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Even harsher new ESA medical approved

13 April 2010

Tens of thousands of claimants facing losing their benefit on review, or on being transferred from incapacity benefit, as plans to make the employment and support allowance (ESA) medical much harder to pass are approved by the secretary of state for work and pensions, Yvette Cooper.  

The shock plans for ‘simplifying’ the work capability assessment, drawn up by a DWP working group, include docking points from amputees who can lift and carry with their stumps.  Claimants with speech problems who can write a sign saying, for example, ‘The office is on fire!’ will score no points for speech and deaf claimants who can read the sign will lose all their points for hearing.

Meanwhile, for ‘health and safety reasons’ all points scored for problems with bending and kneeling are to be abolished and claimants who have difficulty walking can be assessed using imaginary wheelchairs.  

Claimants who have difficulty standing for any length of time will, under the plans, also have to show they have equal difficulty sitting, and vice versa, in order to score any points.  And no matter how bad their problems with standing and sitting, they will not score enough points to be awarded ESA.

In addition, almost half of the 41 mental health descriptors for which points can be scored are being removed from the new ‘simpler’ test, greatly reducing the chances of being found incapable of work due to such things as poor memory, confusion, depression and anxiety.

There are some improvements to the test under the plans, including exemptions for people likely to be starting chemotherapy and more mental health grounds for being admitted to the support group.  But the changes are overwhelmingly about pushing tens of thousands more people onto JSA.

If all this sounds like a sick and rather belated April Fools joke to you, we’re not surprised.  But the proposals are genuine and have already been officially agreed by Yvette Cooper, the Secretary of State for Work and Pensions.  They have not yet been passed into law, but given that both Labour and the Conservatives seem intent on driving as many people as possible off incapacity related benefits, they are likely to be pursued by whichever party wins the election.

We know that many people will find this news deeply upsetting and even frightening and we know that some people will condemn us for publicising the planned changes or for the language that we are using to do so.  But we also believe that it’s not too late to stop these ugly plans in their tracks if claimants and the organisations that represent them act now.

With 1.5 million incapacity benefit claimants waiting to be assessed using the work capability assessment in the next few years and tens of thousands of people already on ESA and set to be reviewed annually, these changes will be of great concern to many voters – if they find out about them before polling day.

So, please spread the word in forums and blogs and to people you know who may be affected. Ask any disability charity you have a connection with to speak out now, before election day, against these plans.  You might also want to contact local newspapers and radio to warn people about the proposals.

And above all, contact not just your MP, but the other candidates in your constituency, and let them know you will not be voting for anyone who does not loudly condemn this shameful attack on sick and disabled claimants.

These plans really are a potential seat loser, but only if enough people know about them.

Limited capability for work
The biggest changes and cuts are to take place in the limited capability for work assessment which decides whether you are eligible for the work-related activity group of ESA.  Claimants need to score fifteen points to be placed in this group unless they are exempt or covered by the exceptional circumstances rules.

The activity of walking has been replaced by the activity of ‘mobilising’, with the fifteen points for ‘Cannot walk at all’ to be removed.  Instead of looking at how far you can walk with a walking stick or other aid if such aid is normally used, the test is now ‘Mobilising with or without a walking stick, manual wheelchair or other aid if such aid can reasonably be used’

In other words, even if you don’t use a wheelchair you can be assessed as if you did – an intention which is made clear in the body of the report. To score fifteen points you will need to show that you could neither walk nor wheel a wheelchair 50 metres without stopping in order to avoid significant discomfort or exhaustion. If you cannot do so repeatedly ‘within a reasonable timescale’ you will also score fifteen points.

Nine points are scored for 100 metres and 6 for 200 metres.

This means that many people who get the higher rate of the mobility component of DLA may not be awarded ESA at all.    Even the fifteen points for being unable to walk up and down two steps is to be cut to nine points.

Standing and sitting
Points for these activities have also been slashed.

At the moment, you can score points if you can’t stand or if you can’t sit for given lengths of time. Under the revised test you will have to show that you can neither stand nor sit for more than 30 minutes at a ‘work station’ before having to ‘move away in order to avoid significant discomfort or exhaustion’.  Even then you will only score 9 points, or 6 points if you can last for an hour, not enough to be awarded ESA.  

Fifteen points are only available from this activity if you can’t move from one seated position to an adjacent one without help.

The chair has also been changed from an upright chair to an ‘adjustable chair’ even though the reality is that these are not readily provided in most workplaces, regardless of what the Disability Discrimination Act might say.

Bending and kneeling
The activity of ‘Bending and kneeling’, for which 30 points are currently available, is to be completely done away with.  Bizarrely one of the reasons for doing so is ‘health and safety reasons’ as people should not ‘bend forward when lifting’.

The fifteen point descriptor for not being able to put either arm behind your back is to be ditched.

Picking up
The panel have decided that the fact that you do not have two hands should not be a reason for scoring points for problems with moving a half litre or one litre carton or moving a light but bulky object.  They argue that ‘an item may be transferred by wedging it against the body, or another limb’ and that many amputees who chose not to have a prosthetic limb ‘remain able to complete the task’.   All references to using hands in this activity are therefore to be removed.

Manual dexterity

The nine scoring descriptors for manual dexterity are to be reduced to just four.  Problems with just one hand and problems with pouring will no longer score points and references to a ‘conventional keyboard’ are to be changed to a ‘suitable keyboard’.  Problems with pressing a button are to be added.

Speech, hearing and vision

The three activities speech, hearing and vision are to be replaced with three new activities.

Speech now becomes ‘Making self understood through speaking, writing, typing or other means normally used; unaided by another person’.  

