Select Committee on Work and Pensions Minutes of Evidence

Examination of Witnesses (Questions 120-139)



  120. Can I move on to another specific client group. I have been approached by the Motor Neurone Disease Association who have been quite concerned again about inconsistencies across the country. Obviously with motor neurone disease, once you are diagnosed you are not going to get better, it is very rapidly progressive and the average life expectancy for them is 14 months. It is a pretty bleak outlook. There are special rules, I understand, that if the client is going to die within six months then they should automatically come under the special rules. Now in some areas the Motor Neurone Disease Association say that as soon as someone presents themselves with motor neurone disease, they have got a confirmed diagnosis, the special rules apply but in other areas that is not the case. There is an argument as to how significant it is. These people are seriously ill, seriously disabled, and will get progressively worse. They have asked that I raise that with you, whether you can look into it and give us an assurance that as soon as someone has a confirmed diagnosis of motor neurone disease that immediately your advice to your Decision Makers are that special rules should apply.
  (Dr Aylward) I can tell you that we have been working very closely with the Motor Neurone Disease Association for the past year to the effect that I have had several meetings with them. I have looked at casework which has been brought to my attention where they have made the points that you have just raised and they have also made presentations to the Disability Living Allowance Advisory Board who are also working with them in updating the chapter on motor neurone disease in the Disability Handbook. The point they are concerned about is one where people with motor neurone disease may have a variable life expectancy. On average, as you say, it is about 14 months but some people can rapidly progress with severe respiratory failure and die within six months whereas others, like the much quoted Stephen Hawking, can live for many, many years and be very productive, so there is a variability there. I think the problem was that the guidance at the time, which has now been amended, was not clear about this variability and did not identify in sufficient detail what were the particular factors to be picked up from the general practitioner's DS1500 report which would indicate that there was to be a rapidly spiralling course rather than a prolonged one.

  121. There is an unpredictability about life expectancy but not an unpredictability about the rapidity of the degeneration. I know a number of people with motor neurone disease and while they may go rapidly downhill then they plateau but when they plateau they are very severely disabled.
  (Dr Aylward) There are various varieties of motor neurone disease and one of those, you are quite correct, is rapid progression and perhaps reduction in life expectancy occurs in some but in many that is not so. The point is we have amended the guidance, we have made sure the Decision Makers are fully aware of this now.

  122. If I can move on very quickly to ethnic minorities, it is something that exercises us and normally Mr Dismore is the one that picks up these questions. The Committee was keen to see a multi-language notice attached to correspondence inviting claimants to contact the area centre if they could not read the letter. Now we understand that such a notice is being developed. When do you expect it to come into effect and why has it taken so long?
  (Mr Chipperfield) I cannot comment on why it has taken so long but it will come into effect within the next six weeks. We are just working on the translation of the 12 different languages at the moment.

  123. How confident are the Department and Medical Services that you are in compliance with the Race Relations (Amendment) Act 2000 which introduced a new positive duty on public bodies to promote race equality?
  (Mr Fisher) From our point of view I think we are confident.
  (Dr Aylward) This has been taken forward. Meetings have been held with the Commission for Racial Equality. The Department has appointed champions who are taking this forward.

  124. Are you convinced again that you have got sufficiently robust methods of research to enable you to determine, in line with the new provisions of the Race Relations (Amendment) Act, that there is equality of treatment for people of different racial groups and that there is no discrimination?
  (Dr Aylward) I do not think the Department could give a unqualified yes to that. What I can say is that the Department are heavily engaged in developing the database and the research to be able to answer those questions and to be able to put these things into effect.

