|©Parliamentary copyright||Prepared 11th May 2011|
Migration to ESA
Written evidence submitted by DWP
1. Starting in October 2010 and ending in spring 2014, customers who receive Incapacity Benefit, Severe Disablement Allowance and Income Support paid on the grounds of illness or disability will be assessed to see if they qualify for Employment and Support Allowance (ESA).
2. Approximately 1.5 million people will be reassessed. Reassessment commenced in October 2010 with a trial in the Aberdeen and Burnley areas. At the end of February, the Department began a limited introductory phase reassessing 1,000 cases a week. Full national reassessment began in April 2010. Jobcentre Plus has redeployed around 1,200 extra staff to handle the reassessment of these cases. Around 16,700 personal advisers will also be trained to deal with reassessment customers.
3. The Government will ensure that the transition runs smoothly for all customers. For those who transfer to ESA the Department will ensure that benefit payments are not disrupted. No one moving from their existing benefits to ESA will see a reduction in the level of their benefit entitlement at the point of change.
4. Other important changes are being introduced alongside the reassessment exercise that will ensure the necessary support is available to incapacity benefits customers both during and after the reassessment process: delivery of changes from Professor Harrington’s independent review of the WCA and the introduction of the new Work Programme arrangements are being dovetailed with reassessment, to optimise the experience for customers, the quality of decision making and therefore delivery of the overall policy objectives.
Background to the reassessment
5. The Department introduced ESA for new customers with a health condition or disability from 27 October 2008.
6. ‘The Coalition: our programme for government’ published on 20 May 2010 committed to reassessing people on incapacity benefits for potential entitlement to ESA between 2010 and 2014. Further detail was provided in Written Ministerial Statements on 29 June 2010 and 25 January 2011. A summary of key facts about the reassessment is included at Annex A.
7. The Employment and Support Allowance (Transitional Provisions, Housing Benefit and Council Tax Benefit) (Existing Awards) (No.2) Regulations 2010 (SI 2010/ 1907), were laid before Parliament on 29 March 2010. They came into force on 1 October 2010 and provide the legal basis for reassessment.
The case for change
8. There are over 2.5 million people on incapacity benefits  and Employment and Support Allowance. This is some 7 per cent of the working age population at a cost to the taxpayer of around £13 billion a year. The Government recognises that many of these people, with the right support, could and indeed do want to work, but the current system does not give them that opportunity.
9. For someone on incapacity benefits it may have been some considerable time since they last spoke to anyone at the Department about their condition or their work options. People have been left on their own with no support or sense of when and how they might get back to work. The Government believes this is not right and that radical reform is needed.
10. The Government will bring people into the Work Programme which will offer targeted, personalised help for those who need it most, when they need it. Supporting families back to work is the only way to break the cycle of inter-generational poverty.
Implementing the change
11. Approximately 1.5 million people will be reassessed by April 2014. This represents a significant challenge for Jobcentre Plus and its partners. Around 1,200 Jobcentre Plus staff have been redeployed to handle the reassessment. Atos Healthcare, the Department’s medical services contractor, is recruiting over 100 additional healthcare professionals to support reassessment.
12. The Government recognises that the timescale for delivery of this change is challenging, but it is important that customers are provided with employment support as quickly as possible.
13. To support staff in delivering this change the Department has produced extensive guidance. A comprehensive programme of learning has also been developed. Overall, the following approximate numbers of staff will be trained :
· 900 staff engaged in processing activities in Benefit Processing Centres;
· 260 staff engaged in telephony activities in contact centres; and
· 16,700 staff in Jobcentres – including advisers involved in back to work activities.
14. The implementation of reassessment is being carefully managed. Rigorous project disciplines, including comprehensive and integrated planning and the management of risk have been adopted. External assurance has been applied throughout the lifetime of the project, including two independent Gateway reviews by the Office of Government Commerce.
Continuous improvement and evaluating the change
15. The r eassessment has been informed by learning from the current ESA experience, best practice within the Department and research with customers.
16. Before reassessment commenced the Department commissioned insight research, including a survey of 2,000 current incapacity benefits customers. This research examined customers’ attitudes towards work, their levels of skills and their preferred methods of communication. The results were used to inform customer communication strategies and Jobcentre Plus staff training.
17. The Department also trialled the reassessment process. This began in October 2010 and involved 1,700 customers in the Jobcentre Plus–led Pathways Districts supported by Burnley and Aberdeen Benefit Centres. 850 customers were selected from each Benefit Centre. The trial was designed to provide early indicators about customer and staff reactions to the reassessment process, evaluate whether the communications were effective and to provide recommendations on how the process could be improved.
THE CUSTOMER JOURNEY
Designing the customer journey
18. The reassessment process, or ‘customer journey’, was designed based on learning from the implementation of Employment and Support Allowance. Feedback from ESA revealed that some customers found it difficult to understand the end-to-end claim process because they were unsure of where they were in the journey and what to expect next.
19. In response Jobcentre Plus have added additional points of contact with the customer. Specifically a telephone call is made to the customer after they have been notified that they are having their benefit reassessed and an additional call is made to discuss the decision about their benefit entitlement. Simplifying the journey for customers in this way allows Jobcentre Plus to:
· identify any additional needs a customer may have, such as the need for an interpreter or other reasonable adjustments;
· provide further information to the customer at each step;
· provide the customer with more opportunities to ask questions;
· explain what will happen next so that the customer knows exactly where they are in the journey; and
· improve the decision making process by providing an opportunity for customers, who may be disallowed, to provide additional evidence in support of their claim.
20. Reassessment also builds in many of the recommendations of the recent review of the Work Capability Assessment (WCA) undertaken by Professor Malcolm Harrington  , including additional telephone contact with customers, and giving customers a chance to discuss the decision in their claim with a decision maker.
