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Health Transformation Programme

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Carri
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I thought it might be useful to collect information about progress of DWP’s Health Transformation Programme in one place. I’ve filed it under Disability Benefits although the changes will also affect UC and ESA.
Prompted by @Owen_Stevens and with credit to Rightsnet for the many useful news articles.

Carri
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Since it was announced in 2019, it’s become clear that the HTP doesn’t just cover the overhaul of assessment services but also covers broader changes to PIP.

I’ll be using the following terms which seem to be the ones DWP are using publicly at the moment:
• Health Transformation Programme – the wider programme
• Health Assessment Service – the planned ‘unified, integrated’ health assessment service. ‘Unified’ in the sense that it would bring together UC, ESA, PIP and other DWP benefit assessments into one service. ‘Integrated’ seems to mean that the HAS brings assessments in-house for DWP, at least to an extent, with DWP and assessors co-located and using a single digital system.
• Functional Assessment Service – the interim assessment service before the Health Assessment Service is fully rolled-out.
• Health Transformation Area – the area in which the Health Assessment Service is being trialled. Sometimes the ‘Departmental Transformation Area’.
• PIP Apply– the start-to-finish online claims platform for PIP. Sometimes ‘Apply for PIP’. Not to be mistaken for…
• Invited Digital. This term covers the digital version of the PIP2 form offered to many telephone PIP claimants - see https://askcpag.org.uk/content/207837/pip-digital-forms-and-online-claims
• PIP Service – the ‘transformed PIP end-to-end journey,’ the PIP process overhaul that DWP is working on under the HTP umbrella. PIP Apply seems to be part of this.

I’ll try to keep these updated

[Edited April 2024 to add Invited Digital]

[ Edited: 17 Apr 2024 at 01:20 pm by Carri ]
Carri
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Carri
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2019

5 March 2019 – Health Transformation Programme announced in Parliament
“I have established the Health Transformation Programme to undertake the significant task of transitioning the currently separate Work Capability Assessment (WCA) for Employment and Support Allowance and Universal Credit (UC), and the PIP assessment services into one unified, integrated service from 2021. To support this, we are developing a single digital platform.”
https://questions-statements.parliament.uk/written-statements/detail/2019-03-05/HCWS1376
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/pip-assessments-and-work-capability-assessments-for-esa-and-universal-credi

5 August 2019 – Appointment of James Bolton as Senior Responsible Owner for HTP:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/883719/senior-responsible-owner-health-transformation-programme.pdf

Carri
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2020

9 July 2020 – Delays to HTP: ministerial statement
https://questions-statements.parliament.uk/written-statements/detail/2020-07-09/HCWS353
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/government-anounces-that-current-contracts-for-pip-and-work-capability-assessments-are-to-be-extended-for-up-to-two-years

On the same date, the Infrastructure and Projects Authority gave the HTP a Delivery Confidence Assessment of ‘red’
Rightsnet: Successful delivery of the DWP’s Health Transformation Programme ‘appears to be unachievable’ https://www.rightsnet.org.uk/welfare-rights/news/item/successful-delivery-of-the-dwps-health-transformation-programme-appears-to-be-unachievable

DWP ‘reset’ the HTP. More details here (p9): https://www.nao.org.uk/wp-content/uploads/2023/06/transforming-health-assessments-for-disability-benefits-summary.pdf

[ Edited: 8 Jul 2023 at 03:17 pm by Carri ]
Carri
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2021

11 January 2021 – ‘We are committed to providing a digital channel - “PIP Apply” - to widen claimants’ choices on how to make a new claim for PIP… [we are] working on how we enable claimants to access this service directly from gov.uk removing the need for the initial telephone call.’
https://questions-statements.parliament.uk/written-questions/detail/2021-01-06/134173

21 April 2021 – The Health Transformation Area begins with a small number of postcodes in Marylebone, London
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-confirms-it-is-restarting-pilot-of-integrated-assessment-service-for-esa-pip-and-universal-credit-from-april-2021
And: https://www.rightsnet.org.uk/welfare-rights/news/item/initial-single-site-to-trial-integrated-assessment-system-for-pip-and-wca-will-be-in-marylebone-london

