Dear Department for Work and Pensions,

Having read a number of FOI requests and other data in the public domain it is unclear to me exactly what the process is for claiming ESA. Please provide me the process, preferably with via process diagrams (or simple flow charts if the DWP don’t carry out normal process modelling) or failing that via a textual description for the following segment of the process.

“From the moment that the DWP receive a completed ESA50 form from a new or existing claimant to the point where the claimant enters the examination room (not the reception) at a medical assessment centre (currently operated by ATOS under contract).”

Please ensure that the following are included:
• Decision points are clearly identified showing what decision is being taken at the various stages of the process and who (obviously this does not refer to a named individual) within the DWP or ATOS is taking the decision.
• What documentation is used in making any decision (either DWP/ATOS internal documents or documents provided by the Claimant or medical staff treating / supporting them?
• At what point is the ATOS HCP that will carry out the face to face assessment assigned to a particular case?
• Who makes the decision are to which ATOS HCP is assigned to a particular case?
• At what point is the ATOS HCP presented with the claimant documentation such that they can read it? How far in advance of the face to face assessment is this point?
• What quality or audit measures are in place to monitor this segment of the process?

Yours faithfully,

John Slater

Dear Department for Work and Pensions,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Department for Work and Pensions's handling of my FOI request 'Process for ESA Assessments from Receipt of ESA50 form'.

Thank you for your response. Unfortunately you have simply referred me to documents that I am already familiar with and do not contain the data requested. As with previous FOIA requests it appears that someone has simply referred to a few existing documents in the hope that it ‘will do’.

The documents referred to do not describe a process in anyway. A process is a logically linked series of tasks or activities that will accomplish a specific organisational goal. Typically a process will define timeframes, decision points along with the possible answers and the next steps respectively, who takes a decision within an organisation and what quality measures are in place to monitor and improve the process. Given that the DWP has told me in other FOIA requests that it is very familiar with business processes I am surprised by the response I received.

Please provide me with the ESA process that is followed by the DWP and Atos Healthcare, surely one exists or how else can the DWP be sure that Atos are doing what they should and that the experience of people claiming ESA is repeatable:

Once again the data I require covers the period “From the moment that the DWP receive a completed ESA50 form from a new or existing claimant to the point where the claimant enters the examination room (not the reception) at a medical assessment centre (currently operated by ATOS under contract).” The documents referred to in the answer cannot be regarded as describing a business process in anyway. If the DWP do not possess any data that describes what I have requested then please say so.

Original Question: Decision points are clearly identified showing what decision is being taken at the various stages of the process and who (obviously this does not refer to a named individual) within the DWP or ATOSis taking the decision.

The documents referred to do not specify decision points within a process and do not define what roles with the respective organisations take them.

Original Question: What documentation is used in making any decision (either DWP/ATOS internal documents or documents provided by the Claimant or medical staff treating / supporting them?

This is partially answered by the documents referred to but they do not explain what documents are used at which stage of the process.

Original Question: At what point is the ATOS HCP that will carry out the face to face assessment assigned to a particular case?

Are the DWP really stating that the HCP has no prior warning of who they will be seeing? Given the complexity of some cases, the fact that specialist training is required for some conditions and that Doctors are required for certain conditions this sounds negligent as best.

Original Question: Who makes the decision are to which ATOS HCP is assigned to a particular case?

There is no relevant data to answer this question.

Original Question: At what point is the ATOS HCP presented with the claimant documentation such that they can read it? How far in advance of the face to face assessment is this point?

There is no relevant data to answer this question.

Original Question: What quality or audit measures are in place to monitor this segment of the process?

What you have described is not a quality or audit measure. Are they specific measures in place that trigger particular actions? For example:
- If an HCP certifies N% of people they see as being suitable for the Support Group then an audit of their work is carried out (I suggest you think about this one carefully).
- If more than ‘N’ WCA are cancelled due to the HCP being unable or unwilling to carry it out then an investigation is initiated.

Obviously these are very simplistic examples to clarify what quality or audit measures are and do not limit the scope of my request.

Please be assured that I will happily refer this to the ICO if the DWP do not comply a required by the FOIA.

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/pr...

Yours faithfully,

John Slater

Dear Department for Work and Pensions,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Department for Work and Pensions's handling of my FOI request 'Process for ESA Assessments from Receipt of ESA50 form'.

