Examination of Witnesses (Questions 260 - 279)
WEDNESDAY 1 APRIL 1998
MR JOHN
LUTTON, MS
URSULA BRENNAN
and MR BILL
FARRELL
260. When was that?
(Mr Farrell) On the evening of the twenty-third.
261. Of?
(Mr Farrell) March.
262. As a member of this Committee I get all the press
releases that the Benefits Agencies put out. Have you put that
out? Is this now widely known? Have you put it out in a press
release?
(Mr Farrell) A press release was issued that
evening which included that piece of information.
263. Do you pay the doctors to fill in the forms?
(Mr Lutton) Yes, we do.
264. Do you insist that they actually see the people
themselves or are they paid to fill out forms without having to
see the client themselves?
(Mr Lutton) There are two different types of report
coming forward from doctors. There are factual reports which are
considered to be straightforward fact based issues where we do
not require the doctor to go and see the person concerned. There
are then examining medical practitioner reports where we do require
the doctor to go and see the disabled person. We pay for both.
We pay more for one than the other.
265. How much do you pay? What is the difference?
(Mr Lutton) It is something like £17 for
the fact based reports and about £47 for the EMP reports,
but we can give you precise figures.[6]
Mrs Stuart
266. What evidence is left afterwards with the person
who has made the claim? I started to get worried when the Project
Manager talked about carbon copies. Let us say I am drawing a
range of benefits. What piece of paper have I got in my possession
to remind me of what I have told you?
(Mr Lutton) You would not have any just now. Unless
you had kept a copy of the claim form you would not have the details
of that. We would give you an awards notice, but we are looking
at that issue within the BIPs.
267. Is not this the simplest of things? Just think of
your own life. If I fill in an assurance form, six weeks later
I would not remember whether I filled it in or not never mind
what I put in there. You say one of the biggest problems is people
do not tell you of changes.
(Mr Lutton) We are looking at the general issue
of communication with customers, what we tell them, what the expectation
is and we do need some more clarity on that.
Chairman: That is all very useful. I want to move on
now to the wider scope of Disability Living Allowance and ask
Edward Leigh if he can open up the discussion in this section,
please. Edward?
Mr Leigh
268. We have heard a lot of evidence in the last few
weeks about the fact that about a million people were in receipt
of this allowance when it commenced in 1992 and it is due to go
up to two million by the year 2000 and there has been a doubling
of the caseload in six years. Obviously all this may or may not
be worrying. I want to give you a comment. My own view is that
this must be inevitable if it is based on self-assessment, if
only one in five of the people are visited and if there are a
large number of life awards. My own initial assessment is that
this is a benefit which is out of control and very badly targeted.
I may be entirely wrong. I want to give you a chance to comment
on why there has been this dramatic increase over a ten-year period.
(Ms Brennan) Could I comment on that because I
think there are several factors in there. The caseloads have risen
since DLA was introduced. The reasons for the growth in caseloads
are difficult to get to the bottom of. There is conflicting evidence
about the take up of DLA and people's understanding of it and
whether it is going to the right people. That is one reason why
in the Green Paper the Government has said we need to have a debate
about gateways on to DLA because we have the emerging findings
from the new disability survey which suggest that, from the complicated
calculations that it is possible to do, the take up may be pretty
low for DLA and yet the numbers have been rising very significantly.
We do have evidence about problems where in some cases there is
incorrectness in the payment of awards that are in payment. You
linked that to self-assessment. It is worth just reminding ourselves
that it is not self-assessment, it is self-reporting and the way
that the DLA works is that the disabled person fills in the form—unless
they opted to have a medical examination—and gives us information
about their disability and how it affects their lives and their
needs. We do still think that the disabled person is the person
who is best placed to give us that information, but what we look
for is corroboration from a health practitioner, a GP or some
other health practitioner, of the disability. We give guidance
to adjudication officers that says, "This is what the disabled
person has reported on their form as their needs and their problems.
This is what has been confirmed as their disabling condition.
