Examination of witnesses (Questions 100 - 119)
WEDNESDAY 25 MARCH 1998
PROFESSOR IAN
BRUCE, MS
LORNA REITH
and MR RICHARD
WOOD
100. I understand that. I would like to ask you two questions
before colleagues come in and you will need to bear with me because
this is quite a complicated question. It basically boils down
to this, to what extent you have been consulted in the provenance
of the whole Benefit Integrity Project. If I can take you back,
the benefits review was carried out when the disability living
allowance under the anti-fraud initiative originally started,
as far as I am aware, in March/April 1996, so it goes back that
far. Its provenance is found in an anti-fraud context which produces
problems of its own in some respects. The next thing that happens
really occurs at the beginning of 1997. On the 23 January we have
got the Social Security Administration (Fraud) Bill in Standing
Committee here in the Commons with the then Minister, Alistair
Burt, giving an undertaking on the benefits review and I wanted
just to put this quote on the record. He said: "We will be
involving disability groups and the Disability Living Allowance
Advisory Board in discussions on the findings and as we consider
what action needs to be taken". He said that in Standing
Committee of the Social Security Administration (Fraud) Bill on
the 23 January. We then go to the 12 February 1997 when we get
the publication of the Benefit Review of disability living allowance.
That was vouchsafed to us by means of a parliamentary answer.
We then go to Parliament being prorogued on the 21 March—
(Professor Bruce) Was that in the Sainsbury review?
(Ms Reith) No. This is the DSS Benefit Review.
(Professor Bruce) Right; forgive me, Chairman.
101. It is very easy to get these reviews mixed up. We
get a parliamentary written answer on the 12 February and then
on the 21 March Parliament was prorogued. Parliament was dissolved
on the 8 April and on the 28 April 1997 we have now been told
in a parliamentary answer that there was a selection and preview
of first postal cases of the disability living allowance Benefit
Integrity Project. I wanted to put all that laboriously on the
record because there is a period here as far as I can see from
the beginning of 1997 to the election where Ministers in the previous
administration were letting it be known that they were taking
advice from disability groups and the Disability Living Allowance
Advisory Board in the generation of the project. I want to ask
you, and maybe you will want to take advice on this because I
understand that people cannot keep accurate dates in the front
of their minds all the time, to what extent were you consulted
at that stage, at the early stage from January 1997 till the election?
(Ms Reith) The answer is, not at all.
102. Not at all?
(Ms Reith) Not at all. During the previous year
when they were carrying out the review we were getting individual
disabled people ringing up our help line, as other organisations
were, and saying, "I have had someone visit me and I have
had this peculiar form through the door. I have had my benefit
book taken away", and we could not pin down what was happening.
We were writing letters trying to find out what was going on because
we were not even aware publicly that there was this review going
on, so it actually made it quite difficult to advise people. There
were no discussions. There was the publication of that report,
as you say, in February. There were no discussions at all as far
as I am aware up until the general election. What happened after
the general election was that on I think the 29 May we were invited
as a consortium of disability organisations to a meeting of civil
servants—
(Professor Bruce) To clarify, the Disability Benefits
Consortium is a loose alliance which was founded in the middle
eighties and which was extremely active between 1988 and 1992.
The relevance of this will become readily apparent. Because it
is an alliance around an issue and disability benefits were not
a national issue between about 1992 and the latter end of 1997,
we were not very active. We were requested by the disability movement
to reconvene in the autumn of 1997. I only say that because when
Ms Reith mentions the consortium, it is not the Disability Benefits
Consortium.
(Ms Reith) It was a group of disability organisations.
(Professor Bruce) The Government wrote a few letters
out to a few organisations, on what basis we were not terribly
sure.
(Mr Wood) May I say it did not include the Disabled
People's Movement. We were not invited.
