Select Committee on Work and Pensions Minutes of Evidence


Memorandum submitted by SchlumbergerSema (MS 03)

1.  EXECUTIVE SUMMARY

  This memorandum is intended to give an update to the original memorandum provided to the Social Security Select Committee in 2000. It provides an overview of all the initiatives instituted to-date and confirms the status of those initiatives. Much of the work undertaken during the past two years has been as a direct result of recommendations made by the Social Security Select Committee in its report of 2000. In addition, we have taken account of the Government's response to the Social Security Select Committee Report published in June 2000 and also the recommendations within the National Audit Office report "The Medical Assessment of Incapacity and Disability Benefits" published early in 2001.

  There are a number of highlights that we would particularly wish to draw to the Committee's attention.

  Most significantly, Sema Group, of which Medical Services was a part, was acquired by Schlumberger Limited in April 2001. The change in ownership has resulted in key senior management changes in SchlumbergerSema and Medical Services, together with a renewed and strengthened commitment to the medical services provided to the DWP. This is evidenced through a number of important recent developments that have considerably built upon and enhanced the improvements that were already starting to be made under the Sema Group ownership.

  Firstly, there has been a sustained, continuous and in some cases dramatic rise in Medical Services' performance during the past 12 months. The quantity of medical examinations being carried-out by Medical Services has increased by 17 per cent over the previous 12 months and a further 10 per cent rise is planned and agreed with the DWP for the next 12 months. Whilst achieving this increase in output, new and more rigorous targets in terms of quality and customer satisfaction which were implemented by the DWP following the original Select Committee Report have been and are being consistently achieved. By March of 2002 we were meeting 43 of 45 key performance indicators laid down by the DWP. The two which were being narrowly missed related to output and both will be achieved from April 2002 onwards.

  Secondly, there has been a significant restructuring of the operational and contractual management relationship between the DWP and Medical Services which has been particularly linked in the past six months to the emergence of JobCentre Plus. This has resulted in a far greater degree of joint planning and co-operation than before and a much clearer understanding of the DWP's requirements and the needs of the overall end-to-end Benefits Process. This has been entirely beneficial and has contributed in no small way to the overall improvement in operational day-to-day delivery.

  The greatest evidence of this new partnership is the existence of the Medical Services Change Programme which formally kicked-off in November 2001. This is a joint programme with six key projects which have already started to deliver further improvements to the overall service delivery and will especially deliver additional improvements in the areas of quality, customer satisfaction and medical resources during the next 12 to 24 months. Whilst this is entirely a joint programme in its design, management and delivery, it should be noted that the vast majority of the multi-million pound investment required to finance the programme is coming directly from SchlumbergerSema.

  Thirdly, SchlumbergerSema has particularly recognised the need to continue to improve the recruitment, retention and development of its critical medical resources in order to deliver increased volumes of medical advice and examinations with improved quality. We have embarked upon an intensive recruitment campaign with the aim of bringing in an additional 100 full-time employed doctors—a campaign which in its first six months has delivered 48 acceptances with 28 new doctors having commenced work by 1 April 2002. In the meantime, we have continued with a progressive programme of training and development of our existing medical workforce that includes an active sponsorship of employed doctors to study for and obtain the DDAM underpinned by a financial reward to those who are successful. Additionally, we have introduced a series of measures to improve the overall remuneration of both our employed and contract doctors (supplied via Nestor Healthcare Group plc) which has resulted in a near 50 per cent reduction in doctor turnover during the last year and significant increases in earnings potential.

  Lastly, whilst we have made real, measurable and demonstrable progress since the original Social Security Select Committee Report in March 2000, we are by no means complacent.

  It is not just through the existing Change Programme that we are demonstrating our commitment to continuous improvement to the medical services delivered to the DWP. We have also signed-up to even more stringent targets on quality of medical reports for all benefit strands, on the ongoing quality and capability of our medical workforce and new customer satisfaction measures which we will be striving to achieve during the next 12 months. Additionally, we have signalled a clear commitment and intent to pro-actively support the DWP with its Welfare to Work challenge and review of Incapacity Benefit and the programme of modernisation for Disability Living Allowance and Attendance Allowance.

2.  WORK OF THE MEDICAL SERVICES' DOCTORS

2.1  Services Provided

  SchlumbergerSema Medical Services provides a national medical advice and examination service as defined in a Contract Specification laid down by the DWP. Medical Services play no part in the decision making process that is the remit of the Department's own Decision Makers.

