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.

What to expect from the Work Capability Assessment

When you apply for ESA, you may have to undergo what a lot of people colloquially refer to as 'the medical'.

The DWP call it the Work Capability Assessment (WCA). That's exactly what it's doing; assessing how capable you are of work, not assessing how ill or disabled you are.

Naively, when I first underwent this in 2003 I believed that they had my interest at heart (that our government looks after us), that they wanted to assess how ill I was, as opposed to how capable of work I was, and that when they referred to 'work' they were referring to the job I used to do. This is why I failed. Lack of understanding. So I advise to be prepared, and know what you're expecting and what is expected of you.

You will be sent a letter inviting you to attend the WCA. It will give you the date of the assessment, and the location. You may well find that the assessment centre they expect you to attend is over an hour's journey for you. They may have included a route for you to use to get there, using public transport, too.

If the assessment centre does appear to be in an unreasonable location for you, contact the DWP to discuss it. There may be one that isn't any nearer, but is more convenient for you to get to; the assessment may be able to be rearranged for you. You can view a list of assessment centres here.

If the date they have scheduled your assessment for is inconvenient, again, contact them to reschedule it.

If you are given a morning appointment, and you find morning's impossible to function (as many people with M.E. do), you might want to contact them and ask for an afternoon appointment. Make it clear why you are rescheduling. Then when you get to the actual assessment, again, make it clear, so that it is noted that you cannot function in the morning. On the other hand though; if an assessor can see how badly you function in the morning, it may help you to score more points on the assessment.

The public transport itineraries they send people are usually totally ridiculous. The one they sent me would have taken six hours, with a 40 minute wait at one station, and a walk across a city. None of it was at all possible. The public transport agenda is essentially their first way of tripping people up. A lot of assumptions are made if you are able to use public transport, for example that you have planning skills, you do not suffer from social phobia or anxiety, you can deal appropriately with people you do not know, etc.

Ideally you will arrange for someone to drive you to the assessment centre. The assessment centre may offer to pay a little towards the fuel. Otherwise you may be able to agree with the assessment centre for them to pay a portion of a taxi fee. If neither of these are possible for you, some areas have voluntary drivers; your Citizens Advice Bureau is most likely to have this list.

Of course, if you can drive, then you may drive yourself there. Again, the assessment centre may pay a little towards the fuel. There are a few things to consider in doing so though:

• Do you normally need to rest before and after driving that distance? - it will be assumed that you do not.
• Are you able to drive the same distance every day? - it will be assumed that you can.
• Are you able to fill your car with fuel, or does someone else usually do that for you? - it will be assumed that you have the manual dexterity and strength to lift the fuel pump nozzle.

Joyce Drummond, who worked for Atos for a while, has given a very insightful account of what to expect from the WCA. I highly recommend reading it for further observations that I may not have made here.

In Joyce's account she states that at the centre she worked in they did not use security cameras to assess people as they approached the assessment centre. However, we've heard so many accounts of people believing this has happened, that it's best to assume they do.

The assessor will ask you where you parked. Your answer will be used, in part, to assess your mobility (how far you can walk). Most centre's do not have parking available nearby. I personally choose to be dropped off outside - even if there are double yellow (or red) lines there. I cannot walk far reliably, repeatedly or safely, so I don't want to mislead them into thinking that I can.

The buildings vary, but most of them do not have the assessment centre on the ground floor. One of my experiences was thus:

I arrived at the assessment centre. Two security guards watched me get out of my partners car. One made notes. After I had reached the door and presented my papers I was asked whether I could use the stairs. I said that I could not, and asked to use the lift. I was told that if I could not use the stairs then I could not go up to the assessment centre in case there was a fire. I started to panic, so the other security guard rephrased, asking whether I'd be able to push myself to use the stairs in case of a fire. So that I could get to the centre, I said that if there was a fire I'd have no choice, even if it meant going down on my bum. I was assessed as being able to use stairs, on the basis of that conversation.