  125. You have mentioned the CRE have agreed to review and monitor work. Can you tell us any of the results of what the CRE have reviewed and monitored?
  (Dr Aylward) I think there is a difference between the two issues here. The CRE issue which you are mentioning, I think, is the one where CRE were approached by Medical Services to help them with their training on ethnic diversity. Although the CRE were approached and there were preliminary meetings with Medical Services, ministers and the Department, the CRE, for reasons best known to themselves, did not provide any information and did not co-operate fully. I am sure because of the demands upon their time. I believe that as an alternative the Medical Services sought another organisation.
  (Dr Hudson) We have met with a representative of the CRE since the report was written and we were keen to explore our response, how we need to respond to the Race Relations (Amendment) Act. I am satisfied that when the Department put forward their guidelines we will accede to those and are happy to do that.

Mrs Humble

  126. We have covered all of these issues in answer to virtually every question because, of course, at the end of the day it is the doctors who are the important people in doing these medical examinations. This is your opportunity to sum up on each of the areas. First of all, on the issue of pay, in the Committee's last report we had a lot of discussion about the level of pay and we recommended a one-off catch-up payment but the Department in its response said that it was a matter for the Medical Services and yet in April of last year the DWP funded half of the 15 per cent pay rise for sessional doctors, even though that was not part of the contract with Sema. Does the Department now accept some responsibility for sessional doctors' pay?
  (Mr Fisher) I do not think the fact that we did that in this particular case means that we have transferred that responsibility to the Department, that was part of a negotiation about how we jointly improve the service, for which ultimately, of course, we still remain accountable. In this respect it is clearly Medical Services who pay the doctors and decide on the remuneration rates. That was a device really to ensure they got over a particular difficulty.


  127. I think precedent really.
  (Mr Fisher) I do not think I would call it a precedent.

  128. I did not think you would call it a precedent. It cost you £2 million.
  (Mr Fisher) I would not rule out doing it again if we had to but, on the other hand, I would not say it is a precedent that we would always seek to follow in the future, it is going to have to be part of a contract negotiation, part of setting levels when we come to review contracts and so on in the future. I do not know if you want to add anything?
  (Mr Chipperfield) No.

  Mrs Humble: I am not going to be churlish because you did respond to the Committee's Report after all.

  Chairman: Mrs Humble is never churlish.

Mrs Humble

  129. Never. We got what we wanted at the end of the day. There is nevertheless also the serious point about putting in place procedures to ensure that doctors' pay is subject to regular review. Have you done that now?
  (Mr Chipperfield) Yes, we review it every year, every 12 months.

  130. I can see another report coming on. We have also covered the major problem of doctor shortages and with sessional doctors the SchlumbergerSema report's figures show that in two years since January 2000 you have lost almost twice as many doctors as you have gained. I think that highlights just how serious the problem is. You set out to recruit 100 new employed doctors by June and have so far managed to get 48. Are you confident that you will reach your target?
  (Mr Chipperfield) Let us be clear about the two different groups. Firstly, on the sessional doctors, we lost that number. We lost a lot in 2000 following events early in the year. The significant thing about sessional doctors is in the last ten or 12 months the attrition rate has halved and we are now recruiting more sessional doctors than we are losing. That is the first point. The second point is the 100 employed doctors, every day it increases. We have another nine new doctors starting on Monday, I am meeting them all this evening. It is the most successful campaign we have ever done and we will carry on until we have 100 new doctors. Whether we have 100 new doctors actually working by the end of June, employed doctors, I think is debatable but we will get 100 employed doctors as soon as we can.

  131. What sort of proportion are you looking for between sessional doctors and employed doctors? Are you looking to change that proportion?
  (Mr Chipperfield) We have a resourcing model which we have developed in the last few months. The resourcing model is shown to the Department. That resourcing model shows with the resources that we have and those that we know we will have we are able to deliver the work that is required of us. I think that is an important point, that we can do the workload that is now required of us. There is no ideal balance. It is not an exact science but what we are trying to achieve is to increase the employed doctor pool to in excess of 250. That enables us to invest more time in not just doing the examinations but doing the mentoring and the coaching and the auditing of the sessional doctor pool. The sessional doctor pool is, broadly speaking, around about the right size at the moment. We are always looking for new people and in some parts of the country we have a higher requirement than in other parts of the country. It is still the case that, for instance, it is a lot easier for us to get doctors, whether it be employed or sessional, in the South East generally than it is, say, for example, in North Wales or the North East of England. I do not know if that addresses exactly your point?

