Dr Teck Khong: A fundamental flaw in our benefit claims system

Dr Teck Khong, Candidate for Bradford North in the 2005 General Election, a GP and forensic physician for Northamptonshire Police, describes the flaws in incapacity benefit.

It has been reported recently that there are 1.65 million people who are unemployed, with a further 7.9 million defined as "inactive". Of the 2.67 million people on incapacity benefit, over half of them have been off work for more than five years. 

Earlier this year, the figure for incapacity benefit claimants who had been off work for five years or more was 1.23 million compared with just under 1 million in 2001, while total incapacity claimants rose only slightly to 2.43 million from 2.42 million. Despite Government assurances that the problem of widespread incapacity claims is being tackled by getting the long-term sick back to work, the Department for Work and Pensions figures show that the proportion of long-term incapacity benefit claimants has been rising steadily in recent years. In financial terms, Incapacity Benefit claims alone total more than £7 billion a year.

Such statistics are socially and economically unacceptable, and they blight many of our former industrial communities. In 2005, the government promised to reduce by one million the number of people officially designated as too sick to work with threats of benefit cuts if claimants with only minor ailments did not try to find suitable work.

The Welfare Reform Act passed this year allows for a detailed review of each incapacity benefit claimant's medical condition before being given personalised support and advice aimed at returning them to work.

Despite these measures, incapacity benefit continues to be a seemingly intractable problem because of the rising value of the claim over time and other in-built flaws in the benefit system.

One such fundamental difficulty lies in the process of certification of incapacity. Although GPs have an unrivalled insight into their patients’ health and capabilities, they are often too close to their patient to make detached assessments and formulate opinions on the duration for which patients should ‘refrain from work’. By the same token, they are also often placed in invidious positions where they are required to comment on the eligibility for Incapacity Benefit and other state benefits under the All Work Test rule. These tensions and difficulties occur in cases where sick notes are requested inappropriately, either for primary or secondary social and domestic reasons, or for conditions that are not actual physical illnesses. 

More importantly, there are situations where hospital and specialised medical services are unable to resolve a condition satisfactorily or where a long time has elapsed before a definitive endpoint in the management is reached. Such NHS delays allow physical complications and social sequelae to develop and jeopardise employment. Even worse, work de-motivation, loss of morale and financial exigencies of the claimants set in, often marking the start of an avoidable decline into ‘dependency culture’.

The issue of patient numbers and reputation are embedded in the conundrum of sickness certification – the potential for confrontational harm on the professional relationship of a supportive doctor and trusting patient through being objective in deciding capacity for work and the consequent risk of losing patients mean that the vast majority of GPs choose the soft option. Others defer the judgement to the Medical Examination Centres. 

An innovative project has been finalised to address this fundamental flaw and assist claimants with pathways to re-employment and support in employment. Funding is being urgently sought for its launch.

Comments

[Ay Up]

Quite, thank you Dr. It's a real scandal that so many people are "incapacitated".

[Gary Etheridge]

Being a ‘mere’ office worker, it would be easy to say, that we appear to have proportion of the population apparently ‘screwing’ the system, claiming incapacity benefit and that all efforts should be made to get them back into work. However, my concerns weigh heavily towards those who are genuinely claiming and what pressures may be brought to bear on these people to return to work before they are able to do so. Working in an office environment has its own dangers, from repetitive strain injury, through to asbestos infections, but at the end of the day, those that are involved in any manual form of labor, will find their bodies physically exhausted long before retirement age. What they gain in incapacity benefit, the Government gets back from those who fail to make retirement age, thus claiming a pension.
Sure bring in a more ‘fairer’ system, but make sure those who have worked and just ‘had enough’, (in other words the easy targets), are left alone.

[Tony Makara]

I feel there is a real danger that any reform of Incapacity Benefit will fail to take seriously the very real nature of mental illness. Having studied psychology I know that a person suffering from anxiety neurosis will not get better simply by being told to pull themselves together or claims that work will bring them dignity etc. The fact is that people with mental illness, with neurosis are often unable to function in a structured way. They may have good days, but also very bad days. They simply would not be in a position to hold down a regular job.

People do not chose to be mentally ill, the condition is imposed by distinct factors and each case is different. Any reform of Incapacity Benefit must understand the reality of mental illness. It was very sad to hear Labour ministers talking about how they hadn't been able to get those with mental illness off Incapacity Benefit, as if they were dealing with a group of benefit fraudsters. Such an attitude is disgusting and reflects the uncaring and ignorant nature of many politicians today.

[Teck Khong]

Thanks Gary for your views. You are absolutely right in expressing your concerns which I share.

Apart from medical objectivity, there are usually a variety of indicators of incapacity to ensure that claimants are not unfairly rejected, and there is always the right of appeal. However, there are situations where a well circumscribed disability or a time limited illness does not preclude gainful employment.

Your other concern relates to "bodies physically exhausted long before retirement age" even though the mind might be willing; Where these are genuine, it would be unreasonable not to be unsupportive of such claimants, especially with knowledge of the individual case, but often there are other factors such as ageist prejudice and economic conditions. That is the grey area between unemployability (ie, disease) and unsuitability for employment (ie, lack of appropriate alternative employment, premature ageing - "exhausted bodies", etc.)

I believe it is important that compassion, realism and fairness to all are integral components of a system that is meant to be caring in the first place.

[Teck Khong]

Tony (Dec 14, 2007: 13:59), I am fully aware of claimants with mental disorders and how easy it is for them to be castigated in the absence of clearly visible signs of illness.