  Approximately 826,000 examinations are conducted annually at over 150 examination centres or in people's homes throughout England, Scotland and Wales for the following Benefits:

    —  Incapacity Benefit;

    —  Industrial Injuries Scheme Benefit;

    —  Disability Living Allowance;

    —  Attendance Allowance;

    —  Severe Disablement Allowance;

    —  War Pensions.

2.2  Subcontractors

  Medical Services select subcontractors on the basis of their ability to meet specified quantitative and qualitative requirements.

  Nestor Healthcare Group plc is the primary subcontractor. They have a contractual obligation to supply medical staff who meet the requisite competency levels demanded to undertake examinations carried out in Medical Services Examination Centres and also in people's homes.

  In addition, where the services of a specialist practitioner are required by Medical Services, another subcontractor, Definitech Ltd, arranges for claimants to be examined by a specialist in the appropriate field of medicine and reports are supplied which meet the necessary quality requirements of both the relevant Government Department and Medical Services.

3.  DOCTORS' PAY

3.1  Employed Doctors Salary Profile

  Employed doctors' salaries are regularly reviewed. Recently and in line with market forces the minimum salary for a medical adviser has been increased to £46,000. Doctors also have the opportunity to increase their earnings by carrying out additional examinations whilst maintaining proper quality standards.

  We have recently introduced a review in pay for employed doctors, the fourth review since March 2000. In addition to raising the minimum salary, the review offers bonuses equivalent to £4,000 and £6,000 pa linked to examination productivity. Quality and customer service standards are an integral part of the system which also offers additional rewards for other doctors who are engaged in quality improvement activities, mentoring, auditing and training delivery. A further element of our new approach provides an enhancement to consolidated pay, by £2,000, for those doctors who have acquired the DDAM.

  A further pay review will be implemented in May, backdated to 1 April. The salary review is linked to the results of annual appraisal and starts with a minimum level of increase of 3 per cent.

3.2  Contract Doctors Remuneration

  Medical Services has now moved away from paying those sessional doctors who carry out examinations in Medical Services Centres on an hourly basis and now pay them for each examination and report. Approximately 96 per cent of doctors have opted to be paid on this basis and it is anticipated that this will rise to 100 per cent in the near future. The doctors are no longer constrained by an artificial "session" of 3.5 hours and are therefore able to continue to spend the optimum amount of time with each person being examined. Quality measures are an integral part of the system. To support this initiative, systems have been introduced which identify any doctor who suddenly alters their working pattern to show a significant increase in the number of examinations they carry out. The reasons for that change are then investigated to ensure that standards have not been compromised.

  There have been two pay increases for doctors which averaged 3 per cent in September 2000 and 15 per cent in April 2001.

  Set rate payments are made by examination type for each report completed. The amount payable per case will be dependent on the benefit type involved. This is significantly different to the hourly rate scheme, which usually compensates doctors for the amount of time worked, irrespective of the number of claimants seen. The doctors, for their part, commit themselves to a specific working pattern which make the scheduling of examinations much more effective. This payment system provides the opportunity for:

    —  A significant increase in payments for those who want it.

    —  Better use of medical time.

    —  Recognition for those doctors who are able to stay longer to make sure that everyone who attends for examination is seen.

    —  Smoother running of sessions with reduced waiting time.

    —  Flexibility in working times for the doctors, suiting those who have domestic or other commitments.

  An analysis of the payroll figures for the contracted doctors reveals the following:

    —  The figures for June 2001 show an average of a 25 per cent increase in pay (the highest percentage is well over 100 per cent).

    —  The figures for Feb 2002 show an average of 35.7 per cent increase in pay (the highest percentage is well over 150 per cent).

  This is due to the combined effect of the recent increases to levels of pay, the introduction of Fee Per Case and the increase in the average amount of work done by the average contracted doctor.

  An analysis of the turnover of contracted doctors since January 2000 to January 2002 is shown in the table below. This clearly demonstrates the turnaround that has been achieved in the past year in the retention of doctors and the recruitment of new doctors.
Period

Joiners

Leavers

Net

Jan 00 to Mar 01 (15 months)

246

665

419 leavers

Jun 00 to Mar 01 (10 months)

183

498

315 leavers

Apr 01 to Jan 02 (10 months)

278

245

33 joiners

4.  RECRUITMENT AND RETENTION

4.1  Recruitment

  As at 1 April 2002, Medical Services employs directly 194 doctors. This figure is increasing on a weekly basis as a result of our on-going, successful recruitment campaign. In addition, there are 2,160 doctors undertaking medical examinations who are subcontracted via Nestor Healthcare Group plc (Nestor). These doctors work on a part-time basis, at times agreed with Medical Services.

