So, you suffer with chronic pain. In all likelihood you’re under the care of a specialist doctor or specialist team at your local hospital who will understand your condition. You may or may not have a good relationship with your GP, but over time they’ve also come to know you and have at least some understanding of your condition.
Most importantly, you know you. You have come to understand your pain, what may trigger a flare, how to pace your day; the dos and the don’ts. After much trial and error you’ve found a cocktail of medication that provides the optimum balance between pain relief and continued daily function. Your life has become a routine, except on the days that you decide to push yourself. You know you shouldn’t and you know what’s coming, but the frustration of your limitations wins out temporarily; and then comes the flare.
If you’re lucky, between you and those treating you, you function within a bubble of understanding. But then comes the Work Capability Assessment. Unfortunately, the extent of your limitations and therefore your entitlement to benefit is not assessed by any medical professional within your bubble. That’s a scary thought, but should you be worried?
Work Capability Assessment
After submitting your application form (ESA50) for Employment and Support Allowance (ESA) or (UC50) for Universal Credit, most people will be asked to attend a ‘Work Capability Assessment’ (WCA), which is classed as a ‘medical assessment’. The purpose of the WCA is to determine whether your limitations are sufficient to satisfy the qualifying criteria for benefit.
We have considered previously what people suffering chronic pain can expect at a WCA. But just who are the assessors and what qualifies them to assess you?
Whilst doctors can apply to be assessors, very few do. Most assessors are by profession either nurses, paramedics, physiotherapists or occupational therapists. To apply, they must have a professional registration and at least two years experience in their profession.
If accepted, assessors must complete an initial training course. The introduction to the training summary includes the following:
“This training has been produced as part of a training programme for Health Care Professionals (HCPs) approved by the Department for Work and Pensions Chief Medical Adviser to carry out benefit assessment work.
“All HCPs undertaking medical assessments must be registered practitioners who in addition, have undergone training in disability assessment medicine and specific training in the relevant benefit areas. The training includes theory training in a classroom setting, supervised practical training, and a demonstration of understanding as assessed by quality audit.” [my emphasis]
Actually, this sounds relatively thorough, so how many months or years does this training take?
Terrifyingly, the length of this training for non-doctor applicants is just 17 days. Yes, it’s even less for doctors. The introduction goes on to explain why so little training is necessary:
“This training must be read with the understanding that, as experienced practitioners, HCPs will have detailed knowledge of the principles and practice of relevant diagnostic techniques, and therefore such information is not contained in this training module.”
With all due respect to most (but not all) nurses, paramedics, physiotherapists or occupational therapists, just how much clinical experience do they have of chronic pain?
Interestingly, the content of the 17 day course for nurses contains no specific training at all in relation to chronic pain. Physiotherapists fair slightly better with one third of one day of self-study focused on “CFS and Fibromyalgia”, the rest of the day taken up with mastering diabetes and epilepsy.
But does this really matter? Isn’t it just ticking boxes?
YES and NO. YES it matters and the reason it matters is that NO, it’s not just ticking boxes. You’ve already done that on your ESA50 or UC50. This is a medical assessment by somebody that the DWP believe has sufficient training, qualifications and experience to pass judgement on the limitations imposed by your condition.
Of course, when I say “pass judgement”, I should stress that technically the assessor doesn’t make the final decision on whether you qualify for benefit. However, the assessor makes a recommendation to the DWP, which frankly is difficult for DWP staff to then ignore; so to all intents and purposes they do make the decision.
The salary paid to assessors is usually a little above the average for their professions, but in return for that, a pound of flesh is expected from them. Workloads are huge, targets are viewed widely as unrealistic and, not surprisingly, turnover of staff is high.
So, in addition to inexperience of chronic pain in a clinical (or indeed any) setting, overwork must be added to the mix. Is it any wonder that so many people suffering chronic pain have been denied benefits? A rhetorical question.
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About the author
Leading Complex Regional Pain Syndrome (CRPS) solicitor Richard Lowes co-founded the first legal team in the UK specialising in representing people suffering CRPS and other debilitating chronic pain conditions. Richard is a popular speaker on the subject of chronic pain in litigation and remains an inveterate blogger.