Examination of Witnesses (Questions 140
- 159)
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
140. The fact that somebody else does something
is never seen as a defence, so the fact that people occasionally
get sent away from the Health Service elsewhere does not necessarily
excuse yourselves. I wonder if you would turn to Page 37, the
customer complaints section. It has always been my impression
that when people have got complaints that on first examination
appear worth pursuing, there is always an inclination not to bother
doing so because it is utterly pointless. Have you undertaken
any research to try and check how many people felt that they had
a complaint that they did not bother making because they thought
either it would annoy the doctor in some way who would get them
next time or annoy the system or they wanted to keep their heads
down generally?
(Mr Raja) We have not undertaken any research to that
effect.
(Mr Haighton) I would add, however, that we have had
some serious discussion between ourselves and SEMA about perhaps
the need for a piece of research which includes trying to bottom
this one because I think it is a very difficult subject to understand.
As we mentioned earlier on, you from your surgeries have a perception
of a higher number of complaints when we have a relatively low
number. We have already had some discussion with SEMA about picking
up a piece of independent research to try to tell us what the
real position is.
141. I am sure I cannot be alone in this, I
have had a number of examples where people have mentioned the
rudeness of doctors. That is not unique to yourselves of course.
There was one particular case where there was an examination taking
place on a Friday or Saturday night and the doctor's wife, who
was in a car outside, phoned during the examination to tell him
to hurry up. You can imagine how that made the customer feel.
They had not pursued it themselves. They came to me about another
issue. When I pursued it, it eventually ran into the sand because
the doctor denied it, the patient asserted and we could not progress
any. If there had been 20 complaints about the same sort of thing
you could maybe make it stick but when there was only one you
could not. It seems to me there certainly is an issue about these
sorts of matters. Could I ask about Page 24, Graph 15, which is
the issue of the delays. Why is it worst of all in the West of
Scotland in terms of delays?
(Ms Cleveland) You will not be surprised to know that
we were looking at this quite actively. One of the points I made
earlier is we have got very poor management information on this
to be able to pick up these cases, so I cannot from the information
immediately available to me today validate these figures.
142. You have agreed all of this Report.
(Ms Cleveland) We have certainly agreed this Report
but this is based on 1999 data. What we are trying to concentrate
on through our performance improvement work is validating the
issues now. The reason you will get differences here is the priority
that this work has been given within the individual area directorates
within each area. I have not been able to pick out anything endemic
other than the priority that has been attributed to the work in
each of the organisations. One of the things that we are looking
to do generally, not just across Incapacity Benefit but across
all our main benefits, is get much more equalisation of performance
across the area directorates. That is one of the key themes of
the Agency at the moment.
143. The final point I want to raise briefly
is whether or not there is any tie-up or liaison between yourselves
and Motability, particularly in relation to the length of time
for which awards are made. I have recently heard of a number of
awards made which would have allowed people to claim a Motability
car had it been for three years. They had awards for three years,
they then got an award for two years and then, of course, they
had to give up the car because Motability would only give them
it for three years. If there is a genuine chance of the situation
getting better I do not want people to be getting benefit who
should not get it but this does seem a trifle bizarre. I wonder
what efforts are being made to overcome this potential area of
difficulty?
(Ms Cleveland) I have not personally had dealings
with Motability but the issue about the length of an award is
key and it is part of our review of the quality of the decision
making that we are taking. I get advice on the quality of that
decision making through various sources, through the Appeals Service
and through my own Standards Committee, which is an independent
group that reports to me, and as part of that it has been flagged
up as an issue. We have gone back and looked at cases and we have
had some of the decisions that have come to attention reviewed
internally and they have come up with the same duration of awards,
maybe a one or two year award. Some of it does depend on the evidence
that the customer has provided, some of it is medical evidence
that has come through. There is no deliberate policy of reducing
awards or making awards so that people cannot get a Motability
car.
(Ms Lomax) People are very well aware of that link
in the Department. Motability do maintain very close contact with
the Department.
Mr Williams
144. Back to the question of the overbooking.
When you put in your initial bid had you identified this as a
possible problem? Just yes or no.
(Mr Raja) Yes, we recognised there was a problem.
Overbooking is not something SEMA have just taken on board, it
was there previously.
145. So did you in your bid spell out that you
would be running a system of deliberate overbooking?
(Mr Jones) The system of overbooking was in place
before.
146. You made the bid to provide the service.
(Mr Jones) I think the reverse is true. We did not
say that we would not be overbooking.
147. But the fact of overbooking saves you money,
does it not? It must save you money. It reduces your cost per
head, per case, does it not? I can understand why you are doing
it.
(Mr Jones) It avoids us spending unnecessary money,
yes.
