Nottinghamshire Injury on Duty Reassessment Program – Part 2

“People who know what they’re talking about don’t need PowerPoint.”
― Walter Isaacson, Steve Jobs

Welcome to part two. If you missed part one, here’s the recap:  Dr Ralph Sampson and Stephen Mitchel of Nottinghamshire Police, in December 2015, gave a presentation to National Attendance Management Forum (NAMF) delegates about how they are attempting to save millions of pounds by ‘cunningly’ and nefariously reducing injury awards.  The nightmare scenario of an active SMP such as Dr Sampson making an unintentional error of revealing his subconscious feelings that a review allows him to perform a ‘reassessment’, mixed with the total absence of referencing any case-law to the audience, leads to emboldened NAMF delegates going back to their forces thinking IODs are ‘ducks to be lined up’.

Notts-IOD-Presentation.pdf

Jumping straight in to where we left off in part one, slide 6 is a rather amateur  and extremely poorly presented summary of some of the statistics generated by the Notts ‘reassessment’ program so far.  There are few people on this planet that would admit to liking staring at text more than they like staring at pictures. Text takes time to read and it is boring to look at. But perhaps worst of all, when an audience is given text, they will, out of habit, attempt to read it. As they do so, you will be talking and they won’t be listening—because they’re reading. But they won’t be able to concentrate on what they’re reading because, well, you’re talking. It’s the vicious cycle of PowerPoint un-communication.

This is expounded further when the numbers don’t add up.  And the audience aren’t going to argue otherwise as they’re all too busy trying to fathom out what the heck is going on in the jumble of words in front of them.

6.Numbers so far

• 381 former officers in receipt of lOD pension,
• 281 aged under 70 and included in programme
• Concluded or currently in process = 235 (16 batches) (87%)
• Number of paper reviews undertaken so far = 140
  • 62 ‘no further action’ (44%)
  • 78 ‘ possible substantial alteration” (56%)
• Individuals where SMP review no longer required:- 26 (deceased; age
  exempt; band 1 non-participants; terminal diagnosis)
• 78 SMP face to face assessments
  • 2O reduced
  • 1 increased
  • 21 remained same
  • 27 appointments scheduled
  • 9 seen and Force awaiting outcome

In about five minutes we’ve cobbled together this graph.

It isn’t perfect but we weren’t the ones giving the presentation.  What it does show is,  out of the numbers given above, 69 out of the 381 are unaccounted for.  They haven’t been reviewed, presumably they aren’t going to be reviewed and they are not in the exempted cohort.

What’s happened to them?  These numbers represent people – disabled former officers and Notts have just erased them from their presentation.  Perhaps they are selective in the data they want to portray. Notts definitely aren’t persistent in chasing a ‘non-engaging band one’ in comparison to when they attack, with shark-like ferocity, a ‘non-compliant’ band four.

The bottom line is that any way that you look at the figures, they are wrong, and they do not stand up to scrutiny.  We have provided the proof of our assumptions at the bottom of this page for the benefit of the mathematically minded. *

This presentation is purportedly given by ‘professionals‘ to ‘professionals‘. They can’t even get their maths right.  Dr Sampson supposedly makes sophisticated calculations of a former officers degree of disablement down to 2 decimal places but he is unable to subtract from 381.

7.Numbers so far

Of 42 ‘face to face’ SIVIP assessments where advised of outcome (28 days elapsed) – 21 changed bands (50%)
PMAB appeals = 3 potential
Numbers reduced to B1 due to non-compliance : O
Number of official complaints = 1

Slide 7 is aimed at promoting the perception that  their ‘reassessment’ program is all about forcing a change to bands and spinning the lie to the NAMF delegates that there are few pitfalls.  There is no neutrality and the agenda is always to change the status-quo. Why emphasis those changed when those kept the same outnumber the former and have just as much  relevance?   There has been 1 complaint and 3 appeals.  This slide skirts over the reason for the appeals and fails to state the outcome of the complaint.

