Comprehensive information on ESA from The ME Association:
The MEA receives a huge amount of often quite complex queries about ESA and we do not have the funding from membership fees available to employ someone who can deal with DWP benefit queries in the detail that they often require
So I have put together some basic information on ESA applications, reconsiderations and appeals that should be of help
MEA information leaflets can be ordered through the MEA website shop:
www.meassociation.org.uk, or by using the literature order form in ME Essential magazine
General information on ESA for the benefit of other people who are going through either an application, review or appeal process:
1 APPLYING FOR ESA
The MEA has a general information leaflet covering ESA as it applies to ME/CFS
We also have a detailed step-by-step guide to filling in all the paperwork that is involved if you apply for ESA:
http://www.meassociation.org.uk/shop/benefits-leaflets/esa-guide/
Feedback from our members indicates that this MEA guide has been very helpful in making sure that the DWP gets the right information about this illness and how it affects your capacity to work.
2 ESA DECISION MAKING
If an application for ESA has not been accepted you can ask the DWP for a reconsideration
And if you feel you have a good case you should appeal - because there is a very high success rate (currently around 40%) on appeal, especially when you can back up your case with good supporting medical evidence from health professionals and others involved in your care and management
The MEA has an information leaflet covering appeal procedures
3 MEDICAL ASSESSMENT BY ATOS, CAPITA OR MAXIMUS
I have been involved in the preparation of an Atos training document and one of the most important messages is that medical assessors must ask about the degree of fluctuation and variability of symptoms in ME/CFS and that people must be able to perform the WCA tasks in a manner that is reliable, repeatable and safe - to both themselves and to others.
4 SUPPLYING SUPPORTIVE MEDICAL EVIDENCE
You need to supply as much 'supportive medical evidence' as you can
Do NOT rely on the DWP asking for and chasing this up - they won't
This means obtains written support, if you can obtain it, from:
1 Your GP
2 Members of a multidisciplinary hospital based service - if you attend one: Doctor, Physio, OT etc
3 Anyone involved in your social care - do you have anyone helping with care or mobility needs?
4 Anyone else who is involved in your care
Letters should focus on your level of disability and relevant symptoms (e.g. cognitive dysfunction; orthostatic intolerance/hypotension etc) in relation to the way in which this is going to be assessed for DWP benefit purposes
The fact that you have a fluctuating medical condition, and this means that you may not be able/are not able to carry out tasks in a manner that is reliable, repeatable, safe (to you and to others) and in a timely manner should also be included/stressed
5 ACTION BEING TAKEN BY THE MEA TO IMPROVE THE SITUATION ON BENEFIT PROVISION
As you may be aware, we still believe that far too many people with ME/CFS are being refused ESA, or are being placed in the WRAG group when this is not appropriate.
We are members of the DWP Fluctuating Conditions Group that has been working with the DWP, and with Professors Malcolm Harrington and Paul Litchfield, on trying to improve the way in which claims for ESA are assessed through the Work Capability Assessment
The FCG produced wide ranging recommendations for reform of the WCA, including new WCA descriptors focussing on measuring severity and fluctuation of symptoms/disability - which were assessed in an evidence based review carried out by the DWP. We are now discussing with the DWP and Maximus (who carry out the medical assessments) how this work can be taken forward, especially in relation to the introduction of a semi structured interview.
The FCG has regular meetings with Maximus, who have taken over the medical assessment contract from Atos, and with the Countess of Mar at the House of Lords (who can ask parliamentary questions relating to benefit problems)
Overall, the work that we have been doing has resulted in a progressive and significant increase in the number of people being placed in the ESA Support Group. This is reflected in the quarterly statistics produced by the DWP on ESA application outcomes.
This change also reflects the fact that some of our key recommendations, especially those relating to people being able to carry out WCA tasks in a manner that is repeatable, reliable, safe, and in a timely manner have been accepted by the DWP.
The FCG report on WCA can be found in the document archive on the MEA website:
www.meassociation.org.uk
6 FURTHER INFORMATION FROM THE MEA
In addition to the information already referred to, this is an updated version of our 10 key points on ESA applications and appeals:
Ten Important things you should know about the Employment and Support Allowance (ESA) and the Work Capability Assessment (WCA) if you are:
·
Applying for ESA
·
Asking for a reconsideration of a decision
·
Appealing against a decision
(1) Feedback to The MEA indicates that a significant proportion of people with ME/CFS are finding it very difficult to qualify for ESA - the long-term sickness benefit for people who are unable to work. Entitlement to ESA is assessed by using what is called the Work Capability Assessment (WCA). The WCA does not determine entitlement to ESA on the basis of the named medical condition (e.g. ME/CFS) a person has. Your entitlement to ESA is supposed to be based on the effect that the disability or health problems resulting from having ME/CFS has on your functional capability to work.
