Brief introduction to me Summarise what I am going to talk about today
Mention explicit focus on IMAs, and the impact of CSR/change of government on shaping our thinking. By way of background, explain some details behind the good practice review and mention that it was led by ITP, but with support from: TAS Partnership Chartered Society of Physiotherapists College of Occupational Therapists UCL Jill Dando Institute of Crime Science Brunel University DWP DPTAC Explain briefly why pilots were necessary & mention ‘core principles’ concept
At a national level, the Blue Badge stats underline how important IMAs are. Over 60% of new and renewal BB applications are considered under the subject to further assessment criterion. Award rates remain quite high (around 90%) but have fallen in recent years – notably they vary from region to region. Partly due to variable factors like the incidence and severity of disabilities, but also different BB assessment regimes. Attributable to the increased uptake of IMA practices among local authorities in England. Suggests what many suspected – we have been over-issuing Blue Badges as a result of the previous system of relying on GP assessments
Came to adopt systems thinking approach – BB Scheme as a national system, the success/failure of which is dependent on the 152 issuing authorities local systems. It was quite clear to us that the way the 152 Blue Badge issuing authorities each determined the eligibility of BB applicants under the subject to further assessment criterion has a big impact on the output (number of badges refused/awarded) in the previous slide. At the local authority level it is also possible to see the impact that eligibility assessment practices have upon a local Blue Badge system. The IMA procedure exerts upstream pressure on the application form design and application handling process, as well as downstream pressure on the way unsuccessful applicants are notified about the outcome of their application, appeals and renewals procedures.
Following on from this I have highlighted some critical dependencies for local authorities wishing to implement, or optimise, their IMA practice. BB Appn form – I would start from the DfT’s model form, and then consider whether each and every question in your application form tells you useful information. In designing this we considered a wide range of local authority’s application forms and sought to include only those questions which we felt added value to the eligbility assessment process. The model form was designed to inform both a desk-based and IMA eligibility assessment. Declarations are also key as they enable cross-checking of locally held information which could save local authorities money by negating the need for a BB applicant to undergo an IMA. Appeals – Really important that you get appeals right, because although we found there was a decrease in appeals following the move to IMAs, people will appeal and ask to be reassessed. Renewals – opportunity to save further public funds by identifying at the end of an assessment which applicants have very static impairments and do not need to be reassessed when they renew. Note that they will still have to renew, just not undergo re-assessment. Reassessment on renewal presents an opportunity to check fluid conditions that may have improved/changed.
Very early in our study it was clear that a large number of different ways of determining the eligibility of BB applicants existed. Also very clear that some local authorities (normally through LEAN assessment) had tried to achieve savings to the way they deliver the BB scheme. Nothing wrong with this as an approach, but it did mean some had gone a bit too far – resulting in practices that make no sense from the customer’s perspective.
Findings from the pilots of our independent review – published by DfT – indicate the extent to which LAs could be making savings, and improving the way they deliver the BB scheme. In particular, the average national cost of referring applicants to their GP takes 3-6 weeks and costs £30.30, compared unfavourably to that of an IMA taking 1-3 weeks to organise and costing £19.10 per assessment. Coupled to this, the better informed decision-making and consideration of eligibility criteria (we believe is borne out by the lower award rate) and lower rate of appeals suggests that IMAs are a more comprehensive and cost-effective approach.
The independent mobility assessment should be conducted by a person who is recognised by the local authority as holding a professional qualification relating to the assessment of a person’s ability to walk, who is not employed or engaged in any other capacity as a provider of goods or services (including medical services) to the applicant and not related to the applicant. The assessment will be carried out on the applicant’s functionality rather than, as was previous carried out by GPs, on their medical diagnosis
OTs and Physios have the necessary skills to consider the mobility of an applicant, in particular to assess their walking ability (but may require a slightly re-tuned mindset!) Caseloads were based on our findings from the pilots, and reflected an assessor having a structured assessment guide and decision-making proforma for reporting their recommendations. All available as appendices to our independent review final report. Pleasantly surprised to find desk-based assessments were pretty accurate (91%) when compared directly with the core principles IMA practice we piloted. Desk-based assessment proforma and guidance that we piloted is also available as an appendix to our final report. Key is to use desk-based assessments only as a means of filtering those applicants who clearly do/do not qualify for a badge, and send the rest for an IMA
These desk-based assessment core principles were derived through our independent review and have been set out in DfT’s scheme guidance published in July 2011 (see Appendix F) Declarations are key to allowing cross-checking!
Scoring mechanism used in our pilots is available in the appendices to our independent review Absolutely key to provide recourse to an IMA – desk-assessment is not perfect!
See appendix G to July 2011 scheme guidance Explain range of functional movement tests
Pain scales and MRC Dyspnoea scale are fairly common and explained in more detail in Appendix G of BB scheme guidance (July 2011) Dyspnoea scale devised by Medical Research Council – emphasised need to use existing standard measures, rather than creating new ones for BB assessment. Easy way to establish if an applicant experiences breathlessness... Important to cross reference all self-reported information against what you see in the assessment itself. Example of ‘extreme pain’ yet no visual signs of pain.
Timing of walk over observed distance can be discretely done (RBKC example). Timing should include any resting/pauses (the duration of which can also be noted). Is the applicant using an aid? Could they use an aid to improve their walking?
Quote is from Appendix G of DfT Scheme Guidance July 2011
If I had some golden rules for sound assessment, then I would say they are...
You can find our independent review, and the latest scheme guidance online at the address above. There is some information in your pack about ITP’s Blue Badge healthcheck service, which is informed by our work on the independent review. If anyone wants to discuss this, or ask questions about the findings from our study, then please feel free to come and chat at lunchtime.
