Businesses out of step with policies on sick and disabled

Pigeon holes, have recently witnessed a very happy post grad MEng in computer science win employment against some able bodied competition then to find the Gov's AtW (Access to Work) funding approve a very nice orthapeudic chair for over a thousand pounds but refuse to fund basic communication equipment costing a couple of hundred pounds.

As he has significant difficulty with speach, his primary disability in terms of access to work, it makes you wonder how a very smart chair is going improve communications as it is not a wii fi or an internet enabled chair although it could be said to sort of be a non-phone compatable mobile ?

I suppose lucky not deaf or they would have got him some screen glasses to improve access to DSE or registered blind and then he could have a hearing aid - bizare these decission makers must live in a second world meeting gov target tick-box KPi's that have nothing to do with applicant needs !

Tony,
re. your second paragraph. I would agree with the sort of percentages you mention but the point missed is that GPs are generally taking a holistic approach, usually being aware of patient circumstances whether they be mental, physical, individual, family etc, before making a decision on issuing the note. So, yes the patient may be given a note because they have asked for one but the decision to do so may be based to an extent on things that may be 'intangible' rather than 'tangible'.

No, we can't afford to go on as we have been doing - but we must remember that it was the Government in their push to massage unemployment statistics who encouraged many of the unemployed to come off the registers and claim incapacity benefit anyway ! Now this doesn't suit they want to play it the other way. Hey ho, ping-pong!

Tony you say you do not do DWP assessments but I must have misunderstood you then when you wrote. " I am a consultant occupational physician, and have to assess levels of disability on a daily basis. Some of my clinics are in Medical Examination Centres for the DWP where my colleagues and I regularly discuss how they assess applicants for disability. "

It may well be that society cannot sustain the current level of disability however when you are one of those is seems like you are being singled out for something that you have done wrong when actually you are trying your level best to do everything right but nobody will do the right thing by you!

Its easy to pick on the disabled - why not pick on the unemployed - tax credits, hell the whole benefit and tax system!!

Sheena is absolutely correct in what she is seeing and its just the tip of the iceberg. Our help line is now inundated with people calling us to ask what to do because their benefits have been stopped as a result of these assessments - suddenly with no warning. These people are ill, they can not work, some can barely get out of bed and are in acute pain, even if they did get a job of some sort they would never manage to sustain it and would be back on the treadmill. What the hell is going on?????

If you really want to do something sensible Tony start by influencing the people who are forcing this ridiculous system on a knee jerk political reaction which is literally going to kill somebody soon.

I have a situation where I have been called up to ATOS as I receive DLA. I work full-time but need help so I am an easy target I guess we will see.

As a manger and rep I have come into contact this week with 2 cases one has Severe Depression and OCD and we have been working hard with his medical team to enable him to return to work which ATOS managed to ruin in one 20 minute appt. Against his GP's and Psycologist advice and our knowledge of him he is deemed fit for work even the local jobcentreplus staff were shocked and helped him do his appeal. This has knocked him back a few months and he has no money from anywhere.

Another case a gentleman with various health issues including Diabetes and Parkinsons has been deemed fit for work. Please find me an employer who will take on this man with his memory lapses etc. All benefits stopped.

Perhaps we should also remember that there used to be a benefit called Severe Disability Allowance however some years ago it was deemed unecessary as all not yet awarded it could claim Incapacity Benefit. So severely disabled people who have never worked and could never be expected to are on Incapacity Benefit. How long before ATOS says they are Fit for Work and that you must employ them or risk DDA Prosecutions.

Also the EMA is means tested so those with Compensation money taking them over the minimum amopunt get nothing in the future think how much compensation will now need to be paid out up go our costs yet again.

Lots of questions that need answering:

I do not do DWP assessments. These have changed and now take longer, usually about an hour. In most cases the doctors will have the benefit of specialist reports which identify any evidence for underlying pathology.

I often hear the view that 'my GP would never just give out sick notes', but the evidence is very different. Studies show that around 60% of GPs will give someone a sick note just because they think the patient wants one. The other 40% will at least take a history and consider the issue, but will still base their decision largely on what the patient says to them, and will have developed strategies to issue sick notes for less time, or closed notes to help encourage the patient to return to work.

