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DESIGNATED DOCTORS – USED BY WORK AND INCOME, some also used by ACC The truth about supposedly "independent" Designated Doctors

#1 User is offline   Marc 

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Posted 06 November 2013 - 12:24 AM

DESIGNATED DOCTORS - used by WORK AND INCOME, some also used by ACC: THE TRUTH ABOUT THEM!

INTRODUCTION:


Over the last couple of years I have been able to collate some highly interesting information from sources like Work and Income (WINZ) clients, advocates, bloggers, certain internet websites, the media and part-time researchers. It includes documents and some other information that could be found by researching past and present media reports, also reports and online manuals from the Ministry of Social Development (MSD) and WINZ websites, through looking at various other websites on the internet, and last not least also by way of Official Information Act (O.I.A.) requests.

The information discloses what the Ministry of Social Development and WINZ have been doing in the areas of medical examinations, assessments and reviews by commissioned "designated doctors". It includes some valuable other information about medical appeals to Medical Appeal Boards (MABs), and it shows, that the MSD did during 2008 conduct a nation-wide "training program " for the "designated doctors ", who they use for getting second opinions, assessments and recommendations on recipients of, or applicants for, sickness and invalid's benefits (now called deferred jobseeker and supported living benefits).

A television expose (or documentary) on what has been going on at ACC ('60 minutes' programme, TV3 on 09 Sept. 2012, available via 'On Demand' or You Tube showed what appalling strategies were followed there. It was revealed that ACC targeted complex, high cost claimants, by using preferred, hand-picked medical assessors, to prepare reports that favoured ACC. Cost saving appeared to come before proper rehabilitation, treatments and compensation, so they used a kind of "exit strategy" to off-load thousands of such claimants, who in many cases ended up having to apply for invalid's or sickness benefits. I am afraid that very similar developments have occurred with Work and Income as part of the MSD, leading to former invalid's beneficiaries having been shifted onto the lower paid sickness benefit, and former sickness beneficiaries been shifted onto the former unemployment benefit.

I wish to provide you with some informative details about the use of so-called "designated doctors", who are expected to perform similar tasks as ACC assessors in this summary report (with relevant resources).

The information available is somewhat complex, and regrettably requires a bit of study and reading to grasp of what has, still is, and what will continue to be done in the areas of medical assessments, reviews, "designated doctor" examinations, Medical Appeal Board hearings and the likes. But I have attempted to summarise it all to keep it within a reasonable amount of information to digest.


BACKGROUND:

Major social welfare reforms came into effect in July 2013. They have led to some changes of the law and processes. WINZ are continuing to apply an ever more rigorous, yes very questionable approach, as they have already done since at least 2008. With the introduction of the Future Focus policies in 2010 the criteria for being considered sick, disabled and thus incapacitated to do any work, has been tightened substantially. WINZ expect their own Health and Disability Advisors, and the esignated doctors they regularly use and work with, to now primarily look at what a client CAN DO, rather than what they CANNOT DO! That is of course a bit of a catchy but ambiguous phrase, and naturally it can lead to subjective ways of diagnosing and assessing persons, as to what they can individually do or not do when it comes to any work activity.

The MSD has long been concerned about the growth of sickness and invalid's beneficiary numbers, and hence looked at possible ways to contain the trend of more persons qualifying and going onto these types of benefit. The following extract from a report by Dr Neil Lunt, published in the Social Policy Journal of New Zealand, from March 2006 (Issue 27), under the section headline The background to reforming SB and IB, page 82 gives a brief insight, of what moves were made under the then National led government in the 1990s:

National' s Welfare to Work brand (Player 1994, Ministry of Social Policy 2001) saw a new approach to medical certification for SB and IB. National' s attempts at reform saw the introduction of the Designated Doctor Scheme in September 1995, with designated doctors having responsibility for assessing benefit eligibility, certifying applications for SB at 13 and 52 weeks, and certifying grants for IB, and recommending a possible review (12, 18, 24 months). From 1998, there was an alignment of SB rates with UB rates for new grants and the introduction of the Community Wage in place of UB and SB. In October 1998, the designated doctor review scheme was revised and doctors signing the certificate were able to certify SB for four weeks and then at 13-week intervals. For IB, designated doctors certify the granting of a benefit, with review being recommended by these doctors for two years, five years, or never. During the first part of 1999, there was also the trial of work capacity assessment for those with sickness, disability, or injury. A Phase one trial was undertaken but Phase two was never completed. The work capacity process for IB and SB sought to identify the level of work, if any, a beneficiary was capable of, and to determine what assistance would help them move into paid work (abridged from Wilson et al. 2005: 5 Table 1.1).

The National government of that time did plan to introduce work capacity assessments, but this was never implemented, as there was another change of government in 1999, thus putting a stop on National' s welfare plans, which were aimed at restricting welfare access, placing much stronger individual responsibilities on persons on benefits, and enforcing more obligations for them to seek and stay in work, or do training.

The same report from Dr Neil Lunt from 2006 described this in the following section (p. 83):

These approaches sought to narrow the gateway to benefits and to ensure those with work capacity did not avoid the obligations that were at this time being placed on other groups of beneficiaries, including those in receipt of UB and Domestic Purpose Benefit. I would argue that the approach was individualised and an underpinning assumption saw problems as located in individual claimants, particularly in their attitudes towards work and unwillingness to meet their obligations.

It appears therefore that the first use of so-called designated doctors - as we now know them - started with the introduction of that Designated Doctor Scheme mentioned above. Prior to that separate examinations and assessments for the earlier Department of Social Welfare (DSW, later WINZ) appear to have been made by certain specialist doctors, if there were uncertainties in host (own) doctor assessments. The writer of that report I quoted from, states that the approach introduced by the government then saw problems as located in individual claimants, particularly their attitudes to work. This indicates that the reforms introduced then were an attempt to include a somewhat judgmental, yes possibly prejudicial approach, based on the belief, or view, that persons claiming sickness or invalid' s benefits were claiming these, rather for avoiding work obligations, than being seriously sick or disabled, although medical certificates were required by the then Department of Social Welfare to prove that the latter applied.

With a change in government, and a new approach that was taken from 1999 onwards, more supportive and inclusive ways were being proposed and introduced, largely based on a social model for dealing with disability and incapacity. The launching of the New Zealand Disability Strategy "Making a World of Difference " (New Zealand Disability Strategy 2001) created a new platform to work from. The Labour government followed a modern style welfare policy, with an investment approach targeted to assist individual WINZ clients with sickness and disability to achieve better outcomes for themselves, by enhancing employability. Enhanced case management was brought in, same as some Innovative Employment Assistance initiatives. By about 2005/2006 the then Labour led government decided to follow a yet more active approach, which was also somewhat inspired or motivated by new reports and approaches presented in the United Kingdom. I will get to what that meant a bit later. Also were there plans for introducing single core benefits from as early as 2007, consisting of one set of rates and one set of eligibility criteria for benefits, but with add-ons to support people who have higher costs such as accommodation or disability-related - whether in or out of work.

Some of these policies were never realised, but trials were run, leading to certain initiatives to be implemented nationally, as this following section from the same report (pages 86-87) mentioned above shows:

There has long been a concern about gateways into SB and IB and particularly the most appropriate locus of responsibility for certification. This was an area that subsequent National and Labour governments have sought to address. Most recently, the government has allowed local general practitioners and case managers to seek a second opinion where doubt exists about new and continued eligibility for SB, thus pre-empting patient capture that is said to result from close or longstanding personal relationships between claimants and their doctors. This initiative was piloted in the Wellington region with national rollout starting from June 2005. There is also enhanced guidance for general practitioners to improve the management of inflow onto SB (Maharey 2005b).

The following chapter from the same report (page 92-93) shows how much the British welfare changes were also given serious consideration by the last Labour government:

Healthy Welfare

Ongoing engagement with the medical profession is likely to be required to clarify general practitioners roles of clinician, advocate, and adjudicator in relation to health and wellbeing. Overseas evidence also suggests general practitioners views about work sickness depends on a general practitioner' s own personal views, patient characteristics, time available, expertise in occupational health, and views about continuity of care (Mowlam and Lewis 2005). General practitioners often feel pressured and are also inclined to take the wider views of claimants/patients into account, perhaps not wanting to commit them to searches for scarce work or where services are poor (Social Market Foundation 2005). A fuller notion of employability clearly encompasses the supply, demand and matching of labour (Lunt 2006).

It seems likely that prevention and managing long-term sickness-related absence will be increasingly important areas, with medical practitioners encouraged to do more to help workers stay in and retain work.


From the same report' s footnotes on designated doctors (page 82) this is quoted:

" Designated doctors assess a person' s medical eligibility for the Invalid' s Benefit. Under current regulations, Designated Doctors must be registered with the New Zealand Medical Council and hold an annual practising certificate. Designated Doctors must be fully informed about their responsibilities under the Social Security Act 1964.


And here is the title and link to the quoted report that can be found on the MSD website on the internet (copies can be downloaded in MSD Word and PDF format):

' Sickness and Invalid's Benefits: New Developments and Continuing Challenges'

http://www.msd.govt....pages77-99.html

By Neil Lunt, Social Policy Programme, Massey University at Albany

" Abstract

The proportion of the working-aged population receiving an Invalid' s Benefit (IB) has increased steadily between 1994 and 2004, and numbers on a Sickness Benefit (SB) rose sharply in the early 1990s and have continued to increase between 2000 and 2005. New Zealand has witnessed considerable policy activity in the field of SB and IB, as well as disability policy more broadly. To date, there has been relatively little attention paid by academic commentators to the increased emphasis on working actively with SB and IB clients. This is despite the fact that the new directions signalled for SB and IB constitute nothin g less than a paradigm shift. At the heart of change is the move beyond individuals – beyond focusing on either their disability or their lack of motivation. "


Also of interest is this separate report, which elaborates on the growth of the invalid' s benefit, also mentioning reforms and measures taken by governments, involving also the designated doctors. Copies can be downloaded in MSD Word and PDF format:

"Understanding the Growth in Invalid' s Benefit Receipt in New Zealand "

By: Moira Wilson, Keith McLeod, Centre for Social Research and Evaluation, Ministry of Social Development:
http://www.msd.govt....ges127-145.html

" Abstract

This paper reports on research that uses the Ministry of Social Development' s benefit administration data to advance our understanding of the growth in the number of people receiving the Invalid' s Benefit over the decade to 2002. It investigates the growth in inflows of people to Invalid' s Benefit, as this was the main cause of growth in recipient numbers. "


Of interest will also be the " official" WINZ website information on designated doctors:

http://www.workandin...ed-doctors.html

" Work and Income have established a panel of respected medical practitioners to provide second opinions on medical information - designated doctors. The provision of a second opinion assists Work and Income to determine a person' s capacity for work and entitlement to financial assistance. It also assists us with helping people to move towards employment. "



CHANGES TO USE OF DESIGNATED DOCTORS AND INTRODUCTION OF HEALTH AND DISABILITY ADVISORS:

From the above information it can be seen that MSD and WINZ have been using designated doctors under both National and Labour governments, and the involvement of these nowadays actually carefully selected medical professionals has fluctuated.

The clear intention was to use them to find ways to gather more information on clients with health conditions and disabilities, but also to offer additional measures to increasingly " assist" or "usher " WINZ clients back into work or training.

Already under the last Labour led government a stronger work focus was gradually adopted for beneficiaries from as early as 2005 on, this leading to introducing some new processes, rules and ways to assess and " assist" applicants, and consequently even more intensive efforts in 2007 and 2008. This was largely based upon the advice of senior policy making staff and management within MSD.

Following reforms under National in the 1990s the number of designated doctors reached over 1,000, although only a small number of them would handle most examinations and reviews. Still in 2007 a memo from MSD states they had 1,090 on their books. About then WINZ still had about 115 psychiatrists, a number of other specialists, but only 3 psychologists in their pool. 226 were only on the " general register", and 224 designated doctors were then based in hospitals. The number of designated doctors was so high then, because until about that time a designated doctor recommendation was usually asked for (by case managers), before any person was granted an invalid' s benefit. Only a much smaller number were used to examine and assess those on (or before being granted) sickness benefits (for " second opinions"). Only barely half of designated doctors were then vocationally registered and based in general practice clinics. In 2005 or perhaps 2007 only 41 designated doctor GPs wrote 26 per cent of all reports (according do a 2007 memo).

