§ Mr. Elfyn Llwyd (Meirionnydd Nant Conwy)
When the present Government came to power in 1997, I asked the Minister then responsible whether the disability living allowance forms could be examined urgently to make them more user-friendly. More than five years later, nothing has happened, despite the assurances then given.
The forms are long and complex but do not provide adequate space for applicants to add to tick-box and one-word answers to illustrate their cases further. Often, that is why they are turned down. For example, if an applicant can walk 100 m unaided, the mobility claim will almost certainly fail. What of sufferers of myalgic encephalopathy—ME—and multiple sclerosis, who sometimes have reasonable days but more frequently have bad days when it is not possible to walk 100 m? I have come to realise that many constituents who appeal have to do so because, in all honesty, they did not present their case very well on the form, and failed to qualify statements or add to the basic questions. They therefore failed to reach the golden threshold of the number of points required.
A recent survey by the Motor Neurone Disease Association, published in June 2001, showed that 52 per cent. of those questioned received help to complete the claim form. Respondents described the form as "very confusing" and "a nightmare" and said:the forms are too long and the questions asked are the same over and over again.There is, to my mind, a glaring conflict of interest in the way in which medical assessments are carried out. General practitioners are paid more than £100 for the visit and for completing the form. I could name one or two doctors in Gwynedd who fail everyone initially, regardless of their condition. It does not take rocket science to see that a GP could feel under pressure to turn down applicants and preserve the status quo, in order to preserve that rather lucrative sideline, rather than supporting the applicant. I raised that matter on the Floor of the House recently, and interestingly, not a single medical practitioner contacted me to suggest that I had got it wrong. GPs' services are secured through a third-party agency, but I repeat my contention that that obvious conflict of interest compromises them.
The MNDA supports what I have said. I shall quote from some responses that it received. One said that the appointments with doctors were made at very short notice, and another that the doctorwas very rude and unhelpful. It felt like I was a scrounger.Another said:He could not understand me very well because of my speech and had no idea of the severity of MND or its progression.Another said:The assessment was totally degrading. My husband was totally humiliated. If we had known what the assessment was like we would not have gone through with it.
Furthermore, 58 per cent. of those questioned said that they had to wait for a month for such an assessment. The report says that only 46 per cent. of claimants received notification within one month that 135WH their claim had been successful, and 11 per cent. of respondents reported having to wait more than three months for notification.
Over the past six to seven years, an increasing number of constituents have come to my advice surgeries seeking assistance to proceed with an appeal. They invariably begin by feeling overawed at the prospect of conducting a quasi-judicial appeal without assistance. Frequently they must rebut evidence from a medically qualified person. Many decide that they are not up to it and want to forget the whole thing, which is the last response that anyone would want. Others decide to battle on. As a respondent to the report recently said,The appeal was hard work for a person feeling unwell.I am legally qualified and have conducted countless appeals, and I can see clearly that the appeal procedure is very difficult for appellants in person. Despite the fact that tribunals are invariably staffed by three caring individuals who are patently independent and go out of their way to put appellants at ease, the procedure is daunting, not least because at the back of every appellant's mind is the awful financial prospect of failing in their appeal.
Since 1992 I have conducted appeals five or six times a year, and only one of those 60 or so appeals failed. I should like to think that that success rate was due to the quality of my advice and advocacy, but I suspect that the real reason was that the appellants should not have been refused in the first place.
A layman such as I can often see that a person's condition is deteriorating and will deteriorate further. A tribunal recently took a few seconds to decide a case in favour of a constituent of mine, and made the benefit "for life", as it was before the benefit integrity project. Back in November 1998, the Minister then responsible told me,We shall continue to improve the process so as to ensure that the right benefit is paid to the right people. As the hon. Gentleman knows, we recently announced that, in due course, we wish to replace the benefit integrity project with a fair and sensitive system for ensuring that DLA cases are correct."—[Official Report, 16 November 1998; Vol. 319, c. 587.]To that I would say, "Hear, hear." However, the targets for savings achieved by the benefit integrity project were based on a belief that almost £499 million per year was involved, and that more than 12 per cent. of claimants were fraudulent. Both those ideas were found to be totally unjustified. In fact, the savings achieved by the BIP—£8 million for 1997–98—have been totally wiped out by the administrative costs of £8.27 million for the same period. The cost of the new system of periodic review has yet to be estimated.
