3 Ways into the Support Group & the ESA Suport Group Descriptors

There are three ways in which you can get into the ESA Support Group:

1. Scoring 15 on some of the general descriptors can place you in the Support Group. You can see them here.
2. Using Regulation 29 or 35 may place you in the Support Group.
3. or, if you fall in to any one of the descriptors below, you will be placed in to the Support Group.

	SCHEDULE 3	Regulation 20(1)
Assessment of whether a claimant has limited capability for work-related activity

Activity	Descriptors
1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid is normally or could reasonably be worn or used.	1 Cannot either:
	(a) mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion; or
	(b) repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.
2. Transferring from one seated position to another.	2 Cannot move between one seated position and another seated position located next to one another without receiving physical assistance from another person.
3. Reaching.	3 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).	4 Cannot pick up and move a 0.5 litre carton full of liquid.
5. Manual dexterity.	5 Cannot press a button (such as a telephone keypad) with either hand or cannot turn the pages of a book with either hand.
6. Making self understood through speaking, writing, typing, or other means which are normally, or could reasonably be, used unaided by another person.	6 Cannot convey a simple message, such as the presence of a hazard.
7. Understanding communication by: (i) verbal means (such as hearing or lip reading) alone; (ii) non-verbal means (such as reading 16 point print or Braille) alone; or (iii) a combination of sub-paragraphs (i) and (ii), using any aid that is normally, or could reasonably, be used unaided by another person.	7 Cannot understand a simple message, such as the location of a fire escape, due to sensory impairment.
8. Absence or loss of control whilst conscious leading to extensive evacuation of the bowel and/or voiding of the bladder, other than enuresis (bed-wetting), despite the wearing or use of any aids or adaptations which are normally or could reasonably be worn or used.	8 At least once a week experiences:
	(a) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or
	(b) substantial leakage of the contents of a collecting device sufficient to require the individual to clean themselves and change clothing.
9. Learning tasks.	9 Cannot learn how to complete a simple task, such as setting an alarm clock, due to cognitive impairment or mental disorder.
10. Awareness of hazard.	10 Reduced awareness of everyday hazards, due to cognitive impairment or mental disorder, leads to a significant risk of:
	(a) injury to self or others; or
	(b) damage to property or possessions, such that the claimant requires 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).	11 Cannot, due to impaired mental function, reliably initiate or complete at least two sequential personal actions.
12. Coping with change.	12 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.	13 Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the claimant.
14. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder.	14 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.	15(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 or 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 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.	16(a) Cannot chew or swallow food or drink;
	(b) Cannot chew or swallow food or drink without repeatedly stopping or 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 someone else in the claimant’s presence.

Special Circumstances

There are certain circumstances whereby you may be able to bypass the normal system. 

You may be treated as exempt from having the medical (the limited capability for work assessment) if:

• you have a terminal illness, and you are expected to pass away within six months.
• you are receiving chemotherapy or radiotherapy for cancer.
• in the next six months you are likely to receive chemotherapy or radiotherapy for cancer.
• you are recovering from chemotherapy or radiotherapy for cancer.

If you fail the medical you may still get ESA if:

• you have a life threatening disease, and have medical evidence that it cannot be controlled.
• there is a risk to you if you were found fit for work.
• there is a risk to anyone else if you were found fit for work.

You may be placed in the Support Group (not have to do work related activity) without meeting the Support Group Descriptors, if:

• you have a terminal illness.
• you are receiving chemotherapy or radiotherapy for cancer.
• in the next six months you are likely to receive chemotherapy or radiotherapy for cancer.
• you are recovering from chemotherapy or radiotherapy for cancer.
• you are pregnant, and work related activity would harm your health or the health of the child you are carrying.
• there is a risk to your health if you are put in the Work Related Activity Group.
• there is a risk to the health of anyone else if you are put in the Work Related Activity Group.

All of the above require medical evidence. As such, if any of the above apply to you, and you do not already have medical evidence that spells it out fairly clearly it is advisable to get a doctor's letter that does. It is essential that doctor's phrase letters carefully so that they are not inadvertently used against their patients. There is a template letter on Black Triangle that you can ask your doctor to use. (It will be placed on this blog soon too). It is advisable when requesting a letter based on the above to give your doctor the legislation upon which it is based. You will find it here.

