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Mr. Bayley: My hon. Friend makes a powerful point to the House, but I am concerned that the Committee has neither investigated the allegations put to it nor asked the Department to do so. The allegations need to be investigated. As a Minister, I asked the Clerk of the Committee to provide the information on who those people are so that we can learn lessons from what happened, and I ask my hon. Friend to ask NACAB to provide the information, which it is often reluctant to supply or cannot substantiate. If it can provide that information, every case will be investigated because we want to get to the bottom of the problem.

Mr. Dismore: I am grateful to my hon. Friend and, in those circumstances, I shall not cite the last case, which is perhaps the most appalling of all. I shall tell him about it afterwards. [Hon. Members: "Go on!"] Oh, all right then, since I am being pressed. A woman client of Chinese origin was visited at home by an examining medical practitioner. The doctor asked the client a number of questions about how she came to England and how she "got her children in". The doctor pulled up the client's skirt, revealing her underwear. Unsurprisingly, the client was made to feel uncomfortable. Such behaviour is unacceptable and I am grateful to my hon. Friend for taking a firm view on that.

I referred a constituent's complaint to the Department, with a full explanation. An Irish gentleman had fallen off a roof, suffering a badly fractured leg. When he went to be examined, he was asked whether he was drunk at the time. Assumptions are made about Irish people. I see the hon. Member for Belfast, South (Rev. Martin Smyth) nodding.

Rev. Martin Smyth: Some of us are TT.

Mr. Dismore: The hon. Gentleman makes his point from a sedentary position, and my constituent made exactly the same one, because he is teetotal and felt grossly insulted by the question. Stereotyping is the problem. In that respect, I am grateful to the Government

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for saying that they adopt a serious approach. We must get to grips with these issues and we can do that by spending a little money on ensuring that proper interpretation facilities are available and that people can understand both the claims forms and what is expected of them during an examination. Above all, we must make the system a lot simpler.

5.39 pm

Mr. Andrew George (St. Ives): I congratulate the Select Committee on a first-class report and my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) on his introduction to a constructive debate that has highlighted the fact that there is a degree of consensus across the Chamber. If Parliament is responsible for scrutinising the Government, we all have a responsibility to point out that the public out there--our constituents--are receiving a service that is clearly failing in a number of significant areas. We must put that right. That is why we are all present in the Chamber, and we should follow up the debate and ensure that the service is improved.

I hope that the Select Committee will continue to press the Government. I agree with my hon. Friend the Member for Roxburgh and Berwickshire that the Government's response was helpful, but it contained a number of commitments for which there were neither targets nor timetables. I hope that the Select Committee will make sure that those commitments are met. One of the failings that has been highlighted in the debate is the uncertainty surrounding issues such as complaints, audit, pay and training. We need a firmer basis on which to assess the progress that the Government are making.

I shall not repeat unnecessarily points that have already been raised, but I shall try to set the debate in a wider context--the need to ensure that disabled and sick people who want to get back into the job market are enabled to do so. The system should be designed not to stop disabled and sick people receiving benefits, but to focus on their abilities and to smooth their path from sickness and disability into gainful employment. That seems to be what the Government are proposing through personal capability assessments. At present the path is not clear and smooth; for many, it is a precipice, and the process becomes understandably stressful.

I was one of the new intake of Members of Parliament, although we are not new any more. We all recognise that we do not have people queueing up at our casework surgeries to congratulate the Government on not taking their benefit away. They come to our constituency surgeries to complain when that happens.

In comparison with the Child Support Agency, the medical services are not doing too badly--[Interruption.]--but as hon. Members say from a sedentary position, that is to damn with faint praise. The CSA is a rather poor benchmark against which to judge the performance of the medical services. Many hon. Members find that after the CSA, one of the most prevalent issues with which they have to deal involves the former all-work test, the problems with the medical services and the difficulties that people experience in comprehending how the system is supposed to work, even when their disability is clearly demonstrated by their evidence to their Member of Parliament.

