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Mrs. Bridget Prentice (Lewisham, East) : Given the amount of consultation that the Secretary of State says he has had on this project, does not he think that it is about time that we had the final, final statement on this route? What comment does he make to my constituents, especially those between Grove Park and Hither Green, and, indeed, others in south-east London, who will have to bear the burden of extra freight trains but will have no benefit from extra commuter trains or the link, and will have to suffer blight on their homes for the next 10 years while the fast trains go through to Waterloo?
Mr. MacGregor : Of course there will be benefits to the hon. Lady's constituents in other ways. I re-emphasise that my announcement safeguards by far the vast majority of the route. There are only two stretches--and they are not significant in relation to the total route mileage--on which we are undertaking further consultations. Those consultations will be completed within a matter of months, well before the competition for the private sector partner is completed and well before the Bill is presented. By then, of course, the entire route will be safeguarded.
Mr. Mark Wolfson (Sevenoaks) : I welcome three matters in particular : the Secretary of State's emphasis on improvements to Thameslink, on keeping the freight options open, and on his commitment to substantial public sector support for the project. I have argued for that from a somewhat lonely position on these Benches ever since the project was mooted. I never thought that it would happen without such support, so I welcome it.
I should like an assurance on two matters. First, will my right hon. Friend's Department continue to keep a close eye on ensuring that the services for commuters using the existing lines in Kent are not downgraded when they are in competition with the international cross-channel services? Secondly, will he ensure that the Bill and the construction of the link are pushed forward with a great deal more urgency than there has been over the past eight years?
Mr. MacGregor : I am grateful to my hon. Friend for his welcome for the three matters that he mentioned. On the first of his questions, there will be no downgrading by my Department--of course, the issue does not concern only my Department--of existing commuter services in Kent. My hon. Friend will know about the efforts that are being made with British Rail to improve existing services and about the substantial investment in rolling stock and in other matters. On my hon. Friend's second point, I hope that he will accept that there has been a pretty speedy resolution of all the difficult issues on the route in the past 18 months. We moved quickly to the preferred route. Six months was the minimum time that we could have given Union Railways to carry out massive tasks--engineering, environmental and others. They did that well. I hope that my hon. Friend will agree that we took our decisions on the report as quickly as could possibly be expected, given the substantial implications. I hope that we can now proceed along the path that I have outlined, and with due speed. But, inevitably with a project of this nature, I suspect that there will be many petitions on the Bill.
Mr. John Gunnell (Morley and Leeds, South) : The Secretary of State knows well that not only the Thames corridor but much of the north of England is in need of regeneration. Will he assure me that links from the west
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coast main line and the east coast main line, which will need to be constructed before St. Pancras becomes a viable option, will be in place before the rest of the line is completed so that the disadvantage already suffered by the north of England in channel tunnel links is not worsened by the changes that have been announced?Mr. MacGregor : The two points that the hon. Gentleman has in mind-- the connections with the west coast main line and the east coast main line to ensure that services coming out of St. Pancras go direct, as I have said, to the north of England, west midlands and Scotland--are an intrinsic part of the proposal.
Mr. Matthew Banks (Southport) : Will my right hon. Friend give the House an assurance that, at the present time, the north of England and the rest of the United Kingdom are not disadvantaged and that the links to which he has referred will be adequate and proper? If he is able to give that assurance, does he agree that the channel tunnel rail link will benefit not only southern England but the whole of the United Kingdom?
Mr. MacGregor : I agree with my hon. Friend ; he makes an important point. I am quite sure that, as with the Jubilee line, there will be construction jobs for firms all over the country. My hon. Friend will know that that is the case with the Jubilee line.
As for freight, a substantial part of the investment that has already been made is designed to benefit the north of England, Scotland, west midlands and other parts of the country apart from the south-east to gain the full benefits that long-distance freight can gain from having the channel tunnel. I repeat that there will be dramatic reductions in journey time for freight on rail compared to the present time--and, indeed, compared with road--when freight services open. There will be direct passenger services from the north of England through the channel tunnel in 1995.
Mr. Peter Kilfoyle (Liverpool, Walton) : Does not the Secretary of State understand that the upgrading that we all anticipated for the west coast main line is extremely important for the industrial heartlands of the west midlands, the north-west and the west coast of Scotland? Will not the lack of urgency in his statement confirm the suspicions of those of us who believe that he does not have a commitment to the fast rail links, without which there will be no regeneration in the industrial heartlands and regions along the west coast main line?
