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5.13 pm
Mrs. Maria Fyfe (Glasgow, Maryhill): I congratulate the Select Committee on Social Security on the excellent work that it has done. I am especially glad because I believe that it will give heart to a number of my constituents who have begun to wonder whether there is anyone out there listening. I also welcome the Government's positive response.
However, I am grateful for the opportunity that the debate gives me to draw attention to a few issues. Earlier today, I spent half an hour having the three-yearly check-up that is offered to Members of Parliament, merely as a way of checking on one's general health. I have absolutely nothing wrong with me, yet it took half an hour simply to question me about various aspects that could be wrong with my health. It seems to me that, although it is fine for an examination to be concluded within 10 minutes if it is patently obvious that the person is so severely disabled or ill that there is no point in continuing an examination at length, if someone is likely to be denied either disability living allowance or incapacity benefit, a considerable amount of time should be spent before a person is denied that benefit and a considerable sum of money is taken from them.
Recently, a father in my constituency came to visit me to talk about two sons, both of whom have the same serious illness. Both applied for disability living allowance, and an odd thing happened: the son whose condition is less severe was awarded the higher component and the son whose case was far more severe was denied it. Mistakes can occur in any organisation that deals with so many cases, but there needs to be a quicker way of putting right an obvious anomaly when evidence is presented by a general practitioner and a hospital doctor.
I know that hon. Members can provide umpteen examples from their constituency case loads, but I will not weary the House with many of my own. However, a particularly atrocious example is that of a constituent who was denied incapacity benefit, but who two weeks later was in a hospice for those dying of cancer. That is how bad the errors can be.
At present in Glasgow, the waiting time for appeals has been reduced to 16 weeks. It had been as long as a year, so I am grateful for the fact that it has been reduced to a more reasonable level. However, people have to make do without their benefit while they wait all those weeks. Perhaps in other parts of the country people have to wait longer, so I suggest to my hon. Friend the Minister that it might be worth while considering the possibility of allowing people's benefit to be restored if they are forced to wait more than a few weeks. I know that the Department intended that people would do without the benefit because their cases would be heard soon. However, if a case is not heard for months, it is unfair to deprive them of their benefit.
In the report of the Social Security Committee, I found a surprising statistic that I want to place on the record. It says:
- In 1998-99, the Independent Tribunal Service (as it was then) received 324,067 appeals.
Finally, I refer to a point that I was not going to make until my hon. Friend the Minister intervened on my hon. Friend the Member for Clwyd, West (Mr. Thomas). I hope that no one with a sense of responsibility would want to create fear among people. However people may not provide their names when they make a complaint, because they fear that it will rebound badly on them. My hon. Friend the Minister was right to ask for evidence of that, but those people's life experiences might have taught them that they should not provide their names. They need reassuring that other people have won their appeals and suffered no adverse consequences. To people in that position I say, "Take courage, make an appeal, give your name and address and don't be afraid." However, people must be shown that they should do that.
I know that my hon. Friend the Minister is deeply concerned about this issue. As someone else has said, the Government's response has his fingerprints on it. I welcome that response, but we need reform and we need it quickly. Bad decisions are being taken and, I am sorry to say, they are affecting the Government's reputation. People are becoming worried about how fair this Government are, and I do not want a Labour Government to suffer from such a reputation. I want us to make sure that people can say that the Government are fair to people because they deny benefit to con men, but provide it to those who deserve it.
5.19 pm
Mr. Desmond Swayne (New Forest, West): It is always a pleasure to follow the hon. Member for Glasgow, Maryhill (Mrs. Fyfe) and I shall endeavour to be as brief as she has been. As a member of the Committee, I feel that I have had my say on the report and I am interested to hear what other Members have to say about it. The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) gave a lucid exposition of the report and an analysis of the Government's response, so there is not more that I wish to add.
I wish to draw attention to one point, however. The evidence presented to the Committee was powerful in respect of the suggestion that Sema had made too lean a bid for the contract. To be fair, Sema inherited many of the difficulties that it now faces. After all, we have been told that there has been no increase in remuneration for eight years. Sema's problems did not arise suddenly but its low bid for the contract none the less gave it little scope to manoeuvre and address problems such as recruitment, pressures on doctors to accomplish examinations quickly, remuneration and particular difficulties with training. I wonder if the Minister can do anything to open up those issues before the contract comes up for renewal? I doubt it, but I hope that the hon. Gentleman will consider the matter seriously.
I wish to draw attention to one other matter. The sessional doctors of whom we are often so critical are the self-same doctors to whom other people go for surgery consultations to get prescriptions to make them better. They are not different people. One may find an examination by one's own GP cursory, painful or uncomfortable, but that will not have the same psychological effect--in terms of humiliation and so on--as it does when one finds the sessional doctor insensitive or when he generates pain or discomfort or makes a cursory examination.