(Ms Reith) We were not sure on what basis the
organisations that had been invited were invited. I suspect it
was that we had all written in at some stage asking questions
and so on, and we were then all invited to a meeting with civil
servants in May where we were told that this project was under
way. We thought it had not started and that we were being consulted
about the programme. We assumed that because of the general election
they had not launched it and it had all gone quiet and we would
have been consulted. We were not. We were being told that it had
started already and it was very unclear whether it had started
on the 28 April or the 1 May, that is, which Government was responsible,
and we were so concerned as organisations at that meeting in May
that through the good offices of Lord Rix we asked for a meeting
with the Minister, Baroness Hollis, which we got, and she suspended
the programme immediately while we had a number of consultative
meetings. But of course it was too late at that stage for us to
have much impact on the programme. All the letters had been printed
and all the rest of it. We were able to secure some exemptions
as part of that consultative process, but we were in no way involved
or consulted about the justification for it. That was not an option
as part of the consultation. The consultation was really about
what was the best way of writing letters to people. We were at
that end of things.
103. There is an important question here in my mind about
to what extent Ministers are entitled to use discretion regarding
the initiation of any new action over continuing a long term activity
in the hiatus of the prorogation of Parliament. It is something
that I want to pursue later but what you have said to me is very
valuable in terms of pinning down exactly who drove the opening
of this programme. I think it may have been civil servants themselves.
(Ms Reith) Yes.
(Mr Wood) Indeed, with the DLA Advisory Board
and their remit to consult us, we were looking at their annual
report yesterday, we believe they actually consulted with one
organisation—whether that was consultation I do not know—but
no other organisations were mentioned there.
104. That brings me neatly to my second question. You
will not have had a chance properly to have studied this when
you submitted your very helpful evidence to us. We had a very
useful session with the Disability Advisory Board a week ago.
Some of the things they said to us were pretty startling in a
number of respects. Would you just take a few minutes to give
us your initial reaction—I understand you may not have had
full time to consult all your members—to what their findings
were?[3]
(Mr Wood) Being an avid reader of sports reports
I always start at the back of the document and it is very interesting
to start at the back of this document because I thought this was
an Advisory Board to advise Parliament on the efficacy of DLA.
Presumably that is what it is for. It is quite interesting to
read the conclusions and financial considerations at the end where
they say: "The Board is aware that the public purse is unable
to satisfy all the mobility and care needs of all people with
disabilities". They also say: "The Board believes that
correct allocation of benefit is capable of channelling funds
to those who need it most, and at the same time reducing the burden
on the Exchequer." I was a little disturbed that that seemed
to be the raison d'eÃtre for the report, that somehow
they had taken on board the financial remit, which is not about
the efficacy of the benefit. It is about other issues. It is about
Government policy and levels of spending, which I would not have
thought was within their remit at all. The other thing that disturbs
me is to read in here that the DLA Advisory Board have examined
some 5,000 cases over a period of time and yet the things that
they are flagging up are not even mentioned in their report. If
they were so concerned about the quality of evidence and the quality
of applications, why are these not mentioned in their annual report?
Somehow they seem to have brought this out as an issue out of
the void and I just find it really curious that they have done
that. It is a strange document. It is very medicalised. I think
if the implications of this were taken literally and carried through
into legislation the impact on disabled people's lives would be
quite profound: far more medical intervention, far fewer rights
for us to determine our own futures. I think it does smack of
the old attitude: disabled people are not competent, are not capable
of making decisions about their lives and about the support services
that they need.
105. They came to the conclusion that 63 per cent of
the awards that they reviewed were in conflict with the facts.
Do you have a comment about that?
(Ms Reith) I think it is a rather odd use of terminology.
They were not clear whether they were looking at entitlement and
whether people were getting the benefit they were entitled to.