After the Labour government introduced the 'Principal Health Advisor ' (PHA) and 'Principal Disability Advisor ' (PDA) positions, which were filled by appointed persons like Dr David Bratt and Anne Hawker. Both were then put in charge of overseeing, mentoring and instructing Regional Health Advisors (RHAs), Regional Disability Advisors (RDAs) and Health and Disability Coordinators (HDCs) sitting in the regional offices of MSD and WINZ.

Following the appointment of those Principal Health and Disability Advisors, the Regional Health Advisors and Regional Disability Advisors, as well as so-called Health and Disability Coordinators in late 2007 and in 2008, changes were brought in by way of a new medical certificate and by changing the way of using designated doctors. They were after then intended to be used rather only for providing " second opinions", rather than for making initial assessments on potential, new invalid' s beneficiaries, or those being reviewed. Also was the intention to keep and recruit rather vocationally registered practitioners, mostly only GPs, rather than the wider pool of partly not sufficiently experienced and registered practitioners. More balance from region to region was anticipated, and RHAs, RDAs and HDCs were being involved in finding and encouraging GPs - and a few other suitable practitioners - to apply to become designated doctors, where there may be a perceived shortage of them. Case managers would also be involved in finding out where shortages existed, and what kind of doctors would be " suitable" for WINZ and MSD.

The result would afterwards be a much smaller pool of designated doctors, most of who would though be vocationally registered (and better qualified and experienced). But given the increased coordination and cooperation of the new MSD staff in the roles of RHAs, RDAs and HDCs (all overseen and instructed by primarily Dr David Bratt, and also Anne Hawker) and the medical practitioners, there would be designated doctors considered to be the more "preferred " ones for WINZ. Naturally certain designated doctors would be found to have a reputation to deliver certain outcomes, that senior MSD and WINZ staff would consider "helpful ", so it can be concluded, that an unofficial, but understandable "selection " would occur, where a small core of doctors out of the total pool of the designated doctors would end up with the larger work-load, given their "preferred expertise " or desired "output " in recommendations.


There appears to have been a somewhat new "culture " within MSD and WINZ in regards to the handling of medical examinations, assessments and reviews, that started to develop under the auspices of Dr David Bratt, who came to the Ministry after having worked as a kind of consultant at the Capital and Coast DHB. He is also known to have done work for ACC, same as a Dr David Rankin, who also worked for MSD.

It was in 2008 also certainly noticeable that there was a kind of media campaign that the National Party opposition appeared to be running, or at least was heavily promoting and driving, and Judith Collins was as their "welfare spokesperson " a main driver behind it, actually "feeding " media with endless National Party "press releases ". There had already been ongoing criticism by certain politicians and some others (likely with ulterior motives) about the fact that the number of persons on the sickness benefit had been increasing under Labour, while unemployment was as low as it had not been for over 16 years.

Various media reports, also from the NZ Doctor magazine, then claimed that there were many incidents of "doctor bullying ", where apparent drug addicts and some sickness beneficiaries were putting undue pressures on GPs to sign off medical certificates, so they could claim a benefit for health reasons. Apart from a questionable "survey " the actual number of such incidents was never clearly established, and there was never sufficient evidence provided, that this was ever serious, wide-spread behaviour. "Drug addicts " were thrown together with "sickness beneficiaries ", as if they belonged into the same "drawer ". Also was there never any proper information on what particular reasons may have been behind cases, where some behaviour perceived as "pressure " may have had occurred. No consideration was given to the possibility that some felt unfairly treated by doctors, some of whom could well have been working as designated doctors for WINZ.

One blog entry and comment thread on ACC Forum did then actually cover these media reports, and the following link does lead you to that one:

http://accforum.org/...o-lazy-to-work/

From the 'NZ Doctor ' magazine on 02 July 2008 Lucy Ratcliffe was quoted as reporting: " Just over a third of GPs polled say bullying is a serious concern for them and drug addicts and sickness beneficiaries are most likely to be the culprits.

The latest New Zealand Doctor/IMS Health faxpoll finds a third of GPs (33 per cent) say they've been bullied two to three times during their career in general practice, and just over a quarter (26 per cent) say it's happened four to five times.

Eighteen per cent say they' ve been bullied more than 10 times and 6 per cent say it' s happened so many times they' ve lost count.


It becomes clear that this "survey " asked "loaded " or ambiguous questions, so doctors referred to incidents "during their career ", which is likely to cover very many years in most cases!

Dr David Bratt did though appear to take up that issue with some passion and added his own comment to certain media reports on incidents, which were only quoting very few GPs. It will not surprise those who know more about Dr Bratt and his clearly biased views that the rounded survey result would later show up in many of his "presentations " that he regularly gives to GP conferences, other medical professional gatherings, to medical trainers and trainees, which are full of such hand-picked, insufficiently proved statistics.



Designated Doctor Training

Under Dr Bratt (a common GP from Wellington, with specialisation in obstetrics), who has been Principal Health Advisor since late 2007, WINZ and MSD soon even started "training" the so-called "designated doctors" that WINZ relies on for giving second opinions and conducting reviews of applicants' and sickness and invalid's beneficiaries' health conditions.

In a memo from T. Mulvena, ' National Manager Strategic Projects' at MSD and Work and Income, and Steve McGill, 'National Manager Health, Disability and Financial Outcomes ', dated 27 June 2008 and addressed to 'Regional Commissioners ', in which a designated doctor training program was proposed, it was stated, that " Work and Income has never provided training for designated doctors in the past. " Dr David Bratt as PHA and Dr David Rankin as 'Senior Advisor ' were mentioned as supporting the move for "training ".

Officially this "training" was supposed to be "neutral" and "objective" and only intended to "assist" designated doctors to understand the WINZ and MSD system and certain administrative and other requirements, but there is sufficient information showing, that the very resolutely "work ability focused" Dr David Bratt has used presentation- and apparently also "training" material, which clearly has a strong, underlying bias to it. In another memo from 27 March 2006 Dr Rankin had already proposed to the "Working New Zealand - SDD " department within MSD, that the role of designated doctors needed to be refined. He recommended in one points under his summary: "Designated doctors should be engaged through a robust selection process and be involved in regular training and education. " In other memos, like one from 05 June 2007, Dr Rankin suggested other changes, raising issues with the then present use and selection of designated doctors, and how a "robust " new GP Second Opinion service program should be rolled out. In this the roles of RHAs and RDAs (working under protocols and oversight by the PHA and PDA) were described, how they should be involved in client referrals to designated doctors.

Training sessions were held during late 2008 all over New Zealand, and the clear intention was to "train " all designated doctors that MSD and WINZ could reach. The new Health and Disability Coordinators (HDCs) were involved in supplying materials, contacting doctors, and so forth. "Training scenarios " and other material were used by Dr Bratt and Dr Rankin, who conducted the training, and looking at those shows that especially the "scenarios " and some "presentations " contained quite biased case scenarios and other information, which portrayed sick and disabled beneficiaries as tending to be dishonest, untrustworthy, shirkers, malingerers or exaggerators. Participating doctors were offered "medical education credits ", an "education fee " of $ 150 for participating, possible help with "travel arrangements ", and in some cases even with "accommodation ".

Another internal MSD memo I have seen is from Debbie Costello and Barbara-Anne Stenson as Programme Managers, addressed to Dr Bratt, T. Mulvena and two others, and dated 23 January 2008. It outlines proposed measures, resources and approaches to take in the planned "Designated Doctor Training ", and on page 5 also says rather openly under "Costs will include ": "Food and non-alcoholic drinks would be provided on arrival, or to assist social networking after the formal presentation. " On page 3 the same memo states that: "Attending a training course should be compulsory for a doctor to remain a designated doctor. "

In yet another memo dated 19 November 2008 Dr Bratt wrote to Mike Smith, 'GM Strategy and Service Development ' at MSD, that the fees paid to designated doctors doing examinations and giving recommendations on WINZ clients should be reviewed and "adjusted ". It appears that training session attendees expressed dissatisfaction with the way MSD would pay them for the assessments they provided. He refers to an established list of contract Designated Doctors. Clearly the WINZ "designated doctors " had expressed their concerns about the time required to complete assessments, which in 1995 was estimated to take only about 30 minutes, but which now was closer to 45 minutes per client. Also did Dr Bratt raise that designated doctors had experienced losses in revenue from assessments, as invalid' s benefit applications and reviews were now no longer regularly requiring reports from them. Dr Bratt did thus suggest that MSD increase the standard fee paid to designated doctors be increased to $ 180 per examination and report, plus an extra $ 60 for such a doctor for requesting an additional report from a client' s host or own doctor. Dr Bratt argued that GPs generally and on average earn (or charge) $ 250 an hour. Also did Dr Bratt state that over the 6 months until October 2008 DD reports asked for by WINZ increased by 60 per cent, due to the new approaches taken. I have no information on what increase was ever agreed to, but it must be concluded, that a significant increase occurred, as at one stage I heard of $ 136 per report being paid a few of years ago.

There are also memos and other information showing that Dr Bratt proposed training for 'Medical Appeal Board ' members. The information shows that Dr Bratt was concerned about board members not focusing strictly and firmly enough on only medical conditions and relevant information on these, and on how health issues impacted on the ability to work. Some other concerns were about the selection of appropriate members, and that panel members were not supposed to "diagnose " or "examine " appellants, only question them and examine medical records and other relevant information to make decisions.



QUESTIONS ABOUT THE INDEPENDENCE OF DESIGNATED DOCTORS:

According to MSD's "official" policies and principles, and certainly according to the law, designated doctors doing reviews under the old sections 44 and 54B (3) and (4) of the Act (now sections 40C, and also 88E (4) and (5)), are supposed to be INDEPENDENT medical professionals providing only truly INDEPENDENT opinions, assessments and advice. Yet, how "independent" would such designated doctors be, while they get "trained", "hosted " and paid by the very agency asking them to provide "independent" opinions on clients and applicants dependent on welfare support from that agency?

This somehow goes down badly with the principles of natural justice and the law, does it not?

Information obtained under the O.I.A. discloses that almost all designated doctors are nowadays simply common GPs (general practitioners). There was in early 2011 NO psychologist available as a designated doctor, while the Social Security Act does in old sections 44 and 54B (3) and (4) (now ss 40C and 88E (4) and (5)) provide for a "choice" (with good reasons) between a medical practitioner (a specialist doctor, registrar, psychiatrist or GP) and a PSYCHOLOGIST (to presumably examine mental health or psychological conditions and disabilities).

There were in 2011 also only 10 psychiatrists listed nationwide as designated doctors, which hardly meets the needs of sick and disabled with mental health problems, who would be spread across the whole of New Zealand. With about 30 to 40 per cent of invalid's and sickness beneficiaries at least partly having psychiatric, psychological and/or addiction issues, it is a rather dismissive approach by MSD, to rely largely only on common "generalist" doctors like GPs, when the vast majority of them have NO (or totally insufficient) expertise and qualifications in psychology or psychiatry.

I have been given information by persons affected, who were asked by WINZ case managers to undergo a review by a designated doctor. The Act does offer an affected client or applicant some input, because s 44 and s 54B (3) and (4) (now 40C, and also 88E (4) and (5)) speak of an agreement between WINZ and a client to be attempted on who to see as such a doctor. Yet in at least some (I dare to presume very many) cases, the client is NOT offered any choice and input, and rather gets told by a case manager who to see! That is a breach of the law. Only if there is no agreement at first between an affected client and WINZ, then can WINZ case managers (usually in consultation with a Regional Health or Disability Advisor) propose and appoint a particular designated doctor. In many cases a client is only presented a short list of selected designated doctors to pick from, again not offered any sufficient input. In any case, it appears that MSD and WINZ have their preferred designated doctors, which I presume is, because they are more likely to make the decisions WINZ would prefer! A doctor I spoke with confided to me that he knows a colleague who does a very high number of reviews for WINZ. MSD have themselves records, proving that a small percentage of designated doctors handle a very large volume of examinations (assessments) for WINZ.

