{jcomments on}17 March 2011

Benefits and Work has been warning for a long time of the probability that when the new work capability assessment is introduced from 28 March claimants will be assessed using an ‘imaginary’ wheelchair if they have mobility problems.

Benefits and Work has now obtained a copy of the guidance issued to Atos health professionals, allowing us to see how they have been trained to interpret the ‘Mobilising’ activity in the new regulations.

The regulations asses a claimants ability in relation to:

“Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid can reasonably be used.”

Guidance to doctors looks first at the support group descriptors.  For mobilising, the 15 point descriptor from the limited capability for work assessment  is also the support group descriptor.  In other words, if you score 15 points for this activity you will automatically be placed in the support group.

To get into the support group you need to show that you:

Cannot either
(i) mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion
(ii) repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.

Health professional are told that:

“This illustrates a severe level of disability relating to the lower limbs and upper limbs or those with very severe cardiorespiratory problems.”

They are also told that:

“In this activity, the HCP [healthcare professional] should consider whether a person could potentially use a wheelchair regardless of whether or not they have ever used a wheelchair.”

And that:

“A manual wheelchair may be considered any form of wheelchair that is not electrically driven.”

There can be little doubt then, that in relation to the support group, claimants who are unable to walk 50 metres will also have to show that they would be unable to propel a manual wheelchair this distance.  This might be, for example,  because of severe fatigue or breathlessness, problems with grip, lack of strength in the arms or shoulders or severe back problems.

Given that the support group descriptor is the 15 point descriptor for the work related activity group and that the other mobilising descriptors are worded identically, except that the distances involved are 100 and 200 metres, then it seems likely that the all claimants wishing to score points for this activity will need to show that they would be unable to wheel themselves in a wheelchair over the same distance.

However, as elsewhere, the guidance is confusing in the advice it gives.

When explaining how the limited capability for work assessment – the test for the work-related activity group -  is applied, the guidance explains that in relation to mobilising:

“The descriptors should not be confused with the traditional concept of walking (i.e. bipedal locomotion), that is, movement achieved by bearing weight first on one leg and then the other.  Those who are wheelchair dependant or can use crutches or a stick to mobilise distances in excess of 200m would not be awarded any points for their inability to walk. ‘

Here, the reference is to people who are ‘wheelchair dependant’  rather than people who could use a wheelchair.

However in relation to vertigo, health professionals are told:

“Walking may occasionally also be affected by disturbances of balance due, for example, to dizziness or vertigo.  The effects of any such condition should be noted and full details given in your medical report.  When considering this issue, the ability to use an appropriate aid, including a manual wheelchair must be considered. A manual wheelchair would be considered any chair that is not electrically propelled. If the person does not actually have a wheelchair, they should be considered in terms of whether they could use one if provided, as manual wheelchairs are widely available. In terms of considering whether or not the person could reasonable [sic] use a wheelchair, the HCP must consider their upper limb function and cardiorespiratory status.”

In relation to observed behaviour they are told:

“Note in general the appearance and use of the upper limbs in relation to their ability to use walking aids/propel a wheelchair.”

In relation to clinical examination they are told:

“Where restriction of walking is apparent, the power/ co-ordination in the upper limbs must be considered. Severe breathlessness and coronary artery disease, for example may also impact on the people’s ability to both walk and propel a wheelchair.”

The issue is further confused by the fact that the new ESA50 questionnaire, to be used with the new WCA, does not ask you to explain about problems you  would have with a wheelchair  unless “you usually use one”.   So, if claimants are going to be routinely assessed using an imaginary wheelchair, they are not being given the opportunity to explain any difficulties they might have with doing so.

We have no doubt, based on the evidence in the guidance that all claimants who have problems walking will be assessed using an imaginary wheelchair.  We are currently working on guides to the new WCA which we aim to publish on 28 March.  Our advice is likely to be that if there are compelling reasons why you cannot us a manual wheelchair you should include them when you complete the form and raise them if you have a medical.  If there aren’t any then you may consider it more prudent not to raise the issue unless asked directly about it. 


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