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.

Assessment Centre's

When the DWP invite you for your Work Capability Assessment, they will tell you which assessment centre your assessment will take place at. Normally it will tell you which floor the assessment takes place on, too, but if your letter does not tell you this, and you do have access requirements, I suggest you contact the DWP using the phone number from your letter, to ask which floor your assessment will be on.

Using Google Maps, and the post code for the assessment centre, you will be able to have a look at the assessment centre and the surrounding area. You are looking to see how accessible it is:

• is there parking outside?
• is there parking nearby?
• is it in a no stopping zone?
• is it in a pedestrianized area?

If for whatever reason, the building looks inappropriate, explore the other centre's that you may be able to get to, in the same way until you find one you feel is suitable for your needs. You can use this document to identify other centres.

Once you have identified a centre that you would prefer, contact the DWP to make the request. A DWP telephonist may be helpful, but if they are not, make the request in writing. A letter from your GP agreeing with you that the centre is not suitable for you will be helpful.

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.