Examination of Witnesses (Questions 20-39)
MR MARK
FISHER, DR
MANSEL AYLWARD,
MR PAUL
KEEN, MR
JOHN SUMNER,
MR SIMON
CHIPPERFIELD AND
DR CAROL
HUDSON
WEDNESDAY 17 APRIL 2002
20. But you will send us the figures?
(Mr Keen) Yes, and it has been in place. It is not
something we put in as part of the extension.
21. Good. Can I come back then to the question
of whether the 50 per cent ratio is the right one and the way
that you are checking that the scrutiny guidelines are complied
with. Are the scrutiny guidelines public?
(Dr Aylward) Yes.
22. Can we have them?[7]
(Dr Aylward) Yes.
23. Can I then ask you why you come to the conclusion
that 50 per cent is the right ratio?
(Dr Aylward) By a series of audits and studies which
look at the characteristics of the people that are sent for examination
and then looking at the final outcome in regard to whether or
not those people are disallowed benefit or not.
24. Do you also check about the allowance for
benefit, rather than the disallowance? If somebody is disallowed
at scrutiny and they think that is unfair then they will appeal,
and there is no problem about that, but the next question is,
of those who appeal against refusal on scrutiny, what percentage
succeed on their appeal? We were concerned last time about the
very high ratio of appeals, and we had evidence from the Appeals
Service who were very angry because it increased their workload.
So put that question in the bank for a minute and let me come
back to the basic incentive point: if somebody is given benefit
to which they should not be entitled they are not going to appeal
that. So do you scrutinise the number of people awarded benefit
to check whether that award was correct? Do you do that, and in
what way?
(Dr Aylward) Can I first correct a misunderstanding
and that is, no one is disallowed benefit without an examination
so the scrutiny process does not determine whether somebody is
disallowed or not; that only appears after the examination has
taken place. What you are asking is whether or not we make checks
on people who have been allowed benefit. The fact that we collect
medical evidence and other information to determine whether or
not the decision to allow them to continue on benefit is the correct
one in itself is a safeguard, and we are collecting more and more
information and more focused information in order to permit us
to do that.
25. What sort of information are you collecting
apart from the medical report from Schlumberger's doctors?
(Dr Aylward) Information is sought from the most appropriate
medical provider, depending upon the medical condition that the
patient has.
26. Well, who? One of the arguments we had before
was the failure of the medical services to look at the medical
records from the GPs and the hospitals. Are you now doing that?
(Dr Aylward) Yes. We are obtaining information from
general practitioners and in the case particularly of people with
mental health problems we are obtaining information from community
psychiatric nurses and from psychiatrists. One of the major projects
that is being taken forward is looking at the very issue you have
raised which concerns getting hold of the GP factual records itself,
because that provides full information on the patient and it does
help the GP free up his time in not having to provide us with
reports, so we are doing a project called the evidence gathering
project, looking at how valuable these reports will be to enable
us to focus better on deciding which claimant should be examined.
27. Obviously that was something we saw last
time and I do not want to go over that ground because I pushed
you very hard on that last time, as I recall. I am surprised it
has taken so long to come to a conclusion in relation to that
project because I understand it will be several years before you
get to the end of the line. Coming back, how do you check that
the proportion is correct? What I want to know for example is
this: is any check done on those awarded benefit through the scrutiny
process, and what is the double check, the quality control, in
relation to those? Are some of them called up for examination
to check whether, in fact, some of the report is accurate as found
by the Medical Service doctor?
(Dr Aylward) Just to clarify matters, what you are
asking is, of those which under scrutiny are not examined, are
any checks made to determine whether or not they should be examined,
if they should remain on benefit?
28. Let me make sure I have this right. At the
moment about half the people submitted for a medical report are
subject to paper scrutiny only in the first instance—
(Dr Aylward) No.
29. Let me finish the point. Of that 50 per
cent, a certain proportion, if they are going to be disallowed
benefit, will then be referred to an examination proper. Of the
remaining half, three quarters, they will be passed through to
the benefit without further ado being proved on papers. Is that
correct?
(Dr Aylward) Of every 100 people referred, 15 will
qualify because of medical evidence to be exempt from the examination
process. They are people with severe illnesses. Of those remaining,
50 per cent will go for examination. The 50 per cent that do not
go for examination do not do so because the evidence we have on
file provided by the GP or their hospital doctor is sufficient
to support the statements that they have made on their limitations
and disabilities. That in itself is a very good check.
30. Is that the paper scrutiny stage?
(Dr Aylward) Yes.
31. Done by a doctor?
(Dr Aylward) Yes.
32. And of that 50 per cent which is effectively
passported through on the papers, how many are disallowed?
(Dr Aylward) None, because the only people that are
disallowed benefit ultimately are those that go to examination.
33. Of that 50 per cent who, on the face of
it, are going to get passed through on the paper, how many are
then referred for examination?
(Dr Aylward) Depending upon the clinical condition
and the treatment they are receiving -
34. In rough percentage terms.
(Dr Aylward) All of them will subsequently be reviewed.
Whether or not they will be re-examined depends upon the further
evidence that is collected later.
35. I think we are at cross purposes again.
Half of them are theoretically going to be passported through.
(Dr Aylward) Correct.
36. All those are still subject to a doctor
scrutinising the papers?
(Dr Aylward) Right.
37. Of those scrutinised by the doctors, the
doctors will say on some, "Oh this one does not look quite
right to me, we had better have him examined". What percentage
are in that category?
(Dr Aylward) About half.
38. That is what I thought. So of the overall
one hundred per cent pool of people, about a quarter get their
benefit automatically.
(Dr Aylward) Yes.
39. Of that 25 per cent, roughly, how do you
check that they are not being improperly passported through to
benefit? Is there, for example, a quality control whereby even
though everybody says you should have benefit they nevertheless
ask for an examination or somebody goes out to see them, just
a check that the paper transaction is accurate and, indeed, that
no fraud has been committed?
(Dr Aylward) I cannot comment upon any fraud aspects
but I can say on the quality of the evidence that we do obtain
on those people who go on to continue on benefits for several
years, we regularly obtain evidence from their doctors to determine
whether or not their condition is persisting and does produce
the limiting functions that we—
7 The Department for Work and Pensions has provided
the Committee with a copy of the scrutiny guidelines but it has
not been published with this evidence owing to its length. Back
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