GP Supporting Letter Guide

Depending upon how open your doctors are, there are a number of documents with which you can provide them. This will not only help yourself, but other patients in future, too. If your doctor is fairly unapproachable, the best method is to simply provide them with the Fightback Example Letter for GPs, which can be found here: FightBack Example Letter for GPs

If however, your doctor or consultant is enthusiastic about providing the best support they can for their patients, then providing them with the following will help:

-          A copy of the ESA50:

-          https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300228/esa-50.pdf

-          The ESA descriptors:

http://www.benefitsandwork.co.uk/employment-and-support-allowance/esa-glossary/1354-work-related-activity-group-descriptors

-          Regulations 29 & 35:

http://helpmewithbenefits.blogspot.co.uk/2013/08/regulations-29-35.html

-          The Support Group descriptors:

http://www.benefitsandwork.co.uk/employment-and-support-allowance/esa-glossary/1353-support-group-descriptors

-          My following explanation:

The Descriptors are used to score each ESA application. You will note that each Descriptor tallies to the like numbered question on the ESA50 form that your patient must complete. For the descriptors appropriate to your patient, please write a sentence in the letter that describes their ability, and why, preferably using wording similar to that of the Descriptor. For Fibromyalgia it is particularly important to note the fluctuating nature of the condition, by explaining that your patient cannot “Reliably, repeatedly, and safely” perform activities.

Your patient must score 15 points or more from the Descriptors in order to placed in the ESA Work Related Activity Group. If you believe that your patient is not ready to be pushed towards work, or will not be at all, please state this clearly in your supporting letter, as per regulations29 & 35. It will be additionally useful if you include sentences that match your patient to the Support Group descriptors.

It is imperative to be mindful of your phrasing when writing the letter. The DWP will discard any sentences which they can consider to be in doubt. For example, “I believe that my patient is in constant pain”, may be discarded, whereas “My patient is in constant pain” will not.

The letter can be kept short, covering the basics that you consider will place your patient in the appropriate ESA group. Or you can include information regarding specialists, test results, and patient history.

Shame

I remember sitting in my bedroom as a teenager, and realising how fortunate I was to have been born into this country. We weren't starving, like they were in Ethiopia. We weren't at war, like they were in some parts of the world. We always had plenty of clean, fresh water available, and always had food on the table. Most people had a roof over their head, and those who didn't had help available. We had councils who helped people, unions that helped workers, there were safety nets in place for nearly every eventuality you could think of. We may be struggling in our every day lives, but we had it made! I realised this as a teen, and my ambition became to help people world wide who weren't so fortunate to have been born into a country like this.

Unfortunately, I no longer believe we are fortunate. I feel shame. Total and utter shame, at what this country is doing.

How much of that remains? When I try and tell certain people about the difficulties of being sick or disabled in this country, I frequently get a response along the lines of "At least you're not starving in Ethiopia". Why is it more acceptable to starve here?

Are people really starving here? YES! 

The government has pretty much gone out of it's way to eliminate any form of income for people who are sick or disabled, and have made it very difficult to get by for those who are simply working class at the minimum wage end of the spectrum. If you weren't born with a silver spoon in your mouth they see you as scum, and we are to be treated as we deserve! 

Take my own example. I cannot claim Contributions Based Employment & Support Allowance (CB-ESA), because the DWP (Department for Work & Pensions) paid my NI (National Insurance) stamp last year. Their type of stamp does not count towards benefits, only towards your pension (should you be unlucky enough to live that long). I cannot claim Income Related ESA, because I am living with someone who earns over £8000pa (the threshold is somewhere around 7000). His outgoings are not taken into account. So, the fact that his outgoings are nearly equal to his income is irrelevant. He cannot afford to support me. As such, I am currently living off hand outs. They won't last forever! There is no point at which I can suddenly claim CB-ESA, as while I'm in this situation the DWP pays my NI, thus cancelling out the possibility indefinitely. It also seems that I will be unlikely to receive DLA; the DWP are putting off giving me a decision month after month. My suspicion is that they are waiting for PIP (Personal Independence Payment); under which I definitely will not qualify. There are no other benefits available to me, no safety net to catch me, nothing. I'm not the only one, there are hundreds, probably thousands of people in this situation across the country. The inevitable is that these people will become homeless, probably starving to death.

