MEMORANDUM SUBMITTED BY SEMA MEDICAL GROUP
TO UPDATE THE COMMITTEE OF THE PUBLIC ACCOUNTS ON RECENT DEVELOPMENTS
The purpose of this memorandum is to outline
to the Committee the efforts SEMA have been making to address
various issues examined in the Comptroller and Auditor General's
report, and to provide further information on some recent developments.
Much of the progress reflects work that has taken place to implement
recommendations from the Social Security Select Committee Report
published on 12 April 2000, and in response to new targets set
by the Department in June 2000, as well as recommendations made
in the Comptrollers and Auditor General's report.
SEMA welcomed the opportunity to submit a bid
for the medical services contract in 1997, and recognised this
decision to move towards the outsourcing of the Benefits Agency
Medical Services represented a sea change in operation for the
Department for Social Security. Equally, SEMA is conscious of
the fact that there has been a change in attitudes towards outsourcing
in general, the need for quality assessment and control, as well
as the continuing need to ensure that the Government and hence
the taxpayer receives value for money; but always in the context
of caring for the people claiming benefitsin this instance,
some of the most vulnerable members of society.
SEMA is satisfied with the positive aspects
of the NAO Report on The Medical Assessment of Incapacity and
Disability Benefits which acknowledges improvements to the speed
and efficiency of the operation of medical services since outsourcing
by the Department.
This contract did pose some unique difficulties
for SEMA since, as the NAO Report recognises, critical quality
performance targets were not sufficiently outlined in the initial
contract. In addition, there have been some important lessons
for the company regarding some of the political sensitivities
and issues which arise as a direct consequence of this type of
One of the most important factors to consider
when assessing the successful running and implementation of a
contract of this nature which involves the assessment of people
for benefits, is that it depends not solely on the contractor.
As the NAO Report acknowledges, it depends on the inter-action
between a number of different players in the processthe
Benefits Agencies offices around the country, the claimants' own
GPs and their consultants, as well as the claimants themselves.
SEMA has always sought to work successfully with all these groups
and continues to seek new ways in which communication with them
can be improved.
SEMA took the Social Services Select Committee
Report of 12 April last year very seriously. The company has worked
hard to meet the four revised targets which were set by the Department
of Social Security last June. These targets related to the quality
of medical reports, medical scrutiny of Incapacity Benefit claims,
training for doctors and customer satisfaction.
Since last year SEMA has worked closely with
the Department to agree new scrutiny guidelines for doctors with
respect to claims for Incapacity Benefit. SEMA and the Department
carried out an audit in the summer of 2000 to identify issues
causing doctors difficulty in interpreting the existing guidelines
and wrote a new version of them. Doctors were trained rapidly
and effectively and the new guidelines were introduced from 6
November 2000. (NAO report paragraph 14 of the Summary and paragraphs
3.8 and 3.24). There has been close co-operation between the Department
and SEMA in evaluating the results of the guidelines. Compliance
is high and SEMA expects to meet fully the target within the timescale
Both sides recognise that further advice to
doctors will be needed in the near future and also accept that
further refinement may be necessary. The company will work closely
with the Department to achieve a workable outcome.
SEMA is now addressing the issue of reports
which do not meet the defined standards (NAO report paragraphs
3.4 and 3.8). The new target requested that within six months
SEMA had to reduce the proportion of "c grade" medical
reports which fail to meet the Department's standards by 10 per
cent; and within one year to reduce the proportion of "c
grade" reports across all areas to less than 5 per cent.
SEMA has met the first part of this target. The percentage of
unsatisfactory reports has fallen from 6.49 per cent at the end
of August to 5.64 per cent at the end of January.
The Department requested that claimants' satisfaction
rates had to be improved within two years to at least 90 per cent
(NAO report paragraphs 4.5, 4.29 and Figure 22). SEMA has met
SEMA has produced better-targeted information
for claimants outlining the processes involved in making a claim,what
to expect in examinations by doctors (NAO report paragraph 4.30).
In this material the company emphasises that SEMA does not make
any decisions with respect to customers' benefits claims.
The company has introduced what it believes
is a more effective scheduling systema system which particularly
focuses on the time and place where claimants' examinations should
occur. This is particularly effective at the local level. Up to
30 per cent of claimants do not attend their scheduled examination
which inevitably has led to a level of over-booking and on occasions
some claimants have been sent away unseen. The scheduling initiatives
outlined above, combined with fee per case payments to doctors
will give greater flexibility. The current pay increase for doctors
which includes a deterrent against doctor cancellation at short
notice will also help the scheduling process.
SEMA has also made a significant investment
in the development of the IT infrastructure in order to assist
the scheduling process.
As outlined at paragraph 4.30 of the C&AG's
report, SEMA does recognise the need and importance of input from
welfare rights groups; for example we now have an on-going dialogue
with the National Association of Citizens Advice Bureaux at both
a national and an area level, as well as a fledgling dialogue
with the Commission for Racial Equality. The company also communicates
with other interest groups which have an interest in the successful
development of the medical services contract.
SEMA has a heightened awareness of the need
to monitor and assess the performance of doctors undertaking examinations
and has introduced tough standards to which medical practitioners
Before the contract was let, there was no formal
continuing medical education programme in the Benefits Agency
Medical Services. The training which the Command Paper identified
as being essential will have been provided to all established
doctors by 30 June 2001. (NAO report paragraph 3.11). Already
some 90 per cent of employed and contracted doctors have availed
themselves of the key new training modules for doctors which include:
Multi-cultural Awareness, Mental Health Disabilitya
Generic Approach to Assessment, Distress Avoidance in Examination
Techniques. Doctors will be paid to attend training sessions.
SEMA is also committed to ensuring the successful
uptake by doctors of the Diploma in Disability Assessment Medicine
sponsored jointly by the Faculty of Occupational Medicine of the
Royal College of Physicians and the Department of Social Security.
There is one issue of particular concern: doctor
shortages (which is discussed in paragraphs 3.12 to 3.17 of the
NAO report). We believe this issue to be a demographic time-bomb.
Throughout SEMA has been constrained in the delivery of this contract
by national trends in the medical profession. We refer here specifically
to the diminishing pool of doctors not only available, but who
are prepared to undertake this type of medical assessment work.
It was with this in mind that from the outset in its initial bid
SEMA set out ways in which other healthcare professionals could
be used to help address this issue. In addition to solving workload
and number problems for those doctors available it may help to
address the gender issues. SEMA has initiated a pilot project
in Manchester designed to investigate the way in which healthcare
professionals could support the assessment of claimants.
SEMA has announced a general fee increase of
15 per cent for the doctors working within their contract. Local
managers are looking to adopt flexible working patterns to ensure
that the maximum number of doctors sign up working for SEMA.
SEMA has endeavoured to be innovative and responsive
from the outset in this groundbreaking departure for the Department.
With the publication of this NAO report we remain so and welcome
both its praise and its commentary. SEMA is a company dedicated
to service and best practice.
SEMA Medical Group
13 March 2001