The Contract between the DWP and Atos Healthcare

It’s a long read but this is what Mike, the the “owner” of the excellent web site Why Wait Forever managed to get out of the DWP regarding the contract between them and Atos with Why Wait Forever. DWP Atos and it’s sister site Why Wait Forever – DWP Atos Military Veterans being essential reading for anybody interested in what is going on between the DWP and Atos or forced into having to deal with Atos.

The Contract between the DWP and Atos Healthcare

This page contains clauses and schedules from the extract of the Contract (500 plus pages) between the DWP and Atos Healthcare dated 15 March 2005 which I obtained following a request made under the Freedom of Information Act.

The Contract provides strong evidence that, in my case, Atos Healthcare has both acted illegally and have on a number of occasions been in breach of the Contract. In breaking the law, in my case, Atos Healthcare have claimed that they have acted “in good faith”. In my view the illegal actions of Atos Healthcare has caused me actual harm, the advice Atos Healthcare gave to the DWP is a libel and has caused the DWP to apply a procedure that has caused me further harm. Atos Healthcare have been given many opportunities to put right the harm they have caused. They have, as yet, not chosen to do this. My rights as a patient have not, as yet, been protected by the DWP.

Atos Healthcare and the company SEMA under which they previously traded has been used by the DWP to supply healthcare services since 2000 and before. If you feel Atos Healthcare has acted illegally or has been in breach of the Contract you should contact the DWP in the first instance and then your MP for redress. You may be entitled to compensation from Atos Healthcare. The DWP are legally obliged to ensure that the Contract is complied with. Even if you feel you have obtained the correct result but you do not know if a qualified medical advisor was used to decide on whether a face to face meeting was necessary, you should find out from Atos Healthcare. Many are sick and unable to do this but if you can, please find out from Atos Healthcare if not for yourself but then for others less fortunate than you.

I have scanned pages of the Contract and then run OCR software that I have developed to convert the images to text. There may be typos as different fonts are used and the photocopy supplied is not too clear in places. I have expanded abbreviations to improve comprehension.

Where does it say the assessor should be qualified?

You should email to Atos requesting in writing who decided that a face to face assessment was necessary and the medical reasons for the face to face assessment. Point out you may wish to check with the GMC prior to the assessment.

You might want to include some of the following in your email. You may want to copy the email to your MP and ask why the DWP does not enforce the Contract between the DWP and Atos.

The key question as I see the matter is as follows.

Given the ESA information supplied. Please can Atos supply the medical reasons in writing why “Further Medical Evidence” is not required in deciding whether a face to face assessment is necessary and if an assessment is necessary why “Further Medical Evidence” is not required for the assessment. You would like to see if the GMC agrees with the Atos medical reasons.

You could go into more details.

The ESA50 is a lay opinion of the patient's medical condition and thus does not constitute
medical evidence.  A medical advisor is required in those medical conditions listed.

"Further Medical Evidence"
means medical evidence obtained from a third party such as, but not exclusively,
a general practitioner or a hospital practitioner and includes, but is not limited to,
written factual reports, hospital case notes including radiological and pathological
investigations.

SCHEDULE 4 SECTION 4.1 PART 2

4.5      Basis of Medical Advice

4.5.1    The CONTRACTOR shall ensure that wherever possible all medical reports and
         medical advice:

4.5.1.1  is evidence based, that is, there is a consensus of critically evaluated,
         published medical evidence in support of the advice provided by the
         CONTRACTOR;

4.5.1.5  is based only on documents that are consistent with one another as to
         the evidence they contain;

4.5.1.7  takes full account of and records the effects of pain, fatigue and
         medication on the Claimant's functional capacity or care needs;

4.19.1   When obtaining Further Medical Evidence, the CONTRACTOR shall make it clear to
         the author of that evidence that all evidence may be given to the Claimant and that
         the only information that can legally be withheld from the Claimant is that which may
         be harmful to the Claimant's health.

11.1   The CONTRACTOR shall, within twenty four (24) hours of completion of their required action,
       use reasonable endeavours to despatch to the AUTHORITY all required documentation,
       including all Referral documentation, any Further Medical Evidence gathered and the
       appropriate output form(s), unless specifically requested to dispose of any documentation by
       the AUTHORITY.

Atos confirms that my medical assessment was unsound.
(http://www.whywaitforever.com/dwpatosletters.html#AH20100108F)
Dr Bruecker has advised that the pathology of your condition is not clear
from the available evidence and in order to establish whether your case falls
within the support group he has arranged for a request to be issued to your GP
to provide further information.

Our National Customer Relations Manager, Mr Pepper, has provided his comments
in response to the other numbered points you have raised:
1. He confirms that an assessment of capacity was undertaken which is different
   to a diagnostic consultation. There is no requirement to have NHS medical
   records available for the assessment. When it is considered appropriate by
   the Healthcare Professional (HCP), further medical evidence can be requested
   from the customer's medical carers.

Atos confirms to the HSE what an assessment comprises of.
(http://www.whywaitforever.com/dwpatoslettersgov.html#HSE20090929F)
The Centre assesses people's functional ability through consultation, discussion
and simple physical tests (e.g. reflex).

Thus if "consultation, discussion and simple physical tests" alone is insufficient
to provide "sound" medical advice "Further Medical Evidence" is required
as defined in the contract (as above).

Letter from the Right Honourable Jonathan Shaw MP, Minister for Disabled People
http://www.whywaitforever.com/dwpatoslettersgov.html#MIN20091028F

... may be pleased to learn that we already screen the information provided by
customers before deciding whether a face to face examination is required.
The precise circumstances for exemption are prescribed in the regulations and
include terminally ill people who are fast-tracked onto the higher rate of benefit.
Every effort is made to identify potentially exempt cases by liaising with the GP
or specialist before contacting the claimant. This ensures that where at all possible,
severely ill people are not troubled by the assessment and in particular do not
have to undergo a medical examination unnecessarily.
     

This approach has some successes. This is a comment from “Josie” on the the Fibro Myalgia forum. This lady, like I, knew that a patient in a medical should be seen by an expert in the condition with full access to the medical history.

Had a appointment some time ago for a home visit for a medical and the doctor rang me on route to ask if he could come earlier, I asked him on phone if he had knowledge of my medical condition and he told me he had no knowledge, he said he would refer it back to them.

Got appointment for this morning between 9am and 10.30am and he turned up late, 10.40, came in and sat down, explained that he would ask me some questions and then do a medical, I asked him if he had knowledge of condition and he said no. He then looked at notes and said they should of sent some one with knowledge and said he would refer it back and get a doctor with knowledge to attend otherwise I would not be having a fair assessment.

How can the Department for Work and Pensions give you a fair assessment when they have no knowledge of the condition, that’s crazy, they are meant to have knowledge of chronic conditions and he had no knowledge, I now have to wait for a third appointment. Has anyone else had this type of service from them and I won an appeal for DLA for personal care and passed my medical with 15 points on the grounds of having this condition, its crazy they don’t use commonsense, you might say that the rules for Incapacity Benefit are different but I passed with 15 points on the grounds of having this condition so why do I have to see a doctor at home who has no knowledge and wants to do a medical. Its crazy.

http://www.fibromyalgia-associationuk.org/community/index.php?topic=30132.msg472897

Breaches of Contract

My case provides the following examples of Atos Healthcare being in breach of Contract.

  1. The Minister was assured by Atos Healthcare that a qualified healthcare professional reviewed the information provided prior to deciding that a face to face meeting was necessary. Initially I was told that a a nurse or midwife reviewed the information. The “Atos” Independent Tier could not identify who made the decision. A medical advisor did not review the information. No qualified medical advisor reviewed the information provided prior to the decision that a face to face meeting was necessary.

    As I have cancer, a medical advisor must be a GMC registered doctor. Because I have a primary brain tumour, the medical advisor should have specialist neuro-science and neurology knowledge or should have contacted my GP and or consultant.

    Breach of the Contract – Appendix 1 of Schedule 4 Section 4.12 Final Version – 15 March 2005

    This lists cancer as a medical condition that must be referred to a Medical Advisor (GMC registered) for advice. The breach of contract has been confirmed by Atos doctor Dr Bruecker and by the “Atos” Independent Tier.

     

  2. The medical assessment should not have taken place. The appointments clerk despite being asked to consider the medical situation refused to do so. If a medical assessment were to have taken place, after taking advice from my GP and Consultants, it should have been carried out by a medical advisor with specialist neuro-science and neurology knowledge.

    Breach of the Contract – Appendix 1 of Schedule 4 Section 4.12 Final Version – 15 March 2005

    This lists cancer as a medical condition that must be referred to a Medical Advisor (GMC registered) for advice. The breach of contract has been confirmed by Atos doctor Dr Bruecker and by the “Atos” Independent Tier.

     

    The quality of the medical report in respect of the standard of written English is below the standard required in the Contract.

    Breach of the Contract – Medical Requirements Schedule 4 Section 4.1 Final Version – 15 March 2005

    4.5.1.9 is legible, presented to the AUTHORITY in the English language and understandable to those without medical qualifications….

     

    In strict legal terms, the illegal medical assessment constituted an assault as the qualified medical practitioner was not qualified in neuro-science and neurology.

    Breach of the Contract – Medical Requirements Schedule 4 Section 4.1 Final Version – 15 March 2005

    4.3 Serious Complaints

    4.3.2 For the avoidance of doubt the main types of complaint that are included in this category shall include but will be not be limited to:

    a) assault as a consequence of examination

     

  3. The medical assessment, the waiting time, the journey to and from the medical assessment exceeded the allowed time. This was the direct cause of actual injury to my person.

    Breach of the Contract – Medical Requirements Schedule 4 Section 4.1 Final Version – 15 March 2005

    4.3 Serious Complaints

    4.3.2 For the avoidance of doubt the main types of complaint that are included in this category shall include but will be not be limited to:

    b) injury as a consequence of examination

     

  4. The medical assessment journey time exceeded the ninety minutes maximum allowed in the Contract.

    Breach of the Contract – Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version – 15 March 2005

    5.5 The CONTRACTOR shall ensure that any Claimant is not required to travel for more than ninety (90) minutes by public transport (single journey) for an examination, …

     

  5. A forty minute waiting time exceeds the ten minutes maximum allowed in the Contract.

    Breach of the Contract – Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version – 15 March 2005

    5.7 The CONTRACTOR shall use reasonable endeavour to ensure that examinations commence within ten (10) minutes, of their scheduled time, when Claimants arrive in time for their appointment.

     

  6. The advice given by Atos Healthcare to the DWP was a defamation in writing and as such constituted a libel.

    The libel was that I should receive the Employment and Support Allowance and that I should be placed in a “Work Related Support Group” and in consequence I am able to attend further face to face meetings. Atos Healthcare at the time did not admit that the medical assessment was invalid. I am pleased to note that at long last Atos Healthcare has admitted that both the original review of the information provided and the medical assessment were invalid.

    The libel by Atos Healthcare caused the DWP to attempt to take action that may have caused further injury to my person as the DWP was obliged to require additional face to face meetings.

  7. The months of delay in providing a copy of the medical contract exceeds the period set in the Contract.

  8. Many complaints were not acknowledged within the two days maximum allowed in the Contract.

    Breach of the Contract – Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version – 15 March 2005

    4.2.1 The CONTRACTOR shall acknowledge all complaints received directly from Claimants or their representatives within two (2) Working Days.

     

  9. Many complaints were not resolved within the twenty days maximum allowed in the Contract.

    Breach of the Contract – Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version – 15 March 2005

    4.2.2 The CONTRACTOR shall provide a full response to each Claimant or their representative within the required turnaround times as set out in Schedule 5 of this Agreement. This schedule defines the time as twenty (20) working days.

     

  10. Customer relations refused to action a number of requests made by email. The Contract specifically lists email as an acceptable means of communications.

    Breach of the Contract – Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version – 15 March 2005

    3.2.2 The CONTRACTOR shall ensure enquiries are accepted in any reasonable format, (e.g. by telephone, in writing, by facimile or e-mail) …

     

  11. Referral to the Independent Tier was not made in the time periods allowed in the Contract.

  12. The Independent Tier operational details are not specified in the Contract but are covered by general clauses that require Atos Healthcare to comply with DWP procedures. Recently the NAO has defined for the DWP what should constitute an Independent Tier process. Once again Atos Healthcare have not acknowledged that they have been informed of this within the two days allowed in the Contract.

    Breach of the Contract – Common Business Requirements Schedule 4 Section 4.1 Part 1 Final Version – 15 March 2005

    See following section and the National Audit Office (NAO) procedure.

The Independent Tier

The Contract between the DWP and Atos Healthcare, Schedule 4 Section 4.1 PART 1 Final Version dated 15 March 2005 page 6 of 15 contains the following:

4.1.7 The CONTRACTOR shall ensure that its complaints procedure includes reference to and details of, a process that will give the Claimant or their representative the right to seek an independent review, by an independent tier, of their complaint should normal procedures not result in a satisfactory resolution.

4.6 Independent Tier

4.6.1 The CONTRACTOR shall implement a revised independent tier for complaints as agreed with the AUTHORITY.

The NAO (http://www.nao.org.uk/) published a document dated 23 July 2008 for compliance by the DWP (which covers the activities of Atos Healthcare). This procedure provides recommendations on the requirements that relate to the Independent Tier.

NAO for the DWP Handling Customer Complaints (http://www.nao.org.uk/publications/0708/handling_customer_complaints.aspx)

6. Since we last reported, the Department has made significant improvements to its complaints handling. It has extended the remit of the Independent Case Examiner (http://www.ind-case-exam.org.uk/) as an additional, independent tier through which customers can seek redress for complaints. In parallel it has clarified its three-tiered complaints resolution process and has made efforts to direct customers more clearly through this process. The Department is also taking steps to embed the Parliamentary and Health Service Ombudsman good practice principles across all the Agencies.

If you review the correspondence you may get the impression that Atos Healthcare is reluctant to follow the NAO procedure. It is hard to understanding the reasoning behind not using the agreed independent tier procedure for a procedure in which the party at fault makes decisions as to the procedure to be followed and selects the individuals who are to decide what matter is to be considered and how to weight that matter.

Contract and the Freedom of Information Request

Here is the cover letter from Ms Michelle Munro, Freedom of Information Officer, dated 10 November 2009 which described the edited copy of Contract that was supplied and those parts that are kept secret.

Dear Mr B…

Thank you for your Freedom of Information request received on 14th October 2009. You asked for:-

A copy of the Contract between Department for Work Pensions and Atos Healthcare.

Please find enclosed an edited copy of the Medical SeNice Contract, the information you requested which has been issued by myself as DWP’s Medical Services Contract Management Team Freedom of Information Officer.

A copy of the contract between the Department for Work and Pensions and Atos Origin IT Services UK Limited (Atos Healthcare) cannot be provided in its entirety. I have removed from this copy those parts that contain information exempt under Section 40 (third party personal information where disclosure would breach data protection principles) and 43 of the Freedom of Information Act 2000. Where information is exempt under Section 43 this is due to it being commercially sensitive and release of the information would prejudice the interests of Atos Healthcare and the Department’s future dealings with Atos Healthcare or other service providers.

 

 

REFERENCE EDITED CONTENT EXEMPTION
Clause 10.11.3.2 Limit of liability Section 43 – Commercial sensitivity
Schedule 3 Contractor’s Proposal Section 43 – Commercial sensitivity
Schedule 12 Pricing and charging information, Para 4.2 – 8.2.3 and Appendices Section 43 – Commercial sensitivity
Schedule 21 Key Personnel Section 40 – Personal
Schedule 25 Liquidating damages including service credits, Paras 4.2.14 – 4.2.19, Para 5, Appendix 1 Service Credits Section 43 – Commercial sensitivity
Schedule 31 Optional Services that may be called off at some future date dependent upon future policy Section 43 – Commercial sensitivity

 

I have applied the public interest test and in the references above it is not in the public interest to release the information.

If you have any queries about this letter please contact me quoting the reference number above.

Yours sincerely

Cover Page

The cover page of the Contract contains the following:-

    THE SECRETARY OF STATE FOR
         WORK AND PENSIONS

             - and -

    ATOS ORIGIN IT SERVICES UK LIMITED

      MEDICAL SERVICES AGREEMENT

    Bird & Bird
    90 Fetter Lane
    London EC4A 1JP
    Ref: HRS/PYS/DEPSS-31

    Tel:             020 7415 6000      
    Fax: 020 7415 6111
    www.twobirds.com

    Clauses Final Version - 15 March 2005
    

Table of Contents

The table of contents is listed on pages 2 to 6 of 76 and contains the following:-

 

1. INTRODUCTION 10
1.1 Interpretations 10
1.2 Severability 11
1.3 Governing Law and Jurisdiction 11
1.4 Entire Agreement 11
1.5 Relationship of the Parties 11
1.6 Co-operation 11
1.7 Scope of Agreement 11
1.8 Subcontractors 12
1.9 Representation by the CONTRACTOR 12
2. PROVISION OF SERVICES 12
2.1 Provision of Basic Services 12
2.2 Provision of Optional Services 12
2.3 Provision of Additional Services 13
2.4 Service Specification 13
2.5 Service levels 13
3. PROVISION OF PROPERTIES 13
3.1 Introduction 13
3.2 Transferring Properties’ Lease Costs 14
3.3 Transfer of AUTHORITY Properties 14
3.4 Transfer of OGD Properties 14
3.5 Site Services at OGO Properties 15
3.6 Relocation in Special Circumstances 15
3.7 Transferring Properties and the Change Control Procedure 16
3.8 CONTRACTOR Default 17
3.9 Service Disruption due to Relocation 17
3.10 Warranties by the AUTHORITY 17
3.11 Warranties by the CONTRACTOR 17
3.12 Use of Transferring Properties for services to other Customers 18
3.13 Scottish Properties 18
4. PROVISION OF ASSETS AND INTELLECTUAL PROPERTY RIGHTS 18
4.1 Introduction 18
4.2 Transfer of Assets 18
4.3 Title and Risk 19
4.4 Warranties by the AUTHORITY 19
4.5 Use of Assets for services to Other Customers 19
4.6 Indemnities by the AUTHORITY 19
4.7 AUTHORITY Software 20
4.8 AUTHORITY Third Party Software 20
4.9 CONTRACTOR Software 21
4.10 CONTRACTOR Third Party Software 22
4.11 Specially Written Software 22
4.12 Deposited Software 23
4.13 Documentation 24
4.14 AUTHORITY forms and Consumables 24
4.15 AUTHORITY Data 24
4.16 Licences on Expiry or Termination of the Agreement 25
5. PROVISION OF PERSONNEL 26
5.1 Introduction 26
5.2 Application of the Transfer Regulations 26
5.3 CONTRACTOR Obligations 26
5.4 Charges Change Request 26
5.5 Indemnities by the AUTHORITY 27
5.6 Indemnities by the CONTRACTOR 27
5.7 Indemnities – General 28
5.8 Information and Consultation 28
5.9 Guidance 28
5.10 Pensions 28
6. CHARGES, PRICES AND OTHER FINANCIAL PROVISIONS 29
6.1 Charges to the AUTHORITY 29
6.2 Charges to the CONTRACTOR 30
6.3 Compensation for Break Option 31
6.4 Payment 31
6.5 VAT 32
6.6 Most favoured Customer 32
6.7 Maintaining Price Competitiveness 33
6.8 Benefit Sharing 34
6.9 Competitive Procurement 35
6.10 Profit Sharing 35
7. TRANSITION 36
7.1 Provision of the Detailed Transition Plan 36
7.2 Approval of the Detailed Transition Plan 36
7.3 Transition Services 36
7.4 Transition Review Process 37
7.5 Failure to Comply with the Detailed Transition Plan 38
7.6 Work in Progress 38
8. CONTRACT MANAGEMENT 38
8.1 Contract Management 38
8.2 Provision of Information 38
8.3 Communications 39
8.4 Amendments to the Agreement 39
8.5 Transfer and Subcontracting 40
8.6 Time 42
8.7 Security 42
8.8 Personnel 44
8.9 Health & Safety Hazards 45
8.10 AUTHORITY Responsibilities 45
8.11 Further Assurance 45
8.12 Provision of Information relating to Claimants 46
8.13 Consent 46
9. WARRANTIES AND STANDARDS 46
9.1 Provision of Services 46
9.2 EMU 46
9.3 Title and Non-Infringement of IPRs 47
9.4 Statements and Representations 47
9.5 Standards and Policies 47
9.6 Authority and Approval 48
9.7 Exclusion of Warranties 48
10. REMEDIES AND LIABILITIES 49
10.1 Audit Access 49
10.2 Open Book Accounts 51
10.3 Service Credits and Liquidated Damages 51
10.4 Additional Resources 52
10.5 Non-conforming Services 52
10.6 Recovery of Sums Due 52
10.7 IPR Indemnity 52
10.8 General Indemnity 54
10.9 Remedies Cumulative 55
10.10 Waiver 55
10.11 Limits of liability 55
10.12 Force Majeure 56
10.13 Loss of Data 57
10.14 Alternative Dispute Resolution 57
10.15 Step in Action 58
11. TERM AND TERMINATION 60
11.1 Term 60
11.2 Break Option 61
11.3 Grounds for Early Termination 61
11.4 Breach 63
11.5 Retender Procedures 63
11.6 Rights and Obligations on Termination or Expiry 63
11.7 Accrued Rights and Remedies 64
11.8 Survival of Obligations 64
11.9 Partial Termination of Services 64
12. MISCELLANEOUS 65
12.1 Corrupt Gifts 65
12.2 Discrimination 66
12.3 Official Secrets Act 66
12.4 Government Property 66
12.5 Confidentiality 67
12.6 Protection of Personal Data, Freedom of Information and Social Security Administration Act 69
12.7 Publicity 70
12.8 Insurance 71
12.9 Guarantee 71
12.10 Rights of Third Parties 71

Schedules and Clause Reference

The most important schedules from the perspective of a patient or claimant are Schedules 1, 4 and 5. Schedule 1 contains the definitions e.g. Claimant, Customer, Contractor, Authority, Medical Advisor etc. Schedule 4 contains the details of how the service should be delivered e.g. what medical conditions do not need a face to face meeting. Schedule 5 defines how performance is measured (or not). Atos Origin is contracted to supply performance information to the DWP which should be able to be seen by MPs and Ministers and maybe the general public though Freedom of Information requests. I do not see any problem in allowing me to know that the medical advisor is qualified and has passed the training courses that are mandatory.

