Progress in improving the medical assessment of incapacity and disability benefits (120-i) Public Accounts Committee 10 Dec 2003

Q12 Chairman: My last question is on shortages of doctors and you seem to have made some progress in tackling that. Can you keep up the good work, the progress you have already made?

Mr Chipperfield: It is a challenge. It is a challenge for every organisation working in the UK delivering any kind of clinical service and whilst we have made a lot of progress, we are not complacent and there are still one or two areas of the country where we would like to have more doctors. How we are dealing with that at the moment is by moving our other doctors around the country for a few weeks at a time or a week at a time or a few days in order to cover those issues. That is one of the flexibilities that we can bring. There are hotspot areas, particularly in the North-West of England, North Wales and West Yorkshire, where we would welcome more doctors and we are doing everything we can to get them.

Q13 Mr. Gerry Steinberg (City of Durham): This is certainly a huge improvement in the way things are going, certainly from the last time we looked at this particular subject. I can remember that I was very, very critical last time, because I had had some horrendous constituency cases. However, there are always concerns in any report and it is our job to look at those concerns as well as congratulating you on doing a good job. Reading the report and from personal experience as well still, as far as I can see, the personal capacity assessment (PCA) is throwing up a large number of incorrect benefit withdrawals. There have been many, many examples over the last year, particularly to the CAB. The CAB in my area has contacted me about it. Most cases seem to arise because the examining medical practitioners - and I have to say I have always had my doubts about them in the past and perhaps been very critical of them - employed by Schlumberger do not provide very good advice on the personal capability assessment score in particular and that makes it very difficult for the DWP decision-makers. Are these doctors just going through the motions sometimes rather than actually being serious about it? I sometimes think they are. Once I have heard your answer I am going to come back.

Mr Anderson: There are rigorous quality processes in place. I should first of all say both to yourself and to the Chairman that it is very kind of you to acknowledge the success which has been achieved and thank you for that. The assessment of personal capability is obviously slightly subjective and it is always going to be a difficult area. The quality checks which are in place and the auditing which takes place is rigorous and it has been checked by the department as well in terms of the quality of reports. I think we are in territory where it is never going to be possible to ensure that two doctors looking at the same piece of information will always produce the same answer. We are trying to implement things like evidence based medicine which should reduce the subjectivity as far as possible. We are trying to encourage doctors to take formal training in disability assessment and the department is pioneering that. That ought to improve things in that area. Progress is being made.

Q14 Mr. Gerry Steinberg (City of Durham): Do you actually believe that some of these doctors are genuinely concerned about the actual people they are assessing? Or do you think they just treat them as a lump of meat and do not have a lot of compassion for them?

Mr Anderson: I have no evidence at all to suggest that people are treated as a lump of meat. The customer satisfaction numbers from medical assessments are very strong.

Q15 Mr. Gerry Steinberg (City of Durham): I had a case only last Saturday morning in my surgery where a lady came along on behalf of her sister. She did not want me to take it any further, but she came along to express her dismay at the way the attendance allowance had been handled. She said that the doctor had actually said that he hated filling in forms. She was complaining about what had actually been said on the form: on the basis of what was put on the form the woman lost the attendance allowance. This is not the first instance I have heard of things like that. I have been very critical of doctors in this Committee on many, many issues. They do not seem to like doing anything which means extra work unless they are very well paid. Do you want to make any comment? The doctors are paramount, are they not?

Mr Chipperfield: Yes, doctors are paramount to this service. Our doctors are experts in the field of disability analysis. They are all trained and specifically trained to do the work we ask them to do and they are continually trained to do so. That is not just about the medicine, it is also about the attitude towards the customer and the understanding of the overall policy and the benefit which they are there to support. We would thoroughly investigate any anecdotal incident which is reported to us with the doctor concerned. If we found there was any substance in it, we would take some action about it and we do so.

Q16 Mr. Gerry Steinberg (City of Durham): Turn to paragraph 3.3 on page 22 and read the second half of that paragraph, "In about a third of cases, tribunals considered the medical report had underestimated the severity of the disability" and it goes on. That seems to be backing up my argument rather than yours. How many is it? At least 51% of cases were overturned, as I read that. That to me does not seem as though they are doing their job very well in the first instance and seems to back my argument that they are not really all that bothered, are they, as long as they are getting their fee?

Mr Chipperfield: I would disagree with you.

Q17 Mr. Gerry Steinberg (City of Durham): Why are the figures so high then?

Mr Chipperfield: I do not think I am the best person to comment on what the appeals tribunals decide and the basis upon which they decide that.

Q18 Mr. Gerry Steinberg (City of Durham): They are your doctors though, are they not?

Mr Chipperfield: Not doing the appeals. Our doctors are doing the examinations.

Q19 Mr. Gerry Steinberg (City of Durham): On their evidence. I may be wrong, but on their evidence it originally gets turned down and then they go to appeal afterwards.

Mr Chipperfield: Yes, that is correct.

Q20 Mr. Gerry Steinberg (City of Durham): Am I getting mixed up?

Mr Chipperfield: The statistic misrepresents the actuality.