Also have there been issues with the appointments to so-called Medical Appeal Boards, who under old section 53A (now new s 10B) hear appeals by the former invalid's and sickness benefit recipients (now "Supported Living " and "Jobseeker " benefits), or applicants for those benefits. Applicants and benefit recipients can appeal against decisions by WINZ staff, that are based on a designated doctor recommendations, with which a client may disagree.

There is no further appeal possible after such a board makes a decision. Strangely also many designated doctors again sit on such boards, although not the same ones who conducted the disputed assessment or review. Members of such a board are appointed by MSD medical appeals coordinators , who are placed in their regional offices.

This is going on under the regime of MSD and their new Principal Health Advisor Dr Bratt, who believes that work is the best kind of "medicine" to assist sick persons on benefits to get well again. Since at least 2010, Dr Bratt appears to have felt very emboldened by the new approach under the new National led government towards social security - and welfare policy in general. He has shown this in the many "presentations " he has since then given, and comments he has made to the media and in public forums.

There is a presentation that Dr Bratt, in that instance "officially " together with his colleague Anne Hawker, that is called "Ready, Steady, Crook Are we killing our patients with kindness ", which was given to a GP conference in Christchurch in 2010. IN it he makes bizarre statements like this one on page 13:

" why these cases?
* in both a patient requested a specific service
from you - and these have clinical or health
consequences/outcomes ... both positive and
negative
* did you react the same way to each? .. the
drug seeker and the benefit seeker?

* and why? "

In the same presentation Dr Bratt then does in further comments on pages 20 (see reference to "opiates "), 21 and 35 link the medical certification for benefit purposes to promoting drug use - with the risk of causing addiction. It culminates in this extreme comparison:

* " The benefit - an addictive debilitating drug
with significant adverse effects to both the
patient and their family (whanau ) - not
dissimilar to smoking
* and NZ GPs write 350,000 scripts for it every
year! "


On page 30 of that presentation (like others that followed) Dr Bratt lists the doctor patient relationship and patient advocacy as "barriers " to "managing health and work issues "!

Dr Bratt has since then continually linked benefit dependence to drug dependence, or made bizarre comparisons between the two. Also has he presented disputed, unproved statistical information, like that about "30 per cent " of GPs "had experienced a sense of threat and intimidation '! This appears to be based on questionable surveys conducted, like the one by 'NZ Doctor ' magazine, asking ambiguous or too unspecified questions. He repeatedly claims that being on a benefit is as bad for your health as smoking 10 packets of cigarettes a day, and more dangerous than working in the most dangerous jobs (e.g. on an oil drilling platform in the North Sea).

Furthermore has Dr Bratt drawn substantially on supposed "findings " from UK "research ", like the ones conducted by the ones of Professors Gordon Waddell and Mansel Aylward, who both worked for the 'Unum Provident ' sponsored "Centre for Psychosocial & Disability Research ", based at Cardiff University in the UK. Other similarly inclined "experts " like Wessely and Burton also get quoted. Financed by the highly controversial (and repeatedly convicted) US insurance giant, Aylward and Waddell prepared reports that serve as supposed "scientific " evidence, to prove that open employment is both "good for a person' s health " and even "therapeutic " . Much of the research is based on other reports and on statistics that appear to simply have been used selectively to prove a pre-conceived point and message. Their adopted position is that many mental illnesses, same as musculo-skeletal conditions that people suffer from, are mostly only "illness belief " , and therefore medically "unproved " . This "research " has been used by the Department of Work and Pensions in the UK, which was during Mansel Aylward' s employment there as Chief Medical Officer also repeatedly "advised " by the same insurance company, and which then led to disastrous consequences of welfare reforms there, resulting in over 1,100 deaths of those affected in 2011 alone. There is evidence of Professor Aylward' s long relationship to Unum Provident, and he was later appointed as the director of the mentioned "research centre " .

It is not surprising then to find references to those "findings " and other selected "research " in Dr Bratt' s many presentations, interviews and speeches. In this year Dr Bratt has even now started using presentations together with Professor Mansel Aylward, like one which was given to the annual 'Rotorua GP CME ' in June 2013. Both spoke there and at some other conferences, and held a joint media interview with 'NZ Doctor Magazine '. Both appear to be working closely together; and Professor Aylward has been advising MSD and the present government on welfare reforms, especially on how to assess and treat sick and disabled.


Below are some links to a presentation and some You Tube videos that show what "presentations " Dr David Bratt made to the Welfare Working Group Forum in 2010:

'Benefit Sunshine ' , PDF presentation by Dr Bratt, see this link:

http://ips.ac.nz/Wel...it-Sunshine.pdf

(this is the more "moderate version" in circulation, there is a longer presentation with more drastic "information" at the end of it!).


YOU TUBE CLIP:





Please check the You Tube website to see for the remaining 3 videos on Dr Bratt's Welfare Working Group Forum presentations (altogether 4 clips exist).


With the comprehensive, draconian and even discriminatory " welfare reforms" the present National led government brought in, and which are only just now being implemented, there are likely to be many more reviews and re-assessments of sick and disabled beneficiaries, and it is anticipated that there will be a much higher work load for designated doctors, who as said above, are "trained" by MSD and WINZ. The many "on site " training sessions in 2008 were only provided as a starting measure, and further training and consultations continued since then on an ad hoc, but also in an ongoing manner, mostly by online and information sharing, by discussions between RHAs and RDAs on the one hand, and designated doctors on the other hand. All is guided, mentored and managed by the PHA and PDA, where Dr Bratt though appears to be the main key person running the whole agenda.

Health and Disability Coordinators continue to be involved also, to liaise between all the advisors and medical and health professionals that are involved. Since early 2012 even the 'Royal NZ College of General Practitioners ' (RNZCGP) has started additional study modules that are supposed to additionally train GP aspirants and already qualified GPs on special subjects like mental health, offering them more "qualifications " to assess and treat persons with such conditions. The "National Health Board " and "Health Work Force NZ " were also involved in developing this new study approach, and it is of concern, that Mansel Aylward and others have even been able to influence the he 'Australasian Faculty of Occupational and Environmental Medicine ' (AFOEM) and 'The Royal Australasian College of Physicians ' (RACP), who released a "Consensus Statement " on the "Health Benefits of Work ".

See this link for the website with information:

http://www.racp.org....enefits-of-work

It is clear that there is now a strong drive into one direction, and it is actually based on much less "evidence " than "experts " like Mansel Aylward, also former ATOS employee Dr David Beaumont (who advised ACC and MSD) and Dr David Bratt try to tell their colleagues and the public. These medical professionals that appear to have " hijacked" the medical profession with the help of corporate funding providers like UNUM Insurance, who have ulterior motives, are able to influence medical practice and training. It appears that the ultimate motivator is providing justifications and measures to achieve COST SAVINGS, and little else, by off-loading sick and disabled from benefits and from claims of insurance or ACC payments.

The present government in New Zealand, the Minister for Social Development and her Ministry have all taken on board what the mentioned "experts " and an increasingly bold and unashamedly biased Dr Bratt recommend, and with this in mind, one now has to view the whole involvement of designated doctors with utmost suspicion and scrutiny.

There appear to be breaches or at least inconsistencies of/with the Social Security Act, as there is nowhere any provision or reference made to "training" of designated doctors that are selected, commissioned and paid for by the Ministry. There certainly appear to have been many cases where natural justice has been - and is being breached, and there are likely to be many, many more in future. As most beneficiaries have little in the way of funds, get poor advice and lack information about their rights, most fully comply with requirements imposed on them. They'll lack finances to access legal advice and support from lawyers, especially now, since access to legal aid has also been tightened and paid aid is often not even covering costs, as a lawyer informed me. Indeed the fear is justified that the lot of sick and disabled beneficiaries is going to get a lot worse.

As mentioned, the government and other involved health professional organisations (Health Workforce, RNZCGP) were aware of certain deficiencies with expertise of certain health professionals, they started a new training system for GPs in 2012. Additional modules of study and training in areas like "mental health" are supposed to give interested GPs and aspiring practitioners the option to add such modules to their program of study or training.

These are not in-depth studies, but the additional "qualifications" are supposed to give MSD also a chance to get away with using almost exclusively GPs as designated doctors for medical assessments and reviews, at the same time also involving them in treating low level mental health conditions (most likely by simply administering medications). That way they can claim the GPs have the needed "expertise" to also review and assess persons with mental health and/or addiction issues and resultant disabilities.

There is a fair amount of information about a lot of these matters, but of course I cannot and do not want to inundate you with it.



In the following I will list some links to relevant information that can be found online:

1) ' Ready, Steady, Crook - Are we killing our patients with kindness? '
http://www.gpcme.co....ratt-Hawker.pdf
(presentation by Dr D. Bratt and A. Hawker, for Work and Income, to GP conference in Christchurch, 2010, see pages 13, 20, 21 and 35 for comparisons to drug dependence)

2) ' Medical Certificates are Clinical Instruments Too! '
http://www.gpcme.co....June%202012.pdf
(GP presentation by Dr D. Bratt, 2012, see pages 3, 16 and 33 for his likening of benefit dependence to "drug dependence ")

3) ' Shifting Your Primary Focus to Health and Capacity - A New Paradigm '
http://www.gpcme.co....%20Capacity.pdf

(Prof. Sir Mansel Aylward, Director Centre for Psychosocial & Disability Research, Cardiff University; Dr David Bratt, Principal Health Advisor, Ministry of Social Development; joint presentation at GP CME Presentation - June 2013; questioning "traditional " diagnosis on a medical model basis, and promoting the Aylward version of the " bio psycho-social model " , and even promoting "Long Acting Reversible Contraception " to improve employability of women, see page 45!!!)

4) ' Happy Docs - true generalism with Welfare Reform '
http://www.conferenc...vid%20bratt.pdf
(RNZCGP Presentation - July 2013, with the usual one-sided information that "work is generally good for you ", trying to explain some welfare changes, but now avoiding the "benefit " to " drug" comparison, after media and other attention to this)

5) ' Getting better at work '

(You Tube video with brief interview of M. Aylward and D. Bratt, by Lucy Ratcliffe from ' NZ Doctor ', published on 10 July 2013)

6) 'Pressure - No Pressure ' (How to deal with "pushy " patients)
http://www.google.co...vZo_cQpC2rFyelg
(PowerPoint presentation by Dr Bratt, downloadable from the web, again likening benefit dependence to "drug dependence " and presenting a lot of selectively gathered information)

7) "Harms lurk for benefit addicts "
http://www.nzdoctor....it-addicts.aspx
(article in NZ Doctor magazine, by Lucy Ratcliffe, 01 August 2012, where Dr Bratt is again quoted with his preposterous claims about benefit dependence being like "drug dependence ", and that: " UK study found of the main obstacles for going to work, medical problems made up just 3 per cent of the list. " )
*****Please search online under the title of the article, if the link does not work!*****

8) MSD, 'Regional Health Advisor ', position description, issued 2007
https://www.bfound.n...81217091658.pdf

9) MSD, ' EXTERNALS ' publication
http://www.workandin...als-issue-1.pdf
(Issue 1 of 'Externals ' with introduction by PHA Dr Bratt and PDA Anne Hawker, and brief explanation of "Health and Disability Coordinators ", Nov. 2009)




CONCLUSION:

What is happening at MSD and WINZ at the moment may "appear" to be reasonable to many in the public, but there is much more to it than most think. The appointment of the Social Welfare Board by Paula Bennett shows that she and her government selected certain persons, who have also a strong "business" and staunchly resolute "work capacity" focused approach in reforming welfare in NZ. The appointment by Dr David Beaumont to the Social Welfare Advisory Board, a former chief advisor for ACC, and responsible for many appalling decisions there, gives reasons for utmost concern!