If you want to do that you need to get to the claimant, the disabled
person. When they say "in conflict with the facts" what
they are saying is that in their view there was not sufficient
evidence there to have made a decision. That seems to be their
key point. That does not mean those decisions were wrong. There
is nothing in the evidence that suggests people were wrongly getting
benefits, and in fact if they think there was a problem with the
evidence gathering then there are likely to be as many people
turned down for the benefit because the collection of evidence
was wrong as people who maybe got benefits and the evidence was
not all there. Again, they have not looked at people who were
turned down for the benefits. It just seems to me that in research
terms it is an inadequate piece of work. There are some very strange
things in here. For example, they say very clearly that there
are major problems with the mobility component of the benefit,
in paragraph 4.4.3, that the Board is concerned at the large number
of applicants who are currently awarded the higher rate of mobility
component inappropriately. You think, okay, where is their evidence
for that? That is quite a sweeping statement to make. Where is
the evidence? I go to the DSS report,[4]
the bigger report, and that first of all says they did not look
at people getting the higher rate mobility component on its own
and where they did look at people getting it in conjunction with
other components there was a 94 per cent accuracy rate. There
seem to be a whole number of things in the DLA Board report that
are just assertions made by them with no evidence to back them
up.
106. They made it clear to us that this was a project
that was not designed by them. They were asked to carry it out.
If it had been given to them they would have done it in other
ways had they been left to their own resources. There was a clear
understanding from the witnesses last week that the application
form was exceedingly complex, perversely complex. Am I not right
in thinking that this form has been trawled over quite recently
by experts, including some of your own members, to try and improve
it and make it more user friendly? Is that the case and do you
have a view about the complexity of the form?
(Ms Reith) There is a new form that came out in
October that had been consulted quite widely on and is an improvement.
I think what we need to look at is that the idea of self-assessment
for a benefit is quite an exciting, innovative, putting the disabled
person at the centre of the process, idea. It had never been tried
before. It is not surprising that it was quite difficult to get
it right and since 1992 there have been various changes to the
form to try to make it easier. Also, people do not like filling
in forms. The Inland Revenue would love to tell you the problems
they have had with the self-assessment tax forms. They are not
easy. I just think there is a difficulty in having something that
allows a disabled person to talk about how their disability affects
their everyday life which would be different from how that disability
might affect the next disabled person, without having a fairly
long form on which to do that.
(Professor Bruce) May I just check, Chairman:
will you be coming back in your questions to this report because
there are one or two points I would like to make on it? I am happy
to delay those until the question pops up as it were, or is this
the last chance on this report? Chairman: No. I will
guarantee you will get a chance to talk about that. We have got
a series of really quite important areas to us which I would like
to try and address. We have only got an hour left and time is
precious. Can we just try and whizz through those and I am sure
we will get an opportunity to come back to that.
Mr Wicks
107. So far it is obvious that you do not like the Benefit
Integrity Project, but can we try to be more specific and because
of time if one of you could summarise it would be helpful. What
exactly are your criticisms of the nature and methodology of the
Integrity Review?
(Ms Reith) I think it is unnecessary in the scale
of it. If what you are trying to do is improve the integrity of
the benefit, make sure it goes to the right people, then you look
at the claiming process. Is the claiming process adequate in terms
of gathering evidence? Should there be better evidence from GPs,
and I think the DSS would say a resounding, "Yes, there should",
and some work on improving the kind of information that GPs put
forward would be helpful. They send back forms without ever having
needed to see the claimant. There are things that you could do
to improve the first tier decision making, and then make it clearer
to people the basis on which they have been awarded benefits.
It is our experience that most people do not fully understand
that the benefit is linked to the existence of care and mobility
needs and the severity of their disability. A lot of people still
believe that it is somehow linked to a diagnosis. They have had
a stroke, someone helped them claim the benefit. They do not fully
recover from the stroke, they are still under the doctor for the
effects of the stroke, and therefore it does not occur to people
what a relevant change in circumstances would be, whereas if you
were on income support and you won the Lottery you would be generally
aware that that was a relevant change of circumstances and that
you should be telling the Benefits Agency. It is not so clear
with disability benefits. That is the way to look at the project
to ensure that the benefit is going to the right people. You would
also include take-up in that. I was quite startled, I suppose,
by the other report, the disability survey, the first results
from that, that are putting take-up rates for DLA still at between
30 and 50 per cent. That is the real scandal. That is where the
problem lies, not with the 0.17 per cent of people who maybe should
have had their benefit reduced.
