3 The Work Capability Assessmentclaimants'
experience and Atos Healthcare
46. In this chapter we look at claimants' expectations
and experience of the Work Capability Assessment (WCA), and its
design and delivery. We also discuss DWP's contract with Atos
Healthcare, the private company which carries out the assessments.
Design of the process
47. The Welfare Reform Act 2007 legislated for
the introduction of the WCA as the assessment for Employment and
Support Allowance (ESA), which replaced Incapacity Benefits for
new claimants in October 2008. We have described how it works
and summarised the range of assessment outcomes in Chapter 1.
48. The assessment was developed by DWP officials,
working in consultation with experts in the field and disability
organisations.[55] As
we have described, it is an assessment of the functional effect
of an individual's health conditions and/or disabilities on their
capacity to workit is not a medical assessment of those
conditions. It also assesses the extent to which an individual's
conditions and/or impairments limit their capability to work by
focusing on everyday functional activities, both physical and
mental, cognitive and intellectual.[56]
49. The physical activities assessed include:
walking ("mobilising") (with a stick or other aid if
such aid is normally used); standing and sitting; manual dexterity;
making self understood (through speaking, writing, typing, or
other means normally used); understanding communication (by both
verbal (such as hearing or lip reading) and non-verbal (such as
reading 16 point print) means using any aid it is reasonable to
expect them to use); navigation and maintaining safety (using
a guide dog or other aid if normally used); continence; and remaining
conscious during waking moments. The mental, cognitive and intellectual
activities assessed are: learning tasks; awareness of everyday
hazards; initiating and completing personal action; coping with
change; getting about; coping with social engagement; and appropriateness
of behaviour with other people.[57]
50. The WCA assesses claimants' functional capability
against "descriptors", which describe the extent to
which the person can undertake the particular activities. Claimants
"score" up to 15 points against each descriptor if they
have limited function in the activity described. For example,
for the manual dexterity descriptor, a claimant will score 15
points if they:
(a) cannot either (i) press a button, such as a telephone
keypad or (ii) turn the pages of a book with either hand
[Or] (b) cannot pick up a £1 coin or equivalent
with either hand.
9 points will be scored if the claimant:
(c) cannot use a pen or pencil to make a meaningful
mark
[Or] (d) cannot use a suitable keyboard or mouse.[58]
If none of the limitations under each of the descriptors
applies to the claimant, they will score no points, will not qualify
for ESA and will normally be advised by Jobcentre Plus to make
a claim for JSA. A score of 15 points in any one activity qualifies
a claimant for ESA. If a claimant does not score 15 points in
any one activity, points scored in all activities are combined.
A combined score of 15 points also qualifies a claimant for ESA.[59]
51. The second part of the WCA assesses whether
claimants qualifying for ESA should be placed in the Support Group,
which is for those claimants whose conditions are considered to
affect their function so severely that an expectation to engage
in work-related activity would be unreasonable. This part of the
assessment uses 25 descriptors under 16 headings which are similar
to those described above. If a person satisfies at least one of
the descriptors they will be placed in the Support Group and will
not be mandated to begin preparing for or looking for work.[60]
Claimants' experiences of the
process
Atos call-centres
52. The first stage in the assessment process
is that the claimant receives a letter telling them that their
claim is to be reassessed as part of the IB/ESA migration. JCP
then telephones the claimant to provide any necessary advice,
and the claimant is sent the ESA50 medical questionnaire to complete
and return. Atos Healthcare call-centre staff then telephone the
claimant to make an appointment for a WCA at an assessment centre.[61]
All subsequent contact about the appointment time is via the call-centre:
claimants are not able to contact the assessment centre
directly.[62]
53. Evidence suggests that many people have experienced
problems with the call-centre service. In one extreme case it
took 135 telephone calls to get through to Atos.[63]
People we spoke to at our open meeting in Burnley told of similar
experiences. Lisa Coleman of Atos acknowledged that the call-centres
had experienced significant problems a year ago, which were due
to technical problems. She assured us that Atos had since invested
heavily in new technology to rectify the problems. This, together
with the retraining of call-centre staff, had enabled Atos to
reduce call waiting times to less than 30 seconds. Over 90% of
first calls are now picked up.[64]
54. Sue Royston from CAB suggested that claimants
had found the appointment booking process inflexible and had found
it difficult to arrange a convenient appointment time. She told
us that Atos call-centre staff work to a rigid script and that
claimants tend to be told, "You must come along because otherwise
you might lose your benefit."[65]
Lisa Coleman from Atos told us that the arrangement of an appointment
time was "a negotiation" between call-centre staff and
the claimant. She said that if the appointment time offered was
inconvenient for the claimant "an alternative appointment
will be offered if there is a suitable one available".[66]
55. Atos acknowledged that its
call-centres had experienced significant problems in the past.
