Select Committee on Work and Pensions Minutes of Evidence


Examination of Witnesses (Questions 60-79)

MR MARK FISHER, DR MANSEL AYLWARD, MR PAUL KEEN, MR JOHN SUMNER, MR SIMON CHIPPERFIELD AND DR CAROL HUDSON

WEDNESDAY 17 APRIL 2002

  60. Just some further questions on this. Could you tell the Committee the outcome of the working party set up in 2000 to investigate the effectiveness of the process by which examining medical practitioners are given information and access to other medical evidence regarding a claimant's disabilities, following the Committee's recommendation on this issue?
  (Dr Aylward) I am not clear about that.

  61. Is this perhaps something you could have a think about and pass on information to the Committee.
  (Dr Aylward) Yes, indeed[8].

  62. It is a bit of a hot potato, I must say. Could you tell us also about the pilot run to identify claimants' satisfaction with the medical reports written about them by Medical Services' doctors?
  (Dr Hudson) I am sorry, could you repeat the question?

  63. Yes. Could you tell us more about the pilot which has been run to identify claimants' satisfaction with medical reports written about them by Medical Services' doctors?
  (Dr Aylward) I think this relates to a survey which was undertaken of people who had been examined, and a copy of their report had been provided to them so that they could comment upon and respond to the customer survey questionnaire in the light of the report they had received. Because there was a perception that perhaps the way in which a person would respond to a customer survey would depend upon the way they see the report. This was done and although the numbers were small, nonetheless we did not feel that there was any difference between the type of information that was being received from the customer and whether or not they had received the report.

  64. Yes.
  (Dr Aylward) However, we are not complacent about that. The sampling did not result in sufficient numbers, as far as I am concerned and statisticians are concerned, to give us a valid result. So we are exploring with SchlumbergerSema a more extensive research programme to capture that.

  65. On the numbers, you say they were small, roughly how many were there?
  (Dr Aylward) I think of the order of several thousand.

  66. So they are small relative to the total number of people you are examining?
  (Dr Aylward) Yes.

  67. Finally, as a general point, it must be terribly difficult for people to make complaints about doctors. There is a power issue. It is relatively simple to write to Marks & Spencer's about a shirt which you are not happy about but it is very, very difficult to complain about relatively powerful people and individual's lives. Is this something obviously you have picked up in, I suppose, the sociology of the studies you are doing?
  (Dr Hudson) The answer is yes and we are doing everything we can in the way of improving the information that goes to people to ease the complaints process against doctors and in a sense to remove the individual doctor from the area of the complainant if the complaint has been made. It is a very, very difficult issue and it is one which concerns us very much.

  68. It is also about getting realistic information back, is it not? People say "I do not like to complain because it might affect future benefits". There is always this big worry.
  (Mr Chipperfield) Can I just make the point that it has no impact on future benefits. There is absolutely no relationship.

  69. I am sure we are convinced by that but I am not sure claimants are.
  (Mr Chipperfield) I understand that but it is worth using this opportunity to reiterate that.
  (Dr Aylward) And also that the message does go out on many different leaflets and letters which go to claimants. It is a very important one. We do not want to discourage people but we want to make it quite clear there is no relationship between the making of a complaint and any ultimate decision, quite simply.

  Mr Stewart: Thank you for that.

Chairman

  70. I want to move from the quality of reports to some issues surrounding complaints and bring in Andrew Selous in a moment to open up the questioning in that area. In passing, your own evidence, the Medical Services evidence at page 19, 6.4, talks about the "Appeals Service feedback". It talks about "A process has been implemented to facilitate the flow of information between the Appeals Service . . . 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". From memory, Judge Harris, who is President of the Appeals Tribunal, suggested I think recently that some 54 per cent of the reports had the disability element under-estimated. Can you confirm that is true and if it is true does paragraph 6.4 really adequately deal with that level of difficulty?
  (Dr Aylward) I believe that the figure in the President's report of the last year is not as high as that. I think he says in about a third of cases the Tribunal felt that the medical report had under-estimated the disability. However, the President's report did not distinguish between reports which were provided by SchlumbergerSema Medical Services and other reports which were provided by general practitioners or hospitals so that did make it difficult for us. But, nonetheless, a system is now in place whereby reports which are seriously sub-standard and are brought to the attention of—

  71. What is the definition of "seriously sub-standard"?
  (Dr Aylward) Something that would result in the decision being flawed.

  72. Any under-estimation of disability must affect the outcome potentially.
  (Dr Aylward) It could.

  73. We are talking about a third which could potentially affect the outcome?
  (Dr Aylward) Yes.

  74. Getting lower. How does that fit with the quality assurance schemes that you are putting in place?
  (Dr Aylward) Although the Tribunal has reached a figure of a third, one has to understand that it is the Tribunal taking a different view of the evidence. They do say that. They say that in again about half of those cases they took a different view of the evidence and that they were informed to reach their decision on an under-estimation of the disability by the oral evidence and further evidence that had been obtained at the time of the hearing.
  (Mr Fisher) I think it is just fair to add that this is not something we are at all content with in terms of the general situation. We have put in place processes for feedback as the SchlumbergerSema report says but this is something we are really going to keep a close eye on.

  75. It is a worry.
  (Mr Fisher) It is a worry, there is no doubt about it.

  76. It is because it does not equate with some of the other ratings that you did on assessment of the quality of the medical reports. I understand there are other issues and sometimes you have got additional evidence which changes things.
  (Mr Fisher) Yes.

  77. I understand all of that but it is still a big number whether it is a third or 54 per cent here according to our copy of the President's report.
  (Mr Fisher) That is only of the cases he sees, it is not of the total number of cases. His report is concerned with the cases which are going to appeal, so it is a third of those cases, not of the total. It is still a significant number.

  78. It is still a big number.
  (Dr Hudson) Those big numbers have not come through to Medical Services. I think it would be remiss of me to say we have large numbers of appeals cases and are satisfied with that. I would certainly welcome an increased look into that. Although I think it is excellent that we are now getting feedback in a way that we had not been in the past, I think more formalisation of the existing process would probably help us to improve the quality of—

  Chairman: It would help the doctors as well if there is an end-to-end process.

Andrew Selous

  79. Carrying on with the theme of complaints, could you tell us if a patient complains immediately following their examination about how they have been treated, as suggested in the leaflet DLA AL1C, which we have got a copy of here, how does that complaint get recorded?
  (Mr Chipperfield) It gets recorded on our complaints management system depending on the route of the complaint. Sometimes it will be made to the local centre, sometimes it will be made directly to our national customer relations team.


8   Please refer to the supplementary memorandum from the Department for Work and Pensions (MS 01B), Ev 70. Back


 
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