| Time spent with claimants
|
| (a) | We recommend that no reduction in average times spent examining claimants should be allowed to occur, unless hard proof can be deployed to show that there has been a genuine increase in claimant satisfaction. We are sceptical that the two can occur simultaneously. We also recommend the present duration of examinations be monitored by the Medical Quality Surveillance Group to ensure that they are sufficient to enable the doctors to produce accurate reports without being under pressure of time (paragraph 30).
|
| | |
| Inaccurate or distorted recording of information
|
| (b) | We recommend that Medical Services design and implement a system of recruitment, training and monitoring that ensures that its doctors can perform the fundamental task of information recording to an accurate standard. Action should be taken to dismiss those doctors who consistently fail to attain the necessary standard (paragraph 32).
|
| | |
| Legibility of reports |
| (c) | We agree [with those who raised the matter in their evidence] that illegible reports are unacceptable (paragraph 33).
|
| | |
| Training in customer care |
| (d) | We recommend that Medical Services has a dedicated training course in customer care for all new doctors, and that customer care issues also run as a 'golden thread' through all other training. There should be regular refresher training in customer care issues, delivered on an annual basis as a minimum, and such training should be assessed to ensure its effectiveness (paragraph 38).
|
| | |
| Dealing with poor performance
|
| (e) | We recommend that Medical Services review their procedures for identifying and dealing with underperforming doctors and report back to the Chief Medical Adviser on these procedures (paragraph 42).
|
| | |
| Treatment of claimants: overall conclusion
|
| (f) | We recommend that Medical Services and the Benefits Agency take urgent steps to achieve better treatment of claimants: present performance is not acceptable (paragraph 44).
|
| | |
| Claimants with mental health problems
|
| (g) | We support the recommendation of Mind, that there be better training on [mental health] issues for all Examining Medical Practitioners [EMPs] and that there should be some specialist resource within Medical Services, which could help provide such training, and also see claimants in cases which were particularly complex (paragraph 57).
|
| | |
| (h) | We recommend that the Chief Medical Adviser instigates a review of Medical Services' treatment of claimants with mental health problems, covering time spent with claimants, doctors' expertise, the ability of the system to assess accurately the nature of mental health problems, to assess how the system could be improved and, in particular, what scope there is for reducing distress caused to claimants. We would expect to see the outcome of such a review in due course (paragraph 59).
|
| | |
| Claimants from ethnic minority groups: interpretation services
|
| (i) | It is of the utmost importance that claimants whose first language is not English are able to communicate effectively with EMPs. All claimants must be told clearly in their first correspondence from Medical Services that they have the right to request the presence of an interpreter if they so wish. Such correspondence should include a multi-lingual notice inviting claimants to contact the centre if they cannot read the letter. We look forward to speedy action in this area (paragraph 66).
|
| | |
| Claimants from ethnic minority groups: cultural insensitivity
|
| (j) | We recommend that doctors who demonstrate cultural insensitivity should receive immediate remedial training and have their subsequent performance monitored. Those doctors failing to improve their performance after such action has been taken should be dismissed (paragraph 71).
|
| | |
| (k) | We believe that Medical Services could be laying itself open to the charge of institutional racism in two ways: in failing to train adequately doctors in issues of cultural awareness; and in failing to make claimants aware that they may request the service of an interpreter. We expect it to address both issues as a matter of priority. We recommend two further steps: that Medical Services monitor the service received by claimants from ethnic minority groups through targeted surveys and other means; and that the Commission for Racial Equality be invited to review the work of Medical Services in relation to its treatment of claimants from ethnic minority groups (paragraph 72).
|
| | |
| (l) | It is unfortunate that doctors have made inappropriate references to claimants' ethnic origins in reports, and it is clear why this has given offence. What is perhaps more worrying, is the suggestion that, despite undertakings having been made, effective guidelines and training on this issue had not been given. We appreciate that the undertakings were given at the time that the Benefits Agency had responsibility for the service. Now that Medical Services is Sema-run, we expect robust guidelines to be followed by all doctors, and the necessary training to be provided to help them do so (paragraph 73).
|
| | |
| Female claimants |
| (m) | We recommend that the availability of an examination by a female doctor should be spelt out clearly in the initial letters sent by Medical Services to claimants (paragraph 78).
|
| | |
| Complaints |
| (n) | We are concerned that, because of the perceived failure of the complaints system, many claimants are choosing to appeal, rather than to complain. We note that Sema have recognised a problem with their complaints procedures and are conducting a review, which we welcome. We would expect to see the results of the review and we expect the Department to monitor performance in this area and push very hard for improvements to be made. At the very least we expect that details of how to complain should be drawn to the attention of each individual undergoing an examination, wherever the examination takes place (paragraph 88).
|
| | |
| Customer satisfaction surveys
|
| (o) | We recommend that a proportion of customer surveys are conducted with claimants after they have seen the EMPs' reports (paragraph 95).
|
| | |
| Complaints and customer satisfaction: overall conclusion
|
| (p) | Changes to the system [of complaints and monitoring customer satisfaction] are required; allied to those more minor ones we recommend in relation to customer surveys, an improved system of customer feedback will give Medical Services indispensable information which they must use to help draw up the improvements we hope to see in their service (paragraph 96).
