ESA Medical - here we go again!

Hastobe_Katt

Some of the obvious failings are that the benefit claim forms only allow you to provide the details of one consultant - I am under five different consultants. You would think that the GP would be the backstop in this case but, for me, I rarely see my GP as my 'primary care' is via the hospital. All my GP prescription are on repeat so only reviewed annually. Therefore, DWP have only part of the picture.

In the same vein, the assessing ATOS doctors are GPs...many of them quite elderly and doing this as a post retirement option. Therefore they are not up to date. My condition is quite rare.

The assessments (for ESA, IB, DLA) focus on your ability to function with you condition - not on the condition itself. This raises two issues. Firstly it means those who struggle on and try to do things (even when they have a serious and debilitating condition) fare worse than those with a less serious condition who paint themselves as not coping well. Secondly, if the primary issue is how the assessed person is coping rather than their illness per se then this is the field of an occupational therapist and not a doctor.

Finally I was disgusted at the references above to removing benefit from individuals with mental health. The public perception of disability is very screwed up and has become politicised. 'Disability' appears to many to mean needing a crutch or other walking aid. Individuals with profound autism, brain trauma, severe bipolar etc may appear at first glance as normal but may be more disabled than someone with obvious physical limitations. My sister and daughter are nurses and both work with patients with severe mental illness. Both of them have had abuse shouted at them when they have been taking patients out and have, quite legitimately, parked in a disabled bay or used the disabled check out.

rogerblack

Hastobe_Katt wrote: »

Some of the obvious failings are that the benefit claim forms only allow you to provide the details of one consultant - I am under five different consultants. You would think that the GP would be the backstop in this case but, for me, I rarely see my GP as my 'primary care' is via the hospital. All my GP prescription are on repeat so only reviewed annually. Therefore, DWP have only part of the picture.

It is permitted to add additional information - and you must do this! (of course they don't tell you)
If you only have space for partial info in the box, put 'see attached letter' or 'see page 39' - the 'extra things you need to tell us' page (or whatever the number is).

Add all your doctors details, what your condition is, how it affects you, even if it takes several more sheets of A4.

Hastobe_Katt

rogerblack wrote: »

It is permitted to add additional information - and you must do this! (of course they don't tell you)
If you only have space for partial info in the box, put 'see attached letter' or 'see page 39' - the 'extra things you need to tell us' page (or whatever the number is).

Add all your doctors details, what your condition is, how it affects you, even if it takes several more sheets of A4.

But, again, this tends to favour the benefit saavy claimants rather than those with genuine illness for whom the whole concept of claiming benefits is an alien one. Forms should be explicit and unambiguous. Given the forms must have had a thorough review before issue I wonder if this is intentional?

One of my consultants (who I also know in a professional capacity) was on the DLA advisory panel and found it very frustrating trying to get DWP to take on board some of these issues or to see things from the claimants perspective.

deeplyblue

apf52 wrote: »

It's proper name is the Work Capability Assessment (WCA) and is supposed to identify those things you can do rather than concentrating solely on those things you can't do - yes, I know the things you can't do are very important and many feel the 'can do' is given much more weight than the 'can't do' but I didn't make the rules, I'm just quoting them.

I agree that it is more useful to discuss the test of functioning as we have it, rather than a medical diagnosis - which it isn't. However, at this stage, I think what you are quoting is the stated aim of the test, not the actual rules.

I think that when we are considering the overall function of the test, it makes sense to remember that the re-drawing of the definition of a condition which prevents someone from taking up paid work, was not done just to try to make everyone think more positively. It was first drawn up under the last government to try to reduce the benefits bill.

They wanted to do this two ways. First they were going to try to identify those who should not have been in receipt of benefits in the first place - those who were either actively committing fraud or working the system. Unfortunately there were not enough of those to (despite the wailings of the Mail and the rant in the Sun), so they decided to re-draw the lines about what made someone disabled enough to warrant state help.

