[log in to unmask],Net wrote at 11:37 on 28/11/98 
about "Fwd: Benefits Agency-Fair,
Consistent,Up-front,Straight-dealing,Transparent?.":
-----------------------------
>Stories of unfair decisions are probably rife amongst GP's. However a
case of

I am more used to decisions which turn out to be wrong - when the 
client takes the trouble to fill in the IB50 form detailing what 
they are claiming is their incapacity, having not done so with care 
to start with...

>What concerns me is not so much the rightness or wrongness of the
decision but
>the inconsistency of the Agency, the lack of transparency in the way
the
>decisions have been reached and perhaps even downright duplicity.

The correlation between successive applications of the "all work 
test" which is what you are talking about, rather than the BA, has 
been studied, and is at least in principle in the public domain.  I 
gather it was accepted to have been shown to be much less variable 
than the previous situation.

>                                                          First call
to BA doc. in November '97
>- 5 points and "fit to work". Disgruntled++ so appeals. Appeal heard
March '98
>- 20 points and "off-sick" though clinical condition no different from
five
>months before. 
Red herring here.  The appeal (SSAT) tribunal, which is BTW part of 
the Independent Tribunal Service, and is _Independent_ of the BA is 
required to hear the appeal relating to the condition at the time of 
the decision.  Indeed, it could hardly do otherwise - since the 
appeal is that the decision reached by the adjudicating officer 
(another little red fish there, since the BA Doc doesn't make the 
decision, they provide a medical report to the admindroid who makes 
it and has the right to award points differently from the examining 
doctor if he thinks fit) was wrong, and this is based on the 
physical state at the time.

>Applies to university and starts Oct. '98, funding it with
>Incapacity Benefit. November '98 recalled by BA and sees another doc.
who
>allegedly asks very personal and apparently irrelevant questions such
as "do
>you beat your wife" and "can you handle your drink?"  3 points awarded
- "fit
>to work" 
Not part of the all work test, and there is actually very little 
time to spare in those tests, and a lot of writing to do during 
it...

>Now mega-disgruntled, with some reason, and bends my ear for 30 mins
>x2.
your decision of course, but he would be better directed to his MP 
who makes laws, or to the Citizens' Advice Bureau who are very good 
at helping citizens through the maze of regulations...
You are I think completely powerless to alter matters, and should 
probably explain that in less than 60 minutes.

>Now I don't think incapacity benefit is necessarily an appropriate way
to fund
>higher education and you could easily make a case out that if he is
fit to
>study (a music course) then he is fit for gainful employment 
Indeed.  Although it may well be in the interest of Society to 
convert ex alcoholic heroin addicts into musicians, that benefit is 
not provided for that purpose (see note above)

>though officially the BA know nothing about his music course. 
a liar then, or a fraudster?  One's sympathy may be slightly 
limited.

>The issues I want to raise are these:

>1) 5, 20 and then 3 points for the same very longstanding condition
over a
>twelve month period with no clinical change is grossly inconsistent.
At least
>one, if not all three of those assessments must be well wide of the
mark. In
>fact I think they are probably all wrong and the truth lies around
about
>twelve - i.e. fit to work but only just and with a lot of limitations.
Giving
>him three points was interpreted, I think correctly, by him as a kick
in the
>teeth and expressed an unwillingness to believe he was telling the
truth about
>his limitations.
Clearly.

>2) If his account is correct then why was he asked apparently
irrelevant
>questions about his personal life when all he was claiming was a bad
back. If
>I as a middle-class professional went in front of a BA doc after six
months
>off with a bad back would I be asked about such things - I suspect not.
Are the answers recorded?  Have you seen the notes of the examining 
doctors?  He will have them since he is appealing.  

>3) What information are Benefits Agency docs party to beside the sick
notes
>and Med4 for the current period of sickness plus the questionaire
replies from
>the patient and GP. Do they know about the previous sickness record -
if so
>then how far back?
The BA is in charge of Benefits, and has a lifetime (or at least 
working lifetime) record of each claimant.  The same sort of stuff 
as Preston has about us, plus all our other occupations, week by 
week, recorded as NI stamps.  It was, last time it was described to 
me, on a rather long piece of card, folded, with a column per week 
we are expected to be workers.

