How open public services is a way to outsource unpopular policies

In this recent series of posts we’ve been exploring the tensions between two competing Government agendas – for so-called ‘open public services’ and ‘open policy-making’. The former is supposed to improve public services by widening the choice of providers, while the latter is meant to improve policy by widening the range of voices that influence policy. These ‘tensions’ aren’t necessarily undesirable for policymakers – outsourcing can be a useful way for Government to ignore the views of those on the frontline when these views conflict with its policy agenda.

Last week Atos was appointed to carry out assessments for the new Personal Independence Payment (PIP) securing two contracts worth over £400 million. PIP is the new benefit to replace Disability Living Allowance from April 2013 for new claimants (with existing claimants migrating onto this benefit by 2016). This decision has proved to be highly controversial because of Atos’ £100 million a year role in the Work Capability Assessment (WCA). The WCA is the main assessment for Employment Support Allowance (ESA) claims.

The WCA has been a public policy fiasco, which has caused real anxiety and fear for people who have been forced to go through this process, as highlighted in recent documentaries by Panorama and Channel 4’s Dispatches. The media has been littered with examples of people who clearly should not have been found fit for work. According to an Early Day Motion last year, 1,100 claimants died while under compulsory work-related activity for benefits and a number of those found ‘fit for work’ and left without income have committed or attempted suicide.

As a result, there is considerable fear, distrust and anger amongst disabled people towards Atos, and the company has faced serious criticism from campaigners, charities and the media for its role in the policy. However, the concerns of disabled people have clearly not featured in the decision to commission Atos to deliver PIP – indeed, they have been dismissed.

Perhaps this is because the problem is the policy, not necessarily the provider. Charities and commentators have argued that the process is flawed, the tests are too impersonal, take little or no account of the wider circumstances and motivation of a person, and that the fluctuating nature of some conditions is not sufficiently taken into account (charities have instead called for a ‘Real-Life’ Assessment rather than a one-sized fits all approach). GPs at their annual conference in May called for the WCA to be scrapped because the assessments are “inadequate” and “have little regard to the nature or complexity of the needs of long-term sick and disabled persons”. They called for the tests to be replaced with a more “rigorous and safe system”. Of the 390,000-plus appeals that have been lodged against decisions not to grant the benefit, just under 40% have been successful. By some estimates the appeals process has actually cost more than the value of the Atos contract to deliver WCA.

Helpfully from the Government’s point of view, criticism of the role of Atos has often obscured concerns about the policy itself, in spite of the fact that the design of the assessment itself is the problem. Professor Harrington was appointed to review the process and recently announced that he is quitting after his third review is completed. Paul Farmer of MIND also stepped down from the Harrington Scrutiny Panel, highlighting a variety of concerns about the WCA. The WCA contract was a poisoned chalice and any provider delivering this contract would have faced similar criticisms.

The policy has also had serious implications for another initiative, the Work Programme (discussed in previous posts), with the flow of customers in receipt of ESA significantly below the estimates provided by DWP to bidders when commissioning the Work Programme. The scale of appeals against WCA decisions has created this logjam in the system, which was not anticipated. The effect of this has been that many charities in the Work Programme who expected to work with ESA customers have seen little or no referrals, whilst the financial models of primes have been affected given that this customer group attracted the biggest financial payments.

Work Programme providers are also required to recommend customers for benefit sanctions – this is an integral part of the design of the programme and providers face consequences if they don’t carry out this aspect. As with WCA however, it is providers who have faced criticism (in this case for their role in sanctioning customers) when the design of this sits with the Department for Work and Pensions. Sanctions are a policy decision and they can only be implemented by DWP – they are not a provider decision.

The outsourcing of both PIP and WCA are examples of the Government’s open public services agenda in practice, whereby public services are opened up to greater competition from the private (and to a lesser extent voluntary) sector. Previously both the WCA and PIP could and would have been delivered ‘in-house’ by Jobcentre Plus. But with outsourced provision, badly designed policies such as WCA and the Work Programme can lumber on while the media and others focus on what’s ‘gone wrong’ with a particular provider. What price open policy then, when providers are effectively being paid to cover for poor policies – at least for a while?