- Email: [email protected]
Disability assessment
1274
New surrogacy
Noticeboard Disability assessment The UK government has announced special compensation arrangements for claimants for disability benefits whose payments are unduly delayed-as occurred, for example, because of the "complete administrative disarray"1 at the Benefits Agency soon after the launch of the two new social security benefits for people with disabilities introduced in April last year. The Disability Living Allowance (DLA) entitled more people to benefits than did the previous Attendance Allowance and Mobility Allowance on which it was modelled, and the Disability Working Allowance was a new means-tested benefit to supplement the income of those at work. The House of Commons Social Security Committee1 reported last week that a huge publicity campaign about the new benefits had been run in early 1992, at a cost of 6.4 million, but a proper forecast of the likely take-up had not been made. By June, 1992, the agency had a backlog of about 400 000 uncleared cases, instead of the 130 000 expected. The delays caused claimants to lose out not only on the allowances applied for but also on other social security benefits to which recipients of the DLA are entitled. The Benefits Agency quickly redeployed 800 staff from other parts of the organisation, worked overtime, and introduced other administrative measures, and by April 9 this year, 99-7% of new claims for the DLA lodged by December, 1992, had been cleared. The compensation arrangements announced are broadly in line with the recommendations made by the committee. The most remarkable feature of the new benefits is that claims are based on self assessment by the applicant and lay adjudication instead of on the medical examination2 much loathed by many claimants and their advocates. Claimants found the assessments degrading, insensitively handled, and too superficial or too detailed. And the percentage of claims initially refused but successful on appeal—eg, 72% for 1991-was high. Policymakers doubted whether a medical examination would provide more information about needs than was known by the claimant’s doctor or social worker. Completion of the 40-page form (a simplified version of which was produced last month) has been a source of much difficulty, and help to complete it has not been adequate. The need for verification of the disability has been the subject of some confusion. Doctors need only state the diagnosis on the form; they are not expected to read through the form or to give an opinion on
severity of the disability, but some claimants have expected an examination, while others have complained that doctors charge
the
them a fee for the statement.3 The key issue, though, is whether the system has swung too far in relying on self assessment and lay adjudication. The Social Security Committee accepted that it was too early to assess the impact of the procedure. Critics of the system point out that the Disability Handbook/ intended to assist lay adjudicators, gives only a general description of how medical conditions are likely to affect mobility and care needs. They are concerned that, even though the adjudicators have medical colleagues to whom they can turn for help, assessments may not be appropriate and that people who might benefit from rehabilitation might not be offered it. Some suspect that the real reason for the change in system was to save on costs of assessors. Critics also point out that should evaluation of the new system indicate that some return to examination is necessary, the assessors, whichever health-care profession they belong to, must be people experienced in disability assessment.
Vivien Choc Security Committee. Disability benefits: the delivery of Disability Living Allowance and Disability Working Allowance. London: HM Stationery Office. 1993. Pp 42. £14.40. ISBN 0-100203132. 2. Assessing the assessors: medical assessment for disability benefits. London: Citizens Advice Bureaux. 1990. 3. Hadjipateras A, Howard M. Too little, too late. London: Disability Alliance and Royal Association for Disability and Rehabilitation. 1992. 4. Aylward M, Dewis P, Scott T. Disability handbook. London. HM Stationery Office, 1992. 1. Social
regulations?
UK courts should soon be able to grant an order that will confer legal parenthood on couples whose children are born to surrogate mothers. At present the only option open to these couples ("commissioning couples") is to adopt the child, which is a very lengthy procedure. The new parental orders1 will provide a simpler and speedier method of transferring legal parenthood to the commissioning couple. A consultation document, which contains the draft regulations, has been published and circulated by the Department of Health. Certain conditions will have to be met before a parental order can be granted. The child must have been conceived from the gametes of at least one of the commissioning couple, both of whom must be over 18 years old and married. The child must be living with the commissioning couple and they in turn must be domiciled in the UK, Channel Islands, or Isle of Man. The (surrogate) parents must agree unconditionally to the making of the order; but their agreement will be ineffective if given less than six weeks after the child’s birth. It will not, however, be necessary to obtain the agreement of a parent who cannot be found or is incapable of giving agreement. Commissioning parents must apply for the parental order within six months of the birth (or within six months of the Act coming into force for children already born). Views on the draft regulations are invited before July 2,1993.
