information from a designated doctor report
● Work Ability Assessment – this is used to determine a client’s strengths, abilities and barriers to work and is carried out by a suitably qualified medical or health professional with expertise in assisting people into work. The assessment helps determine how Work and Income can support the client into suitable employment by building on their strengths and facilitating appropriate supports and services to assist them to find and stay in work.
If a person objects or refuses to attend a Special Assessment or a Work Ability Assessment the reasons for refusing will be discussed with them and the purpose of the WAA will be reiterated. If the client still refuses to attend we will consider if there is a good and sufficient reason for the client not to attend a WAA at this time. A postponement may be considered.
If there is no good and sufficient reason and the client still refuses to attend, the consequences will be discussed and an obligations failure may be initiated. This can affect the rate of benefit the client may receive. A client can re-comply by attending a WAA.
11. What is the purpose of outsourced medical and work capability assessments, when Work and Income has for years been relying on their client’s own doctors’ competence to make proper medical diagnosis, or assessments to establish a patient’s work capabilities, or alternatively refer their patient to a specialist to provide more specialised examinations and assessments? What is the purpose for these outsourced assessments, when WINZ and MSD have for many years also relied on their own pool of designated doctors to provide second opinions and assessments, where uncertainties or contradictions in reports on conditions existed? Are MSD and WINZ therefore going to stop using information from clients’ GPs and other medical professionals they have traditionally tended to rely on? Any information offering clarification on these questions is appreciated and expected.
Work and Income supports many disabled people and people with health conditions to prepare and look for suitable, sustainable work. Work and Income will not stop using information from clients’ GPs and other medical professionals to determine clients’ eligibility and work capabilities.
However, in a few cases, Work and Income may need expert external advice on a client’s work capacity, and the supports and/or services they may need, and refer the client for a Special Assessment or a Work Ability Assessment.
12. As media reports have stated, it is anticipated that such assessments by outsourced service providers will take up to 3 hours and include examinations and face to face interviews. This will by some be seen as unreasonable, and as putting unnecessary stress and pressures on already sick, incapacitated and disabled person suffering from various conditions, including mental illnesses. What accommodations will be made to offer affected persons needed support – like time and space to recover from stress they may then experience. Also, will affected clients be allowed to bring along support persons to such assessments? I appreciate information on these aspects.
Work and Income estimates that Specialist Assessments and Work Ability Assessments will take approximately three hours to complete. The time the assessor is expected to spend with the client is approximately one hour. The other two hours is expected to be used to review relevant information and to prepare a report that sets out the findings of their assessment.
At the time of referral of Specialist Assessment or Work Ability Assessment, Work and Income will identify, with clients, any support they need in order to attend and participate. It is a person’s right to bring a support person with them.
13. What will the interviews consist of, what questions will be asked of the persons to be assessed in the above mentioned outsourced assessments by private operators? If available I would appreciate a list of the proposed questions that have been agreed on between the Ministry of Social Development and the particular providers.
Appendix one details the proposed questions to be asked by the Work Ability Assessor during the assessment.
I hope you find this information about the Mental Health Employment Service and Work Ability assessment helpful. You have the right to seek an investigation and review of my response by the Ombudsman, whose address for contact purposes is:
Office of the Ombudsman
Po Box 10-152
Deputy Chief Executive Work and Income”
PLEASE NOTE re the above: Questions are in normal type, answers provided by MSD are in italics!
Table One: Mental Health Employment Service providers broken down by region and address
Region, Provider and address:
Workwise Employment Ltd
293 Grey Street
West Auckland Living Skills Homes Trust Board
8 Hickory Ave
Elevator Group Inc
Level 1, 1 Marewa Road
215 Wairau Road
57 Market Road
331 Rosedale Road
3 Pilgrim Place
Workwise Employment Limited
293 Grey Street
331 Rosedale Road
Workwise Employment Limited
293 Grey Street
331 Rosedale Road
Appendix One: Proposed questions to be asked by the Work Ability Assessor during the Work Ability Assessment
Are there any health conditions / disabilities affecting the client’s ability to work? (if yes, please describe). How do these impact on the client’s ability to work?
What does the client see as their main abilities to work?
What do you (the assessor) see as the client’s main abilities to work?
What does the client see as their main barriers to work? How are these being managed or treated?
What do you (the assessor) see as the client’s main barriers to work?
Please summarise your key observations as to the client’s abilities and barriers for each of the areas below.
● Work experiences (eg strong work ethic, interpersonal conflict)
● Psychological (including cognition, mood and behaviour)
● Physical (including mobility)
● Social (including ability to communicate, connection with family and community)
● Medical (including treatment and equipment)
Given what you know about the client and their circumstances, please describe the types of work that are best suited to the client and why?
Describe the types of work the client should avoid and why (eg client should not work directly with public as they don’t cope well dealing with others)
Please describe any strengths that could help the client to find or stay in work (eg strong family and community connections, positive approach to life, motivated, regular exercise)
Please outline any strategies that will increase the client’s independence and help them reach their employment goals (eg community participation, exercise routine)
In your opinion, how many hours can this client currently work in suitable employment outlined above?
● Full time (30 hours or over)
● Full time (30 hours or over) with accommodations (please describe further below)
● Part-time (15-30 hours): Hours details ________hours per day, ________days per week
● Less than 15 hours per week Hours details ________hours per day, ______days per week
● Cannot work at all
What supports and services may assist the person to find and stay in suitable work?
● Employment Support (including educational and vocational supports and services)
● Health condition / disability support (including medical, physical, psychological)
● Other (including support to overcome other significant issues)
If these supports and services were put in place how many hours per week do you think this client could work in suitable employment?
● Hours details: _____ hours per day, __________days per week.
E.2.: Own Conclusions and Comments on the O.I.A. response by MSD dated 24 April 2014:
The answers provided on the O.I.A. request from 16 Jan. 2014 disclose some interesting information, but there was also some important information withheld. As contracted service providers are not covered by the O.I.A., MSD was able to withhold information on their staff’s roles, their qualifications and other sought information. This will represent a problem that will remain in future, as the out-sourcing enables MSD and WINZ to avoid transparency in important operational areas, like Work Ability Assessments (WAAs)!
Table one shows the names and addresses of the WINZ contracted MHES providers.
Table two shows the fees structure for ‘Mental Health Employment Services’, and it is interesting, but some of that information had already been published by way of media reports in the middle of last year. It shows that handsome fees are paid based on achieved outcomes, and the economic pressures any contracted provider will face, to make their service delivery “profitable”, will mean, that they will inevitably have to communicate clear expectations to the “clients” they will work with, which will result in pressures, for them to agree to employment placements offered. This will pose risks and potential health hazards for especially those clients with mental health issues, because in many cases a “plan for the achievement of realistic and appropriate employment opportunities that align with the client’s goals and obligations” will have to be compromised, simply to meet basic targets.
The answer to question three suggests that “wrap around services” are primarily only based on such “support” like “one on one” conversations as part of case management, and little else, which shows that there is little true “investment” in offering clients additional health and treatment support services. This seems to apply to WINZ case management and MHES case management.
In reply to question four “common mental health conditions” are referred to as for instance being “depression, stress and/or anxiety”. There is no indication whether clients with other mental health conditions will be included in the MHES scheme, and no clarity, what degrees of the mentioned conditions may fall within or without the scope that may be considered “workable” within this client-group. It indicates a “softening” and “blurring” of the “work ability criteria”. MSD do refuse to provide any information on outcomes of designated doctor examinations, claiming the information is not centrally stored, as it is kept in individual client files. This is a standard reply that was given to earlier requests, and it indicates, they do not wish to comment on this. It is hard to accept that no statistics on designated doctor recommendations and reports are kept, as that would mean, they have no records of the effectiveness or appropriateness of using designated doctors.
I am also not convinced that clients can simply opt out of participation in MHES, but this may for time being be the case, as the scheme is still run as a trial. I expect that to change in future.
Re the answer to question 5 it shows, that only 60 percent of clients approached agreed to apparently voluntarily participate in the MHES scheme! That is not an overwhelming participation rate, although it is not insignificant. Only sixty five clients out of 1,754 participants (3.7 percent) in the scheme did until 27 Jan. 2014 achieve an “employment outcome”, and 328 clients ended their participation with a provider, with no reasons given. This raises serious questions re comments made by Sandra Kirikiri in her interview with Kathryn Ryan on Radio NZ National on 15 April 2014, where she hailed the scheme as a great “success”! But perhaps they’ve had more “success” since then?
On WAAs the answers talk of “taking a closer look” at clients’ ability to work, about a “holistic approach” being used, and otherwise nothing much specific, as to what exact criteria will be used to assess work ability. That is of course intentional, as the idea is to introduce “flexibility”, a “softening up” of criteria, thus offering WINZ case managers, RHAs and RDAs, same as the contracted service provider staff more “discretion” and leeway in making assessments and recommendations on a case by case basis. This will blur the whole process, and make it increasingly difficult for the affected, to question the applied practices and processes. It is absurd to claim that WAA is not about benefit eligibility, as a refusal without good reason to participate will result in sanctions like cutting and stopping benefit receipt! If work ability is established it will mean work test obligations, and non participation in proposed, “agreed” plans and activities will again affect benefit entitlements!
In response to question 7, table three shows the names and addresses of the WAA providers that WINZ has contracted. What it reveals is, that the majority of these providers are hardly “assessment providers” that have no vested interest, that are without any vested interest, and therefore can hardly be called “independent”. They are mostly rehabilitation and in some cases even employment placement service providers. Many have not even set up proper, “independent” assessment services that are cut out to meet work ability assessment requirements to WINZ – as a third party. It seems that most have only done assessment for own, internal purposes, and only to some degree for contracted employers or for ACC. Others have never done assessments before, it seems, and ‘Linkage’ (part of the ‘Wise Group’) and AMP Workcare (from Australia) are also contracted service providers delivering employment services to MSD and WINZ. It does not seem to be an “independent” service to have the same providers provide work ability assessments and also employment placements.
The answer to question 8 only gives some information, as details about staff roles, numbers and qualifications is again being withheld. It is also misleading when MSD claim that assessors conducting assessments for the WAA service providers must “belong” to a profession regulated by the Health Practitioners Competence Assurance Act 2003. “Belonging” to a profession regulated by that Act is not the same as being required to be registered by an authority covered by that Act.
The answer given to question 10 at least confirms that WINZ clients have obligations to cooperate and to attend work ability assessments, just like meeting other obligations. There are now two different types of assessments that WINZ can ask assessors to provide on clients, ‘Specialist Assessments’ for Supported Living Payment applicants/recipients, and ‘Work Ability Assessments’ for those that belong to the Jobseeker Support benefit category. The “moderate” wording “an obligations failure may be initiated” hides the true consequence of benefits being cut or stopped as sanctions! And sanctions will be enforced, where clients have failed obligations without good and sufficient reasons.
While the answer to question 11 may appear reassuring, where it says “Work and Income will not stop using information from clients’ GPs and other medical professionals to determine clients’ eligibility and work capabilities”, the comment that “in a few cases” extra external advice may be needed to establish a client’s work capacity does not sound convincing enough. It seems rather clear that MSD do not trust clients’ own doctors and in some cases not even their “designated doctors”, as there is no other explanation for the need to introduce extra WAAs. Hence I expect the use of WAA providers to be increased substantially over time.
In reply to question 13 Appendix one is provided with proposed questions that WAA assessors will put to clients to be assessed. It again reveals that although the clients is asked for some input and comments, there will ultimately be a lot of discretion given to the assessing health practitioner, to assess and recommend what she/he may consider relevant and crucial to determine work ability. In some ways the process appears to follow ACC’s approach in establishing ability to do certain types of work, although in a less formal, restricted manner. Leaving a fair amount of discretion to the assessor in regards to what recommendations can be made for whatever types of work; I sadly see potential for many flawed, unbalanced, even un-objective recommendations, and even abuse of the assessments.
E.3.: Earlier O.I.A. request and replies from MSD
1. O.I.A. from 29 Dec. 2010, responded to in March 2011:
Question 7., 29 Dec. 2010:
“… a clear, detailed official description of the function of the above named staff members (PHA’s, PDA’s, RHA’s, RDA’s and H+D Coordinators) in regards to their advisory and liaison roles when working with General Practitioners, Designated Doctors and/or other health and medical practitioners;”
Answer to question 7:
“Please see below the descriptions of the functions of the Principal Health Advisor, the Principal Disability Advisor, the Regional Health Advisor, the Regional Disability Advisors and the Health and Disability Co-ordinators in regards to their advisory and liaison roles when working with medical practitioners. These roles are interlinked and all staff work closely together to ensure consistency is maintained throughout the regions.
Principal Health Advisor and Principal Disability Advisor
These two national advisors provide strategic leadership and advice to Ministry staff, specifically the Work and Income Regional Health and Disability Teams. Through their medical knowledge and experience they assist staff to engage effectively with other health and disability sector agencies such as the Ministry of Health, ACC, District Health Boards, Primary Health Organisations and Non Government Organisations.
Health and Disability Co-ordinators
Health and Disability Co-ordinators are located in each of the 11 Work and Income regions. The Co-ordinators liaise with general practitioners, and the Work and Income Regional Health and Disability Teams to provide support and information about the processes and guidelines of health-related benefits which include the Invalids, Sickness and Domestic Purposes Caring for Sick or Infirm benefits, the Disability Allowance and the Child Disability Allowance. This ensures that case managers are fully informed and supported, when making decisions about a person’s medical incapacity when determining benefit entitlements.
Regional Health Advisors and Regional Disability Advisors
Regional Health and Regional Disability Advisors are part of the wider Health and Disability Team within each Work and Income region. When a case manager requires advice about determining medical eligibility, the Regional Health or Disability Advisor are available to discuss a client’s ill health or disability further.”
Question 11., 29 Dec. 2010:
“an internally applied record or manual displaying the contents, types, aspects of topics, instructions and processes that are communicated, applied and implemented under the roles of the Principal Health Advisor and Principal Disability Advisor as “mentors”, “supervisors”, “managers” and/or “trainers” to the Regional Health Advisor(s) and Regional Disability Advisor(s);”
Answer to question 11:
“The Regional Health and Disability Team complete internal web-based training (this is the same for all frontline staff) as part of their orientation and this includes benefit specific training. The Ministry also facilitates workshops providing specific internal information that all frontline staff attend. Ongoing training, mentoring and coaching takes place through regional visits by the Principal Health Advisor and Principal Disability Advisor and through monthly teleconferences and daily discussions around individual cases. In addition, Regional Health Advisors have access to resources such as Work and Income’s Manuals and Procedures, which are publicly available on the Work and Income website, accessible at the following link: http://www.workandincome.govt.nz/manuals-and-procedures”
Question 14., 29 Dec. 2010:
“information about how many Designated Doctors are practising General Practitioners, non practising General Practitioners, practising Psychologists, non-practising Psychologists, practising Physiotherapists, non practising Physiotherapists, practising other health or medical practitioners and non practising other health or medical practitioners;
Answer to question 14:
“As at 22 March 2011, Work and Income had a total 332 Designated Doctors of which 313 are general practitioners, ten are psychiatrists, two specialise in Accident and Medical, two specialise in Internal Medicine, three specialise in Rehabilitation Medicine and two are Surgeons. All Designated Doctors are currently practising.”
It is evident from the answer to question 14, that MSD have at that time had NO psychologist working for them as “designated doctor”, although the Social Security Act offers the option that a client may be required to either be examined by a medical practitioner OR a psychologist, so MSD are not even complying with the law by not making available designated doctors with the required qualifications that a client should by law be able to be seen by!
Question 15, 29 Dec. 2010:
“information about who is involved in making decisions about the acceptance of Designated Doctors (Principal Health Advisor, Principal Disability Advisor, Regional Health Advisor/s, Regional Disability Advisor/s and/or else) to work for the Ministry of Social Development and Work and Income;”
Question 16, 29 Dec. 2010:
“information about who appoints, or who is involved in appointing a selection of Designated Doctors to be presented on a short-list to a client of Work and Income to select from for getting “second opinions” from;”
Answers to questions 15 and 16:
“Each Regional Health and Disability Team identifies potential Designated Doctors in their area. The Regional Health and Disability Advisor will meet to discuss the requirements with the potential doctor, and if in agreement, the doctor will complete an application form to apply to be a designated doctor for the Ministry. The endorse forms are provided to the Principal Health and Principal Disability Advisors at Work and Income National Office, who have the final decision.”