This is a very difficult issue for all involved. We are all well aware of other pressures, particularly the concept of 'secondary gain' where a patient will have a financial incentive to be ill, and 'tertiary gain' where a practitioner will have a financial incentive to persuade the patient that they are ill and need treatment, or a lawyer will have a financial incentive to persuade a patient they are ill in order to make a claim. It is very difficult to separate those who are 'genuine' and those who are deliberately seeking gain. It is even harder to separate those who are 'genuine' from those who genuinely believe they are ill, but only because they believe what they have been told by those out for tertiary gain.

Carole, you have hit the nail on the head by saying 'how can I judge when after 30 minutes the person has not finished telling me about the way they are feeling'. I already know what the underlying pathology is, and therefore whether I expect them to be disabled or not. You are clearly expecting me to make my assessment on the basis of what the patient tells me rather than the underlying evidence.

What society is becoming increasingly concerned about is that many people who have a significant disability have a minor underlying problem that only becomes a major disability because they are obese or unfit. Whose responsibility is this? How should I, as a doctor, make a decision? If I am asked whether they are disabled now, I say 'yes'. If I am asked whether they are permanently disabled, I say 'not if they lose weight, but if they don't their disability will just get worse'.

The bottom line is that society, and that is us, all those who are reading this, cannot afford to sustain the current and projected levels of disability. The first step is a change in the rules, for benefits and for pensions entitlements. Is this really that awful? Is it so terrible that I say to someone 'you are currently very disabled, but if you can lose 50kg in weight I would not expect you to be disabled at all, you will live ten years longer, and you will be at much lower risk of developing diabetes, arthritis, heart disease and stroke'? How, then are you going to provide the motivation they will need to lose that much weight, clearly a very difficult issue for them?

Tony you did not mention that your assessments are only half an hour long for the DWP and that peoples lives and futures literally hang in the balance by the quick assessments that have to be made, especially when medical notes or history's are not forwarded to the assessment centers so that when people turn up for their appointments nothing is known about them.

How is anyone with a list of problems expected to be properly assessed in 30 minutes Tony and how do you judge from what somebody is telling you if after 30 minutes they have not finished telling you fully about the way they are feeling if they have multiple medical problems?

Jennifer,

I particularly agree with your last paragraph. GPs know that their opinions can be and are more likely to be questioned these days and that it would not make sense to issue sick notes willy-nilly just because the patient 'asked' for one. Regrettably many assessment centres of all types are target or tick box driven in one way or another, with certain criteria for selection or otherwise based on one political drive or another.

So what do you answer then Tony - that you do expect em to, or that you don't?- in the case of the arthritis sufferers, presumably you wouldn't be assessing it for the DWP or the employer in the first place unless the person was already off sick? So their own doctor who has lived through their history with the condition (presumably) would not have agreed they were sick enough to be off work in the first place if all that they know about the person and their medical history leads them to EXPECT them NOT to be in that state.

And does knowing that 1 person in 4 might be disabled by it satisfy the DWP and employer that this person is disabled?

Hanged if you do and hanged if you don't, is it?

And on the assumption that you would say yes this person is disabled, would all the doctors employed by ATOS (for instance LOL) use the same rule of thumb? or are you just the lone sensible voice in the wilderness?

I have to say, I am always astounded by the assertion of others that getting a "sick-note" can be done so flipping easily. If there are GP's that do that, I ain't found one yet and if I did - I'd be appalled and change surgeries like a shot. Wouldn't trust a person like that with MY health !!

Carole

It is important that in this debate everyone understands how disability is defined and diagnosed, otherwise we cannot have an informed debate.

I am a consultant occupational physician, and have to assess levels of disability on a daily basis. Some of my clinics are in Medical Examination Centres for the DWP where my colleagues and I regularly discuss how they assess applicants for disability. I am a Health and Work Trainer for GPs, rolling out the Royal College of General Practitioner training programme to help GPs understand how to address the issue of fitness for work and return to work. I appreciate all the difficulties you and others have identified, but the bottom line is that when doctors make a diagnosis, the most important aspect is the history, what the patient tells them.

I will give you an example of the problem. Take four people with identical Grade 2 arthritis if the knee. One is a delivery postman, happy to walk ten miles a day carrying a 16kg bag of mail with minimal symptoms. Another is a nurse, happy to stay on her feet most of the day, caring for patients, but she has some discomfort and her knees are sometimes stiff at the end of the day. Another is a medical secretary who cannot carry a stack of files weighing more than 5kg because of the pain in her knees, and the fourth is a call-centre worker who has been off sick for six months and cannot get in to work, needing two walking sticks for mobility.