That was a dirty trick. At the time I knew no better. If anyone plays a trick like that on you, don't fall for it. If you can use the stairs fair enough, but if you can't, don't be forced to put yourself in a position that causes you pain and/or discomfort. If they prevent you from going upstairs, they are forfeiting the assessment, not you. If you've mentioned on your ESA50 that you have a problem using stairs then they should not have scheduled you to be assessed at a centre that is inaccessible to people who cannot use stairs. What I should have done was ask my partner if he could go up to the centre and explain the situation. I believe I could have insisted upon an assessment downstairs, even if that meant rescheduling it for another date and location.

And that is one of the keys for the whole of the assessment; don't do anything that causes you pain or discomfort. As soon as you feel anything tell them - because they cannot know if you don't do so.

Once you arrive at the assessment centre you need to go to reception to book yourself in and prove you are who you say you are. At my last assessment they played another dirty trick here; three receptionists sat behind the desk giggling and gossipping while a queue built up. I sat on the floor to start with (if you have Orthostatic Intolerance too, you'll understand why), but moved to some chairs after five minutes, to lie down.

If there is a queue when you arrive, I recommend you take a photo of your watch, or preferably a clock on their wall; a screen print of your phone if necessary. The reason I suggest this is because that half an hours queue at the reception desk made me late for the assessment. They later used this as an excuse to send me home without the assessment. Not turning up for an assessment can result in your benefit being revoked.

At the desk they ask you for three forms of ID. I totally forgot to take any one time, so just emptied my entire purse at the lady, which she accepted. So I believe that several things with your name on will be fine. If you usually have trouble remaining standing, you can request a seat while you're at the desk.

If you accept the expenses form, bare in mind that they will be assessing your manual dexterity when you fill it in, and how legible your handwriting is. If you have to submit it in another room, they'll also be assessing your mobility. As such, if your condition is fluctuating, make sure that the assessor knows (once you meet them) what the difference is between these actions and how they would be when you've become fatigued.

Everything you do and say is being watched. From the moment you step into the assessment centre the type of chair you choose to sit in is noted, how you sit in it, whether you fidget, rock, talk to yourself, etc, is all being noted. If you stand or pace, your mobility is assessed. If you use your phone or have brought a book to read, or a book of puzzles, your manual dexterity and concentration are being assessed. Judgements are made according to what you are wearing, and how well groomed you are (not particularly correctly in my experience). Joyce Drummond mentioned that they even make note of whether someone's eyebrows are waxed. I couldn't help wondering how they know.

For most people it isn't particularly unfair that their actions in the waiting room are assessed. The problem for people with M.E. and similar conditions is the fact that our conditions fluctuate. For some of us they fluctuate on a hour by hour basis, others it can be month by month. So, until we actually speak to the assessor to explain where we are in our fluctuations, judgements really should not be made. I've heard of people's assessments not taking place though, because of observations that have been made in the waiting room. (To be fair, though, in these cases the decision has gone in the claimant's favour).

Usually you will be expected to wait a while before you meet your assessor. You may be assessed by a nurse, a physiotherapist or a doctor. Technically speaking the rules state that neurological conditions should be assessed by a doctor. Despite NICE and WHO recognising M.E. as being a neurological condition, the DWP and Atos do not. If your personal condition has been recognised as being neurological you can therefore insist upon being assessed by a doctor. Personally, since we're not seeking treatment from these people, I don't really see that it makes a difference.

The assessor will come to the waiting room and call you by name. They will be assessing, at first, how well you hear them, then they'll assess whether you make eye contact and to some extent your manual dexterity and social behaviour when they offer to shake you by the hand. As you walk with them to the assessment room they are assessing your mobility from whether you walk straight, stumble, bump into doorways, etc.

If you usually use a walking aid or wheelchair, take it with you. The assessor may ask you if they were prescribed or if you bought them. Whichever is your answer, make sure you explain clearly what your reasons are for using it. If there are other aids or appliances you use at home that you believe may help the decision, you could bring them in, or take a photograph to add to the evidence.

You can take someone in to the assessment with you. This person can make notes on the assessment, provided that you allow the assessor to make a photocopy of these notes before you leave. You can have the assessment recorded by prior arrangement. If you want your assessment recorded, you simply phone the DWP and request it. There are not many recorders available throughout Atos as an organisation, so making this request can cause the date of your assessment to be postponed. You can also have home assessments recorded, again, by prior arrangement.