Question 17, 29 Dec. 2010:
“information about who nominates the members of a Medical Appeal Board, whether this is primarily the Medical Appeals Coordinator, whether it is a Regional Health Advisor, whether a Regional Disability Advisor, whether a combination of the two or others, and clear details about how any “conflicts of interest” are avoided in the nomination of Medical Appeal Board members;”
Answer to Question 17:
“It is the role of the Regional Health and Disability Co-ordinators in each region to contact medical practitioners who may wish to become a Medical Appeal Board member and to follow up on enquiries from Medical Practitioners who express an interest in becoming a member. It is the Health and Disability Co-ordinator who has the final decision on the appointment of the members of a Medical Appeal Board.
When a client is referred for a Designated Doctor assessment the case manager provides the client with the full list of Designated Doctors in their area to establish the most appropriate practitioner. If they are unable to agree, the case manager can select the most appropriate designated doctor. …”
The assertion in that answer to question 17 is not always followed, because many WINZ clients have stated that they were simply told by a case manager who to see for a designated doctor examination, and not given any choice at all! Also have many been sent to designated doctors lacking particular medical expertise in areas that would be needed to assess persons with such specified conditions.
Question 18, 29 Dec. 2010:
“information whether it is usual practice to nominate more than one, and like in my appeal case, even three members to a Medical Appeal Board that are also at the same time Designated Doctors;”
Answer to question 18:
“There are ten Medical Practitioners who sit on the Medical Appeal Board in the Auckland Region. Six of these practitioners are also Designated Doctors.
The Medical Practitioners themselves determine their availability to sit on a Medical Appeal Board. The Medical Appeal coordinator selects from the available pool and a monthly schedule of hearing dates is electronically sent to each Medical Practitioner. From the information received back from the medical practitioners, the Medical Appeal Co-ordinators confirm the monthly hearing schedule.
I can advise that it is normal practice for more than one Designated Doctor to sit on the Medical Appeal Board.”
The answer to question 18 contradicted the information that was at least then (2010/2011) published via the Work and Income website, which stated that it was usually (only) 1 designated doctor sitting on a Medical Appeal Board panel, together with two other health professionals.
Question 19, 29 Dec. 2010:
“a statement re the reason why the Ministry of Social Development considers it sufficient and fair to simply have “medical practitioners”, “rehabilitation professionals” or vaguely termed “other persons having appropriate experience” (as outlined under section 53A (1A) and (3) of the Social Security Act 1964) sit on Medical Appeal Boards; and why it does not consider it to be essential to have members present on a Medical Appeal Board who have the matching specialist professional qualifications and expertise to hear particular appeals involving aspects that are covered by their specific scope of practice, qualification and experience;”
Answer to question 19:
“The Medical Appeal Board reviews all the information available to them about a client’s medical condition and/or disability and his or her capacity to work when a client seeks a right of appeal on medical grounds under section 53A of the Social Security Act 1964.
The Medical Appeal Board must decide whether the appellant meets the medical criteria or work capacity criteria for the relevant benefit and considers whether the right decision was made to decline or cancel the benefit.
It is not the role of the Medical Appeal Board to diagnose, treat or manage a client’s health condition and/or disability. Rather, it is an independent body established to ensure that correct and fair decisions are made within the legislation.”
The claim that a Medical Appeal Board is “independent” seems absurd. As these Boards consist of members that were chosen by MSD’s Health and Disability Co-ordinators (see answer to question 17), and then appointed by a MSD Medical Appeal Coordinator, it is the party that has a vested interest in their decision, that appoints them! Hence it is not surprising that many who have had their appeals heard by such a body were not feeling that their recommendations or decisions were “fair” and “correct”.
2. O.I.A. from 18 Oct. 2012, responded to on 06 March 2013:
“A complete list including all names, professional or other titles, positions and medical or health related qualifications, of those persons, who were – besides of Principal Health Advisor for the Ministry of Social Development, Dr David Bratt – conducting “designated doctor training” from 2008 to the most recent time in which training sessions were held all over – or anywhere particularly selected in New Zealand.”
Answer to question 9:
“You have asked for a complete list of names, titles, positions and qualifications of people who, besides Dr David Bratt, conducted designated doctor training. Dr David Rankin has also delivered designated doctor training. Dr Rankin was a Senior Advisor in the Ministry and a qualified medical practitioner who holds a MBChB from the University of Otago.
“The complete lists (including places, regions, times and dates) of all “training sessions” held all over New Zealand, for the purpose of training medical practitioners or other health professionals (to be) used as “designated doctors” by Work and Income for medical examinations according to sections 44 and 54B of the Social Security Act 1964, for the years from 2008 up to the most recent time such training sessions were being held in New Zealand.”
“A complete list of the essential, detailed training materials and presentations commonly used during training of “designated doctors” (by Dr David Bratt or other staff of the Ministry of Social Development) since such training was commenced during the course of 2008 and up to the most recent time. This should include sample work- or training scenarios, PDF or PowerPoint presentations, display sheets, leaflets, brochures and any other material of relevance for this training.”
Answer to questions 10 and 11:
“You have requested a complete list of all training sessions held across New Zealand and training materials used for the purpose of training Designated Doctors in 2008 and since.
A programme of designated doctor training took place in August to October 2008 across New Zealand. A range of materials were used in this training. And they are listed below:
● Designated Doctor Workshops
● Medical Certificate for Sickness and Invalid’s Benefit and Independent Youth Benefit (Sickness)
● Referral for a Designated Doctor Assessment
● Designated Doctor Report
● Host Doctor/ Usual Practitioner Report
● Guide for Designated Doctors
● Scenario 1 Designated Doctor referral – indicated by GP on the medical Certificate
● Scenario 2 Designated Doctor Referral – Unable to determine entitlement from available information
● Scenario 3 Designated Doctor Referral – Duration exceeds entitlement for this condition
● Scenario 4 Designated Doctor referral – Engaged in activities that appear to be at odds with recorded incapacities
● Scenario 5 – Designated Doctor referral – A previous medical certificate contains substantially different diagnosis or recommendations
● Scenario 6 Designated Doctor referral – Diagnosis unclear
● Scenario 7 Designated Doctor referral – Conflicting information on the medical certificate
All doctors have access to the Guide for Designated Doctors which is available on the Work and Income website at …
This page provides information for doctors who are interacting with Work and Income about their role. Ongoing support to both host and Designated Doctors are provided on an adhoc, one-to-one basis from all Work and Income Health and Disability staff.”
“A detailed list displaying the individual annual before tax salaries for the following senior and key-role staff of the Ministry of Social Development paid through the “public purse”:
a) Dr David Bratt, Principal Health Advisor for the Ministry of Social Development
b) Anne Hawker, Principal Disability Advisor for the Ministry of Social Development;
c) the salaries paid to the 13 (or so) Regional Health Advisors placed in each Regional Office of the Ministry of Social Development;
d) the salaries paid to the 13 (or so) Regional Disability Advisors placed in each Regional Office of the Ministry of Social Development;
e) the salaries paid to the Health and Disability Coordinators placed in Regional Offices of the Ministry of Social Development;
f) the individual salaries of Social Welfare Board members: Paula Rebstock, Ian McPherson, Kathryn McPherson, Andrew Body, Reg Barrett and Debbie Packer.”
Answer to question 15:
“I can advise that the remuneration range for regional health and disability advisors is between $57,300 and $78,807 per annum, and for the health and disability co-ordinators the range is between $42,951 and $58,425 per annum as at December 2012.
I am withholding the salaries of the Principal Health Advisor and Principal Disability Advisor as there is only one person in each of these roles, under section 9(2)(a) to protect their privacy. In this instance I believe the need to protect the privacy of these individuals outweighs the public interest in this information. …”
3. O.I.A. from 11 June 2013, responded to on 12 July 2013:
Question 12, 11 June 2013:
“Finally I request a complete list of all Regional Health Advisors and Regional Disability Advisors employed for each administrative region of the Ministry of Social Development, stating clearly their particular medical, rehabilitation or other health related qualifications, that ensure that they are appropriately and sufficiently qualified to perform their specific roles to advise case managers and other Ministry staff on health and disability related matters, including the assessment of medical reports, and the evaluation of recommendations by other health professionals, made on health conditions of sick or disabled clients.”
Answer to question 12:
“I can advise that there are 21 Work and Income staff who are currently employed as Regional Health Advisors and Regional Disability Advisors.
Regional Disability Advisor:
Regional Health Advisor:
Marie Louise Waugh
Regional Disability Advisor:
Regional Health Advisor:
Regional Disability Advisor:
Regional Health Advisor:
Bay of Plenty
Regional Disability Advisor:
Regional Health Advisor:
Regional Disability Advisor:
Regional Health Advisor:
Regional Disability Advisor:
Regional Health Advisor:
Regional Disability Advisor:
Regional Health Advisor:
Regional Disability Advisor:
Regional Health Advisor:
Regional Disability Advisor:
On checking the Medical Council register, the Nurses register, the Psychologists’ Board and the Physiotherapists’ Board, only about 5 of the named persons were registered, and they were all only on the Nursing Council’s register. 2 further persons may potentially be registered as nurses, but due to slightly different names (due to possible spelling mistakes), it is uncertain whether the name of the Advisors are identical with the names on the register. There was NO Advisor registered with the Medical Council or the two mentioned Boards’ registers.
Hence the RHAs and RDAs do apparently not possess that much in the way of comprehensive, higher level medical qualifications and expertise, and they seem to come from a wider background of people. The RDA and at the same time Acting RHA for the Southern Regions does according to received information have no proper “medical qualification”, and rather comes from a social worker background, also with some teaching qualifications and experience working with disabled students, and at times alongside psychologists. That though does not mean she herself has qualifications comparable to a proper medical or health practitioners. As they are not delivering health or disability services, and only act as “advisors”, they will not need to comply with the ‘Code’ contained in the ‘Health and Disability Commissioner Act’, nor with the ‘Health Practitioners Competence Assurance Act 2003’.
“The table below provides the qualifications held by these staff. Please note that staff may hold more than one qualification.”
Registered Nurse including: Advanced Diploma of Master of Nursing; MidWife; Community Health; Registered Psychiatric Nurse; Masters of Health Science (Endorsed Nursing)
Number of staff: 14
Adult Teaching-related qualifications: Post Graduate Teaching papers; Certificate in Adult Teaching; Post Graduate Dip in career development; Graduate Certificate in clinical teaching.
Number of staff: 7
Rehabilitation-related qualifications: Post Graduate Dip Rehabilitation Studies; Post Graduate Certificate in Rehabilitation.
Number of staff: 2
Psychology-related qualifications: Bachelor of Arts (Major in Psychology); Bachelor of Science (Psychology).
Number of staff: 5
Number of staff: 3
Other Health-related qualifications: Supervision in Health Sciences Certificate; Certificate in Quality Health Care; Certificate in Hauora Maori (Maori Health); Post Graduate Certificate in Health Science (Maori Health); Post Graduate Dip Health Science; Post Graduate Certificate Applied Behavioural Analysis; Certificate Interactive Drawing Therapy; Certificate Health Promotion; Bachelor of Applied Science and Environmental Health; National Certificate in Occupational Health and Safety; Certificate in Mental Health; Diploma of Sport and Recreation; Bachelor Therapeutic Recreation.
Number of staff: 9
National Certificate in Employment Support
Number of staff: 2
Other qualifications held: MA Social Policy; BA Social Sciences; Master of Business Administration (MBA); Certificate Small Business Management; Bachelor or Education; Child Care & Protections Certificate; Bachelor of Business (Major in Human Resource Management); Post Graduate Certificate in Public Policy.
Number of staff: 8
“I am withholding the specific qualification of each staff member to protect their privacy under section 9 (2)(a) of the Official Information Act. I consider the public interest is met in the information that is being provided to you.”
Further Conclusions and Comments:
Further to the answer from MSD to question 12 in the O.I.A. request from 11 June 2013, and replied to by way of letter from MSD dated 12 July 2013:
RHAs and RDAs listed on the Nurses Register were only registered in a maximum of 5 cases!
Listed on the Nurses Register were for instance Marie Louise Waugh (general, obstetric nurse), Mary Mojel (general and obstetric), Britt Doodes (reg. nurse), Jennifer Raphael (reg. nurse) and Annette Bridgen (reg. nurse). Others – where there was some lack of clarity re their correct name or spelling of the name, and where the Advisors may potentially be registered under a slightly different name than listed in the O.I.A. response from 12 July 2013, were Christine Adamson and Janette Cahill. None of the other Advisors MSD employs appear to be registered and their exact qualifications can only be presumed, as MSD will not give out information on who as an individual has what kind of qualifications.
The table on page 4 of that O.I.A. reply from 12 July 2013 shows what kinds of qualifications RHAs and RDAs have, and it is clear, that the majority of them are nurses. 5 have “psychology related“ qualifications, which does not mean they are psychologists as such. A fair few have “other health related qualifications“ (of certificate or diploma types), which are probably rather short duration study courses, not comparable to proper doctors’ or nurses’ qualifications. Only two have “rehabilitation related“ qualifications. Tanya Rissman, RDA and for a long time also acting RHA for the Southern Region, appears to have no medical qualifications at all, and is a qualified social worker, also with a teaching qualification for teaching disabled children. In a business she once ran, she worked with other social workers and a psychologist, but that does not make her a psychologist herself!
So those are the people that according to MSD have the qualification and “competence” to advise WINZ case managers on health and disability matters. Re Sandra Kirikiri’s claim in a recent Radio NZ National interview (09:10 am on 15 April), that all WINZ case managers have now been given “general type” training for working with people suffering mental health issues, I can imagine that this will be training at a very basic level, e.g. for how to react and deal with distress and crisis situations, little more.
Page 5 on the attached O.I.A. reply from MSD from 06 March 2013 gives details for the salary range that RHAs and RDAs get paid, and it goes from $ 57,300 p.a. to $ 78,807 p.a.. I would presume that the most will be paid at the lower end of that range, given their limited qualifications for the roles. A fully qualified and experienced medical practitioner like a GP, or any other doctor, and also many nurses, are likely to earn more in their usual employment, than what MSD would pay them. Hence there would be a low incentive for any well qualified medical or health professional to take up a responsible role as RHA or RDA with MSD and for WINZ.
In both O.I.A. responses from 06 March and 12 July 2013 you will find information on a training program that MSD conducted for designated doctors in 2008, which shows that the controversial Principal Health Advisor Dr David Bratt, who has in many presentations likened benefit dependence to “drug dependence”, was in charge of much of the training. It appears, that attempts were made to influence designated doctors WINZ use (for re-assessing and examining clients), to make decisions that are in the interest of MSD and WINZ (e.g. to remove more persons with certain “questioned” health issues from certain benefit entitlements in order to save costs). Case scenarios they used expose a rather biased tone, and the many presentations Dr Bratt has used to “educate”, “train” or “inform” GPs also show, that he himself has a clear bias, and continually seems to try to influence medical professionals by convincing them with hand picked statistics and supposed “evidence based” “research” information. While on site group training of designated doctors was only conducted until late 2008, such training is continued at least on an ad hoc or case by case basis to this day, through systems WINZ and MSD use.
THERE ARE ABOUT TWO POSTS TO FOLLOW IN THIS SERIES OF POSTS!!!
D). RADIO NZ INTERVIEW WITH MSD’s SANDRA KIRIKIRI
D.1.: A revealing interview by Radio New Zealand’s Kathryn Ryan with MSD’s ‘Director of Welfare Reform’, Sandra Kirikiri, on the expansion of a new WINZ scheme using “intensive case-management” and outsourced, private service providers, to place sick and disabled beneficiaries into jobs
On 15 April 2014 Radio New Zealand National broadcast an interesting interview with ‘Director of Welfare Reform’ Sandra Kirikiri from MSD, that revealed how MSD and WINZ now work with certain sick and disabled clients, how they use the new approaches adopted from the UK, and how they work with outsourced private service providers. While the emphasis here seems to primarily have been on “Mental Health Employment Services”, the information that was made available does also indicate, how MSD will work with ‘Work Ability Assessment’ providers.
