Monday, 11 June 2012


B is a 53 year old woman who lives alone. She had a heart attack approximately six months ago and also suffers from fibromyalgia, anxiety and clinical depression. She has attempted suicide ten times in as many years. She walks with a stick most days, is in acute pain throughout her whole body most of the time, is often too afraid to leave the house because of paranoia and anxiety and fantasises about ending her life several times per day. She says that remaining in the same position for more than 15 minutes at a time is almost impossible for her because of the pain in her body.

B is also haunted by memories of sexual and physical abuse from care givers and former partners, so much so that she says she cannot function properly in the world. 

B says that she would like very much to be able to work but that, as a result of her physical and mental health, work is not an option for her.

Until recently, B was in receipt of Incapacity Benefit, an out of work benefit for people who are unwell. As a result of the coalition's welfare reforms, Incapacity Benefit was scrapped and replaced by Employment & Support Allowance (ESA). Not surprisingly, an award of ESA is much harder to secure than an award of the old Incapacity Benefit.

B's Incapacity Benefit was coming to an end and she was invited to make a new claim for ESA, which she did. Entitlement to ESA works on a point-scoring basis; a claimant needs to score at least 15 points by way of a physical and mental health assessment. The points can come from the physical descriptors, the mental descriptors or a combination of the two.

B scored nil points in her medical assessment, the decision about her claim therefore being  that she did not have limited capability for work related activity. In short, her claim was unsuccessful.

B made an appeal against the decision and a copy of the medical assessment was acquired by the caseworker assisting her.

B's medical assessment lasted for eight minutes. The health care professional (HCP) states that B was observed to sit in a chair without difficulty for seven minutes. This is an irrelevant observation as the threshold for the sitting and standing descriptors starts at 30 minutes (a claimant is awarded nine points for being unable to sit in a chair without the help of another person for more than 30 minutes, and six points for being unable to do so for one hour).

In the mental health assessment, the HCP notes that B was able to walk to the local shop, alone, to buy bread and milk 'a few times per week' and that this was consistent with someone in good mental health. There is no mention of what B does for the rest of the week or why she can only manage to get to the shop so seldom and no mention of her long history of abuse, neglect or attempts to end her life. More importantly, there is no mention of B having been asked any of these questions.

The prognosis at the end of the HCP's report (the space where the HCP should give a clear explanation of his/her opinion) simply states that 'a return to work can be expected in three months' which is one of the most used sentences in reports of this kind where a claimant has failed to score points.

B has met with her caseworker four times. Each time they meet, B says the same thing: that she feels like a liar even though she knows she's not; that not being able to work is ruining her life and that she can feel another heart attack coming on.

B's appeal is to be heard by an independent Tribunal this week.

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