THE DISCREDITED, INDEFENSIBLE WORK CAPABILITY ASSESSMENT (WCA), RESPONSIBLE FOR ENDLESS HARASSMENT OF SICK AND DISABLED IN THE UK, AND WHAT ITS DEMISE MUST MEAN FOR NZ WELFARE REFORMS
Contents:
A). INTRODUCTION – THE WORK CAPABILITY ASSESSMENT (WCA)
B). THE WORK CAPABILITY ASSESSMENT HANDBOOK FOR HCPs
C). THE ASSESSMENT PROVIDER ATOS AND THE NEW PROVIDER MAXIMUS
D). INTERPRETATION OF ‘DECISION MAKER’ AT DWP
E) THE 5TH AND FINAL REVIEW OF THE WORK CAPABILITY ASSESSMENT
F). CONCLUSIONS AND COMMENTS ON THE ‘INDEPENDENT REVIEW OF THE WCA – YEAR FIVE’, AND THE ONES BEFORE
G). DR LITCHFIELD’S SUPERFICIAL IMPRESSION OF NEW ZEALAND’S WORK CAPABILITY ASSESSMENTS AND WELFARE REFORMS, AS REFERRED TO IN HIS FINAL ‘INDEPENDENT REVIEW’ OF THE WCA
H). THE WCA REVIEWER DR LITCHFIELD AND HIS LINKS TO ‘FIT FOR WORK’
I). OTHER INFORMATION ABOUT DR LITCHFIELD, HIS BACKGROUND AND WORK
J). CRITICISM OF THE WCA FROM THE UK MEDICAL PROFESSION
K). INFORMATION ABOUT THE WCA, CRITICISM OF IT AND THE DWP – BY SUPPORT GROUPS, A TRIBUNAL UNIT AND THE MEDIA
L). THE MAN AND MIND BEHIND THE ‘ALL WORK TEST’, THE ‘PERSONAL CAPABILITY ASSESSMENT’ – AND CONTRIBUTOR TO THE ‘WCA’
M). AYLWARD, WADDELL ET AL, ALL WORKING ON THE SAME AGENDA
N). FORMS OF WORK CAPABILITY ASSESSMENTS IN USE IN NEW ZEALAND
O). THE CONCLUSIONS THAT NEW ZEALANDERS SHOULD DRAW FROM THE DISASTROUS WELFARE REFORMS IN THE UK, WHERE THE FLAWED AND HARSH APPROACHES HAVE NOT DELIVERED, AND WHERE THE WCA IS NOW DISCREDITED
P). APPENDIX
H). THE WCA REVIEWER DR LITCHFIELD AND HIS LINKS TO ‘FIT FOR WORK’
Some light deserves to be shed onto the Reviewer Dr Litchfield himself, given his involvement with ‘Fit For Work’, his work in other capacities, and also his long term position with BT, a large UK employer. It deserves some questioning, why a Reviewer from his kind of background was the supposed “appropriate” appointment. The former Reviewer appeared to come from a slightly more independent kind of professional background, some will think.
Dr Paul Litchfield has been Chief Medical Officer for BT (British Telecom) and he is a member of ‘Fit For Work’, a “think tank” kind of “stake holder group” and lobby organisation:
Re the author or “Reviewer”, look up info via these websites:
https://uk.linkedin.com/pub/paul-litchfield/44/37b/104
http://www.fitforworkeurope.eu/UK/About/paul-litchfield.htm
from LinkedIn:
“Summary”
“Paul’s main professional interest for the past decade has been occupational mental health and he has been involved in UK national and European initiatives to improve rehabilitation back into work after mental illness and to reduce the stigma of mental ill health. Within BT he has created a framework for health, safety and wellbeing that has driven very significant improvements to the benefit of both the workforce and the business and the company’s performance in these areas is widely viewed as exemplary. Key elements of the approach have been partnership with the Trade Unions and the transformation of data into management information that is of use in managing the company better. He has published and lectured widely not only on mental health issues but also on sickness absence, hazard control and ethics in occupational health.”
He has been ‘Chief Medical Officer’ for BT Group plc (British Telecom) for 14 years, and is thus a medical professional with a corporate business appointment and links.
‘Fit for Work UK Coalition’ website:
http://www.fitforworkuk.org/
‘Fit for Work Europe’ is made up of only 5 partner countries, being the UK, Netherlands, Switzerland, Hungary and Turkey.
http://www.fitforworkeurope.eu/About/our-history.htm
Under the page ‘Our History’ of ‘Fit for Work Europe’ we find that ‘Fit for Work’ was originally established in the UK, and “expanded” into Europe.
Their website informs:
“Fit for Work Europe is a multi-stakeholder Coalition, driving policy and practice change across the work and health agendas. We aim to deliver more investment in sustainable healthcare by promoting and implementing early intervention practices. Research shows this approach is the most effective way of ensuring people with MSDs (musculoskeletal disorders) can enter and remain in work across the EU and globally.”
Also is some info available on Professor Stephen Bevan, their Founding Director
Professor Stephen Bevan, Founding Director
http://www.fitforworkeurope.eu/About/stephen-bevan.htm
“Stephen is Director of the Centre for Workforce Effectiveness at The Work Foundation and an Honorary Professor at Lancaster University. He joined The Work Foundation in 2002 as Director of Research from the Institute for Employment Studies (IES). In 2007, he founded the Fit for Work project and in 2009 he launched the European Coalition.
Stephen has carried out research and policy work for the Number 10 Policy Unit, HM Treasury, the Cabinet Office, the Department of Health, the Department for Work and Pensions and the European Commission. He has also advised many blue-chip companies on aspects of HR strategy and practice. Stephen has conducted research on high-performance work practices, employee reward strategy, staff engagement and retention.”
A UK report from 2007 is quoted, supported by a “grant” from ‘Abbott’:
‘Fit for Work? Musculoskeletal Disorders and Labour Market Participation’
Click to access 44_fit_for_work_small.pdf
Stephen Bevan, founder of ‘Fit for Work’, was co-author of that report. The “Foreword” was presented by Professor Dame Carol Black, the UK Government’s then ‘National Director for Health and Work’, who is known to have based a lot of her own views on the “research” and “findings” by Professor Mansel Aylward and others at the ‘Centre for Psychosocial and Disability Research’ (once “sponsored’ by ‘UnumProvident’).
The report starts with the ‘Executive Summary’ stating a perceived challenge:
“The health of British workers is giving us serious cause for concern. Up to a quarter of the workforce is not healthy enough to drive the improvements in productivity which the UK needs to thrive in an increasingly globalised, knowledge-based economy. Despite record levels of employment and job growth, over 2.6 million people of working age are claiming Incapacity Benefit (DWP, 2007). There is overwhelming evidence that worklessness is, itself, bad for health and that rehabilitation back into work can positively affect physical health, psychological well-being and raise people out of poverty.”
While lamenting the poor health, sickness absence and lack of productivity of UK workers, the report does on page 11 (under ‘Introduction’, 3rd section) bluntly admit the following:
“But, as ever, the truth about the health and well-being of the UK working population is a little more complex than the headlines imply and, although the overall rate of sickness absence has stayed at about the same level for the last thirty years or so, we have witnessed some very significant – and concerning – changes in the nature and composition of work-related incapacity during this period.”
On page 12 that report then comes to the crucial issue it tries to address:
“Despite the stability in the headline rate of sickness absence, we have witnessed a significant increase in the proportion of the total made up of longer-term absences: workers with more serious illnesses or chronic conditions. By some margin, the majority of these longer-term absences can be attributed to two ‘clusters’ of conditions. The first is what is now popularly known as ‘stress’, though should more accurately be termed ‘common mental health problems’. These include depression, anxiety disorders and a number of other conditions. The second, known as musculoskeletal disorders, are the subject of this report. ‘Stress’ grabs the headlines because, each year, work-related ‘stress’ results in the loss of over 10 million working days, at a cost to UK employers of in excess of £3.7 billion (Lehki et al, forthcoming).”
Own Comment:
These are the same kinds of “issues” Aylward, Waddell, Burton et al have repeatedly been stressing in their reports. They mostly conducted “comparative studies” on paper, and interviews with selected groups of affected. Comparing statistical and other medical and even economic reports on “worklessness” and benefit dependence, may reveal some form of association and apparent correlation between “conditions”. But it does not necessarily give a clear cause and effect explanation; like that unemployment itself causes illness and incapacity. We know from experience that ill health, serious and permanent disease and forms of physical and mental incapacity causes unemployment, but the latter may only cause ill health in some cases. What nobody appears to have considered is, that the usually resulting POVERTY that comes with unemployment and long term benefit dependence, may actually be the real cause for further mental and physical illness – not just unemployment itself.
On page 16 of that report it is revealed how the “research” was conducted for the publication:
Extract:
“In addressing the objectives outlined above, we have used the following methods:
Desk Research:
Here we have drawn on existing published research from the medical, occupational health and health economics literature. This has enabled us to draw together the evidence on the nature, extent, impact and costs of MSDs to the economy, to employers and to individuals. We have examined a range of MSDs to assess the extent to which their impact varies and where policy and practice has been both strong and weak in terms of prevention and intervention.
