Page 44 - JUSTICE and AJC Report - Reforming Benefits Decision-Making

The PIP reports are graded as follows:

• A - acceptable
• AF – acceptable: HP learning required
• AA – acceptable: report amendment required
• U – unacceptable

The audit target for the PIP contracts is three per cent or less ‘unacceptable’
reports and a minimum of 85% of reports ‘acceptable’ or ‘acceptable: HP
learning required’.
104

2.46 Data submitted to the Work and Pensions Select committee showed that
neither PIP contractor nor Maximus had met its targets in any rolling three-
month period up to the end of 2017. More recent independent audit data show
that this remained the case from 2017 through to the end of 2019. 105 This is
despite the very low bar required to be met for reports to be considered
‘acceptable’. PIP reports will still be considered ‘acceptable’ where they
contain “clinically improbable advice such that the choice of descriptor is
highly unlikely”, justification which “fails to support the advice or the
descriptor choice” or where important evidence has not been sought. 106

cent grade A and 96 per cent grade A and B. Since the contract available is the original contract which
commenced in 2015, year 3 would be 2018. We assume that the contract extensions continued the year
3 targets DWP and Maximus Health and Human Services, Health and Disability Assessment Services
Contract, Schedule 2.2 Performance Levels, Annex 1 – Service Levels and Service Credits, Table 2 –
Service Levels that attract Service Credits.
104 DWP, PIP Assessment Guide part 3: Health Professional Performance (17 May 2021) para 3.4.9.
105 DWP, 'Response to Freedom of Information Request FOI2020/16390' (21 September 2020).
106 DWP, PIP Assessment Guide Part 3 (see n. 104 above), para 3.5.5. We were not able to find the
exact requirements for WCA reports. In written evidence to the Work and Pensions Select Committee’s
inquiry into PIP and ESA Assessments Maximus stated that “[k]ey requirements include ensuring
assessment reports are legible and in plain English; consistent, appropriate, and the advice provided is
fully justified and medically logical.” (Maximus, ‘Written evidence from MAXIMUS CHDA’
(PEA0446) (2017)).

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