If the DWP is already aware of these circumstances applying to you, you may not be asked to fill in the application form for ESA (the ESA50). One way in which they might already know this information, is if you've supplied sick notes (now called fit notes) from your GP which contain the appropriate information. 

If you do fall into one of the categories above and wish to apply for ESA, but do not know whether they have that information, telephone them and ask. The person you speak to may do a short application questionnaire on the phone with you (it's called the ESA1). Tell them that Special Circumstances apply to you. If they do not currently have evidence of this they may then write to your GP requesting a letter to confirm it. 

If the person you speak to does not do the questionnaire with you, but confirms that they do not have the evidence that Special Circumstances apply to you, take the legislation and template letter to your doctor, and write a letter yourself telling the DWP that you wish to apply for ESA, but believe you are exempt from the ESA50 and / or the work related activity assessment (the medical). They may still send you the ESA50, but the chances are largely reduced.

Regulations 29 & 35

Regulations 29 and 35 are otherwise known as 'special circumstances'. The legislation below is explained in this post.

Regulation 29

Entitles you to be placed in the WRAG because work carries a substantial risk (of being made more ill) to you or another person.

Exceptional circumstances

29.

(1) A claimant who does not have limited capability for work as determined in accordance with the limited capability for work assessment is to be treated as having limited capability for work if paragraph (2) applies to the claimant.

(2) Subject to paragraph (3), This paragraph applies if—

(a) the claimant is suffering from a life threatening disease in relation to which—
(i)
there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and
(ii)
in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; or

(b) the claimant suffers from some specific disease or bodily or mental disablement and, by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work

(3) Paragraph (2)(b) does not apply where the risk could be reduced by a significant amount by—

(a) reasonable adjustments being made in the claimant’s workplace; or

(b) the claimant taking medication to manage the claimant’s condition where such medication has been prescribed for the claimant by a registered medical practitioner treating the claimant.

Regulation 35

Entitles you to be placed in the Support Group because work-related activity (ie what you have to do if you are in the WRAG) carries a substantial risk (of being made more ill) to you or another person. Certain claimants to be treated as having limited capability for work-related activity

35.

(1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;

(b) the claimant is-
(i) receiving treatment for cancer by way of chemotherapy or radiotherapy;
(ii) likely to receive such treatment within six months after the date of the determination of capability for work-related activity; or
(iii) recovering from such treatment, and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity; or

(c)
in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity.

(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 34(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.

The Physical / Mental Dilema

Changes at the beginning of January 2013 mean that points will only be awarded for the mental health part of the questionnaire, for problems that can be directly attributed to a mental health problem or a learning difficulty. Similarly, points will only be awarded for the physical part of the questionnaire, for problems that can be directly attributed to a physical health problem.

Physical symptoms caused by your health condition will (should) be taken into consideration. For example, Post Exertional Malaise should be taken into consideration.

Physical symptoms caused by medication for a physical condition may be taken into consideration. For example, diarrhoea as a result of (too much) thyroid medication should be taken into consideration.

Physical symptoms caused by medication for a mental health condition will not be taken into consideration. For example, Urinary Hesitation caused by anti-depressants will not be taken into consideration.

Mental health symptoms caused by your health condition will (should) be taken into consideration. For example, people with M.E. often suffer a symptom called Acquired Dyslexia; this should be taken into consideration.

Mental health symptoms caused by medication taken for a mental health condition may be taken into consideration. For example, depression caused by anxiety medication should be taken into consideration.

Mental health symptoms caused by medication taken for a physical condition will not be taken into consideration. For example, cognitive dysfunction (brainfog) caused by pain medication will not be taken into account.

The last time I read the guidelines for assessors on Chronic Fatigue Syndrome (2010) it gave them the choice of whether they could assess people with CFS / M.E. as:

• having a mental health condition.
• having a physical condition.
• having a combination of the two.