148. What you are then doing is you are expecting
the people who you calculatedly and statistically overbooked on
average, and I recognise the way in which you have to work, to
bear all of the inconvenience and you get all of the benefits
of the system, is that not so?
(Mr Jones) We pay them the cost of coming back and
we offer them a taxi to come back again.
149. That is very good of you.
(Mr Jones) We do not pay them for their time.
150. I am surprised you do not think they ought
to come back again at their own cost on that assessment. What
I am getting at is the inconvenience is theirs, there is an inconvenience
cost, they are meeting the inconvenience cost and you are making
a financial saving. It seems to me that some thought should be
given as to whether or not there should be some degree of compensation,
some sort of penalty, to make sure you get your arithmetic more
accurate. In terms of performance, as we can now even get penalties
on the trains and so on, I do not see why you should not pay a
penalty when you get it wrong and disabled people turn up, often
at great inconvenience, often travelling reasonable distances,
and then are sent back home and they have to come again. I want
to move on from that. A point that puzzles me is in your bid,
I gather, you detailed plans for using other types of healthcare
practitioners, nurses, occupational therapists and so on, but
at the time of the briefing coming to us no progress had been
made on that. I am not blaming you for this because we are told
very considerably because of legislation that inhibits the extent
to which you can use people other than doctors. Just to come back
to the Department, did the Department when it assessed the bid
from SEMA not recognise that this was a non-starter because of
the legislation? I know you were not there at the time so I am
not blaming you.
(Ms Lomax) Let me address that. It is not a non-starter.
The legislation on Incapacity Benefit does specify the examination
must be carried out by a doctor approved by the Secretary of State
but that does not rule out the use of healthcare professionals
to gather evidence, for example. In DLA I think there may be scope
for using healthcare professionals beyond that. It is not a non-starter.
What I have to admit is that we have probably been a little bit
slow to progress this particular suggestion partly, I suspect,
because the Department has not been entirely of one mind as to
whether this is a good idea. Dr Aylward will probably want to
say something about this. There is more than one view on this.
We have reached a point where we think we ought to be making some
use of healthcare professionals to gather evidence, but beyond
that people still have doubts.
151. Can I just observe that it is six years
on and a "bit slow" does seem to show a rather unusual
capacity for under-statement.
(Ms Lomax) It is two and a half years, it is not as
bad as that. I am admitting that we are not perfect.
152. Let us come then to the scrutiny and the
medical examination. In relation to the appeals we have 23,000
successful appeals, what proportion of those are cases that have
been assessed by scrutiny and what proportion are cases that have
been assessed by medical examination?
(Dr Aylward) None of them will be results of assessment
by scrutiny because they are all results of examination. A decision
is only made after a person has had an examination for Incapacity
Benefit.
153. So the incentive for the company to go
via the scrutiny route does not in any way disadvantage the patient
at the end of the day?
(Dr Aylward) The patient is not disadvantaged at all.
154. There are about 100,000 people a year who
are taken off benefit and we are told that about 50 per cent of
them succeed on appeal. Is that on first or second appeal?
(Ms Lomax) First appeal.
155. How many succeed on second appeal?
(Dr Aylward) I do not think there is provision for
a second appeal. In the first appeal the decision is final except
on a point of law which may go to a Commissioner.
(Ms Lomax) It is the Social Security Commissioner,
which is a different thing.
(Dr Aylward) On a point of law.
156. Now let us go to the table that Mr Davidson
referred to. It is figure 15 on page 24, the variations in time
that it takes the Agency and SEMA to process. This really does
contain some quite grotesque differences. As we have it on our
supplementary brief black is SEMA, so let us turn to the Department
first. If we look at the issuing of the form, in the case of Scotland
it can be as many as 36 days from identification of a case for
action to the issuing of the form to the customer and yet the
best, as it happens down in Wales, is six days. How can one be
six times as long as the other? One can understand differences
in individual cases. What one cannot understand is consistent
failure or what appears to be failure through the early stage
processing, and a difference of this magnitude. How can that happen?
(Ms Cleveland) I think it is unacceptable.
157. You do?
(Ms Cleveland) Yes, I agree. This is one of the areas
in terms of looking at the end-to-end process. If you took the
West of Scotland in terms of the length of time it takes them
to issue the form and the length of time it then takes to deal
with the cases at the end of the process, it is unacceptable.
158. How long has it been unacceptable?
(Ms Cleveland) I mentioned earlier the lack of management
information that we have coming through on a regular basis that
looks at all of the hand-offs in the process to get this end-to-end
view. That is why we are trying at the moment to put a lot of
effort into identifying a management information system so we
can pick up this effort.
159. It is 1995 since this started, is it not?
(Ms Cleveland) Since the Incapacity Benefit came in,
yes.
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