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The Minister for Social Security (Mr. Nicholas Scott) : I am grateful to the hon. Member for Birkenhead (Mr. Field) for raising this case. It has been in the frame, as it were, ever since I assumed my present responsibilities. I have talked to a number of holders of my office and to those who were Parliamentary Secretaries in the Department. They recall the long-running issue involved in Mrs. Moran's claim for a higher rate of attendance allowance. I acknowledge that my hon. Friend the Member for Wirral, South (Mr. Porter) has weighed in behind the hon. Gentleman.
Like the hon. Member for Birkenhead, I cannot but pay tribute to Mrs Moran and to Mr. Moran, who, as he said,
Column 1192is following the debate with great interest, for the way that they have sustained their case. I also pay tribute to Nick Warren, despite the difficulties that he may from time to time have caused for those in the Department with responsibility for these matters. He has a high reputation in this area.
The first thing I have to say will be disappointing, but I cannot think that it will be any surprise to the House to know that, whatever sympathy I have for Mrs. Moran--the hon. Member for Birkenhead knows of my sympathy--I cannot make any decision on her claim. We have a system of attendance allowance claims, in common with claims for all other social security benefits, based on independent adjudicating authorities. The allowance is awarded, or disallowed, by an adjudication officer who is wholly independent of Ministers and civil servants in the Department.
Claimants who are dissatisfied with the decisions of adjudication officers can appeal to a social security appeal tribunal and thence, with leave, to the social security commissioner on a point of law. It is important for the House to realise that the adjudication officer and the SSAT can award an allowance only for the period and at the rate specified on a certificate of attendance needs issued by the attendance allowance board or by a medical practitioner who has been delegated to act on behalf of the board. We have to accept that those basic rules cannot be altered by a Minister, however sympathetic he may be towards an individual case.
Review decisions of the board or its delegates are themselves subject to the same rights of review as initial decisions. Review decisions can also be challenged by way of an appeal on a question of law to the social security commissioner. We cannot decide claims, nor can we alter or try to affect decisions given by the board or its delegates about whether the medical criteria for the attendance are satisfied in individual cases.
The hon. Gentleman raised the record of the board. I believe that the record of achievement of the attendance allowance scheme over the years has vindicated Parliament's decision to entrust those decisions to the board and to the various appeal procedures that are available to claimants.
The board has the duty of applying the criteria in individual cases and to use its expertise and judgment. It is made up of eminent clinicians, expert in various fields of medicine, as well as lay people with interests and insight into the needs of disabled people. Its delegates are usually practising or retired general practitioners who, of course, have practical experience of the effects of disability in all its forms on the daily lives of disabled people. I shall set Mrs. Moran's case in the wider context. The decisions of the board have been instrumental in the award of attendance allowance to more than 2 million people, and some 65 per cent. of all initial claims made since 1971 have been favourable. Today, about 760,000 people are in receipt of attendance allowance. I am certainly not claiming at this Dispatch Box that the board always gets it right first time, or that the needs of individual disabled people do not change over time. That is why the arrangements for the review of the decisions on the medical criteria in individual cases must take account of both those eventualities.
On the face of it, one could say that the number of occasions when changes have been made to that initial decision--approaching 20,000 cases over the years--looks
Column 1193a lot, but it represents only 6.4 per cent. of the number of decisions on new attendance allowance claims in 1987. For the board and its delegates to have given decisions on initial claims which satisfy over 90 per cent. of claimants is a remarkable achievement. It is all the more remarkable when one bears in mind that claimants are encouraged to seek review if they are dissatisfied when details of the decisions of the board and its delegates are sent to them. There is rightly every incentive for dissatisfied claimants to exercise that right and to seek review. Attendance allowance is well worth receiving in its own right. It is a well targeted benefit. It provides welcome help with the extra costs arising from long-term disability, but it also provides a passport to the income support disability premium and severe disability premium and a passport through the disablement test for severe disablement allowance ; and, of course, it is a precondition for payment of invalid care allowance. It is therefore an important passport. There is every incentive for those who may be turned down to seek a review. I do not complain about that at all, because I am anxious to ensure that all those who are entitled, either to the lower or to the higher rate, get that entitlement.