Once you're in the assessment you will be invited to sit down. If the type of chair you are given to sit in is one you are normally uncomfortable in, make sure you mention this to the assessor. If they offer you another chair, don't be fooled into carrying it across the room if it will cause you any discomfort or pain, whether that would be immediate or later.

To every question you are asked, understand that they are making various judgements. For example:

• how much do you need to move around for whatever the question was in reference to.
• how much do you need to move your hands?
• how much do you need to walk?
• how much responsibility does it require?
• how much prior organisation?
• how much social interaction does it require?
• how much social interaction with strangers?

For example, they ask you whether you have any pets. If you simply answer 'yes', it will be assumed that you have a cat or a dog. From that they assume that the animal is fed on the ground, so you must be able to squat (bend the knees) and open a tin (manual dexterity). They will also assume you walk the dog daily. Even if you specify that your pet is not a cat or dog, an amount of responsibility and organisation is assumed, since you will assumably be feeding and watering the animal every day. They do not ask you how many pets you've accidentally maimed or killed. As such, if you have a pet in your household, which you are not responsible for, either do not tell them that it is your pet, or tell them who takes care of it.

You can find a list of the questions you 

may be asked at the assessment, here.

There is also a physical section to the assessment. You will be asked to perform certain movements, some of which you will need to get up onto a couch for. If anything the assessor asks you to do, including climbing on to the couch, causes you discomfort or pain, or usually would, make it absolutely clear to them. If you know that something will cause you discomfort or pain, you can refuse to do it. If they try to talk over you (as one of my assessor's did continuously), say it to them again afterwards.

Once the assessment is over, you should hear what the result is within 4 to 6 weeks. If it seems to be taking forever, phone the DWP to find out what is why. 

Under some circumstances you may be able to arrange for the medical assessment to take place in your home, usually by a visiting doctor. The two scenarios I know of this happening are:

1. By submitting a letter from your GP or a specialist stating that attending the WCA will be detrimental to your health, or that of someone else.
2. When the medical assessment has been cancelled at your detriment, they may offer you a home assessment instead. (This happened to me).

Getting the DWP to agree to a Work Capability Assessment at home is infamously difficult. Simply requesting one yourself rarely works, no matter how hard you state your case. To illustrate how difficult it is; a close friend of mine was in hospital in a neurological unit when she was called for re-assessment. The DWP refused to give her a home/hospital assessment, so she was taken to the assessment centre in an ambulance, and carried in on a stretcher.

The home assessment is very similar to that performed in the assessment centre's. You are asked very similar questions. You are still asked to perform certain movements. The main difference is that the assessor can see for themselves the evidence around your home as to your state.

Useful Links

A comprehensive look at the WCA questions and how to answer them, written by Michelle.

A list of the questions you'll be asked in the WCA.

Work Capability Assessment List of Questions

Below you will find a list of questions that you may be asked during your Work Capability Assessment. It is unlikely that you will actually be asked all of them.

When you look at each question consider what they are assessing, and consider what your thorough answer will be.

They will be looking to make judgements on:

• how much the activity in the question requires you to walk.
• whether you might need to go up or down stairs for the activity.
• whether you may have to reach your arms to perform the activity.
• what kind of weight you can lift.
• how much manual dexterity is required.
• how well you cope in social situations.
• how well you communicate with other people.
• how well you understand other people.
• how safe you are when unattended.
• whether continence problems restrict your abilities.
• how good your cognitive skills are.
• how well you cope with change to routine.
• how well you cope with unexpected changes.

It's very easy to give yes and no answers, but doing so does not give the assessor a proper picture of your situation, and is more than likely to lead to scoring zero points, and therefore not succeeding in your application for Employment & Support Allowance.

A couple of examples of thorough answers:

Question: Do you use the wheelchair every day?

Bad Answer: No.

Thorough Answer: No, because I am usually in too much pain to get out of bed. And my partner cannot push the wheelchair, so I can only go out if we have another person to push it. I do always use it to go out.