Expert Interviews:
We have conducted interviews with experts (see Appendix 1 and 2) across a number of disciplines to identify the main areas of policy and practice which need to be addressed by policy-makers, health professionals and by employers.”
Own Comment:
That is the way much of the research by Professor Aylward was also conducted, by researching other reports, analysing selected data, and writing new reports. What has been shown through reading their reports is, that there is a tendency to “trivialise” certain health conditions or illnesses, such as a fair few mental health conditions that are also included in the DSM, by simply calling them “common mental health problems”. The same is done in this report, also with MSD, simply referring to it as one of “musculoskeletal disorders”. These “experts” are actually attempting to blur the line between more severe conditions, and those that appear to be less severe. Aylward and others admitted in later reports, that this whole area of disability and “worklessness” requires further research and study, as existing reports do not offer sufficient information to draw well based conclusions.
Hence perhaps their cautionary “note on definition” on page 17:
“In the absence of a consensus on a clinical definition of many MSDs, navigating the literature on their prevalence, incidence, diagnoses, epidemiology, treatment and cost to society is a difficult task. The lack of standardisation and validation of the terminology and classification of MSDs is one of the reasons for the contradictory findings in the literature regarding the diagnosis, epidemiology, treatment and rehabilitation of these conditions (WHO, 2003).“
While the contents of the report may not be fully discredited, the above comments do at least indicate, that it should be treated with a lot of caution, in regards to its value and reliability. What appears clear is that MSD can be caused by work, and can become worse if unhealthy work is continued. I note that the medical researchers Waddell and Burton are repeatedly quoted in this report. Like with Professor Mansel Aylward, the two are known to have done a lot of “comparative studies”, in the form of comparing statistical data contained in various other reports. These may show some “correlations” between sickness and disability, and work absence with longer term incapacity and benefit dependence. But that alone does not necessarily mean that sickness and disability are the result of not working, it is more likely to be the other way around. Also is there not sufficient evidence to generally claim that work in ordinary paid jobs on the competitive market is “beneficial” to health. Much work has certain detrimental effects on physical and mental well-being, and instead the emphasis should perhaps rather be to promote some moderate physical and mental activity, where possible, as that may be beneficial. This does though not equate to activity in competitive, paid work.
Under ‘Interventions’ on page 36 the “biopsychosocial model” and “work” are brought into the report:
“The biopsychosocial model is an explanatory framework that recognises the importance of psychological and social factors in determining how MSD sufferers cope with their conditions. The following section provides a brief overview of the biopsychosocial model and outlines the implications that it has for the workforce.”
“The biopsychosocial model advocates that clinicians, occupational health professionals and others should assess the interplay between the biological (eg disease, joint damage), the psychological (eg disposition, anxiety) and the social (eg work demands, family support). Figure 3 below illustrates the role which psychological disposition and behaviour can have on the way a physical ‘injury’ (such as back pain) is approached by a patient. In this example, the injured patient risks entering a self-reinforcing cycle of incapacity,
delayed recovery and even depression if their dominant response to pain is to ‘catastrophise’ it.“
Under chapter 5 ‘The wider Impact of MSDs’ the report stresses the costs caused by MSD, by illness generally, particularly through workplace absence, leading to lost productivity. A range of ‘conclusions and recommendations’ are presented under chapter 6, at the end of the report, which are aimed at reducing the harm and costs caused by MSD, and which could improve workers’ productivity. The underlying message to employers, employees and government is: Focus on capacity, not incapacity. Also the claim is, while MSD affects the ability of some to work, it is work that is generally good for a person’s long term health. Even when unwell or injured, remaining at work in some capacity is better for “recovery” than being absent from work. While some recommendations may represent common sense approaches, others seem rather questionable, like telling employers to challenge GP’s diagnosis, assessment and “sick notes”, same as to avoid a “risk management” mentality when dealing with a sick employee. Many GPs will feel challenged with applying a “biopsychosocial” approach, which involves potentially complex interrelationships and interactions, and can be ambiguous or misleading.
Appendix 1 lists expert witnesses that were interviewed, and amongst others, there was clearly a rather prominent representation by DWP, their favoured “experts” and also the UNUM insurance corporation:
Dame Carol Black – ‘The Government’s National Director for Health and Work’
Dr Bill Gunnyeon – ‘Chief Medical Advisor’ ‘Department for Work and Pensions’
Dr Mike O’Donnell – ‘Chief Medical Officer’ ‘UNUM Provident’
Prof. Gordon Waddell – “orthopaedic surgeon with clinical and academic interests in the field of back pain and related disorders”, but who also (once) worked at the ‘Centre for Psychosocial and Disability Research’ (formerly “sponsored” by UNUM), headed by M. Aylward
Dr Nerys Williams – ‘Medical Policy Advisor’, ‘Department for Work and Pensions’
Hence we have a strong line-up of “experts” that come from vested interest parties, who have also a name for their strong position on the “health benefits of work”.
But with the further above stated fact that sickness absence in the UK has remained rather steady for over 3 decades, what then is the justification and purpose for the position presented with this report? It appears that the main goal is to create a “healthier” Britain, where more people work longer, and produce more, and where attempts are made, to even engage sick and disabled into work, so that socio-economic costs are reduced, simply to be better able to compete with work forces of other nations. The agenda behind “Fit For Work” is therefore rather a politically and ideologically driven one, it seems, where a step change is asked for to be applied by the medical profession, employers and also government.
Interpretation: MSD’ stands for ‘Musculoskeletal Disorder(s)’
Dr Litchfield already being somewhat biased towards a “fit for work” approach
The very involvement of Dr Litchfield with “Fit For Work” appears to show at least a “slight” conflict of interest, which he has, as the Reviewer of the WCA. He is with his membership in that organisation already taking a position that supports the underlying approaches and policies that are reflected in the WCA and the “policy intent” behind it. The report shown above shows the strong influence that leading “experts” had on “Fit For Work” and research they rely on, and it resembles a lot the same messages we have over the years heard coming from the likes of Professor Mansel Aylward, former Chief Medical Advisor to the DWP. Also has Dr Litchfield, or have “Fit For Work”, cooperated with the DWP, and allowed input from vested interest parties such as UNUM. One would have thought that a Reviewer of the WCA would be more suited if coming from a more neutral kind of background.
I). OTHER INFORMATION ABOUT DR LITCHFIELD, HIS BACKGROUND AND WORK
‘the void’ reports on the Reviewer, Dr Litchfield, under this link (27 Feb. 2013):
https://johnnyvoid.wordpress.com/tag/dr-paul-litchfield/
“Member of ‘Fit For Work Coalition’ Brought in to Scrutinise Atos”
Extract:
“The DWP have brought in a member of the ‘Fit For Work Coalition’ and the neo-liberal think tank the World Economic Forum, to carry out a review of the brutal assessments for sickness and disability benefits.
Dr Paul Litchfield will replace Professor Malcolm Harrington who was sidelined after being mildly critical of the Work Capability Assessment (WCA), the relentless health and disability tests which have driven some claimants to suicide.”
‘dns Disability News Service’ reported on Dr Litchfield’s appointment (13 Dec. 2013):
‘Fitness for work’ test: government ‘should start again from scratch’
http://disabilitynewsservice.com/2013/12/fitness-for-work-test-government-should-start-again-from-scratch/
“Disability charities appear to be losing patience with efforts to reform the much-criticised “fitness for work” test, as the government’s new independent reviewer delivered his first report.”
The ME Association reported on Dr Litchfield’s Independent Review of the WCA:
“We report on the fifth and final Independent Review of the Work Capability Assessment 28 November 2014”
“Dr Charles Shepherd reports on a meeting at the DWP on Thursday November 27 at which Dr Paul Litchfield gave a presentation on the fifth and final independent review of the Work Capability Assessment (WCA).”
Extracts:
‘ESA outcomes of WCA: Quarterly official statistics’
“I would also draw attention to the latest quarterly statistics on ESA produced by the DWP:
http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/352885/esa_wca_summary_Sep14_final.pdf
In particular, the most striking change that has been taking place between 2008 and 2013 (provisional figures) is in the numbers of people being found:
• FIT FOR WORK: 2008 = 64%; 2013 = 27%
• UNFIT FOR WORK AND PLACED IN THE WRAG: 2008 = 24%; 2013 = 15%
• UNFIT FOR WORK AND PLACED IN THE SUPPORT GROUP: 2008 =12%; 2013 = 58%
So there has clearly been some effect as a result of the changes that have been made and the work that both Dr Litchfield and the Fluctuating Conditions Group and Mental Health Groups have been doing – especially the emphasis on the need for claimants to be able to do descriptor tasks reliably, repeatedly, safely and in a timely manner. Anecdotal feedback to The MEA also indicates that there ARE more people being placed in the support group and that less people are having to go to appeal.
But many people with ME/CFS, who have a genuine claim to this benefit, are still having to go to appeal in order to obtain ESA.”