Little has happened to aid the sick and disabled, and they continue to be subjected to degrading treatment every three years or so. The project was supposed to be replaced by something that was fairer, but I fear that the periodic review is no fairer and is just the benefit integrity project under another name.
I shall give some brief examples of cases that I have conducted. A Mr. Roberts in my constituency had his left leg amputated after a road accident in 1995. He received high rate mobility from September 1995–96, which was cut down to middle rate from September 136WH 1996–98. He asked for a review in March 1997, received nothing until August and wrote back with the paperwork in November, only to be turned down on the grounds that he was out of time. I complained on his behalf, and the disability benefits director said that it was clear that Mr. Roberts had not received the standard of service to which he was entitled. The appeal went forward in August 1999, and his claim was allowed fully on appeal, nearly three years after it was refused.
A young woman from near Bala in my constituency was awarded the highest rate mobility component because she was suffering from chronic fatigue syndrome. She received the high rate from April 1994–98, reapplied in January 1998 and was refused. She asked for a review in February and was refused again. She sent in some other details, and eventually won an appeal—again, more than two years later. A lady in my constituency from Corris made her first application in March 2000 and was refused. She was suffering from severe arthritis. We appealed on her behalf, and the appeal came through in February 2002, nearly two years later.
A man called Patrick Breen in my constituency had his disability living allowance discontinued in October 1998, having suffered an unsuccessful knee operation in 1997 and further surgery in 1998. He partially lost his sight in 1994. He has recently had confirmation from doctors that he also had osteoarthritis. His doctor expressed surprise that the personal care element was disallowed, and said:at this current time I feel that a high level of personal care is of the utmost necessity".I wrote on Mr. Breen's behalf on 27 October 1998 and did not receive a reply until 10 January 1999. The case went to appeal—in April 2002, believe it or not—and it succeeded on all points. That is another example of a few years wasted, anxiety created and so on.
A young man from Trefriw in my constituency, who suffers severely from myalgic encephalomyelitis, was turned down. He, too, had to appeal. While he was appealing, he was unable to heat his home properly or look after himself because of lack of finances. That is a disgraceful catalogue. Time does not permit me to deal with other cases that I could mention.
The Government have made some movement. The Social Security (Disability Living Allowance) (Amendment) Regulations 2002 will affect between 40,000 and 50,000 claimants. The new rules relate to lower rate mobility component, which is paid to people who can walk, but cannot walk outdoors in unfamiliar places unless they have someone with them—because of a visual impairment, for example. The alterations relate to claims based on fear and anxiety. A new provision, regulation 12(7), was inserted into the DLA regulations, stating that people who cannot take advantage of the faculty of walking outdoors without guidance or supervision from another person because of fear or anxiety will not be eligible for lower rate mobility component.
A second paragraph, paragraph (8), will state that regulation 12(7) is to be ignored if the fear or anxiety is
137WH The intention is that people who claim on the basis of fear or anxiety—because of agoraphobia, for example—will still be able to do so, but people who cannot demonstrate that their fear or anxiety is a symptom of a severe mental health problem will not be eligible for lower rate mobility component.
- "(a) a symptom of a mental disability; and
- (b) so severe as to prevent the person from taking advantage of the faculty in such circumstances."
The Government claim that they are simply clarifying the law, rather than making changes. However, the new rule means that the often severe psychological effects of physical impairment must in future be ignored for the purposes of lower rate mobility component. That is an entirely new rule.