Question: Who helps you with the depression? Are you under a psychiatrist or a GP?

Bad Answer: GP. (Atos, in their wisdom, assess any condition for which you do not see a specialist, as less severe than if you do see a specialist).

Thorough Answer: I see my GP fortnightly at the moment because we're changing my anti-depressant medication. I'm on the waiting list to see a counsellor because my GP is very worried about my state of mind.

Question: Do you live in a house or a bungalow?

Bad Answer: A house.

Thorough Answer: I live in a three story house, but I only use two rooms. When I have to I go downstairs on my bottom, and crawl up the stairs, pausing for breaks usually twice.

Asks who diagnosed the problems and whether I was under a specialist or just a GP?

Do you use the wheelchair every day?

Do you use the wheelchair indoors?

Are you able to propel the wheelchair yourself?

How long have you had depression?

Does your mood vary?

Do you have good weeks and bad weeks with this?

Would you say that you are mostly down then?

Who helps you with the depression? Are you under a psychiatrist or a GP?

Do you drink alcohol?

Have you ever self harmed or attempted suicide?

Do you get suicidal thoughts now?

How long have you had IBS?

What symptoms do you get with the IBS?

Do you get to the toilet in time?

Do you have to wear incontinence pads?

Have you brought a list of your medication?

Goes through all medications I’m taking.

Do you get any side effects with what you are taking?

How did you get here today?

How long did that take you from your house?

Who has accompanied you today?

Who lives in your house with you?

Is it a house or bungalow?

When did you last work?

And you’re not studying or working at the moment?

What is your sleep pattern like?

Do you find you get a disturbed sleep?

Is this due to not being able to switch off or pain?

What time do you normally get up in the morning?

Does your son get himself up and ready now he is older?

How do you manage to get washed and dressed?

Have you got a shower or bath?

Can you wash your hair?

How much assistance do you need to get dressed?

Can you pull your top over your head?

Can you manage buttons?

Do you have assistance with getting your lower garments on?

Have you got a stair lift?

Have you a bathroom upstairs as well as downstairs?

Have you a toilet downstairs?

How do you manage in the kitchen making yourself tea and coffee and snacks?

Can you manage to make yourself a cup of tea?

When did you last make yourself a cup of tea?

Who see’s to the housework?

Do you do any housework?

Do you drive at all?

When did you last drive?

What stopped you driving?

What was the cause of the blackout?

Were you unconscious during the blackout?

These episodes of vagueness you’ve had since then do you go unconscious or is it just your speech is affected?

Where do you go to do your shopping normally?

Do you have assistance to go around the house?

How many minutes can you walk for?

Do you walk outside?

Have you any hobbies or interests?

What do you do during the day?

How far away do you live (this is directed to my father)?

How often do you come and visit (again this is directed to my father)?

Do both your parents come every day?

How do you get to your father’s house?

Does your son make his own way home from school?

What’s your routine in the evening what do you tend to do?

Does your son help you with the evening meal?

Does your son come with you to your parent’s house?

Have you got friends locally that pop in and visit?

Have you got any other family members that come to visit?

Do you keep in touch with other family members on the phone?

How far is the GP surgery from you?

Are you OK making appointments with them when you need to?

Do you have to phone them in the morning?

Do you wear glasses all the time?

Do you wear any hearing aids?

Now she checks limb movements.
Are you able to look up to the ceiling for me?

Are you able to look down to the floor?

Are you able to look over to your father and then look the other way towards the filing cabinet?

Are your neck movements OK?

Can you bring your ear down to each shoulder?

Can you bring your arms out straight?

Turn your arms over and then back again?

Can you bring your arms up to your shoulders?

Can you bring your arm up and behind your head?

Where’s the pain when you do that?

Have you got pins and needles in this hand at the moment?

Can you close your eyes I’m going to get a tissue and touch different parts of your hand and you tell me when you can feel it?

Can you stand up and do a forward flex?

Where would that hurt you?

Could you squat to pick something up off the floor?

Are you able to get on the couch to do some limb movements? Or do you wish to do them in the chair?

Would you be able to get on the couch or would you find it difficult?

Can you bend your left knee and bring it up to your chest?