As such, I personally advise that you fill in both parts of the questionnaire as fully as you are able, in the hope that the person assessing you will assess M.E. as being both a physical and a mental health condition (even if you do not agree that it is).

Be very careful how you phrase what you say, making sure you explain clearly how each symptom is attributed to M.E.. Remember that they have a list of your medications towards the beginning of the form, and are likely to be familiar with common side effects.

 

This isn't reasonable is it? Some symptoms that you suffer as side effects of medication are not taken into account. Yet, if you do not take the medication your abilities are totally different. As such, I make the following suggestion:

• state clearly which symptoms are caused by your illness.
• also state clearly which symptoms are caused by your medication.
• if both your illness and medication cause one symptom, make sure that it is understood that the illness does cause it too.
• state how much you suffer / how much worse your abilities are, without that medication.

For example,
"M.E., pain medication and sleeping medication cause severe concentration impairment. I can barely concentrate for five minutes without being distracted or becoming fatigued. Eliminating pain medication and sleeping medication does not improve concentration."  

Then in the pain and sleeping parts of the form  

"Without sleeping medication I sleep approximately three hours a night at most, and it is unrefreshing sleep" 

and  

"Without pain medication I am in continuous discomfort and pain that I cannot bare."

It may, or may not, be taken into account by the assessor / Decision Maker, but it simply cannot be taken into consideration if you do not include it.

I Can But I Can't!

Remember when filling in the questionnaire (ESA50) that they are assessing you for your ability to work. It is for this reason that I usually suggest that people with M.E. fill in the questionnaire in regards to how they are on their worst days. By describing your worst day, you are describing the least you are able to do every day. Some advice giving places disagree. Obviously it is up to you how you approach it, but what is important is that in the space you are given at the beginning of the form, you tell them how you are filling it in.

For example:

"I am filling in the form describing my worst days. Approximately 4 days in 7 are this way."

(If your worst days are very rare, then I'd suggest filling it in with your most usual days instead).

The form tries to make everything very black and white. Life isn't black and white. Don't go through it just ticking boxes, because you will make it far too easy for them to turn your application down. Write in the spaces you are given to write in, but be concise, because Decision Makers have limited time to look at your evidence (I believe it is ~20 minutes per case).

For each question, consider these things carefully:

• severe discomfort.
• pain.
• breathlessness.
• extreme fatigue.
• repeatability.
• reliability.
• safety.
• variablility.

If you can do the activity, does it cause you discomfort, or severe discomfort?
If you can do the activity, does it cause you pain?
If you can do the activity, does it make you breathless?
If you can do the activity, does it cause you fatigue or extreme fatigue?

If you can do the activity, how often / soon can you repeat it?
If you can do the activity, can you do it to a reliable level?
If you can do the activity, can you do it safely?
If you can do the activity, can you cope with variations in how it is done?

An employer doesn't want an employee who can only climb two steps an hour!  Or an employee who knows how to turn the kettle on, but is likely to pour hot water over their hands.

Some examples of how to use the above points:

• I cannot walk 50 metres repeatedly or safely, without undue discomfort, pain, and extreme fatigue.
• I cannot remain stationary, standing in one place, for more than 40 seconds, without severe discomfort, pain, and extreme fatigue, reliably, repeatedly, or safely, due to Postural Tachycardia Syndrome.
• At times I can raise both arms, but most often it is with severe discomfort and pain, often causing extreme fatigue. I cannot ever raise both arms repeatedly, or reliably.
• I cannot learn to do a task such as using a washing machine without severe discomfort and fatigue, reliably or with variability.

You can of course add your own descriptors (I use 'distress' a lot on my form), but they may not be taken into consideration by the assessor or Decision Maker.

Variability

Most of those criteria are subjective. That which is severe discomfort to someone unused to pain may be mild discomfort to someone who's lived with pain all their life. Variability stands out as a hard criteria to understand.

It is mostly in reference to the mental health section of the form. (Though, you could try and apply it to the physical side; you may be able to climb normal stairs, but totally unable to cope with spiral staircases, for example).