Mr. MacGregor : The hon. Gentleman obviously framed his question before I answered my hon. Friend the Member for Southport (Mr. Banks). I dealt with some of those issues in that answer. We are proceeding with the greatest speed that we can get on the high speed link, because, as I have said repeatedly, it is a complex issue, involves a large number of organisations and people, and must be thoroughly argued through. We are proceeding with it with due speed. As the hon. Gentleman will know, we attach priority to the upgrading of the west coast main line generally and the southern sector, which is the sector most in need of improvement. As my right hon. Friend the Minister for Public Transport said at Question Time, we expect Railtrack to announce shortly the results of the competition for the specification stage. That is moving ahead, too.
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Mr. Mike Gapes (Ilford, South) : Will the Secretary of State tell us what communications links there are between Ebbsfleet and the London Underground ? What communications links are there with the potential crossrail link ? Is it not ridiculous that, instead of taking advantage of linking the channel tunnel link to Stratford, the whole of the Central line and the rest of the underground system , he comes up with an announcement that will be seen as bitterly disappointing by my constituents in Ilford and other people near to the area who could have benefited so much from those proposals ? Those of us in east London already have appalling conditions in travelling to this place and into central London generally, and the proposals do nothing to improve that situation.
Mr. MacGregor : No doubt the hon. Gentleman will talk again to the promoters of the Stratford station. I have made my position on that very clear.
The hon. Gentleman will know that a number of other
improvements--unconnected with the high-speed link--are to go ahead. Improvements to the underground and other transport systems in the east end are being considered, and substantial improvements in all aspects of transport are taking place to assist the regeneration of east London.
I was not able to mention this in my statement, but the report makes it clear that Union Railways and the operators have decided that there are no operational benefits in a direct connection between crossrail and the high- speed link. We have therefore decided not to proceed with the direct link at Forest Gate, and at one other location. I suggest that the hon. Gentleman should read the report in that context.
Mr. William O'Brien (Normanton) : In his statement, the Secretary of State referred to the importance and significance of the link with the north. Can he give us some idea of when it will be completed? This concerns many of my constituents whose properties are blighted by the proposal for a terminal in my constituency. When will the Department of Transport or the Department of the Environment give the go-ahead for the Wakefield terminal? Can the right hon. Gentleman give the project any assistance?
Mr. MacGregor : I was not sure what link the hon. Gentleman meant, but I now understand that he is referring to the rail freight terminal. We hope to make a statement shortly ; as the hon. Gentleman knows, there have been financing problems.
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Mr. Brian Wilson (Cunninghame, North) : What should have been a great national project has been delayed to such an extent that it has taken eight years for it even to reach this stage. Does that not speak volumes about Tory government? The channel tunnel link has been seen as a holy grail into which not a penny of public money must go. Now that has been thrown away, and we are having to start all over again.
Is that the way in which great national infrastructure projects should be treated? Is it not astonishing that the Secretary of State should announce a route to us, while still being unable to tell us with any assurance where the money will come from? Why do not the Government get on with it, and end the national embarrassment that they have inflicted on Britain? Anyone can see the contrast between what has been done in France and what has been done in this country, under successive Tory Secretaries of State.
Mr. MacGregor : That reaction is typical of the hon. Gentleman. Let me make two points.
First, a substantial amount--about £1.4 billion--has been invested in transport infrastructure and rolling stock to enable the railway system and the passengers and freight involved to gain the full benefit when the channel tunnel opens. That will make a huge difference to the travelling time of both passengers and freight, and it will be possible to deal with all likely demand until the turn of the century.
Secondly, all aspects of the channel tunnel high-speed link must be examined very thoroughly. It must be engineered correctly ; all the people and businesses likely to be affected must have an opportunity to be consulted, and we must ensure that their views are taken fully into account. There must be a sensible balance between securing value for money for the taxpayer and enabling the project to be financed partly by the private sector.
I believe that the way in which we are proceeding will produce considerable benefits. The capacity will be there when it is needed ; the private sector will make its contribution, not only financially but by securing real value for money in the building of the link ; and the taxpayer will be given value for money. The hon. Gentleman's answer to every question is simply to demand more and more of the taxpayers' money, irrespective of the merits of the case and irrespective of whether a private sector contribution can be made. That makes nonsense of the Labour party's claims about tax.
