A09Delivery risk: AmberGate: pending
Offer evidence-based employment support alongside healthcare
Existing action A09, assessed at the same scope.
Provisional single-reviewer assessment; not an approved business case.
- Who and where
- Adults with health conditions or disabilities who want to work, in England and Wales. (from the action record) Jurisdiction: England and Wales.
- Result so far
- Range if completed: 17.0–20.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
- Funded now (baseline)
- Connect to Work has taken referrals since April 2025 and aims to support about 300,000 people by 2029/30; IPS also operates in NHS mental health services. The proposal here is to hold it to fidelity and integrate it with care, not to start something new. (from the action record)
- The change assessed (marginal)
- Fidelity reviews, NHS integration and an impact evaluation inside Connect to Work. (from the superseded 4 October selection table)
- Domain home: Jobs & pay
- In the national plan: Growth and prosperity list
- Previous version: NP3: Put employment support alongside healthcare for people who want to work (4 October 2026 slate, superseded 7 October 2026).
- The evidence trail for this option →
What the evidence supports—and the next decision
Evidence for supported employment is relevant, but it does not establish the additional effect of improving an already commissioned service.
AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.
- Define the change
- Select a Connect to Work delivery area with a documented fidelity or NHS referral gap. Compare the specified improvement with its funded delivery plan.
- Test whether it works
- Sustained employment and earnings at 6 and 12 months, health and participant experience; compare eligible participants offered the improvement with a credible comparison group. Record who never enters the service.
- Establish the cost
- Additional employment-specialist, clinical and supervision hours × loaded rates, plus data and evaluation. Deduct only costs genuinely displaced; never count the whole programme award as a new cost or saving.
- Protect against harm
- Participation stays voluntary. Monitor selection of easier cases, job quality and health deterioration.
Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.
Full assessment of Offer evidence-based employment support alongside healthcare: ten criteria, scenarios, delivery, costs and monitoring
The ten criteria (0–3)
Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.
Scale and severity (Sc)3 of 3 — Severe harm across a broad population
Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.
Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery
Reviewer’s reason: Specify cohort and voluntary offer; secure clinical referrals, trained employment specialists, employer links and linked-data evaluation. A missing rating requires a defined marginal change.
Confidence in the proposed action (Ev)1 of 3 — Indirect, mixed, modelled or weak causal support
Reviewer’s reason: Trials exist, but effects differ by setting; pooled out-of-work groups showed no employment impact. Do not infer a uniform national growth effect.
Expected incremental benefit (Bn)1 of 3 — Small
Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.
Reason and score disagree — under review
Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards
Reviewer’s reason: Clinical displacement; unsuitable pressure to work; variable fidelity.
Incremental affordability (Co)Not yet assessed
Reviewer’s reason: Cost integration, staff caseloads, clinical time, data and follow-up against commissioned provision.
Delivery capacity (Ca)1 of 3 — Binding scarce resource
Reviewer’s reason: Specify cohort and voluntary offer; secure clinical referrals, trained employment specialists, employer links and linked-data evaluation.
Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens
Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.
Meaningful first outcome (Ti)2 of 3 — More than one and up to three years
Reviewer’s reason: First meaningful outcome, not announcement: Sustained employment, earnings, health and wellbeing versus a comparator.
Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step
Reviewer’s reason: DWP, health commissioners and local employment partners; Targeted delivery and evaluation
Four weightings
Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.
- Equal weights: Range if completed: 17.0–20.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Evidence doubled: Range if completed: 16.4–19.1 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Scale doubled: Range if completed: 18.2–20.9 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
- Cost ignored (the funding gate still applies): Range if completed: 18.9–18.9 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.
Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.
Delivery risk and gate
Delivery risk shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.
Review’s reason: Cost integration, staff caseloads, clinical time, data and follow-up against commissioned provision.
Why it is not Green yet
- Scope (population, place and increment) not verified against the delivery baseline.
- No verified owner with the powers in place.
- Delivery capacity not verified.
- Lifetime incremental costs not complete.
- No credible funding (a committed allocation for the scope).
- Safeguards not specified.
- Monitoring lacks a metric, a data source or a baseline.
Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.
Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).
Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).
The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.
Cost and funding
Lifetime costing: Partial — some lines costed, no whole-life total. Review: “Full incremental costing not established in reviewed material”.
- Connect to Work grant and programme costs, 2025–26 to 2028–29 (complete for scope; C-CTW-2025-29)
- Connect to Work costs, 2029–30 to 2031–32 (complete for scope; C-CTW-2029-32)
- NHS clinical integration, referral and supervision for IPS (not costed; C-A09-NHS)
Still to cost: Cost integration, staff caseloads, clinical time, data and follow-up against commissioned provision.
Funding status: indicative costing or partial funding.
Owner, powers and capacity
Proposed owner: DWP, health commissioners and local employment partners (proposed, unverified).
Powers: needs a decision or allocation. Capacity: binding constraint.
Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).
- England:
- DWP and local authority delivery areas (Connect to Work), with NHS commissioners (action record)
- Scotland:
- not assessed
- Wales:
- DWP and local authority delivery areas (Connect to Work), with NHS commissioners (action record)
- Northern Ireland:
- not assessed
Connect to Work covers England and Wales; Scotland and Northern Ireland run their own employment support.
Dependencies, safeguards and risks
Depends on: None recorded.
Safeguards
None specified yet.
Risks and residual harms: Clinical displacement; unsuitable pressure to work; variable fidelity.
Monitoring and measured results
Metric: Sustained employment, earnings, health and wellbeing versus a comparator.
Data source: Not yet named. Baseline: Not yet established.
Measures already on the domain page
- Economically inactive because of long-term sickness, aged 16–64: latest 2.74 million (Jun–Aug 2026); baseline 2.08 million (Oct–Dec 2019) (United Kingdom).
A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.
Evidence for the outcome
Outcome: Sustained employment, earnings, health and wellbeing versus a comparator.
Trials exist, but effects differ by setting; pooled out-of-work groups showed no employment impact. Do not infer a uniform national growth effect.
Sources: gov.uk (not yet in the source register)
Effect records for this action
- Working 13 or more weeks in the year after joining (out-of-work participants): +4 percentage points (22% vs 18%) (evaluated, moderate confidence; West Midlands Combined Authority)
- Working 13 or more weeks in the year after joining (people in work but struggling): +3 percentage points (evaluated, limited confidence; Sheffield City Region)
- Self-reported health (EQ-5D-5L) at 12 months: +0.10 standard deviations (evaluated, limited confidence; Sheffield City Region)
SWOT points it addresses
- 2.74 million people aged 16–64 were economically inactive because of long-term sickness, against 2.08 million at the end of 2019.
- Health-linked employment support has been tested in large UK randomised trials: for out-of-work participants in the West Midlands it raised the share working 13 weeks or more in a year by 4 percentage points.
- Match the route to the barrier: paid jobs and apprenticeships for young people ready to work, and health-linked support for people out of work through ill health.
Review record
Assessment status: Provisional single-reviewer assessment; not an approved business case.
Reviewer: Original assessment author (name not supplied). Reviewed: 6 October 2026.
Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.
First 90 days (review): Produce a signed scope and current-delivery baseline; Specify cohort and voluntary offer; secure clinical referrals, trained employment specialists, employer links and linked-data evaluation. Obtain incremental costs and an accountable decision before expansion.
Decision route: Targeted delivery and evaluation
An earlier assessment exists on the 4 October 2026 selection table (nine H/M/L bands; superseded 7 October 2026). Its bands are kept, not converted into these scores.
An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.