02 February 2008

I'm on Benefit, Doctor

Grumble likes to take a decent history when he sees a patient that's new to him. It's not always possible in today's busy NHS but he does his best. What he tries never to skimp on is finding out what it is that the patient has noticed wrong. And he tries too to find out everything medical (and maybe even not medical) that's troubling the patient. He likes to think he does this job well and that he gives the patient plenty of opportunity to mention anything of real concern. Sometimes the patient clearly has one major complaint and mentions nothing else. Often this is not something that would prevent the patient working. After going through the major complaints Dr Grumble asks the patient about their employment and he still has not stopped being surprised when, having listened carefully to all the complaints, the patient tells Dr Grumble they are 'on benefit'. Dr Grumble tries not to look surprised but he does think that anything bad enough to prevent the patient from working might at least have merited a mention by then. But no. Whatever it is, it was not important enough to tell Dr Grumble about. But Dr Grumble does not let his patients get away with just saying that they are 'on benefit'. It is after all his job to know why they are on benefit. Of course he gets a variety of answers. Quite often it is a 'bad back'. Fair enough. It can't be easy to work as a labourer with a bad back. But usually they aren't labourers. And aren't there other jobs that labourers could do? Working with a bad back can't be nice - but sitting at home with it without any work to take your mind off it could just be worse. Who doles out these benefits? Dr Grumble doesn't know. Well-meaning doctors may have a role.

This reminds Dr Grumble of the time when he pulled up at a petrol station to fill his tank. The car in front was plastered in disabled stickers enabling the driver to park almost anywhere without fear of a penalty. Poor man thought Dr Grumble. Obviously wheelchair bound. But no. Out of the car leapt a sprightly man and dashed into the shop to pay coming out laden with heavy goodies from the shop. "Whoever can have given that man all those disablement stickers?" he said angrily to Mrs Grumble. Mrs Grumble looked rather sheepish. "I did," she said. You see at the time Mrs Grumble was the man's GP and she had felt sorry for him. Angina or something. Doctors have a duty to do their best for their patients. But is making people arbitrarily disabled and moving them away from work and onto benefit doing patients favours? Dr Grumble has never thought so. And surely the system should prevent the obvious conflict of interest that results from a patient's own GP becoming involved in such decisions.

Dr Grumble might seem rather harsh over this but he's not you know. He's thinking of the best interests of these people. Dr Grumble takes the view that a slightly chronically ill patient would be better off in work rather than being tied to benefit. But how could you ever prove it? Perhaps you can't but apparently there is some evidence that Dr Grumble may just be right.

Dr Grumble is astonished.

This post was first published on 24th August 2006 but the subject remains topical.


PhD scientist said...

It is a definite problem, Dr G. Our local rag was just telling us that, in the inner city area served by our local University teaching hospital, there were three times as many men on sickness benefit as "unemployed and seeking work". One particular local area / postcode was reported as having 18% of ALL adults of working age "on the sick".

Of course, it may point to a widespread "iceberg" of not-very-well-treated mental illness, and/or to people with personality problems "segregating" into these grungy inner-city areas - the same article reported that a staggering HALF of our city's 30,000+ incapacity benefit claimants were ruled out of work by a `mental or behavioural disorder'.

While that presumably includes "signed off because piss-miserable menial job and psychotic managers had them on the verge of cracking", it is nonetheless a startling figure, at least to me.

Mrs PhD Sci has occasionally toyed with signing up for the agency that the Dept of Employment (or whatever they are called now) is contracting to do the medical (re) assessments on long-term sickness benefit claimants. If the Trust where she works finally get round to making her redundant this may yet come to pass. It does seem amazing that people can end up signed off sick for years without any doctor having a specific remit to decide if they really are medically unfit to work.

Dr Grumble said...

I didn't ever think I would be siding with John Redwood on this but it seems from his experiences of his own 'surgeries' he has a good understanding of the problems. Work is good for people but somehow it seems that the systems are biased towards encouraging people to become dependent on benefit. That's not good for them, it's not good for society and it costs a small fortune. Everybody would be better off if these people could be persuaded to work. The ones that would benefit most is those on Benefit. For many Benefit is really a disbenefit. Quite often in medicine you need to be cruel to be kind. In pure clinical work doctors are quite good at this but when it comes to form filling for the government I am not so sure.

BenefitScroungingScum said...

Whilst fully agreeing there is an issue with fraud within the benefit system, the official statistics (when one can find them) show that overall fraud is only a minute part of the problem, off the top of my
head, usually less than 1% of the overall benefit costs.
However, even for those with seemingly minor conditions there can be major obstacles to entering the workplace. I posted on the subject here http://benefitscroungingscum.blogspot.com/2008/01/i-see-your-true-colours.html
and you may be interested in the discussion further down the comments, one of the participants works for the DWP.
I'm also sure you don't need reminding that many disabilities are invisible, and that just because someone is not 'wheelchair bound' does not mean they don't experience great difficulties in day to day activities..after all, for many people to be 'wheelchair bound' (shocking language btw!) the NHS would have to provide people with the wheelchairs they actually need ;)
Bendy Girl

PhD scientist said...

Hi BendyGirl

I wasn't thinking of people with conditions like EDS, and I honestly don't think "deliberate upfront fraud" is rife... though one inevitably hears plenty of stories about the former dustman signed off for years with a shoulder problem who flogs knock-off gear down the pub etc etc - friend of mine used to live next door to one such, but I don't think that makes it the rule. And on the other side of the coin I've met an ex-builder on sick benefit who has COPD so bad he can hardly get to the kitchen without Oxygen.

The people I was wondering about the most were the huge number on incapacity benefit - at least in the inner city where my Univ is - who are judged unable to work due to "mental or behavioural disorders".

Mrs PhD Sci spends parts of her working life persuading employers to make "suitable adjustments" to working conditions for people, and parts trying to sort out patients who are suffering from physical manifestations of "job issues" (see my earlier post)... it's just that from where she sits it is a little bit too easy for some patients to end up off work and on benefit long term, when that isn't really what they need.

The worry, I think, is that over-stretched GPs with heartsink patients (mental problems and/or difficult personalities, multiple health worries though not really incapacititated) can get into a kind of unspoken collusion with the patient. They sign them off work, and then they both get into a kind of continuing "patient sticks to the sick role and doctor goes along for a quieter life" state. I wouldn't call this deliberate fraud, but I would call it a person who should really be working rather than than not working ending up not working.

It it is obviously a pan-social services problem in the sense of how you

(i) assess what work people realistically could do plus help them to get trained for it if necessary;

(ii) assess their health status and help get them physically and mentally fit enough to do a job, and then;

(iii) help them find one.

In a way it makes me think that for people on long-term sickness benefit who are not flat-out physically incapable of working, there needs to be a sort of "inter services / professions case conference" approach and some ring-fenced money so that the problem can be tackled properly. Which sounds expensive, but the social cost / consequences for my inner city patch (where I used to live as well as work) of having all those people (mostly men) on the sick is quite high too... in all sorts of ways.

Of course I can see that the above is Pie in the Sky given what happens in the present system. As a impoverished PhD student long ago I used to have to wait six months to get Supplementary Benefit to pay my rent, but it does sadden me to hear that the system is still as sclerotic as your and other blogs suggest.

Anne Marie said...

I would high numbers of the population on benefits is a public issue rather than a private trouble of either individual doctors or patients.