Written evidence from Maximus HAB0145

 

Introduction

 

  1. Maximus has been a leading provider of health, work and support services for government and business for more than 45 years. Across the UK, more than 5000 Maximus colleagues deliver services to more than 3 million people every year, for national, local and devolved government, and the private sector. These include health and disability assessments, occupational health services, employment support programmes including the Restart Scheme, and training programmes on behalf of the Ministry of Justice. We are proud to be a Disability Confident Leader.

 

  1. Centre for Health and Disability Assessment (CHDA) (a trading name of Maximus UK Services Limited, being a subsidiary of Maximus) has delivered the Health Assessment Advisory Service on behalf of the Department for Work and Pensions (DWP) since 2015. This includes delivery of Work Capability Assessments for Employment and Support Allowance (ESA) and Universal Credit (UC) and assessments for specialist benefits including Industrial Injuries Disablement Benefit across England, Scotland and Wales. To date, we have completed more than 5 million assessments.

 

1. How can DWP improve the quality of assessments for health-related benefits?

 

  1. We are committed to delivering a sensitive and respectful service for customers. Since assuming responsibility for the Health Assessment Advisory Service (HAAS) in 2015, CHDA has worked with DWP to continuously improve customer experience and the overall quality of assessments.

 

  1. Since the Work and Pensions Committee’s previous report on ESA and Personal Independence Payment (PIP) assessments in 2018, progress has been made across a range of measures, including assessment quality, customer satisfaction, the number of assessments delivered, and the timely collection of medical evidence. 

 

  1. In early 2020, prior to the pandemic and subsequent lockdowns, the service was operating effectively, with record low waiting times, full staffing, consistently high levels of quality, high customer satisfaction and successful stakeholder and GP engagement. We have worked with DWP to maintain this high performance during the pandemic, and where there has been disruption, to minimise and rectify this as quickly as possible.

 

  1. We have engaged proactively with charities, representative groups and other stakeholders to enhance the customer experience at every stage of the assessment process.

 

a. Service improvements in the process since the Committee last reported on PIP and ESA assessments, in 2018.

 

  1. We welcome the opportunity to outline the service improvements we have implemented for ESA/UC and specialist benefit claimants since taking over the service in 2015, and specifically since we last appeared in front of the Committee.

 

Quality

 

  1. We have dedicated significant resources to improving the quality of our assessments, led by senior clinicians in our Clinical Quality Team. We have robust audit and training processes in place to track quality and measure progress.

 

  1. Since 2018 we have continued to make sustained improvements to the quality of our assessments. We are pleased that over the past year we have achieved the highest quality scores to date since taking over the contract, despite the upheaval caused by the pandemic which resulted in significant changes to our operational delivery.

 

  1. We continue to ensure that assessors have the time, training and information to complete an accurate assessment report, allowing a customer to fully share their experience of living with their condition(s). For example, we have expanded our coaching and mentoring programme for assessors and have delivered training on specific conditions in collaboration with specialist charities.

 

The number of assessments completed and average time in assessment process

 

  1. Increasing the number of assessments delivered, and in turn reducing the waiting time for an assessment, has been central to our drive to improve the customer experience for those applying for, or undergoing reassessment for, UC, ESA or a specialist benefit.

 

  1. To date, we have delivered more than 5 million assessments on behalf of DWP. Between taking over the service in 2015 and the onset of the pandemic in 2020, the number of assessments we completed increased every year, rising from circa 800,000 in 2015 to more than 1 million in 2020. We were able to achieve this through operational improvements in partnership with DWP and disability charities and doubling the number of healthcare professionals in the service.

 

  1. Since CHDA last appeared in front of the Committee in 2017, we have continued to make progress on reducing the average time a customer spends in the assessment process, from 16 weeks to just 9 weeks prior to the pandemic. Overall, between taking over from the previous provider in 2015 and 2020, the average time a claimant spends in the process has fallen significantly.

 

  1. Whilst this figure rose significantly during the pandemic as a result of the suspension of face-to-face assessments for much of 2020 and 2021, the wait time has already begun to reduce. We expect this to fall to pre-pandemic levels in the coming months, and this remains an operational priority.

 

Medical evidence

 

  1. Further medical evidence is sought during the assessment process so that, whenever possible, we are able to provide a report and recommendation to DWP without the need for a face-to-face, telephone or video assessment. Whilst we provide information and resources to customers on the types of evidence that should be submitted with their ESA50/UC50 form to support their claim, for some customers further medical evidence is required.

 

  1. We have worked with DWP and representative bodies to improve the flow of medical evidence from GPs and other treating clinicians, to help them understand the benefit of supplying this information in a timely manner. Our sector-leading work in this area was recognised in the previous Committee report into ESA and PIP assessments in 2018.

 

  1. Since then, as recommended by the Committee, we have shared this best practice with other providers and developed a joint programme of GP engagement which has led to an increase in both the number of requests we make for further medical evidence and the return rate within agreed timeframes.