[Thank you for your response to my IRR. I can only assume that the person who answered by original request and subsequent IRR have absolutely no concept of business processes. The referenced documents can in no way be considered to ‘describe the ESA process’ as requested. I will give this one last try before complaining to the ICO.

The ESA Customer journey referred to can at best be regarded as a simplistic diagram and cannot be regarded as documenting a process. It is missing key elements of the ESA process and to confirm I did not ask for the ESA process from the perspective of a claimant.

The Request for Proposal / Medical Services Contract contains the following:

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2.1.2 Atos Healthcare MUST provide proposals for managing the ESA PCA process from determining whether the customer is in the Support Group to completion of the PCA and WFHRA reports, or scrutiny reports or curtailment of the process due to non-compliance by the customer in respect of non-completion of the ESA50, or failure to attend a scheduled PCA examination or WFHRA appointment.

2.1.3 Atos Healthcare MUST provide a proposal for an approach to the gathering of Further Medical Evidence (FME) as detailed in the proposed changes to the scrutiny guidelines submitted via CPF361.

2.1.4 Atos Healthcare MUST provide proposals for any other innovations they consider feasible in relation to the gathering of FME.

2.1.6 Atos Healthcare are already working collaboratively with the ESA Programme to develop processes for the Services required to deliver the Employment and Support Allowance. These processes are being further refined and Atos Healthcare will continue to work with the ESA Programme.

2.1.12 Atos Healthcare response MUST include proposed criteria for identifying those ESA cases that cannot be undertaken by an HCP (other than a doctor).

2.1.13 Atos Healthcare response MUST say how cases will be directed to and scheduled for the appropriate HCP.

2.1.14 Atos Healthcare response MUST include the process for the hand over of complex cases from one HCP to another HCP when the PCA has already commenced.

2.1.15 Atos Healthcare’s response MUST include planning assumptions for the proportion of cases that will be undertaken by an HCP (other than a doctor) and criteria for review should the assumptions prove to be materially flawed.

2.1.16 Atos Healthcare response MUST include proposals for handling electronic referrals from JCP for reconsideration, undertaking all action required, including a PCA if necessary, prior to returning the case to JCP electronically via Secure Gateway.

2.1.17 Atos Healthcare response MUST include proposals for handling electronic referrals from JCP for appeals, undertaking all action required, including a PCA if necessary, prior to returning the case to JCP electronically via Secure Gateway.

2.1.18 Atos Healthcare response MUST include proposals for handling electronic referrals from JCP for advice, undertaking all action required.

2.2.12 Atos Healthcare’s response MUST include proposals for managing the Support Group New & Repeat Claims process and provide proposals for service level measurement of the described process.

2.3.4 Atos Healthcare’s response MUST include proposals for managing the Support Group Re-referrals process.

2.4.5 Atos Healthcare’s response MUST include proposals for managing and completing the New & Repeat claims process.

2.5.6 Atos Healthcare’s response MUST include proposals for managing the re-referrals process.

2.6.2 Atos Healthcare MUST provide proposals detailing how it will contact customers to arrange appointments.

2.6.5 Should information come to light at any stage in the Medical Evidence Gathering process, which indicates that the customer is Terminally ill or in the Support Group then Atos Healthcare must notify the Authority immediately and must provide the reason for decision using ESA85A and cancel all other action including notifying the customer not to return documentation or attend for examination where necessary. The response MUST detail how Atos Healthcare will meet this performance requirement.

2.7.2 This process [did not attend] applies to all appointments for PCA and WFHRA, PCA only and to all Domiciliary Visits (examinations completed within the customer’s home).

2.7.3 Atos Healthcare response MUST include proposals for managing this process

2.8.5 Atos Healthcare’s response MUST include proposals for managing this process [customer unable to attend].

2.14.4 IPC will identify if a case is the first referral, Atos Healthcare MUST ensure that a first referral does not undergo the universal scrutiny process.

4.2.2 Atos Healthcare MUST detail the systems and processes it will implement to recruit and retain a viable pool of staff to deliver the requisite performance and quality targets for administrative, managerial and non-medical professional staff.

5.1.2 Atos Healthcare MUST detail the systems and processes it will implement to recruit and retain a viable pool of medical staff to deliver the prerequisite performance and quality targets for:
• Medical Practitioners (doctors)
• other HCPs

Schedule 01 of the contract includes the following definition:
Work Capability Assessments:
Means the end to end referral process to assess Limited Capability for Work (LCW), Limited Capability for Work Related Activity (LCWRA) and the Work Focused Health Related Assessment (WFHRA).

