Supplementary Memorandum from the Department
for Work and Pensions (MS 01B)
Correspondence between the Chairman of
the Committee and the Secretary of State
Session on Medical Services 17 April 2002
Thank you for the very useful "progress"
session with officials and representatives of Medical Services
on 17 April, when the work of the Department and SchlumbergerSema
in meeting the recommendations of the 2000 report of the Social
Security Committee was explored.
Inevitably, given the scale of the topic, it
was not possible to fully explore every issue raised in the limited
time available to us. I would therefore be grateful if the Department
could further assist the Committee with one or two additional
questions and points of clarification arising from the evidence
given. I am also sending a copy of this letter direct to SchlumbergerSema
for their information.
Claimant's feedback on medical reports
Question 63 referred to the recommendation of
the Social Security Committee that a proportion of customer surveys
should be conducted to capture claimants' views about their medical
reports. In response, the Government said that the Department
was working with Medical Services to develop and pilot a process
whereby a proportion of claimants who were invited to complete
a satisfaction survey were also sent a copy of the doctor's report
(paragraph 52). Further to Dr Aylward's reply on this subject,
it would be helpful if you could provide further details of the
customer survey questionnaire and the opportunity given to customers,
in the survey questions, to give feedback on the accuracy and
general quality of the medical report itself. It would also be
helpful to have confirmation of the number of people to whom the
questionnaire was sent, and the current proposals for a more extensive
research programme to obtain the relevant feedback.
On a point of clarification, Dr Aylward told
the Committee that complaints regarding a doctor's manner had
dropped to 30 per cent (Question 104). The DWP supplementary memorandum
at Annex 1 indicates that, of the 1,029 complaints received in
the quarter ending February 2002, when broken down by category,
648 (or 63 per cent) included a complaint about the doctor's manner.
Can you explain the discrepancy between the figures?
In Questions 87-89, Mr Selous wanted to establish
whether every claimant undergoing examination received a copy
of the green customer care leaflet "Medical Servicescaring
about customer service." Dr Hudson appeared to suggest at
Question 89, that the customer care leaflet was sent out with
the appointment letter. For clarification, could you explain whether
all customers receive the green customer care leaflet, and, if
so, at what stage. If not, please can you explain the availability
of the customer care leaflet to customers.
In Question 90, Mr Selous was referring to evidence
given by Norman Heighton, then Corporate Director at DSS, to the
Public Accounts Committee in March 2001. He told the Committee
that the Department was itself puzzled by the disparity between
apparent public levels of dissatisfaction and the volume of formal
complaints made and said, "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." (Committee of
Public Accounts, Minutes of Evidence, 21 March 2001, Q 140). In
reply to the Work and Pensions Committee, Dr Aylward referred
to work looking at improving SchlumberSema's own protocols. Dr
Aylward may have misunderstood the question. The impression given
in Mr Heighton's evidence was that the Department was looking
to commission independent research, aimed at identifying the extent
to which people did have complaints about their treatment by Medical
Servicesabove and beyond those who had made a formal complaint.
Was such research ever commissioned, or are there still plans
to do so?
In answer to Questions 96 and 97, Dr Hudson
gave the Committee useful information concerning doctor training.
As a point of clarification, can you explain whether Dr Hudson's
information concerned the training of employed doctors only, or
whether it is equally applicable to fee-paid sessional doctors.
If the former, could you please provide the relevant information
concerning the induction training etc given to sessional doctors.
Liaison with The Appeals Service
At Question 70, I drew attention to the Report
by the President of Appeal Tribunals concerning the Standards
of Decision-Making by the Secretary of State. There was some discussion
concerning the actual figures in the President's Report. Having
checked the President's report for 2000-01, I believe the figures
are as follows:
In relation to Disability Living
Allowance and Attendance Allowance, the medical member of the
panel found that the medical report had underestimated the severity
of the disability in 54 per cent of cases (see Table 6 of the
In relation to Incapacity Benefit,
the medical report was found to have under-estimated the severity
of the disability in 54 per cent of cases (see Table 8 of the
Dr Aylward thought the figures in the President's
report were not as high. Can you please confirm that my figures
I would also like to press you on the systems
in place to ensure that Medical Services receives feedback where
the Appeals Service has identified any report supplied by Medical
Services as below professional standards. Could you explain the
systems currently in place? At Question 78, Dr Hudson suggests
that more formalisation of the existing process would probably
help. What would this mean in practice?
