Select Committee on Work and Pensions Minutes of Evidence


Memorandum submitted by DIAL UK (MS 02)


  DIAL UK is the umbrella organisation for a national network of over 140 independent specialist disability advice and information groups. Both DIAL UK and its member groups are run for and by disabled people.

  Over the past six months DIAL UK has been gathering evidence on the experiences of disabled people undergoing medical assessments for sickness and disability benefits, as part of it's "A Bitter Pill" campaign. "A Bitter Pill" was launched in November 2001, calling for improvements to Medical Services and the service provided by the doctors they employ to undertake medical assessments. This campaign was launched in response to the ongoing problems disabled people were reporting to DIALs, throughout the country, in relation to medical assessments.

  This report looks at the recommendations, put forward by the Social Security Select Committee in their Third Report of April 2000, for improvements to Medical Services, and whether any progress has been made in tackling the problems highlighted in that report. It draws on the evidence provided by DIALs relating to the experiences of disabled clients undergoing medical assessments for Incapacity Benefit, Disability Living Allowance and Attendance Allowance since April 2000.


  In the Select Committee Report of April 2000, it was stated that the performance of Medical Services in relation to the treatment of claimants was not satisfactory. It was recommended that urgent steps be taken to improve the quality of treatment of clients.

  Recommendations in this area included:

    (a)  Ensuring that the length of time for examinations is sufficient to enable the doctors to produce accurate reports.

    (b)  Implementation of a system of recruitment, training and monitoring that ensures doctors have the skills to record information accurately.

    (c)  Unacceptability of illegible reports.

    (d)  Increased training in customer care.

    (e)  A review of the systems for identifying and dealing with underperforming doctors.

  The evidence being sent to DIAL UK suggests that disabled people have not experienced a significant improvement in the quality of treatment they are receiving from Medical Services.

  1.1  In over 60 per cent of the cases DIAL UK has received, not enough time was spent to ensure a thorough assessment was made. Clients are reporting that they feel they are not being given enough time to fully explain their disability and the effect it has on their day to day activities.

  In several cases, clients have reported doctors taking a maximum of 10 minutes to complete an assessment.

  1.2  Also, the quality of time spent with clients seems to be very poor. 69 per cent of clients reported that doctors ignored the comments or information offered by themselves or primary carers accompanying them. In one case, a client had arranged for her primary carer to be present during the assessment because she was nervous and not certain she would remember to give all the necessary information as she had memory lapses. However, when the doctor arrived he asked the carer to leave the room, stating that she was "not allowed" to be present during the assessment. Consequently the doctor did not receive a full account of the client's difficulties and benefit was refused. This was overturned on appeal when the client received full representation.

  Another client reported that the doctor that came to her house spent ¾ hour admiring her paintings and only 15 minutes on the actual assessment. The client was then shocked to receive a phone call the following day from the doctor's wife asking if any of her pictures were for sale.

  1.3  In the case of home assessments, several clients have reported that doctors have turned up at the door without any form of identification and some not even offering their names. This is an alarming situation as most of the clients involved are very vulnerable and often on their own.

  1.4  Another area of concern is the fact that, in nearly 50 per cent of cases involving DLA claims, clients report that they have not been given the opportunity to read their statement or have not had it read back to them before signing it. Their signature is supposed to indicate that what the doctor has written is a true record of their own account of their disability and its effects. Some of the comments made by doctors when asking clients to sign the statement have not reflected this. These comments include:

    —  you are signing just to say that I have been here;

    —  you need to sign this but you are not allowed to see what has been written because this is an official document;

    —  you have to sign this to say that you want to claim benefits.

  A significant minority of clients has also reported that having seen the statement and disagreeing with its content, doctors have not allowed them to change the statement. In one case a doctor told the client that if he did not sign the statement the client would not receive any benefits. So the client felt obliged to sign despite the fact that he thought it was not a true account of his problems.

  On receiving a copy of the doctor's report 64 per cent of clients have said that the doctor had not recorded their statement fully, clearly or accurately. Also, nearly 50 per cent stated that the doctor had not recorded all of their disabling conditions within the report.

  1.5  With regard to legibility of reports, DIAL clients are still reporting problems with a number of doctors' reports. Several clients have been unable to read what the doctor has written on the client statement because of the bad handwriting. It does seem, however, that the number of cases of illegible reports is fairly low.

  1.6  In general terms, the attitude and conduct of doctors undertaking assessments continues to be poor. Over 50 per cent of clients found doctors to be rude, dismissive or their conduct to be inappropriate. Many report feeling bullied and intimidated by the doctors. Over 30 per cent of clients said that the physical examination caused pain and discomfort. In one case a female client told the doctor that she could not raise her legs because it caused too much pain. Yet the doctor continued to make her raise her legs pushing them up further than the client was able to do herself. This left the client in severe pain for two weeks following the assessment and restricted her movement severely.

