Group Exemptions from the Personal Capabilities Assessment and Medicals
The Benefit Rules
Exemption from the Personal Capabilities Assessment, and the Medical, can be made under the Social Security (Incapacity for Work) (General) Regulations 1995. Reg10(1) states that a person shall be treated as incapable of work, where, Reg 10(2)(a), the person is in receipt of high rate care component of DLA or Reg 10(2)(e)(viii), the person has a severe mental health problem which affects their mood or behaviour and restricts their social behaviour or awareness of their environment. The notation goes on to state that evidence of severe mental illness can be where one of the following apply:
- a person lives in a sheltered residential facility
- they attend a day care facility at least once a week
- are cared for at home with a weekly visit from a mental health care worker
- are taking anti-psychotic medication which includes a depot injection or a mood-modifying drug
This evidence must come from a medical practitioner (preferably a Benefits Agency Medical Services (BAMS) doctor!), who usually gets this information from the client’s GP.
There are of course a number of other categories of people who can be exempted under the regulations, but these are the ones we have modelled our ‘test group’ on.
Colchester Welfare Rights decided to try and exempt clients from the Personal Capabilities Assessment and Medicals where they were claiming either Incapacity Benefit, Severe Disablement Allowance, Income Support or receiving National Insurance Credits because of incapacity to work.
Origins of idea
The idea was born out of a helpline query we received. This client attended a day centre in the town for people with severe and long-term mental health problems. He had been requested to attend a medical with a BAMS doctor at the local Social Security office. At the first appointment he was unable to cope whilst waiting to see the doctor even though he had his keyworker with him. He was offered a second appointment for 9 o’clock in the morning, so that he would not have a long wait, but he has rituals to go through before he leaves his house, and therefore this appointment was unacceptable to his needs also. It was at this point the keyworker contacted our helpline, where we advised that the client should be exempted from attending the medical and also the Personal Capabilities Assessment.
We considered that there could possibly be a number of other clients at this day centre in the same position as the client on our helpline call. We approached the manager of the day centre, who agreed that this was the case. She suggested that probably 70 out of their 80 clients would need to be looked at.
Initial setback
Our Welfare Rights service has good liaison with most of the organisations in the borough. This has been built up over a number of years. We decided to approach the Incapacity Department of the local Benefits Agency, about the idea of exempting clients in groups rather than individually. They initially said it would be far too much work and that it wasn’t possible.
We were not prepared to give up. We went back to the day centre, and asked them if they would be willing to help administratively if we could devise a suitable system, and persuade the Benefits Agency to proceed with the idea. This the day centre agreed to, and also agreed that they would take responsibility for informing the Benefits Agency if any of the clients were discharged from their care. It is important to note that individual clients must give their written permission for any information about themselves being given to the Benefits Agency.
Saving Benefits Agency Staff time!
When we approached the Incapacity Department the second time, it was with the aim of finding out how much work it would save them if approximately 50 of their customers where exempted for five years. They intimated that the saving would be considerable, but also said that their existing resources would not be able to cope with the work involved at present (October 2001). They did however, agree to contact a doctor at Norwich Medical Services (where they deal with the East Anglian area) to find out what information they would require. We arranged our next meeting for December 2001.
At this meeting we agreed an approach which would result in the least amount of work for the Benefits Agency. I took on the role of co-ordinating and liaising with both the Benefits Agency and Day Care Centre.
The Benefits Agency gave me a list of required information for each client, needed by the Medical Services to assess each case. This consisted of; Name, Address, National Insurance Number, Diagnosis, Medication, Prognosis and the number of days of attendance by the client at the Day Centre each week. The doctor at the Medical Services agreed that this information would be accepted as evidence if it was given by the Charge Nurse at the Day Centre. We devised a client profile sheet for each client to include all these details (see attached). We agreed that the first trial batch of 30 clients, would be made available to the Benefits Agency and Medical Services staff by February 2002.
Trial
The Day Centre completed a client profile sheet for each client and it was signed and dated by the Charge Nurse. The sheets were put into alphabetical order and delivered to the local Benefits Agency. A letter was included signed by the Manager of the Day Centre, accepting responsibility for informing the Benefits Agency of future discharged clients.
The Benefits Agency organised the work and sent it to the Medical Services in Norwich. The Medical Services doctor accepted all the evidence submitted.
A result
The result of the exercise was that every client was awarded an exemption from the Personal Capabilities Assessment and Medical Examination. An exemption can be made for up to 5 years. Most clients were awarded a five year exemption, but some received shorter awards of 18 months. All the clients have been highlighted on the Benefits Agency computer system to show that they belong to this particular day centre. The Incapacity department are willing to refer these clients back to the Medical Services for further exemption at the end of their awards.
We feel that this has been a very worthwhile piece of joint working between the Social Security Department, a Health Authority Department and our own Welfare Rights service. We are unaware of any other Welfare Rights service using a similar system to exempt people in this way.
Of course, for the clients themselves it will mean not having to go through the ordeal of a medical assessment where important mental health issues are least understood. The savings for the Health Trusts will be considerable. Care workers currently involved in this largely unproductive work; will be able to devote more time the ‘real needs’ of their clients.
Finally, the Department will make major savings by recognising and accepting the need for exempting groups of people who clearly meet the legislative criteria.
One other feature for the clients with exemptions is that they will be able to take up permitted or voluntary work without the fear of their benefit being challenged as a result of the Social Security department believing they are ‘fit for work’.
An account together with the various pro formas used was advertised in the discussion section of the Rightsnet, to which we have received a significant response. It was also presented during the information exchange to the National Association of Welfare Rights Advisers meeting and subsequently attached to the minutes for all NAWRA members. More specifically following the NAWRA meeting I was invited to present the topic at a workshop scheduled for their next meeting in September.
The National Association of Citizens’ Advice Bureaux and Child Poverty Action Group has shown interest and hope to publish and article in both the Adviser and the Welfare Rights Bulletin.
It is also being published in Life in the Day, which is a journal edited by Dr Bob Grove who is the Director Employment Support at King’s College. They have indicated that they may be interested in researching the 30 clients involved and how they may have benefited.