All have identical evidence for an underlying condition, but they are all affected very differently by that condition. The level of disability is determined by what they say, not by the X-ray or MRI scan result. None would be harmed by being physically active, and an active lifestyle would be recommended to help with their symptoms and their condition, so they are medically fit for work. When assessing for IB, DLA or a blue badge, the assessment would be based on what they say. If the rules are changed, and the assessment is to be based more on evidence and less on what they say, you can see how this can cause problems.

I am not judgemental here. I understand that some individuals experience different systems and may be more disabled than others. But what would you say to the call-centre worker? I say she is disabled, but on the basis of what she tells me, not on the basis of any underlying evidence of pathology. What about the person with no evidence of knee arthritis but who has the same level of pain and disability? Again, I say he is disabled on the basis of what he tells me.

If we then take all 2.5 million on IB and ask how many have clear evidence of a problem, where 50% of individuals with that evidence would have that level of disability, we would find perhaps 5% of those on IB met that criterion. What about the 40% who have depression or anxiety, symptoms we can only measure by asking about them, not by doing an MRI scan or EEG?

It is really important to understand that disability is an individual issue, and the level of disability is based almost entirely on what the patient tells the doctor, and how the doctor sees the patient perform on examination. I take all patients at face value and believe what they tell me unless I have clear evidence to the contrary. However I am often not asked whether they have that level of disability, instead I am asked whether I would expect them to have that level of disability. The questions are very different.

Tony

I am sorry Stacey that you perceive deviance in the forum and for sure there are some subjects that strike a cord, hit a hot spot, push buttons, pull strings and/or just trigger an outpouring of comment where the inequity of a situation beggars belief.

Compliance or non-compliance is academic when the rules, regulation, good practice and/or the law, after all founded in equity, systemically fails to foster, promote or even enforce equity and/or perceived justice in the society it is created or designed to protect.

Collateral Damage to UK human resources is growing exponentially and heading toward a critical mass of dysaffection and ill health due to the Friendly Fire of weak management and leadership where omission to act accounts for increasing injustice bourne out of a stressed out tick-box driven 'problem averse approach' denial of opportunities for meaningful relationships...........

Human resourse interaction has been minimised leaving relationships to be measured by a solely object driven tick box outcome culture relegating contact to CRM software oddly reserved for external customers only.

Performance is driven by fostering inclusion or a sense of approval and conversely "approval deprivation" results in "performance anxiety" and declining productivity as individual withdraws into their isolated shell before having a complete breakdown in communications missing targets and being left in no doubt that management is pickin on them whas-eveeer...

A self-fulfilling prophesy in terms of performance, productivity and "relationship risk management".

Exactly! And when Employers get away with what they did to me because they can afford expensive lawyers to twist facts and convince witnesses to "deviate from the truth", perhaps more people will realise that disability discrimination is alive and kicking and needs to be dealt with in a fair and equal arena before we end up with a work force based on unlawful bias.

And before somebody writes in and says well i am bitter and twisted and therefore my views tainted, ask yourself how you would feel had you had your job taken away from you just because you had become disabled, despite the fact that you were perfectly willing, capable, passed fit to carry out an administrative role with some reasonable adjustments! The DDA is supposed to protect people like me however companies that really want to play the game know how to get round it. Thats the reality and no amount of advice from here can change that unless the industry as a whole gets genuinely ethical towards disabled people.

Ruth, I agree with you. Unless your voice and that of other disabled people in (or excluded from) the workplace is heard, then nothing will change. Disabled people need others to stand up for them and challenge existing systems which exclude them rather than try to shut them up. It is not just about 'compliance' either but about making people feel welcome, included and valued.

My experience shows that disability discrimination (which is illegal and which is happening in the workplace according to both the story that was originally commented on and my own experience) is combated effectively in a number of ways, one of which is the sharing of personal stories about discrimination and how other firms and other individuals have made adjustments in their practices. As disabled people who are in work, making a contribution to society through taxes if nothing else, our voices are rarely heard above the Daily Mail din about scroungers and the Right to Die - neither positive nor of any practical use to an employer wanting to make reasonable adjustments for the disabled people in their employment. The question I posed in my original post - have you ever had an employee who has epilepsy and if so how would you deal with that person if they had a seizure in the workplace (during the emergency evacuation process) is a valid one in the context of Workplace Law, is it not? Especially as the government, in an attempt to reduce the benefit bill, has picked on the easiest targets and is forcing people with epilepsy into the work place, and so Health and Safety executives are going to be in a situation where they have to deal with this scenario, which has hitherto been dealt with by ruling people with epilepsy out of the workplace. Personally, when I got fed up with reading the Daily Mail letters page, I didn't bother writing in to complain, I just threw the paper in the bin.