Why are people prepared to accept that from their own GP but not from a sessional doctor? There is a psychological difference. People go to their doctor to be examined and given a cure for a problem, whereas a sessional doctor comes to see someone to examine whether they qualify for a benefit or--to put it bluntly--to make sure they are not malingering. Overcoming that barrier and psychological difference requires the sessional doctor to be much more sensitive than a GP has to be. That demands additional training which of course requires additional resources, which brings us full circle to the fact that Sema made too lean a bid for the contract.
5.22 pm
Mr. Andrew Dismore (Hendon): I agree with the final point made by the hon. Member for New Forest, West (Mr. Swayne) and hope to return to that later.
This is an opportune time to debate the issue. The report of the Select Committee on Social Security, together with the outcomes of the two seminars held by the Department of Social Security with Sema's officials at the end of last year, operated as a wake-up call for the Department by bringing to the fore criticisms of the Department's medical services, both when they were in-house and now that they have been contracted out. I welcome the Government's largely positive response to the report. I shall highlight areas in which, perhaps, there may be differences between the Select Committee and the
Government, but I hope that that will not be taken as detracting from the overall thrust of my remarks, which welcome the Government's response.I shall start with one or two points about the contract, especially the ratio of scrutiny to examination, which has been mentioned and which sounds very technical. The Committee was concerned that there may be other than logical reasons behind the falling ratio. The Government accept that our concern needs to be examined, and have identified several possibilities. When we considered the matter, the suspicion was put in our minds that the way in which the contract is formulated means that Sema can make money out of doing examinations not by seeing people but simply by going through the paperwork. If it does that and passes someone for benefit that person will not complain about receiving benefit--for obvious reasons. People who may not be entitled to benefit are potentially getting it, and the cost of that is passed on to a different part of the DSS budget. However, Sema is paid the same whether or not it does a full examination or an examination on paper, thus potentially finding a way of making profit out of the contract, which may not have been anticipated.
I am pleased that the Government said in their response that they would view that with unmitigated disapproval and take decisive regulatory action if it were the case. I am pleased that they have given such a strong response to the suspicion expressed by the Select Committee and that they are studying the issue in more detail. If the falling ratio turns out not to have more valid causes, that is a serious matter that needs to be addressed.
I am pleased also that the Government indicate that the contract with Sema allows the Department to share any financial savings if the ratio is found to have fallen for genuine reasons. I make a plea that, if those savings are identified, Sema and the Government should think about transferring the money to the wages of the doctors who, however one views the matter, are not getting a fair crack of the whip, for the reasons given by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) when he opened the debate.
The issue of complaints has loomed large in the debate. It is a bit rich for the Government to protest that the Select Committee worked on the basis of anonymous complaints. I listened carefully to my hon. Friend the Under-Secretary's intervention on my hon. Friend the Member for Clwyd, West (Mr. Thomas) on that point. The issue is that raised by the hon. Member for New Forest, West, and it is not that people are being victimised because they complain; there is no evidence of that and I have no reason to suppose that it is the case.
We must, however, understand the power balance, or lack of balance, between the claimant, for whom the doctor's decision can mean the difference between living in poverty and being a little, or a lot, better off, and the doctor, to whom the claimant is just one of a dozen that he may be seeing that week. That power relationship inevitably affects the way in which the doctor and the claimant view each other, so even though there is no threat and, as far as I can see, no evidence of victimisation, claimants may perceive that, given the power that the doctor and the Department have over them, it is best to complain anonymously.
I shall turn later to the issue of cultural insensitivity, on which we are again criticised for putting forward anecdotal examples. However, I submitted one of those
examples from my constituency case load, and I wrote to the Department about it 18 months ago, so the Department has chapter and verse on that case at least.We have to make it much easier for people to understand how they can make a complaint, and we have to work to overcome the fear that arises from the imbalance of power in the doctor-claimant relationship. I am pleased that the Government are considering ways of making claimants more aware of the complaints procedure, particularly for those who are examined in their own homes and who, at present, have no direct access to a complaints form.
There is ground to be made up. The National Association of Citizens Advice Bureaux, which wrote to me about this matter the other day, said that it was not surprising that clients found it difficult to get copies of the complaints leaflet because it
- was not even listed in the Benefits Agency's most recent catalogue, issued in May 2000.
We heard earlier of the 88 per cent. satisfaction rate, but that gives rise to the question of when clients are asked whether they are satisfied with the examination. They have no way of knowing whether what they have told the doctor has been accurately recorded. I accept that if the record is later found to be inaccurate, that can give rise to an appeal, but there has to be a way of dealing with a complaint from a client who genuinely believes that what they have said has not been accurately recorded. At the moment, there is a lacuna in the procedure.
