Employment and Support Allowance claimant journey Stakeholder information pack May 2012
Contents Introduction... 2 The structure of ESA... 3 Assessment phase... 3 Main phase... 3 The WCA... 5 Repeat WCA... 6 Back to work support for ESA claimants... 7 The Work Programme... 7 The Jobcentre Plus Offer... 8 Work Choice... 8 The ESA claimant journey... 9 ESA: Continuous improvement and monitoring... 14 Quality assuring Atos Healthcare... 14 The WCA Independent Review (Harrington Review)... 15 Improvements to decision making... 16 Improvements to the reconsideration process... 16 Quality assuring ESA decision makers... 17 1
Introduction From 27 October 2008 the existing range of incapacity benefits (Incapacity Benefit, Severe Disablement Allowance and Income Support where paid on the grounds of incapacity/disability) was replaced for new claimants with the Employment and Support Allowance (ESA). ESA is aligned more closely with Jobseeker s Allowance (JSA) than previous incapacity benefits, with a greater emphasis on a claimant s functional capabilities and the importance of moving towards employment. ESA recognises that most disabled people and people with health conditions can and should move towards employment if they are given the appropriate support and encouragement. A key part of this emphasis on a claimant s capabilities is the Work Capability Assessment (WCA), which is used to assess a claimant s eligibility for ESA. This delivers a more comprehensive and objective assessment of the extent to which a claimant is capable of work, and focuses on what people can do, as well as what they cannot. From October 2010, we began reassessing existing incapacity benefits claimants to ESA if they are eligible. This process will be completed by Spring 2014. From 31 October 2011, changes were also introduced to the way we manage and support people during the course of their ESA claim. This was in response to Professor Malcolm Harrington s recommendations from the first of five annual independent reviews of the Work Capability Assessment. From 30 April 2012, the Welfare Reform Act sets out that contribution-based ESA (ESA-C) will be time limited to 365 days for those in the Work Related Activity Group. This time-limiting does not affect claimants in the Support Group or any claimant who receives income-related ESA (ESA-IR). 2
The structure of ESA ESA is divided into two phases, an assessment phase and a main phase. This is because the process of deciding whether a claimant has limited capability for work takes approximately three months. Assessment phase When a claimant is first awarded ESA, they receive a basic rate of benefit while their capability for work is assessed. This is the same rate as JSA. During this assessment phase, claimants do not have to take part in work-related activity. While they are in the assessment phase, claimants are required to provide up-to-date medical evidence known as the Statement of fitness for work (Fit note) showing that they have limited capability for work for any claim longer than seven days. For the first seven days claimants can self-certify. During the assessment phase claimants fill out a self-assessment questionnaire called the ESA50, and may go to a face-to-face assessment carried out by a trained healthcare professional. Claimants who are found fit for work are not eligible for ESA. They may be eligible for JSA and other benefits depending on their circumstances. Claimants receiving JSA must actively seek work and be available for work. However, the requirement may be tailored to individual circumstances. For example, an adviser may agree with a claimant that he or she can limit his or her availability for work to a certain number of hours, because of a health condition and/or disability or caring responsibilities. Main phase After the WCA, claimants with limited capability for work are placed in the Work Related Activity Group. Claimants who have Limited Capability for Work and Limited Capability For Work Related Activity are placed in the Support Group. Work Related Activity Group The majority of claimants are placed in the Work Related Activity Group, and are expected to take part in some work-related activity with a view to moving into work in the short to medium term. These claimants get an additional payment (a work-related activity component) on top of the basic rate of ESA. If a claimant is placed in the Work-Related Activity Group, they will be expected to take part in work-focused interviews with a personal adviser. They will get support to help them prepare for suitable work. Claimants are not required to attend the Work- 3
Focused Interview (WFI) until it has been confirmed that they have been placed in the Work-Related Activity Group. Support Group Claimants who are placed in the Support Group are not required to take part in workrelated activity, although they can do so if they wish. These claimants get an additional payment (a support component) on top of the basic rate of ESA. The support component is paid at a higher rate than the work-related activity component. These claimants have a health condition or disability that most severely affects their ability to undertake work-related activity and it would not be realistic to expect them to move towards work in the short-term. Claimants go to regular, repeat WCAs to make sure that they are still in the correct group and that they receive the support they need to return to work if their capabilities change. The frequency of these WCAs will depend on their individual prognosis. 4
