Tag: Assessment

DWP accused of altering disability assessment reports to cut or end successful claims

gail

Pictured: Gail Ward, who was told that she did not qualify for Personal Independence Payment, despite living with a rare and potentially life-threatening heart condition – Prinzmetal’s angina – attacks can occur even when she is resting. She also had other health problems. Remarkably, Gail was told by the DWP that she doesn’t qualify for PIP. She won her appeal after waiting 15 months for her case to be heard at a social security tribunal.

It has been claimed that officials within the Department for Work and Pensions (DWP) have edited or removed thousands of work capability assessment reports submitted by privately contracted healthcare professionals.

It’s alleged that officials reduced qualifying points awarded during face-to-face assessments, delivered by ‘independent’ private firms, and in some cases disposed of the reports entirely.  

The Daily Record reports that during the last year paperwork was altered or amended in around 1,840 cases, while a further 460 applications were branded ‘unacceptable’ and simply binned.

In 2018, I raised concerns that the DWP were quietly editing people’s assessment reports for Personal Independence Payment (PIP) and Employment and Support Allowance (ESA), to reduce or end claims for disability support. I reported that a man with multiple sclerosis and mental ill health lost his PIP award after his original assessment report was dishonestly edited during a DWP ‘audit.’

Officials had clearly tampered with the assessor’s original report. The man only discovered the ‘audited’ version of his health assessment report when he asked for copies to make an appeal. He had been in receipt of the basic level of support for two years when he was summoned to be re-assessed for PIP, which is non-means tested and designed to help with the extra cost of living with debilitating conditions.

The original assessment document said the man, has “regular specialist input”. The ‘audited’ version says he does not. The report outlines the patient’s MS, depression and anxiety and tells of his difficulties with tasks including cooking, dressing and washing. The nurse noted his clothes were dirty and his top inside-out. The ‘auditor’ had removed the second point.

The ‘auditor’ changed a part which said the man needed supervision or prompting to wash or bathe, and a section on preparing food. The original said he “needs prompting” but the ‘audited’ version said he could prepare and cook a simple meal himself. In every section of the report where the man scored points towards his PIP award, the ‘auditor’ had reduced his score to zero, without contacting him to ask for information. This tampering with the original report was done without informing the claimant, and therefore without giving him an opportunity to clarify the original report or challenge the altered version of his account. 

He was accidentally sent ‘before and after’ audit copies of his assessment, highlighting the DWP editing designed to trivialise the impact of his medical conditions on his day to day living circumstances, and to remove points for his award eligibility. 

The Daily Record reports than an estimated 11,760 assessment reports were secretly graded by DWP officials as acceptable, unacceptable, or amended.

DWP officials graded around 980 health assessments per month, with up to 200 of these being amended every month, while 20 to 50 were deemed “unacceptable” and rejected outright.

However, the number of amended reports is likely to be much higher because the DWP only publishes data from Independent Assessment Service forms (formerly known as Atos).

The Daily Record also says that 33,670 assessments in total were audited from two private companies contracted by the DWP to carry of disability assessments for PIP. 

SNP MP Marion Fellows commented: “It is concerning that thousands of health reports are being tampered with each year by people who weren’t even present for the assessment.

“There must be a complete halt to audits and an inquiry into the UK Government’s rigged health assessments.

“DWP auditors, who aren’t present during assessments, should not be able to mandate changes which could bear heavily on peoples’ lives.

“Changes should not be made by so-called health professionals who didn’t even carry out the original assessment. This is a clear injustice that must be corrected.

“People have spoken to me about how they feel they are degraded in their assessments.

“For the whole process to be a sham and for the assessment to be undermined by auditors is infuriating.”

The DWP said: “We are absolutely committed to ensuring people receive the support they are entitled to.

“That is why assessments are carried out by qualified health professionals and we continue to work with them to ensure quality is continuously improving.

“Sometimes assessment reports are returned to providers to ensure we have as much information as possible to reach an accurate decision.”

That’s clearly untrue. Information is most often actually removed at ‘audit’ by the DWP.  And inaccurate decisions are unacceptably high. The high success rate indicates that clearly, something is seriously wrong with the system.

Last year, around two thirds of cases heard at tribunal in Great Britain found in favour of the claimant. In Northern Ireland, the figure was around 54% in 2018-19. The rise in the percentage of successful appeals came despite a drop in the overall number of cases being heard at court.

This raises concerns about the overall quality of decision-making in the DWP – both on PIP and ESA, in the apparent push to remove support unlawfully from as many disabled people as possible in the name of austerity.

The hostile environment

The introduction of mandatory reconsiderations in 2013 and cuts to legal aid have deterred many people from appealing. Mandatory Reconsideration don’t seem to function as a genuine check to ensure the original decision is fair and accurate, instead it is an administrative hurdle for claimants to clear, leaving them without any support while the DWP review the original decision. Furthermore, there were targets in place for DWP decision-makers to uphold around 80% of the original DWP decisions.

The DWP have claimed that the largest single reason for the high success rate of those claimants appealing DWP disability benefit adverse decisions. However, the Department has failed to explain why it takes until the appeal stage for evidence to come to light. In almost half of cases the “new evidence” presented was oral (not medical) evidence from claimants, which arose most often during the appeal process. It is difficult to understand why this information was not, or could not have been elicited and reported by the assessor.

The DWP’s attempt at explanation does not absolve the Department of responsibility. It certainly fails to address or explain how a target for upholding original decisions is compatible with ensuring that questionable reports are thoroughly investigated, and clearly flawed, inaccurate decisions identified and corrected.

Government guidelines for assessments are aimed at invalidating disabled peoples’  accounts of their experiences of illness and disability

The government produced guidelines that says assessors must look for ‘inconsistencies’ in disabled people’s accounts. Assessors are told: “All evidence must be interpreted and evaluated using medical reasoning, considering the circumstances of the case and the expected impact on the claimant’s daily living and/or mobility. When weighing up the evidence, it is important to highlight any contradictions and any evidence that does not sufficiently reflect the claimant’s health condition or impairment or the effect on their daily life.”.

This means that rather than focusing on written medical evidence and verbal evidence provided by the claimant, the assessor is looking for any evidence that may be used to discredit the claimant’s account of their disability from the start. 

Disabled peoples’ benefits assessments are carried out on behalf of the Department for Work and Pensions by the private contractors Capita, the Independent Assessment Services (formerly called Atos) and Maximus. However, it is the DWP that makes the decisions regarding a person’s eligibility for social security support.

The government guidance document for PIP assessments (section 3.4 onwards) says that “audit processes are in place for auditing the quality of assessments through:

• DWP Lot-wide audit (random sample); and
The provider – Approval-related audit (for trainees).

And: “Audit has a central role in ensuring that decisions on benefit entitlement, taken by DWP, are correct. It supports this by confirming that independent Health Professional advice complies with the required standards and that it is clear and medically reasonable. It also provides assurance that any approach to assessment and opinion given is consistent so that, irrespective of where or by whom the assessment is carried out, claimants with conditions that have the same functional effect will ultimately receive the same benefit outcome.”

It goes on to say: “The DWP Independent Audit Team carries out lot-wide audit, which is an audit of a controlled random sample from across each contract Lot, feeding in to routine performance reporting for DWP.”

Where a report is deemed ‘unacceptable’: “Any changes made to forms should be justified, signed and dated. It should be made clear that any changes are made as a result of audit activity. Where necessary a new report form should be completed.”

The government guidelines also say that: “Any challenge to the reason DWP has returned a case to the Provider for rework must be made via the nominated rework Single Point of Contact (SPOC).”

In the event of a dispute regarding a request for an assessment report to be changed, “the final decision on whether the case requires rework rests with DWP and not the assessor.” 

So ultimately, an official at the DWP who was not present when a person was assessed, may decide that the assessment report is ‘reworked’, and use non-transparent criteria to change the facts established and recorded during the assessment.

This means that the person making the claim has no opportunity to challenge the changes made to ‘reworked’ reports before the decision is made regarding the claim. 

Over the last few years, evidence has mounted that disability benefits are being reduced or removed from people on fabricated grounds. Disability News Service (DNS) has  carried out an investigation into claims of widespread dishonesty in the disability benefit system. The research found more than 250 PIP claimants who have alleged assessors repeatedly lied, ignored written evidence and dishonestly reported the results of physical examinations. It’s a regular occurrence for disabled readers to read the reports of their benefit assessment, and find a statement of their circumstances, an event or comment that never happened.

For example, one person with a serious spinal injury who is wheelchair-bound was baffled by the comment on her assessment report which said she could bend to feed her dog and could take it out for a walk. She said she doesn’t have a dog, and has never had one. 

The government produced guidelines that says assessors must look for ‘inconsistencies’ in disabled people’s accounts. For example, if a person says they lack dexterity in their hands, but they are wearing jewellery, it will simply be assumed that they can open and close the clasp. They won’t be offered an opportunity to clarify that this is the case. 

In my own PIP assessment report n 2017, it said that the HP had to prompt me several times because of my lack of concentration. She also acknowledged that I needed aids to remember to take my medication. Yet the report is riddled with inconsistencies and inaccuracies. It was concluded that there is no evidence that I have any ‘cognitive difficulties’ because I have a degree (from 1996), and worked as a professional – social work (before I became too ill to work in 2010.) 

It was also mentioned that I had a driving licence as further justification for removing a point, but the report failed to mention I have not been able to drive since 2005 because of flicker-induced seizures, even though I made that clear. I therefore lost one point – which meant I was not awarded the enhanced rate. The reasons provided were not justified, since the assessor referred to events and periods of my life when I was not ill and disabled.

As well as widespread allegations of fabricated reports, secret filming has produced claims of a culture of targets, in which assessors are allegedly monitored to ensure they don’t find excessive numbers of disabled people eligible for benefits, and mounting evidence of toxic punitive measures. As one former jobcentre adviser put it when describing her role with benefit claimants, there were “brownie points for cruelty”.

Consequences of the DWP’s hostile environment

The Conservative’s welfare reforms have led to “grave and systematic violations” of disabled people’s rights, a United Nations (UN) inquiry has concludedChanges to social security “disproportionately affected” disabled people, the United Nations Committee on the Rights of Disabled Persons (CRPD) found.

The UK was the first country to be investigated under a UN convention it has been signed up to since 2007.

However, the government said it “strongly refuted” the committee’s findings and its “offensive” view of disability. Many disabled people, charities and campaigners submitted evidence to the United Nations for the inquiry. The government’s response was offensive.

The committee launched an investigation in 2012 after receiving evidence from individuals (I submitted evidence) and disability organisations about an the adverse impact and harm of government reforms on disabled people. The government have refused to act upon the findings and recommendations of the UN report.

Last year, the DWP disclosed that over 21,000 ill and disabled people died waiting for their PIP assessment to be completed, between April 2013 and 30 April 2018.

Sarah Newton, then Minister of State for Disabled People, published the figures on 11 January following a question raised in parliament by Labour MP Madeleine Moon in December: “How many people have died while waiting for their personal independence payment assessment to be completed; and what were the conditions those people died from?”

Newton responded: “All benefit claims can be made under the special rules for people who are terminally ill which will mean that they are fast tracked. These are currently being cleared within 6 working days for new claimants to PIP. The Department would encourage all claimants with a terminal illness to let the department know and to apply using the special rules.

