Sunday, 9 December 2012

Explaining the ESA Process

I had an appointment with my GP the other day. I noticed it written in my diary the day before, and for the life of me couldn't remember what it was for. It was the first thing in the morning however, too late to cancel it, so I went anyway. I sat down. He asked me how he could help. I looked at him and said 'I have absolutely no idea why I'm here'. He's a really nice GP, so thankfully wasn't cross at me. I hadn't wanted to not turn up, which he understood. We had a short chat, and I left, shortening the waiting time for the patients after me.

During this chat I mentioned to him that my ESA application had been turned down. They turned it down because they say I don't have enough National Insurance Credits. I may explain my personal case in another post at some point, but it isn't relevant to this post. He hadn't heard of National Insurance Credits being involved in ESA, so was thoroughly confused. I came home and wrote up an explanation of how the ESA process works for him. I left it at the surgery the following day when I had a blood test. The next day (I live at that surgery) he chased me out of the surgery to thank me for the description. He had found it very comprehensive, and had copied it for the other GPs. It has therefore occurred to me that other people may also find it useful. 

Below, you will find a (hopefully) simple explanation of how the ESA process works. If you spot any mistakes in it, please leave a comment and I'll make amendments.

Dear GP,

Since we were discussing ESA yesterday I thought I would put it in type for you so that the process is clearer. I hope it is of some help.

There are different phases to ESA.

The first phase starts when you give someone a ‘Fit Note’. If they are not in work, so can’t use it to claim statutory sick pay from their employer, they phone the DWP (Department for Work & Pensions) and fill in a form called the ESA1 over the phone with a DWP telephonist.

The DWP telephonist will establish whether your patient is suitable for:
•    Contributions Based ESA, or
•    Income Related ESA

To qualify for Contributions Based ESA your patient needs to have at least two years (in the last tax year) National Insurance Credits.

If they do not qualify for Contributions Based ESA, they may apply for Income Related ESA; but this is means tested – savings and partners income are taken into account.

If they qualify for neither, they can “claim” Income Related ESA without receiving any payments. The DWP will pay their National Insurance Stamp while they do so, so that two years later they can apply for Contributions Based ESA again (or sooner depending upon their shortfall).

When  someone succeeds in claiming Contributions Based ESA they are only able to do so for 12 months. After those 12 months are over, there must be a gap of at least another 12 months before they try to claim it again.

During this first phase of ESA they receive £70 a week basic rate. (I think, it may have changed again). They will then be sent the next form, the ESA50 (the one that gives everyone nightmares). This is the start of the second phase.

This is also the form I’m used to helping people with. If this form is filled in well enough, with enough supporting evidence, people can be put in the appropriate group (even the Support Group) without having to go for a medical. This is why I prefer GPs to give people supporting letters with their ESA50, rather than waiting for it to go to appeal.

The ESA50 is time limited; it must be filled in, and evidence gathered, by a certain date. Once the DWP receive it, a Decision Maker looks at it. (They have 20 minutes to go through it and the evidence, so the format in which the form is filled in is important). The Decision Maker will decide whether your patient needs to go for a medical, or whether there is enough convincing evidence to be put in one of the ESA groups; and if so, which group they go in.

Otherwise, your patient is then summoned to the Work Capability Assessment. A nurse, doctor, or other health professional will go through a series of questions and exercises with them to assess their abilities. Unfortunately they use a tick box system on a computer which does not allow for much flexibility, and thought they can input their own answers they usually do not. They have an unofficial target of 20% that they must fail on the assessment.

Once the WCA is over, the ESA50, your patients supporting evidence, and the results from the computerised assessment, once again go to a Decision Maker. A decision will then be made over whether your patient is fit for work, or whether they belong in the Work Related Activity Group (WRAG) or the Support Group.

People placed in the WRAG are expected to attend Job Centre interviews, and to participate in activity that moves them towards the goal of returning to work. This can mean going for counselling, doing voluntary work, or simply attending relevant medical appointments. It depends upon how understanding of their condition their advisor is.

People placed in the Support Group are not expected to return to work in the near future. They will be assessed again at some stage however. (At the moment they are assessing some people every three months).

I believe, but could be wrong, that if someone is on Contributions Based ESA and placed in the Support Group, that the year limit does not apply.

It is at this stage, that if your patient is found unfit for work, that they can appeal. They must appeal straight away, otherwise their payments will be stopped. Their case will go back in front of a Decision Maker again to assess whether a wrong decision was made, or whether the case should go in front of tribunal. Last time I went through the process mine was overturned at this point, so it does happen, though it’s rare.

At this stage I get lost. I’ve not helped anyone go through tribunal yet, because everyone I’ve helped has gone straight into the Support Group. I understand it’s an extremely stressful process, that they must gather even more evidence, that it’s best to have someone accompany them, etc.


So, to understand what happened to me [..].

Kind regards,

Olana

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