It is easiest to use in the following questions:

11. Learning how to do tasks
12. Awareness of hazards or danger
13. Staring and finishing tasks
14. Coping with changes
15. Going out
16. Coping with social situations

Fluctuationing Conditions

M.E. is a fluctuating condition. As such, trying to fill in the black and white, yes no, pigeon holing form (the ESA50) is particularly difficult. M.E. is a round peg which we're trying to ram in to a square hole. We have to make it fit.

One part of doing this, as already mentioned, is to state at the beginning of the form whether you are filling it in as regards your condition on a bad day, or your condition on an average day.

The other thing to do, is to give specific examples to illustrate how you fluctuate. When doing this, you need to understand how the Decision Maker works. They essentially have a tick box system, which they have to try and fit your answers into, in order to award you points. And they want to award you as few points as possible. As such, when you describe fluctuations be careful not to give the impression that you can do more than you can. Some examples:

Bad: "Sometimes I can walk quite a lot further than I can other times."
Good: "Most of the time I cannot walk 50 metres. On my best days I might be able to walk 50 metres, but I wouldn't be able to repeat it reliably or safely."

Bad: "I can cope with some social situations, but not others."
Good: "I can cope with official social situations, such as attending a doctor's appointment, but I cannot cope with a social situation with friends, or where there is noise and new people."

 

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.

Supporting Evidence

One of the first things I usually ask people when I'm helping them, is whether they have their supporting evidence in place yet. It can often take weeks to get letters from doctors or other professionals. As such, I generally advise to get as much supporting evidence together before even requesting the ESA50 from the DWP. Of course, if you're being moved from Incapacity Benefit, or being re-assessed, you don't have that luxury.

Your case will go before a Decision Maker for a decision to be made. The three things they will look at are:

• the result of your WCA (Work Capability Assessment)
• your application form (ESA50)
• your supporting evidence

The Work Capability Assessment

As the result of the WCA the person who assessed you makes a recommendation as to what the result of your ESA application should be. Previously, Decision Makers were found to be using primarily the Assessor's recommendation upon which to base their decision. They were and are supposed to use all three sources evenly.

The WCA is essentially someone who is qualified in health, observing factors about your abilities, your body, and your appearance, and ticking boxes on a computer. I presume that the boxes probably add up to give a number, which they may compare to the score from your ESA50. We do know that the tick boxes have very specific answers, and that the assessors prefer to try and pigeon hole you than type in their own answers. Your job is try to get them to make a report that does actually represent you.

The experience of the assessment itself, what to expect, etc, will be covered in another post.

The Application Form

The Decision Maker will go through your application form (ESA50) using the descriptors (which you can find here, and here). This gives your application a score. The score from your form can determine the outcome of your application if you have no other evidence.

Supporting Evidence

Supporting Evidence can come in many forms. It is far from limited to the following:

• letter from your GP
• letters from any of your specialists (eg, physiotherapists, psychologists, counsellors, neurologists, endocrinologists, etc).
• letter from an Occupational Therapist
• letter from non NHS specialists (eg, opticians, osteopaths, accupuncturists, etc)
• copies of blood tests
• copies of scans (eg, MRIs, CT-Scans, X-rays, ultra-sounds, etc)
• letter from a carer
• letters from family or friends who see you on a day to day basis. (I've even heard of letters from Reverands and MPs being submitted).

Medical evidence carries the most weight. Blood tests, and scans are irrefutable. Of course, with M.E. there's not much you can show with a scan, though blood tests that could be helpful include:

• Vitamin B
• Vitamin D
• Thyroid
• Diabetes
• Gluten intolerance
• Ferritin
• Iron
• Antibody levels

(There is only any use in providing the results of these blood tests if they show an irregularity).

If you are requesting a letter from a medical professional:

1. Make them aware of regulations 29 and 35 if you believe they may apply to you.
2. Ask them to give you the letter, rather than have them send it straight to the DWP.
3. Preferably have someone who is familiar with the DWP, check through the letter. Ask the person who wrote the letter to make any changes required, before using it. (You are most likely paying for the letter after all, so you want it to help you rather than be used against you).