The reassessment customer journey
21. A diagram of the customer journey is included at Annex B.
22. Customers are first informed that their benefit is being reassessed when Jobcentre Plus sends them a written notification. Within two weeks of sending this notification, Jobcentre Plus telephones the customer. The member of staff will check that the customer has received the letter, that they understand the action they need to take, and find out if they need any extra help.
The medical questionnaire and WCA
23. Customers will then be sent a limited capability for work questionnaire (ESA50) by Atos Healthcare to complete and return. The customer is asked to provide as much detail as possible on this form about their medical condition and how it affects them. In order to improve this part of the process, the Department has amended the ESA50 to encourage customers to send any relevant, additional, medical evidence when they return the form.
24. Upon receipt of the ESA50 at Atos, a healthcare professional will review the questionnaire and any other medical evidence supplied to decide if the customer needs to attend a face-to-face assessment. If necessary, the healthcare professional can request further medical evidence from a customer’s GP or other professionals.
25. If Atos are able to conclude that a customer satisfies the conditions for the Support Group or Work Related Activity Group (WRAG) on the basis of paper evidence, for example if the customer is terminally ill or is very seriously disabled, they can return the case to Jobcentre Plus with a recommendation without inviting the customer to a face-to-face assessment.
26. If a customer is asked to attend a face-to-face WCA, Atos Healthcare will telephone them to arrange an appointment. A healthcare professional, employed by Atos, will produce an independent medical assessment based on how the customer’s condition affects them. The assessment is a functional assessment which focuses not on diagnosing an individual’s condition but on the effects the condition has on that individual. This report is sent to Jobcentre Plus.
27. Using the information from the questionnaire, the face-to-face assessment and any other evidence provided, a Jobcentre Plus decision maker will decide if the person’s existing award qualifies for conversion to ESA and, if so , whether they qualify for the Support G roup or the WRAG .
If a customer qualifies for ESA
28. If a customer’s qualifies for ESA, Jobcentre Plus will telephone them to inform them of the decision, whether they are in the Support Group or WRAG, and what they need to do next, before putting the customer’s benefit into payment. They will be sent a letter to confirm the decision.
29. Customers placed in the WRAG will be told during this call that they will be invited to a work-focused interview at a Jobcentre. At this interview they will be able to discuss any support they will need to return to work.
If a customer does not qualify for ESA
30. If, on reviewing the evidence, the Jobcentre Plus decision maker believes the customer is likely to be disallowed, they will telephone the customer and explain why they believe the customer may not be entitled to ESA and the evidence they have used to reach this conclusion.
31. If the customer queries the decision and has additional evidence which may alter the decision, this call provides an opportunity for the customer to bring further evidence forward. They will then be given 14 days to send in this evidence before a final decision is made.
32. If the decision maker decides the award does not qualify for conversion to ESA they will then discuss with the customer their benefit options. If a disallowed customer wishes to claim Jobseeker’s Allowance (JSA), they will be transferred straight to someone who will take their claim details. This will help to ensure that customers who claim another benefit do not have a break in their payments.
33. Following a disallowance, benefit will not stop immediately. The date a customer’s payment stops will be at least two weeks after the decision has made. This will provide time for a new benefit claim to be processed and put into payment.
34. Disallowed customers will be sent a letter to confirm the decision.
If a customer thinks the decision is wrong
35. When telephoning or writing about a decision, Jobcentre Plus will also advise people what to do if they think the decision is wrong. If a customer decides to appeal against a decision their case will be automatically reconsidered, before the case is sent to Her Majesty’s Court and Tribunals Service.  A decision maker will call the customer to see if they have any additional information to inform this reconsideration.
Support for vulnerable customers
36. Customers with health conditions that may affect their ability to comply will not be disadvantaged. If someone who is known to have a mental health condition or a learning disability fails to return the ESA50 or attend a face-to-face WCA their case will not be closed immediately. The Department will make every effort to gather the information necessary to process it, including undertaking safeguarding visits to the customer’s home if necessary.
37. During the initial telephone call to the customer, Jobcentre Plus will ask if the customer has any additional needs and will endeavour to meet any reasonable adjustment request.
38. Not receiving the telephone calls from Jobcentre Plus does not stop the journey moving forwards. Where a customer is unable to use the telephone they can request contact is delivered face-to-face. Customers can also contact Jobcentre Plus via a textphone/texbox and the Royal National Institute for the Deaf (RNID) typetalk service. Large print forms are available for people with visual impairments. Jobcentre Plus also supports customers’ right to be accompanied by a representative.
COMMUNICATIONS WITH CUSTOMERS
39. The primary channels of communication with customers are the telephone calls and written notifications delivered by Jobcentre Plus and Atos Healthcare. Comprehensive information has also been made available for customers on the DirectGov website.
Involvement and best practice
40. Reassessment notifications and forms were developed with involvement from the Social Security Advisory Committee, Cu stomer Representative Groups and the Department’s psychologist s . For example, at the request of Citizen’s Advice, the initial notification and disallowance notifications highlight to customers that they can seek additional support from welfare rights organisations.
41. Jobcentre Plus ha s worked with the Department ’s T ransforming L etters P roject, in conjunction with Reading University , to ensure that the letters are in plain English.
42. Members of the Jobcentre Plus Customer Representative Group Forum were given the opportunity to comment on the customer information published on the Government’s DirectGov website. As part of focus groups in the Aberdeen and Burnley trial areas, customer representative groups were also asked to evaluate this content.
Results and l earning from the re assessment t rial
43. The trial demonstrated that the customer journey and customer communications are working well. The customer journey has been shown to be viable, with staff and customers reacting positively to the additional customer interventions. There was little adverse customer reaction and low levels of active non-compliance. Enquiries by telephone and in person have been much lower than expected, suggesting that the communications provided to customers have effectively provided for their needs.
