Dealing with poor performance
39. Some of the concerns raised about Medical Services
suggest that problems can be caused by a small number of doctors
who demonstrate a persistent pattern of poor performance. For
example, NACAB told us that "a CAB in the West of England
reported several cases where the examination lasted between 10
and 20 minutes. When one of their clients asked, at the medical
examination centre, for a complaint form about the generally dismissive
attitude of the doctor, she was told that there were many complaints
about the doctor."[42]
40. A worrying point put to us is that Medical Services
fails to deal adequately with such doctors. The County Benefit
Service, Kent County Council, told us that "one doctor in
particular has been the source of considerable criticism and the
subject of several complaints, but the most recent response from
Sema drew the comment that Dr..... was "an admired and well
respected doctor." This particular doctor stated to one claimant
(whom he had subjected to a previous medical assessment about
which she had complained) that "you can't touch me, I'm under
contract." Such a perceived lack of accountability is very
worrying."[43]
41. The Department's memorandum states that "All
doctors must be approved by the Chief Medical Adviser [to the
DSS] before they can undertake medical assessments."[44]
The Department was asked how many doctors have had their approval
to work for Medical Services removed, and stated that "the
number of doctors who have been "dis-approved" over
the past 6 months is approximately 10."[45]
42. Consistently under-performing doctors diminish
the reputation of Medical Services, cause distress to claimants,
and cost the taxpayer money by producing poor quality reports
which can lead to cases being overturned at Tribunal. Therefore
it is important that these doctors are identified and barred from
working for Medical Services. While we are pleased to note that
the Chief Medical Adviser is willing to exercise his responsibility
in this regard, we are not convinced that Medical Services has
in place an adequate system of identifying such doctors. 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.
Treatment of claimants: overall
conclusions
43. The range and frequency of concerns raised with
the Committee about the treatment of claimants by Medical Services
doctors lead us to conclude that too often the organisation fails
to deliver an adequate service. While we are certain that the
majority of doctors employed by Medical Services take a professional
approach and intend to treat claimants professionally, evidence
we have received makes it clear that too often the service does
the opposite. At its worst, it puts claimants through examinations
which are painful and distressing and gives poor advice to BA
decision makers.
44. We believe that a number of factors lead to this
failure of service, amongst them: consistently poor performance
by a very small proportion of doctors; inadequate training in
customer care; and time pressures imposed by the system which
lead to hurried examinations and reports. More broadly, the failure
of service appears to reflect a broader culture within Medical
Services where 'the customer' is seen not as the individual member
of the public undergoing examination, but the Benefits Agency.
Our inquiry has led us to conclude that, so far, the primary focus
of Sema has been on operational efficiency to achieve value for
money, rather than the delivery of a quality service from the
point of view of the individual examinee. The 'fundamental balance'
referred to in paragraph 36 above has not been achieved. We look
for a major re-balancing exercise towards an improved service
for the public for the remainder of Sema's contract with the Benefits
Agency. We recommend that Medical Services and the Benefits
Agency take urgent steps to achieve better treatment of claimants:
present performance is not acceptable.
19 Welfare Rights Unit, Sheffield Social Services,
quoted in evidence from Disability Alliance and RADAR, ev. p.
7. Back
20
DIAL, Nuneaton, quoted in evidence from Disability Alliance and
RADAR, ev. p. 7. Back
21
The Incapacity Benefit Handbook for Medical Services Doctors,
Appendix I. Back
22
GMB, Appendix 8. Back
23
Ev. p. 15, para 4. Back
24
Rotherham Metropolitan Borough Council Welfare Rights & Money
Advice Service, Appendix 10. Back
25
Cystic Fibrosis Trust, Appendix 11, para 12. Back
26
London Advice Services Alliance (LASA), Appendix 15, para 4. Back
27
Rotherham Metropolitan Borough Council Welfare Rights & Money
Advice Service, Appendix 10. Back
28
Disability Alliance and RADAR, ev. p. 5, para. 4.10. Back
29
Manchester Advice, Appendix 33. Back
30
Manchester Advice, Appendix 33. Back
31
Local Government Association, Appendix 30, para 8. Back
32
Conwy District Citizens Advice Bureau, Appendix 23. Back
33
Manchester Advice, Appendix 33. Back
34
Local Government Association, Appendix 30, para 3. Back
35
Lancashire County Council Welfare Rights and Social Inclusion
Service, Appendix 21, para 12. Back
36
Chesterfield Support Network-Derbyshire County Council, quoted
in evidence from Disability Alliance and RADAR, ev. p. 4. Back
37
Disability Alliance and RADAR, ev. p. 4. Back
38
Q 512. Back
39
Q 516. Back
40
Q 288. Back
41
Q 348. Back
42
Ev. p. 17, para 11.4. Back
43
Appendix 6, para 3.2. See also ev. p. 12, para 4.19. Back
44
Ev. p. 54, para 2.8 Back
45
Ev. p. 171, Q 1. Back