We welcome the assurance that this has been addressed to ensure
that waiting times are significantly reduced and most calls are
picked up first time. We expect call statistics to be maintained
and published to demonstrate that progress is being made and sustained.
However, claimants are still unable to contact the assessment
centre they are due to attend directly, and we believe they should
be able to do so, even if calls are routed through the call-centre.
Over-booking of appointments
56. Atos told us that it routinely overbooks
appointments for the WCA by about 20% (although this varies between
assessment centres). It does this because the non-attendance rate
is as high as 30% in some areas.[67]
We asked Atos whether this overbooking resulted in clients sometimes
being turned away without being seen. Lisa Coleman told us:
It does happen. I am not going to say it does not.
We do have a waiting time of less than 10 minutes, and we do
try to manage within that time. But we also try to make sure
the customers have the appropriate time within the assessment.
So I am not saying it never happens because it does, which is
why we have a target. And in those instances we will investigate
why that happened, put remedial action in place where we can,
and then try to work with the customer to offer an alternative
appointment. But it does happen.[68]
57. We asked the Department about its views on
Atos's overbooking policy. Karen Foulds confirmed that this policy
of overbooking by 20% is based on the 30% non-attendance rate
for new ESA claims. She stressed that the rate for non-attendance
in the reassessment trial was much lower, at 9%, and that Atos
"will be reviewing their policy on that basis". However,
she added that "the number of customers who have actually
gone through the IB reassessment process is still very small in
comparison to those that are going through ESA, and we have not
seen that impact yet on the whole of ESA".[69]
58. Atos routinely overbooks
WCA appointments by 20% on the basis of the non-attendance rate
for new ESA claims, which was 30%. However, the non-attendance
rate in the IB reassessment trials was much lower, at around 9%,
although it is too soon to say whether this low rate seen in the
trials will continue in the national roll-out. We recommend that
Atos reviews its overbooking policy as a matter of urgency, to
take account of this much higher attendance rate by IB claimants,
to ensure that people are not turned away from assessment centres
without being seen. Atos should also continue to monitor and adjust
its overbooking policy as necessary.
"Failure to attend" and sanctioning
59. Sanctions are imposed by Jobcentre Plus on
claimants who do not comply with the requirement to attend a WCA,
known as "failure to attend", in the same way as they
are applied in other parts of the benefit system. Sanctions can
include stopping benefit payments. Witnesses were concerned that
claimants were being sanctioned for "failure to attend"
their WCA when it was not, in fact, a failure on their part. Atos
told us that they do not routinely follow up non-attendance with
the claimant to establish the reasons for it; they pass the information
about non-attendance back to JCP, whose role it is to establish
the reason.[70]
60. Oxford Welfare Rights believed that it was
unlikely that significant numbers of people would wilfully not
attend their WCA. It argued that sanctioning in these circumstances
could have serious implications for claimants:
Whilst there is some protection within the "good
cause" provision, in practice there are long delays in the
determination of good cause by decision-makers. This means claimants
are left without benefit for considerable periods. If good cause
is not accepted there will be a further delay while a new claim
for ESA (or JSA) is made and processed and a new date for a WCA
is set. Frequently claimants in this situation are left reliant
on Crisis Loans for income.
