Select Committee · Public Accounts Committee

Revising health assessments for disability benefits

Status: Closed Opened: 24 May 2023 Closed: 8 Mar 2024 11 recommendations 20 conclusions 1 report

In 2021-22 the Department for Work & Pensions (DWP) spent £63.1 billion on a range of benefits to support people with a disability or health condition. This includes Personal Independence Payments, Employment and Support Allowance and certain Universal Credit payments. DWP undertakes a health assessment of the claimant to decide on their eligibility for these …

Clear

Reports

1 report
Title HC No. Published Items Response
Third Report - Revising health assessments for disability b… HC 79 29 Nov 2023 31 Responded

Recommendations & Conclusions

19 items
2 Recommendation Third Report - Revising health assessme… Accepted

Publish revised business case detailing health assessment transformation benefits and progress tracking for claimants.

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
4 Recommendation Third Report - Revising health assessme… Accepted

Set out preparatory work to maintain a realistic in-house option for future health assessment services.

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

Set out how to involve claimants and raise national awareness of disability benefits system changes.

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
7 Conclusion Third Report - Revising health assessme… Accepted

Write to committee listing unpublished GMPP Accounting Officer assessments with a publication timetable.

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
8 Recommendation Third Report - Revising health assessme… Accepted

Department acknowledges limits to full transformation delivery before 2029 service contracts.

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

Department confident in financial savings, but wider programme success hinges on changing lives.

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
12 Conclusion Third Report - Revising health assessme… Accepted

Department reset programme, separating transformation from service; testing with contractors still required.

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
15 Recommendation Third Report - Revising health assessme… Accepted

Department prioritises balancing outcomes and costs through testing service improvements for claimants.

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
17 Conclusion Third Report - Revising health assessme… Accepted

Interim assessment contracts shift healthcare professional recruitment responsibility to contractors.

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

Department's reliance on separate negotiations for IT integration carries risks.

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

In-housing health assessments poses significant recruitment and retention challenges for DWP.

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

Department deems national in-housing too risky, but will learn from Social Security Scotland.

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

Department engages stakeholders, but has not widely promoted the programme to the public.

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

Department delays publicising programme changes until scaling up health assessment service.

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
26 Conclusion Third Report - Revising health assessme… Accepted

Department is piloting new health assessment services to improve disability benefit decision-making clarity

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
28 Conclusion Third Report - Revising health assessme… Accepted

Accounting Officer Assessments enhance government accountability, decision-making, and programme transparency

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

Departments inadequately utilise and publish Accounting Officer Assessments, hindering government transparency

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

Department delays publishing programme Accounting Officer Assessment pending HM Treasury guidance update

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

Department's claimed transparency contradicted by lack of detailed programme information and risks

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

Oral evidence sessions

1 session
Date Witnesses
6 Jul 2023 James Bolton · Department for Work and Pensions, Katie Farrington · Department for Work and Pensions, Peter Schofield CB · Department for Work and Pensions View ↗

Correspondence

1 letter
DateDirectionTitle
19 Sep 2023 Correspondence from James Bolton, Senior Responsible Owner, Health Transformati…