Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



  20. One of the concerns in the report about the way in which SEMA doctors carry out their assessment is, as I understand it, in the original contract the delivering of assessments on time was not linked to payment. You have talked about increasing the fees for doctors, which presumably incentivises them to deal with claimants more efficiently, more effectively, more quickly or whatever, but the same does not apply to GPs who are an important part of the process.
  (Ms Lomax) I am not sure it is within our gift. Perhaps you would like to answer that?
  (Dr Aylward) I think we should understand that the remuneration that general practitioners receive under their NHS terms of employment includes an element which is specifically focused on the service that they provide the Department of Social Security in providing these reports. To say that the reports are rendered by GPs without fee is not really correct, there is a remunerative element in there which is acknowledged by the GP. On the other hand, if the GP is asked for information which is outside of the information he needs to provide in the issuing of a certificate or a statement for Incapacity Benefit then that GP is paid. As Ms Lomax has said, in DLA GPs are paid for all the information that they provide and all information they provide in Industrial Injuries Benefit. There is an element of fee that is available for GPs to incentivise them.

  21. Let me move on then to the way in which the customers perceive the system which they have to go through. The report says that if customers do not feel at ease in the examination that could influence the quality of the assessment and the information which they give for that. That is an understatement really, is it not? I think all of the Members of Parliament around this table see almost weekly in their postbags concerns from people about the way that they are treated in this system. Let me ask Ms Cleveland, the people who are called in for assessment, are they malingerers, are they law breakers?
  (Ms Cleveland) Certainly not. They are called in for assessment because it has got to the time of their particular claim when a review is due.

  22. If that is the case, why do people who come to me to complain about their treatment believe that they are regarded as malingerers and potential law breakers? Why is it that they complain that doctors are rude to them? Why is it that the medical examination, if they are given one, is regarded as superficial and sometimes downright insulting to the people called for assessment?
  (Ms Cleveland) In terms of the medical assessment I do think there is some confusion about the purpose of the medical assessment. I am talking about Disability Living Allowance in particular here. The medical assessment is to assess how their disability impacts their ability to care for themselves or their mobility, it is not a diagnostic medical examination. Certainly from the letters I get, and I cannot judge whether they are the same representations you get, it is a confusion that quite a short medical assessment can actually make the assessment for DLA purposes, but it is not the same as a diagnostic element. In terms of the way in which people are being dealt with by doctors, clearly that is something that we take up continually with SEMA and through the contract.

  23. When it comes down to a lady constituent of mine who was taken in for what she regarded as a medical examination and the doctor dropped a pencil on the floor and said "pick it up" and when she did said "well, that is it, you have effectively passed the assessment or failed the assessment", whatever words you want to use to describe it, I think she has got just cause in saying "hang on a minute, why am I being treated in this way?" Let me move on from that. Why is it that GPs' evidence appears to have been often ignored? They are asked to provide evidence but it does not appear to have very much bearing on the output.
  (Ms Cleveland) I do not think GPs' evidence is ignored. I think there is an issue about the quality of the GPs' evidence in terms—

  24. How many times do you get complaints from GPs that they believe that the assessment result is entirely at odds with the information that they have provided, and sometimes provided properly, and put into the system?
  (Ms Cleveland) I personally have never received a letter from a GP about that. I just do not know the figures for the numbers that may have come through the medical assessment side.
  (Dr Aylward) I have not received any either.

  25. So you never get any letters from GPs saying "why did you ask me for the information if it then appears to have been ignored?"
  (Ms Cleveland) I am not saying that we do not get them in the Benefits Agency, I am saying I personally have not had any. I can go away and make enquiries to find out how many have we had and let you know[2].

  26. Mr Jones, who actually deals with complaints about the system?
  (Mr Jones) We do have a formal complaints procedure that has been put in place and we are continually updating and working on that. We are continually developing that system in terms of complaints. I would agree with Alexis in the sense that a lot of the complaints come from the fact that people misunderstand the purpose of the examination and they think they are getting a full medical examination when, in fact, the nature of the examination is different. At the moment we are updating our information in this area and there is a new pamphlet on complaints currently being produced and it is just ready to be signed off by the Department for issue in the immediate future.
  (Mr Raja) SEMA directly have received no such letters from doctors, GPs, stating that.

  Mr Campbell: The report seems to suggest that you must have told the NAO that the surveys that you conduct about customer attitudes show that most of them are content with the examination that they get and yet the number of complaints are rising and I would say the number of complaints in my postbag are rising too.

  Mr Rendel: Hear! Hear!

Mr Campbell

  27. Which is true?
  (Ms Lomax) The number of complaints in total is relatively small, it is about 4,000 or 5,000 out of 1.3 million referrals a year. The Customer Satisfaction Surveys have shown ratings of over 90 per cent in recent months. There still may be a number of very seriously aggrieved constituents but it only takes a fairly small number to make your postbag feel uncomfortable. This is a very difficult area. This is an area where people have been denied benefit as the result of a medical examination, and that is something which both GPs and customers can feel very unhappy about. Do you want to say something?
  (Mr Haighton) Indeed. It is a fraction of one per cent, the number of people who complain, and in practice over the last two quarters the number has declined quite significantly. Although we recognise that there are some very serious complaints, the volume is not as perceived, it is actually really quite small. The Customer Satisfaction Survey, which we have now had running for several months, and it was one which we redesigned with the help of the National Audit Office, has actually given us consistent rates of 92-93 per cent in the last few months. So I do not think the anecdotal evidence quite matches the actual figures.