“WINZ expands scheme to support unemployed with illness issues”
Originally aired on Nine To Noon, 09:10 am, Tuesday 15 April 2014
“The Social Development Ministry is preparing to expand a Work and Income service model that came into effect last year which sees more intensive and individual case management for some people who were on the Job Seekers Benefit.” (Duration: 22′ 11″), see this link for the audio recording:
A note based transcript of the interview:
Radio New Zealand’s Kathryn Ryan briefly introduced the new welfare regime by mentioning that MSD is now planning to expand a new WINZ service model offering more personalised, intensive and individualised case management, in order to “support” mentally and physically ill on the Jobseeker benefit into “appropriate” work. She quoted Work and Income as claiming that the new program provided by WINZ case managers and external service providers has been hailed as a “success”. It will soon be rolled out to more people on the Jobseekers benefit.
Sandra Kirikiri, the Director of Welfare Reform at MSD, did answer to questions by Kathryn Ryan in an attempted up-beat tone. On Kathryn mentioning that there are often suspicions that such programs may all just be about pushing people back into work, Sandra Kirikiri gave a comparison how sick and disabled were treated before the benefit reform changes in July 2013. She said that before July last year people could go straight onto a sickness benefit and were not offered any “pro-active engagement” re what they wanted to do, and what intentions they may have had about work. She then referred to their “stats” that people who came onto a benefit and were younger than 24 have a 40 percent “chance” of being on a benefit in 15 years time. “That’s awful”, Sandra said, and she presented the scenario that such persons might “track through” and move from an unemployment benefit onto a sickness benefit, and eventually even onto the invalid’s benefit, because “they might end up getting depressed”. “That’s not a very nice thing for a person to do”, Sandra continued. By asking another question about MSD’s intentions to get people off benefits, Kathryn Ryan made the wrong presumption that persons on the sickness benefit were getting more money than those on the unemployment benefit, clearly not knowing that this has not been the case since the mid or late 1990s.
Kathryn asked whether MSD wanted to be more “pro active” for the right reason to get people back into work. Sandra answered and said it was not about the rate of benefit, and she clarified that Jobseeker Support pays the same amount to those simply without jobs and those without work for health reasons. She pointed out that those formerly on the invalid’s benefit were now on the Supported Living Payment, which was a totally different benefit. Kirikiri then continued describing the new one on one case management approach by WINZ, understanding people’s circumstances and working with them while building a “decent relationship”. Kathryn asked whether persons were already required to be available for work before July, or whether the new changes now required persons to be more available, along with the changes offering more support. Sandra Kirikiri confirmed that more people are now expected to be available for work, and she mentioned part-time and full-time work obligations, as well as “work preparation obligations”. They have got more into that for a wider group of people, she stated. Asked about the “problems” of too many people having been on the benefit before, and younger ones tending to stay on them for longer, Kirikiri then confirmed that assertion, saying “yeah, pretty much”. Asked about how persons were now helped to get back to work, Sandra Kirikiri explained the importance of the one on one relationship with a regular case manager. She described a “self assessment form”, which the client is asked to complete. The client would tell them what they “can do”, and what “supports” they may need. That information would be considered as well as that from the client’s doctor, and an interview would be conducted, during which a “plan” would be “formed” with the client. Sandra then talked about “stair-casing” to employment, and about ensuring that wherever the client is put, “doesn’t exacerbate the situation” for the client.
Sandra used an example of anxiety, and how they would try to find out, what it is about that anxiety a person may suffer from, leading to difficulties re work. Kathryn reflected on how availability for work was previously treated, based on background education and skills, and asked Sandra, whether they were being “a bit more open” about job requirements. “I guess, yes we are”, Sandra replied, but she then went on to say that their focus was previously just on unemployed people, who recently lost their jobs. She said, that they would not need to work intensively with those people, as they were close to the labour market and manage to get a job themselves.
Kathryn asked Sandra whether mental health issues like depression or mood disorders were a “significant player” in the group of people they were working with on this kind of benefit. Sandra Kirikiri confirmed that persons with such conditions belonged to one of their two biggest categories of persons they were working with. She listed depression, anxiety, stress disorder, and described these as a “world wide phenomenon”. There were different triggers for every person, she continued, and it was important that they delve into this through the one on one approach. She said that the first two months were really about “discussions” with the client, and understanding the conditions of the person. They then would work on a plan to work around triggers that may cause exacerbated situations for a person to even get to work, for a start. They would work out what a person wants to do, and what the ideal or suitable job may be for a client in the right kind of environment. They have employment coordinators, that help them find the right kind of jobs for people, Sandra Kirikiri said. Kathryn asked her about medical certification practices before the changes, and Sandra explained that persons were previously eventually returned to the unemployment benefit, when their doctor had certified them as being available or capable for work again. Asked about the new “stepped approach”, Sandra then explained how persons may now be available for work as the doctor may state that they are available to work part-time. Even when a person has “deferred obligations” (i.e. is for a time not able to work), there were now “work preparation obligations”, and they would start “working early” to prepare persons for when they will be able to work again.
Kathryn Ryan asked her whether persons could “opt in”, or whether they could say they do not want to participate, upon which Sandra said, they could have “exemptions” from even work preparation obligations, like where persons might be in a “short term” “treatment course”, like drug and alcohol or medical type treatment, which means they shouldn’t be doing anything towards working. Asked by Kathryn whether it was not strictly speaking an “opt in” approach, Sandra denied this, and said they would take the “appropriate way forward”. Kathryn asked what was done once a client was in the process, and whether there was still a chance that they may end up in a situation where they could put their benefit at risk. Kirikiri then insisted it should be a “joint agreement” (between case manager and client). If a client thought that a work preparation effort may not help, they can then undertake something else, Sandra Kirikiri said. As long as they were involved in some form of work preparation, that’s ok, she said. The client would have to work something out with the case manager, she clarified in her words. When Kathryn notes that this is quite special kind of work that case managers were doing, Sandra confirmed this, saying that they look for barriers to work. Kathryn then mentioned “medium level mental health issues”, which were more speciaised issues, and she asked whether there was more “engagement with the medical advisors”. “Definitely” was the reply by Sandra, and she stated that they gave all their staff “some general type training on working with people with mental health conditions”. She also mentioned they have “Regional Health Advisors” and “Regional Disability Advisors” that give advice to the case-managers, and also work with the medical professionals, if they need further advice or “clarification”. Asked whether it had involved more intensive training for their staff, Sandra said that they ran the training through all the case managers.
Kathryn then raised depression, auto immune diseases, chronic fatigue syndrome, and asked whether there this had required a “change of mindset” for some case-managers, about what this means for the client, and what was possible for the client, and how much of a barrier such conditions were to work. A bit uncertain sounding, Sandra confirmed that there was definitely a different approach now, where they were working with the client and taking into account what the client could do. They were mindful that it is long-term employment which is going to help, even if it is part-time. They would not want to push people into work that would fall over for them in two weeks time. Asked by Kathryn about how they had structured the incentives for staff to achieve getting people into jobs, Sandra said that no staff at MSD would get “bonus payments”. Asked about “targets”, she then though confirmed, that case managers have targets. She stated that staff work for them, because they want to help people, and “this is really giving them a buzz”. She then described an apparently real story, where a young person first turned up with a hoody and accompanied by a support person, and was not very communicative. She described the change of the client’s behaviour from interview to interview, opening up and then speaking for themselves. Later that person was looking for work and got a first interview, and now the person is in full time work. Such experiences were motivating, she explained. Asked further about targets and achievement levels, Sandra then admitted they are watching employment placement rates and durations of jobs. It was not just about “out the door and into employment” for them.
Kathryn asked about the support that case-managers were empowered to offer. Sandra then repeated the self assessment, working with the client and the “coming up with a plan”, for which case-managers would give the client “information” that they “would need to fulfil that plan”. They would in that regards be working with local community providers, mention whatever courses were around, point out courses WINZ offer, like “CV preparation”, “interview training”, “all of those basic sort of things”, Sandra continued. It might also be something as simple as going to a course that “helps them integrate with people”, and it was a real “joint effort basically”, she said.
Asked by Kathryn about the results of clients getting into the work force, Sandra Kirikiri then explained that since July they have a “dedicated 50 case managers” working with about 5,000 clients in this area. Since July there had been “about 1,800 exits” from the benefit system, “out of that population alone” into employment, and over 400 people were working part-time now, she said. The results had been “pretty good”, she said. Asked about the attitude of employers, especially re mental health (anxiety or stress) issues, or auto-immune conditions, Sandra Kirikiri then incredibly commented, that Work and Income do not discuss this (risk) with an employer! It was not their place to do that, she asserted. “If the client wants to disclose that that’s ok”, she continued. “What we’re trying to do is, to make sure, that from our knowledge of the employer, that it would be a good environment for the client”. Kathryn asked: “They don’t have to declare any medical condition?” And Sandra said, “no”, then continuing with an example where they had sent a short list of partly long very term unemployed people to an employer, and where the employer picked the ones they wanted, which included some that Work and Income had considered hard to refer. But “they’re the best people”, she added. An employer does not have a “pre conceived idea”, she said, and the employer takes the people on the basis of the short list and the interview, “and these guys are going, great!” Sandra said that the clients really want to prove themselves, when an employer gives them that “little bit of faith”. She said though, they do not need to do that (tell employers about the conditions of the clients). Sometimes the client wants them to talk to the employer, with them, she conceded, and they were happy to do that. But they were actually not doing that as a first instance.
Asked by Kathryn whether there was a time limit for the intensive efforts they make for clients, Sandra denied this, as they would not have a “time frame”, they were working through a plan, “seeing where we get to”. If they’d “at the end of the day” get another opinion from a doctor, stating that work isn’t right for now for the person, then that was “okay”. There’s no specific time limit for it, she added. Asked about assessments after say 6 months, Sandra Kirikiri said, they do assessments “all the way through”. “Every pro-active engagement is an opportunity for an assessment”, she commented. She elaborates on plans, of various durations, and that these were reviewed as they were going. Asked whether there had been cases where jobs did not work out for clients, Sandra said she was not aware of any that had “fallen out”. She talked of “post placement support” they were offering as well. The case she got are good news, she said, about people “transitioning through to full time work”. Asked about the external providers, Sandra mentioned six providers for the Mental Health Employment Service, and that they were run separately as a trial. Kathryn asked Sandra about their plans to extend the “success” of the program, and she answered, that they were working through that at the moment, as it was early days. Clients told them they want to work, she mentioned, and they were getting positive feedback. They were also using a similar approach for other unemployed people with difficulties to find work, she indicated, but this was so far for a certain number of Jobseeker beneficiaries with illness and disability. Sandra Kirikiri said they could definitely extend the program to thousands more on that benefit. Re further funding, Sandra spoke of “reshuffling” their service, when asked by Kathryn about further funding. She mentions that benefit numbers had reduced quite significantly, and in the year to March there were 15,000 less on benefits. Kirikiri thought that in the more difficult longer term cases group of persons (e.g. those under 24) the numbers had been reduced, but she could not give any exact numbers. She also thought that further investment in this area may not be needed, as when numbers continued to come down, they could use existing numbers (of staff) to do the work. Kathryn Ryan in the end raises the concern that when employment may fall again, the clients that had been put into new jobs may also be the more vulnerable that lose them again. Sandra then talks about the importance of upskilling that would give them the “buffer” to “survive” a downturn. Sandra could not give any figure of how many under 25s were getting the one on one intensive case-management offered. It was a relatively high number, but she was not sure whether it could be called “significant”.
D.2.: Analysis, conclusions and comments on that Radio NZ interview
The 22 minute long interview (see ‘D.1.’) requires careful listening to, and it tells us that the new “regime” that Work and Income are now implementing is really all about drawing up various, endless “plans” to which the client has to commit her-/himself, in supposed “joint agreement” with a case manager. It is about ongoing “assessments”, about expectations, compliance and commitment, and about targets to be met by using cost effective measures to achieve anticipated results.
The use of words like “help”, “support”, “stair-casing” and “overcoming barriers” is hiding the fact that this is nothing but a smartly designed, cunning scheme, which does certainly apply pressures on physically and mentally ill, simply by communicating and suggesting clear expectations that they must prepare for and look for “suitable” work.
This is so, because the WINZ clients approached or referred to this “one on one” case-management scheme, will have been assessed beforehand by their own medical practitioners, and/or by designated doctors or the new “Work Ability Assessment” providers under the new regime, according to the NEW criteria for “work ability”. Those criteria will have been set according to the “science” by Professor Mansel Aylward, and will be enforced by Dr David Bratt and his Regional Health Advisors and Regional Disability Advisors, while “advising” case managers and medical practitioners they work with.
What this means is, they will expect sick and disabled beneficiaries to already start making “work preparation” efforts from the day they apply for a health related benefit under the “Jobseeker” category. Forget the old system, where you were considered sick and were given some time to recover and get well again. Now they start right from day one, and get you worked on by case managers doing this “intensive”, “individualised” case management. They are using a “staircasing” approach, and expect clients to agree to “plans” after more plans, to prepare to look for at least part time work. By studying what UK Professor Mansel Aylward stands for, and what he wrote about “common mental health conditions”, about “musculoskeletal diseases” and that most are (according to his views) simply based on “illness belief”, it will become clear to the ones not yet familiar with his “health benefits of work” approach, what this is all about. WINZ have adopted the same questionable “science” and approaches they have been trying to apply in the UK for a number of years now. And they did it there with disastrous results!
Sandra Kirikiri told Kathryn Ryan that WINZ staff have now been given “general type training“ in how to work with clients with mental health conditions. I ask would you trust the ordinary WINZ case manager to deal with conditions that some psychologists and psychiatrists may struggle diagnosing and “treating”.
And there is talk of their Regional Health Advisors (RHAs) and Regional Disability Advisors (RDAs), supposedly working with case managers and doctors, to assist mentally ill and others with other health issues. Most RHAs and RDAs have rather limited and in some cases somewhat outdated “health qualifications”, one I know of is just a social worker who worked with psychologists, but is not medically qualified at all. Most are former nurses, and not even registered. They get trained and managed by Principal Health Advisor Dr Bratt, for whom benefit dependency is likened to “drug dependency”.
Re “supports” offered Sandra Kirikiri only talked about “wrap around services” in the form of “one on one case-management”, certain basic courses and involvement with community service providers. There was NO information on proper extra medical and rehabilitation support that WINZ offer, nor any mention of incentives given to employers to hire a sick or disabled person.
AND the most worrying and SCANDALOUS REVELATION in this RNZ interview with Sandra Kirikiri comes at about minute 15, and it goes from there, where Sandra Kirikiri admits quite frankly, THAT THEY (WINZ) DO NOT EVEN TELL PROSPECTIVE EMPLOYERS ANYTHING ABOUT THE HEALTH CONDITIONS THE SICK OR DISABLED CLIENTS MAY SUFFER FROM!!!
Now think that one through! They are in all likelihood doing even more irresponsible stuff. I have heard anecdotal feedback that they are in their various courses, and possibly also through their outsourced “mental health employment” service providers, even encouraging clients to NOT tell employers anything about their health issues and so, as that may risk them not getting an offered job that they get proposed or referred to.
This means that the employers run huge risks taking on any such client from WINZ. Work and Income could make themselves legally liable for harm caused if an employer hires a sick or disabled person, who does not fully disclose their conditions that could impact on or interfere with the work they’re expected to do. But as it so often goes with legal matters, it will likely be the WINZ client, who may face legal claims before courts, besides of instant dismissal, if certain conditions are not mentioned during a job interview. I think this is stuff for legal experts to think about.
As for the numbers given on persons who “exited” the service (1,800), there is no clear information on whether they have all ended up in employment on the open job market, and how many of them were still in jobs they may have taken up. 400 are supposed to be in part-time jobs, but as the scheme has only started over half a year ago, this is far too early to comment on the outcomes of it.
Apart from that it was disappointing that Kathryn Ryan simply gave airtime for a senior MSD representative, but none to a beneficiary advocate with some expertise in all this. I am sure that someone from ‘Auckland Action Against Poverty’, perhaps even the ‘Mangere Budgeting Services’ – or Kay Brereton would have something to say on these topics.
