Examination of Witnesses (Questions 60
- 79)
WEDNESDAY 21 MARCH 2001
MS RACHEL
LOMAX, MR
NORMAN HAIGHTON,
DR MANSEL
AYLWARD, MS
ALEXIS CLEVELAND,
MR FRANK
JONES, MR
ZAFAR RAJA
AND DR
CAROL HUDSON
60. How do you find them?
(Dr Hudson) We advertise for them and we chase through
agencies.
61. How long do you employ them for? Do they
have a certain set period they have to go on working for you?
(Mr Raja) The full-time doctors have normal terms
and conditions in line with SEMA conditions. The sub-contracted
doctors which we utilise via the Nestor Healthcare Group have
a contract with them and it is for an indefinite period as long
as the doctor is prepared to provide the service.
62. They could give up at any time?
(Mr Jones) Because they fit in the work around their
other work. Some of them are full time, some of them are not.
63. Even if they have done training courses—which
you pay for or they pay for?
(Mr Raja) We pay for doctors to attend the training
courses which the trainers lay down which are within a classroom
environment we pay the doctors to attend those. There are other
training modules which are done via distance learning that the
doctors do in their own time.
64. I have an interest in this which I should
have declared at the beginning. My wife is a GP, not that she
is planning to apply to work for SEMA but you should know that,
technically at least. What assessment do you make of them when
they apply?
(Dr Hudson) The basic criteria, as Dr Aylward explained,
are laid down in the contract in terms of the background experience
of doctors. In general we would be looking for somebody with broad-based
medical experience who has been qualified long enough to develop
some experience in understanding the effects disabilities have
on individuals and their families. Beyond that we go through a
normal selection process of looking to various skills sets that
the doctors would display and generally through interviewing the
doctor on a face-to-face basis.
65. That applies to the ones sub-contracted
or just the ones you employ?
(Dr Hudson) Sub-contracted doctors too.
66. What records are kept on how many of the
decisions made by those doctors are overturned on appeal?
(Dr Hudson) We do not keep that record.
67. Why not?
(Dr Hudson) Doctor Aylward may want to come and support
or not here, but I think that the links between the end point
of the decision-making process and appeals and the role of the
doctor within it are not yet well established. We certainly welcome
in SEMA more close links with the appeals service so that we have
more direct feedback and I believe Dr Aylward is working on that
so we have the ability to understand what the outcome of appeals
means in terms of both our general learning experience for the
training needs to avoid the sort of problems that Mr Steinberg
and Mr Campbell have described and also of the individual doctors.
68. Ms Lomax, can I turn to you for a few questions
on appeal. What proportion of the appellants who appear in person
are successful and what proportion who do not appear in person
are successful?
(Ms Lomax) I cannot answer that question. Do we know
the answer to that question?
(Dr Aylward) We do know if the person presents themselves
and if they are there in person they are more likely to win the
appeal than not and that the decision might be overturned, but
I have not got the exact figures at the moment.
69. Do you have the figures?
(Dr Aylward) Yes.
70. Chairman, could we ask for those figures[8].
(Dr Aylward) We have now been told at
least, even if we do not know the exact figures, that those who
appear in person are more likely to win their appeals. Do you
advise them to appear in person?
(Ms Lomax) I think we do ask them.
(Dr Aylward) Information that is issued by the Appeals
Service requests the person to appear and they advise them why
it would be better for them to appear rather than the case to
be decided either by a representative or on the papers only.
71. What do you tell them about why it would
be better?
(Dr Aylward) I cannot speak for the Appeals Service.
I know that they do that and again we could provide you with that
information.
72. I would be grateful if you could provide
that as well[9].
What, if anything, is in the contract that you have with SEMA
about the rate of successful appeals? Do you have anything in
there that they will not be paid so much if the rate goes up?
(Mr Haighton) Absolutely not. We carefully
avoided anything that would indicate that the doctor should have
any direct influence over whether the person receives benefit
or not. The aim of the contract is that we ask doctors to give
a comprehensive, evidence-based, objective assessment of the effect
of a person's disability and it is not appropriate that the doctors
should be incentivised one way or the other in terms of benefit.
