 Welcome to the eighth meeting of the Welfare Reform Committee for 2014. Could everyone please make sure that their mobile phones and electronic equipment have switched off? We have a slightly shorter meeting than usual today although that depends on how many questions we've got for our witnesses. The publication of the related work university evaluation of the Scottish Welfare fund has been delayed and we can't take that evidence through as we had planned today. We moved to agenda item one and the first item in business is a decision on whether to take item 5 of this meeting, which is consideration of the committee's work programme in private, and whether to take the consideration of draft reports on food banks and sanctions in private at all future meetings, members agreed. That takes us to agenda item 2. The second item of business is our first evidence session for some time on the issue of personal independence payments. The contract for undertaking personal independence payments assessments is held by ATOS, as it was for the work capability assessments. However, in much of Scotland, they have been subcontracted out to Salas, which I and other Lanetshire members know as the Occupational Health Arm of NHS Lanetshire. I'd like to welcome Mark Kennedy, who is the general manager of Salas, and Kenny Small, who is the director of human resources at NHS Lanetshire, both to the table. Members may recall that we invited Mark and Kenny to the committee last year when they set out how they intended to implement the contract. We have left a return until this point when the contract has been running for some months so that they would have some concrete evidence to provide to us. They have done it, and I thank them very much for their written submissions, but I know that you want to make some opening comments, so I'll hand it over to you. I don't know if you're both going to say something, or if you're Kenny. I'll just go to you first then. Thank you very much, and we appreciate the opportunity to come back and update the welfare reform committee in relation to the PIP contract held by Salas. We believe that it's a positive story, and in a minute or two, Mark will talk you through the paper to give you some of the statistics and performance evidence in terms of our delivery of the contract. Certainly, from our perspective, as you would expect with a complex contract such as this, there are some teething problems in the very early stages, but we now believe that we've got beyond those early teething problems, the vast majority of which were not really of our own making. We've got beyond that, and we're now at a stage where we really believe that the contract is going to pick up and run in a very favourable way. With those very few introductory comments, I'll hand over to Mark to talk you through the paper and then hopefully open that up for questions. OK, good morning. Really, following on from Kenny, it's a kind of high-level report you've been submitted with, which has given you some statistics from when we commenced in July. It's been running for nine months now. We have led consultations for around 7,000 claimants to date, all of them face-to-face from eight venues around Scotland, mainly the west of Scotland plus Edinburgh City. We have had only five complaints to date from the claimants going through the process. The consultation, you may remember previously from where last year the consultation time was under review, and that has now settled down due to a number of IT problems settling and more familiarity with the assessors to around about 90 minutes or so. We are currently providing around—each assessor will provide around four consultations per day comfortably now. We feel to do more than that at this moment in time. We'd be detrimental to the claimant in terms of the duration of the assessment. We are anticipating roundabout—by the end of the calendar year—in about 30,000, 31,000 consultations offered. Probably by that time, certainly we have a workforce at the moment of around 26 or so NHS-based health practitioners. At our peak, hopefully, in August-September, we will be employing around 37. At that point, we will be at full capacity and offering around 3,000 PIP assessments slots per month following that time. We have had some consultation. If you remember, we were determined to take this initiative forward with the ethos and compassion of the NHS at the centre of that. We have invited consultation around disability groups across Scotland. We put on an open day. We had about seven representatives from those groups at that day, and I personally went and presented to the Scottish Social Security Consortium last November. Really, that was just a transparent from day one of your claim. This is how Salas would intend to work with you to come through the claim. We feel that we are delivering a high-quality service. We have had informal feedback from both ATOS and DWP that were among the highest quality in the UK in terms of the report writing that we are submitting. As I said, we have not had to-date touch with many complaints from the general public that are going through the process, so it seems to be settling down and seems to be working well in my opinion. Okay, thank you very much. We will go to questions now. Can I start off just by asking a couple of questions? You said that 7,000 assessments carried out so far, and potentially around 30,000, 31,000 by the end of the year. Is that where you expected to be? Are you ahead of schedule in respect to that, behind schedule? Have you been set targets, and are you meeting those targets, essentially? At present, we are on line for where we want to be. Kenny touched on that. You may remember that at the start, the volumes were a bit inaccurate in what the flow of claimants would be to the service, so there is a degree of catch-up required by ATOS and DWP. The way that it works for us is that we provide appointment slots every month in advance to ATOS, who then fill those slots on our behalf. Our conversation with ATOS is that we will provide you at our fullest capacity 3,000 slots per month, and that is the maximum that we can do. We are kind of there now, almost with the maximum capacity. Regarding performance overall, I would suggest that there is still a bit of catch-up to be done, not by Salis, I have to say, but that has to flow from DWP and ATOS, his figures. I do not know if I have explained that right. You were set a target. My understanding was that DWP wanted to see a reduction in the amount of claims or a reduction in the amount of money being claimed by the overall number of people going through the system. Is that right? Not from a Salis perspective. There is no target setting in this for Salis at all. We deliver an assessment that DWP has endorsed. We have no quota of how many people should either pass or fail that assessment. The target that Salis exclusively works to is a target about the number of available assessment slots and the production of those assessments. What happens thereafter is not part of our responsibility or our contractual liability. Arnach, ddodolwy, the statistics will start to show whether that is true or not. Arnach, ddodolwy, when we have, as a committee, been meeting with organisations across Scotland about the new changes, we are picking up some concerns in relation to PIP about the criteria. We had those with the work capability assessment. I think that we have proven and other people have proven that the work capability assessment criteria does not provide any evidence that people are fit to work. They are deemed to be, in most cases, very, very unfair and serve very little purpose in terms of assessing people for work. Do you believe that the criteria that you have been given to assess people by is fair and provides you with something that you are comfortable assessing in order to determine whether people are entitled to that new benefit? I think that it is fair in terms of—you pointed out that our background is in occupational health and assessing people's functionality is something that we have been doing for decades. I can clearly state that NHS Lanarkshire would not be involved in that if we did not think that it was a fair process to be involved in. I have not picked up any anecdotal evidence at all of people being unhappy with the assessment and the numbers that we have put through as yet, but I also accept that we have not had any formal report from DWP as yet in particular to my knowledge. I think that we