Its view was that JCP should make greater efforts
to establish the reasons for non-attendance at WCA appointments
and that sanctions should only be applied where failure to attend
was wilful.[71]
61. DWP confirmed that sanctions can be applied
to claimants for failure to attend a WCA but that people should
only be sanctioned if JCP "considered there was no good cause
for the person not attending". Karen Foulds of JCP set out
an example of where sanctions would not be applied:
[...] if we know that somebody's got a mental health
condition, then we would take that into account with good cause.
We would do safeguarding visits to people's homes if they had
not responded to either our telephone call, our letter, and had
not attended the appointment. We put safeguards in place to ensure
that, where there is a good reason why the person has not attended,
or, in fact, they have not been able to engage with the process
at all because they have not perhaps understood what is happening
to them, we would put those measures in place.[72]
62. Karen Foulds was clear that sanctioning of
people who turned up for their WCA but were subsequently turned
away without being seen "categorically should not happen".[73]
The Minister believed that it was a rare occurrence but
that, where it had happened, it was "unacceptable" and
that if it were found to be happening on a significant scale it
would require "process changes".[74]
63. Instances have occurred
where vulnerable claimants have had their benefit stopped as a
sanction for non-attendance at a WCA appointment when the non-attendance
arose because of administrative errors on the part of Atos or
JCP, or because the claimant was too ill to attend but was unable
to get in touch with Atos to inform them of this. We agree with
the Minister that this is unacceptable. We recommend that DWP
and Atos Healthcare jointly review the processes for recording
non-attendance and change them where necessary to ensure that
claimants are not sanctioned for "failure to attend"
when the failure is on the part of Atos Healthcare and/or Jobcentre
Plus.
64. Evidence from the trials of IB reassessment
in Aberdeen and Burnley suggests that the reason for non-attendance
at WCAs is rarely wilful non-compliance on the part of the claimant.
The recent DWP research paper on the trials found that "there
was very little evidence of active or deliberate non-cooperation".
It concluded that the reason for non-attendance was most often
"general confusion and inability to cope with the process".
Others were unable to attend due to their fluctuating condition:
These customers had intended to go to the WCA and
had generally planned for it; having a variable or unpredictable
condition they stressed that the appointment had simply caught
them on a "bad day". These customers expressed a clear
intention to attend their WCA appointment if at all possible.[75]
65. Administrative error on the part of Atos
or JCP was also sometimes to blame. The DWP paper reports that
some customers who had their WCA appointment cancelled by Atos
"were sometimes marked as having failed to attend this appointment.
These customers were keen to comply with the process: all intended
to attend their rescheduled appointment".[76]
66. We believe that Jobcentre
Plus should be more proactive in establishing the reasons for
non-attendance at WCAs, including by following up with a phone
call as soon as is practical after an appointment has been missed.
Atos assessment centres
67. Several witnesses complained about the inadequacy
of Atos assessment centres in meeting specific needs arising from
their health condition or disability. One witness, a wheelchair
user, described his experience:
The building is an old office block on a busy road
junction halfway up a very steep hill. It is not on any bus route
and there is no parking of any sort. The nearest car park is about
half a mile away. To gain access to the building you have to ring
a door bell to be let in. The only problem is that the door is
at the bottom of a flight of steep concrete steps with no ramp.
My carer had to leave me on the pavement to let them know I was
there and we were redirected to another door to enter the building.
Once in the building my carer had to fight the wheelchair past
various tables, chairs and plants, through three sets of doors
and down a narrow corridor with two sharp turns. The really big
problem though was when I had to enter the actual examination
room. The doorway was so narrow my wheelchair would not actually
fit through. Surely at least Atos should be made to make the buildings
they use easily accessible to all.[77]
At our public meeting in Burnley in March several
people echoed this dissatisfaction and it was clear that this
is not just an issue which affects wheelchair users. Cases were
reported where reasonable adjustments to accommodate particular
conditions were refused, such as a choice of chairs being offered,
or lighting being adapted. People at the meeting told us that
when they had made requests for adjustments they had been told
that they were "asking for too much".
