| Gerry Steinberg MP | Public Accounts [29 Jun 2004] |
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Mr. Gerry Steinberg (City of Durham): Although it does not relate to the reports in the list, one big failure from many months ago that has still not been put right - it is about time that it was - concerns the Child Support Agency IT system. There are two separate systems operating - one for people who came into the system at an earlier stage and another for more recent entrants. Frankly, the lack of progress made there is quite outrageous. Different rates of maintenance apply to people in basically similar conditions and no progress at all seems to have been made. It is another failure of IT, and perhaps one day we could get round to doing something about it.
Mr. Leigh: I hope that we do. As the hon. Gentleman says, that is not the subject of any of the reports being discussed this afternoon, but the CSA's IT system is of enormous importance. It has been one of the greatest disasters in the public delivery of services over the past 15 years, and I hope that the National Audit Office will look into it again so that we can make further recommendations.
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Mr. Gerry Steinberg (City of Durham): As the Chairman of the PAC said, this is our second debate this Session and I reiterate everything I said in my last speech on the subject a few months ago, especially relating to the National Audit Office, the PAC staff and the Chairman himself. I thanked everybody and congratulated them on their performance. Members will have listened so carefully to my speech that they will of course be able to remember what I said and it will be clear in their minds, so there is no reason to repeat it. I shall not go into great detail, but repeat my thanks to everyone for their work since our last debate.
It shows how much I enjoy the work of the Committee that, this afternoon, I could have been at the centre court at Wimbledon - watching, not playing. However, I declined the invitation as I felt that it was important to participate in the debate.
The Chairman has gone through almost all the reports and has explained the role of the PAC, so I shall not repeat that. We consider about 50 reports a year and he gave an excellent picture of our work. I want to concentrate on two reports.
Each report that we consider has a bearing on our constituents' lives - some have more of a bearing than others. Very often, our constituency postbags include letters from constituents who, frankly, have been given a very bad deal by Departments. In particular, we often receive very harrowing letters about decisions that have been taken with regard to social security benefits and the consequent appeals, as the Chairman of the PAC mentioned in his excellent speech. Very often, that is linked to stories about how people have been treated in the medical assessment procedures according to which their incapacity and disability benefits are determined. So we recently investigated those issues and produced two reports called, "Getting it right, putting it right: Improved decision-making in appeals in social security benefits" and "Progress in improving the medical assessment of incapacity and disability benefits." Those reports were vital to many of my constituents and demonstrate that, frankly, if such things are not done fairly and correctly, a huge amount of misery can be caused to people's lives.
Millions of those benefit decisions are taken each year, and many are very complex. Most people accept the decisions that are made, but others appeal, as they have every right to do. In 1999, the appeals system changed owing to the concerns that were expressed in Parliament. In fact, since then, the number of appeals has reduced by 15 to 20 per cent. and waiting times for appeals has also reduced; but, unfortunately, we found no proof that the standard of decision making has improved. At least, 20 per cent. of those decisions still contain serious errors, and 45 per cent of the decisions that relate to attendance allowance and disability living allowance are incorrect. That is not a very good story, particularly for the people about whom wrong decisions are made. Incidentally, 38 per cent. of income support decisions were incorrect in 2002 - the last year that those cases were looked at. Decisions that relate to medically assessed benefits have the highest rate of overturn on appeal.
The 1999 reforms abolished the role of the chief adjudication officer and transferred responsibility for decision standards to the Department's agency chief executives. At the time, that was a very controversial decision. Under the new rules, the Secretary of State is now required to report to Parliament on performance in benefit decision making, yet the first two reports in 2001 and 2002 were both published about 15 months late and the exercise cost the taxpayer £62 million. So there is still room for much improvement.
Disability living allowance is a self-assessed benefit, but the decision maker can seek medical evidence from other sources, which may include a medical examination. The claim form is 47 pages long and is undoubtedly onerous to complete. Obviously, we found that it needs simplifying. Some 90,000 cases - one in 12 - go to appeal, which is not surprising given the methods involved, and 50 per cent. of them are found in favour of the appellant. Since the 1999 reforms, the number of appeals has risen - obviously, more mistakes are being made.
