Examination of Witnesses (Questions 80-99)
MR MARK
FISHER, DR
MANSEL AYLWARD,
MR PAUL
KEEN, MR
JOHN SUMNER,
MR SIMON
CHIPPERFIELD AND
DR CAROL
HUDSON
WEDNESDAY 17 APRIL 2002
80. And that happens more or less straight away,
does it?
(Mr Chipperfield) Yes. We are measured on providing
a response—forgive me, I cannot remember off the top of
my head what the timescale is for the first response—the
first response we are measured on achieving within a certain period
of time, then a follow up response, a more detailed reply and
also the quality of our response. That is something which is new
since the last Select Committee report. The quality of our replies
is audited by the Department and we have to meet targets in terms
of the quality and content of our responses to the complaints
as well as the speed of our response.
(Mr Keen) I think the contract requires you to respond
in full, not an interim response, to 75 per cent of cases within
approximately 15 days. Seventy-five per cent within 15 days is
obviously allowing for the fact that on some more complex cases
Medical Services would need to go back and seek wider evidence.
81. Is there a timescale for the remaining quarter
within which they have to receive a response?
(Mr Keen) I do not think there is under the contract.
There is not a timescale for that.
82. Is that an area that you are looking at,
perhaps bringing in a final timescale, because that could drag
on for months, could it not?
(Mr Keen) I do not think that it would be in the interests
of anyone for it to drag on for months.
83. But you have no target. You say 75 per cent
have to be within 15 days, but then there is a quarter for which
there is no period, there is no best practice.
(Mr Fisher) We have veered at various points between
measuring performance by 100 per cent of cases in such and such
days or what are called "X in Y targets" which are something
like 75 per cent in a shorter time. It is something I am sure
we can look at in the future if this is not doing what we want.
What we want is every single case within reason answered as quickly
as possible.
84. Can you give us an assurance that the Department
will look into that remaining quarter?
(Mr Fisher) Yes.
85. Thank you. Do you think it is actually realistic,
and I am addressing this perhaps more to the Department officials
here, to actually expect someone undergoing examination in their
own home to complain immediately to the doctor about their treatment,
as they are advised to in DLA AL1C?
(Mr Chipperfield) Can I just make the point that they
are not treated, they are examined, and there is a difference.
Our doctors are examining to look at what the impact is of the
illness or the disability or the condition on that person's everyday
life within their home environment, they are not treating the
patient.
86. I accept that but what I am trying to do
is get into the mind of the person being examined. They are in
their home with the doctor, it is a very important concern for
their future benefit entitlement and they are advised to complain
straight away.
(Mr Chipperfield) Yes. We will accept the complaint
whenever it is made. We do have complaints being made weeks, months,
even years after the original examination and we would still treat
that as a full and justified complaint and it would receive all
of the attention that a complaint received within 24 hours would
receive.
(Dr Aylward) May I just add that I think it is also
to address a culture change which Mr Stewart referred to in his
questions and that is we believe that people should confront doctors
or other professionals if they feel that they are not getting
good service. Clearly it can be a very sensitive, embarrassing
situation but nonetheless we should encourage that. When we say
complain immediately, it includes complaining at the time to the
doctor saying "No, I think you are mistaken in this way"
or "I am unable to do this particular task that you insist
I can do". We do insist that should be done and complaining
straight away also means perhaps within the first day or so when
they look back at their examination and they perceive that they
were not handled properly, sensibly, they should complain. We
want to encourage a culture which is not overawed by professionals.
87. I understand at the moment that you do not
actually send every patient this customer care leaflet, they are
given those in the course of the examination. Is that correct?
(Dr Aylward) Customer care leaflet?
(Dr Hudson) Not the book. There are two documents
you are referring to, the letters that—
(Mr Chipperfield) The AL1C.
(Dr Hudson) Which goes to people when they are sent
their appointment.
88. But they are handed to them at the time
of their examination rather than being sent in advance when they
have perhaps got more time to study them and look through them?
(Dr Hudson) No, they go with the appointment.
89. They do go with the appointment?
(Dr Hudson) Yes.
90. I understand that a gentleman called Norman
Heighton, who was the Corporate Projects Director, was going to
commission some independent research to try to understand why
the level of complaints was very low in comparison with perceived
public dissatisfaction. Can you let us know if any research was
commissioned and what the result of it was?
(Dr Aylward) Work was undertaken to look at surveys,
some of which related to the information I provided to Mr Stewart.
The advice we had from our own Department's analytical services
division, the statisticians, was even after we had conducted several
surveys with several thousand respondents that it was still inadequate
statistically and we needed to take a much firmer view and develop
a more robust approach to looking at research and studying this
area. Informed by those results and by our statistical colleagues
we are working together with SchlumbergerSema to develop a more
helpful protocol that will indeed answer the question that Mr
Heighton referred to in his evidence.
91. Just on a personal matter, I had a lady
in my constituency from Leighton Buzzard last Friday complaining
about her examination for Attendance Allowance. If I understood
her correctly, and I may not have done, perhaps you can clarify
this for me, she told me that no-one had actually come to her
home to view her undertaking the tasks for which she told me that
she needed assistance. Would that have been correct in your opinion?
