The second item of business is our first evidence-taking session for some time on personal independence payments. As with work capability assessments, Atos Healthcare holds the contract for undertaking PIP assessments, but in much of Scotland that work has been subcontracted to Salus, which—as I and other Lanarkshire members know—is NHS Lanarkshire’s occupational health arm.
I welcome Mark Kennedy, who is the general manager of Salus, and Kenny Small, who is the director of human resources at NHS Lanarkshire. Members might recall that, last year, we invited both men to come before the committee to set out how they intended to implement the contract. We have waited until now to hear again from them in order to give the contract a chance to run for a number of months, and to give our witnesses a chance to put together some concrete evidence. They have now provided that evidence, and I thank them very much for their written submission.
I understand that you also wish to make opening comments. I do not know whether you are both going to say something. I will start with Kenny Small.
Thank you very much, convener. We appreciate this opportunity to update the Welfare Reform Committee on the PIP contract that Salus holds.
We believe that the story is a positive one and, in a minute or two, Mark Kennedy will talk you through our submission and give you some statistics on, and evidence of, our performance in delivering this contract. As you would expect with such a complex contract, we had some teething problems in the very early stages. We now believe that we have got beyond those problems, the vast majority of which were not of our own making, and that the contract will pick up and run in a favourable way.
With those brief introductory comments, I hand over to Mark Kennedy to talk you through our paper, after which we will, I hope, take questions from the committee.
We have submitted to the committee a high-level report that contains some statistics starting from when the contract commenced in July. The contract has been running for nine months now and, to date, we have led face-to-face consultations with about 7,000 claimants at eight venues, mainly in the west of Scotland and Edinburgh city, and have had only five complaints from claimants going through the process.
Members might remember from our previous appearance that the consultation time was under review. Things have now settled down as a result of a number of information technology problems being solved and as a result of increased familiarity on the part of the assessors; the consultation itself now takes 90 minutes or so. At the moment, each assessor can comfortably provide about four consultations a day; we feel that to do more than that would be detrimental to claimants, in respect of the duration of the assessment.
We expect that, by the end of the calendar year, 30,000 or 31,000 consultations will have been offered. Our workforce currently comprises 26 or so national health service based practitioners, but we hope that, at our peak in August and September, we will be employing about 37. At that point, we will be at full capacity and offering around 3,000 PIP assessment slots per month.
As members will recall, we were determined to take the initiative forward with the ethos and compassion of the NHS at the centre of it. We have invited disability groups across Scotland to consult with us and we have put on an open day, which included seven representatives from those groups. Last November, I made a presentation to the Scottish social security consortium that set out in a transparent way how Salus intended to work with claimants from day 1 of their claim.
We feel that we are delivering a high-quality service. We have received informal feedback from Atos and the Department for Work and Pensions that the quality of our report writing is among the highest in the United Kingdom and to date we have not—touch wood—had many complaints from members of the general public who are going through the process. Things seem to be settling down and, in my opinion, are working well.
Thank you very much. We will move to questions.
You said that 7,000 assessments have been carried out so far and that 30,000 or 31,000 could be carried out by the end of the year. Is that where you expected to be, or are you ahead of or behind schedule? Have you been set targets, and if so, are you meeting them?
At present, we are on our way to where we want to be. As Kenny Small suggested in his opening remarks, at the start of the process the volumes with regard to the flow of claimants to the service were a bit inaccurate, so Atos and the DWP have been required to do a bit of catching up.
The way it works is that we provide appointment slots a month in advance to Atos, which fills them on our behalf. We say to Atos that we will provide it with 3,000 slots a month, which is the maximum we can do, and we are now just about at our maximum capacity.
As far as overall performance is concerned, I think that there is still a bit of catching up to do—and not, I have to say, by Salus. The need to catch up flows from the figures that Atos and the DWP have put together.
I do not know whether I have explained that correctly.
You were set a target. My understanding is that the DWP wanted a reduction in the amount of money that was being claimed by the overall number of people going through the system. Is that right?
That is not right, from Salus’s perspective. There is no target setting as far as Salus is concerned. We deliver an assessment that the DWP has endorsed and we have no quota for the number of people who should pass or fail it.
The target that Salus exclusively works to relates to the number of available assessment slots and the production of assessments. What happens thereafter is neither our responsibility nor part of our contractual liability.