The cause of death of PIP claimants is not collated centrally by the Department.”

Over 3.6 million applications to PIP were made between April 2013 and 30th April 2018. Of these:

  • 4,760 claimants died between their case being referred to, and returned from, an assessment provider;
  • 73,800 claimants died within 6 months of their claim being registered; and
  • 17,070 claimants died after registering but prior to the DWP making a decision on their claim. Details of the claimant’s primary medical condition, where recorded, are in the accompanying spreadsheet.”

The total number of PIP claimants who died was 95,000. But Newton’s response does not indicate at what stage of their claim the 73,800 people, who died within six months of it being registered, were at. Nor does it indicate what those people who did not have terminal or degenerative illnesses died of – including those with mental illness. For example, 270 of those mortalities are listed as having had anxiety and/or depressive disorders as their primary disorder.

Of those who did have terminal illnesses, we need to ask why these people were  cruelly left waiting so long for their assessment, if, as Newton claims, they are ‘fast tracked’ through the claim and assessment process.

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced. Of course the ever-shrinking category of “those with the greatest need” simply reflects a government that has made a partisan political decision to cut disabled people’s essential income to fund a financial gift to the wealthiest citizens. There is no justification for this decision, nor is it remotely “fair”, as the government claims. 

We also need to ask how and why McVey had those figures in advance of the assessments taking place.

It’s become very evident since that ‘those in the greatest need’ are not being served by social security.  Disabled people are suffering distress, harm and some are dying as a consequence of government policy. The DWP end disabled people’s support any way they can, it seems. And when they can’t find a reason, they edit the evidence to attempt to justify their brutal and incoherent decision making.

In August 2013, Mark Wood starved to death at his home in Oxfordshire after his ESA was stopped.

David Barr, from Glenrothes, Fife, also died that month, having taken his own life following an assessment that deemed him “fit for work”, resulting in the withdrawal of his ESA. He had a long history of serious mental health problems. 

On 23 September 2013, a father-of-two, Michael O’Sullivan, took his own life at his flat in north London. He had a long history of significant mental ill-health.

In November 2015, Paul Donnachie killed himself at his home in Glasgow. His ESA was stopped in error, but the letter informing him of the DWP’s mistake arrived too late. His body was found when the council came to evict him.

All of these people had significant mental health problems, and there are countless others, many whose names are never likely to be known, other than by grieving family and friends. These deaths are inextricably linked to decisions and actions taken by Conservative ministers and senior civil servants from the early days of the 2010 coalition government.

Every one of their deaths could and should have been avoided.

The Disability News Service (DNS) reported more recently that Errol Graham weighed just four-and-a-half stone when his body was found by bailiffs who had knocked down his front door to evict him. He had just a couple of out-of-date tins of fish left in his flat, because the DWP had wrongly stopped his ESA. He starved to death, and his rent support had been stopped as a consequence of his ESA claim being ended. The DWP failed to follow safeguarding rules in their haste to end his claim. He was also denied PIP, which left him without any income whatsoever. 

DWP civil servants had failed to seek further medical evidence from his GP, just as in many other tragic cases that have sparked repeated calls for an independent inquiry into links between the deaths of claimants and the actions and failings of the DWP. The government have consistently refused to acknowledge a correlation between their actions and the death of disabled people, so have no intention of investigating the evidence. 

Assistant coroner Dr Elizabeth Didcock, who heard the inquest, was told that the DWP stopped Graham’s ESA entitlement – and backdated that decision to the previous month – after making two unsuccessful visits to his home to ask why he had not attended a face-to-face work capability assessment (WCA) on 31 August 2017. The inquest heard that it was standard DWP procedure to go ahead with stopping the benefits of a claimant marked on the system as vulnerable after two failed safeguarding visits.

However, the DWP (somehow) managed to stop an ESA payment that had been due to be credited to his bank account on 17 October, the same day officials made the second unsuccessful safeguarding visit.

DWP’s own rules state that it should make both safeguarding visits before stopping the benefits of a vulnerable claimant.

Because Errol lost his ESA entitlement, his housing benefit was also stopped. His family says he had also been found ineligible for PIP. Deprived of all financial support, experiencing significant mental distress and unable or unwilling to seek help, he slowly starved to death. He was 57. His body was discovered on 20 June 2018 when bailiffs arrived at his Nottingham council flat to evict him for non-payment of rent. 

His benefits had been stopped even though he had been receiving incapacity benefit, and then ESA, for many years as a result of enduring mental illness and distress that had led to him being sectioned. Errol was clearly extremely vulnerable.

He had also told the DWP on an ESA form three years earlier that he could not cope with “unexpected changes”, adding: “Upsets my life completely. Feel under threat and upset…”

He added: “Cannot deal with social situations. Keep myself to myself. Do not engage with strangers. Have no social life. Feel anxiety and panic in new situations.”

The assistant coroner said: “There simply is not sufficient evidence as to how he was functioning, however, it is likely that his mental health was poor at this time – he does not appear to be having contact with other people, and he did not seek help from his GP or support agencies as he had done previously.”

She concluded in the narrative verdict, delivered last June, that the “safety net that should surround vulnerable people like Errol in our society had holes within it”.

Those ‘holes’ are a consequence of deliberate, ideologically driven anti-welfare policies. They have intended consequences. The government assumes that people treated unfairly will appeal wrong decisions. Firstly, many people are far too ill to cope with the stress of that process. Secondly, it should never be primarily the role of courts to allocate social security fairly. That is the official role and purpose of the DWP.  However, the government department is clearly failing to fulfil its role. This is because the neoliberal ideology that drives austerity policies is incompatible with the central principles of social security. 

She continued: “He needed the DWP to obtain more evidence [from his GP] at the time his ESA was stopped, to make a more informed decision about him, particularly following the failed safeguarding visits.”

She said that a consultant psychiatrist had told the inquest “that Errol was vulnerable to life stressors” and that it was “likely that this loss of income, and housing, were the final and devastating stressors, that had a significant effect on his mental health”.

But she decided not to write a regulation 28 report demanding changes to DWP’s safeguarding procedures to “prevent future deaths” because the department insisted that it was already completing a review of its safeguarding, which was supposed to finish last autumn.

The DWP had promised her it would “listen to clients and to those representing them, and… ensure that the DWP was focused on support and safety for vulnerable people”.

Dr Didcock insisted that this commitment “must be converted into robust policy and guidance for DWP staff” and that the DWP must ensure that “all evidence that can reasonably be gathered is put together about a client, before a benefit is ceased”.

Disability News Service also highlights that the death of Errol Graham closely mirrors other tragedies caused by the DWP’s repeated refusal to make significant improvements to its safeguarding policies and practices.

Denise McKenna, co-founder of the Mental Health Resistance Network (MHRN), said the network was “absolutely devastated and saddened beyond words to hear of the circumstances surrounding the death of Mr Graham”.

She said: “We are enraged that the DWP continues to treat the lives of people who live with mental distress as disposable.

“This level of cruelty is outside of anything that would happen in a civilised society.

“The fact that Mr Graham had not responded to attempts to contact him following his failure to attend the work capability assessment (WCA) should have raised alarm bells over his safety, but instead the DWP took the opportunity to stop his social security entitlements.”

And there’s the truth: the government have created a hostile environment for disabled people that is heavily weighted towards preventing successful claims, taking its lessons from rogue multinational insurance companies such as Unum, who have systematically employed strategies to pay out insurance only as the last resort, rather than on the basis of need. 

And if the evidence doesn’t suit the politically desired outcome – as outlined by the likes of Esther McVey –  it can always be edited or disposed of by the DWP.

Hostile environment McDonnell

 


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Disabled people claiming PIP are being forced to go through two assessments

PIP pic

Benefits and Work have reported that a number of their members in recent weeks have been been made to go through a second Personal Independent Payment (PIP) assessment before a decision is made on their award, because there was a problem with the first assessment report.

One member faced a two hour assessment on Christmas Eve. In January they were contacted by Capita and told that the assessment was “incomplete” and that someone was to be “sent round to finish it.”

Capita have refused to say what information was missing and would not provide a copy of the report until it was complete.

One member told Benefits and Work:

“This has left me feeling very anxious. All they would say is that they needed further information as the last assessment was incomplete. I’m confused. I feel that they want to trip me up even though I was completely truthful about my conditions in the last assessment.”

I co-run an online group to support people going through PIP and Employment and Support Allowance claims, assessments, mandatory review and appeals. Our members are also reporting that this is happening to them, too.

One person told me: “After suffering two heart attacks and a quadruple bypass plus a brain tumour and a previous devastating head injury , which will never be “cured” he was told to apply for PIP.

“Three months later and the lady sent from a brain injury charity, to help him , phoned up the Department for Work and Pensions regarding his assessment and they denied having any knowledge of said assessment and said it will have to be done again.

“The stress is unbearable for my partner.

“Horrendous.”

Another person said: “I had my assessment in November. I rang to see why I wasn’t told a decision just before Christmas and was told I would need another assessment as the one I’d had didn’t give enough evidence to make the decision.

“I collapsed at the assessment in the examination because I was told to stand up from my wheel chair and I can’t. What more evidence do they need? I have rheumatoid arthritis and a severe spine injury, they have medical evidence from my doctor? I can’t face it all again. The stress is making me very poorly.”

Another member had almost completed their assessment when it was suddenly stopped and they were told they would have to return for a new, full assessment. The only reason they were given was that the assessment should have been done by a physiotherapist instead of a nurse.

One Benefits and Work member took her son for a PIP assessment which lasted 2 hours and 15 minutes. However, this person was then told that the assessor had not filed the report so they would have to return for a new assessment.

The new assessor took 1 hour and 30 minutes. The assessor claimed that she had the original report on screen and would take information from that, but she did not actually do so. As a result our member did not give some of the information that had been covered in the first report.

The member said:

“I was too worried at the time to complain but I did contact my MP.”

Another member was contacted after their assessment in December and told that she would have to attend a second assessment in February before a decision on her claim could be made. When they asked why:

“I was told it was to do a more robust assessment and that if I didn’t attend they would refuse my claim.”

The person concerned is understandably very anxious about the repeat assessment:

“I am in total meltdown mode and if the first one is anything to go by I’m dreading the next one. I was so stressed and anxious I could barely control myself but did manage to answer all the questions they asked.”

One member’s 16 year old child is about to be moved from Disability Living Allowance (DLA) to PIP. They had an assessment in December but have now been asked to attend a second one before a decision is made.

The member commented:

“So I guess we just go to the 2nd assessment and do it all again then? Just what a overly anxious child wants eh!!”

Another member had their PIP assessment in December as part of the process of moving from an indefinite DLA award. However, in January they were contacted by Capita who said that the DWP had requested further information and they would have to have a further assessment. Capita have not said what further information is needed or why it can’t be collected by phone.

The member said:

“I am sick with worry I was already suffering with even more anxiety than usual due to going through this process.”

The PIP assessment process is enormously stressful for many people. To have to go through it twice with no adequate explanation as to why seems unfair and unreasonable. At the very least, people should receive a letter of apology and an explanation of why a telephone conversation would not be sufficient to put matters right.