are delivering a fair assessment in a compassionate manner. I will give you an example of why I am asking the question about the fairness. It was brought to my attention at one of the meetings that we had. One of the people who was going for assessment had been asked whether they could walk a certain distance. They had difficulty doing that. They said that they could probably, on some occasions, walk the distance that was required, but they felt that the test was set up to make them fail because the assessment centre that they were asked to go to required you to walk from the car park to the assessment centre, which was a distance greater than the test. Therefore, if you made it from the car park into the assessment centre, you had effectively proven that you were not entitled to the benefit, and they thought that that was inherently unfair because you were keyed up to go in for an assessment and you want to get there. However, that does not measure your normal ability or capability to walk a certain distance. That type of unfairness was what was being brought to your attention. Would you like to comment on that? I can categorically say that that is not happening in a salis-led provision. We do not take assumptions into consideration of that. Where our assessment starts is when the individual presents themselves at reception in the building. I have heard these stories before. I am not sure what companies are related to, but I am certain that they are not related to NHS Lanarkshire's approach on that. I have heard bits and pieces of where bus stops are in relation to, and I can categorically go on regular. That is not the case here. As soon as the individual presents within the facility, the way that it works in our premises is that the assessor will meet the individual at the desk and escort them to their consultation room. The consultation room could be 10 metres away, but it could be 50, depending on where they are. However, no assumptions like that have ever taken place. I think that it is important to recognise that the initial estimation of how long an assessment would take and our current experience are very different. Our current experience is that an assessment of an individual is taking between 90 and 110 minutes, so it is not a short assessment that 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 to use a prompting set of 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 and a relaxed opportunity to walk us through the implications of their disability in relation to their everyday life, and that informs the assessment process that we then submit. So no assumptions beforehand and no tricks. I know from previous conversations that I have had with you, myself, Kenny, but also from evidence that we took from Atos, that there was a dialogue between the companies carrying out the assessments and the DWP. Atos said that some criteria had been changed. They had raised some issues about the work capability assessment and some modifications to the criteria or the assessment process that have taken place. Has that happened with you? What has the response been if you have had to go back to the DWP to discuss those types of issues? We have not been asked at all to alter or consider alterations to the assessment tool, as it were, in that case. There have been some IT changes that make it a bit easier for the health practitioner to go through in a more timely fashion, but there have been any major changes at all that we have been asked to implement? Sorry, but what you might be referring to is that right at the very beginning, the clinical director of SALAS, Dr Imran Gafour, was heavily involved with Atos and DWP making comments around clinical governance aspects of the original assessment. I think that there were some tweaks made at that time, but that was in the early stages, I think that it was before we even launched the process that Atos and DWP were using some clinical professionals, experienced clinical professionals, to road test the assessment process, but since we have launched this, the assessment process has been what it is now. The Atos went to Great Wends to try and assure us that they had been in a constant dialogue with the DWP in order to try and get some of the assessment changes made because they were picking up from practice things that they were concerned about and had raised them with the DWP and I just wondered the fact that was your experience. I think that that conversation may be around process rather than the actual assessment itself. They did have significant problems with IT at the start, I know that that was one of the things that we were actively discussing with DWP. I'll open up to committee members, the deputy convener, Jamie, to want to go and then I'll put the calendar. Thank you, convener, and welcome, gentlemen. Ms Small, the last time that you were at the committee, you set out that it was Salas's overt intention to seek to add to the value that you believe and appropriately recruited and selected and then trained and supported NHS workforce can bring to the assessment and reassessment process for DWP PIP. Mr Kennedy, you talked of putting the ethos of the NHS at the heart of your work, so I'm just wondering how you're going about doing that. I could start with, I mean, I'm a director of HR, so the jobs part of this is very close to my heart. We have recruited, as Mark said at the moment, something like 26 whole-time equivalents and we anticipate that that will go up to 37 whole-time equivalents and these are new jobs. They are jobs that we have used within Lanarkshire and with other health board partners because obviously, as you know, we have centres that go way beyond Lanarkshire and in the west of Scotland and Edinburgh City and we have recruited those individuals from a combination of sources, some from the external market, some from our own redeployment register, where staff who are affected by organisational change find themselves in temporary roles or roles that are not as fulfilling as others, so we use those opportunities in that area. We also use the opportunities to offer alternatives for staff who find themselves unable through reasons of fitness, fitness to practice, to undertake other substantial roles within the NHS. Our experience and the evidence is there to be seen is that delivering against that aspiration to add substantive income and roles to the NHS in Scotland has been successful and will continue to be increasingly successful as we flex the workforce to meet the demands of the number of assessments as that grows. From the perspective of Salas and its link with NHS Lanarkshire reputationally, I think that the role that we are fulfilling, the evidence that we are getting back from Ahtos and DWP's analysis of our performance, stands the test of anyone in the UK. The complaints that Mark mentioned are something like 0.0007 of the activity, and the majority of those complaints are about people not being able to properly read the map that tells them where to go to to get the assessments. Arguably it is not even a complaint against the quality of the interaction around the assessment anyway, but we are doing something about making those maps better, and you would be confident. From the perspective of the ethos of the NHS and adding value, we are delivering that. As you would imagine, we are also keen to make sure that that continues. All I would add is that the whole structure within Salas has been set up to mirror the NHS. At all our sites, there is no concierge, there is no security, if you like, at it. It just runs like an outpatient department. What we are finding from feedback from Ahtos and DWP is that people are respective of that and are happy with that in general, what the feedback I am getting. When we have our nurses and practitioners trained in this, there is a constant reminder that they are working for the NHS. This is a public service. Those are the same individuals that come through your door, your GP and your previous jobs, and they should be treated with equal respect. It is hard not to go into nitty-gritty stuff, but what we are trying to instill is still a caring ethos around what we are doing. We accept that it cannot be easy for an individual to present himself for a disability assessment, and it is our job to make it as painless as possible for them. We believe that we are doing that to a high degree in the programme. I have not got any alarm bells ringing on, as you see from our complaints. That is helpful, Mr Kelly. Thank you for that. 