My reference is a more global one, especially where and when such "neurosis" improves to the point at which gainful employment is not only considered beneficial but where it is actually sought by the claimant. The other reference, at the heart of the discussion, concerns long term benefit claims. In essence, the benefit system is not properly configured or refined enough to help those who should work when they can work, and distinguish those from people can't work anymore.

[Teck]

December 14, 2007 at 14:57 - "...it would be unreasonable not to be unsupportive of such claimants"

Sorry, it should be "....it would be unreasonable not to be supportive of such claimants"

[Tony Makara]

Teck, where people can be helped, of course it is only right to help them. However it strikes me as curious how politicians can claim to 'Know' that so many incapacity claims are bogus. Do they really 'know' this or is it a case of a herd of politicians following political fashion and trying to score points from people who pay tax? Just think about it, how can anyone know whether any case of incapacity is bogus if the cases are all confidential? Politicians really are quite a dishonest lot at times.

Some forms of anxiety and depression can pass after three months or so of treatment but some can be highly debilitating and last years. I do not want people to suffer if we have a Conservative government that applies what it crassly calls 'Tough Love'. I want to see a Conservative government but do not want to see the suicide of a schizophrenic all because he/she was pressurized into looking for work. The idea of pressurizing the mentally ill into work is also highly unfair on employers, people with mental illness cannot function in the normal way, some cannot even leave their homes or walk down the street. They are sick. Let's help them not abuse them like Labour have done.

[Gary Etheridge]

Recently, within this very forum, I read a number of articles, headed “Why I’m a Conservative”.

Well, this is one of the reasons that I’m a Conservative. Simply that we can discuss important, sensitive issues as adults. Not only is this a very emotive issue, we too, must ensure that we not fall within the same trap when we regain the reins of Government.
I think that it’s excellent that we have professionals within the Party, who are able to bring matters such as this to the attention of all us.
People who find themselves in this situation need to be treated with care and understanding, with the removal from all debates as them being just ‘figures’ in a statistic report.

I for one, always believed that I was a member of the ‘caring’ party, and long may it remain so.

[Tony Makara]

Gary Etheridge, interesting points. Labour's tunnel vision has led them into treating all people in the same way, and with disability we just can't do that because each case is unique.

It makes me very sad when Labour ministers who probably spend more on a meal or a tie than most people on disability get in a week start to talk about clamping down on those claiming Incapacity Benefit. I feel strongly that the Conservative party must not go down this path. I agree with welfare reform, but I'm very worried that any such reform might harm the most vunerable. The party must take on the views of professionals like Teck because politicians are given to herdism and chasing after political fashion.

A character like David Blunkett or Gordon Brown makes statements abusing the disabled or the jobless and suddenly other politicians believe it is open season and the abuse snowballs. Politicians cannot look at sensitive issues like disability dispassionately. The professional judgment is vital in these matters.

[oxymoron]

On the subject of mental illness I had three months off work years ago. I went back to work because I realised that if I kept taking time off I would probably get the sack and fall out of the jobs market. I decided that whatever happened I must never take any time off work for mental issues and I never have since no matter how tough it got, and it has got really tough at times!

I don't really have any answer to the mental health problem except perhaps some kind of therapeutic training. I am aware that counselling, which is relatively cheap and easy to provide nevertheless usually has a months long waiting list, so I can't say I am optimistic at this point. There definitely has to be an attitude change somewhere.

But letting people with mental health problems stay at home doing nothing is not just a cost to the state but every day that passes whilst they are like that they are less likely to ever work again plus they will just end up getting even more depressed in the long run.

[Tony Makara]

oxymoron, thanks for telling us of your experiences. I think we all agree that the sooner we can integrate people with mental illness back into life the better. Of course every individual is different so a Labour style one-size-fits-all approach won't work.

What angers me is the way many politicians try to equate mental illness and disability with idleness or even fraudulent behaviour. That is unfair and creates a false impression. I had hoped such vile attitudes had died in the 1980s but sadly Labour have been more than happy to extend abuse to the disabled and the jobless. Neil Kinnock's speech asking people not to be old, poor or sick must sound pretty embarrassing to Labour supporters these days.

[Yet Another Anon]

Labour's tunnel vision has led them into treating all people in the same way, and with disability we just can't do that because each case is unique.
Everyone's different, but public programmes on such large scale cannot be tailored to the exact needs of each claimant - it is extremley expensive and bureacratic to do things this way, indeed too much in the way of attempts of tailoring health and other welfare programmes goes on already.

The fact is that a crude points system cannot decide how fit someone is to work or not, people with more points are less likely to be able to so do, but someone with few or none equally could be unfit for work and people such as Stephen Hawking do work despite extreme disabilities.

The only thing to do is focus on providing broad based residency benefits - as much as possible moving to a mixture of universal benefits and low interest loans to fund welfare - money can be added on for certain disabilities, after all someone who could work may well have extra costs through day to day living due to their disability whereas someone who couldn't work might actually be able to live on less - someone with severe mental illness could be physically well and very strong, someone intensantly healthy could be quite weak. Things like having to have things delivered rather than carrying them home, getting a bus rather than walking, how much someone might need to eat - all these are factors, but it has to be accepted that it is not possible to take everything into account, nor sensible to try to do.

A more universal system will make it easer for those with chaotic thought patterns, or extreme obsessiveness and those with mental handicap to not be left destitute; a complex system aiming at delivering big money on the basis of savings and income assessments will frequently miss the very target it is aiming at, while those who are the most skillfull at claiming end up getting the most.