WCA / ESA exact descriptors re continence - obstructed defecation

P. Smith made this Freedom of Information request to Department for Work and Pensions

This request has been closed to new correspondence. Contact us if you think it should be reopened.

The request was partially successful.

Dear Department for Work and Pensions,

The current descriptor re continence appear to relate only to INcontinence. This is not the only way in which someone can lack voluntary control over thier bowel.

The NHS Continence Clinics deal with both INcontinence, AND continence issues such as obstrucuted defecation, e.g. due to pelvic organ prolapse, (where evacuating the bowel is impossible without "digitation" (evacuation using fingers -which cannot be achieved in a public toilet), and can only be otherwise achieved by "splinting" (pressing very hard on the perineum to force the contents of the rectum out) and straining at the same time - which combine to worsen prolapse, and bring forward the possibility of an operation that is not guaranteed to be successful (please see relevant NICE reports).

If someone has chronic obstructed defecation, how will they be dealt with points-wise - how many points will they be "awarded", and under which exact descriptor?

This issue is uncomforatble, painful, and limits ability to work (sitting and standing), travel and other aspects of functioning "below decks".

Thank you,

Yours faithfully,

[P. Smith]

DWP Adelphi Freedom-of-Information-Request, Department for Work and Pensions

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DWP Adelphi Freedom-of-Information-Request, Department for Work and Pensions

Our Ref: VTR 3137-1554

Dear [P. Smith],

Thank you for your Freedom of Information request dated 8 April 2012
that was received by the Department for Work and Pensions (DWP) Adelphi
and forwarded on 10 April for response by myself, the DWP Medical
Services Contracts Correspondence Team (MSCCT) Freedom of Information
Officer.

In your email you asked

Dear Department for Work and Pensions,

The current descriptor re continence appear to relate only to
INcontinence. This is not the only way in which someone can lack
voluntary control over thier bowel.

The NHS Continence Clinics deal with both INcontinence, AND continence
issues such as obstrucuted defecation, e.g. due to pelvic organ
prolapse, (where evacuating the bowel is impossible without "digitation"
(evacuation using fingers -which cannot be achieved in a public toilet),
and can only be otherwise achieved by "splinting" (pressing very hard on
the perineum to force the contents of the rectum out) and straining at
the same time - which combine to worsen prolapse, and bring forward the
possibility of an operation that is not guaranteed to be successful
(please see relevant NICE reports).

1. If someone has chronic obstructed defecation, how will they be
dealt with points-wise
2. how many points will they be "awarded", and
3. under which exact descriptor?

This issue is uncomforatble, painful, and limits ability to work
(sitting and standing), travel and other aspects of functioning "below
decks".

In reply to Q 1 please note that the role of the Freedom of Information
Act is about the supply of recorded information held by the Department
rather than providing an explanation to, or confirming whether
assumptions made by the author of the question are correct or not.

In response to Q 2 the role of the Healthcare Professional (HCP) is to
provide an independent, impartial assessment of the claimant's ability
to perform activities within each of the functional areas by choosing
the descriptors that they consider appropriate on the medical report
they complete. This opinion is based on interview with the claimant,
observations and an appropriate clinical examination.

Benefit entitlement is determined by DWP Decision Makers not HCPs. In
order to make a decision on benefit entitlement the Decision Maker
considers all the available evidence not just the reports received from
Atos Healthcare. Other evidence may include the claimant's 'self
assessment', reports from GPs, hospital doctors and HCPs.

In answer to Q 3 for the purposes of Employment and Support Allowance
(ESA), continence is defined in Activity 9 of Schedule 2 of the ESA
(Limited Capability for Work and Limited Capability for Work Related
Activity) (Amendment) Regulations 2011, which can be found at
http://www.legislation.gov.uk/uksi/2011/...

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

Yours sincerely,

DWP Central FoI Team

------------------------------------------------------------------------
------------------------------
Your right to complain under the Freedom of Information Act

If you are not happy with this response you may request an internal
review by e-mailing [DWP request email]. or by
writing to DWP, Central FoI Team, 5th Floor The Adelphi, 1-11, John Adam
Street, London WC2N 6HT. Any review request should be submitted within
two months of the date of this letter.

