Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 100 - 119)



  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?

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