4. RECOMMENDATIONS
The following suggested recommendations are put to Ministers
by the Board:
4.1 "What is the benefit for? " The purpose
of benefit should be restricted to the following areas:
- to help with the extra costs incurred due to
severe disability;
- to avoid discouraging recipients from obtaining
or retaining employment;
- to facilitate a common approach to helping disabled
people by the Department of Social Security, the National Health
Service and Local Authority Social Services.
4.2 "Who is the benefit for? " The benefit
should be aimed at the most severely disabled. Future legislation
should stipulate exclusions from the benefit as well as inclusions,
in order to avoid the current situation in which the benefit entitlement
has been stretched well beyond the original policy intention of
the legislation by Commissioners' decisions. For example, the
care element might specify dependence on the obligatory need for
help from another person, equipment or statutory services; specify
the means and extent to which this financial benefit could be
used to offset the cost of care or equipment required; and include
the circumstances in which benefit payment would continue and
be terminated. It is suggested that in future legislation benefit
entitlement could be detailed in secondary legislation (Statutory
Instruments) thereby allowing Parliament to reimpose what is intended
more easily than at present.
4.3 "How should needs be ascertained? "
Self reporting is desirable, but experience has shown that it
is unreliable as a result both of over- and under-statement. As
the sole source of information (or in conjunction with inadequate
medical or paramedical corroborative evidence) it predisposes
to poor adjudication decisions. Furthermore, the act of completing
the claim pack as currently designed is, in itself, a time-consuming
and onerous task even for the hardiest applicant and his or her
helper. The Department of Social Security ought to play a more
active role in helping applicants with form-filling and in advising
them on checking entitlements in the light of changes in their
condition.
4.3.1 There was general support amongst Board members
in favour of exploring a possible semi-objective quantitative
"All Living Test", along the lines of the "All
Work Test" developed for Incapacity Benefit.
4.4 "How can the benefit be best targeted? "
Life awards should be the exception rather than the rule. The
duration of all awards should always assume that there may be
advances in treatment and management in the future which may reduce
the claimant's disabilities.
4.4.1 The Board strongly believes that in any new legislation
vague terms such as "significant portion of the day"
and "virtually unable to walk" should be avoided with
more reliance placed on the use of more specific descriptors such
as "continual supervision".
4.4.2 The Main Meal Test, which was introduced as "a
theoretical test" for the Lowest Rate of the care component,
has been liable to misinterpretation and abuse. The Board proposes
that it should be abolished. Any future legislation or regulations
should be based on practical evaluations of what the person is
able to do (not what they actually do) rather than on abstract
legal concepts.
4.4.3 The Middle Rate Care (indoor day supervision) and
Lower Rate Mobility (outdoor supervision) components of DLA should
be combined (at a level to be determined) in order to remove the
current duplication and be replaced by a unified single lower
rate for outdoor and indoor supervision. A Lower Rate Mobility
award might be considered for those with a physical disorder who
are able to walk more than a few paces but less than, say, 100
metres, whilst retaining the Higher Rate Mobility award to those
who are unable (or barely able) to walk as judged by the distance,
time, speed, manner of walking and the effort involved due to
a recognised abnormality of an anatomical structure which is highly
significant from the medical point of view. The Board is concerned
at the large number of applicants who are currently awarded the
Higher Rate Mobility component inappropriately.
4.5 "How should the benefit be administered?"
The Board proposes that a simpler form of self-description of
the claimant's capabilities should be retained, and that the assessment
should be based on a combination of self-reporting together with
mandatory professional corroboration. In many cases this need
involve no more than an authorisation (a) to approach the claimant's
General Practitioner for a factual medical report, including a
summary of relevant hospital (and other) assessments and investigations,
and (b) in the case of children, a school report. These reports
would be considered by BAMS, who would decide if the applicant
was potentially eligible. If so, he/she would be invited to have
a disability assessment, the emphasis of which would be on what
the individual can do, rather than, as currently, on what
he cannot.
4.5.1 The assessment should take a multidisciplinary
approach and include a review of any rehabilitation undergone
and the provision of aids to mobility and daily living, already
received and the extent to which future services of this type
might be a more appropriate way of helping the disabled person
than a simple award of a cash benefit. The assessment should be
made by doctors, nurses, physiotherapists and occupational therapists
trained in all aspects of disability and rehabilitation (including
mental health), preferably working as a team. The Disability Assessment
Diploma currently under development by the Department's Chief
Medical Adviser with the Royal College of Physicians could be
extended to cover these additional health professionals through
their respective professional associations. The question of the
availability of these health professionals in sufficient numbers,
their training and the overall feasibility of this proposal would
require careful consideration. This specially trained professional
team could in the longer term take over the role currently played
by Adjudication Officers.
4.5.2 Lay Adjudication - The Board proposes that
lay adjudication be retained in the short term (i.e. until the
multi-professional assessment teams proposed in 4.5.1 above are
in place), but that AdjOs be required to request medical
and other corroborative evidence and to seek BAMS advice in a
more structured way. There should be far greater education, and
training in the special needs of disabled people for both AdjOs
and BAMS medical staff.
4.6 "What are its links to community care?"
Having considered both sides of the arguments posed in paragraph
3.2.2 above, the Board formed the majority view that on balance
a cash payment is preferred to the provision of services by Local
Authorities or Health Authorities, as this gives the disabled
person control over his or her own destiny, and encourages independence
and responsibility. Claimants can purchase care at a time and
of a form suitable to their requirements, rather than having to
rely on services provided at the behest of the local authorities/health
services. Some of the benefit might be earmarked specifically
for the purchase/lease of equipment which will minimise dependence
on help from other people, or health or social services.
5. CONCLUSIONS
AND FINANCIAL
CONSIDERATIONS
5.1 The Board is aware that the public purse is unable to
satisfy all the mobility and care needs of all people
with disabilities, and that the government is faced with a major
challenge in determining priorities and in making difficult choices.
5.2 The proposals submitted are aimed at improving the targeting
of the Benefit and the stewardship of public funds. The Board
believes that a correctly administered benefit is capable of channelling
funds to those who need it most, and, at the same time, reducing
the burden on the Exchequer.
5.3 We appreciate that many of our proposals would need to
be costed in detail, but we trust that Ministers will look favourably
upon them as informed and practical suggestions which would help
in meeting their overall policy objectives.
Disability Living Allowance Advisory Board
March 1998
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