68. DWP told us that the majority of assessment
centres are on the ground floor and that, where centres are not
located on the ground floor, "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 offered an appointment at the nearest ground
floor centre or a home visit but: "Inevitably however, some
customers in this category are not identified and still attend
the centre." [78]
69. We asked Atos about the locations and accessibility
of its assessment centres. Lisa Coleman told us that there are
148 assessment centres, 20 of which are owned by Atos. The remainder
are provided by DWP and "usually co-located with the Jobcentre".
She also reported that:
We are [...] working closely with the Department
on individual locations. There are about 27 of them where disabled
access is okay, but in the event of a fire, there are potential
issues around evacuation. We are working with the Department
to make sure that we can either get ground floor accommodation,
or put some form of evacuation plan in place with the landlords.
This usually affects sites not on the ground floor.[79]
Dr Gunnyeon of DWP said that Atos was "moving
rapidly toward" having ground floor accessible centres suitable
for the needs of "anyone with a disability".[80]
The Minister told us he was "amazed that this was not part
of the original process three years ago".[81]
70. Atos stated that people are asked if they
need transport to the assessment centre and that taxis are provided
"in some instances". Claimants receive, with their WCA
appointment letter, "very tuned travel instructions",
which explain the quickest route to the assessment centre via
public transport. Atos also told us that people are not expected
to travel more than 90 minutes by public transport to get to an
assessment centre.[82]
71. It is unacceptable that
disabled people should be called to attend an assessment at a
centre which is inappropriately located, inaccessible to them
or where reasonable adjustments cannot be made to accommodate
special requirements arising from their health condition. We note
DWP's assurance that Atos Healthcare is "moving rapidly toward"
a situation where this is no longer the case. We request that,
in response to this Report, the Government sets out progress towards
this aim. This should include options for the relocation of assessment
centres where necessary, increasing disabled access, and improvements
to the mechanisms for ensuring a claimant's needs are known to
Atos Healthcare in advance of the WCA.
The assessment
72. Many witnesses highlighted concerns about
the assessment process itself. Professor Paul Gregg of the University
of Bristol believed that claimants go to the WCA expecting to
"present information about their illness and be tested against
their perception of that illness". Instead, they experience
what they perceive as a "tick-box" process. He described
this as a "profound disconnect" between what claimants
expect and what they actually experience.[83]
73. This disconnect between claimant expectation
and the reality of the experience is borne out by evidence we
received from disability organisations and a number of individuals.
Evidence from Citizens Advice Scotland sums up the typical concerns
about the WCA that many witnesses have told us about:
- The WCA is often rushed, and
can last just 20 minutes, leaving claimants with the impression
that they have not been properly assessed.
- The yes/no format of the assessment is too narrow,
leaving little opportunity for the client to explain their condition.
- The health care professionals often fail to listen
or interact with the client, which can lead to mistakes and a
failure to properly assess conditions. [84]
74. One witness who wrote to us had a mental
health condition and had experienced two WCAs. She felt she was
prevented from explaining her circumstances more fully during
the WCA: "I would have appreciated it if she [the Atos assessor]
had taken her time more and let me put more time in to my answers
so she could get a better picture." She also expressed frustration
at not being able to present documentary evidence to back up her
answers. [85]
75. The Minister stressed that these types of
examples were of individual experiences of the WCA before recent
improvements had been made. He told us that:
Almost nobody has experienced the system that we
have put in place over the past few months, and we have learnt
lessons from the trials in Burnley and Aberdeen, which have been
put into place. We have learnt lessons and put in changes as
a result of the Harrington Review. Any experience that you are
hearing from individuals or recounted from pressure groups, unless
they are from people in Burnley and Aberdeen going through the
trials, will by definition have come from the previous system
as new claimants for ESAa system that I fully accept was
flawed and that we sought to improve.[86]
76. Most of the submissions
we received from individuals were from claimants who were dissatisfied
with the WCA process and who did not believe that they had been
accurately assessed. The Minister asked us to bear in mind that
much of the evidence submitted to us related to assessments carried
out prior to implementation of the two sets of review recommendations
and experience from the Aberdeen and Burnley trials. We fully
acknowledge this fact. However, we believe that there is no room
for complacency and we have identified a number of areas where
further improvement is required.
