Examination of Witnesses (Questions 100-119)
Wednesday 10 December 2003
Mr David Anderson, Professor Mansel Aylward CB, Mr
John Sumner, and Mr Simon Chipperfield, examined.
Q100 Mr Williams: It is a challenge
which could have a financial solution. Let us see whether what
you might save would justify that financial solution. Back to
you Professor. I know it is a subjective assessment and it is
unfair perhaps to ask this question, but I cannot think of any
other way of getting to what I want. What proportion of the decisions
would you say are wrong coming from the appeals?
Professor Aylward: I have not
said that. I have not used the word "wrong". What I
have said is that of a random sample of cases which were said
to demonstrate underestimation of disability by the first tier
doctor, of those I felt around half did not demonstrate an underestimation
of disability. I disagreed with the doctor's opinion on the Appeals
Service.
Q101 Mr Williams: That is an important
difference, is it not? We are talking of cases where, 57% in some
instances, one in two of the appeals are successful. Therefore
on that basis, if half of those are wrong, there must be massive
sums of money going in the wrong direction.
Professor Aylward: No. If you
look at both Attendance Allowance and Incapacity Benefit, about
one third are said to underestimate the disability.
Q102 Mr Williams: Half of those.
Professor Aylward: Half of those
in my random sample. I did not look at all of them.
Q103 Mr Williams: That still means
one sixth and that is still a lot of people and a lot of money,
is it not? You must know what these appeals are costing you in
terms of extra payout. It would be interesting, if there were
some way of doing this, if you could give us some sort of statistical
analysis, based on the third being wrong, of what it might be
costing you because the appeals tribunals inappropriately overturn
the decision of the recommendation at the first stage. Then, if
you can tell us how much in ballpark figures that might cost,
or if NAO can help you do that—I do not care where it comes
from—we can work out what sort of pot of money you may have
in hand where you could make sure you get a higher trained quality
of person at the appeal end and still possibly save money.
Mr Anderson: I certainly think
we could look at that. I should be cautious at taking the figure
of one half of one third, that is one sixth, and saying that is
potentially the cases at risk. Professor Aylward looked at a small
random sample and that may produce a misleading result. That does
not alter the general sense of the argument which says that this
difference is significant and warrants investigation. We should
try to get an accurate quantification of what is going wrong.
Q104 Mr Williams: I would ask you
and NAO to see what you can get.[4]
I know that it is a matter of which information is collected and
how it is analysed, but if the two of you could look at this to
see. I think you would agree that if we can resolve something
from this, there could be quite a substantial saving of money
without depriving people who are genuinely in need. May I switch
completely to paragraph 3.17? The point is made about decision-makers
and people wanting to appeal and why things go wrong when they
submit their claims. In the final sentence there it makes the
point " . . . general practitioners may not be able to supply
all the information required. Many people with disabilities or
severe medical problems may be treated by one or more specialists
and may rarely see their general practitioner, yet claim forms
did not prompt claimants to provide consultants' reports".
Surely that is extremely important. Back now to the Professor's
point about quality. It is now not just a doctor who has a general
field of work but now the consultant's opinion. I would have thought
that would have been extremely relevant. Why is that not given
top priority in the evidence you seek from people making applications?
It would seem obvious to the layman that this should be so.
Mr Anderson: We are improving
the process to make sure that the decision-makers have access
to all reports and the forms are being changed.
Q105 Mr Williams: As we speak, the
form is being changed. Will it emphasise the role of consultants?
Can you assure us of that, or will it from now anyhow?
Professor Aylward: When there
is a question of diagnosis, then it is important that we seek
the advice of someone who is a specialist in making this diagnosis.
In that case we do seek the views and opinion of consultants.
However, most of the disability benefits are not related to the
exact diagnosis of a disorder somebody suffers from, but the effects
of that. In that regard we look towards the new speciality of
disability assessment medicine. There the consultant and the general
practitioners admitted themselves that they are not the experts
in assessing the effects of disabilities. Where we need the expertise
of a consultant we would seek it and we would probably seek that
more with the new forms. When we need to look at the effects,
it is far better to get that information to people who are qualified
in disability assessment medicine.
Q106 Mr Bacon: Mr Anderson, in Mr
Williams' request for more information on the chart on page 23,
Figure 12, could you include, in addition to anything you are
going to do for Mr Williams, just a little table which has for
each month the actual number of sub-standard medical reports?
That will only be about 44 rows long and two or three columns
wide, I hope. It would just be interesting to know the gross figures
for each month.
Mr Anderson: Yes.[5]
Q107 Mr Bacon: Mr Chipperfield, how
much do you pay a doctor to do an assessment?
Mr Chipperfield: It depends on
the assessment.
Q108 Mr Bacon: Incapacity Benefit.
Mr Chipperfield: It depends whether
they are a permanent employed doctor, or whether they are doctors
we pay per case.
Q109 Mr Bacon: For example. Can you
give me an example?
Mr Chipperfield: I do not know.
Q110 Mr Bacon: A permanently employed
doctor to do Incapacity Benefit.
Mr Chipperfield: It depends; it
varies. The range would be around £50k to £70k per annum.
Q111 Mr Bacon: If they are not a
permanently employed doctor, then how much would you pay them,
if they are coming in just to do that?
Mr Chipperfield: I do not know
the figure off the top of my head.
Q112 Mr Bacon: If you could send
a note that would be great.[6]
How much do you get from the Department for each assessment?
Mr Chipperfield: I am not so sure
that I am at liberty to disclose that information as I believe
it is confidential.
Q113 Mr Bacon: You get £80 million
altogether.
Mr Chipperfield: Yes.
Mr Bacon: I want to know how much assessments
cost.
Q114 Chairman: I think you could
answer that. Why should you not answer that?
Mr Chipperfield: I do not know
whether I am able to answer that or not.
Q115 Chairman: Are you saying you
will not answer or you do not want to or you cannot?
Mr Chipperfield: I am not sure—
Q116 Mr Bacon: It is taxpayers' money.
We look at how taxpayers' money is spent.
Mr Chipperfield: I am not sure
whether I can answer it. I do not actually have the figures.
Q117 Chairman: Give us a note then.
Mr Chipperfield: I am happy to
do that.[7]
Q118 Mr Bacon: Do you think you lose
money on assessing Disability Living Allowance?
Mr Chipperfield: I am not in a
position to comment on the commercial aspects of the contract.
Q119 Mr Bacon: We have witnesses
from private sector companies constantly and they often comment
on the commercial aspects of contracts. We are a financial committee.
Do you think you lost money on assessing Disability Living Allowance?
Mr Chipperfield: I do not know
whether I can answer that question.
4 Ev 16-17. Back
5
Ev 15-16. Back
6
Commercial in confidence-not printed. Back
7
Commercial in confidence-not printed. Back
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