The relevant change of circumstances reviews are an important part of the process. Reviews on that ground relate exclusively to people who have been awarded the lower rate allowance and whose attendance needs have changed, which is relevant to Mrs. Moran's circumstances. In 1987, relevant change of circumstances reviews resulted in some 24,000 decisons being changed. There is therefore no automatic tendency on review to turn down cases which are raised and for which reviews are asked. We all know that the needs of disabled people are not fixed. Their circumstances genuinely change from year to year, and, indeed, over even shorter time scales. It is right that there should be a system that makes it possible to review the changes and to see whether the higher rate allowance may be appropriate because of the changed circumstances.
One of the most important points raised by the hon. Gentleman was that the board had somehow changed its position on the risks attached to epileptic fits, which especially applies to Mrs. Moran's case. Perhaps, in response, I could quote what I believe to be an especially relevant passage from the recent decision of the tribunal of commissoners explaining why that was a reasonable thing for the board to do :
"Now had the factual situation as found by the Board remained as it was at the time of the Commissioner's decision of 30 April 1986 then, in the light of the guidance of the Court of Appeal's judgment, the claimant might reasonably have expected her claim to succeed. In those circumstances it would be entirely understandable for the claimant to feel that the Board have to use a colloquialism moved the goalposts'. But of course that would be an entirely wrong way to look at it. It is the function of the Board to use their accumulated medical knowledge and expertise objectively to assess each case before them, and it is their right and, indeed their duty, to take account of any advances and other changes in such knowledge so that the opinions they express reflect the most up-to-date established thinking."
However, the relevant paragraph goes on to explain the commissioner's view that this principle should be subject to an obligation on the board to explain why it revised or modified a long-established approach. In that connection, I shall pick up the question put by the hon. Member for
Column 1194Birkenhead about the American evidence which was quoted by the board in support of its contention about the risk of death in bed from epilepsy.
The board may wish to respond to the commissioner's view about the need for explanation when it comes to review Mrs. Moran's case once again. I understand that doctors often have to interpret published scientific evidence, which may not be conclusive in the light of their own clinical experience, when deciding on the management of their patients. In those circumstances, references may be quoted more by way of illustration than as conclusive proof. In that respect, the board is no exception in reaching a view on the risks attached to epileptic fits in bed at night.
That leads me to give the only answer I can give to the two other questions posed by the hon. Gentleman. It is because we have appointed the board as a source of expert advice, based on accumulated experience and the ability to interpret medical experience, that, despite the hon. Gentleman's understandable plea for the Secretary of State to be involved in the next hearing, it would be inappropriate for my right hon. Friend to express to the board the simple and unequivocal support for Mrs. Moran's claim as proposed by the hon. Gentleman.
I do not believe there would be any point in securing the service of expert advisers and adjudicators if one then told them what to do in their sphere of expert judgment. For similar reasons, I doubt that it would necessarily serve the claimants' interests to seek to put one set of experts on top of another. There is already provision for appeal to the commissioners on matters of law and I do not believe it would necessarily improve matters to impose a higher tier of medical adjudication.
The hon. Gentleman asked about the commissioner's comments on the board's guidance to its delegated doctors and about earlier cases decided under these guidelines. The board will undoubtedly be reconsidering those guidelines in view of what the tribunal of commissioners said in its recent decision. In the event that the board revises those guidelines, it will obviously be necessary for consideration to be given to the implications for the previous cases to which the hon. Gentleman rightly drew attention.
I recognise that Mrs. Moran's case has been at issue for a long time. I hope that the hon. Member for Birkenhead and my hon. Friend the Member for Wirral, South will recognise that that is the result of fundamental questions that have been raised in the course of that case. Whatever sympathy I have for the particular circumstances of Mr. and Mrs. Moran--I assure the hon. Gentleman of my sympathy--it was inevitable that that case would be protracted because of its importance to the claimant and to the Department. Therefore, some delay and an extension of the consideration of the case was inevitable. The Department and the independent adjudicating authority have all been involved in that.
Let us consider the circumstances in which it will be for the attendance allowance board again to reconsider Mrs. Moran's case in the light of the guidance on relevant legal issues that has been handed down by the Appeal Court and the social security commissioners. I understand that, at present, the board is discussing with Mrs. Moran's representatives a suitable date when it might be able to hear her case. I am confident that everyone present in the Chamber hopes that that hearing, combined with guidance from the courts and the commissioners and the board's expertise on the medical issues involved, and the
Column 1195subsequent decision--I cannot prejudge what it will be--will be instrumental in bringing Mrs. Moran's case to a satisfactory conclusion.
Column 1196Question put and agreed to.
Adjourned accordingly at twenty-nine minutes past Ten o'clock.
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