The statistics will begin to show whether this is true, but when we have met organisations across Scotland to discuss the new changes we have picked up anecdotal concerns about the criteria for PIP. We heard the same concerns about the work capability assessment criteria, and we and other people have proved that they do not provide any evidence on whether people are fit to work. In most cases, the criteria are very unfair and serve very little purpose in assessing people for fitness for work. Do you believe that the assessment criteria that you have been given are fair and provide you with something that you feel comfortable assessing in determining whether people are entitled to the new PIP?
I absolutely think that the criteria are fair. You have mentioned that Salus’s background is in occupational health; we have been assessing people’s functionality for decades now.
I can state clearly that NHS Lanarkshire would not be involved in this if we did not think that the process is fair. I have not picked up in the numbers that we have put through any anecdotal evidence of people’s unhappiness with the assessment, but I also accept that we have not—to my knowledge—received any formal report on PIP from the DWP. I think that we are delivering a fair assessment in a compassionate manner.
Perhaps I can give you an example to illustrate why I am asking about fairness. In one of the meetings that we had, it was brought to my attention that a person who was being assessed had been asked whether they could walk a certain distance. The person said that on some occasions they might be able to do so, but would find it difficult. That individual felt that the test was set up to make them fail. They were required to walk from the car park into the assessment centre, which was a distance greater than the distance of the test. In making it from the car park into the assessment centre, that person in effect proved that they were not entitled to the benefit, which they thought was inherently unfair. Someone who is keyed up to go in for an assessment wants to get there, but walking that distance does not actually measure their normal ability to walk a certain distance. It is that type of unfairness that has been brought to our attention. Will you comment on that?
I can categorically say that that is not happening in Salus-led provision. We do not take such assumptions into consideration. Our assessment starts when the individual presents themselves at reception in the building. I have heard such stories before, and I am not sure what company they relate to, but they certainly do not relate to NHS Lanarkshire’s approach.
I have heard bits and pieces about where certain bus stops are, but I can categorically go on record as saying that what you describe is not the case as far as we are concerned. As soon as the individual presents within the facility on our premises, the assessor will meet the individual at the desk and escort them to a consultation room. That room could be 10m away or 50m away. No such assumptions are ever made.
It is important to recognise that the initial estimate of how long an assessment will take and our current experience are very different. Our current experience is that assessment of an individual takes between 90 and 110 minutes. It is not a short assessment, and it does not involve any snap judgments. It is very much an opportunity—a relaxed opportunity, we believe—for an individual to tell us their story and for us to use a set of prompting questions for people to tell us what effect their disability has on their normal everyday life. That is what the assessment process does: it allows people a relaxed opportunity to walk us through the implications of their disability in relation to their everyday life. That informs the process for the assessment that we then submit. As Mark Kennedy said, there are no assumptions made beforehand, and there are no tricks.
I know from conversations that I have had with Kenny Small and from evidence that we took from Atos previously that there was a dialogue between the companies that are carrying out the assessments and the DWP. Atos said that some criteria had been changed, and it had raised some issues about the work capability assessment and about some modifications that had been made to the criteria or to the assessment process. Has that happened with you? What has the response been, if you have had to go back to the DWP to discuss issues of that sort?
We have not done that, have we?
No—we have not been asked to alter, or to consider alterations to, the assessment tool. There have been IT changes that have made it a bit easier for the health practitioner to go through things in a more timely fashion, but we have not been asked to implement any major changes, at all.
Right at the very beginning, the clinical director of Salus, Dr Imran Ghafur, was heavily involved with Atos and the DWP and made comments around the clinical governance aspects of the original assessment. Some tweaks were made at that time. I was going to say that that was during the early stages—in fact, Atos and the DWP were using some experienced clinical professionals to road test the assessment process before we even launched it. Since we launched it, however, the assessment process has been what it is now.
Atos went to great lengths to try and assure us that it had been in a constant dialogue with the DWP to get some of the assessment changes made. Atos was picking up from practice things that it was concerned about, and it raised them with the DWP. Was that your experience?
That conversation might be around the process, rather than the actual assessment. Atos had significant problems with IT at the start. That was one of the things that it was actively discussing with the DWP.
I now open up the discussion to committee members, starting with the deputy convener.
Welcome, gentlemen. Mr Small, the last time you were at the committee, you said that your
“overt intention is to seek to add the value that we believe an appropriately recruited and selected and then trained and supported NHS workforce can bring to the assessment and reassessment process for DWP PIP.”—[Official Report, Welfare Reform Committee, 22 January 2013; c 488.]
Mr Kennedy talked about putting the ethos of the national health service at the heart of your work. Can you set out how you are going about doing that?