Reading the commentary to any Workplace Law story these days is getting more like reading a Daily Mail letters page. Is it too much to ask that we, as professionals, respond to all stories only with comments that help our colleagues with their legal obligations and those of their employers, and provide practical advice that helps towards compliance....Please?

Catch 22 - the system has become judgemental, well it's always been, and as the new 'yougov tabloid headline driven reactive tick-box outcome' method of governance has grown so has the stress for short staffed sort of anti-social behaviours of the front line workers who resent no longer have any quality contact time with their clients as more and more of their jobs are outsourced.

The same applies across the board from YOT to Probation and Job Centre where the efficient designation of a pigeon hole and processing has become the king of outcomes regardless of "impact" on the pigeon holed who are just required to be compliant or else.

Little wonder the pigeon holed are becoming beligerant, resentfull and non-compliant to the point of being anti-social rather than pro-social where over time we may be reaching a critical mass of disaffection and public unrest.......

Perhaps that's the plan to ease the transition toward an "Hourglass" economy by 2017 when the havenots will be clearly defined by comparison with the haves in terms of education and functionality.

Scary stuff but as they have failed to make any impact on the growth of functional illiteracy suppose left with fewer choices than to depend on technological saves for the day when half those of working age effectively dysfunctional......

Well said Ruth... Tony if perhaps you stood in our shoes you perhaps would view things differently and would not make what sounds rather flippant comments.

I am disabled and receive the highest rate of DLA for both mobility and care. Anyone who has ever tried to claim that will know it is not easy and not just given out at the drop of a hat. YOUR definition of disability may well be different to those who evaluate for DLA however if they consider me "disabled" then who am I to argue!

The government are now threatening to stop DLA and AA and have prepared a green-paper. You may consider that all of us are scroungers however as this is the only form of income that most disabled people get perhaps you can tell me how they are supposed to survive when they are suddenly pushed below the poverty line when it is stopped?

You say just because you are disabled you cannot work. Perhaps you would like to shout that out to the many employers who are discriminating against disabled people every day because they do not want to have to make the reasonable adjustments or to be bothered to do any of the other things they are obliged to do under the DDA. I myself have just lost my tribunal for disability discrimination for some petty reason which it seams to me had nothing to do with the real issue but I wont go there. The fact is the company was a big organisation who could easily have made reasonable adjustments or found an alternative position all of which I was willing to do but they repeatedly found reasons not to do it and then dismissed me. So please do not lecture me on this subject because you have no idea how hard it is for "disabled" people to either sustain employment or find a new position. There are some very unethical employers out there who in this cost conscience world just want to get the best they can from the most efficient staff which it seems does NOT include anyone with any type of handicap.

I dont agree with what you say when you state that "in the great majority of cases people are considered ill or disabled on what they tell their doctor". Doctors are not that gullible they do tests and most are qualified enough to make a reasonable judgement based on those test results and examination to determine a diagnosis - or the last time i went to a Hospital or surgery thats the way round it worked!! Therefor it is the diagnosis and the every day substantial effects that will result on determining on somebodies disability not just what the patient tells the doctor - he/she has to see some evidence.

So it may well be that what you say is true and some of those on IB are those that have been drafted in from Unemployment benefit. Now this Government are doing another sifting to get people off in order to dress up their statistics and guess what, it is the disabled and genuine that will suffer yet again cos of a typical knee jerk reaction, as they are using outsourced staff having downsized the DWP, who dont know what the devil they are doing! Those "scroungers" you talk about will stay exactly where they are as they know how to work the system, as usual everyone else gets tarred with their brush and your attitude just perpetuates the problem.