Blue badge reform assessments - event - 28 march 2012 - presentation - itp
B l u e B a d g e e l ig ib il it y a s s e s s m e n t: In d e p e n d e n t R e v ie w f in d in g s Neil Taylor Integrated Transport Planning Ltd.
Background Extensive independent review of Blue Badge administration and assessment good practice in England for DfT... Review of 33 local authorities Sep ‘09 – Sep ’10 Evaluate CoE Programme Sep ‘09 – Sep ‘10 Pilot emerging good practices Sep ’10 – Jan ‘11 Prepared updated guidance for DfT June 2011 Final report published August 2011
National Blue Badge scheme data 2010 DfT Blue Badge scheme stats... 1,053,000 BB applications (418,000 new / 635,000 renewal) 86% of new / 93% of renewal applications accepted 906,000 badges issued (558,000 subject to further assessment) 349,000 successful new applications (590,550 renewal) BB acceptance rates range from 91% - 71% by region DfT estimate 300,000 medical assessments in 09/10 2011 DfT Blue Badge scheme stats..... 939,000 badges issued (571,000 subject to further assessment) 324,000 successful new applications
Critical dependencies BB application form: Does it provide useful information about applicant’s condition? Declarations – information sharing / IMAs Appeals procedures: Detailed refusal letter heads off many appeals Separate appeal ‘reviews’ from ‘complaints’ Only ever need to reassess following complaint against procedure No legal requirement to carry out appeals Re-applications Does the applicant need to be reassessed? Opportunity to check fluid conditions
Early findings were bewildering... Multitude of different approaches to BB admin & assessment Partly due to different LA organisational structures/geography Many authorities aiming to reduce BB scheme costs... ... but some seemed to have gone too far: We use a desk-based scoring system (‘some people probably lie’) No IMAs at all (‘admin staff meet borderline applicants’) No renewal reminders (‘too expensive’)
Detailed results made case for IMAs... 63% of BB applicants are subject to further assessment Most have some form of walking impairment Research study pilots found that using IMAs... Reduce costs by 30% compared to GP assessments Reduce award rates from 95% (GP) to 70% Achieve lower rates of appeal (20% IMA, 39% GP) Result in fewer successful appeals (21% IMA, 28% GP) Accelerate the eligibility decision-making process
And prompted new legislation...“In order to ensure a fairer allocation of badges, we havetherefore amended legislation to prescribe that eligibilityunder 4(2)(f) be confirmed through use of an independentmobility assessment unless the authority is satisfied in aparticular case that it would not assist it in deciding whetherthe applicant was eligible (i.e. that it is self-evident that theapplicant is eligible or ineligible). The legislation alsoprescribes the use of Independent Mobility Assessments(IMAs) in assessing eligibility under 4(2)(g) which coverstemporary badges to people “unable to walk orvirtually unable to walk by reason of a temporary orsubstantial disability which is likely to last for aperiod of at least 12 months”.Local Authority Circular November 2011
Other key findings also helpful... OTs/Physios are most appropriate healthcare professionals Suggested caseloads for healthcare professionals: Assessment: 30 mins, Decision & reporting: 10 mins 7-8 applicants /day maximum IMAs have been implemented successfully by all types of LA Desk-based assessments are effective filtering tools Identify clearly eligible/ineligible applicants Piloted approach was 91% accurate compared to IMAs
Eligibility assessment ‘Core principles’ Developed for DfT BB Scheme Guidance in England A way of enabling DfT to emphasise to English local authorities what should go into an assessment, without prescribing a specific approach. Tested through piloting and rigorous evaluation Supported through legislation coming into force in Sept 2012
Core principles – Desk Assessments Get OTs/Physios involved in the design & staff training Devise an objective quantitative scoring mechanism Can be completed by (trained) administrative staff members Require applicants to fully complete BB application form
Core principles – Desk Assessments Cross-check self-reported information on walking ability with disability/condition and local health services accessed Additional information can be sought by phone Look up on a map where applicant walks to from their home
Overview of desk-based assessmentsPro’s: Offers uniformity of outcomes Significantly reduces assessment costsCon’s: Good filtering tool but not suitable for making a decision on every applicant. Recourse to an IMA where a decision can’t be made
Core principles – IMAs Full design & delivery by health professionals (OT/Physio) Check applicant’s ID at start of assessment! Cross-check information from applicant’s application form Observe & record the applicant’s manner of walking
Core principles – IMAs Use functional movement tests as appropriate Observe and time the applicant walking a known distance Observe resting, pauses and amount of time taken to walk MRC dyspnoea scale for breathlessness & observe
Core principles – IMAs Ask applicant about where & how they normally walk Consider (correct) use of walking aids – could an aid help? Discuss (self-reported) pain and observe applicant
Core principles – IMAs Decision is a holistic view of all information gathered... “Consider each aspect of walking (pain, breathlessness, speed, distance, use of walking aids and manner of walking) first in isolation, and then in combination, to reach a decision as to whether they combine to mean the applicant is unable or virtually unable to walk.”
Overview of IMAsPro’s: Most accurate way of determining eligibility Applicants feel their case has been fully considered Reduces number of consequent appealsCon’s: Extends the decision-making process Expensive and time consuming for all parties
Golden rules Always refer to the eligibility criteria for BB Scheme Ensure your assessment regime complies with the following hierarchy of rules/guidance: 1. Primary legislation 2. Secondary regulations 3. Code of Practice & Process Model 4. Research evidence
Thanks for your time today...ITP’s independent review of Blue Badge Scheme for DfT:http://www.dft.gov.uk/publications/blue-badge-good-practice-review Neil Taylor T: 0115 988 6903 ITP Nottingham E: firstname.lastname@example.org