Examination of Witnesses (Questions 120
- 139)
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
Chairman
120. Can that be obtained?
(Ms Lomax) I am sure we could, yes, certainly[11].
Mr Love
121. I was trying to find out the information
via another route to see whether they knew the gross cost of the
appeal process for either one of the benefits or for all the benefits
we are looking at.
(Ms Lomax) What are the running costs for the Appeals
Service? We run a large Appeals Service to process appeals which
costs us, what, some millions a year to operate and which employs
thousands of people.
122. Let me ask you the question is it a significant
cost?
(Ms Lomax) Yes, it is a very significant cost.
123. Are there any offsetting savings related
to that? We would understand that on Incapacity Benefit if the
appeal is unsuccessful then there is a loss to the Treasury, to
the public pursue, but in terms of DLA for new cases do they only
go on to DLA after their appeal has been successful or is it backdated
to the start of the process? In other words, are there any offsetting
savings from the appeal process?
(Ms Cleveland) If someone is successful at appeal
their benefit will be backdated to the point of claim.
124. So there are no offsetting benefits?
(Ms Cleveland) No. We would just simply be paying
the benefit later.
125. My final question because my time is now
up, I am sad to relate, is in relation to whether or not the Department
has looked carefully at the cost of the appeals and whether there
is some priority now being given to try to reduce the number of
appeals in order that savings of that significant extent could
be made?
(Ms Lomax) Yes, indeed. I am sure we will be discussing
the work that was done on decision making and appeals and the
major changes that followed from that at a future hearing.
(Ms Cleveland) In the meantime, clearly anything that
is requiring 50 per cent of cases being overturned means we are
getting it wrong in the process. Those cases should not be going
through to appeal. I mentioned earlier that we are working very
closely with the Appeals Service at the moment to look at how
we can reduce the cases going through when we have clearly got
the decision wrong. It is an expensive process. If you start involving
the judiciary in this it is adding to cost. We are looking at
the overall process. We have a process of review and reconsideration
which is in the hands of my staff and we ought to use that more
to fully make sure that the cases that do go through to the Appeals
Service we are absolutely sure we have taken the right decision
on.
Mr Love: Thank you.
Mr Davidson
126. Can I start by apologising for missing
some of the session, I have had constituency matters I had to
attend to. I apologise if I repeat anything my colleagues have
raised. As I understand it, you can have an evaluation of an individual
either by paperwork or by a medical examination and the paperwork
can be largely based on relevant reports by the GP. To what extent
are there assessments of the reports coming in by GPs? I am conscious
in other spheres that there are occasions when GPs have been intimidated
by patients into producing reports helpful to the patient. What
sorts of assessments are made to make sure that there is a standard
of quality?
(Dr Aylward) What we have done in the past is we have
conducted surveys of GPs anonymously randomly selected for geography
and topography and we have asked them that sort of question. Although
GPs are, and have been, reluctant to give information in that
vein, somewhere between ten to 15 per cent of GPs have indicated
that they are very reluctant to provide reports sometimes either
because of the effect that might have on the relationship that
they have with their patient or, indeed, there might be a souring
of the relationship with the patient's family. We feel if there
is an element of aggression or whatever it probably falls into
that category. I do have isolated examples, but they are isolated,
where GPs have contacted me and, again, want to do that in an
anonymous way to say they have had some trouble. We are talking
about I might get two or three such confidential phone calls from
GPs in a year.
127. How do you know that there is not a large
number of cases where people just fill in the form and take the
easy way out, they just fill in the form perhaps more generously
than they ought to and even though medically their general reporting
standards are up to scratch there is a percentage that they let
through that they should not?
(Dr Aylward) When you say "people" do you
mean general practitioners filling in reports?
128. Yes.
(Dr Aylward) In the 15 per cent where there is some
suggestion of an element of coercion, you can add to that the
reluctance that general practitioners anyway feel both in the
surveys we conduct, in our talks with the BMA and in discussions
with general practitioner groups. General practitioners feel very
reluctant to perform a decision-making or evidence-providing role
in the benefits system because again they feel it compromises
their doctor/patient relationship. This is something we well understand
but, on the other hand, GPs play a most important part in providing
evidence.
129. I understand that. Are you happy with the
standard of reports coming from GPs given the points I have raised?
(Ms Cleveland) I think there is often far more about
the diagnosis and perhaps not the evidence that backs this up.