(Professor Bruce) The bottom line was that the
last Government developed it as a response to what they thought
was fraud, and the minute you start a project like that, it has
got that colour all the way through and you cannot design it out.
108. But when the benefit review found that 27 per cent
of cases were incorrect, albeit that they found very insignificant
evidence of fraud, how do you evaluate the 27 per cent figure?
(Ms Reith) I think it was inadequate, the way
that they did their bit of research, because they did not follow
cases through. They took a snapshot and the visiting officer or
whoever turned up on the doorstep decided that on the evidence
of what they could see this person did not appear to be entitled
to benefit, and then on the confirmed fraud cases they went and
spoke to a neighbour. When we asked the DSS, "What happened
to those people when you took their benefit away? Did they get
it back on review?", has there been a process where first
impressions had then been modified by a longer process where more
evidence had been gathered, well, no they did not. In fact, they
told us that they had not taken anyone's benefit away because
they did not have the evidence in any of the cases, not even in
the confirmed fraud cases did they have sufficient evidence to
withdraw benefit from people, which to me put a huge question
mark over the terms that they were using when they talked about
fraud. It was just a snapshot in time by people whose knowledge
of disability was going to be fairly limited.
(Mr Wood) The thing that underpins this is the
total lack of confidence that people have in the integrity of
the proposal. We have that lack of confidence for reasons which
the Chair has already possibly indicated, that disabled people
and their organisations were not consulted before this exercise
took place. Remember this is a major disability benefit. It has
a massive impact on disabled people's lives. We would have expected
that we would have understood what the basis of this new inquiry
was, what the assertions were, what evidence they were based on,
and the facts. What is happening now is that nobody understands,
and I doubt even the civil servants actually understand, what
is going on and what the basis of this review is. It is very easy
for people who are reviewing cases to say that 27 per cent of
them, or whatever, appear to be incorrect. But if the other participant
in the exercise, which is the person making the claim or having
to make a new claim or re-establish their entitlement, does not
understand what the ground rules are, what it is that they are
being asked to do, then they may not be giving the evidence in
the same way. They may not be giving the quality of evidence that
they would have given before. There are all sorts of factors creeping
in there, for instance the fact that, as Ms Reith has already
said, on review some of these cases, 25 per cent or so, are being
reversed. When you say to us what is it fundamentally we object
to, I think we object to the whole rationale behind it and the
fact that nobody has been consulted and the fact that we cannot
explain to people what is going on. People cannot get answers
from their MPs about what is going on, they cannot get answers
from the agencies that are supposed to assist them with what is
going on, and the only people who seem to know what is going on
are the civil servants.
109. Can I preface this question by saying that I understand
from my own constituency how much concern (and I think "fear"
is an appropriate word) has been created by this project, so I
do understand that. Can I ask you what seems to be a tough question
because I think it enables you to present your position better?
Professor Bruce says you are not against a review; it is a question
of what kind of review. You are about equal rights for people
with disabilities and equal responsibilities therefore. If one
self-assesses one's income tax it is not unreasonable that the
Inland Revenue may ask you questions. Therefore it is not unreasonable
in principle that anyone claiming a benefit—anyone—should
be scrutinised from time to time. The tough question is this.
Is that what you are really saying, or are you saying, "Look;
here we are, a powerful lobby with lots of emotion attached to
it. Really this is a no-go area", or do you have a way of
presenting to this Committee how you think the Government can
properly review this area of disability benefit?
(Mr Wood) It depends what we are reviewing. We
would say as the disabled people's movement (I do not know if
my colleagues necessarily share this view) that we respect the
right of Government to carry out a review because that is within
its mandate as the Government of the day. What we are not supporting
is a review based on cuts—
110. I understand that.
(Mr Wood) — because disabled people are
among the poorest people in society. If you are saying that disabled
people should comply with the rules that are quite stringent,
then again there is no problem with that as long as people understand
what the rules are.
