Supplementary evidence from the Independent Assessment Services (IAS) HAB0159
Re: Health assessments for benefits inquiry
Thank you for giving Independent Assessment Services (IAS) the opportunity to give oral evidence to the Work and Pensions Committee on 25 May as part of the inquiry into health assessments for benefits.
During the inquiry session, we agreed to provide further information where it was not immediately available and you have requested further information in your letter dated 15 June. Please find our responses below.
Q1. 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
In response to a recent Parliamentary Question, Minister for Disabled People published data on remote, face-to-face and paper-based assessments for all PIP providers which DWP has asked us to share.
This data is available in Appendix A.
Q2. 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?
Q2a. What are the reasons why a request might be refused, and what options are given to claimants in those circumstances?
Claimants are able to request that their telephone or face-to-face assessment is recorded if they let IAS know in advance. Recordings are made digitally, with copies provided to claimants on CD.
Claimants are also able to record their assessment on their own devices, for example, using a mobile phone following an update to the PIP Assessment Guide earlier this year.
IAS encourages claimants to request a recording as this makes a copy of the assessment recording easily available in the event they want to raise any issues at a later date. However, we recognise that some claimants want to make their own recording and this may be done without informing the Health Professional. Claimants are entitled to record their assessment as outlined in the PIP Assessment Guide.
However, this does mean that data on the number of assessments audio recorded cannot be accurately given as there may be recordings that we are not aware of.
IAS also did not record the number of audio recording requests until May 2022, where we noted 12 requests, 9 of which were fulfilled. As this is a new marker, we are not confident that this data is currently accurately recorded.
There may be circumstances where a request for audio recording cannot be accommodated. For example, a claimant may give insufficient notice of the request for an audio recording which means the equipment is unavailable. In these cases, we would offer to either reschedule the appointment or offer to continue the assessment without recording, leaving it to the claimant to decide. The claimant could also choose to record the assessment themselves.
We promote audio recording in a number of ways. In the appointment letter, we provide a checklist of reasons on why people might want to contact us in advance. This includes the below, but may include other items (such as requesting SignVideo) which are dependent on the claimant’s stated condition.
Please let us know as soon as possible if you:
In addition, we provide information on our website, which claimants are directed to. This provides further detail on audio recording:
IAS also highlights audio recording as part of our ongoing stakeholder engagement workshops with the Department for Work and Pensions (DWP) and through our Claimant Representative Group (CRG). These workshops aim to provide charities, welfare rights organisations and other advocacy support detailed information about the PIP process so they can provide accurate information to claimants. Nearly 1,500 people attended these sessions in 2021 and they provide an important part of our communications.
I would like to add that IAS has no objection to recording by default provided there were clear opportunities to allow claimants to opt-out.
Q3. What proportion of people are accompanied in an assessment: for example, by an advocate or family member?
Q3a. Are there any reasons why you would refuse a request from a claimant to be accompanied?
IAS does not record data on people accompanied during an assessment, although this is noted on individual assessment reports.
We encourage claimants to be accompanied at assessments, both in our appointment letter and in information provided online. Companions can play a valuable role in providing support and additional information on how a health condition or disability affects a claimant’s day-to-day life. As a result, we would not normally refuse a request for a claimant to be accompanied.
For telephone assessments, IAS has introduced a four-way call service, so that claimants can have a companion as well as an interpreter if needed alongside the Health Professional.
However, due to Covid-19, for face-to-face assessments, DWP has required us to implement some restrictions on companions to ensure that we maintain social distancing during assessments. These currently encourage claimants to contact IAS in advance to let us know that they will be accompanied so we can ensure social distancing is maintained during face-to-face assessments.
Q4: 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
Assessment numbers for normal rules cases have been included in Appendix B.
Q5. 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?
Due to Covid-19, home visits are currently suspended by DWP.
As detailed in the evidence to the Committee on 28 April 2022, prior to the pandemic, IAS would normally agree requests for a home visit if the claimant did not feel comfortable with attending an Assessment Centre. We have always taken a flexible approach to claimant requests for adjustments to encourage them to participate in their assessment.