Are those two consistent or do I need to seek extra evidence because
what they have reported as their needs are either rather high
or rather low in relation to what their disability is?" Those
are the judgments that are being made and I think John Lutton
at the start of the session pointed out that there are judgments
being made at all stages. The disabled person is making a judgment,
the doctor is making a judgment and the adjudication officer is
making a judgement. We do think that the way that those judgments
are made is not as consistent as we would like it to be and that
may be a factor in the growth of the caseload of DLA, but it may
also be the case that it simply was very low take up. There was
low take up of mobility allowance and attendance allowance beforehand
and the take up has increased as awareness of the benefits has
grown. So we do think there is a whole variety of reasons there.
One of the things that we want to discuss at one of the disability
forums that Baroness Hollis has announced with the disability
organisations and with the academics is to get to the bottom of
what the information is. We have already had one session on the
research evidence to understand what it is saying and we want
to go on from that and talk about what implications and try and
get to the bottom of why the caseload has grown, whether there
is a problem in targeting this benefit effectively on the people
that it is meant to be targeted on.
269. What was the original intention of DLA?
(Ms Brennan) The original intention of DLA was
that the care and mobility tests were good ways of targeting on
the most commonly occurring of the most expensive disability related
costs. Rather than try and set up a system in which we tried to
gather a lot of information about a lot of disability needs and
a lot of costs, our survey evidence showed us that the care tests
and the mobility tests were quite good proxies to use as gateways
in order to get at people who had a variety of problems and a
variety of needs. The Green Paper confirms that the concept of
DLA and AA as extra cost benefits on a universal and national
basis should remain. It goes on to say that we are concerned about
the gateways, but that general concept of care and mobility as
gateways we do still believe in. They are very difficult, but
we have not seen anything that convinces us that there is a better
way of producing proxy gateways on care and mobility. What we
want to try and do is make those gateways work much more effectively
and consistently.
270. I have difficulty in this expression gateways. Can
you just explain it to me? What exactly does it mean?
(Ms Brennan) Disabled people have a range of needs
for extra help and they have a range of things which incur extra
costs and you need to find a way of getting at that client group
and there is a whole range of ways you can do that and in different
benefits we do it in different ways. In some benefits like the
Industrial Injuries and War Pension Schemes we have percentages
of disability and the amount of money you get relates to your
actual disabling condition. DLA is rather different. You do not
get money because you are blind or because you have multiple sclerosis
or cerebral palsy or whatever, you get money because your disabling
condition gives rise to need for extra help with care or with
mobility. You have problems in getting around and you need personal
attention. It is not that we said personal attention and getting
around are the only two things that are worth worrying about or
that are worth giving money to, it is simply that we actually
found that if you focus your questions and your entitlement around
does this person need help with their bodily functions, does this
person have mobility problems so that they are virtually unable
to walk and so on, that is a good way of concentrating money on
people who had the most commonly occurring and the most expensive
costs on account of their disability. So that is what we mean
by gateways.
271. What sort of take-up campaigns are you currently
operating?
(Ms Brennan) I do not believe we are actually
operating any national take-up campaigns at the moment.
(Mr Lutton) No. We provide the normal advice and
information as we do for other benefits by way of leaflets, by
way of a help-line. When we come into contact with customers generally
we try to make sure that they have got the right knowledge to
make the right claims, but there is no deliberate targeted take-up
campaign.
272. There are a couple of questions from earlier on
that are worrying me and I just want to be fair to you because
unjustified suspicions might otherwise be raised. What I cannot
quite understand is if you have an operation about which government
is so sensitive it has to be closed down during a general election
and you then implement it on the day that ministers arrive in
the department, does not that raise an undue suspicion that this
is a scene out of Yes, Minister in that however governments
change the services go on running?
(Ms Brennan) I do think that is a subject that
is best addressed with Baroness Hollis next week.
273. You cannot tell us what advice you are going to
give her. How can a minister possibly take a decision on the first
day they arrive in a government department? We do not have to
wait to Baroness Hollis to get that answer. It seems such an obvious
question.
(Ms Brennan) The decision about the BIP project
was, as I understand it, not by one individual minister but I
think by a group of ministers in relation to the spending plans.
274. We are gradually getting a bit closer. The other
thing I do not understand is that when we were asking about home
visits the first answer we got seemed to suggest that these people
who were put on this were experienced, but then somebody at the
back from one of the disability groups, who you could not see,
was vigorously shaking their head. At the end of the questioning
we seem to have arrived at the answer that probably none of them
had experience of actual practical dealings with disabled people.
