We would appreciate any comments & feedback from this letter; use the email link at the top of the page
Dear Steve
I have now had chance to read the report you presented to me at your meeting on 14 May in
the House of Commons Grand Committee room. As I said in response there is clearly a lot of
criticism from your respondents which I would like to do something about. It is obviously
not possible to deal with the specific instances as they are anonymous. However, perhaps I
can provide some explanation and take some general action. As the report is split into
comments on various aspects of claims to DLA I will take these in turn.
ATTITUDES
Benefits Agency Medical Services (BAMS)
The visits from doctors are organised on a regional basis according to the area where the
person claiming lives. The medical services are now provided to BA under contract. I am
sending copies of the major parts of the report and some of the other informative material
to the person responsible for liaison with the contractor. She is sure they will want to
know about the attitude to ME encountered by your respondents and take action to improve
the situation.
I have requested that the material is circulated to the doctors employed to give advice to
adjudication officers and to those who visit. Also that the training material for the
visiting doctors takes account of the comments raised.
ITS
Similarly the section on tribunals has been sent to Judge Bassingthwaigte, President of
the Independent Tribunal Service. at 4th Floor, Whittington House, 19-30 Alfred Place,
London WC1E 7LW. As its name suggests the tribunal service is completely independent of
the DSS who have no jurisdiction over it in any way.
SYSTEM
This includes comments on the DSS attitude to ME. As I explained at your meeting the
Disability Handbook does include CFS/ME as a disabling condition. It is also dealt with in
this way in adjudication officer's training.
There is a comment about the telephone operator not understanding and simply reading
updates from the computer and not being able to speak to the adjudicator.
The telephone helpline operators here at Warbreck House answer enquiries about the
progress of claims and reviews and give general information. This is done from the
computer system as in almost all businesses today.
This frees the operational sections and the adjudication officers to concentrate on
dealing with the work on hand although some calls do have to be transferred to the section
for an answer. I am sure you will understand that for adjudication officers to discuss
claims and reviews themselves with the person concerned can be counter productive.
Information can be taken over the phone and passed on for consideration. All the details
considered by the adjudication officer have to be noted on the file as the evidence on
which the decision was made must be apparent.
General
I enclose a copy of the section on CFS/ME from the Disability Handbook which describes it
as a spectrum of conditions. Whilst the section refers to psychological symptoms and the
effect on psychological functioning it does not conclude that the basis of the illness is
solely psychological.
However, the higher rate of the mobility component can only be awarded to those whose
walking is limited as a result of a physical disability. Adjudication officers must follow
this as it is a condition laid down in law. It does cause difficulty when the medical
advice is that there is controversy about the cause of ME.
The fact that any disability has a psychological basis does not cause difficulty when
considering the care component of DLA but it is the need for help arising from the
disability which must be considered.
The fluctuations in a person's need for help do make a decision on a DLA claim difficult
but the guideline is that the needs must be considered on an overall basis. This would be
over a period of time such as a few months. The adjudication officer needs to know how
many days a week or weeks in a month the person cannot cope with moving around, or self
care without help. The section of the Disability Handbook says:
"It is necessary to discover what a person can do on a bad day as well as on a good
day, and to establish how often each type of day occurs."
The report the visiting doctor completes does ask whether the person was seen on a good
day or a bad day so this would provide an opportunity to give information as to
fluctuations.
Is it possible for me to have the details (name and NINO) of the person who was told by
the adjudication officer to stay in bed and get a neighbour to help them? This sort of
incident needs taking up with the person concerned. I can only guess that the adjudication
officer was referring to asking a neighbour to get in shopping.
Going shopping for someone is not included in the help which can be considered for DLA.
This is in the interpretation of the conditions by the Court of Appeal some time ago.
Recent cases have not changed that aspect and means that DLA does not generally cover
domestic help. The adjudication officer's suggestion of an alternative was ill advised but
probably well meant.
Two Short Case Studies
These are mainly criticism of the visiting doctor but without the persons name and
reference number it is not possible to deal with the specific instances. The area in which
the people lived would be useful as we could then alert the contract manager at the
appropriate office.
I am glad to read of the way the adjudication officer listened at length to the second
person.
Disinformation/Misinformation
DLA can be awarded for a fluctuating condition as long as the need for help when assessed
overall satisfies the conditions. Whilst the benefit is one entity consisting of two
components it is quite possible to be awarded just one component. There is no need to
satisfy the conditions for both.
The other points in this section are about the visiting doctors and I have sent this
section to be forwarded to the BAMS managers.
Forms
The long self assessment questionnaire was introduced in 1992 with DLA itself. This was in
response to requests from organisations representing disabled people who felt that people
claiming were not given the opportunity to give their own details of care and mobility
needs.