With the introduction of telephone assessments, video assessments and the restart of face-to-face assessments, IAS makes every effort to accommodate claimant requests for reasonable adjustments to the allocated assessment channel. We believe that once the service is fully operational with home visits available, this model should remain in place. IAS does not require further evidence from a claimant’s GP or other external professionals in order to support the claimant’s request for a change of assessment channel.
However, we only record these requests on an individual claimant basis, so data on the number of people making these requests is unavailable.
Q6. 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?
Q6a. What proportion of claimants that you see have this marker applied?
The Additional Support marker is a DWP process and the Department would be better placed to respond to this question.
The marker can be applied by DWP or Assessment Provider employees and the guidance for this can be found in Section 1.12 of the PIP Assessment Guide.
Q7. How many FTE assessors do you have? Please provide data back to 2013 if possible
Please refer to Appendix C.
Q8. Please provide a breakdown of the medical backgrounds of your staff.
During the oral evidence hearing, Mr Steve McCabe MP referred to a National Audit Office report (Contracted out health and disability assessments, 2016). This makes reference to the number of health professionals needed to complete assessments and states: “In April 2015, the Department estimated providers would need to increase the number of healthcare professionals by 84% from 2,200 in May 2015 to 4,050 in November 2016 based on its current plans.”
It should be noted by the Committee that this projection includes Health Professionals for all benefits, including the Health Assessment Advisory Service operated by Maximus that delivers Work Capability Assessments (WCAs), Industrial Injury Disablement Benefit and a number of other benefits. This was not clear during the oral evidence session.
Since 2015, the PIP service has been transformed. IAS is currently meeting the expectations of DWP in terms of the number of assessments that we complete and meeting our targets for the quality of assessments. This is a result of improving our recruitment, training and retention activities, which means we have been able to recruit and keep high quality Health Professionals in the service. We recognise there is currently higher than expected demand on the service, but it is too early to know whether this is a long-term trend.
Data on FTE assessors is provided in Appendix C. This includes Health Professionals from our supply chain partners and they are only able to provide accurate data from 2018.
Q9. 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.
Due to GDPR requirements, data on the average number of assessments actually completed is only available from 2019. It should be noted that changes to the PIP Assessment Guide can influence the time assessments take and does not necessarily reflect the productivity of individual Health Professionals.
Average Assessed per Day per HP | 2019 | 2.93 |
2020 | 2.58 | |
2021 | 2.56 | |
2022 H1 | 2.53 |
Q9a. Do assessors complete the whole assessment for a claimant at once, or do they come back to it later (for example, carrying out a block of assessments and then writing up a block of reports)?
IAS operates a “see and submit” policy where assessors will complete the whole report for a claimant and submit it before they begin the next assessment. This approach was initiated by IAS and referenced positively in the PIP Independent Review by Paul Gray.
Compliance with this approach is monitored for all our assessors. The only exceptions to this are home consultations, and if the assessor wishes to seek support while writing up their full report. In these situations, the report will be submitted as soon as is possible after the assessment.
Q10. 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 IAS to a report being returned to DWP?
Q10a. Please could you provide data on waiting times back to 2018.
DWP publishes average clearance times as part of the quarterly PIP outcome statistics https://www.gov.uk/government/collections/personal-independence-payment-statistics. Clearance times from 2018 from this data is available in Appendix D.
Q10b. What steps have you taken to speed up the process?
As detailed in our oral evidence, Covid-19 impacted the delivery of the service. Although we were able to continue paper-based assessments, we had to develop and implement telephone assessments safely and securely in response to the pandemic as face-to-face assessments were suspended. This temporarily reduced capacity. In addition, Health Professionals understandably wanted to support the NHS during the crisis and IAS volunteered Health Professionals to help. This made recruitment of high-quality Health Professionals challenging during lockdowns.
In our written response to the Committee in April 2022, we highlighted changes to our approach to recruitment and retention that has ensured we have attracted and kept the best quality people available, reduced sickness and increased productivity while improving the quality of assessments as monitored by the independent audit process. This means we have been able to return to the number of Health Professionals to meet the volume of assessments asked of us by DWP.
As previously stated, the Work and Pensions Committee has in the past recommended that the Department should improve understanding amongst health and social care professionals on what constitutes good evidence for PIP claims.