The schedules are listed on pages 7 to 8 of 76 and contains the following:-

 

Schedules Clause Reference
1. Definitions 1.1.1.1
2. Statement of Service Requirements 1.7
3. Proposal 1.7
4. Service Descriptions 1.7
5. Service Levels 2.5
6. Assets Used to Provide the Services 4
7. Transition Services 7
8. Transformation Services 2.1.4
9. NOT USED
10. Properties Used to Provide the Services 3
11. Use of AUTHORITY services 6.8
12. Charging 6
13. Invoicing Procedures 6
14. NOT USED
15. Retender Provisions 11.5
16. Contract Management Procedures 8.1
17. Addresses for Communication 8.3
18. Approved Subcontractors 1.8
19. Change Control Procedures 8.4
20. Security Requirements 8.7
21. Key Personnel 8.8.2
22. AUTHORITY Responsibilities 8.10
23. Standards and Policies 8.5.7
24. NOT USED
25. Service Credits and Liquidated Damages 10.3
26. Termination Services and MSA Transition Agreement 11.6
27. Parent Company Guarantee 12.9
28. Documentation Used to Provide the Services 4.13
29. AUTHORITY Forms 4.14
30. Pilot Services 2.1.2
31. Optional Services 2.2
32. Secondment Terms 8.8.4
33. Business Continuity and Disaster Recovery 2.1.6

Medical Services Agreement – Index

MEDICAL SERVICES AGREEMENT

INDEX

CLAUSES

SCHEDULES

1            Definitions
2            Statement of Service Requirements
3            Proposal Parts 1 & 2
4            Service Descriptions
4.1 part 1   Common Business Requirements
4.1 part 2   Medical Requirements
4.2          INCAPACITY BENEFIT/INCOME SUPPORT/HOUSING BENEFIT/
             COUNCIL TAX BENEFIT AND OTHER RELATED ADVANTAGES
4.3          SEVERE DISABLEMENT ALLOWANCE
4.4          INLAND REVENUE STATUTORY SICK PAY /STATUTORY MATERNITY PAY
4.5          AGE DETERMINATION
4.6          JOBSEEKERS ALLOWANCE
4.7          OCCUPATIONAL HEALTH ASSESSMENTS
4.8          INLAND REVENUE CHILD TRUST FUND
4.9          INJURIES DISABLEMENT BENEFITS
4.10         TRIBUNALS SERVICE
4.11         INTERNATIONAL PENSIONS CENTRE
4.12         DISIBILITY LIVING AllOWANCE /ATTENDENCE AllOWANCE
4.13         INLAND REVENUE TAX CREDIT
4.14         SERVICE PERSONNEL AND VETERANS AGENCY-EMP/SPECIALIST/
             REGIONAL CONSULTANT & AUDIOLOGY REPORTS
4.15         VACCINE DAMAGE PAYMENT SCHEME
4.16         NOT USED
4.17         COMPENSATION RECOVERY SCHEME
4.18         CHILD SUPPORT AGENCY
4.19         PROVISION OF IB LiMA DATA STRIP TO INFORMATION
             ANALYSIS DIRECTORATE (IAD)
4.20         REGENERATION OF IB85s FOR DCS
4.21         FINANCIAL ASSISTANCE SCHEME
5            Service levels
6            Assets and Software used in the Provision of the Services
7            Transition Services
8            Transformation Services
9            NOT USED
10           Properties Used to Provide the Services
11           Use of AUTHORITY services
12           Charging
13           Invoicing Procedures
14           NOT USED
15           Re-tender Provisions
16           Contract Management Procedures
17           Addresses for Communication
18           Approved Subcontractors
19           Change Control Procedures
20           Security Requirements
21           Key Personnel
22           AUTHORITY Responsibilities
23           Standards and Policies
24           NOT USED
25           Service Credits and Liquidated Damages
26           Termination Services and MSA Transition Agreement
27           Parent Company Guarantee
28           Documentation Used to Provide the Services
29           AUTHORITY forms
30           Pilot Services
31           Optional Services
32           Secondment Terms
33           Business Continuity and Disaster Recovery Services
      

Schedule 1 Definitions

The definitions from the Final Version dated 15 March 2005 pages 3 – 25 of 27.

The expressions set out below shall have the meanings ascribed thereto:

“Average Actual Clearance time (AACT)”

means the measure that is calculated by taking the cumulative number of Working Days to clear the Referrals and dividing by the number of Referrals cleared.

“Abortive Visit”

means the failure to produce an examination report, whatever the reason, following the arrangement of an examination of a Claimant at his current place of residence.

“Acceptance Criteria”

means the criteria for the acceptance of the Services as set out in Schedule 7 and as further specified in the Detailed Transition Plan.

“Actual Average Waiting Time”

means the time from scheduled appointment time to when the HCP collects the customer from the waiting area.

“Additional Acceptance Criteria”

means any additional acceptance criteria specified in the Detailed Transition Plan.

“Additional Profit”

has the meaning set out in Paragraph 6.2.3 of Schedule 12.

“Additional Service”

means any Service to be supplied pursuant to Clause 2.3.

“Advertisement”

means the advertisement placed by the AUTHORITY in the Official Journal of the European Communities on 10 September 2003 for the supply of the Services.

“Age Determination”

means a medical opinion as to whether the results of an examination support the Claimant’s contention to have reached the age now alleged or if not, the range of years within which those results indicate that the Claimant’s age probably lies.

“Agreement”

means this Agreement including the Schedules hereto.

“Alternative Dispute Resolution Procedure”

means the alternative dispute resolution procedure described in Clause 10.14.

“Annual Review”

means the process set out in Paragraph 4.1 of Schedule 12.

“Approval” or “Approved”

means the written recognition by the Chief Medical Advisor, on behalf of the Secretary of State, that an individual is satisfactorily trained, and has shown to have achieved the required standard to become engaged in the provision of medical or paramedical Services and is dependant on the required standards being achieved for each Service area.

“Assets”

means the hardware and other tangible assets used by the CONTRACTOR in the provision of the Services and which are listed in Schedule 6.

“AUTHORITY”

means the Secretary of State for Work and Pensions.

“AUTHORITY Accommodation”

means Transferring Properties and any other properties where the AUTHORITY has an interest (freehold, leasehold or other) and which is used in the provision of the Services.

“AUTHORITY Consumables”

means the consumables provided by the AUTHORITY to the CONTRACTOR, including AUTHORITY Forms as specified in Schedule 29.

“AUTHORITY Data”

means all data, information, text, drawings, diagrams, images or sounds which are embodied in any electronic or tangible medium (but excluding any computer software), and which are supplied or in respect of which access is granted to the CONTRACTOR by the AUTHORITY pursuant to this Agreement, or which the CONTRACTOR is required to generate under this Agreement other than the CONTRACTOR’s internal business information.

“AUTHORITY Forms”

means the forms licensed by the AUTHORITY to the CONTRACTOR as specified in Clause 4.14.

“AUTHORITY Properties”

means those properties referred to in Schedule 12 Appendix 4, where the AUTHORITY has an interest (freehold, leasehold or other) and which the CONTRACTOR has chosen to use for the provision of the Services.

“AUTHORITY Software”

means the software and all accompanying documentation, in which the Intellectual Property Rights are owned at the execution hereof by the AUTHORITY as listed in Appendix 4 of Schedule 6.

“AUTHORITY Third Party Software”

means the software and all accompanying documentation in which the Intellectual Property Rights are owned by a third party and provided to the CONTRACTOR by the AUTHORITY pursuant to Clause 4.8 as listed in Appendix 5 of Schedule 6.

“AUTHORITY’s Responsibilities”

means the responsibilities of the AUTHORITY listed in Schedule 22.

“AUTHORITY”

means the Secretary of State for Work and Pensions.

“Average Earnings Index”

means as defined in Paragraph 4.2.7 of Schedule 12.

“Basic Services”

means any and all the Services to be performed by the CONTRACTOR pursuant to Clause 2.1.

“Benefit”

means social security benefits delivered by the Department for Work and Pensions. Save a herein amended all other terms and conditions of the Original Agreement shall remain in full force and effect.

“Benefit History Sheet”

means a form used by the AUTHORITY which identifies a Period of Interruption of Work.

“Bidder”

means any organisation, body corporate or service provider seeking appointment as a Replacement Contractor in response to any invitation or request by the AUTHORITY for the provision of tenders in respect of the Services.

“Breach of Security”

means any act or omissions. accidental or deliberate, which contravenes Departmental Security Policy, the law, or both.

“Break Option”

means the right of the AUTHORITY to terminate this Agreement without cause as set out in Clause 11.2.

“British Dental Registered Specialist”

means a registered dentist who appears on the specialist list of the General Dental Council.

“Broadly Comparable”

means in accordance with paragraph 14 of Annex A to the Cabinet Office document “Staff Transfers in the Public Sector” Statement of Practice dated Januay 2000.

“Business Area”

means a benefit or Service for which the CONTRACTOR will provide Services under this Agreement. The Business Areas referred to are:

  • Age Determination;
  • Tribunals Service;
  • Child Support Agency;
  • Compensation Recovery Scheme;
  • Disability Living Allowance/Attendance Allowance;
  • Incapacity Benefit/Income Support/ Housing Benefit/ Council Tax Benefit and other related advantages;
  • Industrial Injuries Disablement Benefit;
  • HM Revenue and Customs Statutory Sick Pay/Statutory Maternity Pay;
  • HM Revenue and Customs Tax Credit;
  • International Pensions Centre;
  • Jobseekers Allowance;
  • Occupational Health Assessments;
  • Severe Disablement Allowance;
  • Vaccine Damage Payment Scheme; and
  • Service Personnel & Veterans Agency – EMP/Specialist/Regional Consultant and Audiology Reports.

 

“Business Continuity and Disaster Recovery Services”

means the services to be provided by the CONTRACTOR as specified in Schedule 33.

“Business Continuity Plan”

has the meaning set out in paragraph 2.1 of Schedule 33.

“Capitalised Assets”

has the meaning set out in Appendix 1 of Schedule 6.

“Casual Hire Properties”

means those properties or rooms within properties which are from time to time used by the CONTRACTOR on an informal basis in connection with the performance of the AUTHORITY’s medical examination functions.

“Certification of Exemption”

means the provision of a statement that indicates that an individual is exempt from the Personal Capability Assessment far Incapacity Benefit. The conditions that provide exemption are stated in legislation and the certificate can only be provided by a Decision Maker who may seek the advice of a HCP approved by the AUTHORITY.

“Change Control Note” or “CCN”

means the form set out in Appendix 2 of Schedule 19.

“Change Control Procedure”

means the procedure for change as set out in Schedule 19.

“Change Proposal Form” or “CPF”

means the form set out in Appendix 1 of Schedule 19 which is raised by either party to facilitate discussion between the AUTHORITY and the CONTRACTOR concerning a change to the Agreement.

“Charges”

means the charges payable hereunder by the AUTHORITY for the Services exclusive of VAT as specified in Schedule 12.

“Charges Change Request”

means the CONTRACTOR’s request for a change to the Charges pursuant to Clause 5.4.

“Chief Medical Adviser” or “CMA”

means the doctor appointed as the senior doctor advising the Secretary of State for Social Security.

“Claimant(s)”

means any person claiming or having claimed entitlement to the receipt of benefits or Other Related Advantages from the AUTHORITY or from any other department, office or agency of the Crown.

“Clearance”

means the effective and satisfactory achievement of an outcome to a Referral, including a Referral for which the outcome is failure to attend for an examination or an abortive Domiciliary Visit or a Referral which has been returned for Rework. It does not include Rejections by the CONTRACTOR which have been returned to the Customer.

“Clinically Urgent”

means a condition that could reasonably be expected to cause harm to an individual, sooner rather than later.

“Commencement Date”

means the date of this Agreement.

“Companion”

means a persan who is deemed suitable by way of age and responsibility, to accompany and assist a Claimant when traveling in relation to the Services, when the Claimant, whom because of a physical or mental incapacity, is unable to travel alone.

“Confidential Information”

means all information designated as such by either party in writing together with all other information which relates to the business, affairs, products, developments, trade secrets, know-how, personnel, customers and supptiers of either party, medical records or personal data of any Claimant, or information which may reasonably be regarded as the confidential information of the disclosing party.

“Continuing Medical Education” or “CME”

means education provided for Approved and Appointed Registered Medical Practitioners to maintain their knowledge to enable them to provide medicat services to the AUTHORITY.

“Contracting Authority”

has the meaning given to it by Regulation 5(2) of the Public Contracts (Works Services and Supply) (Amendment) Regulations 2000).

“CONTRACTOR”

means Atos Origin IT Services UK Limited.

“CONTRACTOR’s Actuarial Assumptions”

means the assumptions set out in Appendix 8 of Schedule 12.

“CONTRACTOR’s Estates Strategy/Plans”

means the CONTRACTORS written proposals for the use of property in delivering the Services, including but not limited to its plans in relation to rationalisation, relocation and modification of any premises.

“CONTRACTOR’s Schemes”

means the CS Scheme and the Sema Scheme.

“CONTRACTOR Software”

means the software and all accompanying documentation in respect of which the Intellectual Property Rights are owned by the CONTRACTOR and which is employed by the CONTRACTOR in the provision of Services as listed in Appendix 6 of Schedule 6.

“CONTRACTOR Third Party Software”

means the software and all accompanying documentation in whjch the Intellectual Property Rights are owned by a third party and provided to the AUTHORITY by the CONTRACTOR pursuant to Clause 4.10 and 4.16 as listed in Appendix 7 of Schedule 6.

“Core Services”

means those Site Services provided by the PRIME Contractor in connection with the Transferring Properties pursuant to Clause 3.5 and as listed in the Site Services Schedules.

“CS Scheme”

means the Atos Origin CS pension scheme.

“Customer”

means a representative of the AUTHORITY for whom the provision of Services is included in the scope of this Agreement.

“Cutover Date”

means one minute past midnight on the date specified by the AUTHORITY for the CONTRACTOR to commence the provision of the Basic Services.

“Data Guardian”

has the meaning set out in the Security Policy.

“Decision Maker”

means a specially appointed officer who uses considerative skills and judgement to weigh evidence and decide entitlement to benefit.

“Default”

means any breach of the obligations of either party (including but not limited to fundamental breach or breach of a fundamental term) or any default, act, omission, negligence or statement of either party, its employees, servants, agents or sub-contractors in connection with or in relation to the subject matter of this Agreement and in respect of which such party is liable (by way of indemnity or othemise) to the other.

“Deposited Software”

means any CONTRACTOR Software or CONTRACTOR Third Party Sofmare which is specified as Deposited Software in Schedule 6 at the date of execution hereof or is agreed by the parties pursuant to the Change Control Procedure to be Deposited SofNvare and which is deposited in escrow in accordance with Clause 4.12.

“Detailed Transition Plan”

means the plan for transition of the Services to the CONTRACTOR to be prepared by the CONTRACTOR pursuant to Clause 7.1 and to be approved by the AUTHORITY pursuant to Clause 7.2.

“Did Not Attend” or “DNA” or “Do(es) Not Attend”

means the Claimant fails to inform the CONTRACTOR, prior to the appointment, that he/she will not be attending his/her appointment.

“Disability Benefit Centre”

means the following 11 regions:

  • Leeds;
  • Newcastle;
  • Midlands;
  • Wales;
  • Bristol;
  • Sutton;
  • Manchester;
  • Bootle;
  • Edinburgh;
  • Glasgow; and
  • Wembley;

 

“Disaster Recovery”

is usually used to describe recovery from IT disaster for IT and premises, however it can be applied to any recovery.

“Disaster Recovery Plan”

has the meaning set out in paragraph 2.1 of Schedule 33.

“Registered Medical Practitioner Capability Measure”

means a measure of the skill and competence of Registered Medical Practitioners employed by the CONTRACTOR, measured against the following five criteria:

  • fully registered with the GMC and validated by the CONTRACTOR;
  • validation portfolio up to date;
  • technical training relating to specialism completed;
  • continuing Medical Education complete; and
  • approved for benefit work by the Chief Medical Adviser.

 

“Documentation”

means the AUTHORITY’s medical and operational guides, manuals and instructions used for the provision of the Services which are listed in Schedule 28.

“Domiciliary Visit”

means an examination carried out at the Claimants current place of residence, e.g. at home, in hospital or other place of care.

“DWP Guidance”

means the documents identified in Appendix 2 of Schedule 28 as those documents for which the CONTRACTOR is not responsible for holding, adhering to and updating.

“Equipment Lease”

means the leases relating to the Leased Equipment transferred to the CONTRACTOR pursuant to Clause 4 and referred to in Schedule 6.

“Essential CONTRACTOR Software”

means any CONTRACTOR Software which is specified as such in Schedule 6 at the date of execution hereof or is agreed by the parties pursuant to the Change Control Procedure to be Essential CONTRACTOR Software and which is essential for the performance of the Services.

“Event Outcome Analysis”

means an analysis showing the performance of Medical Personnel, HCPs and paramedical personnel within the normal distribution of business processing events.

“Evidence Based Medicine (EBM)”

means the integration of up to date, peer. reviewed, medical research with informed medical opinion on current best practice, to develop an analytical, IT supported framework which will enhance the clinical skills and expertise of assessing Registered Medical ‘ Practitioners.

“Examining Medical Practitioner” or “EMP”

means a Registered Medical Practitioner appointed to provide an examination and reporting service for the purposes of determining claims to Disability Living Allowance, Attendance Allowance and War Pensions.

“Examining Medical Practitioner Report”

means the report completed pursuant to Paragraph 2 of Schedute 4, Section 4.10.

“External Staff Day Rates”

means the rates specified as such in Appendix 6 of Schedule 12.

“Fee Paid Registered Medical Practitioner”

means a Registered Medical Practitioner who is not a Transferring Authority Employee and who provides Services under this Agreement for which he receives payment.

“Fee Per Case”

means a Registered Medical Practitioner who is not directly employed by the Contractor and is paid on a fee per case basis.

“Financial Model”

means the model set out in Appendix 1 of Schedule 12.

“Fit for Purpose”

means an Output provided under this Agreement that meets the standards at Schedule 4.1 of this Agreement, as adjudged by the AUTHORITY, and allows the AUTHORITY to determine the next stage of processing to progress the Referral.

“Fixed Charges”

means the charges set out in Appendix 2 of Schedule 12.

“Force Majeure”

has the meaning set out in Clause 10.12.1.

“Further Medical Evidence”

means medical evidence obtained from a third party such as, but not exclusively, a general practitioner or a hospital practitioner and includes, but is not limited to, written factual reports, hospital case notes including radiological and pathological investigations.

“Government Office Region” or “GOR”

means the following 1 1 regions:

  • East Midlands;
  • London;
  • South East;
  • East of England;
  • North East;
  • North West;
  • Yorkshire and the Humber;
  • Scotland;
  • South West;
  • Wales;
  • West Midlands;

 

“Government Property”

means any tangible property Of the AUTHORITY or any other Crown body but excluding all real property and/or any fixtures and fittings attached to or located on any real property excluding Assets and AUTHORITY Consumables.

“GP(s)”

means a medically qualified Registered Medical Practitioner who practices general medicine as a family practitioner.

“GUARANTOR”

means the CONTRACTOR’s parent company, Atos Origin SA.

“Harmful Information”

means information unknown to the Claimant which if disclosed to him may be harmful to his health.

“Health Care Professionals” or “HCP”

means

  1. a registered medical practitioner
  2. a registered nurse
  3. an occupational therapist or physiotherapist registered with a regulatory body established by an Order in Council under section 60 of the Health Care Act 1999 or
  4. a member of such other profession, regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002, prescribed by the Secretary of State in accordance with powers under section 39(1) of the Social Security Act 1998

 

“Hospital Case Notes” or “HCM”

means clinical information relating to a Claimant and held by a hospital, they include, but are not limifed to, clinical records, pathological investigation results, radiographs and reports of radiographs.

“IMPACT Agreement”

means the agreement dated 20 Februay 1998 between the AUTHORITY and the CONTRACTOR.

“Industrial Accident”

means an accident, accepted by a lay Decision Maker as having arisen out of and in the course of employed earners employment.

“Initial Term”

has the meaning set out in Clause 11.1.1.

“Inner Core Network” or “Inner Core Telephone Network”

means the inter departmental site telephone network.

“Intellectual Property Rights” or “IPR”

means patents, trade marks, service marks, rights in data bases, design rights (whether registerable or otherwise), applications for any of the foregoing, copyright, trade or business names and other similar rights or obligations whether registerable or not in any county (including but not limited to the United Kingdom).

“Internal Forms”

means those forms to be used by the CONTRACTOR for internal processing of Referrals. They do not interface with either the Customer, Claimant or GP.

“Internal Staff-Day Rates”

means the rates specified as such in Appendix 6 of Schedule 12.

“Invoicer”

has the meaning set out in Schedule 13.

“Issuing Party”

has the meaning set out in Schedule 13.

“IT Security Manual”

means the IT Security Manual (as amended from time to time by the AUTHORITY), the terms of which are incorporated herein by reference.

“Joint Body”

means the board made up of one (1) representative of each of the parties which shall meet in accordance with Clause 10.14.1 to resolve any issues arising out of this Agreement.

“Key Personnel”

shall mean the persons specified in Schedule 21.

“Leased Equipment”

means the leased equipment transferred to the CONTRACTOR pursuant to Clause 4.2.1b.

“Least Cost Routing”

A direct, cheap out of area route using any of the Government telephone networks that enable a telephone call to automatically go out over that route.

“Licensed Data”

Means data licensed to the AUTHORITY for the purposes of Transport Direct and made available to the CONTRACTOR under the terms of this Agreement.

“Liquidated Damages”

means any damages payable by the CONTRACTOR which are quantified in advance in accordance with this Agreement.

“Location(s)”

means the management level at which Service Levels are measured pursuant to paragraph 3.3 of Schedule 5.

“Management lnformation”

means information communicated to the AUTHORITY about any aspect of delivery of Services in any form and under any requirements, including contractual, legal or other.

“Measurement Level”

means the levels specified in paragraph 3.2 of Schedule 5.

“Medical Education”

means Education for Medical Personnel and Health Care Professionals.

“Medical Process Outcome”

means the result of a process that has two or more potential outcomes. For example, scrutiny of an IB file can result in one of two further processes, those are, examination with report or the provision of written advice.

“Medical Services Centre”

means one of twelve Medical Services Management Units with management responsibility for a number of Medical Service Examination Centres and Satellite units.

“Medical Specialist”

means a General Medical Council Registered Medical Practitioner who is working in a post directly relevant to the service required, or who has retired within the preceding five (5) years from such a post and has maintained a contemporay level of knowledge; and who holds one (1) or more of the following of relevance to the condition under consideration:

  • Certificate of Completion of Specialist Training;
  • an established NHS post of consultant status, full or part time, which has been held for a minimum period of twelve (12) consecutive months;
  • membership of the GMC maintained list of specialists; or
  • a postgraduate degree or higher qualification from a Medical Royal College.

 

For the avoidance of doubt, Diploma holders, Associate Specialists and NHS Staff Grades who do not meet the above criteria are excluded.

“Month”

means a Calendar month

“MSA Transition Agreement”

means the agreement between the AUTHORITY, the CONTRACTOR and the Replacement Contractor annexed to Schedule 26.

“National”

means Great Britain.

“Nationally Classified Information”

means information or data of the which is nationally classified as “Restricted”, “Confidential”, “Secret”, “Top Secret” or such other categories as may be introduced from time to time by the UK Government, together with all originals and copies of documents containing such information or data.