111. But if a person with a serious disability after
a process of self-assessment got the higher rate, is it reasonable
or not that after a year or so someone should scrutinise to see
whether the thing is in order?
(Mr Wood) I think that depends on a lot of things.
112. In principle. I know it does in practice. It depends
on the quality of the assessment. What I am asking you is whether
you think in principle it is right to review that benefit.
(Mr Wood) It is right to be able to review a person's
entitlement to that benefit, which is not the same as reviewing
the benefit.
113. Professor Bruce, what do you think?
(Professor Bruce) Absolutely. I think I said earlier
on that the Government has an absolute right to be able to review
the benefits it distributes. What we are arguing about is the
way it has been designed, the way it has been conceived and the
way it has been carried out.
114. So briefly, Professor Bruce, given that you have
said you are not against the idea of a review, and I know it is
difficult to ask you briefly, what would that review look like
if you were advising Government?
(Professor Bruce) I think the short answer is
I would not wish to give a detailed description now because that
is not the sort of thing we are negotiating with the Government.
At the moment we are trying to stop them doing the current review.
115. No, but you are before a Select Committee and we
are asking you a question. Forget Government for the moment. Parliament
is more important.
(Professor Bruce) I will do my best to answer.
Let me give one or two principles and then perhaps Lorna Reith
could elaborate. The principles have to include ones of fairness,
ones of sensitivity, ones of clarity, and in terms of such a review;
and if it is a new benefit, in the same way as the disability
movement was involved in designing DLA, then we would expect to
be consulted in advance on how that review might take place. The
ultimate decision is with Government not with us, but we would
expect to be consulted. Those are the principles we would expect
to underly the construction of the regular review of DLA.
(Ms Reith) What I would want to throw in is that
collectively we are experts on the inadequacy of benefits. That
is what people draw to our attention all the time. That is where
we could help in looking at the difficulties with the claiming
process for benefits and the suggestions that we have made about
how you build checks into the system. Of course Government has
a right to check that people are getting benefits to which they
are entitled, but spending an enormous sum of money on a huge
disruptive programme with no evidence to justify doing that is
where we would make our criticism. What I think is also important
is that any exercise has to look at people who are not claiming
their full entitlement. One of the issues with BIP is that it
is only looking on the top level of benefit. The only way it can
go is down. It is not looking at people who are on the lower levels
where their entitlement might go up. If you are talking about
integrity, as far as I am concerned integrity has to include all
of those. I would also be interested, and this is why I am very
disappointed in the DLA Advisory Board report, that it does not
look at the problems of disabled people who fall through the particular
categories that DLA has set. DLA says you qualify because your
care or mobility needs but we all know disabled people who just
do not fit those criteria. To give you an example, one of my staff
at work has chronic renal failure, so she has to have kidney dialysis
every night, every day, every week, for ever. She does not get
any benefits. She does not fall into the particular categories.
There are lots of people like that where the design of the benefit
does not quite meet their needs and people with communication
problems also do not fit that well. I would be interested in looking
at that and see if we could do something with the benefit that
recognised those who are falling through the net. That is the
kind of review we would be interested in taking part in.
Mr Roy
116. I would like to take up individual points you have
already raised. Professor Bruce, I would like to ask you about
the leaked letter that you said was later disowned and there was
clarification from the Prime Minister that the review was not
going to be cuts led. How much more clarification do you need
to make yourself feel that really that letter should have been
disowned and any review is not going to be cuts led?
(Professor Bruce) I realise in some senses we
are asking an impossible question because we are talking about
trust between various parties. If that trust has been shaken very
heavily in the early stages it requires a process of healing.
I think therefore the very overt reassurances that have been given
have been helpful. Those assurances, I have to say, could go further
than they have gone. I think they could go further in a more formal
setting. Some of the reasons that I feel more optimistic now than
I did before Christmas are because of quotes I have seen in the
newspaper attributed to individual Ministers, but that, these
days, is not on the record. I would like to see some statements
in Parliament with unequivocal wording and then I would feel considerably
happier. Lastly, as I said on a couple of occasions before, a
relatively small contribution in terms of the overall scheme of
things, but massively important to us, is to suspend BIP. That
would be seen as an enormous sign of good faith. I have to say
though that I would actually have to have to have it in writing
in Hansard as well.
