Supplementary evidence from Maximus HAB0158



Thank you for the opportunity to give evidence to the Committee on 25 May as part of the health assessments for benefits inquiry, and for your subsequent letter of 15 June requesting additional follow up information.


As stated when we appeared before your committee, we welcome the opportunity to outline the service improvements we have introduced since 2015 and our commitment to continuous improvement across every aspect of the assessment process.


You raised a number of specific questions in your letter that I have responded to in turn. Some of the data you request is owned by the Department for Work and Pensions (DWP), and where this is the case we have shared the latest data release in the public domain.



  1. In each year since the start of your contract, what number and proportion of assessments have been carried out:
    1. Face-to-face
    2. Remotely
    3. On paper


Since assuming responsibility of the Health and Disability Advisory Service in 2015, we have completed more than six million assessments, with an increase in the number of assessments in each contract year prior to the pandemic. Increasing the number of assessments carried out has allowed us to significantly reduce the end-to-end time in the assessment process, and improve overall customer experience.


The table below sets out the number of assessments that have taken place in each full contract year (CY) since 2015. Remote assessments commenced in contract year 6 in response to the pandemic.





































    Paper based








   Total (000’s)









Paper based in table above relates to customers who, following a paper-based review, did not require a face-to-face or remote assessment. All applications are initially reviewed on paper, with customers only called to an assessment if additional information is required to make a recommendation to a DWP Decision Maker.



  1. 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?
    1. What are the reasons why a request might be refused, and what options are given to claimants in those circumstances?


We work to accommodate all requests for audio recording, which is why we ask for as much notice as possible if requests are being made. We have developed new approaches to record telephone and video assessments as our assessment channels have changed following the pandemic, and are committed to meeting requests wherever possible. If recording equipment is not available, we typically offer an alternative assessment format. 


We do not formally collect data on requests for recording of assessments. Any customer can request the recording of their assessment by contacting our Enquiries Line prior to their appointment. Information on how to do this is contained on a customer’s appointment letter, and on the CHDA website and website.


As we stated to the Committee in oral evidence, and consistent with our past position, we would be supportive of the recording of assessments becoming standardised with an ‘opt out’, rather than opt-in by request. However, this is ultimately a policy decision for DWP.



  1. What proportion of people are accompanied in an assessment: for example, by an advocate or family member?
    1. a. Are there any reasons why you would refuse a request from a claimant to be accompanied?


Companions, advocates and appointees play an important role in supporting customers through the assessment process, including during a face-to-face or remote assessment. We welcome and encourage their involvement regardless of assessment channel. In response to the pandemic, we adapted our processes to make sure companions, advocates or appointees could dial-in to a telephone assessment or remotely join a video assessment.


We are not asked to formally record the proportion of customers requesting to be accompanied to their assessment. However, this is a very common occurrence. We include detailed information on this topic for customers on our website and appointment letter.


Maximus would never refuse a request for an appointee to attend an assessment, and it would be a very rare occurrence to refuse a request for a customer to be accompanied by a companion or advocate. Where this is the case, it would likely be due to a safeguarding concern.



  1. 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:
    1. a. Face-to-face
    2. b. Remotely (telephone)
    3. c. Remotely (video)
    4. d. Paper-based


When face-to-face assessments were suspended in late March 2020, we worked at pace with  DWP and other partners to adapt our delivery and maintain the ongoing operation of the assessment process wherever possible. Our colleagues were designated as Key Workers and continued to work from Assessment Centres throughout the pandemic, processing claims, requesting additional evidence and scheduling remote assessments.


Because of this, we were able to continue paper-based assessments throughout, and successfully roll out telephone assessments for the first time, despite the majority of Work Capability Assessments (WCAs) previously being delivered face-to-face. We developed the first proof of concept for delivery of video assessments and were the first assessment provider to roll these out.


Data providing a detailed monthly breakdown of assessments by channel over this period is held by DWP.



  1. 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?


Home visits were suspended in March 2020 due to the covid pandemic. The eligibility criteria for home visits is set by DWP, and we will accommodate requests wherever possible if this criteria is met. Maximus does not hold information on the number of requests for home visits.


Since the introduction of remote assessments, the need for home visits has largely been removed, with customers being able to complete a remote assessment by telephone or video in most cases, providing more timely access to an assessment and reducing overall time in the assessment process.