A growing number of voluntary bodies are becoming greatly concerned at the operation of the DLA—not surprisingly, perhaps, given what I have already said. The Headway Association recently wrote to me. In essence, its concern is about the DLA assessment process. It believes that the DLA is too fixated on finding physical or mental health problems and does not allow the recognition of cognitive difficulties, often the result of a head injury, which can cause problems as severe or worse than physical or mental health impairments.
As for the unfairness of the DLA assessment process, the Headway Association says that the DLA assessments place heavy reliance on independent fixed format medical assessments. They will often require the brain-injured person to explain convincingly in the interview how their condition impacts on their care and mobility needs. However, due to their cognitive impairment they might be unable to explain that to the medical examiner.
The Headway Association's experience of clinicians, particularly general practitioners, is that their professional knowledge of brain injury and its impact on the individual is sparse. Additionally, Headway Association members have experienced a range of attitudes from examining medical practitioners. Some are very mechanical in following the medical assessment script, while others are more discretionary, and we must query what assessment training is given.
Individuals with a brain injury may be deemed mentally competent yet suffer impairment of their cognitive abilities that directly impacts on their care and mobility needs. Even medical examiners who are enlightened on the subject of brain injury point out that they are required only to assess mental competence, not cognitive ability. As it is the province of clinical neuro-psychologists, it is unrealistic to expect cognitive ability to be reliably assessed by a non-expert medical examiner, typically a general practitioner, during a routine medical interview and examination, which, as I have said, often takes place swiftly and at short notice.
§ Hywel Williams (Caernarfon)
Does my hon. Friend agree that the gap in the training of doctors who assess the DLA leads to wide variations, even in small geographical areas? That is widely seen as being entirely unfair.
§ Mr. Llwyd
I agree entirely. The DLA is, unfortunately, like postcode prescription. Cognitive ability is often the crux of the matter but it is not addressed, which is a haphazard way of doing things.
I wholeheartedly endorse the recommendations made by Headway: 138WHA separate section on cognitive ability should be included within the DLA questionnaire and medical interview.For the EMP following the DSS assessment script, and where brain injury is claimed or diagnosed, a supplementary sheet of specialist questions could be devised to assess the cognitive and executive reasoning difficulties. There could be a number of them to target a particular neurological condition. In cases of alleged mental problems for those applying for incapacity benefit there is the opportunity to complete additional questions on how their condition affects their ability to work. Medical examiners are obliged to consider this when the problem becomes apparent during the interview. Where there is doubt, and to guard against the possibility of fraud, EMPs, Adjudication Officers and tribunals should be authorised to refer applicants who claim brain injury to a suitably approved clinical neuro-psychologist. They could produce independent reports on the cognitive difficulties of the applicant and how they have impacted on the care and mobility needs of the applicant.The medical assessment procedure should be more flexible to allow the input of the carer. To give a complete picture of a person with a brain injury during an assessment it is often necessary to have their main carer present. This will help where a person's self image is at odds with their actual abilities.I reiterate my call to the Government to review the application forms and make them more user-friendly. The periodical review procedure should be ended for cases in which a recipient of DLA has already succeeded once on appeal. I have been a Member of Parliament for more than 10 years and I am going through the third appeal with some applicants. Their condition worsens with every appeal, for which we have to wait through months of anxiety to present. I do not mind doing it—I am proud to do it—because it is part of my function. However, I say to the Minister that it is a waste of the tribunal's time and is grossly unfair and hurtful to people who feel "done" by the system.
It is also time to speed up the system. The examples that I have given are typical of the length of time an appeal takes. The system is currently failing the most vulnerable in our society, which will not do.
§ The Parliamentary Under-Secretary of State for Work and Pensions (Maria Eagle)
I congratulate the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd) on choosing the subject for today's debate. The matter is of great interest to all hon. Members. He has raised a number of issues on which I shall do my best to comment.