Ultimately the goal is to get as many persons off benefits and into any types of "open employment " (on the market), which for sick and disabled will mostly be marginal, selected part time and casual work. The true agenda is cost saving, containing and possibly reducing beneficiary numbers, and the push to achieve this is now extremely forceful. It will cause immense pressures and in many cases actually harmful effects on person's health. I honestly do not know how beneficiaries with mental illness and psychological conditions will cope.

And we also know: The jobs are NOT there, even not so for the fit and healthy!

Most definitely there are many people, who have faced "designated doctor examinations " that resulted in bizarre and clearly biased decisions, and in quite a number of cases the assessors or designated doctors being used did not have the particular, appropriate medical qualifications needed, to competently assess clients with specific and complex health conditions. GPs are the "standard " "designated doctors " now, also making decisions about mental health conditions they often have insufficient understanding of. Some handle a very high number of WINZ clients.

I hope this information will raise your awareness to these topics and issues, on which I can and will elaborate on a bit further in following 'comments '.


Marc


Attached are some PDF files and a PowerPoint file with the following information:

a) 'Benefit Sunshine' PDF presentation by Dr David Bratt, for Welfare Working Group Forum;
b )'Medical Certificates are Clinical Instruments Too!', another presentation by Dr Bratt -
...see pages 3, 16 and 33, where he compares benefit dependence to drug dependence!!!;
c) 'Ready, Steady, Crook - Are we killing our patients with kindness?', an appalling presentation that Dr Bratt managed to have put under not only his "hat", but also the one of his colleague, the Principal Disability Advisor Hawker, in 2010, comparing benefit dependence to drug dependence;
d) 'Harm Lurks for Benefit Addicts', NZ Doctor magazine article, again comparing benefit dependence to drug dependence, referring to Dr David Bratt's philosophy, 01 August 2012;
e) a reader' s letter in response to that article under "d" in "NZ Doctor", raising concern and criticism about Dr Bratt, dated 29 August 2012;
f) a printout of the Medical Council registration of Dr Bratt, current as on 29.08.2012;
g) Position description for Regional Health Advisor, received w. O.I.A. reply from MSD;
h) Position description for Principal Health Advisor, received with O.I.A. reply from MSD;
i) ' Pressure No Pressure ' , a PowerPoint presentation by Dr David Bratt, Principal Health Advisor at MSD, on page 27 again comparing benefit dependence to drug dependence;
j) ' Shifting Your Primary Focus to Health and Capacity ... A New Paradigm ', joint presentation by Dr Bratt and Professor Aylward, June 2013;
k) ' Happy Docs ... true generalism with Welfare Reform ' , most recent presentation by Dr Bratt, July 2013.


*****IF ANY OF THOSE "PRESENTATIONS " DO NOT REPRESENT ANY BIAS, THEN I ASK, WHAT DOES???*****

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#2 User is offline   Marc 

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Posted 06 November 2013 - 01:32 AM

MSD have been training, mentoring and consulting "designated doctors" since 2008, initially being conducted and managed through both Dr David Rankin and Dr David Bratt, the latter still Principal Health Advisor for MSD (since 2007).

Dr David Bratt has been and still is also mentoring, training and supervising Regional Health and Disability Advisors in Regional Offices of MSD and WINZ. Health and Disability Coordinators are also used to closely liaise with and "co-operate" with GPs and other medical professionals, which includes those that are not necessarily "designated doctors". The latter Health and Disability Coordinators also play a major role in "recruiting" the kinds of "designated doctors" WINZ and MSD want!

Information gathered since gives ample reason to believe that training went beyond the informing about documentation and other basic requirements Work and Income and MSD have and expect of medical practitioners and other health professionals. All indications are, that here has been a clear attempt to influence the views, perception and judgment of designated doctors, which has led to "bias" of doctors involved (mostly GPs) when making assessments, decisions and recommendations about beneficiaries to Work and Income.

See attached to this email some confidential info discretely obtained re designated doctor training by MSD - intended mostly for internal communications! It will simply give you the proof of what has been going on over recent years. MSD is rather quiet on "designated doctor training", as it likes to keep a tight lid on any information related to it.

Newest information is that the involvement of designated doctors appears to have been reorganised slightly, at least for time being, and in at least in some administrative regions of MSD. It appears that MSD got worried about legal complications and challenges, questioning the claimed independence, objectivity, fairness and reasonableness of designated doctor examinations, assessments and decisions.

The reports, assessments and recommendations that were and are being provided by those "designated" "medical practitioners" (mostly GPs) have increasingly been used by Regional Health Advisors and Regional Disability Advisors as supposedly totally "reliable medical reports" for their advice and recommendations to WINZ case managers, who are usually expected to abide by those recommendations, after which usually ALL previous doctor certificates and assessments get ignored!

The fact, that designated doctors have been "trained", are being mentored and consulted by MSD staff, such as Dr David Bratt, raises very serious questions about their "independence" and objectivity. The fact that MSD pay them is another one contributing to concerns.

That seems to have been behind a partial recent review of designated doctor involvement, which has been confirmed to me by a GP (who has not had requests for formerly common "host doctor reports " for many months), and also by a client in Southland, who was told by WINZ staff, that they had not asked for designated doctor examinations for a year, but suddenly resumed these. Regional Health and Disability Advisors do now appear to increasingly take over some internal assessing on their own, followed by making their own recommendations and advising case managers re clients' medical fitness for work. Any issues clients have with decisions based on any designated doctor - or Health and Disability Advisor - recommendations, must go to the MAB.

What is of particular concern is also, that the Regional Health and Disability Advisors are in at least some cases totally lacking sufficient medical qualifications and experience to assess competently all the cases put before them, due to the diversity of illnesses and disabilities, which can of course include psychiatric and psychological illnesses and disorders.

Naturally the agenda has for a few years now clearly been to limit access to, and to reduce numbers of people on sickness and invalid's benefits, which was already started in 2010 with a very resolute, yes "relentless " approach under the "Future Focus " policy. In a growing number of cases extremely harsh decisions were clearly breaching natural justice by being unfair and unreasonable.

There is very poor or limited transparency offered by MSD in all these controversial matters, and this is appalling. Hence I encourage everyone reading this, to consider making Official Information Act requests yourselves to MSD. They should not be allowed to hide so much!


Marc



P.S.:

Re qualifications of RHAs and RDAs, see this example:

Tanya Rissman, 'Regional Disability Advisor ', and temporarily also "acting " 'Regional Health Advisor ' for Work and Income, is in charge of the Southern Region. Here is what could be found as some evidence of her lack of medical expertise and qualifications. She merely has a teaching degree, a diploma or so in counseling and some social work qualifications:

Links:

http://alumnionline....EY-Nov-2002.pdf

http://www.adanz.org...19e2b22/Dunedin LOAD website notes 13 Aug 09 final.pdf

http://www.southernd...49942875-14.pdf


Re sundry other info from the Work and Income website:

http://www.workandin...ed-doctors.html

http://www.workandin...ss-benefit.html

http://www.workandin...al-appeals.html



ATTACHMENTS:


6 various PDF files containing scan copies of internal memos and similar documents, giving clear evidence that MSD conducted designated doctor training by Dr David Rankin and Dr David Bratt (Principal Health Advisor for MSD, who has a very staunch "pro work ability" focus, also comparing in some presentations benefit dependency with "drug dependency").



a) MSD, Design. Dr training proposal, T. Mulvena, memo, to Reg. Commissioners, 27.06.2008.pdf
b )MSD, Working NZ - SDD, Role of Design. Drs, memo, D. Rankin, 27.03.2006.pdf
c) MSD, SDD, Dr D. Rankin, GP Second Opinion, memo, 05.06.2007.pdf
d) MSD, Working NZ, Work Foc. Suppt, designated doctor training resources, memo, 2008.pdf
e) MSD, Design. Dr Training Workshop, and H+D Coordntr, info sheet, 12.08.2008.pdf
f) MSD, Dr D. Bratt, Fee Adjustmt for Design. Drs, memo, 26.11.2008.pdf
g) MASSEY-Nov-2002, Tanya Rissman, 'Antics Ltd', prof. qualifications, article, p. 39, d-load, 15.08.12.pdf

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Posted 06 November 2013 - 01:51 AM

Following my earlier comments, I have further highly interesting, revealing information for you to look at. This is regarding the apparent substantial in crease in Medical Appeal Board hearings held, to deal with an increasing number of medical appeals by distressed and aggrieved Work and Income applicants or clients to/on health related benefits.

I already explained a bit about the involvement of actually more or less "hand picked" and mostly preferred "designated doctors " that MSD and Work and Income use to get additional examinations and assessments done - as "second opinions" and the likes. They have been "trained" by leading MSD health advisors since 2008, and some of whom also sit on Medical Appeal Boards, when as panel members (3) hearing "medical appeals ".

True "independence" is to affected persons not what they are faced with, as it is against natural justice that the very agency or department, that seeks supposed "independent" second opinions, is actually at the same time " instructing", "mentoring ", "consulting " and "training " them. Naturally they do for Medical Appeal Boards also appoint them, through a so-called 'Medical Appeals Coordinator ', who of course is an MSD or WINZ employee!

It is extremely hard to get figures about Medical Appeal Board hearings (formerly conducted under section 53A, now under section 10B of the Social Security Act 1964), about the costs associated with them, and re fees paid to attending medical and rehab professionals, but I managed to find some through searching the internet.

Below are links to website pages with relevant documents containing interesting information.



Check these LINKS for statistical data about Medical Appeal Boards:


http://www.msd.govt....2005-2006-2.pdf
(see page nr. 137 for MAB costs and meetings details)

http://www.msd.govt....-appendices.pdf
(see page number 129, actual page 2, re MAB costs and meetings data)

http://www.msd.govt....ort-2007-08.pdf
(see page 132 for MAB costs and meetings)

http://www.msd.govt....t-2008-2009.pdf
(see pages 121-122, for MAB costs and meetings, increasing)

http://www.msd.govt....t-2009-2010.pdf
(see page 120 for MAB costs and meetings explosion in these since year before!)


http://www.msd.govt....ort-2010-11.pdf
(not that NO details about MAB costs and meetings published now!)


It is obvious, that the information from annual reports by MSD since 2005 and up to 2010 shows, that there has since 2009 been a kind of "EXPLOSION " of costs for Medical Appeal Bord hearings, as there was an increase from the 2008-2009 year to the 2009-2010 year of over 200 per cent!

Clearly under the National led government and under Paula Bennett there has been a substantial increase in appeals and hearings, which shows that more clients are dissatisfied with the decisions by Designated Doctors and Regional Health and Disability Advisors! Also does it appear that there has since mid 2008 been an increase in designated doctor examinations, and further to that internal assessments and recommendations by WINZ health and disability advisors, which would naturally lead to an increase in at least some decisions being disputed.

Anyway, the figures available up to 2010 speak for themselves!

I have also attached the relevant PDF files, stating the details about the "explosion" of costs and hearing by Medical Appeal Boards! MSD have now apparently stopped publishing figures re MAB hearings conducted since 2010!

There is apparently NO mention of them in annual reports anymore, and MSD seem to be keen to not disclose details, which should not surprise, as the "explosion" in numbers and costs has probably continued to date, which in itself could give reason for the interested public questioning what has been going on over recent years!

I can find no other information about MAB hearings, costs and numbers, let alone outcomes, which all appears to be kept very confidential.

It would be interesting to get some reliable statistics on all this from MSD, so that comparisons with past statistics are possible. Maybe an Official Information Act request into this should be considered?