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


At all stages, when reviewing a customer’s application, our healthcare professionals will identify if they are potentially vulnerable or require additional support in the assessment process. We operate a number of markers in the assessment process to identify potential vulnerability or additional support requirements for customers, including a mental health marker which triggers changes in the assessment process including removing the requirement for a UC50/ESA50 form to be returned.


The specific clinical marker indicating vulnerability is used in the PIP process, and not the DWP’s WCA systems.



  1. How many FTE assessors do you have? Please provide data back to the start of your contract if possible.


Since taking over our contract in 2015, we have increased the number of healthcare professionals working as assessors within our organisation by more than two thirds. This allowed us to, prior to the pandemic, assess record numbers of people and reduce waiting times to a record low, while improving customer satisfaction. The total number of assessors by full contract year to date is set out below.


Contract year


CY1 (2015/16)


CY2 (2016/17)


CY3 (2017/18)


CY4 (2018/19)


CY5 (2019/20)


CY6 (2020/21)


CY7 (2021/22)



These figures exclude some management and clinical quality roles.



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


We currently employer doctors, nurses, physiotherapists and occupational therapists, all of whom have undertaken a rigorous training programme to ensure they have the skills and clinical knowledge required to undertake a functional assessment.


Our clinicians bring with them a diverse range of backgrounds and clinical specialisms, including mental health, neurological conditions, musculoskeletal conditions and learning disabilities, and all have access to specialist functional and mental health champions.


The breakdown of medical background is included in the table below. Note that Clinical Standards Leads are senior clinicians who provide advice and support to assessors as well as carrying out internal audit and other quality-focused activities.


    Contract year


























































  1. How many assessments do you schedule per full-time assessor per day? What is the average number of assessments per day that each assessor conducts?


Assessors conduct an average of around 5 assessments per day, and our operating model reflects this. All our colleagues are encouraged to spend as much time as they need to complete the assessment, recognising that every individual is unique and the complex nature of some conditions. Where a customer clearly meets Support Group/LCWRA criteria, an assessment may be curtailed, improving the customer’s experience of the process.


We have worked to improve efficiency in the appointment process through text reminders to improve attendance rates and wider improvements to scheduling that have reduced waiting times and ensured that more than 95% of customers wait less than 30 minutes for their assessment.



  1. 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)?


It is expected that assessors will complete the assessment report immediately after a customer’s appointment, unless exceptional circumstances mean this isn’t possible. We would never expect an assessor to draft a bloc of assessments at the end of the day.




  1. You told us that “typically” an assessment takes an hour. What proportion take longer and what proportion take less time?


Every assessment is unique, and assessors take as much time as is required to fully understand the impact of a customer’s disability and/or health conditions on their functional ability and day-to-day life. The average assessment lasts approximately 50 minutes, with additional time allocated to write the assessment report.


Around 30% of assessments take longer than average, with the remainder taking around the average time or less. It is important to note that, unlike for PIP assessments, a WCA can be curtailed if an assessor has the required information to complete their report and make an informed recommendation to DWP, to avoid prolonging an assessment for any longer than required.



  1. What is the current average length of time from an application being received by Maximus to a report being returned to DWP? A. Please could you provide data on waiting times back to the start of your contract. B. What steps have you taken internally to speed up the process?


Maximus has prioritised reducing the average length of time a customer spends in the assessment process, and were able to reduce this by more than 70% between 2015 and 2020. At the point of taking over the contract in 2015 the total time in the assessment process was around 32 weeks, which we were able to reduce to 16 weeks by 2017 and to 9 weeks prior to the pandemic.


This reduction was largely achieved through an increase in the number healthcare professionals working in the service, and implementing improvements following feedback from stakeholder groups.


Due to the suspension of face-to-face assessments as a result of the pandemic, waiting times did rise through 2020 and 2021, peaking at around 33 weeks in July 2021. The latest published DWP statistics, covering the period to December 2021, show an end-to-end time of 22 weeks. As stated in the evidence session on 25 May, we have continued to reduce this time since then and we are confident of and committed to returning to our pre-pandemic times in the very near future.  



  1. 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?