First, I want to say a little about the DLA because there are some misconceptions—I am not saying that the hon. Gentleman has misconceptions—about what the benefit does and does not do. I shall set out the aim of the DLA before answering some of the hon. Gentleman's specific questions. It is a non-contributory, tax-free benefit that is not income related. It is there to contribute to the extra costs incurred by severely disabled people because of their additional mobility and care needs. It is not an extra payment for people with a particular condition. That is one of the things that most confuses people about the benefit; some think that because they have a certain condition, they should receive it. That might explain the point about variations that was made in an earlier intervention. It is possible for two people to have the same condition, but for their care 139WH and mobility needs to be very different. The system is designed to try to assess what those needs are on an individual basis.
§ Hywel Williams
Is the Minister claiming that decisions are entirely consistent from one assessment officer to another? I have encountered examples of people with very similar conditions seen by different doctors; Dr. Nice has allowed it but Dr. Nasty has not.
§ Maria Eagle
The hon. Gentleman has identified one of the problems of trying to administer the benefit: it has a large subjective element. That is partly because it is trying to deal with the effects on a particular person in a particular situation of a particular condition or disability. There is bound to be a certain amount of subjectivity, whether of the decision maker or the doctor.
Our job in administering the benefit is to try to be as consistent as possible, but it is not to achieve equality in benefit between two people with a particular condition. Because of the way in which it is designed, the benefit has to deal with the effect on the individual of the health condition or disability. There are difficulties in terms of consistency, and in terms of the many issues raised by the hon. Member for Meirionnydd Nant Conwy and his colleague, the hon. Member for Caernarfon (Mr. Williams).
For the record, I accept that there are sometimes difficulties in accessing the benefit. Every Member of this House has had constituency cases in which things have gone wrong. We try to minimise errors and to put things right when they go wrong, but there is an inherent difficulty in administering this benefit. In the last five years, expenditure on DLA has increased by 23 per cent. in real terms, to some £6.5 billion, and 2.35 million disabled people are in receipt of it. That is an increase of some 15 per cent. over the last five years. There is no evidence that the difficulties of claiming are preventing people from accessing the benefit. The trend is upwards; we are getting the benefit to people who are eligible for it as best we can.
The hon. Member for Meirionnydd Nant Conwy will accept that the need for care and help with mobility is a personal matter and varies between individuals. The affects of a particular disability can vary from person to person, according to circumstances. It is therefore difficult to be objective. The diversity of cases for which the benefit has to cater makes it inherently difficult to administer. We have embarked on a programme of improvements, but the hon. Gentleman says that he has not seen much evidence of that. I shall go through some of the things that we have done, and some of the things that we are hoping to do, now that we are introducing a proper IT system into the disability benefit unit, which we have not had until now. The hon. Gentleman will know that one of our difficulties in respect of the benefit is that it has been clerically administered. That has its own difficulties, because there are inefficiencies in clerical administration, especially when files are sent to Blackpool and have to be sent back.
The hon. Gentleman referred to a predecessor of mine who said that the Government's aim was to get people's benefits right at the outset and keep them right. That is 140WH indeed our aim. We are trying to develop processes that will make the system simpler, more straightforward and more responsive to the needs of disabled people who claim disability benefits. We are trying to remove the need for a single "catch all" claim pack, the difficulties of which were referred to by the hon. Gentleman. The claim pack must enable people to set out the effect of their condition or disability on their care and mobility needs, so we need more than a form that asks people what condition they have. The claim pack is bound to be long and more complex than we would like, but we are currently developing a new claiming process both for attendance allowance, which is being trialed, and for disability living allowance. In tests, we have managed to reduce the claim pack for attendance allowance from 44 to 16 pages. We are hoping to be able to replicate that for disability living allowance, although DLA is slightly more complex because of the mobility component. The trials on the AA claim pack for very elderly people have been fairly successful and we hope to apply the lessons that we have learned from that to DLA.
Features of the first stage of the process include a shortened interactive claim form completed through discussion with the customer on the telephone. I accept that people with impairments of various sorts can find it very difficult to complete forms, but the benefit inquiry line should be able to help them. Customers can talk to someone on the telephone, text phone is available, and there are other ways in which customers can access the service. We hope to be able to tailor questions to the customer's needs rather than them having to answer all the questions that might be useful. We hope that medical evidence relating to previous claims, already held by the Department, will be used to speed up the decision process. That might answer some of the hon. Gentleman's points about repeat claims. At the moment, all the information is held in files in Blackpool and is not immediately accessible. Once the IT system is up and running, we should be able to access such information instantly.
