Migration to ESA
Written evidence submitted by Independent Resource Centre, Clydebank
We provide welfare rights and debt/money advice to all sections of the community. We are currently overwhelmed with appeals against ESA Work Capability Assessment decisions to decline benefit payments.
We will outline here our three main concerns with the ESA assessment process, each of which will be illustrated by way of a case study. We would like to point out, from the outset, that these case studies are by no means unusual, but actually represent the experiences of a disturbing proportion of our clients. Our concerns are as follows:
Clients’ experiences and their GPs’ medical evidence are being ignored at the WCA. Clients have to go through the ordeal of an appeal before this ‘evidence’ is taken into account. WCA’s should begin with this evidence, not ignore it until the final stage of appeal.
The WCA itself and the process of appeal is seriously damaging to clients’ health, particularly where the symptoms of their health condition fluctuate and they are wrongly assessed as fit for work. The case we will describe here is not the only one we have dealt with in which a client has died whilst waiting for their appeal to be heard.
3. Many of the lower scoring descriptors have been removed from the ESA WCA criteria as of 28th March 2011. We believe that this will substantially and disproportionately affect those with complex/multiple illnesses, and those with an accumulation of what would individually be considered to be ‘minor’ illnesses but cumulatively have a substantial impact on daily life and ability to work. We are seeing that this particularly affects those with complex mental health needs.
Mr W is a 35 year old with moved discs in his back and neck, nerve damage and inflammation. At the time of the examination he was prescribed an array of strong pain killers and wrist splints and was undergoing a series of tests by a specialist, including MRI scans. After attending his medical and failing to score any points at all, he appealed. He was concerned that the medical examiner had not actually carried out any physical tests on him, using only his brief description of his day to day activities as ‘evidence’ that he was fully mobile and capable of work. Mr W was also confused as to why his current medical treatment, medical tests and the fact that he lost his last job due to his ill health were not taken into account.
The WCA report described disturbed sleep, inability to dress and crippling pain but found that Mr W did not satisfy the criteria for physical disability because he "stands in the shower for a few minutes", "was able to sit in a chair with a back for 28 minutes", "stood independently for 1 minute without difficulty" and "walked 20 meters normally". The examiner found that "although a typical day suggests a high level of limited activity, this was not evident from observations. This indicates that the client does not have a severe disability".
At his appeal tribunal, Mr W was awarded 54 points, for difficulty with walking (6), standing (6), bending (6), reaching (15), moving objects (9) and manual dexterity (9). The tribunal judge stated in his decision letter: "In light of what this claimant has described, and the findings actually made, this tribunal finds it difficult to understand how the HCP could have awarded no points at all".
The details of the medical treatment that Mr W was receiving at the time should have been enough for the assessor to find him incapable of work. Mr W’s descriptions of his daily life, both on the application form and in the WCA should have been more than sufficient. Instead, the medical assessment that he underwent at the hands of Atos Healthcare was inappropriate, unnecessary, unprofessional and damaging.
Mr C was a 59 year old who suffered from severe anxiety and depression, as well as an eating disorder, all of which began when he was made redundant some years earlier. He also suffered from nerve damage, which affected his mobility. At his medical examination he described severe mobility problems, including regular falls, problems with washing, housework and eating, severe problems sleeping, poor concentration and visual hallucinations.
The examiner found him to have no physical disability because he "was able to sit on a chair with a back for 31 minutes", "stood independently for 1 minute" and "walked 15 meters normally". The examiner considered his nerve damage to be "mild" as he had not seen a specialist for this condition, only his GP, and that his mental health condition was "moderate", as he was "pleasant and co-operative" at the examination.
In the 5 months between his medical assessment and his appeal hearing, Mr C died. He may have seemed, during the examiner’s brief meeting with him, to be able to cope with social interaction, self maintenance and his difficulties with mobility, but the examiner took no heed of the variability of either his mental health or physical condition. Mr C was far from fit for work and we feel that this stressful process contributed to his declining health and eventual death.
Ms M is a 52 year old experiencing poor mental health, including depression, tearfulness, anxiety, poor concentration and severe difficulty with social interaction, all of which stemmed from her childhood experiences of abuse. She had been prescribed pain killers and anti-depressants at the time of her examination but described continuing emotional distress, including an inability to bring herself to wash and dress on some days and a lack of motivation to do housework, as well as substantial panic attacks when leaving the house and suicidal thoughts.
As she did not see a specialist for her mental health problems and she was able to shop for food, alone, on a weekly basis, the examiner found that "whilst the client has some impairment of their mental function, overall they are unlikely to have significant disability" and "despite wishing to avoid people, the client will go out when she has to". She was awarded no points at her examination, which was overturned at appeal, where she was awarded 18 points, from 3 separate descriptors.
This again raises the issue of the variability of a person’s condition, as covered in Case 2. It also raises the issue of complex and cumulative conditions. Ms M’s depression and tearfulness may have been moderate, her panic attacks and anxiety may also have moderate, but in combination they were severely prohibitive of a normal and enjoyable life and entering employment was not a viable option for her.
Ms M won her appeal under the old ESA descriptors but the amended WCA points system is proving largely unworkable in such cases. Under the new descriptors, which have substantially reduced the number of points available to those with anything less than very severe mental health conditions, Ms M would struggle to attain 12 points. This brings us to the third and final issue with this case: the medical examiner recognised that "the client will go out when she has to", a comment which was made in reference to her weekly food shopping. Ms M had already described how these outings made her feel: anxious, frightened, panicky, tearful and, at times, suicidal. Yet, the examiner saw fit to declare her fit for work, to create more situations in which she would be confronted by these overwhelmingly unpleasant feelings. We feel that this decision and the system that encourages examiners to make such decisions every day, is thoroughly inhumane.