J). CRITICISM OF THE WCA FROM THE UK MEDICAL PROFESSION
Over the years there has also been increasing criticism of the Work Capability Assessment by senior and also less senior members and spokespersons from the British medical profession. It was also the British Medical Association that spoke out clearly against the WCA and how it is being applied and thus causes serious harm to many of the sickest, the disabled and the weakest in society. In the following I present various critical to condemning reports and statements from various stake holders, also quoting professionals in the medical field:
1. The British Medical Association states this about the WCA:
Extract from a publication on their website:
“The Work Capability Assessment”
“Background
The Work Capability Assessment (WCA) is the method used to judge whether claimants are eligible for the Employment and Support Allowance.
The system, first introduced in 2008, is currently administered by ATOS healthcare. As part of the assessment, ATOS will sometimes request a factual report from a claimant’s GP based on the information contained within the claimant’s patient medical report.
It is not part of the GP’s role to provide any opinion or recommendation on the patient’s capability to work as part of this process.”
„BMA position
The BMA has for some time raised concerns about the WCA. We believe that the current process is insufficiently rigorous and consistent, and could cause avoidable harm to some of the weakest and most vulnerable members in our society.”
“The BMA has called for urgent reform to the WCA based on specific concerns about the system:
● The computer-based process used to assess claims makes it very difficult for health professionals carrying out the assessments to exercise their professional judgement effectively. We strongly believe the computer system is in need of urgent reform.
● The fact that initial decisions are overturned in almost 40 per cent of appeal cases reinforces these concerns. It means that large numbers of claimants are denied the full level of benefit that they are entitled to until their appeal is heard and a fresh decision is made, leaving many in an intolerable position.
● That there has been a lack of progress in implementing the recommendation of the Harrington Report that decision makers should actively consider obtaining further documentary evidence in every case before reaching a final decision. If the recommendation is implemented appropriately, with GPs providing factual information, it should result in better-informed decisions being made about eligibility for ESA by DWP decision makers, earlier in the process. As well as making the system fairer for claimants, this should also significantly reduce the administrative cost of dealing with so many appeals.”
The following link provides a MS Word document containing a BMA briefing on the WCA to the UK Parliament (from January 2013):
bma.org.uk/-/media/files/word%20files/working%20for%20change/negotiating%20for%20the%20profession/wcabriefing.docx
2. My Fibromyalgia published this on their website (fr. 23 May 2012):
http://www.myfibromyalgia.co.uk/2012/local-conference-of-the-british-medical-association-votes-against-atos-the-wca/
‘Local conference of the British Medical Association votes against ATOS + the WCA’
3. The Royal College of Psychiatrists publishes this on the WCA:
“The Work Capability Assessment and people with mental health problems: the case for better use of medical evidence”
http://www.rcpsych.ac.uk/policyandparliamentary/welfarereform/workcapabilityassessment.aspx
A joint statement the College published with other agencies:
Click to access WCA%20Medical%20Evidence%20joint%20briefing%20April%202012%20V%20FINAL.pdf
4. ‘Benefit Claimants Fight Back’ published a letter by various stakeholders, support groups and also leading doctors, incl. the BMA (27.09.2011), see this link:
Extract:
“Open Letter on Atos ‘Healthcare’ to the BMJ and RCN”
“27 September 2011”
“Dr Michael ChamberlainChairman, BMJ (British Medical Journal) Group Board
Andrea Spyropoulos, President,Royal College of Nursing”
“Dear Dr Chamberlain and Andrea Spyropoulos”,
“Re: Atos Healthcare and parent company Atos Origin”
“As sick and disabled people, carers and other concerned people, including professionals, we are writing to you to urge the Royal College of Nursing and BMJ Group to immediately end your relationship with Atos, including stopping any advertising of Atos jobs or Atos the company on your websites, and not having Atos at the RCN Bulletin Jobs Fair 13-14 September, or the BMJ recruitment fair 30 September to 1 October 2011 in London.
As you know, Atos currently has a £100m a year contract with the Department for Work and Pensions (DWP) to carry out examinations for disability benefits.
We are outraged that Atos is profiting from denying those of us who are sick or disabled, the benefits we need to survive and maintain our level of health. In May, at the protest outside Atos headquarters, a number of people spoke about our experiences of the examination, being denied benefit and having to appeal to get it back. One woman testified that her brother, who had severe depression, committed suicide after being cut off. See:
http://www.guardian.co.uk/society/video/2011/may/11/disability-protest-atos-origin-video
The media have exposed more of the dire consequences of Atos’ decisions. In February, the Daily Mirror highlighted the case of a Derbyshire man with a heart condition, found fit for work, who had to go through tribunal to appeal, then was awarded Employment and Support Allowance (ESA) but died of a heart attack the day before his next Atos exam was due.
A Channel 4 News report on 27 July 2011 acknowledged what thousands have been saying: it interviewed the heartbroken partner of a critically ill man whom Atos denied his entitlement on grounds that he was ‘fit for work’ – he died less than three months later. How many more people have died following such cruel and callous treatment? The coverage was prompted by a Parliamentary report from the Work and Pensions Committee of MPs, in which they criticised Atos. Atos the powerful multinational has taken vindictive action against disabled people and carers’ websites where it is criticised, getting sites closed down which isolated people rely on for support.”
5. The website called ‘Grannie’s Last Mix’ ‘Letters from Desolation Row UK’, published this extract from a British Medical Journal (BMJ) publication, quoting a letter from Dr Greg Wood, former naval doctor and former ATOS assessor, then whistle blower, about the WCA:
https://sparaszczukster.wordpress.com/tag/general-medical-council/
‘Another Doctor Speaks Out Publicly Against Atos Work Capability Assessments’
Extract:
“PERSONAL VIEW”
“I blew the whistle on the government’s disability assessments”
“Greg Wood former naval doctor and Atos disability analyst.”
“Greg Wood went to the media with concerns about the ethics surrounding tests for fitness to work—and eligibility for benefits—that the UK government outsourced to Atos.
Actually, two whistleblowers went public before me, and several other doctors have raised concerns anonymously. I am a former general practitioner in the Royal Navy, where work related assessments are bread and butter stuff. The UK Department for Work and Pensions (DWP) devised the work capability assessment (WCA) to judge whether people who receive out of work sickness benefits could, in fact, cope with most forms of work. A more stringent test came into use in 2011, and the government made no secret of the fact that it hoped this would boost the labour market, improve people’s self esteem and personal income, and, of course, reduce government debt.
For many years the information technology and “business process outsourcing” company Atos has had a contract, now worth £100m (€116m; $155.4m) a year, to carry out several social security benefit assessments, including the WCA, for the Department for Work and Pensions. In my view this risks tension between doctors’ professional concerns on the one hand and business imperatives on the other.
The WCA had a troubled childhood. From early on, claimants and disability groups were reporting problems. They felt the assessment was a box ticking process, where medical assessors spent most of their time punching superfluous lifestyle data into the computer. And the likely outcome as they saw it? Computer says no. In fact, the test, on paper at least, isn’t too bad, though it isn’t going to win anyone a Nobel prize. But it cannot adequately take into account health conditions that fluctuate unpredictably, and it tries to include too broad a range of jobs. Driving, call handling, shelf stacking, data entry, and cleaning, for example, are all theoretically covered. And although the test is nominally a pre-employment medical test of sorts, it is really still about measuring the person’s level of disability. In early 2013 the WCA was still causing a rumpus in public, despite a series of external reviews.”
One problem that dawned on me over time was the widespread use of five ill conceived so called rules of thumb that were promulgated during the training of new assessors. On one, manual dexterity, the guidance was just plain wrong. The training said that this all boiled down to an inability to press a button, whereas the regulations allow points to be awarded when there are difficulties forming a pinch grip, holding a pen, or operating a computer. The other “rules of thumb” showed a combination of discrepancies and questionable interpretations of medical knowledge—for example, moving from one room to another at home was supposed to be equivalent to moving 200 metres. The effect was to reduce a claimant’s likelihood of entitlement to financial help. Another concern was the absence of documentary evidence, which, in my experience, occurred in about a fifth of assessments.”
(First publised by the BMJ Publishing Group Ltd in 2013)
*****I strongly recommend you read the rest of that letter on their website, and a supportive letter by Dr Glyn Phillips, GP, dated 23 August 2013.*****
K). INFORMATION ABOUT THE WCA, CRITICISM OF IT AND THE DWP – BY SUPPORT GROUPS, A TRIBUNAL UNIT AND THE MEDIA
As already mentioned and presented above, there has been endless criticism of the WCA, the DWP and ATOS Healthcare. The WCA has had a fair share of negative reporting, and this continued over the years of its use. Support groups and increasingly also media published information and critical reports on the WCA. Below is just a small sample of these:
1. ‘Rethink Mental Illness’, website publication – ‘factsheet’:
‘Work Capability Assessment’
http://www.rethink.org/living-with-mental-illness/money-issues-benefits-employment/work-capability-assessment
For downloading the PDF ‘factsheet’, try this following link:
http://www.rethink.org/resources/w/work-capability-assessment-factsheet
2. From the website ‘Birmingham Tribunal Unit’:
‘The Work Capability Assessment (WCA)’
http://www.btu.org.uk/guide-docs/44-the-work-capability-assessment-wca
3. ‘The Mirror’ reported on 04 April 2012:
‘32 die a week after failing test for new incapacity benefit’
http://blogs.mirror.co.uk/investigations/2012/04/32-die-a-week-after-failing-in.html
Extract:
“More than a thousand sickness benefit claimants died last year after being told to get a job, we can reveal.