44. Management information gathered during the trial suggests that the additional customer contact has improved compliance with the reassessment process. 13% of customers contacted the Department after receiving their initial notification to correct their contact details. 68% of initial outbound phone calls were successful. Finally, only 14% of customers failed to return their ESA50 medical questionnaire and 9% failed to attend their WCA. This compares favourably with the experience of new claims to ESA.
Improvements from the trial
45. The trial evaluation identified some specific recommendations to improve the customer journey and communications, which are being implemented. These improvements include:
· The language used when customers are informed they have been placed in the WRAG has been clarified as some customers were unsure about what was expected of them.
· Decision makers have been given the flexibility to arrange a break of up to 72 hours in the outbound call to disallowed customers, if necessary. This was introduced because the research showed that customers were sometimes unable to engage with this phone call because they needed time to take in the fact they were being disallowed ESA.
· Atos Healthcare is addressing feedback by some customers that the face-to-face WCA felt impersonal through its soft skills training which is already taking account of feedback from the customer satisfaction survey, analysis of complaints trends and the Harrington Review.
Further testing and assurance
46. Staff guidance, learning and development and supporting IT have been evaluated through model office testing, which replicated the conditions in a real, live office environment. Jobcentre Plus operational staff have also been involved throughout the development and testing of supporting IT and business processes. This has taken many forms, including the embedding of operational staff within the project development teams to add technical expertise and assurance at source. These arrangements have identified improvements and confirmed that all products are fit for purpose for national reassessment.
Communications with external stakeholders
47. As well as communicating directly with customers the Department also recognised that customers currently in receipt of incapacity benefits may be vulnerable, may not have had contact with the Department for a considerable period of time and may look to third sector organisations for support. A comprehensive communications strategy for external stakeholders was therefore developed. This involved:
· meetings with representatives of national external stakeholders in July 2010 and again in March 2011, alongside regular updates to stakeholders at the quarterly Jobcentre Plus Customer Representative Group Forum;
· local liaison between Jobcentre Plus District External Relations teams and third sector organisations. As part of this activity External Relations Teams were asked to liaise with Primary Care Trusts, local authorities and relevant disability charities; and
· a series of communications products for external stakeholders, developed with input from key stakeholder groups, hosted on the Department’s Adviser website. 
WORK CAPABILITY ASSESSMENT
48. The Work Capability Assessment (WCA) was introduced in October 2008 to assess entitlement to Employment and Support Allowance.
49. The WCA is based on the principle that a health condition or disability should not automatically be regarded as a barrier to work, that there is a large body of evidence which shows that work is good for physical and mental well-being and can be beneficial for individuals with health conditions and disabilities, and that being out of work can contribute to poorer health and other negative outcomes.
50. The WCA is an independent functional assessment which focuses on the overall effects of a condition or impairment on the individual. This is different from assessments by GPs or other healthcare professionals where the emphasis is on specific diagnosis and condition management, and the healthcare professional takes an advocate role for their patient. Thus as an independent assessment the WCA can help better determine an individual's readiness for work. Other supporting evidence is considered alongside the WCA, where appropriate, to get the fullest picture.
51. To determine how an individual is affected by their condition or impairment, the WCA looks at a range of different activities related to physical, mental, cognitive and intellectual functions. It also assesses certain additional criteria that do not directly measure function (such as terminal illness) to determine capability for work.
52. The WCA also takes account of conditions that fluctuate. If a customer is unable to complete an activity repeatedly, reliably and safely, then they are considered unable to complete it at all.
Development of the WCA
53. The WCA was developed by technical experts and medical specialists, in consultation with specialist disability groups. It sought to take account of the demands of the modern workplace, developments in medicine and our understanding of disability.
54. The Welfare Reform Act 2007 legislated for the introduction of the WCA. Chapter 5, Part I, sections 8 and 9 outline the structure of the assessment, establishing that individuals will be assessed for benefit entitlement on the basis of their Limited Capability for Work (LCW), and for membership of the Support Group on the basis of Limited Capability for Work Related Activity (LCWRA).
55. Enshrined in this legislation was the need to monitor and update the assessment in the light of new experience. A number of reviews have examined the WCA and made recommendations for improvements, which are now being implemented.
The Department-led review of the WCA
56. In March 2010 the Department published an internal review of the WCA. This was undertaken with significant input from technical experts and specialist disability groups. It focused on the technical descriptors and made recommendations for improvements. These changes came into force through regulations on 28 March 2011.
57. Recognising ongoing concerns of specialist disability groups, further detailed work was undertaken. The outcome of this was published as an addendum to the report. These changes are fully reflected in the final legislation.
58. The changes ensure the assessment makes greater provision for individuals awaiting or in between courses of chemotherapy, individuals receiving residential treatment for drug or alcohol misuse and those with severe mental health conditions or communication difficulties. They also ensure the assessment takes greater account of how an individual has adapted to their condition.
59. The Department modelled the impact of these changes using data from almost 60,000 assessments. From this analysis the number of new claimants put in the Support Group, specifically those who are awaiting or between courses of chemotherapy, and some whose limited capability relates to certain mental function and communication difficulties, is expected to increase.
60. By accounting for adaptation, the number of new claimants being found fit for work is also expected to increase by around 5%. This will affect individuals who are well-adapted to their condition and will benefit from the support available on Jobseeker’s Allowance. For individuals with mental health and cognitive conditions a slight increase in the number in the Support Group and broadly no change to the numbers in the Work Related Activity Group are expected.
The Harrington Review
61. In November 2010, Professor Malcolm Harrington published his Independent Review of the Work Capability Assessment, the first of five annual Independent Reviews. The review examined the end-to-end process for the assessment, including the Atos assessment, the decision making process and the appeals process. It found the WCA is the right assessment but it is not working as well as it should. As a result he made a series of practical recommendations for improving the WCA, which the Government has committed to implementing as quickly as possible.
