HC Deb 03 December 1996 vol 286 cc944-52

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Coe.]

11.33 pm
Mr. Llew Smith (Blaenau Gwent)

I represent one of the poorest communities in Wales; linked to that, we have some of the worst health problems. Figures for cancers, and for respiratory and heart disease are among the worst in England and Wales, and the 1991 census showed that 41 per cent. of all households had a member suffering from a long-term illness or disability. In response to a recent question of mine, the Minister for Social Security and Disabled People admitted that, on 31 March 1996, 4,553 people in Blaenau Gwent were on the register of persons with a physical or sensory disability. Linked to poverty are high levels of unemployment. Where there are jobs, they are more often than not low-paid, and increasingly they are part-time.

I make these points about poverty, unemployment and bad health to remind hon. Members that they are interrelated, and to highlight the seriousness of the health problems in Blaenau Gwent, the difficulties that claimants face in finding work, even if they are fit to work, and the importance of the subject to my constituency and many others.

More and more people recognise that the medical examinations conducted for incapacity benefit by Benefit Agency-appointed doctors are not a test of incapacity to work. Those examinations are a degrading experience, conducted in an uncaring manner and introduced by the Government with no concern for the health and well-being of the individual.

I shall comment on those and many other points by referring to the case of David Holmes, who was a constituent of mine before his death on 5 November. I knew him, and he was a much-loved and respected member of the community. To a great extent, I shall repeat David's words: this is his speech. I am merely giving expression to the thoughts that he put in a letter he wrote, but could not post to the Department of Social Security, a day before he died.

In 1982 David experienced a massive heart attack. After recovering in hospital, he recalled in the letter to which I referred that he was told by Dr. Thomas, the consultant at Nevill Hall hospital: 'You can forget about work, as you will never work again, the reason being, if you have another coronary like the last one, you will never survive it'". Over the next few years, David was sent to three independent doctors—Dr. Edwards, Dr. Rau and Dr. Neville. He recalled: those doctors agreed on one salient point—I was medically unfit to work. I was then granted a Mobility pension for the rest of my life. Yet, in October, Mr. Holmes was ordered to appear before a DSS-appointed doctor. On 30 October, he was informed that he was fit to work. Less than a week later, on 5 November, David died of a massive heart attack.

The letter that David wrote to the DSS was an expression of the stress he experienced and the hopelessness he felt at the failure of the DSS to appreciate the true extent of his illness. He recognised that the decision had less to do with the state of his health than with the Government's politics and the challenge to the DSS decision. David wrote: I am convinced that this assessment is based not on the state of my health, but is purely and simply a political issue. We are all aware of the forthcoming general election. We are also all aware of the Government's statement, 'We will get the long-term unemployed back to work.' They did not add 'at any cost'. I share those sentiments. When the Government's priority was to overcome unemployment, or so they claimed, they were willing to keep people like David on the far more expensive invalidity benefit, as it was then, to give the impression that unemployment was falling. 'When their priorities changed, however, to cutting public expenditure, they set about driving David and others off what is now incapacity benefit and on to the dole. Their only concern was to cut costs, as David's tragic death demonstrates.

How can we claim to be a civilised society if we put money before people's health, or indeed their lives? We are rapidly debasing the idea of being civilised by removing dignity from some of the most vulnerable people in our community.

I shall continue to quote from David's letter, in which he refers to the one point upon which he and the DSS adjudicators agreed: his mobility problems. He states: Form 1B–65A states 'Cannot walk more than 200m without stopping or severe discomfort'. (On a bad day, I cannot leave the house). This is the precise reason why I was granted the mobility pension! My mobility problems are caused by respiratory problems, which are caused by angina, which, in turn, is a direct result of the coronary thrombosis!!! How can a doctor, whom I saw for less than 40 minutes, and who asked the most irrelevant questions—'What TV programmes do you watch?' and 'What books do you read?'—and a DSS adjudication officer, make an assessment on the state of my health and state that I am medically able to return to work, based on a questionnaire, which was hardly relevant to my particular circumstances? They have never seen me on a bad day, on the edge of the bed, trying to get my breath before I can even dress, trying to control my breathing before I can make a cup of tea. I count myself very lucky when this happens, as my friend's wife telephones every morning to see that I am all right. On one of my bad days, she will come up to see what she can do for me. Contrary to that stated on form 1B–65A, Lifting and Carrying, my friend and his wife do all my weekly shopping for me as I am unable to carry heavy shopping bags without getting chest pains. Also, with regard to Bending and Kneeling, I am unable to do much of either without suffering shortness of breath. All of which I told the DSS Medical Examiner, to no avail, after reading the report results on form 1B–65A. I have always considered the doctors and nursing profession grossly overworked and it was due to these considerations that I did not send for the doctor when I suffered angina chest pains. It now seems I am being penalised for this oversight on my part. I would like nothing better than to have my health restored, have a job of work with a decent living wage and live a normal life like other people. Instead I get very frustrated and depressed. I fail to see why I should have to risk another coronary and therefore risk my life to further the political aspirations of Government bureaucrats. David also kept a diary, which is worth quoting in order to gain an insight into his feelings about the medical examination. It reads: Medical examination, Pontllanfraith, 9.15 am, waste of time". David was correct once again, for the medical examination is no test of incapacity to work—it is not even a fair test of incapacity. It pretends to measure incapacity for work and is called the "all-work test" in the legislation. People who fail the all-work test are treated as being fit for work. However, the all-work test does not try to assess whether people could do any kind of paid work, given their ill health or disability.