What pain does that cause you?

Can you straighten you leg and bring it up?

Where does that hurt you?

Can you do the same with the right leg?

Can you get your arm behind your back at all?

What about the other arm?

Work Capability Assessment described by Joyce Drummond

I worked as a HCP (nurse) for Atos for 5 months in 2009. I left because of the way I felt I was expected to trick sick and disabled people. I have not worked since. I have recently whistleblown on Atos.

I knew nothing about Atos when I joined, and left as soon as I realised that there was no way to fight from the inside,

I carried out Incapacity Benefit assessments, forerunner to ESA. I stated at my interview for the job that I believed in social inclusion and social justice. I went for 4 weeks training in England. The training did not prepare me for what I was expected to do in real life.

Firstly the forms that are completed prior to assessment, I have recently found out, are first opened by Royal Mail Staff. They are then sent for "scrutiny" where nurses decide whether or not a face to face assessment is required. I was not involved in this and do not know what criteria is used.

It is made clear throughout training and working that we are not nurses- we are disability analysts. Also that we do not carry out medical assessments - we carry out functional assessments. We did not even need a diagnosis to carry out assessments. I had reservations around consent as we were expected to assess patients - sorry we didn't have patients, we had claimants- who appeared to be under the influence of alcohol or other substances. We were also consistently told that we did not make benefit decisions. The final decision was made by a DWP decision maker with no medical qualification. If our assessment was overturned at appeal we never knew about it. There was no accountability for assessments overruled.

Assessment starts on the day by reading the form you complete when applying for benefit. Things that are noted are-

• did you complete the form yourself
• Is the handwriting legible
• are the contents coherent.

These things are already assessing your hand function, your cognitive state and concentration.

• Do the things you have written add up.
• Does your medication support your diagnosis.
• What tests you have had to confirm diagnosis. 

For example a diagnosis of sciatica is not accepted unless diagnosed by MRI scan.

• Do you have supporting medical evidence from GP or consultants. 

If you do it shows that you are able to organise getting this information.

This is also a hidden cost to the NHS. I believe that if ATOS request information there is a charge levied by GP's. However claimants are expected to source medical evidence themselves. It uses valuable NHS time for medical staff to write supporting statements.

There were no hidden cameras, at least in Glasgow, to watch people arriving for assessment or sitting in waiting room.

When the HCP has read your form they input some data into the computer system. The assessment proper begins when they call your name in the waiting room. At this point they assess-

• did you hear your name being called
• did you rise from your chair unaided, did the chair have arms or not
• were you accompanied - this addresses you're ability to go out alone.
• were you reading a paper while waiting - looks at your concentration.
• Did you walk to the assessment room unaided, did you use aids correctly. Did you navigate any obstacles safely - assessing sight.
• The HCP will shake your hand when inroducing herself - are you trembling, sweating- signs of anxiety.
• Often ask on way to waiting room how long you've been waiting - assessing ability to sit- physically and looking at mental state.
• How did you get here today - ability to drive, use public transport.

Assessment begins by listing medical conditions/complaints. For each complaint you will be asked-

• How long have you had it, 
• have you seen a specialist, 
• have you had any tests, 
• what treatments have you had, 
• what's your current treatment. 
• Have you had any other specialist input eg physiotherapy, CPN.

The HCP will use lack of specialist input/ hospital admissions to justify assessing your condition as less severe.

Medications will be listed, are they prescribed or bought. Dates will be checked on boxes to assess compliance. Any allergies or side effects should be noted. A brief note is made of how you feel each condition affects your life. A brief social history will be taken - who you live with, have you stairs in your house or to your house.

Employment history is taken asking when you last worked, what you worked as, reason for leaving employment.

"Typical Day" This is the part of the assessment where how you function on a day to day basis is used to justify the HCP decisions. Anything you say here is where you are most likely to fail your assessment. Along side this the HCP records their observations.

Starting with your sleep pattern, questions are asked around your ability to function.

