FOI-03802

##Request

You asked us:

<i>I write pursuant to the Freedom of Information Act 2000 and request the following information in relation to the administration of the Vaccine Damage Payment Scheme (VDPS).

1 Internal review of medical assessors' decisions prior to communication of outcome

a. Is there any internal quality assurance or reviewing mechanism in place to review a medical assessor's assessment of causation and/or disablement before the outcome is communicated to the applicant? If so, please describe that mechanism.

b. In circumstances where such a mechanism exists, please confirm:

* Whether a second medical opinion is sought as a matter of routine following every medical assessor's assessment of causation and/or disablement;

* If not, please identify the specific circumstances, criteria or triggers that may result in a second medical assessment being sought;

* Who is responsible for deciding whether a second medical assessment is sought, and at what stage of the process that decision is made.

c. Please provide the following data since the NHSBSA took over the VDPS, broken down by year:

* The number of cases in which the medical assessor concluded that causation had not been established, but the decision-maker (NHSBSA) reached a different conclusion on the same facts;

*The number of cases in which the medical assessor concluded that causation had been established but that the applicant did not meet the 60% disablement threshold, but the decision-maker (NHSBSA) reached a different conclusion on the same facts.

If this data is not held in the format requested, please provide whatever data is held that is closest to this request and explain the format in which it is held.

2 Mechanism for reviewing and updating the scientific basis for decisions

a. Is there any mechanism in place to review and update the scientific and medical evidence base — including epidemiological studies, pharmacovigilance data, and clinical guidance — on which decisions about causation and disablement are made under the VDPS?

b. If such a mechanism exists:

* Please identify the body or bodies responsible for fulfilling that function;

* Please describe the process by which updates to the scientific evidence base are incorporated into decision-making under the scheme;

*Please confirm the frequency at which the scientific evidence base is reviewed — whether on a scheduled basis and, if so, how frequently — and whether ad hoc reviews are also possible and, if so, what triggers them.

c. If no such mechanism exists, please confirm that position.</i>

The NHS Business Services Authority (NHSBSA) received your request on 7 May 2026. 

We have handled your request under the Freedom of Information Act 2000 (FOIA).

##Our response

I can confirm that the NHSBSA holds the information you have requested.

<strong>Question 1 - Internal review of medical assessors' decisions prior to communication of outcome

a. Is there any internal quality assurance or reviewing mechanism in place to review a medical assessor's assessment of causation and/or disablement before the outcome is communicated to the applicant? If so, please describe that mechanism.

b. In circumstances where such a mechanism exists, please confirm:

•	Whether a second medical opinion is sought as a matter of routine following every medical assessor's assessment of causation and/or disablement;

•	If not, please identify the specific circumstances, criteria or triggers that may result in a second medical assessment being sought;

•	Who is responsible for deciding whether a second medical assessment is sought, and at what stage of the process that decision is made.</strong>

Each claim is assessed on a case-by-case basis by a medical assessor. All medical assessors are General Medical Council (GMC) registered doctors with a licence to practise and at least five years' experience.

All relevant information is considered to make a complete and fair assessment. The medical assessor thoroughly considers:
<ul>
<li>information given on the claim form</li>
<li>any further evidence submitted by you</li>
<li>any pre-existing conditions that are not caused by the vaccine</li>
<li>medical records (if required)</li>
<li>clinical research</li>
<li>epidemiological evidence</li>
<li>the current consensus of expert medical opinion</li>
</ul>
The medical assessor will advise if the claimant is entitled to a Vaccine Damage Payment, based on the government’s rules for the scheme. As soon as the claim has been assessed, the claimant will receive a letter telling them the outcome, and a copy of the comprehensive medical report VAD 30 (MA) form. The medical assessment report is written by the medical assessor and explains how they reached their decision. 

Depending on the nature of the case and the availability of scientific evidence, the medical assessor may believe further expert opinion is required to provide advice on causation. It will be detailed in the medical assessment report that additional advice has been sought from an expert. The level of involvement of the expert will also be recorded in the medical assessment report, and any advice given by the expert added to the file.   

Every Vaccine Damage Payment Scheme (VDPS) medical assessment report is peer reviewed internally by the third-party medical assessment provider. The third-party medical assessment provider is responsible for ensuring the overall quality of the medical assessment report, and that all credible sources of evidence are appropriately and consistently applied. 

A selection of medical assessment reports are quality assured by the NHSBSA and measured against the principles and standards expressed in the Principles of Medical assessment. You can view the Principles of Medical Assessment on the NHSBSA website at: <br> https://www.nhsbsa.nhs.uk/vaccine-damage-payment-scheme-vdps-claim-process

This is to ensure that the principles are consistently and appropriately applied.  An Integrated Quality Assurance (IQA) form will be completed by the NHSBSA with feedback given if required. Any feedback provided to the medical assessor will clearly indicate where further attention is required. Relevant amendments are then made by the medical assessor and checked by the peer reviewer before the medical assessment report is returned to the NHSBSA for further quality assurance.   

If a claim is rejected, the claimant can challenge the medical assessor’s decision by submitting a mandatory reversal. Under the government’s rules for the VDPS, there is no limit on the number of times a claimant can request a mandatory reversal, and there is no time limit. This means the claim will be assessed again based on the most recent available information.

If a claim is rejected after a mandatory reversal and the claimant wants to challenge it, they can either:
<ul>
<li>request another reversal – this means their claim will be assessed again</li>
<li>submit an appeal – this means the claim will be heard by a tribunal</li></ul>

Appeals are handled outside of the VDPS by HM Courts & Tribunals Service (HMCTS). They make an independent ruling on whether the decision made is correct. There is no time limit for requesting an appeal.