Q21 Mr. Gerry Steinberg (City of Durham): Statistics do not misrepresent anything. All we can go by in any report we receive is the information the National Audit Office gives us and I found paragraph 3.3 very worrying, that so many cases are actually refused on the basis of bad medical diagnosis. That seems to substantiate what I have been saying right from the start.

Professor Aylward: If you look at the figures, what we are seeing is that in around one third of the cases the report was found to be flawed because it seemed to have underestimated the disability. That is correct. In about one half of those cases, they came from Schlumberger. I have actually looked at those cases myself. I have done a random sample and I do not agree with that finding.

Q22 Mr. Gerry Steinberg (City of Durham): Wait a minute. You do not agree with this finding here.

Professor Aylward: I do not.

Q23 Mr. Gerry Steinberg (City of Durham): This report has been signed off as accurate by your Accounting Officer with the National Audit Office. It is no good coming here and saying you do not agree with the report, when we the natural presumption is that this report is absolutely accurate and agreed by you.

Professor Aylward: I am not disagreeing with the report which the National Audit Office has produced. I am commenting upon the figures which have been produced by the appeals service. It is my job as Chief Medical Advisor to the department to look at the cases where there is said to be an underestimation of disability. In my professional opinion, using my judgement, and a scientific method, I looked at those in a random way and I found that in half the cases I did not consider the disability was underestimated. May I add one more thing? If you look at the doctors who are making these decisions sitting in the appeals service compared with a doctors who are working for Medical Services Schlumberger, we should perhaps think that one of the reasons there may be a difference here is that doctors in the appeals service do not receive the significant training that Medical Services' doctors do, they do not get monitored to the same extent and they are not participating in revalidation to the same extent. That may be a reason why there is a difference in opinion between the two sets of doctors.

Q24 Mr. Gerry Steinberg (City of Durham): Did you say this to the National Audit Office at the time of the report?

Professor Aylward: Yes.

Mr. Gerry Steinberg (City of Durham): It is not reported anywhere.

Q25 Chairman: Could the National Audit Office comment on that? This is a very interesting exchange.

Mr Lonsdale: The point which is being made is that the difference of opinion is between the decision which is made by the appeals tribunal, who have commented in 138 and 96 cases where they think the medical report underestimated the severity of the disability. What Professor Aylward is saying is that when he, in his capacity, then looked at that decision made by that tribunal, his judgement was that he did not agree with the appeals tribunal. That is a medical judgement. What we have reported here are the findings of the president of the Appeals Service. This is his view. The 51% of cases are from Medical Services and others are from general practitioners, consultants, a combination of sources. It is a difference of opinion, a judgement on medical evidence which was presented.

Mr Burr: Everybody agrees that this is what the president of the appeal tribunals thinks. Not everybody agrees with the president of the appeals tribunals.

Q26 Mr. Gerry Steinberg (City of Durham): I had a plan of what I wanted to ask and now I have been waylaid. Coming on from that, does it not worry you - it certainly worries me - that the incapacity benefit is suddenly withdrawn, which could have been a person's income for years and years and years, suddenly it is lost because of some sort of sloppy short medical examination by one of your doctors; they lose their income and end up living on about £40 a week because one of your doctors has made an appalling decision? Does that not worry you, because it would worry me?

Mr Chipperfield: Yes, that would worry me. All the efforts we take are to avoid that happening. That is why we are very careful about the doctors we select or recruit, very careful about the training we give to them and the ongoing monitoring and auditing, coaching and mentoring which we provide. That is also why we take action when we find doctors who are not meeting the quality standards. In the last three years, for example, about 420 doctors have been revoked and a goodly proportion of them, at least 25% of them, have been on our own specific action because we did not find them meeting the quality standards. Yes, it would concern me. What I am saying is that we take every action we possibly can and we are not complacent. We are constantly trying to improve to ensure that does not happen.

Q27 Mr. Gerry Steinberg (City of Durham): Bearing in mind the argument I have put forward. Would it not be a better system, if somebody is taken off incapacity benefit, for them to continue to receive it until the appeal has been heard? Would that not be a fairer system?

Mr Anderson: I am not entirely sure in the way regulations are written that would be possible. I cannot answer that question. It may be a fairer system in those cases where appeals are successful; clearly it would not be fair to the taxpayer in those cases where appeals are not successful.

Q28 Mr. Gerry Steinberg (City of Durham): People can see their incomes reduced to something like £43 per week, can they not? Suddenly after years of receiving incapacity benefit, bang, they are down to £43 a week. I could not live on £43 per week; I bet a pound to a penny you could not live on £43 per week, yet that is what they have to live on. Do you think this should be looked into?

Mr Anderson: I believe that the system at the moment, where benefits are stopped when a decision-maker makes the decision, is a fair way of going through this process. We have to get those decisions as good as we possibly can, but the system has to be fair both to the people who are legitimate claimers and fair to the taxpayer who does not want to fund people who are not legitimate claimants. The decision-maker has to employ the rules as they are written.

This is an uncorrected transcript of evidence taken in public and reported to the House. The transcript has been placed on the internet on the authority of the Committee. Neither witnesses nor Members have had the opportunity to correct the record. The transcript is not yet an approved formal record of these proceedings.