  132. What special measures are you taking especially in those areas where you have difficulties in recruiting?
  (Mr Chipperfield) We are using golden hello payments. We give bonuses to our own staff if they recommend people who are ultimately recruited. We are doing advertising. We are doing special events. We are trying to build up contacts in some cases with primary care trusts. We have a number of initiatives going with a couple of primary care trusts to look at how perhaps we might find a way of giving mutual benefit, for example we have access to a greater number of doctors through the primary care trust and we support them perhaps in IT or some areas like that. There are a whole range of initiatives.

  133. A question to the Department. Because of the doctor shortages there was a huge backlog of cases that needed medical examination. I understand in late 2000 you decided to limit the flow of cases to Sema by holding cases in some district offices due to their overstretched capacity. Obviously SchlumbergerSema expected to resolve the capacity issue and allow restoration of full processing, that was supposed to be by December of last year. Given that there are currently 200,000 Incapacity Benefit review cases stockpiled at district offices, is it correct that restoration of full processing is still some way off?
  (Mr Keen) Yes. We cannot be at all complacent because the numbers are still significant. I think what is important is the direction of travel. We had a very significant problem but those figures are going down. We had a very clear contractual target of reducing the figures to 100,000 by the end of the current financial year, by next April, and we are confident that will be met. I think the figures in the Departmental Memorandum said 220,000 and a month on that had reduced to 200,000 so you can see that direction of travel, 20,000 in a month coming down on the backlog is significant evidence that we are now firmly on track and have a grip of that. I think it is significant the way that SchlumbergerSema have increased the number of examinations by 17 per cent last year and are committed to a further 10 per cent increase next year. We have done a lot of very detailed work to assess demand at all levels through the organisation jointly with SchlumbergerSema, so we can manage the end-to-end process; so we can anticipate demand; and so we can manage and adjust the flow in line also with doctor availability—because there is no point in passing on a volume or rate of cases in a particular location if there is a doctor problem. We have also built a lot more flexibility into the overall process, not least by the use of a flexible doctor pool in SchlumbergerSema.

  134. There are two issues there that arise out of your response. One, speeding up the cases, the doctor examination must not be at the expense of the quality of those examinations, and all the questions that we have spent all morning asking you. Secondly, are you happy with the reduction to 100,000?
  (Mr Keen) No.

  135. 100,000 still seems to me to be a huge figure.
  (Mr Keen) Two responses to that. On the second one, no, 100,000 is an important milestone next year but it is not the end of the story, we are committed to go on reducing that backlog, we do not want any backlog in the system. On the first part of the question, we have not planned and managed this at the expense of quality. As I think was said earlier, many doctors are now doing more sessions and we have built more capacity into the system. The fact that doctors are doing more sessions means that more time is being devoted to undertaking more examinations, so we are not squeezing the time for individual examinations to achieve an outcome because that would be wholly unsatisfactory.