Sarah Ramsay
1. Parental orders for gamete donors regulations
1993. Available from Department of Health,
Room 418, Wellington House, 133-35 Waterloo Road, London SE1 8UG, UK.
Helicobacter pyloriinfection in developing world It has become increasingly evident that Helicobacter pylori (HP) infections are more prevalent in developing than in industrialised countries, and that populations in the former are infected very early in life. To evaluate present data and suggest priorities for research in developing countries, a multidisciplinary group of 18 experts convened at the International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B) in February. In developed countries HP infection is found in about 20-25 % of symptom-free adults, and the prevalence increases with age to about 50% by the age of 50 years. HP infections are clustered in families and institutions in the developed world, whereas in the developing world, HP infections seem to be nearly universal. In Peru, the Gambia, and Bangladesh, for example, children become infected during their first few months of life. There may then be temporary clearance of the infection but re-infection occurs and from the age of about 3 years the prevalence (about 90%) remains stable. In countries where socioeconomic conditions and sanitation have improved, such as Thailand, infection rates are lower, with about 50% becoming infected by 10 years of age, and 90% by age 40. Extensive pathological studies in Peru have shown that infected adolescents may have inflammatory gastric mucosal lesions. Progression of the inflammation to the proper antral and body
glands produces deep, interstitial, pre-atrophic gastritis. Finally, chronic atrophic gastritis develops; this chronic lesion affects 34% of Peruvian adults with HP infection and half of these have intestinal metaplasia, a pre-malignant lesion that can progress to the intestinal type of gastric adenocarcinoma, which is common in Peru. By contrast in industrialised countries deep or chronic atrophic gastritis is rare among HP-infected patients, and gastric carcinoma is less common than in developing countries. Although cure rates of over 90% have been reported, recurrence rates in developing countries are very high. In developed countries, the recurrence rate of HP infection is about 0-5-1-0% per year, whereas in Peru, for example, it is 100% by one year. Therapeutic eradication of the infection in developing countries therefore is an unrealistic goal, though therapy has been beneficial--eg, dysplasia of the gastric mucosa has regressed, and hypochlorhydria has improved in patients with atrophic gastritis. The research priorities include the development of a simple non-invasive means of measuring hypochlorhydria in children to
New surrogacy
Noticeboard Disability assessment The UK government has announced special compensation arrangements for claimants for disability benefits whose payments are unduly delayed-as occurred, for example, because of the "complete administrative disarray"1 at the Benefits Agency soon after the launch of the two new social security benefits for people with disabilities introduced in April last year. The Disability Living Allowance (DLA) entitled more people to benefits than did the previous Attendance Allowance and Mobility Allowance on which it was modelled, and the Disability Working Allowance was a new means-tested benefit to supplement the income of those at work. The House of Commons Social Security Committee1 reported last week that a huge publicity campaign about the new benefits had been run in early 1992, at a cost of 6.4 million, but a proper forecast of the likely take-up had not been made. By June, 1992, the agency had a backlog of about 400 000 uncleared cases, instead of the 130 000 expected. The delays caused claimants to lose out not only on the allowances applied for but also on other social security benefits to which recipients of the DLA are entitled. The Benefits Agency quickly redeployed 800 staff from other parts of the organisation, worked overtime, and introduced other administrative measures, and by April 9 this year, 99-7% of new claims for the DLA lodged by December, 1992, had been cleared. The compensation arrangements announced are broadly in line with the recommendations made by the committee. The most remarkable feature of the new benefits is that claims are based on self assessment by the applicant and lay adjudication instead of on the medical examination2 much loathed by many claimants and their advocates. Claimants found the assessments degrading, insensitively handled, and too superficial or too detailed. And the percentage of claims initially refused but successful on appeal—eg, 72% for 1991-was high. Policymakers doubted whether a medical examination would provide more information about needs than was known by the claimant’s doctor or social worker. Completion of the 40-page form (a simplified version of which was produced last month) has been a source of much difficulty, and help to complete it has not been adequate. The need for verification of the disability has been the subject of some confusion. Doctors need only state the diagnosis on the form; they are not expected to read through the form or to give an opinion on
severity of the disability, but some claimants have expected an examination, while others have complained that doctors charge
the
them a fee for the statement.3 The key issue, though, is whether the system has swung too far in relying on self assessment and lay adjudication. The Social Security Committee accepted that it was too early to assess the impact of the procedure. Critics of the system point out that the Disability Handbook/ intended to assist lay adjudicators, gives only a general description of how medical conditions are likely to affect mobility and care needs. They are concerned that, even though the adjudicators have medical colleagues to whom they can turn for help, assessments may not be appropriate and that people who might benefit from rehabilitation might not be offered it. Some suspect that the real reason for the change in system was to save on costs of assessors. Critics also point out that should evaluation of the new system indicate that some return to examination is necessary, the assessors, whichever health-care profession they belong to, must be people experienced in disability assessment.
