Kevin Stewart MSP wrote to the President requesting views with regard to communication he has had with UK Government Ministers regarding Welfare Reform.
Mr Stewart has been in communication with Lord Freud, Minister for Welfare Reform of the UK Government regarding the Welfare Reform Act 2012, and more recently regarding the views of people living with HIV & Hepatitis C.
In a letter from the Minister for Employment, Chris Grayling MP, he appears to assert that healthcare professionals employed by the Department for Work and Pensions' contractors are better placed to consider a person's capability to work than that person's GP or consultant.
Mr Stewart has requested the College's views on this matter, considering that contractors are only required to be trained through a 16 day training course. Mr Stewart has attached both his letter to Lord Freud and the reply from Chris Grayling MP.
Comments on The Scottish Parliament Welfare Reform: People Living with HIV and Hepatitis C - request for views from Kevin Stewart MSP
The Royal College of Physicians of Edinburgh has been asked to respond to a specific point on welfare reform by Mr Kevin Stewart MSP who is seeking clarification on the application of the Welfare Reform Act 2012 for patients with HIV and Hepatitis C and for whom treatment regimens may be such that their fitness for work is impaired.
The College has taken advice from clinical experts in blood borne disease and offers the following information:
- Most GPs and hospital consultants will have limited training in occupational medicine and their clinical opinions should be augmented by occupational health expertise during the assessment process. The College is unable to comment on whether the 16 day training course for all DWP healthcare assessors is sufficient to provide this level of expertise.
- Conflict of interest may be an issue for all clinicians - those treating the patient, whether GPs with a long term and holistic knowledge of the patient, or hospital doctors with specialist expertise, and those at DWP with the responsibility to make a recommendation and commit public funds. Preservation of the essential doctor/patient relationship makes it difficult for a doctor to write a report denying funds to a patient reliant on them at this time of high unemployment and financial austerity. However, the professionalism expected of all doctors should result in an impartial judgement and the consideration of all perspectives is essential to arrive at a fair and balanced decision for each individual patient.
- The number of upheldappeals points to problems in the decision making process and requires significant input from clinicians in writing reports in support of appeals. The DWP should review how its assessors arrive at their decisions given the information available to them.
In terms of the specific diseases in question:
Hepatitis C and liver disease
Patients exhibit a wide range of health problems – from almost no symptoms to fatal liver failure. Many patients with hepatitis C have a range of psychosocial issues including drug misuse and associated chaotic life styles, which can be more of a barrier to work than the infection. However, anti-viral therapy for Hepatitis C is usually arduous, involving a mixture of daily tablets and weekly injections for up to 12 months, often associated with significant side effects. It would be the exception rather than the rule that such patients could work during their anti-viral therapy and the position should be considered as similar to cancer patients on chemotherapy.
HIV
The majority of these patients undergoing anti-viral therapy should be fit enough to work. However, there will be a group of older patients diagnosed over 20 years ago who may have expected reduced life expectancy and retired from work, or never taken up work, and who will require special attention. Some of the same group may also be on older anti-viral regimens with significant side effects such as diarrhoea or peripheral neuropathy which will affect their ability to work.