  136. Joan Humble's questions are surely absolutely critical. The Public Accounts Committee identified a £40 million cost to this backlog of stockpiled cases. How we got into this situation I cannot for the life of me understand. There was no hint that it was anything like as bad as that in 2000. What is your reaction to the Public Accounts Committee's assessment as reported by the Financial Times, of £40 million, and these are people who may be claiming benefit to which under the rules they are not entitled, so what you are saying is "don't worry, it will only be 100,000 next year"? Does that mean it will be £20 million we will be losing next year once we get this sorted? What is going on?
  (Mr Fisher) There are several points. The first is that we are determined, as Mr Keen said, to get to grips with it and reduce it as quickly as we can. We have set pretty ambitious targets for the organisation to do that. Even within that 100,000 there is, in a sense, a normal flow of work in there, it is not all actual backlog, there is in a sense the normal flow of work which we want to get down to. This is one of the many reasons why we are not approaching this from squeezing more cost out of the total system, we are not approaching the contract negotiations with a view to squeezing further costs out, we are not approaching the resourcing of teams within what is now Jobcentre Plus dealing with Incapacity Benefit from the point of view of squeezing costs out, squeezing numbers out. We see the £40 million, which is programme money, as a reason for making sure we resource the system properly. If we continue to squeeze money out of the admin of it we may see the £40 million go up, which is not what we want to do at all, so we are approaching it from a need to put resources in. We have set robust targets for managers throughout Jobcentre Plus to deal properly with Incapacity Benefit. We have given them a new target, which is new for this year, which is to do with the speed with which they make decisions on cases following medical examination. That is one of their top level targets set by the Secretary of State and that is new. This is all designed to increase the profile of Incapacity Benefit for the organisation as a whole - to make sure that managers in Jobcentre Plus focus on what they can do to manage this process. There is clearing the backlogs, there is focus on the speed of decision making and there is a focus on claims clearance. This is all designed to ensure that this has the right priority within Jobcentre Plus. We will not be satisfied until we have got this situation back to a normal flow of work. The trend is moving in the right direction and we want to keep the pressure on to do that.
  (Dr Aylward) I would like to assure you that quantity is not going to be at the expense of quality. We are ensuring that the quality process, looking at auditing, joint audits, is done regularly as at great a level that we were doing two years ago and making sure that if a doctor begins to take on more cases than his usual amount and decreases the amount of time spent with a claimant then that will trigger an individual audit of that doctor.

Mrs Humble

  137. Can I ask you finally to sum up on doctor training. Again, this has been mentioned several times and Dr Aylward has given us some examples of the more sophisticated training and especially raising the awareness of disability issues, carers and the whole package. Is there anything that you want to add to the area of doctor training that you have not already said? Again, Dr Aylward mentioned briefly in an earlier comment the existence of the new Diploma in Disability Assessment. In the Committee's last Report we did recommend that all doctors involved in this area should undertake that diploma and from my recollection at the time only about 12 people had been assessed within the terms of the new diploma. Have more doctors undertaken the qualification? How many more do you expect to undertake that qualification? How does it fit in with the overall training package that you have put together now?
  (Dr Hudson) Starting at the bottom of your very short shopping list, yes, the Diploma in Disability Assessment Medicine was very, very new at the time of the first hearing which was why there were so very few people. There are now altogether about 50 people who have the diploma, 35 of them are from SchlumbergerSema, a number of them are from our subcontractor, Nestor Disability Analysis, and they have been sponsored by the Department. We have sponsored our doctors and have created a training course which the next group of doctors will be attending in the very near future, so the diploma will be taken by some 20 of our doctors this year plus doctors from other areas either from the Department or, indeed, from outside the Department. After that we intend to make it so that up to 35 doctors a year from SchlumbergerSema will continually go through the assessment process for the Diploma in Disability Assessment Medicine. From our point of view it has been a great success in both raising the standards and giving external validation of quality of some of our doctors which clearly we need.

  138. From what you were saying earlier you seem to think your training has improved.
  (Dr Aylward) Yes.

  139. Are you satisfied that it has?
  (Dr Aylward) Most definitely satisfied. I am also satisfied that it has moved away from the perfunctory "doctors will do five days training". It is more based upon what is the training and analysis that we need in doctors delivering this new discipline and we focus upon those issues. It may be more than five days, it may be less than five days, depending on the individual doctor. Again, we also look at the outcome of our training and feed those outcomes back into new training. In addition, looking at the Diploma in Disability Assessment Medicine, the Department is highly committed to it, as we have indicated before, and we are funding each year 20 bursaries for people outside of Sema-directly employed doctors.

  Mrs Humble: Thank you very much.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 13 June 2002