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Orders of the Day
Social Security (Incapacity for Work) Bill
Order for Second Reading read.
4.24 pm
The Secretary of State for Social Security (Mr. Peter Lilley) : I beg to move, That the Bill be now read a Second time.
A year ago, I announced a long-term review of the social security system. The aims of the review are to improve the system, to safeguard the position of the most vulnerable and to ensure that the system does not outstrip the nation's ability to pay. I subsequently published my analysis of the growth of social security over the rest of this decade. That document showed that one of the three areas accounting for most of the likely growth in spending was invalidity and related benefits, so that has been the first sector that I have chosen to tackle.
The Bill, together with the Statutory Sick Pay Bill, introduces a comprehensive reform of the system of benefits for those too unwell to work. The Bill has three objectives : first, to ensure that the huge and rising sums devoted to sickness benefits are properly focused on those who are genuinely too unwell to work ; secondly, to ensure that the cost is affordable ; and thirdly, to provide a more rational structure of benefits.
The Bill replaces sickness and invalidity benefits with a new benefit called incapacity benefit. It introduces a new and more objective test of incapacity for work, and abolishes the lower rate of statutory sick pay.
Before going into the detail of the Bill, let me knock one accusation firmly on the head. The Bill is not an attack on the sick and disabled ; it is the very reverse. It is designed to protect their benefit against those who abuse it. As a result, it will make their benefits sustainable despite the other pressures on the social security system. That is a worthy objective, and one which the whole House should share.
Invalidity benefit is the fastest growing contributory benefit, and it is already second in cost only to the basic pension. Spending on invalidity benefit has doubled in real terms in the past 10 years, from £2.7 billion to £6.1 billion last year. If we left it unchanged, it would grow by a further 50 per cent. or more in real terms by the end of the decade.
It is working people who have to pay for it through their national insurance contributions. Already, on average, the cost for everyone who contributes is £275 a year, and the cost is rising because the number of claimants is growing. Over the past 10 years, the number of people on invalidity benefit has doubled. It has trebled over the past 15.
Mr. D. N. Campbell-Savours (Workington) : The right hon. Gentleman may know that several thousand people in west Cumbria draw invalidity benefit. In his calculations, does he assume that, in the event that invalidity benefit is stopped and restrictions are introduced which mean that fewer people can draw incapacity benefit, many people will move on to the unemployment register? Does he believe that that will be the impact of the changes?
Mr. Lilley : Clearly, many people who draw this benefit at present and who do not have jobs would initially draw
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unemployment benefit or other benefits for the unemployed. I want those who are fit enough to work to be helped back to work by the benefits appropriate to them. It is wrong to give people who are able to work benefits which can eventually lead to their becoming unable to work because of unfamiliarity, lack of motivation and the staleness of skills caused by their being on benefits for some time.Mr. Campbell-Savours : On that point, how many
Mr. Lilley : I would rather make some progress. I answered the hon. Gentleman's question perfectly well.
Mr. Campbell-Savours : How many people--
Mr. Deputy Speaker (Mr. Michael Morris) : Order. The hon. Gentleman cannot ask questions when someone else has the Floor.
Mr. Lilley : I am sure that that issue will arise in due course. I pointed out that the number of people drawing this benefit has more than doubled in the past 10 years. Can it really be that Britain's health is getting so much worse? [Interruption.]
Mr. Deputy Speaker : Order. I must ask the hon. Gentleman--
Mr. Campbell-Savours : It is very important.
Mr. Deputy Speaker : I am sure that it is very important, and if the hon. Gentleman catches my eye he can put it with even more conviction, but not from a sedentary position. Mr. Secretary Lilley.
Mr. Lilley : I believe that, from those questions, the question arises whether we are becoming less healthy as a nation. Is there really an epidemic of incapacity? Of course there is not. The nation's health has been improving. Let me give a number of indicators of that.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : Will the Secretary of State give way?
There has been a dramatic reduction in incapacity caused by peptic ulcers. There has been a marked reduction in the number of strokes, roughly halving the number of people aged under 65 who have died from them since 1970. With developments of modern surgical techniques, long-standing painful and disabling conditions, such as osteoarthritis of the hip joint, can now be successfully cured. Moreover, the general household survey has shown that there was no increase in disability in the general population between 1976 and 1988. Therefore, we have to re-examine the way in which the benefit works.
