Examination of Witnesses (Questions 60-79)|
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.
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
(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.
(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
(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
(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.
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
(Dr Aylward) Something that would result in the decision
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
(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
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
Chairman: It would help the doctors as well
if there is an end-to-end process.
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