DLA was never intended for people to live on. It was intended to be some money that helped disabled people live a normal life contributing to the community. Something those who designed PIP seem to have forgotten, despite it's all encompassing name: "Personal Independence". They have made it virtually impossible for people who are genuinely disabled, to claim. For example, one of the descriptors is that claimants be unable to walk 20m, where it used to be 50m. They have cut down the criteria similarly throughout the assessing process, and have taken out some things under which people used to qualify. They've introduced descriptors, suggesting it is now another tickbox computer based system, similar to that of ESA that assesses people.  So, unless you are wheelchair bound, and almost totally unable to do anything for yourself, you're unlikely to receive PIP. Genuinely disabled people will lose their DLA. For many this means losing their car; that is their ability to get to work. Similarly for some it's losing the money they use for public transport. For some it is money used to bring in respite carers. So many people will be very suddenly thrown into situations where life is totally unmanageable.

And yet suicide is illegal.

It isn't just DLA though, please do understand that. ESA has recently changed, making it more difficult to receive again. More changes are being brought in, in April too. At present, when you apply for ESA, if you are turned down you can appeal. You still receive some money (£70pw - the Assessment Rate) until your reconsideration, appeal, or tribunal are finished. The Assessment Rate is being scrapped. You will no longer be allowed to appeal straight away, but must have a mandatory reconsideration first. To be fair, many decisions are overturned at 'reconsidertion', BUT, the DWP has no time limit on how long their reconsideration's take; so people will be left without money indefinitely. They say that they will be processed as quickly as possible. 

No comment.

What happens when someone has no money? Probably first of all, they go hungry. The government has at least seen fit to open more food banks since they've been in power (that in itself shows us that they knew what they were doing to us); but the housebound and bedbound can't get to food banks! And what of those who have specific dietary requirements (I'm talking Coeliac, etc, not vegetarians)? The next thing that probably happens is being unable to pay the bills. The phone gets cut off, then the electricity and gas. Their landlord may be understanding to start with, but if they're sitting in his property not paying any rent, he's losing money, so at some point they get turfed out of their home. Homeless, starving, and ill or disabled. That's what our government is aiming for!

At the moment, most people can claim a Crisis Loan when they find themselves in that sort of situation (not I, due to the other half's income). So what's the government's next step? They're removing Crisis Loans too!

They're also removing Legal Aid for people going to tribunal over their ESA, DLA, or PIP, decisions. In case you're unaware, there is a long convoluted system involved here. If someone disagrees with the decision made on their application (which they usually do, since the DWP deliberately underestimates people's needs), they can appeal. The appeal goes through reconsideration, at which point it can be changed, but if it is not it goes to Tribunal. If they still disagree with the decision then they can take it to the Upper Tier Tribunal. At this level people really need legal advice, and preferably legal representation, if they want to stand a chance of winning their case (they put people through all of that, just for £90pw). And that legal advice will no longer be available; because the government don't want people to win! They don't want to spend their money on the plebs.

There's more. Much more. The so called "bed room tax" for example. I'm so sick of it. It has now got to the point where I think we'd all be better off in another country. If there was a country open to receiving us, I have no doubt that there would be a mass exodus of sick and disabled people from the UK.

I'm actually kind of surprised that there has been no attempt on the lives of any of the politicians involved with all of this change. Yes, by definition the sick and disabled would be unable to carry out such an act, but we're not the only ones who are totally incensed by it all.

I wonder whether they realise that they are backing everyone in to a corner. It's basically going to be a choice between a life of crime, a life on the streets begging, or suicide. All of which are illegal. I suspect it's the latter that they are waiting for, but I also suspect it's the life of crime that most will turn to.

Eek! My ESA50 form's late!!!

Are you filling in the horrible ESA50 form, hoping you'll be able to claim Employment & Support Allowance? Do you have that horrible big black line on the calendar looming imminently over you? Don't worry. You can rub that line out if you have M.E. or some mental health conditions (sorry, but I don't know which ones).

This subject keeps coming up recently. Mostly because people have still only been given four weeks to fill in their ESA50 despite Christmas and New Year being in the middle of it. A lot of people are running late with their forms and panicking. I knew I had read somewhere that people with M.E. needn't worry about late forms, but I couldn't remember where. Then I found that I had saved the information to my computer ... hoorah ... but doh! 