“Negative Diagnosis”

Means an output from an examination where in the CONTRACTOR’s opinion the claimed Prescribed Disease is not diagnosed

“New Property”

means as defined in Clause 3.7.1.2.

“Notifiable Costs”

means costs notified and charged by the AUTHORITY to the CONTRACTOR, consisting of one or more of the following as listed in Schedule 12 Appendix 4:

  • the Rent Rates and service charge payable under the terms of the relevant Property Agreements in respect of the Transferring Properties;
  • the Rent Rates and service charge payable under the terms of the documentation entered into bemeen the CONTRACTOR and an OGD in respect of the Transferring Properties;
  • the charges payable by the CONTRACTOR to the AUTHORITY under the terms of the Services Deed;
  • Telecomms charges to include:
  • extension to extension dialling;
  • access to the Government Telecommunications Network;
  • a telephone bill apportionment in respect of premises shared with the AUTHORITY;
  • an apportionment of the charges for maintenance of telephone switchboards at premises shared with the AUTHORITY;
  • access to the Government Centrex Network;
  • an apportionment of any call logging charges incurred by the AUTHORITY in order to validate the number of CONTRACTOR calls within any given period;
  • an apportionment of costs in respect of telephone operators at premises shared with the AUTHORITY;
  • an apportionment of costs in respect of production of telephone directories; and
  • e-mail charges in respect of the AUTHORITY’s e-mail service.

For the avoidance of doubt, the telephone charges in respect of Direct Exchange Lines will be payable, direct to the third party by the CONTRACTOR. Similarly any maintenance and call charges in respect of telephone switchboards that have been sold to the CONTRACTOR and are located at premises wholly occupied by the CONTRACTOR shall also be payable, direct to the third party, by the CONTRACTOR.

“Object Code”

means computer code in machine-readable form.

“Occupational Health Assessment”

means as set out in Schedule 4, Section 4.7.

“OGD Praperties”

means real and tangible property, as referred to in Schedule 12, Appendix 4, where an OGD has an interest (freehold, leasehold or other) and which the CONTRACTOR has chosen to use for the provision of the Services.

“Open Bank Accounting”

means the accounting process as specified in Clause 10.2

“Other Government Department” or “OGD”

means any government department other than the Department for Work and Pensions.

“Old Cases”

means the uncleared Referrals at the end of the Service Measurement Period.

“Optional Services”

means any Service specified in Schedule 31 as an Optional Service to be supplied pursuant to Clause 2.2.

“Other Related Advantages”

means any other advantages that accrue to an individual as a result of being accepted as incapable of work.

“Outline Transition Plan”

means the transition plan provided by the CONTRACTOR as part of its BAFO which has been approved by the AUTHORITY.

“Output(s)”

means an output determined by the AUTHORITY as the basis upon which the CONTRACTOR shall levy charges and shall be defined as a Fit for Purpose written medical report, produced by the CONTRACTOR, either in respect of a medical examination or on the basis of documentary evidence, the result of which provides medical advice which fully answers all the questions posed by the AUTHORITY and enables the AUTHORITY to determine the next stage of the Referrals Process.

“Own Occupation Test”

means the test of whether he is incapable by reason of some specific disease or bodily or medical disablement of doing work which he could reasonably be expected to do in the course of the occupation in which he was previously so engaged.

“Parent Company”

means any company which is the ultimate Holding Company of the CONTRACTOR ar any other company of which the ultimate Holding Company of the CONTRACTOR is also the ultimate Holding Company and which is responsible directly or indirectly for the business activities of the CONTRACTOR. The term “Holding Company” shall have the meaning ascribed by Section 736 of the Companies Act 1985 or any statutory re-enactment or amendment thereto.

“Past Default”

means a Default which has already occurred.

“Period of Interruption of Work”

means a spell of 4 or more calendar days in a row where the Claimant is unable to work because of a medical condition.

“Permitted Use”

means the provision without charge of public transport information derived from the Transport Direct portal to any person for the purposes of providing the Services and for no other purpose

“Personal Capability Assessment” or “PCA”

determines the question whether a person is capable or incapable of work for benefit purposes. It assesses the extent to which a person, by reason of some specific disease or bodily or mental disablement, is capable of performing the activities prescribed in the Schedule to the Social Security (Incapable for work) (General) Regulations 1995.

“Personal Information Policy”

means a policy for Agencies and the Social Security Policy Group regarding disclosure of information which will be provided by the AUTHORITY to the CONTRACTOR.

“Pilot services”

means the services to be provided by the CONTRACTOR as set out in Schedule 30.

“Planned Cutover Date”

means the date specified as such in the Outline Transition Plan.

“Planned Transition Period”

means the period from the Commencement Date until the Planned Cutover Date.

“Pooled Assets”

has the meaning set out in paragraph 1.3 of Schedule 6.

“Postal Security Framework”

means the fundamental security measures surrounding post receipt, post opening and the post despatch operations as defined by the CONTRACTOR and approved by the AUTHORITY.

“Potentially Violent Person”

means someone who threatens or conducts violence against a member of staff.

“Predicted Volumes”

means the volumes set out in Appendix 5 of Schedule 12.

“Prescribed Disease”

means a disease accepted as having an association with an occupation and set down in the SS (Industrial Injuries) (Prescribed Diseases) Regulation 1985. Diseases are prescribed by the Secretary of State if:

  • they are a risk of a particular occupation which is not a risk common to all persons; and
  • it is or with reasonable certainty may be presumed to be attributable to the nature of the employment.

 

“PRIME Agreement”

means the Agreement between the Department for Work and Pensions and the PRIME Contractor (as hereinafter defined) for the management of the property portfolio vested in the AUTHORITY.

“PRIME Contractor”

means the third party contractor who is party to the PRIME Agreement.

“Principal list”

means the list of Registered Medical Practitioners that are currently registered with the General Medical Council.

“Profit Incentive Amount”

has the meaning set out in Paragraph 6 of Schedule 12.

“Prognosis”

means the opinion of a Registered Medical Practitioner on the anticipated progress of a disabling condition. In the context of social security it relates to the time expected to pass before the Claimant’s condition alters in such a way that benefit entitlement may change.

“Property Agreement(s)”

means the agreement or agreements documenting the transfer of the Transferring Properties in the forms set out in Appendix 4 of Schedule 10.

“Property”

means any real or tangible property owned or occupied by either party.

“Proposal”

means the CONTRACTOR’s proposal as set out in Schedule 3.

“Protectively Marked Departmental Information”

means records, either clerical or computer, which are marked as having a greater confidentiality requirement than “restricted”.

“Questionnaire”

means the questionnaire issued by the AUTHORITY to the CONTRACTOR dated 21 October 2004.

“Rates”

means the share of building rates payable to the Local Authority properly attributable to a Transferring Property.

“Receiving Party”

has the meaning set out in Schedule 13.

“Recrudescense”

means the “return of symptoms”. It is a term applied to a recurring Prescribed Disease i.e. the condition stems from the original attack of the disease. The meaning of Recrudescence is specified in regulation 7 of the (SS) (II) (PD) Regulations.

“Referral Documents”

means any document the AUTHORITY uses to request an Output from the CONTRACTOR.

“Referral”

means a written or verbal request by the AUTHORITY, or initiated by the AUTHORITY, for Services described in this Agreement.

“Regional Consultant”

means a Registered Medical Practitioner that must:

  • hold full and unrestricted registration with the UK Generat Medical Council or EEA equivalent;
  • hold registration on the relevant Specialist Register;
  • hold a Fellowship of a UK or Republic of Ireland Royal College or equivalent foreign or Commonwealth College, Faculty or Academy recognised and accepted in the UK or Republic of Ireland;
  • have held NHS Consultant or academic equivalent status for 5 years; and
  • revalidate or be revalidating (when statutorily necessary) to meet the GMC’s criteria to remain on the GMC list of Licensed Medical Practitioners, either in their own speciality.

The Registered Medical Practitioner will preferably:

  • Possess higher qualifications such as MD, Ms, PHD or DSc;
  • Have published work in recognised medical or other significant journals; and
  • must be able to analyse written submissions and (usually in conjunction with their own clinical history and examination), write clear and precise authoritative reports answering specific medical questions.

 

“Registered Medical Practitioner”

means a Medical Practitioner practising in the United Kingdom and registered on the principal list of the General Medical Council.

“Registered Nurse”

means a nurse registered with the Nursing and Midwifey Council

“Rejection” or “Rejected”

means a Referral which the CONTRACTOR cannot progress because it is inappropriate, substandard in presentation or contains insufficient information to produce an outcome. It does not count as a Referral or a Clearance for the purposes of measuring the Service Levels.

“Rent”

means this is the rent first reserved figure or the opportunity cost rent figure which is the Treasury valued rental figure for a Transferring Property.

“Repeated Short Period Claims”

means the employee has been sick for four (4) or more short periods.

“Replacement Agreement”

means the Agreement that replaces this Agreement following termination or expiry of this Agreement.

“Replacement Contractor”

means the contractor that replaces the CONTRACTOR following termination or expiry of this Agreement.

“Replacement Services”

means the services to be provided by the Replacement Contractor pursuant to the Replacement Agreement.

“Respiratory Disease”

means Prescribed Diseases which are classified as respiratory. Any decision or medical report requested by the Adjudication Officer to determine the diagnosis question must be provided by a Specially Qualified Adjudicating Medical Practitioner or a Special Medical Board. The diseases covered are those numbered:

  • B6, C15, C17, C18, C22(B), D1, D2, D3, D7, D8, D9, D10, D11 and D12.

“Retained Profit”

has the meaning set out in Paragraph 6.2.3 of Schedule 12.

“Retender Award Date”

means the date, prior to termination of this Agreement, on which the AUTHORITY either selects a Replacement Contractor to perform services similar to the Services or elects to return the provision of the Services to the Authority.

“Retender Notice”

has the meaning set out in Schedule 15.

“Retender Period”

has the meaning set out in Schedule 15.

“Rework”

means a Referral returned to the CONTRACTOR by the AUTHORITY where the Outcome provided by the CONTRACTOR is not completed to the appropriate standards as detailed in para 4 of Section 4.1, Part 2 of Schedule 4.

“Scheduling”

means the administrative task of arranging appointments for Claimants to be examined.

“Scrutiny”

means the consideration of documentary evidence to determine the next course of action to progress the service.

“Secondee”

has the meaning set out in Schedule 32.

“Secondment”

has the meaning set out in Schedule 32.

“Security Manuals”

means the manuals setting out the AUTHORITY’s Security Standards, objectives and policies and being the:

  • Information Technology Security Standards;
  • Protection of Customer Information Guide; and
  • Internal Security Handbook.

 

“Security Policy”

means the security policy as amended from time to time by the AUTHORITY.

“Sema Scheme”

means the Atos Origin (Sema) pension scheme.

“Sensitive Records”

means a record that contains personal or intimate information about a member of staff, employed by either the AUTHORITY or the CONTRACTOR, a relative of a member of staff or a nationally recognisable person or a case defined as such by the AUTHORITY.

“Service Credit(s)”

means any Liquidated Damages which are payable by the CONTRACTOR as a credit against sums owing to the CONTRACTOR by the AUTHORITY.

“Service Descriptions”

has the meaning set out in Schedule 4.

“Service Levels”

means the levels of Service defined in Schedule 5.

“Service Measurement Period”

means the period of time over which performance shall be measured from and including the first Calendar Day of any Month up to and including the last Calendar Day of any Month.

“Service Specification”

means the detailed specification of the Services agreed pursuant to Clause 2.4, as amended from time to time in accordance therewith.

“Service(s)”

means all the Services to be performed by and all the other obligations of the CONTRACTOR under this Agreement, including the Basic Services.

“Services Deed”

means an agreement in the form set out in Schedule 10D (a) for the provision by the AUTHORITY to the CONTRACTOR of the Core Services which were provided by the PRIME Contractor at the relevant OGD Property prior to the Cutover Date (to the extent that the relevant OGD or third party to whom an OGD has outsourced its property management is not obliged to provide such services to the CONTRACTOR pursuant to the terms of the relevant Property Agreement) and (b) for the payment by the CONTRACTOR to the AUTHORITY of the costs incurred by the AUTHORITY in procuring the provision of such Core Services.

“Service Year”

means a period of twelve months commencing on the Cutover Date or any anniversary of the Cutover Date.

“Set-Up Costs”

The outstanding amount of any capitalised Transition Costs (excluding Asset costs) at the net book value of the costs on the date of termination.

“Shared Use Assets”

means those Assets identified as such in Schedule 6 which are employed by the CONTRACTOR in the provision of the Services and which are also, or may also be, employed by the CONTRACTOR in work outside the scope of this Agreement.

“Site Services Schedule”

means the Schedules set out in Appendix 5 to Schedule 10 to be attached to the Property Agreements listing the Core Services provided by the PRIME Contractor, (excluding for the avoidance of doubt such services as are provided by OGD’s, or other landlords pursuant to terms of Property Agreements).

“Site Services”

means the services including the Core Services provided by the PRIME Contractor, or OGD’s, or landlords under the Property Agreements and other third parties to the Transferring Properties.

“Software”

means the AUTHORITY Software, CONTRACTOR Software (including Essential CONTRACTOR Software), Specially Written Software, AUTHORITY Third Party Software and CONTRACTOR Third Party Software.

“Sole Use Assets”

means those Assets identified as such in Schedule 6 which are employed by the CONTRACTOR exclusively in the provision of the Services under this Agreement.

“Special Medical Board”

means a medical board of which at least two of the members are Specially Qualified Adjudicating Medical Practitioners.

“Special Needs”

means the needs of an individual Claimant that could prevent the successful completion of an examination if they were not met. Examples include but are not limited to: deafness, language difficulties, provision of an interpreter, difficulty undressing and provision of a Registered Medical Practitioner of the same Sex.

“Special Rules”

means Referrals for consideration of Terminal Illness.

“Specialist Examination”

means an examination carried out by a Specialist to provide evidence.

“Specialist Medical Service”

means a service provided by a Medical Specialist.

“Specialist”

means an individual with special skills. This term may include Medical Specialist and Regional Consultant.

“Specially Qualified Adjudicating Medical Practitioner”

means a Registered Medical Practitioner qualified, experienced and Appointed by the Secretary of State to provide services in relation to respiratory prescribed diseases.

“Specially Written Software”

means any software developed by the CONTRACTOR during the term of this Agreement and owned by the AUTHORITY in accordance with the provisions of Clause 4.11 and as listed in Appendix 8 of Schedule 6.

“Staff”

means employees, independent contractors and agents of the CONTRACTOR or any of its Subcontractors or agents employed or engaged in any way in the performance of the CONTRACTOR’s obligations under this Agreement.

“Staff-day Rates”

means External Staff-day Rates and Internal Staff-day Rates.

“Statement of Case”

means a statement of case prepared by the AUTHORITY in cases of appeal. It gives the AUTHORITY’s opinion and explanation of how the opinion is derived.

“Step-In Action”

means such steps as the AUTHORITY considers to be appropriate (either by taking such action itself or by engaging others to take any such steps) to ensure performance of the Services to the standards required by this Agreement or as close as possible to those standards as the circumstances permit.

“Subcontract”

means any contract or agreement or proposed contract or agreement between the CONTRACTOR and any third party whereby that third party agrees to provide to the CONTRACTOR the Services or any material part thereof or services fundamentally necessary for the provision of the Services or any part thereof. For the avoidance of doubt, the term “Subcontract” shall not be regarded as including any contract or agreement between the CONTRACTOR and any third party for the provision of equipment or software, facilities or services necessary for the general discharge of the CONTRACTOR’S business or any agreement between the CONTRACTOR and any third party for the provision of Third Party Software.

“Subcontractor”

means the third party specified in Schedule 18 with whom the CONTRACTOR enters into a Subcontract.

“Sublease(s)”

means a sublease of the whole or part of the relevant Transferring Property or Transferring Properties in the agreed form referred to in Schedule 10 A to be granted by the AUTHORITY to the CONTRACTOR.

“Tenancy at Will”

means a tenancY at will in the form set out in Schedule 10.

“Terminally Ill”

means a Claimant is suffering from a progressive disease and his death in consequence of that disease can reasonably be expected within six months.

“Termination Charge”

means the sum payable by the AUTHORITY to the CONTRACTOR under the circumstances specified in, and calculated in accordance with Part 7 of Schedule 12.

“Termination Services”

means the Services set out in Schedule 26 to be provided by the CONTRCTOR in connection with the expiry or termination of this Agreement.

“Terms of Reference”

means, in relation to Regional Consultants, the information passed to the Regional Consultant to enable him to understand the requirements of the AUTHORITY.

“Third Party Software”

means anY software and all accompanying documentation in which the Intellectual Property Rights are owned at the date of execution hereof by a third party.

“Third Party Agreements”

means all maintenance agreements, support agreements and all other supply or service agreements which are transferred to the CONTRACTOR pursuant to Clause 4.2.

“Third Party Data”

means all data, information, text, drawings, diagrams, images or sounds which are embodied in any electronic or tangible medium (but excluding any computer software), and which are supplied or in respect of which access is granted to the CONTRACTOR by a third party.

“Third Party Software Licence”

means any licence agreement relating to the Third Party Software.

“Transfer Date”

means a date on which any employee of the AUTHORITY at anytime during the term of the Agreement transfers to the CONTRACTOR or an Subcontractor pursuant to the Transfer Regulations.

“Transfer Regulations”

means the Transfer of Undertakings (Protection of Employment) Regulations 1981.

“Transferred Assets”

means the Assets comprising the Capitalised Assets and the Pooled Assets.

“Transferring Authority Employee”

means any employee of the AUTHORITY who transfers to the CONTRACTOR or Subcontractor an a relevant Transfer Date.

“Transferring Property( or Properties)”

means AUTHORITY Properties and OGD Properties.

“Transformation Plan”

means the plan to be provided by the CONTRACTOR in accordance with Schedule 8.

“Transformation Services”

means the services to be provided by the CONTRACTOR in accordance with the Transformation Plan as set out in Schedule 8.

“Transition Costs”

Has the meaning set out in Schedule 12 Appendix 2.

“Transition Period”

means the period from the Commencement Date to the Cutover Date.

“Transition Cutover Criteria”

means one of two levels of Acceptance Criteria as specified in Annex 1 to Schedule 7.

“Transition Readiness Criteria”

means one of two levels of Acceptance Criteria as specified in Annex 1 to Schedule 7.

“Transition Review Process”

means the formal reviews undertaken by the AUTHORITY in conjunction with the CONTRACTOR during the Transition Period as specified in Clause 7.4.

“Transition Services”

means the Services to be provided by the CONTRACTOR during the Transition Period as set out in Schedule 7.

“Transport Direct”

means the Internet portal owned by the Department for Transport that uses the Transport Direct Software and the Licensed Data.

“Transport Direct Licence”

means the licence granted to the CONTRACTOR under paragraph 3.3.1 of Schedule 6.

“Transport Direct Software”

means software licensed to the AUTHORITY for the purposes of Transport Direct which is sub-licensed to the CONTRACTOR under the terms of this Agreement.

“Transport Direct Specification”

means technical and other information relating to Transport Direct.

“Tribunals Service Regions”

means the following 8 regions:

  • Leeds;
  • Cardiff;
  • Birmingham;
  • Glasgow;
  • Liverpool;
  • Nottingham;
  • Newcastle and
  • Sutton.

 

“Treat Official Correspondence”

means correspondence issued by a Claimant to a Government Minister.

“Unable To Attend” or “UTA”

means the Claimant informs the CONTRACTOR that they are unable to attend for a pre-arranged appointment before 5 p.m. on the day of the appointment.

“Use”

means the right of either party to load, execute, extract, reutilise, store, transmit, display, copy (for the purposes of loading, execution, storage, transmission or display) or otherwise to utilise the Software as applicable for purposes of the provision or receipt (as the case may be) of the Services. To the extent permitted by law, such right of use shall not include the right to reverse assemble, reverse compile, decode or otherwise translate the Software.

“Variable Charges”

means Charges resulting from medical outputs.

“Working Day”

means any day in the week from Monday to Friday excluding any day which is recognised as a statutory or common law holiday at the locatjons to which the Services are provided

“Year” or “Year of this Agreement”

means a period of twelve months commencing an the Commencement Date or any anniversary of the Commencement Date.

Schedule 1 Glossary

The glossary from the Final Version dated 15 March 2005 pages 26 – 27 of 27.

AA:

Attendance Allowance

AACT:

Average Actual Clearance Times

AIIB:

Analogous Industrial Injuries Benefits

AIIS:

Analogous Industrial Injuries Scheme

BAMS:

Benefits Agency Medical Services

CAA:

Constant Attendance Allowance

CBT:

Computer Based Training

CCN:

Change Control Note

CHD:

Client Help Desk

CME:

Continuing Medical Education

CMS:

Complaints Management System

CPF:

Change Proposal Form

CRU:

Compensation Recovery Unit

CSA:

Child Support Agency

CSD:

Customer Service Desk

DBC:

Disability Benefits Centre

DCPU:

Disability Contact and Processing Unit

DDI:

Direct Dial-In telephone extension numbers

DLA:

Disability Living Allowance

DDAM:

Diploma in Disability Assessment Medicine

DITSO:

Departmental IT Security Officer

DMA:

Decision Making and Appeals

DNA:

Did Not Attend

DO:

District Office

DPA:

Data Protection Act 1998

DSG:

Departmental Security Group

DSM:

Departmental Security Manager

DV:

Domiciliary Visit

DWP:

Department for Work and Pensions

EBM:

Evidence Based Medicine

EMB:

Executive Management Board

EMP:

Examining Medical Practitioner

ESDA:

Exceptionally Severe Disablement Allowance

GAD:

Government Actuary Department

FME:

Further Medical Evidence

GMC:

General Medical Council

GOR:

Government Office Region

HCN:

Hospital Case Notes

HMG:

Her Majesty’s Government

IB:

Incapacity Benefit

II:

Industrial Injuries

IIDB:

Industrial Injuries Disablement Benefit

IPC:

International Pension Centre

IQAS:

Integrated Quality Audit System

IT:

Information Technology

ISSS:

Information Systems Security Standards

ITSS:

IT Security Standards

IVB:

Invalidity Benefit

JSA:

Jobseekers Allowance

MA:

Medical Advisor

MAT:

Medical Appeal Tribunal

MEC:

Medical Exam!nation Centre

MIS:

Management Information System

MSC:

Medical Services Centre

MSCMT:

Medical Services Contract Management Team

MSD:

Medical Skills Database

MSEC:

Medical Services Examining Centre

MSEC(RD):

Medical Services Examination Centre (Respiratory Diseases)

NAO:

National Audit Centre

NCC:

National Computer Centre

NINO:

National Insurance Number

OGD:

Other Government Department

OHA:

Occupational Health Assessment

OOT:

Own Occupation Test

PABX:

Private Automatic Branch Exchange

PCA:

Personal Capability Assessment

PD:

Prescribed Oisease

PDP:

Personal Development Plan

PKI:

Public Key Infrastructure

POD:

Pensions & Overseas Directorate

RD:

Respiratory Disease

REA:

Reduced Earninos Allowance

SDA:

Severe Disablement Allowance

SIAG:

Security and Informat!on Assurance Group

SISP:

System Interconnection Security Policy

SMART:

System for Medical Allocations Referrals and Tracking

SMP:

Statutory Maternity Pay

SPVA:

Service Personnel & Veterans Agency

SS:

Social Security

SS (Adj) Regs 1995:

Social Security (Adjudication) Regulations

SS (Gen Ben) Regs 1982:

Social Security (General Benefit) Regulations 1982

SS (II) (PD) Regs 1985:

Social Security (Industrial Injuries) (Prescribed Diseases)

SS Admin Act 1992:

Social security Administration Act 1992

SS CB Act 1992 :

Social Security Contributions and Benefits Act 1992

SS VDP Act 1979 :

Social Security Vaccine Damage Payment Act 1979

SSO:

Social Security Office

SSP:

Statutory Sick Pay

SSPG:

Social Security Policy Group

SyOPS:

Security Operating Procedures

TSR:

Tribunals Service Region

US:

Unemployment Supplement

UTA:

Unable to Attend

VAC DAM :

Vaccine Damage

VDPS:

Vaccine Damage Payments Scheme

VPN:

Virtual Private Network

WTC:

Working Tax Credit

Agreement

The agreement from the Final Version dated 15 March 2005 pages 9 – 10 of 76.

