Desarrollo de Conocimientos y Capacidades para un Desarrollo Sustentable del Turismo

for incapacity benefit

In the last part of the research interviews tribunal members were asked to reflect on the pilot and the standard arrangements for collecting GP information and invited to offer views on whether it would be better to base future arrangements on one or the other. The respondents used several different points of reference in exploring how medical evidence gathering might develop in future, including:

• earlier discussion comparing the pilot and standard arrangements, • views about the work of GPs and their dealings with their patients,

• the structure of incapacity benefit and current decision making arrangements. There was a general recognition that the standard arrangements, based around the IB113 form, were sound in principle. However, rarely was high quality information produced. The principal reasons for this shortcoming suggested by tribunal members interviewed included:

• GPs worked under severe time pressure which led some to fill in the forms superficially, or not complete them at all,

• some GPs were antipathetic to providing DWP with information, particularly where there was a perception that they received no payment for providing these reports,

• the design of the form encouraged superficial answers by using phrases such as ‘give brief details’,

• IB113 forms sometimes contained opinions that were not backed by clinical findings,

• GP information might not be impartial.

Ideas for improvement included reforming the system of payment for GPs, so that GPs received a direct ‘item of service’ payment for completing a report. This could possibly be linked to some form of quality control so that only adequately completed forms would attract payment. Some doubt was expressed however over whether direct payments would change the behaviour of GPs who were either reluctant or too busy to complete the forms.

There were some suggestions for redesigning the IB113 form to encourage fuller clinical information and to elicit more information about functionality. However, there were doubts expressed by some respondents about whether functional data would be impartial. There were also divergent views on whether IB113 forms would be better if GPs called the claimant in for a consultation before completing the form. One view was that the quality of the forms would increase as a result, but an opposing view was that impartiality could be compromised if a GP and claimant effectively negotiated and agreed responses.

Tribunal members reflected on the types of information that they found useful and reflected on how this might be obtained. Included here for example were hospital consultant letters, X-ray and MRI scan reports, physiotherapy reports, and psychiatric reports from doctors or community psychiatric nurses. Drawing on their current experience of IB113 forms some thought that the pilot arrangements were more likely to generate this kind of information.

Although spontaneous recall of cases involving SB2 forms was limited the tribunal members interviewed were generally positive about their potential. Some respondents said they would prefer the pilot arrangements to replace the current arrangements in the future. Others’ preference was to make efforts to improve completion and quality of IB113 forms from GPs, but these also viewed the SB2 arrangements as a viable alternative.

Preference for the pilot arrangements was explained in a number of ways:

• information extracted from GP medical records was more likely to be impartial, • medical evidence would be available on all cases,

• objective clinical information was preferable to opinion unsupported by clinical findings,

• good clinical information could be an indicator of functionality also, • the burden of paperwork for GPs would be reduced.

As mentioned earlier, there was a view that the pilot arrangements were dependent on GP medical records being of a high standard, and on the skills and judgment of the medical officers in the Leeds Medical Services Centre extracting the information on to SB2 forms. It was recognised that the former was not within the direct influence of DWP, but that the latter was, through training and monitoring procedures. One innovative suggestion was that the CD containing the scanned contents of the GP records could be made available to the tribunal in place of the SB2 form. This would circumvent the possibility that some relevant GP information was overlooked in the extracting process.

3.7 Summary

The essential role of tribunal members is to assess the evidence available to them, make judgments about what constitutes the facts of each case, and apply the appropriate legislation in order to reach a decision. Tribunal members explained that they have to carry this out using the evidence in the appeal papers and, in oral hearings, with the verbal evidence of the appellant and his or her representatives. They must not physically examine appellants, but only ask them questions.

Broadly speaking the decision making process for incapacity benefit that has been in operation since 1995, was, designed to generate objective clinical data and, where required, information on functionality. However, the findings from the interviews with tribunal members is that, in practice, tribunals have to accomplish their task with varying amounts of medical evidence, which can also vary in terms of its quality and reliability. Improving the flow and quality of clinical data from GPs and other health professionals was seen as highly desirable, whether through changes to the existing arrangements or by introducing new arrangements such as those tested in the pilot.