Examination of Witnesses (Questions 80-99)
Wednesday 10 December 2003
Mr David Anderson, Professor Mansel Aylward CB, Mr
John Sumner, and Mr Simon Chipperfield, examined.
Q80 Mr Bacon: Can you tell me how
you discipline the staff if they ignore the rulings of tribunals?
Mr Sumner: That would depend on
the circumstances of the case. It is difficult to generalise but
clearly in a situation where somebody had wilfully and negligently
not followed a ruling of a tribunal, then there would have to
be an investigation as to why that was the case.
Q81 Mr Bacon: Does that happen?
Mr Sumner: If it is deemed appropriate,
yes.
Q82 Mr Bacon: Do you review the quality
of the tribunal service?
Mr Sumner: The quality of the
tribunal service is a matter for the Appeals Service. Certainly,
as far as we were concerned, we would get feedback from them on
the quality of our submissions and the President's report gives
us information on that.
Q83 Mr Bacon: Professor Aylward,
you are the person who makes recommendations to the Secretary
of State that somebody be removed from the list of those suitable
for giving medical assessments, is that right?
Professor Aylward: That is right.
Q84 Mr Bacon: Once that is done,
what else do you do? Anything else? Do you pursue it with the
General Medical Council?
Professor Aylward: I have pursued
it with General Medical Council if the matter suggests there is
an element of serious professional misconduct.
Q85 Mr Bacon: You have done.
Professor Aylward: I would do.
Q86 Mr Bacon: You would continue.
Professor Aylward: In four cases.
Q87 Mr Bacon: I do not want you to
go into them now, but is it possible that you could let the Committee
have a note with details of the cases you have pursued with the
General Medical Council?
Professor Aylward: Of course.[2]
Mr Bacon: I have reason to believe there
is a case which warranted being pursued and I am not sure that
it was.
Q88 Mr Williams: Looking at page
23, just as a matter of interest because I am trying to work out
why you have done what you have done, Figure 12 and the footnote,
from September to November 2002 you used a three-month rolling
average instead of the previous figure. Why have you done that?
Mr Anderson: The process for monitoring
quality was assessed by the Department's internal assurance team.
That specific change in this table I cannot comment on; it may
be the way the information is presented here. In general terms
the way that the quality of reports is audited has been assessed
outside Schlumberger by the DWP internal assurance team who check
the methodology for checking reports and give substantial assurance
that they believe that this is a rigorous approach to checking
the quality of the reports.
Q89 Mr Williams: But it produces
peaks and troughs statistically, does it not? NAO, does this not
have the effect of actually making the graph blander, so you cannot
identify individual monthly peaks and monthly troughs? Switching
to a rolling average must mean that, must it not?
Mr Lonsdale: I cannot really comment.
Q90 Mr Williams: Is there no statistician
here?
Mr Anderson: It must be true,
yes. Taking a three-month rolling average would reduce the peaks
and troughs in the individual months.
Q91 Mr Williams: So why? I accept
you have done it in good faith. I am not suggesting you were trying
to pull a fast one over us. It is just that is the effect it could
have if there were one dramatic month which we might want to inquire
into.
Mr Anderson: It is a question
of why the report is produced. The purpose of this statistic internally
is to make sure that the trend in this particular statistic is
going in the right direction. If you are trying to identify a
trend and manage a longer term position, then in those circumstances
a three-month rolling average would be a better number to use
than the monthly average which, by its very nature, might be more
volatile, as you suggest. If you were trying to understand a specific
peak or trough, then I would agree with you, that would be better.
Q92 Mr Williams: The reality is that
it would be very simple just to produce the monthly changes with
a trend line incorporated in it, would it not? Then you would
have clear information. It could well be that we would want to
know why in one month there was a sudden leap or massive drop
in the figures, but we cannot interpret this now.
Mr Anderson: I am sorry, I did
not choose the graph which went in the Report. It may well be
that we could produce that information if the Committee would
like to see it.
Q93 Mr Williams: It is just a matter
of interest. It just puzzles me. I do not feel you have gained
anything. I actually think that statistically you have lost accuracy
and that is not good in terms of analysing events. That is all
I am trying to get at. I would ask you to look at it again. I
would ask NAO to look at it again, have a discussion and if you
think there is anything—
Mr Burr: I think the intention
was simply to show the falling trend, hence the desire to smooth
the figures. We could certainly produce the monthly more fluctuating
series.