According to the statute, sickness and invalidity benefits were originally intended for those people who,
"by reason of some specific disease or bodily or mental disablement",
were unable to undertake work. However, successive commissioner rulings and court case law have resulted in non-medical factors being taken into account. As a result, the rules have been progressively widened and complicated.
General practitioners have the job of assessing whether their patients are medically too unfit to work and are therefore entitled to the benefit. That has always put GPs in an invidious position. [ Hon. Members :-- "Hear, hear."]
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On the one hand, they have an obligation to their patient ; on the other, they have to act as gatekeeper for the social security system. That job has become harder as the definition of incapacity has become fuzzier.Our research has shown that GPs are far from sure about what the legal position is or whether their decisions conform with it. An independent study conducted by Weekly Monitor found that two thirds of the GPs surveyed had issued medical certificates to people who were either not sick at all or not sick enough to be incapable of work.
We should not blame doctors for that situation. It is up to Parliament to resolve their conflict of interest and to clarify law. Until we do so, access to the benefit will remain haphazard, controls will be lax and the system will be open to abuse.
The public at large resent that abuse. People who work for a modest wage resent seeing neighbours, apparently as fit as themselves, living on invalidity benefit. Too many people regard invalidity benefit as a readily available supplement to their occupational pensions when they take early retirement.
Some employers are as much to blame as employees. It is not unknown for personnel departments to advise perfectly fit staff whom they are making redundant how they can claim invalidity benefit. There are well publicised cases of people on invalidity benefit earning money by cleaning windows at the very same office where they were claiming that benefit, enjoying cycling holidays and winning javelin contests.
Mr. Matthew Banks (Southport) : My right hon. Friend rightly draws attention to some of the abuses. He is aware that I had a very pleasant day close to my constituency last year, when I attended the grand national. Is my right hon. Friend aware that the man who waved the flag at the grand national was on invalidity benefit? [Interruption.]
Mr. Lilley : Obviously, I cannot comment on individual cases, but I have to say that in that case there was come evidence of capacity to perform that task.
Mr. Paul Flynn (Newport, West) : Before the Secretary of State plunges the entire nation into the chaos that the grand national suffered last year, will he take a tiny bit of blame himself and confess, before he scapegoats the sick in the way he is doing, that £8 billion was taken from the national insurance scheme by his predecessor's decision to withdraw the Treasury supplement from the national insurance scheme? That was left out for those three years, and that is the main reason for any shortfall in the national insurance scheme, not the problems of the sick.
Mr. Lilley : I do not think that that is a telling point. We have agreed to top up the fund from taxpayers' money, and we are doing that significantly at present. In other words, the recipients of contributory benefits are receiving benefits of which the total value exceeds the current value of contributions going into that fund. Surely that is one reason why we should look closely at those benefits and ensure that they are going to people who are genuinely sick and disabled--people who are intended to receive them and on whose behalf those contributions have been paid. The hon. Gentleman thinks that is targeting the sick and disabled. It is targeting the benefit on the sick and disabled, which is what we want to achieve.
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Mr. Simon Hughes (Bermondsey) : The Secretary of State knows that my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) is ill and that otherwise he would be speaking on the matter in my place.
Does the right hon. Gentleman not agree with the general view, before he is selective in targeting, that the best way of reducing the number of those who honestly or dishonestly may seek to claim benefit is by maximising the opportunity for people to do a hard day's work and therefore minimising unemployment?
There will never be a system in the world which somebody will not get round. It is important that the system, although tough, deals with individual circumstances and the individual applicant in every event. A strict medical test that does not take account of age or of history of medical illness or of environment or of work will never be able to take account of everybody's circumstances, all of which are different.
Mr. Lilley : I strongly agree with both points. We want to help people back to work : that must be the most constructive thing for people who can work. A test must be sensitive enough to take into account the vast array of different conditions from which people suffer, and I shall be coming to the test and the way in which we are trying to ensure that it achieves that, while being objective and effective.
We obviously need to restore the original policy intention of providing help only to those who cannot work because of their medical condition. I want to clear away the clutter of conditions and focus the benefit on fitness to work. That is why I am proposing a new test of incapacity for work. The test will be more objective, simpler to understand and easier to apply.