The WCA Entitlement to ESA is based on a person s functional ability rather than the condition itself. The WCA is based on assessing the way a condition limits someone s functional capability, it is not about assessing their condition. The WCA was developed with medical and other experts and representative groups to make sure that it deals more effectively with the types of conditions that are common today. The WCA looks at a person s capability for work, taking into account developments in healthcare and the modern workplace. It looks at what someone can do, as well as what they can t. Most people receiving ESA must complete a Limited Capability for Work selfassessment questionnaire (ESA50) during the course of their claim. The ESA50 gives claimants the chance to share their views on how their health condition or disability affects their ability to perform tasks and enjoy daily living activities. Claimants who are terminally ill do not need to complete an ESA50 as they can be automatically placed in the Support Group. A form called a DS1500 is used to provide evidence that a claimant is terminally ill. An Atos healthcare professional will carry out an initial paper check which is called a pre-board check or scrutiny. The purpose of the check is to identify claimants who meet the criteria for the Support Group, or to see if there is evidence that means someone does not need a face to face assessment. If the healthcare professional confirms evidence that can be justified, (sometimes supported by further medical evidence from a GP or other medical professional) the claimant does not need to be called for a face-to-face assessment. All other claimants are asked to make an appointment for a face-to-face assessment. At the beginning of the face-to-face assessment, a healthcare professional will read the ESA50 questionnaire and check any extra medical evidence brought by the claimant. They assess the claimant against set criteria using a group of descriptions. This translates an activity, such as manual dexterity or concentration, into everyday functions. The criteria cover both physical and mental health issues. The healthcare professional does not make a decision on a person s benefit and is not told of the decision. All of the details are recorded during the assessment using a computer based system. The system automatically sends a copy of the medical report to the DWP decision maker who considers all the evidence. If a claimant is not happy with the way the face-to-face assessment was carried out, they should contact Atos directly in the first instance. Claimants can raise any concerns with the healthcare professional at the time of their assessment if they wish to do so. If the healthcare professional cannot resolve the problem, they can give the claimant a brochure explaining the formal complaints procedure. 5
The Atos address for comments/complaints is: Customer Relations Manager Atos Healthcare Block 1, Wing G Government Buildings Otley Rd Lawnswood Leeds LS16 5PU Whilst claimants do not have a right to have their assessment recorded, they can request this service through the Benefit Centre which manages their claim for benefit or direct to Atos Healthcare. A process guide is currently being agreed by Atos Healthcare and the DWP which will describe steps to make claimants aware of their rights to have their face-to-face assessment recorded. Where a request is made, Atos Healthcare will do their best to provide a recording facility which will provide a claimant with a CD recording of the face-to-face assessment The ESA50, the report of the face-to-face assessment from the healthcare professional and any other evidence given by the claimant are used by the DWP decision maker to decide their capability for work. Claimants can provide their own evidence to support their claim at any time during the assessment process. Repeat WCA Every face-to-face assessment includes a suggestion from the healthcare professional on when a claimant should be given a further review. This is based on the healthcare professional s knowledge of the claimant s health condition and/or disability. The DWP decision maker will then give a decision on the actual period they wish to award ESA. This may be short term i.e. three months or any date up to a longer term maximum of three years. 6
Back to work support for ESA claimants A variety of back to work support is available for claimants with health conditions. Claimants in the Work Related Activity Group may be required to attend work focused interviews and to carry out Work Related Activity. If they do not do this, their benefit may be affected. Claimants in the Support Group can volunteer for support. The Work Programme Most ESA claimants who want the extra support offered by the Work Programme will be able to get it as soon as they are placed in the Work Related Activity Group or Support Group. Most ESA-IR claimants, who are expected to be able to return to work within 6 months will be required to take part in the Work Programme and be referred by Jobcentre Plus. ESA-C claimants will be able to volunteer for the Work Programme. If they do volunteer their participation will become mandatory. If they wish, they can stay on the Programme after their benefit has come to an end. When their ESA-C stops, their participation becomes voluntary again. Other ESA claimants, who are not expected to be able to return to work within 6 months can volunteer for the Work Programme. This includes people in the Support Group. If a person is: in the Support Group a Credits Only case, or a Full Time Carer or Lone Parent with a youngest child under 5 their participation in the Work Programme is completely voluntary. If an ESA claimant on the Work Programme: moves into the Support Group becomes a Credits Only case becomes a Full Time Carer or a Lone Parent with a youngest child under 5 their participation will become voluntary. 7
