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Mr. Gareth Thomas (Clwyd, West): I am grateful to my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood), who is Chairman of the Select Committee on Social Security, of which I am a member. He provided a comprehensive analysis of the inquiry conducted by the Committee.
An inquiry and report such as the one that we are debating today offers an admirable example of the good work that Select Committees can do. If the report serves to concentrate the Government's mind on the need to maintain a good quality service in this crucial area, it will have been justified.
I am heartened by the Government's generally positive response to the report. It is worth mentioning, as the Government are at some pains to do in the introduction to their response, that the history of medical services needs to be placed in context. There is reason to doubt the effectiveness of the present contractorised system--I am sure that some of the defects that came to light are only too familiar to hon. Members--but the fact remains that the old system was very far from perfect.
Delays were part of the culture of the old system, and there was a total lack of co-ordination in terms of standards and training. Contractorisation at least gives the Government some significant degree of leverage over how quality should be monitored and the system improved.
As my hon. Friend the Member for Roxburgh and Berwickshire said, the people seeking benefits under the system--which costs £25 billion a year--are the most vulnerable in our society. It is crucial to ensure that examinations for eligibility are conducted by doctors in a professional and fair manner, and claimants must believe that they are being dealt with fairly. I am sorry to say that it became apparent from our inquiry that in many instances that was not the case.
I acknowledge that an enormous bureaucracy is involved, given that a million medical examinations are held every year in relation to medical benefits. No system can be perfect, but there is certainly a need for improvement. I agree with what has been said already: if medical services do not improve significantly over the next year or so, there should be scope to reconsider the contract and take robust action--including the draconian step of withdrawing the contract from Sema.
Many hon. Members will want to inform the House about their experiences in this matter, so I shall confine my remarks to a few about some of the issues highlighted in the report. First, I want to deal fairly and squarely with the perception of fairness.
The perception exists that doctors do not spend enough time with claimants, that they examine them too quickly and do not do justice to their complaints. I agree with the Government's response that time spent with a claimant is not necessarily commensurate with quality. However, I am sure that the Minister agrees that it is essential for examining medical practitioners to devote sufficient time to listening carefully to claimants. Some claimants no doubt have difficulty in explaining themselves, but they must be left with the overall impression that they have been dealt with fairly.
I am dismayed that the Government are somewhat critical of the Committee's approach to what the Government describe as anonymous reports of instances of dissatisfaction. I echo the remarks of the hon. Member for Roxburgh and Berwickshire: it is unrealistic to expect vulnerable people, who may be afraid of the consequences of complaining too strongly, to be very forthcoming in giving their identities.
Mr. Gordon Marsden: Does my hon. Friend accept the close correlation between the cursory way in which some claimants are dealt with by examining medical practitioners and their subsequent reluctance to make a formal, or an identifiable, complaint? In my constituency, I have had several complaints against a particular EMP for giving a physical examination that lasted for only two to four minutes. When I pressed one or two of the claimants subsequently at advice surgeries--
Mr. Thomas: My hon. Friend makes a valuable point. A few doctors keep cropping up, time and again. They are very powerful, or are seen to be powerful, which might account for the reluctance to complain. The complaints system is not particularly user-friendly. The rate of successful appeals has traditionally been very high, although I accept that that is not necessarily a reflection of poor medical evidence. However, the point is well made.
The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley): The pattern has been that about 4,000 people a year make a formal complaint. There has been a lot of debate about whether that is a reflection of the true number of people who are dissatisfied, or a small part of the true number. However, I caution my hon. Friend against creating the myth that something happens to people who complain. Has he any evidence of somebody being victimised as a result of using the complaints procedure? If so, the Committee should bring it forward; it has not done so to date.
Mr. Thomas: I do not have such evidence. I raise the issue--I do not want to dwell too long on it--simply to rebut the Government's suggestion that, because we could not provide a list of identities of individual complainers, that had somehow undermined our evidence.
It is imperative to have a programme of recruitment that ensures that doctors who really want to do this job, and have some pride in their work, are recruited. There is an urgent need to look at their remuneration. I, too, am concerned that there has been no increase in the salary of
A more rigorous system of auditing performance is required. I am very pleased that the Government intend to take action to remove doctors who consistently under- perform. I am sure that that was always so, but it is nice to hear it. It will be welcome if medical services' efforts are redoubled.
Training in customer care is essential, as is dealing with poor performance. The Committee criticised the manner in which EMPs deal with claimants with mental health problems or from ethnic minority groups, and strong conclusions were reached on some doctors' cultural insensitivity. I am pleased that the Government accept that that matter must be rigorously addressed.
Two points should be made on appeals. First, a feedback procedure is necessary. When a pattern emerges of successful appeals involving a particular doctor, there should be some follow-through. Alarm bells should ring so that someone conducts inquiries and asks what is going wrong. It seemed to the Committee that that does not happen, and I should be grateful if the Minister would clarify the Government's approach.
