ESA85 : documentation of internal and external sources of research information utilised by HCP’s & documentation of incomplete medical examination/assessment.

Mr .J Collins made this Freedom of Information request to Department for Work and Pensions

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Dear Department for Work and Pensions,

It would be impossible for HCP’s to have a good working knowledge of the plethora of disabilities, syndromes and illness that they have to assess claimants for at Work Capability Assessments (WCA).

It is my understanding then that HCPs ‘research’ a claimant’s condition automatically prior to the WCA as documented in the ‘The Training & Development, Revised WCA Handbook, ESA (LCW/LCWRA) Amendment Regulations 2011 Version: 4 Final 4th October 2011’. This document states at 3.1.7 pg 57 para 1 ‘Your medical knowledge of the likely effects of the condition. For conditions that are rare or with which you are unfamiliar, you should check the EBM LiMA Repository for information. It is also very important that you gather sufficient information in the history, typical day and examination to allow you to provide robust advice to the decision maker’.

1. Please could you provide me with the cited reference material from the EBM LiMA Repository (an internal resource tool) pertaining to Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS ), Chronic fatigue syndrome (MS) and Fibromyalgia?

2. As the DWP decision maker (DM) is medically untrained, do any of the Atos HCPs ESA85s contain a link to the cited reference material from the EBM LiMA Repository to enable the DM to also scrutinise this information to allow them greater insight into a claimant’s condition?

3. Does the DWP acknowledge that Atos HCPs also utilised the internet via search engines like Google as an external resource to be clear as to what may be reasonably expected within a condition?

4. Do the Atos HCPs document on the ESA85s which particular external source(s) they have scrutinised from the internet to assist them with conditions that are rare or they are unfamiliar with?

5. If the answer to question four is answered in the negative please can you explain how the DM can and for that matter, the claimant check to assess the validity and accuracy of the information gleaned from the internet on which the HCP has relied when forming their opinion in relation to their prognosis? I.e. there is no way to gauge the reputability of the source.

6. Charitable institutions like the Citizens Advice Bureau who provide advice to the general public have to clearly and accurately document every internal and external link of information they have relied on in their reports to ensure their ethical integrity and to safeguard them in case their advice is ever contested for being negligent etc. Concerning this evidence and resource gathering, can you confirm that Atos HCPs are not required to document the internal and external information/evidence in formulating their opinions to the DM?

7. It is my understanding that prior to the Medical Examination conducted by the Atos HCP the ‘details and scope of the physical examination [are] explained to the client, including advice not to perform any movements causing pain or discomfort’ and the claimant must give their consent for the process to proceed. After consent has been established but following this, a claimant clearly states to the Atos HCP at the WCA that they either do not wish to or are unable to perform a specific task or declines to have part of their anatomy assessed/scrutinised because of pain or discomfort or of the risk of pain or discomfort being induced and this is then clearly documented on the ESA85 under the heading ‘Relevant Features of Clinical Examination’ by the Atos HCP to indicate to the DWP DM that the examination was not complete. Is this correct?

8. In a similar vein, if the claimant gives his consent to allow the HCP to perform the examination but subsequently the HCP states to the claimant that he does not require them to perform a specific task due to their actions causing further pain or discomfort or the risk of pain or discomfort being induced by the task, why does the HCP not document this when drafting their ESA85 under the heading ‘Relevant Features of Clinical Examination’?

9. With regard to question seven and eight would the DWP concede that failure by the HCP to clearly and specifically document on the ESA85 that a claimant’s medical examination was not complete due to the Atos HCP not requiring the claimant to perform a given task or examine a bodily area that the DWP DM would subsequently assume erroneously that the Atos HCP’s medical report was appropriate, COMPLETE and fully justified with clinical findings?

As always thank you for your continued assistance.

Mr .J Collins

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DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

Dear Mr Collins

Please see your FOI response attached

Kind regards

Health & Disability Assessments (Operations)/Department for Work and Pensions/Room 306/Block 31/Norcross/Norcross Lane/Blackpool/FY5 3TA

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Dear DWP DWP Medical Services Correspondence,

Thank you for your response.

With regard to question one, thank you for providing me with the reference material which the Atos HCPs research from the EBM LiMA Repository pertaining to Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS), Chronic fatigue syndrome (MS) and Fibromyalgia.

I would be indebted if you could clarify a few matters. Concerning the information pertaining to Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS) is there information missing from your reply due to a ‘typo’ error or is some information missing due to it being ‘cropped’ etc. I note that concerning the other two syndromes documented namely Chronic fatigue syndrome (MS) and Fibromyalgia the EBM LiMA Repository contains the additional headers e.g. WFHRA Information, ESA examination, Clinical Examination and WFHRA Key Areas To Explore Exam, Key areas to Explore – ESA to assist the HCP in making their prognosis and considering how the condition effects a return to work.

1. (i) If this information hasn’t been an oversight and accidently left out of your response, how does the HCP make a prognosis (that the DM relies on in the decision making process) for a claimant to work with severe pain with regard to working ‘shorter hours’ and how do they ‘Define the period over which hours will be gradually increased’ in relation to working with severe pain?

