Doctor and activist


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Category: Workers’ Compensation

Privatised Job Services- Guess who benefits?

21 July 2021

Privatisation of job services was based on the concept that competition improves performances; hey we all run faster in a race than on a jog.

It takes the simple model and assumes that public servants do not work as hard as the lean, mean private sector workers.

I  have worked in the public service here and the UK for some years. I defy anyone to say that salaried doctors do not work hard.  How does a basic 60 hours a week, with a few hours of unpaid overtime a day and on call one night in two for ICU or ED sound?

I was at Sydney Water for 13 years.  The clerical staff worked their 35 hours, but the professional staff were mainly there until 6pm, despite only being paid to 3.30pm. The clerks knew their jobs and did their jobs.  They thought about their work, prioritised the important things and did them.  Their jobs were safe, they were honest, and criticism of them was frankly misplaced.  So was the idea that a ‘blow-in’ manager could do their jobs better than they could.

The assumption of privatisation of job seeking is that contractors would do better than the CES. The Key Performance Indicators were set up so that they go paid less for people who were easier to place and more for those who were hard to place.  So it was presumably staffed as cheaply as possible, and the business model concentrated effort where the most money could be had for the least work.  People who would have got a job without the providers help at all were money for jam.  People who were very difficult to place were not worth spending time on. So instead of an ongoing effort to help people in whatever way possible there were distorting priorities- what do you expect?  In this case you get what you pay for.

There was a similar nonsense when there was a privatised effort to lower unemployment, which was in the mid-1990s.  This drive did not come with any more jobs, so the best hope was reclassification of people who were not working. Many people were sent to me as a doctor to fill in their Disability Pension forms, as the private sector were given bonuses to get people off the dole and putting them disability pension qualified as this.  And they think that the public service does paper shuffling- they are amateurs!

After they had expanded the Disability Pension numbers a few years went by and Morrison decided that there were too may people on this, so he would make it tougher to get.  He boasted that only a third as many people were put on the disability pension in one year than had been the case the year before. I knew some of the people who could not get the disability pension.  There were not enough jobs for healthy people, let alone unhealthy ones. They were demeaned and humiliated, with supposed ‘mutual obligations’.  They had to waste their time writing job applications for jobs that they had no chance of getting, and presumably the bosses wasted time either reading them, or just binning then without bothering. 

When NSW passed legislation that Workers Compensation would only be for 5 years and then they would have to apply for a disability pension the object was to transfer the costs of injured workers from the State insurers’ premiums to the federal taxpayer.  Centrelink was having none of that. Of the people kicked off Workers Comp, only about a third managed to get a disability pension; the rest were on ‘Newstart’ applying for jobs that they had no chance of getting and on far less money than before.  Patients came to me asking for ever more elaborate reports to try to get disability pensions when they needed them.

One man, a 61 year old Middle Eastern man who had been on compo for 13 years and was carer for his disabled wife could not get a disability pension.  He had chronic back pain and a limp. His English was poor, he was illiterate in English (and possibly Arabic) with a file two inches thick.  I spent a lot of time writing a report for him.  Centrelink thanked me but said they could only pay a small amount for such reports.  So I will not do such reports again, and presumably neither will any of the other doctors- we cannot afford to work for free to fight a system with a different agenda.

Meanwhile the private providers are cream-skimming, adding another layer of costs.  Because a market system transfers money upwards to those with more economic power who can control their pieces and costs, a government and a welfare system needs to transfer wealth both to everyone in society equally by building facilities everyone can use or by direct payments to those who are unable to get jobs or who are otherwise disadvantaged.

The problem is that jobs are being offshored to low wage countries or replaced by technology.  This is national problem for high income countries.  It is a problem for the whole country, but it affects some people directly.  We are all lucky that our dollar is high and our goods cheaper because low wage countries make things cheaper. So we all should contribute to make our own country more equal.