Marc



Attachments (PDF files):

a) MSD, Medical Appeal Board expenses and hearing stats, fr. annual reports 2004-2010, 01.09.2012.pdf; ... a file with extracted pages from the reports;
b )MSD, annual-report-2009-2010, MAB cost and meetings data, p. 120, d-load, 01.09.2012.pdf;
c) MSD, annual-report-2008-2009, MAB cost and meetings data, p. 121-122, d-load, 01.09.2012.pdf;
d) MSD, msd-annual-report-2007-08, MAB costs and meetings data, p. 132, d-load, 01.09.2012.pdf;
e) MSD, annual-report-2006-2007-appendices, see p. 129, actual p. 2, re MAB costs + meetings., d-load, 01.09.2012.pdf;
f) MSD, annual-report-2005-2006-2, part 2, p. 137 w. MAB costs + meetings, d-load, 01.09.2012.pdf.

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Posted 06 November 2013 - 02:11 AM

Please find attached to this 4th comment in this matter another PDF file that contains some sample scenarios used in "designated doctor training" by Dr David Bratt, Principal Health Advisor of the Ministry of Social Development, which were used by him to train WINZ "designated doctors" in special training sessions all over New Zealand since 2008.

As you will be able to see, there is always a kind of "bias" in the samples used, implying that WINZ beneficiaries on sickness or invalid's benefits, or applicants for them, are likely to be untrustworthy "cheats", shirkers, malingerers and exaggerators!

Furthermore there are 2 position descriptions for key "advisory" staff the Ministry uses to "advise" WINZ case managers and other staff on disabled beneficiaries (usually adopting the recommendations given as results of assessments by the "trained" "designated doctors").

Also is there a position description for the position of Health and Disability Coordinator, one of each of the total 11 (or so) of them are placed in each Regional Office, and tasked with "liaising" with GPs and other health and disability professionals, and also with finding and selecting prospective "designated doctors".


There is more information available on all this, but I focus on presenting only a selected a core of it.


Marc


Attachments:

a) 1 PDF file containing 7 sample scenarios used in "designated doctor training" by Dr David Bratt, Principal Health Advisor of M.S.D., in special training sessions;
b )1 PDF file containing the position description for Principal Disability Advisor, received w. O.I.A. reply from MSD;
c) 1 PDF file containing the position description for Regional Disability Advisor, received w. O.I.A. reply from MSD;
d) 1 PDF file containing the position description for Health and Disability Coordinator (who work very closely also with GPs!), received w. O.I.A. reply from MSD

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#5 User is offline   Marc 

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Posted 06 November 2013 - 02:46 AM

Official Information and sundry information re MSD, designated doctors, Medical Appeal Boards, RHAs, RDAs, relevant processes:

Looking at some of the attached documentation and information that was obtained under the Official Information Act, and comparing it with more current figures, it can be established that MSD have fewer "designated doctors " now than in March 2011. Total "designated doctors " number about 290 nation-wide now, and they are almost exclusively GPs.

They (MSD and Work and Income) apparently have some problems getting enough of the doctors they need and want, under the conditions and expectations that they have. Also do they have issues with paying them fairly for their efforts and inconveniences, which does not motivate many GPs to volunteer and co-operate with them. Ordinary examinations are paid at going GP pay rates, but attendances of Medical Appeal Board hearings pay really well for the doctors taking part.

From what I have learned, most designated doctors "examinations " have been made in rushed processes, basically within a brief, 15-minute encounter. That is mainly, because the doctors commissioned feel not sufficiently reimbursed for the at times complex work and time needed. It seems that the GPs willing to do these tasks have developed a routine to handle such WINZ processes as swiftly as possible, and some seem to make it worth their while by processing large numbers. Mistakes, misjudgements and so forth are likely to happen in such an environment.

There is core number of GPs always available to willingly work as designated doctors, and some of them handle very high numbers of examinations and assessments. Many WINZ clients are not given a proper choice (by case managers referring them), as it appears, and they are rather simply "told" to see particular doctors that are apparently more favourable to the department, when making assessments and recommendations. I personally know a few persons who were told, whom to see, not even being given a short list to pick from.

Attending MAB hearings pays quite well for doctors and rehab professionals, contrary to doing individual assessments as designated doctors.

They have "few", if "any" experts in mental health that are available, as in early 2011 they had NO psychologists and only 10 psychiatrists on their lists. That exposes mental health sufferers, or persons with addiction and complex issues to likely "incompetent" assessments and decisions by GPs.

A lot of the information attached is over a year - or in some cases a few years old. They (MSD) are not willing or able to give much in the way of information about outcomes of "designated doctor" examinations and recommendations, and similarly Medical Appeal Board hearings. The standard answer is:
"Such information is not centrally collected and kept in thousands of individual client files. It would be unreasonable to expect them to collate the info". That is how they tend to get off the hook, when they refuse to make such information available in response to an O.I.A. request.

Contrary to website information they do often have more than one "designated doctor" (likely to be trained by MSD) on Medical Appeal Boards, so issues re "independence" arise there also. Often there are two, if not three "trained" designated doctors hearing appeals.

Attached is a list with "designated doctors" as it was current in late August 2012. Most appear to have been "long serving" ones, apparently "happy" to risk compromising their profession's 'Code of Ethics' in return to meet MSD's expectations.

As a matter of fact they do risk making serious compromises against their professional ethics, by accepting policy guidelines set by MSD, like the new staunch application of "work capability" focus (already commenced under MSD's 'Future Focus' policy from 2010).

Standard questions asked by "designated doctors" are largely revolving around work related questions, to establish the client's view towards work, certain types of work, previous employment, efforts, preparedness to do "other" or "lighter " types of work, and the focus on this appears to be dominant, health aspects being treated in too many cases almost as only "secondary" matters to consider.

If not work related, the questioning is often targeted to establish whether a sick or disabled client may perhaps be able to do some chores and tasks at home, or perform physically or mentally any other activities, be this in form of "hobbies " or else, that can in any way be "perceived " as indicating that the person "can " do something, which can be applied in any hypothetical kind of work.

Comments in their reports tend to state: "We were meant to look rather at what client X CAN (perhaps) DO, rather than what client X CANNOT DO (expectation by MSD)". So the intended outcome is based on finding any indication of whatever basic physical and mental capability a client or applicant has, so that based on this information, a person can be "considered" to work at least 15 hours a week in whatever hypothetical job, and irrespective of whether there is a realistic prospect of any matching jobs or work existing, that may prove to be an option for paid employment.

The intention is to stop people from meeting the severity criteria for Invalid's Benefit (now 'Supported Living' benefit), and in some cases even for Sickness Benefit (now "Jobseeker " with "deferred status).

This has led to some seriously incapacitated clients of Work and Income being considered to rather meet the criteria for the former sickness (now “jobseeker”) benefit, than the former invalid 's (now ' Supported Living' ) benefit, despite being unable to do much work at all, and that for years, if not permanently. Yet the sickness (now deferred status 'Jobseeker ') benefit is only meant to be a short term benefit for people "temporarily " not fit or able to work (full time)!

Internal Regional Disability and Health Advisors also make (initial) internal assessments, tending to favour recommendations to case managers that benefit Work and Income. They often do this without presenting any realistic scenarios of persons being able to work, and without mentioning any example of a type of work that the client could take up and do in "open employment". The over-ruling (unofficial) criteria rather appears to be, to put the person on a lower paid benefit (sickness - or now ' Jobseeker'), simply to save costs.

Decisions can be over-turned by a MAB decision, but as usually 2 designated doctors make a two third majority on such an appeal body panel, it can be quite difficult to achieve that this happens. This is how MSD and Work and Income work now, and it deserves very deep scrutiny.

It is nor surprising that any client dissatisfied with any treatment will be severely discouraged to take matters to the media, as MSD have since February 2011 been using a kind of "official" new "privacy consent form" that implies that the Ministry and Minister will disclose anything they may view "relevant", if a person dares to involve the media and the media seeks answers from WINZ/MSD, which usually only will happen, if they can provide a signed "privacy consent form" from the client in question.

This is a link directly to the MSD main website page for "media ", offering the "privacy consent form " to media and public users (who approach media re MSD and WINZ issues):

http://www.msd.govt....room/index.html

The following is the very link leading to the document downloadable from the main MSD website:

http://www.msd.govt....rm-feb-2011.doc

The use of this particular form raises very serious legal questions. The text of the " privacy consent form" is quite inappropriate, so that even a lawyer described it as "shocking ". It basically gives the Ministry authority to PUBLICLY make available virtually ANY information considered "relevant" to a matter raised by a client to the media. This means the "wider public", as I would understand it. NO advice is given that clients can legally use their own forms of giving consent to media and MSD or Work and Income.

Marc


Attachments:

a) MSD, O.I.A. request, Design. Drs, MAB appeals, RHAs, RDAs, C.E..'s response, March 2011, re anonymous.pdf;
b )MSD, O.I.A. request, list of questions, for specified information, sent to Ministry, late 2010.pdf;
c) MSD, O.I.A. request, list of questions, re SB + IB beneficiaries, reviews, statistics, fr. Jan. 2011, re anonymous.pdf;
d) MSD, Designated Doctors, staff info, fr. Manuals + Procedures, W+I website, 31.01.2011.pdf;
e) MSD, Med. Appeal Boards, panel compositions, staff info, Manuals + Procedures, website, 31.01.11.pdf;
f) MSD, Designated Doctor List, complete, as in August 2012, PDF version;
g) designated-doctor-application, Work and Income, form, d-load, 12.12.2010.pdf;
h) MSD, Regional Offices, RHA + RDA roles, involvement, fr. Annual Report or info brochure, 06-2008.pdf.

Further information on designated doctors:

http://www.workandin...ed-doctors.html

http://www.workandin...tors/index.html


Regards -

Marc


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Posted 06 November 2013 - 02:58 AM

Last not least I can present some more current information that shows how far the journey has taken WINZ under Dr Bratt and his agenda!

See how Dr Bratt's radical "pro work" focus is even being applied by the Medical Centre of the Auckland City Mission now! So much for the caring approach that such institutions should really take!

From their information leaflet:

"The sickness benefit is not designed to cover illnesses that have a recognised treatment if the patient declines to engage in the treatment of these conditions. This includes also all diagnoses related to alcohol and other drugs addiction problems. If addiction problems are the basis on which you are receiving a sickness benefit, you will be required to show evidence of engagement with a treatment provider (e.g. on-going counselling at CADS or TRANX, having a treatment plan in place with confirmed admission dates for detox (Pitman House or Social Detox) and follow-up treatment programmes (e.g. the Bridge Programme, Higher Ground, Odyssey House, WINGS Trust, AA, NA, Raukura Hauora). Our practice is that the maximum duration for a sickness benefit certificate based on addiction problems is 4 weeks. "

While the City Mission will deal a lot with homeless, and also many alcohol and drug addicts, they are now having their nurse(s) and doctor(s) lay down the harsh rules, by possibly refusing medical certification for needed benefits, if a person seeing them is not able to prove that she/he is "engaged " and committed to treatment, and enrolled with a treatment program provider (for which there usually are waiting lists for weeks if not many months)! How "compassionate " and "caring " a society New Zealand is becoming, under the auspices of Paula Bennett, WINZ and their extremist "Principal Health Advisor " Dr David Bratt!?

The "bio psycho-social model" in its perverted form, as suggested by Mansel Aylward, former Chief Medical Officer for the DWP in the UK, now director of a controversial department doing "disability research" at Cardiff University, and also now advising the Counties Manukau DHB, and other organisations in Australia and New Zealand, is behind all this drive!

It all smells like a nasty "ideology" is taking hold amongst the medical profession, all coming from supposed "international findings" that "work is good for your health", from Mansel Aylward and his fellows, based mostly at Cardiff University in the UK. And WINZ are pushing for doctors to follow suit here in New Zealand!


See 1 more file attached - and also this link to the document found online:

http://www.aucklandc...explanation.pdf



Marc


1 Attachment:


Auck. City Mission, Sickness Benefit explanation, Bratt comment, d-load, 08.04.13.pdf

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#7 User is offline   Marc 

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Posted 06 November 2013 - 03:25 AM

WORK AND INCOME'S DESIGNATED DOCTORS - AS PER LISTING IN LATE AUGUST 2012:


As there is usually not much movement by the doctors that MSD and WINZ use, it can be expected that the list is little changed - still up to this date!


