A tale of two PIP & ESA assessment companies, the DWP and their encounter with a parliamentary committee. Significant changes recommended, including recording of assessments.......
The Work and Pensions Committee has published a report which says public contract failures with assessment providers have led to a loss of trust that risks undermining the operation of the major disability benefits.
The following is a summary of the report and some of its recommendations on;
Efficient, consistent and objective?
The decision to contract out PIP and ESA assessments in the first instance was taken to introduce efficient, consistent and objective tests for benefit eligibility.
The Committee says it is hard to see how any of these aims have been met. None of the providers has ever hit the quality performance targets set for them, and many claimants experience a great deal of anxiety and other health impacts over a process that is regarded as "opaque and unfriendly" throughout. Successive evidence-based reviews done for DWP show a pervasive culture of mistrust around PIP and ESA processes, with concern about the face-to-face assessment by a health professional at its core.
So, the assessment companies have completely missed their target.
The public don't trust assessors to record the facts accurately (a polite way of saying, some assessors are not interested in the claimant and simply aren't paying attention)
On Friday last week the Committee released a report compiling some of the thousands of individual claimants' experiences of the PIP and ESA claims process - from application form to final appeal. The response to the inquiry was unprecedented - in sheer volume, by an order of magnitude - and composed of accounts that were shocking and moving, credible and consistent.
A recurrent, core theme - that claimants do not believe assessors can be trusted to record what took place during the assessment accurately - has implications far beyond the minority of claimants who directly experience poor decision making.
Recording of assessments
The case for improving trust through implementing default audio recording of assessments has been strongly made: the Committee says DWP should implement this measure for both benefits now. In the longer term, the Department should look to provide video recording for all assessments.
Failure of assessors to record information provided verbally by claimants
DWP attests that the most common reason for decisions being overturned at Appeal is that new evidence has come to light. Organisations that support claimants say this is sometimes true, but the "overwhelming reason" for revised decisions is the full consideration of pre-existing evidence.
DWP's own data shows that this "new evidence" is most often oral evidence provided by the claimant. In many cases this evidence could have been gathered at the initial assessment. The Department’s "lack of determination" in addressing this shows real weaknesses in its feedback to, and quality control over, contractors, which must be urgently addressed.
Assessor knowledge and evidence of decision making
All three contractors carry out assessments using non-specialist assessors. Without good use of expert evidence to supplement their analysis, the Department will struggle to convince sceptical claimants that the decision on their entitlement is an informed one.
The Department should introduce new requirements on contractors explicitly to indicate how they have used all additional evidence supplied. The resulting checklist should be supplied to DWP’s Decision Makers, and to claimants alongside a copy of their report.
Overall costs to taxpayer
On Monday the Press Association published a Freedom of Information response giving a breakdown of some of the wider, systemic costs of wrong decisions. The Committee has previously published a table of the cost of benefits tribunal appeals to the Ministry of Justice – MoJ itself attributes the starkly increased costs to PIP appeals and their complexity - but was surprised to learn of the existence of the figures provided to PA, which it had previously requested.
The Chair has written to Esther McVey asking for an explanation of the discrepancy ( PDF 249 KB).
How much is paid to the assessment companies?
The original contract for ESA, with Atos, was due to run from 2008 to 2015. Atos negotiated an early exit from the contract in 2014. The circumstances leading to the exit were somewhat contested. The former Minister told our predecessor Committee that the loss of public confidence in Atos meant the Department viewed an early exit as preferable, but Atos blamed the “very toxic” environment their staff had been working in and concerns about the financial viability of the contract. Maximus’s contract began in 2014. They have delivered all ESA assessments since 2015, under a new three year contract. This new contract allowed for an extension of up to two years, which has since been exercised. It now runs to early 2020. The estimated value of the contract at the outset, up to 2018, was £595 million.
The PIP contracts began in 2012, with service delivery starting from 2013. There are three separate contracts or “lots”, covering different parts of the country. Lot 2, held by Capita, covers Wales and the Midlands, comprising approximately 23% of assessments. Lots 1 and 3, held by Atos, cover the rest of England and Scotland. Like the ESA contracts, the PIP contracts were initially due to finish in 2018. They also allowed for the possibility of contract extension of up to two years. This has been exercised, and the contracts are now due to finish in mid-2019. The combined estimated original value of the PIP contracts, from 2012 to mid-2017, was £512 million.
The definition of an "acceptable" report leaves ample room for reports riddled with errors and omissions.
Despite this low bar all three contractors have failed to meet their key targets in any single period. The PIP contracts set targets for contractors to deliver fewer than 3% "Unacceptable" reports. Neither PIP contractor has met the 3% target to date in any rolling three month period. In Capita’s case, as many as 56% of reports were found to be unacceptable in recent months.
The Department's use of financial penalties to try to bring reports up to standard has not had a consistent effect. Large sums of money have been paid to contractors despite quality targets having been universally missed. The taxpayer has spent hundreds of millions of pounds more checking and defending DWP decisions based on the contractors' reports - not least in externalised feudalocity costs in the Tribunal appeal system.
Pervasive lack of trust; Rt Hon Frank Field MP, Chair of the Committee, said:
"For the majority of claimants the assessments work adequately, but a pervasive lack of trust is undermining its entire operation. In turn, this is translating into untenable human costs to claimants and financial costs to the public purse.
Government cannot, must not, fail to recognise the unprecedented response the Committee had to this inquiry, remarkable for the consistency and clarity of themes that emerged through thousands of individual accounts. No one should have any doubt the process needs urgent change.
Recording the face-to-face assessment would go so far toward increasing transparency and restoring trust it beggars belief that this is not already a routine element of the process.
The resistance from the Department to instituting this is equally bewildering. The cost of providing a record of the assessment is surely nothing compared to the benefits of restoring trust. Those benefits should include far fewer decisions going to appeal – and being overturned there - at considerable legal expense to taxpayers.
The current contracts have not made the system fairer, have not made it more transparent and have not made it more efficient. They are up for review, and market interest appears limp. The existing contractors have consistently failed to meet basic performance standards but other companies are hardly scrambling over each other to take over. The Government should be prepared to take assessments in house."
The Committee says DWP must consider whether the market is capable of delivering assessments at the required level, and of rebuilding claimant trust. If it cannot—as floundering market interest may suggest—the Department may conclude assessments are better delivered in house.
The Committee recommends that the DWP:
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