Until we demand a fair system we will not get one.  Stopping rip offs, and paying CES people a fair wage to do a fair job is a start.

https://theconversation.com/the-problem-with-employment-services-providers-profit-more-than-job-seekers-162421?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20July%2021%202021%20-%202008419727&utm_content=Latest%20from%20The%20Conversation%20for%20July%2021%202021%20-%202008419727+CID_fbb8f126a3150e0c593a044f9ebff43b&utm_source=campaign_monitor&utm_term=The%20problem%20with%20employment%20services%20providers%20profit%20more%20than%20job%20seekers
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iCare= Hopeless in Two Reports but the Bad Joke Continues

30 April 2021

Two reports on iCare have come out on the same day- how convenient, one lot of publicity rather than two.The report of the Parliamentary Committee was one report, the other was a report by Robert McDougall, a retired Supreme Court judge.The political report looked at the disgraceful evidence given by John Nagle which showed almost no care for the injured workers and an appalling attitude of entitlement in him and his crony staff. iCare had not even known what workers’ Pre-Injury Average Weekly Earnings (PIAWE) were, and had not tried very hard to find out so that they could underpay them and minimise their costs. They relied on computer algorithms rather than staff to manage the claims, only getting staff on the case if there were problems, which there usually were, as the poor patients were having their treatments delayed or denied.
The McDougall report had its terms of reference set by Treasury, who were also the department being investigated, and they also staffed the inquiry. The Treasurer, Dominic Perrottet did not agree to be interviewed by McDougall and got away with this. Is this some sort of bad joke? The McDougall report found incompetence etc, but no actual corruption that anyone could be charged with. As such, the McDougall report was a political success. It took the heat off the Treasurer from November to now, and will result in a bit of publicity, no serious recriminations and the usual promises of future action. John Robertson, an old union hack is the new CEO, so Labor will not criticise iCare now.
My poor patients will be mucked around, be underpaid and have their treatment denied as usual. And Treasurer Perrottet will sail on hoping to be Premier as Gladys falls. What a joke!


www.abc.net.au/news/2021-04-30/damning-reports-released-over-nsw-icare/100107076?fbclid=IwAR34I_blTADSxa2OoWxrzOpvgNPZ3KUFmhQmpSFZHd4LSOIVdof0nx8yMGs

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Labour Hire Companies facilitate Wage Scams

5 April 2021

When I was in Parliament the then NSW Labor Government had an inquiry into WorkChoices, which was the Howard Federal government’s preferred industrial relations model. It was, as the Liberals said, an political inquiry designed to criticise what Howard was doing. (Historians will recall that it cost the Howard government s lot of votes).

But both Unions and Employers came and lobbied me, as did Labour Hire business owners. The Labour Hire companies said that they could get a better deal for the employees as they were negotiating on their behalf with employers and if they had special skills the employers would have to pay for these. I asked them how much commission they took on this as obviously employers would have to pay their commission as well as the subcontractor’s payment. They were very reluctant to be specific on this point as it was ‘variable’. But it did seem to me that the chief objective was to make the worker a private subcontractor rather than an employee and thus remove award pay rates, holidays, sick leave, workers compensation, and bargaining power. The Labor Hire company was often just a commission agent, though some employed the workers.

It seems that this model of getting rid of direct employees has evolved and is now standard in many industries. I have seen a woman accidentally stab herself in the forearm while boning chickens at 3.30 am on a 12 hour shift, a man shoot himself in the heart with a nail gun trying to assemble flat pack kitchens alone and RSI in a hotel worker so advanced that it has made no recovery in 3 years, after being expected to clean high-end hotel rooms, including making the bed, vacuuming and cleaning the bathroom in 12 minutes each.

‘Subcontractors’ may have no awards, no unions, no OHS and no redress when people are ripped off. The lumbering ‘Fair Work Commission’, out of sight and out of touch seems to make very little difference to a Darwinian model.