AUCKLAND REGION:

CLIFFORD BRIAN AH KIT, GENERAL PRACTITIONER
NEELA AHMED, GENERAL PRACTITIONER
CECIL W ANTONY, GENERAL PRACTITIONER
SAMIR ANWAR, REHAB MEDICINE
MARK ARBUCKLE, GENERAL PRACTITIONER
RICK BARBER, GENERAL PRACTITIONER
FIONA BROW, GENERAL PRACTITIONER
GRAEME BROWN, GENERAL PRACTITIONER
USHA CHAND, GENERAL PRACTITIONER
SIDNEY TASMAN CHOY, GENERAL PRACTITIONER
HUBERT D'CRUZE, GENERAL PRACTITIONER
KALAWATI DEVA, GENERAL PRACTITIONER
MICK EASON, GENERAL PRACTITIONER
ADRIAN GANE, GENERAL PRACTITIONER
MATTHEW SCOTT GENTRY, GENERAL PRACTITIONER
BRUCE STEPHEN GREENFIELD, GENERAL PRACTITIONER
MARK GROEN, GENERAL REGISTER
CHRISTOPHER GROSS, GENERAL PRACTITIONER
AIDEEN HAWKINS, GENERAL PRACTITIONER
JANE HENRYS, GENERAL PRACTITIONER
HARRY HILLEBRAND, GENERAL PRACTITIONER
DAVID HOADLEY, GENERAL PRACTITIONER
MICHELLE HOLLIS, GENERAL PRACTITIONER
BERNARD KEITH HOLMES, GENERAL PRACTITIONER
SHERYL HOWARTH, GENERAL PRACTITIONER
IVAN HOWIE, GENERAL PRACTITIONER
NEIL HUTCHISON, GENERAL PRACTITIONER
MARK JOHNSTON, MUSCULOSKELETAL MED.
ROY KNILL, GENERAL PRACTITIONER
CHRISTINE LIPYEAT, GENERAL PRACTITIONER
GAVIN LOBO, GENERAL PRACTITIONER
DEXTER LOOS, GENERAL PRACTITIONER
MALCOLM LOWE, GENERAL PRACTITIONER
ALISTAIR DEAN MACKAY, GENERAL PRACTITIONER
WILLIAM MACKEY, GENERAL PRACTITIONER
GARY MACLACHLAN, GENERAL PRACTITIONER
HEIDI MACRAE, GENERAL PRACTITIONER
UMESH PARBHU, GENERAL REGISTER
ROGER PARR, GENERAL PRACTITIONER
GITA PATEL, GENERAL PRACTITIONER
ANDRE PEYROUX, GENERAL PRACTITIONER
CHRISTOPHER (CHRIS) RADLOFF, GENERAL PRACTITIONER
CREASAN REDDY, GENERAL PRACTITIONER
JONATHAN REES, GENERAL PRACTITIONER
HELEN SHRIMPTON, GENERAL REGISTER
ANNIE SI, GENERAL PRACTITIONER
ALISON SORLEY, GENERAL PRACTITIONER
CAROLYN SUTTON, GENERAL PRACTITIONER
JUAN TOLEDO, GENERAL REGISTER
RENATA TOLKS, GENERAL PRACTITIONER
SIOBHAN TREVALLYAN, GENERAL PRACTITIONER
PETER VINCENT, GENERAL REGISTER
JULIET WALKER, GENERAL PRACTITIONER
GRAEME WHITTAKER, GENERAL PRACTITIONER
PETER WOODWARD, GENERAL PRACTITIONER
RODNEY (ROD) WYNNE-JONES, GENERAL PRACTITIONER


BAY OF PLENTY REGION:

JOHN AIKEN, GENERAL PRACTITIONER
GARETH BLACKSHAW, GENERAL PRACTITIONER
NIGEL BRUCE, GENERAL PRACTITIONER
GORDON CALDWELL, GENERAL PRACTITIONER
CHARLOTTE (JANE) CARMAN, GENERAL REGISTER
TIM CHIARI, GENERAL PRACTITIONER
BERNARD CONLON, GENERAL PRACTITIONER
ANDREW CORIN, GENERAL PRACTITIONER
JUDITH DONNELL, GENERAL PRACTITIONER
SIMON FIRTH, GENERAL PRACTITIONER
ALASTAIR FRASER, GENERAL PRACTITIONER
IAN GOURLAY, GENERAL PRACTITIONER
COLIN HELM, GENERAL REGISTER
ROBERT HILLIGAN, GENERAL PRACTITIONER
RICHARD HUDSON, GENERAL PRACTITIONER
BARRY KNIGHT, GENERAL PRACTITIONER
IAIN LOAN, GENERAL PRACTITIONER
HELEN MCDOUGALL, GENERAL PRACTITIONER
SIMON MEECH, GENERAL PRACTITIONER
PAUL NOONAN, GENERAL PRACTITIONER
BRITTA NOSKE, GENERAL PRACTITIONER
DAVID OFFNER, GENERAL PRACTITIONER
ROSEMARY PEDLEY, GENERAL PRACTITIONER
BRIAN PERCIVAL, GENERAL PRACTITIONER
NEIL POSKITT, GENERAL PRACTITIONER
SYMON ROBERTON, GENERAL PRACTITIONER
MALCOLM SCOTT, GENERAL PRACTITIONER
JOSEPH (JOE) SCOTT-JONES, GENERAL PRACTITIONER
GUNAWEN SETIADARMA, GENERAL REGISTER
DEAN TASKER, GENERAL PRACTITIONER
GRAEME TINGEY, GENERAL PRACTITIONER
TESSA TURNBULL, GENERAL PRACTITIONER
JOHN VICKERS, PSYCHIATRY
MARYANN WATSON, GENERAL PRACTITIONER
ROGER WILLIS, GENERAL PRACTITIONER


CANTERBURY REGION:

PHILIP ASHCROFT, GENERAL PRACTITIONER
AVA RUTH BAKER, GENERAL PRACTITIONER
JANE BATCHELOR GENERAL PRACTITIONER
GRAEME PAUL BENNETTS, GENERAL PRACTITIONER
STEPHEN (STEVE) BERRYMAN, GENERAL PRACTITIONER
ROBERT J BLACKMORE, GENERAL PRACTITIONER
GRAEME GEORGE CARPENTER, GENERAL PRACTITIONER
HARSED HIRALAL CHIMA, GENERAL PRACTITIONER
ALAN CRIGHTON, GENERAL PRACTITIONER
IAN CURRIE, GENERAL PRACTITIONER
JOHN L DEWSBURY, GENERAL PRACTITIONER
RICHARD M EDMOND, GENERAL PRACTITIONER
ANTHONY JOHN FERRIS, GENERAL PRACTITIONER
WILLIAM GORDON (BILL) GORDON, PSYCHIATRY
JAMES PHILIP GRAY, GENERAL PRACTITIONER
PETER HARTY, GENERAL PRACTITIONER
LEWIS JOHN HUDSON, GENERAL PRACTITIONER
CLIVE HUNTER, GENERAL PRACTITIONER
STUART KENNEDY, GENERAL PRACTITIONER
PETER LAW, GENERAL PRACTITIONER
KEVIN ROSS LEE, GENERAL PRACTITIONER
STEPHEN LEWIS, GENERAL PRACTITIONER
JOANNE MACGREGOR, GENERAL PRACTITIONER
ANDREW M MANNING, GENERAL PRACTITIONER
ALEXANDER JAMES MARSHALL, GENERAL PRACTITIONER
RICHARD ANTHONY MCCUBBIN, GENERAL PRACTITIONER
STEPHEN A MCGREGOR, GENERAL PRACTITIONER
WILLIAMPAUL(BILL) MCSWEENEY, GENERAL PRACTITIONER
PETER IAN MOODY, GENERAL PRACTITIONER
RICHARD NEWMAN GENERAL, PRACTITIONER
VIVIENNE PATTON, GENERAL PRACTITIONER
DAVID RICHARDS, GENERAL PRACTITIONER
GRAHAM GEORGE RITCHIE, GENERAL PRACTITIONER
DAVID RITCHIE, GENERAL PRACTITIONER
JANET PATRICIA ROBINSON, GENERAL PRACTITIONER
BEVAN LLOYD ROGERS, GENERAL PRACTITIONER
DAVID ROLLINSON, GENERAL PRACTITIONER
PETER HUGH SHARR, GENERAL REGISTER
MURRAY RUSSEL SMITH, GENERAL PRACTITIONER
LINDSAY JOHN WILLIAM STRANG, GENERAL PRACTITIONER
JEFF THOMPSON, GENERAL PRACTITIONER
GERALDINE FIONA TREVELLA, GENERAL PRACTITIONER
PAUL WANTY, GENERAL PRACTITIONER
HAMMOND WILLIAMSON, GENERAL PRACTITIONER
HOWARD WILSON, GENERAL PRACTITIONER
MARK WINTER, GENERAL PRACTITIONER
REX YULE, GENERAL PRACTITIONER


CENTRAL REGION:

PAULINE BLACKMORE, GENERAL PRACTITIONER
KELVIN DE GINDER, GENERAL PRACTITIONER
JURRIAAN DE GROOT, REHAB MEDICINE
KHONDOKER MAHEN HABIB, GENERAL PRACTITIONER
JULIAN JAMES-ASHBURNER, GENERAL PRACTITIONER
DELAMY KEALL, GENERAL PRACTITIONER
CHRIS LANE , GENERAL PRACTITIONER
JANE LAVER, GENERAL PRACTITIONER
STEPHANUS (STEPHAN) LOMBARD, GENERAL PRACTITIONER
QUENTIN MACMURRAY, GENERAL PRACTITIONER
RITA EILEEN MIDDLETON, GENERAL PRACTITIONER
JONATHAN MORTON, GENERAL REGISTER
IYNKARAN PATHMANATHAN (NATHAN), GENERAL PRACTITIONER
GREIG RUSSELL, GENERAL PRACTITIONER
SAM WILSON, GENERAL PRACTITIONER
RENNIE YOUNG, GENERAL PRACTITIONER


EAST COAST REGION (NORTH ISLAND):

TIMOTHY R (TIM) BEVIN, GENERAL PRACTITIONER
AVANI KARL, GENERAL PRACTITIONER
JONATHAN (JON) EAMES, GENERAL REGISTER
KAMAL KARL, GENERAL PRACTITIONER
RICHARD LOAN, GENERAL PRACTITIONER
RACHEL MONK, GENERAL PRACTITIONER
VIVIAN (VIV) ROBERTS, GENERAL PRACTITIONER
ALAN WRIGHT, GENERAL PRACTITIONER


NELSON REGION (INCL. WEST COAST, MARLBOROUGH):

PEDER AHNFELDT-MOLLERUP, GENERAL PRACTITIONER
GLENDA BARBER, GENERAL PRACTITIONER
MARIJKE BOERS, GENERAL PRACTITIONER
TIM BOLTER, GENERAL PRACTITIONER
DAVID (BUZZ) BOOTHMAN-BURRELL, GENERAL PRACTITIONER
ANNA DYZEL, GENERAL PRACTITIONER
PETER GRIFFITHS, GENERAL PRACTITIONER
TIMOTHY (TIM) HANBURY-WEBBER, GENERAL PRACTITIONER
NICHOLAS G HASSAN, GENERAL PRACTITIONER
BRUCE LINTERN, GENERAL PRACTITIONER
LUCIA MITCHELL, GENERAL PRACTITIONER
STUART MOLOGNE, GENERAL REGISTER
FIONA JANE MORRIS, GENERAL REGISTER
IAIN RUSSELL, GENERAL REGISTER
MARTIN SMITH, GENERAL REGISTER
GREVILLE WOOD, GENERAL PRACTITIONER


NORTHLAND REGION:

