In a message dated 28/11/98 23:58:33 GMT, you
[[log in to unmask] (Adrian Midgley)}write:
<<
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.
>>
Do you have the reference to this. Is this compared to certificating GP's who
probably were inconsistent - different partners, trying to maintain rapport
etc etc.. I admit that in theory at least an objective assessment by a doctor
who is not involved in providing care should be fairer and more consistent.
>>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.>>
I accept that the appeal relates to the medical state at the time of the
original assessment but what I don't understand is how this can be challenged
if the case is that the medical examination failed to elicit salient points.
The only evidence that the appellent can offer is from a further medical
examination by a different doctor at a different time and place. In a static
condition such as the one in question this is probably not critical but it
could be if the condition was changing. I am aware that the doctor doesn't
make the final decision as to fitness - but how often are primarily medical
assessments overturned by non-medical staff?
>>>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...>>
Agreed. Doesn't that make it even more surprising if the account is true. The
patient may be lying about this but difficult to see why. It was said very
much as an aside.
>>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.>>
I told him to go and see our MP - Alan Milburn no less. As for the 60 mins -
seemed like that. Explained to him I can't change anything.
>>Are the answers recorded? Have you seen the notes of the examining
doctors? He will have them since he is appealing. >>
I have seen the full papers relating to his assessment in Nov. '97 and
subsequent appeal. There were some null scores which surprised me and were at
variance with what he said he told the doctor he could/couldn't do. He hasn't
yet appealed his recent decision but I have seen the letter relating to it and
there were null scores against everything except being able to sit for any
length of time - again this seemed a very harsh interpretation and was at
variance with what the doctor was told.
>>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.>>
Yes, but what are the examining doctors told? Does the BA only hold the
contribution record?
>>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.>>
It would certainly simplify things for me if I could tell him that he has
demonstrated his ability to work by following a University course and that he
is therefore automatically disqualifying himself from claiming Incapacity
Benefit.
>>_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.>>
Agreed. In my experience though this has not been an isolated incident, I've
had a few patients appeal successfully. It's a long drawn out process, often
quite distressing to the patient and in the meantime the patient is in limbo -
the more so if they genuinely feel that they are unable to apply for work
because they aren't fit but have no source of income if they don't sign on.
Must cost the taxpayer a bob or two as well. Obviously I tend only to see the
contentious ones and I'm sure they've not all been seen by the same doctor.
>>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.>>
Obviously this will happen - patients give different histories to different
doctors. But this is supposed to be a very structured interview, unlike a
standard history taking, and if different people extract very different
conclusions on different occasions on a regular basis then either the process
is at fault or the operators of the process are at fault. If a scientist
conducting an experiment gets one rogue result he discards it but if he gets a
number of rogue results then he takes a long hard look at his experimental
design and his technique and then probably sets about repeating the
experiment. All I meant to say is that such reassessments should be rare I
agree that it is overstating the argument to say that they should never
happen.
>>I think it remains unusual and should continue to do so to record
medical consultations.>>
In this particular type of medical consultation - i.e. a statutory examination
- it would protect whoever is acting in good faith. I'm only suggesting that
the doctor, who is governed by professional standards of confidentiality, and
the patient themselves should retain a copy. Another situation might be formal
interviews under the Mental Health Act. i.e. only situations where decisions
about such things as livelihood and liberty were being taken and subsequent
disputes about what questions were asked and what replies were given are quite
likely to occur. I wouldn't suggest ordinary medical consultations are
recorded except for teaching and audit and then only with the patient's
express consent.
>>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.>>
Yes. Difficult to see what the job satisfaction would be and it would be
difficult to refrain from becoming very cynical. The pay isn't very attractive
either. I understand that they have strengthened the criminal law to prevent
doctors talking about cases - what's wrong with standard disciplinary
proceedures within the agency and the profession as a whole. Improved
communication might obviate a lot of problems - at present we send off sick
notes and reports into an institutional abyss and occasionally get back
decisions, as in this case, which seem arbitrary and what happens in between
seems to occur in a professional vacuum.
Thanks to Adrian Midgley for taking time to respond in detail.
Robert Upshall
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