Family doctors who certify people as being unable to work and whose patients are then consistently found by medical assessors from the Department of Social and Family Affairs as being fit for work should be monitored closely, a new report has recommended.
The report was published yesterday by the Dáil public accounts committee (PAC). Its chairman Michael Noonan said the fact that the number of those claiming disability payments had increased significantly in recent years, combined with the fact that GPs assessments were being overturned by department assessors, led to "a suspicion that some GPs were giving out certs on demand".
He said the number of those claiming under long-term disability schemes had increased from 31,000 in 1994 to 73,000 in 2004. There had also been increases in the numbers claiming other benefits.
The PAC report said when the department selected 1,532 people in Dublin and Cork on disability benefit as a result of having lower back pain to be called for medical review, many either sent in final certificates indicating they could return to work, or did not attend for the department's medical examination. Only 154 of the original 1,532 were found in the end to qualify for the benefit as a result of having lower back pain.
The report recommended the department "keep under close review those GPs who certify persons as incapable for work who are later consistently found capable by the department's medical assessors".
The report also states that social welfare overpayments amounted to €39.4 million in 2003. About one-third of these was as a result of fraud.
"The department has difficulty in recovering amounts overpaid. At the end of 2003 nearly €86 million was outstanding following the writing off of a total of €46 million in the previous five years," it said.
Meanwhile the report, which makes findings and recommendations on a number of issues looked at by the committee from October 2004 to July 2005, states that when the controversial issue of overpayments and underpayments to GPs was looked at by external personnel engaged by the Health Service Executive, the outcome suggested "a relatively net marginal overpayment to GPs".
The report also notes that the overall number of A&E attendances at Irish hospitals has not increased hugely since 1997. In that year there were 1,213,321 attendances and in 2004 there were 1,242,686.
Furthermore, the report states the Department of Health and the HSE should develop, on a national basis, a comprehensive set of health indicators against which outcomes for patients attending different hospitals can be compared.
Mr Noonan said with so much money going into the health service it was now time to look at what this meant for patient outcomes. It should be possible to look at how many patients treated at an individual hospital made a full recovery, and how many were alive six months later, he said.
He rejected the suggestion this would result in a hospitals' league table. "The public have a right to know they have a better chance of making a full recovery if they go to hospital A than hospital B," he said.
The PAC report also recommended effective arrangements be put in place to monitor and control staffing numbers in the health sector. It said staff numbers increased from 67,895 to 98,723, an increase of 30,828 or 45 per cent, from 1997 to 2004. In addition it recommended the numbers of contract and agency staff employed should be kept under close review in view of their cost. For example, Mr Noonan said it cost almost twice as much to employ an agency nurse.