KATHLEEN BAKKE, GENERAL PRACTITIONER
GEIR BJORNHOLDT, GENERAL PRACTITIONER
SIMON DAVID BRISTOW, GENERAL PRACTITIONER
SHANE CROSS, GENERAL PRACTITIONER
GRAHAM FENTON, GENERAL PRACTITIONER
IAN MARK HOFFER, GENERAL PRACTITIONER
STUART D NORRIE, GENERAL REGISTER
SUZANNE PHILLIPS, GENERAL PRACTITIONER
IAN CHRISTOPHER SMIT, GENERAL REGISTER
JONATHAN SPRAGUE, GENERAL PRACTITIONER
ANTHONY (TONY) STEELE, GENERAL PRACTITIONER
PETER GEORGE H SUMMERS, GENERAL REGISTER
ALISTAIR D WHITTON, GENERAL PRACTITIONER
CECIL WILLIAMS, GENERAL PRACTITIONER


SOUTHERN REGION (SOUTH ISLAND):

DAVID ALLEN, GENERAL PRACTITIONER
PAUL BENNETT, GENERAL PRACTITIONER
NEIL BUNGARD, GENERAL PRACTITIONER
JOANNE CANNON, GENERAL PRACTITIONER
THERESA P COCKS, GENERAL PRACTITIONER
JAMES (JIM) COLLINS, GENERAL PRACTITIONER
DIANA ALISON COOK, GENERAL PRACTITIONER
SARAH CREEGAN, GENERAL PRACTITIONER
MARK CURTIS, GENERAL PRACTITIONER
STEPHEN J DAWSON, GENERAL PRACTITIONER
ROGER DEACON, GENERAL PRACTITIONER
RONALD LEON DITTRICH, GENERAL PRACTITIONER
PETER FETTES, GENERAL PRACTITIONER
LINDSAY (ROSS) FIELDES, GENERAL PRACTITIONER
NICHOLAS (NICK) GIBLIN, GENERAL PRACTITIONER
WILLIAM GROVE, GENERAL REGISTER
PATRICIA (PAT) HASTILOW, GENERAL PRACTITIONER
ROBERT STANLEY HEPBURN, GENERAL PRACTITIONER
MARIUS HILL, GENERAL PRACTITIONER
MURRAY JUDGE, GENERAL PRACTITIONER
COLEEN LEWIS, GENERAL REGISTER
TABITHA LUECKER, GENERAL PRACTITIONER
EMMA MACCALLUM, GENERAL PRACTITIONER
ANDREW IAN MCLEOD, GENERAL PRACTITIONER
MARY MCSHERRY, GENERAL PRACTITIONER
BRYAN MOORE, GENERAL PRACTITIONER
ANTHONY (TONY) MORRIS, GENERAL PRACTITIONER
WAYNE MORRIS, GENERAL PRACTITIONER
BRENDAN PAULEY, GENERAL PRACTITIONER
JONATHON (JON) SCOTT, GENERAL PRACTITIONER
BRUCE SMALL, GENERAL PRACTITIONER
NICHOLAS TERPSTRA, GENERAL PRACTITIONER
MARTYN IAN WILLIAMSON, GENERAL PRACTITIONER
CHRISTINE WILLIAMSON, GENERAL PRACTITIONER
ANDREW WILSON, GENERAL PRACTITIONER


TARANAKI REGION:

DAVID E BALDWIN, GENERAL PRACTITIONER
ESTHER BGANYA, PSYCHIATRY
JOHN CANTILLON, GENERAL PRACTITIONER
JAMES (JIM) CORBETT, GENERAL PRACTITIONER
ANDREW (ANDY) CORSER, GENERAL PRACTITIONER
ANNE FARNELL, GENERAL PRACTITIONER
SAMIR HEBLE, GENERAL PRACTITIONER
TREVOR HURLOW, GENERAL PRACTITIONER
MURTAZA K (MUZU) KHANBHAI, GENERAL PRACTITIONER
ANTHONY ROSS MARSHALL, GENERAL PRACTITIONER
DAVID MCLEAN, GENERAL REGISTER
JOHN MOORE, GENERAL PRACTITIONER
MANJUR MORSHED, GENERAL PRACTITIONER
SUJATHA GRACE PAUL, GENERAL PRACTITIONER
HAROLD EDWIN PFEFFER, GENERAL PRACTITIONER
BRUCE RONALD PHILLIPS, GENERAL PRACTITIONER
SATYA PRAKASH, GENERAL PRACTITIONER
GAIL RICCITELLI, PSYCHIATRY
MANMOHAN SINGH, GENERAL PRACTITIONER
DAVID TALBOT, SURGEON
MICHELLE TODD, GENERAL PRACTITIONER
ANTHONY (CAMPBELL) WHITE, INTERNAL MEDICINE
LYN WHITE, GENERAL PRACTITIONER
KENNETH YOUNG, GENERAL PRACTITIONER


WAIKATO REGION:

MARY BALLANTYNE, GENERAL PRACTITIONER
RICHARD BALLANTYNE, GENERAL PRACTITIONER
ROSS DOUGLAS BLAIR, SURGEON
FARINA BRADY, GENERAL PRACTITIONER
SHRI CHAND, GENERAL PRACTITIONER
JOHN COLLIER, PSYCHIATRY
M K RANJITH COORAY, GENERAL PRACTITIONER
SANDRA FLOOKS, GENERAL REGISTER
MOHAMED HARIS FUARD, GENERAL PRACTITIONER
SUE GENNER, GENERAL REGISTRY
SUZANNE GREAVES, GENERAL PRACTITIONER
PETER HARRISON, GENERAL PRACTITIONER
KERRY HENNESSY, GENERAL PRACTITIONER
THOMAS FRASER HODGSON, GENERAL PRACTITIONER
STEPHEN (STEVE) JOE, GENERAL PRACTITIONER
MICHAEL KAHAN, GENERAL PRACTITIONER
ZIYAD (ZIG) KHOURI, GENERAL PRACTITIONER
AMRIT LAD, GENERAL PRACTITIONER
REETA LOCHAN, GENERAL PRACTITIONER
MICHAEL J MILLER, GENERAL PRACTITIONER
CHRISTOPHER (CHRIS) MILNE, GENERAL PRACTITIONER
ANDREW MINETT, GENERAL PRACTITIONER
DANIEL J (DANNY) NEAVE, GENERAL PRACTITIONER
JANE O'DWYER, PSYCHIATRY
ASIT PAREKH, GENERAL REGISTER
DEEPANI PERERA, GENERAL PRACTITIONER
ALFRED PINFOLD, GENERAL REGISTER
NAVIN RAJAN, GENERAL REGISTER
RAJINDER K SAINI, GENERAL REGISTER
LYUTSIYA S (LUCY) SLOOTSKY, GENERAL REGISTER
CHRISTOPHER MICHAEL SMILEY, GENERAL PRACTITIONER
BARBARA LESLEY TOPPING, GENERAL PRACTITIONER
MARK VAUGHAN, GENERAL REGISTER
BARRIE LEWIS WINN, GENERAL PRACTITIONER


WELLINGTON AND HUTT REGION:

GUY JENNER, GENERAL PRACTITIONER
RANATUNGA A KALUPAHANA, GENERAL PRACTITIONER
PATRICIA NEAL, GENERAL PRACTITIONER
PENELOPE (PENNY) ROWLEY, GENERAL PRACTITIONER
IAN ST GEORGE, GENERAL PRACTITIONER


These are the names that were on a list that was current as of 20 August 2012, and the regions listed are MSD regional administrative areas (hence some may also include close neighbouring geographical areas).

Please bear in mind that some of these "designated doctors" are used more frequently than others, yes, anecdotal information says that some are like "hatchet doctors", as they appear to deliver the recommendations that WINZ and MSD prefer, similar to the way ACC uses some "preferred" assessors, although they will of course never admit this!

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#8 User is offline   Marc 

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Posted 06 November 2013 - 03:56 AM

RECENT MEDIA REPORTS INDICATE THAT THERE MAY BE MAJOR CHANGES IN THE ASSESSMENT PROGRAM THAT MSD USE, AND IT LOOKS LIKE AT LEAST SOME FUTURE ASSESSMENTS OF SICK AND DISABLED BENEFICIARIES WILL BE CONDUCTED BY CONTRACTED OUT SERVICE PROVIDERS:

See the following headlines, links and extracts from reports:


'Contractors to assess sick and disabled for work'

BEN HEATHER

03/11/2013


http://www.stuff.co....sabled-for-work


"Private contractors will be paid $650 an assessment to get thousands of New Zealand's sick and disabled ready to return to work.
From February, Work and Income will pay private "medical assessors" to scrutinise sickness and disability beneficiaries who it believes can work.
Only the most difficult beneficiaries, those Work and Income could not find jobs for, would be seen by the assessors. Many could be obligated to complete assessments or face cuts to their benefit."


"The medical assessors will be paid $650 per assessment, which are expected to take about three hours, and are prompted to recommend lifestyle changes to help the beneficiary get a job, such as a "positive approach to life" and more time at the gym. It is expected eventually 3000 disabled people a year will have to visit an assessor, who will judge their fitness for work and report back to Work and Income."

"Disabled people on a benefit are also facing extra scrutiny, with a stronger emphasis on their capacity to work. But disability advocates are wary of the outsourcing scheme, with a similar model in Britain hit by controversy."





Tests for disabled 'flawed model'

http://www.odt.co.nz...ed-flawed-model


By Eileen Goodwin on Fri, 25 Oct 2013


"New work assessments for the disabled and people with health conditions will impose "unnecessary angst" and wrongly put the onus on clients rather than employers, CCS Disability Action Otago patron Donna-Rose McKay says.

Details of the tests, which start early next year, have been released to the Government's electronic tenders website in a Ministry of Social Development request for proposal.

Mrs McKay believed New Zealand was adopting the same "flawed model" as Britain, where work-testing the disabled was highly controversial."

"Work and Income expects up to 1000 clients to be referred for a ''work ability assessment'' between February and June next year, about 2000 in 2014-15, and about 3000 the next year, the proposal document said. The provider would receive $650 (GST exclusive) for each completed assessment. The process would take about three hours, which included a one-hour face-to-face assessment."

""This assessment will be done by a suitably qualified medical or health professional, who will take a fresh look at a person's ability to work, along with the supports and services they need to find and stay in work." "The work ability assessment is intended to take a broader, holistic approach to the factors affecting a client's ability to work," the document said.

Dunedin disability researcher Chris Ford said the tests were likely to find most people able to perform some kind of work, taking no account of the wider economic situation."



Comment:

It may well be that these outsourced, private contractors will only be used for special clients to be assessed, and that "designated doctors" will continue to be used for the rest of sick and disabled WINZ clients. But this development is a very major one, and an extremely worrying one, as the experience in the UK with ATOS has shown.

All affected should be very much on guard, and prepare to attend any "examinations", "assessments" and the likes with "designated doctors", outsourced "assessors" and even with WINZ "interviewers" conducting "work preparedness" conversations together with a support person. This will minimise the risks of being taken advantage of, and of being pressured or misled into unacceptable decisions and "results".

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#9 User is offline   Marc 

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Posted 06 November 2013 - 04:04 AM

A MUST READ FOR ALL FACING "DESIGNATED DOCTOR" OR SIMILAR ASSESSMENTS:


"What to do if you are required to see a WINZ designated doctor":

http://accforum.org/...ignated-doctor/


And this thread also looks extremely informative and uncovers what is behind the whole "welfare reform agenda" here and in the UK:

http://accforum.org/...-and-acc-compo/

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#10 User is offline   not their victim 

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Posted 06 November 2013 - 09:01 AM

great work Marc

thank you so much.
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#11 User is offline   unit1of2 

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Posted 06 November 2013 - 10:12 AM

11 months I waited for Beaumonts report to come through.....only just received it a few days ago. I never received the DuPlessis Addendum he wrote... till yesterday when ACC told me they had considered Beaumonts, DuPlessis and the further dodgey antics of Sth Reh'b unit person whom just like DuPlessis took months to send their reports to me, OH and to my Doctor whom ever received them either. I was given 4wks termination notice yesterday.

How one is supposed to survive I don't know. I worry very much what I am to do, my animals I worry for to.


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#12 User is offline   not their victim 

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Posted 06 November 2013 - 10:20 AM

Hey 1...

hang in there....