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I am a director of human resources, so the jobs aspect of this discussion is very close to my heart. As Mark Kennedy has said, we have recruited about 26 whole-time equivalents, and we anticipate that that figure will go up to 37 whole-time equivalents. Those are new jobs. We have used those posts in Lanarkshire and with other health board partners. As you know, we have centres that go way beyond Lanarkshire, in the west of Scotland and in the city of Edinburgh.
We have recruited the individuals from a combination of sources. Some of them come from the external market and some of them are from our own redeployment register, on which are staff who have been affected by organisational change and find themselves in temporary roles or roles that are not as fulfilling as others. We use those opportunities.
We also use opportunities to offer alternatives for staff who find themselves unable to undertake other substantial roles within the NHS for reasons of fitness to practise. Our experience—the evidence is there to be seen—is that delivery against the aspiration to add substantive income and roles to the NHS in Scotland has been successful. It will continue to be increasingly successful as we flex the workforce to meet the demands of the number of assessments as that number grows.
Reputationally, from the perspective of Salus and its link with NHS Lanarkshire, the role that we are fulfilling—given the evidence that we are getting back from Atos and the DWP’s analysis of our performance—stands testing against anyone in the UK. The complaints that Mark Kennedy mentioned account for something like 0.0007 per cent of activity. The majority of the complaints have been about people not being able properly to read the map telling them where to go to get the assessments, so those are, arguably, not even complaints about the quality of the interaction around the assessment anyway. However, you can be confident that we are doing something about making those maps better.
From the perspective of the ethos of the NHS and adding value, we are delivering that. As you would imagine, we are keen to ensure that that continues.
The whole structure within Salus has been set up to mirror the NHS. There is no concierge at our sites, and there is no security—they run like out-patients departments. In general, judging from the feedback that I am getting from Atos and the DWP, people are respectful of that and are happy with that.
When our nurses and practitioners are trained, they are constantly reminded that they are working for the NHS; they are performing a public service. The people whom they are assessing are the same as the people who come through the door of the general practice or wherever practitioners had their previous jobs, and they should be treated with equal respect.
It is hard not to go into the nitty-gritty stuff. We are trying to instil a caring ethos around what we are doing. We accept that it cannot be easy for individuals to present themselves for disability assessments, so it is our job to make it as painless as possible for them. We believe that we are doing that to a high degree. I do not have any alarm bells ringing as far as complaints are concerned.
That is helpful, Mr Kennedy. Thank you.
In your paper, you say that
“the consultation duration is determined by the claimant. The claimant should be satisfied that they have had enough time to provide an accurate account of their position.”
How does that work in practice? No one can be told, “Your time’s up. Go now.” Is that correct?
Yes—that is the case at the moment. Our average appointment time is about 90 to 110 minutes. On any given day, some people might need to be there only for an hour, while others might require two hours. At the moment, our challenge is to manage that flux as best we can while respecting the needs of the individual.
We do not close people down. As you know, the health practitioners are trained to ask probing questions. If a person is going off track or off at a tangent, the practitioners are trained to bring the discussion back to the person’s functionality and how they are performing. As Kenny Small said, the whole approach is fairly simplistic. The person sits down and tells us what happens, from the moment they open their eyes in the morning until they go back to bed, during their average day and what happens during their most difficult day. However long that takes is how long it takes to deliver the assessment.
You have said a couple of times that the average appointment time is 90 to 110 minutes. I take on board your point that that allows for a fairly comprehensive assessment.
On the flip side, I note that the Scottish social security consortium expressed concern to you that the duration can be too long for some disabled people. How do you square that circle? I know that it is not an easy thing to do.
We are trying to instil in our staff the need to make a judgment. If people become repetitive, we can intervene and say, “Have you anything to add that you have not said, or do you want to stress any point?”
Interestingly, when the consultation came up we went through the whole journey for the individual—including the assessment process—in detail. I have to agree that it is a lot to ask of someone to come and sit in front of us and explain their day for two hours, so we try to keep appointments under two hours. We are very much aware that the process must be driven by the individual; we do not want accusations about people not being allowed to tell their story fully. We manage the process at present within our appointments system. If one person takes a long time, we live in hope that someone else will not, so that we can shuffle things.
A lot of the changes post Atos and the consultation process have been about the efficiency of the process with regard to IT. Those have given us an extra 15 or 20 minutes that we did not have in the early days of the programme.
There have not been many episodes in which the process has gone over two hours—at least, not that I have been told about. The vast majority of assessments last about an hour and a half. We are not actively seeking to push the duration lower because that is about the optimum length.
