Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 140 - 159)



  140. The fact that somebody else does something is never seen as a defence, so the fact that people occasionally get sent away from the Health Service elsewhere does not necessarily excuse yourselves. I wonder if you would turn to Page 37, the customer complaints section. It has always been my impression that when people have got complaints that on first examination appear worth pursuing, there is always an inclination not to bother doing so because it is utterly pointless. Have you undertaken any research to try and check how many people felt that they had a complaint that they did not bother making because they thought either it would annoy the doctor in some way who would get them next time or annoy the system or they wanted to keep their heads down generally?
  (Mr Raja) We have not undertaken any research to that effect.
  (Mr Haighton) I would add, however, that we have had some serious discussion between ourselves and SEMA about perhaps the need for a piece of research which includes trying to bottom this one because I think it is a very difficult subject to understand. As we mentioned earlier on, you from your surgeries have a perception of a higher number of complaints when we have a relatively low number. We have already had some discussion with SEMA about picking up a piece of independent research to try to tell us what the real position is.

  141. I am sure I cannot be alone in this, I have had a number of examples where people have mentioned the rudeness of doctors. That is not unique to yourselves of course. There was one particular case where there was an examination taking place on a Friday or Saturday night and the doctor's wife, who was in a car outside, phoned during the examination to tell him to hurry up. You can imagine how that made the customer feel. They had not pursued it themselves. They came to me about another issue. When I pursued it, it eventually ran into the sand because the doctor denied it, the patient asserted and we could not progress any. If there had been 20 complaints about the same sort of thing you could maybe make it stick but when there was only one you could not. It seems to me there certainly is an issue about these sorts of matters. Could I ask about Page 24, Graph 15, which is the issue of the delays. Why is it worst of all in the West of Scotland in terms of delays?
  (Ms Cleveland) You will not be surprised to know that we were looking at this quite actively. One of the points I made earlier is we have got very poor management information on this to be able to pick up these cases, so I cannot from the information immediately available to me today validate these figures.

  142. You have agreed all of this Report.
  (Ms Cleveland) We have certainly agreed this Report but this is based on 1999 data. What we are trying to concentrate on through our performance improvement work is validating the issues now. The reason you will get differences here is the priority that this work has been given within the individual area directorates within each area. I have not been able to pick out anything endemic other than the priority that has been attributed to the work in each of the organisations. One of the things that we are looking to do generally, not just across Incapacity Benefit but across all our main benefits, is get much more equalisation of performance across the area directorates. That is one of the key themes of the Agency at the moment.

  143. The final point I want to raise briefly is whether or not there is any tie-up or liaison between yourselves and Motability, particularly in relation to the length of time for which awards are made. I have recently heard of a number of awards made which would have allowed people to claim a Motability car had it been for three years. They had awards for three years, they then got an award for two years and then, of course, they had to give up the car because Motability would only give them it for three years. If there is a genuine chance of the situation getting better I do not want people to be getting benefit who should not get it but this does seem a trifle bizarre. I wonder what efforts are being made to overcome this potential area of difficulty?
  (Ms Cleveland) I have not personally had dealings with Motability but the issue about the length of an award is key and it is part of our review of the quality of the decision making that we are taking. I get advice on the quality of that decision making through various sources, through the Appeals Service and through my own Standards Committee, which is an independent group that reports to me, and as part of that it has been flagged up as an issue. We have gone back and looked at cases and we have had some of the decisions that have come to attention reviewed internally and they have come up with the same duration of awards, maybe a one or two year award. Some of it does depend on the evidence that the customer has provided, some of it is medical evidence that has come through. There is no deliberate policy of reducing awards or making awards so that people cannot get a Motability car.
  (Ms Lomax) People are very well aware of that link in the Department. Motability do maintain very close contact with the Department.

Mr Williams

  144. Back to the question of the overbooking. When you put in your initial bid had you identified this as a possible problem? Just yes or no.
  (Mr Raja) Yes, we recognised there was a problem. Overbooking is not something SEMA have just taken on board, it was there previously.

  145. So did you in your bid spell out that you would be running a system of deliberate overbooking?
  (Mr Jones) The system of overbooking was in place before.

  146. You made the bid to provide the service.
  (Mr Jones) I think the reverse is true. We did not say that we would not be overbooking.

  147. But the fact of overbooking saves you money, does it not? It must save you money. It reduces your cost per head, per case, does it not? I can understand why you are doing it.
  (Mr Jones) It avoids us spending unnecessary money, yes.

