Written evidence from Capita HAB0157

 

Re: Health assessments for benefits inquiry

 

Thank you for the opportunity to discuss Capita’s role in the Personal Independence Payment (PIP) assessment process at the Work and Pensions Committee session on 25th May 2022.

 

Please find enclosed responses to the Committee’s information requests, as per your letter dated 15 June 2022. There is also an additional section responding to questions raised during the evidence session.

 

If you require any further clarification, please do let me know.

 

I would also like to extend an invitation to you as Chair and to individual Committee members to meet with me or my team if they have any queries or concerns around the work Capita does on PIP.

 

 

 

 


 

 

 

 

Work and Pensions Committee inquiry into health assessments for benefits

Assessment Provider responses

Question

Notes

In each year since the start of your contract, what number and proportion of assessments have been carried out:  

a. Face-to-face  

b. Remotely  

c. On paper

 

 

Please refer to official statistics from DWP in a recent Parliamentary Question.

 

Written questions and answers - Written questions, answers and statements - UK Parliament

Recording of assessments is currently available on request. Since March 2020, how many requests have you received, and how many of those have been granted?  

What are the reasons why a request might be refused, and what options are given to claimants in those circumstances?  

Please provide quarterly data if possible. 

 

Requests received

March 2020

0

June 2020

3

Sept 2020

30

Dec 2020

61

March 2021

92

June 2021

96

Sept 2021

170

Dec 2021

177

March 2022

158

June 2022

70 (quarter to date)

 

 

 

 

 

 

 

 

As long as we are given advance notice, there are no reasons we would not grant an audio recording. However, there may have been occasions when the claimant changed their mind on the day, or there was an issue with the recording equipment we previously used.

Additionally, requesting an audio recording may have meant a longer waiting time for an assessment slot, which could have influenced claimants’ decisions. To prevent this, we are currently rolling out a digital solution to enable all HPs to be able to facilitate audio recording requests on the day of the assessment. Also, as of January 2022, individuals can now also use their own equipment to audio record their assessment if they wish to. There is no requirement of the claimant to provide a copy of the recording to the assessment provider.

 

What proportion of people are accompanied in an assessment: for example, by an advocate or family member?   

Are there any reasons why you would refuse a request from a claimant to be accompanied?   

We do not track this information.

We encourage all claimants to bring a companion and reference this in the communications we send and on our website.

If a companion is being disruptive during an assessment or not allowing the claimant to speak, the HP could ask them to leave the room. Additionally, if a claimant was accompanied by several companions and the assessment room could not accommodate all of them, we would ask people to wait outside.

If the HP has reason to believe that the companion(s) are attending for a reason other than to support the claimant, the HP has the right to decline the presence of the companion(s) at the assessment.

Face-to-face assessments were suspended in March 2020 in response to the pandemic but have since resumed. For each month since March 2020, what number and proportion of assessments have been carried out:  

a. Face-to-face  

b. Remotely (telephone)  

c. Remotely (video)  

d. Paper-based

 

 

F2F

Remotely (telephone)

Remotely (video)

Paper-based

March 2020

10168 (56%)

5862 (32%)

2032 (11%)

April 2020

0 (0%)

14779 (90%)

1650 (10%)

May 2020

0 (0%)

13670 (93%)

1099 (7%)

June 2020

0 (0%)

13779 (94%)

894 (6%)

July 2020

0 (0%)

9330 (93%)

692 (7%)

August 2020

0 (0%)

14438 (95%)

692 (5%)

Sept 2020

0 (0%)

12921 (93%)

909 (7%)

Oct 2020

0 (0%)

13464 (94%)

832 (6%)

Nov 2020

0 (0%)

15875 (94%)

1041 (6%)

Dec 2020

0 (0%)

9030 (93%)

677 (7%)

Jan 2021

0 (0%)

14276 (95%)

768 (5%)

Feb 2021

0 (0%)

13412 (95%)

698 (5%)

March 2021

0 (0%)

16483 (94%)

1066 (6%)

April 2021

0 (0%)

12608 (95%)

669 (5%)

May 2021

0 (0%)

13981 (94%)

829 (6%)

June 2021

1 (0%)

11884 (93%)

869 (7%)

July 2021

1 (0%)

12462 (91%)

1179 (9%)

August 2021

600 (4%)

12688 (88%)

1098 (8%)

Sept 2021

921 (7%)

11192 (83%)

1433 (11%)

Oct 2021

1194 (8%)

12317 (82%)

1421 (10%)

Nov 2021

1569 (8%)

16177 (81%)

2259 (11%)

Dec 2021

593 (5%)

9011 (83%)

1311 (12%)

Jan 2022

50 (0%)

19675 (90%)

2099 (10%)

Feb 2022

943 (6%)

14099 (84%)

1838 (11%)

March 2022

1659 (9%)

14727 (81%)

1740 (10%)

April 2022

1498 (9%)

13095 (78%)

690 (4%)

1588 (9%)

May 2022

1913 (9%)

17017 (77%)

1133 (5%)

2120 (10%)

June 2022

2405 (12%)

15073 (73%)

916 (4%)

2204 (11%)

 

 

In its 2018 report, the previous Work and Pensions Committee made recommendations on improving access to home visit assessments for people who need them. Since 2018, what number and proportion of claimants request a home visit, and in how many cases are those requests granted? 