The form is long because of the information needed to decide claims by applying the
conditions in the law. I do understand that disabled people find them onerous and many
have help from others. Many people who claim DLA cannot complete the form at all because
of their disability and their carers have to complete the form on their behalf.
The current version of the form was developed over many months of work and consultation,
both written and in seminars, with a number of disability groups.
How to fill in the forms
The last of the points listed is not correct. There is no template used to check tick
boxes or any other quick and easy method of deciding claims. All claims and reviews are
looked at by an adjudication officer who has to go through the form thoroughly.
Adjudication is a semi judicial process where the facts are determined from the evidence
and the law applied to those facts to decide whether the conditions are satisfied.
Help with Forms/Process
If someone with ME has help to fill in the claim form and/or it takes them several days to
complete it is advisable to show this somewhere on the form.
Medicals
I have asked for this section to be forwarded to the BAMS manager.
Appeals
I have passed this section to the Independent Tribunal Service.
Peculiar Decisions
Some of the decisions criticised did not award the higher rate of the mobility component;
or it was awarded and then not renewed. This could be because that component can only be
awarded for a physical disability.
Guidance on this in the Disability Handbook has been subject to change and this may
account for some of the different decisions at different times. We constantly work for
consistency in decisions but this is not always achievable given the conditions for the
benefit which allow different conclusions to be reached.
Length of time to get DLA Allowed
Unfortunately it often takes time for the process of review and appeal to be completed.
The point I think you are making here is that an appeal has to be made before an
application for DLA is successful.
The adjudication officer has to make a decision on the evidence available at the time and
apply the law to that evidence. It is sometimes the case that different evidence is
available to a tribunal, or they take a different view of the evidence before the
adjudication officer.
This is not easy to avoid in a benefit where the conditions are subject to different
interpretations and where the same illness may give rise to different levels of care
needed.
Other Conditions
All the medical conditions a person claiming DLA has should always be included in the
information on the claim. This is to give a full picture of how the need for care and the
mobility problems may have arisen. Other conditions which cause mobility problems and over
which there is no controversy as to the physical cause are particularly important.
Respondents who have not applied for DLA
I know that BRAME have been in touch with those responsible for publicising benefits. This
section does acknowledge that groups such as your own have an important role in this area.
No one should be put off from applying at all. Bad experiences do, unfortunately, tend to
be more quoted than the good ones. You advise that evidence given should be based on worst
days. It is, of course, essential that this information is given but evidence as to good
days and an estimate of how many of each is necessary for an accurate picture.
Miscellaneous
The comment is made that someone who is well enough to apply will not qualify. Since DLA
is a benefit for severely disabled people a great many recipients are not well enough to
apply personally. The comment clearly results from the frustration felt.
The criteria for DLA are a matter of policy for the government rather than the BA. The
fact that someone is eating does not prove they can cook as the test is of cooking a main
meal. Living alone does not prevent anyone being entitled to DLA.
The comment about being 80% disabled applies to Severe Disablement Allowance (SDA) and not
to DLA.
Many of the miscellaneous comments relate to the inconsistency of awards, particularly as
regards the length of them. There is some feeling that the DSS is trying to save money by
denying people benefit.
I must explain that the adjudication system is quite separate from the payment of the
benefit. When making a decision on any claim adjudication officers are not constrained by
cost. This issue is simply not their concern. Guidelines for adjudication officers are
issued by the Chief Adjudication Officer who is independent of DSS and BA. The guidance is
based on the law and the interpretation of it by Social Security Commissioners and the
Courts. I enclose a copy of the relevant parts of the Adjudication Officers Guide.
Conclusions
The quote from Rahela Miah does not make the point that the mobility component can only be
awarded for physical disability. I enclose a copy of the legislation setting out the
conditions of entitlement to DLA.
The visiting doctors do not make the assessments. Their report is to show what the effect
of the illness is. However, because of the legislation the report does ask to what extent
the needs are due to physical factors and this is clearly where your complaints lie.
Part of the solution may lie in the research for which you are pressing and which was the
reason for the meeting on 14 May. I wish you every success with this.
As far as adjudication of DLA claims is concerned I will be sending the synopses of
individual cases to all the DLA offices for circulation to adjudication officers with a
covering minute about the report. I hope this will raise awareness of the problems faced
by people with ME in claiming DLA.
I do appreciate that you went to a lot of trouble to compile this report and it was
presented to me with goodwill. I hope circulating parts of it will bring about some
improvement.
Yours sincerely
Liz Tetlow
National Adjudication Advice Team, AA/DLA
We would appreciate any comments & feedback from this letter; use the email link at the top of the page