APPENDIX 3
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.
Training
This is satisfactory. The Select Committee's
recommendations are being fully implemented.
Payments
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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