To score fifteen points a claimant will need either to show that they:

‘Cannot convey a simple message, such as the presence of a hazard.’ or that they have ‘significant difficulty conveying a simple message to strangers.’  

So, the fact that your speech cannot be understood by other people will no longer score points if, instead, you are able to write, type or communicate by ‘other means’.

Hearing is replaced with: ‘Understanding communication by both verbal means (such as hearing or lip reading) and non-verbal means (such as reading 16 point print) using any aid if reasonably used; unaided by another person.’

To score fifteen points a claimant will have to show that they ‘Cannot understand a simple message due to sensory impairment, such as the location of a fire escape’ or that they  have ‘significant difficulty understanding a simple message from a stranger’.  

Being unable to hear someone talking will no longer score points.

Problems with vision have been turned into ‘Navigation and maintaining safety, using a guide dog or other aid if normally used.’

To score fifteen points you will need to be able to show that you are: ‘Unable to navigate around familiar surroundings, without being accompanied by another person, due to sensory impairment’ or that you cannot safely cross a road.  

Being unable to see well enough to read large print or to recognise people will no longer score points.

This is one area where the descriptors do seem to have been improved.  Previously there were three separate and highly complex activities.  These have been reduced to just one where the issue is whether the loss of bowel or bladder control or the leakage from a collecting device is ‘sufficient to require the individual to clean themselves and change clothing.’  If this happens at least once a month, fifteen points are scored.

Points for losing consciousness at least once a month are to be reduced from nine to six and a six point descriptor for losing consciousness twice in six months is to be axed.

Mental, cognitive and intellectual function assessment
The mental health and learning difficulties section of the WCA has been slashed from 41 point scoring descriptors to just 21.

For example, one of the fifteen point and one of the nine point descriptors have been removed from the ‘Learning tasks’ activity, and a fifteen point descriptor has been removed from the ‘Getting about’ activity.

The three activities relating to ‘Memory and concentration’, ‘Execution of tasks’ and ‘Initiating and sustaining personal action’ are all rolled into a single activity called ‘Initiating and completing personal action’.  

Currently claimants have 5 opportunities to score fifteen points outright from the three activities and many more opportunities to score fifteen points or more from a combination of points from the three activities.

Under the new test, however, there will be just one opportunity to score fifteen points. This is likely to greatly reduce the chances of being found incapable of work due to such things as poor memory, confusion and depression.

The three activities ‘Coping with social situations’, ‘Propriety of behaviour with other people’ and ‘Dealing with other people’ are to be reduced to two activities;  ‘Coping with social engagement’ and ‘Appropriateness of behaviour with other people’.  Again, the opportunities for scoring points have been considerably reduced.

Limited capability for work-related activity

The limited capability for work-related activity assessment decides who is eligible for the support group, based on any one of a range of descriptors applying to the claimant.  These descriptors have largely been altered in line with changes to the  work-related activity group.  

However, there are some notable changes and even some improvements.  For example, distance for being unable to what we must now call ‘mobilise’ has been increased from the original 30 metres to 50 metres.

In addition, there are now more ways to qualify for the support group on mental health and learning difficulties grounds.  These include: ‘Awareness of hazard’,  ‘Coping with change’, ‘Coping with social engagement’ and ‘Appropriateness of behaviour with other people’.

However, descriptors relating to ‘Maintaining personal hygiene’ and ‘Eating and drinking’ have been removed.

The exemptions relating to the support group are also to be widened to cover not just people who are receiving certain types of chemotherapy, but also people who ‘are likely to receive chemotherapy within the next six months’.

It could have been worse
In spite of some improvements in relation to the support group, overall the changes to the work capability assessment are likely to lead to many thousands more sick and disabled people being forced onto jobseekers allowance.

And yet, it could have been even worse.  The original changes proposed by the working group were even harsher.  It was only after their proposals were looked at by the Chief Medical Adviser at the DWP, following complaints by disability group representatives, that some were toned down and additional points attached to some descriptors.  It was this final review, contained in the Addendum, that was approved by the secretary of state.

The participants in the review are listed at Annex B of the Internal Review as:

Individual Attendees:
Brigid Campbell, Social Security Advisory Committee
Dr Angela Graham, Atos Origin Medical Services
Dr David Henderson Slater, Consultant in Neurological Disability/Rehabilitation Medicine, Oxford Centre for Enablement
Dr Ed McDermott, Atos Origin Medical Services
Dr Gordon Parker, Consultant Occupational Physician
Professor Tom Sensky, Professor of Psychological Medicine at Imperial College, London

Represented organisations:
Chartered Institute of Personnel and Development
Citizens Advice Bureau
Disability Benefits Consortium
Disability Employment Advisory Council
National Autistic Society
Parkinson’s Disease Society
Royal College of Psychiatrists
RSI Action

Two issues about this list may be of concern.  

The first is that two of the individual attendees are employed by Atos Origin Medical Services.  Atos is the company that carries out benefits medicals on behalf of the DWP in return for hundreds of millions of pounds of taxpayers money.  Some observers may be troubled that employees of a company which might gain a commercial advantage from the medicals becoming simpler and quicker to carry out should be involved in the process of reviewing how points are scored.

The second is the wide range of disability organisations whom the DWP has been able to name as having participated in this review.  We have no doubt that most of them were against many of the changes proposed and that they even won concessions from the DWP.  But the fact remains that, with the exception of MIND, we are not aware of any agencies speaking out against these proposals with the kind of outrage their clients might reasonably have expected.

If claimants manage to make their voices heard on this issue, it will only be with the genuine and vocal support of the disability charities listed above.

Building bridges to Work
Work Capability Assessment Internal Review