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 that your time is up. Go now, Sir Finger. Yes. As it happens at the moment, we are saying that our average time is around about 90 minutes to 100 minutes. Any given day, that normally means that somebody will probably be there for an hour, so all they need, and somebody may require two hours. At the moment, our challenge is to manage that flux as best we can while still respecting the needs of the individual. We do not close down what the health practitioners will be trained in, as you know, to ask probing questions. If people are going off track and off tangent, they are trained to bring it back into, let us keep it about your functionality and how you are performing. The whole idea, as Kenny said, is a fairly simplistic approach. You sit down and, from the moment you open your eyes in the morning until you go back to your bed, tell us what happens in your average day and what happens in your most difficult day. However long that takes at the moment is how long it is delivered. You have said there a couple of times that 90 to 110 minutes are the average. You made the point that I would take on board. That allows for a fairly comprehensive assessment. On the flip side of that, I noticed when you supported the Scottish Social Security Consortium that they did express some concern that, in some cases, it could be too long for some disabled people. Obviously, there is not an easy thing to do, but how do you square that circle? What we are trying to instill with the staff there is to make a judgment on it. Where people get repetitive, we can intervene and say, if you have anything to add that you have not added on it, or do you want to stress that point more? 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, I think, two hours as I ask for somebody to come and sit in front of you and explain their day. We try and keep it under that if we can, but we are very much aware that it has to be driven by the individual. We do not want accusations of, I was not allowed to tell my story fully. We manage it at the moment just within our appointment system. If somebody takes longer, we live and hope that somebody did not, and we can shuffle it. What I think will settle down a lot of the changes from the ATOS perspective and the consultation process have been an efficiency in the process around IT. That is giving us an extra probably about 15-20 minutes that we did not have in the early days of the programme. I do not have many episodes of it going over two hours, to be perfectly honest, that I am told about, but the vast majority are round about an hour and a half. We are not seeking to push that actively lower than that, to be perfectly honest. I think that that is about the optimum duration. That brings us back to the potential added value of the NHS. NHS health professionals are trained to speak to people in a language that they hopefully understand, and they are also trained in how to test and search people in communication without it appearing that way. That is genuinely where we add value. The core of the training of a health professional is communication and engagement 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 brings us to another question that occurred to me earlier when you were answering my first question. Obviously, there could be another advantage given that this is within the NHS environment. Are your professionals under the assessment picking up on other issues that are unable to refer individuals to other parts of the NHS? As the NHS, we are kind of unique in the fact that we still have a duty of care to any individual that presents us in front of us. Yes, anybody with, for example, suicidal ideation, any chronic complaint that we think requires further examination, we ask them and direct them to contact their GP immediately. We just function in the same way that we function in any other outpatient department of the NHS. That is one final question that I may. You say that this is in relation to the fact that you have had a few complaints and so on that so far no penalty credits have been sanctioned against you. I do not know how much they want to tell us about this, but it is good for Saloth that that has not happened thus far. What are the arrangements in the circumstances that they can be applied and how does all that work? The contractual agreement with Saloth has some service credits or penalty credits that it has, and they are round about quality measures. They come across that things like if somebody waits more than 30 minutes, for example, there will be a charge against reduction in payment to Saloth for that. They are performance drivers. None of them affect the duration of the assessment. What some of them do is the quality of reporting. We submit reports to DWP and are bandied A, B or C. A is a fabulous report that gives them all the detail that is required. A B is a report that, with some fine tuning, could be better and be of more value. A C is what they determine as a failed. There is something fundamental in that assessment that needs changed. We have threshold levels on those measures. If we, for example, submit more than 5 per cent of C reports, there is a service penalty for that. They are performance KPIs. At today's date, we have not instilled any. I would like to go back to something that the convener raised at the start. It was Mark Russel, who said that he had not had any formal reporting back to Saloth from DWP. I wondered what the system was in terms of that formal reporting back. Is it a timescale one every so often or is it after so many assessments? What is it for and what will it take and what do you expect to get from it? We are interested in that as well, because that might help us to add quality depending on what is in those reports. At the moment, it is a contractual range between ATOS and DWP for reporting. There is no direct mechanism between DWP and Saloth for that. However, I would hope that DWP would soon be reporting early findings on PIP in the public arena, which we could perhaps drill into as a percentage of that. We, at the moment, get informal reports from ATOS on claimant journey, satisfaction and management information on how many slots and such. We do not get any qualitative evidence from them as yet, but we are asking up front whether we would appreciate that as a public sector body. You do not get back, for example, statistics on decisions taking and things relating to your assessments. Is that something that you would expect in the future? No, not within the contractual agreement that we have, but obviously something that we are interested in. However, to my knowledge, there has not been a formal report on that, although the members around the table may have more knowledge than me. I have not had anything other than informal rhetoric from DWP. Do you think that it would be useful to have that? I would like to know. I am not quite sure what we would do with just a flat statistical report, but it would be good to know how many decisions are made regarding the reports that we do. As Mark has described earlier, I think that 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 right down to the individual health professional who is undertaking those assessments. Obviously, if there is a need to develop or train an individual further to improve their assessment process, that is something that we want to know about right away, so that we can 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. I was pleased about the consultation that you undertook at the start with the disability groups. It seems that that has been fairly successful. Is it something that you intend to do on a regular basis, just to see how the perception is about the work that you are doing? I intend to have a further event in September, at least offering one opportunity annually to come in and have a workshop on what is involved. It would be good for us, because at the moment we are relying on customer feedback from the contractor, and it is a wide sample of that. However, we also know that word-of-mouth and local working are valuable in that, so probably the workshop in September will be around that organisations should have engaged a lot of people who have now been through PIP and had a decision or not to watch their view on that and what are they telling you? There is a learning issue for us. I am very interested in the experience of when they enter a sales premises and when they leave. Obviously, we