20 July 2021 – DWP’s Health and Disability Green Paper
https://www.gov.uk/government/consultations/shaping-future-support-the-health-and-disability-green-paper/shaping-future-support-the-health-and-disability-green-paper
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/new-health-and-disability-green-paper-marks-important-step-to-improving-how-the-dwp-helps-people-start-stay-and-succeed-in-work-says-minister

12 November 2021 – DWP provides update on integration of PIP assessments and work capability assessments into new Health Assessment Service
https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-provides-update-on-integration-of-pip-assessments-and-work-capability-assessments-into-new-health-assessment-service
As of this date there are 71 ESA claimants, 810 Universal Credit claimants and 1422 PIP claimants in the Health Transformation Area.

Carri
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2022

21 January 2022 – ‘In the HTA, we have completed just over 500 PIP and close to 1500 WCA assessments’
https://questions-statements.parliament.uk/written-questions/detail/2022-01-13/103606

On the same date in a different PQ, more details were shared about the staffing on the Health Assessment Service in the Health Transformation Area and the move to DWP employing HCPs directly:
https://questions-statements.parliament.uk/written-questions/detail/2022-01-13/103607

26 January 2022 – Apply for PIP private beta trial (10 claimants a day) launches
https://news.dwp.gov.uk/dwplz/lz.aspx?p1=Mo7DUzMDEyMDFTMDQzNDpGOUQ1MzI3REZDQzc5MkIyOUNDMDIwMjYyNEJGRTM4Qg%3d%3d-&CC;=&p=0
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-outlines-plan-test-a-new-get-your-pip-online-claims-service-from-january-2022
CPAG article: https://askcpag.org.uk/content/207837/pip-digital-forms-and-online-claims

9 February 2022 – DWP confirms it is expanding its Health Transformation Programme into selected Birmingham postcodes –NB that by this date it was already handling WCA cases in Birmingham – these appear to have started in October 2021
https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-confirms-it-is-expanding-its-health-transformation-programme-into-selected-birmingham-postcodes

4 May 2022 - Not strictly HTP, but relevant DWP digital developments
https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-outlines-plans-to-further-develop-its-online-services-and-claims-processes-for-retirement-bereavement-and-care-needs

[ Edited: 18 Nov 2023 at 04:52 pm by Carri ]
Carri
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2023 so far:

8 March 2023 – (NI) Department for Communities outlines proposed timescales for introduction of ‘multi-channel’ delivery of health assessments and online PIP applications
https://www.rightsnet.org.uk/welfare-rights/news/item/department-for-communities-outlines-proposed-timescales-for-introduction-of-multi-channel-delivery-of-health-assessments-and-online-pip-applications

15 March 2023 – DWP’s Health and Disability White Paper
https://www.gov.uk/government/publications/transforming-support-the-health-and-disability-white-paper
This is a key source of information about the plans/aspirations for the HTP.
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/government-outlines-plans-for-abolition-of-the-universal-credit-work-capability-assessment-in-new-health-and-disability-white-paper
CPAG briefing (focusing on WCA proposals): https://askcpag.org.uk/content/208897/the_future_of_the_work_capability_assessment

24 March 2023 – DWP’s online apply for PIP service currently being offered to 60 people a day
https://www.rightsnet.org.uk/welfare-rights/news/item/dwps-online-apply-for-pip-service-currently-being-offered-to-60-people-a-day
TechMonitor coverage: https://techmonitor.ai/leadership/digital-transformation/dwp-struggling-scale-pip-online-applications-after-beginning-work-2015

20 April 2023 – DWP confirms it will begin testing the matching of claimants’ primary health conditions to ‘specialist assessors’ later this year
https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-confirms-it-will-begin-testing-the-matching-of-claimants-primary-health-conditions-to-specialist-assessors-later-this-year

