Examination of Witnesses (Questions 100
- 119)
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
100. Therefore would you accept the criticism
that they are often short and rushed?
(Mr Jones) I am not sure that that is true. I think
it comes back to the point that was made earlier. I think the
major, fundamental problem with all of this is the fact that the
customer does not get what he is expecting.
101. Let me come on to that. The second criticism
that was made is that the statement often includes things that
the client claims they never said. I suspect that comes up a lot
at appeals. Would you accept that criticism?
(Mr Jones) I am sorry?
102. Statements which are attributed to the
client in the report of the doctor are then claimed not to have
been said, or are being misinterpreted by the client themselves.
(Mr Jones) I am afraid that is a new type of complaint
to me. I am not familiar with it.
103. It is often said that because of the rushed
nature, for example, they will ask someone to walk up and down
in their living room or in the kitchen and then extrapolate from
that that they can walk 300 or 400 yards. Are those sort of complaints
made to you?
(Dr Hudson) Yes, those complaints are familiar to
me.
104. Are they fairly regular? Would you say
there were a lot of complaints of that nature?
(Dr Hudson) There is a variety of things about which
people complain. The question about extrapolating a statement
about walking is very much part of the skill of the disability
analyst. We would not expect people necessarily to have to walk
up and down outside in order to make an assessment of their ability
to do so. In terms of the number of complaints that we have we
do analyse them into proportions and we find that of the number
of complaints that we have a little under 20 per cent do complain
about the contents of the examination. We believe that this is
one of the areas that we need to address in terms of, first of
all, getting people to understand what the examination is going
to hold for them, which is very important in a stressful situation,
and, secondly, to encourage doctors through the training courses
that we have put in place to understand also the situation from
the doctor's point of view.
105. Let me come back to that. Someone said
earlier on that the number of complaints constituted a fraction
of one per cent, yet my local CAB tells me that they get a very
large number of complaints in relation to this. How do we square
those two things?
(Mr Jones) A very large number of referrals take place—1.3
million a year. The average number of complaints is 0.66, less
than one per cent.
106. I understand that. There are very large
numbers that are complaining to the CAB and I suspect if you went
up down and country—and my CAB is a very small one—you
would find that there were very large numbers of complaints.
(Dr Hudson) One of the issues about CABs which is
really very helpful is the fact that we did just that, we went
up and down the country to a series of road shows that were initiated
by CABs and as a result of that we then encouraged our local units
to link to the local bureaux and we have actually spoken directly
to NACAB to try and make sure that the sort of complaints that
are directed towards the bureaus are directed toward us because
that is the only way we can understand the nature of the problems
that are being perceived by the people who are being examined.
107. Almost everyone that has ever come to see
me in relation to these matters—and I am talking in the
main about Disability Living Allowance—has had no idea what
it actually meant when it said that someone would come to give
them a medical examination. They expected something quite different
from what occurred. You said that you are trying to provide that
information. Is the reluctance to be terribly specific about what
the examination actually entails in any way related to any concern
that there might be about people being able to manufacture a disability?
(Ms Lomax) I think the contract actually says explicitly
that SEMA doctors should explain the purpose of the examination
and what it entails. There is no intention at all to trick people
into not giving a good account of themselves.
108. That is not what I meant. Can I characterise
the examination that takes place—and somebody will correct
me if I am wrong. In terms of mobility they ask people to walk.
In many cases that have been reported to me they do ask them to
walk in the garden or out in the street. They certainly ask them
to walk indoors. In terms of care it will range from being able
to dress themselves in some form and being able to make basic
things like toast or a cup tea or whatever. That is perhaps not
a terribly accurate characterisation of what is asked to be done.
Even so, is there any concern that if the client knew that that
was the type of examination they may play up in order to be able
to present themselves as being more disabled than they are?
(Dr Hudson) First of all, the examination is clearly
defined and set down by the DSS and the doctors carry out the
examination that is required of them. Secondly, we are in the
process of reissuing training that actually helps the doctors
that we have deal with a sensitive situation even better than
some of them do—and some of them are actually very good
indeed. I would repeat what Ms Lomax said, there is no intention
whatsoever of doctors trying to trick people into revealing something
about themselves that they do not want to reveal. I am not sure
I understand your question.
109. I shall move on because we are all time-limited
in relation to this. It says in the Report that there are certain
parts of the work that only doctors can undertake. In relation
to DLA I noticed that my characterisation of what the assessment
entailed was in the question. In relation to that assessment,
what parts of the work is it necessary for a doctor to undertake?
