Cultural insensitivity or assumptions
about lifestyles
67. We have been told by witnesses about a number
of examples of Medical Services' doctors acting in an insensitive
way towards claimants from ethnic minority groups, for example:
"Dr C, upon visiting
an Asian client was asked to remove his shoes before entering
the lounge to conduct the assessment. The client and his wife
live downstairs due to severe disability, with one lounge being
used as a bedroom. The outer lounge is used for everyday living
and for prayer. On cultural grounds it is a requirement of everyone
entering a room used for prayer to remove their shoes. Dr C refused
to remove his shoes, resulting in the assessment being conducted
in the hallway."[72]
"Doctors often seem to make assumptions about
claimants' abilities on the basis of cultural misunderstandings.
For instance, a doctor reported a claimant as having no problems
with bending or kneeling—because he went to the mosque to
pray. On a more detailed exploration with the claimant we found
that he did not kneel or bend when praying at the mosque, but
sat in a chair and only gently lowered his head."[73]
68. We also heard examples of doctors making false
assumptions on the basis of crude stereotyping. Mr Andy King,
of Advice Centres for Avon, told us of one case in which a doctor
made allusions to an Irish claimant's alleged alcoholism, when
in fact there was "no evidence that the claimant was a drinker,
let alone an alcoholic."[74]
We were told about a similar case in Sheffield: "We believe
that there is a particular problem with racial stereotyping of
Irish clients. We have had experiences of the doctor asking an
Irish client if he had a drink problem and being unwilling to
believe the client (who is a diabetic and doesn't drink at all)
when he said he did not drink."[75]
69. Concerned about this and other evidence, we asked
the Minister whether he believed that people from ethnic minority
groups received as good a service as other claimants. He told
us that "I cannot give an evidencebased answer to your....question
about whether people from ethnic minorities are getting as good
a service as they should. We are very strongly committed to ensuring
that that is the case. We provide training in ethnic awareness
as part of the basic training. I understand that there is an ethnic
dimension now being built in to each of the training modules.
Perhaps that reflects the fact that we simply do not know whether
we are providing an appropriate service."[76]
70. The Commission for Racial Equality brought to
our attention two cases brought in the Bristol County Court under
the Race Relations Act, concerning medical reports by EMPs involving
the use of racial terminology which was found to be offensive.
The first which pre-dated the award of the contract for Medical
Services to Sema involved the description of a claimant as "a
pleasant negro lady", which was found to be offensive and,
in the words of the CRE "wide open to racial and other stereotyping."[77]
As a result of this case, the Benefits Agency adopted guidelines
in the use of racial terminology in April 1998 and undertook as
part of the settlement of the Court case to use their best endeavours
to ensure that the guidelines would be complied with in all medical
reports.[78]
However, in the second case, settled two and half years later
in January 2000, the Benefits Agency agreed to pay compensation
in respect of a claimant, where an inappropriate reference had
been made to his Irish origin. Again, undertakings were given
by the Benefits Agency as part of the settlement, this time that
the Agency would endeavour to ensure that national guidelines
relating to descriptions of race or ethnic origin were adopted
by all agencies responsible for producing medical and medical
adjudication reports. As part of the settlement, Medical Services
also agreed to endeavour to ensure that all Doctors employed or
contracted to them to prepare medical and medical adjudication
reports were aware of and complied with the Benefits Agency's
Equal Opportunities Policy.[79]
71. 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.
72. Furthermore, in the post-Macpherson era, it is
not enough for public services to root out those people who demonstrate
overt racism. The charge of institutional racism can be made against
any organisation which, albeit unintentionally, offers a different
service to individuals as a result of their ethnicity. 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.
73. 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.
Female Claimants
74. We were told that female claimants should have
the right to be seen by female doctors, and that this was an issue
of particular concern for women from some ethnic minority groups.