I am a disabled person. I too have a history of epilepsy. As you say Gareth, there don't seem to be any symptoms, if you have just met me. It is a long time since I had a fit and I stopped taking medication many years ago. My condition now no longer affects my driving insurance, so I can once again drive. While I was having fits, and during the time when I couldn't drive, the number of jobs that were easily open to me were limited - non-existent, in fact. When dismissing people as scroungers (and I was dismissed as a scrounger last year, when I lost my small but vital disability living allowance because I was 'a fraud' according to the tribunal doctor who met me once, which meant that I had to go back to hospital to have my impairment assessed again and have a brain scan and an eeg, all of which cost tax payers far more than the DLA they took away from me) you should ask yourself whether you are adequately trained and experienced to make decisions about whether the person is disabled or not. I ended up working for myself because, for 10 years , I was the only employer who would offer myself the level of flexibility and access I required to work. I was also well below the poverty line in all that time. Ask yourself - when was the last time you worked with someone who had an epileptic fit? How much training have you had to deal with that situation? If the answer is never and none, it's not surprising that people with epilepsy are not in work is it? I am now working for a disabled people's group, again because this is where I can get the flexibility that I need. Work places need to be more accessible to disabled people, and the workforce needs to be better educated about disability - some of the comments and queries on this very web site demonstrate that there is wide spread ignorance and prejudice across the whole workforce, which is having a negative impact on disabled people gaining and retaining employment. This needs to be addressed, before disabled people have their benefits stopped and labelled as scroungers.

We have to face up to reality here. The numbers on incapacity benefit quadrupled when the government decided to encourage those on unemployment benefit to move to incapacity benefit to massage their statistics, so at most only one in four of those on incapacity benefit need to be. Moving them off again and into work is bound to be a painful experience.

The problem is that in the great majority of cases, people are considered ill or disabled on the basis of what they tell the doctor rather than on the basis of any underlying test results. This makes it extremely difficult to distinguish between the 'genuine' and those 'milking the system'. As we have noted in other threads, the trend for the DDA has moved towards considering everyone to be disabled, but the great majority remain able to work. This current move seems to be saying 'just be cause you are disabled does not mean you cannot work' and that, surely, is a move to be welcomed.

Brickin it as the increasing generation of NEET's driven out of education will be and have now been reaching employable age and have been left unenployable by a morally and ethically bankrupt education system built to provide for the coming Orwellian "Hour-Glass Economy" (HSE RR600) with sufficient 'have-nots' to be the unskilled operaters of the new industrial scale techno-revolution.

They won't need to read and write fluently or have gained other than basic skills to provide the physical labour required to work in factory scale call service centres entering data for the government..............

Wouldn't even have to see them if they lived underground and would ensure their social housing didn't blot the landscape for the have's.......

Agree Gareth, in the mean time the disabled and LTS with genuine reasons for being so will be forced back into the workplace only to make their conditions worse and their companies (if they get a job) will be forced to manage the inevitable LTS which WILL follow.

Round and round we go - who are they fooling just to manipulate a few numbers before a general election. These are REAL people with REAL lives and REAL conditions who are having their lives turned upside down with affects that will last for years to come.

I dont profess to have an answer but what this government is doing is nothing short of disgusting and we will all pay the price in the long run as usual.

The problem is that the genuine people (as usual) lose out because of the few non-genuine scroungers.
I have a relative, who in their 30's has not worked since she was a teenager and has no intension of doing so. She can drink/smoke/party and pop out children to various fathers time and again, but due to epilepsy (which never seems to have any symptoms) CAN'T WORK! Without some way of highlighting these bone idle, drains on society, the tax payer will be under more and more burden to pay for these people to sit at home.
The trick is to find a truly effective way of doing it fairly and efficiently without costing more than it would to allow the scroungers to get away with it any way.

Worse! Disabled people are being targeted because they are easy targets. They get a phone call out of the blue telling them that they have to attend a medical the following week and if they dont attend all benefits stop.

When they turn up the locum doc who has been drafted in to hear their half hour appointment says "Oh Mrs/Mr X I dont seem to have any info on you"! If the person has multiple medical problems they dont stand a chance in hell in getting everything down as its all points scored. The result is they are turned down for their benefits which they lose immediately and find themselves being told they are fit to work as they have not had a chance to have their case properly assessed.

They appeal but are told they can receive the new amount (less than the old incapacity benefit) whist they wait for months for a date. They still have to be ready to accept a job. This is the governments way of getting everyone of of IB!

Next in line for disabled people is DLA which is now targeted in the new green paper. Why dont they just go the while hog and just take them out and shoot them? Talk about discrimination they are leading the way! Businesses out of step.......hmmmm - more about pot and kettle!

Sooo, going to replace the old test for incapacity - 'bending down to pick up a pencil' and 'walking up a short flight of steps' no longer going to be minimum test for incapacity ?

Presume breathing and having a pulse going to be the new test !!!!!