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16 September 2008
Using the Freedom of Information Act, Benefits and Work has obtained a copy of a 218 page Employment and Support Handbook issued to health professionals who are to carry out the new work capability assessments from October 27th.

Confidential employment and support allowance medical documentThe handbook sets out in great detail how the new test of incapacity for work should be carried out.

The publication appears to be modelled on the Incapacity Benefit Handbook for Medical Services doctors which sets out the procedures for the current personal capability assessment. According to the introduction:

“The handbook is designed to be an essential source of information for the HCP [health Care Professional] regarding ESA and should also serve as a reference guide.”

It takes doctors through the entire assessment process, looking at each activity in detail, explaining the kind of evidence that should be collected and the conclusions that can be drawn from it. It is an invaluable source of information about how the DWP intend to administer the new work capability assessment.

The Handbook also covers such issues as:

Domiciliary visits
Claimant has a medical condition which prevents him/her speaking on the telephone
The uncooperative claimant
Lack of an interpreter
Audio and video taping of examinations
Taking of notes during an examination by claimant or companion

Looking both at the draft ESA questionnaire and at this handbook, one thing is becoming increasingly clear: the DWP and its agents have no more idea how to interpret the new mental health test than do the bemused advice sector.

Nowhere is this more apparent than in relation to the ‘Execution of tasks’ activity. In this activity the claimant scores points depending on how much longer they take to complete everyday tasks than would a person without any form of mental disablement (PWAFOMD as we shall henceforth refer to them) For example, a claimant scores 9 points if the following applies:

Takes more than one and a half times but no more than twice the length of time it would take a PWAFOMD to successfully complete an everyday task with which the claimant is familiar.

The guidance says that this activity relates to people with obsessive compulsive disorder, learning disability, brain injury and psychotic or dissociative states.

What the guidance is less forthright about are the answers two further questions: what are everyday tasks and how long does it take a PWAFOMD to carry them out?

In relation to everyday tasks, the Handbook concentrates almost exclusively on getting up, washed and dressed. Other everyday tasks, cooking, housework, shopping and so on are not considered at all.

As to how long washing and dressing should take, the guidance is entirely inscrutable.

”In considering this mental function activity, you should consider routine activities and what would be reasonable for a person taking into account normal variation in a population without any form of mental disablement.”

For example, one person getting up in the morning may only take 20-30 minutes to be up, showered and dressed to leave for work, but others may take longer – perhaps an hour or slightly more.”

If this is the guidance which doctors, led by LiMA software, will use, then every decision in which this activity is at issue may be open to appeal.

This is because two people with exactly the same health condition who took exactly the same length of time to wash and dress could be assessed as scoring different points because two different Atos doctors take different views of what the average time should be for a PWAFOMD.

This is manifestly unjust, unreasonable and arbitrary and such a system is, we sincerely hope, unlikely to be accepted by tribunals and higher courts.

The only sensible way of reaching a fair assessment is to have a legal definition of how long the average PWAFOMD takes to wash and dress and then measure every claimant against this benchmark.

But it may not be that straightforward.

For example, how do you assess claimants who have more or less than the average amount of hair to wash, dry and style? Should there be separate benchmarks for bald people as opposed to very hirsute ones with complex styling requirements?

What about claimants who have both a physical and a mental health condition: how do you decide how much of the additional time is due to their mental rather than physical health?

Should there be a shorter average time in the summer, when people may wear fewer and simpler clothes than in the winter?

The biggest question of all, however, is what has been inserted into the LiMA software which leads doctors through the assessment. Does LiMA have secret benchmark times contained within it, or will doctors have to judge for themselves whether the claimant takes one and a half times or twice as long?

Whichever is the case, and however long it takes to uncover the truth, we can be certain that the work capability mental health test will generate a huge amount of extra work for support and advice workers and enormous distress for some of the most vulnerable claimants.

Members can download a copy of the Training and Development ESA Handbook from the members only ESA section.

Places are still available on our overflow Introduction to Employment and Support Allowance training day on 21 October.