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.