I recall Margaret Thatcher once remarking when she saw just how many people were using the Health Service on a daily basis â€œ They canâ€™t all be illâ€. It was an important observation, but not one that led us to any easy conclusion about what you could do when offering a free service to discourage people from frivolous use, especially when there is always the risk minor symptoms concealed a darker problem which did need medical intervention. We erred on the side of caution, true to the principles of free provision, and allowed people the service even when it turned out they were not ill.
Today a well paid and doubtless able bodied government adviser has asserted that as many as two thirds of those on invalidity benefit should not be. He has said in public about the most vulnerable in our society that they cannot all be ill, when they have been through medical examinations which have confirmed that they are disabled and deserve financial support. In support of his argument he suggests that GPs assess them as incapacitated as the easy way out. He calls this inevitable given the GPsâ€™ conflict of interest.
MPs, like GPs, hold surgeries. Sometimes we see the same people. The long term incapacitated may well come to see the MP for help with the benefits side, having seen the GP to confirm they are sufficiently disabled to qualify. Some people who are depressed, lonely, unhappy, will see both the GP, who may tell them politely they have no physical illness, and the MP, who may explain patiently they have no problem with government. We both have the advantage that we are free at the point of use, and should be sympathetic.
I therefore understand something of the dynamics of the GP-patient relationship. The government requires GPs to move their patients through the consultations quickly â€“ usually offering less time than an MP does. If you wish to encourage quick through-put it would be best to agree with what the person tells you. Querying their view of their symptoms (GP) or government problem (MP) will obviously slow things down. Suggesting they are not ill would take longer, as it would probably lead to sharp exchanges and some redefinition of the symptoms to seek the support and understanding the patient expected.
Furthermore, GPs tell me that people now are much more aware of their rights and of the complaints procedure. Make the mistake of upsetting a patient in the five minutes or so allotted, and the GP could have to devote hours to defending his or her conduct in the subsequent complaint if one is made. This too might encourage the GP to be more trusting of the patientsâ€™ claims.
The truth is the GP only has the word of the patient to go on concerning pain and other symptoms. If the patient says they have a very painful back there may be no visual evidence, and the GP may not be at liberty to watch how the patient moves when they are no longer acting the part of someone with a bad back if it has been fabricated. Much has to be taken on trust.
So can we believe the government adviser that two thirds of all these claims are wrong? I find that difficult to believe. Nor are there any easy answers. Within the large number of people who do claim disability benefit are many who are genuinely struggling because they have lost the use of limbs, have lost hearing or sight, or have problems with vital organs. They rely on their money from the taxpayers, and rightly so. We should not wish to worry them with the possibility that they might lose their benefits, or threaten them with yet more case conferences and medical investigations.
On the other hand, let us assume that there are some bogus claimants who have played the system. Let us suppose claiming a bad back is one of the ways this happens. It would be possible to review cases where there is a lack of additional proof of the disability. If someone has lost their legs it is easy to see that and no need for a further medical test, but if someone has a bad back it would be possible to ask for more tests to see if it has improved or if it was ever that bad.
This would, however, still pose the doctor a problem. Whilst the review could be carried out by a doctor who does not otherwise have to deal with the patient, making it easier to come to a negative conclusion, the doctor will still be subject to the same possibility of complaint by an aggressive claimant.
I find in life things work better if you persuade people to behave differently, rather than attempting to force them to. It may take more effort at the outset, but it may be easier in the long run.
Most of us have had a taste of incapacity at times in our lives. I have struggled with a broken right arm, and in my 30s had a phase of a sometimes very painful back that could leave me bent after stooping. The first condition made it impossible to drive and slowed me down doing many things, but it did not make me give up the job. I spent more money carrying it out, as I needed taxis or more public transport. The second condition did not stop me working at all â€“ indeed I found interesting work was a good therapy as it helped take the mind off the pain. It was easier for me than many who are disabled, both because I expected my disabilities would pass, and because they were not severe.
There are lessons to be learned, however, from this very imperfect glimpse into the world of disability. It should make us all very sympathetic to those who struggle with more severe conditions, knowing they will never get better. It should make us aware that more money helps, as they could then have more assistance of the kind they need. But it should also make us think that where possible we do want to help people into work, as work can be part of the therapy and part of a more rewarding life.
There are no easy answers. I feel sorry today for those who have great disabilities, who will feel threatened by incautious remarks. I do see that retesting some to see if they still have a disability is part of the answer. More importantly it needs staff with time and skill to go through each case with the person concerned and see what help we could pay for to get them into work, instead of spending all the money on keeping them at home out of work.
A big journey starts with a single step. More rigorous and more independent medical testing should be introduced for all new cases, and a compulsory discussion about how someone could be helped to stay in work or to gain work rather than automatically granting benefit for them being out of work would help. Why not start with a better system for new cases? If we find it works and many more do stay in work or take some kind of work, it should be used as well for many of the cases where disability is less obvious or where the people themselves volunteer for help in getting back to work. The Conservatives have pledged to stop paying benefit to people capable of work who refuse jobs. The government is gradually following.