Select Committee on Work and Pensions Minutes of Evidence


Letter to Committee Specialist from Dr Bernard V Lee (MS 05)

  Dear Mrs Allbeson,

  The Benefits Agency Sessional Doctors Association (BASDA) was wound up due to lack of support from the sessional doctors shortly after the Social Security Select Committee made enquiries in early 2000.

  I am quite happy to give further evidence in an individual capacity.


  This is satisfactory. The Select Committee's recommendations are being fully implemented.


  The payment of fees and allowances is now satisfactory.

Pressure of work on sessions

  Many doctors are now being paid on the basis of the number of cases seen, others are still paid on an hourly basis. Enquiries should be made as to whether the doctors are being pressurised into seeing more clients per session than they can deal with effectively.

  Whilst all sessional doctors have now had a special training session on the completion of the mental health questionnaires, there is no evidence of specialist resources available for claimants with particularly complex problems.

  There are no special arrangements being made for clients to be made aware of the availability of female medical examiners.

Appeal Tribunals

  Sessional doctors still do not receive any information on the outcome of appeals.

  There has been no information about the training of Appeal Tribunals in the methods of determining applications for Incapacity Benefit or Disability Living Allowance.

  The medical advisers to the tribunals do not examine the clients. The sessional doctors are not required to give evidence at tribunal hearings.

  The tribunal request for additional medical reports includes a letter, addressed to the claimant stating that the medical report is needed "to support the claimant's appeal", whereas the examining doctor thinks that he should produce an independent report.

  The clients are thus lead to believe that the doctor is trying to help their appeal to succeed and may be lead to treat the examination in a casual manner.

  When tribunals adjourn the hearing for a further medical report, the examining doctors are not briefed on the reasons for the adjournment. The proforma letter refers to the points raised and the points raised are rarely described.

  There is no timetable for the regular review of doctors' pay.

  The letter to the claimants awaiting medical examinations at their home does not mention the necessity for the doctor to make a medical examination. This letter makes no reference to the need for a chaperone to be provided by the claimant.

  The doctors carrying out domiciliary visits do not receive a fee if the claimant is not available at the time arranged. Doctors have to pay the postage for the letter advising the claimant of proposed home visits.

  In claims to the Disability Allowance and Attendance Allowance, the claimant's application for the benefit is not shown to the examining doctor. The claimants naturally expect the examining doctor to be aware of the contents of the claim form which they have completed. The examining doctor is not allowed to defer completing the report until he has seen a report from the hospital or from the family doctor. He is not allowed to see copies of earlier medical examinations.

  There is too long an interval between the claimant completing form IB 50 (the questionnaire in Incapacity Benefit claims). By the time that the claimant is seen, he has forgotten about the questionnaire and the answers to the questions are no longer relevant, yet the doctor still has to complete the report stating whether he agrees or disagrees with the claimant's out of date self-assessment.

  At present, I am seeing claimants who have been receiving benefit for, on average, 12 months.

  The examining doctor receives no fee for the completion of reports following complaints. The doctor has to make his report on complaints without having access to the complete file.

  There has been no assessment of the effectiveness of Medical Services' ability to control the claim to benefit since the National Audit Office's report on 5 March 2001.

  The decision makers often delay sending files for rework or explanation for three or four weeks when the memory of the examination has faded. The rework requests are sent by fax without the full contents of the file being available for the examining doctor and frequently without a copy of the whole IB 85 form.

  An inquiry is needed into whether the introduction of self-assessment by the incapacitated and disabled has been helpful.

  Many cases are now being seen where the previous medical examination showed little or no disability but Incapacity Benefit has been allowed. Could the decision makers be prevented from allowing benefit when the claimant is awarded fewer than five points? Should the threshold for making the award of incapacity benefit be raised to 20 points?

Dr Bernard V Lee

22 March 2002

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