The new tests attracted a lot of criticism, both from those who thought them too harsh, and those who thought them poorly designed and badly implemented, regardless of their severity. They were, however, a real learning experience for the DWP.

Firstly they found that the company carrying out the "disability assessment" was capable of reducing those who were regarded as "unfit for work" on an indefinite basis to a mere 5% of the original applicants, and consigning another 30-40% to "work-related activity". This was very much better than the DWP had expected.

Secondly they found that, amongst those who appealed (and many didn't) there was an unexpectedly high level whose original refusal was over-turned. The Appeals Tribunal was not saying that the original test was unfair or too harsh, just that the original claim by any particular person plus the evidence that was available amounted to a claim which should have succeeded by the rules as they stood.

Everyone agreed that this level of reversal by the Tribunal was undesirable. The DWP didn't want to pay out the money from people they thought should have "failed", ATOS didn't want the embarrassment of explaining why their results were so unreliable and the claimants didn't want the stress and time of going to appeal. And nobody (including the hard-pressed advice services) wanted the much greater degree of cost and effort involved in going to appeal.

One answer to this problem would have been to improve Atos's assessment procedures, another one would have been to encourage the DWP staff who made the final decision on the claim to look more carefully at the documents.

The DWP chose a third method - they looked again at the test (as outside observers had urged), tried to improve the way the test was put together and - principally - made the test even harder to pass. This meant that those who were "simply" blind, wheelchair bound, or autistic would no longer be disabled enough.

The tests were tweaked not to improve the fairness of the test, but to fine tune the desired outcome. The DWP, having scented blood, realised that they could get even “better” results if the tests were a little bit more consistent and the Tribunals had fewer opportunities to overturn the original decision.

The new tests have a gloss put on them for disability organisations and doctors, that they are designed to help people with disabilities to function better in society, or at least better in that sector of society you encounter in the workplace. “Work,” they trumpeted, “is good for your health. Unemployment is worse for your health than 10 cigarettes a day.”

To the wider public they produced the wave of “most of these people are not the real disabled, they are just scroungers. These people get hundreds of pounds every week just by saying they have a bad back and no one checks on them for years at a time. All we are doing is checking up on the scroungers and tightening up the rules a little, to stop those who are working the system. It will all be better for the “real” disabled.”

The underlying truth is that the bill for looking after the elderly and the disabled is not going to go down without a lot of help. The government cannot say out loud that some of these people are going to have to starve or suffer or (best of all) die because we can’t afford them any more. They think that they cannot put up taxes any more, so trying to reduce the amount of money being paid out is the best answer. It is this, more than anything else, which is driving the change in the tests for sickness and disability benefits.

The rules are not designed to see what you can do – they are designed to make sure enough people “fail” the test to bring down the welfare bill by at least a pre-determined 20-25%. They are part of the fallout from the demographic time bomb.

No matter what anyone does, that reduction in the bill is the over-riding priority, and about 1 recipient (or potential recipient) in 4 will have to have all their benefits taken away, or even more of them will have to have them reduced by some mechanism. The number of those who commit fraud or exaggerate their claims is not enough to get back enough money – even if there were a foolproof method of detecting them (which there isn’t).

All that can be done by individuals is to look after their own selfish interests - make sure that someone else is in the “for the chop” category. There are going to be genuinely disabled people who will not get this benefit, any claimant has to prove, indirectly, that he or she is more disabled than others. Nobody should be in any doubt about this.

The worst aspect of the debate here, and everywhere else, is that the WCA pretends to be an objective, absolute test. "Meet the appropriate definition of disabled or sick and you will get the benefits." This is like the height test at fairgrounds - if you are a certain height, you can go on the ride, don't meet it and you can't. But it doesn't work like that in reality. If too many people meet the height test, they will raise the bar. If 250,000 (number picked out of the air - I haven't time to research it) people qualify for ESA and the DWP and the Treasury between them think the country can only afford 200,000, then they will change the qualification.

No amount of good advice and careful preparation is going to change that horrid reality. All the advisor can do is to say, "Make sure that your case is better than that of the bottom 25%." This is what "unsustainable" means - it's now a competition, not a right.