will not have any influence on changing any element of the assessment, but I am interested in what their experience is when they come across the door. I have to ensure that that is as good an experience as it can be. We will, again, probably in September this year, invite people back. To confirm, you assessed the claimants, but the decision made on how that affects their benefits is made by ATOS or DWP, and do they share any of that information with you? Do you know what parts of the assessment that you are carrying out to trigger changes in benefit assessment at all? We do all the assessments. DWP does the decision making. ATOS does not do the decision making. We do not know. The way that assessment works is that it is basically that you talk through the client's working or normal day and you agree what is the best descriptor on that opportunity that they have had, whether they are eating, sleeping or walking. Those descriptors are scored, and I assume DWP adds up those scores at the end of the day and makes a decision on both the score and the quality of information that is provided in there. We do not encourage our staff to look at numbers at all. We just train them and suggest that the purpose of their role is to ensure that the best descriptor is chosen for it. We do not get any feedback on the decision making. It is all done entirely by DWP. Although we have put 7,000 people through the assessment process, I have no knowledge at the moment how many of them I have had a decision even. Your test of how it works is that you will try to make sure that each of the assessors is conducted the same criteria each time so that they are scoring compared to each of the claimants that are coming in. You have no knowledge of how that information is then used. Will you, at some point, be told? Clearly, there is a big dilemma between a caring service and one that is becoming a gatekeeper. Will you be given that information about how the scores then trigger claimants? No, as it is a contractual commercial arrangement. We will not. What we will have access to, like NMDLs, is when DWP report it. You could argue not should I, but I will never get a report back that states that so many thousand people you have assessed x amount have either been successful or not. You have a very low number of complaints about your service, which must be very gratifying, but it is simply an assessment of the professionalism on care that you are providing. The individual concerned might still be extremely unhappy with the decision that they face, but that complaint would then go to the GLP or at us, not to you. That would go to the GLP and I imagine that they would have to report, like they have done previously, more capability assessments. How many of those negative decisions went to appeal and were upheld? Do you call them patients or claimants? We call them patients, but that is because we are the NHS. When they come to see you, do they view you as an interrogation? Do they know how much it matters to their benefit claim? They know how much it matters to their benefit claim. The importance of their visit is not lost on them at all. Obviously, there is a degree of anxiety from anybody undertaking that. That is the whole idea about having the ethos and the quality staff of the NHS that it is their job to try and relax them on that and make it as non-threatening as possible in order that we can do a good assessment. That is what we aim to do, but they do not come naive to the assessment centres. Have you been able to capture—it is a very difficult thing to capture—the idea that you are a fair, impartial assessor, neither the set of criteria nor the judge and jury, in fact, in this one? You are simply carrying out a process that will treat all claimants the same. Do you think that you have that across quite well too? Yes. As Kenny said, when we start to submit assessment reports, problematic reports are flagged up too, so it is very easy to identify whether one of our assessors is struggling with the individuals in front of them or how to do it, so they obviously get more intensive training and support to improve on it. I think that we have some quality measures in there that give us enough reassurance to know whether we are doing a good job on that. Any of the delays that have been—I have beset the larger programme—is there any delay in your part of it, or are you aware of that? Do you simply provide them slots that are filled? I am aware that there is a backlog, not from our perspective, I have to say, but I think that from the patient submitting her claim to DWP to getting to ATOS to Salas, there is a significant period of time. We do not control or influence that because we provide our appointments a month in advance, so all we rely on is ATOS filling those appointments, so we do not influence how quickly the paper trail comes through DWP to ATOS to herself. Are people allowed to bring somebody with them? I am encouraged to do so. Annabelle Cymru In terms of the current coverage of the Salas contract, I wonder if you have any idea what rough estimate of claimants or patients that would entail with respect to the total across Scotland. Do you have any idea how the Salas component fits in with respect to the rest of which is ATOS? I am sure that I am told that somewhere between around 55 per cent to 60 per cent is Salas. We have already heard that, as to outcomes, that is something that you are not aware of vis-à-vis the individual, because I was wondering how that would compare with the ATOS outcomes, both in terms of the result, but in terms of how long it takes to get to see anybody. I have a constituent in Fife, who I referred to on a confidential basis in a debate in the Parliament the other week, who waited, I think, some four and a half to five months to get an assessment from ATOS, notwithstanding that that constituent had had major surgical intervention. I hope that, on the Salas side of things, it is not the same. The issue is there that I would not know, to be perfectly honest, because it has to be processed through ATOS prior to coming to myself. I suspect that the people coming to Salas are waiting a degree of time before their appointment. However, they are written to probably about a month before their appointment with Salas. That is the only bit that I can influence at all. Maybe I have not said in the paper that we have a do not attend rate of around a fifth, so one in five people do not appear on the day and need to obviously re-appointed. I think that that is an issue. The waiting time for the claimant from their original submission is too long. Is there a possibility for a home visit if the circumstances require it? Yes. I should clarify that Salas provides only face-to-face across the venues mentioned. There are two other types of process for assessment. One is to do with a very quick paper turnaround in terms of critical illness and terminal illness, which is a paper referral that ATOS does. Anybody who is also assessed by ATOS is requiring a domiciliary assessment is done by ATOS. In terms of the actual part of the process that you engaged in, you referred a moment to go to the descriptor approach and you referred to the fact that qualitative information is also included. Can you provide a wee bit more information? In your average case, seeing a patient for their assessment, to what extent would there be additional written information to deal with the information surrounding a descriptor? Our confidence in the descriptor approach, at least in terms of the work capability assessment, is not very high because it does not seem to allow you to give additional information that is relevant. There are two stopgaps for that. There is choosing of the descriptor, which is a process in itself. What the health practitioner has to do is justify why that descriptor has been chosen. That tends to be where, if we submit C-level reports, as in unsatisfactory reports, it tends to come back from ATOS and DWT saying that the justification did not meet the choice. We have to put a bit of work in to say that we have chosen this descriptor and this is the rationale why. The right things, like the client has stated on two occasions, are frequently blubber. We have to justify that. There are a number of descriptors. At the end of the assessment, they also have to summarise all of the descriptors. There is a second test, if you like, of the write-up. The write-up has to marry the small summary under the descriptors. At ATOS and