  Medical Services recognises the value of employing doctors in not only carrying out examinations and giving advice but also conducting the audit, training, mentoring and feedback which contributes to the delivery of a high quality service. We therefore intend to increase the number of employed doctors to over 250 during 2002. In spite of a national shortage of doctors, we are running a successful recruitment campaign to attract them. Already 48 new doctors have accepted an appointment within Medical Services whilst a further 10 offers are under active consideration. A total of 28 doctors have already started work. A number of these doctors are currently under training. The recruitment campaign includes:

    —  An extensive national advertising campaign in the medical press.

    —  Medical Services recruitment events held locally to introduce the service to interested medical personnel.

    —  A bonus to attract new doctors to particular areas where doctor recruitment generally is more difficult.

  The recruitment criteria are defined in the contract between Medical Services and the DWP (See Appendix A). Additionally, Medical Services has strengthened its interviewing of potential recruits testing not only their medical knowledge, but also their interpersonal skills.

4.2  Planning

  To assist in the recruitment campaign, Medical Services has developed a new Resourcing Model that demonstrates at a local level any gaps that exist between actual and forecast doctor requirements.

  The overall gap is 30 full-time equivalents in March 2002. Based on our current planning this will reduce to seven in December 2002. However even when this shortfall is taken into account, experience has shown that the contractual requirements can be securely delivered by strategic use of the flexibility that is inherent in a pool of over 2,000 doctors.

4.3  Retention

  It is recognised that, key to a stable professional workforce, is the satisfaction that comes from the role being carried out. However, the skills of the disability analyst are unique, encompassing not only clinical acumen, but also critical evaluation of evidence from many sources and the ability to demonstrate empathy in sensitive situations. In order to promote the role as a career option which is recognised by the external medical profession, Medical Services has embarked on a series of initiatives. Some of these initiatives are being taken forward in the Change Programme, the overview of which is at Section 9.

  The Viable Doctor Pool Project, as part of this Programme, will promote additional experience in, for example, audit, training and management. It will also ensure that doctors are capable of fulfilling the General Medical Council's requirements for revalidation as Disability Analysts. As part of the project, we will continue to offer doctors sufficient educational support to achieve the DDAM, which professional qualification we enthusiastically endorse.

  In the Evidence Based Medicine Project, we will pilot and then roll out the structured use of computer assisted report writing backed by researched medical protocols, which will enable each doctor to produce a more consistent, totally legible and medically sound report for Incapacity Benefit.

  Underpinning all of the initiatives is the commitment to an ever-improving training programme. Our intensive induction course has already been well received by newly recruited doctors and we intend to further exploit more imaginative ways of delivering training with the increasing use of computers.

  As Medical Services moves even further into the field of Occupational Medicine, doctors will be able to develop a broader portfolio of knowledge and skills. This will not only offer the doctors personal satisfaction but, we believe, will also bring benefits to the DWP through the broadened and deeper understanding of what is really meant by fitness for work.

5.  TRAINING

5.1  Induction Training

  An extended induction course has now been introduced for all new employed entrants to Medical Services. This course lasts a total of eight days, covering the following main subject areas:

    —  An introduction to the company and an explanation of the chief features of the DWP contract.

    —  An exploration of the role of the disability analyst, highlighting those areas in which the role differs from that of the clinician.

    —  Guidance on the conduct of examinations carried out for the purposes of disability analysis, focusing on the claimant interview, observed behaviour, and the physical (particularly musculo-skeletal) and mental state examinations.

    —  Guidance on the critical evaluation of evidence and on effective report writing.

    —  Modules on multi-cultural awareness and dealing with potentially aggressive situations.

    —  A full Incapacity Benefit course.

5.2  Initial Benefit Specific Training

  Medical Services have developed in conjunction with the DWP an Approval process for doctors. All doctors must obtain Approval from the Chief Medical Adviser in order to undertake work on behalf of the company. Part of the Approval process is the initial training.