The LiMA computer system
77. Atos healthcare professionals (HCPs) use
a computer system, the Logic Integrated Medical Assessment (LiMA),
to enter information as they go through an individual's WCA. LiMA
records the responses claimants give at the assessment and builds
a final report for each claimant, which is then passed on to the
JCP decision-maker (DM). LiMA helps the Atos assessor focus on
particular descriptors and obtain and record evidence in a relatively
short space of time. It uses stock phrases such as "can load
washing machine (front loading)" that can be input into the
system quickly.[87]
78. DWP stated that LiMA was designed to "improve
and ensure consistency and quality of the reports [...] It serves
as a guide only and the healthcare professionals are required
to use their own clinical judgement to justify the medical opinion
contained in the medical report."[88]
However, many witnesses complained of an over-reliance on the
part of Atos HCPs on the LiMA IT system and therefore a perceived
lack of human contact in the process. One person, a carer for
a disabled relative, described Atos HCPs as "computer-driven
operatives"; another individual, who had been through the
WCA process twice, told us that "the whole thing is done
via a computer program".[89]
79. In his first annual independent review of
the WCA (considered in more detail below), Professor Harrington
was critical of the LiMA computer system, calling it "not
very intuitive". He also found that Atos HCPs were over-reliant
on the system, despite the existence of guidance that warns against
this:
The Atos Training and Development handbook encourages
their HCPs to use open questioning and not to rely on the LiMA
system, but in evidence to this review, this seems to be uncommonly
invoked in practice. It can, perhaps, be too easy for HCPs to
use stock phrases generated by the LiMA system that do not necessarily
capture the whole assessment or allow nuanced responses to be
reflected.[90]
80. Professor Harrington told us that there had
been recent changes to the LiMA system to make it more intuitive
and that there was now a free text paragraph for the HCP to fill
in to allow more individualised information to be provided. He
told us the system now "appears to be more responsive".[91]
We saw how the latest version of the software worked in practice
when we visited the Atos Medical Examination Centre in Marylebone,
London in June to observe a mock-up of a WCA.
The DWP contract with Atos Healthcare
81. Atos Healthcare's role is to carry out the
Work Capability Assessments, scoring claimants against the descriptors
in each activity, and then preparing a report. The report is then
passed to a Jobcentre Plus decision-maker who decides on a claimant's
eligibility for ESA and, if they qualify, to which ESA group they
should be assigned. We discuss the decision-making process in
more detail in Chapter 5.
82. Atos Healthcare has held the DWP contract
for medical services (the Medical Services Agreement) since 2005.
It has therefore been responsible for all the WCAs that have taken
place since ESA's inception in October 2008.
83. The 2005 contract was for £100 million
per annum, which includes "the total number of examinations
undertaken across all benefits and also includes costs relating
to written and verbal medical advice, fixed overheads, administrative
costs, investment in new technology and other service improvements".
DWP has reported that the total amount paid to Atos Healthcare
by DWP "for the scrutiny, face to face and work focused health
related assessment reports" was £1.7 million for 2008-09
and £24.4 million in 2009-10. These figures do not include
costs relating to fixed overheads, administrative costs, investment
in new technology and other service improvements.[92]
84. Atos Healthcare's contract with DWP was originally
for seven years from 2005 and was therefore due to expire in 2012.
DWP took the decision last year to extend it until 2015. When
we asked the Minister why he took this decision he told us that
it was because "it seemed to be a bad idea to try to change
the supplier in the middle of the migration process".