We’ve highlighted worries about the controversial medical tests for people claiming Employment Support Allowance which are being used to slash the country’s welfare bill.
The Government has boasted that more than half of new claimants are found “fit to work” – failing to mention that over 300,000 have appealed the decision and almost 40% have won. Instead, employment minister Chris Grayling (below) says this “emphasises what a complete waste of human lives the current system has been”.”
“We’ve used the Freedom of Information Act to discover that, between January and August last year, 1,100 claimants died after they were put in the “work-related activity group”.
This group – which accounted for 21% of all claimants at the last count – get a lower rate of benefit for one year and are expected to go out and find work.
This compares to 5,300 deaths of people who were put in the “support group” – which accounts for 22% of claimants – for the most unwell, who get the full, no-strings benefit of up to £99.85 a week.
We don’t know how many people died after being found “fit to work”, the third group, as that information was “not available”.
But we have also found that 1,600 people died before their assessment had been completed.
This should take 13 weeks, while the claimant gets a reduced payment of up to £67.50 a week, but delays have led to claims the system is in “meltdown”.”
4. The Guardian, ‘Breadline Britain’, report from 20 June 2012:
‘Mental health of benefit claimants is put at risk by welfare reform’
“Work capability assessments, which identify those fit for work, are singled out for criticism by health professionals, campaigners and claimants”
http://www.theguardian.com/society/2012/jun/20/mental-health-benefit-claimants-risk
Brief extract:
“At the centre of the controversy is the work capability assessment (WSA), the test carried out in the UK by the French healthcare firm Atos that is designed to identify people on incapacity benefit who are “fit for work”. Critics say it fails to pick up complex and fluctuating conditions such as mental health. It is widely feared by vulnerable claimants – and for those who are found fit for work, it can trigger a long, stressful cycle of appeals.”
5. The Guardian reported on 16 December 2013:
“Ministers ‘ignored advice on inhumane fit-for-work tests’ “
“Welfare adviser says he wanted a delay to work capability tests but government pressed ahead with reassessments”
http://www.theguardian.com/politics/2013/dec/16/ministers-ignored-advice-fit-for-work-tests
Extract:
“A government welfare adviser has suggested thousands of ill and disabled people were subjected to “inhumane and mechanistic” fit-for-work tests after ministers ignored his advice not to push ahead immediately with plans to reassess 1.5 million claimants on incapacity benefit.
Professor Malcolm Harrington told the Guardian he believed the work capability assessment (WCA) was “not working very well” when the coalition took power in 2010, and he told ministers a big expansion of the scheme should be delayed for a year to enable the tests to be improved.
Harrington, an occupational health specialist who carried out three official reviews of the WCA between 2010 and 2012, said: “If they had changed the system to make it more humane I would suggest that some of the people who went through it would have had a less traumatic experience.”
Ministers pressed ahead with the reassessment of long-term incapacity benefit (IB) claimants in May 2011, despite Harrington’s warnings and campaigners’ concerns that the system was flawed. The test has since become politically controversial. Critics say it is crude, inaccurate, discriminates against mentally ill claimants, and causes widespread stress, anxiety and even suicidal feelings among claimants.”
6. The Guardian, 27 March 2014:
‘Atos quits £500m work capability assessment contract early’
http://www.theguardian.com/society/2014/mar/27/atos-quite-work-capability-assessment-contract-early
Extracts:
“Atos will receive no compensation and has made ‘substantial financial settlement’ to DWP for early termination of contract”
“The contract with Atos to administer millions of fit-for-work tests for sick and disabled people a year is ending early, the government has announced.
The £500m agreement to carry out work capability assessments had been due to end in August next year but following widespread public and political anger over the tests, which have been criticised by MPs and campaigners as crude and inhumane, the agreement will now end early next year.
There has been mounting evidence that hundreds of thousands of vulnerable people have been wrongly judged to be fit for work and ineligible for government support. The Department for Work and Pensions (DWP) said that the decision had been reached after “joint negotiations” with Atos. Ministers had been in private discussions with the company since the summer over the quality of its operation but if the government had terminated the contract it would have been faced with a penalty payment.
Mike Penning, the minister for disabled people, said: “The previous government appointed Atos as the sole provider for carrying out work capability assessments and since then we have carried out several independent reviews and made significant improvements to the assessment.
“Today we are announcing that we are seeking a new provider to replace Atos, with the view to increasing the number of assessments and reducing waiting times”.”
7. The Guardian, 11 June 2014:
“Work capability assessment system at ‘virtual collapse’, says judge”
http://www.theguardian.com/society/2014/jun/11/work-capability-assessment-collapse-benefits
“Robert Martin, outgoing head of benefits appeal tribunal, says DWP was too optimistic about conducting fit-to-work tests”
L). THE MAN AND MIND BEHIND THE ‘ALL WORK TEST’, THE ‘PERSONAL CAPABILITY ASSESSMENT’ – AND CONTRIBUTOR TO THE ‘WCA’
Very instrumental in the introduction of the ‘All Work Test’ as the earlier form of a work capability test used in the UK was Professor Mansel Aylward. He also helped develop the ‘Personal Capability Assessment’ used by the DWP, and had his own indirect input into the WCA, which is simply a further development of the earlier assessments. See details about Professor Mansel Aylward published on the website of ‘Public Health Wales’:
http://www.wales.nhs.uk/sitesplus/888/page/64606
Extract from the website profile:
“He is also Director of the Centre for Psychosocial and Disability Research at Cardiff University which offers a unique opportunity to extend knowledge and understanding of the psychosocial, economic and cultural factors that influence health, illness, recovery, rehabilitation and reintegration.”
“From 1996 to April 2005 he was Chief Medical Adviser, Medical Director and Chief Scientist to the UK’s Department for Work and Pensions. He was also Chief Medical Adviser and Head of Profession at the Veterans’ Agency, Ministry of Defence. From 2001 – 2009 he was The Royal Society of Medicine’s Academic Sub Dean for Wales.
He is a physician and specialist in rheumatology and rehabilitation, therapeutics and clinical pharmacology; a visiting Professor at several universities in Europe and North America and a consultant to the United States Social Security Administration and Department of Labour.
He entered the British Civil Service in 1985 and was appointed Chief Medical Adviser at the Department of Social Security in 1996 and at the Department for Work and Pensions in 2000. From 1974 to 1984 he was Chairman and Managing Director of Simbec Research Ltd, UK, and President of Simbec Inc, New Jersey USA.
He played a key role in development and evaluation of the UK’s medical assessment for incapacity (the All Work Test), and was heavily involved in developing the Personal Capability Assessment (PCA). He led the Corporate Medical Group on the UK Government’s Welfare Reform initiatives and made a major contribution in establishing the new postgraduate diploma for doctors in Disability Assessment Medicine. He was closely involved in developing the UK’s successful “Pathways to Work” initiatives and a framework for Vocational Rehabilitation.”
Re ‘Department of Social Security’ (DSS) see:
http://en.wikipedia.org/wiki/Department_of_Social_Security
Re ‘Department for Work and Pensions’ (DWP) (created 08 June 2001) see:
http://en.wikipedia.org/wiki/Department_for_Work_and_Pensions
More information about Mansel Aylward, and his somewhat suspicious, peculiar connections to the controversial health and disability insurance corporation ‘Unum’ can be found in a great Guardian article from 17 March 2008 titled ‘E pluribus Unum’, by Jonathan Rutherford:
‚E pluribus Unum’
http://www.theguardian.com/commentisfree/2008/mar/17/epluribusunum
“James Purnell’s reforms of incapacity benefit are inspired by a US company with vested interests and a murky record. Now, that’s really sick“
Extract:
“The history of the work capability assessment provides some answers. In 1994, the Tory government hired John LoCascio, second vice-president of giant US disability insurance company, Unum, to advise on reducing the numbers successfully claiming IB. He joined the “medical evaluation group”. Another key figure in the group was Mansel Aylward. They devised a stringent “all work test”. Approved doctors were trained in Unum’s approach to claims management. The rise in IB claimants came to a halt. However, it did not reduce the rising numbers of claimants with mental health problems. The gateway to benefit needed tightening up even more.
In 1999, New Labour introduced its first Welfare Reform Act. All new claimants had to attend a compulsory work focused interview. Mansel Aylward, now chief medical officer of the DWP, devised a new personal capability assessment (PCA). The emphasis was no longer on entitlement, but on what a person is capable of doing. The task of administrating the PCA was contracted out and is now run by the US corporation Atos Origin. Its computerised evaluation of claims driven by clearance time targets has resulted in significant numbers of rejected claims, particularly for those with mental illness.