If you are not content with the outcome of the internal review you may
apply directly to the Information Commissioner's Office for a decision.
Generally the Commissioner cannot make a decision unless you have
exhausted our own complaints procedure. The Information Commissioner can
be contacted at: The Information Commissioner's Office, Wycliffe House,
Water Lane, Wilmslow Cheshire SK9 5AF www.ico.gov.uk

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Dear DWP Adelphi Freedom-of-Information-Request,

RE "In answer to Q 3 for the purposes of Employment and Support Allowance (ESA), continence is defined in Activity 9 of Schedule 2 of the ESA (Limited Capability for Work and Limited Capability for Work Related Activity) (Amendment) Regulations 2011, which can be found at http://www.legislation.gov.uk/uksi/2011/...

This merely proves my point that the descriptors for continence / bowel problems DO NOT cover pelvic organ prolapse particularly rectocoele & obstruted defecation.

This is discriminatory against women with pelvic organ prolapse, where this is s common. limiting, and debilitating problem.

Are there any plans to review this limited descriptor, which does NOT cover all situations under "continence".

Please research the topic of pelvic organ prolapse, and imagine how you would cope in this situation, relating it to fitness for work.

Yours sincerely,

P. Smith

DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

P Smith

Please see attached reply to your Freedom of Information request

Many Thanks

Business Management Team | Department for Work and Pensions | Contracted Customer Services Directorate | DWP Operations | Room 306, Block 3, Norcross, Norcross Lane, Blackpool FY5 3TA | www.dwp.gov.uk | Please consider the environment before printing

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Dear DWP DWP Medical Services Correspondence,

Thank you for your response.

ATOS "healthcare professionals & DWP decision makers do not take account of the problem that I have outlined at all.

Yours sincerely,

P. Smith

Dear DWP DWP Medical Services Correspondence,

Thank you for your response.

Re: "We keep all areas of the Work Capability Assessment (WCA) under continual review and look
to refine the assessment in light of operational experience. As part of this we laid revised
regulations on 17 December 2012, which amongst other issues clarifies our policy intent regarding how continence is assessed as part of the WCA. For ease of reference, I attach a web link to those regulations; http://www.legislation.gov.uk/uksi/2012/...
If you have any queries about this letter please contact me quoting the reference number
above."

This still doesn't cover the particular problem I outlined.

Please supply any documents which relate to a consideration of the area of continence that I have outlined - the problem of severe difficulty / impossibility of emptying the bowel in the normal manner, due to rectocoele (or other causes, e.g. nerve damage) and the discomfort / pain, and management problems this causes at work.

Yours sincerely,

P. Smith.

DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

Dear Ms Smith

Please see your FOI response attached

<<FOI IR904 P Smith 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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P. Smith left an annotation ()

COPY of RESPONSE

To P Smith
mailto:[FOI #112956 email]

DWP Business Management Team
Health & Disability Assessments (Operations)
[email address]

18 January 2013

Dear P Smith

Freedom of Information Act - Request for Internal Review

Our Reference: FOI IR904

Thank you for your email dated 19 December 2012 requesting a review of the Department for
Work and Pensions (DWP) response FOI reference IR655 dated 19 December 2012.

In your email you asked:-

Thank you for your response.

Re: "We keep all areas of the Work Capability Assessment (WCA) under continual review
and look to refine the assessment in light of operational experience. As part of this we laid
revised regulations on 17 December 2012, which amongst other issues clarifies our policy
intent regarding how continence is assessed as part of the WCA. For ease of reference, I
attach a web link tothose regulations;
http://www.legislation.gov.uk/uksi/2012/...
If you have any queries about this letter please contact me quoting the reference number
above."

This still doesn't cover the particular problem I outlined.

Please supply any documents which relate to a consideration of the area of continence that
I have outlined - the problem of severe difficulty / impossibility of emptying the bowel in the
normal manner, due to rectocoele (or other causes, e.g. nerve damage) and the discomfort
/ pain, and management problems this causes at work.

