A training document that the DWP attempted to keep secret shows the savagery of the universal credit health regime about to be unleashed in April. It will see claimants with the most severe physical and mental health conditions receive only the lower rate of the universal credit health element because of a possibility that their condition may improve, even if not for over a decade.
Under the new rules a 56 year old claimant with debilitating osteoarthritis who is taking morphine for pain relief 3-4 times a day may get only the reduced rate of UC health. A 26 year old claimant with a personality disorder who has “extreme verbal episodes of aggression” and self-harms by “hitting her head off walls or cutting her wrists” on a daily basis is likely to have to wait 14 years before getting full UC health.
In both cases the DWP deems their conditions to not be severe.
These two claimants are case studies in a health assessors’ training guide on the severe conditions criteria (SCC). All the case studies were redacted by the DWP when they provided the document to us under the Freedom of Information act, but we have obtained an earlier copy.
The training was originally produced in 2017, when the SCC was introduced as a way of deciding which claimants should have repeat WCAs.
The training was reissued in 2023 with alterations, which seem mainly to do with filework and formatting, rather than any changes to the assessment criteria.
A carefully chosen extract from the training was quoted by disability minister Stephen Timms at the committee stage of the Universal Credit Act 2025, in order to persuade MPs to vote in its favour.
The Act made two changes to the SCC.
The first is the introduction of the requirement that a limited capability for work-related activity descriptor “constantly applies to the claimant”, which potentially makes it harder for claimants with variable conditions to qualify.
The second change entirely altered the purpose of the SCC.
Because from April, new claimants who meet the SCC will get the full rate of the UC health element, but the vast majority of new claimants – who will not meet the SCC – will get only half as much: £217.26 per month, as opposed to £429.80.
And this is what makes the new rules so incredibly harsh. Because, as you will see from the case studies below, the 56 year old claimant with osteoarthritis has been in pain for many years, cannot walk outdoors and has his wrists in splints.
But, he may have a third hip operation at some unspecified time in the future.
For this reason, his condition is not deemed to be lifelong and therefore, he can only have the reduced rate of the health element. This lower rate is paid to prevent him opting for a life on benefits, when he should be trying to move back towards work.
The 26 year old claimant with antisocial personality disorder has had years of school expulsions as well as juvenile and adult custodial sentences for violence. But now, her “physical violence to others has decreased”, “not all treatment options have been exhausted” and “improvement in function can occur often by the age of 40”.
So again, to prevent her settling for an easy existence on benefits, when she should be focusing on becoming well enough to work by the time she’s 40, she will get only reduced rate UC health.
There might have been some small justification for deciding that it would be reasonable to reassess these claimants at some future date.
But to use the SCC to cut their benefits on the grounds that their health might possibly improve one day, and in the meantime poverty will encourage them to become work ready, is deeply shameful.
It is, nonetheless, what will be happening to new claimants from April of this year.
If, instead of selectively quoting from the training material, Timms had shared the whole document with MPs, the result might have been very different. Which is, of course, why it is being kept secret.
You can read both case studies in full below. Members can download the whole DWP Severe Conditions Prognosis Re-referral Guidance document from the DWP resources section of the members' ESA/UC guides page. There is also more on the guidance document here.
Case Scenario 3
Key Case details
56 year old Male.
Diagnosis- Osteoarthritis. FME returned-confirmed diagnosis of osteoarthritis.
Medication – MST 30mg twice daily. Diclofenac 75mg twice daily. Morphine 10mg as required for breakthrough pain. (Usually 3-4 times daily)
Diagnosed age 45 when he saw his GP with bilateral hip pain. Pain affects mainly hips but increasingly his wrists as well. Minimal variation in pain.
Had a right hip replacement 4 years ago which was successful and gives him few problems. His left hip was replaced 5 years ago – but unfortunately he had recurrent dislocations in this joint. This was revised 2 years ago but he has had ongoing pain in this hip since. His consultant is concerned about infection in the replaced joint and has referred him to a tertiary referral centre for advice on whether a further hip revision would be possible. He manages to walk minimal distances due to the pain in his left hip. (Manages only in the house or out to the car). His physiotherapist has tried various aids and he uses an adapted walking stick in the house. He requires splints for his wrists and with these he manages basic things in the house. He tried to use a self propelled wheelchair but the pain in his wrists was too severe. If he needs to get further distances – e.g. in the hospital, his son takes him and propels him in the wheelchair. He meets criteria for LCWRA - mobilising
Guidance for Case Scenario 3:
Severe conditions advice would not apply.
Functional LCWRA criteria applies (Mobilising)
The level of function would always meet LCWRA
Osteoarthritis is a lifelong condition – however, although he has had complications of hip replacement, further treatment options are still being actively considered, therefore this criterion would not be met at this time.
If a further hip revision is considered reasonable, with further rehabilitation, it would be hoped that improvement in mobility could occur. Therefore at this point, you could not advise that this criterion would be met at this time.
Condition has been formally diagnosed.
Case Scenario 4
Key Case details
26 year old female
Diagnosis – Antisocial Personality Disorder. No FME returned – returned as “no longer registered at this practice. Removed from our practice list for threatening behaviour towards staff”.
Medication – No current medication. Awaits a further referral to the psychiatrists.
MSRS information – PV marker flag.
Attended AC with mother. Consent was obtained to include details of forensic history. Initially diagnosed with ADHD as a child. Had problems from an early age – truanting from school, shoplifting and began to self harm by cutting wrists age 13. By age 15, problems with violence began and she was expelled from various schools. She had been in trouble with authorities and by the age of 16, she received a custodial sentence in a Young Offenders Institution (YOI) as a juvenile offender.
The GP changed the diagnosis to depression while she was in the YOI and commenced her on citalopram. This did not help and following her release she had several more sentences served in the YOI.
Following further release, she again had problems with authorities and after several assault convictions, she received an adult custodial sentence age 22. After some time in prison, she was assessed by the psychiatric team and a diagnosis of Antisocial Personality Disorder was made. She was taken off medication and she engaged in some CBT and anger management therapies which helped her gain control of her behaviour to some degree.
She was released on parole 3 weeks ago and awaits referral to the community psychiatric services. (Appointment next week). Her physical violence to others has decreased, but she still has extreme verbal episodes of aggression and harms herself through hitting her head off walls or cutting her wrists when it all gets too bad. This occurs on a daily basis. (LCWRA for unacceptable behaviour applies).
Guidance for Case Scenario 4
Severe conditions advice would not apply.
Functional LCWRA criteria applies (Unacceptable Behaviour)
The level of function would always meet LCWRA
Personality disorder is a lifelong condition but the therapies she commenced while in prison have helped to some degree and some medications can assist with symptoms of aggression etc. Therefore as not all treatment options have been exhausted, this criterion could not be deemed to be fully applicable.
Although Antisocial Personality Disorder is difficult to treat, current evidence does suggest that improvement in function can occur often by the age of 40 with appropriate therapies, so again this criterion could not be advised as being met.
Although there have been various proposed diagnoses for this person, there is no doubt that she has a significant mental health disorder that would be recognised by the medical community.