I now have evidence that the ACC lawyer lied in Judicial Review!!!!


hard evidence from the lawyers own email.....

thankfully the court has to keep record of what happened on the day....

every day with my injury is tough, as i never know what im facing

but every day, i am one day closer to exposing the truth

lawyer up hun, on legal aid.....its a tough journey ahead...

i had the winter from hell, no heat, no power etc....and facing bankruptcy again!


all thanks to 19 years worth of mistaken identity....

keep up with your files....and challenge everything......

lots of love. xx
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#13 User is offline   sunny 

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Posted 06 November 2013 - 11:46 AM

View Postunit1of2, on 06 November 2013 - 10:12 AM, said:

11 months I waited for Beaumonts report to come through.....only just received it a few days ago. I never received the DuPlessis Addendum he wrote... till yesterday when ACC told me they had considered Beaumonts, DuPlessis and the further dodgey antics of Sth Reh'b unit person whom just like DuPlessis took months to send their reports to me, OH and to my Doctor whom ever received them either. I was given 4wks termination notice yesterday.

How one is supposed to survive I don't know. I worry very much what I am to do, my animals I worry for to.


Go through Beaumonts report very carefully, he contradicts himself in reports, gives his own opinion while ignoring things in reports, hes very sneaky, I had him an found he was the most obnoxious male Iv ever had the misfortune of having anything to do with!
If you can afford it find someone with more qualifications than these 2 idiots an use that at review
Write out a letter of corrections to be place prominently on both of these reports. check every sentence theyv written an correct what needs to be. I sincerly hope you have either a lawyer or an advocate to help you.
Best of luck
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#14 User is offline   unit1of2 

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Posted 06 November 2013 - 11:21 PM

Thankyou heaps for your supportive postings above guys/gals.... if you don't hear anything from me it's because I have no means to be online anymore.

I don't have much brain patience or ability to play detective with all this crap stuff in these reports. DuPlessis, Southern Rehab are pages and pages of bullshit nonsense, repetitive and all over the place, and seriously dodgey at best! Also alot of what they say like Beaumont is a direct result of previous 'embargoed' reports because of consistant inaccuracies.. ACC still used these!! and the use of them 'INHOUSE' was made worse with their 'Summary' reporting styles and tech'necs... sorry spelling??? Due to ACC inhouse summary reporting I was denied Advised Neuropsych rehab via assessments that ACC originally had me do.... ACC have done nothing but deny deny deny.... based on incorrect info and clever fantasy summary opinions... by Inhouse people who have never ever even seen me, nor taken into account any of my statements of corrections OR my written account of actual happenings at the time of accident.

I don't cope with life well since my accident, my head and body let me down. I wish like anything life wasn't like this. I'd much rather have my health and a job!! I'd be so so happy to have it all back!! If I was head and body able I'd be doing it!!! They just don't get it! They don't want to... they are not interested in how your life is no-longer a life, they don't care that one struggles everyday to try and find something to smile about, or feel good about. They don't care or understand how hard life is with Head issues and Cronic Pain, and they get their toadie guys to state these issues are not related to the accident, YET never did I ever suffer with anything of the likes or sort prior to my serious accident!!




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#15 User is offline   Russel 

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Posted 08 November 2013 - 09:22 AM

Take a look at his name "LODEWICUS". Could have some fun with that.

.Below is the registration information for this doctor.

Doctor's detailsName
Du Plessis, Lodewicus Johannes

Status
Practising

Qualifications
MB BCh 1970 Witwatersrand
Bachelor of Medicine Bachelor of Surgery
University of Witwatersrand, South Africa
FCP (SA) 1977
Fellow of the College of Physicians of the College of Medicine of South Africa
College of Medicine of South Africa, South Africa
FAFRM (RACP) 2006
Fellow of the Australasian Faculty of Rehabilitation Medicine of the RACP
Royal Australasian College of Physicians, New Zealand
District
Mosgiel

Practising certificate
from 1 December 2012 to 30 November 2013

Conditions
None

General scope
2 April 2004

Provisional scope
4 April 2003

Scope of practice
General

Vocational

Rehabilitation Medicine (15 May 2006)
Internal Medicine (2 April 2004)


Dr Du Plessis is participating in an approved recertification programme relevant to the vocational scope of Internal Medicine; Rehabilitation Medicine.


Dr Du Plessis may work outside the stated vocational scope but must do so within a collegial relationship.

Definitions of scopes
General
A doctor who has completed a required period of practice in the Provisional General scope of practice will be registered within the General scope of practice.

All doctors who are registered in the General scope of practice must meet recertification requirements set by Council.

The principal recertification programme for General scope registrants requires enrolment in the 'inpractice' programme, administered by bpacnz. The recertification programme requirements include that doctors establish a professional collegial relationship with another doctor who is registered within the same or related vocational scope.

Limited exceptions to the requirement to enrol in the bpacnz recertification programme exist for General scope doctors who:

- are enrolled as a registrar and participating in a Council-accredited medical college vocational training programme. (these doctors will have an established relationship with a supervisor):

- have had their scope limited by the Medical Council to non-clinical practice.

Vocational
A doctor who has completed his or her vocational training as a consultant and has appropriate qualifications and experience can be registered within a vocational scope of practice.

A doctor registered in a vocational scope must participate in an approved continuing professional development programme to maintain competence and be recertified each year.

Rehabilitation Medicine
Rehabilitation Medicine is the medical care of patients in relation to the prevention and reduction of disability and handicap arising from impairments, and the management of patients with disability from a physical, psychosocial and vocational view point.

Internal Medicine
Internal Medicine is the diagnosis and management of patients with complex medical problems which may include internal medicine, cardiology, clinical immunology, clinical pharmacology, endocrinology, gastroenterology, geriatric medicine, haematology, infectious diseases, medical oncology, nephrology, neurology, nuclear medicine, palliative medicine, respiratory medicine and rheumatology.

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#16 User is offline   Marc 

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Posted 10 November 2013 - 11:35 PM

Here is another, newer "presentation" that Dr Bratt put together with Anne Hawker. I suspect though that Bratt has the greater input and only uses her name to "share" the responsibility (and "guilt"):


"Overcoming and Challenging Adversity – the Prequel"

(Social Welfare in NZ 2013)

Dr David Bratt – Principal Health Advisor

Ministry of Social Development

Anne Hawker – Principal Disability Advisor

PMAANZ Conference 2013 Sept


See the attached version in PDF format, which can also be found on the "web" by doing a search and then downloading it!

Here is a LINK by the way:

http://www.conferenc...610%20david.pdf


There are also two other "scan copies" of presentations obtained by way of an O.I.A. request some time ago. Sadly they are a bit too large to load here.

Now Dr Bratt appears to avoid the likening of "benefit dependence" to "drug dependence", but he now seems to be promoting the availability of "special needs grants" to women, who may wish to have long lasting contraception implants and the likes, helping them to become "more attractive to employers". It all shines more light on the "mindset" and pursued "agenda" of our dear "Dr David - the Bratt"!

As I am always doing a bit of part time research, you can count on a bit more to come on all this!

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#17 User is offline   Marc 

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Posted 11 November 2013 - 12:20 PM

There is another interesting "memo" from MSD that is from 23 Jan. 2008, and was sent internally by a J. Russell (Training Manager) and M. Mortensen (Communications Manager) to Dr David Bratt (PHA) and a few others, offering an overview of proposed training for "designated doctors", which somebody made available to me. It appears to have been obtained by way of an O.I.A. request. I made some references to this "memo" above in "comment" number 1.

I forgot to include it in the above, but referred to it in one "comment". It is titled 'DESIGNATED DOCTOR TRAINING AND COMMUNICATIONS REQUIREMENTS' and gives details about what was already decided and planned, but needed to be done to progress the training program. It ties in with other documents about the planning, preparation, organisation and implementation of the training, which actually later occurred between August and October or November in late 2008 (through work-shops all over New Zealand).


On page 2 at the bottom of a chapter titled 'Background' there is mention of the following:

"To ensure designated doctors understand their role and the expectations placed on them by Work and Income, it is recommended that they receive regular communication and attend a training program."


Under another heading on the same page, being 'Communications Approach', it reads:

"Regional training sessions for designated doctors provide an opportunity to further develop sustainable working relationships with one of Work and Income's key partners - health practitioners."

"This training opportunity sets a platform for further communication and greater understanding of the objectives of the Working New Zealand programme."


It also says:

"Communication will be:

...
tailored to designated doctors
...
regular and ongoing."



On page 3 it says under 'Training Approach' that:

"Work and Income has never provided training for designated doctors..."

"Attending a training course should be compulsory for a doctor to remain a designated doctor. A range of times and locations are available to doctors to ensure they are able to attend a training program. This minimises associated travel costs for the Ministry of Social Development (MSD)."

"Regional staff will be encouraged to attend the training sessions so they can meet the local designated doctors and connect what they have been told about the process with the designated doctors."


On page 5 there are details listed under 'Timing', and further down on the page there are also listed cost items that would be covered, which includes travel and accommodation for presenters, food and drink (i.e. finger food and non-alcoholic drinks), attendance fees, transport costs for out of town doctors, and even accommodation for those doctors traveling from out of town.

One sentence is of interest, and it says:

"Food and non-alcoholic drinks could be provided on arrival or to assist social networking after the formal presentation."



Comment:

Now this gives an idea about how "designated doctors" and WINZ staff were actually going to be encouraged to "connect", exchange themselves and do "social networking", which again raises serious questions about what else may have been "communicated", what Dr Bratt and Dr Rankin verbally communicated also during the formal training, and how attempts were apparently made to "influence" the doctors, who under the law and processes to follow are meant to be totally INDEPENDENT!


P.S.:

Also attached is only half of Dr Bratt's more recent "presentation" called 'Happy Docs - Doctors and Documents' (fr. 2013, pages 1 to 18), as the other half of scan copies of it, contained in a separate PDF, is too large and takes too long to load here. But I believe that one can be found on the web, by a link already offered further above (see bottom of attachments to the "comment" 1).

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#18 User is offline   Marc 

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Posted 11 November 2013 - 12:44 PM

Further to "comment" 8, where recent media reports were quoted, and where links lead to articles in 'stuff.co' and the 'Otago Daily Times', there appears to have been a major submission made by the 'New Zealand Medical Association' (NZMA) (like possibly from some others), regarding MSD's plans to outsource and use private assessors to assess work capability of sick and disabled dependent on WINZ benefits.


Their submission from 25 September 2013 expressed some serious concerns that certain professionals were apparently intended to be used, who lacked sufficient, proper "medical qualifications". It can be found on the web via this link here:


http://www.nzma.org....s-Providers.pdf


(A downloaded copy is attached also.)


So it will be interesting to see, what king of staff and "professionals" MSD and WINZ will use when they start their new, supposedly "independent" assessments of sick and disabled on benefits from February 2014, which so far all sounds very much as being along the lines of what ATOS were doing for the Department for Work and Pensions (DWP) in the UK.

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#19 User is offline   anonymousey 

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Posted 11 November 2013 - 01:06 PM

Thank you for keeping on keeping on with updating this very important information Marc :)

I have had a bit more additional ATOS & DWP material sent my way lately so will try to process it & upload asap FYI :)

& this link may be of interest too + I shall try and update the thread with community stories highlighting these lifethreatening consequences for vulnerable people :(

http://accforum.org/...070#entry172070
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#20 User is offline   not their victim 

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Posted 11 November 2013 - 01:39 PM

Privacy Debalce

issue 1 privacy
issue 2 SCU
issue 3 ACC ASSESSORS! AND MINIMIZING LONG TERM ACCESS TO TREATMENT AND REHABILITATION



THE MEDIAN FOR 403 ASSESSORS REPORTS BETWEEN 5 assessors....WAS WAS 245, 000!






tut tut tut, they would be better off putting the money into rehab, than falsified reports, farcical drsl, and then District Court..


how many are on the payroll, just to keep you from entitlement....???


all seems like a horrific nightmare IMHO of course....
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