The Work and Health Programme – How innovative will delivery be?

19 February 2016

The new Work and Health Programme, the replacement of the Work Programme and Work Choice, is still in the design phase at the Department for Work and Pensions (DWP). Whilst all interested potential contractors and sub-contractors await the ITT with interest, the work to build a potential supply chain has already commenced by some.

What then, should we expect to see that is different from the Work Programme in the delivery of services for jobseekers?

Well firstly, because the new programme is expected to help far more benefit recipients with health conditions, we can expect to see prime contractors engaging with health providers and discuss potential collaborations in much greater breadth and depth than we saw with the Work Programme.

What we don’t know at this stage, is the make-up of those health organisations, though we may expect a cross-section of organisations that are experienced in dealing with musculo-skeletal and mental health issues. These have been the main focus of attention in Work Programme delivery, so we can expect a similar approach in the near future.

The difficulties for organisations that focus on health issues working with prime contractors is that few, if any, will be used to a payment by results model, and most will have no expertise in getting people into work. There may therefore be significant tensions to overcome between prime and sub-contractor organisations, in order to agree the balance between payment by results and the achievement of outcomes. Such tensions may not in themselves constrain innovation in delivery, but they may well skew the range of services offered to what is deemed affordable and risk free, rather than what is needed by jobseekers.

It may well be that a supply chain that is sequential in moving jobseekers forward will be more appropriate than the traditional geographically based model as health providers will not have the experience to help jobseekers into work. But a new approach to supply chain establishment and management requires a significant shift in thinking by most prime contractors, particularly if it is done over wide geographical areas. Such an approach was not tried and tested on a wide scale in the Work Programme, so presents some risk, at least in the minds of prime contractors if not in reality. Furthermore, most prime contractors have always favoured a geographical approach to sub-contracting so have little or no experience in establishing and managing a sequential supply chain.

We know too that generally health professionals have higher salaries than their welfare to work counterparts. A quick glance at jobs on offer to health professionals assessing for the DWP Personal Independent Payment (PIP) benefits shows that the individuals making the assessments are paid at much higher rates than case holding advisors in most welfare to work organisations. So are the prime contractors going to be prepared to pay for professional health services? And are health organisations going to be prepared to receive payment by results, especially when income might depend on someone else’s success in helping jobseekers to sustain job outcomes?

There are some difficult decisions ahead.

It would be good to see a focus not just on health, but on rehabilitation. Perhaps DWP should call the programme “Rehabilitation and Work” rather than the current name for the programme. Rehabilitation is a far more widely used term in other countries, such as Canada, where the Vocational Rehabilitation Association has been in existence since 1970. The UK version, on the other hand, was only established within the last fifteen years. A quick look at the Vocational Rehabilitation Association (VRA) for the UK shows few welfare to work organisations are corporate members of that particular body.

There might well be a viable option for welfare to work providers to develop their own staff in rehabilitation skills. This again requires a shift in thinking for many organisations who prefer to recruit for new required skills, rather than investing in existing staff. But there will also be questions around the use of a rehabilitation based model and caseload sizes, with in-depth support requiring manageable caseload volumes, rather than the high numbers that some welfare to work providers encourage.

Clearly, payment by outcomes will influence the levels of innovation that prime and sub-contractors feel they are able to implement. However, with funding inevitably depending on the achievement of sustained job outcomes, in line with current Work Programme thinking, prime and sub-contractors will need to manage risks and opportunities in a robust way, balancing innovation with income value. The risk averse approach taken by many welfare to work organisations in the past need to be reviewed and adapted if income is to be maximised through assisting people with health conditions in partnership with health professionals. Another potential shift in thinking for senior welfare to work managers.

The prime contractors for the Work and Health Programme will be decided through the tender process. Will we see a large rehabilitation organisation enter the market and deliver health related services themselves, with work focused activities sub-contracted to welfare to work operators? If the reverse is true, then the welfare to work organisations that have delivered Work Programme will face significant challenges to their current approach and thinking if we are to see real innovation and results in the Work and Health Programme.

Colin is an Associate Director of PublicCo and can be contacted via, through email at and Colin has over 30 years of experience in the welfare to work market, both in the UK and internationally, successfully achieving business growth and leading high performing teams in senior leadership roles.