THIS AGREEMENT is made the 15 March 2005

BETWEEN:

1)   THE SECRETARY OF STATE FOR WORK AND PENSIONS ("the AUTHORITY"); and

2)   ATOS ORIGIN IT SERVICES UK LIMITED a company incorporated in England and Wales
     under registration number 01245534, whose registered office is at 4 Triton Square, London
     NW1 3HG ("the CONTRACTOR").

WHEREAS:

(a) On 10 September 2003 the AUTHORITY placed an advertisement in the Official Journal of
    European Communities for the supply of services;

(b) By the required deadline the CONTRACTOR responded to that advert and expressed an
    interest in supplying the services;

(c) On 21 October 2003 the AUTHORITY issued the questionnaire and the CONTRACTOR
    responded to that Questionnaire by the required deadline;

(d) On 12 January 2004 the AUTHORITY issued the Operational Requirements ("the OR") to
    potential service providers (including the CONTRACTOR) setting out the requirements for the
    provision of certain services to the AUTHORITY;

(e) On 1 March 2004 the AUTHORITY issued the Statement of Service Requirements ("the
    SSR") to potential service providers (including the CONTRACTOR) setting out the
    requirements for the provision of Services to the AUTHORITY;

(f) On 25 May 2004 the AUTHORITY issued a Revised Statement of Service Requirements ("the
    Revised SSR") to potential service providers (including the CONTRACTOR) setting out
    revised requirements for the provision of Services to the AUTHORITY;

(g) The CONTRACTOR submitted the Proposal by the required deadline in response to the
    Revised SSR and submitted a Final Proposal on 2 August 2004;

(h) The AUTHORITY then invited potential service providers (including the CONTRACTOR) to
    engage in further discussions in connection with their respective Proposals and the
    AUTHORITY's needs for the provision of the required services and accordingly such
    discussions took place;

(i) On 19 October 2004 the AUTHORITY invited potential service providers (including the
    CONTRACTOR) to submit Best and Final Offers in respect of the provision of the required
    services;

(j) The CONTRACTOR submitted a Best and Final Offer in respect of the provision of the
    required services on 29 November 2004;

(k) On 17 December 2004 the AUTHORITY invited potential service providers (including the
    CONTRACTOR to submit revised Best and Final Offers in respect of the provision of the
    required services;

(l) The CONTRACTOR submitted a revised Best and Final Offer in respect of the provision of
    the required services on 4 January 2005, as clarified by subsequent discussions relating
    thereto;

(m) During the period 11 March 2004 to 24 November 2004, the CONTRACTOR was afforded full
    access to the AUTHORITY's relevant properties and assets and successfully carried out all
    due diligence exercises and/or performance audits Sufficient in relation to such properties and
    assets to ensure that it shall be able to meet its obligations as set out in this Agreement;

(n) On the basis of the CONTRACTOR's Proposal as further amplified by the above-referenced
    discussions and on the basis of the CONTRACTOR's revised Best and Final Offer, the
    AUTHORITY has selected the CONTRACTOR to provide the required services and the
    CONTRACTOR undertakes to supply the same on the terms set out below;

NOW THEREFORE IT IS HEREBY AGREED as follows:

1.       INTRODUCTION

1.1      Interpretations

1.1.1    As used in this Agreement:

1.1.1.1  the terms and expressions set out in Schedule 1 shall have
         the meanings ascribed therein;

1.1.1.2  the masculine includes the feminine and the neuter and person
         shall mean corporation, partnership, firm, unincorporated association and
         natural person; and

1.1.1.3  the singular includes the plural and vice versa.

1.1.2    A reference to any statute, enactment, order, reguIation or other simiIar
         instrument shall be construed as a reference to the statute, enactment, order,
         regulation or instrument as amended by any subsequent statute, enactment, order,
         regulation or instrument or as contained in any subsequent re-enactment thereof.

1.1.3    Headings are included in this Agreement for ease of reference only and
         shall not affect the interpretation or construction of this Agreement.

1.1.4    References in this Agreement to Recitals, Clauses, Parts, Sub-clauses
         and Schedules are, unless otherwise provided, references to the recitals, clauses,
         parts, sub-clauses and schedules of thTs Agreement.

1.1.5    In the event and to the extent only of any conflict or inconsistency
         between:

1.1.5.1  the provisions of the Clauses and Schedule 1 and the provisions of
         the Schedules (other than Schedule 1), the provisions of the Clauses and
         Schedule 1 shall prevail;

1.1.5.2  the provisions of the Schedules (0ther than Schedule 1), the
         provisions of Schedules 2 and 4 shall prevail over those of all other
         Schedules (other than Schedule 1);

1.1.5.3  the provisions of Schedules 3, 7 and 8 and any other Schedule, the
         other Schedule shall prevail;

1.1.5.4  the provisions of this Agreement and the provisions of any
         document referred to or referenced herein, the provisions of this
         Agreement shall prevail; and

1.1.5.5  the provisions of this Agreement and the provisions of any
         document agreed by the parties or submitted by the CONTRACTOR and
         approved by the AUTHORITY subsequent to the date hereof, the
         provisions of this Agreement shall prevail unless amended in accordance
         with Clause 8.4.

1.1.6    The party receiving the benefit of an indemnity under this Agreement
         shall use its reasonable endeavour to mitigate its loss covered by the indemnity.

...
    

It is not clear to me that due diligence was conducted by the AUTHORITY on the suitability of the CONTRACTOR to deliver the services.

Schedule 4 Section 4.1 Part 1 – Common Business Requirements

Standards Applied to Referral Requests

These requirements apply to referral requests by the DWP to Atos Healthcare. These clauses cover many of the breaches of the Contract listed above. The extract is taken from pages 3 to 15.

SCHEUDULE 4 SECTION 4.1 PART 1

COMMON BUSINESS REQUIREMENTS

1      GENERAL

1.1    The CONTRACTOR acknowledges that the standards set out in this Schedule 4 shall apply to
       all of the Referral requests made to the CONTRACTOR by the AUTHORITY.

1.2    General Service Communication Standards

1.2.1  The CONTRACTOR shall display in all examination waiting room areas information
       that shall include but not be limited to:

       a) Claimant services standards as detailed at paragraphs 5.1 to 5.10;
       b) Claimant complaint procedures as approved by the AUTHORITY; and
       c) the name of the site manager.

1.2.2  Upon request, the CONTRACTOR shall provide to the AUTHORITY and any
       Claimant or their nominated representative, accurate information in plain language
       about how the Services are administered and provide details of the Claimant's local
       contact point.

1.2.3  The CONTRACTOR shall ensure that all staff provide a courteous and helpful
       service at all times.

1.2.4  The CONTRACTOR shall ensure that its staff, including Medical Personnel, who
       have face to face contact with Claimants wear name badges at all times.

2      PUBLICATIONS IN WAITING ROOMS

2.1    The CONTRACTOR shall display various AUTHORITY publications as provided by the
       AUTHORITY in all claimant waiting room areas when reasonably requested to do so by the
       AUTHORITY.

2.2    The literature that the CONTRACTOR shall display, will include, but not be limited to:-

       AA5DCS         Attendance Allowance (AA)
       AA5DCSW        Attendance Allowance (AA) Welsh version
       CAA5DCS        Carer's Allowance (CA)
       CAA5DCSW       Carer's Allowance (CA)  Welsh version
       DHC1JP         A guide for disabled people, those with health conditions, and carers
       DHC1JPW        A guide for disabled people, those with health conditions, and carers
                      Welsh version
       DLAA5DCS       Disability Living Allowance (DLA)
       DLAA5DCSW      Disability Living Allowance (DLA) Welsh version
       DLACA5DCS      DLA far children
       DLACA5DCSW     DLA far children  Welsh version
       DS2JP          Make it Work - A Guide to Specialist Services for Disabled People
       DS2JPW         Make it Work - A Guide to Specialist Services for Disabled People
                      Welsh version
       ATWA5JP        Access to Work - Information for Disabled People
       ATWA5JPW       Access to Work - Information for Disabled People Welsh version
       BRA5DWP        Benefit Rates
       BRA5DWPW       Benefit Rates Welsh version
       GLA24DWP       If you think our decision is wrong
       GLA24DWPW      If you think our decision is wrong  Welsh version
       HC1 & HC5      Health Benefits
       IB1JP          Guide to Incapacity Benefit
       IB1JPW         Guide to Incapacity Benefit Welsh Version
       IB214JP        Incapacity - The Personal Capabitity Assessment
       IB214JPW       Incapacity - The Personal Capabitity Assessment Welsh Version
       IIDBAA5JP      Industrial Injuries Disablement Benefit - Accidents
       IIDBAA5JPw     Industrial Injuries Disablement Benefit - Accidents Welsh Version
       IIDBASA5JP     Industrial Injuries Disablement Benefit - Asbestos
       JIDBASA5JPw    Industrial Injuries Disablement Benefit - Asbestos Welsh Version
       IIDBDA5JP      Industrial Injuries Disablement Benefit - Diseases
       IIDBDA5JPw     Industrial Injuries Disablement Benefit - Diseases Welsh Version
       Inspire        Jobcentreplus Customer Magazine
       JPS1JP         Jobcentre Plus Services
       JPS1JPW        Jobcentre Plus Services Welsh Version
       NDL70          How a Job Broker can help you get back to work
       NDL70W         How a Job Broker can help you get back to work Welsh Version
       VACDPA5DCS     Vaccine Damage Payments
       VACDPA5DCSW    Vaccine Damage Payments Welsh Version 

2.3    The CONTRACTOR shall obtain prior written approval from the AUTHORITY to display non-
       AUTHORITY literature in accommodation which is used specifically for the provision of
       Services.

2.4    If the site is "Casual Hire": for example where the CONTRACTOR "hires" an examination room
       within a GP's surgery or a hospital, they may not necessarily be given room within the waiting
       area to display posters and leaflets.  In these instances the CONTRACTOR shall have an
       information pack/folder available for the claimant to look at. This pack should contain all the
       information, which the CONTRACTOR is required to display within other MEC's.

2.5    Provision Of Items

2.5.1  The CONTRACTOR shall use reasonable endeavours for ensuring that sufficient quantities of
       the leaflets detailed in paragraph 2.2 of this section are available.

2.5.2  The AUTHORITY shall notify the CONTRACTOR of any known amendment or updates to the
       leaflets listed at paragraph 2.2. The CONTRACTOR shall liaise with the AUTHORITY's
       Leaflet Supplier to obtain additional stocks of these leaflets when required or as and when
       notified of an update or amendment.

3      PROVISION OF ENQUIRY SERVICES

3.1    General

3.1.1  The CONTRACTOR shall provide medical and administrative enquiry services to
       process  enquiries  from  AUTHORITY staff, GPs and  Claimants or their
       representatives.

3.2    Level of Service

3.2.1  The CONTRACTOR shall ensure that all enquiry services are available. as a
       minimum. on Working Days, between 08.30 and 17.OO hours.  Outside of these
       hours the CONTRACTOR shall, as a minimum, provide an answerphone service
       with all messages acknowledged or responded to as detailed in paragraphs 3.3 to
       3.5.

3.2.2  The CONTRACTOR shall ensure enquiries are accepted in any reasonable format,
       (e.g. by telephone, in writing, by facimile or e-mail) and responded to in the format
       requested by the AUTHORITY. The CONTRACTOR shall provide all reasonably
       requested documentation in relation to any such enquiries as and when requested
       by the AUTHORITY.

3.2.3  The CONTRACTOR shall use reasonable endeavours to ensure that all enquiries
       or progress requests made by the AUTHORITY are responded to in the format
       requested by the AUTHORITY.

3.3    AUTHORITY Enquiries

3.3.1  The CONTRACTOR shall use reasonable endeavours to respond to all enquiries
       within two (2) Working Days of receipt of an enquiry. or exceptionally, where the
       enquiry is of a complex nature, within five (5) Working Days of receipt of the
       enquiry.

3.4    Advice to GPs

3.4.1  The CONTRACTOR shall use reasonable endeavours to provide immediate advice
       on Working Days (subject to paragraph 3.2.1 of this Schedule 4.1) to GPs on
       certification issues, completion of medical reports (including DS 1500) and other
       medical matters relating to Incapacity Benefit and shall provide dedicated telephone
       line(s) for this purpose.

3.4.2  The CONTRACTOR shall offer general advice only to GPs through the dedicated
       telephone line(s) and shall not discuss individual cases which are being assessed
       for the benefit.

3.4.3  The CONTRACTOR shall provide contact details for the dedicated phone line(s) to
       the AUTHORITY and shall ensure that the AUTHORITY is notified of any changes
       to those details within ten (10) Working Days of the change.

3.5    Claimant Enquiries

3.5.1  The CONTRACTOR shall use reasonable endeavours to provide an immediate
       enquiry service on Working Days (subject to paragraph 3.2.1 of this Schedule 4.1)
       for Claimants for enquiries connected with appointments for examinations.

4      ENQUIRIES AND COMPLAINTS

4.1    General

4.1 1  The CONTRACTOR shall respond to enquiries and complaints from either
       Claimants or their representatives including Member of Parliament (MPs).

4.1.2  The  CONTRACTOR  shall  provide  appropriate  information  to  assist  the
       AUTHORITY in responses to:

       a) Treat Official correspondence
       b) Ministerial correspondence
       c) Parliamentary Questions
       d) Ministerial Briefings
       e) Parliamentary Commissioner for Administration cases
       f) Press enquiries

4.1.3  The CONTRACTOR shall ensure that all enquiries and complaints are fully
       investigated to address all issues raised.

4.1.4  The CONTRACTOR shall, in addressing all the issues raised, ensure that the
       response includes:

       a) a factual account of the evidence and
       b) a balanced assessment of the evidence provided

4.1.5  Where the outcome of the investigation identifies that remedial action is appropriate,
       the CONTRACTOR shall include reference to the proposed remedial action that will
       be undertaken in the response.

4.1.6  Where the investigation has identified that a medical report has been identified as
       meriting a C Grade the CONTRACTOR shall notify the appropriate business unit of
       the attributes which are deficient. In these types of cases the CONTRACTOR shall
       inform the Claimant or their representative, within the response, that inaccuracies
       have been identified within the report and that this has been brought to the attention
       of the appropriate Business Unit. The CONTRACTOR shall not intimate to the
       Claimant or their representative that the findings may affect the AUTHORITY's
       decision on the Claimant's entitlement to benefit.

4.1.7  The CONTRACTOR shall ensure that its complaints procedure includes reference
       to and details of, a process that will give the Claimant or their representative the
       right to seek an independent review, by an independent tier, of their complaint
       should normal procedures not result in a satisfactory resolution.

4.1.8  The CONTRACTOR shall co-operate with the AUTHORITY to handle complaints
       which relate to both services provided by the AUTHORITY and those provided by
       the CONTRACTOR (known as "dual complaints").  Where appropriate the
       AUTHORITY will direct the CONTRACTOR to coordinate the joint response to the
       Claimant or their representative. The CONTRACTOR shall coordinate the joint
       response when so directed by the AUTHORITY.

4.1.9  The CONTRACTOR shall, when requested by the AUTHORITY, refer to the
       AUTHORITY details of all complaints where the Claimant or their representative
       expresses dissatisfaction with the response received from the CONTRACTOR.

4.1.10 The AUTHORITY reserves the right to instruct the CONTRACTOR to respond to
       any complaints on the AUTHORITY's behalf in relation to the Services, when
       reasonably requested to do so.

4.1.11 The CONTRACTOR shall not enter into any correspondence or provide views or
       opinions on policy issues to any person other than the AUTHORITY.

4.1.12 The CONTRACTOR shall ensure that systems are in place to provide full details to
       the AUTHORITY in relation to enquiries and complaints received, subject to the
       provisions of the Data Protection Act 1998 (DPA).

4.2    Enquiries and Complaints received direct from the Claimant or their representative

4.2.1  The CONTRACTOR shall acknowledge all complaints received directly from
       Claimants or their representatives within two (2) Working Days.

4.2.2  The CONTRACTOR shall provide a full response to each Claimant or their
       representative within the required turnaround times as set out in Schedule 5 of this
       Agreement. Where the CONTRACTOR is unable to provide a full response within
       the required turnaround time, the CONTRACTOR shall provide an update on what
       stage the response has reached and the date the full response is expected shall be
       provided to the Claimant or their representative.

4.2.3  The CONTRACTOR shall reply directly to the Claimant or their representative
       where the complaint is confined to elements of the Services directly within the
       CONTRACTOR's control.

4.3    Serious Complaints

4.3.1  The CONTRACTOR shall ensure that its complaints procedure includes details of
       procedures for dealing with serious allegations of professional misconduct made in
       complaints received.

4.3.2  For the avoidance of doubt the main types of complaint that are included in this
       category shall include but will be not be limited to:

       a)      assault as a consequence of examination
       b)      injury as a consequence of examination
       c)      inappropriate intimate examinations
       d)      missed diagnosis of a serious nature
       e)      racial abuse
       f)      sexual abuse
       g)      serious breaches of professional conduct
       h)      theft or fraud
       i)      criminal activities

4.3.3  The CONTRACTOR shall inform the AUTHORITY upon receipt of all complaints
       which fall into this category.

4.3.4  The CONTRACTOR shall provide a progress report on all serious complaints
       received to the AUTHORITY monthly or as otherwise required.

4.4    Information for Parliamentary Questions Treat Official /Ministerial Correspondence
       Ministerial briefings Parliamentary Commissioner for Administration cases

4.4.1  The  AUTHORITY  will  forward  these  types  of  correspondence  to  the
       CONTRACTOR where the enquiry or complaint relates to those parts of the
       Services wholly or partly within the CONTRACTOR's control.

4.4.2  The CONTRACTOR shall provide the AUTHORITY with all the information as
       required by the AUTHORITY.

4.4.3  Deadlines on these types of enquiries are extremely time critical. The AUTHORITY
       will give individual response deadlines to which the CONTRACTOR shall adhere.
       The CONTRACTOR shall use reasonable endeavours to provide a full response to
       the AUTHORITY within the required turnaround times as set out in Schedule 5 of
       this Agreement. Where exceptionally and with the agreement of the AUTHORITY,
       the CONTRACTOR is unable to provide a full response within the required
       turnaround time, the CONTRACTOR shall provide an update to the AUTHORITY
       which sets out what stage the response has reached and the date the full response
       is expected.

4.4.4  For avoidance of doubt, it is recognised that within the overall target for Treat
       Official Correspondence as specified in Schedule 5 of this Agreement, the
       individual response deadlines for Ministerial Correspondence, Ministerial Briefings,
       Parliamentary Questions and ParIiamentary Commissioner for Administration
       (PCA) cases shall be met in all cases and will count towards the overall target.

4.5    Press Enquiries

4.5.1  The CONTRACTOR shall not respond directly to press enquiries concerning the
       delivery of Services. The CONTRACTOR shall direct the enquirer immediately to
       the AUTHORITY.

4.5.2  The CONTRACTOR shall use reasonable endeavours to provide the AUTHORITY
       with any information relating to press enquiries as requested by the AUTHORITY.

4.6    Independent Tier

4.6.1  The CONTRACTOR shall implement a revised independent tier for complaints as
       agreed with the AUTHORITY.

5      MEDICAL EXAMINATIONS

5.1    The CONTRACTOR shall give reasonable notice to Claimants or their representatives of the
       time and place at which any medical examination will take place. Reasonable notice for these
       purposes begins with the day on which the notice is given and ends of the day before the
       examination is to take place. The CONTRACTOR shall give the following periods of notice,
       which, where necessary, comply with any periods and requirements as stipulated in
       Legislation unless otherwise agreed with the Claimant.

       a)   War Pensions examinations ten (10) Days (EMPs only)
       b)   Vaccine Damage Payments Scheme examinations fourteen (14) Days
       c)   Disability Living Allowance Fast Track examinations three (3) days
       d)   any other medical examination (including Audiology)  seven (7) Days, with the
        exception of Occupational Health Assessments five (5) Days.

5.2    For the avoidance of doubt, when notice is given by post, the requirement is deemed to be met on
       the day after the letter is posted (ie the day after it is collected), and ends
       after 7 clear calendar days where;
       -   where the letter has been property addressed,
       -   the letter has been pre-paid and posted and,
       -   first class post is used.

5.3    For the avoidance of doubt,

       a)  A letter giving the time and place of a medical examination is collected for delivery on
           Wednesday 6th. The first day of notice is Thursday 7th, Wednesday 13th is the 7th day of
           notice and the earliest appointment date must be Thursday 14th.

       b)  A letter giving the time and place of a medical examination is prepared on Friday 1st and
           collected for delivery on Monday 4th.  The first day of notice is Tuesday 5th, Monday 11th is
           the 7th day of notice and the earliest appointment date must be Tuesday 12th.

5.4    The CONTRACTOR acknowledges that if it arranges to undertake two (2) different
       examination types consecutively, then the notice period shall always be that notice period
       which is the greater of the two (2) notice periods.

5.5    The CONTRACTOR shall ensure that any Claimant is not required to travel for more than
       ninety (90) minutes by public transport (single journey) for an examination, unless previously
       agreed with the Claimant, with the exception of Regional Consultant examinations (or the
       Service Personnel & Veterans Agency in which case the CONTRACTOR shall use all
       reasonable endeavours to ensure that any Claimant is not required to travel for more than
       ninety (90) minutes by public transport (5ingIe journey) far an examination, unless previously
       agreed with the Claimant.

5.6    The CONTRACTOR shall make reasonable endeavours to examine all Claimants who attend
       for examination on the day of their scheduled appointment.

