Examination of witnesses (Questions 80 - 91)
WEDNESDAY 18 MARCH 1998
PROFESSOR RODNEY
GRAHAME, MISS
SUSAN KNIBBS,
MRS NICOLE
DAVOUD and DR
JOHN HUNTER
80. Given that you have an immediate focus on the project
and we may well produce a report at the end of our investigation
which makes some specific recommendations in relation to the project,
given that you are becoming bolder, what would your advice to
us be about the way it is being implemented?
(Professor Grahame) We feel that we should be
involved in anything which relates to DLA as important as this.
81. How specifically?
(Professor Grahame) We have not studied how it
is being enacted. We have only hearsay about what is being said
about it.
(Mrs Davoud) May I speak as an individual because
we have not discussed it as a Board? As an individual may I speak
as a claimant of the benefit? I feel that there is clearly something
wrong with DLA and something has to be done to rectify it. You
cannot blame it on fraud alone for one moment. I do not want to
repeat what I said at the beginning of the proceedings. That is
perhaps why from a presentational point of view this project has
been a disaster, because it has focused totally and utterly on
fraud. As no fraud has been proven it looks a bit funny to say
the least. One of the reasons I think they are not coming out
with anything worthwhile to be honest is because what training
do the people who are asking the questions have, how trained are
they? It comes back to the fact that if the AdjOs do not have
training to decide on a case, what training have these people
been given to ask questions? It is not only a question of disability
awareness but a question of actually understanding what this is
all about. The law is difficult for an AdjO to understand the
way it is framed at the moment. How can you train people in a
few weeks to do a project like this? From a training point of
view it leaves a lot to be desired. It is quite simply an additional
manifestation of some of the ills we have been discussing this
morning. Just as they affect people who have infinitely more experience,
you are asking practically newcomers to try to assess whether
the benefit is working. This does not seem very sensible to me.
Miss Kirkbride
82. It has all been very fascinating and most of the
ground has been covered. I have to say your last answers are pretty
surprising about the lack of consultation you had over BIP. I
wanted to ask two things. One is slightly picking up Edward Leigh's
point about the year 2000 and 2.2 million in just eight years,
more than double the number who used to be on this benefit will
be claiming it. Do you have any comparisons with other countries,
what the level of disability need is as compared to other countries
and whether or not we are higher or lower than that in terms of
what we claim?
(Professor Grahame) We do not. Every country has
its own system and there is very little parallel, so it is very
difficult to make comparisons. I do not know whether the prevalence
of disability is measured comparably in other countries. Do you
have any information?
(Dr Hunter) Only on what happens in Scandinavia
and even there things are changing. They found that the number
of people retiring on disability pensions was increasing at an
exponential rate so they changed the rules and it levelled off.
83. There is no way of comparing really.
(Dr Hunter) It depends on what the climate is,
what the regulations are, how you set about it. If the focus is
on what the person can do rather than what they cannot do, then
you change the approach to the assessment. One of the problems
of the benefit at the moment is that it encourages people to emphasise
what they cannot do, rather than saying they have difficulty doing
a lot of things but they can do others. If they could build on
that their capabilities they might be able to go out and do something
else. We really have to consider the whole philosophy behind the
benefit, how the award of cash benefit fits in with all the other
services we talked about earlier. Are all these services singing
from the same hymn sheet. There is some evidence in the paediatric
field that the award of benefit may be counterproductive to some
of the child development issues.
(Professor Grahame) I think Dr Hunter is referring
to behavioural disorders there.
(Dr Hunter) That is right.
(Professor Grahame) Where giving an award may
actually be counterproductive and actually mitigate against so-called
recovery. On the question of the prevalence of disability or disabling
disease, those of us in clinical practice would probably say that
the epidemiological evidence does not suggest that there is increasing
prevalence of disabling diseases, chronic diseases which cause
disability. The rise in the numbers of applicants is not matched
by a comparable rise in the prevalence of disability. I know that
is somewhat disputed by the recent evidence from the Department
which was issued last week on a possible increase in prevalence.
84. In your view is the increase which has varied mainly
to do with the ageing of the population?
(Professor Grahame) It may be a factor, yes, indeed.
It also may be the way that disability is measured and reported.
The authors of this document make it very clear that the methodology
is not the same as was in the original OPCS data ten years ago.
85. Does the Board have a view on whether or not it is
reasonable that 2.2 million people in the British population will
be on the books as being disabled by the year 2000? Do you think
that is probably too many people? Do you have a view on that?
(Dr Hunter) The Board has not discussed it.
(Professor Grahame) It does not have a view on
it.
(Dr Hunter) Therefore it does not have a view
on it. On the other hand one would want to ask what the evidence
is which would back this up. It has to fit in to the epidemiology
of underlying disease otherwise what you are measuring is essentially
a behavioural response. People are applying for benefit because
somebody they know has got it. They are making use of the system
and emphasising what they cannot do.
