Examination of witnesses (Questions 120 - 139)
WEDNESDAY 25 MARCH 1998
PROFESSOR IAN
BRUCE, MS
LORNA REITH
and MR RICHARD
WOOD
120. You say that the Benefits Agency pay a doctor to
fill in these forms?
(Ms Reith) Yes.
121. But do not specify that they have to see the patient
to do it?
(Ms Reith) No. The question says, "When did
you last see the patient" or something like that. There is
no requirement that they should have seen the patient recently.
122. Which, if they did, would probably mean fewer mistakes
being made?
(Ms Reith) Yes. We think that there should be
a requirement that they should see the patient for the purposes
of that form, that they are looking at their care and mobility
needs.
Mr Leigh
123. I was very struck by the session last week with
the Advisory Board. These were not a bunch of Treasury officials.
They were people who have the interests of disabled people at
heart, I am sure, but what we found out last week was that the
number of people in receipt of DLA has increased from about one
million in 1992 and is going to go up to two million in the year
2000. We found out that only one in five claimant is being visited.
We found out that, according to the DSS report in January 1997,
27 per cent were receiving benefit incorrectly. This is all a
fairly damning indictment of this particular benefit. You now
tell us you want to suspend, cancel, BIP. I find that difficult
to accept. One of the things that was impressing us most forcibly
last week was that self-assessment does not work, and I must admit
it seems quite obvious from the figures that I have just quoted
that it is not working, that this benefit is out of control. It
is not in your interests that should be the case because it undermines
public confidence in it and it will stop the benefit going to
those who really need it. What I really want to tease out from
you more is whether you do really think that self-assessment is
working and whether you accept the Advisory Board's point of view
that it should be dramatically changed. Have you got any ideas
of how it could be better applied?
(Professor Bruce) If I could start with the first
half of your question and pass self-assessment over to colleagues.
First of all, in our view spending on benefits is not too high.
This country as a percentage of GDP has one of the lowest expenditures
on social security in the developed world. We know that many disabled
people are poor and that many of those are relatively poorer than
they were a decade or two ago. We know that cuts are already being
introduced into disability benefits, and I mentioned earlier Invalidity
Benefit going into Incapacity Benefit which will be cutting out
about £2 billion per annum fairly soon. Disability benefit
spending is not spiralling out of control, the spending is rising
in a predicted and predictable fashion. First of all the figures
that are used to show the spiralling expansion are comparing apples
and oranges. The base figures include different things than the
figures of today. I can give you just two examples. The first
is that in the past a lot of benefit going to disabled people
under Supplementary Benefit went through what was called Additional
Requirements and would not have been separated out as disability
benefit spending but, of course, it now is included as disability
benefit spending and thus makes it look as though spending has
gone up more than it has. The second example is that 15 or 20
years ago many disabled people were in long-stay institutions
and were covered under a different budget. Luckily we are now
more enlightened, disabled people have exerted their rights and
we have a disability benefit system which will support their independence
rather than their dependence. Thus more disabled people are in
the community but they are under the disability benefit spending
budget. Another reason the budget has expanded is because we have
more disabled people. We are an ageing population and the majority
of disabled people in this country are over retirement age and
therefore, by definition, the spending will go up. We have the
issue of under-claiming which colleagues mentioned earlier on.
If there have been criticisms of the present system they have
been as much about under-claiming as they have been about any
other problems with the system. Luckily the previous Government
had a very active programme of advertising disability benefits,
as it quite rightly should, and we would expect the present Government
to continue so that those people who currently are entitled but
do not claim actually come into the system and that will push
the numbers up. Lastly, and this is absolutely fundamentally important
and it is an area where if I do not get another chance I must
put one sentence in about the DLA Advisory Board report, DLA is
a new benefit. It was designed in particular to bring two new
groups of disabled people into the system, those with learning
difficulties and those who are blind. If you bring in a new benefit
and it introduces new people into the system, initially only a
few will claim. Gradually those numbers will build up but in the
end they will plateau. Certainly as far as blind people are concerned
we believe we are just about plateau-ing. RNIB predicted about
40,000-ish people coming into the system and it has reached that
level now. For all those reasons it is not fair and it is not
accurate to say that the disability benefit system is spiralling
out of control and we believe we will have to afford it. That
is the first half of your question, I think the second half was
how does self-assessment fit in.
