Vol. 415 No. 2
9 Mr. M. Higgins asked the Minister for Social Welfare if his attention has been drawn to the difficulties experienced by old age pensioners arising from the limited availability of black and white television sets and the difficulty in having such sets serviced; and if in view of this he will consider changing the free TV licence to cover colour televisions.
A person who satisfies the conditions for receipt of a free electricity allowance or free natural gas allowance, i.e. living alone or with certain persons and in receipt of a social welfare pension, is entitled to an allowance towards a television licence. The allowance is fixed at the level of the licence fee for a black and white television set, namely £44. If a licence for a colour television set, which costs £62, is necessary, the difference in cost must be paid by the recipient.
I have no plans at present to increase the allowance to cover the cost of a colour television licence. To do so would cost an estimated additional £3 million per annum and would have to be considered in the context of other priorities for expenditure in the social welfare area.
I wish to ask two very brief supplementaries. Would the Minister agree in principle that at the end of the 20th century the idea of an inspector calling to elderly persons who have qualified for a free television licence to check whether their television is colour or black and white and whether they have the right licence smacks of the poor law? To resolve this difficulty would the Minister be willing to have talks with those who administer the licence fee to see if the benefit can be extended to cover colour television sets? It might be possible to extend the service at a negotiated sum of less than £3 million.
We are anxious to ensure that in so far as we can we target the available resources to those most in need of them. In view of the representations of Deputy Michael D. Higgins I will certainly have this matter examined. Perhaps we could have negotiations with the licensing authorities with a view to making arrangements to extend the service. I will ask my Department officials to talk to the people in An Post and in the Department of Communications to see if some provision can be made in that regard.
I am very grateful for the Minister's positive reply. I would also draw his attention to the fact that because elderly people rely on black and white television sets they buy more second hand television sets which break down more frequently and that there is a problem about the regular technical assistance that is required. I would appreciate if, in making representations to An Post and the Department concerned, the Minister would bear in mind that what is being subsidised is a service that will become increasingly difficult to avail of.
When this service was introduced the non-contributory old age pension was about £66 a week, and it is now over £80 a week. From my experience, most people who avail of the free licence have colour television sets and pay the additional £18 for the licence. However in the context of the review which I have undertaken in conjunction with the Department of Communications, we will consider the matter and see if it is possible to bridge the gap.
In the interim I would recommend to elderly people that when the inspector calls they turn down the colour on the television set.
10 Mr. Connor asked the Minister for Social Welfare if he will outline using figures in respect of (1) 1988, (2) 1989 and (3) 1990 (a) the details of the number of recipients of disability benefit who were examined by his Department's medical referees, (b) the number of recipients found fit for work as a result of these examinations and (c) the number of disqualified recipients who, on appeal, had benefit restored by the appeals office; his views on whether the referee system is flawed and is seen by many as merely a disqualification and money-saving procedure used by his Department; and if he will make a statement on the matter.
Examinations by medical referees of disability benefit claimants, including persons receiving occupational injuries benefit are as detailed on the tabular statement circulated in the report. There is a difference between the number of examinations arranged and actually conducted and this results from three main factors. Some persons simply fail to attend and benefit is suspended unless they explain the non-attendance. Others are certified by their GPs as unfit to attend. The balance submit medical certificates indicating that they have resumed work.
Precise figures on the numbers of appellants who have their disability benefit restored, solely on the grounds of incapacity, by an appeals officer are not available for the years in question. However, it is estimated by the independent social welfare appeals office that approximately 45 per cent of the disability benefit cases determined by appeals officers have their appeals allowed. The administration and control of the disability benefit scheme requires, inter alia, evidence of incapacity on the part of each claimant. This is provided in the first instance by the claimant's own doctor. The Department's medical referee system provides a second medical opinion on the level of incapacity which, in some cases, may have altered in the interim. It is also used to provide evidence on the extent of incapacity after some time.
In carrying out examinations, the medical referee reviews the history of the case including the initial diagnosis already made by the person's own medical practitioner, considers any fresh reports received and expresses an opinion based on the results of his or her medical examination of the claimant. It is open to the claimant's own medical practitioner to attend a medical referee examination if he or she so wishes. If, following examination by a medical referee, payment of disability benefit is disallowed because the person is not regarded as incapable of work, he or she may appeal the case to the independent social welfare appeals office. In these circumstances, the normal procedure is to first refer the case to a different medical referee to carry out a further examination of the person.