DWT, we might be looking at the second summary. It is a short essay on why all those descriptors have been chosen with a view to perhaps refining that somewhat. We have to provide more evidence than just ticking the box to say that this is the descriptor chosen. They have to demonstrate why. DWP then assess that to see if it is relevant and feedback to us directly if it is not. There is a check. One last question at this point. In the case of the work capability assessment process, which we have been trying to get to the bottom of, the more hard and fast medical information that is in close with the application, the better the applicant seems to be fair. How does that work with respect to Salis, given that you are an arm of the NHS in Scotland? The same opportunity is given to the patient when they attend. They are invited by DWP to submit further medical evidence of their claim to DWP, but also if they have further sinister submission to bring it to Salis. We have patients arriving with poly bags full of evidence of various sophistication. We are duty bound and contractually bound, although we do it anyway, to view every single piece of evidence that comes. That was one of the issues around the assessment duration. If somebody arrives with 40 pieces of individual evidence, we have to both log it and consider it in the assessment. What we are encouraging DWP to do, or to us, via a number of other partners, is to try and give more detail to the claimant on what would be seen as a priority evidence. We will get various things from—it can be as simple as a receipt from a taxi to say that I need a taxi to get places, or it can be a two-page letter from your GP strongly advising, but people bring everything. We are asking DWP to prioritise and give a wee bit more advice to people on what would help their claim, but it has to be assessed and be part of the assessment. We have information that says that the administration cost for DLA was £49 per claim compared with £182 for PIP. The expected average decision time on a new claim for DLA was 37 days for PIP—74 days. We have already explained part of your answer to Mr McIntosh that a lot of the timescales are out of your hands and are governed by the DWP and ATOS in terms of the timescales. Do you think that that reflects in Salis? Do folk come in to your offices and moan about the level of time that they have to wait and the bureaucracy around this new process? We have had more than occasional individuals at our reception saying, I am so glad to be here, that it has taken so long to get here. That is why I was saying that the waiting duration is too long. It would not be accepted within the NHS, so why is it accepted in the process? However, you are right—I have no control over how that works within the arrangement that we have. I go back to ATOS and to the DWP and say that folk have said this. Obviously, you said that they would not have to wait that long if it was an NHS appointment. You are an offshoot of the NHS. What is your reaction to that, because sometimes folk do not get the kind of differences? I have to say that, anecdotally, we get more patients or claimants coming through our doors that say things like, we are really happy that you are doing this and it is not being done by somebody else. There is an acceptance—I think rightly so—a degree of trust in the NHS with how we will perform this. With respect to whether it can be shortened or not, because it is commercially contracted via DWP, we can only make recommendations. We do feedback on a monthly basis to ATOS to say that our major concerns this month have been. Usually, a consistent one is that people are mentioning the delay and the length that it takes to get to this. The other thing I have to say is that once Salis assesses the individual, I also have no idea how long it takes a decision maker to process that. I take your point. We are in an unusual position where, if we owned this end-to-end, we would look to actively make some efficient changes in it. I have seen a doubling in the average waiting time for a claim. I would like to think that. I think that that is extremely useful. At the beginning of the session, you said in a paraphrase that it was Mr Small, NHS officials are trained to deal with patients and have the right level of communication. One of the things that we have found from other sessions that we have had with ATOS and the DWP is that communication is a major failing in dealing with those assessments. In terms of what you are doing, have you indicated to them the differences between your style and their style in trying to bring others up to the standards that you seem to have in that regard? The conversations that I have been involved in with ATOS and through Mark with his colleagues are almost to look at that from the other end of the telescope. I think that ATOS absolutely recognises the added value that the NHS brings. It certainly seems to recognise the salis performance when it looks at that across the UK in relation to communication and delivery. It has certainly been a subjective conversation that we have been involved in with ATOS about how they might prefer to run the entire contract across the UK or across the whole of Scotland, but that requires either a change in the approach or a change in the interest from the public sector or the NHS in terms of becoming involved in that work. Mr Small might not be able to answer that, but you are describing a situation where the NHS would be better placed to deal with that rather than have private contracts in the first place. I would not necessarily go as far as you have just stated, but I would certainly see, as we did from the outset and certainly articulated when we first came here, that the NHS is in a very strong position because of the nature of the training and the skills that you have described to our staff to get the best out of people when they are in the pressurised situation that Mark has described giving the information on which we create the assessment. We do not treat it as a business, we treat it as a patient contact, and that is part of the reason why it takes so long. I believe that it is also part of the reason why the quality feedback that we get in terms of the key performance indicators is the way it is. It almost could not be better. Mr Kennedy, you talked of logging individual pieces of information that folks bring. One of the things that I have certainly had, and I am sure that colleagues are exactly the same, is where folks feel that those bits of paper, which they think prove that they have certain difficulties, are often disregarded. Have you suggested to colleagues in ATOS and the DWP that that should become the norm? It should be the norm already. We are under contract to record every piece of evidence that comes with the client. To touch on my previous response to that, what I was suggesting was that there is a vast range and the weighting of some of that evidence would carry more weight than others. That was the request to ATOS to why we cannot put this more out in the public realm, as in a letter or a substantial report from a healthcare professional that will carry a lot of weight in that process. Something from a neighbour who says that he has seen the individual's struggle putting his bin out or something like that would not carry the same weight, but you could argue that that was a vital piece of information. We are trying to get some clarity around what is the best form of evidence to present with your claim. I have again fed that back to ATOS. On the DWP, I am unsure at the moment. One final question, convener. That is round about the phrase that you use, the duty of care. The NHS has a duty of care. Do you feel that some of the other contractors, some of the decision makers in the DWP, do you feel that they have that duty of care? If they do, do they adhere to it? I would ask you to ask them that question to skirt round it. I know that we perform our duty of care in this programme. I should also say that, in relation to your earlier comment, I would love to see your performance in relation to the other companies across the UK. I would welcome that, whether I will or not, I am not sure. Also, to add on Kenny's response to your earlier question, I remember the discussions at Lanarkshire health board when this was brought to the table. Most of the discussion around that was 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 I do not see anybody better placed to deliver this service in