124. Do you think it is working well and how can it be
better applied? Thank you for that response.
(Ms Reith) I think the point I made about self-assessment
earlier is the key thing. It is a new method but it puts the disabled
person at the centre of the process. Who is the expert on someone's
disability? We would say the expert is the disabled person. The
DLA Advisory Board are mainly doctors and they see the world differently.
When you look at their reports it is fairly clear that when they
say there was not enough evidence or things were not corroborated
what they mean is there has been no doctor involved. We would
say that there does not have to be. If the disabled person is
describing their own disability and the effects on their life,
yes there needs to be some corroboration, we are not saying that
someone just sends in a form on their own, we have to weed out
the Neil Hamiltons of this world, but the form is countersigned
by someone who knows the claimant well. You are not just leaving
things for the disabled person. They must be at the centre of
the process. Yes, medical evidence can back that up. I do not
think there is a problem with self-assessment. People can opt
for a medical examination if they want. People getting the higher
rate DLA mobility component are already subject to a medical examination,
you do not get on to that benefit without. You went back to the
27 per cent. I think we have shown quite clearly that there are
big problems with the research that came up with that figure.
The Benefit Integrity Project is not showing anything like that
level of inaccuracy.
Mr Leigh: Can I just come back to this once more. As
a layman in all this I can understand the point of view in terms
of personal dignity and that self-assessment is important but
then we hear this form is impossible to understand apart from
for a Cambridge graduate.
Ms Buck: Especially a Cambridge graduate!
Mr Leigh
125. So I really do not see why it is undignified for
you to attack the principle of all or most cases being double-checked
by a doctor. Why is that wrong?
(Mr Wood) Because the DLA is there to promote
our independence. What would we be supporting in a medical test?
We are supporting independent living and the issues that support
a person's ability to live in the community and they are not all
medical. Our lives are complex. It is the case that many doctors
actually do not understand our social needs. They may understand
our diagnosis and prognosis but they do not understand the support
that goes around that. We do understand that, our families understand
it and the people that we interact with understand it. This is
why we have this conflict. People who are trying to promote their
independence who know intimately what their needs are, find it
difficult to put them on a form. The forms are so difficult but
then we get the medical profession saying "no, no, no, X
follows from that, not Z". Actually it is just not true.
It is not so that a medical opinion of our independence is better
than our own opinion. I think we must move away from that. If
all disabled people are going to be subject to medical checks
then I think the Government should legislate for disability equality
training for all GPs in this country because they do not understand
our position, they do not understand the social aspects of our
lives. That is the important part of this benefit. That is what
it is there for. It is not to pay us for a disability, it is to
promote our independence.
(Professor Bruce) It was the previous Government
that was courageous enough to move into the self-assessment area
and our argument is that the evidence you have had that it is
not working is considerably exaggerated.
126. So one last question then. Are lay Adjudication
Officers best placed to make decisions on DLA do you think?
(Ms Reith) I think it partly depends on their
training. We can tell you horror stories about Adjudication Officers.
It is a question of training them and having them being involved
with disabled people. The training that they get at the moment
is very much within the Benefits Agency. We could do with an opening
up of the training that Adjudication Officers get and far more
contact with organisations of disabled people so they get a better
understanding because in general they are not disabled people
themselves, although some might be. We would say there is not
a major problem but there is a problem with the level of training
that those people receive.
