Recommendations & Conclusions
31 items
2
Recommendation
Third Report - Revising health assessme…
Accepted
There is a risk that the Department will deliver a new service without the important improvements to claimant’s experience. The Department intends to make a lot of changes to the process of making a claim before it launches the new health assessment service in 2029. In advance of this, it …
Government response. The government committed to publishing a summary of the Transformation Programme business case by Spring 2024, along with its Accounting Officer Assessment, after receiving necessary clearances.
HM Treasury
3
Recommendation
Third Report - Revising health assessme…
Rejected
The Department’s approach to monitoring the Programme’s progress and performance has so far focused on process and not on the transformation of the service for benefit claimants. The Department has not yet completed the work needed to define how it will track progress with its test-and-learn activity. The Department published …
Government response. The government disagreed with the recommendation to publish outcome indicators in the new business case and annual reports, stating the program is too early-stage and they will refine their approach as it matures.
HM Treasury
4
Recommendation
Third Report - Revising health assessme…
Accepted
The Department’s approach to working with contractors as part of the Programme could leave the taxpayer vulnerable to contractual disputes, higher costs and delays. Integrating digital systems is a common source of contractual failure and dispute. Contractors can use difficulties in the roll-out of a new system as justification for …
Government response. The government stated it has already implemented the recommendation by engaging with Scotland to share best practice and will continue exploring approaches taken by devolved administrations and international comparators, also considering in-house delivery for some elements.
HM Treasury
5
Recommendation
Third Report - Revising health assessme…
Accepted
We are concerned that the Department has not done enough to communicate and engage with the public and claimants about what they can expect from the revised service. The Department is more likely to achieve its ambition to improve the service if it works with disabled people and their representative …
Government response. The government stated it has implemented the recommendation by already involving claimants through user research and engaging with stakeholders, and has communicated program scope through official channels. It will continue to inform the public and Parliament, including publishing the business …
HM Treasury
6
Conclusion
Third Report - Revising health assessme…
Rejected
The Department has not worked out how it will manage the inevitable differences between claims made and processed in its new test areas and in areas using the current service. A key objective of the Programme is to help the Department make the benefit decision ‘right the first time more …
Government response. The government disagreed with the recommendation to monitor and publish specific data points for transformation areas, stating they already publish HTP MI and PIP Official Statistics. They will consider including equivalent measures in future HTP publications once the service is …
HM Treasury
7
Conclusion
Third Report - Revising health assessme…
Accepted
It is not acceptable that the Department has spent £168 million on the Programme, and is about to commit to a further £2 billion for the Functional Assessment Service, without being transparent to Parliament about whether it is meeting Accounting Officer standards. All programmes in the Government Major Projects Portfolio …
Government response. The government agreed with the recommendation to write to the Committee within three months, listing GMPP programmes without published Accounting Officer assessments and providing a rapid timetable for their publication.
HM Treasury
1
Conclusion
Third Report - Revising health assessme…
Acknowledged
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department for Work & Pensions (the Department) about the Health Transformation Programme (the Programme).1 We also received and considered written evidence from organisations which support people with disabilities.
Government response. The government notes the Committee’s conclusion regarding its evidence-gathering process for the Health Transformation Programme.
HM Treasury
8
Recommendation
Third Report - Revising health assessme…
Accepted
We asked the Department how it would manage the delivery of the Programme and about the testing it was undertaking of the new service. We also asked, if the testing was not sufficient to provide the data it needed, whether it would continue with roll-out of the new service or …
Government response. The government agrees with the recommendation, committing to update and publish the HTP business case by Spring 2024, publish quarterly management information, evolve reporting against KPIs, evaluate services through claimant research, and explore publishing evaluation findings to ensure safe and …
HM Treasury
9
Recommendation
Third Report - Revising health assessme…
Accepted
We asked the Department whether it was confident that it could deliver the benefits and savings expected from the Programme. The Department told us that it was confident that it could deliver the financial savings, as “the system costs a lot to deliver, so small improvement can save quite a …
Government response. The government agrees and will update and publish the Health Transformation Programme business case by Spring 2024, committing to track programme benefits through data analysis and research, publish quarterly management information, and explore publication of evaluation findings.
HM Treasury
10
Recommendation
Third Report - Revising health assessme…
Acknowledged
The Department plans to complete the Programme by 2029 with the launch of a new health assessment service. This will require the Department to develop both a new digital system and an operational service to process claims, which both need to be tested.15 In 2021, the Department introduced health transformation …
Government response. The government agrees with the recommendation, stating that FAS contracts contain levers to enable supplier involvement, including test and learn activity and expansion of the new Health Assessment Service (HAS), with suppliers incentivized through partnership and gainshare. It will develop …
HM Treasury
11
Recommendation
Third Report - Revising health assessme…
Rejected
The Department has started to process applications from claimants living in specific postcodes in London and Birmingham through the health transformation. The Department acknowledged that the two health transformation areas alone will not provide it with a representative sample of claimants and that it will need a wider range of …
Government response. The government explicitly disagrees with the committee's recommendation regarding the need for a wider range of claimants in testing. It notes it publishes HTP management information quarterly and will look to include overturn rates in future publications.