That may not be their normal behaviour but it is what the system
demands of them. You would have to be either daft or a saint if
you did not make yourself out to be as needy as possible the way
the system is arranged at the moment.
(Mrs Davoud) What I should like to see by the
year 2000 and beyond is not so much how many disabled people there
will be, but I should like to see - and I am repeating here what
we said earlier on - much more liaison with a rehabilitation service,
community care, social services, to try to ensure that the disabled
people we have are given the means by which they can become independent.
We talk a lot about independence. I have to wait who knows how
long to get a better electric wheelchair. It takes a year and
a half. Let me give you another example. To come here cost me
£50 and my mobility is £37.50.
There is a Barnet travel scheme where I live by which I pay £30
and get £150 of vouchers. If that were done via minicabs,
if that were done via something else, that would give me many
more journeys and it would make it that much easier for me to
go around. It is not just benefit, benefit, benefit, it is thinking
how we can make me or people like me more independent and utilising
the resources we have in a more cost effective manner. Giving
me taxi money is ridiculous because in one journey I spend more
than my entire weekly allowance. That is what we should be looking
at: cost effective ways of administering that type of money.
Chairman: We do pay witnesses' expenses. See me later!
Neither taxed nor means tested.
Mr Pond
86. All of us would wholeheartedly agree with that last
statement from Mrs Davoud that that is where the emphasis should
be. I wanted briefly to go back to the Benefit Integrity Project.
Those of us on this side of the table will be as astonished as
some of you are that you were not consulted before that project
was undertaken. I wonder, as Malcolm Wicks suggested, whether
or not you might be in part, not necessarily to blame but, associated
with that. First of all, to what extent was it felt necessary
to undertake that project because of the weaknesses in DLA which
you had identified? Also, you have now published a report which
your chairman said you were busy working on rather than putting
pressure on the Department to be involved in the project. You
have a report which tends to confirm in the public imagination
that there is a need for major reductions in the number of people
receiving DLA and that the Benefit Integrity Project therefore
has an underlying rationale. I just wanted to give you another
option, if the Chairman will allow me, towards the end of what
I think has been a very useful session, to go back to your answer
to my question earlier on about whether you really do feel that
the assertions in this document, and particularly that lasting
statement which I feel will be the one thing lifted out of this
document into the public debate, that you feel 63 per cent of
those cases were in conflict with the facts. Whether you like
it or not that will be the figure. For all the important statements
you have made in front of us this morning that figure will live
with you. Do you really believe, as you say in the report, that
you have statistical confirmation for those assertions on the
basis of that evidence? It is an opportunity for you to put on
record whether you really think that was a carefully worded statement
because it will be quoted back at you. It will be quoted in the
debate.
(Professor Grahame) It is important to say what
we actually do assert and that is that we were unhappy about the
decisionmaking to that extent. We certainly did not say that a
large number of people should not have their benefit. We are using
that to establish that we were unhappy with that group of decisions.
We think that an inappropriate award may have been made but we
are not going any further than that. We are using it to highlight
our concern that there are major problems with DLA and in the
rest of the document we set out what these problems might be.
Indeed we go on to suggest certain remedies for these problems.
I do not know what else you would like me to say.
We do stand by what we said. We said that we are concerned that
there was not enough, in our view - it is the Board's view being
expressed here and we can only register it as the Board's view
- there was either not enough evidence to make a judgement, that
the judgement may have been inappropriate, that the duration may
have been inappropriate; in some cases it was too long but in
others it was too short. In some cases the award may have been
too high but in other cases it was too low. We are not making
a blanket statement that DLA is being used excessively or being
awarded excessively to the vast majority of people who now have
it. I know that has been mentioned in the press but we would refute
that. That is not our purpose, that is not what we are saying.
We are saying that we are unhappy about the decisions for a variety
of reasons and for a variety of directions.
Chairman
87. If you are attacking anything at all, you are attacking
the process and structure of the benefit rather than the disposition
of the awards.
(Professor Grahame) Yes. I should also like to
state very categorically that we are not attacking Adjudication
Officers. We feel that they have a very difficult job, almost
an impossible task, because they are faced with a dossier containing
the claim pack, further evidence and they have been asked to establish
and decide whether the requirements or the needs of the applicants
comply with the details of the law in terms of the benefit. We
as a Board look at it from a different viewpoint, either as people
who have lived with a disability for the major part of their lives
or professional people who have worked with disabled people for
a large chunk of their lives. We are actually looking at it from
a slightly different perspective and that is why our view may
differ from the view in the individual cases of the Adjudication
Officer. The system we feel is not working well with this current
mix of self-reporting and lay adjudication. We have set out certain
suggestions how this could be improved in the short term by making
more medical and other health professional evidence available
to Adjudication Officers, by making them more knowledgeable about
diseases which cause disability and the impact of disability on
people's lives. We have made strides to improve that. That is
really what we are saying.