  All doctors who join Medical Services are provided with an initial theoretical training course, covering such areas as customer service and the principles of disability analysis, as well as providing detailed technical information relevant to the benefit concerned. This training course culminates with a multiple-choice examination, which must be taken and passed by the doctor before they move on to the next stage of practical training. The initial work undertaken by new recruits is produced in a controlled environment. For examination centre based assessments, the trainee is supervised and appraised by an experienced Medical Adviser as they complete their introductory cases, with the following cases subjected to 100 per cent audit. In the domiciliary visit based benefits, initial cases are 100 per cent audited immediately on return to allow feedback to be given without delay. This high level of supervision is not relaxed until it becomes apparent that the doctor demonstrates that he/she can produce work of an acceptable level.

  Separate approval is required for each benefit area in which the doctor works and is dependent upon the successful completion of all stages of the training programme, together with an ongoing demonstration that the work performed reaches the required standard.

  During 2001, revised and updated initial classroom training was introduced for EMPs (doctors who undertake Home Visits) carrying out examinations for Disability Living Allowance/Attendance Allowance, and for doctors working in the area of Industrial Injuries Scheme Benefits. Medical Services is currently collaborating with the Corporate Medical Group in the development of a revised course for Respiratory Disease assessments.

5.3  On-Going Training

  In response to the Government's Command Paper, Medical Services developed three specific trainer-led courses, which were delivered to all doctors carrying out benefit related assessments, and which will continue to be delivered to all new recruits in this field within 12 months of their initial approval. These courses cover the following subjects:

    —  Distress-avoiding techniques for the examination of people with musculo-skeletal conditions (clinical skills training).

    —  Behaviours, attitudes and sensitivities for dealing with people with disabilities (multi-cultural awareness training, developed in association with the Equality Foundation).

    —  The assessment of people with mental health problems.

  In addition to the above-mentioned generic course covering the assessment of claimants who have a mental health condition, further specific training has been delivered on "The conduct and reporting of the Mental Health Assessment in IB-PCA". This has taken the form of a trainer-led course and a Professional Standard Guidance document.

  An annual Training Needs Analysis is carried out in conjunction with the Department's Chief Medical Adviser (CMA). Reference is made to information gleaned from audit and recorded on the Medical Skills Database (MSD), comments received from claimants and Welfare Rights Groups, and the views of the Decision Makers and of the doctors who carry out the assessments. The Training Needs Analysis provides the basis of each year's programme of Continuing Medical Education (CME), which is developed by Medical Services and delivered accordingly.

    —  The 2000/2001 CME programme consisted of modules on:

    —  Assessing mobility.*

    —  Changes to the mobility component of DLA in children.

    —  Assessing mobility in younger children.

    —  Assessment of illness behaviour.*

    —  The conduct and reporting of the Mental Health Assessment in IB/PCA.*

    —  Exemption advice at the examination stage in IB-PCA.

    —  Regional musculo-skeletal examination techniques.*

    —  Dealing with potentially aggressive situations.*

    —  Dealing with potentially violent people.

    —  Providing advice to the decision maker at the accident consideration stage.

    —  Critical evaluation of evidence.

    —  Update on occupational asthma.

    —  Assessment of claimants with drug or alcohol problems.

    —  Fibromyalgia—guidelines for the disability analyst.

    —  Professional standards—The conduct and reporting of the mental health assessment in IB/PCA.

  NB. Modules marked (*) were delivered as trainer-led courses. Approximately 900 courses were run during 2001. Other modules were distance learning.

  The 2001-2002 CME programme that is already underway includes:

    —  Rehabilitation (Distance learning + trainer-led course).

    —  Caring for clients, helping doctors (Distance learning + trainer-led course).

    —  Guidance for doctors providing reports for the War Pensions Agency.

    —  Sensory problems including visual and hearing problems (trainer-led course).

    —  Statement taking, recording and gathering information.

    —  Computer Based Training on the Evidence Based Medicine musculo-skeletal protocols.

  All Medical Services' training material is reviewed and agreed by the Chief Medical Adviser prior to implementation. The Continuing Medical Education programme is subjected to ongoing detailed evaluation, with an annual report produced for the Chief Medical Adviser.

  Input from specialist groups such as NACAB, The Equality Foundation, RNID and RNIB is actively sought as appropriate during the development of training material, as is medical input from specialists in particular fields (eg for rehabilitation).

  We would be more than happy to welcome members of the Committee to participate in any appropriate doctor training sessions if that was felt to be beneficial to the Committee members in furthering their understanding of the style and content of our approach to this important subject.

