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.”