The Department's officials do not see the client face to face when they make their initial decision and the decision letters sent out are often confusing and unhelpful. Again, that needs rectifying. There are very large variations - about an eight times difference between the best and the worst - in the time taken by Jobcentre Plus districts to prepare appeal submissions. Appellants may attend the hearings and meetings, and the evidence shows that people are more likely to receive a favourable outcome if they are present face to face. The figures show that 61 per cent. of people who turn up win their cases, while only 34 per cent. of those who do not turn up win. However, people are not told that it is better for them to attend the appeal meeting, so that problem should be put right.
Mrs. Angela Browning (Tiverton and Honiton) (Con): The hon. Gentleman is right. Does he agree that we lack an advocacy service for people who attend appeals? Individuals often need people to attend such meetings with them and although the citizens advice bureau and other voluntary organisations can offer a degree of advocacy to assist with such cases, we simply do not have sufficient advocacy services throughout the country.
Mr. Gerry Steinberg (City of Durham): I agree with the hon. Lady. People have the right to take a third party to such meetings, but many people who make appeals are not told that. As she says, it is sometimes difficult for people to find individuals to accompany them. I have often been asked to represent people at appeals, but that is difficult if one does not know the case personally and must get time off to attend.
It is unacceptable for people to have to wait 90 days for a hearing given that they have probably waited about 10 weeks to reach that stage in the first place. As I said, people are not told that their appeal is more likely to be successful if they attend the hearing.
We found several examples of people not pursuing an appeal because the process was too distressing and demanding. I am greatly worried that often only people who are sufficiently articulate make successful cases, which means that the process has little to do with the validity of cases and more to do with an appellant's ability to construct and present an argument. I know of two cases in my constituency, and I am sure that many hon. Members are aware of similar examples, which showed me that people who were persistent and able to construct an articulate case were more likely to be awarded a benefit than those who are less articulate. On the face of it, such people might be more worthy of winning their cases, despite the fact that they are less orally gifted.
For example, I knew of a highly intelligent individual with an undoubted ability to present an argument who was successfully awarded incapacity benefit following an appeal. I am not suggesting that that decision was not right, but saying that the appeal was successful and that he was articulate. On the other hand, I met a cleaner in a community centre who was unable to move or lift tables and chairs after she had had a colostomy reversal, but whose appeal was turned down. Again, I am not making accusations, but it seemed peculiar that the person who was articulate made a successful appeal while the cleaner who was in tremendous difficulty did not.
I turn to the second part of the report regarding progress made on improving the medical assessment for incapacity and disability benefits. Those benefits cost the taxpayer about £18 billion a year, so we must get things right. Apart from that, however, people should get the benefits to which they are entitled. Part of the test for eligibility is a medical assessment, and although claimants' doctors provide some evidence, more than 1 million medical reports are produced each year by Schlumberger medical services, which holds the contract for medical appeals. The situation worries me greatly because it is clear that the quality of the service provided to claimants by the company's doctors varies greatly.
David Taylor: Like me, my hon. Friend might well have had contact with Schlumberger Sema regarding miners' compensation and its performance can be patchy. Will he comment on its recent performance when dealing with people with mental health problems? Such people find it especially difficult to get a fair deal and to obtain the right decisions at medical appeal tribunals. Is he happy that the company's doctors are appropriately trained to deal with such cases?
Mr. Gerry Steinberg (City of Durham): No. One of the complaints by citizens advice bureaux concerns the standard of doctors' assessment of people with mental illness, and it gave us some shocking examples in which such people were failed. Our report makes some recommendations, so I suggest that my hon. Friend read it.
Citizens advice bureaux, which are involved with the claims process, report that across the country personal capacity assessments are throwing up a large number of benefit withdrawals, despite fact, as detailed in the PAC's previous report, that the Department for Work and Pensions is establishing more rigorous targets for the quality of Schlumberger's medical reports. Although the proportion of reports rated substandard has halved from 6 per cent. to 3 per cent., that is still a huge number of mistakes affecting 30,000 cases. Schlumberger doctors underestimate miserably the severity of claimants' disability. Citizens advice bureaux have dealt with scores of such cases, most of which arise because examining medical practitioners employed by Schlumberger fail to provide a correct PCA score to decision makers in the Department for Work and Pensions. For example, a man in the east midlands with cervical spondylosis and heart disease who had received incapacity benefit for 10 years was exempted from the PCA on the grounds of severe illness in 2000, but not in 2004, even though his condition had deteriorated. The examining medical practitioner awarded him only six points - 15 is the threshold - even though the client disagreed with five of the zero scores, and his GP and consultant said that he must not work.
