• 검색 결과가 없습니다.

Contracted out health and disability assessments: progress update

문서에서 Treasury Minutes Progress Report (페이지 79-83)

could publish detailing the reason for the delay as they can be caused by a number of reasons for example complex cases or instances where the claimant has not followed the claim procedures correctly.

2: Committee of Public Accounts conclusion:

Claimants are still not receiving an acceptable level of service from contractors, with particular concerns for claimants with fluctuating and mental health conditions.

Recommendation:

As the previous Committee noted in 2014, the Department needs to ensure that it, and its contractors, make the process easier for claimants and ensure it has well-trained, knowledgeable assessors who are sensitive to complex issues that claimants are dealing with, particularly those with mental health conditions. The Committee expects significant progress to be made within 12 months, when the Department should update the Committee.

2.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

2.2 Significant progress has been made in the last twelve months. Claimant satisfaction surveys show that the vast majority of claimants are satisfied with the service they receive at face to face assessments, for example, satisfaction levels for Centre for Health and Disability have risen from 87.8%

in May 2015 to 94.3% in May 2017. The insight received from the claimants in the survey is utilised by the providers for input into their continuing improvement programmes.

2.3 The improvement in claimant satisfaction flows from the increased training and support from providers, with on-going monitoring by the Department. Personal Independence Payment (PIP) providers have been recruiting additional senior clinical management and mentoring / coaching personnel, ensuring there continues to be a high level of support.

2.4 All health professionals carrying out face to face assessments receive an appropriate level of direct support from senior clinicians, coaches, mentors and mental function champions. A specific Continuing Professional Development module Understanding Mental Health from a customer’s perspective has been developed and delivered to healthcare professionals working on the Work Capability Assessment. There is also a helpline for claimants completing an Employment and Support Allowance/Universal Credit questionnaire about how their health condition affects them. The questionnaire has also recently been redesigned to make it easier for claimants to complete the mental health section. The Centre for Health and Disability Assessment Customer Representative Group has also been extended, with representatives from thirty groups attending.

2.5 The Department monitors and supports its assessment providers on their continuous improvement programmes, with a focus on improving the claimant experience for all. The Department carries out site assurance visits which highlight the claimant experience at the assessment centre, focusing on the provider’s compliance with contractual requirements as well as any areas for general improvement.

3: Committee of Public Accounts conclusion:

Too many assessments do not meet the standard required.

Recommendation:

The Department and contractors need to develop a more complete and effective regime for monitoring and improving the quality of assessments. This includes ensuring contractors meet the required standards for reports.

3.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

3.2 The Department is committed to ensuring all claimants receive high quality, objective, fair and accurate assessments.

3.3 The Department has in place an independent audit function covering both Employment and Support Allowance (ESA) and Personal Independence Payments (PIP) which closely monitors the quality of the assessments delivered by its health assessment providers. Providers continue to complete their own audit of assessment reports, which helps improve internal standards and address issues quickly, before the formal independent audit stage. To supplement the audit processes there are regular meetings

Introduction from the Committee

The Department has increasingly used third-party contractors to provide health and disability assessments. In 2005, the Department awarded a contract to Atos Healthcare (Atos) for Incapacity Benefit and, from 2008, Employment and Support Allowance (ESA) assessments. After Atos requested to exit the ESA contract early, the Centre for Health and Disability Assessments (CHDA) a wholly-owned subsidiary within MAXIMUS, took over ESA assessments from March 2015. In July 2012, the Department signed three concurrent regional contracts to provide Personal Independence Payment (PIP) assessments: two with Atos and one with Capita Business Services Limited (Capita).

In July 2014, the Department signed a contract with Health Management Limited (HML), a wholly-owned subsidiary within MAXIMUS, to provide Fit for Work service in England and Wales. The Department and its contractors have reduced the backlogs that existed. Outstanding PIP assessments fell from 242,000 in mid-2014 to 57,000 in August 2015, and outstanding ESA assessments from 724,000 in early 2014 to 410,000 in August 2015. Over the 3 years from April 2015 to March 2018 the Department expects to spend £1.6 billion on contracts for around 7 million health and disability assessments.