That brings us back to the potential added value from the NHS. The NHS health professionals are trained to speak to people in a language that they understand and to test and search people during communication without appearing to do so. That is where we genuinely add value. The core element of a health professional’s training is about communicating and engaging with people in a meaningful way. Although we have added to that training, the core training has been really important in the success of our experience to date.
That begets another question, which occurred to me earlier when you answered my first question. There could be another advantage, given that the process takes place in the NHS environment. Do your professionals who undertake the assessments pick up on other issues, and are they able to refer individuals to other parts of the NHS?
Yes. As part of the NHS, we are unique in that we still have a duty of care to any individual who presents in front of us. We ask anyone with suicidal ideation or any chronic complaint that we think requires further examination, for example, to contact their general practitioner immediately. We function in the same way that any other out-patient department of the NHS would.
That is helpful. I have one final question. We have heard that you have had few complaints and you said that you have so far not been sanctioned with any penalty credits. I do not know how much you want to tell us about that, although it is obviously good for Salus. What are the arrangements and circumstances in which those credits can be applied? How does all that work?
The contractual agreement with Salus involves service credits—or penalty credits—around quality measures. For example, if someone waits more than 30 minutes, there will be a charge—or a reduction in payment—to Salus. They are performance drivers; none of them affects the duration of the assessment.
Some of them relate to the quality of the reporting. We submit reports to the DWP that are banded as either A, B or C. An A is a fabulous report that gives the DWP all the detail that it requires; a B is a report that, with some fine tuning, could be better and of more value; and a C is what the DWP determines to be a failed report, with something fundamental in the assessment that needs to be changed.
We have threshold levels on those measures. If more than 5 per cent of the reports that we submit are band C reports, there is a penalty. The penalty credits are key performance indicators, and to date we have not invoked any.
I want to go back to a point that the convener raised at the start of the meeting. Mark Kennedy said that Salus had not received any formal reporting back from the DWP. What is the system for that formal reporting? Is it based on a timescale, with the DWP reporting back every so often, or does the DWP report back after a certain number of assessments? What form will the reporting back take and what do you expect to get from it?
That is a good question. We are interested in that as well, because such reports might help us with regard to quality, depending on what is in them. At the moment, there is a contractual arrangement between Atos and the DWP for reporting—there is no direct mechanism between the DWP and Salus for that. However, I hope that the DWP will soon be reporting early findings on PIP in the public arena, which we could perhaps drill into, as our work will represent a percentage of that.
We get informal reports from Atos on the claimant journey and satisfaction as well as management information about the number of slots and stuff like that. We do not yet get any qualitative evidence from Atos, but we are saying up front that, as a public sector body, we would appreciate such evidence.
So you do not get back, for example, statistics on the decisions that are taken and other things relating to your assessments. Would you expect that to happen in future?
No, not within our contractual agreement but, obviously, it is something that we are interested in. To my knowledge, there has not been a formal report on that, although members around the table may know more about that than I do. I have not had anything other than informal rhetoric from the DWP.
Would it be useful to have that information?
I would like to know. I am not quite sure what we would do with just a flat statistical report, but yes, it would be good to know how many decisions are made in relation to our reports.
As Mark Kennedy described earlier, the feedback that we get in relation to the qualitative measurement of the assessment process is very useful, because we have a system in place that allows us to track things right down to the individual health professional who is undertaking those assessments. Obviously, if there is a need to order further development training for an individual to improve their assessment process, we would want to know right away so that we could take immediate action in that respect. In terms of the quality of the input, some of the feedback that we are getting is very helpful indeed.
On another tack, I was really pleased about the consultation that you undertook at the start of the process with the disability groups and so on. It seems as though that has been fairly successful. Do you intend to undertake such consultations regularly—or, indeed, irregularly—to find out what the perception is of your work?
Yes. I intend to have a further event in September and to hold at least one workshop annually on what the process involves. It would be good for us because, at the moment, we are reliant on customer feedback from the contractor and it is a wide sample. We know that word of mouth and local working are valuable. By September, the organisations that we consulted should have engaged with a lot of people who will have been through PIP and who will have either had a decision or not, so the workshop in September will probably be to find out what people are telling the organisations. There is a learning issue for us in that regard.
I am very interested in people’s experiences when entering and leaving Salus premises. We will not have any influence over changing any element of the assessment, but I am interested in people’s experience when they come through the door. I have to ensure that that experience is as good as it can be. We will invite people back annually and will probably do so in September this year.
