Examination of Witnesses (Questions 80
- 99)
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
80. Do you pay them any other expenses if they
have to go back having been overbooked and are not able to have
their examinations that day?
(Mr Raja) There are offers of transport available.
We do offer a facility where if the claimant is asked to come
back the expenses will be paid.
81. So they are only paid travel expenses if
they have to come back, they are not paid travel expenses on the
first visit?
(Mr Raja) Yes, they are. If it is the case that we
cannot see them on the day they are offered a transport facility,
a taxi, if it is convenient for them to come back on a different
day.
82. So on the first day they have to come by
public transport but if they have to come back you give them the
chance of a taxi?
(Mr Raja) No, they can request a taxi in the first
instance. They need to ring up and ask for a taxi, make a specific
request. Normally we would encourage them to come by public transport.
83. So there is no extra compensation of any
sort given if they have to come back having been overbooked and
not getting in the first time?
(Mr Raja) There is no extra compensation, no.
84. Does that not seem a little bit unfair because
they may have wasted a lot of their time that they could have
used for other purposes? Should there not be something in the
contract perhaps next time, even if there was not this time, that
says if SEMA fails to get people through the first time they have
to pay some form of compensation? It might be a way of encouraging
SEMA not to overbook.
(Ms Lomax) SEMA already have quite a strong incentive
not to waste people's time because they do not get paid unless
people are seen.
85. Sorry?
(Ms Lomax) They do not get paid unless people are
seen. It is medical reports that they get paid for. It is an output
based contract.
86. If I may say so, if they have allocated
space to see 16 people and book in 20 and see 16 but 18 turn up,
there is not much incentive to worry about the extra two. I am
suggesting that there should be an incentive of that sort as well.
(Ms Lomax) We will take that away and think about
it.[10]
(Mr Haighton) It might be helpful to
add that there are many reasons for people being turned away unseen.
The fact that we have booked too many is only one of them. For
example, there are a significant number of people who turn up
and who are not in a good state to be examined. There are a number
of types. We need to clarify that it is only where they are true
overbookings that we need to consider.
(Ms Lomax) Of around three per cent of
people who get turned away unseen, about one or one and a half
per cent of them are turned away because they are either drunk
or under the influence of drugs.
87. I accept that there may be other reasons.
(Mr Raja) We accept there is a percentage of claimants
who are turned away unseen. We are instituting a number of initiatives
and we believe that fee per case, which we have piloted in our
Leeds centre for a number of months now, has shown that asking
doctors to work on a fee per case basis does lead to a reduction.
There are initiatives like that in place which we believe will
reduce the number of people we turn away.
88. When SEMA sets up a session to bring people
in to see a doctor, is the session for a fixed time or is the
doctor expected to see a fixed number of people? How does it work?
(Mr Raja) The process we are moving to gives the doctors
more flexibility, hence the movement to fee per case. Initially
the contract was based on fixed sessions in the morning and in
the afternoon but we are trying to bring flexibility into the
working practice so we do not have three and a half hour sessions,
you can go longer than that.
89. So will you be able to guarantee that in
the future everybody who turns up will be seen if they are capable
of being seen? I quite understand there may be some people who
turn up incapable of being seen.
(Mr Raja) I cannot give you that guarantee now but
I can certainly assure you that we are working towards reducing
the number of people we turn away.
(Ms Lomax) One of the Department's targets for SEMA
is to reduce the number of people who are turned away unseen who
turn up on time to three per cent. This is one of the targets
we are attempting to get written into the contract. You are actually
acting as if we have done, I think that is correct. We are focused
on this issue, possibly not as strenuously as you would wish but
we are focused on it.
90. I am pleased to hear you are focused on
it but I am sorry that you are still prepared to accept that anybody
can be turned away. It seems to me that you could write into the
contract, at least the next contract, that these people have got
to be flexible enough to make sure that the doctors, if necessary,
will stay on later and see an extra person or two.
(Mr Jones) I think you have to put it into the context
that was mentioned at the beginning of the current shortage of
doctors and the difficulty of getting doctors to do this work.