Background resources

• NAO report: Contracted-out health and disability assessments - Session 2015-16 (HC 609)

• PAC report: Contracted-out health and disability assessments – Session 2015-16 (HC 727)

• Treasury Minute: May 2016 (Cm 9270) Updated Government response to the Committee

There were 6 recommendations in this report. As of the last Treasury Minute (Cm 9270), 6 recommendations remained work in progress. 4 recommendations have now been implemented, as set out below.

1: Committee of Public Accounts conclusion:

There are unacceptable local and regional variations in the performance of the Department’s contractors.

Recommendation:

By Autumn 2016, the Department should publish quarterly national and regional data on contractor performance and average and maximum times to return both ESA and PIP assessments.

1.1 The Government agreed with the Committee’s recommendation.

Target implementation date: Autumn 2017.

1.2 The Department already publishes median journey times information for Personal Independence Payments (PIP). In September 2017 the Department started to publish additional quarterly information relating to the claimant journey on Employment and Support Allowance (ESA). The data shows the overall median time from claim registration to final Department award decision, while also separating out the different elements of the claimant journey. The breakdown shows the time from the registration of a claim to the claim being passed to the contractor, the time the claim spends with the contractor, and the time from the claim being returned from the contractor to the final decision being made. The data covers performance data going back to the introduction of ESA in 2008. This matches the journey times data already published for PIP.

1.3 The Department’s statisticians publish information that will provide context and be of most use to customers. This includes the median customer journey time for the duration of the customer journey from registration of an ESA claim to Department decision. In their professional view, publishing the maximum clearance time could be misleading as it would not be a typical customer experience and would not be representative of the majority of ESA claims. There is also no accompanying information the Department

Thirty Third Report of Session 2015-16 Department for Work and Pensions

Contracted out health and disability assessments: progress update

could publish detailing the reason for the delay as they can be caused by a number of reasons for example complex cases or instances where the claimant has not followed the claim procedures correctly.

2: Committee of Public Accounts conclusion:

Claimants are still not receiving an acceptable level of service from contractors, with particular concerns for claimants with fluctuating and mental health conditions.

Recommendation:

As the previous Committee noted in 2014, the Department needs to ensure that it, and its contractors, make the process easier for claimants and ensure it has well-trained, knowledgeable assessors who are sensitive to complex issues that claimants are dealing with, particularly those with mental health conditions. The Committee expects significant progress to be made within 12 months, when the Department should update the Committee.

2.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

2.2 Significant progress has been made in the last twelve months. Claimant satisfaction surveys show that the vast majority of claimants are satisfied with the service they receive at face to face assessments, for example, satisfaction levels for Centre for Health and Disability have risen from 87.8%

in May 2015 to 94.3% in May 2017. The insight received from the claimants in the survey is utilised by the providers for input into their continuing improvement programmes.

2.3 The improvement in claimant satisfaction flows from the increased training and support from providers, with on-going monitoring by the Department. Personal Independence Payment (PIP) providers have been recruiting additional senior clinical management and mentoring / coaching personnel, ensuring there continues to be a high level of support.

2.4 All health professionals carrying out face to face assessments receive an appropriate level of direct support from senior clinicians, coaches, mentors and mental function champions. A specific Continuing Professional Development module Understanding Mental Health from a customer’s perspective has been developed and delivered to healthcare professionals working on the Work Capability Assessment. There is also a helpline for claimants completing an Employment and Support Allowance/Universal Credit questionnaire about how their health condition affects them. The questionnaire has also recently been redesigned to make it easier for claimants to complete the mental health section. The Centre for Health and Disability Assessment Customer Representative Group has also been extended, with representatives from thirty groups attending.

2.5 The Department monitors and supports its assessment providers on their continuous improvement programmes, with a focus on improving the claimant experience for all. The Department carries out site assurance visits which highlight the claimant experience at the assessment centre, focusing on the provider’s compliance with contractual requirements as well as any areas for general improvement.

3: Committee of Public Accounts conclusion:

Too many assessments do not meet the standard required.

Recommendation:

The Department and contractors need to develop a more complete and effective regime for monitoring and improving the quality of assessments. This includes ensuring contractors meet the required standards for reports.