<strong>Question c - Please provide the following data since the NHSBSA took over the VDPS, broken down by year: 

* The number of cases in which the medical assessor concluded that causation had not been established, but the decision-maker (NHSBSA) reached a different conclusion on the same facts;

*The number of cases in which the medical assessor concluded that causation had been established but that the applicant did not meet the 60% disablement threshold, but the decision-maker (NHSBSA) reached a different conclusion on the same facts.

If this data is not held in the format requested, please provide whatever data is held that is closest to this request and explain the format in which it is held.</strong>

There are no cases where the NHSBSA reached a different conclusion.

Each claim is assessed on a case-by-case basis by a medical assessor. All medical assessors are General Medical Council (GMC) registered doctors with a licence to practise and at least five years' experience.

All relevant information is considered to make a complete and fair assessment. The medical assessor thoroughly considers:
<ul>
<li>information given on the claim form</li>
<li>any further evidence submitted by you</li>
<li>any pre-existing conditions that are not caused by the vaccine</li>
<li>medical records (if required)</li>
<li>clinical research</li>
<li>epidemiological evidence</li>
<li>the current consensus of expert medical opinion</li></ul>

The medical assessor will advise if the claimant is entitled to a Vaccine Damage Payment, based on the government’s rules for the scheme. As soon as the claim has been assessed, the claimant will receive a letter telling them the outcome, and a copy of the comprehensive medical report VAD 30 (MA) form. The medical assessment report is written by the medical assessor and explains how they reached their decision.

<strong>Question 2 - Mechanism for reviewing and updating the scientific basis for decisions

a. Is there any mechanism in place to review and update the scientific and medical evidence base — including epidemiological studies, pharmacovigilance data, and clinical guidance — on which decisions about causation and disablement are made under the VDPS?

b. If such a mechanism exists:

* Please identify the body or bodies responsible for fulfilling that function;

* Please describe the process by which updates to the scientific evidence base are incorporated into decision-making under the scheme;

*Please confirm the frequency at which the scientific evidence base is reviewed — whether on a scheduled basis and, if so, how frequently — and whether ad hoc reviews are also possible and, if so, what triggers them.

c. If no such mechanism exists, please confirm that position.</strong>

Medical assessors consider all available evidence, including medical records and scientific evidence at the time of the assessment. The NHSBSA contracts a third-party supplier to carry out medical assessments for the VDPS. The third-party medical assessment supplier  is responsible for ensuring that medical assessors keep up to date with ongoing, new and emerging evidence.

The contract also requires that all assessments carried out are undertaken by suitably qualified and experienced Registered Medical Practitioners. This includes being registered on the UK General Medical Council register, with a licence to practise and meet or exceed the following requirements:
<ul>
<li>they are a Registered Medical Practitioner with at least five years’ post graduate experience; and</li>
<li>they have experience of the performance of medical and/ or disability assessment, addressing questions of causation and impact in the context of legislative or policy requirements to assist the decision maker.</li></ul>

Each claim is assessed on a case-by-case basis by a medical assessor. Medical assessors use resources to support their assessment, including, but not limited to, 
some or all of the following:  
<ul>
<li>Vaccine Damage Payment Scheme - Principles of Medical Assessment Guidance.</li>
<li>Medicines and Healthcare products Regulatory Agency (MHRA) data, including Yellow Card information on suspected safety concerns involving a healthcare product.</li>
<li>Vaccine product information and updates.</li>
<li>The Green Book - a reference material produced by the UK Health Security Agency and used by healthcare professionals in the UK. The Green Book brings together all documents relating to immunisation against infectious diseases. Visit Immunisation against infectious disease: the green book front cover and contents page - GOV.UK for more details.</li>
<li>Detailed guidance on disablement assessments relating to Schedule 2 of The Social Security (General Benefit) Regulations 1982 (legislation.gov.uk), which have been developed by the Department of Work and Pensions (DWP).</li>
<li>World Health Organization (WHO) documents.</li>
<li>Established and accepted medical epidemiological research papers.</li>
<li>Past tribunal decisions and case law.</li>
</ul>
Further information is available in the Principles of Medical Assessment which can be accessed on the NHSBSA website:<br> 
https://www.nhsbsa.nhs.uk/vaccine-damage-payment-scheme-vdps-claim-process 

##Data Queries

Please contact <a href=mailto:foirequests@nhsbsa.nhs.uk>foirequests@nhsbsa.nhs.uk</a>  ensuring you quote the above reference if you have any specific questions regarding this response; or, if you feel you may be misunderstanding or misinterpreting the information; or, if you plan on publishing the data.

##Reusing the data and copyright

If you plan on producing a press or broadcast story based upon the data please contact <a href=mailto:communicationsteam@nhsbsa.nhs.uk>communicationsteam@nhsbsa.nhs.uk</a>. This is important to ensure that the figures are not misunderstood or misrepresented.

The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988 and is subject to NHSBSA copyright. This information is licenced under the terms of the Open Government Licence detailed at: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Should you wish to re-use the information you must include the following statement: “NHSBSA Copyright 2026” This information is licenced under the terms of the Open Government Licence:<br>
http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Failure to do so is a breach of the terms of the licence.

Information you receive which is not subject to NHSBSA Copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. Please obtain their permission before reproducing any third party (non NHSBSA Copyright) information.

Tags: NHSBSA corporate, VDPS, Vaccine Damage Payment Scheme, nhsbsa
Organization: Freedom of Information Disclosure Log