HM Treasury
12
Conclusion
Third Report - Revising health assessme…
Accepted
In order to deliver the new service from 2029, the Department told us it needs certainty over the design of the new health assessments service by 2027 to either procure the new 12 Qq 45–46 13 Q 47 14 Q 76 15 Q 12; C&AG’s Report, para 3.14 16 Q …
Government response. The government agrees with the Committee’s recommendation and states that the Functional Assessment Service (FAS) contracts contain specific contractual levers and mechanisms to enable the supplier involvement required to support transformation.
HM Treasury
13
Recommendation
Third Report - Revising health assessme…
Rejected
In May 2023, the Department published the evaluation strategy for the Programme.24 The evaluation strategy includes nine key performance indicators, which focus more on the performance of the service the Department is building rather than the outcomes for claimants. The NAO found that the Department was still working out what …
Government response. The government disagrees with the recommendation, stating the program is in early stages and they will refine their performance measurement approach as it matures, including defining outcome indicators. They are already publishing quarterly management information and will evolve it to …
HM Treasury
14
Recommendation
Third Report - Revising health assessme…
Rejected
We also asked the Department how it would ensure that the performance indicators and metrics it used encapsulated the outcomes intended from the Programme, and linked outputs to these outcomes. The Department acknowledged that there was more that it can do to “link some of these input/output metrics with outcomes”. …
Government response. The government explicitly disagrees with the recommendation. It acknowledges the need for transparency and states it will refine its performance measurement approach as the programme matures, including defining and tracking outcome indicators, and will continue to publish management information quarterly.
HM Treasury
15
Recommendation
Third Report - Revising health assessme…
Accepted
We asked the Department whether it considered its existing performance indicators and metrics were adequate to ensure that it achieved the time and cost reductions, and increased satisfaction among claimants, intended for the Programme. The Department told us that it was seeking to provide the “best balance between outcomes and …
Government response. The government agrees and commits to updating and publishing the Health Transformation Programme business case by Spring 2024, which will detail costs and benefits and outline how programme benefits will be tracked using administrative data analysis and research.
HM Treasury
16
Conclusion
Third Report - Revising health assessme…
Rejected
We asked the Department about how it measured the quality of benefit decisions, why it did not publish more information on the performance of contractors given the potential impact of their decisions on the lives of claimants, and about difference in satisfaction levels between the Department and Social Security Scotland. …
Government response. The government explicitly disagrees with the committee's implied recommendation regarding publication of information on contractor performance. It states it has published the first of a new series of HTP MI, which will continue quarterly, and will keep under review what …
HM Treasury
17
Conclusion
Third Report - Revising health assessme…
Accepted
The Functional Assessment Services contract will see a new set of contractors providing functional health assessments on behalf of the Department from 2024 to 2029 as an interim service until the Health Assessment Service is delivered in 2029. We asked the Department about the distinction between the Functional Assessment Service …
Government response. The government agrees with the Committee’s recommendation and states that the Functional Assessment Service (FAS) contracts contain specific contractual levers and mechanisms to enable the supplier involvement required to support transformation.
HM Treasury
18
Conclusion
Third Report - Revising health assessme…
Accepted
Integrating digital systems is a common source of contractual failure and dispute. Contractors can use difficulties in the roll-out of a new system as justification for not 27 Q 32 28 Q 42; Civil Service People Survey 2022: Benchmark Scores, table 3 29 Qq 2, 37, 43 30 Qq 6, …
Government response. The government agrees, stating that current Functional Assessment Service (FAS) contracts include levers for supplier involvement and transformation. It commits to mitigating competitive advantage through market transparency and developing a future health commercial strategy from 2024 to explore new contracting …
HM Treasury
19
Conclusion
Third Report - Revising health assessme…
Accepted
There is also a risk that the current contractors will gain an advantage for the new service that reduces competition. One way to maintain competitive pressure on the contractors to perform is to keep open the question of whether the service will continue to be outsourced once the new service …
Government response. The government agrees and states it will mitigate competitive advantage through market transparency and robust procurement processes. Its future health commercial strategy, to be developed from 2024, will consider the department's role and delivery model for services post-2029.