So, I apologise, I do not know where this information came from, but do please feel free to use it. Personally, I would not recommend running anymore than a week late with your form. If you are returning your form late copy and paste the information below into a document and submit it along with your form and a letter explaining your reasons for lateness.

DWP will insist that they do not give anyone a time extension for completing the ESA50.

This is contrary to their own guidelines. In a letter to the Countess of Mar dated 21 November 2011 regarding the Incapacity Reference Guide, and the flagging of ME/CFS along with mental health conditions, the DWP stated:-

"Therefore, for the avoidance of doubt I can be clear that the Department does not classify CFS/ME as a mental health disorder. The asterisk next to CFS/ME in the Incapacity Reference Guide (IRG) is not as an indicator of its classification, but rather to alert decision makers to the fact that a proportion of people with CFS/ME have symptoms related to altered mental function. Mental health condition and those that have mental function impairment as a feature are highlighted in the IRG so that appropriate safeguards can be put in place. These safeguards include not automatically rejecting a claim to benefit should an individual fail to return the related questionnaire, together with procedures for additional contact with the claimant during their application if required."

It may be useful to quote this to the DWP when you ask for an extension, in any case ensure that they make a note of your conversation on your records, or perhaps it is better to put it in writing to them, so that, if ATOS refer your case back to DWP as a non-returned form, then they should have to take this information into account before making any decision to end your claim.

The incapacity reference guide is here:-

http://www.hmrc.gov.uk/manuals/spmmanual/spm50600.htm

The correspondence with the DWP regarding ME is found here:

http://www.meassociation.org.uk/?p=9327

Should anyone know where this information came from, please let me know so that I can give the relevant credit.

My benefit claims

I've been working on my own benefit claims over the last month or so; ESA and DLA. I have to say that I am sincerely disappointed with the DWP. Until now I had pretty much given them the benefit of the doubt; I thought that the employees were not to blame for how the system works, but as much victims of it as the claimants. Just part of the machine.

I can now categorically tell you that, sometimes, they do not even look at our application forms before making a decision. I realised after posting my DLA form that I had not signed it. I therefore fully expected it to be turned down, with a letter asking me to resubmit it, having sign it. However, what I actually received was a fail based on the medical assessment I had for ESA 18 months ago.

I will point out at this juncture, that the medical 18 months ago was over-turned immediately. It was wrong, the assessor had made unreasonable assumptions based on no evidence, which I clearly illustrated to the DWP as soon as I received her report. I received ESA from a reconsideration, and placed a complaint against the assessor to Atos. (Atos of course defended her).

While it is outrageous that they are using outdated evidence, that is not my point. Had they actually looked at my form they would have realised straight away that they could turn it down based on the lack of signature. They didn't look at it! That is disgusting. Do they have the slightest idea of how much effort, how much energy, how much blood sweat and tears, go into those forms? I severely neglected Christmas preparations because they expected the form back just before Christmas; my waking hours were utilised on the form (plural actually, as I had my ESA50 too). They obviously do not care. I wonder how many people are declined at this stage, not realising that their form has not even been looked at, and not aware that they can appeal. I wasn't aware that you could appeal the first time I was declined after all. No one actually teaches you how the system works.

I can't help thinking that it would save them money if they didn't faff around like this, playing silly buggers. If they actually processed peoples claims properly when they were first sent in, based upon their form and accompanying evidence, surely there would be less need for appeals.

Unfortunately, my experience with ESA is no better. In fact I think I would go as far as to say it's worse. It's a lot more complicated though, so if you cannot follow what I try to explain now, don't worry too much about it.

Whilst getting divorced in 2010 I applied for ESA over the phone. The DWP friendly telephonist I spoke with checked that I had enough National Insurance Credits to claim Contributions Based ESA. My ex had tried to scare me, telling me that I hadn't paid enough of them, which is why we checked, and why it is so memorable that I did have enough of them. (My ex was trying to scare me regarding money in a lot of ways). So, I applied for CB-ESA, got through the application process, and started receiving ESA basic rate.

At the beginning of November I moved into my own flat (call this location A), so changed my address over the phone with the DWP. A couple of weeks later in November I received my divorce settlement. I phoned the DWP to find out if this had any baring on my claim, as I had heard that it could do. I was told that I would no longer receive ESA payments, but that my National Insurance would still be credited. It's a shame that I did not know the system so thoroughly then, as what he told me was wrong and I would have recognised it.

