Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 60 - 79)



  60. How do you find them?
  (Dr Hudson) We advertise for them and we chase through agencies.

  61. How long do you employ them for? Do they have a certain set period they have to go on working for you?
  (Mr Raja) The full-time doctors have normal terms and conditions in line with SEMA conditions. The sub-contracted doctors which we utilise via the Nestor Healthcare Group have a contract with them and it is for an indefinite period as long as the doctor is prepared to provide the service.

  62. They could give up at any time?
  (Mr Jones) Because they fit in the work around their other work. Some of them are full time, some of them are not.

  63. Even if they have done training courses—which you pay for or they pay for?
  (Mr Raja) We pay for doctors to attend the training courses which the trainers lay down which are within a classroom environment we pay the doctors to attend those. There are other training modules which are done via distance learning that the doctors do in their own time.

  64. I have an interest in this which I should have declared at the beginning. My wife is a GP, not that she is planning to apply to work for SEMA but you should know that, technically at least. What assessment do you make of them when they apply?
  (Dr Hudson) The basic criteria, as Dr Aylward explained, are laid down in the contract in terms of the background experience of doctors. In general we would be looking for somebody with broad-based medical experience who has been qualified long enough to develop some experience in understanding the effects disabilities have on individuals and their families. Beyond that we go through a normal selection process of looking to various skills sets that the doctors would display and generally through interviewing the doctor on a face-to-face basis.

  65. That applies to the ones sub-contracted or just the ones you employ?
  (Dr Hudson) Sub-contracted doctors too.

  66. What records are kept on how many of the decisions made by those doctors are overturned on appeal?
  (Dr Hudson) We do not keep that record.

  67. Why not?
  (Dr Hudson) Doctor Aylward may want to come and support or not here, but I think that the links between the end point of the decision-making process and appeals and the role of the doctor within it are not yet well established. We certainly welcome in SEMA more close links with the appeals service so that we have more direct feedback and I believe Dr Aylward is working on that so we have the ability to understand what the outcome of appeals means in terms of both our general learning experience for the training needs to avoid the sort of problems that Mr Steinberg and Mr Campbell have described and also of the individual doctors.

  68. Ms Lomax, can I turn to you for a few questions on appeal. What proportion of the appellants who appear in person are successful and what proportion who do not appear in person are successful?
  (Ms Lomax) I cannot answer that question. Do we know the answer to that question?
  (Dr Aylward) We do know if the person presents themselves and if they are there in person they are more likely to win the appeal than not and that the decision might be overturned, but I have not got the exact figures at the moment.

  69. Do you have the figures?
  (Dr Aylward) Yes.

  70. Chairman, could we ask for those figures[8].

  (Dr Aylward) We have now been told at least, even if we do not know the exact figures, that those who appear in person are more likely to win their appeals. Do you advise them to appear in person?

  (Ms Lomax) I think we do ask them.
  (Dr Aylward) Information that is issued by the Appeals Service requests the person to appear and they advise them why it would be better for them to appear rather than the case to be decided either by a representative or on the papers only.

  71. What do you tell them about why it would be better?
  (Dr Aylward) I cannot speak for the Appeals Service. I know that they do that and again we could provide you with that information.

  72. I would be grateful if you could provide that as well[9]. What, if anything, is in the contract that you have with SEMA about the rate of successful appeals? Do you have anything in there that they will not be paid so much if the rate goes up?

  (Mr Haighton) Absolutely not. We carefully avoided anything that would indicate that the doctor should have any direct influence over whether the person receives benefit or not. The aim of the contract is that we ask doctors to give a comprehensive, evidence-based, objective assessment of the effect of a person's disability and it is not appropriate that the doctors should be incentivised one way or the other in terms of benefit.

  (Dr Aylward) Could I add something which I think will help and that is in regard to the arrangements that we are currently taking forward with the President of the Appeals Service, Judge Harris, they will ensure that those cases where the medical evidence provided by a SEMA doctor or a Nestor doctor is considered to be in some way indicative of poor performance or not meeting the point, that will be sent by the Judge to me so that I may look at them and refer them back to Carol Hudson so that she can investigate this, and then I can be provided with the findings which will be fed back to the Judge and also use those findings, if necessary, to ensure that SEMA undertakes remedial training. This process will go some way towards giving us some more data on the relationship between poor medical evidence, if it is there, and a decision on appeal. I would point out that at appeal the medical evidence does not include only the report that has been done by a Benefits Agency doctor.

  73. I understand that. I understand that about 56 per cent of those turned down for Incapacity Benefit do not appeal but of those who do appeal nearly half are successful. Do you have any information for us on how many of those who do not appeal might well have been successful if they had appealed?
  (Ms Lomax) No.

  74. Have you done any tests of that? Have you looked into doing surveys of small groups of those who do not appeal and taking their cases again?
  (Dr Aylward) I think the only way we could answer that is if SEMA undertakes a random running sample of doctors' reports but that would only tell us whether or not a doctor's report had met a particular level of quality. It would not inform us on what would have happened if that person had sought an appeal.

  75. Have you done any surveys of why people do not appeal?
  (Dr Aylward) Not to my knowledge.

  76. It looks to me, if half of those who go to appeal are successful, that the likelihood is that quite a number of those who do not appeal would be successful. Obviously I cannot tell that any more than you can without doing the work but it looks as if that may well be the case. I am sure that we would all have anecdotal evidence of people who do not appeal because they get fed up with the system or they go into hospital. There are all sorts of reasons why they might not appeal, which are quite different from the fact they are not going to win their case. It strikes me that the sort of figures we have seen indicate there is quite a large number of people who do not appeal but would win if they did, and I would have thought that was the sort of evidence the DSS would want to know because that might indicate that people were not getting benefits when they should be.
  (Ms Lomax) We are concerned to improve the quality of the decision taking first time around so that people do not have to go through the distress of having to appeal in order to get a correct decision. I think that probably would be our priority in allocating scarce resources in this area.

  77. I am all for what you say but it seems to me a pity if you do not have the resources to go into the other as well, at least on a sample basis. You have not even done a trial.
  (Ms Lomax) If I can be absolutely candid with you, the fact that so many people succeed on appeal does not make me feel that the major problem is that people are not being successful on appeal. The major problem to my mind is that we are not taking the right decisions first time around. In terms of prioritising what we ought to be concentrating on, I think that is what we should pursue.

  78. I have no difficulty with your priorities, I have a difficulty with the fact that you are not doing the other at all.
  (Ms Lomax) The way things are in the Department of Social Security priorities is the name of the game.

  79. That says a lot about the Department of Social Security, if I may say so, if that is true. Can we go on to overbooking now for a moment. I gather that you pay people travel expenses when they come for their interviews, is that correct?
  (Ms Lomax) Yes, it is.

8   Note by Witness: In the latest quarter for which figures are available oral hearings attended by the "appellant only" had 49.3 per cent found in favour of the appellant. For hearings attended by a "representative only" 56.3 per cent of the decisions were found in the appellant's favour. The percentage of appeals found in the appellant's favour where both the appellant and their representative attended was 63.6 per cent. Where neither the appellant nor their representative attended the proportion of decisions found in the appellants favour was 17.2 per cent.  Back

9   Note by Witness: Leaflet GL24 states "If you choose to go to an oral hearing you will be able to deal with any questions or issues that arise. People who go to their own hearing usually do better than those who do not." Back

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