Vivien Choc Security Committee. Disability benefits: the delivery of Disability Living Allowance and Disability Working Allowance. London: HM Stationery Office. 1993. Pp 42. £14.40. ISBN 0-100203132. 2. Assessing the assessors: medical assessment for disability benefits. London: Citizens Advice Bureaux. 1990. 3. Hadjipateras A, Howard M. Too little, too late. London: Disability Alliance and Royal Association for Disability and Rehabilitation. 1992. 4. Aylward M, Dewis P, Scott T. Disability handbook. London. HM Stationery Office, 1992. 1. Social
regulations?
UK courts should soon be able to grant an order that will confer legal parenthood on couples whose children are born to surrogate mothers. At present the only option open to these couples ("commissioning couples") is to adopt the child, which is a very lengthy procedure. The new parental orders1 will provide a simpler and speedier method of transferring legal parenthood to the commissioning couple. A consultation document, which contains the draft regulations, has been published and circulated by the Department of Health. Certain conditions will have to be met before a parental order can be granted. The child must have been conceived from the gametes of at least one of the commissioning couple, both of whom must be over 18 years old and married. The child must be living with the commissioning couple and they in turn must be domiciled in the UK, Channel Islands, or Isle of Man. The (surrogate) parents must agree unconditionally to the making of the order; but their agreement will be ineffective if given less than six weeks after the child’s birth. It will not, however, be necessary to obtain the agreement of a parent who cannot be found or is incapable of giving agreement. Commissioning parents must apply for the parental order within six months of the birth (or within six months of the Act coming into force for children already born). Views on the draft regulations are invited before July 2,1993.
Sarah Ramsay
1. Parental orders for gamete donors regulations
1993. Available from Department of Health,
Room 418, Wellington House, 133-35 Waterloo Road, London SE1 8UG, UK.
Helicobacter pyloriinfection in developing world It has become increasingly evident that Helicobacter pylori (HP) infections are more prevalent in developing than in industrialised countries, and that populations in the former are infected very early in life. To evaluate present data and suggest priorities for research in developing countries, a multidisciplinary group of 18 experts convened at the International Center for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B) in February. In developed countries HP infection is found in about 20-25 % of symptom-free adults, and the prevalence increases with age to about 50% by the age of 50 years. HP infections are clustered in families and institutions in the developed world, whereas in the developing world, HP infections seem to be nearly universal. In Peru, the Gambia, and Bangladesh, for example, children become infected during their first few months of life. There may then be temporary clearance of the infection but re-infection occurs and from the age of about 3 years the prevalence (about 90%) remains stable. In countries where socioeconomic conditions and sanitation have improved, such as Thailand, infection rates are lower, with about 50% becoming infected by 10 years of age, and 90% by age 40. Extensive pathological studies in Peru have shown that infected adolescents may have inflammatory gastric mucosal lesions. Progression of the inflammation to the proper antral and body
glands produces deep, interstitial, pre-atrophic gastritis. Finally, chronic atrophic gastritis develops; this chronic lesion affects 34% of Peruvian adults with HP infection and half of these have intestinal metaplasia, a pre-malignant lesion that can progress to the intestinal type of gastric adenocarcinoma, which is common in Peru. By contrast in industrialised countries deep or chronic atrophic gastritis is rare among HP-infected patients, and gastric carcinoma is less common than in developing countries. Although cure rates of over 90% have been reported, recurrence rates in developing countries are very high. In developed countries, the recurrence rate of HP infection is about 0-5-1-0% per year, whereas in Peru, for example, it is 100% by one year. Therapeutic eradication of the infection in developing countries therefore is an unrealistic goal, though therapy has been beneficial--eg, dysplasia of the gastric mucosa has regressed, and hypochlorhydria has improved in patients with atrophic gastritis. The research priorities include the development of a simple non-invasive means of measuring hypochlorhydria in children to