In the west midlands, a man with severe heart disease was told by his GP that he should not work, but the examining medical practitioner thought otherwise, and decided that he had failed the PCA. He did not start work again, but he had a heart attack five months later and needed a coronary artery bypass, suggesting that his GP was right and the Schlumberger doctor wrong. A man in the north-west with severe arthritis in all his joints who had received incapacity benefit for 10 years was not awarded any points at his medical examination, which lasted 10 minutes.
Such cases must be looked at so that tests are done properly in future. One questions whether the EMPs are merely going through the motions in an assessment or are genuinely concerned about the people whom they assess. It is a great concern that the withdrawal of incapacity benefit, which may have been someone's only income for many years, may result from a short, sloppy examination by a Schlumberger doctor. We were told that 22 doctors have been sacked and 40 have been told to improve, which is a poor record. The report shows that it is not just Schlumberger doctors who need to improve - many GPs are reluctant to complete medical reports for their patients because it may harm the patient-doctor relationship. I find that a weak excuse. Perhaps they do not like filling in forms or having their normal procedures disturbed. I have regularly found that to be the case with some GPs.
When an individual fails the personal capability assessment, incapacity benefit stops immediately and there are knock-on effects: income support stops because the person is expected to claim Jobseeker's allowance, having been declared fit to work. Housing benefit and other benefits may stop. The individual can do one of two things - appeal and claim Jobseeker's allowance, or claim 80 per cent. of income support until the appeal is resolved and reapply for housing benefit and the other benefits. That can all be traumatic. People's income could drop to as little as £44 a week. For those under 25, it could drop to less than £35 a week. That causes stress and could endanger health, so benefits should be stopped only on sound evidence, not on the basis of sloppy findings by a doctor who may just want to get the case out of the way.
We found that there were administration problems with the Schlumberger doctors. When that happens, the stress and the inconvenience caused to disabled people can be worse than one imagines. In many cases the effect is made more serious by benefits being stopped as a result of an unjustified decision. I shall give examples. The client of a London citizens advice bureau informed Schlumberger that he would be unable to attend a PCA examination and his invalidity benefit was stopped. The problem was compounded because although the Department for Work and Pensions agreed that the invalidity benefit should be reinstated, the computer system went wrong and he never received it. Such administrative errors are not at all helpful.
A citizens advice bureau in East Anglia reported that a young man with severe learning difficulties and behavioural problems missed two appointments for his assessment, the first time because he was ill, and the second time because his mother was too ill to take him and he needed to be accompanied. Each time his mother had informed the medical centre of the reason and was told that it was okay. What happened? His invalidity benefit and income support were stopped and he had to apply for a crisis loan for food. That is not good enough. The administration must be better than that.
Most medical examinations relating to disability living allowance and attendance allowance are carried out at clients' homes by doctors who are not employees of Schlumberger, but have jobs elsewhere as GPs. They often try to fit their medicals outside their working hours, which can result in phone calls to clients inappropriately late at night or early in the morning, and requests that can appear to be demands to carry out medicals at weekends or in the evenings. For example, an 80-year-old asthmatic man received a phone call at 7 p.m. on a Saturday to say that the doctor would call at 8 am the following day - Sunday - to examine him in his own home. He found it difficult to be up and dressed by 8 am, he was distressed when he was asked to go up and down the stairs several times, but he was afraid to tell the doctor that the time proposed was inconvenient. That is no way to do business, is it?
Also in the South-East, a mentally ill woman was telephoned at 7.20 am by a Schlumberger doctor who wanted to conduct a medical the same evening. The client was naturally confused and distressed by the call. That cannot be fair on the patient, who made an appeal. As far as I am concerned, such GPs are moonlighting. The conduct is not appropriate and needs rectifying.
Notwithstanding all the problems, improvements have been made, but the Government still have a long way to go. I am confident that the two reports that we produced on these matters will lead to further improvements and will consequently give a better deal to people who, unfortunately, have to apply for benefits.
4.54 p.m.