Minutes of the Countess of Mar’s ForwardME meeting of 26 January are now available.
They include notes from a presentation by Dr Jane Rayner, Chief Medical Member of social security tribunals
The following is an extract from the minutes:
[Dr Rayner] told the Group that the tribunal service was part of the court service, was neutral and was independent of the Department for Work and Pensions (DWP). As 50% of decisions were overturned, she felt it would be helpful to ascertain why people were deterred from appealing.
Dr Rayner was employed to set up and oversee an appraisal and training system for all the medical members who sit on social security tribunals. Doctors in the Social Entitlement Chamber now have 3-yearly appraisals with a doctor and a judge.
When asked what training was given on difficult conditions such as M.E. Dr Rayner explained that once a year doctors in the chamber were given a self-appraisal questionnaire and asked to identify any training needs. Dr Rayner then devised training taking those needs into account. This year, for example, they were looking at chronic fatigue syndrome and chronic pain.
She was asked whether it was possible for doctors in the chamber to specialise. Dr Rayner said that this was not necessary, as cases were not listed by diagnosis. Assessments were made on the basis of functional loss rather than diagnosis. However, she encouraged doctors to do background research if they were presented with a case involving a diagnosis with which they were not familiar.
Dr Rayner confirmed that the service was given feedback on complaints and that they were taken seriously.
Dr Rayner was asked whether doctors should express their reservations about the validity of a diagnosis of M.E. She said that she could not comment on DWP doctors, as they belong to a separate organisation, however she would take reports of tribunal doctors making disparaging remarks very seriously.
When asked about the complaints procedure, Dr Rayner said that the claimant should write to the regional judge. There was a robust complaints procedure. In many regions the hearings were recorded so that they could be referred to. She was unsure whether it was also possible to complain via the website. [A list of Regional Judges’ addresses is available by calling Action for M.E.’s Welfare Rights line - 0845 122 8648].
Dr Rayner said that she had met Professor Malcolm Harrington [author of an independent review of the work capability assessment) and she had told him that sometimes, when she read a report, she had an image of an individual in her mind but when they appeared before her the person bore no resemblance to the person portrayed in the report and that it was as if the report had been written by somebody completely different. She had also encountered cases where examining doctors had insisted that the claimant sign their medical report without having been allowed to see it.
After being told that most people with chronic conditions want to concentrate on the things they are able to do and found it very hard to describe what they could not do, some of which they found embarrassing to describe, Dr Rayner said that people must leave the tribunals procedure with their dignity intact. They were exercising their right to an appeal and the tribunals system should act as a safety net for those who have been incorrectly assessed.
Dr Rayner was asked whether the system was coping with its current workload, and whether it would cope in the future as claimants were migrated from incapacity benefit to employment and support allowance (ESA)
Dr Rayner replied they were not currently coping which was why they have just appointed 200 new doctors. Their workload had increased. They used to work at 250,000 appeals a year. That had now risen to 500,000 appeals a year following the introduction of ESA.
Dr Rayner said that she was concerned about the internal review of descriptors. Having looked at the proposals for the new descriptors, she wondered who would qualify for ESA. The importance of evaluating not just whether someone could perform an activity, but whether they could sustain this level of activity over time was stressed. The importance of getting decisions right in the first instance in order to reduce the number of appeals and to save money was also stressed.
Dr Rayner referred to the chamber’s president’s report, which stated that the most common reason for overturning a decision is additional evidence: most commonly verbal evidence from the claimant.
When asked whether there were any specific concerns about Atos reports Dr Rayner said not, although they did struggle with the standard of some of the medical reports. Some of the recorded information was untrue and claimants denied making some statements.
It was agreed that, when people complained, they often did it in the hope that it would prevent the same thing happening to someone else. It would be an incentive to people to report problems if they felt that they could influence the process.
When asked whether feedback forums could be held between members of the chamber and patient groups, Dr Rayner said that it would be difficult to maintain judicial independence. Doctors were bound by the rules laid down by Parliament and could not use clinical judgement. The DWP had complained that the tribunal service had become part of the benefits culture and needed to be reminded that work is actually beneficial to most people. Her personal view was that it would be helpful for doctors in the Chamber to be allowed to exercise clinical judgement.