From 2019, IAS worked with DWP and the two other assessment providers to help educate health and social care workers on what constitutes good evidence and the benefits it can provide the people they are treating. This education and engagement programme was ongoing until the pandemic lead to it being suspended. We continue to work on ways to improve knowledge about what constitutes good evidence with the health and social care community through our stakeholder engagement programme.
To help gather evidence further, we have increased the use of telephone calls rather than standard forms and are working on accessing NHS email systems and exploring automated methods of evidence collection to obtain information. The use of new technology has the potential to streamline the evidence gathering process, increasing the number of potential paper-based assessments while better informing the assessment process, thereby reducing the average time in the assessment process.
Finally, we continually work with DWP and other providers on piloting methods of improving the service and reducing the time claimants spend in the process.
As a result, despite increased and unexpected demand on the service, IAS continues to reduce the number of outstanding cases and expects this to be reflected in the official published statistics over the coming quarters.
Q11. 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?
Contractual targets are owned and monitored by DWP. They have provided the relevant data in the attachment to this submission.
Q12. What proportion of your assessments are audited?
In May 2022, IAS audited 20.48% of PA4 (telephone, face to face or video) assessment reports . 16.45% of PA3 (paper-based) assessment reports were audited in the same period.
Q12a How many staff are dismissed each year due to performance-related issues?
In 2021, 61 Health Professionals were dismissed for performance related issues. Of these, seven failed probation, 41 were dismissed due to failing training, while 13 were dismissed for general performance issues or because they could not meet the demands of the role.
Q13. In what proportion of cases do assessors request additional evidence (eg. from medical professionals, carers etc)?
Q13a. In what proportion of cases are these requests met?
Q13b. 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?
PIP claimants frequently provide further evidence as part of their claim. In addition, IAS makes written requests for further evidence in 19.3% of cases, with 55.6% returned in the latest available figures. As highlighted in the written evidence of 28 April 2022, we predominately seek to gather further evidence by telephone as this provides more a more effective and timely method of securing more information on a claimant.
DWP and the Assessment Providers have all sought feedback from GPs and other treating healthcare professionals on reasons for not returning further evidence.
It should be firstly noted that the application processes for ESA/UC is different from PIP. In ESA/UC, the claimant would generally secure a ‘Fit Note’ from their GP to make an application. As a result, the GP is likely to expect a request for further evidence to support the claim from the Assessment Provider.
For PIP, the claimant initiates the claim themselves and may not notify their treating health professionals in advance. This means they may be more likely to submit evidence with their claim, but their GP and other treating healthcare professionals may not be expecting a request for further evidence.
Payment models for requests for evidence are also different as a result of these application processes, with ESA/UC requests part of a GP’s NHS contract, whereas PIP requests are paid on a per request basis at a fixed rate.
For PIP, medical professionals have also reported amongst other issues:
As detailed above, DWP and all the Assessment Providers began an engagement programme with GPs and health and social care professionals as a result of recommendations from the Committee in 2018. However, this was suspended due to Covid and discussions between providers and DWP have begun to restart this programme.
Q14. 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 (UE1) is used by all Assessment Providers to give immediate support to claimants where required. This support depends on the nature of the concern, but may involve contacting the claimant’s GP or the emergency services. IAS only records these on an individual basis so no overall data is available.
Additional request for financial information
At the Committee, we agreed to request from DWP permission to release profit margin and actual profit detail. In response, the Department has stated to us:
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.
Thank you again for providing us with the opportunity to give evidence and please do not hesitate to contact me if you require further information.