If we manage to prove that the sick and the disabled are being unfairly targeted then something or someone else is going to have to make up that shortfall in the budget. When the immediate problems from the crash of '08 have passed, and assuming that another such disaster is not on the way, the demographic timebomb will still be with us.

Consider the implications of the fact that all three main party leaders have children under the age of 3. I cannot think of any other period in our modern political history (the last couple of centuries, say) when that has been true. The government of this country has passed into the hands of the young and the healthy.

George Osborne, who is in charge of the nation’s money, is also young, fit (as far as we know), healthy (ditto) and above all, rich. He can afford to restrain his sympathy for the old, the sick and the poor. He sees no inconsistency about trumpeting about how evil it is that somebody should live off money they have not worked for when that somebody is too ill to work, whilst himself living off money for which he has not worked, because he inherited riches.

So the place of the sick, the disabled and the old in the great scheme of things is set for the next decade at least, and probably the next two or three generations. They are “unsustainable”. This situation will affect almost everyone, since most become sick or grow old, and many are or will become disabled. One way or another the cost to the government for the welfare of all of us will have to drop. Currently that way is via the WCA and, soon, PIP. (It has also impacted on pensions, and that one too is not going to get better.)

To that extent, ATOS is merely the tool and not the task.

There's another part of the story, however, which I'll post later. Sorry this is so long, but I haven't the time to edit it down.

db

Mrs_Arcanum

The new ESA test from 28th March 2011 is even more stringent (and more of a Dogs Breakfast).

It seems to matter not what your Doctor or Consultant may say when you appeal; unless you can directly relate this to your results ESA85/ESA85a. You have one month from the date of the letter with your decision (letter dated 4th May 2011 you must appeal by 4th June 2011). Late appeals have up to 13 months but you are in the hands of the Jobcentre deciding if your reasons for a late appeal are valid.

An advisor is highly recommended for any appeal. To prepare the case and even represent you.

1. Go through the descriptors on the Work Capability test and see what they should have scored. What evidence can be drawn on to show this? A daily diary or GP/Consultants input can help here.

2. What is the effect of any medication on their ability to carry out any of these tasks?

3. What about the affect of pain or fatigue if this is the case?

4. It is the ability to perform the task reliably, safely, repeatedly and at a reasonable speed that is at issue.

(GP's may charge for their evidence so be prepared)

5. It is your health at the time that the decision was made that is at issue, so if the persons condition has got worse this is not relevant to the appeal. If this has happened contact Jobcentreplus with evidence that this has happened and this may mean a fresh Work Capability Test will be carried out.
The appeal should still go forward as they may win their case and have a full backdate.


There has been an increase of 128% in appeals. With 40% winning their appeal.

deeplyblue

Mrs_Arcanum wrote: »

The new ESA test from 28th March 2011 is even more stringent (and more of a Dogs Breakfast).

...

1. Go through the descriptors on the Work Capability test and see what they should have scored. What evidence can be drawn on to show this? A daily diary or GP/Consultants input can help here.

2. What is the effect of any medication on their ability to carry out any of these tasks?

3. What about the affect of pain or fatigue if this is the case?

4. It is the ability to perform the task reliably, safely, repeatedly and at a reasonable speed that is at issue.

Thank you for this summary. I am especially interested to know if points 2, 3 and 4 are actually stated on the claim form, in the new descriptors, or in DWP guidelines (if any) and/or ATOS handbook(s).

I note that ATOS stress that they are providing "objective" evidence of a medical condition, and I believe that this is quite frequently a code for "not believing the patient/ claimant" - especially when it comes to matters of pain, fatigue and concentration. All of them can be regarded as "subjective" and are almost impossible to measure on any useful scale. Try asking someone with ME/CFS about this!