Let us see if criminalising wage theft makes any difference. There are a lot of laws on the books that are never enforced.

https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.smh.com.au%2Fbusiness%2Fworkplace%2Faustralia-s-shocking-wage-theft-scandals-keep-coming-by-the-truckload-20210312-p57a5p.html%3Ffbclid%3DIwAR3FoKWzuLj-nv9W5moUs7K-HmlfV8msxTXhOicq62KM83zMerzWwcFiJYM&h=AT3RrEZXGjEyZeQ7rNBoGGgl9Flo0_zzfDuqRAnUxguMlUcU-J9oiuQGDpT01vJnqPsdtFErgLw0g92bkmtQt_TQ-vPzVqPsWvYaVFbIYosdg1YBYAm5Fke4e4-OdaDB8JwYckGgwuhNR5mltMZO&tn=-UK-R&c[0]=AT2ipxj2y11laB8hdM-suLNA2ij5tamnMBYbjAGX5r25jhtlSzzvd-Dn6kj1lQ88fBiyw1dyFFnNXi8tEuTfOVY_74RgrorvDvqc2EuyAIWBJMbsZjzjqyCneyp7HOlhnr8r_bd9dZtlDER2pMrWsThzMw
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iCare Doesn’t Know and Doesn’t Pay Underpaid workers

7 March 2121

The incompetence of Perottet’s iCare never ceases to amaze.

It underpaid injured workers but was not sure how many. It was initially 240,000. Then it changed its to estimate to 52,000 people underpaid up to $80 million. Then possibly as little as $5 million. In March it is 23,000 and $20 million. They don’t actually know. After 18 months 25 have actually been compensated!!!
This is all treated as some of ‘management error’ as if this makes it OK. These are a lot of abstract words, but few concrete ones. The idea of abstract words is that the concepts can be discussed better. But mostly management words are so general as to be meaningless, and principally serve to make everything non-specific and also euphemistic. No one says, ‘They did not know or care and their incompetence led to immense suffering for the families who were underpaid’. It becomes, ’There was a lack of management understanding and focus and some workers may have been paid less than their entitlement’.
Naturally no one will be punished.
All I know is that even the routine service takes about 3 weeks to get anything done. I had a patient doubly incontinent after a spinal injury. It takes up to 10 working days to get a claim approved, then up to 10 working days for them to approve an MRI and a specialist consultation. This is normal. When they delay things it is worse, and sometimes they refuse to pay at all.
www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

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Scathing PWC Report Finds Perottet’s iCare Incompetent

6 March 2021

A 100 Page report by consulting from international PWC (Price Waterhouse Coopers ) found weakness in performance and governance, and the Board did not hold management to account. 

We might also consider that the Minister, Dominic Perottet did not hold the Board accountable, and appears to show no interest at all in the injured people for whom the whole scheme supposedly exists. We might note that no doctors or patients appear to have been interviewed either- Hey, it’s all about money you know!  One could ask why PWC did a report when Justice McDougall was simultaneously doing one that it coming out in April?  Perhaps he is a lawyer and does not know enough about money.

The bottom line is that it was run from the top by people who only knew about money with little input about its proper function from the people at the coal face, who presumably should have some knowledge of the people that they are supposedly helping.  (I say that with reservation, as the case managers that I deal with have high turnover, little insight and seem to assume that a large percentage of their cases are fraudulent, the doctors are hell-bent on inventing pathologies to over-treat and they have to follow elaborate protocols designed to ensure that no one could under any circumstances get one cent more than was absolutely necessary).

So we digest the Management-speak of this report and await the McDougall report which had terms of reference that allowed little input from patients or doctors, held no hearings and seemed to exist principally to take the heat off the Minister from last August until its April release.

It seems that there has been a generic concept since the 1980s that managers know best, that other degrees and knowledge from lesser beings or lesser ranks and incomes are not of value or to be listened to.  It has come unstuck in so many situations that its time that some little boy (or girl) points out that ‘The Emperors have no Clothes’.  Then we can go back to an older time, where people had appropriate training, worked their way up, knew their jobs, were promoted on merit and had small salary increments reflecting their incremental status rise.  But I suppose that this would rely on people having permanent jobs and depower the whole new managerial class and their symbiotic consultants and reduce the workplace ‘flexibility’ that allows the obscene salaries at the top and insecurity at the bottom. 

