Recommendations & Conclusions
9 items
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 …
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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 an evaluation strategy in May 2023 which sets out its nine key performance indicators for the Programme. These are focused on the process of running the service, such as the average cost of the service or the capacity and demand for health assessments, rather than tracking the experience of claimants. 6 Revising health assessments for disability benefits The Department has not set out what performance measures it will use to ensure that the Programme delivers the benefits promised for claimants, such as increased trust in services and decisions made. The Department does not yet have the data it needs to undertake testing and to judge if the new Health Assessment Service is successful, but intends that the outline business case for the Programme, expected in 2024, will set out how it will fill these data gaps. Recommendation 2: The Department should publish, as part of its new business case and through annual progress reports, outcome indictors that include the benefits of the Programme for claimants, which it, Parliament and the public can use to: • evaluate its testing of the new service, including establishing baseline performance against the 47 key performance indicators; • assess whether it is on track to achieve the benefits it intends for claimants; and • monitor claimants’ experience of the Health Assessment Service and Functional Assessment Service.
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Government response AI summary
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.
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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 …
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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 of the time’. Around 15% of initial decisions where the claimant was not awarded the full amount for their PIP payment are later revised by the Department through mandatory reconsideration or having been overturned at appeal. The Department is testing improvements to health assessments and the PIP application service within its health transformation 8 Revising health assessments for disability benefits areas in London and Birmingham. By 2026, the Department intends to process up to 20% of new claims using the new service. The Department hopes that these claimants will experience a faster process and improved accuracy in initial decisions. The Department claims that it has a low tolerance for inconsistencies between the new service it is developing and the existing service, and that both services should apply the same legislation and provide the same standard of service. There is an opportunity for the Department to learn from improvements they are making in the current service and input these to the new services so that they can be much improved for clients. Recommendation 5: The Department needs to monitor and publish data on the services provided in each transformation area and by each provider, so it can identify and manage any differences in the standard of service being delivered. This should include measures of how initial health assessment recommendations are changed by DWP officials and decisions are altered at mandatory reconsideration and appeal.
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Government response AI summary
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 mature.
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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 …
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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 claimants to give assurance that the proposed changes to the service are working as expected. It told us that it planned to try the new service in a range of different areas and to make sure that it took into account a “wide range of customer types from across the country” as part of its evaluation of the new service.18 It intends to increase the number of claimants involved in its testing to up to 20% of new claims nationally to provide it with sufficient volumes to provide it with the assurance it needs.19
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Government response AI summary
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.
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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 …
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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 metrics it will use and what data it needs to monitor the transformation of the service as a whole. We therefore asked the Department whether its performance indicators were fit for purpose. The Department asserted that it wanted to be “very open” about its approach to evaluation and the key performance indicators it was seeking to use, and that there were two elements it was considering as part of this – the first where it did not yet have the data it needed, and the second where it had the data but needed to be clear about which metrics it would use and monitor. It explained that, of the nine key performance areas, there was one, covering “customer query resolved at first contact”, where it had not yet identified what data it needed to monitor this. The Department explained that it had “not yet resolved exactly where that data is coming from and how draw that together” and that it thought that “we have time, but this is something we know that we need to do”. The Department said it will update the business case in spring 2024.25 In order that the Department’s progress can be more accurately monitored, we would expect the business case to be included in the baseline assessments for its 47 key performance indicators.
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Government response AI summary
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 report against KPIs, and are …
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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”. …
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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”. It similarly recognised that the overall objectives for the Programme were around “making a difference in outcomes for individuals’ lives, making the right decision first time, increasing trust and understanding of the process, and helping more people into work”.26 20 Qq 26–27 21 C&AG’s Report, paras 3.14–3.15, 3.17 22 Q 20 23 Q 29 24 Q 32; Department for Work & Pensions, Health Transformation Programme evaluation strategy, 25 May 2023 25 Qq 32–33; C&AG’s Report, figure 13 26 Q 33 Revising health assessments for disability benefits 13
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Government response AI summary
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.
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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. …
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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. Social Security Scotland is starting to manage a wider range of benefits in Scotland, including a PIP replacement benefit – the adult disability payment. The most recent annual civil service employment survey shows that staff at Social Security Scotland generally view how it is operating more positively compared to the Department’s staff. For example, the leadership and managing change theme for the Department in 2022 is 49.9 compared to Social Security Scotland of 67.4, a 17.5 percentage point difference.28 The Department told us that it worked closely with colleagues in Social Security Scotland and that it intended to learn from it given that Social Security Scotland was “trying different things” in how it administered a similar benefits system.29 Working with contractors
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Government response AI summary
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 data can be published on …
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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 …
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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 unhappy with the initial benefit decision they have the opportunity to appeal through a mandatory consideration and then ultimately to a tribunal. Between April 2018 and March 2022, the Department made 2.1 million initial decisions about applications for PIP, of which 0.5 million claimants raised a mandatory reconsideration. Around 15% of the initial decisions where the claimant was not awarded full amount of PIP payment were later revised – either by the Department through mandatory reconsideration or by being overturned at appeal.48 The Cystic Fibrosis Trust reported that sufferers who it had supported through the tribunal process had their case decided in their favour.49
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Government response AI summary
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 include equivalent measures in future …
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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 …
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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 for benefits such as income replacement benefit or state pension. It explained that “a huge amount of time” went into understanding the way in which a particular health condition is disability was affecting someone’s daily living or mobility, “but you can sometimes look at the same situation and take a different judgement”. It explained that this was rarely because new evidence was provided, but sometimes because the medical condition had fluctuated over time. It told us that in some instances, when it came to a tribunal, “the case is put more clearly or the questions are answered in a different way, and you suddenly see the picture more clearly than earlier in the process when it was missed”.50
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Government response AI summary
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 HTP publications.
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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 …
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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 and that claimants in the trial areas were not being disadvantaged. The Department told us that in the early stages of the testing, there were relatively few claims being processed in the new way, there was a lot of support available, including senior staff reviewing “each and every case as it comes through”. It 47 Q 15 48 Qq 13, 15; C&AG’s Report, Figure 8. 49 Cystic Fibrosis Trust (RDB00002) para 4 50 Q 15 51 Q 15 52 Qq 22, 25–26, 29 Revising health assessments for disability benefits 17 also told us that it had “active management through a case manager”, which it didn’t have for the current service, which meant that it could pick up and address issues quickly.53 The Department told the us that it had a ‘very low tolerance for inconsistency between the two services’.54 The Department said that it was being very careful to ensure that it was applying the legislation in a consistent way, that it was providing the same standard of service, and that the outcomes were right for customers.55 Providing transparency to Parliament
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Government response AI summary
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 services or safeguards claimants in …
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HM Treasury