Ms Buck
127. Can I pitch in one question on this. I take very
much your point, Richard, about the impossibility and undesirability
of an independent person who possibly does not know you very well
and has a medicalised kind of model telling you your own experience
and your own condition, how long it takes you to get dressed in
the morning or how long it takes you to get to the bathroom and
so forth, it is not possible. But the critical question, and it
is certainly a question on which we need to assure the public
in terms of how we explain disability benefits, is how we reconcile
self-assessment with the risk of— It puts a premium on incapacity.
How do we create a self-assessment system that does not actually
encourage people or is not perceived to encourage people constantly
to be driving up their level of incapacity in the application
process?
(Mr Wood) You are asking exactly the sort of question
that should be asked as part of the review. What is happening
at the moment is chaotic. If DLA, amongst a whole range of benefits,
is going to be reviewed and if organisations of disabled people
in the disabled community and people involved in our lives sit
down with Government and say: "Look, we have got a whole
range of benefits here, some seem to be in conflict, there is
chaos, the forms are horrendous to fill in, how can we deal with
things like self-assessment?". Obviously, possible fraud
is always there at the back of people's minds but so the people
actually do self-assess correctly and they do get the benefits
that they are entitled to. Surely we are entitled to say "Yes,
these are serious questions but let us ask them as part of the
review".
128. I am quite happy with that but I suppose what I
am saying is you, as disability organisations, must be grappling
with this.
(Professor Bruce) We are but the problem is almost
the reverse. One phrase in your sentence, asked whether self-assessment
might not be driving up the needs. Now if you look at the Sainsbury
study of 1995,[5] it concluded
that around a quarter of the DLA and AA samples said the picture
they presented of themselves in the claim form was better than
was actually the case in reality. The problem is not that the
claimants are driving up needs, they under-estimate them, so we
have still got the problem you are describing but it is not the
problem that is implied in self-assessment driving up need.
(Mr Wood) That is why it needs to be part of the
review so we get it right.
Chairman: We have got about half an hour, 25 minutes,
left and I have five areas I really am very anxious to cover.
Julie Kirkbride?
Miss Kirkbride
129. I was quite interested in what you said about the
international comparisons and I wondered if you had any figures
on how mean the British taxpayer is and what disabilities—
(Professor Bruce) Yes. I have to take my glasses
off to read it. On the scale, I am starting with the meanest countries
on social security spending and going up to the more generous
ones.
Mr Gibb
130. Disability not social security, does that include
pension contributions?
(Professor Bruce) It does, you are quite right.
Mr Gibb: That is a wholly different regime so that
would be misleading. What have you got on disability?
Chairman: Thank you, Nick.
Miss Kirkbride
131. He understands these things.
(Professor Bruce) I would still like to put this
on the record and then come on to disability spending because
the problem is you cannot get an answer on disability spending
without looking at social security spending.
Mr Gibb
132. We can put that question if you like.
(Professor Bruce) In social security spending
in general, of which disability spending as we all know is a very
large percentage—I will not read out the figures in that
case—the UK is in the lower half of the developed countries.
If you look at disability spending which can be identified, we
end up just a little bit above the middle of the developed countries.
The key issue here is that in most other countries they do not
have cost allowance, they have income replacement methods of treating
disabilities. This disability spending in those other countries
does not show in their disability spending budget, it shows in
their main social security budget which is why I would defend
quoting social security rankings as well. It is going back to
that old position in the UK that a lot of disabled people were
helped under social security in general which was an Additional
Requirement of Supplementary Benefit which was not separated out.
It is the old problem of international comparisons. I do recognise
it is not a precise answer but as a generality we, as a movement,
stand by the fact that in this country social security spending
for disabled people is not as generous as it should be.
Chairman: That is an important question. Would it be
a burden to ask you to do a note. We have just heard your knowledge
is incomplete and so is ours, if you could do one side of A4 on
that we would be interested to pursue it.[6]
Mr Wicks: It is an enormously difficult question. Good
of you to ask.
Miss Kirkbride
133. In terms of proportions, as much as claiming disability
allowances identifies you as disabled, can you give me the percentage
of the population as to how many people in Britain are classed
as disabled. Is that information available?
