Appendix 1: Our audit methodology

Ministry of Social Development: Changes to the case management of sickness and invalids' beneficiaries.

This appendix sets out more detailed information about our audit approach. It discusses:

Our audit fieldwork

Our audit fieldwork was carried out from September to December 2008. We spoke to staff in the Ministry's head office and in Work and Income's national office about the management of sickness benefits and invalids' benefits. These staff represented the service development, policy analysis, planning and performance, finance, and research and evaluation functions of the Ministry and Work and Income.

We visited five of Work and Income's 11 regional offices, and two service centres in each of those regions.

Region Two service centres we visited in that region
Southern Dunedin Central and South Dunedin
Waikato Dinsdale and Cambridge
Auckland Waitakere and Mangere
Nelson Richmond and Greymouth
Northland Kaitaia and Kawakawa

In the regional offices and service centres, we spoke to Work and Income's regional health advisors and regional disability advisors, regional and service centre managers, training co-ordinators, employment co-ordinators, staff responsible for purchasing and managing service contracts, and case managers.

Review of documents and records

We examined regional and service centre plans and strategies where these were relevant to sickness and invalids' beneficiaries, reports on performance against targets for numbers of sickness and invalids' beneficiaries, data about the beneficiary population, management reports, and documentation used for case management. We also examined information held about sickness and invalids' beneficiaries in SWIFTT, the system used by Work and Income to record information about recipients of financial assistance and the assistance they receive.

To assess how Work and Income staff were deciding whether people were eligible for a sickness benefit or invalid's benefit, we examined available computer and paper records for a sample of beneficiaries. We also used these records to assess case management processes.

Our findings on how well eligibility and case management processes were working at the time of our audit were based on our examination of the sample, combined with the knowledge we gained from other sources. We have referred to numbers of cases in the report to illustrate the extent of what we found in the sample we examined. The numbers sometimes relate to a subgroup of our sample. Where cases relate to a subgroup, we have given the size of that subgroup. The figures should not be extrapolated to all sickness and invalids' beneficiaries.

Sampling case files

In consultation with the Ministry of Social Development (the Ministry), we chose a sample of 160 sickness beneficiaries and 160 invalids' beneficiaries, using data supplied by the Ministry from beneficiary records current at the end of June 2008. We selected 16 sickness beneficiary cases, and 16 invalid's beneficiary cases for each of the 10 service centres we visited.

We drew the cases from two broad incapacity groups recorded by the Ministry:

  • psychological or psychiatric conditions – this group includes people with stress, depression, bipolar disorder, schizophrenia, and intellectual disability; and
  • musculoskeletal disorders – this group includes people with back pain, muscle strains, and arthritis.

We chose cases from these groups because these are the two major categories of incapacity among sickness and invalids' beneficiaries, and because both types of incapacity have grown significantly in past years. The growth in mental health disorders has been particularly marked. Stress, bipolar disorder, schizophrenia, and depression have become the main mental disorder growth categories for sickness and invalids' beneficiaries. Sickness and invalids' beneficiaries with mental health disorders and musculoskeletal disorders are also among the most likely to remain on a benefit for the longest time.

These two incapacity groups encompass a wide range of medical conditions, with some short-term and others permanent, and with varying levels of severity and effect on the person's ability to work.

From the sample population provided to us by Work and Income, we chose individual beneficiaries across all age groups, but including:

  • people who were recorded as having moved to the sickness benefit or invalid's benefit from another benefit, such as the unemployment benefit or domestic purposes benefit; and
  • people who had been on the sickness benefit or invalid's benefit for shorter or longer periods of time.

We included these in order to establish whether any differences in practice existed in such cases.

Because our examination of case files was carried out later in 2008, a small number of our chosen sample group were no longer receiving a sickness benefit or invalid's benefit. In these cases, the Ministry's computer system retained only limited records of their history on that benefit.

Each of the service centres we visited had retrieved files for the chosen sample of beneficiaries. Previous medical certificates were occasionally missing from these. In a small number of cases across the sample, paper files had not been retrieved, so we chose other beneficiary cases in their place.

Questionnaire for general practitioners

We also invited general practitioners (GPs) to complete a questionnaire, because they are the health practitioners who fill out most of the medical certificates that applicants for a sickness benefit or invalid's benefit must provide to Work and Income. The questionnaire asked GPs about this role, the design of the medical certificate, and their communication with Work and Income.

In total, 150 GPs responded to our questionnaire. We analysed responses to each of the questions, as well as their comments. The questions that GPs answered are reproduced below.

Communication

In the last 12 months, overall, how would you rate the quality of Work and Income's communication with you on matters relating to sickness and invalids' beneficiaries?
  • very good
  • good
  • satisfactory
  • poor
  • very poor
  • other (please specify below)
Comments and suggestions for improvement:
Responding to the person's needs

The medical certificate allows you to ask Work and Income to contact you about a person's diagnosis or ability to work. Does Work and Income contact you when you ask them to?
  • always
  • usually
  • sometimes
  • rarely
  • never
  • other (please specify below)
Comments and suggestions for improvement:
The medical certificate provides for you to tell Work and Income what interventions might help a person into work, when the person is likely to be capable of work planning, training, or likely to be ready for some form of work, and what other support might be appropriate for the person.

In the last 12 months, how well or poorly has Work and Income responded to your comments in the medical certificate about the needs of the person?
  • very well
  • well
  • adequately
  • poorly
  • very poorly
  • other (please specify below)
Comments and suggestions for improvement:
Ability to work

The medical certificate asks you to assess how the person's medical condition or treatment affects their ability to work, and when they are likely to be capable of work planning, training or some form of work. You are also asked to judge how many hours the person is able to work in a week.

Do you think that a medical consultation provides the necessary information to make an assessment of the person's ability to seek, undertake or be available for work?
  • always
  • usually
  • sometimes
  • rarely
  • never
  • other (please specify below)
Comments and suggestions for improvement:
The medical certificate

Does the medical certificate enable you to express a clear and balanced assessment of the person's medical condition, and its current and future effect on their ability to work?
  • yes
  • no
  • to a limited extent
Comments and suggestions for improvement:
Does the medical certificate enable you to comment on the person's future needs and potential for employment, including any non-medical barriers to work?
  • yes
  • no
  • to a limited extent
Comments and suggestions for improvement:
Awareness of services

The medical certificate asks about support services and other services that might be useful to aid recovery and rehabilitation, and help a person move towards employment. Are you aware of the services available through Work and Income?
  • yes
  • no
  • uncertain
Comments and suggestions for improvement:
Your location (city, town, or region)

This is optional but will help us identify any significant differences between regions and districts.
page top