Select Committee on Work and Pensions Minutes of Evidence

Examination of Witnesses (Questions 80-99)



  80. And that happens more or less straight away, does it?
  (Mr Chipperfield) Yes. We are measured on providing a response—forgive me, I cannot remember off the top of my head what the timescale is for the first response—the first response we are measured on achieving within a certain period of time, then a follow up response, a more detailed reply and also the quality of our response. That is something which is new since the last Select Committee report. The quality of our replies is audited by the Department and we have to meet targets in terms of the quality and content of our responses to the complaints as well as the speed of our response.
  (Mr Keen) I think the contract requires you to respond in full, not an interim response, to 75 per cent of cases within approximately 15 days. Seventy-five per cent within 15 days is obviously allowing for the fact that on some more complex cases Medical Services would need to go back and seek wider evidence.

  81. Is there a timescale for the remaining quarter within which they have to receive a response?
  (Mr Keen) I do not think there is under the contract. There is not a timescale for that.

  82. Is that an area that you are looking at, perhaps bringing in a final timescale, because that could drag on for months, could it not?
  (Mr Keen) I do not think that it would be in the interests of anyone for it to drag on for months.

  83. But you have no target. You say 75 per cent have to be within 15 days, but then there is a quarter for which there is no period, there is no best practice.
  (Mr Fisher) We have veered at various points between measuring performance by 100 per cent of cases in such and such days or what are called "X in Y targets" which are something like 75 per cent in a shorter time. It is something I am sure we can look at in the future if this is not doing what we want. What we want is every single case within reason answered as quickly as possible.

  84. Can you give us an assurance that the Department will look into that remaining quarter?
  (Mr Fisher) Yes.

  85. Thank you. Do you think it is actually realistic, and I am addressing this perhaps more to the Department officials here, to actually expect someone undergoing examination in their own home to complain immediately to the doctor about their treatment, as they are advised to in DLA AL1C?
  (Mr Chipperfield) Can I just make the point that they are not treated, they are examined, and there is a difference. Our doctors are examining to look at what the impact is of the illness or the disability or the condition on that person's everyday life within their home environment, they are not treating the patient.

  86. I accept that but what I am trying to do is get into the mind of the person being examined. They are in their home with the doctor, it is a very important concern for their future benefit entitlement and they are advised to complain straight away.
  (Mr Chipperfield) Yes. We will accept the complaint whenever it is made. We do have complaints being made weeks, months, even years after the original examination and we would still treat that as a full and justified complaint and it would receive all of the attention that a complaint received within 24 hours would receive.
  (Dr Aylward) May I just add that I think it is also to address a culture change which Mr Stewart referred to in his questions and that is we believe that people should confront doctors or other professionals if they feel that they are not getting good service. Clearly it can be a very sensitive, embarrassing situation but nonetheless we should encourage that. When we say complain immediately, it includes complaining at the time to the doctor saying "No, I think you are mistaken in this way" or "I am unable to do this particular task that you insist I can do". We do insist that should be done and complaining straight away also means perhaps within the first day or so when they look back at their examination and they perceive that they were not handled properly, sensibly, they should complain. We want to encourage a culture which is not overawed by professionals.

  87. I understand at the moment that you do not actually send every patient this customer care leaflet, they are given those in the course of the examination. Is that correct?
  (Dr Aylward) Customer care leaflet?
  (Dr Hudson) Not the book. There are two documents you are referring to, the letters that—
  (Mr Chipperfield) The AL1C.
  (Dr Hudson) Which goes to people when they are sent their appointment.

  88. But they are handed to them at the time of their examination rather than being sent in advance when they have perhaps got more time to study them and look through them?
  (Dr Hudson) No, they go with the appointment.

  89. They do go with the appointment?
  (Dr Hudson) Yes.

  90. I understand that a gentleman called Norman Heighton, who was the Corporate Projects Director, was going to commission some independent research to try to understand why the level of complaints was very low in comparison with perceived public dissatisfaction. Can you let us know if any research was commissioned and what the result of it was?
  (Dr Aylward) Work was undertaken to look at surveys, some of which related to the information I provided to Mr Stewart. The advice we had from our own Department's analytical services division, the statisticians, was even after we had conducted several surveys with several thousand respondents that it was still inadequate statistically and we needed to take a much firmer view and develop a more robust approach to looking at research and studying this area. Informed by those results and by our statistical colleagues we are working together with SchlumbergerSema to develop a more helpful protocol that will indeed answer the question that Mr Heighton referred to in his evidence.

