Examination of Witnesses (Questions 20-39)
Wednesday 10 December 2003
Mr David Anderson, Professor Mansel Aylward CB, Mr
John Sumner, and Mr Simon Chipperfield, examined.
Q20 Mr Steinberg: Am I getting mixed
up?
Mr Chipperfield: The statistic
misrepresents the actuality.
Q21 Mr Steinberg: Statistics do not
misrepresent anything. All we can go by in any report we receive
is the information the National Audit Office gives us and I found
paragraph 3.3 very worrying, that so many cases are actually refused
on the basis of bad medical diagnosis. That seems to substantiate
what I have been saying right from the start.
Professor Aylward: If you look
at the figures, what we are seeing is that in around one third
of the cases the report was found to be flawed because it seemed
to have underestimated the disability. That is correct. In about
one half of those cases, they came from Schlumberger. I have actually
looked at those cases myself. I have done a random sample and
I do not agree with that finding.
Q22 Mr Steinberg: Wait a minute.
You do not agree with this finding here.
Professor Aylward: I do not.
Q23 Mr Steinberg: This Report has
been signed off as accurate by your Accounting Officer with the
National Audit Office. It is no good coming here and saying you
do not agree with the Report, when the natural presumption is
that this Report is absolutely accurate and agreed by you.
Professor Aylward: I am not disagreeing
with the Report which the National Audit Office has produced.
I am commenting upon the figures which have been produced by the
Appeals Service. It is my job as Chief Medical Advisor to the
Department to look at the cases where there is said to be an underestimation
of disability. In my professional opinion, using my judgment,
and a scientific method, I looked at those in a random way and
I found that in half the cases I did not consider the disability
was underestimated. May I add one more thing? If you look at the
doctors who are making these decisions sitting in the Appeals
Service compared with a doctors who are working for Schlumberger
Medical Services we should perhaps think that one of the reasons
there may be a difference here is that doctors in the Appeals
Service do not receive the significant training that Medical Services'
doctors do, they do not get monitored to the same extent and they
are not participating in revalidation to the same extent. That
may be a reason why there is a difference in opinion between the
two sets of doctors.
Q24 Mr Steinberg: Did you say this
to the National Audit Office at the time of the Report?
Professor Aylward: Yes.
Mr Steinberg: It is not reported anywhere.
Q25 Chairman: Could the National
Audit Office comment on that? This is a very interesting exchange.
Mr Lonsdale: The point which is
being made is that the difference of opinion is between the decision
which is made by the appeals tribunal, who have commented in 138
and 96 cases, where they think the medical report underestimated
the severity of the disability, and Professor Aylward, who is
saying is that when he, in his capacity, then looked at that decision
made by that tribunal, his judgment was that he did not agree
with the appeals tribunal. That is a medical judgment. What we
have reported here are the findings of the President of the Appeals
Tribunals. This is his view. 51% of cases are from Medical Services
and others are from general practitioners, consultants, a combination
of sources. It is a difference of opinion, a judgment on the medical
evidence which was presented.
Mr Burr: Everybody agrees that
this is what the President of the appeal tribunals thinks. Not
everybody agrees with the President of the appeals tribunals.
Q26 Mr Steinberg: I had a plan of
what I wanted to ask and now I have been waylaid. Coming on from
that, does it not worry you—it certainly worries me—that
the Incapacity Benefit is suddenly withdrawn, which could have
been a person's income for years and years and years, suddenly
it is lost because of some sort of sloppy short medical examination
by one of your doctors; they lose their income and end up living
on about £40 a week because one of your doctors has made
an appalling decision? Does that not worry you, because it would
worry me?
Mr Chipperfield: Yes, that would
worry me. All the efforts we take are to avoid that happening.
That is why we are very careful about the doctors we select or
recruit, very careful about the training we give to them and the
ongoing monitoring and auditing, coaching and mentoring which
we provide. That is also why we take action when we find doctors
who are not meeting the quality standards. In the last three years,
for example, about 420 doctors have been revoked and a goodly
proportion of them, at least 25% of them, have been on our own
specific action because we did not find them meeting the quality
standards. Yes, it would concern me. What I am saying is that
we take every action we possibly can and we are not complacent.
We are constantly trying to improve to ensure that does not happen.
Q27 Mr Steinberg: Bearing in mind
the argument I have put forward, would it not be a better system,
if somebody is taken off Incapacity Benefit, for them to continue
to receive it until the appeal has been heard? Would that not
be a fairer system?
Mr Anderson: I am not entirely
sure in the way regulations are written that would be possible.
I cannot answer that question. It may be a fairer system in those
cases where appeals are successful; clearly it would not be fair
to the taxpayer in those cases where appeals are not successful.
Q28 Mr Steinberg: People can see
their incomes reduced to something like £43 per week, can
they not? Suddenly after years of receiving Incapacity Benefit,
bang, they are down to £43 a week. I could not live on £43
per week; I bet a pound to a penny you could not live on £43
per week, yet that is what they have to live on. Do you think
this should be looked into?
Mr Anderson: I believe that the
system at the moment, where benefits are stopped when a decision-maker
makes the decision, is a fair way of going through this process.
We have to get those decisions as good as we possibly can, but
the system has to be fair both to the people who are legitimate
claimers and fair to the taxpayer who does not want to fund people
who are not legitimate claimants. The decision-maker has to employ
the rules as they are written.