We would very much always like the doctor to stay on and see the
people who have turned up, it is not at our instigation that it
does not happen, but it is not always possible for the doctor
to stay on and do that because he has got other commitments.
91. Can I ask another question about the home
visits. Are doctors who go on these home visits for examinations
always accompanied by chaperones if they are seeing people of
the opposite sex?
(Dr Hudson) I can answer that. No, they are not.
92. They are not?
(Dr Hudson) They are not. We make every effort to
inform people who are to be examined by a doctor that if they
wish to have a friend or a carer with them then that is very welcome.
The doctors do not routinely take chaperones with them.
93. Do you tell them in advance if the doctor
is going to be of the same sex as them or not?
(Dr Hudson) I think there is an area whereby if an
individual wishes to have a doctor of the same gender, and certainly
this is something that we are aiming to improve, then we will
do everything we can to offer a doctor of the same gender. One
of the difficulties we have is particularly in the area of home
visits. I assume you are talking about women wanting to have women
doctors?
94. It could be either way, yes.
(Dr Hudson) In the case of women wishing to see a
woman doctor we do have some constraints about the gender spread
of the doctors, not only who work for us but in the profession
generally as a whole. Something like one in six of the doctors
who do home visits are female. Given the time constraints because
people are waiting for their benefits we are not really in a position
to offer everything to everybody. A number of people are happy
to have a carer or a friend with them to act as a chaperone.
95. My understanding is that it is seldom in
GP surgeries now that they act without chaperones if they are
seeing somebody of the opposite sex in any examination that might
be at all personal. Have you had any problems with clients who
have later complained about the doctor having acted inappropriately
on a home visit?
(Dr Hudson) Yes, we have, and when we have had complaints
those complaints are taken extremely seriously and we treat them
as—we have a term—special complaints investigations.
An accusation of an assault, whether it be a sexual assault or
otherwise, is treated as a serious complaint and is investigated.
96. One of the reasons why it might be unattractive
to doctors is if you do not send chaperones they are under threat
all the time.
(Dr Hudson) Some of the doctors are concerned. Some
of the doctors who are experienced in carrying out home visits
in general practice as their primary role are not as concerned
about the outcomes as others. I am not saying they are cavalier
about it in any way but they feel confident enough to cope with
that.
Mr Williams
97. Is there anywhere on the application form
for a member of the public to indicate whether they specifically
want a doctor of the same sex?
(Dr Hudson) At the present—I think somebody
may have to help me on this.
(Mr Haighton) We have developed a statement covering
a whole range of things like complaints, interpreters, same gender
doctors, and so on, into a standard set of words which we are
incorporating in all the forms, not just the ones issued by SEMA
to invite people to examination, but also to benefit forms themselves
so there is a standard and prominent offer of a same gender doctor
if required.
98. And that is now on all forms going out?
(Mr Haighton) The wording is agreed and is going on
all forms as they are reprinted and running to their cycle. It
is certainly on many of them and within the next two or three
months it will be on all of them. It is just the cycle of reprinting.
Mr Williams: Thank you. Mr Love?
Mr Love
99. Good afternoon. It is rather unusual to
have so many of you in front of us, it is a little imposing—and
we thought that it was the Committee of Public Accounts that was
meant to be imposing! Can I start with you, Mr Jones. The first
thing I did when I received this Report was ring up my Citizens'
Advice Bureau, with whom I have a very good relationship over
cases of this nature, and the first thing they said to me of the
very many complaints (and I will come back to the numbers in a
minute) that they get most people complain, first and foremost,
that the assessment is short and rushed and there is not enough
time given to finding out about the client. Taking into account
the recommendation of the Select Committee Report last year, is
there any recommendation about the amount of time that the doctor
should spend with a client?
(Mr Jones) I do not think there is a definite recommendation
on the amount of time that is spent with the client.
10 Note by Witness: Of around 3 per cent of
people who are turned away unseen, around half are due to overbooking.
The remainder are turned away for a variety of reasons, some of
which are beyond SEMA's direct control, including customers who
will not wait to be seen, or who are unfit to be seen." Back
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