3.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

3.2 The Department is committed to ensuring all claimants receive high quality, objective, fair and accurate assessments.

3.3 The Department has in place an independent audit function covering both Employment and Support Allowance (ESA) and Personal Independence Payments (PIP) which closely monitors the quality of the assessments delivered by its health assessment providers. Providers continue to complete their own audit of assessment reports, which helps improve internal standards and address issues quickly, before the formal independent audit stage. To supplement the audit processes there are regular meetings

between senior Departmental clinical staff, performance managers and Assessment Provider’s Chief Medical Officers to ensure that standards are agreed and reinforced on a regular basis.

3.4 The Department is focusing on the claimant experience within individual assessments, alongside the on-going conversations about the quality of assessment reports. For example, the PIP providers are looking at the way information is gathered from claimants and how to encourage claimants to talk about how their health condition or disability affects them, before discussing their medical history.

4: Committee of Public Accounts conclusion:

The unit cost of assessments has increased, but there has been no noticeable benefit for claimants or taxpayers.

Recommendation:

To demonstrate value for money for increasing costs, the Department must show that these costs lead directly to better performance and outcomes. The Department should update the committee in 12 months’ time on actual costs incurred and the service received.

4.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

4.2 The Department proactively monitors Health Assessment contracts closely to ensure that they continue to deliver value for money. The Department manages a number of metrics which have led to better performance and outcomes.

4.3 The number of assessments completed for both Health and Disability Assessment Services and Personal Independence Payment (PIP) increased considerably during 2016-17, whilst the overall unit cost per output reduced.

4.4 The improvements in performance were supported by an improvement in the quality of assessments delivered to customers. Personal Independence Payment suppliers have delivered improvements in quality outcomes and the Health and Disability Assessment Services provider continues consistently to meet their A-grade targets.

4.5 To support the customer journey and monitor assessment performance, the number of outstanding referrals is closely monitored. Health and Disability Services has seen a significant reduction in outstanding cases since the contract was inherited in 2015. PIP customers saw a downturn in 2016-17, albeit there has been a slight increase in the last couple of months of the year, due to an increase in the number of customer new claims received. The Department is working with the suppliers to ensure their plans support the increased delivery capacity required.

5: Committee of Public Accounts conclusion:

The Department appears to have repeatedly misjudged what contractors can deliver and the uncertainties underlying what can be achieved.

Recommendation:

The Department must challenge the underlying assumptions used in bids using the experience it has now acquired of the contracts in practice and set out consistent principles for identifying and handling the uncertainty of critical assumptions during procurement and the contract itself.

5.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

5.2 The PIP contract expires in 2019 and the Department is beginning the process for procuring their replacement. The Department will through its lessons learnt, open book accounting and performance management processes, identify the key strategic drivers for its health contracts. The Department will supplement this with detailed market engagement sessions in July 2017, with a series of supplier events being held to discuss future delivery. These events will ensure that the market has a greater understanding of the key contractual requirements and potentially bring innovation and increased competition. These events will drive a more appropriate understanding, allocation and ownership of risks that could lead to a reduction in risk premiums and ultimately lower delivery costs. The Department is seeking to build contractual flexibility to support the review of critical assumptions in live running of future contracts.

6: Committee of Public Accounts conclusion:

There is a real risk of value for money if there is not a competitive market for health and disability assessments.

Recommendation:

The Department should consider the merits of different commercial approaches, particularly those used in markets where competition has been limited, to ensure it is well-placed to deliver value for money if market interest falls.

6.1 The Government agreed with the Committee’s recommendation.

Target implementation date: Autumn 2017.

6.2 The Department has in train a number of actions including the development of an overarching Health Services commercial strategy. Market consultation has already begun through a series of supplier engagement events. As noted above further market engagement activity is being undertaken in July 2017, with supplier bi-laterals and conference events. These are the first in a series of engagement sessions, with further events planned in the autumn to help test alternative commercial options in preparation for forthcoming sourcing exercises.

between senior Departmental clinical staff, performance managers and Assessment Provider’s Chief Medical Officers to ensure that standards are agreed and reinforced on a regular basis.