Q94 Mr Williams: If you are saying
it is just to do that, why three-monthly, why not six-monthly,
why not twelve-monthly? The Chancellor works on twelve-monthly
trends. Why three-monthly trends? Would you both look at it and
drop us a note about it?[3]
I do not want to make a big fuss about it. It just puzzles me
that it is achieving nothing good and concealing information which
could be of value. What concerned me again was on the opposite
page to discover that there have been attempts to analyse what
has been going wrong, but there is no feedback to the doctors.
"Doctors suggested that it is at this level that feedback
needs to be improved to ensure that both they and decision-makers
are aware if they are systematically misinterpreting the guidance".
That seems to me to be logical. Coming back to Professor Aylward's
point about different quality of doctors in one part of the process
and another, it would be helpful, would it not, to practitioners
in this process, if they knew they were consistently getting things
wrong, particularly if they knew they were persistently getting
the same thing wrong? Why, having this information, do you not
make proper use of it?
Mr Anderson: I did comment at
the beginning of this conversation that I believe the area of
feedback to decision-makers from appeals and to doctors from appeals
is something which we need to continue to work on and I acknowledge
that. The processes in place do ensure that doctors are made aware
when reports are sub-standard. They are not necessarily made aware
when another doctor takes a different view and that is a different
thing. It would require a very major systems development process
to feed back to original doctors out of that decision. What we
are trying to do is put together medical representatives and decision-makers
with regional appeals chairmen to look at the trends happening
here so they can have a substantive discussion. That process is
being implemented.
Q95 Mr Williams: Professor, I may
have misunderstood something you said in answer to Mr Steinberg.
I tried to jot it down. I did not get which end of the process
was the better. You said that the doctors at one stage of the
process are better trained, if I understood it correctly, than
doctors at the other stage. Was it that the doctors doing the
initial assessment are better trained or the doctors doing the
appeal are better trained?
Professor Aylward: I would argue
that the evidence points to doctors at the first tier, the beginning
of the process, receiving better training, they receive more monitoring
and they are subject to quality assurance to a greater extent,
to a more significant extent in a structured way than are doctors
who sit on the appeals tribunals except for those who work for
the Appeals Service and also work for Medical Services.
Q96 Mr Williams: Why should this
be so? What leads to that situation? Obviously what we need, if
we are to cut out inappropriate payment and inappropriate non-payment,
both of which are of interest to this Committee, is for those
who deserve the money to have it and we want those who do not
deserve the money not to be having taxpayers' money. Why is it?
This obviously must be a persistent thing for you to make the
point. Why has it persisted?
Professor Aylward: I find difficulty
in responding to that because I think this is a matter for the
Appeals Service and not directly for me. I am working very closely
with the President of the Appeals Service to ensure that difference
is remedied, particularly in regard to the criteria which doctors
now need to meet in order to remain on the medical register in
the process of GMC revalidation.
Q97 Mr Williams: Can anyone else
answer about the inadequacy of the appeals system? Someone must
be able to. Quite an important observation is being made here.
It has implicit in it the fact that money is going to the wrong
places or not going to the right places. It is lots of public
money. If the professor has observed this, have you fed it into
the system? If so, at what level have you fed it in?
Professor Aylward: I fed it in
at the highest level. I fed it in at the highest level in the
Appeals Service. I have made my colleagues in DWP aware of it
recently. It is not something which one concludes without some
quite significant data research and evidence, so I have only recently
reached this conclusion.
Q98 Mr Williams: Mr Anderson, obviously
the buck stops with you and there is no-one else to try to pass
it to at the moment who can answer on this. I would not grin with
too much comfort at the end; we may get to you eventually anyhow.
Were you aware of this assessment? It has been put into the system
at the top and I do not for a moment dispute what you say—you
are a fellow Welshman so I would not dare. Are you aware that
this judgment has been fed into the Appeals Service?
Mr Anderson: I have not heard
that directly from the Appeals Service, though I have heard it
from Professor Aylward.
Q99 Mr Williams: That is okay. I
do not mind where you heard it from, so long as you heard it.
Now you are not just the person who is sitting there, you are
the person sitting there knowing this. Why has it happened?
Mr Anderson: This is something
we need to take up with the Appeals Service and try to discuss
with them how we can ensure that doctors who attend appeals get
a certain level of training and the same exposure as doctors who
work on the main cases. Part of the problem of course is that
doctors who work for Schlumberger see far more activity in this
area particularly employed doctors and therefore the number of
training days they can devote to it is significantly greater.
Finding a way of getting doctors who are available to turn up
and fulfil appeals, who can devote sufficient time to being trained
to the same level, is a real challenge for the Appeals Service.
2 Ev 14-15. Back
3
Ev 15-16. Back
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