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Mr. Eric Pickles (Brentwood and Ongar): The hon. Gentleman's points about personal capacity are interesting. Will he confirm that the medical test for the personal capacity assessment is identical to the one for the all-work test?

Mr. George: The hon. Gentleman has asked me a question that I am about to ask the Minister. As far as I am aware--

Mr. Bayley: The test for incapacity is exactly the same.

Mr. George: I am grateful for that clarification. Perhaps the Minister will comment on the relevance of personal capacity assessments and the effect on our debate in his winding-up speech.

The report provides a picture of a service that is driven by profit, and not necessarily by quality. From the report, medical services appear to provide the minimum that they can get away with and to maximise their use of the scrutiny rather than the examination method. Many doctors are poorly paid; many of our constituents have been treated brusquely and impatiently, and some have, sadly, suffered rudeness, insensitivity and racism. The system operates without a proper, independent complaints procedure or independent audit.

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As I said earlier, the Government should reconsider their response to the Select Committee report and provide clearer targets and timetables to deal with the important issues that have been raised.

5.56 pm

Valerie Davey (Bristol, West): I welcome the debate, and I know that constituents who have visited my surgery because they have suffered traumatic experiences as claimants also welcome it. I stress at the outset that my hon. Friend the Minister has always responded with understanding to the individual cases that I brought to his attention. He has looked into them, and I respect his concern for the subject that we are considering.

If only a handful of cases existed, perhaps they could be tackled individually. However, through talking to other hon. Members, especially in the Bristol area, I have begun to perceive a pattern of anxiety. I therefore welcome the Select Committee's report, especially as its members visited Bristol and were able to take direct evidence. I welcome the reference by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) to that experience.

Wide experience has been gained by the Avon and Bristol law centre, to which many people have brought their cases. I want to draw on that experience in presenting four main points. The importance of communication is paramount. When the hon. Member for Roxburgh and Berwickshire mentioned his Bristol experience, he talked about the way in which dedicated professionals and people bringing complaints showed completely different sides of one coin. That is worrying, and I am glad that the hon. Gentleman brought it to light. As has also been said, if English is not a person's first language, the disparity and the scope for misunderstanding is even greater.

The first point that the Avon and Bristol law centre emphasised to me was the importance of the Select Committee's recommendation that all claimants should be clearly told in initial correspondence with medical services that they have the right to request the presence of an interpreter. Like some hon. Members, the Avon and Bristol law centre was dismayed by the Government's response. It would like interpretation services to be expanded throughout the Benefits Agency rather than pulled back. It asks the Department to investigate further the cost and benefit of a policy that would mean greater use of interpreters. From my experience of constituents who have come to my surgery, I fully endorse the law centre's first point.

Secondly, the Avon and Bristol law centre would welcome greater recognition by the Government that there are a small proportion of appalling reports and a larger proportion of substandard reports. It requests that other organisations--advice agencies and the BMA--monitor the reports.

The Avon and Bristol law centre's third point is about racism. Based on its experience, it believes that the Government have been too dismissive of the Committee's findings. It supports greater participation by the Commission for Racial Equality in training doctors. It was felt that the Government should make a real commitment to the investigation, and to rooting out racism.

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The fourth issue was that of complaints, to which many others have referred. The Avon and Bristol law centre feels that the whole procedure needs to be overhauled. It says that


would be welcome.

The Bristol centre commented specifically that there had not been a single admission of fault, and that there had been no apology. Given the complexity of the organisation and the number of people involved, the failure to admit to a single mistake is inhuman. It is a reflection on the system that no one was prepared to make an apology, or to admit to a mistake.

Nevertheless, I want to end on a positive note. I welcome the report and, indeed, the Government's response, which is positive on the whole and which--in the hands of the Minister--will, I trust, be explored and developed fully. Similarly, the Avon and Bristol law centre welcomed the commitment to a diploma course, which was seen as an important step. It also made special reference to the training that is now being recommended for those who must deal with people suffering from mental health problems. It said that mentally ill patients had specific requirements in terms of those dealing with them. I am sure that the provision of more training would be welcomed by all concerned.

This is an important debate for many of the most vulnerable people in my constituency and those of my hon. Friends. I trust that the Select Committee's admirable report, which has done a remarkable job in a difficult sphere, will be taken on board by the Minister, the Department and the Government, and that the points made by the Avon and Bristol law centre will be considered.

6.2 pm

Ms Linda Perham (Ilford, North): I, too, congratulate the Committee on its report, and welcome the Government's response. I also thank the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) for letting me know--as a person who signed the early-day motion--the timing of the debate. As I am sure many hon. Members know, on Thursday afternoons, the calls of the constituency are sometimes greater than those of the Chamber.

The great majority of cases concerning problems with disability living allowance or incapacity benefit that come to me concern assessment by Sema, on behalf of Benefits Agency medical services. People who have been unable to walk a few steps from their doors to my surgery have been assessed as "fit for work". In those cases, there have clearly been shortcomings in the conduct of medical examinations, especially with regard to the time that they have taken. Others have mentioned that.

In some cases, a doctor has been present for only 10 or 20 minutes, and a report has subsequently stated that the person concerned was able to engage in an activity for much longer. On at least one occasion that I remember, an assessment included comments on a person's appearance. For instance, someone was described as an "obese lady". That person was very upset when she saw the report.

A woman who lives near me in north Ilford has been unable to work for nearly 20 years because of her spinal problems. Over the years, when examined by doctors at

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our local practice, at local hospitals and by those whom she describes as "Government doctors", she has been told many times that her condition can only worsen. According to a letter that I have from her, the examining doctor said that she could not sit comfortably for more than two hours. She says that she cannot sit comfortably for more than 10 minutes. No points! The doctor said that she had no problem with rising after sitting down; she says that she cannot get up without holding on to something--"usually my husband". Again, no points. The doctor says that she cannot walk more than 800 m without stopping or severe discomfort. She says that she cannot walk more than 200 m without stopping or severe discomfort--again, no points on that assessment.

Looking through the report's recommendations and the Government reply, I can say on behalf of my constituents that a good number of their concerns have been addressed. They include the time spent with claimants, which my hon. Friend the Member for Clwyd, West (Mr. Thomas) covered in some detail; the quality of reports; the recruitment, training and monitoring of doctors, which is important, and how poor performance is dealt with; and communication difficulties and providing interpretation services, which my hon. Friends the Members for Bristol, West (Valerie Davey) and for Hendon (Mr. Dismore) highlighted. He also touched on the availability of female doctors to examine women, especially those whose religious or cultural background precludes contact with males outside the family circle.

The complaints procedure was another concern. From looking at the report, Sema is conducting a review, but it is disturbing that so many claimants are appealing, rather than complaining. That is dealt with in the Government's response.

All in all, it is a thorough and much needed report. I look forward to improvements in service for a lot of anxious and deserving people, who are already facing lives full of frustration and pain.


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