Committee of Public Accounts HC 744

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Written evidence from the Department for Work and Pensions

Validation of Invoices

What is the total number of invoices from which the sample for validation is selected?

Routine contract payments are based on three invoices, submitted to the department by Atos each month:

¾a fixed Costs invoice. This invoice covers all the fixed costs incurred by Atos, and by its nature is of known value;

¾an interim variable costs invoice paid mid month. This invoice is for the assessments Atos have conducted in the first half of the month; and

¾a final variable costs invoice, paid at the end of the month. This invoice is for the variable charges due in the second half of the month.

Pre-Payment Validation Check

Before any payments are made, all invoices are checked to ensure that the number of cases requiring payment matches the number of cases the department is expecting to pay for. Where the numbers do not match, this is referred back to Atos for resolution before payment is made.

Post-Payment Validation Check

The final variable cost invoice shows all the assessments undertaken by Atos during the month (including those paid for via the interim variable cost invoice). In a typical month, this invoice will include some 128,000 individual cases (77,000 Work Capability Assessments, 47,000 ESA/IBR paper scrutiny assessments & 4,000 other outputs).

Each final variable cost invoice is validated by a sample check of the cases on the invoice, against the Department’s own records. The invoice passes the validation if every case in the sample matches against the Departments own records. If any of the sample records fail to match, the Department would seek an appropriate credit from Atos: but, in practice, not a single error has been found in any of the monthly Invoices since this validation began in May 2012 (up to and including the invoice of October 2012).

In more detail, the monthly sample is of 139 cases on each invoice, which allows the Department to be 95% confident that 90% of all the records on this invoice match the Department’s records, with a 5% margin of error.

Role of the Decision Maker

Why are we using non-medical decision makers to make "medical" decisions?

The role of a Decision Maker is to take a decision on entitlement to benefit in accordance with the regulations laid down by legislation. As such they are trained in assessing evidence available to them against the requirements of relevant legislation based on their understanding of the law and the benefits system. The decision to award a claimant benefit is not, therefore, a medical one, but a benefits decision, based on all the evidence available including that provided by the claimant themselves and from advice provided by Atos Heath Care Professionals (HCPs).

Claimants are encouraged to provide all evidence that will be relevant to their case, including medical evidence supplied by their GP or other medical professional, at the outset of the claim. HCPs are expected to seek further medical evidence in situations where that would help them provide advice without calling a claimant in for a face-to-face assessment. It is important to point out that the HCP report on the functional limitations imposed by a claimant’s illness or disability is not a medical assessment but rather a functional one, designed to assess the impact of a claimant’s health condition or disability on their capability to undertake work. The DM will assess all this evidence, and seek more if that is required, in order to reach their decision.

What training do HCPs receive?

All HCPs are registered with a professional body such as the General Medical Council or the Nursing and Midwifery Council and must have at least three years post-qualification experience. In addition, all HCPs are fully trained in disability assessment. They receive comprehensive training (doctor nine days, nurse 18 days, physiotherapists 21 days) before being approved by DWP Chief Medical Adviser.

Once approved, all HCPs are subject to ongoing quality checks through audit, which the Department validates. There have been approximately 20,000 such checks in the last year.

Training of HCPs consists of three distinct areas:

¾Generic training-includes principles of disability analysis, professional standards (including manner & behaviour) and multi-cultural awareness;

¾Training to undertake benefit-specific assessments-includes ESA and other benefit, assessments, with modular training and competency testing at each stage; and

¾Scrutiny/filework training-includes provision of advice to the decision maker on the basis of available documentation within a customer’s file, with theory and casework exercises, followed by supported individual casework.

Following the WCA training course, HCPs will, for a variable period, complete assessments under the continual supervision of an experienced trainer. Only when they are considered to have achieved competency will they progress to unsupervised assessments. At this stage every assessment is audited until they produce four consecutive A-grade reports, meaning that their reports have reached a high standard. At this stage they are referred to the Chief Medical Adviser for approval on behalf of the Secretary of State. Following approval, audit of their performance continues, at a reduced frequency.

All training material for HCPs is quality assured by the DWP Chief Medical Adviser.

What is the number and type of HCP employed by Atos?

ESA regulations allow for assessments to be carried out by a wide range of HCPs, including doctors, nurses, occupational therapists, physiotherapists or any other healthcare professional regulated by the Health and Care Professions Council.

For ESA, Atos use doctors, nurses and physiotherapists. This consists of a mixture of employed HCPs and self-employed doctors, some of whom work for the NHS.

The number of HCPs employed by Atos in the current DWP contract (across all benefits including those for the WCA) is around 1400: approximately 750 doctors (including approximately 500 contracted doctors) 600 nurses and 50 physiotherapists. This equates to 962 full time equivalents (628 nurse/physiotherapists, 199 employed doctors, 135 sessional doctors).

What percentage of Doctors employed by Atos on this contract have English as a first language?

We are unable to hold information on the first language of any HCPs, but all HCP’s undertaking Work Capability assessments speak English. Atos Healthcare operates strict recruitment criteria, which includes the assessment of an applicant’s oral communication skills during a formal interview, conducted by experienced medical and administrative managers. If the applicant’s oral skills are not deemed to be to the required standard, the applicant will not be successful at interview.

Of the 38% of cases overturned by tribunals, what proportion are people coming off of IB?

Data specifically relating to cases overturned by tribunals in relation to Incapacity Benefit reassessment is not available.

Robert Devereux
Permanent Secretary

4 December 2012

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Prepared 7th February 2013