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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???*****
Attached File(s)
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David-Bratt-Benefit-Sunshine.pdf (356.66K)
Number of downloads: 3 -
Fri_DaVinci_1400_Bratt_Medical Certificates are Clinical Instruments too - June 2012.pdf (402.76K)
Number of downloads: 4 -
C1 1515 Bratt-Hawker, 'Ready, Steady, Crook - Are we killing our patients with kindness', present'n, 2010.pdf (219.46K)
Number of downloads: 2 -
Dr D. Bratt, MSD, 'Harm lurks for benefit addicts', article, NZ Doctor, 01.08.12, scan, 18.08.2012.pdf (660.82K)
Number of downloads: 2 -
Dr D. Bratt, MSD, PHA, critical ltr by reader T. Walker Nelson, NZ Doctor, 29.08.2012.pdf (273.59K)
Number of downloads: 2 -
Medical Council of NZ, Dr David L. Bratt, GP, registration details, current as on 29.08.2012.pdf (533.34K)
Number of downloads: 2 -
MSD, O.I.A. Request, Reg. Health Advisor, position description, highlighted points, Feb., 2007.pdf (2.91MB)
Number of downloads: 2 -
MSD, O.I.A. Request, Princ. Health Advisor, position description, highlighted points, Jan. 2007.pdf (3.19MB)
Number of downloads: 2 -
D-Bratt.ppt (411.5K)
Number of downloads: 1 -
Bratt + Aylward - Shifting Your Primary Focus to Health and Capacity, June 2013.pdf (799.42K)
Number of downloads: 2 -
1100 - cs3-a - happy docs true generalism with welfare reform - david bratt.pdf (523.16K)
Number of downloads: 3
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