asked the Minister for Social Welfare the criteria which are set by his Department for the conduct of medical examinations by his Department's referees; and if he has any plans in this regard.
34.
Ceisteanna — Questions. Oral Answers. - Medical Examinations.
42.
asked the Minister for Social Welfare whether he has established guidelines in relation to the conduct of medical examination by medical referees; and whether he has satisfied himself that these guidelines are being fully observed.
I propose to take Priority Question No. 42 and Question No. 34 together.
Medical referee examinations provide additional medical opinions on those claiming benefit in respect of incapacity for work.
Detailed guidelines are issued by the Department to all doctors who participate in the medical certification scheme. The guidelines include full information on assessing and deciding incapacity for work as well as details of the medical referee system. The guidelines also govern medical referees in carrying out examination of claimants and review of their claims.
Medical referees are qualified medical practitioners. They are recruited by the Civil Service Commission and a condition of their appointment is that they must have at least six years experience in general medical practice.
Every effort is made to ensure that the interests to persons referred for medical referee examination are fully safeguarded. Their own certifiers are advised of the forthcoming examinations and invited to submit an appropriate medical report including references to any recent consultant examinations. In addition, it is open to a certifier to attend a medical referee examination if he or she so wishes.
In carrying out medical examinations, medical referees conform to the ethical conduct and behaviour guidelines of the Medical Council. All examinations are carried out in the presence of the official nurse and all reports of examinations are submitted to the Department's Medical Adviser.
I am satisfied that the medical referee system is operating in a fair and reasonable manner and that the relevant guidelines are being fully complied with.
It would not be my intention in any way to challenge the competence of the GPs who carry out these examinations but it seems that many women are being called in for medical examination at regular intervals; some have even been called to two or three medical examinations within a very short space of time. What worries me and what I ask the Minister to examine is that many people who are called for medical examination suffer from very serious complaints, a fact which can only be established through the attendance of a specialist or on the production of X-ray evidence and so forth. Is the Minister aware that his Department pay something like £33 towards the cost of bringing a consultant to an examination by a medical referee? I understand, and I have checked this out, that consultants are charging a fee of £133 to attend at a medical examination. Therefore, if a woman wishes to bring a consultant with her to a medical examination she would have to pay approximately £100 of her own money to do so. I would like the Minister to comment on that.
The Deputy spoke about women. Let me say that no distinctions are made. It is a question——
Has the Minister looked at his figures?
If one looks at the figures one will see that a higher percentage of women are called. People are not called at random but rather they are called on the type of illness they are suffering from. As the system is now computerised it is possible to call people suffering from a particular illness at particular times. They will be first called in for examination at the time when it would be expected that they would have recovered from that illness. In that sense the system is somewhat more efficient but when we come to those who are suffering from, say, back problems and so on for years you happen to have a Minister who is very sympathetic towards those suffering from back problems — because I know a good deal about them——
So do I.
By and large the system works quite well. There are some cases where I know I would not have agreed with the decisions made but in that respect there is the appeals system, and there is a second medical referee. As regards the question on the fees charged by a specialist, it is not necessary for a specialist to attend. The submission of a report would be adequate. A person's own doctor should be able to provide all that is required but I agree that in some cases it is necessary to bring along a specialist. This is a question which I will take another look at to see if there is another way in which we can deal with this matter.