5.7    The CONTRACTOR shall use reasonable endeavour to ensure that examinations
       commence within ten (10) minutes, of their scheduled time, when Claimants arrive in time for
       their appointment.

5.8    The CONTRACTOR acknowledges that the examination is deemed to start when the
       Claimant is called through for the examination.

5.9    The CONTRACTOR shall use reasonable endeavours to ensure that late arrivals (more than
       ten minutes after the appointment time) are examined on the day of their original appointment
       or offered a mutually acceptable alternative appointment.

5.10   The CONTRACTOR shall use reasonable endeavours to ensure that, where a Domiciliary
       Visit is being undertaken, examinations shall commence within their scheduled time frame.
       The CONTRACTOR shall, when arranging Domiciliary Visits specify a time slot in which the
       Registered Medical Practitioner will arrive at the Claimant's address or designated place of
       examination which shall not exceed one (1) hour.

5.11   Special Needs

5.11.1 The CONTRACTOR shall comply with any reasonable requests to accommodate
       Claimants who have Special Needs.

5.11.2 Special Needs shall be deemed to include but not be limited to the requirement of
       the Claimant for the examination to be undertaken by a Health Care Professional of
       the same sex and the Claimant's need for an interpreter during examination.

5.11.3 When a Special Need is identified on the day of the examination appointment and
       the Special Need cannot be reasonably be accommodated the CONTRACTOR
       shall use reasonable endeavours to ensure that an alternative appointment is
       arranged within twenty four (24) hours of the Special Need being identified and
       shall ensure that the Claimant's Special Needs will be accommodated at the new
       appointment. The CONTRACTOR shall use reasonable endeavours to inform the
       Claimant of the new arrangements within twenty four (24) hours of the new
       appointment being made.

5.12   Did Not Attend And Abortive Visits

5.12.1 In the event of an Abortive Visit or a Did Not Attend, the CONTRACTOR shall
       automatically, without reference back to the AUTHORITY, offer the Claimant a
       further appointment. If the Claimant Does Not Attend or fails to avail themselves for
       examination at home at the second attempt, the CONTRACTOR shall use
       reasonable endeavours to return all papers to the AUTHORITY within twenty four
       (24) hours of that failed appointment or Abortive Visit.

5.12.2 The CONTRACTOR shall use reasonable endeavours to ascertain the reasons why
       the Claimant Did Not Attend or did not avail themselves of the examination(s) at
       home and shall record the reasons on the appropriate form(s) which shall be included
       in the documentation to be returned to the AUTHORITY.

5.12.3 For the avoidance of doubt the CONTRACTOR must adhere to the specific
       requirements relating to Claimants who Did Not Attend in relation to Incapacity
       Benefit and Severe Disablement Allowance examinations as set out in the
       appropriate Section(s) of the Schedule 4.

5.13   Claimant Unable to Attend for Examination

5.13.1 In the event of a Claimant being Unable to Attend an appointment, the
       CONTRACTOR shall automatically, without reference back to the AUTHORITY,
       offer the Claimant a further appointment. Where the Claimant advises that they are
       Unable To Attend a second appointment, the CONTRACTOR shall use reasonable
       endeavours to despatch all documentation to the AUTHORITY, including the
       documented reasons for non-attendance, within twenty four (24) hours of the
       Claimant's second cancelled appointment.

5.13.2 In the event of a Claimant in the first instance not attending an examination, and on
       the second occasion being Unable To Attend for examination or vice versa, the
       CONTRACTOR shall offer one more appointment to the Claimant.

5.13.3 Upon receipt of a Referral, from the AUTHORITY, in respect of a Claimant who was
       previously Unable to Attend, the CONTRACTOR shall use reasonable endeavours
       to reschedule a further appointment, if appropriate, within fifteen (15) Working Days
       of receipt of the said Referral.

5.14   Claimants turned away unseen

5.14.1 The CONTRACTOR shall use reasonable endeavours to examine all Claimants
       who attend for examination.

5.14.2 The CONTRACTOR shall note that only those Claimants who arrive late for their
       appointment (i.e more ten (10) minutes after their scheduled appointment time) or
       who arrive in an unfit state to be examined are excluded from the Service Level
       requirements in Schedule 5 of this Agreement.

5.15   Treatment of Domicilliary Visits

5.15.1 The CONTRACTOR shall undertake a DV on the following occasions:

       a)  at the AUTHORITY'S request

       b)  when the Claimant's GP has indicated that the Claimant is unable to travel on
           health grounds or

       c)  at the Claimant's request, if supported by a suitable medical condition as
           determined by the CONTRACTOR.

5.15.2 The CONTRACTOR may undertake DVs for business reasons, at its discretion,
       notwithstanding the provisions of paragraphs 5.14.1

6    WELSH LANGUAGE ACT

6.1    The CONTRACTOR shall comply with the provisions of the Welsh Language Act to provide a
       bi-lingual  service for those  Claimants  who  are  resident  in Wales  in  respect  of
       correspondence, telephone communications, face to face communications, and published
       and printed materials.

6.2    Where either the AUTHORITY or the Claimant has previously advised the CONTRACTOR
       that Welsh is the Claimant's preferred language, the CONTRACTOR shall use reasonable
       endeavours to ensure that Welsh speaking health Care Professionals are used to deliver
       medical examinations.

6.3    The CONTRACTOR shall provide a report showing details of their compliance with the Welsh
       Language Act as required by the AUTHORITY and in the format specified by the
       AUTHORITY annually or as otherwise required by the AUTHORITY.

6.4    Correspondence

6.4.1  Where either the AUTHORITY or the Claimant has previously advised the
       CONTRACTOR  that Welsh  is  the  Claimant's  preferred  language, the
       CONTRACTOR shall correspond in Welsh.

6.4.2  Where a letter is received from a Claimant in Welsh, the COhlTRACTOR shall
       respond in Welsh.

6.4.3  Where the Claimant's preferred language is not known, the CONTRACTOR shall
       issue all correspondence bi-lingually.

6.5    Telephone Communications

6.5.1  The CONTRACTOR shall provide a bi-lingual greeting for all incoming telephone
       calls in offices in Wales.

6.5.2  Where the Claimant requests that the call be conducted in Welsh and where the
       person who answers the telephone in Wales is unable to advance further than the
       greeting in Welsh, the CONTRACTOR shall arrange for the call to be referred to a
       Welsh speaking member of staff.  Where this is not immediately possible, the
       CONTRACTOR shall arrange for the call to be refurned by a Welsh speaker as
       speedily as possible and no later than within one (1) Working Day of receipt of the
       telephone call.

6.5.3  Where the Claimant has previously advised that Welsh is their preferred language,
       the CONTRACTOR shall ensure that all out going telephone calls are made by a
       Welsh speaker. for all other out going calls the Claimant shall be offered the
       opportunity to conduct business in Welsh.

6.5.4  The CONTRACTOR shall ensure that where answer phones are used in offices in
       Wales, all recorded messages are bi-lingual.

6.5.5  Where call centre telephony systems are used, irespective of the location, the
       CONTRACTOR shall provide Claimants who are resident in Wales with the
       opportunity to conduct their business in either Welsh or English at the earliest
       stage.

6.6    Face to face Communications

6.6.1  The CONTRACTOR shall ensure that they provide access to Welsh and English
       language services in offices in Wales for all Claimants.

6.6.2  Where the Claimant has previously advised that Wetsh is their preferred Ianguage,
       the CONTRACTOR shall ensure all face to face communications with all staff
       including Medical Personnel are conducted in Welsh.

6.6.3  The requirements detailed above apply equally to Domiciliary Visits.

6.7    Medical Reports

6.7.1  For the avoidance of doubt. the CONTRACTOR acknowledges that medical reports
       provided for the sole use of the AUTHORITY shall be provided in English in all
       Cases.

6.8    Published and Printed Materials

6.8.1  The CONTRACTOR shall ensure that all published and printed material directed to
       Claimants is available in Welsh. Wherever practical, all published and printed
       material should be produced bi-lingually rather than as separate English and Welsh
       documents. This includes all forms and associated explanatoy material for use by
       the public in Wales including:

       a)      posters
       b)      signs
       c)      directions
       d)      instructions
       e)      leaflets
       f)      staff badges

6.9    Claimant Surveys

6.9.1  The CONTRACTOR shall ensure that all Claimant surveys issued to residents in
       Wales are produced bi-lingually rather than as separate English and Welsh
       documents.

7      CLAIMANT SATISFACTION SURVEYS

7.1    The CONTRACTOR shall undertake month1y surveys to gauge Claimants' perception of the
       service they receive.

7.2    The CONTRACTOR shall ensure that at least 90% of Claimants who respond to the survey
       are satisfied with the service provided and shall continually strive to make improvements.

7.3    The CONTRACTOR shall ensure that the survey administration, sampling methadology,
       questionnaires and data analysis conform to generally recognised market research industry
       standards and shall ensure that the surveys are undertaken objectively and without bias.

7.4    The CONTRACTOR shall ensure fhat the surveys are conducted across all benefit streams,
       to a sample size agreed with the AUTHORITY which will be drawn from yearly national
       volumes.

7.5    The CONTRACTOR shall ensure that Claimants are randomly selected in accordance with
       agreed AUTHORITY guidelines.

7.6    The CONTRACTOR shall ensure that the survey findings are analysed according to the
       agreed AUTHORITY requirements with the facility for provision of data by a range of criteria,
       e.g. age, gender, ethnic origin.

7.7    The CONTRACTOR shall ensure that all survey evaluation reports are foMarded to the
       AUTHORITY within agreed timescales.

8      CHANGES OF CIRCUMSTANCES

8.1    Upon receipt of notification of any relevant change to a Claimant's circumstances the
       CONTRACTOR shall use reasonable endeavours to inform the AUTHORITY immediately. If
       directed to do so by the AUTHORITY, the CONTRACTOR shall despatch all documentation
       requested by the AUTHORITY to the AUTHORITY on the day of the request or by no later
       than the next Working Day-

8.2    The types of changes that might be relevant, include but shall not be limited to:

       a) admittance of the Claimant to hospital, or similar institution, as an in-patient
       b) detention of the Claimant in legal custody
       c) change of name and/or address of the Claimant
       d) death of the Claimant
       e) absence abroad of the Claimant
       f) return to work of the Claimant and the Claimant has terminated the benefit claim
       g) the Claimant's claim for benefit has been withdrawn.

8.3    Upon notification of a change of circumstances of the Claimant by the AUTHORITY, the
       CONTRACTOR shall use reasonable endeavours to take appropriate timely action to avoid
       inconvenience to the Claimant and any embarrassment to, or criticism of, the AUTHORITY
       which arises from the CONTRACTOR'S acts or omissions.

9      HOSPITAL CASE NOTES

9.1    Upon request by the AUTHORITY, or upon the necessity arising during the course of
       processing a Referral, the CONTRACTOR shall provide a verbatim extract of all information
       in Hospital Case Notes relevant to the condition(s) under consideration and to the
       requirements of the Referral type.

9.2    For the avoidance of doubt the CONTRACTOR shall adhere to the specific requirements
       relating to Hospital Case Notes as specified in the appropriate sections of this Schedule 4.

9.3    The extract shall be made anonymous and not refer to or identify any individual other than the
       Claimant and the individual preparing the extract

9.4    Original Hospital Case Notes shall not be copied by the CONTRACTOR other than to
       facilitate the expeditious production of the extract and return of the Hospital Case Notes to the
       NHS Trust from which they were obtained. Any copies so made shall be destroyed as secure
       waste within twenty four (24) hours of completing the extract. For the avoidance of doubt no
       copies of Hospital Case Notes shall be retained for inclusion in the Referral documentation.

9.5    The CONTRACTOR shall endeavour to return Hospital Case Notes to the NHS Trust from
       which they were obtained within ten (10) Working Days of their receipt from that NHS Trust.

10     RECEIPT OF DOCUMENTATION

10.1   The CONTRACTOR shall, within one (1) Working Day of receipt of any Referral, formally
       record the date of the receipt the Referrat and be able to provide proof on request by the
       AUTHORITY, at any time, of the date of the receipt of the Referral.

10.2   For the avoidance of doubt, where a Referral is received after 16.OO hrs, the date of receipt
       will be deemed to be the following Working Day.

11     RETURN OF DOCUMENTATION

11.1   The CONTRACTOR shall, within twenty four (24) hours of completion of their required action,
       use reasonable endeavours to despatch to the AUTHORITY all required documentation,
       including all Referral documentation, any Further Medical Evidence gathered and the
       appropriate output form(s), unless specifically requested to dispose of any documentation by
       the AUTHORITY.

11.2   The CONTRACTOR shall return all documentation to the AUTHORITY in the same format as
       received, unless otherwise directed by the AUTHORITY.

11.3   The CONTRACTOR shall ensure that when disposing of all documentation referred to in
       paragraph 11.1 that this is destroyed in a confidential manner.

12     TRAINING FOR DECISION MAKERS

12.1   The CONTRACTOR shall confirm that it will work with the AUTHORITY to deliver a maximum
       of 300 man days basic initial and angoing training, face to face and on the AUTHORITY's
       premises, as required, in respect of the medical aspects of service delivey.

12.2   The CONTRACTOR shall deliver the training for, including but not limited to:

12.2.1 Decision Makers for Incapacity Benefit;

12.2.2 Decision Makers and Disability Living Allowance/Attendance Allowance;

12.2.3 Personal Advisers; and

12.2.4 Disability Employment Advisers.

12.3   The CONTRACTOR shall keep a record by benefit type of the number of man days delivered.
       Any additional man days required for training will be discussed with the CONTRACTOR and
       subject to change control.

12.4   The CONTRACTOR shall ensure that the cost of any additional days are pro-rata with the
       300 days previously agreed.

12.5   The CONTRACTOR shall work towards ensuring that all Health Care Professionals providing
       training for Decision Makers have appropriate accreditation that meets the requirements of
       the Authority within pre-agreed timescales.

13     CLAIMANT EXPENSES

13.1   The CONTRACTOR shall consider the most cost effective approach to undertake the
       examination of a Claimant in accordance with current legislation. The CONTRACTOR shall,
       at all times operate within the parameters of this Section 4.1 of Schedule 4 when considering
       the appropriate payment of any expenses, incurred by a Claimant and/or Companion, in
       travelling to attend an examination.

13.2   The CONTRACTOR shall as a minimum adhere to the legal requirements imposed by the
       Secretary of State with regard to the payment of Claimant expenses.

13.3   The CONTRACTOR shall also pay subsistence and financial loss allowance to Companions
       of VDPS Claimants and War Pensioners who apply and who are eligible, and additional
       expenses claimed in respect of VDPS Referrals.

13.4   Notwithstanding the requirement in paragraph the CONTRACTOR shall pay all reasonable
       and actual expenses to Claimants and/or Companions who attend an examination and who
       apply for reimbursement.

13.5   The CONTRACTOR shall from the Cutover Date:

13.5.1 ensure complete accuracy in all payment of expenses;

13.5.2 provide an effective system to pay and monitor all expenses payments with numerous
       audit trails;

13.5.3 provide relevant and timeous Management Information (MI) in respect of Claimant
       expenses;

13.5.4 make any payments properly due, upon receipt of a correctly completed and
       documented application, within 14 Days of receiving the application; and

13.5.5 use the mileage rate as instructed by the AUTHORITY. From 6th April 2006 the rate
       will be 20 pence a mile.

13.6  Claimant Expenses Legislation

       BENEFIT                         LEGISLATION
       IB/MA                           SS Admin Act 1992 sec 180
       SSP/SMP                         SS Admin Act 1992 sec 180A
       SDA                             SS Admin Act 1992 sec 180
       NTC                             SS Admin Act 1992 sec 180
       DLA/AA                          SS Admin Act 1992 sec 180
       IPC                             SS Admin Act 1992 sec 180
       IIDB                            SS Admin Act 1992 sec 9 (2)
       OHA                             SS Admin Act 1992 sec 180
       VAC DAM                         SS VDP Act 1979 Para 12 (3) a&b
       VA                              SPOrder 1983. Naval, Military and Air Forces
                                       (Disablement and Death) SPO 1983 and the
                                       Personal Injuries (Civilians) Scheme 1 983
       Analogous Industrial Injuries   Employment Training Act 1973 Sec 11 (2)

14     SUSPICIONS OR ALLEGATIONS OF FRAUD

14.1   The CONTRACTOR shall work collabaratively with the AUTHORITY to ensure that it reports,
       in writing, to the AUTHORITY all suspicions of fraud and allegations of fraud received against
       Claimants.

15     MISCELLANEOUS

15.1.1 Whilst the CONTRACTOR shall provide advice on Prognosis, in accordance with agreed
       guidelines, the AUTHORITY will retain the right to determine the actual timing of any
       subsequent Re-Referrals to the CONTRACTOR.

16     GRIEVANCES/INDUSTRIAL TRIBUNALS

16.1   Monitoring Requirements

16.1.1 The CONTRACTOR shall provide the AUTHORITY with details of grievances and Industrial
       Tribunals (ITs) relevant to Schedule 3.17 of this Agreement, within five (5) Working Days of
       an official grievance/IT being notified to them. At each Annual Review, the AUTHORITY will
       review this requirement when the requirement for the production of any future reports will be
       decided.
    

The above seems straightforward and clear.

Schedule 4 Section 4.1 Part 2 – Medical Requirements

Medical Standards Applied to Referral Requests

These requirements apply to referral requests by the DWP to Atos Healthcare.

These clauses cover many of the medical related breaches of the Contract listed above.

  • The “Health Care Professional” must be fully registered, without restrictions or conditions, on the Principal List of the General Medical Council.

  • The Medical report produced must be “fair and impartial”, “legible and concise”, “in accordance with relevant legislation”, “comprehensive, clearly explaining the medical issues raised”, “in plain English and free of medical jargon”, “presented clearly” and more see below.

The extract is taken from pages 3 to 17.

SCHEUDULE 4 SECTION 4.1 PART 2

MEDICAL REQUIREMENTS

1        GENERAL

1.1      Medical Recruitment Standards

1.1.1    The CONTRACTOR shall ensure that it's Health Care Professionals, whether
         employed or fee paid, are:

1.1.1.1  fully registered, without restrictions or conditions, on the Principal List
         of the General Medical Council (GMC}; and in addition

1.1.1.2  from the date on which the GMC issues licences to practice, hold a
         current licence to practice.

1.1.2    In addition they must have three (3) years post full registration (GMC or EEA
         equivalent) experience as a minimum.  In individual cases, solely at the discretion
         of the AUTHORITY's Chief Medical Adviser, the requirement that:

1.1.2.1  no conditions be attached to registration; and

1.1.2.2  Health Care Professionals must have a minimum of three (3) years
         post-registration experience,

         may be waived.

1.1.3    The CONTRACTOR shall ensure that it's registered nurses, whether employed or fee
         paid, are:

1.1.3.1  fully registered, without restrictions or conditions, with the Nursing and
         Midwifey Council (NMC).

1.1.3.2  In addition. they must have a minimum of (3) years post registration
         experience.

1.2      That experience should feature broad based medical practice in roles that have clear
         relevance to a career in disability assessment medicine, unless specialist knowledge and
         experience are required as detailed in this Schedule 4. The CONTRACTOR shall provide the
         AUTHORITY with written confirmation of compliance with paragraph 1.1 by 31st March of
         every year.

1.3      The CONTRACTOR shall ensure that Health Care Professionals providing the Respiratory
         Disease Service shall be appropriately trained and assessed as being fit to provide the
         Services to the standards laid out in Schedule 4 Section 4.1 of this Agreement.

1.4      When providing Specialist Medical Services the CONTRACTOR shall use only a Medical
         specialist as defined in Schedule 1 who shall have training, qualifications and experience
         pertinent to the condition under consideration.

1.5      The CONTRACTOR shall ensure that all audiometric technicians have contemporary and
         relevant specialist qualifications.

1.6      The CONTRACTOR shall ensure that all Health Care Professionals providing or supporting
         the provision of Services have appropriate qualifications, experience, training and hold current
         registration with the relevant licensing body.

2.       MEDICAL TRAINING FOR NEWLY RECRUITED AND HEALTH CARE PROFESSSIONALS

2.1      The CONTRACTOR shall provide a training programme for each benefit area in accordance
         with the requirements, detailed below, which will ensure that Health Care Professionals have

         The required level of knowledge and skills to achieve Approval.  The knowledge and skills
         required in respect of the CONTRACTOR's Health Care Professionals shall include but not be
         limited to:

2.1.1    an understanding and an ability to perform the role of the disability medical analyst;

2.1.2    a knowledge of the legislative requirements far each of the benefits in which they
         will be required to have an input;

2.1.3    an understanding of the legislative framework in which they are working. This may
         include attendance as an observer at an Appeal Tribunal as part of ongoing training
         for the relevant benefit area;

2.1.4    an up-to-date knowledge of relevant clinical subjects, which should specifically
         include a knowledge of the disabling effects of musculoskeletal, mental, cardio-
         respiratory and any other relevant disorders identified by the AUTHORITY;

2.1.5    an awareness of the AUTHORITY's approach to Customer service and equal
         opportunities;

2.1.6    disability awareness; and

2.1.7    an ability to deal with potentially violent situations.

2.2      Where no formal training programmes are detailed for specific benefit areas the
         CONTRACTOR shall liaise with the AUTHORITY to develop and implement an appropriate
         training programme. The CONTRACTOR shall provide all necessary information, reasonably
         requested by the AUTHORITY, prior to implementation of the programme.

2.3      The CONTRACTOR's Health Care Professionals shall be given a course of theoretical and
         practical training, which shall be developed and implemented by the CONTRACTOR in each
         benefit area they are to work. The CONTRACTOR shall, following such training, conduct a
         written and practical examination of each individual to ensure that, at the least, the minimum
         Levels of skills and knowledge have been achieved.  The CONTRACTOR shall provide the
         AUTHORITY with details of the satisfactory results of such testing within a reasonable period
         of time; thereafter the AUTHORITY will Approve the individual Health Care Professional to the
         appropriate role.  The guide entitled Guide on the Approval/Revocation of Approval of
         Registered Medical Practitioners detailing the process for Approval and Revocation of
         Approval is listed in Schedule 28 of this Agreement.  For the avoidance of doubt. the CMA
         has sole discretion whether to grant or revoke Approval.

2.4      The CONTRACTOR shall, undertake during practical training, close supervision of new
         Health Care Professionals as set out in the quality and training sections of the relevant
         guidance listed in Schedule 28 of this Agreement.

2.5      The CONTRACTOR shall ensure that Health Care Professional giving advice and conducting
         examinations shall be Approved by the AUTHORITY acting on behalf of the Secretary of
         State. Approval will be dependent on individual Health Care Professional completing, to the
         CONTRACTOR's satisfaction, a course of training and appraisal in the relevant benefit area.

2.6      The CONTRACTOR shall ensure that all of its Health Care Professional providing Services to
         the AUTHORITY are accredited in accordance with the requirement to retain registration with
         the relevant licensing organisation.