In December I went to stay elsewhere (call this location B) while problems with my flat were sorted out, so I phoned the DWP and gave them the new address again. At that time I was not informed of any problems with my claim.

I moved again in March due to problems with location B, and location A never got sorted out (so call this location C). I contacted the DWP again to give them the address for location C. I was told that they could not change the address on a closed claim. I asked when the claim had been closed, and was told it had been closed in the November, when I had told them about the divorce settlement. I was astounded, as I had not been told in November that he was closing my claim, nor had I received any paperwork to that affect.

When I had returned to location A to check I'd got everything, I found two letters from the DWP; one summoning me for a medical assessment, and another telling me that because I had not attended the medical assessment my benefit would be revoked. They were dated February, and expected me to be at the medical a few days before I found the letters.

So they had screwed up:

• they should not have discontinued a Contributions Based ESA claim based upon a divorce settlement. Contributions Based ESA is not means tested.
• if my claim was closed in November 2011, and you cannot change the address on a closed claim, then I should not have been able to change my address in December.
• when my claim was closed, I should have received paperwork to inform me.
• if my claim was closed in the November, I should not have been summoned for a medical assessment in February.

So, recently, my GP gave me a fit note to cover me for two months. He wanted me to have some income. I wasn't sure what you do with fit notes, so I phoned the DWP to ask. I spoke to one of their helpful telephonists (as opposed to the unhelpful ones), who tried her best to initiate an ESA claim for me, but just could not do it. My record was screwed. Every time she tried to start a claim the computer gave her an error. She probably should not have told me that really. Anyway, she put a request in for me to be sent an ESA1 in the post so that I could fill it in manually and return it myself.

I received the claim pack for Housing Benefit.

I received the claim pack for Carers Allowance.

I received the claim pack for some Disability thing I've never heard of.

Eventually an ESA1 arrived.

On the ESA1 you have to decide whether you wish to claim for Contributions Based ESA, or Income Related ESA. Being aware that my record was a complete mess I thought I'd better check what state my National Insurance was in, so, again I phoned the DWP. I was given a different number to contact the NI Office. I spoke to a lovely man who told me that I have three years of Class 1 credits, should have no problem placing a claim, and that he was disgusted that I was having to do the DWPs legwork for them. 

So, confident that they'd screwed my record up enough for me to claim Contributions Based ESA, I ticked that box. Surprise surprise; I received notification back that I do not have enough NI to claim Contributions Based. I already know I can't claim Income Related because my other half's earnings are above the threshold, despite the fact that his outgoings don't allow him to support me.

I'm stuck in a rut. I have made my MP aware of the situation. She is trying to get my National Insurance sorted out, but I suspect that when it is sorted out it will still not be the right kind of credits to claim ESA. She has also given me a supporting letter for my DLA reconsideration, as she was already aware of my health before any of this happened. 

Over the last few weeks, working on these claims, I have found out a couple of things that people with M.E. may find interesting:

M.E. claimants, along with claimants who suffer from mental health conditions, are given time limit concessions. That means that they are expected to get their forms back a little late. The DWP telephonists aren't actually aware of this, so if you're phoning the DWP to inform them of lateness, you'll need to explain it to them. It's also a good idea to remind decision makers in a note with your claim. I wouldn't advise returning your form late if you can avoid it, and certainly not weeks late.

M.E. is assessed as CFS by Atos. The Atos guidelines for assessing CFS do not tell the assessor what kind of condition it is, but give them the choice as to whether they assess it as a physical condition, a psychological condition, or a mixture of both. Personally, I don't like this. M.E. is recognised by the WHO and NICE as being a neurological condition, with neurological indicators. The DWP is supposed to use doctor's to assess neurological conditions, but M.E. is exempt from this. I was assessed by a nurse. I know others who have been assessed by physiotherapists, health workers, etc. The reason for this is, apparently, that people with M.E. do not show neurological indicators. Well; I know I do. I also know that they are described in some detail on my form. As such I SHOULD be assessed by a doctor, but can guarantee I will not be. 

Honestly, it probably doesn't make any difference. I just feel indignant that M.E. is degraded in this way.

Petition worth signing!