We are committed to delivering an accurate, expert and respectful service, and recognise the importance of the service to our customers. It is right that we are subject to robust contract management process. This includes the application of comprehensive performance regimes, including the use of service level agreements, service credits, key performance indicators, in addition to audit.


We understand that the DWP is likely to release additional, more detailed information on contractual targets shortly. However, a redacted version of our contract which covers the period to 31 July 2023 has recently been published on the Contracts Finder website:


This recently published redacted contract does give details of the Performance Measures (Schedule 2.2) in place for the HDAS Business as Usual Agreement and covers the period to 31 July 2023. Commercially sensitive information has been redacted. During the pandemic and whilst  easements were in place which impact on the channel mix for HDAS, we operated under Schedule 19 (available within the link).


As stated in the oral evidence session on 25 May, we have worked to continuously improve the quality of the service we deliver, and as of May 2022 we are meeting all of our contractual quality targets We have met our key customer satisfaction targets consistently since 2015.



  1. What proportion of your assessments are audited?


We operate a robust quality assurance and audit process, to ensure the report being shared with a DWP Decision Maker is accurate, comprehensive and adheres to the [standards] set down in legislation.  Across internal and external audit, at least 15% of assessment reports are formally reviewed, either by an independent DWP auditor, or by a Senior Clinician within our organisation.


In addition to post-assessment audit activity, we have put in place a number of quality assurance initiatives that have allowed us to continuously improve the quality of the assessments, as part of our focus on delivering consistently accurate reports to the DWP decision maker. This includes senior clinicians sitting in on assessments and providing follow-up reflection sessions; one-to-one quality-focused discussions between assessors and senior clinicians; and access to clinical specialists and training modules on specific conditions.



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


Through our systems and processes, Maximus is committed to delivering an accurate and effective functional assessment service, and the performance of our assessors is critical to our operation.


In addition to their medical training, all healthcare professionals entering our business undertake a comprehensive and challenging training programme to become a functional assessor. This includes classroom-based learning and live audit of assessments to ensure quality standards are met. It typically takes at least three months before we put an assessor forward for formal approval from DWP.


Once approved, if we have concerns about an assessor’s performance, we take swift action, typically including increased supervision and audit, and a training plan to rectify any gaps in knowledge or understanding. In some cases, we will remove the assessor from carrying out assessments and instigate disciplinary action, which can lead to dismissal.


The number of assessors dismissed due to performance-related issues varies each year, but is typically between 20 and 30. Performance-related issues can be varied, and are not solely related to the quality of work delivered.



  1. In what proportion of cases do assessors request additional evidence (eg. From medical professionals, carers etc)? a. In what proportion of cases are these requests met? B. In the Committee’s previous inquiry we heard that many requests from contractors from additional evidence are not returned. What information do you have on why that is? 


Additional medical evidence is requested in around 55% of cases, which is an increase from just over 40% from when we last appeared in front of the Work and Pensions Committee in 2017.


More than 80% of additional medical evidence that is requested is returned to us by a customer’s clinician within 20 days. We proactively engage with clinicians once a request has been made to improve the timely returning of any relevant information.


We acknowledge that obtaining additional evidence in the depth of detail we need, and at speed to avoid delays in the assessment process, can be challenging, and this has been exacerbated by the additional pressures placed on the health system during the pandemic. We have worked hard to engage with clinicians to improve understanding of the process and the importance of medical evidence in an assessment. This has included, prior to the pandemic, a comprehensive GP engagement programme, that was commended by the Committee in your previous inquiry in 2018, as well as working with professional bodies and taking part in GP-focused events and conferences.



  1. You told us that you have a system where you can alert a claimant’s medical professionals to “unexpected findings” during an assessment. Since Maximus took over the WCA contract, how many times has this system been used?


All of our assessors, as healthcare professionals, are trained to identify and act on any safeguarding risks or wider concerns they have about a customer’s safety and welfare. While we have a robust formal safeguarding process for when we believe a customer is at risk of abuse or harm, our primary route to escalate any concerns is through the Unexpected Findings process. This will often involve us contacting a customer’s GP or, if the concern is more acute or immediate, the emergency services.


The total number of unexpected findings reports completed each year is not centrally recorded.


I hope our responses are helpful in informing the recommendations in the Committee’s upcoming report. If you have any further questions, or require any additional clarifications, please do not hesitate to contact me.



July 2022