The number of appeals that we know about, and the proportion of cases in which appeals are upheld and benefits restored, show that the system is not working.

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It is not working in a number of ways. If the Government intend to reduce to 10 per cent. the failure rate of the medical services to meet professional standards, they are setting the rate too high. Poor quality reports result in poor decisions. Although arrears will ultimately be reimbursed to those whose benefits are wrongly withdrawn, the process still results in trauma and poverty.

In addition, to mount an appeal a claimant must obtain additional medical evidence, which may be costly. For example, Carol Simons, a Leicester resident who successfully challenged a decision to refuse her claim to incapacity benefit, had to pay £40 for additional medical evidence to support her appeal. A Leicester city council report reveals that charging for medical reports is widespread, with charges ranging from £11.50 to £60, with some doctors charging more than £100 an hour. Not only does withdrawal of benefit mean trauma and poverty, but an appeal to have it reinstated costs money. The disabled person is clearly not at fault, but he must still pay, and no one will reimburse him. Clearly, the system is failing there.

From the disabled person's point of view, the system is self-policing. As has been pointed out, its approach to mental health is inadequate. The hon. Member for Hendon (Mr. Dismore) articulately described cases showing that ethnic minorities and others with language problems have also had to face prejudice and difficulties from the service.

The British Medical Association has requested a meeting with the Minister and medical services, but has yet to receive a reply. As has been pointed out, the fact that doctors have not had a pay increase for eight years is clearly a matter of deep concern. The fact that the Government intend to apply valid measures of professional services, but have not worked with the BMA in devising them, is also a matter of concern. Free training for doctors has been dealt with inadequately, as a number of hon. Members have said.

In September 1998, in a letter to my hon. Friend the Member for Bath (Mr. Foster), the Under-Secretary, the hon. Member for Wallasey (Angela Eagle) said:

The BMA informs me that it still awaits a new fee structure. Apparently, medical services offered a pay increase of 3 per cent. in February 1999, which the BMA rejected. We need to be clear about the status of those negotiations and what the Government intend to do to move them on. Clearly, doctors are unhappy about their pay, and one can understand why.

In delving into the subject, I was concerned about whether the system could adequately pick up some of the less common illnesses suffered by those on incapacity or other benefits, and I looked up Guillain-Barre syndrome. I also looked up ankylosing spondylitis in the disability handbook published by the Department of Social Security. Its purpose is as follows:

Ankylosing spondylitis is a condition that I have. I am sure that my intellectual handicaps are obvious to all, but my physical ones may not be apparent. I have only a mild form of ankylosing spondylitis and I did not recognise the

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extent to which some people are crippled by it. It affects their legs and hips and they are unable to walk. That is not identified in the handbook.

I contacted Professor Richard Hughes, who is head of the division of clinical neurosciences, about the Guillain-Barre syndrome. I asked him to read the guidance that is provided in the disability handbook with regard to it. In his response, he stated:

He offered an alternative text book for consideration. As I have said, Professor Hughes is the head of the division of clinical neurosciences of Guy's, King's and St. Thomas' school of medicine. It is clear from the two texts that the handbook attempts to diminish the potential impacts of Guillain-Barre and the way that it affects the patient. If that is the case with Guillain-Barre, to what extent is the rest of the handbook adequate in providing an accurate assessment for adjudication authorities when considering the evidence that is presented to them?

I suspect that the Minister may comment on the fact that the Government are introducing personal capability assessments in one pilot area. To what extent has the Minister learned from these assessments and when will they be trialled or moved into other areas? Is there evidence that is helpful to the debate?

We take the same view as the Government. We talked about personal capacity tests, while the Government call them personal capability assessments. However, we are considering the capability of a client rather than his or her incapacity. While we may argue about something being half full or half empty, we wish the Government to take a different approach. If we are to encourage and enable people who are disabled or sick to have work trials and to move back into the employment market, we need to support that with a social security system that allows them a smooth passage back into the world of work.

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