Schedule 04 includes the following:
4.7.5 Any business process revision or any other change that will cause any of these Medical Process outcomes to fall outside the agreed range shall be subject to Change Control Procedures.

11. ENHANCEMENT OF THE MEDICAL SCRUTINY PROCESS
11.1 The CONTRACTOR shall provide full cooperation to the AUTHORITY in the provision and analysis of Personal Capability Assessment data and provide full cooperation in any revisions to the Scrutiny process whether on a national or pilot basis that might arise from that analysis.

Schedule 07 includes the following:
Service Delivery
23. Critical processes for all services to be delivered from Cutover to be documented, understood and tested including but not limited to:
• all Services to be delivered including but not limited to;
• Occupational Health
• Compensation Recovery Unit
• Veteran’s Agency Audiometry
• Isle of Man doctors
• Child Trust Fund
• Independent Tier
• agreed improvements in VA Specialist reports and Regional Consultant reports;
• change control;
• quality assurance systems including management, administrative, data, security and medical;
• performance monitoring;
• maintenance of a viable pool of medical resource
• workflow management;
• rejections;
• rework
• complaints;
• security policy and procedures;
• data protection policy and procedures;
• customer satisfaction surveys;
• business continuity and disaster recovery;
• new business and additional services, and
• Approved Subcontractors including but not limited to, contract management procedures, IT and finance systems and back to back agreements with the Medical Services Agreement

Schedule 28 includes the following:
34 LiMA produced report rework Administration procedures MED LPRRP01 V2
Process for Health Care Professionals carrying out CSD, IB S-Scrutiny and DLA/AA work MED OHCPSW01 V1.
227 MS Guidance Process for Health Care Professionals carrying out CSD, IB S-Scrutiny and DLAAA Work MED PHCPSW01 V3.

Appendix 2 makes numerous references to ‘ESA Process Changes’

Appendix 7 includes the following:
Programme Scope
4.12 Responsibilities and activities for the ESA Programme include:
• Development and delivery of the new ESA Business Process Model (including links to the new Personal Capability Assessment (PCA) and Pathways to Work (PtW) processes),
• Development and delivery of a new Business Delivery Model for ESA,
Operational Delivery Model
4.15 A range of ESA operational delivery models are being considered by the Programme as part of work for the Preliminary Design Review stage of the DWP Change Lifecycle. These include delivery through:
a) The current 2008 Jobcentre Plus model utilising Contact Centres, Jobcentres and Benefit Delivery Centres (BDC),
b) A variation on the current model involving dedicated ESA Contact Centre staff feeding information into BDCs; and
c) A model of dedicated ESA Delivery Centres delivering the end-to-end ESA process, providing a combined customer contact and processing capability for claims, changes, enquiries and reviews.

Changes to staff numbers required to process new claims and ESA decision makers. The potential benefits for the ESA project mainly revolve around efficiencies through benefit simplification and process automation.

Clearly the contract refers to documented procedures, business processes, workflow and process automation. The data referenced in the DWP reply is wholly insufficient and incapable of satisfying the contract. The DWP must hold detailed documented business processes, workflows, procedures etc.

Original Question 1
Therefore please provide me with the documented detailed business process, procedures, workflows (or whatever else the DWP has chosen to call it) that covers the stage of the ESA process stated.

If the DWP is claiming that it does not hold such data please do me the courtesy of admitting it rather than trying to direct me to documents that are wholly inadequate. If it is easier to provide me with the complete end-to-end ESA Process (according to DWP documentation it exists) then that is fine.

Original Question 2
The documents referred to do not specify all the decision points within the process and do not
define what roles within the respective organisations take them. For example is it the same decision maker that decides if a WCA is required as assesses the claim after the WCA has been completed. Who decides in which organisation if a WCA needs to be carried out by a Doctor rather than a Nurse?

Original Question 3
There must be a detailed list of all possible documents that a decision maker can use as part of the decision making process. Surely there is a minimum standard of documentation that is required. The referenced documents do not answer my question.