Scotland. I think that that has been very useful for me. A couple of brief questions that might be slightly different from the others that you have had. First of all, can you confirm that you are working as subcontractors to ATOS? ATOS has made it clear that they do not want to have their contract extended with the DWP. Does that affect your contractual position in the longer term? No, the ATOS withdrawal from work capability assessment is an entirely different contract. What I wondered was, given that ATOS has made that indication, have you found anything in the model that you have been operating that could be extended into the other areas that ATOS currently work in? From limited knowledge of work capability assessment, because we don't have anything to do with work capabilities. I think that ATOS is learning that there is a different approach to have with the claimant in terms of process, and it does not need to be as harrowing at some times than it currently is. There are bits and pieces that they have commented on with the fact that one day they were surprised that we did not have any security on site. We took the view, as I said before, that they are individuals who access the NHS, so why would you? We have several people who have claimed that patients who have been through the process have already been through a work capability assessment and are now applying for a PIP, who are basically saying that it is night and day. It is a totally different experience from it. Culturally, there is something that ATOS or other providers on this could learn from. You will accept that it is not my job to teach them. However, it would be nice for a summary at some point involved in this. ATOS, as you know, will not be involved in work capability assessments going forward, so I am not quite sure of the other portfolio in welfare or the PIP. The final question is a repeat of part of the question that I asked previously. Could you see an organisation like Salas at some point in the future being involved in things such as work capability assessments? I have to be honest and say that I am unsure how to answer that. From what I have said already, I went on record to say that there is nobody better placed to look at the functionality of an individual than the NHS. From a clinical point of view, I would say that there is no reason why that would not be the case still in assessing whether somebody is fit for work or not. However, not all of you are on the table, but we have some reticence around the current work capability assessment infrastructure. We are making no moves to enter that market at this place. The immediate answer to the question is, and Mark Smith might be just too embarrassed to say it, but Salas's core role for NHS Lanarkshire involves workplace capability assessment. That is a core part of their job for the staff of NHS Lanarkshire, so they are very, very experienced and, I believe, very diligent and successful at conducting that role for NHS Lanarkshire and, indeed, for other employers across Scotland and beyond as part of an occupational health service. The experience is there. The same question once more in different words. If Atos was not there and the contract was up for grabs, could you do the job better? I do not think that we could answer that. I would like to ask one more question from me in relation to the process, just to get again a comparison between how you operate and Atos with the work capability assessment operated. It took us a long time to get clarification on the process and the differential between Atos assessment centres and the work that they do and the decision makers at the DWP. Part of the confusion centred around the reports that were done by Atos being sent to the claimant so that they knew what the Atos assessment had concluded, if you like, although no decision had been made. The decision was made by the decision makers and they could add points to the assessment based on further information and what have you. There was a lot of confusion because people were receiving those reports from Atos which gave an indication of the points that had been awarded at that assessment, but that was not the decision. The decision was made later based on that assessment. Is that the same process that you have to undertake? Do the claimants that come before Salas receive a report with or without points attached? Do they get a report based on what you assess them? To my knowledge, they will get a report. That report will be provided via DWP, but to my knowledge, that comes with the decision making. I am not aware—it might be my naivety—of them receiving a report prior to a decision being made. I could not understand why that would be relevant. We do not get one from Salas. There was a lot of confusion because people were coming to us and saying that they had been made aware that Atos had given them certain points. Atos was saying that we do not make the decision, but people assumed that we were making the decision. It was actually— I can see your point on that. All I can say is that, fundamentally, Salas do not provide anybody who has been assessed with their report. I am uncertain what Atos does with that report, but I cannot see any reason to provide somebody with a scored report without a decision yes or no being with that report. Was that just in case any of that same confusion was occurring in relation to that, if you had identified any of those? I will take that back and clarify that. That would be helpful, Mark, if you could do that, because, as I said, it took us a long time to pin down exactly why that confusion was occurring because people were coming to us saying that Atos decided that he was 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, but that did not necessarily mean that that is what the DWP decision makers had decided. It created quite a bit of confusion and, certainly, a lot of claimants were finding difficulty in coming to terms with the differential between the report that they received and the final decision. I suppose that the detail that would be in the contract between Atos and DWP, I am not aware of Atos having that behaviour in PIP, but I will clarify whether that is the case or not. A lot of the confusion led to Atos being blamed for a lot of the decisions that have been made by the DWP. I have been very concerned to make sure that the responsibility for those assessments lies with those who make those assessments. That is the DWP, not either yourselves, as Sal is acting a subcontractor for Atos or Atos themselves. I think that it is absolutely vital that we ensure that people are aware that these decisions are made by the DWP and it is the DWP's assessments that are being operated to you. On that note, our health assessors also feed that back to the patients when they arrive to put their mind at rest that it is not going to be the individual in front of them that is going to make a judgment of them on that. We explain that that is done by DWP. Do you have any other comments that you would like to make? Is there anything that you think we have not covered that you would like to make us aware of? I suppose only the fact that the introduction of the reassessment of DLA, the natural reassessment, is due to commence around about October. At that point, we will have individuals who are currently in receipt of benefit coming for assessment. That is not lost on us. That will be a difficult time for both the claimants and, possibly, Sal us when we are doing our job to objectively assess. However, that does not come into play until I am told October. I will watch right for that. You may find yourself being invited to come back and tell us how things have progressed, because we certainly want to keep on top of that. We have had the DWP officials and ATOS on a number of occasions giving us updates. If things are going well with the Salas application of the process, then all well and good. Obviously, as a committee, we want to make sure that that continues. If you can come back to us with good news, then we will hopefully have the opportunity at some point in the future for that to happen. I suppose that the only other thing that I would add is, again, to repeat the invitation to MSP colleagues to visit any of the sites. We have had one or two of your colleagues coming to Glasgow in particular. The difficulty being that you can see the site and how it operates, you cannot necessarily speak to the clients or patients unless they are prepared to do that, but one or two