|
| | |
| Appeals |
| (q) | We note that the Chief Medical Adviser and Dr Carol Hudson of Medical Services intend to hold regular meetings with the Appeals Service to discuss issues coming through on Appeal. We welcome this (paragraph 104).
|
| | |
| |
| Appeals: EMPs' access to other medical evidence
|
| (r) | We appreciate that allowing EMPs greater access to other medical information relating to claimants would have resource implications. However, we think it would also help raise the quality of reports produced and lower the number of successful appeals. We therefore recommend that Medical Services and the Benefits Agency explore ways in which such records can more frequently and readily be made available to EMPs. One alternative might be for EMPs to be able to request medical records in DLA/AA cases. This might provide more accurate case histories and could also prove to be more cost-effective (paragraph 107).
|
| | |
| Appeals: use of feedback |
| (s) | We think that as a matter of quality control, Sema should be made aware if a significant proportion of successful appeals can be related to cases where particular doctors have provided the medical report (paragraph 108).
|
| | |
| (t) | We recommend that individual Medical Services doctors should be informed of the outcome of appeals where the Tribunal has chosen not to endorse that doctor's findings. Furthermore, we recommend that Medical Services monitor this feedback and take appropriate action where individual doctors have a higher than average proportion of such cases (paragraph 108).
|
| | |
| Sessional doctors sitting on Tribunals
|
| (u) | It seems surprising that legal advice has not been taken on the potential incompatibility of the present practice of sessional doctors sitting on Tribunals with the European Convention on Human Rights. We recommend that such advice be taken (paragraph 114).
|
| | |
| Cases determined by scrutiny and by examination
|
| (v) | We welcome the fact that the Department has now acknowledged that the Committee's concerns regarding the falling number of medical examinations being carried out were justified. However, we remain concerned that there may be structural reasons, relating to the nature of the contract with Sema Group, why this problem is occurring (paragraph 124).
|
| | |
| (w) | We recommend that the contract be renegotiated in such a way as to ensure that there can be no question of profits being increased as a result of a policy which could cost the taxpayer millions of pounds through the payment of benefits which should not be made. We further recommend that the Committee of Public Accounts considers inquiring into this matter (paragraph 128).
|
| | |
| Pressure to see more claimants
|
| (x) | We criticise the approach taken by Medical Services which encourages doctors to produce reports which might be of a lower quality than that which the doctors might want to produce. Interfering with the judgment of medical professionals in this way is not acceptable (paragraph 131).
|
| | |
| (y) | We recommend that the Benefits Agency and the Department should monitor closely Medical Services' performance in order to ensure that, by increasing claimant numbers per session, profitability is not put before performance (paragraph 132).
|
| | |
| Financial pressures: conclusions
|
| (z) | As we have noted, the falling number of examinations as compared to cases dealt with by scrutiny, and the increasing numbers of claimants seen per session, lead to the suspicion that standards are coming second to profitability. It would be naive to blame Sema for trying to make a profit—that is their business. The onus must be on the Benefits Agency and the Department to monitor Medical Services and, if necessary, make contractual renegotiations, in order to ensure that financial pressures do not lead to a lower quality service (paragraph 133).
|
| | |
| Doctors' pay |
| (aa) | We recommend that Sema examines the case for a one-off 'catch-up' increase in payments to doctors to account for the fact that their pay has not increased since 1992. We further recommend that Sema lays down a timetable for ongoing regular reviews of doctors' pay (paragraph 136).
|
| | |
| Responsibility for the service
|
| (bb) | We recommend that, in exercising their overall responsibility for the service, Ministers act speedily to remove confusion as to where day-to-day responsibility rests for detailed aspects of the service (paragraph 139).
|
| | |
| Training |
| (cc) | As a minimum, we recommend that Medical Services meet their contractual obligations to provide 5 days training to all doctors annually. We deplore the fact that Sema has failed to meet this contractual obligation to date (paragraph 144).
|
| | |
| Diploma in Disability Analysis Medicine
|
| (dd) | We recommend that if the Department are serious about achieving a step change in quality in the delivery of Medical Services they should make it a long term objective that all sessional doctors attain it and they should set a timetable in which this will be achieved. There should be a financial incentive available to encourage doctors to undertake the Diploma. The Department should begin to explore funding options to this end (paragraph 148).
|
| | |
| Performance since contractorisation
|
| (ee) | We recommend that the Benefits Agency explores the reasons why decision makers appear to demand reworked cases so infrequently and makes systemic reforms to ensure that unsatisfactory reports are never accepted (paragraph 155).
|
| | |
| (ff) | We recommend that the sample of reports audited be larger, especially for IB cases, and that the audit be carried out by an outside body, so as to increase confidence that it is an independent and objective exercise (paragraph 156).
|
| | |
| (gg) | The Committee has not been convinced that there has been an improvement in the quality of examinations and reports since contractorisation. Some efficiency improvements have been made: the challenge now must be to improve the quality of reports and the treatment of claimants. Given that there is pressure on doctors to see more patients more quickly it is difficult to see how this can be achieved. Ministers should ask themselves whether one of the goals of contractorisation—improved service to the public—has really been achieved. If they conclude, as we do, that it has not, they should take steps to renegotiate the contract, or otherwise influence performance to ensure that this goal is met (paragraph 157).
|