Sorry if I am going back to basics, but I want to confirm that although you assess claimants, the decision on how an assessment affects their benefits is made by Atos or by the DWP. Do they share any of that information with you? Do you know at all which parts of the assessments that you carry out trigger changes in benefit assessment?
We do all the assessments. The DWP makes the decisions. Atos does not make the decisions. In an assessment, we talk through the client’s normal day and we agree on the best descriptor of the opportunity that they have—whether they are eating, sleeping and walking, for example. The descriptors are scored. I assume that the DWP adds up those scores at the end of the day and makes a decision based on the score and on the qualitative information that is provided. We do not encourage our staff to look at numbers at all—we just train them. The purpose of their role is to ensure that the best descriptor is chosen. We do not get any feedback on the decision making, which is all done by the DWP. Although we have put 7,000 people through the assessment process, I currently have no knowledge even of how many of them have had a decision.
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You try to ensure that each of the assessors is conducting assessments according to the same criteria each time and that they are scoring in a suitable way compared with one another for each claimant. You have no knowledge about how the information is used. Will you be told at some point? There is clearly a big dilemma involved in being a caring service and a gatekeeper. Will you be given information about how the scores trigger claimant—
No. We have a contractual commercial arrangement. Like anybody else, we will have access to information when the DWP reports it. I will never get a report back—nor should I, you might argue—stating that, out of the so many thousand people whom we have assessed, X have been successful in their claims.
You have received a very low number of complaints about your service, which must be very gratifying. Whereas that is simply an assessment of the professionalism and care that you are providing, the individual concerned might still be extremely unhappy with the decision that they face. Their complaint about that would go to the DWP or Atos, not to you. Is that right?
That would go to the DWP. I imagine that it would have to report—as it has done previously for work capability assessments—how many of the negative decisions went to appeal, how many were upheld and so on.
When the patients—do you call them patients or claimants?
We call them patients, but that is because we are the NHS.
When patients come to see you, do they view your assessment as an interrogation? Do they know how much it matters for their benefit claim?
They know how much it matters to their benefit claim. The importance of their visit is not lost on them. There is obviously a degree of anxiety on the part of anybody undergoing an assessment. That is the whole idea behind using the NHS ethos and quality NHS staff. It is our job to try to relax people and to make the assessment as non-threatening as possible, so that we can do a good assessment. That is what we aim to do. People are not naive when they come to the assessment centres.
It is a very difficult thing to capture, but the idea is that you are a fair, impartial assessor. You are neither the setter of the criteria nor the judge and jury. You are simply carrying out a process that will be fair and will treat all claimants in the same way.
Yes.
Do you think that you have put that across well?
Yes. As Kenny Small says, when we start to submit assessment reports, problematic reports are flagged up to us. It is very easy to identify whether one of our assessors is struggling with the individuals in front of them or with how to proceed. They will get more intensive training and support in order to improve. We have some quality measures that give us enough reassurance to know whether we are doing a good job.
Are you aware whether any of the delays that have beset the larger programme concern your part of it? Do you simply provide slots, which are filled?
I am aware that there is a backlog—although that is not from our perspective. There is a significant period of time for the patients between submitting their claim to the DWP and getting to Salus. We do not control or influence that. We provide our appointments a month in advance. We rely on Atos filling the appointments. We do not influence how quickly the paper trail comes through the DWP to Atos to us.
Are people allowed to bring somebody with them?
Yes. They are encouraged to do so.
Good morning, gentlemen. I have a few questions. Do you have a rough estimate of the total number of claimants or patients in Scotland who are currently covered by the Salus contract? Do you have any idea how the Salus component fits in with respect to the rest, which is Atos?
I am told that about 55 or 56 per cent of the total is covered by Salus.
We have heard already that you are not aware of the outcomes for the individual. How do the outcomes for Salus compare with the Atos outcomes, in terms of both the result and how long it takes to get to see somebody? I have a constituent in Fife—to whom I referred on a confidential basis in a debate in the Parliament the other week—who waited four and a half to five months to get an assessment from Atos, notwithstanding that they had had major surgical intervention. I hope that the situation is not the same on the Salus side of things.
I would not know, to be perfectly honest, because a case has to be processed through Atos prior to coming to me. I suspect that the people who come to Salus wait for a degree of time before their appointment. However, they are written to probably about a month before their appointment with Salus—that is the only bit that I can influence. Maybe my submission does not mention that we have a do not attend rate of around a fifth, so one person in five does not appear on the day and needs to have their appointment rescheduled. The waiting time from a person’s original submission is too long.
