ESA - neurological syndromes list discrepancy & statistics pertaining to neurological qualification.

The request was refused by Department for Work and Pensions.

Dear Department for Work and Pensions,

I do apologise but I added these two questions to the end of my original request entitled ‘Neurologically trained HCP’s’ dated the 18/06/12. I understand that this was remiss of me to do so as any additional questions must be submitted as a new FOI request.

Your department previously supplied me with a response in answer to an earlier post (10/05/12) entitled ‘ESA Assessment’ (which was responded to on the 11/06/12). Your response pertained to neurological conditions and whether a nurse who had undertaken and qualified in assessing neurological syndromes (an additional qualification to the Disability Assessment Medicine qualification) could be allowed to assess claimants. I also received a PDF attachment indicating various neurological conditions in two lists highlighting whether a nurse could assess the claimant or a doctor was required to assess said condition. Your department’s response informed me that ‘The document states that Reflex Sympathetic Dystrophy is a medical condition that can be assessed by a neurologically trained nurse, and that this list is not exhaustive and will be updated periodically as required’.

I have subsequently read PV Sutton’s FOI request entitled ‘Decisions about who conducts WCAs in neurological claims’ dated the 07/06/12 and was required to be responded to by the DWP by the 05/07/12 (although there appears to be some indecision as to whether the post should be ‘tagged’ as being delayed) which parallels my own request entitled ‘Neurologically trained HCP’s’ dated the 18/06/12 and was due to receive an answer no later than the 17/07/12.
PV Sutton received a response which also included a PDF file that contained a list of neurological conditions which stipulates the criteria as to who can be assessed by a neurotically trained nurse or whether a doctor is required.

PV Sutton additionally requested clarification to the DWP response as to whether the list of neurological syndromes was exhaustive on the 08/07/12 which to date has been unanswered.

I have discerned that the two PDF files differ concerning the neurological syndromes they contain.

I left PV Sutton an annotation concerning his FOI request on the 19/07/12. For your convenience I have copied the annotation below:

Hi PV Sutton

Not sure if this is what your after but it has me puzzled. I asked a similar request entitled ESA Assessment by Mr .J Collins 10 May 2012. I too wanted to check the neurological lists for nurses/doctors etc.

If you check the list which they sent me on the PDF the last few conditions on the list are different to yours. If your list was an updated version with additional syndromes added why are the last few not included in your list when your FOI request was submitted after mine??? There may be a simple logical explanation but my paranoia these days is becoming more acute.

Mine has for nurses:
Shingles (peripheral nerves)
Vibration White Finger
Reflex Sympathetic Dystrophy
Essential Tremor

Yours has for nurses:
Dizziness
Vertigo
Essential Tremor
VWF
Alzheimer’s

Mine has for doctors:
Shingles (cranial nerves)
Cerebellar disorders
Basilar migraine
Charcot Marie Tooth
Tourettes syndrome
Dyspraxia
Dystonia

Yours has for doctors:
Fits (secondary to brain tumour)

Similarly did you know that the DWP will not divulge HCP's qualifications other than the Disability Assessment Medicine qualification as this is considered a breach of the Data Protection Act. Consequently I have submitted a further request (Neurologically trained HCP's) to ascertain if a claimant can submit a request to confirm whether a HCP has this additional qualification to assess neurological syndromes. Presently said request is 2 days overdue.

END OF ANNOTATION

Concerning this annotation I have subsequently acknowledge that Vibration White Finger was indeed listed in PV Sutton’s list by the initials VWF as was Essential Tremor. My apologies.

1. Can you please respond and inform me why the lists differ? Surely PV Sutton’s list should contain all the syndromes in my PDF list in addition to the ones as documented in his PDF list (as his FOI request was submitted after mine) if these were added at a later date when said list was ‘updated periodically as required’.

2. I respectfully request that you provide me with a breakdown figure of all the nurse HCP’s who have undertaken and passed the neurological assessment training (in addition to holding the Disability Assessment Medicine (DAM) qualification) in 2011. I also request this figure for the first half of 2012 (i.e. up to and including the month of June of this year). I.e. how many nurses have said qualification and how many do not possess this qualification.

3. Concerning the chronic pain syndrome Reflex Sympathetic Dystrophy, would it be possible for the DWP to also update the neurological list to contain the other recognised name for this condition namely Complex Regional Pain Syndrome alongside it as indicated on the DWP homepage A-Z of medical conditions?