Yeah yeah, I know there are loads of these things going around. Most of them are really naff though, written by someone with half a brain who is angry over something so they've whipped up a really badly worded petition in five minutes, without thinking it through properly. This one is NOT one of those. This one is very well thought through, asks for what we seriously need, and should actually be taken seriously by parliament because of how it is written.

Personally, I have given up on parliament. I think they are throwing out everything that comes their way if it isn't in their interests. I think we no longer have a proper democratic government, but that's a totally different matter. It's worth trying, so please sign it.

Please sign here.

We call for:

A Cumulative Impact Assessment of all cuts and changes affecting sick & disabled people, their families and carers, and a free vote on repeal of the Welfare Reform Act.

An immediate end to the Work Capability Assessment, as voted for by the British Medical Association.

Consultation between the Depts of Health & Education to improve support into work for sick & disabled people, and an end to forced work under threat of sanctions for people on disability benefits.

An Independent, Committee-Based Inquiry into Welfare Reform, covering but not limited to: (1) Care home admission rises, daycare centres, access to education for people with learning difficulties, universal mental health treatments, Remploy closures; (2) DWP media links, the ATOS contract, IT implementation of Universal Credit; (3) Human rights abuses against disabled people, excess claimant deaths & the disregard of medical evidence in decision making by ATOS, DWP & the Tribunal Service.

I am unfamiliar with what an Impact Assessment is, but we do need someone unbiased to seriously look into why the cuts and changes to everything are affecting the sick and disabled so much more than the rich. Asking for the ability to vote on such changes is genius.

In case you are unaware, the British Medical Council voted that the Work Capability Assessment - that scary medical you're sent for if you wish to claim Employment & Support Allowance - be ended. I agree 100% with this request, though am uncertain of how practical it is. There needs to be something in place. Personally I'd appreciate it if they took the ESA50 and medical evidence seriously in the first place.

Again, I agree 100% with ending forced work for the sick and disabled. Personally, I want to work, and I like the idea of gradually being re-introduced to it. BUT I do not think it should be forced upon anyone, and am disgusted that they take away 70% of someone's benefit if they cannot make it to that work. The nature of being sick and disabled means they will be unable to attend at times.

And yes oh YES, please please can there be an inquiry into all of the above. Independent and unbiased. The problem I have with inquiries is that they nearly always find what the government to find though. Either that of the government just ignores them.

Support Group Descriptors

The previous post lists the point scoring system used with the descriptors for the ESA50 & WCA. As stated in that post, you need 15 points to get ESA. If you score 15 points in only one section you will be placed in the ESA Support Group, as opposed to the Work Related Activity Group. The other way to be placed in to the Support Group is to meet one of the descriptors below.

If you are unfamiliar with the terms used above, please see this post.

Support group descriptors

Qualifying for the support group of employment and support allowance (ESA) is not about scoring points.  Instead, if the decision maker accepts that any of the following descriptors apply to you, then you will be placed in the support group. 1.  Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid can reasonably be used. Cannot either  (i)  mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion or (ii)  repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.  2.  Transferring from one seated position to another. Cannot move between one seated position and another seated position located next to one another without receiving physical assistance from another person. 3.  Reaching. Cannot raise either arm as if to put something in the top pocket of a coat or jacket. 4. Picking up and moving or transferring by the use of the upper body and arms (excluding standing, sitting, bending or kneeling and all other activities specified in this Schedule). Cannot pick up and move a 0.5 litre carton full of liquid. 5. Manual dexterity. Cannot either: (a) press a button, such as a telephone keypad or; (b) turn the pages of a book with either hand. 6. Making self understood through speaking, writing, typing, or other means normally used. Cannot convey a simple message, such as the presence of a hazard. 7. Understanding communication by hearing, lip reading, reading 16 point print or using any aid if reasonably used. Cannot understand a simple message due to sensory impairment, such as the location of a fire escape. 8. Absence or loss of control over extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting) despite the presence of any aids or adaptations normally used.  (a) At least once a week experiences (i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device; sufficient to require cleaning and a change in clothing. 9.  Learning tasks. (a) Cannot learn how to complete a simple task, such as setting an alarm clock, due to cognitive impairment or mental disorder. 10. Awareness of everyday hazards (such as boiling water or sharp objects). (a) Reduced awareness of everyday hazards leads to a significant risk of:  (i) injury to self or others; or (ii) damage to property or possessions, such that they require supervision for the majority of the time to maintain safety. 11. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks). Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions.  12. Coping with change (a) Cannot cope with any change, due to cognitive impairment or mental disorder, to the extent that day to day life cannot be managed.  13. Coping with social engagement due to cognitive impairment or mental disorder Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual. 14. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. 15.  Conveying food or drink to the mouth. (a) Cannot convey food or drink to the claimant’s own mouth without receiving physical assistance from someone else; (b) Cannot convey food or drink to the claimant’s own mouth without repeatedly stopping, experiencing breathlessness or severe discomfort; (c) Cannot convey food or drink to the claimant’s own mouth without receiving regular prompting given by someone else in the claimant’s physical presence; or (d) Owing to a severe disorder of mood or behaviour, fails to convey food or drink to the claimant’s own mouth without receiving — (i) physical assistance from someone else; or (ii) regular prompting given by someone else in the claimant’s presence. 16.  Chewing or swallowing food or drink (a) Cannot chew or swallow food or drink; (b) Cannot chew or swallow food or drink without repeatedly stopping, experiencing breathlessness or severe discomfort; (c) Cannot chew or swallow food or drink without repeatedly receiving regular prompting given by someone else in the claimant’s presence; or (d) Owing to a severe disorder of mood or behaviour, fails to— (i) chew or swallow food or drink; or (ii) chew or swallow food or drink without regular prompting given by another person in the physical presence of the claimant.