If Anglo society does not want to fall to more realistic societies in Germany and Asia, there needs to be a large rethink of the Harvard 1980s management nonsense that is the foundation of these sort of debacles.

www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

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Police Leaving the Police On Medical Grounds Triples- Why?

7 February 2021

We might ask why NSW Police leaving the force on medical grounds has increased from 150 a year in 2014-15 to 420 in 2019-20, almost triple.

There is talk of a culture of bullying.

We might ask what they are being asked to do. Public perception seems to have changed when the changed their name from ‘Police Service’ to ‘Police Force’. The perception that they are now revenue raising, and that their cameras are so that they cannot use their discretion as they themselves are being watched may have contributed to this.

My own view is that the ever-more invasive laws that they are expected to enforce tends to have this result as they are more often thrown into conflict with ordinary citizens who they thought that they were there to help.

www.smh.com.au/national/nsw/fish-swimming-amongst-sharks-why-so-many-police-are-quitting-the-force-20210202-p56yp6.html

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Workers Compensation in NSW and Victoria- ‘Immoral and Unethical’ – 4 Corners Exposes It. 28/7/20

This is what I have been saying for years. If you think the banks are bad, you have not dealt with insurers. They will do anything rather than pay people’s legitimate medical and living expenses.

My poor patients literally starve. They change their addresses each visit as they couch-surf their friends. The foreign patients with no Medicare cannot even get GP treatment, and because they are often paid sub-award wages in cash cannot even prove their incomes. Most specialists simply will not operate for the Medicare rebate, and even if they will the waiting time is a year. I tell the patients where the soup kitchens are. They are in huge pain and the most I hear from governments are warnings that they have been on narcotics too long, as they wait for the surgery that the insurers have refused to pay for.

The patient Scott with his supportive wife, at the beginning of the 27/7/20 4 Corners tells the story of his shattered life, which is just like what my patients tell me.

The Victorian the Ombudsman, Deborah Glass did an investigation into WorkSafe Victoria, the callous government insurer there. She found appalling behaviour and says so very clearly.

In NSW it is the same- the appalling, hopeless iCare, who should be called ‘I Don ‘t Care’ put together a bunch of insurance executives who had no experience in working with people. They all got awarded huge salaries and set about having computer algorithms to replace claims clerks. So when a claim goes wrong (which takes a while to figure out as 3 week delays are pretty much the norm), you call and ask to speak to the case manager. You can’t. But if you persist eventually you find one, but he or she only got the claim yesterday. i.e. There had been no person managing it until you hassled like hell, and it is often refused anyway.

Meanwhile the patient had no treatment and the fat cats at the top had not noticed that their system had a few glitches. And most of the concern in both the management echelons and the media is about some financial deficit which, if we are to believe the totally out-of- touch iCare CEO, Ken Nagle, depends how you do the accounting.

No one seems to remember that this is just a health insurance scheme to help Workers’ Compensation and Motor Vehicle accident Victims. If Medicare worked it would be completely unnecessary, and it cannot even manage to function like a private health insurer. It assumes that all doctors are crooks who cannot be trusted to order just the tests and operations necessary- they all have to be evaluated and denied by insurers who get every dollar that they refuse to pay, and who seek out dodgy doctors to carry out ‘Independent Medical Examinations’ (IMEs) to deny normal treatments. If the IME doctors do not do what the insurers want they get no more work from them.

The directors and top executives of iCare should be sacked and the whole thing given to ICAC to examine. ICAC needs more resources also.

SIRA (State Insurance Regulatory Authority) has been more hopeless than ASIC and APRA were with the banks, and should be abolished also. This story came from a whistle-blower, not from SIRA, the responsible agency, though some of us have been trying to get SIRA to act for years.

