Friday, 19 July 2013

Doctors told not to support the sick.

I discovered this article on the BBC web site entitled
GPs in south east Wales told not to help benefit appeals

I propose another headline:
Limited Company with financial agenda found bullying GPs to commit corporate manslaughter.

Medical Committee found promoting abusive culture in NHS for financial gain.

This is how far the fascists have got to date!  The situation is getting worse by the hour.  It is like a grand plan crystallising in front of your very eyes.

It may seem incredible but a Medical Committee in Wales has recently instructed doctors not to provide "... letters of support or letters to confirm care needs." to Atos, the DWP, patients or any other enquiring body.

Unfortunately this is true.
I have done the research myself and am a little shocked.

An even more insidious comment in the letter from the medical committee states "GPs need to have a consistent approach to this issue and colleagues who do this work make it more difficult for others to resist"  If that isn't coercive bullying I don't know what is.

Here is the letter from Bro Taf LMC to their members:

It is clear just from the information available on the Bro Taf Local Medical Committee's web site that if patients die as a result of professional negligence that doctors are liable to charges of corporate manslaughter.  And yet Bro Taf Local Medical Committee have intimidated their member GPs to refuse to support appeals against the DWP decisions which are contrary to their professional decisions.

It follows that if a patient's only way to appeal against a decision to stop their sick pay or disability allowance is to provide more expert opinion and the doctors refuse to supply it that the doctor is complicit in any detrimental outcome.  Since we already know of over 10,000 additional deaths brought about by this new 'welfare' system it won't be long before there are charges of corporate manslaughter brought against doctors.  (Well except that it is only the poor being killed by this method and the legal aid has been stopped for cases like this.  Who could suggest this hasn't been thought through by someone behind these government policies?)

Sometimes when arguments are polarised it seems there are just two views and each 'side' presumably assumes themselves to be correct.  If it were as simple as doctors refusing to help sick people that would clearly be wrong.  Uncovering the real problem here has taken me too much time.

The real problem may be that people are not willing to stand up for what is right and to oppose what is wrong.

Of course there is the small matter of beliefs, feelings, opinions and so on but I deliberately left them out because they are superfluous distraction given that people often don't stand up for what is good whether it is their feeling, belief or opinion and the same applies to opposing what is wrong.  The point is that people fail to stand up for their views but rather cower under threat.  And a salient reminder of why people can fail to stand up is the case of Malala Yousafzai.  The threats are too real.

It seems the 'problem' in this case is a fairly easy one to grasp.  With the new (though rapidly evolving) changes in the rules, regulations and procedures of the welfare system more and more people are being declared 'fit for work' by the DWP (advised by Atos) and are having to appeal against the decision to stop their disability or sickness allowance.  In order to appeal they need to provide 'more' evidence of their condition.  The medical expert who has that information is obviously their doctor and so patients go to their doctor requesting letters and more information to support their appeal.  Doctors surgeries are becoming overloaded with this extra demand on their time and resources.  There is clearly a problem here.

The correct solution is to fix what is wrong.  What too often happens is people are tempted to botch a quick solution.  It seems the perceived 'quick solution' in this case is to stop supporting appeals.  But, unfortunately, this is supporting the erroneous decisions by Atos and the DWP.  This is why opinion or beliefs are superfluous because it is a matter of fact, logic and rationality at this point.  Conveniently there are facts to illustrate and support what I am proposing although they are not what 'make' this argument correct.  For example over 35% of appeals are successful, the proportion of sick or disabled people dying has risen tenfold since the introduction of these measures, the expressed intent is to 'help' the sick and disabled etc.

There are some fundamental flaws in the new 'system' that I am surprised ever got past whoever they got past.  For all the voices and opinions about what is going on with these 'welfare' reforms I don't think I have once encountered the view that we already pay highly trained doctors vast amounts of money to distinguish between 'sick' and 'fit'.  To override the experts by paying Atos to do a point score to determine whether the doctor is correct is ludicrous.  How has this ever been allowed to happen?

My brain does these interludes sometimes.

