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!!!