Dr Teck Khong, Candidate for
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
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.