Just because there is no appeal, it doesn’t mean the decision was just or legitimate.  Perhaps the ‘fight’ has left the former officer and they can’t cope with the dehumanising nexus of appeal forms and procedure.  Despite the strength of their appeal, they make a conscious choice that appealing against the  harmful side of bureaucracy is futile.  In the Judicial Review case of Crudace, the presiding  judge stated that twenty-one appellants withdrew their appeals after receiving a letter from the force Solicitor Nicholas Wirz, that in effect threatened the disabled former officers with a £6,200 adverse costs award if they persisted with their appeal.

Winston Churchill once said that the whole history of the world is summed up in the fact that when nations are strong they are not always just, and when they wish to be just they are no longer strong. And there is the clearest explanation possible of the case for justice where the former officers involved are not strong enough to do that themselves.  Banking on the weak to not appeal is a pitiful and inexcusable show of strong-arm tactics.

Stating the number of appeals is meaningless.  As far as Sampson & Mitchel are aware all twenty that were reduced could be submitting their complaints to the Pension Ombudsman.

The red highlighted bullet point shows the new invented weapon in the armoury of those SMPs trained by NAMF.   The weapon of mutual destruction (WMD) is in the form of ‘if the former officer is non-compliant then we will reduce to band one.’  Of course, such a bullying course of action is not permitted anywhere in the Regulations.  The presentation makes no reference to the actual Regulation 33 that only permits the police pension authority to make a determination on the available evidence if there is a failure to attend a medical examination.  Pressing the ‘big red button’ on this WMD will be financial catastrophe for the victim but the response would be so massive that Notts would suffer “assured destruction” at Judicial Review.

8. £ to date

Funding for programme agreed
GP notes – approx £50 each
Impact to date -18 out of 21 that have changed band = £10ok net saving per year
With average life expectancy estimated at age 83…possible £20 million saving on the cases so far.

And the spin continues with slide 8.  With a slide callously titled ‘£ to date‘ there is no doubting this is all about the money and this not about a genuine medical assessment, but rather, an opportunity for Notts to take away the injury award the former officer is entitled to.

The slide assumes the ‘savings’ are fixed.  That Notts have got what  they wanted, they can spend the £20 million they will save over the lifetime of those reduced and that’s the end of the matter. This could not be further from the truth.

This mindset is further evidence that Sampson cares not for the Regulations but only to please his bosses.  Those reduced on his evidence of an improvement to their degree of disablement are surely, under the logic of Sampson’s suitable interval and positive power to review, absolute certainties to be reviewed again and their degree of disablement invariably likely to deteriorate accordingly.

Sampson & Mitchel surely can’t  be insinuating  that Regulation 37 vanishes once Notts  have got their way, and once the goal of reduction is achieved then the former officer is gone clean out of their mind and consigned to oblivion?

The stench of hypocrisy oozes from slide 8.  Later in the presentation (slide 15 to be exact) Sampson makes his brazenly duplicitous point that former officers were ‘reluctant to engage’ and there is a ‘misunderstanding from officers who claim previous SMP advised for life’.  But in slide 8 Sampson is saying the reduction in banding is for life – with no balance check review ever again to see whether the reduction is perdurable.

9.

We have heard recently of an Australian qualified physiotherapist who is being used as an SMP. He has never practiced general medicine and although registered with the GMC is not on the GP register. How could someone like that be qualified to form an opinion on PTSD or complex trauma injuries? I wouldn’t let him lance a boil on my bum let alone make a decision about my degree of disablement.
I am sorry to say, but he is by no means untypical.
Forces are deliberately hiring the lowest level ofthe medical profession – those for whom payment was” ___is more important than professionalism

Slide 9 would be hilarious is the issue wasn’t so serious.  A bias SMP, dancing to the tune of his paymasters and forgetting his Hippocratic oath, criticising other forces from using not only an physiotherapist – but an Australian physiotherapist!  The nerve.  These antipodeans coming over here and taking money from members of the faculty of occupational health – it’s obscene!