 

 

Requests received

Requests

granted

2018

Not available

Not available

2019

110

99

2020

88

77

2021

96

0

2022

20

0

 

Note: home assessments were suspended by DWP in March 2020 due to Covid-19 and are yet to resume.

You told us that you now share a “clinical marker” with DWP that indicates if claimants are vulnerable. What is the criteria for applying the marker, and what guidance is given to staff on this?  

What proportion of claimants that you see have this marker applied? 

Clinical markers are applied at the discretion of a HP. There are no set criteria, as we want our HPs to feel empowered to add the marker when they feel it is necessary to do so. The purpose of the marker is to alert anyone who may interact with the case in the future to a claimant who has additional support needs. Employees are advised that if a claimant has a clinical marker (Additional Support Needs/Protecting Vulnerable Claimant) then they may need to make reasonable adjustments when speaking to this individual or when taking actions related to their claim. This may be taking more time on a phone call to listen to their concerns, or ensuring a Paper Based report is completed.  

Within our current head of work, 47.1% of claimants have an Additional Support Needs marker, which is visible to both Capita and the DWP.

How many FTE assessors do you have? Please provide data back to 2013 if possible.   

 

2013

Not available

2014

Not available

2015

379

2016

428.9

2017

437.5

2018

402.5

2019

435.3

2020

385.7

2021

481.8

2022

642

 

Note: this number is FTE assessors (face-to-face, telephone, video and paper-based). It does not include contractors or clinical support staff such as auditors, coaches, trainers and those in management positions.

Please provide a breakdown of the medical backgrounds of your staff. 

  • Nurse: 999 Heads
  • Physiotherapist: 62 Heads
  • Occupational Therapist: 54 Heads
  • Paramedic: 53 Heads
  • Doctor: 2 Heads

Note: this does include contractors, clinical support staff such as auditors, coaches, trainers and clinicians in management positions.

 

You told us in evidence that you aim to schedule three appointments a day for your assessors. What is the average number of assessments a day that assessors actually complete? Please provide data at three-month intervals if possible.  

Do assessors complete the whole assessment for a claimant at once, or do they come back to it later (for example, carrying out a bloc of assessments and then writing up a bloc of reports)? 

 

 

Avg assessments p/day

Attended Not Complete rate

Failure To Attend rate

March 2020

2.75

2%

6%

June 2020

2.35

6%

16%

Sept 2020

2.48

6%

11%

Dec 2020

2.35

9%

13%

March 2021

2.49

8%

9%

June 2021

2.52

6%

10%

Sept 2021

2.44

7%

12%

Dec 2021

2.46

7%

11%

March 2022

2.62

2%

11%

June 2022

2.38

8%

12%

 

HPs are scheduled to complete 3 assessments per day and will usually complete all their assessments and then write up all the reports. Sometimes the number of assessments completed by a HP is reduced due to last minute cancellations or an individual failing to attend their appointment (details included in the table above).

 

HPs are asked to complete their reports within one working day of the assessment. This can sometimes take longer due to the complexity of a case, or the need for the HP to seek advice from the HP support line or a clinical coach. We are targeted as an organisation to complete 75% of all reports within one working day of the assessment, which we achieve consistently.

We have heard that there are currently long waits for PIP assessments, due to larger numbers of claimants requiring assessment. What is the current average length of time from an application being received by Capita to a report being returned to DWP?  

Please could you provide data on waiting times back to 2018.   

What steps have you taken to speed up the process?   

The average length of time from a case being received by Capita to a report being returned to DWP is reducing and currently stands at 45.5 days.

 

Waiting times from previous years are detailed in the table below.

 

2018

Not available

2019

32.66

2020

45.77

2021

64.64

2022

43.9 (year to date average)

 

 

As discussed with the Committee, we are seeing increasing demand for PIP, with new claims rising significantly. We are working hard to clear cases, however this can never be at the expense of quality.

Some of the interventions we have put in place to improve this include:

  • Working with DWP to prioritise cases to ensure no one is out of payment – focus on new claims and DWP completing some reassessments to reduce number of referrals sent to providers 
  • Increased HP recruitment and retention activity, such as enhancing training and support, re-structuring assessment reports, developing a smoother onboarding process
  • Introduced more channels of assessment e.g. telephone and video to allow for more flexible scheduling

You told us that you have multiple contractual targets (eg. relating to quality of assessment) and internal customer satisfaction targets. Please could you tell us what those targets are and provide data on whether they are being met? 

Please find attached the information supplied by DWP.

 

What proportion of your assessments are audited?  

How many staff are dismissed each year due to performance-related issues? 

Our internal guidance is to audit 40% of assessment reports. Below are the latest audit figures. this figure includes audit such as for HPs in approval, targeted audit for HPs we have identified as needed more support and rolling (random) audit. Below are the latest audit figures.