Secondly, as a lawyer experienced in personal injury cases, I know that, in addition to the medical report for the case, one of the most valuable pieces of evidence for a court determining liability and quantum is a person's entire medical history--general practitioners' notes, hospital records and so on. If one is successfully to assess someone's eligibility for benefits, that is essential. I did not know until I heard it in Committee that there appears to be no systematic approach to ensuring that additional medical evidence is obtained. The procedure requires tightening.
I share concerns about financial pressures in the system, which give rise to suspicion that there is a disincentive to carrying out full examinations. There is evidence that the scrutiny procedure--examining the papers, not the patient--is increasing. The Government are concerned about that, and the figures are particularly worrying.
I emphasise the need for adequate training of doctors. The status of doctors who specialise in this area should also be enhanced. There is a strong case for encouraging doctors to have training, paid for by medical services or the Government, to improve their skills and obtain further qualifications, including a diploma in disability assessment medicine.
The Committee was right to ask whether the objective of contractorisation had been achieved. If improvements are not seen to be happening fairly quickly, the Government should bite the bullet and re-examine the contract.
Rev. Martin Smyth (Belfast, South): I appreciate this opportunity to make a brief contribution to the debate. I join the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) in paying tribute to the Under-Secretary, the hon. Member for York (Mr. Bayley). I worked with him when he was a member of the Select Committee on Health. He is open and helpful on all issues.
I thought we had moved on from the situation that existed 15 years ago when I took up the case of an elderly woman. She was asked whether she could walk unaided and, because of her dignity, she replied that she could and showed the examiner how she did so. Mr. Deputy Speaker, you might know, from your Scottish background, that in our Ulster Scots parlance, we talk about doing the rounds of the kitchen. She moved from the table to the dresser, but held on to the furniture all the time; that was supposed to show that she could walk without help. The medical examiner put on the form that she could walk unaided.
One of our traditions in this place is that, during Prayers, we turn towards the Bench. Some people say that the tradition arose because it was easier to kneel on the seat. Not long ago, I was involved with the appeal in the case of one my constituents. The medical examiner had put on the form that the person could kneel unaided. Before the tribunal, I asked my constituent where the medical examiner had asked him to kneel. My constituent had been asked to kneel on a chair. I can kneel reasonably well on the floor, but it is far easier to do so on a chair. To pass that person as having mobility because he could kneel on a chair and could do certain things was ludicrous. That quality of examination does down the service.
One is left with some doubts, because, under the contractual arrangements, the examiners are paid by the hour and by the number of people with whom they deal. Surely, in health and social services, we should be concerned to put the patient first. However, there is some recent evidence that a person in at least one branch of the health profession put his office needs before the care of the patients in his area. That does down the care of people with disabilities. We should be more concerned about them.
I would have no difficulty in removing from the list those people who find a way around the system--who fill in the forms so as to give the impression that they are in a bad way. On the other hand, the job of the medical examiner should be to discover whether the case is genuine rather than to try to get people off benefit.
Only this morning, I spoke on the telephone to the constituent of one of my colleagues, whose case reflects some of the concerns felt by patients when they talk to doctors. She has a girl of 10, vaccine-damaged, and a young man, now 17 years of age, also vaccine-damaged. It transpired that even her own GP had not been given the proper notes from the hospital, and that he was unaware of certain treatment that one of those young people had received, but his guidance to her was that she had a case and should pursue it, either against the firm who supplied the vaccine or against him. She replied, "Doctor, I would not want to bring a case against you as my doctor."
That personal relationship is first and foremost: people trust doctors and are rarely ready to complain about them. I believe that that is one reason why, although the number of successful appeals regarding medical examiners has been growing, some people do not consider that they have a right to appeal, and therefore do not appeal. I believe that the authorities expect people to appeal if they are wrongly turned down, but I am not convinced that they will necessarily do so in many cases.
Therefore, we should start by raising the standard of medical examiners. I have not met any. I find it hard to decipher their signatures. They do not turn up to give evidence to support their case when we go to appeal. The matter is left to an adjudicating officer, who must take the decision in the light of the form that the medical officer has returned. That is one reason why I questioned the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) as to what difference he had discovered between Northern Ireland and the rest of the kingdom, but I now know what he intended.
I believe that perhaps in Northern Ireland we are still suffering, with the rest of the regions of the kingdom, because some medical examiners are not doing their job properly in the interests of the client or patient, but are more concerned to fulfil their contractual arrangements, which may be to get through as many examinations as possible in a given time. That is not a proper examination.
I sometimes tell folk, "If there is something wrong with you, you had better go to the vet." They ask, "Why do you say that?" I reply, "Well, when you go to the doctor, the first thing that he will say is, 'What's wrong with you?' whereas a vet has to find out for himself what is wrong with an animal." When I tell my medical friends that, they say, "If you go to a vet, the next thing that he will say is, 'Where's the shotgun?'" In a caring society, we cannot spend our time getting rid of people who may be an economic drain, but who have a right to the facilities and support of society.