When they are referred to the Work Programme the claimant will stay with that provider for 104 weeks regardless of any change in benefit. Once someone has volunteered for the Work Programme they will be expected to fulfil their obligations under the programme and may be sanctioned if they fail to do so. Claimants who are not referred to the Work Programme immediately are expected to attend an information session with a Work Programme provider. The Jobcentre Plus Offer Most ESA claimants in the Work Related Activity Group who do not go to the Work Programme will be expected to prepare for a return to work with help from Jobcentre Plus. Jobcentre Plus managers and advisers have been given more flexibility to judge what will best help individual claimants. Advisers can refer claimants to a flexible menu of activities for extra support, that will fit with one-to-one support from an adviser. What options there are will depend on local circumstances but will probably include services such as job brokering, Next Steps skills training, Work Clubs, work experience, support for those looking to move into self employment, and sectorbased work academies. Jobcentre Plus will also be able to refer claimants to external services, for example as those provided by the voluntary sector or health service, supported by resources from a Flexible Fund where appropriate. Work Choice People with greater disability related barriers to work may be referred to Work Choice, if the Jobcentre Plus offer is not suitable for them. Work Choice helps people with more severe disabilities or complex needs to prepare for work and to take supported employment, with the aim of progressing into unsupported employment where possible. Work Choice participants get consistent, quality support from providers based on their individual needs. The main referral route into Work Choice is through Jobcentre Plus Disability Employment Advisers. An ESA claimant will not be referred to the Work Programme provider if Work Choice is the most appropriate support. Claimants cannot take part in the Work Programme and Work Choice at the same time. 8
The ESA claimant journey The journey below shows someone making a new claim to ESA I make a claim for ESA Assessment phase ESA put into payment I attend a face to face Assessment with Atos 2 3 1 4 5 6 I receive a letter telling me what will happen next Someone calls me to arrange an Assessment appointment Atos make a recommendation on prognosis to DWP Face to face Assessment is not needed if recommendation can be made on paper evidence 7 ALLOWED DISALLOWED A DWP decision maker makes a decision on ESA entitlement A DWP decision maker calls to tell me the decision and ask if I have extra evidence. If I wish to claim JSA I am transferred to someone who takes my claim The Jobcentre contacts me to arrange a WFI A DWP decision maker calls me to tell me the decision and what will happen next 8 9 WRAG I attend the WFI SUPPORT GROUP Evidence changes decision I receive a letter with my ESA award notification 15 16 I receive a letter informing me of benefit disallowance and the reasons for the decision Appeals 10 11 14 Claimants in the Support Group can volunteer for back to work support at any time 17 I appeal I am supported by Jobcentre Plus 12 I am referred to Work Choice 13 I am referred to a Work Programme provider Step 1 Claimant contacts Jobcentre Plus and claims ESA Most claims to ESA are taken by telephone. If a claimant needs reasonable adjustments these can be made. Step 2 Basic rate of ESA is put into payment When a claimant is first awarded ESA, they receive a basic rate of ESA whilst their capability for work is confirmed and a notification of this is sent to the claimant. The basic rate is set at the same rate as JSA. During the assessment phase, claimants do not have to take part in work-related activity. While they are in the assessment phase, claimants are required to provide up-to-date medical evidence now known as the Statement of fitness for work (Fit note) showing that they have limited capability for work for any claim longer than seven days. 9
Step 3 The claimant receives a letter telling them what will happen next The claimant is sent a letter explaining what will happen next in the claim process. This letter tells claimants that they will receive a self-assessment questionnaire and that they need to fill in and return the questionnaire by the time stated or their benefit may be affected. This letter also encourages them to provide any extra evidence with the questionnaire to support their claim. The letter also explains what will happen during the face-to-face assessment. Step 4 The claimant receives a Limited Capability for Work self-assessment questionnaire to complete Claimants are sent a Limited Capability for Work questionnaire (ESA50) by Atos Healthcare (our medical services contractor) to fill in and return. Claimants should receive the ESA50 within 28 days of their first contact to make a claim. They are allowed four weeks to fill in and return the form. The questionnaire asks claimants about their physical and mental health. The answers the claimant gives tell us how their health condition or disability affects their ability to work. Claimants are able to provide medical evidence to support their claim to DWP at any point during their claim. This includes when a person goes to their face-to-face assessment. To improve this part of the process, we have changed the ESA50 to encourage claimants to send any relevant medical evidence when they return the form. Step 5 Atos Healthcare call the claimant to arrange a face to face assessment Atos Healthcare will call the claimant and arrange an appointment for them to go