Throughout the year, we have had extensive discussions with experts on disability and occupational medicine. As a result, we have developed a test based, first, on identifying the key faculties whose impairment can make people unable to work. The essential physical faculties include bending, lifting, walking, vision, hearing, reaching and so on. Following consultation, we have included climbing stairs and tinnitus as well. In addition, there are a number of measures on how mental health problems affect the ability to handle different situations.
The second step is to calibrate the extent to which loss of any of those faculties impairs ability to work. A number of people have tried to mock that approach and the basic test, which we have spelt out in the consultation document. I regret to say that even the hon. Member for Glasgow, Gaescadden (Mr. Dewar) has, rather
uncharacteristically, joined in the mockery. That mockery is not appreciated by disabled people. The approach underlying the test is highly respected by disabled people and their representatives. It has the same basis as that used in the definitive study measuring the extent and severity of disability in Britian.
Our new test has already been welcomed. Today I received a letter from the National Back Pain Association, welcoming a more objective test. If the hon. Member for Garscadden says that we should listen to the views of disability organisations, let me read him the NBPA's conclusion :
"For some time now the Back Pain Association has been concerned with the issue of benefits of those disabled by back pain. The nature of the condition, with its invisibility, its many causes and often difficult diagnosis, has led both to some abuse by claimants and also to unfair views of the back pain sufferer as
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a malingerer. A move towards a more objective' test would thus be welcomed. The NBPA is pleased to note that the added emphasis on self-assessment in the proposed process."The association adds :
"However, this organisation feels that the ability to sit must be added to the list of functions assessed."
We have duly added that function. [Interruption.] No, that is the only function that the association mentioned in its conclusions.
Mr. Donald Dewar (Glasgow, Garscadden) : Let me just correct the record. I think that I am right in saying that the National Back Pain Association has also made it clear that it is deeply concerned about the present test, especially as it affects remission. Someone may be able to do the physical test satisfactorily on day A, but may pay a heavy price for it on subsequent days. The association has made strong representations and, as I understand it, remains unsatisfied on that point.
Mr. Lilley : A number of organisations have stressed the important point that the test must not be merely a snapshot taken at one point in time. We have taken that on board--indeed, we had done so before we issued the consultation document. The test must take account of the fact that conditions come and go. That fact will be taken into account in the assessment ; that is right and proper. I shall deal shortly with the consultation and evaluation procedures. We want to take such comments on board, and the National Back Pain Association's letter shows that we are doing so.
The third step in developing our test is to establish how partial loss of two or more faculties may combine to make someone unable to work. The fourth step, which we have introduced as a direct result of our discussion with the expert panel, is to cross-check how the loss of faculty would influence ability to undertake the 100 most common occupations in this country. Together, those occupations account for three quarters of all people in work, so it will be a fairly comprehensive check.
The fifth step is to establish a threshold of incapacity beyond which people will qualify for the benefit. Clearly, that is a crucial decision. The threshold must be set at a reasonable level and must not exclude the people whom we want to help--the genuinely unfit. I want to draw upon the widest possible expertise in setting it. That is why I have set in train a wide-ranging process of consultation and evaluation before bringing forward regulations to implement the test.
I have published a consultation paper setting out our proposals in detail. I have sent more than 4,000 copies to individuals and organisations who expressed an interest in them. I have also formed a panel of some 80 experts, including disabled people, doctors, academics and representatives of disability organisations. I have asked those experts to help define the threshold of incapacity and to refine ways of measuring it. Their involvement will help to ensure that the threshold is set at a fair and reasonable level. In the spring, I will be carrying out a full trial to evaluate the new procedures. We will examine how the test would work if applied to a large number of specific individuals. We will check that the test gives results that are consistent with those from a direct medical examination of each individual. I hope that that will reveal any pressure points,
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unforeseen problems and exceptional cases. Following that process, we can refine the test and the adjudication procedures.I intend to publish the results of both the consultation and the evaluation process before introducing forward secondary legislation to implement the test. Parliament will therefore be able to make an informed judgment on the effectiveness of the new test before considering the regulations.
Mr. Dafydd Wigley (Caernarfon) : The Secretary of State is trying to establish a definitive set of conditions--a level above which someone may be entitled to benefit and below which he or she will not be entitled to it. Does the right hon. Gentleman accept that disability varies enormously from individual to individual--that it is not a homogeneous condition? It may be well-nigh impossible for people to operate such clinical rules unless there is a considerable degree of latitude. Is the right hon. Gentleman prepared to give that latitude?