of your colleagues have found that useful. That is really helpful, Ken. We will probably take you up on that. We have gone out to other centres and made sure that we are as aware of the processes as we possibly can be so that any deliberations that we have are as informed as we can make them. Thank you very much to you both for coming through this morning again. I appreciate your time. I will suspend for a couple of minutes to let the witnesses change. Three members will recall that Linda Fabiani was off to North America, so we sent her with a mission, which she chose to undertake before the recording was self-destructed. It was to see how food banks worked over there. Linda, you took the opportunity to do that, so do you want to give us a report back and colleagues the opportunity to discuss what you discovered when you were there? Yes, thank you, convener. It was really interesting. I was out in North America in April during Scotland week, as the convener said, so I took the opportunity to visit the New York City Human Resources Administration Department of Social Services and also with the Ontario Association of Food Banks, when I was in Toronto. First of all, in New York, I met with the team of Cecile Noll, who was the Executive Deputy Commissioner for Emergency and Intervention Services. The main points that came out of that was that the department itself provides adult protective services and it is a cover all, so food provision is also in the same department as domestic violence, and they also have what they call emergency feeding services, which was interesting. They have got 500 programmes of food bank support in New York City through the emergency feeding services, and that is about 50 per cent of the support in the city. They receive state and federal funding, amounting to £8.3 million equivalent for their food banks. Most of the service provides food pantries, and 25 per cent of it is the provision of soup kitchens, as we imagine them to be people turning up to be fed within a specific place. They have found a recent fairly sharp increase in families using the services other than their main client group, which was always single people before. They also operate a food stamp scheme, and they have introduced a debit card scheme, which they hope will cut down on the degree of corruption that has been there, mainly, I have to say, by the retail outlets, as opposed to the individual. They pay a supplement on to the debit card, which can be used at any store, but already they are finding that there is some malpractice getting involved with that as well. There are more than 1.5 million New Yorkers who receive food stamps. They apply an income-based eligibility criteria to the debit card scheme, and 1.8 million people use it. The maximum US dollars is £189 per month per person. It depends on the household size, expenses and clients' income, and they can use the debit card and food banks. Food banks are non-judgmental, if you like, and people can turn up, so there is no question asked about whether they are also in receipt of anything else. They started to operate a food stamp nutrition outreach programme, trying to give education about food as well. They work very closely with supermarkets and other food companies about increasing donations of healthy, nutritious food, and they start to operate cooking classes and workshops. It is all run under an umbrella organisation called Food Bank New York City, and they have a formal arrangement with supermarkets to offload surplus food. I will come back to this at the end, but just to finish in the New York City experience, I think that what really struck me was that it was just part of the fabric of what happens, as part of what seemed to be a social service. There was no real strategic approach to the provision, but really just a reliance on the voluntary sector to plug the gaps and an expectation that that would happen because it has ever been thus. I moved on to Toronto. It was a bit different, and it is the Ontario Association of Food Banks, and they are voluntary and do not receive any Government funding, completely autonomous, and individual food banks affiliate to the Ontario Association of Food Banks, which started in 1992. It struck me that our own experience, limited though it is of trussel, is moving along that same model. There are 127 food banks as members and 1,100 affiliates for hunger relief programmes and agencies across the province. They have a more holistic approach than I found in New York. They are trying to address the root causes of hunger, and they talk about, as others do, sustainable solutions wanting to make food bank use unnecessarily. The first Canadian food bank came in 1982, and what they were saying is that, since then, food banks have gone from being that sort of temporary solution to a need. It grew from the grassroots and was born out of the church system, like so many of those things are. You can go to a food bank once a month and receive three to four days' food, which is intended to get you through to the end of the month. So, while they are not judgmental, they have a limit on how many visits someone can make. They were saying that they have particular issues in rural areas, and I remember that came up here when we had our session about the stigma and the loss of dignity associated with everyone knowing where you go. They do not do food stamps or vouchers. 2.8 per cent of the population in Toronto is served by the food banks. They are also finding a big increase in the use of food banks households coming for the first time. 69 per cent of the client's primary source of income is social assistance and disability support. I found the statistic really high when they said that most recipients are rental tenants and spend 71 per cent of their income on housing. I mean, I have to say when I asked whether, because I know in Ontario, if you rent a house sometimes, it includes the utilities, et cetera, and a degree of furniture, but there wasn't the statistic that broke that down that would enable us to compare because we tend not to have these things included in rent. So, they have a very, very clear intel. Again, the average food bank user uses it for one year to 18 months, and they reckon that less than 5 per cent of their users are long-term. Recent drivers of demand since 2008, food bank use increased by 28 per cent between 2008 and 2009, and it hasn't fallen since. So, I guess what they were saying was that they reckon that it was impacted the recession, but actually the recession was relatively mild in Canada compared to other places. Their politics at the moment in Ontario would perhaps account for some of that as well, those in control. As I said earlier, they are very holistic in their approach. They campaign as well, the Ontario Food Banks Association, as they see it as a symptom of poverty, and they are trying to create community hubs to address the much wider issues. So, they have got a big focus as well on promoting healthy food. They also work with the five major grocery chains in Canada. What their conclusion was was that food banks are plugging the gaps in state provision, and, although they said that they felt that there was a danger that it became institutionalised and became mainstream support, they also recognised the view that, if this started in 1982 and has just been increasing and increasing, perhaps it is the case that it is already mainstream support and is becoming institutionalised for all that government, either local or national, does not support food banks directly. They also said to us, and I have to say on a personal level that I pick it up from my family when I am there quite often, that people just automatically give to food banks. It is just something that is done and that people see as one of their responsibilities, and it just happens. The Ontario local food act means that farmers can claim a 25 per cent tax credit, which is based on the fair market value of food donated to food banks and other charitable meal programmes. So, even at that level, you get farmers directly supplying food banks. One of the things that the Ontario Association said that they thought we should take on board and we asked that question was that we should get very firm information in order to monitor trends in use, characteristic food bank users etc. It is only comparatively recently that they undertook to do that and they have been very surprised at the findings. We have already heard evidence of that kind of work