24 May 2023 – Public Accounts Committee launches inquiry into ‘revising health assessments’ for disability benefits
https://www.rightsnet.org.uk/welfare-rights/news/item/public-accounts-committee-launches-inquiry-into-revising-health-assessments-for-disability-benefits

25 May 2023 – DWP sets out high-level strategy for evaluating and tracking the performance of the Health Transformation Programme
https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-sets-out-high-level-strategy-for-evaluating-and-tracking-the-performance-of-the-health-transformation-programme

26 May 2023 – New Health Transformation Programme assessment contracts for period from 2024 to 2029 awarded to Maximus, Capita and Ingeus
https://www.rightsnet.org.uk/welfare-rights/news/item/new-health-transformation-programme-assessment-contracts-for-period-from-2024-to-2029-awarded-to-maximus-capita-and-ingeos

23 June 2023 – NAO warns that scale and complexity of DWP’s Health Transformation Programme leaves it at high risk of delay, cost overruns and not achieving intended benefits https://www.rightsnet.org.uk/welfare-rights/news/item/nao-warns-that-scale-and-complexity-of-dwps-health-transformation-programme-leaves-it-at-high-risk-of-delay-cost-overruns-and-not-achieving-intended-benefits

NB the NAO’s report sets out three phases for HTP (p7, more detail on p10):
Phase One (2019–2024) Setting up the health transformation areas and creating the start of the HAS to use for testing and learning, while procuring FAS for the bulk of claims.
Phase Two (2024–2029) Transformation of PIP customer journey and scaling of assessment services and may scale improvements into current FAS service.
Phase Three (2029 onwards) New HAS in place processing all new and ongoing claims

26 June 2023 – Government’s response to the Work and Pensions Committee’s inquiry on health assessments for benefits. The inquiry had published its report in April 2023.
https://publications.parliament.uk/pa/cm5803/cmselect/cmworpen/1558/report.html
Rightsnet coverage: https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-rejects-select-committees-recommendations-for-short-term-improvements-to-the-health-assessment-process
CPAG briefing: https://askcpag.org.uk/?id=209507

The government’s response mentions ‘some of the key areas of change currently being developed [in the Health Transformation Area]’:
• ‘Automating clerical processes, reducing the manual steps to speed up claimant journeys;’
• ‘Looking to reduce the burden on claimants by exploring opportunities to draw evidence from different sources including previous applications;’
• ‘Making the claimant journey more consistent, with the steps and actions within claims consistent across different benefits, rather than each having their own language and approach.’
• Also mentions work on the recording of assessments in the HTA. ‘The programme is looking at how audio recording can also be offered for video assessments and will be seeking ways to improve the whole process, including helping claimants to better understand the current availability of the opt-in option.’

On the other aspects of the HTP, DWP said:
‘Through the Health Transformation Programme, the Department is transforming the entire PIP service and will make improvements to existing ways to claim and create a new digital PIP service, giving claimants the option to apply online.’

3 July 2023 - Stephen Timms wrote to Tom Pursglove seeking clarification on several points from the DWP’s response to Work and Pensions Committee report on benefit assessments https://committees.parliament.uk/committee/164/work-and-pensions-committee/publications/3/correspondence/

6 July 2023 – DWP Permanent Secretary sets out plans for rolling out Health Transformation Programme
https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-permanent-secretary-sets-out-plans-for-rolling-out-health-transformation-programme
Briefly, the plan is that Health Assessment Service will cover 20 per cent of the country by 2026 and be fully rolled-out by 2029.

Also on 6 July 2023, DWP’s annual report and accounts 2022/23 mentioned the Health Transformation Programme - mainly at p43.

[ Edited: 24 Aug 2023 at 08:30 pm by Carri ]
Daphne
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Thanks Carri - and now - https://www.rightsnet.org.uk/welfare-rights/news/item/roll-out-of-health-transformation-programme-is-capped-at-20-per-cent-until-2029-due-to-limitations-in-the-functional-assessment-services-contracts

So limited to 20% roll out until 2029 and also no better outcomes expected for claimants despite the new service allegedly being better at collecting and considering evidence…

keith
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Loving this innovation (from the 6th July announcement):

“We are trying new ways of doing things ... the approach of having the health assessor and the case manager working together in the same place. That means that where the case manager who is making the decision has a question, they can often go over to the next-door desk and say, “You did the assessment for this person. I’m a little confused by this. Can you explain this? Can we talk through this particular condition?”, or whatever is required. “

Anyone else remember the Benefits Agency Medical Services (BAMS) where the health assessment staff were in the same buildings as the Incapacity decision makers?