Please consider complaining to your MP if this happens to you.

Benefits and Work are interested in hearing from anyone else who has been forced to attend two assessments.  Please click on the link and leave your comment here.

You can also leave a comment on this article, as I will be sending this information to government and shadow ministers.

 


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DWP disclose controversial mortality rates of those awaiting PIP assessments

Image result for PIP assessments kittysjones

The Department for Work and Pensions (DWP) has disclosed that over 21,000 ill and disabled people died waiting for their Personal Independence Payment (PIP) assessment to be completed, between April 2013 and 30 April 2018. PIP is claimed by people with a range of health conditions and disabilities, many of which are chronic, degenerative or life limiting.

newton

Sarah Newton, the Minister of State for Disabled People, published the figures on 11 January following a question raised in parliament by Labour MP Madeleine Moon in December: “How many people have died while waiting for their personal independence payment assessment to be completed; and what were the conditions those people died from?”

Newton responded: “All benefit claims can be made under the special rules for people who are terminally ill which will mean that they are fast tracked. These are currently being cleared within 6 working days for new claimants to PIP. The Department would encourage all claimants with a terminal illness to let the department know and to apply using the special rules.

The cause of death of PIP claimants is not collated centrally by the Department.”

Over 3.6 million applications to PIP were made between April 2013 and 30th April 2018. Of these:

  • 4,760 claimants1 died between their case being referred to, and returned from, an assessment provider;
  • 73,800 claimants died within 6 months of their claim being registered; and
  • 17,070 claimants died after registering but prior to the DWP making a decision on their claim. Details of the claimant’s primary medical condition, where recorded, are in the accompanying spreadsheet.”

The total number of PIP claimants who died was 95,000. But Newton’s response does not indicate at what stage of their claim the 73,800 people, who died within six months of it being registered, were at. Nor does it indicate what those people who did not have terminal or degenerative illnesses died of – including those with mental illness. For example, 270 of those mortalities are listed as having had anxiety and/or depressive disorders as their primary disorder.

Of those who did have terminal illnesses, we need to ask why these people were  cruelly left waiting so long for their assessment, if, as Newton claims, they are ‘fast tracked’ through the claim and assessment process.

Newton also warns on her data release: “This is unpublished data… It should be used with caution and it may be subject to future revision.”

There is, however, an Excel spreadsheet that indicates some of the primary conditions of those people who have died. But we cannot assume that those mortalities have arisen as a consequence of the recorded condition.

The DWP are experts at reluctantly providing data that lacks both context and details, which, they often say, they simply don’t collate. And 9,020 people’s main condition was not recorded at all by the DWP.  There is no means of useful comparison between mortality rates year by year, or a reference point to start from. A similar statistical analysis of Disability Living Allowance (DLA) claimant mortalities would help us establish a useful baseline. 

I rang the DWP press office on Friday for a response and to ask for details of DLA claimant pre-assessment mortality rates, and was promised an email that has not arrived. 

Personal experience

As someone who has undergone both Employment and Support Allowance (ESA) and PIP assessments, I know from personal experience they are dehumanising, and  the stress they create exacerbates the symptoms of chronic illness. I have lupus. 

Back in 2013, I wrote about the terrible impact of  stressful, continuous work capability assessments on disabled people, particularly those with chronic illness. It’s long been understood that distress exacerbates the symptoms of both physical and mental illness. In my case, the ESA assessments and subsequent Tribunal were so stressful that the process itself created a deterioration in my mental health at the time.

My physical symptoms worsened to the point where I became severely underweight at less than seven and a half stones. I was often left without enough money to buy food and keep warm. I also have Raynaud’s, which means I have to keep warm. My rheumatologist prescribed a chemotherapy – methotrexate – and other immune suppressants to halt the rapid acceleration in disease activity and to try and stop the subsequent wake of permanent widespread damage being done to my body. 

Those exacerbations were stress-related, and have left a wake of damage to my joints, nerves, tendons, organs and blood cells, and, together with the treatments, the severe illness flares have irrepairably damaged my immune system, leaving me even more susceptible to serious infections like pneumonia, abcesses, kidney infection and an abnormal immune response to those – sepsis.

I was very poorly when I claimed ESA, but was critically ill by the time I was forced to appeal the DWP’s decision that I was ‘fit for work’.  

A government that cared about monitoring the impact of its’ policies on vulnerable citizens would do a much better job of collating and recording information about mortalities, and would also present a context that permits us to make meaningful comparisons. Instead, we see the Conservatives micromanaging information with expedience, while claiming that there is “no causal link established” between policy and any increase in harm or mortality.

However, the government have no grounds for making that claim, since there has been a persistent refusal to carry out a cumulative impact assessment of the welfare reforms, or to open an inquiry regarding the many concerns raised and cases presented where people have suffered harm, distress and premature mortality, indicating a correlation with the government’s policy changes.

Although correlation isn’t the same thing as causality, it often implies causality. Without further investigation, we cannot say that there is or isn’t a causal relationship between punitive policies and distress, harm, premature mortality. But we can say there is an association evident. It’s worth bearing in mind that much social science research establishes correlations, not causality.

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

The Department for Work and Pensions have issued a guidance document for providers carrying out assessments for PIP. It can be found here: PIP Assessment Guide. From the document: “The HP should check the consistency of what is being said by using different approaches, asking questions in different ways or coming back to a previous point. When considering inconsistencies, HPs should bear in mind that some claimants may have no insight into their condition, for example claimants with cognitive or developmental impairments.”

This approach – “checking for inconsistencies” by using indirect questioning and assumption is NOT “objective”. It is a calculated strategy to justify a starting point of disbelief and skepticism regarding the accounts provided by ill and disabled people about the impact of their conditions and disabilities on their day-to-day living. As such, it frames the entire assessment process, weighting it towards evidence gathering to justify refusing awards, rather than being “objective”, as claimed.

It’s simply a method based on side-stepping and discounting people’s own accounts of their experiences of their disability, and any medical evidence submitted to verify that.

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced. Of course the ever-shrinking category of “those with the greatest need” simply reflects a government that has made a partisan political decision to cut disabled people’s essential income to fund a financial gift to the wealthiest citizens. There is no justification for this decision, nor is it remotely “fair”, as the government claims.

It becomes easier to disassociate from someone you view “objectively” and to distance yourself from the impact of your calculated and target-led decision-making, constrained within a highly political framework. Such an objectification of a person or group of people serves to de-empathise us, which is a key characteristic requirement of neoliberal ideology, embedded in inhumane “small state” policy and extended via administrative (and outsourced, privatised) practices. It leaves us much less likely to relate to the circumstances, emotions or accept the needs and choices of others.

Surely a considerable part of our experience of being objectively diagnosed as ill and/or disabled, in any case, is initiated by a person’s subjective experience of it, rather than categories and counts; quantifiable, reductive and speculative statements about how we may perform highly specific tasks.

Quantitative medical evidence is important, because it does often give a general indication of conditions that would entail loss of function. But considering medical evidence isn’t a central part of the assessment process. Whether or not we can perform certain tasks, and inferences drawn from that are the central considerations for PIP eligibility.

The tasks I was asked to perform at assessment were not related to those I carry out from day to day. Consequently, as they were unfamiliar, I had no idea what I could and couldn’t actually do. It was a shocking experience for me to learn how much mobility I have lost in my hands, wrists, shoulders and neck. It was also very painful attempting what looked like simple movements, which the assessor demonstrated as she conducted the examination. Because she moved quickly from one movement to another, I had no time to assess if I could do the activities. I was trembling because of the pain and effort, and couldn’t understand why I was struggling with what looked like basic movements. I left in a lot more pain than when I arrived. My shoulder and calf swelled inexplicably during the assessment and I couldn’t walk for over a week afterwards.

Many conditions “fluctuate” – they vary so much that it’s difficult to assess performance of specific tasks consistently. Many conditions become progressively worse at a varied pace, often leaving little scope for a person developing coping strategies and adapting their everyday lives to the changes as they happen, such as a progressive loss of mobility, cognitive impairment, mood changes, anxiety, depression, sleep disruption and other psychological impacts, and the increasing pain and fatigue that they may experience.   

If the process were genuinely “fair, accurate and objective” then there would be no need for mandatory reviews and scrutiny through the appeals process. The introduction of the mandatory review – another layer of bureaucracy and a barrier to justice, where the DWP decide whether their first decision should be changed – has deterred many from appealing wrong decisions.

Those making the decisions about PIP awards are: “trained DWP staff who are familiar with the legislation governing PIP, but who do not have a healthcare background. The HP enables CMs to make fair and accurate decisions by providing impartial, objective and justified advice.”

The PIP assessment is geared towards looking for “inconsistencies” in “functional limitations”. For example, if you say you can’t sit unaided for half an hour, but then say that you watch soaps on TV, it will be assumed you sit unaided for at least half an hour to watch TV, and that will be classed as a “discrepancy between the reported need and the actual needs of the claimant.”

The whole assessment process is set up and designed to look for “inconsistencies.” In other words, the assessor is looking for any excuse to justify a decision that you are not among those in “greatest need” for a PIP award. The entire process happens within a framework of reducing welfare costs, after all. This makes a mockery of the government’s fondness for using the words “objective” and “fair.”

What has become clear is this so-called support for those who are “in the greatest need” is not working for disabled and ill citizens. It most certainly does not help disabled people maintain their dignity and support them in independent living.

It is not such a big inferential leap to conclude that continually cutting essential lifeline support for ill and disabled people will ultimately lead to harm, distress, hardship and other negative consequences, and will, ultimately, have wider political, social, cultural and economic “adverse” consequences, too.

dpac


For people who can’t translate the coded statement at the foot of the Excel Spreadsheet, it says:

These figures include claims made under both Normal Rules and Special Rules for the Terminally Ill and include new claims and Disability Living Allowance (DLA) to PIP reassessment claims. · This is unpublished data from the PIP computer system (PICS) management information. It should be used with caution and it may be subject to future revision. · Claimants may often have multiple disabling conditions upon which the decision is based but only the primary condition as recorded on the PIPCS. · Figures are rounded to the nearest 10 and ‘#’ is used for totals of greater than 0 but less than 5. · Components may not sum to totals due to rounding.


 

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A man with multiple sclerosis lost his PIP award after assessment report was dishonestly edited during ‘audit’

 

DWP

A man with multiple sclerosis and mental health problems had his personal independence payment (PIP) stopped after officials tampered with the assessor’s original report.  The man only discovered the ‘audited’ version of his health assessment report when he asked for copies to make an appeal.

He said that no one spoke to him or the nurse who carried out the assessment before the report was altered and his PIP was stopped.

The man had been in receipt of the basic level of support for two years when he was summoned to be re-assessed for PIP, which is non-means tested and designed to help with the extra cost of living with debilitating conditions.

Private companies Atos and Capita carry out the tests across the UK, but Atos contractor Salus do much of the work in Scotland.

His local SNP MP, Marion Fellows, said: “The tampering of a health assessment report by someone who wasn’t even in the room is utterly disgraceful and deceitful.

“It shows that, for many people, the system is rigged against them and the outcome is a foregone conclusion.”

An approved nurse at Salus Glasgow carried out the assessment in September last year. The Daily Record has seen the original and ‘audited’ versions of the man’s report.