  1.7  Several DIALs have reported that SchlumbergerSema have done little to tackle the bad performance of individual doctors in their areas. In one area, despite over 30 complaints being made against the same doctor, the doctor continues to undertake medical assessments. In this case there does not seem to have been any attempt made to address these complaints, to audit the doctors work or to instigate remedial training. The number of cases of individual doctors continuing to produce bad reports or continuing to exhibit inappropriate practices and conduct during assessments without being checked by Medical Services is still significant.


  The Select Committee put forward recommendations to improve the treatment of claimants with mental health problems, those from ethnic minorities and female claimants.

  These recommendations included:

    (a)  Improved training around mental health issues for doctors.

    (b)  Improvements in the system to reduce the stress caused to claimants with mental health problems.

    (c)  Claimants to be made aware of the availability of interpreters for assessments.

    (d)  Training to be provided on cultural issues and cultural sensitivity.

    (e)  Claimants to be made aware of the availability of a female doctor for examinations.

  Whilst DIAL UK has not received a large amount of cases referring to these issues, those that have been received indicate that problems still exist in these areas.

  2.1  Several DIALs have reported that doctors are not giving clients with mental health problems the time and support to answer the questions put to them during assessments.

  Also, DIALs have found that, particularly in the cases of clients who have both physical disabilities and mental health problems, often doctors overlook mental health problems and focus purely on physical problems.

  2.2  In several cases DIALs have reported that clients with mental health problems have been severely traumatised following doctors' assessments. This has been due to the insensitivity of doctors during the examination. The lack of awareness of the needs of clients during assessments has led to several clients dropping their claims because they cannot face the stress of going through further assessments or appeals.

  DIAL clients are still reporting a lack of awareness of the availability of interpreters. There is also evidence that where an interpreter has been requested, one has not been provided for the assessment. This situation has been exacerbated by the practice of doctors turning up for home visits unannounced or arriving at a different time than previously arranged. In one case where an interpreter was provided, the interpreter was not able to speak the same language as the client.

  The lack of provision of interpreters is also an issue for clients with hearing impairments. In one case, a client requested a sign language interpreter to be present for his assessment. An appointment time was booked but the interpreter was not available at that time. A further appointment was booked and an interpreter but the interpreter did not turn up. So the assessment could not go ahead. The client waited for a further appointment but this was not forthcoming after two months because of the lack of available interpreters. After a wait of nearly four months the client was forced to book and pay for his own interpreter in order to make his claim.

  2.3  The incidence of cultural insensitivity on behalf of doctors has not been a major problem in the evidence received by DIAL UK. There have been a few examples, however, where the lack of awareness of the availability of female doctors has caused problems for ethnic minority clients. Female clients from ethnic minorities have had to refuse an assessment due to the fact that a male doctor has been sent to undertake the examination. In these cases, the doctor has simply recorded the fact that the assessment was refused without any explanation of the reasons for this.


  The Select Committee identified the need for improvements to the Medical Services complaints system including better information for claimants about how to make a complaint and a more transparent system of investigating complaints.

  DIAL UK has found very little evidence of improvements in this area of Medical Services in the experiences of disabled people.

  3.1  From the evidence received, less than a quarter of clients experiencing problems with their medical assessments have made a formal complaint to Medical Services. Of those that have complained over half thought the time taken to respond to and investigate the complaints was excessive. Also, over half of clients complaining were unhappy with the response they received from Medical Services. Clients have found responses have not addressed the specific issues raised by their complaint. Also, in many instances the word of the doctor has been taken over that of the client without any further investigation. This has even been the case when several clients have made similar complaints against the same doctor.

  3.2  There are two main reasons given for clients not making official complaints.

    (a)  Clients are unaware of how to complain.

    This seems to be a particular problem with clients having home assessments.

    (b)  Clients do not want to complain in case it affects the outcome of their claim.

    There is still a feeling of mistrust in the system. Clients feel that if they complain those deciding on their eligibility for benefit will note this and it will go against them when decisions are made.

  The majority of clients still see the Appeals system as their only satisfactory means of complaining about the conduct or content of medical assessments.


  It is clear, from the evidence that DIAL UK has received, that disabled people are still experiencing major problems with the system of Medical Services. Many of the problems identified by the Select Committee for Social Security in April 2000 are still occurring throughout the country.

  Whilst Medical Services have evidently made changes to improve the system of medical assessments, these have not led to significant improvements in the experience of disabled people undergoing these assessments.

  DIAL UK feels that major steps need to be taken immediately to address the poor quality of the treatment of claimants, the quality of the doctors undertaking assessments and the standard and efficiency of the complaints system.

Lucy Birkinshaw

Social Policy Worker

April 2002

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