23 January 2007
Over 50 ways to challenge DLA and AA medical report forms are explained in a new Benefits and Work guide released today. The 27 page manual includes dozens of fully referenced extracts from previously unpublished DWP training resources, obtained using the Freedom of Information Act, and dozens of sample paragraphs for written submissions.
The authors also uncovered, via confidential emails, how unhappy and divided sections of the DWP were over the introduction of the new medical report forms last year and how DWP chiefs hope that the reports will silence the 'disability lobby'.
The guide to the Best Possible Ways to Challenge a DLA or AA Medical Report is a unique tool, with detailed sections on challenging every stage of the medical report process. It is written for claimants, but contains a great deal that will save time and provide fresh ideas for even experienced welfare rights workers involved with appeals.
To support grounds of appeal and show that the EMP has not done their job properly, the guide quotes from texts such as the Facilitators Notes from training attended by all EMPs when the new medical report forms were introduced in 2006. The guide also draws on training materials used by EMPs learning the 'Art of Disability Analysis'.
For ease of use the guide is divided into sections that mirror the DLA medical report form, with additional sections on 'Challenging the way the evidence was collected' and 'Challenging the way the evidence has been presented.'
Challenges range from basic issues, such as whether the report is legible, to much more complex issues. For example, in relation to the function grid for upper and lower limb function at section 2, question 7, EMPs were told in their training that:
'Although function levels 2 & 3 refer to impairment, it is disability that is being considered. This is particularly important in claimants with medically unexplained symptoms.'
The guide explains the relevance of this to conditions such as ME/CFS and provides a detailed extract from a training pack on Disability Analysis to explain the difference, according to Medical Services, between 'disability' and 'impairment'. The guide then offers a sample paragraph challenging an EMP assessment based on lack of muscle wasting.
Other challenges look at issues such as whether Medical Services belief that the 'normal' walking speed is 90 metres per second - used in relation to assessing eligibility for higher rate mobility, is accurate and whether the wording of the question 'Is the customer destructive to property or to others?' may have led to the EMP giving insufficient evidence.
The authors even obtained confidential emails from the DWP, using the Freedom of Information Act, which helped them to identify flaws in the medical report forms. For example, one consultant hired by the DWP comments in a confidential email:
"Falls - if customer does not claim any falls, Dr is not "invited" to complete the box but there may be a risk of falls. Especially AA does not encourage the Drs to think about potential for falling."
Another email from the 'Rapid action Implementation Team' raises further concerns:
"Section 6 seems to replace seven pages of the original EMP [report] and it is left to the claimant to decide what to state whereas the original format steered them through a sequence. This appears to be the purpose of section 7 so I'm not clear what purpose section 6 actually has . . . An explanation of a couple of terms would not go amiss either - what is the reticloendothelial system?"
Another exchange of emails shows that Atos Origin Medical Services were regarded as 'forgetful' and difficult by some within the DWP. Moira Henderson, head of the Corporate Medical Group was particularly unimpressed by Atos Origin's request for more consultation and more time to pilot the forms:
"I'm very much afraid that Medical Services, by this reaction, are playing into the hands of certain elements of DCS [Disability and Carers Service] who are totally averse to bringing in the revised EMP reports, and who will very rapidly and persistently latch onto any excuse for not doing so."
Ms Henderson was also clearly unimpressed by the quality of some of the reports being produced by EMPs. In an email dated 3 August 2004, she reveals that:
'With Medical Services, I have been having a blitz on quality standards of EMP reports. A recurrent theme in reports not up to standard is inadequate justification of the EMP's opinion on functional limitations. This is also borne out by the study I am currently engaged in, looking at medical reports considered substandard by medical members of appeal tribunals. . . We need to address the medical quality issues. The revised report gives EMPs a far greater steer on carrying out and reporting a thorough and appropriately justified assessment'
The same email reveals that the DWP intended that the new reports would be 'rolled out, at latest by the start of the new contract in September 2005'. In fact, perhaps delayed by 'certain elements' it was July 2006 before they reports were finally rolled out.
Whenever the roll-out, there was one important aim of the new report forms according to Ms Henderson, to deal with " . . . the ongoing issue, popular with the disability lobby, of the number of decisions overturned at appeal. It is less easy for an appeal tribunal to justify overturning a decision based on robust evidence and a justified opinion."
In this, Ms Henderson may well be correct. But faced with submissions based on the new Benefits and Work guide, the DWP may find it will also be less easy for a tribunal to overlook flaws and inaccuracies in reports created by EMPs who have received just half a day's training and who are frequently in too much of a hurry to do their job properly.
Download the Best Possible Ways to Challenge a DLA or AA decision from the members area