§ Mr. Llwyd
I appreciate the fact that the Minister is responding to the subject in a thoughtful and helpful way, something that does not often happen in such debates. I follow her arguments, but there is a problem with the helpline, because many people have difficulty speaking about their private affairs and some have speech difficulties. Does the Minister agree that it seems ridiculous that a person who has a degenerative disease and who has succeeded on appeal the first time around, should be put through the hoops two or three times subsequently? Surely that is wrong.
§ Maria Eagle
I shall come to the latter point in due course because there are particular issues relating to chronic and deteriorating conditions.
In respect of the helpline, if customers find it impossible to get the help that they need, we do our best to arrange home visits. We try to make arrangements that will suit the customer. It is not in our interests for inadequate claim forms to be returned because that just extends the process. I hope that the hon. Gentleman will accept that we want to administer the benefit, which has inherent difficulties, as well as we possibly can, with the aim of getting to eligible people the money that they 141WH need as soon as possible without the hassle that they might have previously experienced. We are all on the same side in that we all want to get this right.
On IT, we are beginning to acquire the capability to access information relating to previous claims more quickly. We are not there yet, but we are introducing IT in disability benefit units where initial claims are handled. We hope that, in due course, we shall see significant improvements as a result.
At every stage, development proposals on claim forms are presented to a forum of disability organisations, the modern service working group, to ensure that the changes meet the needs of and are in the best interests of disabled people and are not just administrative expedients. Those organisations can tell us whether we are on the right track. I hope that hon. Members will accept that we are doing our best to improve the administration, although I accept that there are still problems with it.
The hon. Gentleman more or less said that there is a continuation of the benefit integrity project and that periodic inquiry is no fairer than the benefit integrity project. Periodic inquiry was designed to do something very different from the benefit integrity project. Whereas the benefit integrity project appears to have been designed by the previous Administration to meet targets, periodic inquiry is a random check. Cases are chosen randomly from the case load and a visiting officer is sent out to complete the form. The idea is to try to ensure that people receive the right benefit. In fact, it is far more frequently the case that the benefits of someone who has gone through a periodic inquiry are increased rather than decreased, which gives the lie to the idea that periodic inquiry is the same as the benefit integrity project.
§ Annabelle Ewing (Perth)
Does the Minister have any statistics to back up her assertion that periodic reviews result in great news for people who are receiving benefit?
§ Maria Eagle
I do indeed. In fact, the hon. Lady has anticipated my next remark.
Results from the first two years of periodic inquiry have identified that in 75 per cent. of the cases where care or mobility needs changed, the inquiry led to higher entitlement. That gives the lie to the idea that periodic inquiry is the benefit integrity project with a different name. In fact, customer reaction to it has generally been very positive. When I visit those of my officials in disability benefit units who do periodic inquiries, I always ask them what reaction they get when they knock on people's doors. Generally, I am told that they and the process are welcomed. One might understand why that might be the case, as 75 per cent. of the cases result in increased benefit. I do not recognise the description of periodic inquiry as some form of rehashed benefit integrity project. Its aim is to ensure that people get the right benefits for their needs.
The hon. Gentleman complained that sometimes people have to reapply for their benefits. Sometimes people on indefinite awards do not have to reapply. It might become clear that their needs have increased when we visit them on a periodic inquiry. Our aim is to try to get people on the right level of benefit so that they get the support to which they are entitled, not to cut the costs on a targeted basis, which I understand was the purpose of the benefit integrity project.
142WH I am sorry if the hon. Gentleman has come across examples where periodic inquiry has seemed to operate like the benefit integrity project. If he would provide me with individual examples—obviously, not today—I would be more than happy to review them. It is certainly not our general impression from what comes back to us or from our statistics.
