SEMA Medical Services (Hansard, 18 April 2000)

§ Mr. Pickles
To ask the Secretary of State for Social Security, pursuant to the recent survey conducted by his Department into SEMA Medical Services' doctors, concerning the following of scrutiny guidelines by doctors, how many doctors(a) were subject to the survey and (b) have been identified as needing any remedial training. [119140]

§ Mr. Bayley
Medical Policy Group audited 200 scrutiny decisions of 23 doctors from one medical centre. Twelve doctors were found to have given advice below the standard required by the Medical Services Scrutiny Guidelines and appropriate remedial training will be given.
It is important to recognise that this survey was not based on a representative sample and we shall therefore be carrying out further audit of the scrutiny process to check whether or not a wider problem exists.

§ Mr. Pickles
To ask the Secretary of State for Social Security, pursuant to the survey conducted by his Department into SEMA Medical Services' doctors, concerning incorrect awards of Incapacity Benefit, how many awards have been(a) disallowed and (b) increased. [119141]

§ Mr. Bayley
The Department's Medical Policy Group recently conducted a survey of a sample of 200 claims for Incapacity Benefit which had been subjected to scrutiny by SEMA Medical Services' doctors to determine whether medical examination of claimants should be undertaken. The survey revealed that some Medical Services doctors had not followed the new scrutiny guidelines introduced in February 1999. Had the guidelines been followed claimants in the sample who may have continued in receipt of Incapacity Benefit would have been further assessed by medical examination. It is not possible to predict the outcome of the Benefits Agency's decision-maker's determination of eligibility for Incapacity Benefit in an individual case if evidence provided in the form of an examining doctor's report had been made available.
A report of a medical examination by a Medical Services doctor is but one piece of evidence alongside other information provided by the claimant and from other sources, which may include other medical evidence from the claimant's General Practitioner, that the decision-maker will consider in determining eligibility for an award of benefit.
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As part of normal claims processing, those claimants in the sample upon whom advice was given by Medical Services' doctors to award benefit without medical examination will have their claims reassessed by strict adherence to the scrutiny guidelines and, where applicable, further evidence will be gathered.
No award from the survey sample was disallowed, although some may have been approved on insufficient evidence.

§ Mr. Pickles
To ask the Secretary of State for Social Security, pursuant to the recent survey by his Department into SEMA Medical Services' doctors, if he will list the principal failures in relation to doctors who were found not to be following scrutiny guidelines. [119138]

§ Mr. Bayley
The Department's Medical Policy Group's audit of the 200 Incapacity Benefit cases subjected to scrutiny by SEMA Medical Services' doctors highlighted three areas where Medical Services' doctors had not followed scrutiny guidanceAcceptance of the claimed level of disability with insufficient medical evidence. Inappropriate requests for further medical evidence when the case is re-referred. Inappropriate advice given on the period in time following which the claim should be reassessed.

§ Mr. Pickles
To ask the Secretary of State for Social Security if he will deposit in the Library a copy of the letter from the Benefits Agency to SEMA Group's Director of Medical Services instructing Medical Services to ensure compliance with the medical quality standards specified by his Department. [119102]

§ Mr. Bayley
A copy of the letter from the Benefits Agency to Sema Group's Director of Medical Services will not be deposited in the Library in accordance with paragraph 7 of "The Code of Practice on Access to Government Information". However, I am able to tell the hon. Member that the letter sought assurances that Medical Services would ensure compliance with the medical quality standards in the contract and take corrective action where appropriate.