(Professor Bruce) It is. At the moment it is in
a minor bit of disarray because there have been two major disability
surveys. In the middle 1980s the figures of disabled people, and
if you pro rata them up, come we reckon to about seven million.
The latest disability survey, which was done by a different methodology,
raises that figure up to 8.5 million.
134. In the UK?
(Professor Bruce) In the UK and that is out of
60 million, so we are talking about a very significant percentage.
The vast majority of those are over retirement age. At the moment
the statisticians and researchers cannot reconcile the seven million
figure with the 8.5 million figure. My own belief is that it is
a lot to do with methodology but that is not yet accepted.
135. I have been asked to ask you this but I think I
know what the answer is going to be but so we have it on the record
for our report. The DLAAB recommends that disability allowance
should be restricted to the most severe disability. That is just
for you to put on the record what your view of that would be for
the purpose of our report.
(Professor Bruce) I find it difficult to stay
rational against that proposal because the Disability Living Allowance,
as I have already described, was introduced in part to bring new
groups of severely disabled people into the system. For example,
before 1992 blind people were not eligible for any kind of disability
benefit on account of blindness. For the first time in 1992 they
have been. Is the DLAAB saying that blind people are not severely
disabled? If they are it beggars belief in my view. Are they saying
that blindness does not bring extra costs? I have brought this
piece of equipment along. You all use pencils and pens. This is
a Perkins Brailler. Your pencil probably costs, what, 50 pence?
A blind person pays £252 for their pencil. Quite apart from
the fact of the severity of the disability, there are extra costs.
I could go through the extra taxis and extra costs. Look at a
blind person's forearm, covered in bruises, what is the implication
in terms of costs? It means probably you have to renew your clothes
twice as often as anybody else. The extra costs involved in people
with learning disabilities were brought in, the extra costs of
people with hearing disabilities which once again the report seems
to under-estimate. You yourselves see Jack Ashley at work in Parliament,
how much do you think it costs to have a Pallantype machine operator
working there? The extra costs of disabilities that the DLAAB
seems to be dismissing, are very high and the social justice of
what they are proposing seems to me highly questionable especially
when it is based upon such poor data. I have to say I find their
report monstrous.
(Mr Wood) Absolutely, I second that. I also think
it shifts the whole focus of what that benefit is about. It becomes
a medical benefit and not an independent living benefit. It begs
the question what will happen to the potentially hundreds of thousands
of disabled people who are struggling to live in the community,
what will happen to those people? What are they suggesting, that
we all go back into institutions and cost four times what the
benefit costs anyway? It is ludicrous to make that suggestion.
Again, I think that underpins the feeling that we have, that whatever
assurances are given, it is difficult to find any assurances,
but whatever assurances could now be given it would be difficult
to convince us that it is not cost led because statements like
that are clearly cost led. With no rationale behind it about how
that supports independent living, what happens to other people
who fall out of independent living? It is money driven.
136. The other observation in the report is that benefit
entitlement goes well beyond, or has in practice gone well beyond,
that which was intended by the original legislation. I wonder
if you agree with that, why you think it might have happened and
whether you think it should?
(Mr Wood) With respect, what I find extraordinary
about this, I know there is no bottomless purse, we understand
that. As I said, our lives are very complex as disabled people.
The thing which will move or has the potential to move disabled
people to full citizenship and, to echo your words I think, it
is about rights and responsibilities and about our ability to
contribute to society. I would argue by the way we do contribute
vastly to society but if you want to look at it in monetary terms,
you want to put disabled people into employment, you want people
into education, you want to make disabled people financial contributors,
then you have to invest in them. We seem to have this view all
the time that disabled people are a burden. This is what lays
behind these reports: disabled people are a burden and we must
look at a way of reducing that burden. I suggest to you, firstly,
that this should be refuted by a Government which is supposed
to be promoting civil rights for disabled people. This is a Government
that actually stated that in its Manifesto: full and equal civil
rights for disabled people. Our ability to live independently
is so much a part of that. If BIP carries on, if there are profound
changes to what are fairly low levels of benefits anyway—we
are talking about £50 a week for the high rate care component—if
you compare that to local authority services you would not buy
many hours of local authority services and you take away disabled
people's independence. If that is the road that we are going to
go down, looking at cuts all the time, then the costs to all of
us morally, socially and financially will be far greater than
they are now, I do assure you of that. If we start putting disabled
people back in institutions the implications are profound and
they are not just about money, they are about the morality of
the sort of country that we live in.