The hon. Gentleman rushed through some points about GPs at the beginning of his remarks, and it was not clear to me whether he was referring to the GP reports for which a decision maker might ask if they need more evidence because they are not sure about a form that has been returned, or whether he was referring to the examining medical practitioner or some combination of both.
§ Maria Eagle
The EMP is someone to whom our decision maker can resort if they do not feel that they have enough information to make a determination of the claim. It is certainly true that some of them are GPs. It is also true that our contractor SchlumbergerSema has been strengthening its management of the contracting doctors, at our behest. They receive significantly more training than they used to on appropriate behaviour.
I know that there are complaints about individual EMPs. I encourage hon. Members and their constituents to complain if they have come across any EMP whom they believe is behaving in an offhand way, making assumptions or not treating them with due respect and dignity. Arrangements are in place with SchlumbergerSema to deal with complaints in a way that can result in an EMP, a GP, or whoever is doing the report, being thrown off our lists, as people are. If there are sufficient numbers of complaints, we will investigate them. Some doctors are retrained.
§ Mr. Llwyd
The Minister has been generous in the debate. I see that my hon. Friend the Member for Caernarfon is here. He and I have a complaint in common. I will not name the person here despite privilege, but he has been reported to the General Medical Council and remains on the books of the third party—the contractor.
§ Maria Eagle
I should be happy to have further details from the hon. Gentleman if he would like to forward them to me. Under the new contract with SchlumbergerSema, strengthened procedures are in place to ensure that doctors who do not do their job appropriately do not do it at all. It is not our intention to subject disabled people and people with health conditions to degrading treatment or to make them jump through hoops to receive benefit. That is not what we are about. The hon. Gentleman must surely agree that we sometimes need more evidence than that provided on the form, and that sometimes there is no alternative to an examining medical practitioner. However, there is no reason why people should experience what he has described as happening to his constituents. We want to stamp that out. If he would like to send me details of the individual in question, I will look further into what he has said. I am aware that there are EMPs who have been removed from the lists and 143WH who no longer receive instructions to deal with this sort of case. It is not the case that removal never happens; it does, but we need to have the complaints to ensure that we pursue the bad eggs.
The hon. Gentleman made some important points about what Headway had to say to him about cognitive impairments and brain injury. We want to ensure that our procedures get to the nub of the issue and that those people who are eligible for the benefit receive it.
We are always open to representations about such issues, and I encourage Headway and other organisations to contact us. We have training and guidance for our decision makers about how such issues should be dealt with, but I do not pretend that it is perfect. We can always improve it, but we do set out to ensure that it is as good as it can be. I have some problems with the hon. Gentleman's suggestion about referring to clinical neuro-psychologists. We are not in the business of trying to medicalise the benefit beyond the degree to which it has already been medicalised—there are doctors' reports. Disabled people would not like that. They do not want the benefit to be turned into an assessment of how bad their condition is. The benefit is about dealing with care and 144WH mobility needs, and the person best placed to tell us what those needs are is the person concerned or their family and friends. That is the basis of the benefit, so we must be careful not to go too far away from that. I therefore have some concerns about the idea of bringing in clinical neuro-psychologists if it can be avoided. It would also be bound to lead to more delays. However, I am happy to take up issues and points that some of my officials raised about particular problems. The issues that Headway raised with the hon. Gentleman are also important.
The hon. Gentleman also talked about the changes to the lower rate mobility benefit. There have been debates in the other place about that issue, but I reiterate that the aim of that change was to keep the benefit true to its original intentions. It is not the case that people who have fear and anxiety and a physical impairment cannot receive the lower rate mobility benefit. We hope that the change will affect only a very small number of people, and I hope, given what I have been able to say to him today, that the hon. Gentleman will accept that that is by no means all that we have been doing to try to improve the administration of DLA and to ensure that those who are eligible for the benefit receive it, receive it quickly, and at the level to which they are entitled.
§ Question put and agreed to.
§ Adjourned accordingly at one minute to Two o'clock.