It lists a range of activities, each of which has a point score if the claimant cannot perform that activity. The schedule to the Social Security Incapacity for Work (General) Regulations 1995 lists all of those activities and says that they are disabilities which may make a person incapable of work". However, a person's score depends on how many of the activities he cannot perform—not on how his ability or inability to perform them affects his capacity to do paid work.

Unless a person scores 15 points, he cannot be treated as unfit for work. Someone who cannot walk is automatically treated as unfit for work and scores 15 points. However, we all know plenty of people who cannot walk but who are perfectly able to do a full day's work. Equally, if a person's only disability is that his hands are too weak to allow him to lift a full kettle, he receives 15 points and is classed as unfit for work. However, someone would receive only eight points for being unable to lift some potatoes.

The test seriously disadvantages many people who can walk a bit, bend and kneel a bit, or whose conditions fluctuate but who, because of pain or low stamina, for example, would not be able to sustain such activities in a manner that allows them to work. For example, someone who cannot walk for more than 200 m without stopping or suffering severe discomfort scores only seven points—below half what is needed to be accepted as unfit—but in many instances that would be a serious impediment to holding down a job. Other claimants—perhaps this applied to David Holmes—might be able, in a purely technical sense, to walk, bend and lift things, but should not do so because it puts their health at risk or could cause them to deteriorate.

Some people who are perfectly able to work could easily be classed as "unfit for work" according to the all-work test. On the other hand, many people who are not fit for work, with which doctors, family friends—anyone with common sense—would agree just by looking at them, regularly fail to score the necessary 15 points.

If a benefit system requires people to sign on unless they are unfit for work, there has to be some test or proof of incapacity, but whatever Parliament or Government opt for should be a fair test of whether someone is well enough to do a job, and individuals should not find that their status has changed overnight, when their state of their health has not, just to suit the political or economic priorities of the Government of the day.

David's closest friends, Dennis and Pauline Johnson, are convinced that the worry about the adjudicator's decision contributed to his death. Pauline Johnson said: David has been worried sick about going to the medical … After finding out he had lost his benefit, David was a changed man". The DSS spokesperson said: I am sorry to hear about Mr. Holmes' death, but can't discuss individual cases. The local community have demanded that I raise this issue in Parliament, because they want David's case discussed. They want explanations of why he was declared "fit for work" when he obviously was not; why he regarded the examination as a "waste of time"; how the examinations are conducted and conclusions reached; and why, as David said, he should have to risk another coronary and therefore my life to further the political aspiration of Government bureaucrats. We are not pretending that David's is an isolated case or that thousands of claimants have not been victimised by the system, but we are determined that his treatment by the DSS is not forgotten and that he does not merely become a statistic of a system that does not work or care.

David's case would not have been highlighted were it not for his friends and the local newspaper, the Gwent Gazette—particularly Gordon Caldecott, one of its journalists.

We all hope that something positive can come from David Holmes's tragic death.

11.47 pm
The Minister for Social Security and Disabled People (Mr. Alistair Burt)

I am grateful to the hon. Member for Blaenau Gwent (Mr. Smith) for raising this case. I know that he has taken a great interest in it. I begin by expressing my personal sympathy for the family and friends of Mr. Holmes at this difficult time.

Mr. Holmes's death so soon after his medical examination is, of course, of great concern to the Department. It is quite right that spokesmen do not discuss personal details, particularly with the media, after an incident, but it is equally proper that the matter is raised at times such as this. The Benefits Agency has looked very carefully at the facts and circumstances of the case, and I understand that the Agency's chief executive is to respond separately to the hon. Gentleman shortly.

Having looked at the details of Mr. Holmes's case, I am satisfied that at every stage the claim was handled in a proper manner and in line with the procedures and guidance provided. The arrangements for dealing with claims for incapacity benefit have been carefully designed. They ensure that all relevant information is taken into account, and in particular that people with severe medical conditions are dealt with sensitively.

