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Dáil Éireann debate -
Thursday, 20 Oct 1994

Vol. 446 No. 2

Ceisteanna—Questions. Oral Answers. - Report on Medical Referee System.

Bernard Allen

Question:

1 Mr. Allen asked the Minister for Social Welfare his views on the recent report published by the Coolock Community Law Centre, Fit for Work - Who Decides; and if he intends to implement the recommendations of this report. [184/94]

Eamon Gilmore

Question:

23 Mr. Gilmore asked the Minister for Social Welfare if his attention has been drawn to the recent report entitled Fit for Work - Who Decides, prepared by the Coolock Community Law Centre, which describes the medical referee system as humiliating for people claiming sickness benefit; his response to the report; if he intends to introduce any changes in the system; and if he will make a statement on the matter. [1623/94]

I propose to take Questions Nos. 1 and 23 together.

I was very pleased to receive a copy of the Coolock Community Law Centre's report: Fit for Work — Who Decides. All of the reforms which I have made in the Social Welfare system over recent years have been aimed at making the service more client-orientated and user-friendly. This report will aid that process by its examination of the disability benefit service and, in particular, the decisions and appeals offices. Most importantly, the report has focused on the perception of clients of the Social Welfare system and the improvements which might be made. I have already written to the Coolock Community Law Centre and commended it for the detailed work which went into compiling the report.

The focus of the report has been on the need to improve the flow of information both within the Social Welfare Services Office and between the client and the office. The first of these is subject to ongoing review within my Department and the views expressed within the report will be considered as part of that process.

Better information for customers is an area which I am particularly keen to develop. This becomes particularly important with the increasing array of services which my Department provides and the development away from passive income maintenance programmes to a proactive and dynamic approach. In recent years, I have introduced a significant number of initiatives to bring about a much greater customer orientation and dynamism within the service. Those that are particularly relevant in the context of the Coolock Community Law Centre's report are as follows: I recently established a Decisions Advisory Office within my Department which will provide better information and advice to Social Welfare clients about how their entitlements are worked out under the social welfare law; the new office will provide advice and guidance to deciding officers who — although appointed by the Minister for Social Welfare — are independent in the exercise of their duties and responsibilities. The Office will put the principles of natural justice — one of the principal concerns of the report — at centre stage in improving information for the public. I am particularly keen to see the introduction of individual personalised letters for customers explaining decisions and how they were made in individual circumstances; in 1991, I established the independent Social Welfare Appeals Office which has surpassed all expectations in the success it has had. Appeals are now made directly to its director who is also the Chief Appeals Officer. In practice, this means that the appellant is in touch with the appeals office from the point at which the appeal is made up to the time when the decision issues. In establishing the Social Welfare Appeals Office it was my intention to retain and build on the strengths of the former system and to increase client confidence in the appeals process. I can confidently say that this has been achieved: as part of my Department's ongoing commitment to improving its service to clients, new payment methods have been introduced which improve the flexibility and userfriendliness of the administration of the system. As far as disability benefit is concerned, all those who have been in receipt of benefit for 12 months or more are now paid by order book cashable at their post office and are not required to submit weekly or monthly certificates of incapacity for work.

It goes without saying that any administrative system must be continuously reviewed and reformed to take account of experience gained and changes in needs. The medical referee system is also subject to such review.

The function of the medical referee is to provide a professional medical opinion for the deciding officer on whether the client's illness, as certified by their own doctor, renders them incapable of work.

In carrying out examinations, the medical referee reviews the history of the case, including the initial diagnosis already made by the person's medical practitioner, considers any fresh reports received and expresses an opinion based on the results of their medical examination of the client. It is open to the client's medical practitioner to attend a medical referee examination if they wish.

The serving medical referees are all highly qualified medical practitioners, many with specialist qualifications, including a consultant physician, a consultant occupational physician and a doctor with a masters degree in psychotherapy.