It seems ridiculous to me that all this money is being wasted on radically changing the welfare system with the intent of saving this near bankrupt nation some money.  For example Atos has over £3 billion worth of contracts with the DWP.  If you take a population (any size will do because we are talking proportions here)  if all of the population shares the resources, provided there are enough resources, everyone will be okay.  An okay population is the best chance of being creative and innovative in improving the living conditions for all.  There is no lack of wealth in this country it is just coagulating at the top leaving rafts of people at the bottom to get ill, starve and die.  So what is being achieved.  It looks to me as if more is being spent that is being saved.  Facts are far better than impressions or feelings although all have a part to play.  So here is a fact:  10,000 people died in the first 10 months of these DWP/Atos tests above and beyond the statistics for the previous year.  This is why people are calling for this government to be tried for corporate manslaughter.  But 10,000 people - gone.  I don't know the figures so please send them in if you know them - A disabled person must have £5,000 per annum to eat and keep warm and £5,000 per annum for a place to live.  I'm guessing but in round figures I think £10,000 is a ball park figure that a sick or disabled person requires.  I don't care if it is not accurate and I know it will vary a lot but bear with me.  So if, just IF, this government has caused 10,000 deaths in the first year (10 months/year whose counting)  they have slashed £100,000,000 off the welfare bill.  That is £100 million.  But it gets better.  They are all dead, gone, no more, vanished!  That is £1 billion saved over the next 10 years.  If you compile this and assume an average stay on disability is 10 years it accrues to £10 billion saved per year after you get to your tenth year.  And that is an accrued £55 billion actually saved in the first 10 years.  Now I can see why they are doing it.  And we are only at the beginning of the plan.  Knowing politics I am confident I am not the first to have worked this out.

Sorry about that aside - It just worried me.

Back to the case in point.  The solution to this problem is not to compound the problem by not supporting appeals but to stop the clearly erroneous behaviour that is giving rise to this demand.  So the doctors have to confront the government.  Interestingly they have made significant objections to these welfare reforms but to fail themselves and their patients by colluding with the DWP now is cowering in the face of threat.  This is why it is not a matter of different opinions or beliefs.  The doctors views have been made clear repeatedly.

So what of the Bro Taf LMC

On their website Bro Taf LMC Ltd say...
Bro Taf Local Medical Committee Ltd is the statutory representative organisation for GPs in Cardiff, Vale of Glamorgan, Rhondda Cynon Taff and Merthyr Tydfil.

The reference to "statutory" means it is a legal requirement and as such they have legal responsibilities including appropriate policies regarding health and safety.  If they advise doctors to behave in a way that endangers someone's life and that 'someone' dies then they are liable to a charge of Corporate Manslaughter (as explained in THEIR OWN advice to their members in a document entitled "Focus on… the Corporate Manslaughter Act"

There is a document produced and supplied by the DWP to Bro Taf LMC which they have duly made available to their members entitled "Employment and Support Allowance Medical Reports: A Guide to Completion" (I have to point out that on the front cover in the bottom right it says "Employment and Support Allowance: Working for a better life" and in the current climate it begs the question "For whom?")

Here are a few  excerpts from the document:

Wherever possible, information collection is kept to a minimum but at times professional reports to substantiate claims are needed.  This information is invaluable to ensure your patients get their entitlement with the minimum of disruption.

So they acknowledge the information is invaluable.  This is important because if the patient is wrongly assessed they must (and currently do) have a right to appeal.

1.1.3 Will the information be used?
Absolutely. Departmental decision makers are required to consider all the available evidence before deciding on benefit entitlement.

So if something was not understood and needs more explanation by a qualified doctor why would anyone want to stop the patient asking for clarification to be provided to the DWP (via Atos - that Information Technology conglomerate masquerading as a "Healthcare" company)

1.1.5 Further information
If you consider that your patient may have a potentially terminal illness you should complete a DS1500 to help us ensure that your patient receives the benefits they are entitled to.

But, given the torrent of rules, regulations, guidelines and advice,  if the doctor didn't fill out a DS1500 form because they believed the 'evidence' was conclusive why would anyone want to STOP the patient requesting this.

3.1 Contractual obligations
3.1.1 General Practitioners
There is a contractual obligation for any GP who has issued a Med3 (certificate of incapacity for work) to provide medical reports in relation to Employment and Support Allowance. This should be done free of charge as covered by the contractual arrangements between GPs and the relevant Primary Care Trust.