2.7      The CONTRACTOR shall involve the AUTHORITY in the quality assurance process for the
         development and refinement of all requirements, outcomes and standards of medical training
         and Health Care Professional training courses relating to the delivery of the Services.

3.       MEDICAL TRAINING PROGRAMME FOR CME FOR HEALTH CARE PROFESSIONALS

3.1      The CONTRACTOR shall develop and deliver the medical training programme for CME (the
         "Training Programme") and its evaluation as part of the Services.

3.2      The Training Programme shall be developed, delivered and evaluated on an annual basis in
         respect of each contract year from 1st September to 31st August (a "Year").

3.3      The AUTHORITY shall, by 31st March in each year, provide the CONTRACTOR with an
         outline stating topics that the AUTHORITY requires to be included in the Training Programme
         for the forthcoming Year, and if the AUTHORITY considers it appropriate, an outline of the
         manner in which such Training Programme shall be delivered (the "Outline").

3.4      The CONTRACTOR shall provide all of its Health Care Professionals with a personal training
         plan on an annual basis, The personal training plan shall contain details of the timescale for
         which delivery of each individual module will need to be delivered to that individual.

3.5      New entrants shall be provided with a personal training plan within three months of their
         formal approval/re-approval. New entrants will have the following training modules included
         in that personal training plan for delivery within twelve (12) months.

3.5.1    clinical skills in the assessment of musculoskeletal problems;

3.5.2    multicultural awareness; and

3.5.3    mental health training.

3.6      The CONTRACTOR shall undertake a Training Needs Analysis (TNA) that will identify areas
         of training needs together with priorities for implementation.  Information from the personal
         training plans for the year to 3th June shall be incorporated into the TNA.  The TNA shall be
         provided to the Authority by 30th June of each year.  The scope, objectives and
         methodology of the TNA shall be subject to prior approval by the AUTHORITY. The outcome
         of the TNA shall be subject to approval by the AUTHORITY (such approval not to be
         unreasonably withheld or delayed) prior to incorporation into the training plan.

3.7      The CONTRACTOR shall, within one month of agreeing the TNA outcome, provide the
         AUTHORITY with a plan setting out in detai1 the manner in which the Training Programme
         shall be delivered (the "Training P1an").  The Training Plan shall include as a minimum the
         following:

3.7.1    the name of the training module, and for each training module;

3.7.2    a timetable for delivery of each training activity;

3.7.3    the training personnel to be involved in the training activity;

3.7.4    the aims and objectives of the training;

3.7.5    the target population that includes the number of Registered Medical Practitioners
         to be trained at each Medical Service Centre; and

3.7.6    the proposed method and estimate of duration of that training.

3.8      The Training Plan shall be developed in co-operation with the AUTHORITY and shall be
         subject to approval by the AUTHORITY, such approval not to be unreasonably withheld or
         delayed.

3.9      Any changes or amendments must be submitted in writing for consideration to the
         AUTHORITY's Change Control manager who will have sole discretion as to whether the
         amendment is significant enough to require formal Change Control procedures to be
         instigated.  Any agreement to dispense with formal Change Control action will not be valid
         unless written agreement is provided by the AUTHORITY's Change Control manager.

3.10     For the avoidance of doubt, the AUTHORITY's approval of a Training Plan shall not relieve
         the CONTRACTOR of its overriding obligation to meet the requirements and all other
         applicable provisions of the Agreement unless otherwi5e specifically agreed in writing by the
         AUTHORITY.

3.11     The CONTRACTOR shall provide the AUTHORITY with information in relation to training
         activities organised by the CONTRACTOR in a form agreed with the AUTHORITY. The
         CONTRACTOR shall

3.11.1   carry out surveys at the times specified, in order to evaluate the perception of training
         and the effectiveness of training delivery.  Such surveys shall be subject to the
         AUTHORITY's prior approval (such approval not to be unreasonably withheld or
         delayed); and

3.11.2   summarised in an annual report to be provided to the AUTHORITY no later than
         31st December.  The report shall contain detailed analysis of surveys completed by
         a randomly selected sample of at least fifteen per cent (15%) of the target
         population for each completed trainer led and distance learning module. The report
         shall cover the twelve (12) month period ending 31st August in the same year

3.12     The surveys shall be completed in two stages as follows:

3.12.1   immediately upon completion of the training activity:

3.12.1.1 a reactionnaire for trainer led modules to be issued to a randomly
         selected sample of a minimum of fifteen per cent (15%) of the target
         population;

3.12.1.2 a muliple choice questionnaire for trainer led modules to be issued on
         occasion following agreement between the AUTHORITY and the
         CONTRACTOR;

3.12.1.3 a multiple choice questionnaire for distance learning modules to be
         issued to one hundred percent (100%) of the target population unless
         considered inappropriate for any specific module by both the
         AUTHORITY and the CONTRACTOR; and

3.12.2   six months after completion of the training activity for both trainer led and distance
         learning modules, a follow up Questionnaire to be sent to a randomly selected
         sample of a minimum of fifteen per cent (15%) of the target population. The
         questionnaire will:

3.12.2.1 test perception of the training; and

3.12.2.2 apply to at least fifty per cent (50%) of modules, that will include a
         mixture of trainer fed and distance learning modules that are
         considered to be relevant, subject to the AUTHORITY's prior approval
         (such approval not to be unreasonably withheld or delayed).

3.13     The CONTRACTOR shall carry out audit, in conjunction with the AUTHORITY on areas
         relevant to a minimum of three (3) of the training modules undertaken in order to ascertain
         that the principles of training have translated into good practice:

3.13.1   the timescale and methodology of such audit to be subject to the AUTHORITY's
         prior approval (such approval not to be unreasonably withheld or delayed);

3.13.2   the audit to be carried out on an agreed sample size, at all Medical Services
         Centres, subject to a minimum of ten (10) randomly selected cases se1ected per
         Medical Services Centre for each identified module; and

3.13.3   results to be summarised in an annual report as specified in paragraph 3.11.5. The
         content of the report shall be subject to approval by the AUTHORITY (such
         approval not to be unreasonably withheld or delayed).

3.14     The CONTRACTOR shall provide the AUTHORITY with ad hoc reports on request.

3.15     The CONTRACTOR shall liaise with the AUTHORITY when defining the requirements for
         CME for Health Care Professionals.

4.       MEDICAL PROCESS STANDARDS

4.1      General Standards

4.1.1    The CONTRACTOR shall use reasonable endeavours to ensure that a minimum of
         ninety nine per cent (99%) of Health Care Professional reports, in each business
         area, are fit for Purpose and do not result in Rework.  Health Care Professional
         reports shall be adjudged fit for the required purpose by the AUTHORITY's
         representative (for example a Decision Maker) making use of the report against the
         standards defined in this Schedule.

4.1.2    The CONTRACTOR shall ensure that all medical reports and medical advice
         provided by Health Care Professionals shall be fit for Purpose, that is:

4.1.2.1  fair and impartial;

4.1.2.2  legible and concise;

4.1.2.3  in accordance with relevant legislation;

4.1.2.4  comprehensive, clearly explaining the medical issues raised;

4.1.2.5  in plain English and free of medical jargon;

4.1.2.6  presented clearly;

4.1.2.7  complete,  with answers to all questions relating to disability or
         incapacity matters  raised  by the AUTHORITY, free of medical
         abbreviations and in keeping with advice as directed, taking into
         account written material; e.g. the Disability Handbook;

4.1.2.8  fully detailed where necessary and consistent, fully clarifying any
         contradictions in medical evidence; and

4.1.2.9  capable of comprehensively answering questions posed by the
         AUTHORITY without compromising any subsequent decision making.

4.1.3    Any cases supplied to the AUTHORITY's representatives and deemed as being not
         Fit for Purpose wirJ be Reworked at the CONTRACTOR's expense.

4.1.4    The AUTHORITY will have sale discretion on determining whether medical advice
         or medical examination reports are Fit for Purpose.

4.1.5    The AUTHORITY will specify the reason for cases being returned as not Fit for
         Purpose.

4.1.6    The CONTRACTOR shall accept Rework Referrals in accordance with the fit for
         Purpose criteria which will be specified by the AUTHORITY.

4.1.7    The CONTRACTOR shall use all reasonable endeavours to ensure that any issues,
         with regard to Rework Referrals, are dealt with and resolved locally at an
         operational level, in the most timeous and efficient manner.

4.1.8    The CONTRACTOR shall collect data and provide Management Information
         relating to Rework an the reports detailed in Schedule 1 6 of this Agreement.

4.1.9    The CONTRACTOR shall ensure that all RefeFrals relating to the Terminally Ill, or
         potentially Terminally Ill, are handled with priority and dealt with in a way that
         minimises inconvenience and distress to the Claimant. For the avoidance of doubt,
         potentially Terminally Ill or Special Rules cases require examination, the
         CONTRACTOR shall comply with the relevant statutory notice of appointment.

4.1.10   The CONTRACTOR shall ensure that the following persons are excluded from
         examining a Claimant or providing advice:

4.1.10.1 anyone directly affected by the case in question;

4.1.10.2 any Health Care Professional who has regularly attended the Claimant;

4.1.10.3 any Health Care Professional attending, who has attended. or who is
         anticipated to attend the Claimant at some time in the future for the
         purposes of providing reports in respect of commercial matters;

4.1.10.4 any Health Care Professional providing, who has provided, or who is
         anticipated to provide services at some time in the future to the
         Claimant's employer;

4.1.10.5 anyone previously involved in advising or examining on a claim that
         has resulted in an appeal, in relation to this Claimant;

4.1.1O.6 anyone identified as unsuitable by the AUTHORITY:

4.1.10.7 anyone who has attended an examination as a witness in relation to
         this Claimant;

4.1.10.8 anyone who is an employer of the Claimant, or employed by the
         Claimant, or is employed by the Claimant's employer;

4.1.1O.9 anyone not appropriately qualified or Approved; and

4.1.1O.1O friends or relatives of the Claimant.

4.2      Where the Claimant in question is an employee of the CONTRACTOR, the exclusion at
         4.1.11.8 above shall not apply and the Referral shall be processed in accordance with the
         relevant documentation in Schedule 28 of this Agreement. However, the CONTRACTOR shall
         apply all the other criteria listed.

4.3      The CONTRACTOR shall not comment upon or offer advice to Claimants about any aspect of
         the Claimant's medical care, or the potential decision on the claim to benefit or pension.

4.4      Where an Appeal Tribunal has raised an issue with the quality of a medical report, the
         CONTRACTOR shall provide to the AUTHORITY the total number of Referrals that have
         been received from the Tribunals Service by the CONTRACTOR every six (6) months.

4.5      Basis of Medical Advice

4.5.1    The CONTRACTOR shall ensure that wherever possible all medical reports and
         medical advice:

4.5.1.1  is evidence based, that is, there is a consensus of critically evaluated,
         published medical evidence in support of the advice provided by the
         CONTRACTOR;

4.5.1.2  where no such consensus exists, the CONTRACTOR shall explain the
         reason for the advice in clear terms demonstrating why no other
         reasonable interpretation of the medical situation could apply given the
         onus of proof required for that particular Referral;

4.5.1.3  is fully justified, particularly when any advice is at variance with other
         evidence including the Claimant's statement or a medical report;

4.5.1.4  addresses, explains or refutes, any variation of the Claimant's condition
         from the expected manifestation and progress of the condition within
         the same statistically predictable group (in general, that group of the
         same age and sex);

4.5.1.5  is based only on documents that are consistent with one another as to
         the evidence they contain; inconsistent evidence shall be indicated and
         the inconsistency explained when providing advice to the AUTHORITY.
         The CONTRACTOR's advice supporting claimed disablement and
         activities reported by the Claimant, shall only be given if the activities
         and disablement are consistent with each other and in keeping with the
         diagnosis and the likely disabling effects:

4.5.1.6  takes full account of variations in the relevant medical condition(s) that
         shall be described and the advice shall reflect the degree of the
         Claimant's disability and it's effects which are present most of the time;

4.5.1.7  takes full account of and records the effects of pain, fatigue and
         medication on the Claimant's functional capacity or care needs;

4.5.1.8  is appropriate to the questions raised by the AUTHORITY and shall
         comprehensively answer the questions posed by the AUTHORITY;

4.5.1.9  is legible, presented to the AUTHORITY in the English language and
         understandable to those without medical qualifications. The
         CONTRACTOR shall ensure that medical jargon and abbreviations are
         not used in advice to the AUTHORITY and that medical terminology is
         explained unless the terms have passed into every day use;

4.5.1.10 accounts for all conditions claimed to be relevant by the Claimant;

4.5.1.11 documents conditions which may be less tangible, such as claimed
         mental health problems. These shall be fully explored and their effects,
         or lack of effect, on disablement of the Claimant, shall be documented
         and carefully explained; and

4.5.1.12 takes full account of the guidance in respect of each benefit. where
         appropriate, in respect of the use of aids, prostheses and medication.

4.6      The CONTRACTOR shall ensure that if an examination is required then it shall be performed
         in such a way that it gathers all the evidence required to present the appropriate advice and
         provide the factual information in the manner required by the AUTHORITY.  Any additional
         questions to be answered, or particular areas of difficulty that require explicit clarification, will
         be communicated to the CONTRACTOR by the AUTHORITY.

4.7      Medical Process Outcome Standards

4.7.1    The CONTRACTOR shall use reasonable endeavours to ensure that the advice
         given shall be consistent in that, where possible, the Medical Process outcome
         advised falls within a range of results related to the mean of all the
         CONTRACTOR's Medical Process outcomes advised as a result of that process.

4.7.2    The CONTRACTOR acknowledges that the Medical Process outcomes information
         provided shall be reviewed and refined from time to time when necessary to reflect
         the AUTHORITY's requirements and to reflect the CONTRACTOR's processing
         initiatives.

4.7.3    The specified categories, within which the CONTRACTOR shall make reasonable
         endeavours to ensure Medical Process outcomes fall are as follows:

         Process
         IB S cases examined
         IB CSD exemption advised
         PCA exam exemption advised
         PCA exam 3 month prognosis advised
         PCA exam no functional change anticipated advised
         PCA exam non functional descriptor advised
         EB/EX Referral exemption advised

4.7.4    The ranges shall apply at individual unit and individual Health Care Professional
         level. It should. be noted that there may be great inter-unit variation due to
         demographic and other factors. Therefore consistency of the results over a period
         of time at both individual unit and individual Health Care Professional level is of
         greatest relevance.

4.7.5    In the event that any of these outcomes fall without the agreed range the
         CONTRACTOR shall provide written explanation to the AUTHORITY, within ten
         (10) Working Days of the report's production. The CONTRACTOR shall describe
         how the Outcome will be brought back within range or initiate Change Control
         Procedures.

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

4.7.7    In the event that any such Change Control Procedure is approved by the
         AUTHORITY, the AUTHORITY shall revise the range accordingly.

4.8      Unexpected Findings

4.8.1    If, during the examination of the Claimant, the CONTRACTOR's findings indicate or
         suggest the existence of a disease or medical disorder that may not be apparent to
         the Claimant or the Claimant's medical carer, the CONTRACTOR shall provide an
         explanation to the Claimant and obtain the Claimant's consent to pass on the
         information unless there are circumstances in which failure to obtain consent can
         be justified. The CONTRACTOR shall use reasonable endeavours to communicate
         those findings to the Claimant's Medical Practitioner or other appropriate medical
         carer within twenty four (24) hours.  If the CONTRACTOR's findings are
         communicated by telephone and are Clinically Urgent, reasonable endeavours shall
         be made to communicate the findings in writing, within twenty four (24) hours, by
         the CONTRACTOR. The CONTRACTOR shall advise the Claimant to consult their
         Medical Practitioner, in a manner that does not give rise to undue concern to the
         Claimant. In the case of International Pension Centre (IPC) the CONTRACTOR
         shall, if the Claimant does not have a UK based Medical Practitioner, advise the
         Claimant that he should seek medical attention; the CONTRACTOR shall provide
         the Claimant with a letter detailing the clinical findings.

4.8.2    If, during review of the file of the Claimant for the purpose of provision of advice to
         the AUTHORITY, the CONTRACTOR's findings indicate or suggest the existence
         of a disease or medical disorder that may not be apparent to the Claimant or the
         Claimant's medical carer, then the CONTRACTOR shall provide an explanation to
         the Claimant and obtain the Ctaimant's consent to pass on the information unless
         there are circumstances in which failure to obtain consent can be justified.  The
         CONTRACTOR shall use reasonable endeavours to communicate those findings to
         the Claimant's Medical Practitioner or other appropriate medical carer within twenty
         four (24) hours following confirmation that the Claimant consents to release of the
         information.

4.9      Customer Service

4.9.1    The CONTRACTOR shall use reasonable endeavours to ensure that any specialist
         examination required shall be performed in such a way that it gathers all the
         evidence required to form accurate advice and to provide the factual information
         required by the AUTHORITY.  If there are additional questions to be answered or
         particular areas of difficulty that require explicit clarification, these will be
         communicated by the AUTHORITY to the CONTRACTOR with the Referral
         documentation.

4.9.2    If the behaviour of the Claimant is abnormal, due to a medical condition, (for
         example chronic alcoholism or mental health problems), the CONTRACTOR shall
         use reasonable endeavours to ensure that the examination is completed to the
         extent that allows advice to be given on the questions posed by the Decision Maker
         without causing distress to the Claimant.

4.9.3    If, during the course of providing the Services, it becomes apparent to the
         CONTRACTOR that the Claimant may be in receipt of a benefit that is unsupported
         by the contemporary evidence, the CONTRACTOR shall record this separately to
         the Referral under consideration and advise the AUTHORITY by returning the
         record with the Referral.

4.10     Medical Certificates and Medical Reports

4.10.1   Certificates and reports are provided by General Medical Practitioners under their
         terms and conditions of service as laid down in the National Health Service (NHS)
         (General Medical Services) Regulations 1992 (as amended 1998) and the NHS
         (General Medical and Pharmaceutical Services (Scotland) Regulations 1974 in the
         case of Scotland. The Medical Practitioner is remunerated for this service by the
         NHS. Hospital Medical Practitioners provide a similar service, free of charge under
         the standard model NHS contract of employment as long as the report is
         reasonably incidental to the treatment being given to the Claimant.

4.10.1   The CONTRACTOR shall notify and copy all evidence to the AUTHORITY if any incapacity
         related certificates or reports provided by Health Care Professionalss:

4.11.1   are frequently completed to a poor standard;

4.11.2   frequently fail to comply with the practitioners terms and conditions of service; or

4.11.3   are, or may be fraudulent.

4.12     In respect of these medical certificates and medical reports the CONTRACTOR shall:

4.12.1   provide the advisory service to the AUTHORITY described at paragraph 4.11;

4.12.2   maintain existing local arrangements whereby Registered Medical Practitioners
         provide training and guidance to Health Care Professionals at educational or
         professional meetings;

4.12.3   liaise with the author of reports or certificates which are frequently completed to a
         poor standard, with a view to improving the author's understanding of the
         requirements to the AUTHORITY, and his own responsibilities under the terms and
         conditions of service; for the avoidance of doubt the required standard is specified
         in the IB204 that is sent to all certifying Registered Medical Practitioners; and
         therefore includes reports and certificates that are not completed, not completed
         within the satisfactory time in addition to those completed to a "poor standard";

4.12.4   subsequently notify the AUTHORITY's CMA of any such Registered Medical
         Practitioners who continues to fail to comply with his terms and conditions of
         service in this respect;

4.12.5   immediately notify the AUTHORITY's CMA of any Registered Medical Practitioners
         who provides a certificate or report that is, or may be, fraudulent; and

4.12.6   ensure that all advice is consistent with the requirements of the AUTHORITY.

4.13     In the event that the CONTRACTOR notifies the AUTHORITY's CMA, the AUTHORITY's
         CMA shall be provided with a copy of the report(s) or certificate(s), if one exists, and copies of
         all relevant evidence, correspondence and telephone conversation records.

4.14     The CONTRACTOR shall not take any action or correspond directly with local or National
         Health Authorities in respect of medical certificates or reports.

4.15     The CONTRACTOR shall develop administrative systems and training that will meet the
         contractual requirements.

4.16     Sensitive Information

4.16.1   The CONTRACTOR shall ensure that all written medical reports and advice are
         phrased with the expectation that they will be seen by the Claimant, therefore
         sensitive information shall be handled as set out in the quality and training sections of
         the relevant Documentation detailed in Schedule 28 of this Agreement.  The
         CONTRACTOR acknowledges that sensitive information includes, but is not limited
         to:

4.16.1.1 harmful information;

4.16.1.2 embarrassing information; and

4.16.1.3 confidential information.

4.17     The CONTRACTOR shall ensure that potentially Harmful Information apparent at Scrutiny or
         examination is identified to the Decision Maker as set out in the quality and training sections
         of the Documentation detailed in Schedule 28 of this Agreement, so that it can be withheld
         from the Claimant if the Decision Maker so directs.

4.18     The CONTRACTOR shall provide to the AUTHORITY as requested written advice and
         identification where necessary in respect of any Harmful Information contained within the
         Referral documentation.

4.19     Further Medical Evidence

4.19.1   When obtaining Further Medical Evidence, the CONTRACTOR shall make it clear to
         the author of that evidence that all evidence may be given to the Claimant and that
         the only information that can legally be withheld from the Claimant is that which may
         be harmful to the Claimant's health.

4.19.2   The CONTRACTOR shall use reasonable endeavours to provide advice based upon
         the evidence provided by the AUTHORITY. Where this is not possible because the
         existing evidence does not materially support the Claimant's stated incapacity or
         disablement the CONTRACTOR shall use reasonable endeavours to ensure that the
         evidence it seeks to gather. which may include examining the Claimant, will materially
         contribute to the advice given to the AUTHORITY.

4.20     Posthumous Claims

4.20.1   The CONTRACTOR acknowledges that a new claim can be made, or an existing one
         may continue to be processed, following the death of a Claimant. In such cases a
         representative acts for the estate of the deceased and shall give consent in the same
         circumstances as a living Claimant, to progress the claim. The CONTRACTOR shall
         use reasonable endeavours to progress the claim on the documentary evidence held
         or obtained.  The CONTRACTOR acknowledges that in these circumstances the
         representative has the same legal rights as the deceased Claimant.

4.21     Health Care Professional Standards

4.21.1   At all examinations the CONTRACTOR shall adhere to the standards of conduct
         required by the AUTHORITY that includes but is not limited to the following:

4.21.1.1 allow the Claimant sufficient time to give their relevant medical history,
         disability or loss of faculty;

4.21.1.2 maintain a non-adversarial manner;

4.21.1.3 explain the purpose of the examination and what it entails;

4.21.1.4 perform the examination in a manner that avoids unnecessary
         discomfort to the Claimant; and

4.21.1.5 answer any appropriate relevant medical questions posed by the
         Claimant, without giving an opinion on the outcome of the claim or
         medical condition.