Mr. Lilley : I have a great deal of respect for the expertise of the hon. Member for Caernarfon (Mr. Wigley), who has specialised in these matters, and I take to heart the point that he has made. I said earlier that we are trying to ensure that the test is sensitive and that it absorbs and incorporates the expertise of a whole range of different experts and groups.
We want to get it right. We have an interest in doing so, because we want to get the benefit to those who are entitled to it and who have the underlying requirement for it. We seek only to exclude those who are not entitled to it--those who are fit enough to work and who ought to be helped back to work through the back-to-work benefits. We recognise that the test should not be a single snapshot of a particular point of time ; that we must take into account the nature of the ailment or incapacity from which a person suffers ; and that we must ensure that the test achieves that. That is why we are going through the evaluation and consultation process. I hope that the publication of the findings will enable Parliament to be sure when it comes to consider the detailed regulations that we have done precisely that.
Clearly, however, any benefit must have a criterion attached to it and that criterion must be applied. Ultimately, the choice is between an objective criterion and a subjective one, and a subjective criterion relying on the simple opinion of an individual and his luck and good fortune in having a sympathetic local doctor can be much more unfair and unjust than an objective one. I hope that the procedure will result in something fair, reasonable and sensible that meets the complexities to which the hon. Member for Caernarfon referred.
Mr. Geoffrey Dickens (Littleborough and Saddleworth) : Does my right hon. Friend agree that we have perhaps been hoist with our own petard? In our compassion, we tried to give a very generous benefit to those suffering from invalidity. We are now replacing that with something that is more fair because it is targeted on those who are genuine invalids. Will my right hon. Friend tell the House the difference between the rewards that someone enjoys who can get on to invalidity benefit--even if he or she is not really entitled to that benefit--and what he or she will get in future?
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Mr. Lilley : My hon. Friend makes a good point. Invalidity benefit is a more attractive benefit than the back-to-work benefits. [Interruption.] I am talking about the present, and at present invalidity benefit is more attractive than the back-to-work benefits and does not have the conditions attached to it that the benefits intended to encourage people back to work carry. There have therefore been attempts to get on to invalidity benefit when it is not the best or most suitable benefit.
Mr. Campbell-Savours : Will the Secretary of State give way?
Mr. Lilley : I will give way to the hon. Gentleman for the second time.
Mr. Campbell-Savours : Can the Secretary of State give me the figure that really interests me? How many tens of thousands--in the view of the hon. Member for Littleborough and Saddleworth (Mr. Dickens), perhaps hundreds of thousands--of new people will be seeking work and want to register unemployed?
Mr. Lilley : We estimate that it will be some 95,000 in the first year, rising in the second year to 190,000. That is working on the most pessimistic assumptions.
Let me explain how the new test will be applied in practice. For the first 28 weeks of sickness, claimants will be entitled to statutory sick pay or the lower rate of incapacity benefit which replaces sickness benefit. During that first 28 weeks, the criterion for entitlement--normally inability through sickness to undertake one's current occupation--will be unchanged. So will the current reliance on a general practitioner's certificate. After 28 weeks, however, claimants will automatically move on to incapacity benefit at the middle rate.
Those who could not be expected to handle a questionnaire on their fitness- -because of severe mental illness or terminal illness--who will be identified from their records during the first 28 weeks, will be handled directly by the Benefits Agency medical service and their doctor. But most people will then be sent a copy of the incapacity benefit questionnaire to assess long-term incapacity for work. That will ask claimants to give details of how their sickness or disability affects each of the key faculties. The process will be similar to that required of people claiming disability living allowance.
Their GP will then simply be asked to give his diagnosis of their illness and the principal disabling conditions to which it gives rise. He will not be asked to confirm the patient's self-assessment. Nor will the GP any longer be required to express a view of his patient's ability to undertake any kind of work.
The Benefits Agency medical service will then examine the claim form. In straightforward cases--for example where the diagnosis is of an invariably serious disabling condition--the adjudication officer will accept the claim without medical advice. But we would expect the adjudication officer to seek advice from the Benefits Agency medical service in about 85 per cent. of cases.
BAMS would then assess whether the questionnaire and diagnosis leave room for doubt. If so, it may seek further clarification from the GP and, if appropriate, invite the claimant for examination. We estimate that it will want to examine two thirds of cases referred to it. That means that just over half of all claimants may be called for examination.
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