Revising health assessments for disability benefits

Public Accounts Committee Closed Inquiry
Opened: 24 May 2023 Closed: 8 Mar 2024 Parliament page
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 … Read more
11 Recommendations
20 Conclusions
1 Report
1 Oral session
1 Letter
1 Event
Activity timeline 4 events
8 Mar
2024
Report published
29 Nov
2023
Report published
19 Sep
2023
Correspondence
6 Jul
2023
Oral evidence
Oral evidence sessions 1 session
6 Jul 2023
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Revising health assessments for disability benefits
James Bolton · Department for Work and Pensions Katie Farrington · Department for Work and Pensions Peter Schofield CB · Department for Work and Pensions
Recommendations & Conclusions
31 results
2 Recommendation
Third Report - Revising health ass…
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 … Read more
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3 Recommendation
Third Report - Revising health ass…
Publish comprehensive outcome indicators for health assessment programme, measuring claimant benefits and experience.
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 … Read more
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4 Recommendation
Third Report - Revising health ass…
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 … Read more
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5 Recommendation
Third Report - Revising health ass…
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 … Read more
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6 Conclusion
Third Report - Revising health ass…
Monitor and publish data on health assessment services by area and provider to identify differences.
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 … Read more
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7 Conclusion
Third Report - Revising health ass…
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 … Read more
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1 Conclusion
Third Report - Revising health ass…
Committee scrutinises Health Transformation Programme evidence from DWP and external stakeholders.
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 … Read more
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8 Recommendation
Third Report - Revising health ass…
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 … Read more
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9 Recommendation
Third Report - Revising health ass…
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 … Read more
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10 Recommendation
Third Report - Revising health ass…
Health Transformation Areas are testing radical changes in health assessment service delivery.
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 … Read more
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11 Recommendation
Third Report - Revising health ass…
Department plans wider testing of health transformation service to ensure representative claimant sample.
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 … Read more
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12 Conclusion
Third Report - Revising health ass…
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 … Read more
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13 Recommendation
Third Report - Revising health ass…
Include the updated business case in baseline assessments for all 47 key performance indicators.
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 … Read more
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14 Recommendation
Third Report - Revising health ass…
Department acknowledges need to better link performance metrics with claimant outcomes.
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 … Read more
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15 Recommendation
Third Report - Revising health ass…
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 … Read more
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16 Conclusion
Third Report - Revising health ass…
Significant disparity in staff satisfaction between Department and Social Security Scotland.
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 … Read more
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17 Conclusion
Third Report - Revising health ass…
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 … Read more
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18 Conclusion
Third Report - Revising health ass…
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, … Read more
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19 Conclusion
Third Report - Revising health ass…
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 … Read more
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20 Conclusion
Third Report - Revising health ass…
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 … Read more
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21 Conclusion
Third Report - Revising health ass…
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, … Read more
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22 Conclusion
Third Report - Revising health ass…
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 … Read more
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23 Conclusion
Third Report - Revising health ass…
Charities advocate for specialist assessors to improve disability benefit assessments for specific conditions
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 … Read more
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24 Conclusion
Third Report - Revising health ass…
Fifteen percent of initial PIP benefit decisions are revised or overturned on appeal
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 … Read more
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25 Conclusion
Third Report - Revising health ass…
Department attributes overturned decisions to assessment judgement and fluctuating medical conditions
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, … Read more
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26 Conclusion
Third Report - Revising health ass…
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 … Read more
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27 Conclusion
Third Report - Revising health ass…
Department ensures consistency and fairness in pilot health assessment services through intense oversight
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 … Read more
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28 Conclusion
Third Report - Revising health ass…
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 … Read more
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29 Conclusion
Third Report - Revising health ass…
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 … Read more
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30 Conclusion
Third Report - Revising health ass…
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 … Read more
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31 Conclusion
Third Report - Revising health ass…
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 … Read more
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Correspondence 1 letter
19 Sep 2023 Correspondence from James Bolton, Senior Responsible Owner, Health Transformation Programme, Department for Work and Pensions, re DWP follow up to the Public Accounts Committee Hearing on Revising Health Assessments for Disability Benefits 6 July 2023, dated 20 July 2023
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