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I would like to comment on some of the points made in the editorial by Dr Frank and Dr Sawney (November 2003 JRSM1). It seems to me that vocational rehabilitation will fail unless stricter criteria are set for eligibility for some of the disability allowances. I am a rheumatologist and regularly sit as a medical member on the Appeal Service Tribunals for Disability Living Allowance (DLA). I am also involved in medical appeals for Industrial Injury and the Severe Disablement Allowance.
Applying the 'top-down' policies where they impact on the Appeals Service as presently organized is ineffective. DLA is based on self-assessment of disability, although additional evidence is taken from the appellant's general practitioner and/or an assessment from a doctor from the Ministry for Work and Pensions. The appellant fills in a form which is full of direct questions, such as 'do you stumble or fall', 'do you feel dizzy', frequently bringing positive answers in people without the medical conditions which cause these symptoms.
In addition, certain criteria need to be fulfilled to obtain the allowance. For the lowest care component, one has to be unable to prepare and cook a meal for one person. This is clearly out of date, as many people under the age of forty do not cook; they buy fast food, or eat sandwiches. Important cultural differences are also not taken into account; men from some ethnic minorities will not cook for themselves if their wife or a female relative is there to do it for them.
The mobility component also lends itself to misinterpretation. For the higher mobility allowance the appellant should be 'virtually unable to walk'. In the eye of the law this means unable to walk more than 50–100 yards before severe discomfort. This does not take into account that many conditions, such as arthritis and intermittent claudication, often cause pain at the onset of walking which improves with perseverance.
The most unfortunate aspect of the above allowances is that they remove motivation for physical and mental improvement. This is particularly evident when attempts at rehabilitation fail.
I gather from the Sunday Times, 30 November 2003, that the cost of the DLA has risen by £3 billion in the past six years and that the Government plans to target benefit fraud. As far as I can see, the benefits are granted following the letter of the law and this needs to be reviewed urgently.
Having trained in medical rehabilitation I find the current system depressing and greatly flawed. At present 'illness behaviour' is encouraged, and it is sad to see many potentially useful lives blighted by sometimes inappropriate benefits.