4.22     Conduct of Specialists

4.22.1   The CONTRACTOR shall use reasonable endeavours to ensure that the conduct of
         Specialists engaged by the CONTRACTOR, is to the same standard as the
         CONTRACTOR's Health Care Professionals.

4.23     Miscellaneous Medical Requirements

4.23.1   Where no medical training or procedural guidance exists for the provision of a
         Service the CONTRACTOR shall ensure that relevant Documentation is created
         which meets the requirements of the AUTHORITY.

4.23.2   The CONTRACTOR shall contribute towards training and any necessary training
         material required for the AUTHORITY'S personnel when specified by the Authority.

5        MEDICAL QUALITY ASSURANCE

5.1      Systems for recording and reporting information relating to recruitment, training
         and monitoring

5.1.1    The CONTRACTOR shall maintain databases that collect and report information in
         relation to recruitment, training, monitoring, Approval and revocation of Approval.

5.1.2    The information that is required to be captured includes but is not limited to the
         following details:

5.1.2.1  Recruitment:

5.1.2.1.1    employment history;
5.1.2.1.2    qualifications; and
5.1.2.1.3    professional Registration.

5.1.2.2  Training:

5.1.2.2.1    training undertaken to support Approval; and
5.1.2.2.2    Continuing Professional and Medical Education.

5.2.2.3  Monitoring:

5.2.2.3.1    audit;
5.2.2.3.2    complaints;
5.2.2.3.3    rework; and
5.2.2.3.4    feedback including appraisal.

5.2.2.4  Approval and revocation of Approval.

5.2.2.5  Revalidation.

5.1.3    In relation to training the information that is required includes, but is not limited to
         the following:

5.1.3.1  dates and training module completed for:

5.1.3.1.1    disability analysis;
5.1.3.1.2    disability awareness;
5.1.3.1.3    professional standards;
5.1.3.1.4    legislation and policy intent;
5.1.3.1.5    customer requirements and service;
5.1.3.1.6    equal opportunities; and
5.1.3.1.7    potentially aggressive situations.

5.1.3.2  dates, assessment modules completed and outcomes for:

5.1.3.2.1    all written tests of training content; and

5.1.3.2.2    all practical tests of training content including benefit
             type, number and extent of satisfactory performance and
             number and extent of unsatisfactory performance.

5.2      The CONTRACTOR shall record and maintain, separately, for full time Health Care
         Professionals, data for each benefit area in which those personnel work, that shall include,
         but not be limited to:

5.2.1    the number passing the written assessment the first time;
5.2.2    the number passing the written assessment at resitting;
5.2.3    the number passing the practical assessment the first time;
5.2.4    the number passing the practical assessment at resitting; and
5.2.5    the number dropping out 0f training for any other reason.

5.3      The CONTRACTOR shall provide a Medical Quality Monitoring report as detailed in
         Schedule 16 of this Contract.  The Medical Quality Monitoring Report shall, as a minimum,
         report on and analyse the following:

5.3.1    MED 14;
5.3.2    MED 15;
5.3.3    MEDIEBEX
5.3.4    KPI O12 (Rework);
5.3.5    KPI O15 (Complaints);
5.3.6    Actual versus Expected Audit Sample size;
5.3.7    Quality Report (C grades by Benefit/Overall);
5.3.8    Mitigation (level of detail dependent upon the performance against targets);
5.3.9    Scrutiny target; and
5.3.10   KPI021 (Dr Capability - quarterly).

5.4      The CONTRACTOR shall report additional information pertaining to recruitment, training,
         monitoring, remedial action, Approval and revocation of Approval and revalidation in an
         agreed format periodically, as required by the AUTHORITY.

5.5      The CONTRACTOR shall:

5.5.1    take account of complaints about the conduct, manner or behaviour of it's Health
         Care Professionals; and

5.5.2    ensure the ongoing good conduct, manner and behaviour of its Health Care
         Professionals.

5.6      Health Care Professional Capability Measure

5.6.1    The skill and competence of all Health Care Professionals employed by the
         CONTRACTOR shall be measured against the following five (5) criteria:

5.6.1.1  fully registered with the GMC (Registered Medical Practitioners only),
         NMC (Nurses only) and validated by the CONTRACTOR;

5.6.1.2  validation portfolio up to date (Registered Medical Practitioners only);

5.6.1.3  technical training relating to specialism completed;

5.6.1.4  continuing Medical Education complete: and

5.7.1.5  approved for benefit work by Chief Medical Adviser.

5.6.2    The number of Health Care Professionals who fail to fulfil all the five (5) criteria
         specified for the Health Care Professional capability measure shall not exceed zero
         (0).

5.6.3    Any Health Care Professional shall, for the first twelve (12) months of his/her
         employment by the CONTRACTOR, be measured against the Health Care
         Professional Capability Measure but will not have that measure applied to him/her.

5.7      Multiple Complaints Against Health Care Professionals

5.7.1    The definition of multiple complaints is more than three complaints received within a
         three-month period - More information is provided in KPI 15 as listed in Schedule 16.

5.8      Only the AUTHORITY may remove Approval from any of the CONTRACTOR's Health Care
         Professionals.

5.9      Revalidation

5.9.1    The CONTRACTOR shall provide all Registered Medical Practitioners working for
         and on behalf of the CONTRACTOR with all necessary evidence required for GMC
         revalidation from the first date for presentation of annual revalidation evidence after
         implementation of the GMC revalidation legislation.

5.10     Diploma in Disability Assessment Medicine

5.10.1   The CONTRACTOR shall provide, to the AUTHORITY by 31st March of each year,
         a proposal that meets the requirements of the AUTHORITY, which includes details
         of the number of Registered Medical Practitioners who will be sponsored by the
         CONTRACTOR to sit the Diploma in Disability Assessment Medicine.

6.       POLICY ADVICE AND ADVISORY BODlES

6.1      The CONTRACTOR shall attend in order to give evidence to bodies as required, which shall
         include but not be limited to the following: any government committee, statutory body or
         judicial AUTHORITY as required by the AUTHORITY.

6.2      The CONTRACTOR shall use reasonable endeavours to attend other fora as invited guests
         as required by the AUTHORITY which shall include but shall not be limited to:

6.2.1    policy research;

6.2.2    policy development and maintenance;

6.2.3    development of benefits for sick and disabled people;

6.2.4    evaluation of provision of medical services to the AUTHORITY; and

6.2.5    promoting Social Security medically related issues to GPs and 0ther interested
         groups by way of presentations to courses.

6.3      The CONTRACTOR shall comply with any invitation to attend or provide representation on
         the council of the European Union of Medicine in Assurance and Social Security (EUMASS}.

6.4      The CONTRACTOR shall provide the AUTHORITY with advice, guidance and support on any
         issues relating to the provision of Services, when reasonably requested to do so.

6.5      The CONTRACTOR shall take positive action to share with the AUTHORITY any proposals or
         views and initiatives which could bring about improvement in the Services.

6.6      The CONTRACTOR shall provide information to the AUTHORITY as reasonably required, to
         assist in the monitoring and evaluation of the likely effect of any proposed policy development
         on the Services.

7.       APPEALS

7.1      Should the AUTHORITY decide to implement mechanisms for improved feedback on the
         outcome of Appeals at local levels, the CONTRACTOR shall fully cooperate with the
         AUTHORITY in that implementation, at all times complying with agreed timescales.

8.       HEALTH CARE PROFES5IONAL5 (excluding Registered Medical Practitioners)

8.1      The Welfare Reform Act 2007, Section 62, permits the Secretary of State to refer a person to
         Health Care Professional, far either medical examination report or medical advice.

8.2      Prior to use of Health Care Professionals, other than Registered Medical Practitioners, in any
         benefit area in which they are not currently employed, the CONTRACTOR must obtain prior
         approval from the AUTHORITY for the pilot and subsequent implementation.

9.       PROVISION OF TRAINING TO REGISTERED MEDICAL PRACTITIONERS IN THE ISLE OF MAN

9.1      The CONTRACTOR shall confirm that it is willing to provide training to Registered Medical
         Practitioners in the Isle of Man Department of Health and Social Security.

10.      MEDICAL REPORTS - MISCELLANEOUS REQUIREMENTS

10.1     Should the AUTHORITY require it, the CONTRACTOR shall work with the AUTHORITY to
         provide, IB85 reports and other reports to the AUTHORITY, electronically, in addition to the
         requirement to provide electronic IB85 reports to DCS as specified in Schedule 4 Section 4.12

10.2     Should the AUTHORITY agree to the replacement of LiMA as the software for the production
         of electronically generated, evidence based reports the CONTRACTOR shall be responsible
         for all costs associated with installing and configuring new software, data migration and any
         staff training.

10.3     The CONTRACTOR shall work collaboratively with the AUTHORITY to implement the
         national rollout of electronically generated, evidence based medical reports for individual
         benefits that includes but may not be limited to:

         - AA/DLA
         - IIDB; and
         - Service Personnel & Veterans Agency

10.4     Should the AUTHORITY require it, the CONTRACTOR shall work collaboratively with the
         AUTHORITY to progress the production of reports via a single medical examination.

11.      ENHANCEMENT OF THE MEDICAL SCRUTINY PROCESS

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

ESA Medical Conditions and Requirement to Attend a Medical Assessment

The ESA medical conditions and categories which define whether a face to face medical assessment is necessary.

These are defined in Appendix 1 of Schedule 4 Section 4.12 Final Version – 15 March 2005 – Pages 6 to 11 of 11

In my case, I have cancer (primary brain tumour under 13% are expected to survive 5 years) so a qualified medical advisor should have reviewed the information provided. This did not happen. Atos Healthcare committed a breach of Contract in that they allowed a nurse or midwife to make the decision without reference to a qualified medical advisor.

It is so important that you are told who the medical advisor is, what their qualifications are and why they feel a face to face assessment is necessary. If the medical advisor does not have specialist knowledge of the pathology and treatment of your medical condition and declines to consult with your GP and or Consultants, then Atos Healthcare are in breach of Contract. In such a case the medical advisor should be reported to the GMC (http://www.gmc-uk.org/). In such circumstances it could be argued that any advice given by Atos Healthcare to the DWP is a written defamation (libel). It could further be argued that Atos Healthcare have acting illegally in that contrary to Law they have not carried out a valid and legal medical assessment which they are required to do in conformance with statute, regulations and the detailed Contract signed with the DWP.

Medical Conditions and Categories

For the purposes of administrative scrutiny of cases to determine suitability for inclusion in the DLA in Medical Examination Centre project, 5 categories of case have been devised:

In 2005 the Welfare Reform Bill, which introduced the Employment and Support Allowance (ESA), had not yet been enacted hence the reference to the Disability Living Allowance (DLA).

  1. Unsuitable for calling to a Medical Examination Centre.

  2. Reference to Medical Advisor required for advice.

  3. Tentatively invite to Medical Examination Centre.

  4. Invite to Medical Examination Centre.

  5. Any other Diagnosis.

For each category a list is attached.

1. Unsuitable for calling to a Medical Examination Centre.

Age >75 years      

Age <12 years

Both Blind and Deaf
Registered Blind (needs to be seen in own environment)
Cases accepted under the Special Rules defining Terminal illness.
Alzheimers
Amputation of both legs
Asperger's
Autistic Spectrum Disorder / Autism
Cerebral Palsy
Dementia
Hemiplegia
Huntingdon's Chorea
Korsakoffs Psychosis
Macmillan Nurse attending.
Motor Neurone Disease
On oxygen
Paraplegia
Quadraplegia
Renal Dialysis
Severe Mental Impairment
Severe Learning Difficulty
Spastic Diplegia
Tetraplegia
Total Parenteral Nutrition
Unstable Angina
Wernicke's Encephalopathy

2. Reference to Medical Advisor required for advice.

AIDS
Astrocytoma
Bone Marrow Transplant
Brittle Bone Disease
Cancer
Cystic Fibrosis
Dermatomyositis
Glioma
Guillane-Barre Syndrome
Hodgkin's Lymphoma
Leukaemia
Liver Failure
Mental Retardation
Mental Subnormality
Multiple Sclerosis
Muscular Dystrophy
Non Hodgkin's Lmphoma
On Morphine / MST
Osteogenesis Imperfecta
Parkinson's Disease
Poliomyelitis
Polymyasitis
Registered partially sighted
Respiratory Failure
Rheumatoid Arthritis
Schizoaffective Disorder
Schizophrenia
SLE
Spinal Injury
Systemic Lupus Erythematosis
Scleroderma
5evere Depression
Thallassaemia

3. Tentatively invite to Medical Examination Centre.

Agoraphobia (offer taxi)
Anorexia Nervosa
Ataxia
Bipalar Affective Disorder / Bipolar Disease Manic Depression
Burns
Cardiomyopathy
Cerebrovascular Accident / CVA
Cerebrovascular Disease
CFS
Chronic Fatigue Syndrome
Crohn's Disease
Diabetic Neuropathy
Eating Disorder
Fibromyalgia
Haemopphilia
Heart Transplant
Hemiparesis
Learning Difficulties
Leg Ulcers
Myalgic Encephalomyelitis / ME
Obsessive Compulsive Disorder
Peripheral Neuropathy
Phobic Anxiety
Sickle Cell Anaemia
Social Phobia
Spina Bifida
Stroke
Subarachnoid Haemorrage / SAH
Ulcerative Colitis
Varicose Ulcers

4. Invite to Medical Examination Centre.

Alcohol Dependence
Anaemia
Angina
Ankylosing Spondylitis
Anxiety
Arrythmia
Asthma
Atrial Fibrillation
Back Pain
Bronchiectasis
Bulimia Nervosa
Cardiac Arrythmia
Cervical Spondylosis
Chronic Bronchitis
Chronic Obstructive Airways Disease
Chronic Obstructive Pulmonary Disease
COPD
Coronary Artery Disease
Coronary Heart Disease
Depression
Dermatitis
Diabetes
Diverticular Disease
Diverticulitis
Dizziness
Down's Syndrome
Drug Dependence
Eczema
Endometriosis
Epilepsy
Hearing Impairment
Hernia
HIV
Hypertension
Hyperthyroidism
Hypathyroidism
Hysterectomy
Incontinence
Ischaemic Heart Disease
Irritable Bowel Syndrome / IBS
Joint Pain
Kyphosis
Kyphoscoliosis
Labyrinthitis
Liver Transplant
Lumbar Spondylosis
Meniere's Disease
Migraine
Myasthenia Gravis
Neck Pain
Osteoarthritis
Osteoporosis
Overactive Thyroid
Panic Attacks
Pelvic Inflammatory Disease
Peripheral Vascular Disease
Personality Disorder
Prolapsed Intervertebral Disc
Psoriasis
"Registered Alcoholic"
Renal Transplant
Rheumatic Heart Disease
Scoliosis
Slipped Disc
Underactive Thyroid
Valvular Heart Disease
Varicose Veins
Visual Impairment

5. Any other Diagnosis.

Not listed above should be referred to a Medical Adviser for advice

Schedule 5

It is surprising that in 2010 according to the Parliamentary Inquiry statistics are only available for 2002-2003.

Service Levels

These service levels relate to Clause 2.5.

SCHEDULE 5

SERVICE LEVELS

1       PRINCIPLES

1.1     From the Cutover Date, the CONTRACTOR shall provide the Service in accordance
        with the service standards set out in Schedule 4 and to the Service Levels set out in
        Appendix 1 to this Schedule 5. The CONTRACTOR shall provide the Optional Services
        when requested by the AUTHORITY in accordance with the service standards set out in
        Schedule 4 and to the Service Levels set out in Appendix 1 to this Schedule 5.

1.2     The CONTRACTOR shall achieve or better the standards specified in the Service Levels
        set out in Appendix 1 to this Schedule 5 throughout the term of this Agreement.

1.3     The CONTRACTOR shall perform the Services and meet all Service Levels at the
        Measurement Levels specified in Appendix 1.

2       REPORTS

2.1     The CONTRACTOR shall provide the AUTHORITY with the reports specified in
        Schedule 16 of this Agreement.

2.2     Where the CONTRACTOR has knowledge of actual or potential failures to meet Service
        Levels, the CONTRACTOR shall immediately advise the AUTHORITY in writing of the
        extent and nature of such failures. In addition, the CONTRACTOR shall notify the
        AUTHORITY of any potential interruptions in the Services.

3       MEASUREMENT OF SERVICE LEVELS

3.1     The CONTRACTOR shall, in each Month following the Cutover Date, measure the
        performance for each of the Service Levels for the Basic Services and Pilot services (set
        out in Appendix 1 to this Schedule 5) at the specified Measurement Level(s). The
        CONTRACTOR shall, in each Month following the commencement of such service,
        measure the performance for each of the Service Levels for the Optional Services (set
        out in Appendix 1 to this Schedule 5) at the specified Measurement Level(s).

3.2     The Measurement Levels specified in Appendix 1 are:

        a)  Government Office Region (GOR);
        b)  Tribunals Service Regions (TSR);
        c)  Disability Contact and Processing Unit (DCPU);
        d)  Disability Benefit Centre (DBC); and
        e)  National.

3.3     The Service Levels will be measured at each individual GOR, TSR, DCPU and DBC as
        applicable, and each shall be a "Location" for the purposes of this Schedule 5 and
        Schedule 25.

3.4     For the avoidance of doubt, for the following Service Levels measured in relation to C
        Grade Medical Reports, such Service Level shall be measured as follows:

        a)  for Service Level 33, the number of C grades from IQAS resulting from the
            cases audited by random sampling determined by the Model developed by the
            0perational Research Division of the DWP (Appendix 2 of this Schedule 5)
            aggregated across the five (5) benefit activities ie. IB, SDA, IIDB (including
            Analogous II), AA/DLA advice, and EMP examinations (DLA/AA, Tribunals
            Service and Service Personnel & Veterans Agency) calculated at a national
            level on a rolling three (3) Month basis; and

        b)  for Service Levels 35, 36 and 37, the number of C Grades from IQAS resulting
            from the cases audited by random sampling determined by the Model
            expressed as a percentage of the number of cases audited individually for IB
            examinations, IIDB examinations (including Analogous II) and DLA/AA
            /Tribunals Service EMP examinations calculated at national level on a rolling
            three (3) Month basis.

3.5     For Service Level 34, a non compliant report shall be a scrutiny output report (IB85A
        only) which fails to meet the standards detailed in the IQAS desk aid contained in
        Schedule 28. Using the number of C Grades from IQAS resulting from cases audited by
        random sampling determined by the Model, the proportion of non compliant reports shall
        be calculated at a national level on a rolling three (3) Month basis as follows:

        the number of C Grade scrutiny output reports
        --------------------------------------------- x 100
        the number of scrutiny output reports audited

3.6     In respect of any Service Level measured by AACT and Old Cases:

        a)  Old Cases shall be measured against performance in each Month; and

        b)  AACT shall be measured against performance on a rolling twelve (12) Month basis.

3.7     In calculating the level of achievement for a Service Level the relevant period for
        measurement shall commence on the date of receipt of a Referral by the CONTRACTOR
        and end on the date of despatch of a Referral demonstrating Clearance to the
        AUTHORITY and shall not include any Working Days in an earlier period for which a
        Rejected Referral was received and retained by the CONTRACTOR.

4       SERVICE MEASUREMENT PERIOD

4.1     Where measurement is by AACT and the Service Measurement Period is specified as a
        rolling twelve (12) month period the Service Level shall be measured as the Cumulative
        Actual Time to Clear less the Cumulative Target Time to clear over that Month and the
        preceding 11 Months.

4.2     For the avoidance of doubt, for each of the first eleven (11) Months following the
        Cutover Date the AUTHORITY shall measure the cumulative actual time to clear less the
        cumulative target time to clear over that Month and all of the preceding Months from the
        Cutover Date.

4.3     For the avoidance of doubt, where there is a change to a Service Level, the rolling twelve
        (12) Month period will be reset. For each of the first eleven (11) Months following the
        change, the Authority shall measure the cumulative actual time to clear less the
        cumulative target time to clear over that Month and all of the preceding Months from the
        date of the change.

4.4     For the avoidance of doubt, where a new Service Level is introduced, the Service
        Measurement shall be in accordance with Paragraph 4.3 of this Schedule 5.

5       ANNUAL REVIEW

5.1     The Service levels may be revised each year in accordance with the Annual Review
        process as set out in Schedule 1 2.

5.2     For the purposes of this annual review the CONTRACTOR shall submit an annual report
        by 31 October of each year summarising performance against each of the Service Levels
        set out in Appendix 1 to this Schedule 5.

The following information is from pages 5 to 20 of 23. There are 47 services and service levels listed.

