Examination of Witnesses (Questions 40-59)
Wednesday 10 December 2003
Mr David Anderson, Professor Mansel Aylward CB, Mr
John Sumner, and Mr Simon Chipperfield, examined.
Q40 Jim Sheridan: Why does the individual
not keep the benefit until the appeal process? What is wrong with
that?
Mr Anderson: The way the process
works at the moment, as I understand it, there is no barrier to
anyone appealing and therefore there is a one-way street for everyone
who gets a negative decision to appeal straightaway. In a very
high number of those appeals, the changes are made because of
new evidence and half the appeals, despite that, are still unsuccessful.
That therefore suggests that the system would be open to widespread
abuse if benefits were continued after the decision-maker had
looked at the evidence.
Q41 Jim Sheridan: Is that different
from any other appeals procedure in terms of benefits? If people
are taken off other benefits, whatever they may be, do they retain
those benefits until the appeal process?
Mr Anderson: I do not believe
so. Mr Sumner might be able to answer that question.
Mr Sumner: No, that is fairly
standard across the benefit system. Once a decision-maker has
made a decision adverse to the customer, the benefit ceases. There
may be certain limited exceptions, but in the vast majority of
cases benefit ceases until an appeal is decided in favour of the
customer.
Q42 Jim Sheridan: I just think we
are in danger of underestimating the anxiety that causes amongst
people, not only in telling them they have some hope for the future,
but that they do not get any benefit money to live on. I think
it is just unacceptable. Mr Chipperfield, you mentioned earlier
some of the new pilot systems being introduced and you mentioned
my own constituency of Renfrewshire in terms of Pathways to
Work and people with disabilities being re-engaged back into
the workplace. It has caused a bit of concern, certainly amongst
my constituents who felt that perhaps they were being forced back
to work against their will and against the best advice of their
doctors. I know it is early days, but do you have any evidence
that is actually working?
Mr Chipperfield: I am not in a
position to make any comment about that. It is very early. The
pilot started in November and it is a DWP pilot. What we in Medical
Services are doing is an additional assessment on top of the Personal
Capability Assessment; we are doing what is known as a capability
report which looks at those things the individual is capable of
doing. It also makes a generalised recommendation as to whether
or not that individual may benefit from some form of condition
management, some form of rehabilitation to support their condition
and therefore prepare them potentially for the workplace. The
overall project is not my remit and perhaps one of my colleagues
might wish to make a comment.
Mr Anderson: It is very early
days but the response to the three pilots has been very positive.
I saw a report this morning which said that already 50 people
had returned to work as a result of the process, who at the time
they were approached had not been considering a return to work
and therefore from their perspective it had been a very positive
experience.
Q43 Jim Sheridan: What I am finding
is that it certainly gives people back some sort of self-confidence
when they go back to work and there is a social aspect there as
well.
Mr Anderson: Absolutely.
Q44 Jim Sheridan: They meet people
and that kind of thing. It seems to be working reasonably well.
Mr Anderson: It is a very important
area. When people go onto Incapacity Benefit, around 80% of them
at the time say that they would like to return to work.[1]
In practice most of them end up staying on the benefit for five
years or more. It is a real mismatch in terms of people's initial
hope and what happens to them. We have to try to address that.
Pathways is part of that process.
Professor Aylward: What is being
provided is extra support in addition to the NHS, not replacing
the NHS but additional support for people with mental health problems,
people with cardio-respiratory problems and people with musco-skeletal
problems. This is a distinct step forward.
Q45 Jim Sheridan: On the question
of people with mental illness problems, sometimes they may find
it difficult to go along for a personal capacity medical assessment.
They are not all treated with the greatest of understanding and
sometimes are penalised for that mental illness. Certainly questions
have been asked. We should like to know what extra measures will
be put in place by Schlumberger to help these people through this
difficult period.
Mr Anderson: We do provide extra
training for our doctors for these cases and extra help for those
customers in the way they are called for examination and the process.
Mr Chipperfield: As part of the
rollout of evidence based medicine new protocols have been developed
for people suffering from some kind of learning difficulty or
mental health problem. All of our doctors have been trained in
the new protocols. That is not just the medicine; it is actually
understanding the impact of the condition on somebody's daily
life. With the implementation of the IT application which has
those protocols embedded, we have now put that into the examination
room and that is helping the doctors to conduct a more consistent
and better examination of someone in that situation. There is
always further progress to be made and we are constantly looking
at ways in which we can more effectively communicate with that
group in our society, particularly to get them to attend for examination
and to understand the process they are going through. We are putting
some more focus on that. One of the things we are doing is working
with a number of the welfare rights and disability organisations
to understand better some of the training techniques we could
implement in our doctor training, which would help our doctors
establish a more effective rapport with people in that situation
as well. We have made progress, but there is always more we can
do.