The original document said the man, diagnosed with multiple sclerosis (MS) last year, has “regular specialist input”. The ‘audited’ version says he does not.

The original report outlines the patient’s MS, depression and anxiety and tells of his difficulties with tasks including cooking, dressing and washing. The nurse noted his clothes were dirty and his top inside-out. The ‘auditor’ had removed the second point.

The ‘auditor’ changed a part which said the man needed supervision or prompting to wash or bathe, and a section on preparing food. The original said he “needs prompting” but the ‘audited’ version said he could prepare and cook a simple meal himself.

An ATOS assessment form which Marion Fellows MP claims was altered by officials (Image: Daily Record)

While the original report said that the man had “regular specialist input” and took regular medication for mental health, the altered report stated that he “has no regular specialist input”.

The man, who is from Motherwell, said: “They didn’t ask me any more questions, they just decided to go back and change the document. I’d say this can’t be a one-off situation.

“It’s disgusting. It’s picking on the weak.”

Fellows, MP for Motherwell and Wishaw, wrote to Atos and the Department for Work and Pensions (DWP) in August about the ‘audit’.

Atos, who now call themselves Independent Assessment Services, told her they did not choose which reports were audited. They wrote in an email: “This happens on a random basis. However, independent DWP audits are a DWP process.”

The DWP wrote in their reply to the MP: “If a health professional’s advice is of poor quality which could result in an incorrect decision, the case will fail the audit activity.”

Fellows said that in every section of the report where the man scored points towards his  PIP award, the ‘auditor’ had reduced his score to zero.

She added: “It is outrageous.

“It isn’t even clear who carried out the audit, as Atos say it was the DWP and the DWP say it was someone independent from them.

My constituent is now going to tribunal.

“This sums up the Tories’ austerity-driven welfare regime, which attacks the most vulnerable.

“There needs to be a complete halt to these audits, and an inquiry so that whoever is responsible is held to account.”

The government guidance document for PIP assessments (section 3.4 onwards) says that “audit processes are in place for auditing the quality of assessments through:
• DWP Lot-wide audit (random sample); and
• The provider – Approval-related audit (for trainees).

And: “Audit has a central role in ensuring that decisions on benefit entitlement, taken by DWP, are correct. It supports this by confirming that independent Health Professional advice complies with the required standards and that it is clear and medically reasonable. It also provides assurance that any approach to assessment and opinion given is consistent so that, irrespective of where or by whom the assessment is carried out, claimants with conditions that have the same functional effect will ultimately receive the same benefit outcome.”

It goes on to say: “The DWP Independent Audit Team carries out lot-wide audit, which is an audit of a controlled random sample from across each contract Lot, feeding in to routine performance reporting for DWP.”

Where a report is deemed ‘unacceptable’: “Any changes made to forms should be justified, signed and dated. It should be made clear that any changes are made as a result of audit activity. Where necessary a new report form should be completed.”

The government guidelines also say that: “Any challenge to the reason DWP has returned a case to the Provider for rework must be made via the nominated rework Single Point of Contact (SPOC).”

In the event of a dispute regarding a request for an assessment report to be changed, “the final decision on whether the case requires rework rests with DWP and not the assessor.” 

So ultimately, an official at the DWP who was not present when a person was assessed, may decide that the assessment report is ‘reworked’, and use non-transparent criteria to change the facts established and recorded during the assessment.

This means that the person making the claim has no opportunity to challenge the changes made to ‘reworked’ reports before the decision is made regarding the claim. 

There is increasing evidence that disability benefits are being removed on flimsy and fabricated grounds. Disability News Service (DNS) has been carrying out an investigation into claims of widespread dishonesty in the disability benefit system, with more than 250 PIP claimants alleging assessors repeatedly lied, ignored written evidence and dishonestly reported the results of physical examinations. It’s a regular occurrence for disabled readers to read the reports of their benefit assessment, and find a statement, of an event or comment that never in fact happened.

The government produced guidelines that says assessors must look for ‘inconsistencies’ in disabled people’s accounts. For example, if a person says that they cannot bend because of spinal problems, but they have a pet, such as a cat or dog, a decision will be made that the person making the claim can bend to feed the pet. 

In my own PIP assessment report last year, it says that the HP had to prompt me several times because of my lack of concentration. She also acknowledged that I needed aids to remember to take my medication. Yet the report is riddled with inconsistencies and inaccuracies. It was concluded that there is no evidence that I have ‘cognitive difficulties’ because I have a degree (from 1996), and worked as a social worker (before I became too ill to work in 2010.) It was also mentioned that I had a driving licence as further justification for removing a point, but the report failed to mention I have not been able to drive since 2005 because of flicker-induced seizures, even though I made that clear. I therefore lost one point – which meant I was not awarded the enhanced rate.

As well as widespread allegations of fabricated reports, secret filming has produced claims of a culture of targets, in which assessors are allegedly monitored to ensure they don’t find excessive numbers of disabled people eligible for benefits, and mounting evidence of toxic punitive measures. As one former jobcentre adviser put it when describing her role with benefit claimants, there were “brownie points for cruelty.

Last year, figures released by the government indicated that neither Atos nor Capita – the private companies contracted by the government – paid more than £500m to assess people for Personal Independence Payments (PIP) – are actually meeting the target of 97% of assessments conforming to standards. 

The government released the data to the Commons Work and Pensions Committee, which was due to take evidence from Atos and Capita regarding the assessments.

While private companies carry out the assessments, it is the DWP that makes the final decision on whether to award people financial support. However, those decisions are informed by the contents of reports that privately contracted ‘health professionals’ write during the assessment process.

One of the current performance measure – which sees an independent team pick cases at random – was launched in March 2016. Under the previous method, the private providers audited assessments themselves. 

The NAO found last year that the number of completed ESA assessments were below target, despite an expected doubling of the cost to the taxpayer of the contracts for disability benefit assessments, to £579m a year in 2016/17compared with 2014/15.

The NAO said that nearly 1 in 10 of the reports on disabled people claiming support were rejected as below standard by the government. This compares with around one in 25 before Atos left its contract. The provider was not on track to complete the number of assessments expected last year and has also missed assessment report quality targets.

The proportion of Capita PIP tests deemed ‘unacceptable’ reached a peak of 56% in the three months to April 2015.

For Atos, the peak was 29.1% for one lot in June 2014. 

More than 2.7million people have had a DWP decision regarding PIP since the benefit launched in 2013 – this suggests that tens of thousands went through an ‘unacceptable’ assessment.

However, it’s difficult to acertain what ‘unacceptable’ actually means, in light of the fact that the DWP orders some reports are ‘reworked’. This editing may – and undoubtedly has – result in grossly inaccurate final reports which in turn inform a fatally flawed and unjust decision-making process, aimed at declining disabled people’s claims for lifeline support.

 

Related

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

Thousands of disability assessments deemed ‘unacceptable’ under the government’s own quality control scheme

 


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Our social security has been redesigned. It’s now a welfare deterrent

PIP

Hunger and desperation used quite ruthlessly by a “health care professional” to controversially justify refusing a disability support claim. Access to food banks can only happen if you are referred by a professional, such as a doctor or social worker. Furthermore, you can generally have a maximum of only 3 referrals per year. The ESA and PIP eassessment guidance says that a person must be able to walk the distance specified “reliably, consistently, safely and in a timely manner.”

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Iain Duncan-Smith struggled financially once, but then he got off his backside and was given a Tudor mansion by his father-in-law, the fifth Baron Cottesloe, which proves rewards come to those prepared to make an effort.  Reuters.

“Universal Credit doesn’t go far enough – work won’t pay until people are running naked through stinging nettles to get their benefits.

As Universal Credit develops, it can encourage other skills, so if your electricity has been cut off, you have to screw your application form into a ball and dribble it through a line of cones before kicking it into a bucket. That way you can soon come off benefits and earn £5m a year as a winger for Manchester City.” Mark Steel, writing for the Independent

The Conservative notion of “deserving” and “undeserving” poor is a false dichotomy. No-one deserves to be poor

“Deserving” is a politically divergent word if there ever was one. The Conservatives have used it to apparently wage an all out class war, using austerity as a smokescreen. They certainly don’t take the side of the proverbial underdog. In fact the more need you have, the less this government considers you “deserving” of support and sympathy.

Policies aimed at people with what are politically regarded as “additional needs” are largely about ensuring your compliance, conformity and commitment to “behavioural change”, on the assumption that people somehow erroneously “choose” to need financial support. Claiming any form of state support has come to entail a deeply hostile and extremely challenging process that is causing psychological distress and often, physical harm, to our most vulnerable citizens. There are plently of examples of cases where this has happened documented on this site alone.

Such a disciplinarian mindset is now embedded in social security policy, rhetoric and administration. But we’ve been here before, back in 1832, when the Poor Law Amendment Act was aimed at categorising and managing “deserving” and “undeserving” poor. Those considered “deserving” were unfortunately placed in workhouses and punished by a loss of citizens freedoms and rights, in order to “deter” people from being poor. (See also The New New Poor Law, 2013.)

I’ve yet to come across a single case of someone being punished out of their poverty. Someone ought to send every government minister a copy of Maslow’s hierarchy of human needs, and remind them all that our post-war social security was originally designed and calculated to ensure people could meet the costs of basic survival needs, such as for food, fuel and shelter.

It was recognised back then that people struggling with basic survival requirements were highly unlikely to fulfil other higher level psychosocial potential, such as looking for work. If we want people to find work, we must first ensure they have the necessary resources to do so. And that the work available will make a real difference to their standard of living. 

Poor people don’t create poverty, state decision-making does. The economy and labor market conditions do. The punitive approach to poverty didn’t work in the 1800s and 1900s, and it isn’t working and can’t possibly be made to work now. It’s an ideological dead horse. It died because of the brutal and unrelentless use of too much political brutality, the heavy hand of the state offering all stick and no carrots for poor people.

Being poor is itself punishing enough. Now the poor are being punished for being punished with poverty.  No-one chooses to be poor, our overarching socioeconomic organisation is founded on the very principles of competition. Neoliberalism invariably means there will be a few “winners” (1%) and a lot of “losers” (99%). It’s embedded in the very nature of such a competitive system that emphasises individualism, rather than collectivism, to create increasing inequality and poverty. 

It’s worth considering that people on low pay, or with part-time hours in work are also being sanctioned, if they claim “top up” benefits to supplement their exploitative rate of pay or poor and unstable work conditions. This fact is hardly a good advertisment for the government’s claim of “making work pay”, unless of course we refer back to the poor law reform “deterrence” of 1834. Apparently, making welfare sufficiently punitive to deter people from claiming it is how we make work pay, not by raising wages in line with the cost of living. Silly me. I mistook a propaganda soundbite at face value. It seems old ideolologies die hard, with a vengeance.

Apparently it’s an individual’s fault for not “progressing in work”. Nothing to do with increasingly precarious employment situations, executive decision-making, or a deregulated labor market, of course. 

In-work benefits have effectively subsidised employers’ wage costs. Yet low paid workers are being punished by the government for this state of affairs.

It’s not so long ago that we had a strong trade union movement that used collective bargaining as a method of improving wages and working conditions. But the free market ideologues don’t like trade unions, or welfare provision. They like a neat, tidy and very small, limited interventionist state. Or so they claim.