(ii) The EBM LiMA Repository cites the medical source for both Chronic fatigue syndrome (MS) and Fibromyalgia as being taken from the Oxford Textbook of Medicine (online version). Could you confirm where medical authority was referenced concerning Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome (RSD/CRPS) as this was not indicated in your response?

2. With regard to question two, four and six thank you for confirming that ‘the Healthcare Professional (HCP) does not provide references within the ESA 85 for the Decision Maker (DM) relating to LiMA, or information obtained from external sources’.

Just an aside, I acknowledge that DWP Decision maker is a layman and has no medical experience/training. I also acknowledge that Atos and the DWP state that the information the HCPs rely on ‘may be of interest to non-medical readers, some of the information may not be readily understood without background medical knowledge and an awareness of the other training and guidance given to HCPs’. However I cannot see the logic/safeguard for withholding the documentation of internal/external references the HCP has relied on to assist the DWP DM in the decision making process and to allow the claimant to have access to the same information to scrutinise and check its content (particularly if it is from an external source). Evidently the information held concerning the three cited medical conditions from the EBM LiMA Repository is understandable to an average man/women in the street without any medical training. Moreover these conditions, their symptoms, diagnosis and treatments are far more greatly expounded on via the NHS Choices website available to the public than the EBM LiMA Repository.

http://www.nhs.uk/conditions/Complex-Reg...
http://www.nhs.uk/conditions/Fibromyalgi...
http://www.nhs.uk/conditions/Multiple-sc...

With regard to my other questions it is apparent that you have not addressed my clear and specific questions. Consequently I will resubmit them again in their entirety and request an internal review to obtain said answers.

3. Does the DWP acknowledge that Atos HCPs also utilised the internet via search engines
like Google as an external resource to be clear as to what may be reasonably expected
within a condition? (A simple yes or no response will suffice).

5. If the answer to question four is answered in the negative please can you explain how
the DM can and for that matter, the claimant check to assess the validity and accuracy of
the information gleaned from the internet on which the HCP has relied when forming their opinion in relation to their prognosis? I.e. there is no way to gauge the reputability of the source. (It is my understanding from your response that the DWP DM and the claimant cannot check the ‘accuracy of the information gleaned from the internet on which the HCP has relied when forming their opinion in relation to their prognosis. Can you please confirm this? Again a simple yes or no response will suffice).

7. It is my understanding that prior to the Medical Examination conducted by the Atos HCP the ‘details and scope of the physical examination [are] explained to the client, including advice not to perform any movements causing pain or discomfort’ and the claimant must give their consent for the process to proceed. After consent has been established but following this, a claimant clearly states to the Atos HCP at the WCA that they either do not wish to or are unable to perform a specific task or declines to have part of their anatomy assessed/scrutinised because of pain or discomfort or of the risk of pain or discomfort being induced and this is then clearly documented on the ESA85 under the heading ‘Relevant Features of Clinical Examination’ by the Atos HCP to indicate to the DWP DM that the examination was not complete. Is this correct?

Thank you for the link pertaining to the Revised Work Capability Assessment (WCA) Employment and Support Allowance (ESA) (LCW/LCWRA) Amendment Regulations 2011 Handbook alluding to 3.1.4 with regard to questions seven through to nine. Said section does confirm my understanding of consent and for the medical examination as well as alluding to the HCPs documenting a claimant’s inability to perform a required function (due to stiffness/pain etc) as documented in question seven. The applicable exerts are found at 3.1.4 paragraphs 3, 9 & 17 namely...

‘Explicit consent to the examination and its different parts must be obtained verbally from the claimant, and the fact that this has been done should be noted in the report. A suitable form of words would be along the lines of, "The details of the physical examination were explained to the claimant, who gave consent for the process to proceed.’... ‘Pain must be avoided during the MSO examination. The claimant should be advised to inform the HCP if any movement is uncomfortable and further attempts to move that limb/spine are then avoided. The MSO should never be slavishly followed-always be prepared to curtail the sequence of actions if a claimant indicates they are uncomfortable. The range of joint movements must be assessed through active movements and the use of passive movements to assess these movements would not be considered appropriate in a work capability assessment’... ‘Remember when recording your clinical examination findings to interpret them for the Decision Maker by explaining in plain English the significance of the findings, e.g. "Forward flexion of L shoulder restricted to 90 degrees (about half the normal range) and this means that the claimant cannot reach upwards above shoulder level with the L arm.’

Could you confirm that my understanding is correct?
With regard to question eight you have not supplied an answer and the scenario is not documented in the WCA Handbook at paragraph 3.1.4 or anywhere else.