D.3.: Some links to websites offering relevant media reports
Just any work is not necessarily the solution to those suffering mental illness, as this story tell us. It may in many cases actually have rather harmful, high risk consequences than any “health benefits”:
“What works and what doesn’t: How a job affects mental health” http://thewireless.co.nz/themes/hauora/what-works-and-what-doesn-t-how-a-job-affects-mental-health
“WINZ staff interfere in treatment plans of beneficiaries” , Scoop, 20 Oct. 2013
“Unqualified WINZ staff interfere in treatment plans of beneficiaries”
“Graham Howell, spokesperson for the Benefit Rights Service expresses concern at the interference by unqualified Work and Income staff in treatment plans of those on benefits and low incomes.”
“Work ands Income use Regional Health Advisors (RHA) or Regional Disability Advisors (RDA) to tell case managers to exclude items from the “Disability Allowance”. The Disability Allowance is intended to reimburse treatment costs if the person or their children has on-going health issues likely to last six-months or more. These RDA or RHA staff often have no formal medical qualifications, and even those that do have not been employed in a medical capacity for years – yet they are saying to case managers, “do not include” this item or that item when the person’s doctor says it necessary for ensuring their well-being.”
“This behaviour directly impacts on treatment plans that are discussed between the GP and their patients. Beneficiaries are often forced to go without prescribed medicines and then, they or their children end up in hospital.”
“Beneficiaries in turn are not aware of their rights and because of the way they feel disempowered when at Work and Income, they simply take what is dished out to them.”
Some other media reports about risks and consequences of wrong assessments, and also accidents and disability caused by work or else:
“Winz apologises to sick woman placed on wrong benefit”, ‘NZ Herald’, 18 Nov. 2013:
“Work and Income New Zealand has apologised to a woman with a debilitating medical condition for placing her on a benefit requiring her to find work.
Carolyn Gane was denied a supported living payment, previously known as an invalid’s benefit, despite having her GP’s recommendation and was instead placed on jobseeker support, previously known as the sickness benefit. Jobseeker support is for people who can work but are temporarily unable to do so, and requires them to seek employment while receiving benefit payments.
The 49-year-old Hamilton mother of four is afraid to leave her house in case she has an “embarrassing accident” caused by medical problems with her bowel, and was gobsmacked when Winz deemed her fit for work. Ms Gane was diagnosed with diverticular disease in 2008 and irritable bowel syndrome in December. The medical conditions cause her pain and to lose control of her bowel with little warning, and as a result she rarely leaves her house in Hamilton East in case she is caught.”
“A medical certificate supplied to Winz in July meant she had short-term exemption from finding work, but last month Ms Gane’s condition worsened and her GP, Dr Tiwini Hemi from the Tuhikaramea Medical Centre, deemed her unable to work in the longer term. She used the medical report to apply for the supported living payment.”
“A letter from Winz said Ms Gane did not meet the medical credentials to qualify for the benefit and would remain on jobseeker support. Winz Waikato Regional Commissioner, Te Rehia Papesch, said they had made an error and would be re-examining Ms Gane’s case.”
“Bad calls can affect generations”, Wairarapa Times-Age, APN, 14 April 2014:
“I often wonder how many Government department, ACC or Work and Income, or rest home decisions and actions would stand up to the scrutiny of court – if people had the resources, time and energy to challenge those decisions.”
“Diana Clement: Serious illness can trigger financial misery”; 12 April 2014:
“Kiwis insure lives but ignore risk of disability and the cost this entails”
“If you want to know what you might get from Work and Income in the event of a partner dying or being disabled by illness then check out its handy calculator at tinyurl.com/WINZcalculate.
I entered details for a hypothetical family and assumed that the main breadwinner was disabled, the partner wasn’t working, the mortgage was $800 a week and there were cash assets over and above the house of $50,000.
The weekly “Supported Living Payment” it estimated was $214.79, plus an accommodation supplement to cover some or all of the mortgage, but not living expenses. Not much to replace a breadwinner, although there would be a small disability living allowance to cover some of the additional costs of being disabled.
One thing that occurred to me when I was doing the Work and Income calculation was that it took into account dividends. If part of your retirement plan was to reinvest dividends as you get them, then this isn’t going to happen. They will need to be taken into account in Work and Income payments.
These Work and Income figures are a real eye-opener. Yet more of us insure our possessions than ourselves, according to research carried out in 2011 by Nielsen for the Financial Services Council.
One of the main reasons we don’t insure against disability, according to the survey, is that people believe disability will happen as a result of an accident and ACC will pay out 80 per cent of their wage for the rest of their working lives. But statistically, says Hutchinson, we’re more likely to be disabled through illness. According to the Stroke Foundation, strokes are the leading cause of serious adult disability in New Zealand.
In the case of a stroke, cardiovascular disability or other illness ACC wouldn’t pay.”
C). WORK AND INCOME’S CONTRACTED WORK ABILITY ASSESSMENT (WAA) PROVIDERS
C.1.: New Zealand Doctor publishes details of WAA contractors
On 02 April 2014 the ‘New Zealand Doctor’ magazine did publish an article on the newly appointed “work ability assessment” providers that MSD and Work and Income have entered contracts with. Nowhere else in the media was there any report to be found with these details. The names of the 15 private, supposedly “independent” providers were published. The list included the following providers for the mentioned regions:
• APM Workcare – National
• Catapult Employment Services Trust – Canterbury
• Company Medic – Northland
• ECS Connections Ltd – Taranaki, Central
• Enableworks Ltd – Canterbury
• Linkage Limited (Wise Group) – Auckland, Waikato, Taranaki, Central, Wellington, Canterbury
• Mana Recovery Trust – Wellington
• OTRS Group Ltd – Auckland, Waikato, Bay of Plenty
• PhysioACTION Ltd – Auckland
• ProActive Rehab – Northland, Auckland, Waikato, Bay of Plenty, East Coast Taranaki, Central, Wellington
• Southern Rehab (plus ProActive Rehab) – Nelson, Canterbury, Southern
• Te Oranganui Iwi Health Authority – Taranaki
• WALSH Trust – Auckland
• Wayne Hudson Physiotherapy Ltd – East Coast
• WorkRehab Ltd – Nelson, Canterbury, Southern.
These are links to the websites with relevant information on the contractors involved, and it is highly interesting and revealing, what these providers are actually all about and specialised in:
http://www.catapult.org.nz/ and http://www.catapult.org.nz/about
(so far only has a P.O. Box address!)
http://nz-companies.com/wayne-hudson-physiotherapy-limited.307761.review and http://www.workrecovery.co.nz/consultants.html (little info available on this company) http://www.workrehab.net.nz/
Details found on the Work Ability Assessment (WAA) providers
Upon doing some research or investigation of these so-called new “independent” ‘Work Ability Assessment’ providers that MSD and WINZ appear to have contracted, it becomes apparent, that these are not really and simply medical or rehabilitation assessment providers who are truly independent, or without any vested self interest in prospective future “business”.
The vast majority of them are not doctor’s practices, psychologist’s clinics, or actual physical and mental health assessment providers. They are indeed rather REHABILITATION and EMPLOYMENT PLACEMENT agencies and organisations, most clearly run as proper businesses in that field. Hence they will be anything but truly independent, or without any conflicts of interest, because they have a strong interest in finding referred WINZ client as “fit” to do some forms of work, to then offer them some “needed” rehabilitation measures, and to then also try to place them into any “suitable” kind of jobs as they may see it, all for nice fees paid by MSD or WINZ.
Most have so far not even set up proper, separate assessment services that could be used for WINZ commissioned assessments. What some of them appear to have been offering so far have only been internal types of assessments, for their own patient/client evaluation for the purpose of preparing the delivery of client focused rehabilitation services. Only some appear to have been doing assessments for selected employers, but not simply as an independent, outsourced assessor as a third party – solely for assessment delivery. It all seems to be linked to rehabilitation services. Some of the providers have also been providing assessment and rehabilitation services to ACC, and at least some anecdotal evidence suggests, that they are not considered to act that “neutrally” and not without own interests at heart. Also do hardly any of these have any proper or sufficient experience with – and emphasis on – mental health conditions clients do suffer. Clearly the public and the affected must feel being misled by MSD re the stated purpose of them delivering “independent work ability assessments”!
This can hardly be called an “independent”, outsourced “work ability assessment” program that MSD and WINZ are starting, it is simply a gradual employment preparation and placement service for sick and disabled clients, who WINZ staff (e.g. Regional Health Advisers and Regional Disability Advisers) may view as not seriously ill or disabled enough, to exclude them from work expectations.
There is more detailed, revealing information on each single contracted provider listed above provided in Part ‘F).’ toward the end of this study!
B) ACC’S APPROACH AND PROCESSES IN REGARDS TO WORK CAPABILITY ASSESSMENTS AND REHABILITATION
B.1.: Legislation: The Accident Compensation Act 2001
Incapacity for employment
“102 Procedure in determining incapacity under section 103 or section 105
(1) The Corporation may determine any question under section 103 or section 105 from time to time.
(2) In determining any such question, the Corporation—
(a) must consider an assessment undertaken by a medical practitioner or nurse practitioner; and
(b) may obtain any professional, technical, specialised, or other advice from any person it considers appropriate.”
“103 Corporation to determine incapacity of claimant who, at time of personal injury, was earner or on unpaid parental leave
(1) The Corporation must determine under this section the incapacity of—
(a) a claimant who was an earner at the time he or she suffered the personal injury:
(b) a claimant who was on unpaid parental leave at the time he or she suffered the personal injury.
(2) The question that the Corporation must determine is whether the claimant is unable, because of his or her personal injury, to engage in employment in which he or she was employed when he or she suffered the personal injury.
(3) If the answer under subsection (2) is that the claimant is unable to engage in such employment, the claimant is incapacitated for employment.
(4) The references in subsections (1) and (2) to a personal injury are references to a personal injury for which the person has cover under this Act.
(5) Subsection (4) is for the avoidance of doubt.”
“104 Effect of determination under section 103 on entitlement to weekly compensation
If the Corporation determines under section 103(2) that the claimant is not incapacitated for employment—
(a) a claimant who is receiving weekly compensation for loss of earnings from employment—
(i) loses that entitlement immediately; and
(ii) cannot be subject to a determination under section 107 in respect of that incapacity:
(b) a claimant who is not receiving weekly compensation for loss of earnings from employment is not entitled to begin receiving it.”
“105 Corporation to determine incapacity of certain claimants who, at time of incapacity, had ceased to be in employment, were potential earners, or had purchased weekly compensation under section 223
(1) The Corporation must determine under this section the incapacity of a claimant who—
(a) is deemed under clause 43 of Schedule 1 to continue to be an employee, a self-employed person, or a shareholder-employee, as the case may be; or
(b) is a potential earner; or
(c) has purchased the right to receive weekly compensation under section 223.
(2) The question that the Corporation must determine is whether the claimant is unable, because of his or her personal injury, to engage in work for which he or she is suited by reason of experience, education, or training, or any combination of those things. (3) The references in subsection (2) to a personal injury are references to a personal injury for which the person has cover under this Act.
(4) Subsection (3) is for the avoidance of doubt.”
“106 Effect of determination under section 105 on entitlement to weekly compensation
If the Corporation determines under section 105(2) that the claimant is able to engage in work for which he or she is suited by reason of experience, education, or training, or any combination of those things,—
(a) a claimant who is receiving weekly compensation—
(i) loses that entitlement immediately; and
(ii) cannot be subject to a determination under section 107:
(b) a claimant who is not receiving weekly compensation is not entitled to begin receiving it.”
“107 Corporation to determine vocational independence
(1) The Corporation may determine the vocational independence of—
(a) a claimant who is receiving weekly compensation:
(b) a claimant who may have an entitlement to weekly compensation.
(2) The Corporation determines a claimant’s vocational independence by requiring the claimant to participate in an assessment carried out—
(a) for the purpose in subsection (3); and
(b) in accordance with sections 108 to 110 and clauses 24 to 29 of Schedule 1; and
(c) at the Corporation’s expense.
(3) The purpose of the assessment is to ensure that comprehensive vocational rehabilitation, as identified in a claimant’s individual rehabilitation plan, has been completed and that it has focused on the claimant’s needs, and addressed any injury-related barriers, to enable the claimant—
(a) to maintain or obtain employment; or
(b) to regain or acquire vocational independence.”
“108 Assessment of claimant’s vocational independence
(1) An assessment of a claimant’s vocational independence must consist of—
(a) an occupational assessment under clause 25 of Schedule 1; and
(b) a medical assessment under clause 28 of Schedule 1.
(2) The purpose of an occupational assessment is to—
(a) consider the progress and outcomes of vocational rehabilitation carried out under the claimant’s individual rehabilitation plan; and
(b) consider whether the types of work (whether available or not) identified in the claimant’s individual rehabilitation plan are still suitable for the claimant because they match the skills that the claimant has gained through education, training, or experience.
(3) The purpose of a medical assessment is to provide an opinion for the Corporation as to whether, having regard to the claimant’s personal injury, the claimant has the capacity to undertake any type of work identified in the occupational assessment and reflected in the claimant’s individual rehabilitation plan.”
“109 When claimant’s vocational independence to be assessed
(1) The Corporation may determine the claimant’s vocational independence at such reasonable intervals as the Corporation considers appropriate.
(2) However, the Corporation must determine the claimant’s vocational independence again if—
(a) the Corporation has previously determined that the claimant had—
(i) vocational independence under this section; or
(ii) a capacity for work under section 89 of the Accident Insurance Act 1998; or
(iii) a capacity for work under section 51 of the Accident Rehabilitation and Compensation Insurance Act 1992; and
(b) the Corporation believes, or has reasonable grounds for believing, that the claimant’s vocational independence or capacity for work may have deteriorated due to the injuries that were assessed in the previous vocational independence or capacity for work assessment.
(3) The claimant may give the Corporation information to assist the Corporation to reach a belief under subsection (2)(b).”
B.2.: Information on assessments from the ACC website
‘Work rehabilitation assessment – medical and occupational’
“Purpose of the service
The purpose of the work rehabilitation assessment services (medical and occupational) is to:
1. Receive an occupational assessment to provide ACC with a comprehensive list of occupations for which the claimant is suited by reason of experience, education, or training (or any combination of these). These are the ‘Identified Jobs’.
2. Receive a medical assessment to consider the consequences of the claimant’s personal injury and make one recommendation to ACC as to whether the claimant has capacity to engage in work for each of the occupations identified as suitable by the occupational assessor, or whether further rehabilitation is required.
Medical practitioners are approved by ACC from time to time to provide assessments/reassessments under this Agreement.
The assessment services may only be carried out by the approved assessor/s who must:
● have a tertiary qualification relevant to vocational guidance
● be trained in using and interpreting validated psychometric test and assessment instruments
● have experience in assisting people to identify realistic job choices, and
● have and retain current membership of a relevant professional association (eg, NZAC, NZPS, or NZAOT).
The provider will ensure that all assessors receive clinical supervision and participate in a minimum of ten supervised assessments per year with an experienced clinical psychologist (or some other similarly qualified supervisor).
The provider will not change any approved assessor unless:
● the assessor is unavailable for reasons of ill health, poor performance, parental leave or resignation
● the substituted assessor has the qualifications described in (a) above, and
● ACC has, in its sole discretion, agreed to such substitution”
“What do the services involve?”
Assessment or reassessment of a claimant by an assessor must include, but need not be limited to:
● Review of background information provided with the referral, prior to the appointment with the claimant, to enable the approved assessor to become familiar with the claimant’s personal injury, interventions to date and the identified jobs;
● Explaining the medical assessment component of the work capacity assessment process to the claimant;
● Clinical examination of the claimant which has as its focus the claimant’s personal injury or injuries. Where a claimant has multiple injuries, covered by ACC or another insurer, all injuries should be taken into account when determining capacity for work;
● Use of professionally recognised objective assessment methodologies during the clinical examination that achieve defensible and recognised findings;
● The results of any specialist medical assessments of the claimant’s condition;
● Inviting the claimant to comment on all job options identified as suitable for the claimant and ensuring the claimant’s comments are contained within the report;
● Inviting the claimant to make submissions and raise any issues or concerns about their personal injury or injuries, their capacity to work in the job options identified as suitable, and the assessor’s findings and proposed recommendations. These claimant issues, comments, submissions, and/or concerns will be included in the report and considered prior to recommendations being made to ACC;
● Consideration of the claimant’s current capacity to consistently engage in work for 35 hours or more per week in each of the job options identified as suitable having regard to the present consequences of the claimant’s personal injury (Capacity for Work).”