The medical referee examination system works well and the medical referees carry out their duties in a conscientious and impartial manner. The system is nonetheless kept under review to ensure that client needs are fully met and the report of the Coolock Community Law Centre will undoubtedly be helpful in this regard.

Like the Minister I commend the Coolock Community Law Centre and indeed FLAC who also highlighted the injustices of the appeal system relating to supplementary welfare. Will the Minister agree that the policy of appointing appeals officers from his Department alone creates the perception that the appeals office is not totally independent? Will he agree also that certain injustices remain in the system? Mr. Justice Henchy has commented on this system also. When appellants attend an oral hearing they are cross-examined and their representative is cross-examined but the medical referee or the deciding officer who made the original decision does not have to be present. Is that not an injustice? Will the Minister comment on the views of Mr. Justice Henchy on Regulation SI 344/90 where documentary evidence is accepted in the appeal system?

Will the Minister agree there should be an end to the practice where deciding officers are making decisions on issues about which they were not asked? For example, persons receiving disability benefit who are seeking invalidity pensions, are being examined and subsequently disbarred from receiving disability benefit. Again, I ask the Minister to comment on the Dominic Murphy v. the Minister for Social Welfare case which was heard by Mr. Justice Blayney in 1987. Despite——

That question should be adequate.

——Mr. Justice Blayney's comments, the practice continues.

On the question of appeals officers being appointed from the Department, they are civil servants carrying out work on behalf of the Oireachtas. A good knowledge of the legislation, is a basic requirement, and preferably a good knowledge of the workings of the system. As the Deputy will realise that is crucial because these cases require straightforward medical determination which does not reflect the work conditions or their practicality. To establish another system and bring people in from outside the Department would require new training and knowledge of the operations on the ground and that would require substantial funding apart from other considerations. I know from my experience that appeals officers act independently in their decisions. There is no criticism of them in that regard other than in individual cases.

That is what we are talking about — individual cases.

The system deals with approximately 55,000 cases per week and it is easy for someone to sit in judgment and say in some cases they would do things differently. What would such a person decide about the 55,000 cases the following week, the week after that and so on? We do not want to create a system that is enormously expensive. We have a good system but I agree with the Deputy that it needs to be modified. This report will be helpful. As regards having a medical referee examined at an oral hearing, the report is examined and the facts show that a substantial proportion of appeals are decided in favour of the appellant. The Deputy mentioned invalidity pensions. This is a difficult area because such pensions are given for life. In the legislation introduced last year we allowed for the quicker determination of cases such as cancer, heart conditions and so on. Effectively they can by-pass the system. The function of the recently established decisions advisory office is to improve the flow of decisions and it has already done that.

Almost half the time available to us for dealing with priority questions has been exhausted and we are still on Question No. 1.

That is true.

It is neither fair not equitable.

My question was reasonably short but the Minister's answer was reasonably long.

I am sure the Deputy will agree that what I said is the factual position.

We are beginning a new term and I hope the Minister will decide to answer the questions he is asked and not what he chooses to answer. When I spoke about invalidity pensions I did not speak about the rate of success——

Let us proceed by way of question, please.

What percentage of appeals are successful? Does the Minister agree there is a perception that the appeals system is unjust and unbalanced? We are talking about individuals. How can the Minister justify a one-eyed man in Cork being disallowed invalidity pension despite the fact that he was fired by his employer?

I ask for brevity. An inordinate amount of time has been devoted to this question.

How can he explain the fact that a woman in a wheelchair has been disallowed disability benefit if the system is as fair as he states?

The system is simple, flexible and administratively good. Some people suggest we should have a legalistic system but I do not think that would be workable from the point of view of the customer.

We need a fair system.

The Deputy asked the percentage of appeals in favour of appellants. That information is included in the annual report but it is between 45 per cent and 50 per cent.

In a previous answer the Minister said it was a majority.

They are small numbers compared to the total.

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