Original Question 4
The DWP have not made it clear at what point the HCP is assigned a specific WCA. Given the case that some claimants must be examined by a Doctor a simple ‘the next one off the pile’ cannot work. Also this approach clearly does not give the HCP time to read all the data provided by and on behalf of the claimant. Given that a HCP is expected to complete 8 WCA per day and according to DWP figures on average each WCA is costed at 43 minutes. If we assume that a HCP needs 30 minutes to read and understand a file before starting a WCA and then a further 30 minutes to complete the LiMA report then each HCP would need to work 14 hour days (not allowing for breaks and lunch) which is clearly not the case.. The referenced documents do not answer my question.

Original Question 5
The referenced documents do not mention which role within which organisation decides if a doctor or nurse is allowed to complete the WCA.

Original Question 6
None of the referenced documents explain how long before a WCA starts that the HCP has access to the associated documentation.

Original Question 7
Clearly the DWP has no concept of quality or audit measures. The answer provided in the IRR is meaningless. I did not ask about oversight or supervision I asked about audit or quality measures. The recent TV programmes demonstrated that HCP are monitored against so-called ‘norm’ and any variation from the norm triggers a review. Clearly there is at least 1 quality/audit measure in place. Are the DWP stating that it was unaware of such measures? What other measures are in place?

This is my last attempt at obtaining the data that the DWP clearly must possess before I pass the matter to the ICO. Can I suggest that you pass this IRR to someone who has at least a basic understanding of documenting business processes and quality/audit measures?

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/pr...

Yours faithfully,

John Slater

Dear Department for Work and Pensions,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Department for Work and Pensions's handling of my FOI request 'Process for ESA Assessments from Receipt of ESA50 form'.

DWP Response
For Qs 1, 2 & 4 the Internal Review Officer (IRO) has partially upheld your request for a review as you should have been supplied with the Medical Assessment Centre Guide. This guide details the administrative process for all claimants from the receipt of the ESA 50 through to the assessment.

Why was the “Medical Assessment Centre Guide” not actually attached as claimed? Please provide the data without delay. One would have thought that for a FOIA request related to quality and audits the department would have wanted to make sure that references were actually attached – I truly despair!

DWP Response
In answer to Q 6 the IRO has upheld your request for a review regarding the quality audits as the audit process you have been supplied with relates to the Medical Testing process and not the claimant process from receipt of the ESA50 to the Assessment phase. All the procedures undertaken by Atos Healthcare have audit trails in place through both clerical and electronic processes and are fully auditable. Under the medical services agreement, the Authority has the right to audit any part of the medical testing process at their discretion.

Whilst the above answer is interesting the requested data remains absent. Please provide me with the documentation I have requested as clearly they do exist. This is the department’s last chance before yet another one goes to the ICO.

DWP Response
Original Q 5
The referenced documents do not mention which role within which organisation decides if a doctor or nurse is allowed to complete the WCA.
This has been registered as a new FOI request, as you have not asked this before and the purpose of an internal review is to reconsider questions that have been already been posed.

If, as claimed, this has been registered as a new FOIA request please provide me with the unique reference for the request, when it will be fulfilled and the method that will be employed (i.e. will it be via the WhatDoTheyKnow website?)

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/pr...

Yours faithfully,

John Slater

Dear Department for Work and Pensions,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Department for Work and Pensions's handling of my FOI request 'Process for ESA Assessments from Receipt of ESA50 form'.

Thank you for supplying the MEC Administration Guide V6. This document could not be further from specifying or describing business processes.Is the DWP stating categorically that it does not hold any further data that describes the stage of the ESA process requested in this FOIA request?

I find it very hard to believe that neither the DWP nor Atos Origin have produced either detailed discriptions or process diagrams for the ESA process.

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/pr...

Yours faithfully,

John Slater

Dear Department for Work and Pensions,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Department for Work and Pensions's handling of my FOI request 'Process for ESA Assessments from Receipt of ESA50 form'.

Thank you for the attached files. I submitted my original FOIA request on 30 June 2012 and a further 4 IRR and yet these documents have only just been released to me 6 months after my original request.

Unless the DWP can offer a well reasoned and compelling reason to justify its abject failure to comply with the FOIA the only logical conclusion that can be drawn is that it deliberately attempt to avoid complying with the law.

Unless I receive the “well reasoned and compelling justification” within 20 working days I will be submitting a complaint to the ICO as I have had enough of the DWP withholding information subject to the FOIA unless people pursue the DWP for many months

A full history of my FOI request and all correspondence is available on the Internet at this address:
http://www.whatdotheyknow.com/request/pr...

Yours faithfully,

John Slater