The paradox, of course, is that in order to reduce supportive provisions, and dismantle the welfare state in order to fulfil the terms and conditions of neoliberalism, the government has to implement strategies that ensure citizen compliance. Many of those strategies are increasingly authoritarian, rather than “non interventionist”, in nature.

It’s not the welfare state, but the state of welfare that is the pressing problem

Private companies have become more firmly embedded in the core concerns of all departments of government in designing and delivering on public and social policies, and policies have become increasingly detached from public need, and more directed at meeting private interests, largely involving making huge and private profits. The Conservatives don’t seem to consider that rogue private businesses like G4S, Atos, Maximus, A4E, and so on, are extensions of the state, fulfilling what are, after all, state-determined functions.

Of course this creates an imbalance between the role of the welfare state in aiding private capital and its role in maintaining and supporting labor, and fulfilling the basic needs of citizens. Corporate welfare underpins neoliberal economies, and it costs the public far more than reduced public provisions promises to save.

In January 2016, the National Audit Office (NAO) published its evaluation of the DWP’s health and disability assessment contracts. It said the cost of each Work Capability Assessment (WCA) had risen from £115 under Atos to £190 under Maximus. The report also states that only half of all the doctors and nurses hired by Maximus – the US outsourcing company brought in by the Department for Work and Pensions (DWP) to carry out the assessments – had even completed their training.

The NAO report summarised:

5.5
Million assessments completed in five years up to March 2015

65%
Estimated increase in cost per Employment and Support Allowance (ESA) assessment based on published information after transfer of the service in 2015 (from £115 to £190)


84%
Estimated increase in healthcare professionals across contracts from 2,200 in May 2015 to 4,050 November 2016

£1.6 billion
Estimated cost of contracted-out health and disability assessments over three years, 2015 to 2018

£0.4 billion
Latest expected reduction in annual disability benefit spending

13%
Proportion of ESA and Personal Independence Payment (PIP) targets met for assessment report quality meeting contractual standard (September 2014 to August 2015).

Before 2010, cuts to disability support were unthinkable. Now the Treasury regards our provision as their pocket money for tax cuts for the very wealthy

This summary reflects staggering economic incompetence, a flagrant, politically motivated waste of tax payers money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people. Some people are dying after being wrongly assessed as “fit for work” and having their lifeline benefits brutally withdrawn. Maximus is certainly not helping the government to serve even the most basic needs of sick and disabled people.

However, Maximus, and other private companies involved in the delivery of welfare programmes are serving the needs of a “small state” doctrinaire neoliberal government, and making a massive profit in doing so. It would cost much less to simply pay people the support they were once simply entitled to. However, the Conservatives are systematically dismantling the UK’s social security system, not because there is an empirically justifiable reason or economic need to do so, but because the government has purely ideological, anticollectivist prescriptions. 

As well as the heavy cost of each assessment to the public purse, there is also the considerable cost of many tribunals, because of the many “wrong decisions”on the part of the Department for Work and Pensions. That’s despite the fact that the government introduced another layer of bureacracy in the form of “mandatory review” in order to deter appeals. People going through mandatory review for a decision to stop their ESA cannot claim ESA again until after mandatory review (if you need to appeal, you can claim ESA once you have the review decision), and so are forced to either try and claim Universal Credit, going 6 weeks at least without any support, or to wait out the Review outcome, which has no set time limit, but usually takes at least 6 weeks for the decision about the original decision. Which is usually the same decision as the original decision, due to outrageous targets that were revealed in the department’s response to a Freedom of Information request, that stated staff conducting mandatory reconsideration reviews were held to a “key performance indicator” that said “80 per cent of the original decisions are to be upheld”.

This is a government that claims social security is “unsustainable” and a “burden” on the public purse, yet has no problem with an extraordinary profligacy with public funds and dispossessing tax payers when it comes to implementing “cost-cutting” and draconian welfare “reforms.” Conservative anti-welfare dogma and traditional prejudices are costing the UK billions of pounds. 

The Tories are all about ideology and not facts. As two authors astutely noted recently, the government seems to be driven by an idea that creating the conditions of purgatory for those they consider “undeserving” will somehow cleanse, redeem and purify people into not being so sinfully poor.  So it’s not actually “welfare” any more, but rather, it’s a “correctional” institution, for coercing citizens into conformity, compliance and a class contingent meekness, with a liberal dash of the protestant work ethic in with the catholic inquisition flavoured ingredients in the mix. Yes, the nasty authoritarian Conservatives really do think like this.

Disability support is virtually impossible to access for many people that doctors consider severely disabled, and involves a measured and ritualised humiliation. The assessments are solely designed to look for “discrepancies” in people’s accounts of how their illness/disability impacts on your day to day living. In other words, it is aimed at looking for reasons, no matter how flimsy, to ensure that welfare support for disabled and ill people is pretty much unobtainable.

Those questions you are asked by the (inappropriately named) Health Care Professional (HCP) that seem like innocent conversation, such as “Do you watch TV? Do you like the Soaps?” translate onto a report that says “Can sit unaided for at least half an hour”. “Do you have a pet?”becomes “Can bend to feed cat/dog.” “Do you use the internet at all?” becomes “No evidence of focus or cognitive difficulties, adequate hand dexterity.”

If you wear any jewellry, that may be noted and used as evidence that you have dexterity in your hands, even if you have severe arthritis and can’t fasten your buttons or a zip,  you won’t be asked if you ever remove your locket/ring/earrings. It will be assumed that you do. It’s a kind of opportunism of neglect and assumption used by HCPs to justify refusing some elements of PIP, or all of your claim. Or it’s the difference between being placed in the ESA Support Group, being placed in the WRAG on the lower award, or simply being refused an award altogether, and told you are “fit for work”. 

If you are unfortunate enough to need a referral to a food bank, and you actually manage to get to the appointment,  because you are desperate, that may also be used as evidence that you can walk further than 200 or 500 metres, even if you can’t, and managed to get a lift there and back.

Challenging such ridiculous assumptions wears you down. It creates distress when someone acting as a gatekeeper to the support you need dismisses your medical reports and account with such disdain, just stopping short of calling you a liar. Challenging the reasons provided for the DWP refusing you a PIP or ESA award is tedious, very stressful and time consuming and tiring. I’m sure that if you manage to do so successfully, even the fact that you managed to collate evidence, ask you doctor for supportive evidence and so forth may be used as evidence that you can function too well to warrant any support. If you demonstrate any ingenuity in coping with your condition, you’ve basically had it.

Once upon a time, support for disabled people was designed to help us remain independent, and to enable us to participate in society. PIP is non means-tested and people can claim it (allegedly) whilst in work.

However, I worked for social services until I became too ill to work. I loved my job, and my salary was very good, too. It was a terribly dehumanising experience to have to face the fact I was no longer well enough and fit for my post. 7 years later, at my PIP assessment, it was decided that my previous job “proved” that I don’t currently have “any cognitive problems.”

That’s despite the assessor acknowledging  in the report I now even need an aid to remember to take my treatments and medications, and that during the appointment, I had to be reminded several times what I’d been asked, as I kept forgetting what I was supposed to be answering. I have systemic lupus erythematosus (SLE), and cognitive dysfunction is very commonly experienced  symptom of this illness

People have even been refused PIP at appeal because they “spend too much time on Facebook.” Too much for what, exactly? Last time I checked, there were no laws in place that meant sick and disabled citizens were prohibited from using social media. Since when did it become acceptable for government officials to endorse and promote the social exclusion of disabled people online? 

But apparently, contradictions and paradoxes are allowed if you happen to be the assessing HCP. The report said that I was “thin” abut “adequately nourished”. She didn’t check my vitamin and mineral levels at all. Nor did she ask me about what I ate and how often. She just said that the aids I have were “adequate” (a perch stool, easy to use tin opener and specially designed easy to use cutlery, which are not especially designed for disabled people, but are easier for me to use because of the handle design and the steak knives instead of standard ones.)

What’s the point of welfare “support” if so few people are able to access it, despite their obvious need?

The United Nations (UN) inquiry into the allegations many of us made regarding the systematic abuse of the human rights of disabled people in the UK has exposed the multiple injustices of targeted cuts and the disproportionate burden of austerity heaped on sick and disabled people, their carers and their families, evidencing and detailing the effects of a range of policy measures affecting them that have been introduced since 2010. These include the bedroom tax and cuts to disability benefits, funds to support independence and social care.

The report concludes that the overall effect of what is now an essentially punitive welfare regime, which has been based almost entirely on unevidenced political claims and assumptions, has had an extremely detrimental and regressive effect on the rights of disabled people, to live independently, to meet their basic needs, to seek and stay in work,  and to be able to live an ordinary life as citizens.

The UN report documented multiple violations of disabled people’s rights, including the way that they are politically portrayed as being lazy and a “burden on taxpayers”, the harm to health caused by unfair assessments, the cuts to legal aid and curtailed access to justice, the imposition of the bedroom tax and the ending of the Independent Living Fund.

I wrote a lengthy article about the unsurprising but nonetheless disquieting report findings and recommendations, as I read throughit at the time, here.

The government have of course indignantly refused to accept the findings of the UN, or accept the accounts of individuals and campaigners like me, disability groups and charities, and other organisations. That’s because the government prefer to cling relentlessly to free market dogma and their traditional prejudices rather than face empirical evidence, facts and truths.

The days of genuine support, to ensure disabled people can maintain dignity and independence, and to be socially, economically, politically and culturally included, are gone. PIP and ESA focus exclusively on what you can’t do: on “functionality”. If you walk your dog or take a holiday, this is taken to somehow indicate that you are not ill or disabled enough to need support. In fact the media turns you into some kind of nasty folk devil and state parasite for trying to live as normal life as possible. If the government and media had their way, we would be trapped indoors in abject misery, or institutionalised.

How dare we try to live an ordinary life.

The government have formulated draconian policies aimed particularly at disabled people. And unemployed people, low paid people, and young people. And migrants. And old people who, like many disabled people, have paid in contributions towards a welfare system, should they need it, but now they also have to work until they drop.

Hey, and you thought governments are elected to meet public needs and spend our money wisely? No, apparently we’re here to serve government needs, to behave exactly as the Conservatives think we should. 

Welfare as a deterrent to… well, welfare.

 

Image result for poverty welfare punishment

And social security has been redesigned to punish those citizens who have the misfortune to find themselves in poverty.

 


 

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PIP assessments are dehumanising, degrading, very distressing and potentially harmful

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I co-run a support group for people going through Employment and Support Allowance (ESA) and Personal Independent Payment assessments and appeals. I have heard many people’s harrowing experiences of these assessments, I have written about them, and I’ve written critically about the assessment process itself. However, it isn’t until you experience one of these assessments for yourself that you may fully appreciate just how utterly distressing, surreal, degrading and dehumanising the process actually is. Or how potentially harmful.

I had my first ever Personal Independence Payment (PIP) assessment today. I have systemic lupus and pulmonary fibrosis, among other problems, all of which affect my mobility and capacity to live independently, day-to-day. My consultant is a rheumatologist and more recently, I have been seeing a pulmonary consultant. Other specialists I sometimes need to see are a neurologists, opthalmologists, physiotherapists and haematologists.