  28. I think that is exactly my question. That is what I cannot understand; why the impression that was created in the Report does not seem to match up with what we as Members of the Parliament might see. I want to move on, if I may, to look at some figures. As I understand it, SEMA have got the contract for five years at a cost of some £305 million over that period and the savings are in the range of 10 to 14 per cent. Are those figures right?
  (Mr Haighton) That is correct.

  29. If that is the case, 10 to 14 per cent over that five-year period would mean savings of somewhere between £30 million and £50 million. Is that right?
  (Mr Haighton) Yes.

  30. We have just been told that the fees are increasing by 15 per cent and according to the Report the Government are funding half of that. Is that right?
  (Ms Lomax) Fees per session for doctors.

  31. So that is £2 million a year?
  (Ms Lomax) That is right, yes.

  32. So if the savings are at the lower end, which is £6 million a year, am I right to conclude that a third of that is now taken up by this extra cost to the Department, so the savings will not be as great?
  (Ms Lomax) They will not be as great, no.

  33. Paragraph 2.10, the Department is entitled to £16 million worth of service credit for SEMA's failure to meet performance targets[3]. Has that money been collected?

  (Ms Lomax) Some money has been collected in the form of a service credit.

  34. How much of it?
  (Ms Lomax) About £600,000. There was another £1.6 million due to us which was basically put in suspense against improvements in service that we wanted to see. The purpose of that was to incentivise SEMA to put those improvements into place.

  35. So that is money the Department could have claimed because of failure to meet targets in the past but you have not collected it to incentivise them to meet their targets in the future?
  (Ms Lomax) Yes, as something for SEMA to go for, especially at this stage in the contract.

  36. Presumably the same incentives exist into the future as existed in the past. They are incentivised from day one but you have not collected on their failure to meet those targets?
  (Ms Lomax) There may be a range of reasons why we do not collect service credits, including sometimes problems which led to new service credits which may not have been entirely within SEMA's control. Sometimes the judgment is that it is better that SEMA hangs on to the money and uses it to improve service than we take it off them with a risk of giving it back to them in the form of putting money on top of the contract. We are having to put extra money into this contract in order to deliver the quality that we as a Department feel is absolutely necessary. We do not feel that taking money off SEMA and then giving it back is a sensible thing to do.
  (Mr Haighton) If I could describe more fully what the service credit regime is for[4]. It is there to act as an incentive, it is there to provide remedies where the supplier has not met the targets that we imposed, but it is also there to recognise there is not always a clear responsibility for failure to meet these targets. For instance, there is a whole range of things that have happened in the last year like fuel strikes which have had a direct effect on some of this. Each month we look at what the service levels are, we work through the reasons and then decide whether it is proper to apply service credits or withhold them or just abandon them, depending on the circumstances.

  Chairman: Can I ask the witnesses to try and keep the answers a little briefer or we will be here for a very long time. Mr Gerry Steinberg?

Mr Steinberg

  37. I want to pursue what Mr Campbell was originally questioning you on. I get very cross because I see some of the most appalling decisions, frankly, made by this Department in terms of some of the constituents that I come to meet. I was interested in Part 3 of the Report which is entitled "Improvements in the quality of assessment have yet to be fully delivered." I thought that was a bit of an under-statement really, particularly in Paragraph 3.2 where it says: "And reporting by the President of the Appeals Tribunals has indicated that insufficient or poor quality medical evidence is one of several key factors affecting the quality of decisions." Does that refer to the GPs and the medical appeals doctors?
  (Ms Lomax) It is all sources of medical evidence. It is hospital doctors as well as SEMA doctors and GPs.

  38. So insufficient or poor quality medical evidence is affecting the quality of decisions, can we assume?
  (Ms Lomax) The appeals success rate suggests that the quality of decision-taking is not as good as it could be.

  39. If there is poor quality medical evidence which affects the quality of decisions, what can be done about it?
  (Ms Lomax) We need to improve in two areas. First of all, we need to improve the quality of medical evidence and there is a range of things that Mansel can expand on what we are doing towards that, including introducing a new Diploma in Disability Assessment. This is a particular area of medicine which needs upgrading. We also need to improve the ability of decision-takers in the BA to interpret the medical evidence they receive.

2   Note by Witness: The Department acknowledges that it will have received letters in support of customers from their GP but cannot provide any figures as these letters are recorded under the benefit customer's name and not the doctor's name. Back

3   Note by Witness: The Department is, in fact, entitled to £1.6 million, not £16 million, worth of service credit for SEMA's failure to meet performance targets. Back

4   Note by Witness: Service credits can only be held over for a maximum of three months after which they either have to be applied or extinguished. Back

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