10. IOD REVIEW – Medical Assessment – REG 37.1

No pre-conditions for Reg 37.1 review suitable intervals
Degree of disability vs degree of disablement Need to clarify
Complete GP records/OHU records
Can’t revisit causation
Reviewing LOE calculation

Slide 10 incorrectly says there is no pre-conditions for a suitable interval.  If this was the case the ‘suitable interval’  qualifier would not have been written into the Regulations.  In fact the interval between reviews has a defined pre-condition – it has to be suitable, right or appropriate for a particular person, purpose, or situation.  The pre-condition is implicit.

The presentation is also confused about their remit as they need to clarify whether a review concerns the Degree of disability vs degree of disablement.  Surely it is rather too late to be asking such a question?  The revisiting causation is a contradiction as that is exactly what they do in slide 14 but we will come to that later.

LOE is their acronym for level of earnings.  Again this is contrary to the Laws judgement.  We think that the 3 appeals now have the evidence they need to overturn Dr Sampson’s decisions.

11. IOD REVIEW – Medical Assessment – REG 37.1
Degree of Disablement – The degree to which their earning capacity is reduced by the injury condition, and expressed as a % of the appropriate comparator salary

(UEC-AECVCOMP SALARY
UEC – Uninjured earning capacity – same as Comp salary if no non-injury conditions affecting earnings
AEC – Actual Earning Capacity – takes into account injury and any non-injury conditions if present

Slide 11 defines degree of disablement.  Sampson & Mitchel are totally incorrect to say it is expressed as a percentage of comparator salary.  In fact it is minimum income guarantee expressed as % of the final average pensionable pay.

12.

Change in assessed LOE
Change in assessed LOE
Medical condition – improve/worsen
Non injury medical conditions affecting work capability/earnings
New Training/Qual Skills
New job/career opportunities – may be evidenced by salary

Slide 12 shows this ‘reassessment’ program is really an unlawful work capability test.

13. Outcomes so far
Paper Screen – 157
Assessments – 55
No change – 22
Change in perm disabling condition – 2
Non injury conditions – 14
Salary – 6
Change to comparator salary – 3

Slide 13 is another example of Sampson & Mitchel’s figures not standing up to scrutiny.

Remember slide 6 and the bullet point informing everyone that 140 had been papered reviewed?  By slide 13 of the same presentation this number has increased to 157.  In other words, whilst Sampson & Mitchel were talking to the NAMF delegates, at the same time and without a pause of breath, they magically managed to paper review another seventeen people.

Of the  former officers who had a change of banding, only two had a change in their disabling condition – the prerequisite for substanstial change as dictated by the Laws judgement.  But again the numbers do not add up.  Earlier in the presentation it was stated there was twenty-one former officers who evidenced substantial alteration and had their bands changed.  On this slide the count is twenty-five.

Fourteen former officers had their award reapportioned.  Six reported a salary of whatever amount and had their awards changed.  It is evident that Sampson has not been following the Laws determination at all.

14. Diagnoses l Causation
LBP – playing table tennis at lunchtime
No of sports injuries
Neck Pain – 80% – then commercial pilot for 12 years
Collapsing chairs
“Psychological defects of Low Self esteem and Low Confidence” Band 1

Slide 14 revisits causation.  An avenue barred to any SMP upon a review and explicitly referred to as verboten in slide 10.   This slide is one of those faux ‘humorous’  ones – put in so that everyone in the audience can have a good giggle.  The commercial pilot anecdote is intended to spark outrage from the delegates.  What it takes out of context is the pilot could have been earning £160K a year if his neck injury didn’t restrict his flying hours.  Instead he is only earning, say £80K.  This analogy is pure supposition, but technically this fictional example has lost 100% of his potential capacity to earn.  Rather than point out a similar possibility, Sampson & Mitchel use a sensational tabloid headline, absent of any context, to get the delegates ‘clucking’.