The medical examination itself was developed with the help of a panel of 80 experts, drawn from the various medical disciplines and groups representing disabled people, to ensure that the method of determining someone's capacity for work was both reasonable and fair.

It is also important to emphasise that doctors who are employed by the Benefits Agency medical service are trained to very high standards. To be considered for employment, they must have clinical experience, and have skills in areas of medicine relevant to the assessment of incapacity. They must then pass a rigorous approval process, which involves four days of theoretical training followed by a written exam. Newly approved doctors are supervised during their first four assessments to ensure that they are able to perform to the required standard.

We have taken great care in the design of procedures to determine incapacity for work, and to ensure that those applying the procedures have the right training and experience. I should like to explain briefly how the process works. I hope that that will reassure the hon. Gentlemen and his constituents.

In order to claim incapacity benefit, a person must supply medical evidence from his or her general practitioner. If sickness continues beyond 28 weeks, consideration is given to whether a medical examination is necessary to confirm continuing incapacity or whether the condition is so severe that a medical examination is not required.

The effects on individuals of medical conditions such as heart disease can vary from mild to very severe. An individual medical examination will therefore be required in most cases. However, a number of conditions are such that it would be unreasonable to expect the person concerned to be capable of work—for example, severe learning disabilities or severe mental illness.

If the medical certificate from the general practitioner indicates that the claimant may be suffering from such a condition, the Benefits Agency will obtain a full report from that GP, and ask for advice from a Benefits Agency medical service doctor, who will have been specially trained and approved in the way I described. The doctor will provide advice on whether the claimant's condition falls into an exempt group, in which case benefit will be awarded without the need for an examination. It is relevant to note that the majority of people who have recovered after a heart attack will not be in such a category.

Mr. Llew Smith

The Minister said that people with severe conditions would not be expected to work again, or to return for continual medical examinations. I accept that, but how much more severe could David's condition have been? His consultant told him that, if he worked again, he would not survive—he said that that was it; that was the end. He was not speaking in isolation. David saw three other doctors, and the outlook was considered to be equally gloomy.

Mr. Burt

If the hon. Gentleman will allow me, I shall come to the circumstances of Mr. Holmes's examination later.

During the development of the incapacity benefit, Ministers wanted to ensure that people with severe medical conditions would not be put through a medical examination. A limited number of circumstances were subsequently identified in which the severity of the person's functional limitations would be beyond doubt, such that they would clearly be incapable of work.

The criteria used for determining those categories were, first, that the person was suffering from one of the most severe medical conditions, such as severe heart and lung disease or severe mental illness; secondly, that recovery or improvement in the condition could not be expected; and thirdly, that there could be no doubt that all persons suffering from the condition would be functionally incapable of work.

If the claimant is not suffering from one of the exempted conditions, further evidence is obtained before he is invited to attend a medical examination. He will be asked to complete a questionnaire, in which he can give his own account of how his condition affects him. At the same time, he is asked to obtain a further statement from his own doctor, who can provide more details of his own diagnosis of his patient's condition. The claimant's doctor is asked to provide factual clinical information on the medical condition. That information will help the Benefits Agency to decide whether a medical examination is necessary.

We have taken particular care over the design of the method of examining claimants to establish their capacity for work, and we have provided examining doctors with comprehensive guidance. The examining doctor will begin by asking the claimant about the history of the illness and about everyday activities relevant to the claimant's condition, after which he will conduct an examination.

The doctor will consider all the information and exercise clinical judgment to reach an opinion on the nature and effects of the medical condition. Full account is taken of factors such as pain, fatigue and breathlessness and the possible variability of the condition. If someone can, for example, perform a particular activity only by incurring a considerable degree of pain or breathlessness, he will be assessed as incapable of performing that activity. The doctor will also consider the effects of that condition over time, so that the opinion will not be based on a snapshot picture of the claimant's condition on the day of examination.

In the case of heart disease, the doctor will obtain, in particular, details of any walking restrictions caused by breathlessness and chest pain. The examination will concentrate on looking for evidence of complications of the disease—either angina or heart failure. The doctor will then prepare a comprehensive report for an adjudication officer—an officer appointed by the Secretary of State to determine entitlement to benefit independently of Ministers and departmental officials.

The adjudication officer decides, on the basis of all the evidence available, whether the claimant should be treated as incapable of work. In doing so, he will take full account of any reported pain, fatigue or variability caused by the claimant's medical problem. He must also take account of evidence provided by the claimant and the claimant's doctor.

A further important safeguard is built into the all-work test arrangements. We realised from our work in developing the test that there are a minority of claimants who are clearly incapable of work, but who would fail the test because their current condition causes only limited functional impairment. The hon. Gentleman referred particularly to the type of test in which someone would score only seven points but clearly would be incapable of work. Therefore, regulations specify that people who fail the test shall be treated as incapable of work if one of the prescribed exceptional circumstances applies.