5.4  Remedial training

Remedial training is provided to individual doctors when specific areas for improvement are identified either under the Approval process or via the various types of auditing that take place. The Medical Skills Database is now operational and together with other management information assists managers with the identification of either individual training needs or trends that develop over a period of time.

  Remedial training is implemented through local medical managers, usually on a one-to-one basis and by a variety of methods. It may, for example, comprise a doctor being accompanied by an experienced mentor when carrying out medical examinations and receiving feed back. Or, the doctor may be expected to attend afresh a specific training course or work through a distance learning training document.

  In all cases, the doctor will be required to demonstrate their improved understanding before the remedial training is deemed to be successful.

6.  PROFESSIONAL AND QUALITY STANDARDS

6.1  Professional Standards

  Medical Services have a contractual obligation that all doctors carrying out work for the DWP will adhere to a series of professional standards specified by the Department. Compliance with Equal Opportunities Legislation is required.

  The subject of professional standards is discussed during initial training and the standards are listed in full in the guidance notes given to each doctor.

  Part of the auditing/monitoring processes focuses on professional standards and reports are judged against these in addition to other attributes required to produce a report that meets the appropriate professional standards.

6.1.1  Diploma in Disability Assessment Medicine (DDAM)

  The DDAM is sponsored by the Faculty of Occupational Medicine of the Royal College of Physicians together with the DWP and SchlumbergerSema Medical Services, and is an external recognition of the professional standards expected of doctors providing services to the DWP.

  To date 35 SchlumbergerSema doctors have achieved the Diploma whilst working for Medical Services. A further 26 SchlumbergerSema doctors are planning to take the examination this year, in addition to a number of NDA doctors.

  The diploma is regarded as a standard of excellence and is recognised externally.

  SchlumbergerSema have demonstrated their commitment to the DDAM by recognising, by an increment to their salary of £2,000, the achievement of those employed doctors who are awarded the diploma.

6.2  Quality Standards

  Medical Services has two inter-supporting systems that assist in assessing, recording and managing medical quality.

6.2.1  Quality Systems

6.2.1.1  Integrated Quality Assurance System

  The IQAS is based upon:

    —  A standard process that allows suitably trained and experienced doctors to audit completed work against defined standards of professional practice.

    —  Systematic feedback of results and trends linked to the need for ongoing training and guidance.

    —  A mentoring system with each doctor having a nominated experienced professional colleague responsible for continuity of advice and development.

  The Quality Audit System is based on an evaluation of all reports and identifies the professional standards under four main headings:

  Presentation and process

    —  legibility, completeness, and clarity (assessed by a non-medical person).

  Medical Examination

    —  the medical examination, including history and statement-taking, formal clinical examination and the recording of clinical findings.

  Medical reasoning

    —  the step-by-step medical reasoning and deduction which ensues after the consideration of medical evidence;

    —  performance of a medical examination and the decision making or advice which follows.

  Professional Issues

    —  the general principles of medical good practice which underpin all Medical Services work.

6.2.2  The Medical Skills Database system

  The system records a variety of information, including:

  Personal Data:

    —  GMC Registration number which will be the unique identifier for each doctor.

    —  Surname.

    —  First Name and initials.

    —  Date of Birth.

    —  Retirement Date.

    —  Employment Status (ie Currently Employed, Not-Employed, Transferred).

    —  Whether NDA, FTMA or Other Doctor Type.

  Doctor Qualifications.

  Doctor Experience.

  Doctor Employment.

  Doctor Benefit Training Details.

  The Benefit Training record will include:

    —  approval Status (not approved, awaiting approval, approved, Approval removed);

    —  date Approved;

    —  date Refresher training completed.

  We intend to maintain improvement of the quality of reports.

6.2.3  Achievement of Government Targets

  Particular attention has been paid to the recommendations of the Social Security Select Committee (Session 1999-2000), the Government's response to that report and the National Audit Office Report 2001. Targets relating to medical quality were accepted by Medical Services. These targets were:

    —  Within six months 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 benefits to less than 5 per cent;

    —  Within one year to demonstrate improvement in compliance with the agreed medical scrutiny guidelines for Incapacity Benefit claims so that the proportion of non-compliant reports is less than 5 per cent;

    —  Within one year to deliver training to all doctors covering: the assessment of people with mental health problems; behaviours, attitudes and sensitivities for dealing with people with disabilities; and distress avoiding techniques for the examination of people with musculo-skeletal conditions;

    —  Within two years to improve customer satisfaction rates to at least 90 per cent.