“In considering capacity for work, the approved assessor will:
● Consider the claimant’s capacity as at the date of the examination;
● Disregard factors other than the claimant’s personal injury(s) which may affect the claimant’s capacity, such as:
● illness before the personal injury
● non-injury related illness developed after the personal injury
● alcoholism or drug dependency
● psychological conditions present before the personal injury, or
● lack of job opportunities.
● Requesting additional information where necessary and taking all steps contemplated in this schedule on receiving that information, such as incorporating that information in the medical assessment report;
● If the claimant does not have capacity for work in any of the identified jobs, consideration of the health and rehabilitation needs and goals of the claimant, with the aim of increasing their ability to engage in work for more than 35 hours per week in at least one of the identified jobs;
● Preparation and provision to the case manager of the medical assessment report.”
“When pain presents as an issue in the medical assessment process, the approved assessor is to consider the following:
● Does the pain represent an objectively verifiable medical condition because of which the claimant is likely to suffer harm if they resumed work in any of the identified jobs?
● The medical condition must be attributable to the claimant’s personal injury. While a claimant may experience similar or greater levels of pain upon resuming work, this does not indicate in itself that harm is occurring.”
Assessment of a claimant by an assessor must include, but need not be limited to:
● Review of the information provided with the referral, prior to the appointment with the claimant, to enable the assessor to become familiar with the claimant’s background, current skills and vocational interventions to date;
● Explaining the occupational assessment component of the WRAP process to the claimant;
● Consultation with the claimant, which has as its focus the skills the claimant has obtained through experience, education and/or training (including any skills developed since the injury, through vocational rehabilitation and work experience);
● Use of professionally recognised objective assessment methodologies during the consultation that achieve defensible and recognised findings;
● Identification of all paid jobs requiring a minimum of 35 hours per week that the claimant is suited for by reason of the claimant’s experience, education or training, or any combination of these (the Identified Jobs).”
“In identifying such jobs, the assessor will:
● Consider the claimant’s suitability as at the date of the consultation;
● Disregard the following factors:
● the effects of the claimant’s injury on the claimant’s ability to work. The assessor should not exclude jobs because s/he believes the claimant may not be able to perform them due to the claimant’s Injury (this is the role of the WRAP medical assessor)
● job availability
● the claimant’s child care requirements
● transportation availability
● the claimant’s pre-injury occupation, except when prioritising job options, ie, job options must not be limited to those which compare with the claimant’s pre-injury earnings, hours of work or perceived status or prestige
● Be realistic about job choices. Jobs must exist within the current New Zealand labour market or be stated within the NZ Standards of Classification of Occupations (1995);
● Document claimant reaction to all job choices; …”
Also from the website
‘Helping people return to work – workplace rehabilitation’
“Return to work is ACC’s workplace rehabilitation philosophy. It reflects an international view, based on a growing body of research, that injured workers heal faster and avoid psychological impairment if they can safely recover in the workplace, or return to it as soon as possible after their injury.”
“Positive work fitness certification
ACC is focussed on supporting GPs to make informed clinical decisions on certifying patients for time off work, because helping injured patients to recover at work, or return quickly and safely, is recognised as good practice.
In the past, health professionals and employers focused on return to work for injured patients only after their full recovery.
Today, the benefits of early return to work are recognised by health professionals and employers, and modern practice supports safe and sustainable work that quickly integrates people back into the workplace and their normal lives.”
‘Making a Claim’ and ‘What support can I get?’
“ACC is committed to helping you recover and get back to work as soon as possible. We call this vocational rehabilitation. If you have a job, we will help you to return to it. If you can’t return to your old job because of your injury we will help you to prepare for finding a new one.”
“What help can I get?”
“Your ACC case owner or General Practitioner (GP) will arrange for a professional, non-ACC staff assessor to determine your needs in the workplace.
The assistance you receive will depend on your individual needs, but may include:
• purchasing or modifying equipment for your workplace
• short-term transport assistance to help you get to and from work
• developing a rehabilitation plan to gradually increase your hours or tasks at work, and providing a support person to monitor your progress
• preparing for job seeking and re-entering the employment market
• a work-ready programme to help you regain your ability to work and build your confidence through work experience
• training to build on your existing skills and prepare you to enter a new occupation.”
“What do I need to do to get help?”
“Your case owner will arrange a time to meet to develop your rehabilitation plan. Your vocational rehabilitation is a part of your overall rehabilitation plan. It may be good idea to talk through your needs for your rehabilitation plan with a support person beforehand and you are welcome to bring them with you when you meet with your case owner.
Your case owner will discuss the following options with you to decide which one best meets your needs:
• maintaining your employment by continuing with the same job, or doing a different job with the same employer
• obtaining new employment by searching for the same type of job with a different employer
• getting assistance, such as training, to help you use the skills you had before your injury to find new employment.”
“How am I eligible?”
“ACC can provide vocational rehabilitation if your injury has been approved for cover and you are either:
• entitled to weekly compensation
• likely to be entitled to weekly compensation if ACC does not provide vocational assistance or
• on parental leave.
Your actual entitlement depends on your individual circumstances. Contact us to confirm if you are eligible, or to identify other ways in which we can help.
“How long might ACC take to determine if I am eligible?”
“ACC regards 21 days as a reasonable timeframe for the majority of decisions about what assistance you may be entitled to; however, you may be contacted by ACC or a provider within the first week to discuss appropriate services.
Contact us if you have not heard from us within 21 days.”
“What happens next?”
“If you have not been referred to a service by your GP already, your case owner will discuss your needs with you. If you are returning to your current work:
• a professional non-ACC staff assessor will conduct a workplace assessment to determine how much of your old job you can still do
• the assessor will report back to your case owner and help them to determine the assistance you will need to reach your goals.
If it is likely that you will be unable to return to your current work, your case owner will organise:
• an occupational assessment to help us to identify your skills and suitable work options
• a medical assessment to find out which work options are medically suitable for you. These assessments will help determine the assistance you need to reach your goal.
Your case owner will discuss your needs with you, and if appropriate, your employer and GP. Together everyone will work out the types of assistance that best meet the needs identified by your assessments.
Once you and your case owner agree, the rehabilitation plan is updated to include the assistance you can expect from us, the date it will begin and the date your rehabilitation is expected to be complete.
If you complete a rehabilitation plan and still feel you need to continue receiving weekly compensation payments, you may need to take part in a vocational independence assessment to measure your ability to return to work.”
If you are unhappy with the decision, you can ask for it to be reviewed. See What if I have problems with a claim?”
“Last updated: 4 March 2014
Last reviewed: 17 February 2014”
Rehabilitation Plan (and related information):
Registered Counsellors (e.g. Auckland Region):
ACC publication for GPs:
‘Making Return to Work a reality for your patients’
“In the past, health professionals and employers focused on return to work for injured patients only after full recovery. Today, the benefits of early return to work are recognised by health professionals and employers, and modern practice supports safe and sustainable work that quickly integrates people back into the workplace and their normal lives. Work, modified for the patient’s circumstances, should be viewed as a form of therapy.”
Electronic ACC18 Work Capacity Certificate – User Guide:
“ACC supports workplace rehabilitation and accepts that, for many injured people, it’s better at work. Research shows that, in many cases, an early return to work after injury will result in a better recovery for your patient.”
‘Helping employees get back to work’, ‘medical certificates’ ACC resource for employers, 2006
Conclusions and own comments:
From the ‘Accident Compensation Act 2001’ (and I presume related regulations) and especially the website information made available by the Accident Compensation Corporation (ACC) it becomes clear, that ACC does have a strong emphasis and focus on rehabilitation, where this is considered as being an option for a person, who lost earning ability due to a suffered injury.
They can expect repeated medical and occupational assessments, to establish entitlement to weekly compensation and to rehabilitation plan services, and there have been enough factual and anecdotal cases where such assessments, to establish injuries, suffered consequences like work incapacity, and vocational independence have been flawed for various reasons. Of course ACC claims, like Work and Income, that their contracted assessors are totally independent and sufficiently qualified. At least re the first aspect, there have been disputed claims, and many have gone through reviews and also to the courts. What is important to note is that for a number of years, there has been the adoption of concepts, ideas and approaches, that clearly come from mostly UK based “experts” like Mansel Aylward, who have links to the ‘Research Centre for Psychosocial and Disability Research’ at Cardiff University in Wales. We get the same information presented on the ACC website, which has now also been adopted by MSD and Work and Income, namely that work is “therapeutic”, that it is “beneficial” to person’s health, and that work is part of rehabilitation and recovery.
It is not within the scope of this summary study to analyse in detail what ACC now does and expects off claimants, but with the information that media have published over especially the last few years, there is some evidence of ACC having made every attempt to “exit” certain costly, complex claims cases, in order to save costs, which has usually happened by disentitling them to compensation and shifting them onto the benefit system administered by Work and Income. By way of re-assessments questioning claimants’ own medical practitioner and specialist reports, and by using other information obtained from other “experts”, or even from non medical and rehabilitation sources, this has happened in a number of cases. See also part ‘B.4.’ in this study, for media reports on this and other details. A useful source for feedback and experiences by affected claimants has for years been ‘ACC Forum’.
B.3.: Critical reports and submissions on ACC processes and practices
ACC Futures Coalition, December 2010:
‘Submission to the Welfare Working Group’ on “Reducing Long-Term Benefit Dependency: The Options” (referring to issues with ACC practices that were considered for welfare reform)
“4. Lessons from ACC
4.1 The paper floats the use of a number of tools currently used by ACC as having relevance for the welfare system.
4.2 Under ‘gatekeeping’ on page 6 the paper suggests the use of “robust work capacity assessments to ensure people with work capacity are on the unemployment benefit”. If it is envisaged that something like the VI process of ACC be introduced we would recommend against it.”
‘Vocational Independence: outcomes for ACC claimants’
“A follow up study of 160 claimants who have been deemed vocationally independent by ACC and case law analysis of the vocational independence process.”, Wellington, Feb. 2007
From the Foreword:
“The basic flaws in the legislation are, first, that it sets a low standard for actual rehabilitation outcomes, and, secondly, that it uses work-capacity assessment for a purpose for which it is ill-suited – namely, for legitimizing the termination of weekly compensation.”
B.4.: Media reports on ACC and their questionable practices and failures
You Tube video w. ’60 minutes’ expose “The eye of the storm”, 12 June 2012:
You Tube video with ’60 minutes’ program “ACC Exit Strategy”, loaded June 2013:
“ACC pays millions to send its ‘hatchets‘ “, Stuff.co, by Phil Kitchin, 08 Sept. 2012:
“ACC is spending millions of dollars flying doctors around New Zealand to assess long-term clients who have already been assessed by other doctors.
The policy has been slammed by John Miller – one of the country’s top lawyers specialising in ACC legislation – who said the so-called “independence” of some assessors was a sham. ACC lawyers, advocates and claimant groups know those doctors as “hatchet men and women”, Mr Miller said. “They are not independent, as a substantial part of their income comes from ACC,” he said.
ACC figures reveal the corporation pays millions of dollars a year to a group of “independent assessors”, often flying them to towns or cities where other doctors with suitable qualifications already practise.” “Mr Miller said medical professionals had expressed serious concerns to him about the issue. Because some assessors earned virtually all their income from ACC it was “inevitable” they would tend to “provide reports ACC wants”.
“The old saying of ‘he who pays the piper calls the tune’ definitely applies with ACC assessors. The use of such assessors actually damages and diminishes ACC’s reputation,” Mr Miller said. “ACC knows the assessors who have particular fixed medical views, for example on degeneration . . . and they keep sending injured claimants to be assessed by those assessors as they know they will receive reports they want.”
“ Mr Miller said ACC advocates know when clients are sent for assessments by “the same usual suspects . . . there will be an adverse outcome for the injured claimant”.
ACC has seen a drop in the number of cases it is winning as claimants fight assessments. The corporation won 77 per cent of cases challenged by clients in 2009 but in the year to date that figure has dropped to 56 per cent. Mr Miller said his firm had experienced cases where independent assessors such as occupational therapists for seriously injured clients refused to provide reports “for us in ACC disputes”. “They fear that it will affect their livelihood from ACC contracts,” he said.”
“Few trust ACC: report”, Fairfax, Stuff.co, “Businessday”, by Rob Stock, 09 Feb. 2014:
“Dismal figures showing a collapse in public confidence in ACC after a government-led claims crackdown have been released to the Sunday Star-Times.
In an internal report titled “Change ACC” from November 2012, the insurer said just 26 per cent of its customers believed it was “honest and open”, and only 30 per cent agreed it could “be relied on to do what is right”.
The release follows publication by the Sunday Star-Times on January 19 of one segment of the report showing the effect of political interference in ACC’s payouts. The report, prepared for a former ACC chief executive after warnings of a funding crisis under former ACC Minister Nick Smith’s watch, found the level of coverage provided by the no-fault accident compensation scheme rises under Labour governments and falls under National.
ACC has now released the rest of Change ACC, showing that the crackdown under Smith resulted in “customer” satisfaction figures which no private insurer could live with. Among other findings, 36 per cent of customers surveyed agreed that ACC “ensures people get the help they are entitled to”, and nearly six in 10 were “detractors” of ACC, willing to bad-mouth the organisation, with just 17 per cent “promoters”.
ACC chair Paula Rebstock, appointed in September 2012, has told MPs the organisation’s trust ratings are now improving.” “Rebstock indicated ACC was also aiming to counter a perception that it sought out medical professionals who would provide biased advice.
“Our medical assessments project is focused on clients having a choice of assessor and on making the process more transparent,” Rebstock said. “We are exploring the use of external medical panels covering various specialties to advise on claims and help monitor ACC decisions. We believe expert independent consensus opinion will enhance the quality assurance of clinical advice in ACC, and that in turn will increase client satisfaction.”
While ACC under a National government may be criticised for its focus on reducing claims, under Labour, Change ACC concluded there had been “mismanagement over the last decade”. ““Demoralised staff, many of whom felt the organisation had a poor reputation, was not a great place to work, but who would personally go the extra mile to “make sure that a customer/client feels good about the service”.
Scott Pickering, the chief executive of ACC from early 2013, said the 2012 report was “helpful as a starting point”, but that he “set little store” by some of it. And he said he was disappointed at the nicknames given to certain classes of ACC customer in the report, which conveyed “unfortunate impressions that are the antithesis of ACC’s current desire to better understand its customers and to tailor the delivery of its services in a more user-friendly way”. The nicknames included long-term claimant “Dependent Doris”, and the self-employed “Frustrated Felix”.”
“Thousands of ACC forms now illegal”, Stuff.co, “businessday”, by Phil Kitchin, 14 April 2014:
“ACC has been given a judicial kicking for demanding claimants sign an unlawful form gathering private information, or face their claims being cut off.
Two decisions just released from the District Court say ACC acted unlawfully when it told two clients it could insist they sign the consent forms and that, if they didn’t, their compensation would end.
A lawyer specialising in ACC work said there were huge ramifications for the corporation because “there must be hundreds of thousands of these forms that are now illegal”.
“This is wholesale collection of information that they had no right to,” Dunedin lawyer Peter Sara said.”
B.5.: Comparison between the WINZ / MSD approach and the ACC approach to work ability and related assessments
I have provided some information on the way ACC administer, conduct and follow up on medical, occupational and vocational independence assessments, in order to establish their claimant’s work incapacity or alternatively work capabilities. It is not my intention to go too much into the details of the processes and practices followed, about which there has been no lack of criticism, which in many cases appears quite justified. What is important to note is, that the focus by ACC is to establish, whether there is a serious degree of incapacity, that warrants paying a claimant weekly income compensation payments. The incapacity must be accident and injury related, and the claimant must due to the suffered incapacity be unable to work in the previous role, and/or earn an income.
ACC also expects clients to agree to rehabilitation programs, to re-establish at least some work capacity and vocational independence, where this is considered being an option. The goal is to return injured to the work they used to do, or to prepare them and “support” them to be available for other forms of work and employment. Supports are being offered in different types and ways.
The main difference between ACC and Work and Income support is of course, that ACC run a compensation scheme (somewhat similar to an insurance organisation) for those who suffered work related or other accidents or injuries, while WINZ provide basic income support for those who fall outside of that category, and cannot work for other reasons, to earn a living. It is my understanding that those assessed as capable to do some work, can be exited by ACC onto WINZ benefits, if there is no work available, for which they are considered capable to apply for.