(Dr Aylward) I think that the essential role that
the doctor has, particularly in DLA, is to have a knowledge of
diagnosis and the factors important in reaching that diagnosis
and also using the diagnosis as a focus on expectations. With
a particular diagnosis you expect to have a certain level of functional
disability or limitation. That is a skill that only a doctor could
provide. Over and above that, the doctor would be expected to
look at the natural history of disease. All diseases evolve in
different ways and respond to treatment differently. Again, it
is the skills of doctor rather than any other health care professional
that are best applied there. Beyond that, looking at the effects
of disease and disorder, quite clearly there is a role for people
other than doctors to look at effects, and certain health care
professionals might well do the job just as effectively.
110. In the first half of your answer I thought
you were doing a very good trade union job in representing your
members as far as the particular skills they had. I am a little
confused by the second part of your answer. But let me go on to
ask this question in a different way. What skills are not represented
by other health care professionals which, if they were to take
the diploma that is being suggested for doctors, would not allow
them then to be able to carry out these assessments as good as,
or perhaps in some cases better than, a doctor?
(Dr Aylward) The Diploma in Disability Assessment
Medicine is a diploma that currently has been sponsored by the
Royal Medical Colleges and is, therefore, a diploma that is only
applicable to registered medical practitioners. Perhaps I was
not that clear. The major skill of the doctor in assessment is
being able to relate what the findings are to what the person
says they can or cannot do due to the disease or disorder that
they have. The skill is needed to ensure that disorder is present
and the expectations arising from that disorder. That was my main
point. However, I went on, and perhaps I was not clear in explaining,
to say that there are other elements. Once one knows that the
disease or disorder is present and it is at a certain evolution
then quite clearly healthcare professionals, particularly community
psychiatric nurses, are equipped to go along and assess the effects
of that illness, diagnosis or disease.
111. As I listened to you I was reminded of
the solicitors' defence of conveyancing as being something that
only they could undertake. I shall pass on to the natural conclusion
of this discussion. You know that there is going to be, or already
is, a severe shortage of doctors and that shortage is not going
to be solved and it is leaving you in some particular difficulties.
This report says very little is being put into providing other
health professionals to carry out some of these functions. What
efforts are being made to involve others in this type of work?
(Mr Jones) Certainly that is an important point. From
the beginning we have tried to introduce the use of healthcare
professionals and through discussions with the Department we have
now introduced a pilot scheme using healthcare professionals to
do part of the work. That pilot scheme has been initiated in Manchester
and, subject to that success, we will attempt to roll out that
work further. It would not replace the work of the doctor but
it would support the work of the doctor so that you can get more
throughput, if you like, from the available doctors. Equally there
are some parts of the work, as you quite rightly say, that we
believe can be done just as well by healthcare professionals as
it can by doctors.
112. Let me ask you a question. How many doctors
have you sacked at SEMA because of their incompetence to carry
out this work or because of persistent failures?
(Dr Aylward) There have been 17 doctors—
113. Seventeen?
(Dr Aylward) Seventeen, one-seven, doctors that I
have had to dis-approve because they were either found to be not
competent enough to deliver the service or there were other issues
relating to their registration with the General Medical Council.
(Dr Hudson) Could I just add to that, that they are
not employees of SEMA but rather part of the independent contractor
pool of doctors that we use.
(Dr Aylward) I have not disapproved any full-time
SEMA doctor.
114. When you say "dis-approved",
that means you have stopped them from working?
(Dr Aylward) I have stopped them from working, yes.
115. How many of them were related to their
accreditation with the BMA?
(Dr Aylward) I think perhaps you mean their registration
with the GMC?
116. The GMC, I apologise.
(Dr Aylward) That is fine, there is often a confusion
there. There were three of those.
117. So it was 14 who could not carry out their
functions properly?
(Dr Aylward) Yes, but there was some question about
the competency of those who were also affected by the GMC registration.
118. Can I move on to appeals. We have the figures
for Incapacity Benefit but can somebody provide me with the figures
for DLA because from memory they would be along similar lines,
something in the region of 50 per cent of those who appeal are
successful. Would that be correct?
(Ms Cleveland) It is slightly over 50 per cent, from
memory.
119. Can I ask you what it costs to hold a Disability
Living Allowance or Incapacity Benefit appeal? Do you have an
average cost element to that?
(Ms Cleveland) I do not know whether the Appeals Service
keeps that information. It is not something I have got, I am afraid.
Mr Love: Do you have any estimate of the cost
of the total number of appeals?
| 