Decisions weren’t any better but at least they could talk to each other.

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21 July 2023 - Infrastructure and Projects Authority maintains ‘Amber’ rating for HTP
https://www.rightsnet.org.uk/welfare-rights/news/item/infrastructure-and-projects-authority-maintains-amber-rating-for-dwps-universal-credit-and-health-transformation-programmes

31 July 2023 - Apply for PIP private beta trial expanded, so new PIP claimants in a list of postcode areas can apply for PIP directly via gov.uk without an initial phone call
https://www.rightsnet.org.uk/welfare-rights/news/item/online-apply-for-pip-service-now-live-in-selected-postcode-areas

Mike Hughes
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keith - 11 July 2023 09:12 AM

Loving this innovation (from the 6th July announcement):

“We are trying new ways of doing things ... the approach of having the health assessor and the case manager working together in the same place. That means that where the case manager who is making the decision has a question, they can often go over to the next-door desk and say, “You did the assessment for this person. I’m a little confused by this. Can you explain this? Can we talk through this particular condition?”, or whatever is required. “

Anyone else remember the Benefits Agency Medical Services (BAMS) where the health assessment staff were in the same buildings as the Incapacity decision makers?

Decisions weren’t any better but at least they could talk to each other.

Only just picked up on this thread. Excellent stuff.

My frustration with this stuff is that we effectively already had twenty years of data showing that stuff like this didn’t work before DLA was introduced and we have thirty more since.

Putting DMs and HCPs in the same space solves nothing and never will. It reinforces bad practice rather than creating good practice. Bringing assessments in house simply recreates the very failures which allegedly led to DLA etc.

Having specialists in your health issue is an irrelevant nonsense in a world where people have multiple health conditions with complex interactions which are often poorly understood before you even start digging into meds.

The issue is really with having HCPs involved in the first place and continuing to pretend they have a training and expertise which they simply do not. The issue is with having claim packs which use words like “mixing” when it means “engaging” and which nowhere mention to claimants the pivotal nature of the word “reliably” and DWP being essentially fundamentally unable to do any rapid learning on same. Changing a claim pack is like turning a dredger. That’s where the issues actually lie.

Ask people the wrong questions in the wrong way; add in HCPs who are often about as relevantly qualified as the sometimes teenage work coaches in their first job are to talk about work and… guess what.

I do appreciate we’re veering OT here so I’ll shut up now but the answers to much of this are so obvious and the evidence so overwhelming that it’s immensely frustrating to be faced by civil servants who with the best will in the world simply don’t get this and if they do get it they too are unable to access the routes by which rapid change might be affected.

Carri
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1 Aug 2023 (but published today) Tom Pursglove replies to Stephen Timms (WPC) letter of 3 July on the topic of benefit assessments.
https://committees.parliament.uk/publications/41157/documents/202429/default/

Has some info on experimental data sharing between DWP and an NHS Foundation Trust - more detail here:
https://www.maudsleybrc.nihr.ac.uk/facilities/clinical-record-interactive-search-cris/cris-data-linkages/

“This linkage is the first between NHS health records and DWP data. The main purpose of this project is to examine the effect of welfare reform and current assessment policies on mental health recovery and relapse: this would include examining the impact of potentially positive events (engagement in a work support packages) and negative events (regular work capability assessment, benefit sanctions, and the reduction or removal benefits) on a patient’s mental health… This linkage will help to provide high quality research outputs that examine the interface between mental health, work and welfare. Ultimately, this will provide much needed evidence to direct occupational health and welfare policy initiatives.”

