1 Improving the medical assessment process
1. Since 1998 the Department for Work and Pensions
has contracted for the supply of medical services. The Committee
reported on performance under the contract in 2002.[4]
Following the agreed take-over of the then contractor, SEMA Group
by Schlumberger in 2001, the Department offered to extend the
contract—due to expire in 2003—to 2005 as an incentive
to deliver service improvements. The extension amended the contract
to introduce new targets for customer service, the throughput
and adequacy of medical reports, and the recruitment, retention
and skills of the doctors employed. These targets were met by
April 2002, and go some way towards meeting the recommendations
from our previous report. Figure 1 summarises progress.[5]
Figure 1:
Summary of progress against the Committee's recommendations
| Recommendation
| Progress
|
- Delays in making decisions about benefit, and variations across the country, impacted on customers and the taxpayer. The Department should set clear targets for improvement (conclusions (i) and (ii)).
|
- Implemented. New performance targets have been set and are being met or are on track to be met by April 2004.
|
- Explore the use of other healthcare professionals to offset shortages of doctors, speed up assessments and reduce costs (conclusion (iii)).
|
- Ongoing. The Department experimented with using other professionals but they did not speed up the process or reduce costs. Increased recruitment and more flexible deployment have dealt with doctor shortages in the short term. The Department are exploring how to use more evidence from other professionals in the assessment of disability benefits.
|
- Reduce the number of appeals that are successful because of mistakes in interpreting medical evidence (conclusions (iv) and (v)).
|
- Ongoing. Feedback from appeals tribunals has been improved, but these have not resulted in a reduction in appeals overturned because of the medical evidence or its interpretation. The Department are taking further steps to learn from the results of appeals.
|
- Improve the quality of medical reports, especially those carried out in customers' homes, with tighter Departmental oversight of standards (conclusion (vi))
|
- Implemented. Targets for reducing the number of substandard reports have been built into the contract and are monitored by the Department. The proportion has halved since September 2000.
|
- Resolve the conflict of interest for general practitioners to overcome their reluctance to provide medical evidence (conclusion (vii))
|
- Ongoing. Reports requested from general practitioners have been revised to focus on clinical information only. A number of pilot schemes are trialling a range of alternative ways of obtaining medical evidence.
|
- Pay compensation if customers are turned away unseen as a result of overbooking of appointments ((conclusions (viii) and (ix))
|
- The Department do not consider compensation appropriate. They have attempted various measures to address overbooking, but have not improved the proportion of customers sent home unseen. They are doing more work to understand why customers do not attend examinations, the underlying reason for overbooking.
|
- Ensure that Schlumberger provide a responsive service to all customers and respond to special needs (conclusion (x)).
|
- Implemented. Medical Services meet nearly all special requests and the number of complaints against them has reduced steadily.
|
2. Disability Living Allowance and Attendance Allowance
are administered by the Disability and Carers Service from 11
regional centres. Since early 2000, there has been a steady improvement
in processing times for these benefits, which meant that in 2002-03
customers under the normal rules of the benefits received cash
on average 5-6 days earlier than in 2000-01. The Department consider
some further marginal improvement possible without jeopardising
quality. It had set and achieved targets for narrowing the gap
in average processing times between the best and worst performing
offices, but in 2002-03 this still ranged from 34 to 48 days for
Disability Living Allowance (Figure 2).[6]
3. Incapacity Benefit customers meeting basic eligibility
criteria are paid benefit immediately, but have a medical examination
periodically to determine they are still incapable of work. At
the time of our previous report, there was a large backlog of
such examinations, which grew to 368,000 by June 2001. This has
almost been eliminated (Figure 3), with a resultant saving
to the taxpayer of some £29 million through withdrawing benefit
from ineligible customers. The Department and Schlumberger have
also substantially reduced the time they take to process these
assessments—from 52 to 30 days to complete the examination
and from 27 to 15 days to make a decision on entitlement. This
has saved a further £21 million a year.[7]
4. Following the Green Paper Pathways to Work,
from October 2003 the Department began to pilot reforms to
the administration of Incapacity Benefit in Bridgend, Renfrewshire
and Derbyshire. These are to assist people to return to work more
quickly, and involve the completion of a capability report on
claimants as well as the current medical assessment. The Department
said early results were positive. The revised process also involves
an earlier medical examination, and Schlumberger is trialling
completion of these in 15 days, compared to the current average
of 30 days. For this to become the norm would require changes
to the organisation of assessments, but it could realise further
substantial savings.[8]
5. The Department pays Schlumberger about £80
million a year under the Medical Services contract. However, this
is not the full cost of administering the £18 billion annual
expenditure on incapacity and disability benefits. The costs to
the Department, as well as managing the contract, include the
costs of decision-making, paying benefits, and checking accuracy,
as well as the cost of dealing with 140,000 appeals a year. The
Department was unable to tell us the value of this activity because
they have no unit costing system. An organisation paying out billions
of pounds in routine transactions to millions of people must know
the costs of these activities and in the absence of unit costing
it is difficult to see how it can judge the efficiency of its
operations or make sensible decisions about allocating and deploying
resources.[9]
6. The Department is due to let a new contract in
August 2005 and intends to put into practice lessons from five
years of operating the current contract. As part of the tendering
process, bidders are to be asked to make their own suggestions
about how service delivery can be improved. The Department is
looking for innovation in four areas: better use of information
technology especially in developing electronic interfaces with
the Department, more flexible use of accommodation, wider use
of other healthcare professionals and redesign of existing processes.[10]
4 27th Report from the Committee of Public
Accounts, The medical assessment of incapacity and disability
benefits (HC 683, Session 2001-02) Back
5
C&AG's Report, paras 1.13-1.14, Figure 3 Back
6
C&AG's Report, paras 2.2, 2.5-2.6; Q 1 Back
7
C&AG's Report, paras 2.9-2.12 Back
8
Qq 8-11, 42-44 Back
9
Qq 65-66, 126-130 Back
10
Q 131; Ev 17-18 Back
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