Supplementary Memorandum submitted by
the War Pensions Agency (WPA 8A)
APPEALS TARGETS
1998-99
1.1 The Committee discussed the problems
faced by the Agency in meeting the Secretary of State target "
to have no more than 23 per cent of outstanding appeals more than
260 days old". To further aid the Committee's understanding
of the issue the following information is submitted.
1.2 Background
1.3 The two major appeals targets set by the
Secretary of State for 1998-99, were:
to clear 6,000 appeals by 31.3.99;
and
to have no more than 23 per cent
of appeals in progress which were over 260 days old.
1.4 The 23 per cent target was set to ensure
that in striving to clear a large volume of appeals, the older
and more complex cases were not overlooked in favour of the newer,
and perhaps easier, appeals. The initial target of 23 per cent
was based on an assumption that 4,500 new appeals (the statistical
forecast) would be received in the year, to be added to the 5,934
existing appeals. Using this combined figure of 10,434 and anticipating
clearance of 6,000 appeals, it was calculated that we would need
to have no more than 1,020 old appeals outstanding at the end
of the year to meet the target of 23 per cent.
1.5 The Agency exceeded the first target, clearing
6,558 appeals by 31 March 1999 and reducing the total number of
appeals in progress to only 2,686 at the end of the year.
1.6 The Agency also reduced the number of old
appeals to 944, which exceeded the original estimate of reducing
to 1,020 needed to achieve the 23 per cent target. However, because
the intake of new appeals was 1,270 below the statistical forecast,
and because we cleared 500 more appeals than the 6,000 target,
the 944 represented 35.15 per cent of the total of 2686 appeals
outstanding at the end of the year. This missed the 23 per cent
target even though the original intent of the target was achieved.
1.7 If the forecast number of appeals had been
received, the 944 appeals over 260 days old at the end of March
1999 would, in that situation, have represented 23.86 per cent
of the appeals in progress and the target could have been achieved.
Conversely, if the new appeals had exceeded the statistical forecast,
the 23 per cent could have been achieved by processing fewer old
appeals and this was clearly not the intention of the target.
1.8 With hindsight, it would have been more
sensible to set a target to clear a fixed number (e.g., 1020)
old appeals rather than express this as a percentage which was
sensitive to fluctuations in intake.
Deafness Claims
2.1 The Committee requested details of the
percentage of claims for deafness awarded during the peak of claims
in 1995 and since.
2.2 The table below shows the number of claims
in respect of hearing loss awarded for the period from April 1995
to March 1999:
|
| 1995-96 | 1996-97
| 1997-98 | 1998-99 |
|
Awarded pension
(20 per cent and above)
| 3,393 | 1,568 | 500
| 183 |
Gratuities paid
(claims made prior to 7 January 1993)
| 639 | 431 | 325
| 146 |
Gratuities unpaid
(claims under 7 January 1993 or after)
| 4,341 | 3,727 | 3,398
| 1,865 |
Nil assessments | 4,116
| 2,817 | 2,172 | 1,359
|
|
Total | 12,489 | 8,543
| 6,395 | 3,553 |
|
2.3 The following information shows the amount of war pension
paid by percentage in respect of hearing loss:
|
Percentage | 100 | 90
| 80 | 70 | 60 |
50 | 40 | 30 | 20
|
|
1996-97 | 7 | 8
| 21 | 26 | 59 |
133 | 299 | 539 |
476 |
1997-98 | 6 | 5
| 9 | 22 | 28 |
62 | 99 | 129 |
140 |
1998-99 | 1 | 1
| 7 | 11 | 20 |
23 | 37 | 32 | 51
|
|
2.4 Data for the period April 1995 to March 1996 prior to
the implementation of the War Pensions Computer System is not
available by percentage. However, the total number of pensions
awarded (20 per cent or more) for the year 1995-96 is 3,393.
Levels Of Sickness Absence within WPA
3.1 The Committee requested information about the actual
number of days lost on sickness absence along with details of
the sorts of initiatives in place to address the problem.
3.2 The Occupational Health Services Agency (OHSA) publicises
information on sickness absence levels within the Civil Service.