to a face-to-face assessment with a healthcare professional. Not all claimants need to go to a face-to-face assessment. Atos Healthcare will make a recommendation on somebody s benefit entitlement using the ESA50 questionnaire, or the DS1500, if they can. Step 6 The claimant attends a face-to-face assessment The claimant goes to a face-to-face assessment with a healthcare professional employed by Atos Healthcare. The claimant can take someone with them if they wish. Atos health care professionals are trained specifically in disability assessment medicine and provide independent advice to DWP decision-makers about a claimant s fitness for work. This assessment focuses on what a person is functionally capable of and identifies the help they need to overcome any barriers and make a return to work. During the assessment, the health care professional assesses the claimant s physical and mental capabilities. This gives a full assessment of their ability to work, taking into account the modern workplace and developments in healthcare. The health care professional then makes a recommendation on a claimant s entitlement, which is sent to a DWP decision maker. 10
The average length of a face to face assessment is currently 54 minutes, but the length varies according to the needs of the person. Step 7 A DWP decision maker decides if the claimant is entitled to ESA A DWP decision maker will consider the: result of the claimant s face-to-face medical assessment Atos Healthcare s medical report, and the ESA50 and any other information given. They will then decide if the claimant has Limited Capability for Work and Limited Capability for Work Related Activity, and whether or not the claimant qualifies for ESA. Any evidence given by a claimant s GP, consultant or health care adviser is very important. There are processes in place to make sure this evidence can be requested and this information is fully considered. Step 8 A DWP decision maker calls the claimant to tell them they are entitled to ESA A DWP decision maker will phone the claimant and tell them that they are entitled to ESA. The claimant will be told if they are in the Work-Related Activity Group or the Support Group and what they have to do next. Claimants in the Support Group will not need to take part any work-related activity to receive their benefit, but can volunteer to be given work-related support if they want to. Step 9 The claimant is sent a letter confirming their entitlement to ESA Claimants who are entitled to ESA will be sent a letter to confirm the decision. This will tell them how much ESA they will get and of the date from which the higher amount is payable. Claimants who are placed in the Work Related Activity Group will receive an additional payment (a work-related activity component) on top of the basic rate. Claimants who are placed in the Support Group will receive an additional payment (a support component) on top of the basic rate. The support component is paid at a higher rate than the work-related activity component. The letter will inform them of the amount of ESA to which they are entitled, and of the date from which the higher amount is payable. Steps 10 and 11 Jobcentre Plus contact the claimant to arrange a Work Focused Interview and the claimant goes to the interview Claimants in the Work Related Activity Group are expected to attend work focused interviews with personal advisers, and take part in work-related activity to receive their benefit. 11
Claimants who are already on the Work Programme when their eligibility decision is made will continue to receive back to work support through the Work Programme. Step 12 The claimant receives support from Jobcentre Plus Claimants receive support from Jobcentre Plus. This includes work focused interviews and support based on their needs. Step 13 The claimant receives support from Work Choice Work Choice is designed to make sure that people with more severe disabilities or complex needs get help to prepare for work, progress in the workplace or, where appropriate, move into open unsupported employment. Step 14 The claimant is referred to a Work Programme provider Most income-related ESA claimants, who are expected to be able to return to work within 6 months will be required to take part in the Work Programme. Other ESA claimants can volunteer for the Work Programme. Step 15 A DWP decision maker calls a claimant to tell them they are not entitled to ESA Where the decision maker does not consider that the claimant is entitled to ESA they will phone the claimant and explain their reasoning. They will also ask the claimant if they have any extra evidence which they feel the decision maker needs to be aware of. This will take place before a final decision is made. If the decision maker then decides that the claimant does not qualify for ESA they will tell them on that phone call. They will then tell the claimant of their options. The claimant may be entitled to Jobseeker s Allowance, Income Support on grounds other than incapacity for work, or Pension Credit. If they wish to claim Jobseeker s Allowance, they will be transferred to someone who will take their claim details. They may also move off benefit. If the claimant says that they have additional evidence which may affect the decision, the decision maker will ask them to provide this evidence in writing before making a decision on their claim. This call particularly encourages people to supply extra medical evidence and makes sure we address any potentially incorrect decisions at the first opportunity. Step 16 The claimant receives a disallowance notification. If a claimant is not entitled to ESA we will send them a letter to confirm this. This letter will include a summary of the decision maker s reasons for the decision. This letter will also tell the claimant what to do if they think the decision is wrong. Step 17 The claimant appeals A claimant who thinks the decision on their benefit entitlement is wrong has the right to appeal against it. A valid appeal must normally be made within one month of the benefit decision being made. 12