Appendix A: Assessments completed by calendar year
Year | Remote | Paper-Based | Face-to-Face |
Jun-13 to Dec-13 | 0 | 12,890 | 24,950 |
2014 | 0 | 103,680 | 295,170 |
2015 | 0 | 148,220 | 534,230 |
2016 | 0 | 182,050 | 786,080 |
2017 | 0 | 160,620 | 871,000 |
2018 | 0 | 136,050 | 818,820 |
2019 | 0 | 154,050 | 776,080 |
2020 | 441,390 | 139,040 | 153,180 |
2021 | 611,530 | 125,130 | 22,380 |
Jan-22 to Apr-22 | 236,180 | 53,330 | 14,720 |
Appendix B: Monthly normal rule clearances from March 2020
Mode | Mar 20 | Apr 20 | May 20 | Jun 20 | Jul 20 | |
Paper-based assessments | Volume
| 11,358 | 10,083 | 6,527 | 4,978 | 4,567 |
Percentage
| 33.5% | 31.5% | 18.8% | 12.8% | 9.7% | |
Face to Face assessments (Assessment Centre & Home Visits) | Volume
| 22,524 | 9 | 0 | 0 | 0 |
Percentage
| 66.5% | 0.0% | 0.0% | 0.0% | 0.0% | |
Telephone assessments | Volume
| 0 | 21,939 | 28,107 | 33,959 | 42,364 |
Percentage
| 0.0% | 68.5% | 81.2% | 87.2% | 90.3% | |
Video assessments | Volume
| 0 | 0 | 0 | 0 | 0 |
Percentage
| 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | |
Total | 32,031 | 34,634 | 38,937 | 46,931 | 32,031 |
Mode | Aug 20 | Sep 20 | Oct 20 | Nov 20 | Dec 20 | ||||||||
Paper-based assessments | Volume
| 4,924 | 7,784 | 10,448 | 8,438 | 6,955 | |||||||
Percentage
| 12.0% | 16.3% | 19.1% | 17.3% | 16.7% | ||||||||
Face to Face assessments (Assessment Centre & Home Visits) | Volume
| 0 | 0 | 0 | 0 | 0 | |||||||
Percentage
| 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | ||||||||
Telephone assessments | Volume
| 36,100 | 40,009 | 44,243 | 40,348 | 34,610 | |||||||
Percentage
| 88.0% | 83.7% | 80.9% | 82.7% | 83.3% | ||||||||
Video assessments | Volume
| 0 | 0 | 0 | 0 | 0 | |||||||
Percentage
| 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | ||||||||
Total | 41,024 | 47,793 | 54,691 | 48,786 | 41,565 | ||||||||
Mode | Jan 21 | Feb 21 | Mar 21 | Apr 21 | May 21 | ||||||||
Paper-based assessments | Volume
| 7,998 | 7,507 | 7,872 | 7,518 | 7,679 | |||||||
Percentage
| 16.9% | 16.0% | 15.1% | 17.5% | 18.4% | ||||||||
Face to Face assessments (Assessment Centre & Home Visits) | Volume
| 0 | 0 | 0 | 0 | 0 | |||||||
Percentage
| 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | ||||||||
Telephone assessments | Volume
| 39,455 | 39,445 | 44,258 | 35,311 | 33,759 | |||||||
Percentage
| 83.1% | 84.0% | 84.9% | 82.1% | 80.9% | ||||||||
Video assessments | Volume
| 0 | 0 | 0 | 179 | 279 | |||||||
Percentage
| 0.0% | 0.0% | 0.0% | 0.4% | 0.7% | ||||||||
Total | 47,453 | 46,952 | 52,130 | 43,008 | 41,717 |
Mode | Jun 21 | Jul 21 | Aug 21 | Sep 21 | Oct 21 | |
Paper-based assessments | Volume
| 7,514 | 7,944 | 7,506 | 7,589 | 7,526 |
Percentage
| 16.3% | 17.1% | 16.9% | 15.1% | 15.3% | |
Face to Face assessments (Assessment Centre & Home Visits) | Volume
| 29 | 102 | 2,096 | 4,363 | 3,935 |
Percentage
| 0.1% | 0.2% | 4.7% | 8.7% | 8.0% | |
Telephone assessments | Volume
| 38,342 | 38,031 | 34,356 | 37,923 | 37,163 |
Percentage