I am satisfied that the medical referee examination system works in a satisfactory manner. The role of the medical referees is to provide my Department's deciding officers and appeals officers with advice on matters about which they have professional expertise. I believe they do this in a conscientious and impartial manner. I reject any suggestion that medical referees compromise their professional judgments to save expenditure. The system is a balanced one where every opportunity is afforded to claimants to present the facts of their case.
|
Year |
Examination Arranged |
Examinations Actually Conducted |
Capable Result |
|
1988 |
91,212 |
67,738 |
23,495 |
|
1989 |
86,410 |
65,228 |
21,345 |
|
1990 |
66,381 |
50,848 |
13,721 |
It is pity we do not have that information before us. The Minister imparted a great deal of superfluous information but the point that amazed me is that 45 per cent of those whose claims for disability benefit are disallowed by a medical referee have their benefit restored on appeal to an appeals officer. Does the Minister agree that this is an extraordinary figure? The content of my question is correct because many people see the referral to a medical referee as a device used by the Department as a cost-cutting exercise. I do not wish to reflect on the qualifications of medical referees but will the Minister tell us the additional qualifications a doctor must have before being appointed a medical referee?
Medical referees are required to be medical practitioners who are registered in the general register of medical practitioners while holding an appointment. Medical referees must have at least six years satisfactory experience in the practise of medicine since registration or provisional registration, as the case may be. They must otherwise possess the requisite knowledge and ability, including ability to communicate effectively, to be suitable for discharging the duties of the position. Among the medical referees, there is a consultant physician, a consultant occupational physician, a doctor with a masters degree in physiotherapy and 11 referees are members of the Society of Occupational Medicine. Two medical referees hold a diploma in occupational health and another is currently studying for that diploma.
Most of the medical referees have been senior house registrars and have worked at junior consultant level. Most have considerable experience in general practice and some are also members of the College of General Practitioners. In the circumstances medical referees are considered fully qualified to assess all types of illness.
The position of medical referee is whole-time and the officer may not engage in private practice or be connected with any outside business which would interfere with the performance of his or her official duties.
The system of reviewing claims by medical referees is operated in agreement with the representatives of the medical profession. Generally medical referees are highly qualified and are quite capable of doing their work. They decide each case on the basis of an examination and there is no question of financial considerations.
A number of Deputies are offering. I call Deputy Connor and perhaps he will be brief.
It sounds impressive that so many of the medical referees have occupational injury training. However, is there not something fundamentally and radically wrong with the system when they get it wrong 45 per cent of the time, indeed almost half the time? If only for that reason does not the instruction given to them by the Department need to be reviewed?
I do not accept that. The Deputy knows as well as I that circumstances change and a person's health may change between the time the matter is first decided, the date of the appeal and the date of the examination. I am not going to go into this point other than to say that it seems the present system is adequate. The staff have the professional qualifications to do the job. Allegations are made from time to time that the medical referees do not accept consultants reports but this is not true. They take the consultant's report into consideration during the examination of the claimant.
The figure the Minister gave of a 45 per cent success rate on appeal is extraordinary. Is the Minister aware — as I am sure he is — of the constant complaints from sick people who go before medical referees about their extremely bad manners and the way they are treated. People also complain about the superficial examinations that are carried out. People who are under the medical care of a consultant may be disqualified from benefit by a medical referee who has not examined them adequately. I do not mind reflecting on the professional performance when I see that 45 per cent of their decisions are wrong.
I will give a further indication of the way this is dealt with so that Deputies will not be under any misapprehension about the system. The medical referee staff consists of a medical adviser, a deputy medical adviser, an assistant deputy adviser and 19 medical referees who carry out medical examinations. Examinations are carried out in rotation at 70 centres throughout the country. The medical referees give a second medical opinion which assists the Department's deciding officers. When a medical referee is conducting an examination, he is not making an initial diagnosis but will be confirming or otherwise the diagnosis of the person's general practitioner and giving a second assessment of the person's incapacity at that time on whether the person is able to work.