The "Analysis of Sickness Absence in the Civil Service 1996"
report showed WPA as having lost 17.63 days per person per staff
year. The recently published 1997 report now shows that the sickness
absence rate has fallen to an average of 15.9 days per person.
This is the only published report in the public domain. As there
is a considerable time lapse between the collation of the information
at the end of each year and the eventual publication of the report,
the information within the public domain is in effect out of date
and does not reflect the improvements made by the Agency to date.
Staff Absences Per Year Per Person
|
Year | Staff in post | Averages days
per person
|
|
1994 | 1,646 | 12.9
|
1995 | 1,593 | 13.0
|
1996 | 1,331 | 17.7
|
1997 | 1,159 | 15.9
|
1998 | 958 | 14.6
|
|
3.3 Agency Strategy to Reduce Long Term Absence
3.4 The Agency has produced a plan outlining the measures
it is taking to improve staff absence. The plan includes the following:
Stress awareness days provided by the Lancashire
Health Promotion Unit. These include stands, leaflets, and advice
on stress, blood pressure, diet and exercise.
The introduction of a Human Resource Liaison Officer.
The Liaison Officer will offer both staff and managers clear practical
guidance on sickness absence issues. Initial contact by telephone
is made with staff who have been off sick for 4 weeks followed
by a home visit if necessary. The aim is to keep in touch as part
of the Agency's "duty of care" and involves establishing
whether anything can be done to help staff return to work, referral
to Care First for counselling if appropriate plus the offer of
guidance and support.
Regular review of guidance available to staff
and managers in managing attendance, with revisions as appropriate
to ensure provision of up to date relevant and meaningful direction.
The introduction of " Return to Work Interviews".
The aim of the interview is to show staff that their absence has
been noted, offer help if required, investigate the reasons for
absence and ensure that the officer is fit to return to work or
whether alternative duties will help to re-enter the working environment.
An upgrade of the Agency's Management Information
System to ensure that information relating to staff absence results
in earlier referrals to line managers and effects speedier action.
Best practice shared through Departmental Sickness
Absence Working Group. Consideration of more flexible working
patterns and family friendly policies.
Treatment of Officers and Other Ranks
4.1 The Committee asked whether there was a logical reason
for treating Officer ranks differently to other ranks.
4.2 Rank differentials for war disablement purposes were
abolished in April 1993, with the result that there are now no
longer separate rates of payment for Officers and Other Ranks.
The only difference, which now remains, is in the method and frequency
of payment.
4.3 The main reason for treating Officer ranks differently
to other ranks is purely historical however, the legislation reflects
and prescribes for such differences. Responsibility for administrations
of pensions at the outbreak of the 1914 war was vested in the
War Office for Army Officers and their widows and the widows of
soldiers; the Chelsea Commissioners for Army Other Ranks; the
Admiralty for Navy Officers and widows and seamen.
4.4 The Ministry of Pensions Act 1916 transferred the administration
of pensions and grants in respect of disablement and death arising
out of the 1914 War to the Ministry of Pensions. This also incorporated
the powers and duties of the War Office, the Chelsea Commissioners
and the Admiralty.
4.5 From 1917, Orders and Royal Warrants consolidated and
amended the existing provisions, which provided separate schemes
for officers and other ranks. With the advent of the Second World
War, the 1939 Pensions Act gave the Minister the same powers in
relation to the Armed Forces that he had in respect of the First
World War. Additionally, it gave powers to make pension schemes
for Mercantile Marines etc. under the provisions of Orders and
Royal Warrants.
4.6 Thus subsequent consolidation of earlier legislation
has perpetuated the differential provisions for Officers and Other
Ranks. However, as stated previously, rank differentials for war
disablement purposes were abolished in April 1993.
Noise Induced Sensorineural Hearing Loss/Gulf War and Radiation
Cases
5.1 Dr Braidwood agreed to provide a note about Noise
Induced Sensorineural Hearing Loss and the evidence required in
the assessment of Gulf War and Radiation Cases.
5.2 Assessment of Noise Induced Hearing Loss.
5.3 War Pension may be awarded for any disablement caused
by service. The main function of assessment in the scheme is to
determine the level of financial compensation. The legislation
sets out the assessment method, which is by comparison of the
disabled person with a normal person of the same age and gender.
