Third Report - Revising health assessments for disability benefits

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 … Read more 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 plans to build its own case management IT system and develop the new service. It then needs to use a ‘test-and- learn approach’ to trial changes and identify what works to improve the claimant experience. The Department needs to have identified exactly what its new health assessment service will look like by 2027 to either invite the private sector to bid for new contracts or prepare to bring the service in-house. The Department recognises that if its test-and-learn activity reveals the proposed changes do not deliver the intended transformation in claimant experience, it can still issue the contracts for 2029 based on the current service. Given the extent of changes it wants to trial before 2027, we believe the greatest risk to the programme is that the Department focuses exclusively on the delivery of a new digitalised service, without achieving the important transformational change in the experience of claimants on which the wider benefits of the programme rely. Recommendation 1: The Department should publish a revised business case, no later than spring 2024, with details on how its desired transformation of the health assessments for disability benefits will result in the promised benefits for claimants and how it will track and assess progress towards this. Show less

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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 … Read more 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 not providing the services expected, or performing to the standards agreed as part of the contract. The National Audit Office identified three sources of this integration that the Department will need to successfully manage. The Department asserts that it has included sufficient flexibility in its contacts with providers to allow it to change them to include the scaling of the service, testing, and integration of systems that it needs. However, the Department is using standard service contracts and each change will need to be negotiated separately, which can be time consuming and introduces the risk of both cost increases and delay. We are also concerned that, without an alternative viable option, the contractors involved in testing the new service could have an advantage when it comes to letting contracts for the new health assessment service in 2029. The Department intends to keep the option of bringing the service in-house service when it decides in 2027 how to deliver the new transformed service from 2029. This will also improve its ability to negotiate with contractors. However, designing, introducing and implementing an in-house service would be time consuming and the Department would need to do a lot of preparatory work to maintain this as a realistic option. Social Security Scotland directly employs its health care professionals for functional health assessments rather than using contractors. The Department has committed to working with Social Security Scotland to understand how this works in practice and what it could learn for the new service. Recommendation 3a: The Department should set out, as part of its Treasury Minute respo Show less

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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 … Read more 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 bodies to identify the best ways of delivering functional health assessments. The Department has engaged with national and local stakeholder groups and has held 18 stakeholder workshops with over 72 different organisations. The Department asserts that it has used customers’ feedback to help it design parts of the service, for example the wording on the screen and how claimants navigate through the process. Some charities and stakeholder groups welcome the Department’s proposed changes, specifically, its decision to trial having more specialist assessors for specific health conditions. However, the Department has not promoted the Programme widely to the public. Given the scale of the project and the number of clients that it will impact, the Department agrees that it should consider a national campaign to improve claimant awareness of the changes it is proposing to adopt. However, the Department does not currently intend to consider this until it reaches the stage of at scaling up the programme, which will not happen for a couple of years. Recommendation 4: The Department should set out as part of its Treasury Minute response how it will: • fully involve claimants in the design and implementation of the changes it plans to the disability benefits system; and • raise awareness nationally of the changes it is making to the health and disability benefits system and what this will look like in practice for claimants. Show less

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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 … Read more 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 delay it. The Department recognised it may not be able to deliver all the transformation it wants to before letting the contracts to deliver the service from 2029. It said that it “was being very clear within the Programme on what needs to be ready, what quality needs to be like, what sort of service we are providing … and we will not continue 6 Qq 1, 25, 45 7 Q 1 8 Q 13 9 Qq 33, 45, 76; C&AG’s Report, para 2.15 10 Q 5, C&AG’s Report, paras 2.15–2.16 11 Q 45; Department for Work & Pensions, Health Transformation Programme evaluation strategy, 25 May 2023 Revising health assessments for disability benefits 11 to expand the service unless it is safe to do so and meets our exit criteria”.12 It explained that it will only let the new contracts based on what it is confident that it can deliver, even if that meant that those contracts would include less of the transformational benefits it currently envisaged from the new service. It told us that the rate at which it rolled out the Programme would be determined by how successfully it made progress.13 Show less

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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 … Read more 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 lot of money”. But it recognised that the success of the programme depended on ‘the [wider] savings and benefits that come from changing people’s lives for good’, which was “not just supporting some of the most vulnerable people in our country to live independently, but helping and encouraging those who can to live an independent life, which involves some ability to work”.14 Developing the health assessment service Show less

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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 … Read more 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 costs” through its testing to determine which service improvements to scale up. For example, the Department explained that its testing approach required some sophistication in order to consider when to best introduce case managers into the application process to achieve the right outcome.27 Show less

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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 …

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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 …

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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 …

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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, …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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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 …

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