Would procedure have been followed in that case?
(Dr Aylward) The answer would be no. I would be most
surprised if she had made a claim for Attendance Allowance—No,
may I withdraw that. Yes, it is quite possible that the lady when
she did apply completed a form which was based upon a self-report
of her condition and that in itself could have been used by the
Decision Maker to make the decision in her case. Frequently it
is accompanied by supporting statements from people who know the
lady or the lady's medical attendants, but it is possible within
Attendance Allowance for a decision to be made without that person
being visited at home.
92. She had also gone to appeal and she had
lost the appeal. In that case as well that still holds, does it,
it is possible even having appealed no-one would come and see
her in her home?
(Mr Sumner) The Attendance Allowance is essentially
a self-assessment benefit where the Decision Maker will, if they
deem it necessary, get additional evidence which may be a medical
examination through an examining medical practitioner in the person's
home. If from the self-assessment form that the claimant completes
it is very clear that they do not satisfy the conditions for benefit
then the Decision Maker will make a decision on that basis.
93. So you have no current plans to change that
system even on appeal. This lady felt particularly aggrieved,
she said "no-one has seen that I cannot get into the shower
easily".
(Mr Sumner) When the case goes to the Appeals Tribunal
they of course review the evidence again and if they take a different
view or if they are doubtful then they have the opportunity to
ask for such an examination to be undertaken.
94. This claimant was not able to get to the
Appeals Tribunal. She felt very cut off from the whole process.
She felt that no-one had been to see her, she had not been able
to get to the appeal because she is quite frail. Is this something
that concerns you?
(Mr Sumner) Obviously that is of concern. She would
nevertheless have the opportunity for somebody to go on her behalf
or to make representations, written representations, which the
tribunal would consider.
Chairman
95. Presumably the representations from your
own general practitioner would be valid evidence.
(Mr Sumner) Absolutely, yes.
Chairman: I think she should write to her MP
again.
Andrew Selous: No doubt she will.
Miss Begg
96. If I can move on, also about treatment of
claimants but in particular customer satisfaction. There is a
great deal of unease perhaps amongst people with disabilities
and people who are ill about going through a medical assessment.
It is a frightening and daunting thing, particularly for people
with mental health problems, and we have some questions on that.
It is very important that they are treated correctly and they
are treated well and they feel they have had a fair hearing and
it is not something that is difficult for them. Dr Hudson, you
mentioned that there is training for doctors doing the assessment.
Can you explain in more detail what that training consists of?
(Dr Hudson) Yes, certainly. There are three areas
of training. First of all, there is our induction training which
every doctor who comes to Medical Services as an employed doctor
in particular goes through. There is continuing medical education
and there is remedial training. Our induction programme consists
of eight days' worth of training which is in general where doctors
move into an environment which is an entirely training environment.
At that stage they are introduced to the concept of disability
assessment medicine but also to the importance of understanding
that they are not in a clinical and therapeutic environment, they
are there to do a different type of job and their clients do have
needs that are very specific to being within a benefits process.
We embark on essentially retraining them in examination techniques
which are different, as I say, from examination techniques used
by clinicians. Also, we have modules on multi-cultural awareness,
on dealing with people with disabilities, on managing the critical
evaluation of evidence and writing good reports, effective reports,
for non-medical Decision Makers. In essence, because Incapacity
Benefit, as Mr Chipperfield has said, is the major part of our
work, that carries on to a four day module which is specific to
Incapacity Benefit.
97. The reason I ask that question is I know
from my own experience that just because somebody has a medical
background, a doctor, they do not necessarily understand disability
at all. In fact, sometimes perhaps with the doctors—I do
not want to insult all the medical professions, the ones who are
here—it is worse because there is something of an arrogance
that because they have a medical training they must know what
it is like to have a disability and, therefore, they do not always
listen. I am trying to get a grasp of how do you ensure that the
doctors who are making that judgment are judging people on their
capabilities and their disability and not on the medical needs?
That is the crucial thing for the benefit.
(Dr Hudson) You are absolutely right. We have learned
that it is an iterative process and that there is essentially
an unlearning process for the doctors to go through which is why
an induction process is increasingly important where we say "No,
this is not what you have done before and there are specific aspects
of the work that you are about to embark on which are very particular
and very sensitive".
98. If you find there are a number of complaints
through the complaints procedure, which we have already heard
is actually getting more, so perhaps there are more complaints
coming in about a particular doctor, about them being offhand
or really not appreciating, not listening, do you take that doctor
back in and retrain or do you say "No, you cannot work for
us any more. You are not the type of person we need"?
(Dr Hudson) We would retrain in general unless there
was something so bad.
99. Has it ever happened where you have found
somebody is just so offhand that they are obviously not cut out
for the kind of work?
(Dr Hudson) Yes. I think we would still attempt to
retrain them because we have selected and sifted in the first
instance, we have made the judgment early on that doctor will
be capable of reaching a specific standard and we need to make
sure that our training programme that has been specific to that
doctor has been adequate, particularly if it is an employed doctor.
At that stage we have no hesitation if a doctor cannot come to
terms with what they are doing in ceasing to use his or her services.
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