I am not certain that Deputies can read anything specific into the 45 per cent success rate of appeals.
In 45 per cent of the cases that were appealed, the doctors were wrong.
It was suggested that the Department use the system as a cost saving exercise. That is inaccurate and I refute it.
Every time this matter comes up in the House, everybody wants to speak because we have all come across relevant cases. I have seen some remarkable cases. It is very hard to understand how people who could hardly walk out from the examination by the medical referee could be disqualified from benefit. I could not understand that. We know that doctors differ. Are there arrangements in place to ensure that doctors are consistent in their approach. It appears that there is a world of difference between the decision of one medical referee and another.
I am not certain that one can adopt an overall consistent approach in this. Each case is judged on its merits and each applicant has to be examined. Each claimant is examined on foot of a certificate from his general practitioner. I am not certain that we could adopt a broad overall arrangement. That is not the way to conduct this business. Claimants with problems have to be dealt with sensitively, in a professional and individual way.
In response to Deputy Stagg, I would be appalled if claimants were not treated in the proper fashion. Recently I dealt with a similar problem in relation to people making claims for unemployment assistance or benefit. I wish to assure the House that the staff of my Department must deal with people in a caring, sensitive and professional manner. I will not tolerate any suggestion that they are doing otherwise.
I am not happy with the Minister's reply. It is extremely disturbing that 45 per cent of those disqualified from disability benefit have subsequently been found to be legitimate claimants. I want to question the Minister sincerely. Are the Department pursuing a policy of intimidation, especially intimidation of housewives, in order to drive them off the disability benefit scheme? I was absolutely horrified to learn that a woman who was disqualified in November and subsequently had her benefit restored was called to appear before another medical referee in January of this year. Will the Minister assure me that this male dominated medical profession are not discriminating against women and that it is not Department policy to try to intimidate married women in particular to go back to work by disqualifying them from disability benefit? Would the Minister be kind enough to give me a gender breakdown of the 45 per cent of successful claimants?
I do not have that information with me, but I am sure it is within the Department and, if so, I shall communicate it to the Deputy.
Thank you, I would appreciate that.
I wish to make it quite clear that I absolutely reject any suggestions of a policy of discrimination against women. I would not tolerate such a policy. The Department would not entertain such a policy, nor is discrimination carried out. Discrimination against women is not my policy, it never has been and it never will be.
The case in question was referred by the appeal system. I could show the Minister that women suffering from psychological difficulties, from panic attacks and other related psychological illnesses, have been dismissed and told they are fit for work when in fact they are not.
Let us have an orderly Question Time.
Psychiatrists can back up those cases.
Deputy Byrne should rise in his place and be recognised by the Chair before asking a question.
If Deputy Byrne has any particular instances of discrimination — indeed, if any Member of the House knows of such instances — I shall be very glad to have them thoroughly investigated and shall communicate directly back to the Deputy within a reasonable time.
The beauty of the system is that the Department of Social Welfare appeals procedure has not come to our rescue.
I am calling Deputy Browne (Carlow-Kilkenny).
That indicator of 45 per cent should not be removed.
Please, Deputy Byrne, desist.
I am saying that I blame the Minister's Department.
(Carlow-Kilkenny): Would the Minister seriously consider undertaking a review of the system of medical referees visiting country areas? When a person is accepted two years after being first rejected, despite the fact that she has been in hospital and received two years' treatment, as being unfit for work surely there is something wrong with the system that declared her fit for work two years previously, before she received any treatment? When a person is cut off from the invalidity benefit after eight years, put back on disability allowance and then, on appeal, put back on the invalidity benefit, surely there is something wrong. At one stage I asked that medical referees be taken out into the Atlantic and told to swim for shore. On mature reflection, it is the system that is wrong. Medical referees cannot go down to the country with a briefcase, go into a barren room and become experts. Previous statements are so true. It is not possible for medical referees to analyse and determine a condition, while sitting opposite a claimant, when experts at top-class hospitals have previously differed.
I am afraid that this matter cannot be debated now.
As I said earlier, each case is an individual case in its own right and must be dealt with on that basis. As I have said, if there are particular cases or individual claims about which Deputies have a grievance or a complaint, then if I am provided with the details they will be thoroughly investigated, and reported back to the House.