Unum has built up its influence in Britain. In July 2004, it opened its £1.6m Unum Centre for Psychosocial and Disability Research at Cardiff University. The company appointed Mansel Aylward as director following his retirement from the DWP in April. The launch event was attended by Archie Kirkwood, recently appointed chair of the House of Commons select committee on work and pensions. Malcolm Wicks, minister of state in the DWP, gave a speech praising the partnership between industry and the university.
The aim of the centre is to transform the ideology of welfare and so help develop the market for Unum’s products. In 2005, the centre produced a monograph The Scientific & Conceptual Basis of Incapacity Benefits (TSO, 2005) written by Aylward and his colleague Gordon Waddell. It provides the framework for the 2006 welfare reform bill. Its methodology is the same one that informs the work of Unum.”
Own Comments re Mansel Aylward
Professor Mansel Aylward has been a leading promoter of the idea and the related theories that “work is good for health”, supposedly even “therapeutic”. His position is that sick and disabled would be better off working, in jobs on the open employment market, where they would “contribute” to society, are “active” and thus “participate” socially, and represent less of a burden to society. He claims that many health conditions and various conditions or degrees of impairment – due to injury or a more congenital nature, could be “treated” better by having the persons that have them go and work.
His now often quoted “research”, which may in some respects look convincing and even follow some scientific study principles, does though by looking at it more closely reveal, that it was mostly conducted on reading other literature, other medical, economic and social statistical reports, and drawing his conclusions out of perceived “correlations”. An apparent association or “correlation” between two sets of data, or two conditions, does though not necessarily give clear, convincing information on whether one is the cause of the other. Presentations used by Mansel Aylward, and some that support his theories, do reveal, that there is some evidence of hand-picked, selected data being used to make a certain point. The claim seems to be that “worklessness” is bad for health, is actually causing “serious harm”, and is therefore aggravating already poor health, and adding further ill health. Aylward and like minded “experts” attempt to argue that sick, injured and disabled should not be allowed to take time off to recover and rest for too long, as a return to work would be more “therapeutic”. There is only marginal acceptance that much work may also be harmful to health, and no consideration appears to be given to the fact, that is may rather be some moderate, safe physical and mental activity that has the beneficial effect on health, helping sick and disabled “recover”. That may be proper advice to give, rather than send them out to find work on an already very competitive job market, where many suffer endless stress, anxiety and many other conditions, due to so much work being insecure and precarious.
Also may the actual cause for much ill health, disease and further incapacity, that is associated with long term unemployment, rather be found in the POVERTY that comes with not being able to work and earning a good enough income to live. And in any case, the attempts by Aylward et al, to blur the lines between the severities that certain conditions may have, to then facilitate “work capability assessors” to classify more sick and impaired as “fit for work” (on the open market), these are ethically questionable approaches. They expose many with serious enough health conditions and disability to risks that they will face, by being expected to go and find work, and then maintain it, while it is often very hard for the fit and healthy people to do so. Encouraging welfare agencies, administered by governments, to also tighten benefit entitlements, and pay the affected lower benefits, is equally questionable.
Here is an earlier post that reveals and presents ample other information on Mansel Aylward, his like minded medical professional colleagues, his “research” and the on the medical and work capability assessments in the UK, to some degree now followed in New Zealand:
MEDICAL AND WORK CAPABILITY ASSESSMENTS – BASED ON THE CONTROVERSIAL BIO PSYCHO-SOCIAL MODEL
M). AYLWARD, WADDELL ET AL, ALL WORKING ON THE SAME AGENDA
Besides of Professor Mansel Aylward, there has been repeated reference to, and mention of, a number of his colleagues with similar research interests and also views. Some like Professor Gordon Waddell have also worked at the ‘Centre for Psychosocial and Disability Research’ at Cardiff, for years once “sponsored” by ‘UnumProvident’ health and disability insurance company, others have more indirect affiliations. They all share a strong, supportive position on the supposed “health benefits of work”, are very critical of the state and consequences of “worklessness”, and interpret the “biopsychosocial model” in a way, where much in the way of illness is suspected to be merely having its origin in people’s minds.
The following presents a list of interesting publications by Dr Gordon Waddell, Kim Burton, Mansel Aylward, Peter Halligan and John LoCascio (once with UNUM), that give insight into their research theories and thinking behind them.
Also perhaps see and read this post on a blog from 11 August 2006:
http://www.benefitsandwork.co.uk/news/143-us-medical-scandal-company-at-heart-of-uk-welfare-reform
Relevant publications of special interest that deserve much scrutiny and that should be treated with some scepticism re their actual scientific reliability and value:
One of the publications by Dr Gordon Waddell, who also closely worked with Dr Mansel Aylward, both based at the ‘Centre for Psychosocial and Disability Research’ at Cardiff University, is the following:
‘IS WORK GOOD FOR YOUR HEALTH AND WELLBEING?’, Gordon Waddell and A. Kim Burton, 2006:
Click to access hwwb-is-work-good-for-you.pdf
Further publications by “experts” from that Centre, all apparently designed to “blur” the conventional lines in medical science, and to “soften” the resistance that there may have been, to accept these controversial “new findings” that their research delivered, are these:
‘MODELS OF SICKNESS AND DISABILITY’, Aylward and Waddell, 2010:
Click to access Models-final-proofs2.pdf
“APPLIED TO COMMON HEALTH PROBLEMS”
‘The Scientific and Conceptual Basis of Incapacity Benefits’, G. Waddell and M. Aylward, not freely available via the internet, but available as a book, 11 Oct. 2005:
A presentation that is now used to serve as an “evidence base” for conducting radical social security reforms in relation to health and work ability assessments, is this one:
‘REALISING THE HEALTH BENEFITS OF WORK’, Mansel Aylward, presentation, RACP (Royal Australasian College of Physicians) and AFOEM, Australia and NZ, May 2010:
http://www.racp.org.nz/page/racp-faculties/australasian-faculty-of-occupational-and-environmental-medicine/realising-the-health-benefits-of-work/may-2010-video-presentation-professor-sir-mansel-aylward/
http://www.racp.org.nz/index.cfm?objectid=58C41516-C2D1-1FF1-8CC71B74C8444FB3
That presentation contains summarised selectively chosen statistics and “research findings”, all prepared to “convince” the medical professionals, their organisations and governments “Down Under” (in Australia and New Zealand)!
‘The Power of Belief’, ‘Psychosocial influences on illness, disability and medicine’; edited by Peter W. Halligan and Mansel Aylward (see short book extract), Oxford University Press:
http://ukcatalogue.oup.com/product/academic/medicine/9780198530107.do?sortby=booktitleascend
‘Malingering and illness deception’, a book by Peter Halligan, Christopher Bass and David A. Oakley, “enthusiastically” supported by Mansel Aylward, Oxford University Press, 2003*:
Click to access Malingering_and_Illness_Deception.pdf
* See and read Mansel Aylward’s own “contribution” in this publication, from page 287 on. Also John LoCascio (once with Unum) provides a “contribution” from page 301 onwards.
To understand the significance of the above publication, read ‘Vox Political’ on this:
“Found: The book that helps the government smear the sick as ‘malingers’ “, fr. 04 Aug. 2014 (posted by Mike Sivier):
http://voxpoliticalonline.com/tag/mansel-aylward/
Please also take note of this fact:
Professor Peter Halligan, who published various controversial reports on mental health, he also worked with Professor Mansel Aylward at Cardiff University in Wales, see this link:
http://psych.cf.ac.uk/contactsandpeople/academics/halligan.php
He is based at the ‘School of Psychology’, at Cardiff University in Wales, and his “School” has worked closely with Mansel Aylward’s “Centre for Psychosocial and Disability Research” based at the same university!
Here is reference to more of his “publications”, much apparently pre-occupied with “malingering” and similar behaviours:
http://orca.cf.ac.uk/58314/
‘Factitious disorders and malingering: challenges for clinical assessment and management’
See Professor Halligan’s LinkedIn profile:
http://uk.linkedin.com/pub/peter-w-halligan/21/43a/91a
It says in the summary on the front page (as on 17.01.2015):
“Dean of Interdisciplinary Studies at Cardiff University from 2006 until 2012. Professor Halligan joined the School of Psychology as Distinguished Research Professorial Fellow from Oxford University where he was a Research Fellow working in the Departments of Clinical Neurology and Experimental Psychology.
Since joining Cardiff, he has played a central role in establishing Cardiff University Brain Research Imaging Centre (CUBRIC), Wales Research and Diagnostic Positron Emission Tomography Imaging Centre (PETIC), Wales Institute of Cognitive Neuroscience (WICN), the UnumProvident Centre for Psychosocial and Disability Research, the Cardiff Cognitive Neuroscience Seminar Series, School of Psychology MindArt project, Haydn Ellis Distinguished Lecture Series and the Cardiff University Research Institutes.”