88. Obviously the whole area is now high politics.
A lot of political debate will probably now have to take place
in order to try to resolve some of these questions. We are certainly
convinced, because we see the evidence in our own postbags, that
there are thousands, maybe even millions of people, out there
who are apprehensive and suffering anguish because of some of
the things which have been said in the press. Of course I understand
that you in your very peculiar and important role have to be very
careful about what you say and what you do not say. Would it be
right to assume that your Board, from everything you have said
this morning, could make a more useful contribution from their
own perspective if they were given more of a proactive role? That
is not to say you have to get drawn into the party political debate,
but that in your relationship with Ministers, if you had a little
more ability to influence their thinking, you would react positively
as a Board to that. Is that a fair question to put to you?
(Professor Grahame) It is a very fair question
and I can answer without hesitation: we would be very pleased
to take on that role. We were very pleased when the Baroness asked
us to prepare a report. It was the first opportunity we had to
express what we had built up over the last five years when we
were not able to express it, our concerns and misgivings about
the running of DLA and AA.
89. Certainly we have been very much helped and assisted
by learning of the work you did. Speaking personally I confess
that your experience and value has been kept as a closely guarded
secret from me. If that is true of me, I am sure it is true of
a lot of my other colleagues in this House. It is time we put
that right.
(Mrs Davoud) May I also say - and perhaps I am
speaking by myself here so please forgive me - that it is not
just more contact with Ministers on policy issues that we want?
We would really like to feel that the voluntary organisations
themselves feel that when it comes to DLA they can come to us
and tell us the problems they have to help us understand. We get
all the cases dry but if other organisations would come and tell
us they have these people who have a problem with this, that and
the other, then we as the Advisory Board can take it on board,
can perhaps question them more deeply as to what these problems
might be, with perhaps a more professional perspective rather
than an emotive one. Between the two of us, emotion and intellect
if you like, we can come up with a far better decision than we
are coming up with at the moment.
Mr Pond
90. What stops that happening at the moment?
(Mrs Davoud) I do not know. You must ask the voluntary
organisations that when you see them.
Chairman
91. We see them next week so that is a very neat cue.
May I also say on behalf of the Committee that perhaps we are
at fault too in that perhaps we should have made more direct contact?
I certainly think that this exchange has been extremely valuable
for us this morning and perhaps we should have a semi regular,
annual or whatever, meeting in the same way that we do with the
Social Security Advisory Committee.
(Mrs Davoud) Please, please do.
Chairman: It certainly would be very helpful to us.
May I say thank you very much for your time. I know it is not
just a question of appearing here this morning; a lot of work
was done beforehand. Thank you and all your members for the invaluable
work you have been doing in the past and will continue to do in
the future. Thank you very much for coming. The public session
is closed.
Copies of the following presentations to the DLA Advisory
Board have been submitted but are not printed here:
| 7 November 1995 | British Polio Fellowship
| DLA 4A |
| 11 March 1997 | Incontinence presentation by Christine Norton, Northwick Park and St Mark's NHS Trust
| DLA 4B |
| 4 July 1995 | Viscountess Runciman, Chairman of Mental Health Act Commission
| DLA 4C |
| 7 March 1995 | National Association for Colitis and Crohn's Disease
| DLA 4D |
| 1 November 1994 | Organisation for Sickle Cell Anaemia Relief
| DLA 4E |
| 2 November 1993 | Professor P K Thomas and Dr S Wessely on ME
| DLA 4F |
Letter to Chairman from the Disability Living Allowance
Advisory Board (DLA 8)
On behalf of my colleagues and myself, thank you for facilitating
such a thought-provoking and encouraging meeting. May I respectfully
summarise the main points raised?
- The Disability Living Allowance Advisory Board Regulations
1991 (S.I. 1991 No. 1746), severely restrict our remit "to
give advice to the Secretary of State on such matters as he may
refer for consideration". We find this frustrating. Board
members have considerable research experience and we believe that
the Board is well placed to initiate and undertake research that
would underpin the development of a much improved benefit for
people with disabilities.
- Baroness Hollis invited the Board to present her
with its ideas on DLA/AA on 2 July 1997 (not in August as I stated).
- We regret that the study of DLA and AA awards did
not include a comparable control group consisting of applications
which had been disallowed. We certainly wish to study this group.
- We very much regret that one of the key messages
from the study has been misunderstood. We stated that in two-thirds
of the 1,200 dossiers we examined, the award was "in conflict
with the facts". In these cases we felt, either that the
Adjudication Officer should have postponed a decision whilst seeking
further information, or that an award had been allowed or refused
incorrectly, or had been awarded at the wrong rate or for the
wrong duration. An incorrect award might be one given at too high
or too low a level or for an inappropriate duration. It is unfair
to people with disabilities to continue with such an unreliable
system.
- Life awards are a particular problem as they do
not allow for improvement in the applicant's condition leading
to reduced care or mobility needs.
- We will pursue arrangements to initiate meetings
with disability groups.
- Finally, we welcome the proposal to hold regular
meetings with the Select Committee.
Professor Rodney Grahame
Chairman
19 March 1998
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