In its report, the Social Security Select Committee
recommended that SEMA should be made aware if a significant proportion
of successful appeals could be related to cases where particular
doctors have provided the medical report. Are the systems now
in place to monitor the relative frequency with which reports
of individual doctors feature in the decisions going to appeal,
particularly where those appeals are successful?
The Committee also recommended that individual
Medical Services doctors should be informed of the outcome of
appeals where the Tribunal has chosen not to endorse that doctor's
findings. Can you confirm that this is now done?
Involvement of the CRE
The Department's memorandum to the Committee
(Annex 1, box (k)) gives details of two areas of agreement reached
between Medical Services and the Chairman of the CRE. Firstly,
the CRE "would review and monitor the work of Medical Services
in regard to the treatment of claimants from ethnic minority groups".
Secondly, the CRE had agreed to assist in evaluating relevant
training. In answer to Question 125, Dr Aylward dealt with the
second area of liaison. Can you please advise the Committee of
what work has been done with the CRE to take forward the agreement
reached with the Chairman, that the Commission would review and
monitor Medical Services' treatment of claimants from ethnic minority
22 April 2002
Letter to the Chairman of the Committee
from the Secretary of State
Session on Medical Services 17 April 2002
Thank you for your letter dated 24 April, on
behalf of the Work and Pensions Committee. I am pleased that the
progress session on Medical Services on 17 April was useful. There
has clearly been a significant change in attitude and approach
since SchlumbergerSema took over Sema Group, and this is reflected
in the improved performance of Medical Services in the past year.
The information and clarification requested
in your letter is contained in the attached note, which also takes
into account information provided by Medical Services. The note
also picks up a number of issues where further information or
clarification was requested at the session with officials and
Medical Services on 17 April.
17 May 2002
Additional Information Requested
1. This document provides additional information
requested by the Work and Pensions Select Committee as a result
of the update oral hearing held on 17 April 2002.
Service levels not met (question 4)
2. The Department's evidence referred to
Medical Services' failure to meet two out of 45 service level
targets set in relation to confirmation of the decision to extend
the contract. Two individual clearance time targets were missed
in one contract package area in March 2002. These were examination
clearance time for Incapacity Benefit (target 95 per cent, achievement
in South East contract package 89.1 per cent) and examination
clearance time for Disability Living Allowance (target 95 per
cent, achievement in South West contract package 87.2 per cent).
3. All service levels have improved, and
these two service level targets were met in April.
Value of contract to SchlumbergerSema (questions
4. The actual and projected net costs of
the contract are shown in the table:
5. The contract was not let on an "open book"
basis, therefore SchlumbergerSema are not obliged to divulge their
profit margins. This information is regarded as commercial in
Sum returned to the Department as a result of fall in scrutiny
to examination rate (questions 14/15)
6. As part of annual review commercial settlements with
Sema Group in the first and second years of the contract the department
recovered a total of £2 million. This figure was used to
offset legitimate commercial claims from Sema Group during the
annual review negotiations.
Differential price for scrutiny and examination (question 18)
7. For Incapacity Benefit the cost of an examination
is £84.81, and the cost of a case cleared by scrutiny is
Scrutiny Guidelines (question 22)
8. A copy of the clarified scrutiny guidelines is attached
at Appendix 1. 
Information available to EMPs (question 61)
9. All requests for EMP assessments are now accompanied
by information about the diagnosis given by the claimant and by
the claimant's doctor, together with information about current
treatment, plus any other information felt to be of relevance
to the EMP.
10. The DLA/AA Modernisation Programme project on medical
evidence gathering continues to investigate the optimum use of
further evidence from the most appropriate sources.