Mentioning sports injuries is another example of sensationalism.  The last final decision is a given and it is not up the the SMP to revisit the medical judgement of the previous doctor.

The ‘loss of confidence’ is a repulsive bullet point.  If the index injury is, or leads to, an impact to self-esteem of the former officer by psychological detriment to the capacity to earn then the award is designed to reflect this.  Such a detriment often means that there is no prospect of maintaining any employment.

A previously high-functioning individual who attained all the tests to become a police officer and is now unable to leave their home due to psychological affect of low self-esteem and poor confidence is, by definition, suffering from a personality disorder.  People with avoidant personality disorder often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. As the name suggests, the main coping mechanism of those with avoidant personality disorder is avoidance of feared stimuli.

Let’s emphasis again that these people used to be police officers – an occupation where avoiding stimuli is the antithesis of the necessary qualities required – and their index injury has forced them along the road to suffer from such a disability.  To proclaim in such circumstances that it is an automatic band one fails on all measures to take the position of the individual into account.

15. Lessons Learnt / issues

lnitial letter despatched Christmas time – Fed / NARPO availability
Locate relevant IOD information
OHU and IOD files mixed
Addresses ~-~- stage 3 / those that live abroad
Former officers reluctant to engage in process
Misunderstanding from officers who claim previous SMP advised ‘for life’
Some former officers want reassurance medical records and questionnaire are not seen by non-clinical staff
Draft report – 28 days
Overpayment recovery
Traveling – Skype?

The ‘lessons learnt’ mention that a batch of review letters were sent just before Christmas time.  Notts police is such a heartless and uncaring organisation that it never struck them at the time that this was a bad idea.  They aren’t seemingly concerned of the impact to the individual by dumping such grief over the festive period – they just think its a lesson learnt because local Fed & NARPO couldn’t answer the worries of those affected as they were off enjoying their own Christmas break.

NAMF allowed Sampson & Mitchel to present their talk as so-called ‘experts’, to help delegates to fill in their gaps, to add to their shallow knowledge concerning reviews. Supposedly they had the hands on experience.  Instead they’ve perpetuated all that is wrong with mass review programs.

These ‘experts’ are stuck in their own prejudicial thinking and are inflicting significant harm onto disabled former police officers. When SMPs such as Dr Sampson perform reviews just as a cost-saving mechanism they are renouncing  the ethics, morals, culture, empathy, philosophy and understanding of their role as the medical authority required by the Regulations into much simpler factors based on numbers and calculations. They are manifestations of the phenomenon of  doctors who know the price of everything and the value of nothing.

They are anachronisms who deny the changes, the evolution that’s happening since the case-law has defined how reviews should be carried out post HOC 46/2004.  Their so-called experience is jaded (and diminished) by the ‘way they’ve always done it wrong’.  They should not be allowed sustain the errors by briefing others.

So that’s it.  There are bound to be glaring misdemeanours that you have found and we’ve missed.  Feel free to post such findings in the comments.

*The proof:

Out of 381, 100 are age exempted – excluded because they are over 70 (why can’t those over 70 go up a band?). Of the remaining 281, 46 are yet to be contacted at all. This leaves 235. 62 are No-Further-Action. We are down to 173. 78 include those where they think there is evidence of substantial alteration.
Of the 78, 20 have been reduced. 21 Not altered. 1 Increased. 27 Future Appointment.9 Awaiting an outcome

Let us take the 78 from the 173:

Ninety-five remain. the 26 who are deceased, terminally ill or are band ones who have not ‘engaged’. 

Sixty-nine are left over. The 69 forgotten few.  All the colours match so you can check this for yourself. A missing sample of nearly 25% of the eligible 281 makes a mockery of the denominator used in their percentages throughout the presentation.