§ Mr. Robin CookTo ask the Secretary of State for Social Security how many medical practitioners examine patients for attendance allowance; how many of these are principals in general practice; how many of these are retired medical practitioners; how many of them are medical practitioners without other remuneration; how many of them have a specialist psychiatric qualification; and how many of them have training in psychiatry lasting six months or more.
§ Mr. ScottThere are 3,742 examining medical practitioners (EMPs) in Great Britain who examine patients for attendance allowance. Of these it is estimated that 82 per cent. are principals in general practice and 16 per cent. are retired medical practitioners. No information is held on the number of EMPs without other remuneration.
Data on the numbers of EMPs possessing a specialist psychiatric qualification or having post-graduate training in psychiatry are not routinely recorded; and to obtain such information would incur a disproportionate cost.
§ Mr. Robin CookTo ask the Secretary of State for Social Security how many medical practitioners, annually, are discharged from their responsibilities for assessing for attendance allowance, because of their incompetence in obtaining psychiatric histories or undertaking mental state examinations.
§ Mr. ScottNo central record is kept of the reasons for discontinuing the services of examining medical prac-tioners for attendance allowance. Doctors are carefully 101W chosen before starting this work. They are given instruction in the requirements for the examinations, their work is monitored and any further training required is given. It is very rare therefore for these doctors' services to be discontinued because of incompetence.
§ Mr. Robin CookTo ask the Secretary of State for Social Security (1) what specific instructions are given in the form of guidelines, in the obtaining of a psychiatric history or examination of mental state;
(2) what training in the eliciting of a psychiatric history or in mental state examination is provided by the Department to practitioners prior to or consequent upon their appointment to assess patients for attendance allowance.
§ Mr. ScottDoctors selected to examine attendance allowance claimants are usually recruited from among general practitioners within the locality who will have demonstrable knowledge of local socio-economic conditions, established experience in general medical practice and evident expertise in conducting medical examinations. Guidance is given by the regional office senior medical officer (ROSMO), or regional office medical officer (ROMO), on the background of, and conditions for the award of attendance allowance.
The performance of new examining doctors is closely monitored by the ROSMO who will institute further training sessions as appropriate; thereafter doctors' reports are regularly monitored to identify any further need for guidance. The form, nature and pattern of such monitoring may vary and are dictated by the individual ROSMO.
In conducting an examination for attendance allowance purposes the examining doctor's principal role is to complete the standard report form which has been designed to give an account of the patient's needs for attention and/or supervision. By their very nature the medical examinations required for the purpose of determining eligibility for these allowances need the expertise and experience possessed by general medical practitioners who are able to give consistent advice across a wide range of disabilities and age-groups. In the small number of cases where a specialist opinion is required an independent report is sought from a consultant clinician with the necessary specialist knowledge. The attendance allowance board or its delegate has access not only to the examining doctor's report but other evidence considered necessary, such as psychological, head teacher's and hospital's reports etc. The present arrangements thus allow for suitably qualified persons to be approached, as necessary, in an individual case.
The attendance allowance board has also issued a "Handbook For Delegated Medical Practitioners" a copy of which is in the House of Commons Library. That handbook, together with the written guidelines given to examining medical practitioners upon appointment, describe the medical factors which should be taken into account in the obtaining of a psychiatric history from, and examination of mental state of, those claimants who exhibit mental disorders. As with physical illness, neither the diagnosis nor the disability is the determining criterion in the assessment for attendance allowance. The attendance needs are the determining factor.
§ Mr. Robin CookTo ask the Secretary of State for Social Security what system there is for checking102W independently, by a medical practitioner with psychiatric experience, that assessments for attendance allowance have been carried out competently.
§ Mr. ScottAll reports of medical examinations conducted on claimants for attendance allowance are scrutinised either by the attendance allowance board or by the independent medical practitioners to whom the board has delegated its powers to make decisions in individual cases. The board, one of whose members is a consultant psychiatrist, recognises that the assessment of the amount of attention and/or supervision required by patients suffering from psychiatric illnesses may pose particular problems. Guidance has been issued by the board in the "Handbook for Delegated Medical Practitioners", published by Her Majesty's Stationery Office in 1988. Aided by the board's guidelines and possessing expertise and experience in the practice of clinical medicine and in the evaluation of medical reports on claimants for attendance allowance, the board's delegated doctors provide an expert and efficient check that attendance allowance assessments are carried out competently.