Claimants' feedback on medical reports (question 63)
11. In September 2000 a pilot was conducted in which
a representative proportion (25 per cent) of claimants invited
to complete a customer satisfaction survey were also given a copy
of the medical report. Standard survey questionnaires were issued
to facilitate direct comparison with the main survey. Of 209 surveys
with medical reports issued, only 83 were returned.
12. The survey questionnaire was not designed to test
the doctor's report, so it contained no direct questions about
this. The questionnaire included questions about the overall rating
of the doctor, and how the examination compared with the claimant's
expectations, in terms of duration and thoroughness. Of the 83
completed returns, only 3 contained a comment on the medical report.
13. An overall review of customer satisfaction surveys
was initiated earlier this year, in response to the NAO recommendation
that surveys should be revised to ensure they meet Industry Standards.
Specifications for the revised survey methodology are expected
by the end of May, following which costed proposals will be submitted
to the Department. The proposals will include the development
of a process for validation of survey results. The plan is to
test the revised survey process in September, with full roll out
from November 2002. Further work on surveying claimants who have
received a copy of their medical report forms part of this review,
with the specific objective of identifying ways to improve the
poor response rate experienced in the earlier pilot.
Liaison with Appeals Service (questions 70, 78)
14. The figures quoted by the Committee Chairman are
correct. The Report by the President of Appeal Tribunals on the
standard of decision making gives figures in Tables 6 and 7 of
54 per cent of medical reports underestimating the severity of
disability in DLA and IB respectively. The oral evidence given
to the Committee, that the figures were not as high as that, referred
to Table 3, which shows the outcome for all cases overturned by
a Tribunal, and in this table the figure for medical reports underestimating
the degree of disability is 34 per cent. This figure is lower
because Table 3 includes benefits which do not involve medical
15. The President's Report did not distinguish between
reports prepared by Medical Services examining doctors and those
provided by the claimant's own doctor.
16. A feedback system has been developed and agreed with
the Appeals Service, and has been in operation since July 2001.
Reports completed by Medical Services doctors which are considered
by Appeal Tribunals to cause concern because they fall substantially
below professional standards, are referred to the Department's
Chief Medical Adviser. The agreed protocol offers guidance to
Appeal Tribunal members, but it is not prescriptive. Features
which might put a report into this category include reports which
substantially fail to address the medical issues; or are completely
out of touch with informed medical opinion; or are full of inconsistencies;
or conspicuously fail to relate to the individual concerned; or
are substantially illegible.
17. Reports referred to the Chief Medical Adviser are
forwarded to Medical Services for investigation and confirmation
that appropriate action has been taken. Feedback is always given
to the doctor concerned.
18. The current process, which has been in operation
for almost a year, is due for review. The Department also continues
to work with the President of Appeal Tribunals to better understand
concerns about medical reports which do not fall into the above
category but nevertheless are felt by Appeal Tribunal members
to need improvement. There have been only 13 referrals under the
protocol, which is significantly less than the number of reports
where the Appeal Tribunal felt the severity of disablement had
been underestimated, as reflected in the President's Report. Detailed
feedback on these reports would be valuable in improving standards.
The Department will explore with the Appeals Service how this
feedback might be achieved.
19. With the exception of cases referred under the protocol,
there is currently no other monitoring of the relative frequency
with which reports of individual doctors feature in cases going
to appeal. A successful appeal does not necessarily mean that
either the original decision, or the evidence upon which it was
based, were faulty. The President's Report acknowledges the significant
part played by additional evidence put before the Appeal Tribunal,
and that in a number of cases, the Tribunal takes a different
view of the same evidence. However, this issue will form part
of the review of the current arrangements for feedback from Appeal
Tribunals. One proposal which is being considered is to hold regular
regional meetings between Medical Services and Appeal Tribunal
chairmen, to discuss medical quality issues.
