Medicandus

Medicandus

DSP Reassessments - the new phrenology

It seems inevitable according to most commentators that some type of reassessment of DSP recipients under 35 will be introduced into the Budget tonight. Figures as high as 30,000 people to be affected have been quoted in the media. I have previously pointed out the faulty and prejudiced reasoning behind such an idea, as well as the devastating consequences (including multiple suicides) which have resulted from an essentially identical scheme being introduced in the UK.

As a member of one of the medical specialty groups upon whom the bulk of the work of ‘reassessing’ these 30,000 unfortunate souls will likely fall, I want to offer some thoughts.

Rehabilitation Medicine is the branch of medical endeavour which specialises in managing disability. Although in the DSP legislation, the terms disability and impairment are seemingly used interchangeably they are quite distinct concepts in rehabilitation. Impairment is the organ or tissue level problem. Missing a finger, having a kidney that works at reduced capacity or having poor eyesight are all impairments that can be objectively verified by an assessor. Either you have the impairment or you don’t. Chronic pain is perhaps the only major type of impairment which cannot be externally assessed with ease, which is unfortunate because it’s the commonest reason for being on the DSP.

Disability (also known as activity limitation) is the person-level consequences of your impairment. If you have the impairment of a frozen shoulder, you have disability related to activities like dressing, showering, gardening, bowling a cricket ball and reaching up to the cornflakes on the high shelf, but you don’t have disability related to things like intellectual achievement, walking distance or sitting time.

Handicap (aka participation restriction) refers to the social and interpersonal consequences of disability. Having disability related to bowling a cricket ball is no great loss for me, but would be a national tragedy for Mitchell Johnson. His handicap would be much bigger than mine for the same disability because his living (and our number one ICC ranking) depend on his not having that particular disability.

Fitness for work is the main differentiating factor in deciding eligibility for DSP instead of NewStart. The rate of pay is higher for DSP because the extra problems that make one eligible are assumed to lead to out of pocket costs for medical care, dressings, medicines, taxis and carers. Working out whether someone is eligible for DSP requires medical reports from professionals who have treated the applicant for some time, and there is a scoring system which is applied using criteria which assess the impact of the impairment on everyday function. For interested readers, the scoring system is published here. In order to qualify, an applicant has to show that they meet the eligibility for both having an impairment, and also that that impairment makes them unfit for sustainable employment. Sustainable employment is defined as

ability to reliably perform work of 15 hours (or 30 hours, if subject to this rule) or more per week for a period of 26 weeks without excessive leave or work absences.

In practice this is calculated by a formula that need not detain this discussion, but the key to note is that for people with variable medical conditions such as migraine, diabetes or back pain there may well be periods of several weeks where they might conceivably be able to complete a normal shift on most days. They would not be sustainably employable however, since their condition would be such that it requires excessive leave or causes unpredictable absences.

To return to the definitions I have given above, determination of work ability is a mixture of disability and handicap, and not as simple as impairment assessing. You simply can’t reliably determine from a single assessment whether a person previously judged as eligible is currently still eligible because you can’t determine disability and handicap in a work setting in a single sitting. It’s about as scientific as phrenology. The evidence from previous exercises of this sort is that the initial assessment is virtually never overturned. Weeding out the small numbers of flat-out rorters will be more expensive and generate far less in savings than Treasury imagines.

I for one will decline if invited to be part of it. It would be unprofessional to be part of a political initiative which is not evidence-based and not supported by those who have disabling conditions, their carers and health professionals. I have previously written that I would welcome new money into the sector if it was going to be spent according to best practice. We’d happily work for something that would leave our disabled clients better off. I urge my colleagues in Rehabilitation Medicine to consider their own possible participation in such a program, and whether they can in conscience offer their professional skills to such a futile and wasteful exercise.

*These views are Dr Vagg’s own and do not represent official comment from Barwon Health, the Australasian Faculty of Rehabilitation Medicine or the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists.

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