  ALL of these targets have been and are being consistently achieved. For example:

6.2.3.1  Percentage of "C" grade reports


6.2.3.2  Scrutiny to Exam ratios

  Scrutiny to Exam ratios have settled between 50 and 55 per cent following the introduction of the New Scrutiny Guidelines which were issued in November 2000 and which initially led to an increase in the ratio from around 35 per cent to 65 per cent. We are continually exceeding the target of 95 per cent compliance with these new guidelines.

6.3  Rework

  The Rework volumes have remained well below the 1 per cent target throughout the last 12 months.


6.4  Appeal Service feedback

  A process has been implemented to facilitate the flow of information between the Appeals Service, Corporate Medical Group, IMPACT and Medical Services. This process allows appropriate feedback where the Appeals Service has identified any report supplied by Medical Services that falls below professional standards.

6.5  Revocation of Approval

  Experience has shown that, on occasion, doctors do not meet the requirements of the work of a disability analyst. Under those circumstances, the Chief Medical Adviser will revoke the doctor's Approval to prepare reports for the DWP. To date there have been 22 instances where a doctor's Approval has been revoked. These included 13 who had their approval revoked due to performance/conduct issues.

  There is one more revocation that is currently in the pipeline.

7.  OPERATIONAL PERFORMANCE

  Medical Services has now recovered from a dip in performance against service levels that came about in late 2000. The reasons for the initial drop in performance are understood by both the DWP and Medical Services as follows:

    —  Doctors leaving when work volumes were low;

    —  An intensive programme of essential training in 2000 which kept doctors away from the workplace;

    —  The very significant increase in the numbers of claimants being examined following reworking of the scrutiny guidelines—the ratio climbed almost overnight from 35 per cent to 65 per cent.

  A recovery programme has been successfully implemented and has resulted in a 17 per cent increase in the number of examinations performed in 2001 compared to 2000, with a further 10 per cent increase expected in 2002.

  Present operational performance is illustrated below:

7.1  IB Examination Performance

  Service performance is measured contractually by service level targets set by the DWP. These mainly measure turnaround times.

  Medical Services managers and employees have achieved significant improvements over service levels since the time of the last Social Security Select Committee report.

  Below is a table that shows examination performance over the last 12 months. The target is 95 per cent of IB examinations turned-around within 50 days.

7.2  IB Volumes

  IB Volumes have continued to rise as medical capacity has increased.

7.3  Examination performance

  Daily examinations performance has steadily increased to accommodate the rising volumes received and assist in reducing backlogs.


8.  STANDARDS OF SERVICE TO CLAIMANTS

  The contract provides for a wide range of service standards a number of which are referenced in our Customer Surveys.

  Improvements were sought in several areas and work has been undertaken to make these improvements.

8.1  Waiting Times

  There has been a steady rise in the percentage of claimants seen within 10 minutes of their arrival.

  The Medical Services target for seeing claimants within 10 minutes is 77.15 per cent


8.2  Unseen Claimants

  Reductions have been achieved in this area as can be seen from the graph below.

  The Medical Services target is to reduce Unseen Claimants to below 3 per cent. We are on target to achieve this in March.


8.3  Time spent with Claimants

The figure reported at the Social Security Select Committee for IB examinations was 46 minutes. At the time this was the figure which approximated most closely to the time spent with claimants. It was derived by dividing the standard session time by the average numbers of claimants seen.

  Since then, as a result of fee per case and the recommendations of the Social Security Select Committee, we have moved to a recording system, which more approximates to the time spent with claimants. Fee per case and the flexibility it has brought to scheduling has meant that the concept of the 3.5-hour session has disappeared (salaried doctors work longer than a 7 hour day). The best measure of time spent with claimants has to exclude the downtime between cases and that wasted at the end of the 3.5 hour sessions when there was insufficient time for doctors to see an extra case.

  Information about time spent is recorded on the front of the IB85 (the examination report form). The figure that is recorded on the IB85 excludes all dead time and shows an average of 37 minutes over the past 6 months. The time spent by the doctor pre-reading the file, introducing himself or herself to the claimant and collecting the claimant from the waiting room is also excluded from this figure and therefore, at least a further 5-10 minutes should be added to obtain the most reliable comparator.