3.4 The Department is focusing on the claimant experience within individual assessments, alongside the on-going conversations about the quality of assessment reports. For example, the PIP providers are looking at the way information is gathered from claimants and how to encourage claimants to talk about how their health condition or disability affects them, before discussing their medical history.

4: Committee of Public Accounts conclusion:

The unit cost of assessments has increased, but there has been no noticeable benefit for claimants or taxpayers.

Recommendation:

To demonstrate value for money for increasing costs, the Department must show that these costs lead directly to better performance and outcomes. The Department should update the committee in 12 months’ time on actual costs incurred and the service received.

4.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

4.2 The Department proactively monitors Health Assessment contracts closely to ensure that they continue to deliver value for money. The Department manages a number of metrics which have led to better performance and outcomes.

4.3 The number of assessments completed for both Health and Disability Assessment Services and Personal Independence Payment (PIP) increased considerably during 2016-17, whilst the overall unit cost per output reduced.

4.4 The improvements in performance were supported by an improvement in the quality of assessments delivered to customers. Personal Independence Payment suppliers have delivered improvements in quality outcomes and the Health and Disability Assessment Services provider continues consistently to meet their A-grade targets.

4.5 To support the customer journey and monitor assessment performance, the number of outstanding referrals is closely monitored. Health and Disability Services has seen a significant reduction in outstanding cases since the contract was inherited in 2015. PIP customers saw a downturn in 2016-17, albeit there has been a slight increase in the last couple of months of the year, due to an increase in the number of customer new claims received. The Department is working with the suppliers to ensure their plans support the increased delivery capacity required.

5: Committee of Public Accounts conclusion:

The Department appears to have repeatedly misjudged what contractors can deliver and the uncertainties underlying what can be achieved.

Recommendation:

The Department must challenge the underlying assumptions used in bids using the experience it has now acquired of the contracts in practice and set out consistent principles for identifying and handling the uncertainty of critical assumptions during procurement and the contract itself.

5.1 The Government agreed with the Committee’s recommendation.

Recommendation implemented.

5.2 The PIP contract expires in 2019 and the Department is beginning the process for procuring their replacement. The Department will through its lessons learnt, open book accounting and performance management processes, identify the key strategic drivers for its health contracts. The Department will supplement this with detailed market engagement sessions in July 2017, with a series of supplier events being held to discuss future delivery. These events will ensure that the market has a greater understanding of the key contractual requirements and potentially bring innovation and increased competition. These events will drive a more appropriate understanding, allocation and ownership of risks that could lead to a reduction in risk premiums and ultimately lower delivery costs. The Department is seeking to build contractual flexibility to support the review of critical assumptions in live running of future contracts.

6: Committee of Public Accounts conclusion:

There is a real risk of value for money if there is not a competitive market for health and disability assessments.

Recommendation:

The Department should consider the merits of different commercial approaches, particularly those used in markets where competition has been limited, to ensure it is well-placed to deliver value for money if market interest falls.

6.1 The Government agreed with the Committee’s recommendation.

Target implementation date: Autumn 2017.

6.2 The Department has in train a number of actions including the development of an overarching Health Services commercial strategy. Market consultation has already begun through a series of supplier engagement events. As noted above further market engagement activity is being undertaken in July 2017, with supplier bi-laterals and conference events. These are the first in a series of engagement sessions, with further events planned in the autumn to help test alternative commercial options in preparation for forthcoming sourcing exercises.

Introduction from the Committee

HM Revenue & Customs (HMRC) is responsible for administering the tax system, including the management and reduction of risks to tax revenue. HMRC measures the tax gap and assesses what behaviour led to that gap. Three types of behaviour that illegally deprive the Exchequer of tax revenue are referred to as tax fraud:

• evasion - when registered individuals or businesses deliberately omit, conceal or misrepresent information to reduce their tax liabilities;

• the hidden economy - which involves people whose entire income is unknown to HMRC (‘ghosts’) and those for whom HMRC knows of some sources of income but not others (‘moonlighters’); and

• the hidden economy - which involves people whose entire income is unknown to HMRC (‘ghosts’) and those for whom HMRC knows of some sources of income but not others (‘moonlighters’); and

문서에서 Treasury Minutes Progress Report (페이지 79-83)