62. As a result, the Department is:
· empowering Jobcentre Plus decision makers to make the right decision. They are being given clear responsibility for the decisions they make and the support they need to ensure those decisions are independent and considered;
· ensuring individuals are treated with compassion by clearly explaining everything to them, helping them fully understand the process they will go through, and ensuring they know they can provide additional evidence for consideration at any time;
· improving the transparency of the face-to-face assessment by running a pilot to look at audio recording assessments; and
· accounting for the particular difficulties in assessing mental health conditions by supporting Atos to create and use mental health champions.
63. Many of the recommendations are already in place and the remainder of those that the Department is responsible for will be in place by this summer. A high level timeline for the remainder includes the following milestones:
· a review of the ESA customer journey, to include additional interventions supporting customers throughout their benefit journey. This will be tested from June 2011, prior to national rollout from October 2011; and
· the introduction of a plain English Personalised Summary Statement of a customer’s medical assessment from June 2011, copied to disallowed customers from the end of September 2011.
64. Professor Harrington has been reappointed to take forward the second annual review of the WCA, continuing the process of improvement. As part of this, he will look in more detail at the assessment of mental health and other fluctuating conditions and provide any recommendations as appropriate.
The role of Atos Healthcare
65. Atos Healthcare provides independent medical assessments on behalf of the Department for Work and Pensions. The Departmental decision maker makes a decision on benefits entitlement using this advice as well as other equally important sources of information. The result of the assessment has no bearing on Atos Healthcare targets or remuneration.
66. Atos Healthcare is responsible for:
· recruitment and training of healthcare professionals - doctors, nurses and physiotherapists;
· managing the assessment centres;
· scheduling appointments via its contact centre;
· conducting medical assessments developed by the Department that are designed to see what people can do; they are not the same as an examination carried out by a doctor or consultant which is designed to diagnose a medical condition; and
· providing an independent medical report to decision makers in the Department.
67. An overview of the Atos Healthcare process for ESA is included at Annex C.
Each assessment looks at how the customer’s health condition affects their ability to do everyday tasks, so is not the same for everyone. The average time taken for an assessment is around forty five minutes, calculated from over five hundred thousand assessments completed each year.
69. The assessment is largely ‘non touch’. The physical aspects of the assessment are different from that used for diagnostic/treatment purposes and rely largely on ‘active movements’ (that is, movements carried out under the direction of, but without the physical intervention of, the assessing healthcare professional. This is as opposed to the ‘passive movement’ examination often carried out in the diagnostic setting (where the examiner will move the joints without the customer having to do anything). The level of the physical assessment is determined by the claimed medical conditions i.e. asthma (a peak flow would be taken), hypertension (blood pressure would be taken).
70. During the assessment, the healthcare professional refers to a computer programme to complete the assessment and captures information given by the customer in real time. The programme, called LiMA (Logic-integrated Medical Assessment), was developed to improve and ensure consistency and quality of the reports. It is an evidence-based computer programme that includes medical protocols and incorporates the latest clinical research on mental health, musculo-skeletal and cardio-respiratory conditions. It serves as a guide only and the healthcare professionals are required to use their own clinical judgement to justify the medical opinion contained on the medical report.
71. Atos Healthcare professionals are expected to be mindful of the fact that many illnesses produce symptoms that vary in intensity over time and are instructed not to base their opinion solely on the situation as observed at the medical assessment. Part of the training for healthcare professionals involves the effects of variable conditions on daily life. The aim is to make sure that the assessing healthcare professional provides sufficient information on the pattern of variability for the decision maker.
Training for Atos Healthcare staff
72. All doctors working for Atos Healthcare must be registered with the General Medical Council, all nurses with the Nursing and Midwifery Council and all physiotherapists with the Health Professions Council. There are about 1,400 doctors, nurses and physiotherapists working to deliver the contract.
73. All healthcare professionals must have three years broad-based clinical post-registration experience and achieve approval (post training) from the Department for Work and Pensions Chief Medical Adviser in the appropriate benefit. All doctors, nurses and physiotherapists are provided with comprehensive training in disability analysis. For the WCA this includes an eight day course for all doctors and a seventeen day course for nurses and physiotherapists, which is accredited by the University of Derby.
74. To provide consistent, high quality, independent medical assessments to the Department, Atos Healthcare has put in place:
· a rigorous selection process to recruit the best medical and non-medical staff – less than 15% of applicants who apply are successful;
· comprehensive training in disability assessment on joining for all doctors, nurses and physiotherapists plus on-going training to ensure skills and knowledge are up to date;
· a continual programme of internal and external audits to ensure high standards in medical assessments and reports are maintained; and
· strong performance management governance to enable high performance of all staff and to support their career development.
75. Training of healthcare professionals consists of three distinct areas:
· generic training - includes principles of disability analysis, professional standards (including manner & behaviour) and multi-cultural awareness;
· training to undertake benefit-specific assessments - includes learning path approach for ESA and other benefits, assessments, modular training with competency testing at each stage and approval process; and
· scrutiny / file work training - includes provision of advice to the decision maker when appropriate on the basis of available documentation within a customer’s file, theory and casework exercises followed by supported individual casework.
76. Following the WCA training course, healthcare professionals will complete assessments under the supervision of an experienced trainer. Only when they are deemed to have achieved competency will they progress to unsupervised assessments. Every assessment is audited until they produce four consecutive A grade reports. Once this has happened they will be referred to the Chief Medical Adviser for approval on behalf of the Secretary of State.