ESA Descriptors

When you apply for Employment & Support Allowance (ESA), you receive a form called the ESA50. This form, and the Work Capability Assessment (WCA - the Atos medical assessment) are scored on a point system. The DWP / Atos use "descriptors" to award these points. The descriptors are below. The points are in blue after each descriptor. I have explained in my previous blog post the best way to use them.

You need at least 15 points to get ESA.

Limited Capability for Work Descriptors

Points are indicated in blue beneath the descriptor

Descriptors and scores for each physical activity

Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid can reasonably be used.

(a) Cannot either:

(i) mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion;

or

(ii) repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.

15

(b) Cannot mount or descend two steps unaided by another person even with the support of a handrail.

9

(c) Cannot either:

(i) mobilise more than 100 metres on level ground without stopping in order to avoid significant discomfort or exhaustion;

or

(ii) repeatedly mobilise 100 metres within a reasonable timescale because of significant discomfort or exhaustion.

9

(d) Cannot either:

(i) mobilise more than 200 metres on level ground without stopping in order to avoid significant discomfort or exhaustion;

or

(ii) repeatedly mobilise 200 metres within a reasonable timescale because of significant discomfort or exhaustion.

6

(e) None of the above apply

2. Standing and sitting.

(a) Cannot move between one seated position and another seated position located next to one another without receiving physical assistance from another person.

15

(b) Cannot, for the majority of the time, remain at a work station, either:

(i) standing unassisted by another person (even if free to move around); or

(ii) sitting (even in an adjustable chair) for more than 30 minutes, before needing to move away in order to avoid significant discomfort or exhaustion.

9

(c) Cannot, for the majority of the time, remain at a work station, either:

(i) standing unassisted by another person (even if free to move around); or

(ii) sitting (even in an adjustable chair) for more than an hour before needing to move away in order to avoid significant discomfort or exhaustion.

6

(d) None of the above apply

3. Reaching.

(a) Cannot raise either arm as if to put something in the top pocket of a coat or jacket.

15

(b) Cannot raise either arm to top of head as if to put on a hat.

9

(c) Cannot raise either arm above head height as if to reach for something.

6

(d) None of the above apply.

4. Picking up and moving or transferring by the use of the upper body and arms.

(a) Cannot pick up and move a 0.5 litre carton full of liquid.

15

(b) Cannot pick up and move a one litre carton full of liquid.

9

(c) Cannot transfer a light but bulky object such as an empty cardboard box.

6

(d) None of the above apply.

5. Manual dexterity.

(a) Cannot either:

(i) press a button, such as a telephone keypad; or

(ii) turn the pages of a book with either hand.

15

(b) Cannot pick up a £1 coin or equivalent with either hand.

15

(c) Cannot use a pen or pencil to make a meaningful mark.