 

  1. Whilst GP and wider clinical engagement was paused during the pandemic, we are committed to resuming this work with agreement from DWP and building on the previous success. 

 

Training for healthcare professionals

 

  1. The role of our Healthcare Professionals (HCPs) is to provide customers with a fair and accurate assessment of how their health condition or disability affects their functional ability to carry out work or work-related activity.

 

  1. Their clinical experience is complemented by a rigorous training programme to equip them with the skills they need to carry out an accurate functional assessment. Every HCP we employ is fully medically qualified and registered with their relevant professional body and undertakes a minimum of 21 days of classroom-based learning. In addition, during training, a HCP will complete a significant number of audited assessments before receiving approval from DWP. Typically, the induction process will last between 3 and 6 months.

 

  1. In addition, HCPs are required to complete at least 35 hours of Continuous Professional Development each year, and through our MyLearning platform and Knowledge Library HCPs have ongoing access to more than 450 specialist training modules and documents on specific conditions.

 

  1. We recognise the diversity and complexity of conditions presented at an assessment, and the importance of having specialist expertise in these conditions within our organisation. Since 2018 CHDA has increased the number of expert Mental Health Champions and Functional Champions in specific condition areas including neurology, cancer, learning disability, and sensory impairment. HCPs in these roles receive additional training and provide all their HCP colleagues with easy access to expert advice whenever it is required, particularly in complex cases.

 

Engagement with charities and representative groups

 

  1. Addressing the specific issues and concerns of customers and the organisations that represent them remains a priority for CHDA. Since 2015 we have operated a Customer Representative Group (CRG) of disability charities, representative groups and welfare rights organisations, which meets quarterly to facilitate constructive two-way dialogue and allow stakeholders to ask questions directly to CHDA clinical and customer experience leaders, as well as DWP representatives. Since 2018 we have expanded this group from around 40 to more than 50 organisations.

 

  1. Through collaborative working with the CRG, we have delivered tangible improvements to the customer experience. This has included working with stakeholders to develop new training on fluctuating conditions, working closely with charities that represent a diverse range of fluctuating conditions, DWP and our own clinical team, which resulted in a significant increase in customer satisfaction in relation to variability

 

  1. In addition, members of our CRG have developed and delivered specialist training to our HCPs and customer services teams, and reviewed new material for our website, including videos to explain the assessment process and updated guidance during the pandemic.

 

  1. We continue to source feedback from CRG members and wider stakeholders as an integral part of our continuous improvement process.

 

Customer satisfaction

 

  1. Customer satisfaction is another important aspect of our contract delivery, with robust targets set by DWP that we have met consistently since 2018.

 

  1. CHDA has invested heavily in improving the customer experience and driving improved satisfaction levels, led by our Customer Director and dedicated Head of Customer Experience. This has included expanding the number of Customer Champions across our assessment centres around the country to more than 100. They offer additional support to customers who might be anxious about their assessment, or additional information about the process to put them at ease.

 

  1. Levels of customer satisfaction are measured on a quarterly basis through a survey carried out by an independent market research agency. We are pleased that the activity and improvements outlined in this submission have resulted in record customer satisfaction scores which exceed the target set by DWP. Satisfaction levels have remained high during the pandemic, despite the significant disruption to service delivery.

 

Pandemic response

 

  1. The pandemic placed an unprecedented strain on the delivery of almost every aspect of the health system, including health and disability assessments. Face-to-face assessments, which accounted for the majority of assessments carried out prior to the pandemic, were suspended in March 2020.

 

  1. Despite this, given our critical work, CHDA maintained operation of the service throughout every stage of the pandemic, with dedicated colleagues clearing hundreds of thousands of assessments through paper-based review, where possible, to ensure access to financial support for the most vulnerable.

 

  1. Through 2020 and 2021, CHDA worked with DWP, members of our CRG and clinical experts to develop and rollout telephone and video assessments for the first time, which now account for the majority of Work Capability Assessments delivered. This involved additional training for HCPs to adapt to new forms of assessment, and the rollout of new platforms to host video assessments, which have now been adopted by other providers. Feedback from our CRG members and other representative groups on the rollout has been overwhelmingly positive, in particular the introduction of multi-channel delivery of assessments.

 

  1. As a result, we have been able to deliver more than a million assessments since the onset of the pandemic. Despite an increase in the average waiting time for an assessment increasing significantly at the height of the pandemic, this has subsequently reduced and is now heading towards pre-pandemic levels. We also maintained record high customer satisfaction scores despite the disruption.

 

  1. Clinical staff that were not carrying out assessments volunteered in huge numbers to return to the NHS during the initial wave of the pandemic to support the national effort, and earlier this year to support the national vaccination programme.

 

  1. We remain committed to building on these service improvements and continuously improving the service we deliver, in collaboration with DWP, disability charities and representative groups.

 

 

May 2022