77. Atos Healthcare has a strong Continuing Medical Education programme. Healthcare professionals receive training in response to changes in legislation, changes resulting from decisions made by the Upper Tribunal, and alterations in procedure. Atos Healthcare regularly updates healthcare professionals on current best practice, often in response to issues that have been identified as causing difficulty to the decision maker or customer. The data derived from Atos Healthcare’s auditing processes is used extensively as a source of information to assist it to determine the content and priorities for the Continuing Medical Education programme.
78. Training in medical topics is based on up to date, critically evaluated published research and, wherever possible, is evidence-based. Different training media are employed according to circumstances. These range from formal trainer-led sessions to the issue of bulletins and guidance notes or the use of video. The trainer-led sessions are designed to promote participation by trainees by including inter-active elements and case examples. In 2010 a National Training Event was held for all employed healthcare professionals in preparation for reassessment. Expert independent speakers presented on a range of topics such as Cognitive Impairment, Chronic Pain, Fatigue and Post Traumatic Stress Disorder. All training that takes place is recorded in the individual healthcare professional’s record.
79. Quality monitoring is carried out by both Atos Healthcare and the Department. This includes regular audit of reports by accredited auditors and the monitoring of complaints. Atos Healthcare aims to audit every healthcare professional every six months.
80. Management information is provided to the Department on a regular basis. If the Department has any concerns in relation to an individual healthcare professional, Atos will investigate further and subsequent action will be taken in consultation with the Department.
81. Doctors working for the Department and experienced auditors from within Atos Healthcare carry out a regular programme of joint audit in order to ensure the quality of audit at individual units is maintained.
82. If any individual healthcare professional’s work is found to be deficient, he or she is contacted by a mentor. The mentor will arrange for retraining if necessary, or feedback face-to-face, by letter or telephone call depending upon the issue raised.
83. Targeted audit is used when a problem has been identified with a particular healthcare professional, as a result of random audit, a complaint, rework, or as a chance finding. It involves consideration of a number of reports by the healthcare professional to gauge the overall standard of their work. Persistent failure, despite remedial action by Atos Healthcare, to meet a satisfactory standard may result in revocation of approval to carry out medical assessments by the Department’s Chief Medical Adviser.
84. Medical reports that are audited are rated with an A, B or C grade to enable appropriate feedback, mentoring and retraining as necessary. Up to 20,000 national audits were randomly undertaken in the last twelve month period. Atos Healthcare has a target to achieve 95% reports rated A or B. In the past twelve months its achievement has been consistently above 95%. Medical and Clinical Directors participate in the Atos Healthcare Clinical Governance Forum where all aspects of their clinical practice and standards are reviewed regularly.
85. The Department’s Commercial Management Team undertakes continuous monitoring of Atos Healthcare’s performance. Information is gathered from various sources including customer surveys, mystery shopping activity, and information from complaints. Other sources of information include reports which Atos Healthcare is mandated to supply to the Commercial Management Team, and various checks are undertaken to ensure that the reports are accurate. The Team also has access to staff working at the Department for Work and Pensions local offices who report issues when they arise.
Contract and buildings
86. The services are delivered from 123 permanent assessment locations and 25 casual hire sites. Of the permanent sites, 20 are directly leased by Atos Healthcare to deliver the contract and 103 are located within government buildings. The majority of these are Jobcentre Plus offices.
87. The majority of assessment centres are located on the ground floor. There are 31 locations that are not located on the ground floor. For these locations, prior to a customer being called to an assessment, efforts are made to identify customers who may have problems in evacuating via the stairs during an emergency. These customers are either offered an assessment at the nearest ground floor centre or a home visit. Inevitably however, some customers in this category are not identified and still attend the centre.
88. In four of the sites, that difficulty has been overcome by acquiring the use of a ground floor room in the building that can be used on an ad hoc basis for customers who arrive at the locations and who would not be able to safely exit the building in the event of an emergency evacuation.
Atos Healthcare is exploring a range of measures to improve service to these customers including:
· improving communications when scheduling of the appointment over the telephone;
· improving appointment documentation; and
· the use of Personal Emergency Evacuation Plans with increased on site support with a ‘buddy system’.
90. Atos Healthcare uses an independent market research company to survey over 31,000 customers each year. Customers are selected at random and include those who failed to attend an assessment. Customers are informed their replies are anonymous and their identity will not be shared with Atos Healthcare. Questions asked of the customer focus on six key areas:
· scheduling of the appointment over the telephone;
· appointment letter information;
· queries made by the customer;
· how polite, helpful and knowledgeable the receptionist at the assessment centre is;
· the facilities in the assessment centre; and
· how courteous, professional, gentle and unhurried the healthcare professional is.
91. For 2010, Atos Healthcare’s overall satisfaction rating was 88.6%. The professionalism and approach of Atos’ healthcare professionals is often in excess of 90%.
92. Atos Healthcare analyses the results and comments on the surveys at an individual Assessment Centre level. It ensures that appropriate action is taken to rectify problems with accommodation, administration or staff.
93. Nationally, Atos Healthcare has instigated a number of activities to ensure levels of customer satisfaction are improved. These include additional enhanced customer service training for staff at the Virtual Contact Centre, for assessment centre receptionists and healthcare professionals.
94. As part of the implementation of the recommendations of the Harrington review, Atos Healthcare has recently launched a Customer Charter which explains to customers what to expect during an assessment and what their responsibilities are.
Atos Healthcare complaints
95. Atos Healthcare has a three-tier complaints process agreed with the Department. All customers are informed about how to make a complaint. All issues of dissatisfaction are investigated and following the investigation, the appropriate remedial action is always taken.
96. Complaints about the manner or approach of healthcare professionals are very low at approximately 0.14% of all assessments.
97. The decision-making process starts when the decision maker in Jobcentre Plus considers information from the ESA50 questionnaire, the WCA and any other relevant evidence provided. Where there is a discrepancy in the medical evidence, the decision maker can seek advice from Atos Healthcare, our medical services provider, or ask the customer for clarification.
