Select Committee on Work and Pensions Minutes of Evidence


Letter to the Clerk of the Committee from the British Medical Association (MS 06)

  The BMA has repeatedly stated that the present system for medical assessment of benefits is not sustainable in the long term, firstly because the All Work Test and Personal Capacity Assessment are too mechanistic to ensure that all those entitled to benefit receive it—or that those not entitled to it do not—and secondly because of the on-going problems surrounding doctors' pay and conditions of service. At a time of acute shortages of doctors in all fields of medical practice, these difficulties are making this area of work increasingly unattractive, and we are aware of a number of areas where SchlumbergerSema have great difficulty in filling sessions. The shortage of doctors contributes to delays and a backlog of medical assessments and has also prevented the Department and SchlumbergerSema from guaranteeing same gender doctors for medical examinations. Despite these problems, many doctors are working hard and conscientiously to make the system operate.

  In Spring 2001 the Department for Work and Pensions considered that extending the contract with SchlumbergerSema offered the best opportunity to make necessary service improvements. We understand that the contract has been amended with new performance and delivery conditions as part of the extension, but that the agreement to extend the contract is subject to confirmation by the Department by 31 May 2002.

  The Social Security Committee's Third Report drew attention to concerns raised by both claimants' organisations and the BMA that the quality of medical examinations was being compromised by pressure on doctors to increase the number of claimants examined in each session. This trend has continued: even more claimants are now called for each session in order to meet performance targets, and we are concerned that the value of the medical examination is being seriously undermined, denying claimants the opportunity to express themselves fully (a common complaint) so that a full assessment can be made. Future assessments which take into account the earlier assessment are also, therefore, flawed. The current average time for an examination is approximately 47 minutes, which is wholly insufficient to read the necessary forms, take the claimant's history, conduct the medical examination and write a reasoned medical report capable of legal challenge. It is therefore no surprise that there are such high complaint and successful appeal rates. People with mental health problems, either declared or discovered during the examination, tend to lose out most due to the time pressures.

  The Government, in its response to the Third Report, acknowledged "the challenges posed in devising and applying valid measures of medical quality" but neither the Department nor the company have attempted to work with the BMA, or with the doctors themselves, to agree such measures. At the same time the Government insists that "sufficient time" is given to claimants at examinations—without indicating what "sufficient time" is. In evidence on 9 February 2000 the Minister referred to research that indicated that the new Personal Capacity Assessment might require 77 minutes to complete, which is in excess of the five claimants per session which Medical Services currently requires.

  In its report "The Medical Assessment of Incapacity and Disability Benefits", published 10 April 2002, the Committee of Public Accounts was critical of the Department for slow progress in exploring ways of using healthcare professionals other than doctors. Medicine is not an exact science and, while undoubtedly some claimants do not require a doctor to examine them, many do, in order to ensure that they receive the benefits to which they are entitled and which are appropriate to their disability or illness. Not infrequently doctors find that it is the chance remark which, when considered in conjunction with other seemingly insignificant remarks, reveals the disability. This is a diagnostic skill which forms the basis of the clinical report on which a decision is based, and is the reason that medical expertise is required. In contrast, the medical component of the All Work Test requires the doctor to give simple "yes or no" answers to questions that require clinical judgement and are often not amenable to such answers.

  This work used to be offered, on the recommendation of their peers, only to senior members of the local medical community who could demonstrate considerable clinical experience. The employment and remuneration policies initiated by BAMS and continued by Schlumberger/Sema/NDA/Medical Services have resulted in a major loss of these experienced doctors. The Social Security Committee recommended that Medical Services make available training resources in a number of areas for doctors, such as customer care (for new doctors), mental health, and remedial training for cultural insensitivity. Little progress has been made, with only a number of inappropriate courses offered, and only recently has the company been prepared to pay doctors to attend such courses.

  The Social Security Committee also condemned the absence of a pay increase for sessional doctors since 1992 for sending out the wrong message and hindering the ability of the service to attract high quality doctors, and recommended that Sema examine the case for a one-off "catch-up" increase in payments to doctors and set a timetable for ongoing regular review of doctors' pay. In September 2000 doctors who have continued to work on a sessional basis only received a 3 per cent pay rise and, while the fee for DLA examinations was also increased at that time, the fee previously paid for aborted visits was withdrawn, so in fact, especially in rural areas where doctors might make a long journey to visit a claimant only to find that they were out, the pay rise was minimal. Some doctors have stopped doing DLA work for this reason, and the BMA is concerned that, to plug the gaps, the company might be tempted to reduce the standards for appointment, which again will reduce the value of the examination. Importantly, at present the fees do not cover the cost of a locum for a GP's practice, let alone any of the other expenses that GPs incur if they do this work.

  The BMA was disappointed in a number of aspects of the Government's response to the report of the Social Security Committee, and we believe that neither the Department nor the company have endeavoured to improve the service for claimants by addressing the criticisms made of the medical workforce—both quantity and quality—by entering into dialogue with the workforce and the BMA to address such matters as pay and training.

C V Hartley

Secretary, Professional Fees Committee

15 April 2002

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