Audits

H1 2020

H2 2020

H1 2021

H2 2021

H1 2022 to date

 

43%

40%

41%

41%

37%

 

From 2021 to May 2022, there were 68 leavers from HP specific roles where the primary reason could be attributed to quality. 37 of these were resignations prior to probable or anticipated dismissal and 31 were dismissed due to failing probation, unsatisfactory performance during probation period, or poor quality.

 

In what proportion of cases do assessors request additional evidence (eg. from medical professionals, carers etc)?  

In what proportion of cases are these requests met?  

In the Committee’s previous inquiry we heard that many requests from contractors for additional evidence are not returned. What information do you have on why that is? 

 GPFR (GP Factual Report) sent (May’21 – Apr’22)

In 23% of cases

GPFR return rate

71%

 

 

 

 

 

We have limited information on specific reasons why not all forms are returned.

There could be various factors in play, for instance GPs often don’t have the functional information relevant to PIP or have limited capacity to complete the forms.

In addition, evidence can be returned late in the process, when it’s too late to influence the report or decision.

We also do a lot of evidence gathering through telephone calls. For instance, between January 2021 and April 2022, we made over 250,000 calls to named contacts to try and gather relevant information.

You told us that you have a system where you can alert a claimant’s medical professionals to “unexpected findings” during an assessment, which has been in place since PIP started. For each year since 2013, how many times has this system been used? 

The unexpected findings process (or Health Professional Contact (HPC) as we call it in Capita) is part of our wider safeguarding processes. Whilst we have always had safeguarding processes in place, we only began tracking the volume of HPC referrals from July 2020 onwards.

2020

860 (July-Dec)

2021

2,686

2022

2,159 (Jan-May)

 

 

 

If one of our HPs believes there is a safeguarding risk with an individual, they will make a referral to our dedicated safeguarding team, who will review and take action where necessary. This could involve notifying an individual’s GP, completing welfare checks, or passing the referral on to the multi-agency safeguarding hub.

 

 

Responses to queries raised during the Committee appearance

 

Please provide a copy of the communication sent to claimants when inviting them to their assessment – highlighting the section on audio recording.

 

As per the legislation (PIPAG section 1.6.58), upon prior request, providers have the facility to record assessments for face-to-face and telephone assessments. Please note, audio recording is not currently permitted for video assessments to ensure the safety and privacy of staff and claimants.

 

We promote this in the booklet that we send with every appointment letter. In 2021, we moved away from sending a long, dense letter as stakeholders told us the length of the letter could cause undue anxiety and would therefore not be read in full. Instead, we send a much shorter letter with the appointment details, accompanied by a more accessible booklet. See attached.

 

There is a section for each assessment type in the booklet and the first FAQ always relates to audio recording.

 

We also include this information on our website and will be including messaging about audio recording in the SMS appointment reminder sent to claimants.

 

As mentioned within our submission and during the evidence session, we would welcome an ‘opt out’ for audio recording.

 

Please review the case mentioned of a claimant’s request for audio recording not being fulfilled.

 

We have reviewed the case we believe Mr McCabe was referring to.

 

We have responded to the individual’s complaint and have apologised for this shortcoming. We would be happy to discuss audio recording in more detail with Mr McCabe.

 

We are currently rolling out an enhanced solution for audio recording that allows all Healthcare Professionals to record assessments without needing prior notice from the claimant.

 

Review and comment on the NAO report from 2016 (Contracted-out health and disability assessments) specifically referencing the required number of HPs required to deliver PIP.

 

With regards to the NAO report published in January 2016, Mr McCabe referenced the finding that that there would be an estimated 84% increase in total healthcare professionals required from 2,200 in May 2015 to 4,050 in November 2016.

 

Having reviewed the report, Capita would like to highlight some points that should be considered when referencing this figure.

 

a)      The report appears to have covered a range of assessments, namely PIP, ESA and Fit For Work. Capita conducts PIP assessments on behalf of DWP in the Midlands and Wales, therefore cannot comment on historical resourcing requirements for other benefits with other providers.

 

b)      The report states that the 84% figure comes from the Department but doesn’t describe how it was arrived at. Again, this makes it difficult to comment, however, we can say that between May 2015 and November 2016, we increased our workforce of Healthcare Professionals from 331 to 576, which is an increase of 74%.

 

c)      With regards to the size and make-up of our workforce, we determine this using data modelling against the referral forecasts we receive from DWP.

 

Please share profits and other related information with the committee.

DWP considers the information requested in respect of profit margin/actual profit paid under each contract to be confidential information.

 

Should such confidential information be disclosed, it would be likely to cause prejudice to suppliers’ commercial interests and to DWP’s ability to contract for services. Further, in respect of an FOIA analysis, DWP has redacted such information from its publication of each contract on the basis of the commercial interests qualified exemption at section 43(2) FOIA (through application of the prejudice test).

 

On this basis, we are not able to issue the Committee with details of the profit that is paid under this contract.

 

 

 

July 2022