The reconsideration process When an appeal is received, the decision maker will look at the reason for the appeal and whether the claimant has provided any extra information that could lead the decision maker to change their original decision. They will also review all of the available evidence if the decision has not been reconsidered prior to the claimant appealing. The Jobcentre Plus decision maker will telephone the claimant to ask if there is any further information or evidence that should be considered. A claimant can also ask for a reconsideration. The appeals process If extra information is provided and the decision remains the same, the appeals process will continue. An appeal will ordinarily then go to an independent tribunal. There are time limits for reconsidering decisions and appealing. What happens during an appeal If a claimant appeals a decision based on the result of the Work Capability Assessment, they will be entitled to an award of the basic rate of ESA until Her Majesty s Courts and Tribunals Service, tell Jobcentre Plus of the outcome of the appeal. If a claimant wants to appeal against being placed in the Work-Related Activity Group rather than the Support Group, they will receive ESA at the Work-Related Activity Group rate pending the outcome of the appeal. These claimants will not need to supply medical evidence during the appeal process. 13
ESA: Continuous improvement and monitoring The Department for Work and Pensions is committed to monitor and improve ESA. A range of measures have been put in place to ensure that this monitoring and continuous improvement takes place. Quality assuring Atos Healthcare Atos Healthcare provides independent medical assessments on behalf of DWP. The results from the medical assessment is one part of the decision making process. Atos Healthcare is responsible for: recruitment and training of doctors, nurses and physiotherapists managing the assessment centres scheduling appointments via its contact centre conducting assessments developed by the DWP that are designed to see what people can do; they are not the same as an examination carried out by a doctor or consultant which is designed to diagnose a medical condition, and providing an independent medical report to decision makers in DWP. Quality monitoring is carried out by both Atos Healthcare and the DWP. This includes regular audit of reports by auditors and monitoring complaints. Atos Healthcare audits every healthcare professional at least every six months. Management information on monitoring activities is also supplied to DWP on a regular basis. Medical reports that are audited are rated with an A, B or C grade to give appropriate feedback, mentoring and retraining as necessary. Medical and Clinical Directors take part in the Atos Healthcare Clinical Governance Forum where all parts of their clinical practice and standards are reviewed regularly. All doctors working for Atos Healthcare must be registered with the General Medical Council, all nurses with the Nursing and Midwifery Council and all physiotherapists with the Health Professions Council. To provide consistent, high quality, independent medical assessments to the Department, Atos Healthcare has put in place: a thorough selection process to recruit the best medical and non-medical staff less than 15% of applicants who apply are successful comprehensive training in disability assessment for all doctors, nurses and physiotherapists when they join, plus on-going training to make sure their skills and knowledge are up to date 14
a programme of internal and external quality monitoring to ensure high standards in medical assessments and reports are maintained, and a strong performance management process to enable high performance of all staff and to support their career development. There are three parts to training healthcare professionals: general training - includes principles of disability analysis, professional standards (including manner & behaviour) and multi-cultural awareness training on how to do benefit-specific assessments - includes learning path approach for ESA and other benefits, assessments, modular training with competency testing at each stage and an approval process; and scrutiny / file work training - includes how to give appropriate advice to the decision maker from documentation within a claimant s file, theory and casework exercises followed by supported individual casework. Following the WCA training course, healthcare professionals will complete assessments whilst they are supervised by an experienced trainer. Only when they are considered to have achieved competency will they progress to unsupervised assessments. Every assessment is audited until the health care professional produces four A grade reports in a row. Once this has happened they will be referred to the Chief Medical Adviser for approval on behalf of the Secretary of State. The WCA Independent Review (Harrington Review) Government has committed to a five year independent review of the Work Capability Assessment (WCA) to ensure it is a fair and effective means of assessing an individual s entitlement to Employment and Support Allowance (ESA). Professor Malcolm Harrington has been commissioned to complete the first, second and third year reviews. The report from Professor Harrington s first year review was published on 23 November 2010 and contained 25 recommendations in total. All of the year one recommendations have been delivered. Professor Harrington s second review was published on 24 November 2011, and sets out a further series of recommendations. All of which have been accepted or accepted in principle, and include: monitoring the implementation of the year one recommendations further work to improve the WCA descriptors involving a range of experts where appropriate improving the quality and transparency of the Atos Healthcare assessments; and better communications and sharing of information between all parts of the system for claimants, Atos Healthcare, DWP Operations and the Tribunal Service. 15