When sending in additional evidence with your form:

• Keep a copy of every piece of evidence you send.
• Put your name, your date of birth, and most importantly your National Insurance number somewhere clearly visible, on every piece of evidence.
• On page 20 of your ESA50 tick the box to state that you are including medical reports, and list in the box what evidence you are including with it. If you know you will have more to send on afterwards, list it there too.

You don't have to send all your additional evidence with the form. You can send it late, but it's best to get it to them as soon as possible, because you want it to be with your form when the Decision Maker looks at your case. When you send in late evidence:

• Keep a copy of every piece you send.
• Put your name, your date of birth, and most importantly your National Insurance number somewhere clearly visible, on every piece of evidence.
• Include a request for them to verify that they have received this information and placed it with your case. You could a self address envelope (they don't tend to use them). You could simply send it recorded delivery to start with. Or you can phone them to check it's been received.

Getting Supporting Letters Right

 

Medical Professionals

When writing supporting letters, people (doctor's in particular) need to make statements of their own observations, rather than flaky sentences. Some examples:

Bad: "Ms Jones has told me that she has M.E.."
Good: "Ms Jones is diagnosed with M.E.."
Better: "Exploratory tests have proved inconculsive for Ms Jones, but her symptoms are consistent with M.E.."

Bad: "I think Ms Jones is affected by severe anxiety."
Good: "Ms Jones suffers with anxiety."
Better: "Ms Jone's medical records show a history of anxiety attacks. She is being treated using Sertraline 50mg/day"

Bad: "Ms Jones cannot work most of the time, but sometimes she can."
Good: "It is my assessment that my patient would not manage a full time job."

(It isn't actually your GPs responsibility assess whether you can work or not, so unless they are saying you cannot work at all, it's best to ask them to remove any reference to your work-ability from the letter).

This is one of the reasons it's so important to see your GP regularly, even if you don't have any new problems. You need your medical records to be kept up to date; and you definitely need them to state that you do have M.E.. Think of it this way; if the DWP write to your surgery requesting information about you, but your personal GP is away on holiday, what sort of picture is another GP going to build of you from what they find on your records?

Another issue: Most surgeries are now requesting that people pay for supporting letters, because of the rising number in people asking for them. (Nb, the number of requests rising is because of the DWP insisting upon them, rather than the number of people applying for ESA rising). The Decision Maker has a responsibility to request information from any medical professionals you list on your ESA50, if you have not sent evidence from them already. If they fail to do this, it is grounds for appeal in itself.

As such, even if you cannot afford the surgeries charges for a supporting letter, it is still advisible to have an appointment with your GP (and write to any specialists you list) about the application. Make sure they are up to date on your condition. It can be worth talking specifically about what you need them to say to the DWP, and give them a copy of Regulations 29 and 35.

 

Friends and Family

Letters from people who are not medical professionals are not given anywhere near as much weight, but the useful thing about them is that they can give the Decision Maker an insight into your every day life. Friends and family often make observations that we are so familiar with ourselves that we don't notice them any longer. Some examples that surprised me from my boyfriend's supporting letter:

"She has recently taken to bringing a childhood toy to bed"
"Her sleep is extremely poor anyway, [..] she spends all night tossing and turning."

"It is extremely obvious to me when the pain killers wear off. (She becomes very irritable)" (I hadn't personally made this connection).

"she walks like a crab"

"making her cry for days on end (which then causes migraines)" (I hadn't made this connection either).

As with medical professionals, you need to be certain what your friends and family say won't do you more harm than good. Where a medical professional can speak with authority though, your friends and family cannot. It is best if they don't specifically comment on your diagnoses, but that they work to make clear the difficulties you struggle with.

Some of the things it can help for them to explore:

• difficulties with getting out of bed
• difficulties with washing and or dressing
• difficulties with preparing meals
• difficulties with eating meals
• difficulties with continence
• difficulties with walking
• difficultires with using stairs

(Basically go through the questions from the form and see if they have any comments to make).

When asking someone to write you a supporting letter I advise against leading them. You want a totally unbiased account of your abilities. Once they've written it you can ask them to tweak it if you're not happy with it, but do not ask anyone to write anything that is not true.