Good Quality Evidence

Scottish Public Pensions Agency Presentations 2011

NHS Superannuation Scheme

Presentation Outline

▶ The relevant part of the Regulations▶ What evidence makes a good application▶ General trends in ill health retirement▶ Reasons for refusal

Administration changes brought into operation on 01-10-2008

▶ No additional FME gathering▶ No face to face assessments, therefore▶ Fast turn around 5 days▶ Remove review facility ▶ Switch to 2 IDR procedures to comply

with Internal Disputes Regulations Procedures 1995.

▶ New forms designed to extract more evidence to be submitted.

Two Tier Ill-Health Retirement Benefitsfrom 01-04-2008

Low er T ier U pper T ier

Tw o Benefits

Lower and Upper Tier Criteria

▶ For the Lower Tier criterion to be satisfied it must be accepted, on the balance of medical probabilities, that the applicant is permanently incapable the duties of that employment.

▶ For the Upper Tier criterion to be met, as well as meeting the Lower Tier criterion, the applicant must be considered to be permanently incapable of undertaking any regular employment of like duration.

Factors to take into account and disregard

▶ Whether the member has received appropriate medical treatment in regard of the incapacity,

▶ The members mental capacity,▶ The members physical capacity,▶ Such type and period of

rehabilitation which it would be reasonable for the member to undergo in respect of their incapacity, irrespective of whether such rehabilitation is undergone.

▶ Such type and period of training which it would be reasonable for the member to have undergone taking into account the member

▶ Any other matter which the Scottish ministers consider appropriate.

▶ The members preference▶ The Geographical location

The meaning of words.

▶ Permanent - to Normal Pension Age.

▶ Incapable of the duties of that employment - an inability to undertake the tasks requires for that role.

▶ Like Duration, For the Upper Tier there is a requirement to consider the members capability for any other work in the general filed of employment of like duration to the hours work in the NHS employment.

▶ Illness or injury = a diagnosed medical condition {covered in the International Classification of Diseases}. Where there are multiple possibilities we need to be far enough along the diagnostic pathway to be able to estimate prognosis.

Reasonable treatment

▶ Reasonable treatment = the treatment that a reasonable person should undertake for their illness. The scheme is entitled to consider that a member would benefit from any reasonable treatment for which there is good evidence.

▶ For psychiatric illness –

» have they seen a psychologist / psychiatrist?

» Have they had adequate medication?

▶ For Musculoskeletal Illness-

» Have they been worked up?

» Attempted or been rejected for surgery?

» Attended a pain clinic?

▶ For Cancers

» Have they seen an Oncologist and

» Completed Chemotherapy / Radiotherapy?

Where we hope to find the evidencethe Referral Documents

In Service AW8, AW8 MED

Out of Service AW8 P AW8P MEDAvailable from the SPPA website.

In practical terms,

▶ The Medical Adviser does not know the person, their medical history,

nor where they work.

▶ The medical adviser is required by the Legislation to consider the

medical evidence that is presented, and only that.

– We are completely dependent on what is submitted.

Things may not be quite what they seem.

▶ The level of incapacity from a disease can vary a lot.

▶ People survive diseases they previously died from and recover to lead

normal lives.

▶ Even if they don’t die, people get less disability from diseases they

previously were badly disabled by.

▶ The starting point is that people are living longer and healthier lives,

even ones with a disease label.

Source: National Statistics

Disability Free Life expectancy (England)

Males Females

2000-2002 2004-2006 2000-2002 2004-2006

Years 60.7 62.8 63.0 64.1

Proportion of life free from disability

79.9% 81.3% 78.2% 78.7%

Men are catching up.

13

Fortunately

▶ An employee may not be as sick as they seem

▶ They may be capable of staying in their jobs with some assistance from their employers

▶ They may not get an Ill Health pension unless they employer has undertaken consideration of adjustments and provides evidence for this.

– And therefore every application has to be examined on its own merits

▶ The standard of applications from NHS OH services is good and some are exemplary.

Medical reasons for applications in the 2 tier scheme in England and Wales

Top 10 diagnostic codes for applications in the NHS scheme 2008-2011

Musculoskeletal non back -20%

Mental and behavioural disorders- 17%Musculoskeletal -back -17%

Neoplasms -16%

Nervous system - 11%

Circulatory system - 5%

Respiratory system - 3%

Chronic Fatigue Syndrome -3%

Digestive system -2%

Endocrine, nutritional andMetabolic diseases -1%

Reasons for rejection

▶ Insufficient evidence of an incapacitating condition

▶ Incomplete investigations

▶ Incomplete treatment.