• Lower limb problems- look at ability to mobilise to shops, around the house, drive, use public transport, dress, shower.
• Upper limb- ability to wash, dress, cook, shop, complete ESA form.Vision- did you manage to navigate safely to assessment room.
• Hearing- Did you hear your name being called in waiting room.
• Speech- Could the HCP understand you at assessment.
• Continence- Do you describe incontinence NOT CONTROLLED by pads,medication. Do you mention it's effects on your life when describing your typical day.
• Consciousness- Do you suffer seizures- with loss of continence, possible injury, witnessed, or uncontrolled diabetes.

HCP obsevations include- 

• how far did you walk to examination room, 
• did you remove your coat independantly, 
• did you handle medications without difficulty, 
• did you bend to pick up handbag.

Formal exam consists of simple movements to assess limited function.

Things HCP also looks out for- 

• are you well presented, 
• hair done, 
• makeup, 
• eyebrows waxed.

• Do you have any pets- looks at ability to bend to feed and walk.
• Do you look after someone else- parent or carer- if you do this will be taken as evidence of functiong
• Any training, voluntary work, socialising will be used as evidence of functioning.

This is not a comprehensive list, but gives you an idea of how seemingly innocent questions are used to justify HCP decisions.

Mental Health

• Learning tasks- can you use phone, computer, washing machine.
• Hazards- Can you safely make tea, if claiming accidents- must have had emergency services eg fire service. Near miss accidents do not count.
• Personal Actions- Can you wash, dress, gather evidence for assessment

Manage bills.
Observations by HCP= appearance and presentation, coping with assessment interview, abnormal thoughts, hallucinations, confusion.
Coping with change= Ability to attend assesment, attend GP or hospital appointments Shopping and socialising.
HCP observations- appearance, eye contact, rapport, no signs/symptoms abnormal mood/thoughts/perceptions. No suicidal thoughts.

Coping with social engagement/appropriateness of behaviour-
Inapproprite behaviour must have involved police

Ability to attend assessment, engage with assessor, behave appropriately.
Again this is not an exhaustive list, merely examples

There are some "special cases". Off the top of my head:-

• terminal illness 
• intravenous chemo
• danger to self or others if found fit to work

I am happy to speak to any politician, of any party- except BNP. I think it is telling that Atos have made no attempt to sue or silence me. They know I am speaking the truth. 

At present to qualify for ESA you need to score 15 points. This can be a combination of scores from physical and mental health descriptors. To qualify for support group you must score 15 points in one section. As long as you are claiming income based ESA your award can be renewed at each assessment, if you gain 15 points.

Contribution ESA lasts for 1 year only, unless you are in the support group. After 1 year, out with support group, you only get income based ESA if your household income is below a certain threshold. It makes no difference how long yoy have previously paid NI for.

For clarity, as far as I know in the real world, doctors carry out medical assessments, nurses carry out nursing assessments and physios carry out physiotherapy assessments. In the world of Atos each of these separate professions are employed as disability analysts, carrying out functional assessments.

Nurses are employable for these posts - if they have been qualified for at least 3 years, are registered to practice with the NMC, and have basic computer skills.
My interview consisted of-

• face to face interview with medical director and nurse team leader.
• a written paper assessing a scenario, in my case someone with back pain
• A 10 minute basic computer test.

In order to be approved as disability analyst I had to complete 4 weeks Atos disability training, reach a certain standard of assessment reports- as decided by audit of all cases seen (don't know what criteria was) and finally approval to carry out WCA assessments from the Secretary for Works and Pensions.

In my opinion the money given to Atos and spent on tribunals should be given to NHS GPs. They are best placed to make assessments re patients work capability. They have access to all medical reports, past history, specialist input and know their patients. My concern would be what criteria the DWP would impose on GPs risking the doctor/patient relationship. GPs already assess patients for "fit notes", which have to be submitted to DWP during assessment phase of ESA Re wages at Atos. 

While I worked there sessional medical staff were being paid £40 per assessment, as far as I am aware. I have no idea of wages of permenant medical staff. Nurses were on a salary, which based on 10 assessments a day (Atos target) equalled around £10 per assessment. These are approx, figures but may give a clue as to why Atos are employing nurses rather than doctors.

I hope this is of some help to your committee.
Please do not hesitate me for further clarification.
Joyce Drummond.