N). FORMS OF WORK CAPABILITY ASSESSMENTS IN USE IN NEW ZEALAND
1). ACC’s “Functional capacity evaluation”
So far there has in New Zealand not been a similar approach taken to use a single, points based functional assessment like the WCA in the UK. But there have been and are other kinds of assessment processes, like for instance one called ‘functional capacity evaluations’ that ACC (the Accident Compensation Corporation) uses, and which have been conducted by special service providers that ACC use:
Details re this are found on their website, see this link:
http://www.acc.co.nz/for-providers/contracts-and-performance/all-contracts/WCMZ002169
Extract from the ACC website:
“Overview”
“A task-specific functional capacity evaluation is a structured process of observing and measuring an individual performing tasks in order to identify performance deficits and safety issues, functional abilities, strengths, skills and capacity to perform specific work-related tasks.
The provider will provide assessment services to ACC claimant’s referred to the provider by a case manager.”
“Purpose of the service”
“The purpose of the task-specific functional capacity evaluation is to provide the case manager with base-line information about a claimant’s ability to reliably and safely sustain specified tasks.
The Task-specific functional capacity evaluation is an assessment undertaken by the provider in respect of a claimant’s ability to sustain specified job tasks which have been identified by the case manager in the referral.
It differs from a full functional capacity evaluation in that a provider is not required to identify suitable vocational tasks or determine broad occupational functioning abilities in respect of the claimant.”
“● A task-specific functional capacity evaluation involves four components:
• reviewing the history
• interviewing the claimant
• observing the claimant undertaking specific tasks, which have been identified in the referral from the claimant’s case manager, and
• conducting a variety of measurements while the claimant performs the specific duties/tasks of the claimant’s job.
● Task-specific functional capacity evaluations are tools to assist the development or implementation of a rehabilitation plan. They are not stand-alone assessments and must always be used in conjunction with other sources of information about the claimant. Task-specific functional capacity evaluations are useful adjuncts to the delivery of pro-active and positive case management, leading to a safe and durable return to employment, work readiness or independence in activities of daily living.
● The purpose of purchasing task-specific functional capacity evaluations is to:
• provide case managers with access to task-specific functional capacity evaluation services which are cost-effective, provided in a safe environment, and delivered in a timely manner
• support sustainable and measurable improvements in claimant’s rehabilitation and return-to-work, work readiness or independence outcomes
• match claimant capabilities to specific identified work tasks where possible
• identify the maximum level of functional performance relating to specific tasks which acts as a point from which to build rehabilitation
• assist rehabilitation planning and implementation
• enhance objectivity in the rehabilitation and return-to-work process, and
• determine the occupational functional ability of the individual claimant to perform specific occupational tasks.
● Task-specific functional capacity evaluation reports are time-limited documents reflecting what a claimant can do at a particular point in time. For most claimants, task-specific functional capacity evaluation reports older than six months should not be relied on to predict performance.
2). ACC’s ‘Initial Occupational Assessment’ and ‘Initial Medical Assessment’
Other assessments that ACC use are briefly outlined and explained in the following:
Of particular interest is an official document found via this link:
‘Vocational Medical Assessors’, ‘Operational Guidelines’, ACC, October 2008:
http://www.google.co.nz/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0CCgQFjAC&url=http%3A%2F%2Fwww.acc.co.nz%2FPRD_EXT_CSMP%2Fidcplg%3FIdcService%3DGET_FILE%26dID%3D59660%26dDocName%3DPRD_CTRB093519%26allowInterrupt%3D1&ei=DxrHVOOjA8fd8AW2-YHgBQ&usg=AFQjCNEc9EXo28qo_xWetvSAgV-RVWmcVQ&bvm=bv.84607526,d.dGc
Note: If the above link does not work, try to download and read the attached MS Word document copy – freely available via the web:
ACC, Vocational Medical Assessors, Operational Guidelines, prd_ctrb093519, Oct. 2008
Two main types of assessments are explained in this operational guide (fr. pages 7-8):
“The Initial Assessments (IOA and IMA)
Initial Occupational Assessment (IOA)
The purpose of the IOA is to:
● Assess the client’s skills, experience and ability to undertake employment
● Identify suitable types of work for the client based on their education, experience, pre-incapacity earnings, and training
● Complete a work type detail sheet for each suitable work type.
Initial Medical Assessment (IMA)
Purpose of the IMA
The purpose of the IMA is to produce a report that ACC uses to determine the client’s vocational rehabilitation needs and direction. It requires the medical assessor to consider the types of work that have been identified in the IOA and give an opinion on whether any of the types of work are, or are likely to be, medically sustainable for the client.
The tasks on the work type detail sheet must be considered against the client’s post-injury condition, and the sheets used with the Department of Labor Physical Demand Characteristics of Work (see Appendix 7 on page 47 for an example) which defines the terms used by occupational assessors and includes the terms occasional, frequent, and constant with the percentages of the workday, as well as physical demands such as sedentary, light, medium, heavy, very heavy, and the typical energy required.
If the type of work is only likely to be sustainable, the report needs to show evidence of the rehabilitation the client will need in order to carry out the identified type(s) of work.
Assessors to list their qualifications
As experts it is important that medical assessors specify their qualifications. This should include all qualifications and experience relevant to the type of report they are writing. In terms of the information considered and the history obtained, the assessor should:
● Identify the documents sent to them by ACC or other sources, eg the client
Note:
If the assessor needs more information from ACC, they should request this from the client service staff member who referred the client to them.
● Detail who attended the assessment, eg support person or lawyer and what input they had, if any
● Identify elements of the history given by, or obtained from, other parties
● Highlight any relevant inconsistencies in the history and information.
For the examination and clinical findings, medical assessors should:
● Document the time taken for the assessment
● Document all the aspects of the examination – it is easy to omit parts of the routine clinical examination, eg pertinent normal findings
● Describe all tests performed – detail reduces the potential for later dispute.
When commenting on the types of work, medical assessors should:
● Comment on the adequacy or otherwise of information provided on the tasks involved in the types of work
● Focus on the generic aspects of the tasks
● Give reasons why a type of work is, or is not, medically sustainable – a simple list is not sufficient
● Tie the reasoning back to the examination findings, the comments and input of the client, and the information provided
● Include comments on the non-injury related conditions, and the impact or otherwise on medical sustainability or the client’s capacity to undertake work
● Provide recommendations for treatment/rehabilitation that could assist the client in sustaining a work type, eg pain management, work trial.
The IMA must determine whether the types of work identified by the IOA are, or are likely to be, medically sustainable. This is required under Part 4 section 89 of the AC Act.
See also Qualifications required for Occupational and Medical Assessors on pg 4.”
The following document, found online, from July 2013, contains some more current information on the above types of assessments:
‘Initial Medical Assessment and Vocational Independence Assessment’, ‘Guidelines for Providers’, ACC, July 2013:
Click to access prd_ctrb093519.pdf
If there are problems with the link, click this:
ACC, IMA and VIA, Guidelines, document, prd_ctrb093519, 2013
That Guide does (perhaps not that surprisingly, given the intense efforts to influence politicians, government agencies and medical professional organisations) also contain this familiar, very revealing bit of information (from page 28):
“9. Employment and Work Ability”
“Employment and Health
There have been numerous studies on the effects of employment on a person’s physical and mental well being.
In 2006 Waddell and Burton published “Is Work Good for Your Health and Well Being?”1 in which they examined the role of employment in the wellbeing of individuals, their families and their communities and also looked at the association between worklessness and poor health. They found a strong evidence base that work is generally good for physical and mental health and well-being and that worklessness was associated with poorer physical and mental health.
They also found that work could be could be therapeutic and could reverse the adverse effects of unemployment in the majority of healthy people of working age as well as for sick and disabled individuals and they should be supported and encouraged to remain in or to re-enter the work force as soon as possible because of the benefits.
We do need to remember this evidence in assessing the fitness for work and the relative enhancement of health.“
And in relation to these kinds of assessments used by ACC, there are also a number of discussion threads on ACC Forum, debating the policy and practices that ACC has in recent years been following. One highly disturbing development was what was later identified as being their commonly called “exit strategy” for long-term, complex costly claims. Here are two links to relevant discussion threads:
Re ‘Functional Capacity Evaluation’ (from 31 January 2008)
http://accforum.org/forums/index.php?/topic/6175-functional-capacity-evaluation/
Re ‘ACC Limiting Choice For Initial Medical Assessment’ (fr. 15 May 2009)
http://accforum.org/forums/index.php?/topic/7761-acc-limiting-choice-for-initial-medical-assessment/
Own Comments:
In relation to the above, it is of interest that the capacity evaluation or assessment is here only about “task specific” functions. So this is not a full functional capacity evaluation. ACC also has more comprehensive assessments, but what intrigues us here, is that a “case manager” may specify what tasks and necessary functions to perform them may need to be evaluated. This is a selective, somewhat narrowed down approach, which can leave an affected ACC claimant exposed to unreasonable presumptions and expectations by a case manager, who may try and seek any hypothetical functional ability a person has, that may be considered sufficient to expect the person to find some particular forms of work. Whether it is a realistic and reasonable expectation is another question.
