Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 120 - 139)




  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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