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"Expert" doctors exposed

1 June 2005

"Expert" doctors who have cost thousands of claimants their DLA have had just two days training and passed only a multiple choice test to achieve “expert” status, Benefits and Work can reveal. Yet the blanket assertion that Examining Medical Practitioners (EMPs) are experts has been repeated so many times that it is even accepted uncritically in a judgement currently before the House of Lords.

Wizards
Many claimants do not get the award of DLA that they consider to be correct, or do not get an award at all, after a visit from an EMP. If claimants appeal against the decision they will often provide medical evidence, usually from their GP, to support their claim. The tribunal then has to decide which evidence it prefers, the EMP’s or the GP’s.

To help them make their decision the decision makers have what appears to be a standard submission, quite possibly created by their Appeals Wizard, which explains that the EMP is an “independent expert” in disability assessment whose evidence should be preferred to that of the GP, who has no such expertise. (Members can read instructions to the Decision maker on how to use the Appeals Wizard para 160 onwards)

Tribunals are free to decide which evidence they consider is the most reliable, but they must be able to explain why they made the choice they did if the claimant appeals to the Commissioners. So, for example, if the tribunal has accepted the GP’s evidence where it has been at odds with the EMP’s evidence, they may say that they did so because the GP has known their patient for years and has a detailed knowledge of the effects of their condition. But where it is the EMP’s evidence that is preferred tribunals will almost invariably trot out the DWP’s claim that the EMP is an independent expert without offering any proof that this is the case.

Widow Twanky makes a house call
The fiction that EMP’s are experts has been repeated so often that it has now been accepted throughout the legal establishment. So, while the claim that EMP’s are all ‘independent’ is about to be challenged in the House of Lords in the Gillies case, the claim that they are all ‘experts’ has not been examined at all. In the run up to the House of Lords case a Tribunal of Commissioners held that EMP’s

“. . . are not in our view, simply 'Benefits Agency doctors', but rather independent expert advisers . . .”

Following that Tribunal of Commissioners decision, the Scottish Court of Session held that “a reasonable and well-informed observer” would not suspect that doctors who sit on tribunals and who also work as EMPs would be biased in favour of the DWP because:

“Such an observer would surely be blessed with the knowledge that Dr. A and the other EMPs were independent expert advisers in carrying out the work of examining and reporting to the Benefits Agency”.

"Gillies case: pantomime dames declare "Trust them, they're DWP doctors!"

What the well informed observer would not have known however, because the DWP have not made it public, is the risibly tiny foundation of learning on which an EMP’s so called ‘expertise’ totters.

Is there a McDoctor in the house?
The truth is that the transformation from GP to DWP expert requires only the undertaking some pre-course reading and attendance at two training days, at the second of which the budding experts have to pass a multiple choice test.

And that’s it! It undoubtedly takes longer to become a qualified burger fryer at McDonalds than it does to become a DWP McExpert.

Following this extensive training, the first five reports the new EMP writes are all audited and the EMP then has a final ‘structured interview’ with a mentor before their name is passed to the DWP’s Chief Medical Adviser for approval as a fully fledged expert in Disability Analysis.

We would suggest that an expert is commonly accepted to be someone who, through much study and long practice, has raised their skills far above the level of other practitioners in their chosen field. A fraud, on the other hand, could well be defined as someone who does two days training and then claims to be an expert in anything.

Listen carefully: I will say this only once . . . andveryveryquickly
Whilst the training itself – which is delivered by full-time Medical Advisers and may be supplemented by input from decision makers - is astonishingly short, the list of subjects covered by the “course” is remarkably long, consisting as it does of:

1. The ethos of the Department of Work and Pensions.
2. Equal opportunities policy and relevant legislation.
3. Medical Services Professional Standards.
4. Customer service.
5. Disability awareness.
6. Benefit awareness.
7. Decision making awareness.
8. Examination technique and report completion.
9. Approval.
10. Quality systems and audit.
11. Interview technique.
12. Fraud awareness.
13. Risk management of problem situations.
14. Administrative arrangements.
15. Complaints procedures

A sceptical observer might consider that covering 15 subjects of such apparent complexity in the course of two days might lead to “experts” who know next to nothing about an awful lot of things. Certainly, it wouldn’t be possible to spend more than an hour on average on each topic. Though it's encouraging to note that they actually remembered to squeeze in some training on examination technique and report writing at number 8 in the list.

Claimants will also be reassured to learn that, in order to keep their expertise well honed and at the cutting edge of medical and legal practice, EMPs are circulated with updated information when there are changes in the law and are provided with details of ongoing training. Sadly, there doesn’t appear to be any requirement that they actually attend any of the ongoing training.

I’m independent – if you say so. (That’ll be £74 please).
The details of the training provided to EMPs raises questions not only about their expertise but also about their independence.

The Scottish Court of Session in the Gillies case above were called upon to decide whether doctors who work as EMPs should also continue to be allowed to sit on DLA tribunals where their fellow EMPs medical reports are challenged by claimants. The court’s conclusion that EMP’s are independent is open to serious question given that EMPs receive training in “The ethos of the DWP” and given that some of their training may have been provided by Decision Makers – the very people whose decisions the EMPs sitting on tribunals are supposed to judge in an unbiased fashion.

The Gillies case is due to be heard in the House of Lords in November of this year. We very much hope that their noble lordships will be informed of, and be as bowled over by, the details of the extensive and unbiased training provided to EMPs as we’re sure, dear reader, that you are.

Sorry, members only
Finally, if you or your clients is appealing against a DLA or AA decision and you receive a DWP submission claiming that the EMP is an expert or a specialist, then visit the new Benefits Brief section in the members area. There you’ll find a detailed submission which you can copy and paste for use in your own appeal. (For those not familiar with written submissions, we give a brief run down on writing and submitting them in our guide to Improving the odds for clients with DLA and AA appeals). And, in case you’re worried that the tribunal might object to you using a submission written by someone else, bear in mind that every single submission produced by the DWP is created almost entirely by their Appeals Wizard software and not written by the decision maker at all. What’s sauce for the extremely well resourced goose . . .