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26 July 2005

Were MPs misled into believing that the President of the Appeals Service agreed that private sector doctors working for the DWP were better trained than the doctors who sit on appeal tribunals? And are we about to witness a drug free revolution in the treatment of conditions such as stress, depression and ME/CFS that will see many thousands of sufferers miraculously returned to health, happiness and work?

Lumps of meat
In December 2003 Professor Mansel Aylward CB Chief Medical Advisor of the DWP’s Corporate Medical Group gave evidence to the Public Accounts Committee’s enquiry into progress in improving the medical assessment of incapacity and disability benefits.

The committee was very concerned by the fact that 51% of appeals against IB and DLA decisions were being won by claimants. There was clear scepticism about the skills and commitment of privatised doctors working for Schlumberger Sema. One MP questioned whether the doctors were “genuinely concerned about the actual people they are assessing” or whether they “just treat them as a lump of meat” and “are not really all that bothered, are they, as long as they are getting their fee?” (According to evidence given at this hearing, doctors get between £50 -£70 per medical, which would allow them to earn in excess of £100,000 a year).

Professor Aylward CB leapt to the defence of the private doctors. He claimed that the Appeal Service statistics, which showed that one third of all cases were won by claimants because the privatised doctor underestimated their disability, were wrong. The Professor claimed to have taken a random sample of these cases and, using “judgment, and a scientific method” found that, in his professional opinion, in half the cases the disability had not been underestimated.

In other words, in the Professor’s professional opinion, the privatised doctors had got it right and the tribunals had got it wrong. However, because tribunals ask questions which should have been, but were not, asked during hasty medicals they tend to discover more about the claimant’s disability than cash driven examining doctors do. The Professor didn’t explain – and wasn’t asked - how his “scientific method” took into account all the additional evidence given under cross examination at the tribunal to which he had no access

Instead, Professor Aylward argued that the reason for the difference in opinion between tribunals and privatised doctors was that the privatised doctors were better trained.

Undeserving poor
One of the MPs returned to this matter later, telling the Professor that he they needed to “cut out inappropriate payment” of benefits because “we want those who do not deserve the money not to be having taxpayers' money”. Why, he asked did this problem of poor training of tribunal doctors happen? “This obviously must be a persistent thing for you to make the point. Why has it persisted?”

Professor Aylward answered gravely that:

“I find difficulty in responding to that because I think this is a matter for the Appeals Service and not directly for me. I am working very closely with the president of the Appeals Service to ensure that difference is remedied, particularly in regard to the criteria which doctors now need to meet in order to remain on the medical register in the process of GMC revalidation”.

This was a very important claim. What the Professor was saying was that not only was there a problem with the training and validation of Appeals Service doctors, but it was clearly accepted that this was the case because Judge Harris, the president of the Appeals Service, was working with him to remedy the difference.

Alan Williams MP apparently now convinced that privatised doctors were getting it right and tribunals getting it wrong, went on to say that:

“Quite an important observation is being made here. It has implicit in it the fact that money is going to the wrong places or not going to the right places. It is lots of public money. If the professor has observed this, have you fed it into the system? If so, at what level have you fed it in?”

Professor Aylward responded:

“I fed it in at the highest level. I fed it in at the highest level in the Appeals Service. I have made my colleagues in DWP aware of it recently. It is not something which one concludes without some quite significant data research and evidence, so I have only recently reached this conclusion”.

By the end of the hearing, so convinced did the committee appear to be by the evidence of the Professor that Alan Williams was talking about the possibility of finding “a pot of money” to improve the training of Appeals Service doctors

Absent minded professor
Here at Benefits and Work we were very concerned at the possibility that one party to the appeals process appeared to be in a position to influence the President of the Appeals Service and possibly persuade him that his doctors should be trained by a privatised company in order to reduce the number of claimants winning appeals.

At the time there was nothing much we could do about it. But with the introduction of the Freedom of Information Act we finally had our chance. So we made a request to see copies of any communications between Professor Aylward and the Appeals Service, relating to such things as panel members training, monitoring, quality assurance, and the criteria members need to meet to be selected. That, we thought, should get us a fine haul of documents.

We were wrong.

Instead, we received a response from Professor Aylward CB stating that:

“In response to your request for information, I have not personally written to Judge Harris or anyone else within or connected to the Appeals Service on any of the four listed topics in the period from January 2003. Therefore I do not hold any such communications on the specified matter.”