It is important to notice, that in regards to medical and work capability assessments (or incapacity assessments), WINZ are to some degree now following similar approaches to the ones already in place at ACC. There is at WINZ now a similar approach towards assessing and re-assessing sick, injured and disabled for work ability, and with using new forms of assessment and new contracted outside providers, the focus is on establishing what types and degrees of work clients can do.
It is very evident and of great concern that both ACC and WINZ have adopted measures based on the supposedly “evidence based” approach to assess work ability along the lines strongly recommended, supported and propagated by Professor Mansel Aylward, Professor Gordon Waddell and others.
I am certain that this is no co-incidence, and that it is due to the input by consulted “expert advisors” of the types of Dr David Beaumont, formerly employed by ATOS Healthcare in the UK, now operating his own ‘Pathways to Work’ business based in Cromwell, Otago, and also “co-incidentally” President Elect of the AFOEM, who formulated their “Position Statement” on the “health benefits of work” primarily on Aylward’s UNUM sponsored “research”.
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME – PARTLY FOLLOWING ACC’s APPROACH: A REVEALING FACT STUDY
(This is the first part of a number of related posts presenting information on the introduction of ‘Work Ability Assessments’ – and other new services – that Work and Income are now increasingly using from contracted, outside “service providers”.)
A). WORK AND INCOME INTRODUCES “INDEPENDENT” WORK ABILITY ASSESSMENTS PROVIDED BY PRIVATE, OUTSOURCED CONTRACTORS
A.1.: Introduction and Background Information
Without much notice by the wider public, and with only limited media attention, the Ministry of Social Development (MSD) has introduced a completely new approach to assessing work ability of sick and disabled clients as part of a new welfare regime that came into force in mid July 2013. Most in the public and the media were fed limited information that only mentioned new “social obligations” for beneficiaries looking after children, “drug testing” obligations for jobseekers, and provisions to stop benefits for those, who had warrants for their arrest issued against them. Hardly anyone learned anything about major changes in the way sick, injured and disabled would be treated under the new system that is now being gradually implemented.
These changes are based on supposedly “new scientific findings” in medical and disability research, which though strangely, primarily all come from one leading “expert” and a small number of his fellow “researchers”, who are (and were) mostly based at or linked to the so-called ‘Research Centre for Psychosocial and Disability Research’ at Cardiff University in Wales (see link: http://medicine.cf.ac.uk/person/prof-mansel-aylward/research/ ). That Research Centre, initially called the “UNUM Provident Research Centre for Psychosocial and Disability Research”, was for many years “sponsored” by one of the largest health and disability insurance companies in the world, called UNUM. The director and main researcher at the Centre is Professor Mansel Aylward, who wrote and co-authored a number of publications, largely based on the study and analysis of various statistical reports. He bases his “findings” and theories on a somewhat bizarrely interpreted version of the older so-called “bio psycho social model” (BPS model) for illness and disability diagnosis and treatment, and he has claimed that most illnesses causing disabilities are based on little else but “illness belief”. He frequently uses concepts like “common mental health problems”, “psychosomatic conditions”, “subjective complaints” and “psycho-social issues” in his “research” publications. He blames many sick and disabled of “catastrophising” illness, clinging to a “victim” attitude, and he recommends “condition management”, “self management” and “independence” through work, which is according to his research supposedly “therapeutic”, and “good for health”. Barriers to recovery and a return to work are according to him primarily “personal, psychological and social” and not health related.
Professor Aylward did already as Chief Medical Officer for the United Kingdom (UK) Department for Work and Pensions (DWP) “enthusiastically” work closely with a Dr Peter W. Halligan and others at the School of Psychology at Cardiff University, and it was with some funding from the DWP that certain “research” could be conducted to deliver some sought, supposed “proof” that illness was really too often just nothing much more but imaginations in people’s minds. As a result report like the following, titled ‘Malingering and illness deception’ (fr. 2003) were published, found via these links:
Not surprisingly the name John Lo Casio (p. 289 and from p. 301) also surfaces in that book and insiders know he was the Vice Chair at UNUM, who had substantial advisory input in welfare reforms introduced in the UK. More information on the involvement of Aylward, Lo Casio and others in the welfare reforms there is found in this very revealing publication by Debbie Jolly from DPAC:
It is beyond the scope of this humble study and report to go into the details of the “research” and related developments that contributed to the welfare reforms as they were implemented in the UK. But there are some other online “forum” and “blog” publications available, that shine more light on Mansel Aylward, UNUM and the reforms in the UK, where both Aylward and UNUM had substantial influence on what kinds of measures were introduced. It must be of great concern to the New Zealand public, that the same “experts” gave “advice” on welfare reform there and also had substantial input into the formation of recent welfare reforms here in New Zealand. To gain further insight into these reforms and who and what were behind it, the following online website-publications will assist:
‘E pluribus Unum’, ‘The Guardian’ on UNUM insurance and UK welfare reforms, 17 March 2008:
‘From the British Welfare State to Just Another American State’, Mo Stewart, ‘The Centre for Welfare Reform’, UK, 2013:
‘THE HIDDEN AGENDA’ a research summary by Mo Stewart, Centre for Disability Studies, Leeds University, March 2013:
‘British Government uses might of U.S. Insurance Giant UNUM to destroy U.K. safety net’, report by Mo Steward, ‘Black Triangle Campaign’, 14 Sept. 2012:
The very substantial, unprecedented welfare reform changes that came into force in New Zealand in mid July 2013 were preceded by the initial adoption of some new concepts, approaches and processes, copying measures already in place in the UK. It was the ‘Future Focus’ policy that introduced a new focus on what people “can do” rather than what they “cannot do”, and brought in work test obligations for sickness beneficiaries, with an “unrelenting focus on work”. Future Focus was already heavily influenced by the supposed “evidence based” approach promoted by the ones like Aylward.
Publications on Future Focus can be found here:
John Key and Paula Bennett officially announcing the ‘Future Focus’ reforms on 23 March 2010:
A special feature on the ‘Future Focus’ welfare reforms:
The ‘Social Assistance (Future Focus) Bill’ on ‘New Zealand Legislation’:
That legislative reform was firmly opposed by advocacy groups and other organisations, like for instance the ‘New Zealand Council of Christian Social Services (NZCCSS)’, whose submission can be downloaded here: http://www.nzccss.org.nz/site/page.php?page_id=254 ; see the document itself here:
The Social Security Act 1964 was changed accordingly, and Work and Income was empowered to not only assess sick and disabled on the then still kept ‘Sickness Benefit’ for their capacity to seek, find and do certain work, but to then also place clear work test obligations on them. But the National led government was not going to settle with having just these reforms put into place and practice, plans already existed for more far reaching reforms, in the social security area, to follow the report by the controversial ‘Welfare Working Group’ (WWG) 22 February 2011. See details here:
‚Reducing Long-Term Benefit Dependency Recommendations’
That report recommended the introduction of a single work-focused payment called ‘Jobseeker Support’ (recommendation 20) and “more effective support” under a “new model of welfare”, which would be strongly focused on work capacity and employment. Recommendation 6 outlined ‘work expectations for people who are sick or disabled’, and recommendation 7 ‘Assessing what a person can do’. Under ‘b)’ and in relation to the latter recommendation they wrote: ”The assessment system is developed to make use of the existing and developing information systems and other infrastructure within the health and ACC system”.
There were also recommendations to replace “sick notes” with “fit notes” (as done in the UK), to bring in outsourced employment services, drug and alcohol testing and to offer free contraceptives to persons on benefits, which would also become part of the following welfare reforms. Also proposed was the adoption of a scheme similar to ACC’s “Better@Work scheme”.
The discussions and recommendations by the government appointed WWG were largely rejected by an ‘Alternative Welfare Working Group’, set up with the help of Caritas and other concerned organisations. Their critical second report on WWG proposals, titled “Welfare Justice”, can be found via this link: http://www.caritas.org.nz/sites/default/files/Welfare%20Justice%20for%20All.pdf
The ‘Alternative Welfare Working Group’ described the considered recommendations by the WWG as punitive, and it criticised that the emphasis on paid work was too narrow, and excluded significant matters such as benefit adequacy, and the need for a more consultative style in working with beneficiaries. Their report and recommendations were rejected by the government, which continued with their preferred but controversial reforms based on the WWP recommendations.
The ‘Health and Disability Panel’ advising on further reforms
Social Development Minister Paula Bennett instructed MSD to select and appoint members to a ‘Health and Disability Panel’ to provide further advice on welfare reforms. Its role was to particularly seek further advice and to consult on health and disability matters in relation to proposed and planned further welfare reforms. The names of the 14 members of the panel were not made public, until ‘NZ Doctor’ magazine finally obtained them by way of an Official Information Act request. See this link:
http://www.nzdoctor.co.nz/in-print/2012/february-2012/29-february-2012/four-gps-advise-on-new-benefit.aspx (try to conduct a search online by putting in key words, if the links fails).
Extract from the NZ Doctor article from 29 February 2012 titled ‘Four GPs advise on new benefit’:
“The names of the four – Tane Taylor, Bryn Jones, Ben Gray and Sandra Hicks – were made public by social development and employment minister Paula Bennett after a New Zealand Doctor Official Information Act request.”
“New Zealand Doctor tried to get the names of panel members last year when the welfare reforms were announced, but was told they could not be revealed. An Official Information Act request was sent to the minister’s office in January and the response was received earlier this month.”
“Other members of the panel are: Fit For Work medical director David Beaumont; psychiatrist and former Ministry of Health director of mental health David Chaplow; disability advocate and accessible communications specialist Robyn Hunt; employment and mental health expert Helen Lockett; Auckland University of Technology rehabilitation professor Kathryn McPherson; Allied Health executive director Janice Mueller; Capital and Coast DHB chief medical officer Geoff Robinson; What Ever It Takes disability support director Charmeyne Te Nana-Williams; Wellington Pasefika Disability Network chair Pati Umaga; and Hamilton-based Career Moves Trust chief executive Roy Wilson. Panel members have responsibilities aside from those listed above and several have been GPs, Ms Bennett says.”
See also the following information on input from the ‘Health and Disability Panel’:
‘Regulatory Impact Statement’ (see parts 2 (B), (C) and especially (D), July 2012:
„Health and Disability Panel“
“12 As directed by Cabinet, MSD set up the Health and Disability Panel to provide specialist,
expert advice on welfare reform changes for people who are sick or disabled. They were
asked to advise on:
• triage and entry into the benefit system
• assessment processes and how to identify work ability.
13 The Panel of fourteen included representatives from professional and stakeholder
groups, experience in disability support services, disability advocacy, general practice,
occupational medicine, rehabilitation, physiotherapy, supported employment, and mental
health and addictions.
14 The Panel first met in October 2011. They met four times, the last being on 17 April
2012. A smaller working group of Panel members also met on two further occasions.”
‘Welfare Reform Paper C: Health and Disability’, Office of the Minister for Social Development:
“This paper is focused on establishing a work programme for officials to deliver a new approach to working with people in the benefit system who are either sick or disabled.”
See page 7 and 8 of that Cabinet Paper C, for the ‘Health and Disability Panel’ advice on welfare reforms. A senior member of that panel was Dr David Beaumont, who formerly worked as ‘Regional Consultant Occupational Physician’ at ‘Atos Origin Healthcare’ in the UK, and who had earlier also offered advice to not only MSD but also ACC in different roles. He is “coincidentally” the President Elect of the ‘AFOEM’ (Australasian Faculty of Occupational and Environmental Medicine) and he had invited Professor Mansel Aylward to present his report on the “health benefits of work” to that organisation already in 2010. It is clear that Dr Beaumont fully supports the approaches recommended by Dr Aylward. Re ATOS Healthcare see this info link:
Mansel Aylward and Dame Carol Black* were also advising the ‘Health and Disability Panel’ as this paper shows. They are quoted as having both confirmed the Panel’s view about the UK model of assessment. In addition they emphasized that:
• a person’s motivation is a good indicator of where to begin work-focused initiatives
• people on health-related benefits face barriers to work that are primarily related to social, educational and environmental factors – Sir Mansel suggested that, for many, only 10 – 15 % of what stops them working is related to the person’s health condition or impairments
• early assessment and work-focused intervention is needed to ensure that the system itself does not increase detachment from work.
*Info re Dame Carol Black:
Although acknowledging some problems with the welfare reform approach in the UK, in the end the ‘Health and Disability Panel’ appears to have in their majority supported the approach proposed by the New Zealand government, which would later adopt much of what had been tried in the UK after all.
This becomes clear when looking at what Social Development Minister Paula Bennett announced during a speech she held to medical professionals at the ‘Otago University Wellington’ campus on 26 Sept. 2012, as part of the launch of the last major part of social welfare reforms:
Link to ‘beehive.govt.nz’ website, with speech by Paula Bennett to medical professionals, announcing and explaining the welfare reforms (26 Sept. 2012):
“Across the board we will be asking more people on benefit about their work expectations, and what they might need to get into work. The focus for people with disabilities and long lasting conditions will be on their barriers to work not just their health, and we’ll be hands on, early on. This was an important point made by the experts on the Health and Disability panel which I established to review our proposed welfare changes.
It also echoes the UK’s assessment processes and the “Pathways to Work” initiative for vocational rehabilitation designed by Professor Sir Mansel Aylward. When I sat down with Sir Mansel earlier this year he told me that health conditions account for just 10 to 15 per cent of barriers to work for people on disability benefits. He said that many health conditions or disabilities can be well managed in work but addressing other barriers are just as important.”
“Since the mid-2000s a growing international movement of medical practitioners has been promoting the health benefits of work. The 2011 New Zealand Consensus Statement on the Health Benefits of Work indicates widespread agreement that sick or disabled people should be supported to work as soon as possible. The final point of this statement says, “that health professionals have a significant impact on work absence and work disability,” and I’ll talk more about that soon.
So work is good for your health and wellbeing, but equally and more importantly long term unemployment is detrimental.
In fact renowned academic and clinician Dame Carol Black found that joblessness is likely to lead to a myriad of health problems both psychological and physical. Points echoed by Professor Sir Mansel Aylward and Australian academic Dr Debra Dunstan. Sir Mansel says that health wise, after six months of unemployment each day off work is as detrimental as smoking 200 cigarettes.
While Dr Dunstan says that the risk of a prolonged absence from work increases dramatically after just 12 weeks. Unemployment not only affects the individual, it impacts the whole family.
Dame Carol has found that the impact of parental ill-health and ‘worklessness’ increases the risk of childhood stress, behavioural problems, and poor educational achievement. In particular Dame Carol highlights psychiatric disorders among children in families whose parents have never worked. She points to similar evidence from Scandinavian countries which shows that children in families where no parent is working have a higher rate of recurrent psychological problems, chronic illness and low well-being.”
“GPs hold a unique and trusted place in society and are key to providing much of the support people need to stay in or return to work. You have heard the evidence, and if like many of your colleagues you believe that work is the pathway to wellness, don’t you think GPs have a responsibility to promote this to patients? Shouldn’t work be an important part of their recovery plan?
When a GP sees someone with moderate depression or a bad back, and signs a certificate saying they are too sick or disabled to work, at all, what’s the message? What’s the message when the Government support that person qualifies for with this certificate is a weekly payment called ‘Invalid’s Benefit’? I know that under our current system, some GPs feel pressured to sign a medical certificate because they believe that if they don’t, their patient will not get a benefit.
I also know that many GPs have been frustrated when after providing detailed medical information to Work and Income nothing is done. I have heard these messages and the changes we are making reflect them.”
Comment on Bennett’s speech:
Paula Bennett’s speech reveals that without any doubt, Mansel Aylward and Carol Black (who has herself over the years been much influenced by Aylward’s advice and “teachings”), were having major advisory input in social policy formation by the National led government in New Zealand.
For more information on the ‘Health and Disability Panel and aspects of welfare reform see these online forum- and blog-publications:
The ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’
The ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’ was introduced to Parliament on 17 September 2012, and after select committee hearings and the usual three readings it was passed into law by Parliament on 09 April 2013, and got the Royal Assent on 16 April last year. Despite of overwhelming criticism and opposition presented in the form of 732 submissions, only miniscule changes were made to the original bill. The law was changed with little true consultation.