Professor Aylward: I agree with
you about people not wishing to attend in certain circumstances,
mental health problems. We are aware of that and we are working
with Medical Services to try to identify the particular characteristics
of those types of people so that we can prevent them attending
for a medical examination.
Q46 Jim Sheridan: The National Audit
Office Report shows that there are some difficulties with people
failing to attend for these personal assessments and I know that
Schlumberger are attempting to reduce that number. There is a
number of cases where benefits have been withdrawn from people
not attending these assessments, despite the fact that Schlumberger
were notified that they could not attend.
Mr Chipperfield: I honestly do
not know; I am not aware of anything of that nature.
Q47 Jim Sheridan: There is evidence
from the Citizens' Advice Bureaux suggesting that Schlumberger
were aware of it, but no extra measures were put in place to deal
with it.
Mr Chipperfield: We were aware
of what?
Q48 Jim Sheridan: Of people who,
for whatever reason, could not attend these personal assessments
and their benefits were withdrawn despite them reporting.
Mr Chipperfield: Our initial contact
for a Personal Capability Assessment is via the phone in 70% of
cases these days. If we are unable to get somebody on the phone,
we do write to them and ask them to respond to us. If they do
not respond, we then sent them an appointment and we send them
the time and place of the appointment. If they then do not turn
up, we refer the file back to the Department and then it is the
Department's decision, what they call the personal adviser gets
in touch with an individual to find out the circumstances of their
non-attendance. On many occasions people do contact us the day
before the day itself and say they cannot make it. In that situation
we reschedule the appointment; we do not just refer the file back.
We refer to those as "unable-to-attends". Where they
actually do not attend the file goes back to the Department and
they do the follow-up. We are not informed specifically about
the decision that the decision-maker then takes in respect of
that individual.
Q49 Mr Bacon: Are your doctors subject
to the same professional expectations and disciplinary regime
as other doctors?
Mr Chipperfield: Yes, they all
have registration with the GMC, they have to have a GMC registration
otherwise they cannot work for us.
Q50 Mr Bacon: How were these 22 doctors
who were stopped from carrying out examinations identified?
Mr Chipperfield: They were identified
probably through a variety of means: audit, would have been one
of them; maybe because of the complaints record; possibly because
of observed activity which the medical manager or other professionals
who have worked with them have noticed.
Q51 Mr Bacon: Professor Aylward,
you referred to 52 because of unacceptable quality. Is that 52
out of the 80?
Professor Aylward: No. The 80
were revoked because of unacceptable quality since the year 2000.
Q52 Mr Bacon: What was the 52 you
mentioned?
Professor Aylward: The 52 were
in the last year.
Q53 Mr Bacon: Fifty-two were identified
in the last year.
Professor Aylward: Who had unacceptable
quality and therefore had their approval revoked.
Q54 Mr Bacon: I do not understand.
Why do we have a figure of 22 and a figure of 52?
Professor Aylward: The 22 were
the number of cases reported at the time of the NAO Report. I
am giving you an update.
Q55 Mr Bacon: Are you saying there
have been another 52 since then? It is getting worse.
Professor Aylward: No; no.
Mr Chipperfield: The 52 includes
the 22.
Q56 Mr Bacon: So another 30. It is
still getting worse.
Professor Aylward: Yes, in the
last 12 months.
Mr Chipperfield: It is not getting
any worse. We are very proactively managing the quality of the
doctors and the quality of the work which is performed on our
behalf by those doctors.
Q57 Mr Bacon: When you find doctors
who are doing this poor quality work, do you pursue their cases
with the General Medical Council?
Mr Chipperfield: That depends
on the nature of the situation.
Q58 Mr Bacon: For example, if a doctor
has acted in a way which would be considered grossly unprofessional.
Mr Chipperfield: If a doctor has
acted in a way which would contravene the regulations of the GMC,
then we would report them; absolutely.
Q59 Mr Bacon: Do you pursue the case
with the GMC? I happen to know of a case with a constituent of
mine where your company requested that the GMC stop their investigation.
Mr Chipperfield: I am not aware—
1 Pathways to Work: Helping People into employment.
Cm 5690. Department for Work and Pensions, London; November 2002. Back
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