The ‘Initial Medical Assessment’ (IMA) and ‘Initial Occupational Assessment’ (IOA) are more comprehensive, traditional types of assessments, gathering medical, occupational and various other information on the claimant, including past work, education, and social and environmental details. At least for the IOA the “biopsychosocial” approach for assessments is being used. ACC offer support for rehabilitation, and expect claimants to participate where reasonably possible, and efforts are made to establish types of work that a person may be able to perform, for usually at least 30 hours a week.
These assessments and evaluations may generally follow similar approaches as used in the UK, but are still rather different to the WCA itself. The ACC assessments are rather made by using existing medical and other records, and by interviewing the claimant with targeted questions, to which the answers will be noted down and analysed. It appears that all these various evaluations and assessments have over time been altered to integrate the same “findings” that are so often quoted, by Waddell, Burton and Aylward et al, from the school of thought, which insurance companies, state welfare agencies and others now prefer to rely on. The emphasis is on work ability, rather than disability, and medical factors that may in the past have given reason to categorise a person as not having capacity for work are increasingly being given less credit, as theoretically and hypothetically every person can still perform some kind of functions, to potentially “work”. The fact that the many limited functions so many people with injuries, with permanent, serious physical and mental health conditions have, do not realistically enable them to do jobs on the employment market, is treated as not relevant. Existence and availability of employment is not meant to be part of the consideration for the assessors. Through re-categorisation of existing conditions and cases, and strict assessments for future cases, an increasing number of persons are thus considered “fit for work”, and put on welfare or other support, that is at a lower rate, and which has some forms of work obligations attached to them. It is again the main agenda to simply save costs. People that suffer from frequent or permanent pain, or other symptoms, will be expected to either use condition management practices or to take medication.
A decision based on evaluations and assessments done for and by ACC can be challenged through the ACC review process. ACC claimants still have the chance to take matters further to the courts, which WINZ clients can only do if a Medical Appeal Board made a decision that was wrong in law, so a judicial review may be possible.
3). Work Ability Assessments now also conducted for Work and Income and MSD
Following the major welfare reforms with the passing of the ‘Social Security (Benefit Categories and Work Focus) Amendment Act’ (in 2013), the Ministry of Social Development (MSD) and their department Work and Income NZ (WINZ) have in early 2014 also introduced ‘Work Ability Assessments’ for clients with ill health, injuries and forms of disability. They introduced a range of newly contracted service providers that are commissioned to assess the probably more complex cases of clients for their ability to perform certain work.
There is though not one single “assessment” or “test”, nor a clearly defined set of medical criteria or guidelines that have been published, that would give any public insight into how such ‘Work Ability Assessments’ have to be conducted. There is NOTHING shedding any light on what medical or occupational standards and guidelines are used when conducting these assessments. This is hard to believe, especially since there was some serious concern about this during the Select Committee hearing process, the Readings and the passing of the ‘Social Security (Benefit Categories and Work Focus) Amendment Bill’ in 2012 to 2013. But it was only briefly reported on during the “Select Committee” process.
It appears though that the Members of Parliament and their political parties have failed to further examine and follow up this completely irresponsible and unacceptable lack of transparency and information. This serious failure may be due to the fact, that the leading opposition Labour Party did during their last term in government (until late 2008) plan to implementing similar, only slightly more moderate welfare reforms, that included new ways of “assessing” sick and disabled for their fitness for work. Smaller parties may have lacked the human and other resources, or sense of urgency, to conduct their own investigations.
The only tangible, but highly summarised, and general information that can be found on ‘Work Ability Assessments’ through an internet search is found by clicking the following links:
For general information on the ‘Work Ability Assessment’ and its purpose:
http://rnzcgp.org.nz/work-and-income-update-on-work-ability-assessment/
Click to access Work-Ability-Assessment-Questions-and-answers-3.pdf
For information on the “self assessment questionnaire” that WINZ clients now have to complete as part of their application for benefit support, and for maintaining support:
http://www.workandincome.govt.nz/online-services/myaccount/help/self-assessment.html
For a PDF file copy of the ‘self assessment questionnaire’ itself:
Click to access self-assessment-questionnaire.pdf
And again, some very general, brief information on such assessments, offered by one of the contracted service providers ‘Linkage’ (as part of the ‘Wise Group’):
http://www.linkage.co.nz/services/work-ability-assessments
For information for clients that claim ‘Jobseeker Support’ from Work and Income, re their obligations:
http://www.workandincome.govt.nz/individuals/obligations/obligations-for-getting-jobseeker-support.html
Further other important info of relevance can be found via these links:
‘Social Security (Benefit Categories and Work Focus) Amendment Act 2013’:
http://www.legislation.govt.nz/act/public/2013/0013/latest/DLM4542304.html
‘Social Security (Benefit Categories and Work Focus) Amendment Bill 2012’:
http://www.parliament.nz/en-nz/pb/legislation/bills/00DBHOH_BILL11634_1/social-security-benefit-categories-and-work-focus-amendment
All evidence and submissions presented on that Bill to Parliament:
http://www.parliament.nz/en-nz/pb/sc/documents/evidence?custom=00dbhoh_bill11634_1
The Select Committee Report on the submission hearings and discussions:
http://www.parliament.nz/en-nz/pb/sc/documents/reports/50DBSCH_SCR5776_1/social-security-benefit-categories-and-work-focus-amendment
http://www.parliament.nz/resource/en-NZ/50DBSCH_SCR5776_1/8c96283ba5105e2776ac6c6c449518a168b0a164
Further comments
During the welfare reform process, there was some mention made by some senior staff at the Ministry of Social Development, and by the then Minister for Social Development (Paula Bennett), that they looked at how ACC was working with rehabilitating injured persons that claim support from that state run corporation. So it appears that some approaches have been taken over from ACC, but we have little reliable, clear, detailed information about how such assessments are done, what processes are followed, and what guidelines they use.
This astonishing fact, that medical and now also especially work capability assessments conducted for ‘Work and Income’ and MSD seem to lack any clear set of standards and guidelines, is extremely disturbing. Despite of all its faults, the WCA in the UK has at least offered some clarity with the activities and descriptors used, although this was applied in a very negative and harmful way. No such clarity exists here in New Zealand, with the way how MSD and WINZ have their contracted providers conduct and deliver assessments on “work ability”.
At least some insightful information has been gathered and published in a range of posts that are found on this blog-site via the following links:
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part A
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part B
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part C
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part D
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part E
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part F
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Parts G and H
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME – A REVEALING FACT STUDY: PART I
O). THE CONCLUSIONS THAT NEW ZEALANDERS SHOULD DRAW FROM THE DISASTROUS WELFARE REFORMS IN THE UK, WHERE THE FLAWED AND HARSH APPROACHES HAVE NOT DELIVERED, AND WHERE THE WCA IS NOW DISCREDITED
For New Zealand and New Zealanders, the abundant information presented in this comprehensive blog contribution should make it absolutely clear, that the radical, rather draconian welfare reforms introduced under the last National Party led government here in New Zealand have been based on extremely poor “research” and “advice”. The very persons behind the development of the WCA in the UK, first and foremost Professor Mansel Aylward, also “advised” the New Zealand government (Paula Bennett as Minister), and the Ministry of Social Development on welfare reforms. Mansel Aylward and Dame Carol Black (who adopted many of Dr Aylward’s and his close colleague’s “findings” into her reports), BOTH of them “advised” the appointed, so-called ‘Health and Disability Panel’ (which was again “advising” the then Minister and New Zealand government) on the “value” of the “research” into the “health benefits of work”. A senior role within that ‘Health and Disability Panel’ was also played by Dr David Beaumont, formerly of Atos Healthcare in the UK, who has over the years provided sometimes controversial “advice” on ACC review cases, and who runs his own ‘Pathways to Work’ business here in New Zealand. He is now also the President of the AFOEM (Australasian Faculty of Occupational and Environmental Medicine), and was instrumental in having Mansel Aylward introduce his “findings” and recommendations on the “health benefits of work” into the AFOEM and with that the New Zealand and Australian medical science professions.
It was the same ideas and approaches that culminated in the introduction of the WCA in the UK, that lie behind the new approaches taken here, in the area of “work ability assessment”. Only because the widely reported harm and damage done by the even more draconian, rigorous welfare reforms and assessments in the UK alerted some media and disabled support groups here in New Zealand, could similar harm be avoided here. They raised questions which the New Zealand government appears to have become concerned about. Yet instead of completely abandoning the new approach, to look rather at what sick and disabled “can do”, than what they “cannot do”, the planned new systems and approaches were given some tweaks, and then still introduced. While in the UK there is at least some clarity with the WCA they use, in New Zealand there are NO clear standards, legally binding guidelines or “tests” in use, that determine how in particular assessments for “work ability” should be conducted. Despite of earlier promises by the Minister, there has to date not been any transparency on how doctors or other health professionals – tasked with conducting such assessments for WINZ – are supposed to do their work, and what criteria should be applied. We have a vague, “discretionary”, almost secretive case by case approach, where sick and disabled appear to be “experimented” with, to establish, whether they can do some work on the open market, or not.
