Examination of witnesses (Questions 60 - 79)
WEDNESDAY 18 MARCH 1998
PROFESSOR RODNEY
GRAHAME, MISS
SUSAN KNIBBS,
MRS NICOLE
DAVOUD and DR
JOHN HUNTER
Chairman
60. There is a good deal of shaking of heads behind you.
A very powerful signal.
(Dr Hunter) If you are physically disabled most
local authorities require, in fact it may be more national than
just local regulations, that if you are under 65 which presumably
is because he is working, you are passported in via DLA.
61. Yes, he is.
(Dr Hunter) If you are over 65 by and large you
are examined by an official of the local authority.
(Mrs Davoud) May I add something to Ms Hewitt's
question as to how we would describe severely disabled? Like you
I am not terribly familiar with all the various gradings. Perhaps
we could all put our minds to trying to find a uniform way of
assessing disabled people because that would be tremendously helpful.
Every single benefit seems to be operating at a different assessment
procedure. If we could put it in day to day language, what would
I describe as severely disabled? To me DLA is there to assist
me with care and mobility needs. Basically a severely disabled
person in my eyes is a person who for physical, mental or perhaps
sensory reasons is totally unable to cope with the key daily activities.
They are unable to get up, they are unable to dress themselves,
they are unable to wash themselves, unable to feed themselves.
That is severely disabled. Unless there is somebody there to provide
that help, they would be left in bed or in the chair or whatever
it is for 24 hours, two days, three days, four days. That to me
is severely disabled.
That is one extreme and from there you can just go down gradually.
Mr Roy
62. Two points on the re-focusing of the DLA. At the
moment we have a mobility component and a care component. I should
like your thoughts on why we do not have a mental health component,
why we just have those two brackets at the moment. The other point
I should like you to look at is the self-assessment. How is it
possible for someone with mental health problems, schizophrenia,
manic depression, who does not realise their illness, to do that
self-assessment? How can we help this process?
(Professor Grahame) If I may answer your second
question first. We have already referred to that. They actually
need someone else quite often to express their needs for them
because they just do not have the capability to fill in the form
without great difficulty.
As for a psychological component of the benefit, that is a very
interesting idea. I am aware of the fact that in incapacity benefit
part of the test is very much bound up with the psychological
aspect. It is a very important part of the test. That aspect should
be borne in mind in any suggestions for further development of
the benefit. It has not arisen because on the whole there are
questions which tend to cover the needs of people with psychological
disorders in the claim pack but they are the very people who have
most difficulty in completing them.
63. That is not in this report. Would that be able to
be expressed in future, that that mental health component should
be there?
(Professor Grahame) If we are asked we will certainly
express it.
(Dr Hunter) To some extent what we are suggesting
would cover that. One of the options might be a ten point scale
and some of the components would be considered there.
64. They could be quantified.
(Dr Hunter) Yes. If you happen to have a knee
which is completely beyond repair and you are hardly able to walk
then you are going to get £35 a week tax free as a mobility
allowance. For a similar degree of damage to your brain you might
well not get anything more than the lower rate of care at the
moment. If we could put these things onto a uniform scale, this
comes back to how you measure the components. It is not beyond
human wit to be able to try to devise a system or to apply a system
which has already been devised for this particular purpose. It
would require a lot of work and if it were to be followed I beseech
that it should be researched properly in advance rather than simply
applied by parliamentary fiat.
65. You would put that down in a report only if you were
asked.
(Professor Grahame) This report was asked for
and I have said that our terms of reference, as set out in the
statute, are to respond with advice when asked to do so by the
Secretary of State.
Chairman
66. In other words, `Speak when you are spoken to'.
(Miss Knibbs) May I come in on a point of information?
I cannot at the moment find it but we do mention that the form
does not cater adequately for people with hearing impairment and
mental health problems. We do say that.
67. Could you just say two sentences about your rather
interesting idea of an All Living Test? That is something which
we would want to consider further.
Could you very briefly give us the background and what that would
look like?
(Professor Grahame) We put this forward as an
interesting idea that we should like to follow and encourage.
The idea stems from the incapacity benefit All Work Test where
an attempt has been made to quantify the degree of disability
by an objective test.
That is our starting point. We know that attempts are being made
to devise such a test and we think that would be an interesting
idea.
68. Attempts are being made by the Department.
(Professor Grahame) We understand that this notion
has been considered or is being considered. We do not know how
far that has gone. It would be of great interest to us to see
whether we could work along this totally new approach to the measurement
of disability by applying it, not to features which are involved
in work but to everyday life because that is what DLA is all about.
69. This is not your original idea, this is something
you know is being worked on.
(Mrs Davoud) No.
(Professor Grahame) No, it is something we have
thought about a great deal. Mrs Davoud has views about this which
I am sure she would like to express.
(Mrs Davoud) I have been greatly involved in welfare
to work and benefits for a very, very long time.
I am very familiar with the objections to the All Work Test and
that is something which I totally and absolutely support. You
cannot determine capacity for work by functional impairment alone.
That said, some of the descriptors used in the All Work Test relate
very much and could easily be adapted and utilised for an All
Living Test. That means basically you are taking key daily activities
and trying to ascertain what movement or what degree of function
you need in order to be able to accomplish those key daily activities.