98. The decision maker assesses this information and, following any discussion with the customer, decides whether or not the customer is entitled to ESA. The decision maker issues a decision notice informing the customer of the outcome and whether or not they are entitled to ESA. If benefit is awarded, the notice specifies the amount of benefit and the date from which it is paid, and informs customers whether they will be placed in the Work Related Activity Group or the Support Group.
99. The decision notice advises the customer on what they can do if they are not satisfied with the decision, and informs them of their right to appeal to an independent tribunal. The decision notice informs customers that they can ask for leaflet GL24, If you think our decision is wrong, which provides a detailed explanation of the decision-making and appeals process.
100. The decision notice invites customers to get in touch with Jobcentre Plus by telephone or in writing, within one month of the date of the letter. The customer can do any or all of the following:
· ask for an explanation;
· ask for a written statement of the reasons for the decision;
· ask for the decision to be looked at again to see if it can be changed, pointing out that there may be some facts they think have been overlooked, or that they may have more information which affects the decision; and
· appeal against the decision.
Improvements to decision making
101. Jobcentre Plus has recently made improvements to the decision making process. Since 13 December 2010 arrangements have been made for Atos Health c are p ractitioner advice to be provided to ESA decision makers . 33 Benefit Centres now benefit from a weekly on site visit by a h ealth c are p ractitioner. This enables decision makers to discuss complex cases and to raise questions relating to the WCA report before deciding a case, or if an appeal has been received, to seek advice on the issues raised by the custome r as part of their appeal. The h ealth c are p ractitioners can provide advice to decision makers at other Benefit Centres that do not have someone from Atos on site.
102. Since September 2010 the Jobcentre Plus Director of Benefit Centres has regularly hosted a conference telephone call with decision makers to share information and views on issues relating to decision making and appeals. The call allows decision makers to hear directly about initiatives to improve quality and effectiveness . It also provides an opportunity for decision makers to ask questions and offer their thoughts and comments on decision making and appeals related topics. A recording is made available after the call to ensure all decision makers have had the opportunity to hear it. All questions and answers are published internally for future reference , to extend knowledge and spread best practice.
103. Jobcentre Plus has developed a new learning and development package for all decision makers. The learning focuses on equipping decision makers with the skills and knowledge required to make good quality decisions on a consistent basis.
104. The training emphasises the role of the decision maker in the process and, in so doing, implements one of the key findings from Professor Harrington’s review of the WCA. It builds on the lessons learnt from the Aberdeen and Burnley trials. The content centres on: understanding the Limited Capability for Work Assessment, raising awareness of the WCA descriptors, facilitated by Atos Healthcare practitioners, and gathering and using evidence effectively. It also equips decision makers with the skills for communicating their decisions by phone with customers.
The reconsideration process
105. If a customer is not satisfied with a decision, they can ask for an explanation and for the decision to be reconsidered. If a customer appeals this will also trigger the reconsideration process, as the Department aims to put decisions right at the earliest opportunity. A decision maker will telephone the customer to see if there is any additional evidence the customer wishes to be taken into account, re-examine the original decision in the light of the customer’s representations or additional evidence, and decide if the decision should be changed; legally this is known as a revision. If the decision is changed, the customer has the right of appeal against the new decision. If an appealed decision is revised in favour of the customer, the appeal will lapse and action is discontinued.
Improvements to the reconsideration process for ESA
106. Her Majesty’s Courts and Tribunals Service is an executive agency of the Ministry of Justice and its responsibilities include administration of the First-tier Tribunal. The Department and the Ministry of Justice have been working together to improve the appeals handling process, including the reconsideration stage. During 2009-2010 there were three joint Lean  exercises to review the end-to-end appeals process, including one between Jobcentre Plus and the former Tribunals Service that focussed on ESA appeals.
107. Jobcentre Plus conducted a pilot at Wrexham following the joint Lean exercises with the Tribunals Service on the appeals process for ESA and Income Support. Following this, Jobcentre Plus implemented a new approach to have one person conducting both the reconsideration and preparation of the appeal response on an individual case, which has reduced the need for two people to look at a case in detail. This was fully rolled out nationally for all benefits by 1 November 2010.  The new approach also involves direct telephone contact with ESA customers, to explain how the decision has been arrived at and to identify any other information that may be relevant to the decision. This telephone contact has been built into the incapacity benefits reassessment process.
108. An exercise was also carried out to apply this more robust reconsideration process to over 55,000 appeals that had already been sent to the Tribunals Service, but not yet heard. This took the form of seven teams of decision makers deployed on Tribunals Service premises carrying out a systematic review of live appeals and revising decisions if appropriate. Ultimately the objective of the exercise was to prevent appellants needlessly attending Tribunal hearings. The work was completed at the end of March 2011 and saw approximately 7,000 decisions revised, removing the associated appeals from the Tribunals Service workload.
109. Customers are informed of their appeal rights by the decision notice, which explains what needs to be done and within what time. However, the Department encourages customers to seek explanations for decisions before appealing. Where a customer feels that the decision is wrong, the Department will look at it again, so that any favourable change can be made as soon as possible. Where the Department does not change the decision, the customer has the right of appeal.
110. The Department produces an appeal response that gives a full explanation of how the decision was reached, including copies of all the evidence used to reach the decision. The response sets out the relevant law, case law, evidence and argument in support of the decision under appeal and stands alone as the Department’s case. The appeal response is copied to the customer at the same time as the case is referred to the Her Majesty’s Courts and Tribunals Service, well in advance of the hearing.
111. The First-tier Tribunals are administered by the Ministry of Justice’s Her Majesty’s Courts and Tribunals Service, and are independent of the Department. An appeal can be decided at an oral hearing or the customer can ask the Tribunal to make a decision on the papers only.
