House of Commons Hansard Debates for 3 Dec 1996 (pt 44)

11.47 pm

The Minister for Social Security and Disabled People (Mr. Alistair Burt): I am grateful to the hon. Member for Blaenau Gwent (Mr. Smith) for raising this case. I know that he has taken a great interest in it. I begin by expressing my personal sympathy for the family and friends of Mr. Holmes at this difficult time.

Mr. Holmes's death so soon after his medical examination is, of course, of great concern to the Department. It is quite right that spokesmen do not discuss personal details, particularly with the media, after an incident, but it is equally proper that the matter is raised at times such as this. The Benefits Agency has looked very carefully at the facts and circumstances of the case, and I understand that the Agency's chief executive is to respond separately to the hon. Gentleman shortly.

Having looked at the details of Mr. Holmes's case, I am satisfied that at every stage the claim was handled in a proper manner and in line with the procedures and guidance provided. The arrangements for dealing with claims for incapacity benefit have been carefully designed. They ensure that all relevant information is taken into account, and in particular that people with severe medical conditions are dealt with sensitively.

The medical examination itself was developed with the help of a panel of 80 experts, drawn from the various medical disciplines and groups representing disabled people, to ensure that the method of determining someone's capacity for work was both reasonable and fair.

It is also important to emphasise that doctors who are employed by the Benefits Agency medical service are trained to very high standards. To be considered for employment, they must have clinical experience, and have skills in areas of medicine relevant to the assessment of incapacity. They must then pass a rigorous approval process, which involves four days of theoretical training followed by a written exam. Newly approved doctors are supervised during their first four assessments to ensure that they are able to perform to the required standard.

We have taken great care in the design of procedures to determine incapacity for work, and to ensure that those applying the procedures have the right training and

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experience. I should like to explain briefly how the process works. I hope that that will reassure the hon. Gentlemen and his constituents.

In order to claim incapacity benefit, a person must supply medical evidence from his or her general practitioner. If sickness continues beyond 28 weeks, consideration is given to whether a medical examination is necessary to confirm continuing incapacity or whether the condition is so severe that a medical examination is not required.

The effects on individuals of medical conditions such as heart disease can vary from mild to very severe. An individual medical examination will therefore be required in most cases. However, a number of conditions are such that it would be unreasonable to expect the person concerned to be capable of work--for example, severe learning disabilities or severe mental illness.

If the medical certificate from the general practitioner indicates that the claimant may be suffering from such a condition, the Benefits Agency will obtain a full report from that GP, and ask for advice from a Benefits Agency medical service doctor, who will have been specially trained and approved in the way I described. The doctor will provide advice on whether the claimant's condition falls into an exempt group, in which case benefit will be awarded without the need for an examination. It is relevant to note that the majority of people who have recovered after a heart attack will not be in such a category.

Mr. Llew Smith: The Minister said that people with severe conditions would not be expected to work again, or to return for continual medical examinations. I accept that, but how much more severe could David's condition have been? His consultant told him that, if he worked again, he would not survive--he said that that was it; that was the end. He was not speaking in isolation. David saw three other doctors, and the outlook was considered to be equally gloomy.

Mr. Burt: If the hon. Gentleman will allow me, I shall come to the circumstances of Mr. Holmes's examination later.

During the development of the incapacity benefit, Ministers wanted to ensure that people with severe medical conditions would not be put through a medical examination. A limited number of circumstances were subsequently identified in which the severity of the person's functional limitations would be beyond doubt, such that they would clearly be incapable of work.

The criteria used for determining those categories were, first, that the person was suffering from one of the most severe medical conditions, such as severe heart and lung disease or severe mental illness; secondly, that recovery or improvement in the condition could not be expected; and thirdly, that there could be no doubt that all persons suffering from the condition would be functionally incapable of work.

If the claimant is not suffering from one of the exempted conditions, further evidence is obtained before he is invited to attend a medical examination. He will be asked to complete a questionnaire, in which he can give his own account of how his condition affects him. At the same time, he is asked to obtain a further statement from his own doctor, who can provide more details of his own

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diagnosis of his patient's condition. The claimant's doctor is asked to provide factual clinical information on the medical condition. That information will help the Benefits Agency to decide whether a medical examination is necessary.

We have taken particular care over the design of the method of examining claimants to establish their capacity for work, and we have provided examining doctors with comprehensive guidance. The examining doctor will begin by asking the claimant about the history of the illness and about everyday activities relevant to the claimant's condition, after which he will conduct an examination.

The doctor will consider all the information and exercise clinical judgment to reach an opinion on the nature and effects of the medical condition. Full account is taken of factors such as pain, fatigue and breathlessness and the possible variability of the condition. If someone can, for example, perform a particular activity only by incurring a considerable degree of pain or breathlessness, he will be assessed as incapable of performing that activity. The doctor will also consider the effects of that condition over time, so that the opinion will not be based on a snapshot picture of the claimant's condition on the day of examination.

In the case of heart disease, the doctor will obtain, in particular, details of any walking restrictions caused by breathlessness and chest pain. The examination will concentrate on looking for evidence of complications of the disease--either angina or heart failure. The doctor will then prepare a comprehensive report for an adjudication officer--an officer appointed by the Secretary of State to determine entitlement to benefit independently of Ministers and departmental officials.

The adjudication officer decides, on the basis of all the evidence available, whether the claimant should be treated as incapable of work. In doing so, he will take full account of any reported pain, fatigue or variability caused by the claimant's medical problem. He must also take account of evidence provided by the claimant and the claimant's doctor.

A further important safeguard is built into the all-work test arrangements. We realised from our work in developing the test that there are a minority of claimants who are clearly incapable of work, but who would fail the test because their current condition causes only limited functional impairment. The hon. Gentleman referred particularly to the type of test in which someone would score only seven points but clearly would be incapable of work. Therefore, regulations specify that people who fail the test shall be treated as incapable of work if one of the prescribed exceptional circumstances applies.

The exceptional circumstances apply if, for example, the person is found to be suffering from a previously undiagnosed life-threatening condition, or if his medical condition cannot be controlled by medication. Benefits Agency doctors are required to consider at every examination whether those conditions apply, and the procedure provides an additional check for people who otherwise would fail the all-work test.