Please be assured that your request has been given our full consideration and that all aspects
of your review were taken fully into account.

The review was conducted by an independent official of the Department, of the relevant grade
and authority to carry out such requests. The case has been examined afresh, and guidance
has been sought from domain experts to ensure all factors were taken fully into account.

--------------------------------------------------------------------------------

Following consideration, I can add that although there is no specific activity/descriptor in
regulations that specifically covers manual evacuation of the bowel; claimants will be assessed
as to whether their condition affects activities set out in regulations e.g. standing/sitting.

In reviewing your request I uphold the decision of the Freedom of Information Officer in part
and have added information where appropriate. I am therefore satisfied now that all the
information that DWP are able to supply to you has been supplied
If you have any queries about this letter please contact me quoting the reference number
above.
Yours sincerely,

DWP Business Management Team
------------------------------------------------------------------------------------------------------

Your right to complain under the Freedom of Information Act

If you are not happy with this response you may request an internal review by e-mailing
[DWP request email] or by writing to DWP, Central FoI Team,
Caxton House, Tothill Street, London SW1H 9NA. Any review request should be submitted
within two months of the date of this letter.

If you are not content with the outcome of the internal review you may apply directly to the
Information Commissioner’s Office for a decision. Generally the Commissioner cannot make a
decision unless you have exhausted our own complaints procedure. The Information
Commissioner can be contacted at: The Information Commissioner’s Office, Wycliffe House,
Water Lane, Wilmslow Cheshire SK9 5AF www.ico.gov.uk

--------------------------------------------------------------------------------

Gerald Carzer left an annotation ()

Yet another lame reply, how on earth do these people get away with it? or is it the fault of the ICO? for being to soft? at the end of the day its all government departments.

DWP DWP Medical Services Correspondence, Department for Work and Pensions

1 Attachment

Dear

Please see your FOI response attached

<<FOI 5046 P Smith 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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P. Smith left an annotation ()

I have copied and pasted their reply here (below) for ease of viewing.
It's truly pathetic, and continues to avoid genuine. valid, significant health problems / the issues.

NOTE particularly:-

"The Work Capability Assessment (WCA) focuses on the functional effects of an individual’s condition rather than the condition itself".

To P Smith

DWP Business Management Team
Health & Disability Assessments (Operations)
[email address]

Our Reference: FOI 4252-5046

22 January 2013

Dear P Smith

Freedom of Information Act - Request for Internal Review

Thank you for your email dated 19 December 2012.

In your email you asked:- ATOS "healthcare professionals & DWP decision makers do not take
account of the problem that I have outlined at all.

There is no specific activity/descriptor in regulations that specifically covers manual evacuation
of the bowel; claimants will be assessed as to whether their condition affects the various
activities that are set out in ESA regulations, considered by HCPs when completing the Work
Capability Assessment and by Decision Makers when considering benefit entitlement e.g.
standing/sitting.

The Work Capability Assessment (WCA) focuses on the functional effects of an individual’s
condition rather than the condition itself, and the HCP looks to provide a comprehensive and
accurate assessment of an individual’s ability to work, taking into account the modern
workplace.

Introducing a more accurate assessment has led to more claimants being found fit for work.
This is in line with the evidence which shows that work is generally good for your health.

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

DWP Business Management Team
-----------------------------------------------------

Dear Department for Work and Pensions,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Department for Work and Pensions's handling of my FOI request 'WCA / ESA exact descriptors re continence - obstructed defecation'.

[ RE: "The Work Capability Assessment (WCA) focuses on the functional effects of an individual’s condition rather than the condition itself". This says it all. It avoids looking at the individual's health problems and the associated management and pain issues, and the fact that having to work in certain ways can make a condition worse. This needs addressing, if it is not already. The WCA is an ongoing injustice and scandal, a deliberately deeply flawed assessment.]

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/wc...

Yours faithfully,

P. Smith

DWP freedom-of-information-requests, Department for Work and Pensions

This is an automated confirmation that your request for information has
been accepted by the DWP FoI mailbox.