Yours faithfully,

Mr J. Collins

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DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

Dear Mr Collins

Please find enclosed a response to your request for information under the
Freedom of Information Act by the Medical Services Contract Correspondence
Team Freedom of Information Officer, who apologises for the delay in
providing you with a response.
<<3601-2874 Response Mr Collins.pdf>>

Kind regards

Medical Services Contract Correspondence Unit, Department for Work and
Pensions, Room 306, Block 3, Norcross, Norcross Lane, Blackpool, FY5 3TA
Tel 01253 611556, extn 69956

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Dear DWP DWP Medical Services Correspondence,

Thank you for your response concerning Your Ref: VTR 3601-2874

Concerning your response to my first question I acknowledge that you state you elect not to answer said question citing ‘Section 14(2) of the Freedom of Information Act, the Department is not obliged to comply with a subsequent identical or substantially similar request it has previously responded to. The letter of the MSCCT Freedom of Information Internal Review Officer dated 20 August 2012 (FOI 3594-IR465) refers’.

I am very sorry but I am unhappy with this response. I am simply trying to establish clarity as to why the lists differ. Both myself and PV Sutton have requested lists of neurological syndromes in conjunction with which type of HCP can assess said conditions. I respectfully wish to understand why when logic dictates that as the list is periodically updated PV Sutton's list should include the conditions included in the list you forwarded myself.

My earlier request has for Nurse HCP’s to assess Shingles (peripheral nerves), Reflex Sympathetic Dystrophy whereas PV Sutton’s latter request does not have these conditions but includes Dizziness; Vertigo and Alzheimer’s which were not in my list contained within the PDF file you forwarded to myself entitled Training & Development Neurological Condition List by Practitioner Type MED-NEURODA~001 Version: 3 Final 14th February 2012

Similarly the list I received for Doctor HCP’s differed from PV Sutton’s namely my list from the above document included Shingles (cranial nerves); Cerebellar disorders; Basilar migraine; Charcot Marie Tooth; Tourettes syndrome; Dyspraxia and Dystonia. Conversely PV Sutton’s did not include these but had Fits (secondary to brain tumour) which was not included in my list.

As you can hopefully appreciate if there are two different types of list in circulation for Nurse/Doctor HCP’s to check as to whether they possess the credentials to assess a claimant, a breach of duty of care is almost certainly going to arise if it has not already done so.

1. I submit the question again.

a) Why does the list of neurological conditions supplied to PV Sutton’s latter request differ significantly to my earlier request?
b) Does the DWP acknowledge and concede that having two different lists in circulation defining which type of HCP can assess a claimant is at least confusing and at worst negligent? E.g. a condition may not be recognised as being one of a neurological nature and then assessed by a HCP sans the additional neurological qualification.

I acknowledge your response to my second question.

You stated ‘In reply to Q 2 it is not possible for nurses to obtain the Disability Assessment Medicine (DAM) qualification, this is only available to Doctors. It is estimated that the cost of complying with your request would exceed the appropriate limit of £600 for central Government, which has been specified in regulations. This represents the estimated cost of one person spending 3½ working days in determining whether the Department holds the information, and locating, retrieving and extracting the information from the personnel file of each Healthcare Professional employed by Atos Healthcare. Under section 12 of the Freedom of Information Act the Department is not obliged to comply with your request and we will not be processing your request further’.
I am somewhat confused. You clearly state that ‘it is not possible for nurses to obtain the Disability Assessment Medicine (DAM) qualification, this is only available to Doctors’. In a response to questions submitted to the Medical Services Contracts Correspondence Team Your Ref: FOI 3246-1823, I received an explanation (dated the 25/05/12) from Freedom of Information Officer P Cuerden concerning a submitted question pertaining to ‘the qualifications and specialisms of the HCP who completed [my] medical assessment’. Ms Cuerden goes into great length and detail explaining on page one paragraph four through to page three paragraph three that:

In answer to Q2 the approved HCP who conducted your WCA was Nurse ***** *********; the HCP’s registration expiry date and Geographical Locations are **/**/**** and ********** and the ***** ******* respectfully.

Please refer to www.nmc-uk.org then click on “search the register” from the menu and complete the appropriate fields prior to clicking “submit”
‘Nurses must be fully registered (level 1) Registered Nurses without current or previous restrictions or cautions with the Nursing and Midwifery Council (NMC). In additions they must have at least 3 years post full registration experience. In individual cases, solely at the discretion of the DWP Chief Medical Advisor (CMA), the requirements that no cautions be attached to registration and that the nurse must have a minimum of 3 years post registration experience, may be waived.