Odd, we thought. Still, perhaps he’s one of those absent minded Professors. Maybe, if we remind him what he told the Public Accounts Committee we’ll have better luck. So we made a further request, quoting in detail from the Professor’s evidence and asking for information about such things as the work the Professor had undertaken with Judge Harris and any documents relating to it.

What we got back was another email from the Professor himself, stating that:

“In response to your requests for information as listed in your email of 4 April 2005, I have no documents or communications as it is not within my roles and responsibilities to be involved in the training, quality assurance and management of the medically qualified panel members of the tribunals. This is a matter for the Appeals Service judiciary. The limited feedback I have given to the Appeals Service has been given verbally. The appeals service has been offered full use of training modules undertaken by examining doctors in Atos Origin Medical Services”.

We were astonished. Hadn’t he told the committee that he was “working very closely with the President of the Appeals Service”? Had he not fed his conclusions, based on all that magnificent scientific method, data research and evidence in at the highest level of the Appeals Service? Well . . . umm, not exactly no. What he’d done is give “limited feedback” verbally.

Nothing to do with me, guv
We wrote to the Professor, explaining that we were going to write about his evidence and asking for any comment he might have on what we considered was the apparent disparity between his evidence to the Public Accounts Committee that he was working very closely with Judge Harris and his statement to us that he had given only limited verbal feedback. We pointed out that

“Given that the potential effect of your evidence appeared to be the undermining of MPs faith in the judgements of Appeals Service doctors and the boosting of their confidence in Atos Origin doctors this seems an extremely important matter”.

The Professor responded thus:

“I do not accept that my statement to the Public Accounts Committee is at variance with my subsequent communication with the President of Appeal Tribunals having been verbal and not written”.

Perhaps not. But is there really no difference between “working closely with” the President of the Appeals Service and giving “limited feedback” to the Appeals Service? Professor Aylward CB went on to say:

“I repeat that this issue of training and quality assurance of tribunal members is a matter for the Appeals Service Judiciary”.

Quite so. And the issue of whether or not the Chief Adisor at Medical Services misled a commons committee is a matter for that committee and not for us. We are writing to our MP asking that he refer the matter to the Public Accounts Committee and that the Professor’s evidence be further investigated.

Nice work if you can get it
This is not a small matter for two reasons.

Firstly, Professor Aylward CB’s evidence to the Committee carried with it the implication that a large number of disabled people are not only claiming money to which they are not entitled, but also that they are so good at giving false evidence that they can fool experienced tribunals into believing them.

Secondly, not long after the Committee hearing, the bidding process started for a contract for £500 million of taxpayers money to carry out DLA and incapacity benefit medicals for a further seven years. Schlumberger Sema, now swallowed up by Atos Origin, faced stiff competition from other multinationals hungry for this profitable work. The opinions of bodies like the Public Accounts Committee about present provision would have to be taken into account in deciding who should get the contract.

In March of this year it was announced that Atos Origin had held onto the contract.

Stupid doctors, wise professors
At the same time a new research centre was being set up at Cardiff University, funded by an American based multinational, Unum Provident, who provide sickness insurance cover to employers. The opening of the £1.6 million UnumProvident Centre for Psychosocial and Disability Research was attended by Works and Pensions minister Alan Johnson and Wales’ First Minister Rhoddri Morgan.

The aim of the centre is to find out why so many people go off sick with what it refers to as “complaints which cannot be understood in the same way as more identifiable diseases”. The kinds of conditions they have in mind are stress, depression and ME/CFS. The centre is particularly interested in “the doctor/patient relationship and how this affects an individual’s reaction to their illness”. The centre aims, within the next five years, to “facilitate a significant re-orientation in current medical practise in the UK” in order to “bring benefits to employers, insurers and to society as a whole; but more importantly, it will benefit the individual who is healthier and happier when actively involved in work."

Or, to put it another way, the research centre hopes to persuade GPs to stop signing so many people off sick with conditions like stress, depression and ME.

And the person who is to head this new centre, bringing increased wealth to UnumProvident shareholders and big savings to the DWP?

Step forward Professor Mansel Aylward CB, former Chief Medical Officer at the DWP, recently appointed Chair in Psychosocial and Disability Research at Cardiff University and now Director of the UnumProvident Centre for Psychosocial and Disability Research. And those of you with less ”identifiable diseases” rejoice: within five years the Professor of Limited Feedback will have you healthier, happier and back at work.