(Dr Aylward) Could I add something which
I think will help and that is in regard to the arrangements that
we are currently taking forward with the President of the Appeals
Service, Judge Harris, they will ensure that those cases where
the medical evidence provided by a SEMA doctor or a Nestor doctor
is considered to be in some way indicative of poor performance
or not meeting the point, that will be sent by the Judge to me
so that I may look at them and refer them back to Carol Hudson
so that she can investigate this, and then I can be provided with
the findings which will be fed back to the Judge and also use
those findings, if necessary, to ensure that SEMA undertakes remedial
training. This process will go some way towards giving us some
more data on the relationship between poor medical evidence, if
it is there, and a decision on appeal. I would point out that
at appeal the medical evidence does not include only the report
that has been done by a Benefits Agency doctor.
73. I understand that. I understand that about
56 per cent of those turned down for Incapacity Benefit do not
appeal but of those who do appeal nearly half are successful.
Do you have any information for us on how many of those who do
not appeal might well have been successful if they had appealed?
(Ms Lomax) No.
74. Have you done any tests of that? Have you
looked into doing surveys of small groups of those who do not
appeal and taking their cases again?
(Dr Aylward) I think the only way we could answer
that is if SEMA undertakes a random running sample of doctors'
reports but that would only tell us whether or not a doctor's
report had met a particular level of quality. It would not inform
us on what would have happened if that person had sought an appeal.
75. Have you done any surveys of why people
do not appeal?
(Dr Aylward) Not to my knowledge.
76. It looks to me, if half of those who go
to appeal are successful, that the likelihood is that quite a
number of those who do not appeal would be successful. Obviously
I cannot tell that any more than you can without doing the work
but it looks as if that may well be the case. I am sure that we
would all have anecdotal evidence of people who do not appeal
because they get fed up with the system or they go into hospital.
There are all sorts of reasons why they might not appeal, which
are quite different from the fact they are not going to win their
case. It strikes me that the sort of figures we have seen indicate
there is quite a large number of people who do not appeal but
would win if they did, and I would have thought that was the sort
of evidence the DSS would want to know because that might indicate
that people were not getting benefits when they should be.
(Ms Lomax) We are concerned to improve the quality
of the decision taking first time around so that people do not
have to go through the distress of having to appeal in order to
get a correct decision. I think that probably would be our priority
in allocating scarce resources in this area.
77. I am all for what you say but it seems to
me a pity if you do not have the resources to go into the other
as well, at least on a sample basis. You have not even done a
trial.
(Ms Lomax) If I can be absolutely candid with you,
the fact that so many people succeed on appeal does not make me
feel that the major problem is that people are not being successful
on appeal. The major problem to my mind is that we are not taking
the right decisions first time around. In terms of prioritising
what we ought to be concentrating on, I think that is what we
should pursue.
78. I have no difficulty with your priorities,
I have a difficulty with the fact that you are not doing the other
at all.
(Ms Lomax) The way things are in the Department of
Social Security priorities is the name of the game.
79. That says a lot about the Department of
Social Security, if I may say so, if that is true. Can we go on
to overbooking now for a moment. I gather that you pay people
travel expenses when they come for their interviews, is that correct?
(Ms Lomax) Yes, it is.
8 Note by Witness: In the latest quarter for
which figures are available oral hearings attended by the "appellant
only" had 49.3 per cent found in favour of the appellant.
For hearings attended by a "representative only" 56.3
per cent of the decisions were found in the appellant's favour.
The percentage of appeals found in the appellant's favour where
both the appellant and their representative attended was 63.6
per cent. Where neither the appellant nor their representative
attended the proportion of decisions found in the appellants favour
was 17.2 per cent. Back
9
Note by Witness: Leaflet GL24 states "If you choose
to go to an oral hearing you will be able to deal with any questions
or issues that arise. People who go to their own hearing usually
do better than those who do not." Back
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