Select Committee on Work and Pensions Minutes of Evidence


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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