Select Committee on Work and Pensions Minutes of Evidence


Memorandum submitted by Prospect (MS 04)


  1.1  Prospect (formerly known as the Institution of Professionals, Managers and Specialists) represents 105,000 members predominantly, scientists, engineers, technologists and professionals in the civil service, non-departmental public bodies and other parts of the public and private sectors. We submitted written evidence to the enquiry commissioned by the Select Committee in 2000 covering the provision of Medical Services to the Benefits Agency on behalf of the full-time Medical Advisers who are members of Prospect. We welcome the opportunity to provide further evidence to the Select Committee on developments since the enquiry and prior to the Government's decision on whether to confirm the extension of the Medical Services contract held by SchlumbergerSema for a further two years.

  1.2  It is not normal convention for Prospect to submit evidence of this nature to a Select Committee unless a change in policy has been proposed by Government. Prospect has not been made aware of any fundamental changes to the contract that have been imposed on SchlumbergerSema in seeking a two year extension or of any revisions to Government policy. However, Prospect does have considerable interest in how the contract is delivered and the lessons that have been learnt over the past three and a half years that the contract has been working.

  1.3  Our main concern principally rests with the apparent lack of true "partnership" with the Company. Whilst an industrial relations forum does exist we do not believe that it is used to its best advantage as we have experienced difficulties in the past in persuading SchlumbergerSema to take into account the views that the trades unions have expressed not only on employment issues—which are of legitimate concern—but also on issues affecting the delivery of the contract. As a consequence, members have been left demoralised, demotivated and frustrated in their belief that neither their views or their personal contribution to work counts for anything. We have raised this problem with management and we have jointly agreed that we need to concentrate more effort into both consultation and communication in the future. Part of the problem perceived by members is the sharper financial focus and commercial interest which has been introduced by Schlumberger which at times detracts from what they believe are legitimate medical issues.


  2.1  Following the Report of the Select Committee on Social Security, the National Audit Office conducted a follow-up investigation into the financial arrangements of the contract. The NAO identified tensions inherent in the way that the contract had been structured. There were conflicts between improving the quality of reports while, at the same time quickening file throughput, maintaining customer service, levering in investment and reducing cost for the Contractor. Therefore the viability of the business remains under acute pressure and the contract is focused on reducing the cost of the service whilst speeding up throughout.


  3.1  In our earlier submission to the Select Committee, we highlighted the pressure being placed on Medical Advisers to increase the number of Incapacity Benefit (IB) examinations completed in a 3.5 hour session. In the written evidence that was given to the Select Committee by Sema Group Medical Services, they stated on page 24 of their memorandum that the current workload of Medical Advisers was based on the average number of clients examined per session for Incapacity Benefit. The explanation put forward by the Sema Group Medical Services was that the increase in the number of people examined per session since they took over the contract had resulted principally from improved management of the scheduling process which had ensured that the Medical Adviser was fully occupied in the examination session. Dr Hudson went on to say in her evidence to the Select Committee that there was no evidence that the amount of time Medical Advisers spent with clients, producing statements or writing up reports had either increased or decreased since cutover. The statistics that were produced by Sema Group Medical Services suggested an average throughput of clients of 4.3 per session which resulted to an average of 47 minutes being spent on each IB case. In its subsequent conclusions, the Select Committee stated the following: "We recommend that no reduction in average times spent examining claimants should be allowed to occur, unless hard proof can be deployed to show that there has been a genuine increase in claimant satisfaction. We are sceptical that the two can occur simultaneously. We also recommend that the present duration of examinations be monitored by the Medical Quality Surveillance Group to ensure that they are sufficient to enable the doctors to produce accurate reports without being under pressure of time."

  3.2  Since then, Prospect has raised the issues of the quality of medical assessments, examination times, numbers of examinations per doctor session and the effects of the present system on Medical Advisers' health on numerous occasions with SchlumbergerSema management without reaching totally satisfactory solutions.