I also missed seeing a direct reference to being able to do a task "safely". I know that there is a general point where a doctor can say that a claimant could not work at all without a risk to their own (or anyone else's) life or health. What I did see was something that might say (for example) "Can you mobilise for 50m on level ground?" but does the claim form have anything where the claimant can say, "not without losing control of the wheelchair and banging into other people," or, "it all depends on what you mean by level ground - a vinyl floor in Marks, yes, but a standard LA-maintained pavement with potholes, no." In fact I notice that there is no distinction drawn (as there used to be on DLA forms) about what the claimant can do indoors and what they can do outdoors.

This is something that could be brought up at the Tribunal stage, but is it something which can be added at the WCA? And will an ATOS HCP add in "but not reliably, safely or at a reasonable speed"?

rogerblack

Hastobe_Katt wrote: »

But, again, this tends to favour the benefit saavy claimants rather than those with genuine illness for whom the whole concept of claiming benefits is an alien one. Forms should be explicit and unambiguous. Given the forms must have had a thorough review before issue I wonder if this is intentional?

I've spent much of my 'spare' time in the last 3 months understanding the eligability criteria, descriptors, way decision making and appeals happen for ESA and DLA. (of course, much of this becomes out of date soon - joy!)

I have maybe an hour a day on average when I'm fit enough to do stuff. The form-filling and research has left me unable to complete stuff I'd normally do in that period - such as personal hygine, what limited social life I have, and has most of my 'productive' energies focussed on how I can make sure I can obtain benefits.

Rather than what I'd much rather be doing, which is designing items for short-run production and sale, which I have the skills (and barely energy in good weeks) for, but have been unable to do, simply as I've been so focussed on getting ESA and DLA.

Further, I'm worried about how any attempts I make at starting a buisness will reflect on my claim.

:mad:

Why the hell would I want to claim benefit that totals perhaps a eighth of the salary I'd hope to be bringing home if I was fit I have no clue.

Hastobe_Katt

rogerblack wrote: »

Why the hell would I want to claim benefit that totals perhaps a eighth of the salary I'd hope to be bringing home if I was fit I have no clue.

Oh boy do I empathise with you!

Maybe what they should be doing at ATOS is asking the question "On the basis of what I have seen, would I employ this person on a permanent basis?" Viz would I be willing to:
i) pay them 'the market rate for the role they would have
ii) pay SSP
iii) deal with the health and safety risks
iv) cope with the uncertainty and potential lack of staff continuity if / when they need to take time off etc.

It ATOS had to deal with the consequences of their answer to that question you can be sure they would be very thorough when ascertaining what the individual could and could not do.

de1amo

if i stood in a bucket of water(not supplied) with 2 knitting needles stuffed up my nostrils singing god save the king would it make them believe i was unfit for work or just mad--the psychiatrist says i am and the section 3 i once had confirms this fact for life-of course i am not always in the extreme but it can be re-enacted with not taking my meds for a few days--QED

İncidentaly i never see my gp or my consultant because my wife takes care of me- i work full time so i dont claim any money but if i were as ill as the psychiatrist says i am i would be deemed unfit for work---he made all attempts to stop me working but i ignore the realities and get on with life--i do drink a bit so ignore my rambling!

deeplyblue

rogerblack wrote: »

Why the hell would I want to claim benefit that totals perhaps a eighth of the salary I'd hope to be bringing home if I was fit I have no clue.

That's easy. You want the pleasure of not having to get up in the morning, and the delights of sitting in an armchair watching daytime TV.

It's one of the minor depressing features of this piece of politics that so many of our fellow citizens think that it is worth committing fraud in order to have that sort of life.

Of course some of them think that you (or others like you) would be prepared to live a life where the basics were provided by state benefits and the claimant then moonlights for pocket money.

Few seem to contemplate a reality where being able to sleep until an alarm clock rings would be a luxury, or having the visual control to watch TV for hours on end is only a memory.

However, most people manage to get round this dilemma by saying, as a compassionate and well-informed nurse told me only the other day, "it's just designed to catch the cheats." Real disabled people would still get the help they needed.

Those lobbying against the benefit changes have an awful lot of eduction to do.