Would the Minister agree that the system of medical examination in some way casts aspersions on ordinary medical practitioners who have already certified that a person is not fit to work? The fact that the opinion of the medical practitioner is doubted and claimants are put through another procedure surely casts some aspersion on the medical profession. If that is not so, could the Minister say why medical inspectors and referees refuse to accept additional documentary evidence on the day of an examination? Medical referees do not seem to be interested in that evidence at all. As Deputy Browne says, medical referees go in to a room that has no facilities to enable them to carry out proper and adequate examination and then they make decisions based on their files without even looking at up-to-date evidence.
I welcome the Minister's assurance that he will make sure that medical examiners from his Department do not treat people unfairly or rudely, because that has happened. The Minister's most recent assurance in relation to unemployment assistance worked miracles — everyone sat up an did their business in the way that we, and the Minister, would expect them to do it.
Let us make progress on other questions.
Obviously, I shall deal thoroughly with any complaints received. I give that assurance here. What I do not want to hear are widespread general comments such as the comment that medical examiners do not examine documents. They do examine consultant's documents fully; I have been assured that that is so.
Not if they are handed in on the day people attend; they look at the file.
If Deputies give me an opportunity to consider the position thoroughly in the light of what has already been said in the House, and further questions, then I shall come back to the House and discuss the issue later.
Fair enough.
I shall certainly take a special interest in the issue now in view of what has been said by Deputies, comments which I take seriously. I give a further assurance that I will not tolerate rudeness or abuse to the public, especially when people are at their most vulnerable in that they suffer from disability or illness.
12 Mr. Connaughton asked the Minister for Social Welfare if he will outline the difference in money terms between the rates of social welfare currently paid to a married couple with no children on long term unemployment assistance and the rate of social welfare proposed by the Commission on Social Welfare for the same couple on similar assistance.
The Commission on Social Welfare recommended a priority rate of £45 and a main rate of £50 in 1985 terms. In 1992 terms these rates are equivalent to £56.50 and £62.80. The Commission recommended that an adult dependant should receive 60 per cent of the personal rate. In 1992 terms, then, the recommended rate for a couple would be £90.40 at the priority rate and £100.50 at the main rate.
The increases in the weekly rates of social welfare payments announced yesterday will increase the long term unemployment assistance rate to £57.20 and the adult dependant rate to £34.30, giving a total payment of £91.50 for a couple from next July. I am glad to be able to emphasise to Deputies that this rate is ahead of the priority rate recommended by the Commission on Social Welfare.
I understand that following yesterday's budget increase the rate of short term unemployment assistance for a couple with three children will be £124 a week. I ask the Minister a straight, personal question: could he live on and support three children seven days a week on £124 a week? Irrespective of the rates struck, I want to make a point that is being echoed all over the country by people on unemployment assistance, that it is very difficult to manage for seven days a week on £124. I do not want to labour the point now, but I do want to get the message across to the Minister that although it is very difficult to find the money to meet all social welfare payments — we all acknowledge that fact — it is certainly no fun for a man, his wife and their three children to live on £124 a week. I ask the Minister his opinion on the position.
I was asked a specific question by Deputy Connaughton and I have given him a specific answer. My answer shows that the specific rate of assistance is ahead of the priority rate recommended by the Commission on Social Welfare; that answers the question that I was asked. If Deputies want to go into a debate on social welfare benefits——
What is £124?
—— I will have an opportunity next week — as, I am sure, will the Deputy, if he has not availed of it already — to outline improvements made in social welfare this year.
Answer the question.
The cause of welfare recipients will not be advanced by Deputies making wild allegations such as those made by the Deputy on numerous occasions, including those made just before Christmas, which completely misrepresented——
No.
——what I was endeavouring to do. The Deputy is out of line with his own party's policy in that regard.
No, could the Minister live on £124?
If Deputies want a debate on the subject then I will join in it at any time.
Could you live on £124?
The Deputy asked me a specific question and I gave him a specific, reasonable and fair answer. The Deputy cannot have it both ways.
Minister, you have sidestepped.