In that way only disablement causally related to service can be
included.
5.4 The War Pensions and Industrial Injuries Schemes are
closely related, with assessment on the same basis. To provide
consistency and equity across the range of conditions, the schemes
have the same statutory scheduled assessments. These act as benchmarks
in the assessment of unlisted conditions. (Loss of an eye and
below knee leg amputation equates to 40 per cent: loss of all
toes, one foot: loss of two fingers equates to 20 per cent).
5.5 Since 1995, the Industrial Injuries Scheme has had a
compensation threshold for occupational deafness. Like noise induced
hearing loss in war pensions, this is assessed using pure tone
audiometry. Award for occupational deafness becomes payable where
hearing threshold level averaged over 1, 2 and 3 kHz reaches 50
dB, equivalent to 20 per cent disablement. For noise induced hearing
loss assessment, the War Pensions Scheme was brought into line
with industrial injuries by legislative amendment in 1992.
5.6 The increase in claims for NISHL in 1991-92 led to re-examination
of war pensions practice in hearing loss claims. This included
expert consultation. The new practice acknowledged that hearing
loss due to noise injury does not progress on removal from the
noise. Assessment of service-related disablement was then based
on the position at service release.
5.7 War Pension law permits review of previous decisions,
for example, to reflect worsening of an accepted condition. Any
increase in assessment must, however, be due to service-related
disablement. When a deterioration claim for noise induced hearing
loss was made, since any increase in hearing loss after service
was not due to service, no direct increase in service-related
disablement could, therefore, be lawfully made.
5.8 Exceptionally, where an accepted and a non-accepted condition
interact so that overall disablement is more than additive, war
pensions assessment may be increased in respect of the interactive
factor. In 1992 it was believed that there was such interaction
between disablement due to noise induced hearing loss and that
due to subsequent ageing.
5.9 The scientific issues were further investigated in 1994-95.
It was concluded that disablement due to noise injury is discrete
and circumscribed and does not increase on removal from the noise,
and that hearing loss due to noise and subsequent age related
loss are not more than additive. In 1996 assessment practice was
changed to reflect this.
5.10 Following the 1997 election to confirm that the approach
to the assessment of noise induced hearing loss was in line with
current medical and scientific understanding; the new Government
ordered a review of the scientific evidence behind the Agency's
assessment approach. The review was undertaken by four independent
experts and was chaired by the Government's Chief Medical Officer.
5.11 The report held that, in the context of war pensions,
hearing loss due to noise does not increase after removal from
the noise injury or as subsequent age related hearing loss is
added to it. These conclusions confirmed that the approach to
the assessment of hearing loss was sound. The review also recommended
that the matter be looked at again in a years time.
5.12 The report of this further review was placed in the
Libraries of House of Commons and the House of Lords on 2 March
1999. It found no new scientific evidence to raise a reasonable
doubt that noise induced sensorineural hearing loss deteriorates
once a person is removed from the source of the noise which caused
it; or that the combination of noise induced sensorineural hearing
loss and subsequent hearing loss due to age is more than additive.
5.13 Evidence in Relation to Gulf and Radiation Claim
Determinations
5.14 Decisions in war pensions are individual and depend
on specific case facts, accepted medical understanding of conditions
claimed, and the relevant law. To inform decisions, both medical
and service case specific evidence is collected. It is the responsibility
of the Secretary of State to obtain and make decisions on factual
matters relating to claimed service accidents, incidents, and
exposures. War Pensions Medical Advisors identify the medical
evidence relevant to the claim.
5.15 For service evidence, the Agency has a service level
agreement with the Ministry of Defence. Enquiries are generally
made on service dates, type and theatre and on specific incidents,
accidents and exposures. Where an UK atmospheric nuclear test
participant claims a condition which might be due to ionising
radiation, dosimetry data on the man's exposure is obtained from
the Atomic Weapons Establishment, Aldermaston. For Gulf claims,
the Ministry of Defence has a dedicated unit providing service
details including vaccinations, exposures etc.
5.16 Medical evidence is obtained from service medical records,
hospital case notes, the claimant's general practitioner or other
health professional. The claimant may be examined by a medical
specialist or a Departmental Board. For very complex cases, or
where there is a conflict of medical opinion, in relation say
to diagnosis, claimants may be referred to Regional Consultants.