After a bout of pneumonia and sepsis earlier this year, which almost cost me my life, a follow-up scan found further lung problems, which have probably been ongoing for some time. Fibrosis can happen as a result of connective tissue illnesses like lupus, scleroderma or rheumatoid arthritis. It can also happen to people whose conditions have been treated with a chemotherapy called methotrexate – which I was given from 2012 onwards. My mother, who had rheumatoid arthritis, died suddenly of pulmonary fibrosis in 2009. The coroner said it was a complication of her illness, not because of a treatment. She was never given methotrexate.

The interview part of the assessment seemed okay, initially. I provided further evidence regarding my recent assessment, undertaken by my local council’s Occupational Therapy Service, which led to the prescription of aids and appliances in my home. The assessment report was quite clear about my basic medical conditions and day-to-day mobility limitations. I was asked about medication. I explained that following my second appointment with my new rheumatologist, I was prescribed some new medications, including one for secondary Raynaud’s syndrome, which has arisen because of my having lupus, as a complication.

A recent thermal imaging and microvascular study shows that this condition has got worse over time, and so my rheumatologist prescribed a treatment called Amlodipine. It concerned me that the Health Care Professional looked confused and skeptical when she asked for a list of my medication, and she said that this is a treatment for high blood pressure, she seemed to disbelieve what I had told her. I explained that I don’t have high blood pressure, and that calcium channel blockers such as Amlodipine are used for more than one condition, such as certain types of angina – which I also don’t have – and secondary Raynaud’s syndrome, which I do have. 

I was asked about the impact of my illnesses on my day-to-day living. At one point I explained that I find preparing and chopping food difficult because of the tendonitis in both wrists. I have been diagnosed with De Quervian’s Tenosynovitis, which makes putting any weight or strain on my wrists very painful.

I was also concerned that I was then asked if I have had my wrists splinted. This shows a lack of understanding about my condition. I have had splints but it did not make any difference to my wrists. I was diagnosed with De Quervain’s syndrome by my rheumatologist and a physiotherapist in 2011, but had the problem for considerably longer. As my physiotherapist pointed out, my wrists are not injured or strained through overuse and so won’t get better with rest or splinting. This is because they are damaged by a chronic systemic inflammatory disease process that is ongoing, and he told me it is medication rather splinting that is needed to try to manage the level of inflammation in my body as a whole.

Splinting my wrists is akin to putting a plaster cast on a knee affected by rheumatoid arthritis, or a plaster on cancer. It won’t help at all. That the HCP didn’t seem to understand the difference between the chronic inflammatory symptoms of connective tissue disease and curable strain and injury related conditions bothered me.

Another thing that bothered me is that I was asked about the frequency of my periods of severe illness and how that impacts on my ability to manage things like personal care. She wanted an actual number of days, which of course is impossible to give with any precision when you have a fluctuating condition. Sometimes I struggle getting dressed and spend days on end in my pyjamas, and the HCP asked me “how often”? I tried to give an average number of days per month, but because the acute flares of my illness vary so much from month to month, week to week, that was very difficult to do. She also seemed impatient that I struggled to try and work out an average. I have cognitive problems as a result of my illness.

Another problem is that I struggle with washing my hair sometimes, and she demanded to know how often I need assistance with that task. The best I could do was to explain that when I have no help, I can go up to two weeks at a time with matted, unwashed hair. I felt embarrased and ashamed enough in having to discuss these personal difficulties with someone I have never met, but it was made to feel somehow like a confict, that part of the discussion. I felt that if I didn’t provide precise and quantified “evidence”, the qualitative details – my experience of my disability – would not be taken seriously by the HCP. 

Another problem with the assessments that worries me is that there was nowhere near enough time to discuss the complex impact of all my complex medical conditions and wide-ranging symptoms on my day-to-day life.

The ‘examination’

After discussion of my conditions and how my illnesses impact on upon my day-to-day living, I was asked to do some tasks during an examination, which have left me in a huge amount of pain. I also felt stripped of dignity, because I struggled to manage the exercises and felt very anxious and distressed. I was shocked at some of the tasks I was asked to do, and also shocked at the fact I couldn’t actually undertake a number of these tasks. My shock turned to anger later, as I had to leave in significantly more pain that I had arrived with at the start of the appointment. I was also asked to do each of the unfamiliar tasks and exercises in quick succession, which made assessing any likely pain and potential damage difficult before trying to do them.

It is also a traumatic experience to suddenly discover that your illness has insidiously robbed you of a degree of mobility that you previously assumed you had. That is always a shock. 

Last year, my GP was carrying out a standard examination and smear, when my hips locked painfully, as I tried to move my legs. She couldn’t completeher examination and the procedure as my egs would not move. After this, she told me to not get up for a while, and she described the experience – discovering that my mobility had been painfully restricted by my illness – as “traumatic.” It was.

I have, among other problems, very painful inflammatory arthritis and tendonitis in my knees, hips, spine, Achilles’ tendons and ankles. Because the inflammation and damage is bilateral and symmetrical – affecting both knees, both hips, both ankles and both Achilles’ tendons equally, and across my lower spine – it leaves me unable to compensate for pain, stiffness and weakness by shifting my weight and balance onto another limb, as that is also weak, stiff and painful. It leaves me unsteady. I often use a stick to stop me falling over, but as an aid for walking, it’s pretty useless generally, because my shoulders, elbows and wrists also won’t take any of my weight.

The inflammation process causes marked stiffness as well as severe pain, and so restricts my mobility. I was asked to “squat down” at the start of the examination. I refused, and told the assessor that I couldn’t do that. It would have certainly caused me severe pain and possibly an injury. As I can’t support weight on my shoulders and wrists – I also have osteoporosis in my wrists and hands –  had I tried and fallen backwards, I may have easily ended up with a fractured bone. I was horrified at being asked to do that. I struggled to equate the “health care professional” with what I had been asked to do, and felt confused and shocked that she had asked me to do something that may have been harmful.

I also felt that the HCP may have misconstrued my comments that I couldn’t undertake this task as an unwillingness to cooperate, as she looked unhappy about it. She did ask why, and I explained. I felt that trying some of the other tasks she set, which looked to be less dangerous, would at least demonstrate that I wasn’t being uncooperative, and most looked like they wouldn’t inflict any damage at first glance, when she demonstrated them.

However, other exercises I tried to do resulted in my neck locking and severe pain when I was told to turn my head to look over my shoulder – and couldn’t. I have neck problems through longstanding inflammation there and an upper spine injury involving a displaced vertebrae, which is sometimes very painful. In addition, the problems in my shoulders also contributed significantly to the level of pain when I turned my neck, and my neck clicked painfully at the base of my skull. 

I was asked to put my hands and wrists in positions that looked impossible to me. I tried, though. I was asked to line the backs of my wrists up with my hands flat, which I couldn’t do, and it hurt me a lot to try this.

Phalens-maneuver
This is called Phalen’s Manoeuvre. I was asked to do what is actually a provocative diagnostic test for carpal tunnel syndrome – which entails compression of the median nerve. The test provokes the symptoms of carpal tunnel problems, in the same way that the painful Finkelstein test provokes symptoms of severe pain in people with De Quervain’s. I have never been diagnosed with carpal tunnel problems, but I do have more than one diagnosis of bilateral De Quervian’s Tenosynovitis, as stated previously.

I tried to do this manoeuvre, even though it isn’t applicable to my condition (though I didn’t know that at the time, I have since researched the test, as I wanted to know why I couldn’t perform it). I couldn’t even get close to managing it, it hurt my shoulders a lot when I tried to align my elbows at right angles with my dropped finger tips, and I couldn’t drop my wrists fully due to an incredible pain and stiffness that I had not expected. The backs of my wrists simply painfully refused to meet.

I do struggle with pain when putting any weight on my wrists, but didn’t realise how much they had stiffened up, restricting their movement. Not being able to perform this movement doesn’t mean I actually have carpal tunnel syndrome. Nonetheless, I feel that given my previous concrete diagnosis, I was put through this painful and traumatic series of medical tests for no good reason. 

This is the problem with a short assessment of complex conditions. Many of my problems and diagnoses go back years, and only some of them are summarised neatly on my consultant’s report. My relationship with my new rheumatologist started in April, my old one moved in 2015. My new rheumatologist decided to “challenge” the previous diagnoses of two former rheumatologists. Her report to my GP was woefully inaccurate because she had not read my notes or listened to what I told herLong story short, she re-diagnosed me, inaccurately, with fibromyalgia, she didn’t read my notes, she sent me for tests and scans I had already had previously, whilst suspending my treatment pending results. The scans and tests took months. That resulted in a serious lupus flare, which culminated in a bout of pneumonia and sepsis. During the time I was in hospital, I was re-diagnosed with lupus following abnormal test results. My having lupus is thought to be the key reason why I had got so ill – unfortunately, lupus leaves me very susceptible to serious infections like pneumonia, kidney infections and sepsis. I now have a new rheumatologist who says I definitely have lupus.

Atos say they won’t carry out ‘diagnostic tests’ but they did.

In the appointment letter from Atos, it says: “The Health Professional will talk to you about how your health condition affects your daily life”. Much of this was covered with the council’s initial care plan report, but I did discuss my health issues and barriers to independence at length during the assessment.

The letter from Atos then says: “This will not be a full physical examination or an attempt to diagnose your symptoms.” 

My neck and shoulders are stiff, painful and I currently have limited mobility in them, yet I was asked to put my hands behind my head, raise my arms and so on. Loud joint cracking, popping, creaking and gasps of pain and my screwed up face didn’t stop the demands of what I felt was the impossible. I was actually sweating and trembling with the effort and pain, and still she did not stop the “examination”. I felt I couldn’t say no, as I would have seemed somehow unreasonable. I kept thinking that if I tried, gently, I was at least showing willing, and that would be okay, but unfortunately I wasn’t. 

It’s difficult to equate these artificial manoeuvres with day-to-day activities, and therefore it is also difficult recognise the impact it would have on my mobility limits before I tried them and to gauge how much a movement in isolation is going to hurt. 

Immediately following the examination/tests, my left calf has inexplicably swollen to twice its normal size, I could feel the uncomfortable tightness in it, and the swelling was visible through my jeans, whilst still with the assessor, and I commented on it.

My pain level has significantly increased everywhere. I had no groin or neck or elbow pain when I arrived until I was asked to do activities that were beyond my capability and that caused me a good deal of needless pain. I felt undignified trying to do those tasks, shocked and dazed at the pain, and sometimes, at how limited my movements have become. It was an extremely distressing and dehumanising experience. I was also shocked at how the effort made me tremble and sweat, and at how my clear distress was completely ignored by a so-called “health care professional”.

Of course I am going to make a formal complaint about this. It shouldn’t cause people so much pain and distress to be assessed for support. And any examination part of the assessment ought to take your medical conditions and descriptions of mobility constraints fully into consideration without such a grueling and painful examination regime.

It is worth bearing in mind that in addition to my own account, medical evidence from my rheumatologist was submitted in advance, and a report of recent assessments by a council occupational therapist who prescribed aids and adaptations, which clearly outlined my mobility difficulties, following two assessments, was also submitted. This was a report written by a qualified professional and was based on her own examination of my level of functionality and mobility while I tried to perform directed tasks in my home, such as climbing stairs, preparing food and using a bath board in my bathroom.