112. The Tribunal will consider the appeal and the evidence submitted by the customer and the Secretary of State, as well as taking oral evidence at a hearing. The Tribunal will then consider the evidence and issue its decision. Both the customer and the Secretary of State have the right of appeal, with permission, on a point of law only, to the Upper Tribunal. Further rights of appeal lie with the higher appellate courts.
Support for customers during the appeal process
113. The Department publishes leaflet GL24 If you think our decision is wrong which contains the form that can be used to make an appeal. The leaflet explains how the appeals process works and provides advice on the type of organisations who may provide free assistance in preparing for a tribunal hearing. This information is also available on the Directgov website, together with links to the website for Her Majesty’s Courts and Tribunals Service.
114. On receipt of the appeal response, Her Majesty’s Courts and Tribunals Service assumes responsibility for handling the appeal and providing support for the appellant. They will contact the appellant and provide further information about the hearing.
115. The Department sends a Presenting Officer to a hearing if the appeal is complex or where directed to attend by the Tribunal. If the Presenting Officer attends, he or she will make points in favour of the customer where appropriate, as part of their role.
Time taken for the appeal process
116. There is currently no single system that records the average length of time taken for appeals to be processed from initial lodgement at the Department until receipt at Her Majesty’s Courts and Tribunals Service and final clearance of the appeal. Information is only held on those cases which proceed to the Tribunal. Therefore, customers who abandon their appeal, fail to provide evidence or withdraw their original appeal, are not recorded. Her Majesty’s Courts and Tribunals Service data indicates that for ESA, on average, it takes 9.2 weeks between an appeal being notified to the Department and submission of papers to the Tribunal.
117. Her Majesty’s Courts and Tribunals Service records all appeals received within the Social Security and Child Support (SSCS) jurisdiction of the First-tier Tribunal and has a published performance indicator which measures the percentage of appeals where the final outcome is promulgated within sixteen weeks of receipt at SSCS.  In the period between April 2010 and the end of February 2011 the SSCS performance stood at 47%, against a target of 75%. SSCS also records the average time taken to clear or dispose of a case and as at February 2011, this average stood at 21. 8 weeks.
118. In the financial year to February 2011 the combined total of Employment Support Allowance and Incapacity Benefit (ESA/IB) cases accounted for 55% of the SSCS intake of appeals. Sizeable monthly increases have been evident since June 2009 when the monthly intake stood at 10,200 appeals. Since that time the number of appeals has generally continued to increase until August 2010, reaching a peak of 23,600 appeals for that month. Since then receipts have gone down each month until December 2010. There was a slight increase in the following two months and in February there were 18,500 ESA/IB appeals received.
119. Both the Department and the Ministry of Justice recognise the importance of reducing the time taken to process appeals which has been mainly caused by the introduction of ESA which resulted in a large number of appeals being received above original forecasts. As a result, tribunals capacity was not then in place. In 2009-2010 receipts exceeded the original autumn 2008 forecast by 82,000. For the period 1 April 2010 to 28 February 2011 receipts exceeded the original 2008 forecast by 107,000.
120. The Ministry of Justice and the Department are working together to manage the increase as part of a Task Force with Her Majesty’s Courts and Tribunals Service, Jobcentre Plus and the Pensions, Disability and Carers Service. The Task Force is working on two broad fronts. The first is to reduce the high level of appeals arising from initial decision making. The second is to increase capacity within Her Majesty’s Courts and Tribunals Service.
121. As discussed above, Jobcentre Plus is focussing its efforts on improving the quality of decision making and the reconsideration process so that cases do not unnecessarily proceed to a hearing. Her Majesty’s Courts and Tribunals Service has been concentrating on increasing its capacity through the recruitment of additional staff, judiciary and medical Tribunal Members, as well as a range of judicial and business process improvements. As a consequence Her Majesty’s Courts and Tribunals Service will, by the end of the 2010-2011 business year, have cleared a third more social security cases than in 2009-2010, and 50% more than it did in 2008-2009. It is also significant that ESA/IB disposals have generally increased month on month since June 2009, reaching the highest level of 20,100 appeals in the month of February 2011 and at three times in the last four months: November 2010, January 2011 and February 2011, the number of disposals has outstripped receipts. In December 2010 receipts outstripped disposals by 8 appeals.
THE OUTCOME OF THE REASSESSMENT PROCESS
122. The Department published interim results from the reassessment trial on 1 April 2011. These show that, as of the 2 2 March, 1,626 decisions on whether a customer’s claim qualifies for conversion to Employment and Support Allowance had been made. Of these:
· 526 individuals (32%) were not entitled to Employment and Support Allowance ;
· 484 individuals (30%) w ere placed in the Support Group; and
· 616 individuals (38%) were placed in the Work Related Activity Group .
123. Further results from the trial are being received and the Department will update the findings in due course. The Department commissioned the independent research company, IFF Research Ltd, to carry out research into the trial reassessment and the results from this research will be published in mid-May. This should provide insights into the impact of the process and the final decision on claimants.
124. The trial has run from October 2010 and the results are still coming through. Information on claimants destinations is particularly thin because it is presently too early in the process. For ESA claims the Department does not get reliable information about destinations until a few months after the decision.
The impact of the decision to time limit contribution based ESA
125. On the 20th October, the Chancellor set out the intention to introduce a time limit of one year for those claiming contributory ESA who are placed in the WRAG. This proposal will not apply to people in the support group and income-related ESA will continue to be available for the poorest. The change requires primary legislation and is included in the Welfare Reform Bill which is currently being considered in Parliament.
