APPENDIX 1
Memorandum submitted by DIAL UK (MS 02)
INTRODUCTION
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.
1. TREATMENT
OF CLAIMANTS
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.
2. CLAIMANTS
WITH MENTAL
HEALTH PROBLEMS,
ETHNIC MINORITIES
AND FEMALE
CLAIMANTS
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.
3. COMPLAINTS
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.
(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.
CONCLUSIONS
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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