Well this is a little insane (and just part of the completely insane whole).  The Doctors are the highly trained and qualified expert professionals designated by statute to issue Med3 certificates (Note: A Med3 is SPECIFICALLY a certificate of incapacity for work) (Med3's have been superseded but the same must be true of the replacements).  Having established the BMA, this 'Medical Profession' with many years of experience in maintaining the standards and integrity of Doctors, how can it possibly make any sense to employ a hastily thrown together department in an IT company with a trade name "Atos Healthcare" as a facade to take a brief summary from the Doctor in order to either agree or disagree with the Doctor's decision (evidenced in their professionally issued Med3 certificate)?  And this is demanded free of charge whilst they complain about the cost of an appeal!  How can a less qualified individual (and we know from much other evidence how disgraceful the training is for Atos) possibly override a fully qualified and monitored professional with guidance that the Doctor should NOT back up their professional opinion.  I will add here that later in the document the doctor is explicitly advised against giving his opinion.  There lies a philosophical issue but I will simply assert that this document changes the meaning of words to suit its own purposes.

3.2 Information provision
3.2.1 Consent
Consent has already been provided by your patient and checked before any request for a medical report is issued. Therefore, it is not necessary for you to discuss with your patient before releasing clinical information and you don’t have to show them the report before sending. This is enshrined in the GMS Contract Regulations 2004 (Appendix A).

I include the above simply because it sent a shiver down my spine (metaphorically).  It is the attitude (and yes, it was they who emboldened the 'not') - and the 'guidance' got worse from here on.  One can detect the attitude of the writer just by what they chose to include, what they chose to omit and what is highlighted.

I can't do this.  I am browsing the web site and far too much of what I read is contentious, dangerous, presumptuous, cruel, ignorant authoritarian or downright stupid.

The next document I wanted to check up was the "Statement of Fitness for Work: A guide for General Practitioners and other doctors".  This is regarding the change from what was called a 'sick note' to the renamed 'fit note'.  It is a grubby piece of literature indulging in an excess of doublespeak.

It was page 5 where I gave up.
It says:
Why change? Improving your patients’ health through work Evidence shows that work has therapeutic value and is generally good for physical and mental health. The longer a patient is off work, the lower their chances of getting back to work. There is strong evidence that long periods out of work are associated with poor mental and physical health, increased use of health services and poverty.

What I find so disturbing about that is that it is true.  Coming from a benign institution it would makes a lot of sense.  But people and doctors already know this so: A/ why is the point being made and B/ where is the other part of the equation?  It is, in fact, the omission of the other part that is so sinister.  There are NOT ENOUGH jobs to go round!  So YES - this is WHY there is such a burden on the welfare system.  These sorts of comments are about the importance of having work available for people.  It is as cruel and insane as the Nazis putting ARBEIT MACHT FREI on the concentration camps.  But I guess the simple minded authors of the document hadn't done their history homework - or had they?

Well of course they had!  This is not a couple of people just writing something to fill up a document.  This has the entire weight of the government and all its recourses behind it.  Historically we always find out that more was planned than was evident at the time.  Well here and now with the internet there is no excuse to pretend we couldn't work it out.

And finally there is the contentious letter from Bro Taf LMC Ltd to their members.  If this link mysteriously disappears do let me know and I will provide the original document because I have kept a copy available 'just in case'.

The letter contains a preamble and a sample letter that they suggest doctors copy and simply hand over in the case of a request for supporting facts or opinions.  The draught letter supplied explicitly asserts that doctors should not be asked for "... letters of support or letters to confirm care needs." whilst asserting that they will no longer provide such things.

But I found a statement in the preamble to be very disturbing too because it employs an underhand bullying technique: a veiled threat of ostracism, which is coercive, subversive and abusive.  In the preamble the Bro Taf LMC Ltd say (in reference to writing appeal letters):

"GPs need to have a consistent approach to this issue and colleagues who do this work make it more difficult for others to resist ."

That has shocked me to the core.  It is overt bullying and it is EXACTLY the problem with the ABUSIVE CULTURE in the NHS.  Ironically it is a Limited Company with its own financial agenda that is bullying the GPs.

Are the GPs so submissive that they cower to threats like this?  Do they have any sense of personal responsibility?  This letter alone would convince me as a doctor to deal with every appeal letter request.

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