137. I want to look at one statement there. Obviously
you represent a group and therefore your words are going to be
more strenuous. I think 25 billion we spend on disability benefit
is the figure that we use at the moment and that is equivalent
to more than ten pence in tax. There is a taxpayer's view in this.
I think it is legitimate to say that. Whilst I would entirely
agree with you that the benefit rates should not be cut because
you clearly do need that money, would you have any objection to
a review of people who are not entitled having that money taken
away with the result that the global budget would be cut? Without
benefit rates being cut but the actual cost to the taxpayer would
be cut. Would you have any objection to that?
(Ms Reith) If people are not entitled to benefit
they are not entitled to benefit and they should not be getting
it. That is the answer to that.
(Professor Bruce) We are fiercer against people
who are not entitled than you are because the reputation of disabled
people unfortunately is affected by people falsely claiming. We
have been through a lot of these statistics this morning and it
is not the case with DLA. Can I just quickly say the expansion
that the DLA Advisory Board talked about last week is factually
incorrect. The Mallinson and Halliday judgments stuck about two
per cent on. For example, six thousand blind people at a maximum
probably got through because of Mallinson. It is a hypothesis
which is factually incorrect. It is misleading.
Chairman
138. I want to ask Paul Goggins to turn to Life Awards
but can I ask Julie Kirkbride's question a slightly different
way first. These are medical models as opposed to the social self-assessment
models and I understand the distinction. Just concentrating for
a moment on the medical model, I understand that there are scales
from 1 to 10 of disability. Firstly, do you recognise those scales?
Are they useful? I was just trying to find it in the transcript
and I cannot just as I speak. The point seemed to be put to us
from the evidence that the DLA design was really originally intended
to target the top seven, eight, nine, ten per cent, eight to ten
per cent, of severity disability. The Advisory Board seemed to
be expressing some views about the fact that it was drifting down
to the two, three, four level of restriction in disability and
they believed that was not the original intention of Parliament
in designing the benefit. Do you have a view about that? I think
it was Dr Hunter who put this to us last week.
(Professor Bruce) Regrettably, once again, factually
incorrect. The Advisory Board in their evidence to you I think
said that it should be restricted to categories eight, nine and
ten. I actually checked so I think I am correct in saying that.
139. Yes, you are, I have just found it.
(Professor Bruce) That was their view because
they thought it was drifting down. Eight, nine and ten is far
higher than DLA was designed to be. A few moments ago I explained
that people with learning difficulties and people who were blind
were deliberately designed into the system in 1992. Blind people
normally come in category seven, not eight, nine or ten, which
is why I know that the Advisory Board is actually recommending
that blind people should be cut out of DLA which is why I get
rather hot under the collar, as you can imagine. It is an issue
which needs to be watched. I am not trying to dismiss it. I go
back to the Sainsbury report of 1995 and in that they say "unsuccessful
applicants are often no less disabled than DLA recipients and
share common problems". There was another part. "Lower
rate recipients are more severely disabled than anticipated and
on the whole they are as severely disabled as middle or higher
rate recipients". This is tough research, not 1,200 forms
that DLA Advisory Board members non-researchers, had strewn around
their tables to read, and only doing their research on the basis
of written evidence; this (Sainsbury) is real research.
5 DSS Research Report 41, Evaluation of Disability
Living Allowance and Attendance Allowance by Roy Sainsbury,
Michael Hirst and Dot Lawton. Back
6
Not printed. Copy from Observer, 18 January 1998. Back
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