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The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley): I start by echoing the sentiment expressed by many right hon. and hon. Members in thanking the Select Committee on Social Security for producing this report. The Chairman and
Let me start with the quality of the service that we inherited from our predecessors when we came to power three years ago. Our view was that the previous in-house service--the Benefits Agency medical services, or BAMS--was not performing satisfactorily in the areas of administration or medical quality. One of the first tasks in which the Government engaged after the election was to consider ways of changing the culture within the medical service and improving standards of service to the public.
We decided that we would be more likely to achieve the changes that were necessary by making a fresh start with a new organisation. That was fundamental to the decision to go ahead with putting the work out to contract. That was based on many years of experience of running an in-house service.
Contracting out the service meant that standards of performance had to be defined, which had never happened before. They had to be put on paper so that people knew what was expected of them and performance could be measured. That was done in the contract, and data are collected monthly to compare performance in medical services against the standards set out.
Some of the standards are administrative. For example, there is a requirement that 95 per cent. of incapacity benefit examinations should be conducted within 50 days. In September 1998, when Sema took over the contract, achievement of that standard was 75 per cent. Now, the target has been hit in all three areas of the Sema contract. By April 1999, it had been achieved in the south-western area; by June 1999, it had been achieved in the north; and, by November 1999, it had been achieved in the south-east.
A second administrative requirement is that 95 per cent. of disability living allowance examinations should be conducted within 20 days of being requested. In September 1998, when Sema took over the contract, only 62.5 per cent. of examinations were made within 20 days. That was the standard of performance inherited from BAMS. Now, 95 per cent. has been achieved in two of the three areas. The target was hit in the north-west last October, and in the south-west in November. The target is still not met in the south-east, however, where 87 per cent. of DLA examinations were conducted within 20 days in May. Improvements remain to be made. None the less, there have been major, measurable and demonstrable improvements in the administrative efficiency with which Sema provides a service.
Other standards in the contract relate to the quality of medical work conducted by doctors. For example, the proportion of reports graded A, B or C is measured. As the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said, a C report is not fit for purpose, a B report is fit for purpose but not perfect, and an A report fully meets all requirements under the contract.
A further example of medical quality standards is the proportion of doctors who complete required training. As I told the Committee some months ago, we have not yet seen a demonstrable improvement in the medical quality of the work being carried out. There has been no deterioration, but no improvement either. I am concerned
I shall say a little about standards of customer service. Sema employs more than 3,000 doctors, most of whose work fully conforms with the standards set out in the contract. Good practice in terms both of medical quality and customer service is the norm, but there are still too many cases--a small minority, but too many--of bad practice. All complaints are investigated, and we find some are justified and others not. In some cases, where there is a conflict of report between the benefit claimant who has complained and the doctor who conducted the report, it is simply impossible to tell where the truth lies. We must address that matter.
The Select Committee's discovery that there was a problem over the public perception of Sema and its predecessor, BAMS, was not new. Before the Committee instigated its inquiry, I had called two meetings for Members in the House--as the hon. Member for Roxburgh and Berwickshire acknowledged--so that they could give me case studies that demonstrated their concerns. I wanted to collect and learn from such examples in order to discuss the problems with colleagues. I also wanted to explain the improvements that we are undertaking: in recruitment standards; postgraduate medical education; in-service training; the base for professional standards--the new diploma in disability assessment medicine; and in the quality of clinical advice to doctors.
I held two meetings because there was such a large response from hon. Members who wanted to express concern; so many wanted to attend the meeting that they could not reasonably be accommodated in Committee Room 14. Those meetings may have been one of the many factors that prompted the Select Committee to investigate the matter.
To follow up those discussions with colleagues, I convened--with the help of the National Association of Citizens Advice Bureaux--a series of regional meetings throughout the UK, so that welfare rights advisers from CABs, local authorities and other bodies could share with us their experience of problems with the service. That was extremely useful. As a result of those meetings, Sema is revising its complaints procedures, as we recorded in our response to the Committee's report; that action was welcomed by many hon. Members.
I shall outline my priorities, as the responsible Minister, for the year ahead. Above all, I want to achieve significant improvements in medical quality. I took advice from the Department's chief medical adviser on which of the indicators that we use regularly to collect data under the contract best showed medical quality. In our response to the Select Committee, my right hon. Friend the Secretary of State set out challenging targets for Sema on four specific matters.
The first was that, within one year, the percentage of C grade reports, across the whole spectrum of benefits, should be reduced to less than 5 per cent. I point out to the hon. Member for St. Ives (Mr. George) that we do not
The third target is that, within one year, we require Sema to deliver training for all doctors in three categories. We have decided to set outcomes as a target--the fact that doctors complete the training courses, rather than that they undergo a specific number of days of training.
We, jointly with Sema, have selected three categories. First, there is to be a course on assessment of people with mental health problems, which is an issue that several hon. Members have raised. Secondly, there is to be disability awareness training. Thirdly, Sema has developed a new training package on how to avoid creating distress among people with musculo-skeletal problems--the biggest single group of people claiming incapacity benefit--by using what I would describe in lay terms as a hands-off examination process so that, where there is an alternative, people are not manipulated and do not have their joints moved by the doctor. Of course, on occasions, manipulation will be necessary, but the package covers alternatives to that.
After setting those targets, not before, the Government discussed them with Sema. Therefore, they were not targets set by a process of bargaining or negotiation; they were targets set by the Government because we believe that they are attainable, and we believe that they will make a significant difference or reflect a significant improvement in medical quality. We have since discussed them with Sema. It agrees with us that they will be extremely challenging, but it also agrees with us that they can be met.
Mr. Kirkwood: Those are very helpful confirmations. Do I understand the Minister to be saying that those performance improvements are being required of the contractor without any compensating financial allowances?