  148. What you are then doing is you are expecting the people who you calculatedly and statistically overbooked on average, and I recognise the way in which you have to work, to bear all of the inconvenience and you get all of the benefits of the system, is that not so?
  (Mr Jones) We pay them the cost of coming back and we offer them a taxi to come back again.

  149. That is very good of you.
  (Mr Jones) We do not pay them for their time.

  150. I am surprised you do not think they ought to come back again at their own cost on that assessment. What I am getting at is the inconvenience is theirs, there is an inconvenience cost, they are meeting the inconvenience cost and you are making a financial saving. It seems to me that some thought should be given as to whether or not there should be some degree of compensation, some sort of penalty, to make sure you get your arithmetic more accurate. In terms of performance, as we can now even get penalties on the trains and so on, I do not see why you should not pay a penalty when you get it wrong and disabled people turn up, often at great inconvenience, often travelling reasonable distances, and then are sent back home and they have to come again. I want to move on from that. A point that puzzles me is in your bid, I gather, you detailed plans for using other types of healthcare practitioners, nurses, occupational therapists and so on, but at the time of the briefing coming to us no progress had been made on that. I am not blaming you for this because we are told very considerably because of legislation that inhibits the extent to which you can use people other than doctors. Just to come back to the Department, did the Department when it assessed the bid from SEMA not recognise that this was a non-starter because of the legislation? I know you were not there at the time so I am not blaming you.
  (Ms Lomax) Let me address that. It is not a non-starter. The legislation on Incapacity Benefit does specify the examination must be carried out by a doctor approved by the Secretary of State but that does not rule out the use of healthcare professionals to gather evidence, for example. In DLA I think there may be scope for using healthcare professionals beyond that. It is not a non-starter. What I have to admit is that we have probably been a little bit slow to progress this particular suggestion partly, I suspect, because the Department has not been entirely of one mind as to whether this is a good idea. Dr Aylward will probably want to say something about this. There is more than one view on this. We have reached a point where we think we ought to be making some use of healthcare professionals to gather evidence, but beyond that people still have doubts.

  151. Can I just observe that it is six years on and a "bit slow" does seem to show a rather unusual capacity for under-statement.
  (Ms Lomax) It is two and a half years, it is not as bad as that. I am admitting that we are not perfect.

  152. Let us come then to the scrutiny and the medical examination. In relation to the appeals we have 23,000 successful appeals, what proportion of those are cases that have been assessed by scrutiny and what proportion are cases that have been assessed by medical examination?
  (Dr Aylward) None of them will be results of assessment by scrutiny because they are all results of examination. A decision is only made after a person has had an examination for Incapacity Benefit.

  153. So the incentive for the company to go via the scrutiny route does not in any way disadvantage the patient at the end of the day?
  (Dr Aylward) The patient is not disadvantaged at all.

  154. There are about 100,000 people a year who are taken off benefit and we are told that about 50 per cent of them succeed on appeal. Is that on first or second appeal?
  (Ms Lomax) First appeal.

  155. How many succeed on second appeal?
  (Dr Aylward) I do not think there is provision for a second appeal. In the first appeal the decision is final except on a point of law which may go to a Commissioner.
  (Ms Lomax) It is the Social Security Commissioner, which is a different thing.
  (Dr Aylward) On a point of law.

  156. Now let us go to the table that Mr Davidson referred to. It is figure 15 on page 24, the variations in time that it takes the Agency and SEMA to process. This really does contain some quite grotesque differences. As we have it on our supplementary brief black is SEMA, so let us turn to the Department first. If we look at the issuing of the form, in the case of Scotland it can be as many as 36 days from identification of a case for action to the issuing of the form to the customer and yet the best, as it happens down in Wales, is six days. How can one be six times as long as the other? One can understand differences in individual cases. What one cannot understand is consistent failure or what appears to be failure through the early stage processing, and a difference of this magnitude. How can that happen?
  (Ms Cleveland) I think it is unacceptable.

  157. You do?
  (Ms Cleveland) Yes, I agree. This is one of the areas in terms of looking at the end-to-end process. If you took the West of Scotland in terms of the length of time it takes them to issue the form and the length of time it then takes to deal with the cases at the end of the process, it is unacceptable.

  158. How long has it been unacceptable?
  (Ms Cleveland) I mentioned earlier the lack of management information that we have coming through on a regular basis that looks at all of the hand-offs in the process to get this end-to-end view. That is why we are trying at the moment to put a lot of effort into identifying a management information system so we can pick up this effort.

  159. It is 1995 since this started, is it not?
  (Ms Cleveland) Since the Incapacity Benefit came in, yes.

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