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State benefit claimants and the GP's role

Deborah Padfield explains the tough eligibility rules for the employment and support allowance and why patients want GPs' help.

The emphasis of the employment and support allowance is on encouraging people to shift from disability to participation in work (Photograph: SPL)
The emphasis of the employment and support allowance is on encouraging people to shift from disability to participation in work (Photograph: SPL)

GPs and other clinicians have recently been assigned an ambiguous but often crucial role in decision-making for employment and support allowance (ESA), the replacement for incapacity benefit (IB).

There has been no consultation or effective attempt to explain the system to medics. So it makes sense to set out briefly what is expected of people claiming ESA and the help they may consequently want from their GPs.

ESA has been running since 2008 but in the last few months there have been two developments: people on long-term IB (or income support on the grounds of incapacity) are being moved to the ESA or the job seekers allowance (JSA); and the ESA criteria have been tightened.

People on IB for years with no questions asked are undergoing a newly rigorous assessment. Since review at between six-monthly and three-yearly intervals is a feature of ESA, many already on it are facing repeated reassessment.

The emphasis is on encouraging people to shift from disability to participation, avoiding ‘dumping’ people on IBs. So ESA and JSA are on a continuum:very few people are assigned to the ESA support group for those currently unable to contemplate work. More are put in the work related activity group, where support and encouragement should be offered to help them back to work.

Most are shifted to the JSA, where tough conditions and sanctions relating to active job-search come into play. While Job Centre Plus should tailor these conditions to individuals’ capabilities, how this is done is left up to each Centre

A manageable life and recovery often depends on being allocated to an appropriate category. People potentially able to return to work at the right pace and with the right support may be thrust back into disability by excessive pressure. It is not in dispute either that people with significant disabilities will be found fit for work.

The role of doctors
What is this ambiguous but crucial role? Particularly where disorders are hard to prove – including mental health conditions, fatigue and chronic pain – assessors will be looking for ‘objective’ evidence of their substantially disabling impact.

The mere assertion by a claimant or their GP that conditions are disabling is insufficient. The diagnosis is almost peripheral: the key is the person’s ability to cope with specific aspects of life, tightly defined by the ESA criteria (‘descriptors’). There is sense in this. While one person who is blind or has bipolar affective disorder will be significantly disabled, another will become home secretary or a TV star.

Evidence of a seriously recalcitrant disorder, such as referral to a pain clinic, is useful. Supporting letters from GPs and consultants,  according to the Department for Work and Pensions (DWP), are both encouraged (this is not made very clear to claimants), and potentially devalued by clinicians’ lack of benefit-specific knowledge.

So it is crucial for patients that evidence from clinicians is tied as tightly as possible to the ESA descriptors. Below is a potted version of these.

Apart from these descriptors, the only grounds on which people can claim ESA are ‘exceptional circumstances’ relating to an uncontrollable or uncontrolled life-threatening illness. Or where someone suffers a disease or disablement resulting in ‘a substantial risk to the mental or physical health of any person if the claimant were found to have limited capability of work.  

Physical health problems

The ESA tests the activities relevant to the physical assessment:

  • Mobilise (walk/wheelchair/go up or down steps).
  • Stand or sit without exhaustion.
  • Raise either arm (problem with one arm is not enough).
  • Pick up and move objects.
  • Use fingers eg to write, pick up coin, use keyboard.
  • Make self understood by speaking, writing, typing or other means.
  • Understand by hearing, lip-reading, reading.
  • ‘Navigate’ safely unassisted, with or without a guide dog.
  • Prove bowel/bladder incontinence.
  • Prove loss of consciousness/seizures.

 

Mental health problems/learning difficulties

The ESA tests the activities relevant to the mental, cognitive and intellectual function assessment:

  • Difficulty with learning new tasks.
  • Unawareness of everyday hazards (eg boiling water) causing significant risk of injury or damage to property.
  • Inability to organise/plan/motivate self to ‘reliably initiate or complete at least two sequential personal actions’.
  • Inability to cope with planned or unplanned change to routine, making day to day life seriously difficult.
  • Inability to get to familiar or unfamiliar places without being accompanied.
  • Inability to take part in social activities for most or all of the time.
  • Uncontrollable episodes of aggressive/unacceptable behaviour.

Onus on claimant
Unlike the disability living allowance assessment – and unlike what is suggested on the above link – Job Centre Plus rarely contacts claimants’ GPs. The emphasis is on encouraging an individual sense of responsibility, so people are expected to prove their own incapacity for work. Therefore, no DWP payment for reports is available to clinicians.

Atos Healthcare, which assesses claimants for DWP, has no incentive to ensure that its report gives a full picture of their situation and is not responsible for decision-making.

Its contract is to provide evidence and a recommendation to Job Centre Plus, the decision-making body. Should that evidence prove inadequate or misleading, people must turn to the appeal process, involving first an internal reconsideration by Job Centre Plus and then if necessary,  a tribunal hearing perhaps several months or more later depending on area.

The DWP is now encouraging claimants to provide supporting evidence early in their claim. We at Cambridge Citizens Advice Bureau encourage our clients to talk realistically with their doctors about the descriptors, where possible asking them for appropriate evidence.

It is no part of most clinicians’ role to become a specialist in welfare benefits or disability analysis. Unfortunately, unless doctors are able to provide relevant evidence to Job Centre Plus it is likely to be the most vulnerable people who will be wrongly deprived of ESA.

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