9

(d) Cannot use a suitable keyboard or mouse.

9

(e) None of the above apply.

6. Making self understood through speaking, writing, typing, or other means normally used, unaided by another person.

(a) Cannot convey a simple message, such as the presence of a hazard.

15

(b) Has significant difficulty conveying a simple message to strangers.

15

(c) Has some difficulty conveying a simple message to strangers.

6

(d) None of the above apply.

7. Understanding communication by both verbal means (such as hearing or lip reading) and nonverbal means (such as reading 16 point print) using any aid it is reasonable to expect them to use, unaided by another person.

(a) Cannot understand a simple message due to sensory impairment, such as the location of a fire escape.

15

(b) Has significant difficulty understanding a simple message from a stranger due to sensory impairment.

15

(c) Has some difficulty understanding a simple message from a stranger due to sensory impairment.

6

(d) None of the above apply.

8. Navigation and maintaining safety, using a guide dog or other aid if normally used.

(a) Unable to navigate around familiar surroundings, without being accompanied by another person, due to sensory impairment.

15

(b) Cannot safely complete a potentially hazardous task such as crossing the road, without being accompanied by another person, due to sensory impairment.

15

(c) Unable to navigate around unfamiliar surroundings, without being accompanied by another person, due to sensory impairment.

9

(d) None of the above apply.

9. Absence or loss of control leading to extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting) despite the presence of any aids or adaptations normally used.

(a) At least once a month experiences:

(i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or

(ii) substantial leakage of the contents of a collecting device sufficient to require cleaning and a change in clothing.

15

(b) At risk of loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder, sufficient to require cleaning and a change in clothing, if not able to reach a toilet quickly.

6

(c) None of the above apply.

10. Consciousness during waking moments.

(a) At least once a week, has an involuntary episode of lost or altered

15

Consciousness resulting in significantly disrupted awareness or concentration.

(b) At least once a month, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration.

6

(c) None of the above apply.

Descriptors and scores for each mental, cognitive and intellectual function assessment

11. Learning tasks.

(a) Cannot learn how to complete a simple task, such as setting an alarm clock.

15

(b) Cannot learn anything beyond a simple task, such as setting an alarm clock.

9

(c) Cannot learn anything beyond a moderately complex task, such as the steps involved in operating a washing machine to clean clothes.

6

(d) None of the above apply.

12. Awareness of 15 everyday hazards (such as boiling water or sharp objects).

(a) Reduced awareness of everyday hazards leads to a significant risk of:

(i) injury to self or others; or

(ii) damage to property or possessions such that they require supervision for the majority of the time to maintain safety.

15

(b) Reduced awareness of everyday hazards leads to a significant risk of:

(i) injury to self or others; or

(ii) damage to property or possessions such that they frequently require supervision to maintain safety.

9

(c) Reduced awareness of everyday hazards leads to a significant risk of:

(i) injury to self or others; or

(ii) damage to property or possessions such that they occasionally

6

(d) None of the above apply.

13. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks).

(a) Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions.

15

(b) Cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions for the majority of the time.

9

(c) Frequently cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions.

6

(d) None of the above apply

14. Coping with change.

(a) Cannot cope with any change to the extent that day to day life cannot be managed.

15

(b) Cannot cope with minor planned change (such as a pre-arranged change to the routine time scheduled for a lunch break), to the extent that overall day to day life is made significantly more difficult.

9

(c) Cannot cope with minor unplanned change (such as the timing of an appointment on the day it is due to occur), to the extent that overall, day to day life is made significantly more difficult.

6

(d) None of the above apply.

15. Getting about.

(a) Cannot get to any specified place with which the claimant is familiar.

15

(b) Is unable to get to a specified place with which the claimant is familiar, without being accompanied by another person.

9

(c) Is unable to get to a specified place with which the claimant is unfamiliar without being accompanied by another person.

6

(d) None of the above apply.

16. Coping with social engagement due to cognitive impairment or mental disorder.

(a) Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual.

15

(b) Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the individual.

9

(c) Engagement in social contact with someone unfamiliar to the claimant is not possible for the majority of the time due to difficulty relating to others or significant distress experienced by the individual.

6

(d) None of the above apply.

17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder.

(a) Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.

15

(b) Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.

15

(c) Occasionally has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.

9

(d) None of the above apply.