  Time spent completing IB85s is closely monitored and is one of the factors used to trigger further investigation to ensure that customer service is not being compromised.

8.4  Special Needs Provision

  A new leaflet—AL1 C has been developed and updated in line with "The Better Letters" initiative which provides more targeted information for the claimant.

  The new leaflet allows claimants the opportunity to contact Medical Services prior to their examination to advise that an interpreter will be required, or that they can provide their own via friends and family. The target of 95 per cent of requests to be met has been achieved.

  The AL 1C also provides the claimant with the opportunity to request a doctor of the same sex. The target of 95 per cent of requests has been achieved. Where possible, Medical Services endeavour to do this in all cases.

8.5  EMP Home Visits

  A new leaflet has been developed which mirrors the information contained on the AL1C. It is sent out on receipt of the case within Medical Services to provide information prior to the home visit and examination. The leaflet was introduced from 2 April 2002.

8.6  Complaints Leaflet

  Provides information about how to make a complaint. The new leaflet has been developed and issued giving greater detail on how to make comments, complaints and suggestions about Medical Services performance. It is in a more user-friendly format and has a tear-off page at the back for use by the claimant.

8.7  Cultural Sensitivity

  There is now a training module on Multi-Cultural Awareness, which has been delivered to all Medical Services doctors.

  A new Multi-Lingual notice is being developed for 12 specified languages, which allows the claimant to contact Medical Services requesting an interpreter.

  Medical Services introduced a new national complaint management system from 1 June 2001, which captures all customer complaint issues, under designated issue codes. The code relating to cultural insensitivity shows a very small number of issues relating to this category nationally—reducing each quarter from 10 (June to Aug 2001), 7 (Sept to Nov 2001) to 5 during the most recent quarter (Dec 2001 to Feb 2002). We investigate all complaint issues and this has resulted in management action being taken in respect of the examining doctor where appropriate.

8.8  Claimant Satisfaction

  Medical Services survey over 30,000 claimants every year, with a 50 per cent return rate, for all types of benefit examinations.

  Our findings, provided to the DWP, show well over 90 per cent satisfaction levels—we have consistently exceeded the 90 per cent customer satisfaction criteria set by the DWP. At no time has Customer satisfaction score dropped below 96 per cent since March 2001.

  We have also reviewed our survey methodology with National Opinion Polls.

  Medical Services are working with the DWP currently to explore additional ways of further improving the surveys and the robustness of sampling methods.

  We analyse and use the valuable information from these surveys to improve our service nationally and locally.



8.9  Complaints in Medical Services

  Medical Services welcomes feedback including complaints, which contain vital information to improve our service and we investigate all complaints received.

  The definition of a complaint is an expression of dissatisfaction about services provided by Medical Services, that originates from a claimant. In our communications to claimants it is clearly explained that dissatisfaction with the outcome of a claim as a result of the decision of the DWP Decision Maker is a matter between the claimant and the DWP. Claimants have a right to request reconsideration of the decision or to submit an appeal and are advised to contact the DWP office dealing with their claim. We therefore make the distinction between an appeal and a complaint about our service.

  We have extensively revised our complaint procedure and provided improved guidance and training to all Customer Relations Managers about roles and responsibilities. The new procedure includes:

    —  Greater accessibility through the introduction of a new complaint leaflet and advice to customers with all appointment letters. We have also explained the new procedure to many interest groups such as at the National Conference of NACAB held in York in September 2001.

    —  A new national complaint management system, which enables analysis of all complaints and ensures appropriate action is taken following each complaint investigation—whether this relates to the doctor or our administrative service.

    —  A clear escalation route in the event that a complainant is unhappy with the way his/her complaint has been handled including referral to an independent tier.

    —  Contractually agreed contract standards and targets relating to response times and the standard of responses to claimants.

  The main categories of all complaint issues for quarter ending February 2002 are shown in the following chart:


  For the most recent quarter ending February 2002 new complaints have fallen to 1,029. Overall the number of new complaints about our service is now less than 0.5 per cent of all examinations completed. Of these new complaints, issues relating to doctor manner has declined from 35 per cent for the quarter ending August 2001 to 30 per cent of all issues during for the quarter ending February 2002. The training programmes for all doctors and the quality monitoring system are key contributing factors.

  We are achieving all contractual complaint targets relating to response times and quality, set by the DWP during 2001. However, we are never complacent and use complaint feedback to continually improve service on a national, local and individual basis.

