Sickness and Disability Benefits: Medical Examinations (Hansard, 24 May 2000)

§ Lord Ashley of Stoke
asked Her Majesty's Government:
What deficiencies have been reported in the medical services responsible for examining claimants for sickness and disability benefits.

§ The Parliamentary Under-Secretary of State, Department of Social Security (Baroness Hollis of Heigham)
My Lords, the Social Security Select Committee recently published a report of its inquiry into Medical Services; that is, the services of the DSS. The report criticises the current service to claimants and makes recommendations for improvement in many areas. The Select Committee takes a similar approach to the Government on the measures needed to improve the quality of service provided by SEMA Medical Services.

§ Lord Ashley of Stoke
My Lords, I am grateful for that reply. Is my noble friend aware that the Select Committee was scathing about the private medical agency, the SEMA Group, which is used by the Benefits Agency to examine sick and disabled people who claim benefit? The Select Committee accused that group of imposing on sick and disabled people unacceptable delays, painful examinations, rude treatment and racial discrimination? Is my noble friend aware that, although the recommendations of the Select Committee are welcome, in my view they are wholly inadequate and the Government need to reconsider the use of these private medical agencies 764 and certainly should get rid of the SEMA Group which is responsible for so much distress to many sick and disabled people?

§ Baroness Hollis of Heigham
My Lords, the Government will publish their response to the report of the Select Committee at the end of June. My colleagues in the other place and officials are working on that response. I do not for a moment dissociate myself from some of the comments made in the report. The Government accept the criticism that some of the 3,000 part-time and sessional doctors, not so much the 250 full-time doctors who were with the original Benefits Agency Medical Service (BAMS) when it transferred over, have exhibited the behaviour described by my noble friend. It is quite clear that some doctors have been somewhat crass in their response to patients' needs. I believe that the right response to that is that advocated by the Select Committee, which is significantly to increase the training available to doctors, particularly part-time ones. After all, those doctors provide advice on about £25 billion of benefit. As a result, it is crucial that we get the most highly qualified and best trained doctors to deal with a very sensitive area of medicine. That is why the proposals made by the Select Committee in terms of improving the training of doctors, the auditing of their reports and so on are being taken seriously by government.

§ Baroness Gardner of Parkes
My Lords, I make no comment on the findings of the Select Committee. If things are wrong, they must be dealt with. Is it not very important that people who claim a disability benefit are subject to an objective assessment of their condition in order that the money goes to those in real need because of their disability and that others who are not so entitled are sorted out from the genuine?

§ Baroness Hollis of Heigham
Yes, my Lords. The criticisms that are made by people who have been examined by doctors tend to be of two kinds. One relates to the process in which the doctor's behaviour may have been quite unacceptable. There are one or two—not very many—anecdotes of racist behaviour, and certainly some cases of insensitivity. But that is different from complaints which arise on appeal where the disabled person is perhaps less disabled than he or she believes and there is dissatisfaction with the decision based on the assessment. These are two separate considerations. The first must be addressed by training, which we seek to do. As to the second, the number of disallowed claims has remained exactly the same under SEMA as under the old Benefits Agency Medical Service. Therefore, we have no reason to believe that in terms of professional judgment there has been any diminution or alteration of standards.

§ Lord Addington
My Lords, does the Minister agree that the failure to provide a minimum of five days' training for the doctors involved is one of the basic problems that is highlighted in the report? Is the Minister able to provide an update on the establishment of the diploma in medical analysis which was recommended in the report? When will that 765 become a regular part of the training of those who deal with this matter, or at least of the doctor in charge? Surely that degree of medical knowledge will remove many of the problems.

§ Baroness Hollis of Heigham
My Lords, as to the second point, I wonder whether the noble Lord refers to the newly established postgraduate diploma in disability assessment. If so, that is now up and running. I believe that 28 doctors are taking the diploma. Another seven are regarded as already qualified by virtue of the qualifications that they bring to it. The noble Lord is right that we must establish this as a proper, decent, honourable and esteemed clinical specialty alongside others, such as paediatrics, with which noble Lords will be more familiar.
As to the first point about SEMA's failure to provide the full five days' training, the noble Lord is absolutely right. SEMA has tried to increase the amount of training. We have asked for, and SEMA is providing, extra modules of training on disability and ethnic awareness, gender issues and the like. We must improve that. In addition, the Chief Medical Adviser insists that all reports from medical doctors are assessed on the basis of a 2 per cent sample. He also insists that all doctors are validated and, if necessary, revalidated in terms of their ability to practise. We take the issue of training and what both SEMA and the DSS must do very seriously. This report has shown up some of the flaws in the present system.

§ Lord Higgins
My Lords, first, I wish the noble Baroness a happy birthday. The noble Baroness will be aware that the committee suggests that because of the perceived failure of the complaints system many claimants choose to appeal rather than complain. Can the Minister give an assurance that details of the complaints procedures will be given to all applicants?

§ Baroness Hollis of Heigham
My Lords, I could not have had a nicer birthday present than this Question in the House today. I am sure that my noble friend Lord Ashley precisely tailored the Question for me. We are concerned that people should be made fully aware of their entitlement to appeal about the decision as well as about the complaints procedure. There are posters and we send out information. My honourable friend Mr Bayley has given an undertaking to look at the forms to see whether they require greater clarification on these points.

§ Lord Morris of Manchester
My Lords, naturally I warmly share in the birthday greetings extended to my noble friend. Since she did not dissociate herself from all of the findings of the Select Committee, are the Government considering any interim action in advance of a full response to the report? Meanwhile, is my noble friend aware that I am informed, by noble friends of hers and mine, that the evidence of racial discrimination is actual, not anecdotal?

§ Baroness Hollis of Heigham
My Lords, that may be right, but we do not know. The difficulty is that we do 766 not collect statistics about the ethnic background of claimants of incapacity benefit or DLA. I do not know whether or not we should collect such information, and at some stage I invite your Lordships' views on the matter. We are aware that perhaps one-fifth or one-quarter of our doctors have an ethnic community background which should make for greater sensitivity in relation to some of these matters. Having carefully read the report of the Select Committee and some follow-up evidence associated with it, my understanding is that several stories tend to be recycled. How widespread is this undeniably crass behaviour we cannot tell, but clearly just one case is unacceptable. For that reason, the training that SEMA requires doctors to undertake includes increased ethnic and disability awareness training. We hope that as a result we do not experience such complaints in future.