My hon. Friend the Member for Clwyd, West pointed out the need for an accurate medical history. The Department rarely asks for medical records and notes from GPs and consultants. I fully accept the point made by the Department in its response, which is that in those circumstances doctors are primarily concerned with diagnosis, prognosis and treatment. However, like my hon. Friend, I was a personal injury lawyer. I practised in personal injury law for almost 20 years. I cannot recall a case in recent years in which the doctor preparing a report for use in court did not first ask to see the medical records.
The supposition in the Government's response is that issues relating to disability and function might not be dealt with in such records, but, in fact, they are. I have looked at many dozens, if not hundreds, of records while preparing cases over the years, and they often contain that information. The questions that doctors in personal injury cases have to address in court not only involve prognosis, but are rooted in the need to deal with functional disability because that represents the lion's share of any assessment of compensation.
Those doctors are asked to decide exactly the same questions with which Sema doctors deal, sometimes in medical examinations that last only a few minutes. They can do so because they get the history from medical records. It is important to get the history from the medical records when determining whether any pre-existing medical condition is relevant to the case because, with the best will in the world, I have found that many clients are not very good at giving a full account of their medical history. Such information is more easily and quickly obtained from their medical notes.
The kernel of all the complaints and submissions that we have received--and, indeed, all the discussions that we have had with hon. Members on both sides of the House during the Department's seminars and during the inquiry--is the way in which the Department treats people. I am concerned that the Department has not followed up our recommendations on claimants with mental health problems.
A separate review of how claimants with mental illness and mental health problems are treated is necessary, because they are special and the doctors involved need special training, especially in considering the degree of functionality. I fully accept that additional training is being given and that the emphasis is being placed on a much more empathic, active listening approach, but such a review is needed.
We criticised the services offered to members of ethnic communities in two main ways, the first of which relates to interpretation services. I am concerned that, as the hon. Member for Roxburgh and Berwickshire mentioned, the Government have not taken up our suggestion that there should be a multilingual notice. The reason given is that it is not consistent with the agency's practice. Perhaps that suggests that there is a question mark over the agency's practice, rather than over the recommendation.
Coincidentally, the Select Committee paid an informal visit to my constituency this morning as part of our pensioner poverty inquiry. Some of this morning's discussions were with ethnic community groups from the Asian and Afro-Caribbean communities in my constituency. We considered take-up, claims and so on, and they made the point that a much more simple claims procedure and face-to-face explanations are needed so that people understand what is happening.
We were given copies of the questionnaires that people must complete. The questionnaire that claimants must fill in is some 20 pages long. It is difficult to imagine people filling in those forms if English is not their first language. Completing the form would be bad enough if English was their first language. People may need interpreters because they do not speak English or have difficulty with it. That fundamental problem must be addressed. Similarly, the medical report form that doctors have to complete runs to 24 pages of questions.
Without an adequate interpretation procedure, and even with interpretation, there is enormous scope for misunderstanding between doctors and claimants for whom English is a second language, or those who try to answer the doctor's questions through an interpreter. Many of the complaints that we have had from ethnic minority communities and those who advise them on such matters arise out of misunderstandings caused, as much as anything, simply by the complexity of those forms.
I am disappointed to see from the Government's response that the Commission for Racial Equality has so far not been involved. From what is said there, that seems to be as much a problem of the CRE as of the agency. I hope that it can be much more involved in trying to deal with some of the problems, but we must not see those examples as merely anecdotal. I return to the fact that there is so much anecdotal evidence that it cannot be disregarded.
NACAB wrote to me yesterday with a batch of other examples. First, a young Somali woman with chronic back pain was examined, although none of the physical
descriptors for incapacity benefit were mentioned. She was simply asked to hold out each arm. The doctor remarked that her English was very good "for a Somali". Secondly, a black woman lost benefit after a medical examination when, in a stage whisper, the doctor asked a colleague whether he thought that the client was "faking it".Thirdly, a Muslim woman felt unable to disclose details of her incontinence to a male Asian doctor. The client felt insulted. The doctor asked whether she was married. When she responded that she was single, she was asked whether she had any children.
Fourthly--we have stressed the need for women doctors--a woman client was visited at home by an examining medical practitioner on a Saturday. The doctor made remarks about the client
- having a child out of wedlock
Fifthly, a woman client was alone when a doctor called. The doctor asked the woman to go upstairs to the bedroom for a medical examination. The client declined and said that she was on her own, but would be examined on the sofa. The doctor did not want to do that and dismissed her symptoms and complaints.
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