APPENDIX 1

No. Service Measurement Level Service Level Service Measurement Period
1

Incapacity Benefit

Customer Service Desk/Scrutiny

GOR

AACT of 4 Working Days

WEF 01.11.06 AACT of 5 Workings Days

Rolling 12 Month Period

Old Cases must not contain more than 3% of referrals which are older than 17 Working Days

Monthly

2

Incapacity Benefit

Examinations

GOR

Year 1: AACT of 30 Working Days

Year 2: AACT of 30 Working Days (29 days from 1 June 07)

Year 3: AACT of 27 Working Days from 1 September 07

Year 4: AACT of 24 Working Days

Year 5: to termination or expiry of the Agreement: AACT of 22 Working Days

Rolling 12 Month Period

Year 1: Old Cases must not contain more than 3% of Referrals which are older than 48 Working Days

Year 2: Old Cases must not contain more than 3% of Referrals which are older than 48 Working Days (47 days from 1 June 07)

Year 3: Old Cases must not contain more than 3% of Referrals which are older than 45 Working Days

Year 4: Old Cases must not contain more than 3% of Referrals which are older than 42 Working Days

Year 5: to termination or expiry of the Agreement: Old Cases must not contain more than 3% of Referrals which are older than 40 Working Days

Monthly

3

Incapacity Benefit (Pilot)

Capability Reports

Fast Track Examinations

GOR

ACT of 15 Working Days

Rolling 12 month Period

Old Cases must not contain more than 3% of Referrals which are older than 25 Working Days

Monthly

4

Incapacity Benefit (Pilot)

Capability Reports

Fast Track Examinations

Performance for this Service Line is included in the performance of Service Lin 2 – IB Examinations

GOR

Year 1: AACT of 30 Working Days

Year 2: AACT of 30 Working Days (29 days from 1 June 07)

Year 3: AACT of 27 Working Days from 1 September 07

Year 4: AACT of 24 Working Days

Year 5: to termination or expiry of the Agreement: AACT of 22 Working Days

Rolling 12 month Period

 

Year 1: Old Cases must not contain more than 3% of Referrals which are older than 48 Working Days

Year 2: Old Cases must not contain more than 3% of Referrals which are older than 48 Working Days (47 days from 1 June 07)

Year 3: Old Cases must not contain more than 3% of Referrals which are older than 45 Working Days

Year 4: Old Cases must not contain more than 3% of Referrals which are older than 42 Working Days

Year 5: to termination or expiry of the Agreement: Old Cases must not contain more than 3% of Referrals which are older than 40 Working Days

Monthly

5

Industrial Injuries Disablement Benefit

GOR

AACT of 15 Working Days

Rolling 12 month Period

Advice

National

Old Cases must not contain more than 3% of Referrals which are older than 25 Working Days

Monthly

6

Industrial Injuries Disablement Benefit

Examinations

GOR

Year 1: AACT of 28 Working Days

Year 2: AACT of 28 Working Days

Year 3: AACT of 26 Working Days

Year 4: AACT of 24 Working Days

Year 5: to termination or expiry of the Agreement: AACT of 22 Working Days

Rolling 12 month Period

 

Year 1: Old Cases must not contain more than 3% of Referrals which are older than 48 Working Days

Year 2: Old Cases must not contain more than 3% of Referrals which are older than 48 Working Days

Year 3: Old Cases must not contain more than 3% of Referrals which are older than 46 Working Days

Year 4: Old Cases must not contain more than 3% of Referrals which are older than 44 Working Days

Year 5: to termination or expiry of the Agreement: Old Cases must not contain more than 3% of Referrals which are older than 42 Working Days

Monthly

7

Industrial Injuries Disablement Benefit

PDD3 Referrals

National

AACT of 8 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 15 Working Days

Monthly

8

Disability Living Allowance / Attendance Allowance

Special Rules Advice

DBC/DCPU

AACT of less than 1 Working Days

Rolling 12 month Period

9

Disability Living Allowance / Attendance Allowance

Advice – Other

DBC/DCPU

AACT of less than 1 Working Day

Rolling 12 month Period

National

Old Cases must not contain more than 1% of Referrals which are older than 5 Working Days

Monthly

10

Disability Living Allowance / Attendance Allowance

Examinations

DBC/DCPU

Year 1: AACT of less than 13 Working Days

Year 2 to termination or expiry of the Agreement: AACT of 12 Working Days

Rolling 12 month Period

Year 1: Old Cases must not contain more than 1% of Referrals which are older than 29 Working Days

Year 2 to termination or expiry of the Agreement: Old Cases must not contain more than 1% of Referrals which are older than 28 Working Days

Monthly

DCPU New Claims

Year 1: Old Cases must not contain more than 3% of referrals which are older than 29 Working Days

Year 2 to termination or expiry of the Agreement: Old Cases must not contain more than 3% of referrals which are older than 28 Working Days

11

Disability Living Allowance / Attendance Allowance

Examinations Fast Track

DBC/DCPU

AACT of 9 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 15 Working Days

Monthly

12

Tribunals Service

Examinations (including HCNs)

TSR

AACT of 14 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 30 Working Days

Monthly

13

Service Personnel & Veterans Agency

EMPs

National

AACT of 16 Working Days

Rolling 12 month Period

Old Cases must not contain more than 3% of Referrals which are older than 30 Working Days

Monthly

14

Service Personnel & Veterans Agency

Specialist Reports and Regional Consultants Reports

National

AACT of 33 Working Days

Rolling 12 month Period

Old Cases must not contain more than 5% of Referrals which are older than 80 Working Days

Monthly

15

Service Personnel & Veterans Agency

Audiology

National

AACT of 33 Working Days from September 2005 to May 2006. From 1 June 2006 AACT of 19 Working Days

Rolling 12 month Period

Old Cases must not contain more than 3% of Referrals which are older than 80 Working Days from September 2005 to 31 May 2006. From 1 June 2006 Old Cases must not contain more than 10% of Referrals which are older than 50 Working Days

Monthly

16

Jobseekers Allowance

Advice

National

AACT of less than 1 Working Day

Rolling 12 month Period

Old Cases must not contain more than 3% of Referrals which are older than 5 Working Days

Monthly

17

Others – Advice

Vaccine Damage Payment Scheme

HM Revenue and Customs Tax Credit

SSP/SMP HM Revenue and Customs

International Pensions Centre

Analogous Industrial Injuries

Child Support Agency

National

AACT of 10 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 15 Working Days

Monthly

18

Others – Examinations

Vaccine Damage Payment Scheme

SSP/SMP HM Revenue and Customs

International Pensions Centre

Analogous Industrial Injuries

Age Determination

National

AACT of 20 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 50 Working Days

Monthly

19

Compensation Recovery Unit

Special Advice

National

AACT of 33 Working Days

Rolling 12 month Period

Old Cases must not contain more than 5% of Referrals which are older than 80 Working Days

Monthly

20

Rework

Response Times

Advice

National

AACT of 2 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 10 Working Days

Monthly

21

Rework

Response Times

Examinations

National

AACT of 10 Working Days

Rolling 12 month Period

Old Cases must not contain more than 10% of Referrals which are older than 15 Working Days

Monthly

22

Rework

Accuracy

IB (incl SDA) at GOR; and

IIDB at GOR

DLA/AA at DBC/DCPU;

and

Tribunals Service National,

Service Personnel & Veterans Agency National and

All Others together National

No more than 1% of reports cleared in any Month returned for Rework

Rolling 12 month Period

23

Rejected Referrals

Response Times

GOR; and

DBC/DCPU; and

and

TSR; and

National

AACT of 5 Working Days

Rolling 12 month Period

24

Claimant Special Needs – Interpreters

National

95% of Claimant requirements must be met

Monthly

25

Claimant Special Needs – Same sex Health Care Professional

National

95% of Claimant requirements must be met

Monthly

26

Complaints

Response Times

National

AACT of 20 Working Days

Monthly

Old Cases must not contain more than 3% of Referrals which are older than 30 Working Days

Monthly

27

Complaints Quality of responses

National

95% of all responses must be Fit for Purpose as defined in the Complaints Validation Process as referenced in Schedule 28

Rolling 3 Month Period

28

Number of complaints against Health Care Professionals after an examination

National

No more than O.5% of all examinations conducted will result in a complaint against the examining HCP as defined in the Complaints Procedures Guide as referenced in schedule 28.

Quarterly (ending November, February, May and August)

29

Treat Official Correspondence

National

Response Times for Treat Official Correspondence will be agreed on a case by case basis. Agreed deadlines for individual responses MUST be adhered to. The response provided within the required turnaround time MUST be a full response or, if a full response cannot be provided, an update on what stage the response has reached and the date the full response can be expected by the AUTHORITY

Monthly

30

Claimant Satisfaction Rate as specified in Paragraph 7.1 of Schedule 4.1

National

Claimant Satisfaction Rate to be at least 90% across all benefits

Monthly

31

Provision of Management Information

Response Time

GOR; and

DBC/DCPU; and

TSR; and

National

Reports received within the specified number of Working Days (as detailed in Schedule 16) at the end of the Service Measurement Period

Monthly

32

Provision of Management Information

Accuracy

GOR; and

DBC/DCPU; and

TSR; and

National

100% Accurate Reports as detailed in Schedule 16

Monthly

33

Quality measures

Overall C Grade Medical Reports

National

The proportion of C Grade medical reports, measured using the sample size determined by the Model is not more than 5% for IB, SDA, IIDB(incl Analogous IIDB, DLA/AA Advice and EMP Examinations (DLA/AA, Tribunals Service and Service Personnel & Veterans Agency)

Rolling 3 Month Period

34

Quality measures

Incapacity Benefit

Compliance with Scrutiny Guidelines

National

The proportion of non-compliant medical reports, measured using the sample size determined by the Model is not more than 5%

Rolling 3 Month Period

35

Quality measures

C Grade Medical Reports

Incapacity Benefit

National

The proportion of C Grade medical reports, measured using the sample size determined by the Model is not more than 5% for IB Examinations

Rolling 3 Month Period

36

Quality measures

C Grade Medical Reports

Industrial Injuries Disablement Benefit

National

The proportion of C Grade medical reports, measured using the sample size determined by the Model is not more than 5% for IIDB Examinations (including Analogous II)

Rolling 3 Month Period

37

Quality measures

C Grade Medical Reports

Disability Living Allowance / Attendance Allowance

National

The proportion of C Grade medical reports, measured using the sample size determined by the Model is not more than 5% for DLA/AA (incl Tribunals Service) Examinations

Rolling 3 Month Period

38

Quality measures

Training for Medical Personnel

Delivery of Training Plan

National

By 31 August each year, the CONTRACTOR shall deliver to the AUTHORITY an agreed Training Plan which sets out in detail the manner in which the agreed training Programme will be delivered during the following year

Annually

39

Quality measures

Training for Medical Personnel

Delivery of Training Programme

National

By 31 August each year, the CONTRACTOR shall deliver all components of the agreed training Programme to Medical Personnel for that year

Annually

40

Quality measures

Training for Medical Personnel

Training Needs Analysis

National

The CONTRACTOR shall deliver the Training needs Analysis by 30 June each year

Annually

41

Claimants Sent Home Unseen

GOR; DBC/DPU

Tribunals Service Region

SPVA National

and

Others National

No more than 1% of claimants who attend their examination to be sent home unseen.

Others no more than 5% of Claimants who attend their examination to be Sent Home Unseen.

GOR Monthly

DBC/DCPU – Rolling 12 Months Year 1

Service Personnel & Veterans Agency Monthly

Others Rolling 12 Month

42

Claimants who Do Not Attend – IBExaminations (including SDA)

GOR

Year 1: 25%

Year 2: 22%

Year 3 to termination or expiry of the Agreement: 20%

Monthly

43

Claimant Waiting Time

GOR; and

DBC/DPU; and

Tribunals Service Region

SPVA National

and

Others

National

Actual Average Waiting Time of 10 minutes

GOR Monthly

DBC/DCPU – Rolling 12 Months Year 1 and Monthly from Year 2

Service Personnel & Veterans Agency Monthly

Others Rolling 12 Month

44

Occupational Health Assessments

National

AACT of 15 Working Days

Rolling 12 Month Period

0ld Cases must not contain more than 10% of Referrals which are older than 20 Working Days

Monthly

45

IB85 Regeneration

National

AACT of 2 Working Days

Rolling 12 Month Period

46

HM Revenue and Customs – Child Trust Fund Advice

National

AACT of less than 1 Working Day

Rolling 12 Month Period

Outstanding Work must not contain more than 20% of Referrals which are older than 1 Working Day

Monthly

47

Financial Assistance Scheme

National

AACT of less than 1 Working Day

Rolling 12 Month Period

Outstanding Work must not contain more than 20% of Referrals which are older than 1 Working Day

Monthly

 

Pages 21 and 22 of 23 are Appendix 2 – Sample Size Calculation. The following is page 23 of 23.

 

Service Subject to 100% Audit

SERVICE OUTPUT
Age Determination Written medical report by Medical Specialist/British Dental Registered Specialist
Service Personnel & Veterans Agency Regional Consultants Report Written medical report by Medical Specialist/British Dental Registered Specialist
Child Support Agency Written medical advice
Compensation Recovery Unit Written medical advice and Examination Report
JobSeekers Allowance Written medical advice
Vaccine Damage Payments Scheme Written medical / Specialist advice and xxamination Report
HM Revenue and Customs Tax Credit Written Medical Advice
HM Revenue and Customs Statutory Sick Pay / Maternity Pay Written Scrutiny Report
HM Revenue and Customs Statutory Sick Pay / Maternity Pay Written Examination Report.
International Pensions Centre UK Exams for Foreign Authorities Written Examination Report.
HM Revenue and Customs Child Trust Fund Credit Written Medical advice

Service Subject to a 1 in 10 Audit

SERVICE OUTPUT
Occupational Health Assessments Typed Medical Examination Report

Schedule 16

 

Common Management Procedures (Clause 8.1)

 

1        INTRODUCTION

1.1      For the avoidance of doubt, the AUTHORITY and the CONTRACTOR agree and
         acknowledge that the work carried out by the CONTRACTOR in accordance with the
         provisions of this Schedule 16 is at no additional charge to the AUTHORITY.

2        INTERFACES

2.1      The CONTRACTOR shall ensure that its Key Personnel and business management
         organisation are in place by the Cutover Date.

2.2      The AUTHORITY shall provide nominated representatives to act on the AUTHORITY's behalf
         on all matters relating to this Agreement. The interfaces described in this Schedule 16 shall
         operate between the AUTHORITY and the CONTRACTOR and shall be defined and
         maintained in detail in the Service Specification.

2.2.1    Strategic Interface

2.2.1.1  The objectives of the Strategic Interface shall be to review the overall success of the Services
         delivered by this Agreement, discuss the operational strategies, efficiency opportunities and
         their implications for the direction and content of this Agreement and, in particular the
         Services.

2.2.1.2  Regular meetings shall be held between the AUTHORITY and the CONTRACTOR as
         required by the AUTHORITY. Meetings shall be held to discuss issues related to the
         objectives described in Paragraph 2.2.1. 1 to this Schedule 16 and other relevant business. An
         agenda shall be produced by the CONTRACTOR and agreed with the AUTHORITY.

2.2.1.3  The AUTHORITY and the CONTRACTOR shall provide suitable senior business and contract
         management representatives to attend the meetings.

2.2.1.4  The frequency and nature of meetings shall be determined by the AUTHORITY and agreed
         with the CONTRACTOR during the Transition Period.

2.2.1.5  The AUTHORITY shall make, retain, and distribute a record of the meetings. The
         CONTRACTOR will be given the opportunity to provide comments regarding the minutes of
         the meeting prior to them being distributed.

2.2.2    Contract Management Interface

2.2.2.1  The objectives of the contract management interface shall be to manage this Agreement and
         shall include but not be limited to:

         a)  monitoring the CONTRACTOR's compliance with its obligations under this
             Agreement;

         b)  agreeing any changes to this Agreement, which has been raised through the
             Change Control Procedure, as detailed in Schedule 19;

         c)  reviewing the performance of the CONTRACTOR against the Service Requirements
             set out in Schedule 2 and the Proposal set out in Schedule 3 of this Agreement;

         d)  resolving operational and contractual problems, which may have been raised using
             the Alternative Dispute Resolution Procedure as detailed in Clause 10.14 of this
             Agreement or through agreed operational routes; and

         e)  transferring and exchanging information as required to ensure that all business
             needs are met.

2.2.2.2  Regular meetings shall be held between the AUTHORITY and the CONTRACTOR
         required by the AUTHORITY to discuss issues related to the objectives described
         Paragraph 2.2.2.1 to this Schedule 1 6 and any other relevant business. An agenda shall
         produced by the CONTRACTOR and agreed by the AUTHORITY.

2.2.2.3  The CONTRACTOR shall provide suitable representatives with the necessary authority to
         consider service performance and to ensure that any issues impacting the AUTHORITY are
         surfaced and resolved.

2.2.2.4  The nature and frequency of meetings shall be determined by the AUTHORITY and agreed
         with the CONTRACTOR during the Transition Period.

2.2.2.5  The AUTHORITY shall make, retain, and distribute a record of the meetings.
2.2.2.6  Each party reserves the right to change its nominated representative(s) with staff of the
         appropriate authority and responsibility and shall notify the other party as soon as practicable
         of any changes.

2.2.2.7  The names of the nominated representatives of the AUTHORITY's and CONTRACTOR's
         contract management teams shall be documented in the Service Specification.

2.1.3    Performance Reviews

2.2.3.1  Performance reviews shall be held on a monthly basis between the AUTHORITY and the
         CONTRACTOR for the purposes of reviewing performance against Service Levels set out in
         Schedule 5 to this Agreement and conformance by the CONTRACTOR to all other standards
         and policies set out elsewhere in this Agreement.

2.2.3.2  Performance review meetings shall be supported by procedures to be specified and
         documented in the Service Specification during the Transition Period.

3        MANAGEMENT INFORMATION

3.1      The CONTRACTOR shall provide the AUTHORITY with such Management Information as the
         AUTHORITY shall from time to time require for the following purposes:

         a)  to monitor the performance of the CONTRACTOR in the provision of Services set
             out in Schedule 4 to the Service Levels set out in Schedule 5 and in accordance
             with all other provisions of this Agreement;

         b)  to monitor the CONTRACTOR's adherence to all standards defined in this
             Agreement;

         c)  to monitor the quality of its medical reports and advice as detailed in Section 4.1 of
             Schedule 4; and

         d)  to provide information or various types to the AUTHORITY on Service provision in
             relation to this Agreement provided that the information to be furnished includes
             any relevant information included within the AUTHORITY's Data together with
             details of all such information maintained by the CONTRACTOR for its own
             purposes in relation to the provision of the Services and any other additional
             information agreed between both parties and documented in the Service
             Specification.

3.2      The CONTRACTOR shall provide to the AUTHORITY information on performance against
         Service Levels, and additional information as requested by the AUTHORITY including but not
         limited to:

         a)   Medical Recruitment standards;
         b)   Health Care professional Capability;
         c)   Multiple Complaints against Health Care professionals;
         d)   Process Outcomes;
         e)   Medical Quality monitoring;
         f)   list of assets used to deliver the Services;
         g)   list of those properties used in the delivery of the Services;
         h)   records of staffing profiles;
         i)   staff redundancies;
         j)   personnel grievance cases;
         k)   data processing and contingency arrangements;
         l)   business continuity and contingency procedures;
         m)   proposals for the number of Registered Medical Practitioners sitting DDAM; and
         n)   the CONTRACTOR's Estates Strategy / Plans.

3.3      The CONTRACTOR shall provide Management Information, which shall include but not be
         limited to that detailed in the Appendix to this Schedule 16.

3.4      As part of the Management Information requirements the CONTRACTOR shall furnish
         Management Information such that provides assurances about the quality of its medical
         reports and advice. In order to do this the CONTRACTOR shall implement quality procedures
         and standards by the Cutover Date which are sufficient to demonstrate to the AUTHORITY's
         satisfaction that performance is being monitored against the quality criteria relating to fitness
         For Purpose detailed in Section 4.1 of Schedule 4 to this Agreement.

3.5      The CONTRACTOR shall provide evidence to the AUTHORITY of the Claimants' perception
         of its Services by, for example, undertaking periodic surveys of Claimant opinion which
         surveys shall include elements and questions which shall be agreed in consultation with the
         AUTHORITY during the Transition Period. Such surveys shall be undertaken by the
         CONTRACTOR regularly, at intervals to be agreed in consultation with the AUTHORITY
         during the Transition Period.

3.6      The CONTRACTOR shall provide evidence to the AUTHORITY of Customers' perception of
         its Services provision by, for example, undertaking periodic surveys of Customer opinion
         which surveys shall include elements and questions which shall be agreed in consultation
         with the AUTHORITY during the Transition Period. Such surveys shall be undertaken by the
         CONTRACTOR regularly, at intervals to be agreed in consultation with the AUTHORITY
         during the Transition Period.

3.7      For the avoidance of doubt the CONTRACTOR shall supply to the AUTHORITY a
         management summary of all findings of any Claimant and Customers survey described in
         Paragraphs 3.5 and 3.6 of this Schedule 16. The CONTRACTOR acknowledges that the
         AUTHORITY has the right to audit, as appropriate, the CONTRACTOR's processes where
         problems have been identified.

3.8      The CONTRACTOR shall provide Management Information to the AUTHORITY about the
         range and level of rates of expenses payable to Claimants and their Companions or
         representatives, in relation to Services. Such information shall be notified to the AUTHORITY
         within thirty (30) days of such rates being changed.

3.9      The CONTRACTOR shall provide the AUTHORITY with a detailed report in the event of a
         major failure to meet Service Levels set out in schedule 5 or any other service standards set
         out in Schedule 4 of this Agreement, which includes the reason for failure and any action
         being taken to retrieve the situation.

3.10     The CONTRACTOR shall provide Management Information to the AUTHORITY in an
         electronic format at the frequencies and due dates as specified in Appendix 1 of this
         Schedule.

3.11     The CONTRACTOR shall provide various types of Management Information to the
         AUTHORITY in accordance with the timescales and periodicity specified by the AUTHORITY
         as part of the delivery of the Services. Management Information will generally be required an
         a monthly basis to report on service delivery and shall coincide with and reflect the invoicing
         period for the same Month. Otherwise Management Information shall generally be required on
         a quarterly basis.

3.12     The AUTHORITY shall from time to time require the CONTRACTOR to provide reports to the
         AUTHORITY, detailing the standard of provision of the Services in a particular location,
         district or area, for any or all of the Business Areas.

3.13     The AUTHORITY shall from time to time require ad-hoc reports to satisfy particular business
         requirements. The CONTRACTOR shall use reasonable endeavours to support the
         AUTHORITY's requirements and shall agree the format of the report with the AUTHORITY
         prior to its issue. The CONTRACTOR shall provide each report within the reasonable
         timescale specified by the AUTHORITY.

3.14     The CONTRACTOR shall ensure that all Management Information delivered to the
         AUTHORITY has been validated and is accurate.

3.15     The CONTRACTOR shall provide exception reports to the AUTHORITY on any occasion
         when a Breach of Security standards, facilities, and procedures set out in Schedule 20 is
         discovered.

3.16     The CONTRACTOR shall develop and implement systems during the Transition Period to
         provide Management Information in accordance with the AUTHORITY's requirements.

3.17     The detailed format, content, frequency and distribution of the Management Information
         reports shall be determined in the Service Specification by the AUTHORITY in consultation
         with the CONTRACTOR during the Transition Period.
    

Schedule 28

Documentation (Clause 4.13)

1.  GENERAL

1.1  The CONTRACTOR shall adhere to the Documentation detailed at Appendices 1, 2 and 3 of
     this Schedule 28 far the performance of the Services. Far the avoidance of doubt, each listed
     guide is deemed to include any relevant updates, bulletins and desk aids.

1.2  The CONTRACTOR acknowledges that the Intellectual Property Rights of the Documentation
     will be retained by the AUTHORITY.

1.3  The CONTRACTOR is responsible for developing, holding and updating the Documentation
     detailed at Appendices 1 and 2 of this Schedule 2B, for the performance of the Services. The
     Documentation shall be comprehensive and any changes to such Documentation will be
     subject to the Change Control Procedure.

1.4  For the avoidance of doubt, the CONTRACTOR must, as a minimum, hold a six monthly
     review to ensure the Documentation listed in Appendices 1 and 2 is up to date and implement
     Change Control Procedures if appropriate.

1.5  The AUTHORITY retains the right of approval to all changes to the Documentation and shall
     have a quality assurance role when the CONTRACTOR drafts new and/or amends the
     existing 0ocumentation detailed in Appendices 1 and 2 of this Schedule 28.

1.6  Each party shall be responsible for it's associated costs of ensuring the Documentation fully
     meets the requirements of the AUTHORITY.

1.7  The CONTRACTOR shall provide all reasonable assistance as required by the AUTHORITY
     in developing any amendments to the Documentation in Appendix 3 far which the
     AUTHORITY retains responsibility.

1.8  Whereas the AUTHORITY will be responsible for issuing any amendment to
     the Documentation detailed in Appendix 3, the CONTRACTOR shall be responsible for any
     associated costs, which arise from updating and disseminating its own copies of the same.

1.9  For the avoidance of doubt the Change Control Procedure will not apply to the content of the
     Documentation detailed in Appendix 3.
    

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