| 83.0% | 82.0% | 77.5% | 75.5% | 75.7% | |
Video assessments | Volume
| 302 | 304 | 374 | 385 | 486 |
Percentage
| 0.7% | 0.7% | 0.8% | 0.8% | 1.0% | |
Total | 46,187 | 46,381 | 44,332 | 50,260 | 49,110 |
Mode | Nov 21 | Dec 21 | Jan 22 | Feb 22 | Mar 22 | |
Paper-based assessments | Volume
| 8,105 | 6,490 | 8,929 | 9,833 | 11,290 |
Percentage
| 15.2% | 15.2% | 15.9% | 17.6% | 17.9% | |
Face to Face assessments (Assessment Centre & Home Visits) | Volume
| 4,793 | 3,729 | 154 | 3,069 | 6,382 |
Percentage
| 9.0% | 8.7% | 0.3% | 5.5% | 10.1% | |
Telephone assessments | Volume
| 40,072 | 32,015 | 45,220 | 40,486 | 42,240 |
Percentage
| 74.9% | 74.8% | 80.4% | 72.4% | 66.8% | |
Video assessments | Volume
| 525 | 544 | 1,928 | 2,518 | 3,315 |
Percentage
| 1.0% | 1.3% | 3.4% | 4.5% | 5.2% | |
Total | 53,495 | 42,778 | 56,231 | 55,906 | 63,227 |
Mode | Apr 22 | May 22 | Jun 22 | |
Paper-based assessments | Volume
| 9,102 | 10,174 | 10,092 |
Percentage
| 17.1% | 16.6% | 17.5% | |
Face to Face assessments (Assessment Centre & Home Visits) | Volume
| 5,658 | 6,491 | 6,424 |
Percentage
| 10.6% | 10.6% | 11.1% | |
Telephone assessments | Volume
| 35,967 | 41,685 | 37,829 |
Percentage
| 67.6% | 68.2% | 65.4% | |
Video assessments | Volume
| 2,459 | 2,765 | 3,464 |
Percentage
| 4.6% | 4.5% | 6.0% | |
Total | 53,186 | 61,115 | 57,809 |
Appendix C: FTE Assessors
The below data provides FTE by assessor background from 2018. This data does not include Clinical Standards Leads, who provide clinical auditing and support for assessing Health Professionals.
Nurses | 2018 | 1228.4 |
2019 | 1130.3 | |
2020 | 1135.9 | |
2021 | 1379.9 | |
2022 Q1 | 1485.1 | |
Paramedics | 2018 | 146.8 |
2019 | 118.6 | |
2020 | 102.9 | |
2021 | 98.0 | |
2022 Q1 | 101.9 | |
Physios | 2018 | 100.2 |
2019 | 78.1 | |
2020 | 112.0 | |
2021 | 105.0 | |
2022 Q1 | 105.4 | |
Doctors | 2018 | 3.0 |
2019 | 5.8 | |
2020 | 5.7 | |
2021 | 2.5 | |
2022 Q1 | 2.5 | |
Occupational Therapist | 2018 | 114.4 |
2019 | 104.1 | |
2020 | 93.0 | |
2021 | 98.1 | |
2022 Q1 | 101.6 |
Appendix D: DWP referral to Assessment Provider to return to DWP
The current time period for referral to the Assessment Provider to return from the Assessment Provider for all new PIP claims is 12 weeks. The published times in weeks are below.
Jan-18 | 4 |
Feb-18 | 3 |
Mar-18 | 3 |
Apr-18 | 4 |
May-18 | 5 |
Jun-18 | 6 |
Jul-18 | 6 |
Aug-18 | 7 |
Sep-18 | 7 |
Oct-18 | 7 |
Nov-18 | 6 |
Dec-18 | 7 |
Jan-19 | 7 |
Feb-19 | 7 |
Mar-19 | 6 |
Apr-19 | 6 |
May-19 | 7 |
Jun-19 | 6 |
Jul-19 | 5 |
Aug-19 | 5 |
Sep-19 | 5 |
Oct-19 | 6 |
Nov-19 | 6 |
Dec-19 | 7 |
Jan-20 | 8 |
Feb-20 | 9 |
Mar-20 | 8 |
Apr-20 | 10 |
May-20 | 14 |
Jun-20 | 18 |
Jul-20 | 17 |
Aug-20 | 14 |
Sep-20 | 10 |
Oct-20 | 11 |
Nov-20 | 11 |
Dec-20 | 12 |
Jan-21 | 12 |
Feb-21 | 12 |
Mar-21 | 11 |
Apr-21 | 11 |
May-21 | 12 |
Jun-21 | 12 |
Jul-21 | 19 |
Aug-21 | 15 |
Sep-21 | 14 |
Oct-21 | 13 |
Nov-21 | 13 |
Dec-21 | 13 |
Jan-22 | 14 |
Feb-22 | 13 |
Mar-22 | 12 |
Apr-22 | 12 |
July 2022