We have been working with our staff both in terms of GPs and SEMA
doctors so that if the quality of the reports coming through is
not sufficient for them to make a decision they go back on some
of those. There is more focus on the SEMA contract rather than
GPs.
130. There is a difference, is there not, between
reports which are incomplete and those which are perhaps over-generous?
You did not pick up the over-generous element?
(Ms Cleveland) We have not done work to go back and
see if a report is valid. If there is a report that suggests that
someone meets the conditions for the benefit then that is accepted.
131. I am not quite sure to whom this question
on the 30 per cent non-attendance at examination should be directed.
It is penalty free. If anybody managed to win a watch by getting
an assessment in their favour the last time and they are now being
called in again, they have a financial interest in spinning it
out and not attending. Even if they get stopped at the end it
is never reclaimed, is it?
(Ms Cleveland) You have touched on a very valid point.
There is a process which is about looking at good cause—did
the person have good cause for not attending the interview. I
think we have been too generous in not tackling people on good
cause. We do turn people down for benefits at that point but the
numbers are fairly small and that is something, again as part
of our looking at the overall process, that we are addressing.
132. You turn them down for non-attendance on
occasion but only after repeated non-attendance?
(Ms Cleveland) No, it could be after the first non-attendance.
133. Mr Jones, the bit about over-booking does
concern me. Having had that done to me on an airline the airline
usually ends up paying compensation in these circumstances. Would
it not be appropriate for you to provide some form of compensation
to patients in these circumstances given that it is for your benefit?
(Mr Jones) It is not for our benefit, it is for the
benefit of making the right use of resources available to us.
We over-book because of the fact that 30 per cent of people do
not turn up.
134. If it is not for your benefit, why do you
do it? It is for your benefit. Clearly it is exactly the same
as airline over-booking. I do not want to have a debate about
that.
(Mr Jones) We are just trying to fill the doctors'
time and get as many examinations done in the time available.
135. For your benefit, that is right. In circumstances
where you do over-book and people end up getting turned away—and
it has been in many cases quite a traumatic experience for them,
just the expectation of coming—where they are coming along
and then being dismissed, is that not something you should be
paying them for because you are getting the advantage of having
overbooked and having full use of the member of staff's time?
(Mr Jones) One of the things that we are doing is
changing the payment to the doctors and instead of paying them
by session we are paying them now on a fee per case. That is to
do two things (a) to encourage the number of doctors available
by giving them more flexibility to turn up and (b) to encourage
them to stay and do more than just a half day and as many sessions
as they can if there are people there still waiting to be seen.
We are trying to minimise the effect of over-booking by encouraging
flexibility of supply on the doctors' side.
136. So I take it that in terms of the question
I asked you on compensation that is a no?
(Mr Jones) We have not considered at this point in
time paying compensation. I do not think it is within our remit
to do so without consultation with the Department.
137. Have you initiated any discussions with
the Department? No?
(Mr Jones) No.
(Mr Raja) Not on that particular point, no.
138. Would it not be reasonable for people to
feel that they are being treated with some degree of respect in
these circumstances? If you feel obliged for efficiency reasons
to condone overbooking surely some degree of compensation would
be appropriate in these circumstances?
(Ms Lomax) Does the NHS pay if you get sent away without
being seen? I would want to ask what is happening in other public
services before I went down that road. We want to incentivise
SEMA to minimise the number of people who get turned away and
we have set a target that they should reduce to three per cent
the number of people who turn up on time and get turned away without
being seen. We have also agreed a number of changes to the way
doctors are used precisely to encourage them to minimise the number
of people who have that experience. Of that three per cent, perhaps
you were not here, half the people who get turned away without
being seen are unfit to be seen because of drink or drugs. So
it is a rather smaller problem than perhaps the raw figures might
suggest.[12]
139. But it is certainly an issue that has been
raised with me by some of my constituents on occasion. Word goes
around and it all contributes towards the attitude that—
(Ms Lomax) It is very upsetting when it happens. It
is very upsetting when people get sent away from hospital when
they have taken time off work and they thought they were going
to have an operation, as one of my colleagues recently did, and
I do not recall him being compensated.
11 Note by Witness: The Appeal Service's estimated
total running costs for 2000/01 are £47.243 million. The
current average cost of processing an appeal across all social
security benefits is £177.00. The current average cost of
processing a disability appeal is £215.00 and the current
average cost of processing an incapacity appeal is £171.00. Back
12
Note by Witness: See footnote No. 10 page 14. Back
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