For example:
"Provision should be
made for women to be assessed by female medical professionals
as and when requested. This I feel is a very important point when
dealing with female members of the various ethnic groups who may
be reluctant to disclose medical details to male medical staff."[80]
75. This point—that female claimants might
feel pressurised to see male doctors—was also made to us
by Ms Cas Scholes of St Pauls Advice Centre: "In my experience,
nobody has ever been given a choice before the doctor has arrived
at the house. It is the usual thing with the doctor being in a
position of power and people not wanting to say "sorry, I
didn't know this was going to be a physical examination."
They do not feel they have the right to say "no, stop, I
don't want you to do that." Also, they have the fear of losing
their benefit. It is very rare for people to say, "stop,
no, I do not want this to happen."[81]
76. When we visited Bristol, we were told by Medical
Services that, in that area, "if it is a home visit and somebody
specifically requests a woman doctor they will always get a woman
doctor. If they turn up at a centre where there is not a woman
doctor available on that day and we are not aware at the beginning
that they require the services of a woman doctor, we would re-arrange
that appointment with a female EMP."[82]
We are aware that doctors in Bristol will make real efforts to
ensure that, when requested, female claimants are seen at home
by female doctors, even when this involves travelling considerable
distances.
77. The Minister told us that "We do not have
enough women doctors to be able to guarantee in all cases that
women will be examined by a woman doctor. If somebody made a particular
request we would do everything we could to meet that request,
but I cannot give you a guarantee that in all cases that would
be so.... I absolutely share your aspiration [to have female doctors
see female claimants whenever this was requested], but I cannot
put my hand on my heart and say that we are about to deliver it
because we do not have enough women doctors in the service at
the moment. The service needs to do better, I agree absolutely
with what you are saying."[83]
78. We are glad that the Minister believes that all
female claimants requesting to be seen by a female doctor should
expect this request to be met. We would hope that this would already
be the case, other than in exceptional circumstances, and we recognise
the efforts made by Medical Services in this respect. However,
we make an analogous recommendation to that which we made in relation
to interpretation facilities: women have to know that this is
an option, and have to be asked routinely whether they require
it. 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.
46 Ev. p. 20, para 4. Back
47
Ev. p. 20. Back
48
Ev. p. 20, para 5. Back
49
Ev. p. 20, para 5. Back
50
Ev. pp. 20-21, para 7. See also NACAB's evidence, ev. p. 18,
para 12. Back
51
North Shrewsbury Community Mental Health Team, Appendix 12. Back
52
Alan Pugh, Blackpool Advice Centre, Appendix 3, para 1(h). Back
53
Chesterfield Support Network, Derbyshire County Council, Appendix
9. Back
54
Welfare and Employment Rights Advice Service, Leicester City
Council, Appendix 25, para 1.4. Back
55
Ev. p. 70. Back
56
Q 56. Back
57
Q 113. Back
58
Ev. p. 32, para 3. Back
59
Q 391. Back
60
Appendix 10, para 5. Back
61
Ev. p. 35. Back
62
Q 393. Back
63
Ev. p. 21, para 14. Back
64
National Schizophrenia Foundation. Back
65
Q 558. Back
66
London Advice Services Alliance (LASA), Appendix 15, Section
11. Back
67
Wandsworth Borough Council Social Services Department, Appendix
13, para 3. Back
68
Rotherham Metropolitan Borough Council Welfare Right & Money
Service, Appendix 10, Section 6. Back
69
QQ 549-551. Back
70
QQ 334-335. Back
71
Q 437. Back
72
Ev. p. 7, para 4.12. Back
73
London Advice Services Alliance (LASA), Appendix 15, Section
11. Back
74
Q 172. Back
75
Ev. p. 7, para 4.12. Back
76
Q 548. Back
77
Appendix 18, para 5(b). Back
78
Appendix 18. Back
79
Appendix 18, para 5(e). Back
80
D.D. Ahir, Community Advisor, Telford & Wrekin Council, Appendix
1, para 3. Back
81
Q 186. Back
82
Q 249. Back
83
QQ 553 & 556. Back