(2) The situation regarding ESA has been made even more difficult for people with ME/CFS following legislation to bring in a revised set of WCA descriptors back in 2011. This legislation also removed some of the original WCA descriptors (e.g. the one on cognitive dysfunction – problems with short-term working memory and concentration) that are very relevant to people with ME/CFS. More information on the WCA descriptors can be found at:
www.meassociation.org.uk/?p=4534 (>> pdf of Statutory Instrument)
(3) People who are currently claiming ICB are now being re-assessed to see if they are eligible for ESA. Feedback to The MEA indicates that they are having very similar difficulties.
(4) The WCA descriptors are a list of questions relating to various aspects of disability and ill health along with point-scoring answers. The MEA believes that the current set of descriptors are not a fair or effective way of assessing capability for work in people who have long-term fluctuating medical conditions such as ME/CFS. Our reasons for coming to this conclusion can be found in our submission to Professor Malcolm Harrington’s review of the WCA:
www.meassociation.org.uk/?p=1639. Since then, The MEA has been involved with a group of charities representing people with fluctuating medical conditions in the production of a report that contains recommendations on how the WCA descriptors could be made fair and effective for people with fluctuating medical conditions. The recommendations in the report, along with recommendations covering mental health descriptors, have been assessed by the DWP in an evidence based review. The results of the review can be found here:
http://www.meassociation.org.uk/201...-and-statement-from-the-mea-17-december-2013/
A copy of the Fluctuating Conditions Group report can be downloaded on the MEA website:
http://www.meassociation.org.uk/wp-content/uploads/2011/05/Fluctuating_conditions_report_FINAL.pdf
(5) So if you are applying for ESA, or appealing against a refusal to grant ESA, or trying to move from the WRAG to Support Group, it is very important to give careful consideration to the way you provide answers to the WCA descriptor questions.
(6) During a House of Lords debate, which sought to annul the legislation which revised the WCA descriptors, a number of useful contributions were made which relate to people with ME/CFS and other fluctuating conditions. Lord Freud (DWP government minister) made the following important statement, which follows on from the work of the FCG, and is very relevant to people with fluctuating medical conditions:
“
It must be possible for all the descriptors to be completed reliably, repeatedly and safely, otherwise the individual is considered unable to complete the activity.”
A Hansard transcript of the debate can be found on the MEA website:
www.meassociation.org.uk/?p=5180
(7) There is a high rate of success on appeal involving ESA refusals – with around 40% of DWP decisions being overturned. So anyone who believes they have not been treated fairly should consider going to appeal.
(8) The chances of success at appeal are often increased by appearing in person and providing good supportive medical evidence from health professionals (and any other professional – including care workers) who are involved in your care – especially if this was not provided at the time of the application.
(9) Useful information on benefit appeal procedures can be found in a presentation given by Dr Jane Rayner (Chief Medical Member of Social Security tribunals) to the Forward ME Group at their meeting on 26 January 2011. The minutes of this meeting can be found here
: www.meassociation.org.uk/?p=4569.
Dr Jane Rayner has also produced a video on the appeal process. This can be found on the MEA website:
http://www.meassociation.org.uk/?p=13201
The Tribunal Service has produced a useful booklet called ‘How to Appeal – A Step by Step Guide’. This can be downloaded from the Tribunal Service website:
http://www.justice.gov.uk/downloads...s-and-how-to-appeal/HTA_English_Final_rev.pdf
(10) The MEA has a fully comprehensive list of leaflets covering all aspects of the benefits system – including applications for individual benefits and appeals.
Three helpful videos have also been produvced by Maximus on what happens during the process of claiming ESA,, including the medical Assessment:
https://www.chdauk.co.uk/updates/2015/09/helpful-videos-now-available
Information last updated in August 2016 by Dr Charles Shepherd - Hon Medical Adviser, MEA
Please note that regulations relating to DWP benefits are constantly changing and that this information is correct at the time of publication.
Dr Charles Shepherd
Hon Medical Adviser, MEA