SIRA became a bit more interested after the Hayne Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry reported in February 2019, presumably as they realised that if the Commission has been given enough time to look at insurance, they would have had their own hopeless regulatory efforts scrutinised. They had an internal investigation, the Dore Inquiry (no, you almost certainly have not heard of it), but it did actually find that iCare was behaving appallingly. The report release was delayed 5 months (July-December 2019) and released just before Christmas with iCare’s reaction, which was to admit that they had made ‘mistakes’ and that they accepted all the recommendations. Great PR! Released on a busy day to avoid scrutiny and if you as a journo were a tiny bit interested, there was no story because iCare accepted the changes suggested. The SIRA strategy worked- no scrutiny of either iCare or SIRA.

At last there is a 4 Corners on this! Watch it if you missed it!

Let us hope that when it goes to ICAC some major changes are achieved. It seems that 4 Corners is the only regulatory force in the country. I guess that is why the government wants to de-fund the ABC.

https://youtu.be/fxIvKogrE2Q

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Domestic Violence Becomes a Workers Comp Issue 8/6/20

The NSW Supreme Court has held that the children of a worker killed at home by her mentally ill partner in a domestic violence incident can have compensation.

It is good that the issue of domestic violence gets publicity and that the children get compensation. But it raises the issue of whether employers are seriously able to assess the domestic situation of all employees and then whether they can ever hope to intervene in them.  Employers ran a long campaign not to have to pay for journey accidents, people injured on the way to work, on the basis that it was not a risk that they could control, yet which potentially might cause a big change in their insurance premiums and thus costs.  If we want our employers to be concentrating on making their businesses efficient and looking for hazards in the workplaces that they do control, it is slightly dubious public policy to have them sniffing around about employees’ home life.  This case is slightly unusual in that the employer was effectively a partnership bet ween the couple rather than having a distant employer, and the company had been deregistered which suggests some dysfunction  But the money accessed was Workers Compensation insurance and this will affect premiums and potentially other work situations.

It is true that a lot needs to be done about the discovery and action on domestic violence.  It is also true that mentally ill people need to live somewhere and that their carers are at risk.  Judges faced with people in dire need of help such as the children in this situation search for answers, and the Workers Compensation insurance scheme is a source of such funds. But the precedent set is not a good one.

The same principle applies when a baby gets into trouble at birth and has long-term adverse effects. If the obstetrician is found to have erred, there is a lot of money to give the unfortunate infant.  If he or she is not found to have erred, there is no money for the infant.  So now the premiums for obstetricians are very high and some retire in consequence.  4 Corners ran a show on this issue some time ago and it turned out that one doctor was responsible for about 60% of the problem births in Western Australia and had declined to speak to the show. Wow- go after him!  Who was he?  The Professor at the biggest teaching hospital of course.  Most of the difficult cases in the State were admitted under his name, and the staff of the hospital did their best with these cases. 

What is needed is a compensation system that is no fault.  Sometimes bad things happen.  Sometimes people make mistakes. Sometimes big mistakes have small consequences and sometimes little mistakes have big consequences.  With systems, it is not usually one person who makes a mistake, there are miscommunications, lack of clarity who was responsible, lack of availability of something or someone.  Accident causation theory is now an academic discipline, but the legal profession has not really caught up, let alone the political system.

A lot needs to be done about domestic violence, but I am not sure that making it a workers compensation issue will do anything more than push it into the public eye and help these children.  Employers and insurers will run a successful political campaign to change the law to exclude it.  I am not often on the side of Workers Compensation insurers, but a better solution has to be found.

www.smh.com.au/business/workplace/no-longer-a-private-matter-employer-held-responsible-for-family-violence-20200605-p54zy1.html

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Workers Compensation- WIRO the Watchdog is beheaded 11/12/19.

In the sad saga of treating NSW Workers Comp patients it is hard to know where a bad deal becomes a rip off becomes a scam becomes systemic fraud, but the NSW insurance scheme is a long way down the track.  Much worse than the Banks. The Hayne Royal Commission did not get to the […]

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Power, Injury and Awards

26 November 2016 Power, Injury and Awards.  I work in medicine, treating mostly third party motor vehicle injuries and workers compensation injuries.  There are much fewer of the latter because there are less employees.  Many people working as couriers are ‘self employed’ contractors.  One man had to pay $75,000 for the right to deliver parcels […]

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