117. Mr Wood, you said that people had not got answers
from their MPs about what is going on. Have some of your members
found that, if they write to Members of Parliament, they do not
get answers?
(Mr Wood) Oh, no, the MPs cannot find out what
is going on. People are getting responses from their Members of
Parliament, but their Members of Parliament are finding it difficult
to find out what is going on.
118. I take it the parliamentary system has not been
letting down the most important people, who are their constituents.
(Mr Wood) Answers to questions such as we asked
back in the autumn about taxing, about means testing, about handing
over services to local authorities, took ever such a long time
to get answers to, two or three months before the answers started
to appear on those, and even now I am not sure that categorically
you have got statements that these things are not going to be
part of the future of DLA.
119. I was very interested to hear you speaking earlier
about GP evidence. I have got a whole caseload that I gave to
my colleagues regarding the Citizens Advice Bureau in my constituency
and they had been giving me all these case notes about actual
people who have been horrendously treated. I went through a couple
of them. One was a report on an older woman living alone with
hearing difficulties having problems with the DLA form. The client
would not apply for this benefit without help because the questions
put to her were too complex and she was embarrassed answering
many of the points raised. They also brought up a second case
where they report a client who is the guardian of a grandchild
who has asthma. She has applied for DLA for her but she found
the DLA application pack forms too complex and intimidating to
deal with without assistance. She did not feel confident about
using the DLA help line. The third case is regarding GP evidence.
In their paper they say that often the GP's unwillingness to co-operate
with a client through the CAB causes claims to be refused and
then reinstated at a later date. Many GPs are not happy about
the responsibility this places on them and often charge clients
for this service. To give a specific example, Motherwell and Wishaw
CAB reported a disabled client who had been receiving DLA mobility
component at the higher rate and care component and whose case
was reviewed in May 1997. The GP was asked to fill out a report
and she answered all questions as "Unknown" to make
the point to the DSS that she was not obtaining payment for the
task. The client was then taken off DLA immediately. The GP admits
that she has done this with many of her patients, all of whom
seem to have been removed from benefit as a result and the clients
now are appealing the decisions and the GP now supports them.
Where does that fit in with your GP evidence?
(Ms Reith) That is very typical, the cases you
have raised. There is a new DLA form for children which is an
enormous improvement on what you had before, so it may be on that
particular instance that the person had claimed before the new
form came in. On GPs what happens is that the Benefits Agency
will send a form to the GP and ask them to comment on the claimant's
disabilities. GPs may not have seen their patient recently. They
may only have seen them for a repeat prescription. If someone
has a condition that not a great deal can be done about there
is no reason for them to have regular contact with their GP. The
GP may also not be the person who knows. With lots of people with
AIDS for example their GP does not know; they get their medical
treatment elsewhere, so GPs are not always the best people to
know. We think there should be a requirement that if the GP is
being asked to provide evidence to the Benefits Agency—and
they are paid for this—they should have seen their patient
for the purposes of supplying that evidence because even if a
GP has seen somebody for medical intervention, has been to see
whether the pills that they are on are keeping their blood pressure
down or whatever, it will not be to assess their care and mobility
needs, which are different; they are not medical. I think there
is a major problem there. We have the same things with GPs who
presumably sat down one night with hundreds of forms, filled them
all in, sent them off, people lost benefit and then the GP said,
"Oh, I did not mean to do that", or "I got that
wrong". Well, it is a bit late, and of course, as you say,
when it comes to an appeal and the claimant is having to collect
evidence to take to appeal, the GPs sometimes charge them.
3 Ev p. 1-24 HC 641-i. Back
4
A Study of Disability Living Allowance and Attendance Allowance
Awards by Kirby Swales, DSS In-house Report 41, March 1998. Back
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