The exceptional circumstances apply if, for example, the person is found to be suffering from a previously undiagnosed life-threatening condition, or if his medical condition cannot be controlled by medication. Benefits Agency doctors are required to consider at every examination whether those conditions apply, and the procedure provides an additional check for people who otherwise would fail the all-work test. Turning specifically to Mr. Holmes's case, the investigation by the Benefits Agency shows that there was nothing improper in the application of those arrangements. Full and expert consideration was given to whether he was suffering from any one of the exempt conditions, and it was concluded that he was not.

Mr. Holmes attended a medical examination on 14 October 1995. The examining doctor—who was an experienced doctor—completed a thorough report on his ability to perform the activities in the all-work test. There is no reason to doubt that the doctor considered all the evidence, including the history of heart disease, and that he carried out a full and proper assessment. He also concluded that, in his opinion, Mr. Holmes's condition did not fall within the specified exceptional circumstances.

I understand from my medical advisers that a person who had a heart attack 14 years ago would not necessarily be considered to be at a high risk of sudden death. Obviously, however, a full medical assessment has to be performed to take account of individual circumstances. On the basis of all the evidence, including the doctor's report, the adjudication officer decided that Mr. Holmes was no longer entitled to incapacity benefit. Sadly, heart disease is all too common, and sudden death from heart disease is not uncommon, in people both with and without a previous history of the condition.

Mr. Smith

Does the Minister accept that those so-called "experts" had it wrong? Sadly, only a few days after they reached their conclusion, David died. Is it any wonder that, after David went to the examination, he wrote that it had been a waste of time, or that, in his letter to the Department of Social Security, he wrote that people were not listening?

Mr. Burt

On the latter point, it is not uncommon for people who are called for a medical test who have not been for one for a long time, and who—for whatever reason—do not enjoy the experience, to describe it in the terms used by Mr. Holmes. Others have described the medical test in the same terms.

I cannot answer the second point, on whether doctors should have noticed something.

I do not know whether there was anything that the doctors should have found that might have indicated a death to result within five days. Can the hon. Gentleman tell me of a medical technique to predict a death from heart disease within five days? If he can, perhaps we can incorporate it in the test.

I was saying that sudden death from heart disease is not uncommon. Such deaths cannot be accurately predicted by any known medical test, but all the evidence suggests that they are more likely to occur in the weeks immediately following a heart attack. A person who survives a heart attack by many years is at little greater risk of sudden death than the general population of his particular age and sex. Indeed, as we all know, most people with a history of heart disease, including some with angina, can, with modern medication, lead a relatively normal life.

While we all deeply regret the death of Mr. Holmes, from the information that we have we do not believe that it can be attributed to the application of the all-work test. I believe that the test is fair in principle, and I am confident that sufficient safeguards have been built into the process to ensure that it is applied properly and with due regard to the medical conditions and circumstances of those to whom it is applied.

I repeat my personal sorrow at the death of Mr. Holmes. In the light of everything that the hon. Member for Blaenau Gwent has said this evening, I ask again whether anything further could have been gleaned from all the information available to the doctor at the time he made his judgment on Mr. Holmes's health. All our investigations to date show that the nature of Mr. Holmes's condition could not have suggested that he would have died within a few days. If there was a test to predict that, or anything similar, everyone would obviously want to know. However, I shall go back to the doctors on the points that the hon. Gentleman has raised.

Mr. Smith

The Minister said that many applicants regarded the examination as a waste of time because they did not like the experience. That was not David's reason for saying that it was a waste of time. He said that because people were not listening to what he said about his condition. He was proved right, because, a few days later, he was dead. His reasons had nothing to do with the issues that the Minister has mentioned.

The Minister has asked me whether I know of a way to anticipate that someone was about to die if they returned to work. I do. It is fairly easy. Just speak to the people who were responsible for David—the medical team and the consultants who said that, if David returned to work, history would repeat itself. Indeed, they said that the situation would be even more severe, and David would die. Those consultants was found to be right. David was found to be right. The doctors who examined him are guilty of disregarding David's condition.

Mr. Burt

I cannot offer a comment on what evidence the doctor who examined Mr. Holmes took into account. I believe that all the evidence that the hon. Gentleman has put to us tonight was available to the doctor when he made his judgment.

I do not believe that it is possible to predict the moment of death of someone with a condition such as that that Mr. Holmes had, nor is it possible to predict that it should happen so soon after an examination.

I accept what the hon. Gentleman says about Mr. Holmes's reasons for considering the test a waste of time. If that was his experience, he was entitled to refer to it in that way.

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at three minutes past Twelve midnight.