I ask the Minister to make clear to the House the difference between the priority rate recommended by the Commission on Social Welfare, which he referred to, which was a rate recommended by the commission for immediate emergency implementation, and the rate referred to in the question, which is a much higher rate and is the rate recommended by the Commission on Social Welfare as the desirable rate that should be attained. Could the Minister confirm that the priority rate to which he referred was in fact an emergency rating?
That is a more sensible approach. There is a difference of £9 when the rate is compared with the main rate recommended by the commission. As is stated in the Programme for Economic and Social Progress, there is a Government commitment to the achievement of the recommended main rate as the resources and the economy grow. That is a firm commitment and one that will be maintained and undertaken.
The Minister is really playing with words.
I am not playing with words — they are facts and figures.
The Minister is playing around with words. He stands in the House to tell us that the Government are on target with the recommendations of the Commission on Social Welfare. The Minister has taken a cursory glance at the document containing those recommendations, which was published in 1986 — six years ago — and compares the rates as recommended. What about the priority rates that the Minister says have been achieved? The unemployment benefit is £53 today, that is £10 less than the priority rate recommended by the Commission on Social Welfare.
I gave the Deputy the actual figures in 1992 terms.
At today's rates a couple in receipt of the unemployment benefit get £87.30, thanks to yesterday's budget. The priority rates today should be £14.70 more than that to reach the priority rates stipulated six years ago. In other words, the Minister is six years or, put another way, is £14.70 per week behind in so far as the treatment of couples in this context is concerned. The Minister has not got anywhere near the priority rates.
I want to help the Deputy elicit information but he is giving a lot of information rather than seeking it.
That is correct.
That is not in order now, Deputy.
14 Mr. Durkan asked the Minister for Social Welfare if he has any plans to reduce the qualifying age for receipt of old age pension; if he will outline the cost in a single year if there was a reduction to 60; and if he will make a statement on the matter.
Social welfare retirement pension is payable at age 65 and old age pensions contributory and non-contributory are payable at age 66.
The net cost of the reduction of the pension age by one year is estimated to be in the order of £30 million in a full year. On this basis the cost of reducing the pension age to 60 could be as high as £180 million per year.
The question of pension age is one of the issues being addressed by the National Pensions Board in the context of their final report on the future development of pensions generally. I expect to receive the board's recommendations shortly.
Would the Minister not accept that perhaps the figures he has given are somewhat misleading, although perhaps not deliberately if he takes into account the pre-retirement pensions which are in operation and the number of people in that age group who might be unemployed? Would the Minister not consider it expedient now to have an immediate look at the situation with a view to determining whether or not it might be better to award these people old age pensions?
I will give the Deputy a breakdown of the figures. The additional cost of the pensions — and one would have to include the free schemes as well — would be roughly £37.4 million. These are the figures I have from the Department. The loss of PRSI contributions and tax revenue would be about £4.6 million. There would be savings then under the other social welfare schemes of roughly £13.5 million. The estimated total cost would be about £30 million. On that basis we are talking about £180 million reduced to £60 million. When I get the report of the National Pensions Board I will make it available here and we can consider it.
As a major reduction in the qualifying age for old age pensions has not taken place since the early seventies, would the Minister not agree that it is now time to look urgently at the situation, notwithstanding the figures he has given? Would the Minister not accept that there is further latitude within those figures? The figures do not appear to add up, as far as I am concerned.
There has been an element of cost in every question that arose here today relating to pensions, assistance or allowances. I have endeavoured over the last few months to measure the available resources and target them to the people who need them most. In this case roughly £30 million is involved and, in view of the fact that the whole issue is being addressed by the National Pensions Board, whose report should be available fairly soon, I would prefer not to make any commitment here until I see their findings and recommendations. We can then decide on how to proceed.
Would the Minister agree that there is not a widespread demand for a reduction in the pension age to 60, that many people in that age bracket would not want to be forced into retirement, and that many people of that age have a continuing useful contribution to make in their jobs? We do not have any better example than of those in this House.
That is the other side of the issue. We would be well advised to await the recommendations of the professional people who have been engaged to consider this whole matter.
Surely the Members of the House and the Minister must know that qualification for contributory old age pensions does not necessarily mean retirement?
I absolutely agree with that.