The Welfare Reform Act makes provision for medical assessments in connection with benefit entitlement to be carried out by a range of HCPs specified in the legislation. This move has been taken because nurses and other HCPs are increasingly being used in roles which were once reserved to doctors; and it is appropriate to extend this to benefit entitlement assessments. HCPs primary qualifications are held in the public domain and appear on the NMC website.

The CMA approves HCPs to carry out assessments. Approval is dependent on strict recruitment criteria, completion of a course of training in disability assessment medicine approved by the CMA and evidence of a satisfactory performance.

Minimum experience criteria for recruitment are laid down for both employed and contracted HCPs.

All HCPs have passed strict recruitment and experience criteria and are registered with an appropriate professional body such as the General Medical Council, NMC or the Health Professional Register. The CMA approves HCPs to carry out assessments. Approval is dependent on strict recruitment criteria, completion of a course of training in disability assessment medicine approved by the CMA and evidence of satisfactory performance.

HCPs are also fully trained in Disability Assessment Medicine. Expertise in this field qualifies the HCP to give impartial, independent assessment on the way in which a customer’s illness or disability affects them in carrying out a range of everyday work related activities. Training includes the assessment of the effects of specific conditions, for example mental health, or where a condition may fluctuate. Emphasis is always placed on the differing circumstances of each individual customer. They also receive training in customer rights, equal opportunities and professional standards.

The assessment carried out is different to the more usual type of medical examination in which the Medical Clinician’s aim is to make a diagnosis and decide on appropriate treatment. A GP or Specialist is not usually trained in disability assessment medicine and therefore will often not have specific experience in assessing the disabling effects of medical conditions and the way in which a customer’s illness or disability affects them in carrying out a range of everyday work-related activities. As well as this difference in emphasis within the assessment process, the HCP will, when giving an opinion, be aware of the law relating to benefit entitlement. A Specialist on the other hand is less likely to be familiar with Social Security Legislation.

The role of the HCP is to carry out an assessment of the functional effects of the customer’s disabling condition, and to utilise the information gathered to provide the DWP Decision Maker with an impartial and independent assessment. Therefore, unlike the more widely known type of examinations, the assessment is not concerned with diagnosis or decisions about treatment so specialist diagnostic qualifications are unnecessary. However a customer may submit evidence from their doctor or specialist if appropriate.

We cannot supply any further information relating to qualifications, CV’s and information relating to post-graduate qualifications of an HCP, which are held by Atos Healthcare, constitutes that person’s personal data. This information cannot be disclosed in accordance with Section 40 of the Freedom of Information Act 2000 as disclosure would breach that person’s right to privacy under the Data Protection Act (DPA) 1998. This is an absolute exemption and does not require a public interest test.

In considering this exemption, the Department has balanced a HCPs right to privacy against the public’s right to know they are qualified for the task. In this, the criteria for a HCP’s qualification for the post are provided whenever asked. It is not, however, relevant to provide details that go beyond those needed to show the person is qualified to be a HCP, particularly as further qualifications and previous employment details do not impact of a person’s qualification for the role as a HCP. As such the HCP will have a reasonable expectation that their privacy will be protected under the DPA.

I can advise you that HCPs are not required to hold specialist qualifications or experience in mental health conditions. As part of their induction training the HCPs all receive training in mental health issues, and as a part of their induction are required to read evidence based protocols on mental health conditions. In addition, all HCPs are required to engage in a programme of continuing medical education which includes modules on mental health issues.

2. In relation to my submitted second question:
a. Which FOI request is accurate i.e. can Nurses obtain DAM or is this qualification as you state only available for Doctors to obtain?

b. If the Nurse who assessed me had not obtained the DAM due to this qualification being only available to Doctors, what qualification did said Nurse hold to enable him to assess me i.e. a claimant?

c. How does a claimant ascertain if their HCP has undertaken the additional training and received an additional qualification pertaining to assessing neurological conditions as apparently the HCP is protected by Section 40 of the Freedom of Information Act 2000 and right to privacy under the Data Protection Act (DPA) 1998?

d. To which academic organisation is the additional neurological qualification for HCP’s accredited to?

