A Tale of Two Assessments

Senior Casework Manager Anne Killeen shows how two medical assessments by the Department of Work and Pensions produced two opposite decisions

Anne Killeen, Senior Casework Manager

Normally in Z2K blogs we focus on cases when things have gone either extremely well for a client or extremely wrong for a client.  However, in this blog I will focus on how two medical assessments by the Department of Work and Pensions produced two opposite decisions. One led to the client having to go to appeal to obtain Employment and Support Allowance (ESA) while the other led to Personal Independence Payment (PIP) being awarded immediately.

I understand the requirements are different for the two benefits – ESA is about your ability to function in a work environment while PIP is about the impact the disability has on your daily life – but often the need for one suggests a need for the other.

Jack attended one of our outreach sessions in the south of the borough of Westminster in May 2017. He had approached the service, which also has a foodbank, after accessing his GP to request a foodbank voucher.
His GP was later to say that when Jack approached him he was in a state of starvation.

I have worked in the advice sector for many years and this is one of the worst cases I have encountered. It’s hard to believe that someone with this level vulnerability could get to the stage of starvation whilst living in one of the wealthiest boroughs in London. What could have been a tragic event was only averted by building a relationship of trust over a period of time to allow intervention.

Jack completed his ESA form himself; this must have caused him great distress and taken days to complete. He attended the medical assessment and was awarded 0 points. Jack said the Healthcare Professional would not listen to his answers and the report did not reflect what he said. This assessment had a profound effect on him. A mandatory reconsideration was requested and the decision was upheld. An appeal was lodged by someone Jack met at the launderette which he used to sit in – credit has to go to this person who intervened on his behalf to lodge the out-of-time appeal.

At the initial approach to our service in May 2017 to get a foodbank voucher we advised Jack to apply for Personal Independent Payment, and when the form was received he was assisted under the Z2k form filling service. We would like to offer this service more often – however, we frequently have to use our resources to challenge negative decisions. At this appointment it was discovered Jack was not receiving ESA pending appeal which he was entitled to at the point the appeal was lodged. To remedy this it involved going to his GP to obtain duplicate sick notes and going to the Job Centre to get the sick notes and confirmation of appeal scanned to the DWP quickly. Jack has said he would not approach the Job Centre again as when he tried before he felt the staff laughed at him. My own experience of attending the Job Centre to advocate on his behalf was not pleasant, in fact it was somewhat hostile. Eventually at the end of August Jack received his ESA pending appeal.

He had had no income from February 2017 apart from foodbank vouchers and a small amount of money from a relief from poverty fund.

Jack had decided he could not face going to another medical assessment for his PIP. I agreed to attend with Jack and on a few occasions had to intervene in the assessment in order that Jack was given the opportunity to respond to questions in his own time. Post assessment Jack had mentioned that this was a very different experience to his ESA assessments. The outcome of the PIP application was enhanced daily living and enhanced mobility. I could be cynical and say that the award was made because we assisted in completing the form or attending the assessment with him, however, I believe it was made because Jack’s health conditions warranted the award.

Submissions for his ESA appeal were submitted and directions were made by HMCTS (the courts and tribunals service) for Jack’s medical records to be provided. On receipt of the medical records the tribunal made reasonable adjustments and listed it for hearing without the need for Jack to attend. At the tribunal, Jack was placed in the support group with a recommendation that “in view of the degree of disability found by the tribunal and unless the regulations change, the tribunal would recommend that the appellant is not re-assessed.”

Having been awarded 0 points at the initial assessment, Jack was awarded 42 at tribunal. This clearly shows he should have been awarded ESA at the first assessment stage, as he was with PIP.

Whilst Jack’s benefit issues have been resolved I fear that in a few years’ time the same cycle will occur again. Hopefully Jack will access Z2K services again if the need arises. In the meantime I will be liaising with other services to make sure Jack has access to the immediate support he needs.

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