9.  CHANGE PROGRAMME

  Medical Services and The Department for Work and Pensions have worked together in order to put this programme together. It is aimed at delivering service improvements that will enhance the running of the Medical Services business and the interface between Medical Services and DWP. The detail of the individual projects is set out below.

9.1  Evidence Based Medicine (EBM)

  This project's objectives are to:

    —  develop protocols based on medical best practice;

    —  develop an IT system which enables doctors to use these protocols in a systematic way.

  Successful completion of this project will generate high quality, legible reports and will provide a more sustainable working environment for examining doctors. It will also give better information to Decision Makers which should enable them to make better informed benefit decisions. Initially this project covers musculo-skeletal, mental health, cardiovascular and respiratory illnesses. The IT system and medical protocols will be rolled out to all Incapacity Benefit (IB) medical examiners from the summer of 2002 onwards. Not only is this massive logistical undertaking in its own right but there is a high level of doctor training required and so it will take until early 2004 to fully complete the implementation plan.

9.2  DNA-Did Not Attend

  The objective of this project is to reduce the number of missed appointments. It is doing this by using best practice in scheduling appointments which essentially means tele-programming. This project will should improve customer service and reduce expenditure, whilst creating more effective and efficient internal procedures for MS and DWP.

  The project has already considerably reduced DNAs and is now installed in Stoke, Derby, Bootle, Acton and Euston with full roll-out scheduled to be achieved by the end of June 2002.

9.3  Evidence Gathering

  The objective of this project is to provide better initial medical evidence to medical assessors. It will do this by setting-up a new system with GP practices to receive up to five years of patient information before examination. This information will enable decision makers to disallow invalid claims with confidence whilst also ensuring the best use is made of doctor capacity and improving customer service for the most seriously ill. GPs responses have been mixed but so far 76 practices with around 248 GPs have agreed to participate in the pilot which is running in the Sheffield and Rotherham areas.

9.4  Viable Doctor Pool Project

  This project was set up to:

    —  recruit 100 employed doctors by June 2002;

    —  improve retention of the existing workforce;

    —  integrate employed and sub-contract doctor recruitment activity;

    —  put a career structure in to disability assessment medicine;

    —  equip Medical Services for GMC revalidation; and

    —  ensure the size of the future doctor pool is appropriate to the size of the business, through better joint resource forecasting and planning.

  To-date 73 doctors have been offered employment with Medical Services, 48 have accepted our offer, a further 10 are actively considering and 28 have actually started working with us.

9.5  Governance, MIS and Project Management Enhancement (PME)

  These projects were initiated in order to:

    —  give targeted and better information to customers within DWP,

    —  ensure a more focused strategic and operational relationship between DWP and Medical Services,

    —  excel at project delivery, project management expertise, and

    —  implement project management best practice.

  Governance changes were made in December 2001, formats and content of KPI reports were agreed with IMPACT and the first sample reports were sent in January.

  Project management standards for initiation and closure have been developed and agreed. All project managers have consolidated their understanding of project management standards and will be applying them consistently in the future. Competency-based assessments have been carried out with all project managers and action plans agreed.

Simon Chipperfield

Managing Director

5 April 2002

APPENDIX A

RECRUITMENT CRITERIA

  The CONTRACTOR shall ensure that its Medical Personnel, whether employed or fee-paid, are registered with the General Medical Council. In addition, they must have either at least three (3) years post-registration experience, including one (1) year in general practice and at least six (6) months experience of psychiatry, rheumatology, rehabilitation medicine or occupational medicine; or at least five (5) years post-registration experience as a principle (or equivalent) in general practice. The CONTRACTOR shall ensure its Medical Personnel have broadly based medical experience unless specialist knowledge and experience are required as detailed in this Schedule 4.

  The CONTRACTOR shall ensure that Medical Personnel providing the Respiratory Disease Service shall be appropriately trained and assessed as being fit to provide the Services to the standards laid out in Schedule 4 Section 4.1 of the Agreement.

  When providing Specialist Medical Services the CONTRACTOR shall use only a Medical Specialist as defined in Schedule 1 who shall have training, qualifications and experience pertinent to the condition under consideration.

  The CONTRACTOR shall ensure that all radiographers and audiometric technicians have contemporary and relevant specialist qualifications.

  The CONTRACTOR shall ensure that all Paramedical Personnel providing or supporting the provision of Services have appropriate qualifications, experience and training.


 
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