>4) Did the Benefits Agency know about his University course? If so
how? Did
>the University tell them? 
I refer that question to Ross Anderson.  Probably not, and probably 
not, unless for instance he had upset the Bursar (more dried frog 
pills anyone?)

>5) If the University course was behind the decision to call him in
then find
>him fit then shouldn't he and I be told that?
This would be part of natural justice, but why would you expect to 
hear about the trigger if there is a reaosnable (according to the 
legistation) cause.
He should be expected to be called for examination every 6-12 months 
in any case, so presumably would have to survive 3-6 to complete an 
Arts degree, 10 or so for Medicine.

>6) What do I advise other patients in the future if they want to
follow an
>educational course whilst claiming incapacity benefit?
Talk to the CAB.  

>7) Do BA docs have quotas and performance targets to get people off
the sick?
>What happens if they get a run of genuine cases - are they tempted to
see
>malingering if it doesn't exist?
Pass, pass, and pass.  Dr Mansel Aylward is their chief Dr and I see 
no reason why you should not put pointed and difficult questions to 
him directly.   (CMO, BAMS, BA)

>8) Are some patients targetted for removal even before they're seen?
Does a
>past history of drug and alcohol addiction - even if successfully
overcome -
>render a person liable to being written-off as a scrounger and a
malingerer?
Quite the opposite.
The usual reason for active drug and substance abusers ( a weird 
label to my mind - what is the alternative to a "substance" to be 
abused?  "He abuses a figment of his imagination, m'lud"?) even 
being called for an all work test is that they have concealed it 
from the BA - on the IB50 they sign - and no cause has arisen for an 
IB113 to be sent to their medical attendant and returned showing 
this diagnosis.
OTOH, if he says he is, honest, entirely better from these 
conditions.....one might look to see if he is better enough to work.
Now _I_ don't grudge paying 1/56 000 000 of th cost of educating 
him, but the dozen or so remianing conservative voters out of theat 
56M probably would.  And they made the laws involved.

>9) If a benefits agency doc. has a bad record of decisions being
overturned on
>appeal does anyone ask any questions?
Pass, is this a clinical governance issue?  Does clinical governance 
extend to BAMS?  

>I accept that the Benefits Agency have a difficult job in cases like
this and
>as a taxpayer I accept that they have a duty to detect fraud plus some
>patients do need a boot firmly placed over the sacrum to get them back
to work
>(I'm very glad it rarely needs to be my boot nowadays). However I do
think
>they should try to be consistent -a successful appeal should trigger
some
>internal audit because unless new information comes to light it should
hardly
>ever need to overturn the initial doctors assessment 
_One_ successful appeal?  Wow.  And if you are later shown to have 
been wrong about one illness in one patient are you looking for an 
audit?  Consistent trends I think merit investigation, monitoring 
certainly.

>and certainly never add 15 points - 2 or 3 maybe. 
Why not?  I have sat with Tribunals where the history as given by 
the patient to the examining doctor and the history given tothe 
Tribunal are different by 30 points, and where the Tribunal has been 
quite willing to accept it as would I had I been part of the 
decision making process rathr than just there to assist with medical 
matters.
Are you suggesting that unless the score is within 2-3 points of the 
threshold there should be no right to appeal?  I think not.

>Questions should be to the point and if the
>patient's ability to tell the truth is in doubt then perhaps specific
>mechanisms to handle that needs to be invoked - e.g. audiotaping the
interview
>and giving both doctor and patient a copy.
I think it remains unusual and should continue to do so to record 
medical consultations.

>If information is being used to make assessments other than directly
relevant
>sick notes and questionaires  then that should be made explicit. I
accept
>individual informants may need the protection of anonymity but
certainly not
>institutions like Universities. 

Indeed so, theTribunal would insist that all information used to 
make the decision is provided to it.
Employers have to disclose who is working for them to the BA, do 
educational establishments have to do so?  Students, I think, get 
credits for NI stamps (this may only be younger ones) and this 
would be assumed by the university to be to the benefit of any honest 
ones...and may well be statutory anyway.  


The BMA is dissatisfied with the conditions of work for BAMS 
doctors, insufficient time is allowed to do a good job.
Last time I looked, the Assosiation did not advise doctors to apply 
for those posts, until conditions are improved.
--- OffRoad 1.9r registered to Adrian Midgley


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