[93] DWP told us
that the contract extension was negotiated on the basis of Atos
"delivering substantial savings against the current estimated
cost of £100 million per annum".[94]
85. We were keen to find out how Atos Healthcare
expected successfully to deliver an increasing number of WCAs
during the IB/ESA migration process while simultaneously delivering
cost savings to DWP. Lisa Coleman told us "we have reduced
our prices to do that. Future savings are around making the process
more efficient, looking at where we can make sure that we are
using technology to support the end-to-end process, and that we
are using the right people at the right point in time."[95]
The Minister said that savings were expected across all Government
contracts and that the coalition Government had renegotiated all
such contracts on this basis when it took office. Dr Gunnyeon
of DWP told us:
It is reasonable to expect any organisation to look
at how it can do things more efficiently, and certainly Atos have
been doing that. There has also been a move to look at how we
can use different healthcare professionals, and that is in keeping
with what is happening across healthcare generally: for example,
the use of more nurses to undertake assessments after appropriate
training. That happens in different aspects of the NHS, where
there is more responsibility being devolved to other healthcare
professionals who have the right skills to do things, and that
has an impact on costs as well. A number of things were part
of that process.[96]
Karen Foulds also pointed out that not all of the
claimants coming to Atos as part of the IB/ESA migration process
would constitute additional work for them: some IB claimants would
have had a Personal Capability Assessment carried out by Atos
as part of their IB claim.[97]
86. We were aware of considerable public suspicion
that payments to Atos Healthcare are made on the basis of the
outcomes of WCAs. Some claimants clearly believe that Atos healthcare
professionals (HCPs) are encouraged through targets within the
DWP contract to find people fit for work. DWP has made clear that
this is not the case: "the result of the assessment has
no bearing on Atos Healthcare targets or remuneration"; and
that the Medical Services Agreement "does not include any
provisions either from the Department or from Atos Healthcare
to incentivise health care professionals to find claimants undergoing
the WCA fit for work".[98]
Lisa Coleman of Atos confirmed that, contractually, Atos is paid
for the number of satisfactory assessments it completes, not on
the basis of the results of those assessments.[99]
Monitoring quality
87. We wanted to know what quality control procedures
were in place in relation to the contract. Lisa Coleman told us
that Atos was monitored by DWP on both the quality and timeliness
of assessments and reports. She told us that Atos faced financial
penalties if it did not meet the required standards.[100]
88. DWP stated that Atos Healthcare have put
in place several measures to ensure that "consistent, high
quality, independent" assessments are provided to the Department:
- a rigorous selection process
to recruit the best medical and non-medical staffless 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.[101]
89. The quality of Atos assessments is monitored
in two ways. Firstly, Jobcentre Plus decision-makers must judge
that the Atos report is of acceptable quality; if it is not it
is sent back to be re-done at Atos's own cost. Dr Gunnyeon, Chief
Medical Adviser at DWP explained:
[...] the decision-maker needs to be able to have
a report that shows why the recommendation of the healthcare professional
is as it is. They have to be reassured that the points that have
been allocated look right on the basis of the information that
the claimant has provided and the assessment report itself. Clearly
if the decision-maker cannot see why the recommendation is as
it is, for example, if it looks as though points should have been
scored on some descriptors where they have not, then that would
not be acceptable, and the decision-maker would send that back.[102]
DWP was not able to tell us in oral evidence what
proportion of Atos reports had been sent back by JCP decision-makers
but in subsequent written evidence informed us that this was only
0.22%.[103] Such a
low percentage would seem to indicate that this aspect of DWP
quality control over Atos's service is not functioning as it should.
It also reinforces Professor Harrington's point, discussed in
Chapter 5, that decision-makers rarely question the advice provided
by Atos.
90. The second strand of quality control is Atos's
internal audit of assessments, which DWP described as follows:
Each healthcare professional is subject to audit
once they have completed their training until they have reached
an acceptable standard, and they are then subject to random audit,
so that we are continuing to check the quality. Those reports
are graded either A, B, or C, and C are of an unacceptable standard.
The proportion of Cs is very small, and remedial action is taken.
The challenge is to try to have as many at grade-A standard as
possible and to continue to look at that, and there are certain
standards set. [104]
Atos aims to audit each of its HCPs every six months.[105]
If an HCP demonstrates persistent unsatisfactory performance,
their approval to perform assessments can be revoked. Atos told
us that five of its HCPs had had their approval revoked in the
last six months. This is from a total of about 1,500 HCPs.[106]
Atos Healthcare as the sole provider of the WCA
91. We asked the Minister whether it would have
been better, from the outset, to have had two providers delivering
the WCA in order to provide competition and to drive up performance.