See links: http://www.parliament.nz/en-nz/pb/sc/documents/evidence?custom=00dbhoh_bill11634_1
Criticism that was directed at the legislative changes that were made
The newly amended Social Security Act gives the Chief Executive and her/his staff a very wide range of “discretionary” powers. The ‘Legislation Advisory Committee’ did in its submission express concerns, that the Amendment Bill to amend the Social Security Act did not create understandable, accessible legislation. It was concerned the Act had already been subject to amendment 131 times. It stated that past and present amendments had left the Social Security Act in a “messy and confusing state”. It is in need of a total rewrite in order to create a coherent, comprehensible, straightforward framework, the Committee concluded. The Bill would also raise rule of law issues was further criticism. Particular criticism was expressed re the new section 11E for the Act, which gives the Chief Executive discretion to determine whether someone has the capacity to seek, undertake and be available to work. The Committee critically remarked that the amended Act would give the Chief Executive power to use discretion in making 50 different decisions, which was not in line with modern day legislation. It commented that the law should be clear and consistent, and not rely on discretionary decision making on a case-by-case basis. The Committee also criticised that the Bill provided for appeals to be restricted to be made to a Medical Appeals Board, and that new provisions of the Act were imposing other more specific limitations for appeals. Last not least the Committee expressed concerns about privacy/information sharing issues. This was just one of many critical submissions made by submitters on the ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’.
These are some of the more important ones of a total of 732 submissions that submitters presented as evidence to the Social Services Committee hearing concerns about the ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’ (found via the links provided):
a) The ‘Legislation Advisory Committee’ submission (01 Nov. 2012):
b) The Human Rights Commission:
c) The New Zealand Psychological Society (30 Oct. 2012):
d) CCS Disability Action, 01 Nov. 2012
e) ICH New Zealand, 01 Nov. 2012
f) The Salvation Army
g) BAS (Beneficiary Advisory Service), Christchurch
h) National Beneficiary Advocates Consultation Group
i) ‘Disabled Persons Assemby (New Zealand)’
A.2.: Social Security Act changes facilitating the new, draconian measures introduced as part of the major welfare reforms
After the passing of the ‘Social Security (Benefit Categories and Work Focus) Amendment Act’ the ‘Social Security Act 1964’ (the Act) was amended, to provide for new powers for the Chief Executive of MSD, who also administers Work and Income (WINZ) as their largest department. Under delegated authority case managers and other staff of MSD and WINZ can and do take actions that have been granted by law to the Chief Executive.
Links to the legislation:
‘Social Security (Benefit Categories and Work Focus) Amendment Act 2013’:
‘Social Security Act 1964’:
Important new provisions in the ‘Social Security Act 1964’ in detail
A new section 60 GAG was introduced and inserted into the Act, bringing in obligations for beneficiaries, to work with contracted service providers. WINZ can enter such contracts with selected providers under the also further amended section 125A of the Act. This includes any administrative or other specified services. Since the amendments to the Act took effect mid July 2013, MSD and WINZ have entered contracts with private service providers for “Mental Health Employment Services” and “Work Ability Assessments”, besides of some other services.
Extracts from the Act
“60GAG Obligations to work with contracted service providers
(1) A person who is receiving in his or her own right, or as the spouse or partner of the person granted the benefit concerned, an emergency benefit, sole parent support, supported living payment, or jobseeker support, is subject to the following obligations:
(a) when required by the chief executive, to attend and participate in any interview with a contracted service provider specified by the chief executive:
(b) when required by the chief executive, to attend and participate in any assessment of the person undertaken on behalf of the chief executive by a contracted service provider specified by the chief executive:..”
“125A Chief executive may contract with service providers
(1) The chief executive may from time to time, on behalf of the Crown, enter into a contract with any person, body, or organisation (a contracted service provider) for the provision by the contracted service provider of services—
(a) that, in relation to young persons, are—
(i) services of the kind referred to in section 123E(a); or
(ii) services in relation to Part 5; and
(ab) that, in relation to persons other than young persons, are services in relation to all or any of Parts 1 to 1P and 2; and
(b) that are services of a kind or description stated for the purposes of this section by regulations under this Act.
(2) The chief executive must not enter into a contract with a person, body, or organisation for the provision of services of a kind stated in subsection (1) unless the chief executive is satisfied that it—
(a) is suitable to provide the services specified in the contract; and
(b) is suitable to work with persons to whom the services relate in providing those services; and
(c) has the powers and capacity to enter into and perform a contract for those services.
It is important to note, that such contracted service providers can be used in relation to ALL or ANY of PARTS 1 to 1P AND PART 2 of the Social Security Act! This includes services in relation to the administration of activities covering “Jobseeker support, and administration: assessing work ability, work-testing, and sanctions”. It includes services in the form of medical examinations covered by section 88E, particularly section 88E (4), where the Chief Executive or any WINZ staff member working under the authority of him/her “may at any time require the applicant or a jobseeker support beneficiary to submit himself or herself for examination by a medical practitioner or psychologist.”
Sections 88F and 88H lay out strict requirements to meet in regards to work test obligations, and for any deferrals based on primarily medical conditions causing work ability limitations, or in some cases based on childcare situations. It is important to note also, that according to section 88E (2) (d) MSD can under regulations made under section 132 use “health practitioners” that are not medical practitioners, to conduct examinations and thus deliver recommendations for assessments.
Section 88F (2) authorises the Chief Executive, or any of her/his staff, to require a jobseeker granted a benefit on grounds of sickness, injury or disability to undergo a work ability assessment:
“(2) The chief executive must after granting a person jobseeker support on the ground of sickness, injury, or disability, and may at any later time, determine whether the person has, while receiving that benefit, the capacity to seek, undertake, and be available for part-time work (as defined in section 3(1)).”
Also do applicants for, or recipients of the Supported Living Payment benefit, face the possible requirement to undergo virtually the same kind of medical examinations under section 40C (2):
“(2) The chief executive may require the applicant or beneficiary to submit himself or herself for examination by a medical practitioner or a psychologist. The medical practitioner or psychologist
must be agreed for the purpose between the applicant or beneficiary and the chief executive, or, failing agreement, must be nominated by the chief executive.”
Section 40B of the Act outlines the tight criteria to fulfill for being granted that benefit.
It is important to note, that spouses or partners of Jobseeker Support – and other beneficiaries – are under specified circumstances also being work tested! The now extremely stringent work test obligations are covered by sections 102 and 102A to 102E of the Act. Other obligations for beneficiaries and their spouses and partners, who have been exempted from work test requirements, may still have to be met, such as to participate in work preparation and planning efforts, which may include “work assessments”, attending skills and motivational seminars, education programs, voluntary or community work, and rehabilitation or medical treatment programs. These obligations are covered by section 60Q.
“60Q Certain obligations may be placed on beneficiaries and their spouses and partners”
“(1) This section applies to every person (other than a person who is a work-tested beneficiary or is for the time being exempted under section 105) who—
(a) is the recipient of a benefit under section 20D (sole parent support) and has a youngest dependent child under the age of 5 years; or
(ba) is a sole parent with a dependent child under the age of 1 year, and is a recipient of a benefit under section 88B (jobseeker support) instead of a benefit under section 20D (sole parent support) solely because that child is an additional dependent child (within the meaning of section 60GAE(1)); or
(bb) is the recipient of a benefit under section 40B (supported living payment on the ground of sickness, injury, disability, or total blindness) if the chief executive is satisfied that the person has the capacity to comply with obligations under subsection (3); or
(bc) is the recipient of a benefit under section 40D (supported living payment on the ground of caring for patient requiring care) if the chief executive is satisfied that the person has the capacity to comply with requirements under subsection (3); or
(c) is the spouse or partner of a person who—
(i) is the recipient of an emergency benefit, a supported living payment, or jobseeker support; and
(ii) has a youngest dependent child aged under 5 years.”
“(1A) This section also applies (despite subsection (1)) to a person who—
(a) is a work-tested beneficiary (other than one to whom subsection (1)(ba) applies); and
(b) has been granted under section 88I a deferral of the person’s work test obligations.
(1B) The chief executive may require a recipient of a benefit under section 40B or 40D to attend and participate in an interview with an officer of the department, or other person on behalf of the chief executive, for the purpose of helping the chief executive to determine under subsection (1)(bb) or (bc) whether the recipient has the capacity to comply with obligations under subsection (3).
(2) A person to whom this section applies (other than a person to whom subsection (1)(bb) or (bc) applies) has a general obligation to take all steps that are reasonably practicable in his or her particular circumstances to prepare for employment and (in particular) an obligation to comply with any requirement under subsection (3).
(3) The chief executive may, from time to time, require a person to whom this section applies (including, without limitation, a person to whom subsection (1)(bb) or (bc) applies)—
(a) to undertake planning for employment:
(aa) to attend and participate in an interview (other than one for the purpose specified in subsection (1B)) with an officer of the department or other person on behalf of the chief executive:
(ab) to report to the department or to any other person acting on behalf of the chief executive on the person’s compliance with the person’s obligations under this section as often as, and in the manner that, the chief executive reasonably requires:
(b) to participate in or undertake (as the case requires) any of the following activities specified by the chief executive that the chief executive considers suitable to improve his or her work-readiness or prospects for employment:
(i) a work assessment:
(ii) a programme or seminar to increase particular skills or enhance motivation:
(iii) a work-experience or work-exploration activity:
(iv) employment-related training:
(v) an education programme:
(vi) any other activity (including rehabilitation) other than medical treatment, voluntary work, or activity in the community.””
The work ability assessments themselves are covered by sections 100B and 100C of the Act:
Extracts from sections 100B and 100C:
“100B Chief executive may require person to undergo assessment
(1) This subsection applies to a person who is, or who is the spouse or partner of, a beneficiary in receipt of —
(a) sole parent support; or
(b) a supported living payment (except as provided in subsection
(c) an emergency benefit; or
(d) jobseeker support.
(2) Subsection (1)(b) does not apply to a person receiving a supported living payment on the ground of sickness, injury, or disability if, in the chief executive’s opinion,—
(a) the person is terminally ill; or
(b) the person has little or no capacity for work, and the person’s condition is deteriorating or not likely to improve.
(3) The chief executive may at any time require a person to whom subsection (1) applies to attend and participate in a work ability assessment made to determine, or help to determine, all or any of the following matters:
(a) whether the person is entitled to a benefit and, if so, what kind of benefit:
(b) if the person is in receipt of jobseeker support (other than jobseeker support granted on the ground of sickness, injury, or disability), whether the person is entitled on an application under section 88H, or under section 88I(4), to a deferral of work test obligations under section 88I:
(c) if the person is in receipt of jobseeker support granted on the ground of sickness, injury, or disability, whether the person has for the purposes of section 88F(2) the capacity to seek, undertake, and be available for parttime work:
(d) whether the person is entitled on an application under section 105 on the ground of limited capacity to meet those obligations to an exemption from work test obligations or work preparation obligations under section 60Q:
(e) whether the person, being a person who is subject to work test obligations or work preparation obligations under section 60Q, has the capacity to meet those obligations:
(f) what is suitable employment for the person for the purposes of section 102A(1)(a), (b), or (c):
(g) what are suitable activities for the person for the purposes of section 60Q(3) or 102A(1)(f):
(h) what assistance and supports the person needs to obtain employment.
(4) An assessment under subsection (3) must be undertaken in accordance with a procedure determined by the chief executive.
(5) After an assessment under subsection (3) is made, the chief executive may determine the matter or matters in subsection (3) for which that assessment was made—
(a) in reliance on that assessment; or
(b) having regard to the assessment and to any alternative assessment under subsection (3).“
Section 100C covers reassessments, which follow the provisions just quoted above!
Failure to comply with any of the above obligations without good and sufficient reasons will result in severe sanctions that are outlined and applied as stated in sections 113, 116B, 116C and 117. That may mean having a benefit cut by half, or suspended or stopped altogether.
A.3.: Aylward’s “UNUM-sponsored” “research” adopted by the AFOEM
Parallel to the determined efforts by health and disability insurance companies and certain state governments (e.g. in the UK, New Zealand) to adopt new measures to reduce claims for insurance payouts and welfare benefits, there have also been efforts by health professional organisations to adopt new approaches in providing more “effective” and “efficient” health care and support services, in order to adapt to budget limitations placed upon them by governments funding the health sector.
Not surprisingly the partly by UNUM, and by the Department for Work and Pensions (DWP) financed “special” ‘Centre for Psychosocial and Disability Research’ at Cardiff University, was under Professor Mansel Aylward only too happy to “share” their new “research findings” with other interested parties in other jurisdictions, such as in Australia and New Zealand. Professor Aylward was at the forefront of this, and it begs belief, how easily he was able to convince the leadership of the AFOEM (‘Australasian Faculty of Occupational and Environmental Medicine’) as part of the RACP (‘Royal Australasian College of Physicians’) of the supposed “health benefits of work”.
But Aylward’s motivations were clear from the beginning, as a presentation he gave at a forum in Stockholm, Sweden on 01 December 2008:
“Health, Work and Wellbeing – Pathways to Work”, Stockholm, Sweden, 01 Dec. 2008
A very similar presentation was given to attendants at the AFOEM in Sydney on 18 May 2010: ‘REALISING THE HEALTH BENEFITS OF WORK – A POSITION STATEMENT’
His message at both forums was rather revealing (see extracts from slide 8 of that presentation):
“Changing beliefs and attitudes: the evidence base
Getting politicians and key policy makers on side:1”, also:
“ • Economic burden of status quo …
1. Halliigan P, /Aylward M (2005) The Power of Belief , Oxford University Press, Oxford”
What will have assisted Ayward was the fact, that the ‘President Elect’ of the AFOEM was (and is) a Dr David Beaumont, who once worked for ATOS in the UK, and who was not only familiar with the approach promoted by Aylward, but also fully supported it himself. Again, it was Dr Beaumont, who actually invited Aylward to present his findings to the AFOEM. Dr Beaumont has in the past not only consulted ACC and MSD on various matters here in New Zealand, he is also running his own rehabilitation service business: http://www.pathwaystowork.co.nz/ and also heads http://www.fitforwork.co.nz/team . Without any doubt, the man has many vested interests. See the following publications via the RACP – AFOEM website to follow the process of their introduction of a “Positions Statement” on the “health benefits of work”:
a) The AFOEM, as part of the RACP, has with these efforts adopted the “research findings” of Professor Mansel Aylward and his like minded colleagues in the UK, launch 18 May 2010:
b) AFOEM, ‘Prof Dame Carol Black – Stakeholder Meeting’, October 2010:
c) AFOEM ‘Launch – Consensus Statement on the Health Benefits of Work’, March 2011:
d) ‘November 2011 Stakeholder Meeting’
e) AFOEM, ‘The role of GPs in realising the health benefits of work’
f) AFOEM ‘Position Statement on the Health Benefits of Work’ (2010/11):
g) AFOEM: ‘No work or bad work: both can make you sick – AFOEM launches position statements on healthy workplaces’, Oct. 2013 (apparent reaction upon first criticism on position statement):
So while the politicians in the New Zealand government were preparing to more or less adopt many of the same kind of welfare reforms that had already been introduced in the UK, the medical fraternity was at the same time being induced by the same like-minded “experts” from the UK, to convince them to adopt the ideologically influenced sets of ideas and approaches, that would profoundly facilitate the introduction and implementation of proposed reforms in New Zealand (and Australia). Networks of vested interest parties appear to have been involved to get the clear agenda pushed forward this far.
The firm drive to promote the supposed “health benefits of work” is based on the unproved belief, that it is work in roles on the ordinary job market (in the various countries and societies), that is “therapeutic” and “good” for even sick, injured and disabled persons. While there may well be evidence that physical and mental activity are beneficial to persons’ health, and that for some persons actual work in suitable forms and places may also be of some benefit, there totally insufficient evidence that ordinary paid employment, which is generally done in highly competitive environments in most work places, is suitable for sick and disabled. Even many “healthy” workers tend to have serious issues with unsatisfactory, unsafe and stressful work and work-place conditions. This means, that such a drive to “usher” – or even pressure sick, injured and disabled into open employment, bears significant risks and dangers, which could cause more harm than good in the medium to longer run. It is very worrying to see the medical fraternity being led to believe otherwise. Sadly most medical and health professionals are kept so busy with their day to day work and challenges, that they do not have the time to read much in the way of complete scientific report publications. They do often simply rely on the “leadership” and advice by institutions like the AFOEM, which though in this case appears rather ill advised on the approaches propagated by Aylward et al.