Q29 Jon Cruddas: May I refer you
to paragraph 3.8 onwards, "The standard of medical reports
has improved since 2001"? Could you explain to us the nature
of the C grade indicating that a report is below Medical Services'
professional standards? How many is that now?
Mr Anderson: It is under 5%.
Q30 Jon Cruddas: Under 5% and that
has been quite a dramatic reduction since April-June 2000. What
accounts for that reduction in your mind? Tougher vigilance and
scrutiny of the work here and more effective sampling? Has there
been a change in behaviour in terms of medical examinations themselves?
Mr Anderson: I believe that the
improvement is in part a result of a new target which was agreed
with Schlumberger and implemented and the effect of some of the
actions which Mr Chipperfield has been describing in terms of
driving up the quality of the reports. The target is 5%; we have
to get under and it is currently at 4%.
Q31 Jon Cruddas: It has now gone
to under 4% since February 2003. I want a bit of clarity about
Figure 11 here on page 22 "Factors contributing to the success
of appeals against incapacity and disability benefit decisions".
The figures are very high: 42%—"The tribunal formed
a different view of the same evidence"; 27%—"The
medical report underestimated the severity of the disability";
24%—"The tribunal formed a different view based on
the same medical evidence". Do you at all detect a slight
difficulty for you between the number who establish a C grade
and the scale of the successful appeals? Does that indicate that
there is a possibility that the C grade indication is slightly
too low in terms of the effectiveness of the medical examinations
themselves?
Mr Anderson: That goes back to
the discussion we were having before about the difference of view
that doctors can take on what is a relatively subjective assessment
in this area. I do not think it indicates that the reports themselves
were wrong if a tribunal took a different view of the medical
evidence.
Mr Chipperfield: The populations
are different. The 3% or 4% C grade is based on auditing of the
entire population which goes through the Personal Capability Assessment
process or the Disability Living Allowance assessment process.
These are proportions of people who have made an appeal.
Q32 Jon Cruddas: There are still
50% of appeals in the system.
Mr Chipperfield: Not of all cases,
no.
Q33 Jon Cruddas: May I ask for clarity
there? "The Committee felt that the high proportion of cases
where appeals were successful (over 50% appeal . . . "
Mr Chipperfield: Of those who
have a decision against them.
Q34 Jon Cruddas: In terms of the
box on page 21, "(over 50% appeal . . .)".
Mr Anderson: Where there is a
decision against them.
Q35 Jon Cruddas: Okay; sorry. On
the question of the 22 occasions in the last year where you stopped
doctors carrying out examinations, is that higher or lower than
preceding years?
Mr Anderson: I do not have that
number.
Professor Aylward: The revocations
are carried out by me on behalf of the Secretary of State on the
basis of information I receive from Medical Services. Since the
year 2000, I have revoked 80 doctors' approval because of unacceptable
quality standards, of which 22 were in the year to which the recent
NAO Report refers and there have been 52 occasions during the
past year when doctors had their approval revoked because of unacceptable
quality standards. The remainder of doctors have revocation because
of retirement and resignations.
Q36 Jon Cruddas: That does not cover
those who are registering C grades. Is that the lower C grades?
Professor Aylward: No, it may
well be that the majority of these people have obtained C grades.
That is an indication of poor performance. If one or two C grades
are obtained within a period of a few months then these doctors
are focused upon for specific monitoring. If they do not respond
to remedial training, because we think it fair for that to take
place, then a recommendation comes to me to consider whether or
not I should revoke. I take that very seriously, because it may
affect a doctor's career, it may affect remuneration.
Q37 Jon Cruddas: What I was trying
to find out was, given the sheer scale of medical examinations
and reports which were issued and still we have about 4% or 5%
at C grade, but over the last year only 22 individual cases of
them stopping to take examinations, so presumably there are many
doctors out there who have registered C grades and are still carrying
out examinations.
Professor Aylward: No, I would
not say that was so. Every doctor who registers a C grade is monitored
and if their performance cannot be improved, then they are revoked.
We are talking about a significant number among the 80 doctors
I have mentioned to you during the last three years, 52 in the
last 11 months.
Q38 Jim Sheridan: May I follow up
the theme Mr Steinberg raised about the difference of opinion
between doctors? I am just concerned that the doctors who make
these medical assessments have the appropriate time to read all
the reports closely. Sometimes that can be difficult and quite
time consuming. One of my own constituents has been on Incapacity
Benefit for a number of years and he was told when he went to
be assessed that he was being taken off Incapacity Benefit. This
man had advanced mesothelioma which is incurable and can only
deteriorate. Not only did they take him off Incapacity Benefit
and withdraw the money, they gave him false hope that he was going
to be cured. He really was in a rather pathetic position, having
no money and being told he was going to be cured, yet his GP had
told him consistently that there was no cure. Why does that happen?
Professor Aylward: Obviously I
do not know the details of the case you are speaking of, but if
those are exactly right and the person was suffering from a mesothelioma,
which is a highly malignant disease which can rarely be effectively
treated and results in a terminal illness, I cannot imagine why
that would have taken place. Both within Disability Living Allowance,
Attendance Allowance and Incapacity Benefit, there are special
rules which take account of people suffering from a condition
like that and he would not have to be exposed to an examination.
Q39 Jim Sheridan: His money was just
stopped at a stroke.
Mr Anderson: I cannot explain
that. That sounds in that particular case as though—
| 