Is there a possibility of a home visit if the circumstances require that?
Yes. I should clarify that Salus provides only face-to-face assessments at the venues mentioned, but there are two other processes for assessment. One is to do with a very quick turnaround for people with critical illness and terminal illness, for whom Atos does a paper referral. Also, Atos deals with anybody whom it assesses as requiring a domiciliary assessment.
On the part of the process that you are engaged in, you referred to the descriptor approach and to the fact that qualitative information is also included. Can you provide a wee bit more information? In an average case, when you see a patient for their assessment, to what extent would additional written information be provided in relation to a descriptor? Our confidence in the descriptor approach, at least in the case of the work capability assessment, is not very high, because it does not seem to allow you to give additional relevant information.
There are two aspects. There is the choice of the descriptor, which is a process in itself. The health practitioner then has to justify why that descriptor has been chosen. If we submit C level—unsatisfactory—reports, Atos and the DWP returns them to us saying that the justification did not meet the choice. We have to put a bit of work in to say, “We have chosen this descriptor—this is the rationale for why we have done so.” The health practitioner will write things such as, “The client has, on two occasions or frequently, stated, ‘Blah, blah, blah’.” The health practitioner has to justify their choice. There are a number of descriptors and, at the end of the assessment, the practitioner also has to summarise all the descriptors. There is therefore a second test—if you like—in the write-up, as it has to marry the small summary with the descriptors.
I think that Atos and the DWP might be looking at the second summary, which is like a short essay on why all the descriptors have been chosen, with a view to refining it somewhat. We have to provide more evidence than just ticking a box to say, “This is the descriptor chosen.” The health practitioner has to demonstrate why they chose it. The DWP then assesses the decision on the descriptor to see whether the descriptor is relevant and feeds back to us directly if it is not, so there is a check.
I have one last question at this point. In the case of the work capability assessment, which we have been trying to get to the bottom of, the more hard-and-fast medical information—stricto sensu—is enclosed with the application, the better the applicant seems to fare. How does that work with respect to Salus, given that it is an arm of the NHS in Scotland?
The same opportunity is given to the patient when they attend. They are invited by the DWP to submit further medical evidence of their claim to the DWP and, if they have a further submission, to bring it to Salus. Patients arrive with poly bags full of evidence, of varying sophistication. We are duty bound—and contractually bound, although we would do it anyway—to review every piece of evidence that comes in. That has been an issue affecting the duration of assessments. If someone arrives for an assessment with 40 pieces of evidence, we have to log and consider that evidence.
We are encouraging the DWP, or Atos, via a number of partners, to try to give more detail to claimants on what would be regarded as priority evidence. People can arrive with something as simple as a receipt from a taxi, saying, “I need to use a taxi to get to places,” or they might have a two-page letter from a GP that contains strong advice—people bring everything. We are asking the DWP to give a wee bit more advice to people about what would help their claim. The evidence has to be assessed and is part of the assessment.
We have information that the administration cost for disability living allowance was £49 per claim, compared with £182 per claim for PIP, and that the average decision time on a new claim for DLA was 37 days whereas for PIP it is 74 days. In your response to Mr Macintosh, you said that the timescales are mostly out of your hands and are governed by the DWP and Atos. Does that reflect on Salus? Do folk come into your office and moan about the bureaucracy around the new process and how long they have had to wait?
We have occasionally—more than occasionally—had individuals come to reception and say, “I’m so glad to be here, because it’s taken so long to get here.” That is why I said that the wait is too long. It would not be acceptable in the NHS; why is it acceptable in this process? You are right that I have no control over how that works, given the arrangement that we have.
Do you go back to Atos and the DWP to tell them what folks have said?
Yes.
You do. You said that folks would not have to wait as long for an NHS appointment. You are an offshoot of the NHS. How do folks react to that? They sometimes do not get that there is a difference.
I can say anecdotally that more patients or claimants come through our doors saying that they are happy that we are doing the assessment and not someone else. There is an acceptance of us and—I think rightly—a degree of trust about how the NHS will perform.
On whether the wait could be shorter, because the work is commercially contracted via the DWP we can only make recommendations. We feed back our major concerns to Atos monthly, and a concern that people consistently mention is the length of and delays in the process. I should say that I have no idea how long it takes for a decision maker to process a case once Salus has assessed the individual.
We are in an unusual position, in that, if we owned the process end to end, we would actively look to make it more efficient—
If you owned it end to end, do you think that the average waiting time for a claim would not have doubled?
I would like to think so.