As the welfare reforms in New Zealand were introduced and implemented in a rushed manner, relying on insufficiently researched and partly even blatantly biased, unsubstantiated “advice” and reports, they deserve relentless scrutiny and re-examination. The way the reforms were introduced, with a lack of sufficiently convincing, reliable and actually truly independent research and advice, this totally discredits the whole reform approach, and should lead to at least the most draconian measures being immediately reversed. The information provided in this post and research summary shows again, how a close circle of UK based “experts”, led by controversial Professor Mansel Aylward, and supported by vested interest parties, managed to use concerted efforts and effectively influenced policy formation and implementation. The background of Aylward and others, their links to UnumProvident, and their various “experts” and “research”, cast a dark shadow of doubt about the supposedly “independent” and “evidence based” advice the New Zealand Government received and accepted. While the UK and DWP are now going as far as reconsidering and reviewing the ESA and WCA, further changes here should be avoided – or actually rather be put on an immediate hold. The New Zealand Government would be well advised to wait until more reliable, objective research is done and completed, by independent researchers, before they proceed with their radical reforms to “support” or rather PRESSURE sick and disabled into questionable, potentially unsuitable employment on the competitive job market.
It may indeed be a more constructive approach, to perhaps seriously consider the introduction of a Universal Basic Income (UBI), which would be topped up by specific supplements for persons with particular extra needs, such as sick and disabled unable to work. That would abolish the requirement for those having serious health conditions and suffering incapacity to “prove” that they are “deserving” of financial support, and save an enormous amount of administrative costs. What is certainly needed is a truly science based, proven, fair, respectful and reasonable assessment regime, to have persons with health conditions and disabilities examined for work ability. It would be more constructive to design a smarter welfare system that does away with the punitive, sanction driven approach we have now, and offers sensible, constructive incentives for persons to seek suitable employment, while also introducing legal responsibilities for employers to offer work for such people. At the same time more recognition must be given to voluntary work person may do. What is also more than overdue is the introduction of a different, truly independent, competent and fair review system for those that disagree with WINZ assessment outcomes. The present appeal system offered by the ‘Social Security Act 1964’ (to be “re-written” very soon), is not meeting basic natural justice requirements, and Medical Appeal Boards must not be appointed by MSD staff anymore. A proper further appeal stage must be introduced, to allow persons to take their cases to at least a form of Tribunal, like in the UK, or to the courts as such, not just in the form of judicial review. Also would an official investigation into the use, training and management of “Designated Doctors” be appropriate, given serious questions about their “independence” in making recommendations.
The present systems in New Zealand and the UK leave much to be desired, and an overhaul of systems is certainly something we need. On this note, I close this post with thanks to the readers for their interest and shared concerns. Those that can take action, please lobby for change and make submissions on any prospective legal and other reforms we may face.
Quest For Justice
31 January 2015
(updated 05 Feb. 2015)
Here is a PDF file with the whole post as above, but perhaps better readable:
The discredited WCA in the UK, its demise and what it means for NZ, QFJ, NZSJB, 05.02.2015
APPENDIX:
Here is a list of other publications that reveal more of the truth behind the “reforms”:
MEDICAL AND WORK CAPABILITY ASSESSMENTS – BASED ON THE CONTROVERSIAL BIO PSYCHO-SOCIAL MODEL
‘The Health and Disability Panel’ and its hand-picked Members
DESIGNATED DOCTORS – USED BY WORK AND INCOME, some also used by ACC: The truth about them
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part A
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part B
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part C
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part D
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part E
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Part F
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME: A REVEALING FACT STUDY – Parts G and H
WORK ABILITY ASSESSMENTS DONE FOR WORK AND INCOME – A REVEALING FACT STUDY: PART I
ADVICE TO WINZ BENEFICIARIES FACING MEDICAL EXAMINATIONS AND WORK ABILITY ASSESSMENTS
ADDENDUM 1: 14 FEBRUARY 2015:
‘Intolerable pressure real cause of MSD security issues’
Media release Wednesday 11 February 2015: Auckland Action Against Poverty (AAAP)
“The MSD report released yesterday deals with the consequences of a system which daily sets out to harass, belittle and punish people while failing to recognise deeper causes of security problems,” says Auckland Action Against Poverty spokesperson Sue Bradford.
“The intolerable pressure placed on staff and beneficiaries by successive welfare reforms is the true cause of security problems at Work & Income offices.
“There is no question that MSD staff deserve to be safe at work, as do all workers.
“But Government should be looking way beyond guards and risk compliance policies for genuine, longterm solutions.
“What’s needed is a wholesale change to welfare policies and practices, starting with an end to the culture of denial which sees thousands of people turned down each day for the support to which they’re entitled.
“At Auckland Action Against Poverty’s Mangere beneficiary ‘impact’ in August 2014 we helped over 500 people in three days.
“Almost all of them had been being treated with some degree of disregard and disentitlement by the department. We continue to help people in similar situations on a daily basis.
“National’s welfare reforms have focused on pushing or keeping people off benefits no matter the consequences for their physical and mental health and wellbeing.
“This has meant that many of the most vulnerable people in the country are constantly harassed as a matter of everyday practice.
“The stress is often unbearable, and it is nonsensical for the Minister Anne Tolley and John Key to pretend otherwise.
“It’s high time we had a serious review of welfare policy and practice. The current departmental culture hurts all involved. It’s way past time for a change.”
ends
Source: Scoop Media
(see the above link for the original report)
ADDENDUM 2: 28 APRIL 2015:
GROWING CONCERNS ABOUT THE INDEPENDENCE OF SCIENCE AND RESEARCH
Developments in the ever changing world of Science, where government and private enterprises appear to bring in certain expectations into what scientists research and report give rise to major concern. “Science by cheque-book” does appear to become the modern day science policy pursued by governments and private enterprises, who are keen to get the “science” and results that suit them. It comes in sneakily through the backdoor, and it has already become more of the “normal” in many overseas countries (particularly the USA and UK), and it is coming here too. There was an interesting interview on ‘Nine to Noon’ on ‘Radio NZ National’ on 10 April 2015, where Kathryn Ryan spoke with Nicola Gaston, President of the Association of Scientists. She and many of her colleagues are very worried about what is happening in the science and research departments, funded by government and/or private enterprise. We also hear more and more about public private partnership (PPPs), and it seems that is becoming the norm in science.
What it means is, we get science that is deemed to be “useful”, and less science that is truly independent. Also are scientists more often given the message, that they better hold back with their expert opinions, where it may not be so welcome.
Anyway, that is exactly what UNUM was doing, when they went into partnership with the UK government and a Department at the University of Cardiff, to fund the ‘UNUM Provident Centre for Psychosocial and Disability Research’, headed by our well known “expert” professor, Mansel Aylward. “Science on order”, some will cynically say, to serve the DWP and UK government, to achieve more welfare cuts and cost savings, by declaring more persons “fit” for some forms of work, no matter whether there would be any realistic prospects to get truly suitable, lasting and sufficiently paid jobs on the market.
Sadly they have achieved some of their goals, and even managed to bring their “science” into NZ, where former Social Development Minister Paula Bennett and Finance Minister Bill English happily welcomed supposed new “findings” with their open arms.
Here is the RNZ audio recording of the mentioned interview, found via this link:
“Scientists speak out about fears of attacks on freedom”
And here is a good summary of what UNUM was involved in in the UK, for years, playing their role in “welfare reforms”, at least giving “advice” on it:
“A Tale of two Models: Disabled People vs Unum, Atos, Government and Disability Charities :Debbie Jolly”
And while the reforms took place, UNUM did there – supposedly by “pure coincidence” – bring new insurance products onto the market, hoping that more people would insure themselves privately, as reliance on state support would in future be discourage!
These forces – such as UNUM and other vested interest parties, they are hard to beat, as they have immense funding to their avail, and a lot of “allies” all over the place. I am saddened that there is not more awareness out there, of what is really going on. But then, we know, it is not encouraged to inform oneself about it. As we can more often observe, even the media are becoming more “mindful” of what they report and what not, and they seem to be somehow complicit in spreading the propaganda for selectively conducted, interpreted and used science.
I fear Mansel Aylward et al at the ‘Centre for Psychosicial and Disability Research‘ and their work and efforts were just the beginning. What would true and genuinely independent science say about it? We many never know, as true science appears to be stifled.
nzsocialjusticeblog2013 
#1 by Michael Gibson on 28/01/2015 - 12:01 pm
The Ministry of Social Development is well advanced on its program to implement the same work assessment regime here – with the assistance of luminaries like Prof Des Gorman, New Zealand’s answer to Mansell Aylward. One advantage that New Zealand eugenicists have is that decisions based on their medicolegal advice are immune from review or appeal under the provisions of the Social Security Act 1964. Recent amendments to the Act ousted the jurisdiction of the Social Security Appeal Authority (itself a toothless tiger) and the Courts (little better) in respect of 20 discrete forms of decision, including termination of Supported Living Payment on the grounds of assessed work capability. Thus, the WINZ medical police (of which Gorman is Chief Constable) will be allowed to proceed as they see fit, an outcome even more congenial to them than the ACC regime.