Select Committee on Public Accounts Minutes of Evidence


  The purpose of this memorandum is to outline to the Committee the efforts SEMA have been making to address various issues examined in the Comptroller and Auditor General's report, and to provide further information on some recent developments. Much of the progress reflects work that has taken place to implement recommendations from the Social Security Select Committee Report published on 12 April 2000, and in response to new targets set by the Department in June 2000, as well as recommendations made in the Comptrollers and Auditor General's report.


  SEMA welcomed the opportunity to submit a bid for the medical services contract in 1997, and recognised this decision to move towards the outsourcing of the Benefits Agency Medical Services represented a sea change in operation for the Department for Social Security. Equally, SEMA is conscious of the fact that there has been a change in attitudes towards outsourcing in general, the need for quality assessment and control, as well as the continuing need to ensure that the Government and hence the taxpayer receives value for money; but always in the context of caring for the people claiming benefits—in this instance, some of the most vulnerable members of society.

  SEMA is satisfied with the positive aspects of the NAO Report on The Medical Assessment of Incapacity and Disability Benefits which acknowledges improvements to the speed and efficiency of the operation of medical services since outsourcing by the Department.

  This contract did pose some unique difficulties for SEMA since, as the NAO Report recognises, critical quality performance targets were not sufficiently outlined in the initial contract. In addition, there have been some important lessons for the company regarding some of the political sensitivities and issues which arise as a direct consequence of this type of outsourcing.


  One of the most important factors to consider when assessing the successful running and implementation of a contract of this nature which involves the assessment of people for benefits, is that it depends not solely on the contractor. As the NAO Report acknowledges, it depends on the inter-action between a number of different players in the process—the Benefits Agencies offices around the country, the claimants' own GPs and their consultants, as well as the claimants themselves. SEMA has always sought to work successfully with all these groups and continues to seek new ways in which communication with them can be improved.


  SEMA took the Social Services Select Committee Report of 12 April last year very seriously. The company has worked hard to meet the four revised targets which were set by the Department of Social Security last June. These targets related to the quality of medical reports, medical scrutiny of Incapacity Benefit claims, training for doctors and customer satisfaction.


  Since last year SEMA has worked closely with the Department to agree new scrutiny guidelines for doctors with respect to claims for Incapacity Benefit. SEMA and the Department carried out an audit in the summer of 2000 to identify issues causing doctors difficulty in interpreting the existing guidelines and wrote a new version of them. Doctors were trained rapidly and effectively and the new guidelines were introduced from 6 November 2000. (NAO report paragraph 14 of the Summary and paragraphs 3.8 and 3.24). There has been close co-operation between the Department and SEMA in evaluating the results of the guidelines. Compliance is high and SEMA expects to meet fully the target within the timescale set.

  Both sides recognise that further advice to doctors will be needed in the near future and also accept that further refinement may be necessary. The company will work closely with the Department to achieve a workable outcome.


  SEMA is now addressing the issue of reports which do not meet the defined standards (NAO report paragraphs 3.4 and 3.8). The new target requested that within six months SEMA had to reduce the proportion of "c grade" medical reports which fail to meet the Department's standards by 10 per cent; and within one year to reduce the proportion of "c grade" reports across all areas to less than 5 per cent. SEMA has met the first part of this target. The percentage of unsatisfactory reports has fallen from 6.49 per cent at the end of August to 5.64 per cent at the end of January.


  The Department requested that claimants' satisfaction rates had to be improved within two years to at least 90 per cent (NAO report paragraphs 4.5, 4.29 and Figure 22). SEMA has met this target.

  SEMA has produced better-targeted information for claimants outlining the processes involved in making a claim,what to expect in examinations by doctors (NAO report paragraph 4.30). In this material the company emphasises that SEMA does not make any decisions with respect to customers' benefits claims.

  The company has introduced what it believes is a more effective scheduling system—a system which particularly focuses on the time and place where claimants' examinations should occur. This is particularly effective at the local level. Up to 30 per cent of claimants do not attend their scheduled examination which inevitably has led to a level of over-booking and on occasions some claimants have been sent away unseen. The scheduling initiatives outlined above, combined with fee per case payments to doctors will give greater flexibility. The current pay increase for doctors which includes a deterrent against doctor cancellation at short notice will also help the scheduling process.

  SEMA has also made a significant investment in the development of the IT infrastructure in order to assist the scheduling process.

  As outlined at paragraph 4.30 of the C&AG's report, SEMA does recognise the need and importance of input from welfare rights groups; for example we now have an on-going dialogue with the National Association of Citizens Advice Bureaux at both a national and an area level, as well as a fledgling dialogue with the Commission for Racial Equality. The company also communicates with other interest groups which have an interest in the successful development of the medical services contract.


  SEMA has a heightened awareness of the need to monitor and assess the performance of doctors undertaking examinations and has introduced tough standards to which medical practitioners must adhere.

  Before the contract was let, there was no formal continuing medical education programme in the Benefits Agency Medical Services. The training which the Command Paper identified as being essential will have been provided to all established doctors by 30 June 2001. (NAO report paragraph 3.11). Already some 90 per cent of employed and contracted doctors have availed themselves of the key new training modules for doctors which include: Multi-cultural Awareness, Mental Health Disability—a Generic Approach to Assessment, Distress Avoidance in Examination Techniques. Doctors will be paid to attend training sessions.

  SEMA is also committed to ensuring the successful uptake by doctors of the Diploma in Disability Assessment Medicine sponsored jointly by the Faculty of Occupational Medicine of the Royal College of Physicians and the Department of Social Security.


  There is one issue of particular concern: doctor shortages (which is discussed in paragraphs 3.12 to 3.17 of the NAO report). We believe this issue to be a demographic time-bomb. Throughout SEMA has been constrained in the delivery of this contract by national trends in the medical profession. We refer here specifically to the diminishing pool of doctors not only available, but who are prepared to undertake this type of medical assessment work. It was with this in mind that from the outset in its initial bid SEMA set out ways in which other healthcare professionals could be used to help address this issue. In addition to solving workload and number problems for those doctors available it may help to address the gender issues. SEMA has initiated a pilot project in Manchester designed to investigate the way in which healthcare professionals could support the assessment of claimants.

  SEMA has announced a general fee increase of 15 per cent for the doctors working within their contract. Local managers are looking to adopt flexible working patterns to ensure that the maximum number of doctors sign up working for SEMA.


  SEMA has endeavoured to be innovative and responsive from the outset in this groundbreaking departure for the Department. With the publication of this NAO report we remain so and welcome both its praise and its commentary. SEMA is a company dedicated to service and best practice.

SEMA Medical Group

13 March 2001

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