Conclusions and recommendations
1. Since 2001 performance has improved in
many aspects of medical assessment.
The Department has taken action in relation to all of our earlier
recommendations. New performance targets have been set and met,
or are on track to be met. Schlumberger has halved the number
of substandard medical reports and the number of complaints against
them has reduced steadily. In some areas, our recommendations
have been implemented but have not yet fed through into service
improvements.
2. The Department has improved the time taken
to process medically-assessed benefits, but performance in poorer
offices needs to be brought up to the standard of the best.
For Incapacity Benefit, the backlog of examinations, which had
reached 368,000 cases in 2001, has almost been eliminated, saving
the taxpayer £29 million in payments to those no longer eligible
for benefit. For Disability Living Allowance and Attendance Allowance,
improved processing times means that in 2002-03 customers received
their benefit on average 5-6 days earlier than in 2000-01, but
there is still a 25% difference between the best and worst offices.
3. Pilot Incapacity Benefit reforms have led
to further reductions in the time taken to carry out examinations.
The Department should make these levels the norm.
Schlumberger have reduced the average time taken to carry out
medical examinations from 52 days to 30 days, which has contributed
to an annual cost saving of £21 million. On the basis of
evidence from Incapacity Benefit reform pilots, the Department
consider it is possible to reduce this further to 15 days, which
would result in further financial savings as ineligible customers
are identified quicker.
4. The Department should determine the unit
cost of processing benefit claims to improve its management of
the decision-making process. The Department
cannot allocate and manage resources efficiently without knowing
the full cost of assessing medical benefits.
5. The re-tendering of the medical services
contract should be used to seek further service improvements and
more innovative ways of delivering medical services.
The Department needs to encourage bidders to make better use of
information technology and to gather medical evidence more effectively
from a range of sources. Investment in improving IT systems should
be a criterion for selecting the winning contractor.
6. The Department should assess the risk that
a significant proportion of decisions are incorrectly overturned
at appeal. If so the Department will need
to improve the training of appeals tribunal doctors and provide
for more systematic review of their work.
7. It is difficult to see how doctors and
decision-makers can improve their performance if they do not know
the outcomes of the cases they examine.
In our report Getting it right, putting it right: Improving
decision-making and appeals in social security benefits[3]
we highlighted the error rate of nearly 50% for Disability Living
Allowance decisions. The Department should:
- provide regular feedback on
decisions reached and on the results of appeals;
- speed up implementation of systems to improve
the quality of medical evidence; and
- look again at the standards used to assess the
adequacy of medical reports and consider whether they should be
raised, or the contractor set a more demanding target.
8. The calibre of the doctors conducting examinations
is crucial and the Department and its contractor should enforce
rigorous standards.
The Department should act swiftly to identify and, where necessary,
remove those who fail to reach the necessary standards of care.
9. The Department must understand better the
causes of non-attendance and introduce measures to address them.
The Department has put in place measures
to deter non-attendance, but not all non-attenders are deliberately
avoiding an examination. The Department and Schlumberger should
identify and deal with those who are avoiding examination. But
they should also make it easier for others to attend by for example,
rethinking where examinations take place and improving the accessibility
of medical examination centres.
10. Improvements should be made to medical
assessments for specific groups, such as those with mental health
problems. There is evidence that people
with mental health problems experience greater than average difficulties
in attending examinations, being assessed and getting a fair hearing.
The contractor's doctors should be trained to recognise and deal
with customers with mental health problems.
3 12th Report from the Committee of Public
Accounts, Getting it right, putting it right: improving decision-making
and appeals in social security benefits (HC 406, Session 2003-04) Back
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