Carri
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4 September 2023 Westminster hall debate about benefit assessments:
https://hansard.parliament.uk/commons/2023-09-04/debates/E7E6E6E9-3167-4E47-9CE4-362EBF85C373/DisabilityBenefitsAssessments

[edited when the rest of transcript came online]

(1) possibly an insight into the specialist assessor trials, from Justin Tomlinson:
‘Not everybody presents with one single health condition, so it may be that people would have a hybrid assessment in two parts. There would be a general assessment, which in many cases would pick up things on the mental health side that people did not realise were having an impact on their day-to-day life; there would also be a specific assessment of the primary health condition.’

(2) And comments about the ‘severe disability group’ of claimants who wouldn’t have to fill out normal forms or go through assessment, per Green Paper and White Paper, from Justin Tomlinson and Tom Pursglove (rightsnet coverage here: https://www.rightsnet.org.uk/welfare-rights/news/item/dwp-minister-outlines-criteria-to-be-used-for-the-new-severe-disability-group-that-will-be-subject-to-a-simplified-disability-benefit-assessment-process - note that Justin Tomlinson talks about ‘250,000 to 300,000 assessments [that] could be lifted out of the system every single year’ through changes to who is assessed.

(3) recording of assessments - Tom Pursglove thinks opt-in system ‘strikes [the right] balance’ but says: ‘However, the health transformation programme is looking at how we can create greater awareness of the ability to record the assessment. We may see more people accepting the opportunity to record their assessment on the back of that.’

(4) confirmation that the (optional) online PIP claims platform should become available ‘across England, Wales and Northern Ireland in 2024’

(5) at one point Tom Pursglove says re: ‘changes to eligibility for PIP. I can confirm that there are no plans for that. I want to be very clear about that.’  But seems just to be talking about threat of means-testing and not about the possibility of changing the disability conditions, because he says later: ‘PIP and its descriptors are kept under continued review to ensure that they meet the needs of claimants and help the Department to reach an accurate assessment of an individual’s entitlement, but I take on board the points raised during the debate and will raise them with officials back at the Department in future conversations and decisions around PIP and its descriptors.’

 

[ Edited: 5 Sep 2023 at 05:59 pm by Carri ]
Carri
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5 September 2023 - Government launches consultation on new proposals to reform the WCA
https://www.rightsnet.org.uk/welfare-rights/news/item/government-launches-consultation-on-changes-to-wca

Government proposing to cut the numbers of claimants getting LCWRA/support group by reviewing the eligibility rules.  Specifically looking at changes to: mobilising; continence; coping with social engagement; ‘getting about; (LCW only); and substantial risk.

Consultation on the proposals closes 30 October.

Seems likely that the changes being consulted on would affect the White Paper plan to start scrapping WCA from 2026 onwards, though DWP says it is committed to doing both.

UB40
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Unsurprisingly the guns are out for the Substantial Risk regs which are so helpful at Tribunal.
LCWRA Substantial Risk – A 21-year-old man with episodes of psychosis on a background of bipolar disorder. He has periods of mania followed by low mood and dropped out of university due to a relapse last year. He has been engaging regularly with mental health services and recently reduced his medication. There is no history of self-harm and recently he has been stable and functioning well, including completing an online web design course. - Through these changes, he could receive DWP support to encourage him back into higher education, boosting his life prospects. - We expect a Disability Employment Advisor or work coach to consider what DWP provision and support the individual could be eligible for, including signposting to provision in the local area. - A person in this circumstance can be referred by their community mental health team to Individual Placement and Support (SMI). Individual Placement Support (IPS) is an employment support service integrated within community mental health teams for people who experience severe mental health conditions or have complex mental health needs. IPS aims to help people to gain and retain paid, competitive employment. The service consists of intensive, individual support from trained employment specialists, and rapid job search followed by placement into paid employment. It also provides in-work support for both the employee and the employer.

https://www.gov.uk/government/news/government-announces-new-welfare-reforms-to-help-thousands-into-work
Contact Press Office
Media enquiries for this press release – 0115 965 8781