These are eminent specialists appointed by the Chief Medical Advisor
of the Department. Their examination of claimants and reports
are informed by a Statement of Case containing the medical and
other evidence on the claim as known at the date of referral.
Specialists and war pensions regional consultants are required
to provide independent impartial opinions and answers to questions,
based on evidence and with reasons stated.
5.17 Medical Evidence to Inform Adjudication Guidance,
Policy Statements, Appendices in Relation to Gulf and Radiation
Cases
5.18 For quality decision making in War Pensions certification
and advice must be medically sound, reflecting contemporary accepted
medical understanding. To support this, the Agency has a well-stocked
medical library and information facilities. A wide range of medical
journals are on circulation to the medical staff. There is access
to the Internet, and medical and scientific papers and texts can
be readily obtained. The Department and Agency is committed to
the professional development medical staff and encourages attendance
at relevant meetings and courses.
5.19 The medical policy adviser is in routine close contact
with medical and scientific colleagues throughout the Department,
in other Government departments and academic institutions in the
UK and overseas. There is communication with doctors in the United
States Department of Defense and Veterans' Affairs Departments
in the United States, Canada and Australian Repatriation Medical
Authority. These wide sources are used to inform the guidance
and statements produced on medical aspects of disablement issues.
5.20 In assessing medical or scientific evidence, regard
is paid to whether conclusions of studies are hypotheses; or whether
there is supporting evidence, which goes beyond hypothesis, and
if so its basis - the reaction of other experts in the field to
the evidence; the weight of overall evidence on the matter.
5.21 As in the wider medical and scientific world, evidence
for any new approach in science is always considered and weighed
relative to the existing body of evidence on a subject, with account
taken of the robustness and authority of new studies. In particular
the design and methods, sample size, case and control selection,
statistical validity, repeatability of findings, approach to bias
and possible alternative factors and hidden influences. Other
important factors include whether the findings have been replicated
by other independent researchers and the overall plausibility
and consistency relative to contemporary understanding.
5.22 This process is followed in the production of all war
pensions medical appendices, medical adjudication guidance and
the medical aspects of policy statements including material related
to Gulf and radiation issues.
WPA Press and Publicity
6.1 Following questioning at the Hearing about the Agency's
"Programme of Publicity" the Committee may be interested
in the attached supplementary information
6.2 WPA has an ongoing annual programme of publicity activity,
aimed at providing information about the Agency and its business
and giving advice about how to claim a war pension. A number of
different mediums are employed within the programme.
6.3 To maximise the programme's potential and ensure a wider
distribution of information, Agency staff both at Norcross and
throughout the War Pensioners' Welfare Service (WPWS) work closely
with colleagues in the ex-service organisations who, in turn,
promote the WPA Scheme on our behalf.
6.4 Some examples of the activity within the programme are
as follows:
WPA supplies leaflets and posters on a regular
basis to welfare outlets and organisations. These include GP's
Surgeries, Hospitals, Libraries, Regimental Museums and advice
centres such as NACAB, Age concern and Welfare rights. Over 13,000
outlets have been contacted to date.
Information on how to contact the Agency is displayed
in all BT phone directories. The Helpline number is also quoted
on all relevant WPA and DSS literature.
WPA has recently updated its Website to include
information on all aspects of claiming a war disablement pension,
how to contact the WPWS and also has a dedicated page which invites
enquiries and comments on service improvements.
WPWS staff undertake a publicity role for the
War Pensions Agency providing a presence at major ex-service events
and combining with other organisations to organise events promoting
awareness of war pensions.
Provision of factual articles for publication
within newspapers, magazines and ex-service journals. We also
produce a dedicated Newsletter entitled "At Your Service"
which includes information on Agency performance and topical issues
such as the "Hearing Loss Review" etc. The Newsletter
is distributed to all ex-service organisations and Benefit Agency
Offices with an agreement that they may reproduce articles within
their own publications.
Tours of the Agency Headquarters in Norcross are
actively encouraged for visitors such as MP's, representatives
of ex-service organisations, other Agency staff etc. to promote
awareness and provide a greater understanding of our work and
processes.
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