He told us that it "probably" would have been better
and that other companies had been interested, but he reiterated
that he thought it would have been unwise to change providers
during the reassessment process.[107]
The Minister defended Atos Healthcare, saying that although they
"get a lot of grief", the quality of the service provided
by Atos "has steadily improved as time has gone by".[108]
92. We recognise that Atos Healthcare,
as the sole provider of the Work Capability Assessment, takes
the brunt of public criticism about the WCA. Some of this arises
from the understandable anxiety which claimants feel about the
process. We accept that considerable efforts have been made on
the part of both Atos Healthcare and DWP to improve the quality
of assessments. However, it is also clear that many claimants
have not received the level of service from Atos which they can
reasonably expect.
93. We remain concerned about
whether there are sufficient levers within the DWP contract with
Atos to ensure that Atos consistently gets the assessment right
first time. We therefore recommend that, when the contract is
re-let in 2015 and in future contracts for other medical assessments,
DWP reviews the performance indicators, with significant financial
penalties built in if standards are not met.
94. We agree with the Minister
that it would not have been practical to introduce a second provider
for the IB reassessment but we believe that the Government should
consider contracting a second provider to deliver the ongoing
Work Capability Assessments for new ESA claims when the reassessment
of existing claimants has been completed, in order to drive up
performance through competition. We recommend that the Government
publishes proposals, before the end of 2012, for how such a system
of competition could work in practice.
55 DWP, Explanatory Memorandum for the Social Security
Advisory Committee: The Employment and Support Allowance (Limited
Capability for Work and Limited Capability for Work-Related Activity)
Amendment Regulations 2011, August 2010. Back
56
Ev 71 Back
57
DWP, A Guide to Employment and Support Allowance - The Work
Capability Assessment, ESA214, June 2011, pp 17-23 Back
58
DWP, A Guide to Employment and Support Allowance - The Work
Capability Assessment, ESA214, June 2011, p 19 Back
59
The Work Capability Assessment for Employment and Support Allowance,
SN/SP/5850, House of Commons Library, February 2011, p 7 Back
60
DWP, A Guide to Employment and Support Allowance - The Work
Capability Assessment, ESA214, June 2011, pp 24-26 Back
61
Q 81 Back
62
Qq 101-2 Back
63
Ev w110 [Tom Greatrex MP] Back
64
Q 120 Back
65
Q 41 Back
66
Q 83 Back
67
Q 104 Back
68
Q 85 Back
69
Qq 301 and 305 Back
70
Qq 93-94 Back
71
Ev w34 Back
72
Q 306 Back
73
Q 307 Back
74
Q 307 Back
75
DWP Research Report 741, p 42 Back
76
Ibid. Back
77
Ev w75 [M Turner] Back
78
Ev 74, para 87 Back
79
Q 108 Back
80
Q 298 Back
81
Q 298 Back
82
Q 105 Back
83
Q 12 Back
84
Ev w29 Back
85
Ev w6 [Samantha Fulstow] Back
86
Q 266 Back
87
Harrington Review, p 37 Back
88
Ev 73 Back
89
Ev w2 [Mrs M Bernard] and Ev w7 [Samantha Fulstow] Back
90
Harrington Review, p 37 Back
91
Q 211 Back
92
HC Deb, 9 February 2011, col 312w Back
93
Q 258 Back
94
Letter from the Secretary of State to the Chair of the Committee,
28 September 2010, following up oral evidence taken on the work
of the Department on 15 September 2010 at which the Atos contract
was discussed. Printed in: Work and Pensions Committee, Work
of the Department for Work and Pensions, Oral and Written
Evidence, HC 468, Ev 23. Back
95
Q 192 Back
96
Q 260 Back
97
Q 261 Back
98
Ev 72, para 65 and HC Deb 9 February 2011, col 334w Back
99
Q 193 Back
100
Q 194 Back
101
Ev 73, para 74 Back
102
Q 262 Back
103
Ev 82 Back
104
Q 263 Back
105
Ev 74, para 79 Back
106
Qq 147-148 Back
107
Q 270 Back
108
Q 269 Back
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