on going. They also said that they thought that we should set standards for use, for example for people in need, not on the grounds of any other criteria and have a code of conduct in terms of decent treatment. To conclude from my own views of hearing about it, I found some of it quite depressing in terms particularly of what is happening here in Scotland today and that we have heard evidence about because it was almost like looking at it and thinking, unless something very big happens to change things here, that is the road down which we are heading. The big difference between New York City and Ontario from what I picked up is that, even at official level in New York City, they did not really get what I was saying about where worried that it becomes mainstream and institutionalised because for them it always has been and they did not really understand that distinction, but certainly what was very telling was the Ontario Association absolutely got what I was saying and were very frustrated that they had suffered from provision creep, if you like, and it had become institutionalised without anybody knowing. For me that is the big warning for us. If that is not what we want in our society, we have to get that big warning out there and not allow ourselves to get pulled into this is just the way things are and this is what happens and fight very hard against it, so that is all I would like to say. That sounds very interesting, Linda. Just an observation rather than a question. Based on your last comments here, I was reading an article a little while ago which was making the point about the different views that people can have of the system. We take great pride in having a welfare system, we provide a lot of things because society should do it, so we take great pride in the benefit system, we take great pride in free school meals and various other things that are provided, but there is always the sense that those who are in receipt of the benefits and those who have to make the claims feel stigmatised and don't want to do it and therefore when we have things like food banks there is a sense of shame that we have to have them here, but in other parts of the world there is a sense of pride that they provide them and it is a cultural thing and I think that what you picked up is just a cultural thing, but are that contained in that, is that danger that it becomes an institutionalised thing? I think that that is absolutely right and if you excuse my personalising it again, I did talk quite seriously with some of my relatives about that. Canadians who are very supportive through their local church of the food banks and that is the kind of thing that I was trying to put across and yes, they are quite proud of the fact that their church does so much, they are quite proud of the fact that their children automatically do it the same as they do and that they have brought that together. When we talked about it further, I think for them was the realisation that they had made it normal and that there were people who were relying on charitable handouts and I guess that made them think about it and that is the danger I think is that we get into that same culture. I mean yes, I am proud of the fact that Loaves and Fishes and Dennis and Cathy Curran do such great work and that some of the local churches do it but it is back to the reality that there will always be people who need that kind of provision for whatever reason, for a very short time or maybe even longer, but what Dennis was saying is that the client group has changed and that is what we have to guard against basically saying that we should not have hungry families and hungry children in our towns, cities and rural areas and that is for me what we have to guard against institutionalising and as I called it food bank creep if you like I think that is very much what has happened in Ontario and perhaps other parts of Canada and it is certainly not something that I am going to see. Any other colleagues have comments or questions for Linda? You said very clearly that the biggest rise recently in Canada was because of the recession rather I am afraid to ask you this because you were just visiting them and you wouldn't be able to do any research on it but are you aware of any welfare changes in the Canadian system because there is evidence from Germany for example that welfare changes there drove a huge increase? When I relayed that that was what directly came from the officers of the association of food banks I can't speak with it with any basis in research, Ken, about anything like that and it totally I can say yes. There have been over the past few years changes certainly in the Ontario welfare system and I know that some of them have been driven at a federal level down to the provinces whether or not that has had a direct effect I don't have the knowledge to comment on. I think it is very interesting convener just particularly the interaction between the state and voluntary programmes and the as Linda put it the danger of food bank creep and whether or not we wish to support that actively or actually go into the interaction. Interesting here what Linda has to say about the particularly Canadian experience and the suggestion that the recession may have been the cause of the increase in demand. What worries me is that the creep that she describes has the effect that whether pressure for increased demand increases and when that pressure ceases to exist demand doesn't reduce proportionally so I wonder if we might actually seek information on whether there are any examples of countries in the world where demand has been significantly managed downwards at any time. Briefing from Spice on food banks if Spice continue to watch that and can come up with any evidence then we would welcome it I would imagine but I don't know if you know I'll speak to Spice and see if there is more work that can be done but I found that their briefing on food banks to be quite helpful because as I said I read an article but I was sort of guided towards that by what I'd read in the Spice document so it's something I'm sure Spice will keep an eye on for us and if there is evidence to that effect I'm sure they'll get it to us. I believe we were going to talk about this in the informal session because Spice hadn't at the table to give evidence just my own thoughts on this the evidence on the Facebook from Germany is that welfare change was very much part of the increase I think anecdotally as Linda's alluded to I think they're having welfare changes in Canada too which have accompanied the recession it possibly we might want to discuss this in private session but in my view it might be worth conducting a literature review of this because it's quite important for our own report on food banks and particularly the relationship between the rise in food banks, the recession and the welfare changes. There seem to be parallels less in America the American situation seems to be slightly different if I may say so but the Canadian example and the general examples certainly had I believe some helpful maybe not lessons but certainly information that could we can share. Right Ken we can take that when we come to look at our report on food banks and where we can draw information to assist that so that's where that will lead us. I think that's concluded that part of our business we come then to our next item which is the annual report it's a very standardized process the format's there to create the report every year colleagues have had a chance to see it are you happy with the content of it Jamie you want to make a comment? I'm entirely happy with the content of it the only thought I had was that we could add a little to it in terms of the engagement and innovation section we've undertaken a number of informal visits over the course of the year for example Ken and myself went to visit Death Blind Scotland and Lensie I went to visit New Horizons borders and Gala Shields yourself and Annabelle went to the Glasgow Disability Alliance a number of us went to various food banks in our own constituency and I think maybe our report would benefit by just reflecting that as well. I think the collapse are a bit to that any other comments? I would ask is something that we've done previously and note my objection to the use of the term bedroom tax. We'll work that in as normal. Any other comments from colleagues? In which case then as agreed at the start of today's meeting we now move into private session. Thanks everyone.