That is extremely useful. I think that it was Mr Small who said at the start of the meeting—I paraphrase—that NHS officials are trained to deal with patients and have the right level of communication. Sessions that we have had with Atos and the DWP have led us to conclude that communication is a major failing in relation to the assessments. Have you indicated to Atos and the DWP the differences between your style and theirs in order to bring others up to the standards that you seem to have in this regard?
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In the conversations that I have had with Atos and with Mark Kennedy and his colleagues, we have looked at the issue almost from the other end of the telescope. I think that Atos acknowledges the added value that the NHS brings. It certainly seems to recognise Salus’s performance on communication and delivery relative to performance elsewhere in the UK. In conversation with Atos we have discussed how it might prefer to run the entire contract throughout the UK, or indeed throughout Scotland. However, for the NHS or the public sector to become more involved in this work would require either a change in approach or a change in interest.
I will be a bit naughty here—I know that Mr Small may not be able to answer this. Are you describing a situation that would be best dealt with by the NHS rather than through private contracts?
I would not necessarily go as far as that. However, as we have seen it from the outset, and as we articulated when we first came before the committee, the NHS is in a very strong position because of our training and skills—as you have described them—and the ability of our staff to get the best out of people when they are in the pressurised situation that Mark Kennedy described of giving the information on which we create the assessment. We do not treat this as a business; we treat it as a patient contact. That is part of the reason why it takes so long. It is also part of the reason why we get the quality feedback on the key performance indicators that we do. It almost could not be better.
Mr Kennedy, you talked about logging individual pieces of information that folks bring. One of the things that I have been told—I am sure that colleagues are the same—is that those bits of paper that folks think prove that they have certain difficulties are often disregarded. Have you suggested to colleagues in Atos and the DWP that that logging process should become the norm?
It should already be the norm. We are under contract to record every piece of evidence that comes with the client.
To return to my previous response on that issue, I was suggesting that there is a vast range of information, some of which carries more weight than others. We asked Atos why we could not put that out in the public realm. A letter or substantial report from a healthcare professional will carry a lot of weight in this process. A note from a neighbour to say that they have seen the individual struggle to put their bin out would not carry the same weight, although you could argue that that is a vital piece of information. We are trying to get some clarity about the best form of evidence that someone can present with their claim. I have fed that back to Atos. I am unsure what Atos, via the DWP, has done on that.
Mark Kennedy said that the NHS has a duty of care. Do you feel that other contractors and decision makers in the DWP have a duty of care? If so, do they adhere to it?
To skirt round the question, I would ask you to ask them. We perform a duty of care in this programme.
In relation to your earlier comment, I would love to see our performance relative to that of the other companies throughout the UK. I would welcome that. Whether I will see that, I am not sure.
To add to Kenny Small’s response to your earlier question, I remember the discussions at Lanarkshire NHS Board when this process was brought to the table. Most of the discussion centred on the question of what makes us better at doing this than anybody else. I reiterate that the NHS deals with disability every minute of every day. Our view was that no one was better placed to deliver the service in Scotland.
Thank you. That was useful.
I have a couple of brief questions that might differ slightly from the others. Will you confirm that you work as subcontractors to Atos?
Yes.
Atos has made it clear that it does not want its contract with the DWP to be extended. Does that affect your longer-term contractual position?
No. The withdrawal of Atos from work capability assessments involves an entirely different contract.
Given the indication from Atos, have you found anything in the model that you have operated that could be extended to the other areas in which Atos currently works?
I have limited knowledge of the work capability assessment, because we do not have anything to do with it. However, I think that Atos is learning about taking a different approach to the process with the claimant. The process does not need to be as harrowing as it sometimes is.
Atos has commented on bits and pieces. It was surprised that we had no security on site. As I said, we took the view that such individuals access the NHS, so why would we have security? We have several claimants or patients who have been through the work capability assessment process and are now applying for PIP and who have said that the experiences are as different as night and day.
Culturally, Atos or other providers could learn something. The committee will accept that it is not my job to teach them, but it would be nice for a summary to be provided. As the committee knows, Atos will not be involved in work capability assessments in the future, but I am not sure about the rest of its welfare portfolio or its involvement in PIP.
My final question will partly repeat a question that I have asked before. Could an organisation such as Salus be involved in things such as work capability assessments in the future?
To be honest, I am unsure how to answer that. I have said on the record that nobody is better placed to look at an individual’s functionality than the NHS. From a clinical point of view, there is no reason why that should not be the case in assessing whether somebody is fit for work. However, like the committee—although maybe not everybody round the table—we are reticent about the current work capability assessment structure. We are making no moves to enter that market at this point.