A.4.: Sundry information on medical certification and work ability assessments – in forms and relevant publications
So with the mentioned welfare reforms now in place, we have learned that MSD and WINZ are already using outsourced, private assessors, who they have entered contracts with. The genuine question arises, why is this necessary, and why do WINZ not trust and rely on their clients’ own doctors or specialists, potentially not even their own designated doctors? For some further basic information on how work capacity medical certification and work ability assessments will look like, or how it should perhaps alternatively be done, the following information may assist.
Work and Income and/or MSD publications
There are “strangely” NO sample forms for the ‘Work Capacity Medical Certificate’ available, and on the Work and Income website. Other information is available though, which covers questions and answers about the use of this newly designed and formulated form. The following types of information can be found by clicking the provided links to their website:
‘Work Capacity medical certificate – Information for health practitioners’, WINZ website:
‘Supported Living Payment medical certificate for a person being cared for – Information for health practitioners’, from the Work and Income website:
Work and Income ‘Self-Assessment questionnaire’
“If you have a health condition, injury or disability we need to understand how this impacts on your ability to work. We want you to tell us about your work background and your health. When you answer these questions we will be able to work out the best way to help you.”
Own Comment on “self assessments”:
The ‘Self-Assessment questionnaire’ now used by Work and Income is not the first kind of “questionnaire” that they have been using to establish a client’s work readiness, motivation and barriers to work. Under ‘Future Focus’ they introduced a so-called ‘Work Readiness Assessment’ that sickness beneficiaries had to complete once a year, by answering targeted questions put to them by a case-manager. It included rather wide reaching questions, not just about disability and illness.
The new questionnaire therefore appears to be a further development. But instead of focusing on assessing how particular existing health conditions and impairments due to disability do directly affect clients, it asks virtually only wider questions about their work, hobbies, volunteering activities, personal interests, views a client has re what work she/he may be able to do, and what they have done in the past. It asks what activities they may be able to do with supports, and what difficulties the client sees there are – to access and do work.
While it is of course a positive step to allow clients input into the assessment for their work ability, the form asks the clients to provide answers that can and will in too many cases be given from a rather subjective view point. The clients may fail to give sufficient consideration to potential risks with attempting to resume and take up paid work. A fair percentage of affected sick and disabled may well desire to work, but their aspirations and expectations may well be somewhat unrealistic, and fail to recognise the realities that exist at most work places. It may indeed expose the clients to the risk of WINZ staff exploiting their sincere willingness to try work, by using their motivation as a convenient excuse to move them off benefits. Clients may take on jobs, which they will not be able to cope with, and push themselves, simply to “prove” themselves. That can lead to excessive, unreasonable and unhealthy pressures the affected put onto themselves, which is likely to lead to physical and mental stress, burnout and collapse, which could prove disastrous to especially those suffering mental health issues.
This approach by MSD and WINZ is somewhat similar to some methods used in the UK, where the opening up and use of “other” information for assessing sick and disabled, intentionally leads to a “softening up” of applied work capacity criteria. It will provide case managers, work brokers, employment coordinators and outsourced service providers with opportunities to apply and use too wide discretion and lead to incorrect, inappropriate and unreasonable assessments of persons, by potentially misinterpreting their work ability. This can lead to abuse of the process, by finding more clients as “fit for work”, simply to meet set targets.
Other relevant publications
Royal New Zealand College for General Practitioners (RNZGP):
‘Work Capacity’ medical certificate, sample form, July 2013:
This appears to be the only source where a copy of the current form can be found online.
The New Zealand Medical Association’s submission to MSD (from 25 Sept. 2013) on “independent work ability assessment” providers and the staff they planned to use:
It is important to note that the New Zealand Medical Association (NZMA) expressed serious concerns about how MSD had proposed to use outside contractors for work ability assessments!
Extract from submission:
“Our first major concern relates to the inclusion of ‘vocational practitioners’ among the range of practitioners identified by MSD as being suitable to provide the assessments. Our understanding is that ‘vocational practitioners’ may have no healthcare background at all and are not registered medical practitioners. Rather, their primary qualifications are in Career Development. Given that the target population for these assessments includes patients with mental health conditions (40%), musculoskeletal system disorders (15%) and people with a range of other conditions such as cardiovascular disease, chronic respiratory diseases, diabetes, cancer and nervous system disorders, the NZMA believes there are significant risks in engaging the services of non-healthcare workers to review medical information and discuss recommendations on condition management or treatment.”
“We submit that the role and importance of front line general practitioners appears to have been underplayed in this proposed list of assessment providers; this group of medical practitioners (not just those general practitioners with qualifications in occupational medicine) are well placed to understand a patient’s health-related and other barriers to employment, and we believe they have useful experience to offer MSD in relation to the objectives of this assessment.
Our second major concern relates to the duality of a role in which a seemingly independent assessor is paid by MSD to undertake an assessment of an MSD client but then also provides advice and recommendations on the management for the individual concerned. To avoid a conflict of underlying motivations, we believe that better practice would entail some sort of firewall between these two roles. Such a separation of roles would also be consistent with what occurs in other spheres (e.g. assessments in the military and for members of sports teams).
Finally, we suggest that it would generally be more appropriate for MSD to liaise with the patient as well as their general practitioner when formulating an assessment of their work ability. Where independent assessments are required, we suggest that these are best undertaken by a general practitioner who is not the patient’s own general practitioner. While we appreciate that MSD is keen to avoid an over-medicalised model, we believe that general practitioners and other health professionals (e.g. psychiatrists or psychologists where mental health concerns dominate) are best placed to undertake assessments that focus on how a patient’s health condition or disability impacts on their potential for employment.”
The New Zealand Medical Association, publishing information made available by Work and Income, 04 April 2014:
‘Work Ability Assessment – Questions and Answers’
‘Linkage’, member of the Wise Group (who are a WAA provider contracted by WINZ)
‘Registered health professional – work ability assessment, Position description’
“Registered health professional – work ability assessment”
This position description gives some insight into what kind of staff will be employed by outsourced work ability assessment providers, and how they will be expected to work!
A.5.: The use of Designated Doctors to conduct examinations / assessments
Work and Income has been using so-called “designated doctors” since September 1995, to provide medical examinations and second opinions on their clients’ health conditions, disability and capacity to work. The health and medical professionals used for this were always predominantly general practitioners, but also included some other health practitioners, and their numbers fluctuated over the years, with some always having been used more frequently than others.
‘Sickness and Invalid’s Benefits: New Developments and Continuing Challenges’, Neil Lunt, Social Policy Programme, Massey University at Albany, ‘Social Policy Journal Of New Zealand’, 03-2006:
“National’s Welfare to Work brand (Player 1994, Ministry of Social Policy 2001) saw a new approach to medical certification for SB and IB. National’s attempts at reform saw the introduction of the Designated Doctor Scheme in September 1995, with designated doctors having responsibility for assessing benefit eligibility, certifying applications for SB at 13 and 52 weeks, and certifying grants for IB, and recommending a possible review (12, 18, 24 months). From 1998, there was an alignment of SB rates with UB rates for new grants and the introduction of the Community Wage in place of UB and SB. In October 1998, the designated doctor review scheme was revised and doctors signing the certificate were able to certify SB for four weeks and then at 13-week intervals. For IB, designated doctors certify the granting of a benefit, with review being recommended by these doctors for two years, five years, or never. During the first part of 1999, there was also the trial of work capacity assessment for those with sickness, disability, or injury. A Phase one trial was undertaken but Phase two was never completed. The work capacity process for IB and SB sought to identify the level of work, if any, a beneficiary was capable of, and to determine what assistance would help them move into paid work (abridged from Wilson et al. 2005:4–5 Table 1.1).
These approaches sought to narrow the gateway to benefits and to ensure those with work capacity did not avoid the obligations that were at this time being placed on other groups of beneficiaries, including those in receipt of UB and Domestic Purpose Benefit. I would argue that the approach was individualised and an underpinning assumption saw “problems” as located in individual claimants, particularly in their attitudes towards work and unwillingness to meet their obligations.” (End)
WINZ still primarily rely on their clients’ own medical practitioners (or other health practitioners or specialists), and in certain cases on their own pool of “designated doctors”, to conduct medical examinations and provide certificates, which since last year has primarily been the newly introduced ‘Work Capacity Medical Certificate’. Their “designated doctors” have for some time been under the suspicion of having in at least some cases been influenced by MSD’s Principal Health Advisor Dr David Bratt, and also the various Regional Health Advisors (RHAs) and Regional Disability Advisors (RDAs), that work under him. Designated doctors are indeed trained, mentored and consulted regularly by Dr Bratt, as well as the RHAs and RDAs, and MSD do pay them for their services. It is of great concern that Dr David Bratt is apparently fully convinced and supportive of the approaches recommend by the UK based “experts” like Professor Mansel Aylward. He has repeatedly made comments and given speeches, which quote selected concepts and “research results” from disability researchers like Aylward, Waddell and Burton, who have all co-operated in their “research”.
The use of certain presentations by Dr Bratt, in which he provided only selected statistical and other information, and even made bizarre comparisons between benefit dependence and “drug dependence”, has only reinforced mistrust in the approaches followed by MSDs Principal and Regional Health and Disability Advisors. One such presentation was called “Ready, Steady, Crook – Are we killing our patients with kindness?” See this link for a down-loadable copy:
(see pages 13, 20, 21 and 35 for likening the benefit to a drug – and alleged harms it causes)
There have in the past been a fair number of cases of apparently flawed, if not biased, reports and recommendations, and the issues relating to such doctors, who are almost exclusively general practitioners (GPs), have been described and explained in other publications found under these links:
Good advice on what to do if you are required to see a designated doctor can be found here:
Work and Income have by way of information provided in reply to at least one Official Information Act request, and by some online and/or public comments stated, that they intend to continue using medical and work capability related information from clients’ own doctors, same as “designated doctors” and specialists, besides those obtained from external “work ability assessment providers”.
A.6.: Media reports on the changes in the area of work ability assessments
Since before the last major welfare reforms came into force with the amended Social Security Act in mid July 2013, there have been some newspaper articles and “blog” publications reporting on the expected changes for sick, injured and disabled on benefits. But most have only been written with a limited amount of information that MSD and WINZ have made available. There has been very little information about the detailed aspects of how new “work ability assessments” will be done and applied. There is still rather little information to be found on how beneficiaries with health issues will likely be affected by all these changes. During the Select Committee process and even after passing the ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’, the government would not disclose, how such assessments would look like in detail. To this date virtually nothing has been reported and made public about the expected change in medical criteria for assessing work capacity, and how certain physical and mental health conditions will be considered in future, in regards to impacting on work ability. And this has not changed, while MSD and WINZ have now already signed contracts with providers of ‘Work Ability Assessments’! But by studying the reports and presentations by Professor Aylward and his selected few colleagues, it becomes clear where the journey is heading.
In the following I will list a few published articles and links to them, which report on what the media has learned and reported on so far (largely ignoring Professor Aylward’s “research”):
“Work tests concern disability organisation”, Stuff.co, 11 Jan. 2013
“Welfare now has health warning”, New Zealand Herald, Simon Collins, 16 July 2013
“Benefits likened to addictive drug as new medical certificate urges GPs to avoid putting patients off work.”
“Doctors told to prescribe work ethic”, Stuff.co, 14 Aug. 2013:
Extract from article:
“Doctors are being encouraged to question unemployed patients on their career goals as part of sweeping welfare reforms, which critics fear will penalise the disabled. But advocates say getting patients off the benefit is part of a GP’s job, and work-focused conversations need to start in the doctor’s clinic.”
“The Government estimates 28,000 to 44,000 people will come off benefits by 2017 because of the reforms, saving up to $1.6 billion. In a speech at the Conference for General Practice last month, ministry principal health adviser David Bratt said that it was important GPs talk to their unemployed patients about working. This included asking people “what they wanted to do for the rest of their life”.
But CCS Disability Action chief executive David Matthews said it had concerns about doctors grilling already stressed patients. “Disabled people tell me they feel checked up on and questioned all the time. Another set of questions just seems to be more and more pressure. “I think it’s great people are being encouraged to explore options about their future, but it’s not a simple solution of telling them to go off and get a job.” Disabled people often had other barriers to work, including transport, security and access to suitable jobs, which had nothing to do with a GP, he said.”
‘Regime still untried’, Otago Daily Times, 12 March 2014
Extract from article:
“A new work testing regime has started for ill and disabled people, but no-one has been referred in its first couple of weeks. Under the new system, Work and Income can refer clients with a health condition or disability for a work ability assessment with one of 16 newly contracted providers.
Yesterday, CCS Disability Action chief executive David Matthews said the organisation remained concerned about the regime. It had had reassurances, but wanted to see how it would work in practice. Mr Matthews, of Wellington, was disappointed by the medical background of the providers, because the organisation preferred assessors with a disability background. The focus should be on supporting the disabled into employment, rather than an ”impersonal medical-based assessment around capability”.”
“A hugely controversial testing regime in the United Kingdom caused ”chaos and churn” for the disabled, and Mr Matthews did not want to see anything similar in New Zealand. The service began officially on February 24, although the Ministry of Social Development was still finalising some of the 16 contracts.”
“”Although we have had no referrals so far, we are on track. Before making a referral, our staff need to decide if a work ability assessment is the most appropriate step, or if some of Work and Income’s other services may be more useful for a particular client,” Mr Crafar said.”
“Tests for disabled ‘flawed model’”, Otago Daily Times, 25 Oct. 2013
“New work assessments for the disabled and people with health conditions will impose ”unnecessary angst” and wrongly put the onus on clients rather than employers, CCS Disability Action Otago patron Donna-Rose McKay says.”
“Mrs McKay believed New Zealand was adopting the same ”flawed model” as Britain, where work-testing the disabled was highly controversial. ”The process focuses on the person as having to overcome the barriers, but in reality for many people with impairment or many people who have an illness, the barriers are not with themselves; the barriers are with employment and other people’s attitudes.” It meant ”more hoops, more bureaucracy” when opportunities were scarce.”
“Work and Income expects up to 1000 clients to be referred for a ”work ability assessment’‘ between February and June next year, about 2000 in 2014-15, and about 3000 the next year, the proposal document said. The provider would receive $650 (GST exclusive) for each completed assessment. The process would take about three hours, which included a one-hour face-to-face assessment. ”This assessment will be done by a suitably qualified medical or health professional, who will take a fresh look at a person’s ability to work, along with the supports and services they need to find and stay in work. ”The work ability assessment is intended to take a broader, holistic approach to the factors affecting a client’s ability to work,” the document said.”
“Dunedin disability researcher Chris Ford said the tests were likely to find most people able to perform some kind of work, taking no account of the wider economic situation. In effect, this depressed wages in the employment market for everyone, he said.”
“Contractors to assess sick and disabled for work”, Stuff.co, Fairfax, 03 Nov. 2013
“Private contractors will be paid $650 an assessment to get thousands of New Zealand’s sick and disabled ready to return to work. From February, Work and Income will pay private “medical assessors” to scrutinise sickness and disability beneficiaries who it believes can work. Only the most difficult beneficiaries, those Work and Income could not find jobs for, would be seen by the assessors. Many could be obligated to complete assessments or face cuts to their benefit.
The medical assessors will be paid $650 per assessment, which are expected to take about three hours, and are prompted to recommend lifestyle changes to help the beneficiary get a job, such as a “positive approach to life” and more time at the gym.”
“It is expected eventually 3000 disabled people a year will have to visit an assessor, who will judge their fitness for work and report back to Work and Income. The scheme, revealed in a tender proposal, is part of the biggest welfare shake-up in decades, with the Government aiming to have 28,000 to 44,000 people off benefits by 2017, saving up to $1.6 billion.”
“CCS Disability Action chief executive David Matthews said Work and Income had assured him disabled people would not be treated as they were in Britain. “But none of us will really know until it is in place,” he said.
He also questioned the focus on a medical assessment, when the barriers to work were often social. However, a far bigger problem was employers’ prejudice against the disabled and no assessment could overcome a lack of jobs, he said.”