126. As with other contributory ESA claims, those people who have undergone the reassessment process will be affected by the time limiting proposals if they have been allocated to the WRAG. Subject to Parliamentary approval, the proposals are:
· customers in receipt of incapacity benefits who are reassessed and qualify for contributory ESA before April 2012 will have their benefit time limited, with the 12 months period running from the point of conversion. As with existing claims, the period of time already spent on contributory ESA before April 2012 will be taken into account in calculating the 1 year period; and
· those who are in receipt of incapacity benefits and are reassessed and qualify for contributory ESA after April 2012 will also receive 12 months benefit from the point of conversion.
127. No one will receive less than 12 months contributory ESA, and those who were reassessed early in the process will receive more than a years benefit entitlement by the time the change comes into effect. Introducing a time limit of a year from the individual date of conversion will ensure that reassessment cases are treated in the same way as new ESA claims.
Back to work Support for customers moving onto ESA
128. The vast majority of ESA customers who want the more intensive support offered by the Work Programme will be able to access it as soon as they are placed in the WRAG or S upport G roup. Additionally, where a healthcare p rofessional assesses that a return to work in 6 months or less is likely, the customer will be required to access the Work Programme if they receive income-related ESA . This will place these customers in the best possible position to return to work once they are well enough to do so.
129. Contributory ESA customers will be able to volunteer for the Work Programme, and if they wish, remain on the Programme after their benefit has come to an end.
130. Most ESA customers in the WRAG who do not access the Work Programme will be expected to prepare for a return to work with support from Jobcentre Plus. Those with greater disability related barriers to work may be referred to Work Choice, if mainstream support is not appropriate for them. Work Choice helps people with more severe disabilities or complex needs to prepare for work and to undertake supported employment, with the aim of progressing into unsupported employment where possible.
131. Disabled people will also have access to Residential Training College provision, which can provide intensive support and training, in particular for people with sensory impairments or very complex barriers to work. Where a disabled person moves into work, Access to Work can provide funds for support over and above that which an employer could reasonably be expected to provide.
132. Subject to the passage of secondary legislation, from June 2011 advisers will be able to require customers in the ESA WRAG, with some exceptions, to undertake work related activity to prepare for a return to work.
Back to work support for customers claiming JSA
133. Most people who make a claim for Jobseeker's Allowance are able to move off benefit relatively quickly. This reflects in part that the labour market is dynamic, with thousands of new job opportunities coming up every day, so that people who are actively looking for a job have a good chance of finding one. However, the Department recognises that former incapacity benefits claimants who choose to claim JSA may need extra support to find work compared to a typical claimant, particularly at a time when unemployment remains high following the recession.
134. Therefore, customers who move from incapacity benefits on to JSA will be able to access the Work Programme from 3 months into their claim, recognising the additional challenges that may be faced by jobseekers that have been away from the labour market for a long time. They will receive personalised support from Jobcentre Plus before their Work Programme referral.
135. Customers on JSA must actively seek work and be available for work. However, the requirement may be tailored to individual circumstances. For example, an adviser may agree with a customer that he or she can limit his or her availability for work to a certain number of hours, in light of a health condition or caring responsibilities.
The Work Programme offer
136. For customers entering the Work Programme, the Government is clear that providers are best placed to know what works for customers and as such the Government will not specify what providers should deliver. This means that the exact nature of the support provided will vary from provider to provider, and from customer to customer.
137. However, all bidders for Work Programme contracts have been asked to provide a summary in their tender of the minimum service they will offer to all customer groups. These promised service levels will be made public so that customers and their representatives will be able to judge whether providers are delivering what they have promised.
138. All customers will be attached to the Work Programme for two years, or until the provider has received all the sustainment payments that they are able to, as a result of the customer spending a sustained period in work. During this period the customer will remain attached to the programme whether they are in work or not, incentivising providers to help customers stay in, as well as find, work.
The Jobcentre Plus offer
139. Jobcentre Plus managers and advisers will have more flexibility to judge which interventions will help individual customers. Advisers will be able to refer customers to a flexible menu of activities for additional support, to complement one-to-one support from an adviser. The specific options will depend on local circumstances but are likely to include services such as job brokering, Next Steps skills training, Work Clubs, support for those seeking to move into self employment, and Service Academies. They will also be able to refer customers to external services such as those provided by the voluntary sector or health service, supported by resources from a Flexible Fund where appropriate.
TIMETABLE AND SEQUENCING OF NATIONAL REASSESSMENT
140. The reassessment exercise is scheduled to be completed by April 2014. Customers receiving Incapacity Benefit and Income Support paid on the grounds of illness or disability, previously attended Personal Capability Assessments (PCA) to determine and review their entitlement for benefit. The order in which customers will be selected for reassessment will be based upon the date on which they would otherwise have been called for their next PCA. Customers currently claiming Severe Disablement Allowance will be reassessed at the end of the reassessment process.
141. The national rollout of reassessment is being undertaken in three stages:
· On the 28 February 2011, a limited introductory phase was implemented. This involved the extension of the controlled trial conditions nationwide, with around 1,000 customers commencing their reassessment journeys every week, for five weeks.
· On the 4 April 2011 national reassessment was implemented. From this date around 7,000 customers a week are being reassessed.
· On 9 May 2011 this number will be increased to around 11,000 cases per week.
142. This steady increase in activity has been designed to ensure that Jobcentre Plus and its partners are ready for and could deal with customers effectively as the volumes built. The approach also meant that the lessons learned from the trial in Aberdeen and Burnley could be shared across all centres and progress carefully monitored. Importantly, the timetable also enabled many of the findings in the recent Professor Harrington review of the Work Capability Assessment to be put into practice.
143. The Department is committed to continually monitoring and reviewing the reassessment process. Management information is reviewed at a senior level, supported by regular and close liaison between the project and operational working teams. Plans are currently on track. Further improvements will be incorporated into the reassessment process going forward as they are identified. The Department is confident that it has the capacity to deliver the reassessment exercise to the agreed timetable.
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