You continue to explain in question 2 that ‘It is estimated that the cost of complying with your request would exceed the appropriate limit of £600 for central Government, which has been specified in regulations. This represents the estimated cost of one person spending 3½ working days in determining whether the Department holds the information, and locating, retrieving and extracting the information from the personnel file of each Healthcare Professional employed by Atos Healthcare. Under section 12 of the Freedom of Information Act the Department is not obliged to comply with your request and we will not be processing your request further’.

e. Can you confirm in writing then that, the confusion from your department concerning whether nurses can or cannot undertake the DAM qualification, due to section 12 of the Freedom of Information Act it is subsequently impossible for claimants to establish from the DWP the ratio of nurse HCP’s who have undertaken and possess the additional neurological assessment qualification?

f. At the risk of sounding impertinent (and this is not my intention) would you concur that relevant and specific information that should be in the public domain if requested, to ensure that originations, authorities and their contractors/partners who hold a position of power and influence of the populace are not abusing said power and position can elect not to implement a FOI request due to a budget cap of £600?
Concerning question three I am grateful that the ‘DWP will forward [my] request for the inclusion of this medical condition [Complex Regional Pain Syndrome] in the desk aid to Atos Healthcare for it to be considered at the next review of the guidance list’.

Yours sincerely,

Mr .J Collins

DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

Dear Mr Collins

Please find enclosed a response to your request for information under the
Freedom of Information Act by the Medical Services Contract Correspondence
Team Freedom of Information Officer.

<<3734-3303 Mr Collins Response.pdf>>
Kind regards

Medical Services Contract Correspondence Unit, Department for Work and
Pensions, Room 306, Block 3, Norcross, Norcross Lane, Blackpool, FY5 3TA
Tel 01253 611556, extn 69956

Please consider the environment before printing

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Mr .J Collins left an annotation ()

I am posting this information on my husbands behalf as he is presently unwell. The DWP have finally responded 5 months later (approx) to this FOI request. However the response has been posted on the FOI request entitled “Neurologically trained HCP's”. For readers convenience I have posted the response here as well as the link to the reply.

https://www.whatdotheyknow.com/request/n...

They have once again failed to respond to a very relevant question which I have copied below.

1. I submit the question again.

a) Why does the list of neurological conditions supplied to PV Sutton’s latter request differ significantly to my earlier request?

b) Does the DWP acknowledge and concede that having two different lists in circulation defining which type of HCP can assess a claimant is at least confusing and at worst negligent? E.g. a condition may not be recognised as being one of a neurological nature and then assessed by a HCP sans the additional neurological qualification.

I have copied the response below whereby the DWP cite that they are not at liberty to answer due to s14(2) of the FOI Act. Clearly my husband is not asking a similar or identical request. I have forwarded the response to the Information Commissioners Office in an attempt to secure a reason why the neurological lists differ within a month of two FOI requests for this “living document”.

D M Collins

https://www.whatdotheyknow.com/request/e...

https://www.whatdotheyknow.com/request/1...

https://www.whatdotheyknow.com/request/d...

https://www.whatdotheyknow.com/request/1...

“Dear Mr Collins,

Thank you for your Freedom of Information request which we received on 24 August 2012.

You asked the following (see Annex A).

Please accept our apologies for the delay in providing this response, which was noted in our records as being for issue to Whatdotheyknow.com on 4 December 2012, but for some unexplainable reason it appears that the email did not arrive at its destination.

Your review has been conducted by an independent official of the Department, of the relevant grade and authority to carry out such requests, consideration has been given to whether the handling of your request was dealt with appropriately and that all aspects of the time compliance of the request were taken fully into account.

DWP have already supplied you with full information about your requests within Qs 1a & 1b. Therefore in accordance with Section 14(2) of the Freedom of Information Act, the Department is not obliged to comply with a subsequent identical or substantially similar request it has previously responded to. The Freedom of Information Internal Reviewing Officer letter dated 17 August 2012 (reference FOI 3594-IR465) refers.

In response to Q 2a & 2e all HCPs receive training in Disability Assessment Medicine (DAM) from Atos Healthcare, prior to being approved by the DWP Chief Medical Adviser to conduct medical assessments for DWP. There is no recognised educational qualification available in DAM to any HCP. Diploma of Disability Assessment Medicine is only available to Doctors, and
they are not required to inform Atos Healthcare if they obtain the qualification.

The remaining questions raised in your email have been answered within FoI reference 3734-3303.

If you have any queries about this letter please contact me quoting the reference number above.
Yours sincerely,

DWP Business Management Team”