By the next working day your request will be forwarded to the relevant
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GEOFFREY REYNOLDS (Account suspended) left an annotation ()

Why do they call this the freedom of information act when any government office that wishes to withhold information, goes unchallenged.

Michael Mansfield QC wrote an amazing article in the Daily Mirror a few days ago. It highlights how secretive our country is becoming.
It mentions the Iraq War Report and how info has been suppressed,the Hutton Inquiry into the death of Dr. David Kelly and how access is blocked....

Cash for Questions, the Met and Journalists and Rupert Murdochs corporation, Hillsborough, Stephen Lawrence....

The list goes on, litvinenko Inquiry, MPs expenses, Lord Rennard.......

Each and every one a state cover up to deny the truth....

Next Week the Justice and Security Bill being pushed through parliament.......

All drawn up to protect the state?
Not really, just to protect the politicians and their evil deeds..............

As for the Freedom of Information Commissioner, a clown in union jack trousers. A puppet of the privileged to deny information to the plebs......

P. Smith left an annotation ()

Yes Geoffrey, it is a cloaking device. The way things are going like this in dear old UK makes me want to weep.

DWP OPD COO FOI Requests, Department for Work and Pensions

1 Attachment

Dear P Smith,

 

Please find attached the response to your request for an internal review.

 

Yours sincerely,

 

DWP | Central FOI Team

 

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P. Smith left an annotation ()

Dear DWP,

Re: "I have reviewed your case and note that in previous responses you have been advised that
each case focuses on the functional effects of an individual’s condition rather than the
condition itself, and the Healthcare Professional looks to provide a comprehensive and
accurate assessment of an individual’s ability to work, taking into account the modern
workplace. There is no further recorded information to provide. I should note that your internal
review is not challenging whether we provided the information requested, but rather, wants us to engage in a debate about the Work Capability Assessment (WCA). Freedom of Information
is not about creating more information or entering a debate, none of this is Freedom of
Information related."

I do not merely want to engage in a debate about the WCA.
I just want to find out if it considers a particular very important function (defaecation) and pain "in the modern workplace", and it clearly does not.

The fact that you can provide me with NO information related to this specific question, to reflect a humane and fair system that has considered all possibilities proves that it is not a fair and humane system.

So I have in effect got the information I wanted. It proves a point. The system is deeply flawed and biased.

There is no evidence to prove that all conditions can be fairly dealt with by the system. It leaves some valid conditions out.

Thus there is no discretion, humanity, logic or fairness. It illustrates the inhumanity and lack of fairness in the system and in this current government.

Thank you, you have proved the point.

Kind regards,

P. Smith.

William Hammonds left an annotation ()

Atos HCP can misrepresent a client in all wca reports.
The only way to put a stop to this is to have an audio recording made of the wca.
Atos will offer to supply the audio equipment. When you arrive at your wca they will ask you to sign a waiver which states that you will not use the recording for any other purpose than to assist your claim. After all, the recording will belong to them and they can decide what a copy can be used for.
If you have a wca booked you can take your own recording equipment as long as you give formal notice that you intend to record.
This will make the recording yours, and you can use it to prosecute the HCP privately. The Hcp can not hide behind the corporation when accused of misrepresentation which has caused loss or harm.
Small claims courts were designed to simplify claims, and I can assure you that you will be surprised at how easy it can be to prosecute. One step above small claims courts are fast track courts. These courts are also a breeze. Try visiting any of these courts and ask an official how to make a claim, they will gladly help you as it is in their interest to have the business.

Kes left an annotation ()

I would sincerely like to personally get in touch with
Mr P Smith whom graciously challenged the current ESA Incontinence descriptor, to recognise things like Obstructed Deafecation.
Please contact me if you are interested in joining forces to challenge this area. Unfortunately, I'm living the hell this condition causes and worse.
I'd be so grateful if I could be placed in contact with Mr Smith, so I'll keep checking this thread for any reply.
Many thanks indeed, Kes