The Sickness Route to Benefits

The Sickness Route to Benefits Contents: The Sickness Route to Benefits— history and the future 26 Being off sick whilst with an employer 28 The first 6 months of sickness 29 The sickness route—which benefits and when? 30 Pathways to Work 31 Work Focused Interviews deferrals and waivers 33 good cause for non participation 35 work –related activity 36 condition management programmes 37 Incapacity Benefit and Income Support Introduction/ Group exemptions 38 The Personal Capability Assessment 39 Completing the IB 50 form 42 Surviving the Switch to the New ESA system 44 Employment and Support Allowance ESA—which bits when? 46 The Assessment Phase 47 The Work Capability Assessment Deemed Criteria Work Focused Interviews Work Capability Assessment descriptors/ scoring 48 Completing the ESA 50 form 51 The Medical Assessment 68 The Work Focused Health Assessment 68 Which Component of ESA? 68 The Support Component 68 The Work Related Activity Component 70 How Much will ESA Pay? 70 Supporting Evidence for Sickness Route Benefits 71 Medical Assessments/ how to complain 79 What Can be Done when Sickness Status is Lost? 81 ESA Appeals/ Sample Submissions 83 Stop Press! Proposed Future Changes to the WCA/ Pathways 89 25 undergone a two day training course on The Sickness Route Incapacity Benefit, including a 30 minute video on interviewing people with mental health problems. A further five day course was to Benefits available on a voluntary basis, including a half A little history: day on awareness of disability and mental health issues... Way back in 1948, the Government of the day introduced measures to ensure some sort of Many, many people who were too sick to work income for people who were too sick or disabled found themselves thrown off the sickness route to work. to benefit and the All Work Test was derided by Labour in opposition as clearly not working... By the early 90s, Invalidity Benefit was costing around £6 billion a year. The Government of the The new Labour Government of 1997, then, day suggested that some people receiving the pledged to rethink and reform Incapacity - to benefit were fit for work. “Frankly, it beggars concentrate on what people could do, not on belief that so many more people have suddenly what they couldn’t. All that actually happened become invalids, especially when the health of though was that the infamous ‘All Work Test’ the nation has improved,” said John Major in was renamed the ‘Personal Capability 1993. Assessment’, without any change to its format. “Too many people regard Invalidity Benefit as a An organisation called ‘SEMA’ was awarded the readily available supplement to their contract for the medical service originally occupational pensions when they take early provided by BAMS and we were told that retirement,” said Peter Lilley… Secretary of training had improved. Evidence suggested State for Social Security “There are well though that it remained far from good, especially publicised cases of people on Invalidity in the field of mental health, where many bad Benefit .... enjoying cycling holidays and decisions continued to be made. Tribunal after winning javelin contests...” tribunal found in claimants’ favour. So in 1995, Incapacity Benefit and the ‘All Work Test’ were introduced. It was planned that this In February 2004 SEMA was bought up by Atos Origin, an international IT services company. ‘But then the javelin fell out of the rucksack and In an attempt to salvage the reputation of the caught in the spokes...’ doctors’ reports, we saw the introduction of ‘mouse driven’ medicals, where, dependant on diagnosis/ treatment regime etc. a computer programme prompted the doctor to consider particular descriptors. The stated aim was to remove some of the subjectivity from a much criticised process, but doctors continued to be told not to ask people directly about the mental health descriptors, the choice of which button to push was still open to interpretation and the process remained a subjective one. The resulting reports came—and continue to come - under fire for often being inconsistent would save money (pilot studies showed that 50 and impersonal. per cent of people on the old Invalidity Benefit were effectively finding themselves fit for work through their own answers, saving the Department having to do so), provide a ‘clearer’ definition of incapacity and reduce the role of GPs in the process The then Benefits Agency Medical Service staff had their numbers doubled. When Incapacity Benefit was introduced, BAMS doctors had 26 Plus ça change... They say that history repeats itself and the Welfare Reform agenda of recent years has felt very like 1995 all over again… HasHas full full limb limb Murmurings from government that many people function........ on Incapacity Benefit could actually be working function........ grew louder and louder - albeit that the message was now presented in terms of ‘if only they were enabled to do so’ rather than ‘if only they would get on/ off their bike/ leave their javelin at home’ - culminating in the introduction of Employment and Support Allowance in 2008. The long term aim is to reduce the number of people on Sickness Route Benefits by 1 million. Changes include: The expansion of the Jobcentre Plus-based Incapacity Benefit and/ or Income Support and ‘Pathways to Work’ system of work Severe Disablement Allowance to ESA, starting focused interviews, personal advisers etc. in October of 2010, with completion by 2014. to cover the whole of the country ‘Nobody will be worse off under Employment ‘Old’ Pathways areas have seen the and Support Allowance’ pledged the extension of a series of mandatory work- Government back in 2005—and yet the detail of focused interviews to people who have ESA has revealed a very different picture: been on the sickness route to benefit for less than three years and in some areas for The loss of amounts paid for an adult all claimants. looking after the claimant’s child(ren) The introduction of Employment and The loss of ‘age addition’ amounts paid to Support Allowance for new sickness route people younger when they first became claimants on October 27th 2008 with unwell—who were thus less able to build people with mental health problems up financial security for their future singled out for particular attention… The loss of a means-tested amount paid New work-focused conditionality attached for some partners after a year of being on to receipt of Employment and Support the sickness route plus the loss of a means Allowance for the majority of claimants, -tested top-up element for many who are with sanctions for claimant who fail to long term sick—and thus the associated comply. These sanctions, when applied, route to passported Housing and Council can leave some people existing on Tax Benefits, the Social Fund and free Jobseekers’ Allowance levels of benefit— prescriptions potentially indefinitely. Massively more people (68 per cent at the The loss of vital group exemptions which time of updating for 2010) are failing the used to spare all people deemed to have new test for ESA compared with the old severe mental health problems or severe one for Incapacity Benefit/ Income learning disabilities from the assessment Support for sickness—and hence losing all process. entitlement to sickness route benefit. A radically reformed, much harder test for The promise of a new, even harder test to ESA—the Work Capability Assessment come in future... The creation of a ‘two tier’ system of sickness route benefit ‘Employment and Support Allowance will only be for new claimants’ said the Government back in 2005 and yet they have since announced plans to ‘migrate’ all existing claimants on both old 27 Being off sick whilst still with an employer: Going off sick with the flu or a stomach bug is towards their convenience. To get Statutory Sick one thing. You know that it will fairly soon be Pay though, all you are actually obliged to do is over and your employer—although temporarily to notify them within seven days. You may, of inconvenienced—is probably quite glad you’re course, decide you want to meet the conditions not spreading your germs around the entire laid down in your contract for the sake of workforce. Going sick when you have mental goodwill— and to preserve any right to health problems feels very, very different. entitlement under more generous contractual schemes! Beyond seven days, you will need to Chances are that you will actually have been provide them with a medical certificate—sick struggling with your symptoms for some time— note/ line/doctor’s paper etc. in fact may already have had to take some days off sick because of them, even if you explained From April 2010 the familiar sick note has been them to your employer as a migraine or virus. replaced by a ‘Statement of Fitness for Work’. Some people manage to carry on like this Contradictory as it sounds, it still serves the indefinitely— or even find that their symptoms same purpose. It looks like this: improve. Others eventually reach some sort of breaking point and have to disclose to their employers—and sometimes to loved ones—that they are experiencing mental health problems. ‘I’d been having problems for months—but then just broke down one night— couldn’t stop crying—and, STATEMENT OF FITNESS FOR WORK what really frightened me— FOR SOCIAL SECURITY OR STATUTORY SICK PAY didn’t want to stop crying… It felt as if some storm that Patient’s name Mr, Mrs, Miss, Ms had been gathering for a long, long time inside me I assessed your case on / /

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