Further information on the independent review, Professor Harrington s reports and recommendations can be found on the DWP website. Improvements to decision making Jobcentre Plus has recently introduced improvements to the decision making process. Since the start of December 2011 a telephone service has been introduced for Atos healthcare practitioner advice to be provided to all ESA decision makers. This allows decision makers to discuss complex cases and to raise questions about the WCA report before deciding a case, or if an appeal has been received, to ask for advice on the issues raised by the claimant as part of their appeal. Since September 2010 the Jobcentre Plus Director of Benefit Centres has regularly hosted a conference telephone call with decision makers to share information and views on issues about decision making and appeals. The call allows decision makers to hear directly about initiatives to improve quality and effectiveness. It also means decision makers can ask questions and offer their thoughts and comments on decision making and appeals related topics. A recording is made of the call and is shared afterwards. This makes sure that all decision makers have the opportunity to hear it. All questions and answers are published internally for future reference, to increase knowledge and share best practice. Jobcentre Plus has developed a new learning and development package for all decision makers. The learning concentrates on giving decision makers the skills and knowledge required to make good quality decisions on a consistent basis. The training emphasises the role of the decision maker in the process and implements one of the key findings from Professor Harrington s review of the WCA. The training focuses on understanding the Limited Capability for Work Assessment, and raising awareness of the WCA descriptors and is supported by Atos Healthcare practitioners. It also covers gathering and using evidence effectively, improves awareness of mental health and provides decision makers with the skills for giving their decisions by phone to claimants. Improvements to the reconsideration process Her Majesty s Courts and Tribunals Service is an executive agency of the Ministry of Justice and its responsibilities include administration of the First-tier Tribunal. The DWP and the Ministry of Justice have been working together to improve the appeals handling process, including the reconsideration stage which takes place before the appeal. Jobcentre Plus carried out a pilot at Wrexham. Following this, Jobcentre Plus put in place a new approach to have one person do both the reconsideration and preparation of the appeal response on an individual case. This has reduced the need 16
for two people to look at a case in detail. This was fully rolled out nationally for all benefits by 1 November 2010. The improved approach also involves direct telephone contact with ESA claimants, to explain how the decision has been made and to identify any other information that may be relevant to the decision. Quality assuring ESA decision makers A Quality Assessment Framework (QAF) was introduced in August 2011 and applies to all ESA WCA disallowance decisions. The aim of the Decision Making QAF is to find any fundamental errors, rather than minor mistakes that have no potential effect on the decision making process or the outcome. The standard for Quality Checking requires that each of the following points be met. A decision that fails on one, or more, of these points will not reach the required standard: The crucial issues are correctly identified and the decision is focused on these. The necessary evidence has been gathered to establish the relevant facts, if any of these were missing, or to clarify any points of doubt. The law, including the legislation, has been interpreted and applied correctly to the facts of the case. The decision maker is impartial and the claimant has been fairly treated. The key conclusions and the reasons for them are recorded and the decision is soundly based in fact and law. The outcome of the decision is one that is right in the circumstances. The check is done by Executive Officer grade technical experts, with the level of checking set at 1 decision per decision maker per week. Feedback and/or performance improvement discussions, where appropriate, take place between line managers and decision makers using a printed output as a basis for discussion. Management Information about the QAF is available for all levels by decision maker, team, office etc. It is used to identify areas for improvement or where there is best practice. Extra checks are also in place to review good cause decisions related to Failure to Attend WCA and Failure to Return the ESA50 questionnaire. Regular calibration exercises take place each quarter and check staff to make sure standards are consistently applied. The calibration exercises are shared at national, group, Benefit Centre and team level and use real cases to highlight issues found by applying the checking standards. 17