Customer care leaflet (questions 87-89)
20. All claimants who are to have a medical assessment
receive an appointment letter which explains the assessment process,
advises claimants to contact Medical Services if they have special
needs (for example, if they need an interpreter), and provides
information about the action to take if the claimant is unhappy
with the standard of service. The information includes details
of how to obtain a customer service leaflet. Leaflets are available
from all Medical Services' customer helpdesks, from customer relations
managers, at medical examination centres, and from visiting examining
Independent customer research (question 90)
21. This issue is being considered as part of the review
of customer satisfaction surveys mentioned at paragraph 13 above.
Doctor training (questions 96, 97)
22. All doctors, whether employed or sessional, receive
the same benefit-specific initial training. This varies in detail
and duration according to the benefit involved, but follows a
similar basic pattern of:
Trainer-led theoretical training, including such
aspects as principles of disability assessment, professional standards,
and customer care.
Demonstration of understanding of the training,
assessed by multiple choice test paper.
Practical training in a controlled environment.
For examination centre based assessments, the trainee is initially
supervised and appraised by an experienced medical adviser. For
domiciliary assessments, initial reports are monitored immediately
on return, to allow feedback to be given without delay.
Demonstration of understanding of the training,
assessed by audit. All initial reports produced by the trainee
are monitored, and training is not considered complete until the
trainee has demonstrated an acceptable standard. Feedback is given
on any problems identified, and if necessary the doctor will be
required to repeat the training process. Continued lack of progress
will mean the doctor being informed that no further training,
and no work, can be offered.
Approval by the Department's Chief Medical Adviser.
Separate approval is required for each benefit area in which the
doctor is involved, and is dependent on successful completion
of all stages of training, and ongoing demonstration that the
work is of a satisfactory standard.
23. In addition to core training, all employed and contracted
doctors participate in Medical Services' programme of Continuing
Medical Education (CME). The programme is developed in response
to a training needs analysis conducted by Medical Services in
close collaboration with the Department's Chief Medical Adviser.
The precise details of each doctor's training plan will vary,
mainly according to the benefit areas in which they work; but
all doctors will receive around five days per year of CME. All
doctors receive the three mandatory CME modules on mental health
assessment, sensitivities for dealing with people with disabilities
(including multicultural awareness), and clinical skills training
in distress-avoiding techniques for clinical examination.
24. In January 2002, to coincide with the latest recruitment
campaign, Medical Services introduced an eight-day induction course
for all new employed doctors. The course includes the standard
four-day Incapacity Benefit theoretical course; the three mandatory
CME modules; and additional input on the skills of the disability
analyst. This added input is considered necessary because as employed
doctors, they will be called upon to guide and advise the sessional
doctors as they progress in their careers with Medical Services.
Complaints (question 104)
25. Medical Services' Update Memorandum to the Select
"Of these new complaints, issues relating to doctor manner
has declined from 35 per cent for the quarter ending August 01
to 30 per cent of all issues during the quarter ending February
02" (paragraph 8.9).
26. These percentages relate to the total number of issues
within all complaints received. There is often more than one issue
contained within a complaint, and sometimes more than one issue
relating to doctor manner. For example, the doctor may not have
been punctual and may also have been considered to be rude.
27. For the quarter ending February 02, 1,029 new complaints
were received, and within these there were 2,164 issues in total.
Therefore, 648 issues within the doctor manner category represents
30 per cent of all issues.
28. As an individual complaint may contain more than
one issue relating to the doctor's manner, it would not be accurate
to report that 63 per cent of complaints in this quarter included
an issue about the doctor's manner.
Involvement of CRE (question 125)
29. Despite the apparent promise of early meetings with
the Chairman of the CRE, repeated subsequent approaches by both
the Department and Medical Services have been disappointing in
their outcome. Invitations to comment on training modules have
gone unanswered, as have invitations to hold further meetings.
Medical Services have therefore successfully forged relationships
with alternative advisory groups, such as The Equality Foundation,
which has been very co-operative in assisting with development
of multicultural awareness training.
30. Complaints alleging cultural insensitivity have steadily
decreased. In the quarter ending February 02, there were five
such complaints (0.5 per cent of the total number of complaints).
All complaints alleging cultural insensitivity are reviewed by
Medical Services senior managers.
Not Published. Back