  3.3  SchlumbergerSema has introduced a system of audit (IQAS). However, we have not been provided with evidence that the system is working effectively or that it accurately reflects the true quality of the medical filework or examination assessments. We would welcome the opportunity not only to review this information jointly with SchlumbergerSema management to ensure that the quality audit is delivering the information that it should be, but also to suggest improvements if we believe they can be achieved.

  3.4  Last year, the preferred method by which the sessional doctors employed by Nestor were paid to carry out Incapacity Benefit examinations was altered from that of a sessional fee to one of fee per examination. We have little doubt that the reason for doing so was to provide an incentive to increase the number of cases examined per doctor session which is normally 3.5 hours. Since the introduction of this method of payment, we have seen certain doctors carrying out 7, 8, 9 and sometimes more cases in a session. Indeed, we know of doctors who have regularly carried out 10 examinations per session. At weekend sessions, doctors have been known to complete 16 PCA reports within a 7 hour period. However, some these examinations will have included exemptions, and whilst we do not hold the appropriate statistics, we believe that these may have increased. In general, examinations completed during weekend sessions do not form part of the audit results forwarded to Impact or the Chief Medical Adviser.

  3.5  The increasing number of examinations completed per session inevitably means that less time is spent on each individual examination. Members believe that this may have an adverse effect on the quality of the reports being produced. We are aware of several sessional doctors, who completed a large number of quick Personal Capability Assessment (PCA) reports who have now been the subject of complaint.

  3.6  In addition, we have frequently been told by our members who work as full time Medical Advisers for SchlumbergerSema that pressure has been placed on them to increase the number of clients seen per examination session. A recent communication from Simon Chipperfield, the Managing Director of Medical Services has stated that the company will pay a bonus to those doctors achieving and maintaining, on a regular basis over 3 monthly periods, an output of five IB cases or six IISB per session or six EMP visits per day at least three days per week. Larger bonuses are offered for doctors achieving six or more IB or seven IISB per session or seven EMP visits per day on the same regular basis.

  3.7  We believe that this rate of examining is likely to have several unsatisfactory effects. Firstly, the legibility of reports is likely to be compromised, and it is not uncommon for the Benefits Agency to return reports for clarification for this very reason. Secondly, we do not consider that it is possible to assess clients' disabilities properly in such circumstances. Inevitably, this may result in the wrong decision being made about continuance or otherwise of Incapacity Benefit. Equally, there is little point in carrying out PCA examinations unless clients are fairly and properly assessed.

  3.8  In relation to scrutiny of cases prior to possible examination, the scrutiny to examination rate which Medical Advisers have been expected to achieve has, over the years that Incapacity Benefit has existed, greatly varied. At one time, the rate was around 70 per cent, but it later fell to 30 to 35 per cent. One of the present work objectives, dictated by management is for Medical Advisers to achieve a 54 per cent call rate or "whatever rate is deemed necessary." The scrutiny guidelines have been clarified over the past two years by the Chief Medical Adviser, Department of Works and Pensions—principally as a result of the recommendations of the Select Committee about the standards and consistency of filework—and Medical Advisers are expected to determine which clients should be called on the basis of these guidelines. Indeed, their work is monitored to check that they are adhering to those guidelines. Given that the case mix of scrutiny files may vary from day to day or from area to area, we consider that it is unreasonable for Medical Advisers to be expected always to achieve exactly the designatedscrutiny to examination rate while determining each case according to the guidelines. In other words, we do not consider these two objectives are necessarily compatible.


  4.1  In our opinion, the result of applying unreasonable and sometimes mutually exclusive targets for quality and output has had an adverse effect on the health and morale of Medical Advisers. Many are deeply unhappy that their medical standards are being eroded. They are demoralized by the fact that those doctors who carry out high numbers of examinations per session are highly regarded by management while their own attempts to maintain medical standards are not always encouraged.