  91. Just on a personal matter, I had a lady in my constituency from Leighton Buzzard last Friday complaining about her examination for Attendance Allowance. If I understood her correctly, and I may not have done, perhaps you can clarify this for me, she told me that no-one had actually come to her home to view her undertaking the tasks for which she told me that she needed assistance. Would that have been correct in your opinion? Would procedure have been followed in that case?
  (Dr Aylward) The answer would be no. I would be most surprised if she had made a claim for Attendance Allowance—No, may I withdraw that. Yes, it is quite possible that the lady when she did apply completed a form which was based upon a self-report of her condition and that in itself could have been used by the Decision Maker to make the decision in her case. Frequently it is accompanied by supporting statements from people who know the lady or the lady's medical attendants, but it is possible within Attendance Allowance for a decision to be made without that person being visited at home.

  92. She had also gone to appeal and she had lost the appeal. In that case as well that still holds, does it, it is possible even having appealed no-one would come and see her in her home?
  (Mr Sumner) The Attendance Allowance is essentially a self-assessment benefit where the Decision Maker will, if they deem it necessary, get additional evidence which may be a medical examination through an examining medical practitioner in the person's home. If from the self-assessment form that the claimant completes it is very clear that they do not satisfy the conditions for benefit then the Decision Maker will make a decision on that basis.

  93. So you have no current plans to change that system even on appeal. This lady felt particularly aggrieved, she said "no-one has seen that I cannot get into the shower easily".
  (Mr Sumner) When the case goes to the Appeals Tribunal they of course review the evidence again and if they take a different view or if they are doubtful then they have the opportunity to ask for such an examination to be undertaken.

  94. This claimant was not able to get to the Appeals Tribunal. She felt very cut off from the whole process. She felt that no-one had been to see her, she had not been able to get to the appeal because she is quite frail. Is this something that concerns you?
  (Mr Sumner) Obviously that is of concern. She would nevertheless have the opportunity for somebody to go on her behalf or to make representations, written representations, which the tribunal would consider.


  95. Presumably the representations from your own general practitioner would be valid evidence.
  (Mr Sumner) Absolutely, yes.

  Chairman: I think she should write to her MP again.

  Andrew Selous: No doubt she will.

Miss Begg

  96. If I can move on, also about treatment of claimants but in particular customer satisfaction. There is a great deal of unease perhaps amongst people with disabilities and people who are ill about going through a medical assessment. It is a frightening and daunting thing, particularly for people with mental health problems, and we have some questions on that. It is very important that they are treated correctly and they are treated well and they feel they have had a fair hearing and it is not something that is difficult for them. Dr Hudson, you mentioned that there is training for doctors doing the assessment. Can you explain in more detail what that training consists of?
  (Dr Hudson) Yes, certainly. There are three areas of training. First of all, there is our induction training which every doctor who comes to Medical Services as an employed doctor in particular goes through. There is continuing medical education and there is remedial training. Our induction programme consists of eight days' worth of training which is in general where doctors move into an environment which is an entirely training environment. At that stage they are introduced to the concept of disability assessment medicine but also to the importance of understanding that they are not in a clinical and therapeutic environment, they are there to do a different type of job and their clients do have needs that are very specific to being within a benefits process. We embark on essentially retraining them in examination techniques which are different, as I say, from examination techniques used by clinicians. Also, we have modules on multi-cultural awareness, on dealing with people with disabilities, on managing the critical evaluation of evidence and writing good reports, effective reports, for non-medical Decision Makers. In essence, because Incapacity Benefit, as Mr Chipperfield has said, is the major part of our work, that carries on to a four day module which is specific to Incapacity Benefit.

  97. The reason I ask that question is I know from my own experience that just because somebody has a medical background, a doctor, they do not necessarily understand disability at all. In fact, sometimes perhaps with the doctors—I do not want to insult all the medical professions, the ones who are here—it is worse because there is something of an arrogance that because they have a medical training they must know what it is like to have a disability and, therefore, they do not always listen. I am trying to get a grasp of how do you ensure that the doctors who are making that judgment are judging people on their capabilities and their disability and not on the medical needs? That is the crucial thing for the benefit.
  (Dr Hudson) You are absolutely right. We have learned that it is an iterative process and that there is essentially an unlearning process for the doctors to go through which is why an induction process is increasingly important where we say "No, this is not what you have done before and there are specific aspects of the work that you are about to embark on which are very particular and very sensitive".

  98. If you find there are a number of complaints through the complaints procedure, which we have already heard is actually getting more, so perhaps there are more complaints coming in about a particular doctor, about them being offhand or really not appreciating, not listening, do you take that doctor back in and retrain or do you say "No, you cannot work for us any more. You are not the type of person we need"?
  (Dr Hudson) We would retrain in general unless there was something so bad.

  99. Has it ever happened where you have found somebody is just so offhand that they are obviously not cut out for the kind of work?
  (Dr Hudson) Yes. I think we would still attempt to retrain them because we have selected and sifted in the first instance, we have made the judgment early on that doctor will be capable of reaching a specific standard and we need to make sure that our training programme that has been specific to that doctor has been adequate, particularly if it is an employed doctor. At that stage we have no hesitation if a doctor cannot come to terms with what they are doing in ceasing to use his or her services.

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