Work Capability Assessment*, the test undertaken to determine whether a person is eligible for Employment and Support Allowance (ESA)**, fails to recognise the impact of HIV on ability to work, according to a new research report by NAT (National AIDS Trust).
The report Unseen disability, Unmet needs – A review of the impact of Work Capability Assessment on people living with HIV details concerns with both the design of the WCA and how it is implemented in practice. For example, the WCA does not fully reflect the impact that fluctuating symptoms, fatigue, side-effects of HIV treatment and depression can have on capacity for work. In addition, claimants going through the medical examination do not always have the opportunity to discuss the important issues around how their HIV affects their physical and mental health in ways that that limit their capability for work.
NAT‘s research finds continuing ignorance about HIV amongst medical assessors and decision makers drastically reduces the likelihood of a fair and accurate assessment on a claimant’s ability to work and need for disability-related benefits.
Deborah Jack, Chief Executive of NAT, says:
‘HIV is a disability, and like many other disabilities, people living with HIV can have vastly varying experiences relating to their condition. Whilst some find they can still work, many others find the impact of HIV or their treatment means employment is not an option at the moment and they need to claim disability related benefits.
‘As it currently stands, the WCA is based on an outdated model of disability which only recognises a narrow medically defined set of physical and mental impairments. Also, it does not appropriately acknowledge the fluctuating nature of the condition and the impact that low self esteem due to HIV related stigma can have on a person’s ability to work.
‘NAT has submitted our ongoing concerns to the Independent Review of WCA, lead by Professor Malcolm Harrington, and hopes these will fully considered before any new rules are finalised and come into effect.’
Key findings from the report include:
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The WCA does not take into consideration key HIV clinical markers, such as CD4 count***, in making the medical assessment
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During the assessment, WCA decision makers often give greater weight to the opinions of those contracted to make the medical assessment than to HIV clinicians and other specialists who have provided medical evidence
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A wide range of problems with administration and communication of the WCA process materially disadvantage claimants, and the stress and pressure of the process impacts negatively on their health
Case Study - Tim
Tim is a young man who applied for Employment and Support Allowance (ESA) with the help of his aunt and an HIV specialist benefits adviser. At the time of completing his ESA50 form, Tim’s CD4 count was 19. Medical evidence from his doctor explained that at the time of diagnosis, Tim had a CD4 count of 0 and PCP, a form of pneumonia associated with a low CD4 count.
Despite providing information about his blood test results, these were not discussed at the medial examination. The HCP’s record of the examination noticed, contradictorily, that Tim experienced ‘no side-effects’ but that he experienced diarrhoea as a result of his medication. The HCP also concluded that Tim did not score any points under the incontinence descriptor.
Tim was found fit for work. His doctor submitted further medical evidence but the case still ended up at appeal. Tim’s adviser said that, “on the day, we won that appeal, without me having to say a word or even sit down...The judge looked up and said, “oh – ESA successful, he’s in the support group, that’s not a problem”.’
Tim is now in the support group of ESA.
Case Study - Grace
Grace had a CD4 count of 40 when she was refused ESA. She claimed Job Seeker’s Allowance and attended the jobcentre for help to find work, where she was placed in a job as a cleaner. Grace became sick after only a couple of hours work, owing to her compromised immune system. She was ill for a fortnight.
Her HIV-specialist benefits adviser said, ‘me and the social worker went ballistic at her when we found out [that Grace had gone to work] but she said “I wanted to try because I don’t want to claim”. We said “we know darling but you’re too knackered so don’t”.’
The adviser took Grace’s case to appeal, and was successful. Grace is now in the support group.
What is CD4 count?
CD4 cells (or T-Cells) play an important role in the immune function. A low CD4 count (below 200 in someone living with HIV) is an indication of low immunity and greater susceptibility to a range of illness and infection.
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Notes to the editor:
*The Work Capability Assessment (WCA) is the test undertaken to determine whether a person is eligible for Employment and Support Allowance (ESA). The WCA aims to identify claimants who have ‘limited capacity for work’ or ‘limited capacity for work-related activity’, so that they may receive the right support to help them live well and (where appropriate) return to work. Those who are found ‘fit for work’ are not entitled to receive ESA. The test contains a series of questions, called ‘descriptors’, which relate to physical and mental functions, and from which claimants score points.
**In October 2008, Employment and Support Allowance (ESA) was introduced to replace Incapacity Benefit and Incapacity-based Income Support as the primary income support benefit for people who are unable to work due to disability or illness.
NAT would like to thank the following organisations for their vital assistance in this research:
The report is available to download at:
http://www.nat.org.uk/News-and-Media/Press-Releases/2010/October/Work%20Capability%20Assessment%20report.aspx
PDF version
Changes to sickness benefit assessments, announced yesterday, will not make the system fit for purpose and cannot be delivered before the government starts reassessing 1.5m existing claimants, experts have warned.
The government said it would accept the recommendations of an independent review of the work capability assessment, which determines whether people are eligible for employment and support allowance, which replaced incapacity benefit for new claimants in 2008.
The review recommended that the government introduce more personalised assessments, in addition to tick-box scoring of people's capabilities, and move away from an over-reliance on the medical assessment conducted as part of the WCA.
The WCA has been roundly criticised for wrongly finding many people fit for work, leading to them being placed on jobseeker's allowance, which is worth about £25 per week less than ESA and involves less support.
Employment minister Chris Grayling said the reforms would make the assessment fit for purpose by summer 2011, when the government is due to start reassessing 10,000 claimants of incapacity benefit on their eligibility for ESA, the first tranche of the 1.5m reassessments.
However, welfare rights trainer and consultant Neil Bateman said he did not think the Department for Work and Pensions had the capacity to make the changes in time. "They have already reduced their temporary staff and it takes ages to get decisions looked at; it is pretty clear that they don't have a lot of capacity," he said.
He added: "It's going to take a major sea change in staff attitudes and practices and it's going to require them to do quite a lot more work on individual cases."
Jane Alltimes, senior policy officer at Mencap, said she was also not confident that the reforms would be enacted in time.
The review recommended that assessment centres recruit champions with specialist knowledge of mental, cognitive or intellectual impairments to improve the quality of assessments, which Alltimes said she felt could be achieved swiftly. However she was less confident that changes to the culture of the system to make it more empathetic and personalised would be achieved in time.
Even if the department does implement reform by next summer some campaigners are sceptical that it will make the assessment effective in distinguishing between people who can work and those who need the further support that ESA brings.
"The outcome of the review is that we are going to be using the same test with greater support," said Neil Coyle, director of policy at Disability Alliance (DA). "It won't mean people are routinely put on the right benefit with the right support."
Coyle said disabled people would still be wrongly found fit for work because a rise in the eligibility criteria for ESA instituted by the government this summer, which is due to come into force next March. These will mean that assessors will be able to take adaptations into account, meaning people will not automatically be eligible for ESA if they cannot walk and can successfully use a manual wheelchair.
The government estimates that under the new rules the proportion of ESA claimants found fit for work will rise from 39% to 44%. However, Coyle said that when those whose claims do not reach the assessment stage are excluded from consideration, the proportion found fit for work will rise from 66% to 75%.
http://www.communitycare.co.uk/Articles/2010/11/24/115885/sickness-benef...