§ 2. 38 p. m.
§ Lord AYLESTONEMy Lords, I be leave to ask the Question which stands in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government whether the replacement of medical certificates by "doctors' statements" which may now be issued "until further notice" is likely to lead to abuses and claims covering a longer than necessary period for sickness benefit claims.
§ Lord WELLS-PESTELLMy Lords, the revised arrangements for the provision of medical evidence for the purposes of claims to incapacity benefit, which came into operation on 4th October, are unlikely to result in abuses and longer claims. It will be exceptional for doctors' statements to be issued "until further notice"; and the Department of Health and Social Security's system of supervising claims to benefit will continue to apply.
§ Lord AYLESTONEMy Lords, while thanking my noble friend for his reply, may I ask him what advantages there are and to whom in this change from medical certificates to doctors' statements? Secondly, who will vet the unscrupulous applicants for benefit who could apply, obtain a certificate "until further notice", work and still draw benefit?
§ Lord WELLS-PESTELLMy Lords, in reply to the first question put to me by my noble friend, the doctors themselves felt that the previous form of certificate was not adequate from their point of view, and this change has come about as a result of discussions with the medical profession. It is mainly designed to stop people—I was about to say a vast army of people—who are unfit for work continually going to their doctors to renew their certificates and taking up a tremendous amount of time, and very often to stop doctors having to visit them for the purpose of giving them a certificate. Now the doctor will be able to set out in the certificate what his views are and the minimum period, in his view, that a patient will need to remain off from work.
4 In reply to the second question put to me by my noble friend, for a very long time the Department at regional level has had an office that continually looks at claims from people sending in certificates which seem to be renewed over an unduly long period. If a person is suffering from a certain type of complaint, the Department has some idea how long it will last; and, if the certificates tend to go on being renewed, the regional office has the right to ask the claimant to come for an independent medical examination, and the person's own doctor is informed.
§ Lord PEDDIEMy Lords, would my noble friend agree that the primary purpose of this change is to effect some saving in doctors' time, and in consequence there is the likelihood that there will be a reduced check upon those who would seek to take advantage of the system?
§ Lord WELLS-PESTELLMy Lords, in reply to the first part of my noble friend's question, the answer is, Yes. I do not think that there will be a reduced check—unless I have misunderstood his question—because the checking will still go on.
§ Lord TRANMIREMy Lords, can the noble Lord say what is the estimated annual saving from this change?
§ Lord WELLS-PESTELLMy Lords, I am sorry; I just do not know.
§ Lord SLATERMy Lords, is my noble friend aware that the system of issuing medical certificates has been in being ever since many of us can remember since we first started work? On the part of the medical profession of this country, it is absolutely scandalous to put forward this proposal to counteract this system, by a form of examination. Is my noble friend further aware that in certain industries firms have their own doctors? If a workman has an accident at work and is off work for any period of time, he is brought in front of that medical officer of the firm for a medical check, and that is supplemented by the examination of his own doctor.
§ Lord WELLS-PESTELLMy Lords, the only thing I can say in reply to my 5 noble friend is that this matter was discussed in some depth with the medical profession and furthermore it was recommended—and I would emphasise this—by the National Insurance Advisory Committee.
§ Baroness SUMMERSKILLMy Lords, if the doctor puts on the statement the minimum time for which he thinks the patient might be ill, is there not a danger that conscientious workers, men or women, may feel that they must return to work after that time has elapsed although in fact they are not fit to do so?
§ Lord WELLS-PESTELLMy Lords, I suppose that that is a possibility. I understand that the doctor will certify that the patient should refrain from work for a particular period. If at the end of that period the patient feels that he, or she, is not fit for work, then there is nothing to stop the patient from going down to see the doctor and getting it extended if the doctor agrees.
§ Baroness SUMMERSKILLMy Lords, in the household where a man has been at work for some years and the wife perhaps is out at work also, and the man is not fit to return in this minimum time, undoubtedly pressures are brought to bear on these people. It seems to me rather unfair, rather unjust, that the time that the man (I am putting the case of the man because he is more likely to be sensitive in this respect) has to stay at home will be necessarily limited in the eyes of a family. Is there not an element of cruelty in this?
§ Lord WELLS-PESTELLMy Lords, if the doctor is of the opinion that the patient really is not fit for work for a prolonged period, then he would give him in the first instance a certificate which would last six months and thereafter could give him a certificate until further notice. This, we imagine, will not be done in very many cases, but I think it would mean that if a patient felt that he was under pressure from his family and he was not really fit, and the doctor felt he was not fit, the matter could be dealt with by one of these "until further notice" certificates.
§ Lord SLATERMy Lords, can my noble friend make clear to me who should be the final arbiter in regard to the 6 medical examination of an employee who has been certified by his own medical doctor, after a valid means of diagnosis, to be suffering from a certain form of complaint and the employer's doctor disagrees with the findings of the employee's doctor? Who is the final arbiter in that situation?
§ Lord WELLS-PESTELLMy Lords, so far as I understand the situation, the employer's doctor does not come into this at all. If a patient is unwell he goes to his doctor. The doctor gives a certificate for one, two, three, or four weeks, one month, or so on. If the nature of the complaint is such that the Department feels there ought to be another medical opinion, it is the Department which informs the patient's general practitioner that it is going to call the man up for an independent medical examination by a medically qualified person connected with the regional authority.
§ Lord LEATHERLANDMy Lords, will not this new system enable doctors to devote more time and attention to people suffering from acute and sometimes serious illnesses?
§ Lord WELLS-PESTELLMy Lords, this is what we hope, and what the doctors hope.
§ Lord BALFOUR of INCHRYEMy Lords, in view of the obvious misgivings from all parts of the House on this scheme, are the Government willing to reconsider the matter after it has run for a reasonable period of time?
§ Lord WELLS-PESTELLMy Lords, I think I can say in all sincerity that matters of this kind are automatically reviewed. I would take issue with the noble Lord when he says that there are widespread reservations so far as people in your Lordships' House are concerned. I do not think there are. I think there has merely been a searching questioning of the matter.