Aids & Appliances

The new legislation that came into effect at the end of January 2013 states that if an aid or appliance can be used and the claimant could be reasonably expected to use it, then they will be assessed as using it.

The following is taken from a memo to Decision Makers, which you can see in full here: http://www.dwp.gov.uk/docs/m-24-12.pdf

Aid or Appliance Prescribed or Advised

7 The Decision Maker should establish whether the claimant normally uses an aid or appliance, and if not, whether the use of it has been prescribed or advised.

8 If the claimant does not have an aid or appliance which they have been

prescribed or advised to use, the Decision Maker should establish

i. whether it would help the claimant

ii. why they are not using one

iii. whether the explanation is reasonable.

Example 1

Billy has been advised by his GP to use a walking stick to help with balance problems when walking and standing. He states that he doesn’t like the idea of a walking stick because it makes him look old. The Decision Maker considers that it would be reasonable to expect Billy to use a walking stick, and assesses LCW as if he is using it.

Example 2

Annie lives in a one bedroom apartment on the upper storey of a two storey block. There is no lift. She has been advised by her GP that a wheelchair would help her to mobilise over longer distances and that a wheelchair could be provided on request. Annie states that she could not get a wheelchair into her apartment, and could not store a wheelchair, either in her apartment or elsewhere. The Decision Maker considers that it would not be reasonable to expect Annie to use a wheelchair, and assesses LCW without it.

Aid or Appliance Not Prescribed or Advised

9 The Decision Maker must consider all the circumstances in order to determine whether it would be reasonable to assess the claimant as using an aid or appliance that has not been prescribed or that they have not been advised to use.

10 Factors include whether

i. the claimant possesses the aid or appliance

ii. the claimant was given specific medical advice about managing their condition, and it is reasonable for them to continue following that advice

iii. the claimant would be advised to use an aid or appliance if they raised it with the appropriate authority such as a GP or occupational therapist (advice may only be given on request)

iv. it is medically reasonable for them to use an aid or appliance

v. the health condition or disability is likely to be of short duration

vi. an aid or appliance is widely available

vii. an aid or appliance is affordable in the claimant’s circumstances (people are not routinely required to buy equipment where it can be prescribed.)

viii. the claimant is able to use and store the aid or appliance

ix. the claimant is unable to use an aid or appliance due to their physical or mental health condition, for example they are unable to use a walking stick or manual wheelchair due to a cardiac, respiratory, upper body or mental health condition.

Example 1

Miranda has significantly reduced mobility due to arthritis of the right hip and is on the waiting list for a hip replacement. She uses a walking stick to help with balance, but this does not enable her to walk any further than 200 metres before she experiences pain. She has not been advised to use a wheelchair. The HCP advises that she has no other health problems, and in their opinion based on clinical experience, would be provided with a manual wheelchair if she asked her consultant about this. If she had a wheelchair, she would be able to mobilise over longer distances. The Decision Maker decides that it would be reasonable, having considered all relevant factors, for Miranda to use a manual wheelchair, and that none of the Activity 1 descriptors apply.

Example 2

Gary has problems standing due to a condition which affects his balance. He would normally be helped by the use of a walking stick. However, the HCP advises that due to arthritis of the hands, Gary would have difficulty using a stick because he has reduced grip. The Decision Maker determines that it would not be reasonable to assess Gary taking a walking stick into account.

11 Where it is considered that the claimant should be assessed using an aid or appliance they do not have, the Decision Maker must give a clear explanation of how it could help the claimant. In the majority of cases the HCP will give advice on their use in the medical report. If not, or if the advice is not clear, the Decision Maker should seek further advice as to how reasonable it is to expect the claimant to use or benefit from the aid or appliance.

12 The aid or appliance must be relevant to the activity being assessed. For example, when assessing activity 5, manual dexterity, it is not appropriate to consider the use of devices, such as a grabber, which substitute for the hands, other than prosthetic hands.

13 DMs are additionally reminded that some activities and descriptors specify that the person must be assessed without the help of another person.

M.E. and Fibromyalgia are such complicated and neglected conditions, that while there may be many aids or appliances available to help us, firstly we probably don't know about them, and secondly we're likely to be unable to use them due to another facet of our condition.

For example,

A decision maker may consider that because I have a back issue, and that other people with similar back issues are helped with a walking stick, that I should use a walking stick. They would also need to take into consideration the fact that my hands are frequently too painful to grip the handle of the stick, due to the pain of Fibromyalgia.

Where we are aware of aids or appliances that are available to help with symptoms and issues that we have. If we do not have those aids or appliances or cannot use them, for whatever reason, we must state it clearly on our ESA50 form.

I will populate the end of this blog post with examples of this as they occur to me, simply because I find it very unfair that a Decision Maker can assess us as using an aid or appliance when we do not even know they exist. If you have any suggestions, please leave a comment below.