The fundamental difference between the assessments is that the one for my care plan allowed me to undertake tasks at my own pace, with dignity, and the Atos assessment did not. The former also felt like it was a genuine assessment of my needs, with support being the aim, whereas the latter felt like some sort of skeptic’s test to see if a way could be found to claim my account and those of my doctors were somehow incorrect. The Atos assessment was so horrifying because it felt like it was about reluctantly providing support for maintaining my independence as a very last resort only. 

According to the government’s PIP handbook, for a descriptor to apply to a claimant they must be able to reliably complete an activity as described in the descriptor. Reliably means whether they can do so:

 safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity.

The descriptors at no point demand that a person completes the Phalen manoeuvre or squats. The brief and painful completion of raising your hands above your head does not demonstrate either a fluctuating ability to do so, or your ability to hold your arms up long enough to, say, wash your hair and rinse it, even on a good day. Nor does it adequately account for severe pain, profound fatigue, coordination difficulty and breathlessness that often impact on any performance of that task. I did point this out, and the fact that the activities had left me in a lot of pain.

It’s now the day after my PIP assessment. I am still in a lot of pain with my joints and tendons. I feel ill, anxious, depressed and I am still shocked and angry. I can’t even manage to wash today. I have also developed pain on the left side of my chest, which feels rather like pleuritis. I feel really unwell, profoundly tired and haven’t felt this bad since my bout of pneumonia. The assessment hasn’t made me ill – I was already seriously ill. But it HAS exacerbated by symptoms. 

No-one should be made to feel worse because of an assessment for support. The activities I was asked to do should have been stopped when it became clear I was struggling. I stated I was in pain, I was visibly sweating, trembling, weak and clearly in a lot of pain with the effort, and as a “health professional”, the assessor should have halted that examination. I am very concerned that unintended harm may be caused by assessors conducting examinations because they do not have qualification, sufficient information or understanding about patients’ conditions.

My condition, for example, has left a trail of individual symptom diagnoses and medical data that goes back many years. With such a complex array of joint and tendon problems, I felt that there was absolutely no consideration of the impact that, say, a hand and wrist manoeuvre may have on a person’s damaged shoulders and elbows, as well as their wrists, or how a neck movement may impact on an upper spine injury and inflammatory shoulder problems, as well as the neck.

Given the assessment report I submitted and medical evidence, in addition to my own account, I feel that such a painful physical examination ought to be restricted to cases of absolute necessity. I don’t believe those simple isolated movements I was asked to do can possibly demonstrate he complex limitations on my day-to-day independence, and how I manage (or don’t) to cope with domestic tasks and general mobility.

The fact I couldn’t do some of them was both traumatising and humiliating, as well as very painful. I am still in a lot of pain as a result. 

The shame of being there to explain to a stranger about your illnesses, the intimate details of your life, your vulnerabilities and why you need help, is difficult enough, without the added distress of being coldly assessed by someone who doesn’t understand your conditions and does not care that what they ask you to do may be traumatising, painful and potentially very damaging.

Image result for PIP disability

Related

What you need to know about Atos assessments

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’ 

Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

Tory MP says PIP should only go to ‘really disabled’ people, not those with anxiety ‘taking pills 

Disabled mum took fatal overdose after she was refused PIP

Fear of losing disability support led a vulnerable man to a horrific suicide

Theresa May euphemizes savage cuts to PIP when confronted by an angry disabled person demanding democratic accountability


 

I don’t make any money from my work. But you can support Politics and Insights and contribute by making a donation which will help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated, and helps to keep my articles free and accessible to all – thank you.

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Essential information for ESA claims, assessments and appeals

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Essential Information for claims, assessments and appeals. 

There are three essential ideas to keep in mind when claiming Employment Support Allowance (ESA) because of the nature of the ESA50 form, and the fact that Atos are seeking to deny benefits, and NOT assess disability: this will not be a fair investigation of your health issues.

This information needs to be shared widely so people are made aware of them, and can use them when claiming ESA or appealing.

These very helpful ideas are:

  •  Reliably, repeatedly and safely
  •  Exceptional circumstances – Regulations 25 and 31, 29 and 35
  •  Atos assessments and pitfalls – how they try to deceive you

1. Reliably, repeatedly and safely. 

‘Lord’ Fraud made this statement in the House of Lords:

“It must be possible for all the descriptors to be completed reliably, repeatedly and safely, otherwise the individual is considered unable to complete the activity.”

You might be able to go up three steps once – but if cannot do it “reliably, repeatedly and safely”, in Freud’s own words you CAN NOT do it at all.

Apply the phrase “reliably, repeatedly and safely” all through your ESA50 or appeal form, use it on each of the descriptors. Make sure you state clearly which activities you can not do reliably, repeatedly, safely and in a timely manner, because Atos will otherwise assume you are consistently capable of them all.

2. Exceptional Circumstances – Regulations 25 and 31 for Universal Credit and Regulations 29 and 35 for current and ongoing ESA claims and Contribution-based ESA.

Regulations 25 and 31 will replace the old Special Regulations 29 and 35 from April 2013 for Universal Credit. This is in preparation for the abolishment of income-related ESA only, and not contribution-based ESA.

However, the old Regulations 29 and 35 still apply to ongoing cases that are not yet affected by Universal Credit, and will remain in place indefinitely for all Contribution-based ESA. So there are two sets of Regulations in place for Exceptional Circumstances.

Income-based ESA will be replaced by Universal Credit, as (or if) it is rolled out, but there will be the same additional financial components added as we currently have for ESA – you will be able to claim either the work-related activity or the support component.

The contents of both sets of Regulations are essentially the same. They are applied in the same way. 25 and 29 are for those who are not capable of work, and would usually be placed in the Work-Related Activity Group, and 31 and 35 apply to those not capable of work-related activity, and would normally be placed in the Support Group.

Because of the tick-box nature of the ESA50 form, it is likely that people will fall below the number of points required to be declared incapable of work – it doesn’t take into account variable illnesses, mental illness, or the effects of having more than one illness.

However, the Exceptional Circumstances Regulations may cover us – they both state that the claimant should be found incapable of work (Regulation 29 for ongoing ESA claims, 29 for Universal Credit) or work-related activity (Regulation 35 for ongoing ESA claims, 31 for Universal Credit) if:

  • they have an uncontrolled or uncontrollable illness, or “the claimant suffers from some specific disease or bodily or mental disablement and
  • by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work/work-related activity”.

If you feel this reflects your circumstances, then we suggest adding something like this, where you put “other information” on the ESA50:

“If the scoring from my answers above is insufficient, then I believe applying the Exceptional Circumstances Regulations would be appropriate due to the severity and interaction of my conditions, and my inability to reliably, repeatedly and safely encounter work-related situations and/or safely perform work-related tasks.

I am taking all available and appropriate medication as prescribed by my doctor(s), and there are no reasonable adjustments to a workplace which would mitigate my medical condition(s).

Therefore I believe being placed in the Support Group would be appropriate, because there would be a serious substantial risk to mental and/or physical health if I were placed into a workplace environment or in the work-related activity group.”

You can word it yourself, of course. Please change the wording to fit your situation, delete “mental” or “physical” if appropriate, leave both in if necessary. If your illness cannot be controlled at all, or medication can’t be used to control it, add that instead.

Regulations 29 (for ESA) and 25 (for Universal Credit) cover people who might be put in the Work-Related Activity Group (WRAG), which has work-focused activities, sometimes it has workfare placements, and sanctions may apply, while Regulations 35 (for ESA) and 31 (for Universal Credit) cover people who are not well enough for any kind of work activity. This is for people who might be placed in the Support Group. There are no conditions placed on you for getting your ESA, such as workfare, if you have limited capability for work-related activity.

You can ask your doctor to support you with this claim, as it is stated in the regulations:

“(b) evidence (if any) from any health care professional or a hospital or similar institution, or such part of such evidence as constitutes the most reliable evidence available in the circumstances” may be presented to support your case. 

You can ask for copies of any communication from your consultant to your GP. You can also ask to be copied into any further correspondence between your doctors. 

Here are some links so you can download and print off documents to give to your GP to support your claim or appeal. You ought to submit copies of these to the DWP as soon as you can. (Make sure that you keep a copy).

In some cases, this may mean that your case will be reconsidered in your favour without having to wait for a tribunal hearing.

These templates are for ongoing ESA claims and Contribution-based ESA:

(CLICK)   Cover letter for your GP

(CLICK)   ESA Appeals Letter for your GP

(CLICK)   Legal Advice of Counsel for GPs: Prevention of Avoidable Harm Interpretation and Application of ‘Substantial Risk’ ESA Regulations 29 & 35

With many thanks to the Black Triangle Campaign for these extremely helpful links and templates.

Please remember: Regulations 29 and 35 still apply to all ongoing ESA claims, and will remain in use for contribution-based ESA claims.

Regulations 25 and 31 apply to Universal credit when that is rolled out. If you are one of the few currently claiming Universal Credit in one of the pilot areas, and if you are not eligible for contribution-based ESA, Regulations 25 and 31 apply now. You may amend the print off documents for your GP, as they cite the Regulations most likely to be applicable at the moment.

The full text of the legislation appears at the end of this article (Appendix A).

3. The Atos assessment and what you need to know.

You have a right to ask for your assessment to be recorded. You will need to request this in advance, but it’s worth making sure you use this opportunity to gather evidence on record because in doing so, you make it much more difficult for the Health Care Professional (HCP) to disregard what you tell them and write “inaccuracies” in their assessment report. We would strongly recommend you exercise this right.

It’s also worth knowing that Atos don’t conduct “medical” assessments,  they conduct “disability analysis“. You are not a patient to Atos, you are a “claimant”.

Bear in mind throughout the assessment that your answers to any apparently innocent questions, such as:

  • Do you watch television
  • Do you read
  • Do you use the internet 

These may be translated into phrases for the assessment report such as:

  • Can sit unaided and unsupported for at least half an hour. 
  • Has no problems with concentration and focus
  • Has no visual problems

Assessment starts on the day of your appointment with the HCP reading the form you completed when you applied for benefit. Remember that every single question you are asked is designed to justify ending your claim for ESA and passing you as “fit for work.” That is what Atos are contracted to do by the Government. This is not a genuine medical assessment, but rather, an opportunity for the DWP to take away the financial support that you are entitled to.

Things that are noted from your form:

  • Did you complete the form yourself
  • Is the handwriting legible
  • Are the contents coherent

These observations are already used in assessing your hand function, your cognitive state and concentration.

Further observations made:

  • Do the things you have written add up, is there consistency
  • Does your medication support your diagnosis
  • What tests have you had to confirm diagnosis. For example a diagnosis of sciatica is not accepted unless diagnosed by MRI scan
  • Do you have supporting medical evidence from your GP or consultants. If you do, it shows that you are able to organise getting this information

When the HCP has read your form they input some data into the computer system. The assessment properly begins when they call your name in the waiting room.