I am still not quite clear how many have dealt with disabled people
in a practical sense. Should not she have ensured that they were?
After all, we are dealing with a very sensitive issue here.
(Mr Lutton) We do have general disability awareness
training. Certainly for this project we did not insist on people
having had contact with a disabled person in their home within
the previous six months. I do not think that would have been practical
to get the right person in place to do this because a fair part
of the job within disability benefits is in dealing with people's
claims and doing the paperwork and dealing with people over the
telephone. Up until this project we have not been involved very
much in actually visiting disabled people in their homes. So in
that respect we did not have a pool of people who had actually
been doing that.
275. Does not that raise huge questions about how you
make policy in your department? You have just admitted that there
you are making policy, none of you visit disabled people, none
of the people you send out have any experience. Do you not realise
that people must question what is going on here?
(Mr Lutton) It is not that we do not understand
issues to do with disabled people, that we do not come into contact
with disabled people. Right through the organisation, and certainly
at a senior level, we are involved with disability organisations
and many of the representatives are disabled. I chair regular
fora with disability organisations and colleagues do the same.
So I would not want you to think that the fact that we have not
actually, in an official capacity as opposed to a personal capacity,
been in a disabled person's home suggests that we do not understand
the disability issues.
Chairman
276. May I reassure the witnesses, and for avoidance
of any doubt and to prevent neckache in the public gallery, that
any nodding and shaking of heads will not form part of the official
report. It is a wee bit unfair for the witnesses who do not know
what is going on behind them, but we are not supposed to make
any reference to that. There is a question about take-up. Edward
asked an important question about the take-up. I want to come
to Nick in a moment and make some progress, but what role are
local authority and voluntary groups playing in take-up campaigns?
I have evidence myself that there is quite a lot of activity.
It may not be official departmental activity but have you had
any discussions with welfare rights organisations, voluntary groups
and others in relation to this particular benefit?
(Mr Lutton) There may be some of that going on
locally. We do not tend to join deliberately in a take-up campaign
with local authorities or any other organisations. We do co-operate
where we can. We give information where we can and we are anxious
to work with them in all ways possible, including the take-up
of benefit, but that is different from getting alongside them
and actively getting involved in a take-up campaign, which can
have resource implications, both in terms of the manhour input
into that and in terms of the spending input.
277. Does that mean that that is a bit demand-led? If
they make requests to you you will assist them with published
material and other things?
(Mr Lutton) Yes, most certainly.
Mr Gibb
278. During Ursula's response to Edward Leigh she gave
the view that you believe that self-assessment is the right approach
to delivering DLA. The DLA Advisory Board are quite critical of
that method. They think it is not designed properly. Do you think
they have any points? Do you think the whole method of delivering
DLA is well designed to be self-sufficient?
(Ms Brennan) I did not want to imply that self-assessment
as it stands at present is the right approach. What I wanted to
say was that the concept of getting the disabled person to give
us information about his or her needs is something that we still
believe is right. We would not, in other words, want to move to
a regime in which we simply subjected everybody to a medical examination
and the disabled person only gave us his or her name and address
and NI number. We do believe that it is right for this benefit
to ask the disabled person questions designed to elicit information
about his or her needs. We think that is a legitimate component
of the decision-making. The question is whether we have got the
balance right between the evidence we get from the customer and
the corroboratory evidence about their disabling condition. Clearly
we do think there are problems. The DLA Advisory Board believe
there are problems. There is the BIP, the benefit review, the
award study: all of these are telling us that there are problems
in decision-making. So obviously we are not satisfied with the
regime as it stands at present. It is just that we do not want
to throw the baby out with the bathwater. We do think it is important
to give disabled people that chance.
279. How could it be improved?
(Ms Brennan) That is one of the things that we
want to discuss with the disability organisations in the new forum
that the Minister has announced she is going to set up, but clearly
there are all sorts of ways in which we could improve the quality
of the evidence we receive, the type of evidence we receive, the
guidance to staff, the guidance on when to seek different types
of evidence, the use that we make of our own medical staff in
giving advice, the use we make of evidence that we obtain by writing
out for reports and so on. That can all help us but also actually
looking at the gateways themselves and the definitions in the
legislation must be a major factor in this. This is not purely
an operational matter.
6 Note by Witness: Figures quoted are correct. Back
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