  4.2  A large number of Medical Advisers have complained to the union about the unfair pressure and resulting stress that is being applied to them. After a number of meetings with their management, SchlumbergerSema eventually agreed to carry out a Stress survey of the doctors. However, despite the fact that this survey was completed several months ago, and Prospect have been promised a report on the findings, this has not been forthcoming. Prospect conducted its own stress survey and amongst the reasons for this work related stress, we would cite the following:

    —  Unsympathetic management.

    —  Impossible targets.

    —  Lack of control over the pace of work and hence the ability to maintain quality of work.

    —  Bullying.

    —  Lack of proper medical control over medical aspects of the work, leading to erosion of the ability to maintain professional standards.

    —  Emphasis on performance related pay and, more recently, on non-consolidated, non pensionable bonuses for levels of work output which we do not regard as sustainable in the long term.

    —  SchlumbergerSema's reluctance to discuss, with Prospect, the introduction of an incremental pay structure which would allow doctors who joined the service within in the last seven years to catch up with the pay of longer established colleagues.

  4.3  Long term sickness absence for Medical Advisers was recently estimated by us to be around 10 per cent. While we do not have access in every case to the reasons for their prolonged absence from work, we are of the opinion that the level of work related stress encountered by Medical Advisers has contributed to this high absence rate.

  4.4  A significant number of doctors have, within the past three years, reported work related upper limb problems (WRULD) because of the amount of writing involved, particularly when completing IB reports. Far from dealing satisfactorily with these legitimate health and safety issues, which have been brought to their attention on several occasions, the increasing pressure on doctors, by management, to complete more reports in a given time has, in our opinion, exacerbated the problem. The Prospect stress survey indicated that at least one-third of all Medical Advisers had experienced work related upper limb disorders during various times of their employment. Only in isolated occasions has the problem been dealt with by the provision of voice- activated software in order that computerized reports may be completed. It is to be hoped that the proposed introduction of evidence based medicine and computerised reports at some time in the future will help to reduce the incidence of upper limb problems.

  4.5  In their conclusions, the Select Committee recommended a one off catch up increase in payment to doctors followed by ongoing regular reviews of doctors' pay. Unfortunately, we have to report that the pay of medical advisors employed for SchlumbergerSema has fallen behind on average by 6.5 per cent compared to other Medical Advisers employed in the Civil Service.

  4.6  We are concerned that there may be insufficient doctors in the future to service the Impact contract adequately. Since SchlumbergerSema took on the contract in September 1998, we would estimate the number of Medical Advisers employed has fallen from approximately 220 to 186. Some of this reduction will be accounted for by ShlumbergerSema's inability to recruit Medical Advisers, but others have been moved, either in whole or in part, from Impact contract work to occupational health work for which the company has secured a number of contracts with the Civil Service and the public sector. Last year, SchlumbergerSema indicated to Prospect that they intended to recruit a further 50 to 100 new Medical Advisers. Whilst, we are encouraged that the recruitment of new Medical Advisers appears to be moving in the right direction and that a number have already accepted appointments and others are arranging start dates, this needs to be sustained in order to meet the delivery of targets.


  5.1  In summary, we are concerned that the present policy with regard to examining claimants for the various state benefits and pensions can be maintained in the longer term, given the current shortage of full-time Medical Advisers, the levels of job dissatisfaction of Medical Advisors already working for SchlumbergerSema, which may give rise to a greater turn over in staff.

  5.2  We are concerned that commercial pressures, including the terms of the Medical Services contract, may result in a policy of encouraging Medical Advisers and sessional doctors to carry out examinations at a speed which is not conducive to producing legible, well considered and well justified reports as required by Benefits Agency Decision Makers.

  5.3  We are also concerned about what the present system is achieving in terms of ensuring that the correct levels of benefit are awarded to the right people and, where clients are found fit to work, that they receive adequate rehabilitation to assist their return to work.

  5.4  Prospect would be happy to meet with any members of the Select Committee to give further oral evidence if this is required.


  NB. Full-Time Medical Staff employed by SchlumbergerSema are referred to as "Medical Advisers" Sessional medical staff employed by Nestor are referred to as "doctors"

Geraldine O'Connell

National Officer

27 March 2002

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