8. In a similar vein, if the claimant gives his consent to allow the HCP to perform the examination but subsequently the HCP states to the claimant that he does not require them to perform a specific task due to their actions causing further pain or discomfort or the risk of pain or discomfort being induced by the task, why does the HCP not document this when drafting their ESA85 under the heading ‘Relevant Features of Clinical Examination’?
With regard to question nine I sincerely believe this warrants a response as to cite the WCA Handbook 3.1.6 Completing the LCW/LCWRA Medical Assessment Report Form (ESA85/ESA85A): An Overview paragraph 6 & 7 ‘The Decision Makers will rely heavily on the report in coming to a decision on limited capability for work or limited capability for work related activity, and their needs must be uppermost in your mind. The LCW/LCWRA medical assessment report must provide an objective and fair assessment of the claimant's disabilities in the physical, sensory and mental function areas, as laid out in the ESA regulations. It must make clear to the Decision Maker what descriptors you have chosen and why you have chosen them. Your choice must be supported by appropriate medical evidence.

Where your choice of descriptor differs from the claimant's stated level of disability, your supporting evidence must give the Decision Maker sufficient information to indicate why your opinion, rather than the claimant's, should be accepted’.

9. With regard to question seven and eight would the DWP concede that failure by the HCP to clearly and specifically document on the ESA85 that a claimant’s medical examination was not complete due to the Atos HCP not requiring the claimant to perform a given task or examine a bodily area that the DWP DM would subsequently assume erroneously that the Atos HCPs medical report was appropriate, COMPLETE and fully justified with clinical findings?

Thank you for your continued assistance in aiding my understanding of the WCA and decision making process.

Yours sincerely

Mr Collins

DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

Dear Mr Collins

Please see your FOI response attached

<<IR 171 J Collins Response.pdf>>

Kind regards

Health & Disability Assessments (Operations)/Department for Work and
Pensions/Room 306/Block 31/Norcross/Norcross Lane/Blackpool/FY5 3TA

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Dear DWP DWP Medical Services Correspondence,

Thank you for responding to my FOI request. I do apologise for the delay in submitting a response to yourself but I have been unwell the last two weeks. I would be grateful if you would accept my apologies.

I am very appreciative for your explanation of the Freedom of Information Act (FOIA) outlining section 84 and acknowledge you application of this legislation contained in your responses whereby you are unable to respond to given scenarios etc. I am very thankful of your clear, concise and unambiguous answers.

I am also very grateful that you have acknowledged the 15/02/13 response “did not fully answer all [my] questions and that responses to some of [my] questions could have been clearer. I am sorry for any confusion this may have caused”.

Due to a delay in receiving an answer, I submitted the FOI to my local MP Mr Kelly on the 27/02/13 who informed me via email he would raise the matter for clarification to the Minister responsible. If you have not received said communiqué or do in the future, please let it stand that your response to my FOI request was sufficient to satisfy the questions I was seeking.

Thank you for your continued assistance.

Yours sincerely,

Mr .J Collins

Karen M left an annotation ()

Dear Mr Collins,
I was awarded 0 points despite CRPS. I looked up your FOI request for the LiMA Repositary on CRPS and I was appalled by what I read. Now I know why I failed despite good objective evidence, including imaging reports. Why can't DWP and Atos follow the Budapest Criteria and get up to date information from the US Social Security Authority about the disabling effects caused by CRPS?

I find you website very useful and informative. Many thanks, from Karen

Karen M left an annotation ()

I have an update: I have been put into the support group without a WCA being thought necessary.

Thank you so much for the time and energy you have all put in for FOI requests. Your website has been invaluable and I will certainly suggest it as a source for other people.

Mr .J Collins left an annotation ()

That is great news Karen M. I hope your pain decreases somewhat now that a lot of additional stress has been removed from you.

I too have been placed in the support group (2 years). I went from 0 points to 15. It took a senior judge and doctor only 10 minutes to decide in my favour at tribunal. Ironically the DWP had subsequently elected to place me into the WRAG for 12 months due to a change in circumstances as I was diagnosed with AD (Adjustment Disorder) a form of acute depression as a direct result of the WCA and my endeavouring to gather relevant and pertinent evidence to represent myself at tribunal.

It really is criminal what is happening. History will judge this dark period of suffering.

Karen M left an annotation ()

I think the way in which mental health problems are treated by DWP/Atos is truly appalling. The whole experience of WCA and tribunal is bound to make anybody ill, be it mentally and or physically. I was lucky in that my pain specialist saw what I was going through and acted quickly to avert a breakdown. I am pretty sure harm has been done but I will not litigate, instead (like all of us) I shall be an "extremist", as Paul Maynard MP so charmingly put it.

Sie Plant left an annotation ()

Hi guys:

I have a similar tale of woe. I acquired a severe form of SNHL 18 months ago, in both ears, and it has disabled me very effectively. "
I have a -70db drop in both ears, with pronounced, permanent tinnitus, and sounds I can hear are distorted. It takes a massive effort of will to focus on one conversation, and I am dog-tired after a single hour's social interaction. I have acquired anxiety, depression, insomnia, and social phobias.
But my WCA merely comments "Mr P has some difficulty in understanding a simple message from a stranger "
I only jumped up here to say thanks for keeping the site going, and I'll let