According to that you would be grading them and according to that
you might develop a test which would be simpler, more objective,
a lot easier for the Adjudication Officers, it might simplify
a lot of the problems we are facing at the moment. It would also
save the burden of the claimant.
70. These are issues you have some thoughts about and
you are confident that they will be taken on board by the officials
in the Department.
(Professor Grahame) Most of the ideas we put forward
are ideas which we think are interesting and worth pursuing but
we have not taken them very far ourselves. I think that would
be a fair assessment.
(Mrs Davoud) We have voiced these views.
(Professor Grahame) Amongst ourselves.
(Mrs Davoud) We have voiced these views amongst
ourselves and the report has been published.
Mr Goggins
71. The Benefit Integrity Project provides this Committee
with an immediate focus for many of the issues you have raised
today. Some of the things we know about. We know that it was implemented
three days before the general election. We know that it has become
very confused with the Government's wider welfare reform debate.
Members of the Committee are as aware as any people are about
some of the very worrying cases of implementation which have led
to a tightening up of the guidelines in relation to the Benefit
Integrity Project. We also know that 12,000 of the 55,000 cases
which have been reviewed have led to changes in the award. Quite
simply, I am sure the Committee would be interested to hear of
any evidence you have received about the Benefit Integrity Project,
any comments you would want to make and in particular perhaps
whether the Secretary of State has asked you to bring forward
any comment or evidence in relation to this.
(Professor Grahame) The answer to that part is
very easy. We have not been involved in the project.
We were not consulted when it was being devised.
Chairman
72. At all?
(Professor Grahame) It was a project with the
Benefits Agency and therefore it would not normally come before
us unless the Secretary of State asked us to look at it. What
we know about the project is not very much but what we hear and
read about it. It is not something we have been directly involved
in at all.
Mr Goggins
73. Do disabled people and their organisations not come
to you with evidence?
(Professor Grahame) Not on this issue, no.
74. You have not sought any evidence.
(Professor Grahame) Our role is constrained. We
cannot take the initiative in our present role, initiate any inquiry
or studies. It is not something which has come across to the Board
except we know about it.
Chairman: The implication is that you read
about this in the papers. Would that be putting it too strongly?
Mr Goggins
75. Could we not persuade our witnesses to give us some
views based on their undoubted experience of these issues? What
are your views? What comments would you make about the project?
(Dr Hunter) At the last Board meeting we were
given an update on this project and were told how many people
had been assessed, in what way and what the initial outcome was
and so on. No doubt that was also made available to a wider audience
at the time.
If you are asking for personal views, I know that there are people
who are in receipt of benefit who have improved from the time
they were awarded it, where it would not be unreasonable for them
now to relinquish that benefit and there are people who have deteriorated
as well. This comes out in the figures.
None of us has any way of knowing whether the way that the Department
are approaching this is the right way or the wrong way because
we have not been involved in this at all. On the central issue
that some errors have been made in the past and we have perhaps
to look at ways of trying to correct these errors, it would be
in keeping with some of our own observations that there may have
been - -
76. In your view it would be improvement or deterioration
rather than fraud.
(Dr Hunter) I suspect that fraud is extremely
rare, from personal experience.
(Mrs Davoud) First of all may I say that we were
not involved and I hope I speak for all of the members and I know
that I do to some extent when I say that we regret we were not
informed. I should like to say that the Board is evolving. We
are being given more responsibility. The role of the Board is
evolving and becoming more important, hopefully, and more involved
with policy. This is something we have wanted and we are very
indebted to Baroness Hollis for having given us the opportunity
finally to come out and be able to voice some of these views.
Quite rightly we come before you and you very rightly ask us what
we feel about the Benefit Integrity Project which affects DLA
and here is the DLA Advisory Board and we are biting our lips.
I am finding it extremely hard not to blow my top at this but
unfortunately it is wrong: either we are the Disability Living
Allowance Advisory Board or we are I do not know what.
Mr Wicks
77. Could the fault be yours? There you are, you are
meant to be in the business of advising the Secretary of State
on matters relating to DLA and you are enabled to produce an annual
report. Why sit there waiting for a Minister or someone to ask
your advice? Perhaps you need an assertiveness training course.
Why not be a bit bolder about this?
(Professor Grahame) We are getting a lot bolder.
We have made enormous strides by stealth over the last five years
from a situation where we were restrained from criticising or
even commenting on a decision made by an Adjudication Officer.
We have become progressively bolder and as a result we have produced
this report you have just seen. We have actually worked within
the framework in which we are placed and in which we find ourselves
to a situation now where we produce a report which is outspoken
and expresses our views in a way that would not have been thought
possible three or four years ago. Yes, we should have shouted
about the project or we should have approached but, as it happens,
at the time we were very busy on the report and on the study so
it did not happen yet.
78. I can remember the Supplementary Benefits Commission,
the body before SSAC, which, whatever its terms of reference,
actually became the major annual report on social security issues
looking at all sorts of territory.
(Professor Grahame) Yes, but SSAC have a very
different remit and they have a very much more important role
in terms of Government policy.
Government, as I understand it, are obliged to submit any changes
or proposed changes in regulations to SSAC before they are enacted
and we are not in that fortunate position. We have very restricted
terms of reference.
Mr Goggins
79. Given that you are getting bolder - -
(Professor Grahame) By the hour.
(Mrs Davoud) By the minute.
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