HM Treasury
20
Conclusion
Third Report - Revising health assessme…
Accepted
The Department recognised that Social Security Scotland is changing how it operates compared to the Department. For example, Social Security Scotland has brought the functional health assessments process in-house, something the Department says would be challenging to successfully do nationally.38 The Department told us that it reviewed its delivery options …
Government response. The government agrees, stating it has been engaging with Social Security Scotland to share best practice and will closely scrutinise outcomes. It confirms the programme will continue to explore approaches by devolved administrations, and future delivery model assessments will consider …
HM Treasury
21
Conclusion
Third Report - Revising health assessme…
Accepted
The NAO found that the department had worked with stakeholders to design the Programme but had not promoted the programme widely to the public.40 The Department told us that engaging with disabled people and their representative bodies and the public, is “really important” for the Programme. The Department explained that …
Government response. The government agrees, stating that HTP's claimant-focused design continues to be informed by user research and stakeholder engagement. It will publish a summary of the business case in Spring 2024 and continue to inform Parliament and the public about programme …
HM Treasury
22
Conclusion
Third Report - Revising health assessme…
Accepted
The Department has yet to widely publicise or raise awareness of the changes the Programme is likely to bring to functional health assessments. We therefore asked whether the Department planned to have national information programme or equivalent to inform people about the changes to the benefits system. The Department agreed …
Government response. The government agrees, stating that it has already communicated through written statements and a White Paper, and will publish a summary of the business case in Spring 2024. It also recognises the need to build public awareness as the programme …
HM Treasury
23
Conclusion
Third Report - Revising health assessme…
We received written evidence from some charitable organisations who work with people with disabilities, who said that they would support many of the proposed changes the programme is designed to deliver. For instance, three of the four organisations who wrote to us expressed the need for benefit assessors to be …
HM Treasury
24
Conclusion
Third Report - Revising health assessme…
Rejected
As part of the Programme, the Department wants to ensure that the new service provides “getting the decision right the first time more of the time”. It recognised this may mean it needs to spend “more time up front to get the decision right the first time”.47 When claimants are …
Government response. The government explicitly disagrees with the committee's implied recommendation regarding 'right first time' decisions and overturn rates. It states it has started publishing new HTP MI quarterly and already publishes overturn rates in PIP Official Statistics, and will look to …
HM Treasury
25
Conclusion
Third Report - Revising health assessme…
Rejected
We therefore asked the Department whether it was concerned that so many decisions were being overturned. The Department stressed that there was a degree of judgement involved in the health assessment process it used to determine eligibility for disability benefits, compared to, say, a mathematical formula, which could be used …
Government response. The government explicitly disagrees with the committee's implied recommendation regarding overturned decisions. It states it has started publishing new HTP MI quarterly and already publishes overturn rates in PIP Official Statistics, and will look to include equivalent measures in future …
HM Treasury
26
Conclusion
Third Report - Revising health assessme…
Accepted
The Department is testing improvements to the how it decides disability benefits using functional health assessments by developing the new health assessment service and the PIP application service within health transformation areas located in London and Birmingham. It told us that part of the testing would look at how it …
Government response. The government agrees, confirming that HTP's claimant-focused design is informed by user research and will enable iterative development and tailored communication, aiming to increase trust and improve outcomes. It also highlights ongoing stakeholder engagement and public communication efforts.
HM Treasury
27
Conclusion
Third Report - Revising health assessme…
Rejected
The Department is running two distinct health assessment services, one processing most claims using its current approach and one which is testing how it might change its approach in the future. We asked the Department how it was ensuring that any issues with the pilot service were being picked up …
Government response. The government explicitly disagrees with the committee's implied recommendation, stating it has started publishing new HTP MI quarterly and will keep under review what data can be published. It does not address how it ensures consistency between distinct health assessment …
HM Treasury
28
Conclusion
Third Report - Revising health assessme…
Accepted
An accounting officer assessment (AO assessment) is an important mechanism to help hold government to account for how it spends public money, whilst also providing a framework for accounting officers to show how their decisions on major programmes align with expected standards. AO assessments have been a key part of …
Government response. The government agrees with the committee's observation on the importance of accounting officer assessments and commits to writing to the committee by February 2024 with information on the status of assessments for Government Major Projects Portfolio programmes.
HM Treasury
29
Conclusion
Third Report - Revising health assessme…
Accepted
When we examined the Accounting Officer Assessment process in November 2022, we were disappointed that Departments were not making as much of these assessments as they should. We found that accounting officer assessments were not being used widely enough across government, Despite the fact that HM Treasury was encouraging departments …
Government response. The government agrees with the committee's findings regarding the underuse and inconsistent publication of accounting officer assessments. It commits to providing the committee with information on GMPP programmes and their AO assessment status by February 2024.
HM Treasury
30
Conclusion
Third Report - Revising health assessme…
Accepted
HM Treasury policy is that all programmes within the Government Major Projects Portfolio (GMPP) should have an accounting officer assessment conducted initially in 53 Q 30 54 Q 49 55 Q 30 56 Committee of Public Accounts, Improving the Accounting Officer Assessment Process, Twenty-Eighth Report of Session 2022–23, HC43, 30 …
Government response. The government agrees with the committee's observation concerning the application of accounting officer assessment policy for GMPP programmes. It commits to providing the committee with information on GMPP programmes and their AO assessment status by February 2024.
HM Treasury
31
Conclusion
Third Report - Revising health assessme…
Accepted
Despite the lack of an accounting officer assessment for the programme, the Department told us that it had “sought to be transparent throughout” and had published information on the Programme as part of the Department’s annual report. It noted that the Infrastructure and Projects Authority also published an annual review …
Government response. The government agrees with the committee's observation regarding transparency of programme details despite the lack of an accounting officer assessment. It commits to providing information on GMPP programmes and their AO assessment status by February 2024.
HM Treasury