At this point the HCP assesses:

  • Did you hear your name being called
  • Did you rise from your chair unaided, did the chair have support arms or not
  • Were you accompanied – assessing your ability to go out alone
  • Were you reading a paper while waiting – assessing your concentration
  • Did you walk to the assessment room unaided, did you use aids correctly. Did you navigate any obstacles safely – assessing sight

The HCP will shake your hand on introduction – assessing your handshake, noting if are you trembling, sweating – signs of anxiety. Note that you are under constant scrutiny. The HCP will often ask on the way to the assessment room:

  • How long you’ve been waiting – assessing your ability to physically sit, and appraising your mental state
  • How did you get here today – assessing your ability to drive or use public transport

Formal assessment begins by listing medical conditions/complaints. For each complaint you will be asked:

  • How long have you had it, have you seen a specialist
  • Have you had any tests, what treatments have you had
  • What’s your current treatment. Have you had any other specialist input e.g. physiotherapy, CPN

The HCP will use a lack of specialist input/ hospital admissions to justify assessing your condition as less severe. Medications will be listed and it will be noted if they are prescribed or bought. Dates will be checked on boxes to assess compliance with dosage and treatment regime. Any allergies or side-effects should be noted.

  • A brief note is made of how you feel each condition affects your life
  • A brief social history will be taken – who you live with, if have you stairs in your house or steps outside your house
  • An employment history taken – when you last worked, what you work entailed, reason for leaving employment

Your typical day – this is the part of the assessment where how you function on a day to day basis is used to justify the HCP decisions. Anything you say here is most often used to justify the HCP “failing” you and assessing you as “fit for work”. The HCP records their observations.

Starting with your sleep pattern, questions are asked about your ability to function. This will include:

  • Lower limb problems – ability to mobilise to shop, around the house, drive, use public transport, dress, shower
  • Upper limb – ability to wash, dress, cook, shop, complete the ESA form
  • Vision – did you manage to navigate safely to the assessment room
  • Hearing – did you hear your name being called in the waiting room
  • Speech – could the HCP understand you at assessment
  • Continence – do you describe incontinence NOT CONTROLLED by pads, medication. Do you mention its effects on your life when describing your typical day
  • Consciousness – do you suffer seizures – with loss of continence, possible injury, witnessed, or uncontrolled diabetes
  • The HCP observations include noting how far you walked to the examination room, watching to see if you removed your coat independently, did you handle medications without difficulty, did you bend to pick up your handbag

Formal examination consists of simple movements to assess limited function. Things the HCP also looks at:

  • Are you well-presented, hair done, wearing make-up, eyebrows waxed
  • Do you have any pets – this can be linked with ability to bend to feed and walk
  • Do you look after someone else – as a parent or carer – if you do, this will be taken as evidence of functioning
  • Are you doing any training, voluntary work, do you socialise – this will be used as evidence of functioning

This is not a comprehensive list, but it gives you an idea of how seemingly innocent questions are used to justify HCP decisions to pass you as “fit for work.”

Mental Health:

  • Learning tasks – can you use a phone, computer, washing machine
  • Hazards – can you safely make tea, if you claim you have accidents, there must be emergency services involvement, e.g. fire service. Near miss accidents do not count

Personal Actions:

  • Can you wash, dress, gather evidence for assessment
  • Do you manage bills

Other observations made by the HCP – appearance and presentation:

  • Coping with assessment interview – any abnormal thoughts, hallucinations, confusion, suicidal thoughts
  • Coping with change – ability to attend assessment, attend GP or hospital appointments, shopping and socialising

More HCP observations include:

  • Appearance, eye contact, rapport, any signs/symptoms that are abnormal mood/thoughts/perceptions. Any suicidal thoughts
  • How you cope with social engagement- appropriateness of behaviour – any inappropriate behaviour must have involved police to be considered significant
  • Your capacity to cope with the assessment, overall responses and level of engagement with the assessor

Again, this is not an exhaustive list, merely some examples.

Additional information:

Special cases: exemptions from assessment include – terminal illness, intravenous chemotherapy treatment and regular weekly treatment of haemodialysis for chronic renal failure; treatment by way of plasmapheresis; regular weekly treatment by way of total parenteral nutrition for gross impairment of enteric function.

At present to qualify for ESA you need to score 15 points. This can be a combination of scores from physical and mental health descriptors.To qualify for the support group you must score 15 points in one section. As long as you are claiming income-based ESA then your award can be renewed at each assessment, if you gain 15 points.

Remember that you may also qualify without meeting the 15 points criterion, even if you don’t score any points, because of Exceptional Circumstances (Regulations 25, 29 and 31, 35) if there would be a substantial risk to your mental or physical health if you were found not to have limited capability for work and/or work-related activity respectively.

Contribution-based ESA lasts for 1 year only, unless you are in the Support Group. After 1 year, in the Work-Related Activity Group (WRAG), you may only get income-based ESA if your household income is below a certain threshold. It makes no difference how long you have previously paid National Insurance. 

Further information:

Lord Freud – “Reliably, repeatedly and safely”  – Source: Hansard, column 326, paragraph 4.

*There are Judges who interpret the law and where applicable, set precedent. There are Ministers who set policy. With specific reference to the use of repeatedly, reliably, safely, and in a timely manner, this is the result of Upper Tribunal judges interpreting the law and setting precedent through case law.*

Exceptional Circumstances: Employment and Support Allowance Regulation 25
Exceptional Circumstances: Employment and Support Regulation 31
Employment and Support Allowance: 2013 Regulations in full
Explanatory memorandum to all benefits 2013: Full legislation document
Recommended – Implications of the changes and advice: Employment Support Allowance claim update: Exceptional Circumstances – Regulations 25 and 31 and Universal Credit
Recommended – The Black Triangle Campaign: How to Gain Exemption from DWP/Atos ‘Fit for Work’ & WRAG decisions by Applying ESA Regulations 29 and 35 (see note for 25 and 31)
The new Work Capability Assessment 2013: DWP Guide
The Employment and  Support Allowance Regulations 2008 (as amended) – judiciary.gov.uk

Appendix A: 

Regulation 25

25.—(1) A claimant who does not have limited capability for work as determined in accordance with the limited capability for work assessment is to be treated as having limited capability for work if paragraph (2) applies to the claimant.

(2) Subject to paragraph (3), this paragraph applies if—

(a) the claimant is suffering from a life-threatening disease in relation to which—

(i) there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and

(ii) in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; or

(b) the claimant suffers from some specific disease or bodily or mental disablement and, by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work.

(3) Paragraph (2)(b) does not apply where the risk could be reduced by a significant amount by—

(a) reasonable adjustments being made in the claimant’s workplace; or

(b) the claimant taking medication to manage the claimant’s condition where such medication has been prescribed for the claimant by a registered medical practitioner treating the claimant.

(4) In this regulation “medical evidence” means—

(a) evidence from a health care professional approved by the Secretary of State; and

(b) evidence (if any) from any health care professional or a hospital or similar institution,

or such part of such evidence as constitutes the most reliable evidence available in the circumstances.

*Regulation 25 outlines exceptional circumstances in which a person will be treated as having limited capability for work, but may be capable of work-related activities. People in these circumstances are placed in the ESA work-related activity group (WRAG)

However, there are further exceptional circumstances in which a person  will be treated as having limited capability for work-related activity in addition, and will therefore be placed in the ESA support group. These are outlined by Regulation 31.

Regulation 31 

31.—(1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;

(b) the claimant is—

(i) receiving treatment for cancer by way of chemotherapy or radiotherapy;

(ii) likely to receive such treatment within six months after the date of the determination of capability for work-related activity; or

(iii) recovering from such treatment,

and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity;

(c) in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity; or

(d) the claimant is entitled to universal credit and it has previously been determined that the claimant has limited capability for work and work-related activity on the basis of an assessment under Part 5 of the Universal Credit Regulations 2013.

(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 30(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.

For all ongoing cases where Universal Credit does NOT apply, and for ALL Contributions-based ESA claims:

Regulation 29

29.—(1) A claimant who does not have limited capability for work as determined in accordance with

the limited capability for work assessment is to be treated as having limited capability for work if:

paragraph (2) applies to the claimant.

(2) This paragraph applies if—

(a) the claimant is suffering from a life threatening disease in relation to which—

(i) there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and

15(ii) in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by

a recognised therapeutic procedure; or

(b) the claimant suffers from some specific disease or bodily or mental disablement and, by reasons of

such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work.

Regulation 35

35.—(1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;(b) the claimant is—

21(i) receiving treatment by way of intravenous, intraperitoneal or intrathecal chemotherapy; or

(ii) recovering from that treatment and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity; or

(c) in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity.

(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 34(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.

Appendix B

Most Atos HCPs are not doctors, they are usually nurses or occupational therapists. You can demand that a qualified doctor or specialist conducts your assessment under some circumstances. I’ve gathered the following list from various Freedom of Information responses from the Department for Work and Pensions.

List of conditions judged suitable for assessment by neuro – trained nurses/any health care profession, so make sure that you are seen by a qualified HCP: 

Prolapsed intervertebral disc
Lumbar nerve root compression
Sciatica
Slipped disc
Lumbar spondylosis
Lumbar spondylolisthesis
Lumbar spondylolysis
Cauda equina syndrome
Spinal stenosis
Peripheral neuropathy
Neuropathy
Drop foot
Meralgia paraesthetica
Cervical spondylosis
Cervical nerve root compression
Cervicalgia
Nerve entrapment syndrome
Carpal tunnel syndrome
Trapped nerve
Paraesthesia
Tingling
Numbness
Brachial plexus injury
Polyneuropathy
Dizziness
Vertigo
Essential Tremor
VWF
Alzheimer’s

List of conditions judged by the DWP and Atos Healthcare as suitable only for assessment by doctors:

Stroke
Head injury with neuro sequelae
Brain haemorrhage
Sub Arachnoid Haemorrhage
Brain tumour
Acoustic Neuroma
Multiple Sclerosis
Motor Neurone Disease
Parkinson’s disease
TIAs
Bulbar Palsy
Myasthenia Gravis
Muscular Dystrophy
Guillain-Barre Syndrome
Amyotrophic lateral sclerosis
Syringomyelia
Neurofibromatosis
Spina bifida
Polio
Fits (secondary to brain tumour)
Learning difficulties (with physical problems)
Nystagmus
Myelitis
Bells Palsy
Trigeminal Neuralgia
Paraplegia
Quadriplegia
Huntington’s Chorea
Huntington’s Disease

Further reading:

More on questions you may be asked at assessment: dwpexamination forum 
How to deal with Benefits medical examinations: A Useful Guide to Benefit Claimants when up against ATOS Doctors
More support and advice here: How to deal with Benefits medical examinations
Step by step guide to appealing a ESA decision: Good Advice Matters

Important update

Clause 99, Catch 22 – The ESA Mandatory Second Revision and Appeals

Additional support:

The LawWorks Clinics Network is a nationwide network of free legal advice sessions which LawWorks supports.Clinics provide free initial advice to individuals on various areas of law including social welfare issues, employment law, housing matters and consumer disputes – List of LawWorks  clinics

V-STARTU

Thanks to Robert Livingstone for his valuable contributions.

With many thanks to Joyce Drummond for contributing such valuable information about the Work Capability Assessment.

With many thanks to The Black Triangle Campaign for sharing their work on the GP support letter template, and covering legal and explanatory documents


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