The immediate answer to the question, which Mark Kennedy is perhaps embarrassed to give, is that a core part of Salus’s job for the staff of NHS Lanarkshire involves workplace capability assessment. Salus is experienced, diligent and successful at conducting that role for NHS Lanarkshire and other employers across Scotland and beyond as part of an occupational health service.
I will ask the same question once more in different words. If Atos was not involved and the contract was up for grabs, could you do the job better?
I do not think that we can answer that.
I keep trying.
I have one more question about the process. I want to compare how Salus operates with how Atos does work capability assessments. It took us a long time to get clarification on the differential between the work that Atos assessment centres do and the work of the decision makers at the DWP. Part of the confusion centred on Atos’s reports being sent to claimants, which means that they know the conclusion of the Atos assessments although no decisions have been made. The decisions are made by the decision makers, who can add points to an assessment on the basis of further information.
There was a lot of confusion, because people received reports from Atos that indicated the points that were awarded at their assessment, but that was not the decision—the decision was made later, on the basis of the assessment. Do you have to undertake the same process? Do the claimants that come before Salus receive a report, with or without points attached, based on your assessment?
To the best of my knowledge, they get a report. That report will be provided via the DWP, and I believe that it accompanies the decision making. I might be being naive, but I am not aware of claimants receiving a report prior to a decision being made.
They do not get one from us.
That is correct—they do not get one from Salus.
There was a lot of confusion on that. People told us that they were made aware that Atos had given them certain points. Atos said that it does not make the decision, but that people assumed that it made the decision. It said that it was actually—
I see your point. All that I can say is that, fundamentally, Salus does not provide anyone who has been assessed with a report. I am uncertain what Atos does with the report, but I cannot see any reason to provide someone with a scored report without a yes or no decision accompanying it.
I asked that question just in case any of the same confusion was occurring in relation to the PIP assessments. I wondered whether you had identified any of the same problems.
If you do not mind, I will clarify that and get back to you later.
It would be helpful if you could do that. As I said, it took us a long time to pin down exactly why the confusion was occurring. People told us that Atos had decided that they were not to receive the benefit, but Atos did not make the decision. People were being given their reports, which indicated what the Atos assessment had concluded in terms of points. However, that was not necessarily what the DWP decision makers had decided. That created quite a bit of confusion, and a lot of claimants had difficulty coming to terms with the difference between the report that they received and the final decision.
I suppose that the detail of that would be in the contract between Atos and the DWP. I am not aware of Atos having that behaviour with regard to PIP, but I will clarify whether that is the case.
Just to clarify, the confusion led to Atos being blamed for many decisions that had, in fact, been made by the DWP. I am concerned to ensure that the responsibility for the assessments lies with those who make the decisions. It is the DWP that is responsible, not Salus, as a subcontractor for Atos, or Atos itself. It is vital that we ensure that people are aware that the decisions are made by the DWP and that it is the assessments of the DWP that are in operation.
Our health assessors feed back that point to the patient when they arrive, in order to put their mind at rest by letting them know that it will not be the individual who is in front of them who will make a judgment. We explain that it is done by the DWP.
Do you have any other comments that you would like to make? Is there anything that we have not covered that you would like to make us aware of?
There is only the fact that the natural reassessment of the DLA is due to commence around October. At that point, individuals who are currently in receipt of benefit will come for assessment. I want to put on record that the importance of that is not lost on us. That will be a difficult time for the claimants and possibly for Salus in doing our job to objectively assess people. However, I am told that that does not come into play until October.
We will watch out for that. You might find yourself being invited to come back to tell us how things are progressing. We certainly want to keep on top of the matter. Officials from the DWP and representatives from Atos have appeared before us a number of times to give us updates. If things are going well with the application of the process by Salus, that is all well and good. However, the committee wants to make sure that that continues. If you want to come back to us with good news, we will give you the opportunity to do so at some point in the future.
The only thing that I would add is to repeat the invitation to MSPs to visit any of the sites. One or two of your colleagues have come to Glasgow and have found that useful. The only difficulty is that, although you can see the site and how it operates, you cannot necessarily speak to the clients or patients unless they are prepared to speak to you.
That is helpful and we will probably take you up on that. We have gone out to all the other centres and have made sure that we are as aware of the process as we can be, so that our deliberations are as informed as we can make them.
I thank you both for taking the time to come to the committee this morning—we appreciate it.
10:59 Meeting suspended.