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Professor Grahame (March 2002 JRSM1) suggests that an escalation in the cost of disability benefits may be due to the decline in rehabilitation services. I was fortunate to gain experience in medical rehabilitation in the 1960s, while registrar in Dr Frank Cooksey's department at King's College Hospital. There, short but intensive courses of rehabilitation were offered with the purpose of a return to employment in suitable work or, in the case of housewives, independence in the home and kitchen. It became clear to me, at that time, that without motivation this exercise was not as fruitful as one would wish. This impression is supported by the extremely good outcome from rehabilitation reported in airmen in the Second World War, a highly motivated group of people.
The sharp rise in non-means-tested benefits in the past ten years could in part be due to lack of rehabilitation shortly after the incident causing the disability. However, my experience as a medical member on benefit appeals tribunals suggests that the main problem is often a lack of motivation for improvement. This is at times due to cultural differences in coping with disability. It is also due to the intervention of certain welfare rights organizations that urge clients to claim greater disability than can be objectively demonstrated, with a hope of obtaining the highest benefits.
It therefore appears to me that the present system and criteria for obtaining financial benefits does not encourage or motivate claimants to improve, and expensive rehabilitation, unfortunately, would yield only a marginal improvement.