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Work Capability Assessment fails those living with HIV

Wednesday, October 27, 2010

Work Capability Assessment*, the test undertaken to determine whether a person is eligible for Employment and Support Allowance (ESA)**, fails to recognise the impact of HIV on ability to work, according to a new research report by NAT (National AIDS Trust).

The report Unseen disability, Unmet needs – A review of the impact of Work Capability Assessment on people living with HIV details concerns with both the design of the WCA and how it is implemented in practice. For example, the WCA does not fully reflect the impact that fluctuating symptoms, fatigue, side-effects of HIV treatment and depression can have on capacity for work. In addition, claimants going through the medical examination do not always have the opportunity to discuss the important issues around how their HIV affects their physical and mental health in ways that that limit their capability for work. 

NAT‘s research finds continuing ignorance about HIV amongst medical assessors and decision makers drastically reduces the likelihood of a fair and accurate assessment on a claimant’s ability to work and need for disability-related benefits.
Deborah Jack, Chief Executive of NAT, says:

‘HIV is a disability, and like many other disabilities, people living with HIV can have vastly varying experiences relating to their condition. Whilst some find they can still work, many others find the impact of HIV or their treatment means employment is not an option at the moment and they need to claim disability related benefits. 
‘As it currently stands, the WCA is based on an outdated model of disability which only recognises a narrow medically defined set of physical and mental impairments. Also, it does not appropriately acknowledge the fluctuating nature of the condition and the impact that low self esteem due to HIV related stigma can have on a person’s ability to work.
‘NAT has submitted our ongoing concerns to the Independent Review of WCA, lead by Professor Malcolm Harrington, and hopes these will fully considered before any new rules are finalised and come into effect.’

Key findings from the report include:

  • The WCA does not take into consideration key HIV clinical markers, such as CD4 count***, in making the medical assessment
  • During the assessment, WCA decision makers often give greater weight to the opinions of those contracted to make the medical assessment than to HIV clinicians and other specialists who have provided medical evidence
  • A wide range of problems with administration and communication of the WCA process materially disadvantage claimants, and the stress and pressure of the process impacts negatively on their health
Case Study - Tim
Tim is a young man who applied for Employment and Support Allowance (ESA) with the help of his aunt and an HIV specialist benefits adviser. At the time of completing his ESA50 form, Tim’s CD4 count was 19. Medical evidence from his doctor explained that at the time of diagnosis, Tim had a CD4 count of 0 and PCP, a form of pneumonia associated with a low CD4 count.
Despite providing information about his blood test results, these were not discussed at the medial examination. The HCP’s record of the examination noticed, contradictorily, that Tim experienced ‘no side-effects’ but that he experienced diarrhoea as a result of his medication. The HCP also concluded that Tim did not score any points under the incontinence descriptor.
Tim was found fit for work. His doctor submitted further medical evidence but the case still ended up at appeal. Tim’s adviser said that, “on the day, we won that appeal, without me having to say a word or even sit down...The judge looked up and said, “oh – ESA successful, he’s in the support group, that’s not a problem”.’
Tim is now in the support group of ESA.

Case Study - Grace
Grace had a CD4 count of 40 when she was refused ESA. She claimed Job Seeker’s Allowance and attended the jobcentre for help to find work, where she was placed in a job as a cleaner. Grace became sick after only a couple of hours work, owing to her compromised immune system. She was ill for a fortnight.
Her HIV-specialist benefits adviser said, ‘me and the social worker went ballistic at her when we found out [that Grace had gone to work] but she said “I wanted to try because I don’t want to claim”. We said “we know darling but you’re too knackered so don’t”.’
The adviser took Grace’s case to appeal, and was successful. Grace is now in the support group.

What is CD4 count?
CD4 cells (or T-Cells) play an important role in the immune function. A low CD4 count (below 200 in someone living with HIV) is an indication of low immunity and greater susceptibility to a range of illness and infection.

- Ends -

Notes to the editor:

*The Work Capability Assessment (WCA) is the test undertaken to determine whether a person is eligible for Employment and Support Allowance (ESA). The WCA aims to identify claimants who have ‘limited capacity for work’ or ‘limited capacity for work-related activity’, so that they may receive the right support to help them live well and (where appropriate) return to work. Those who are found ‘fit for work’ are not entitled to receive ESA. The test contains a series of questions, called ‘descriptors’, which relate to physical and mental functions, and from which claimants score points.

**In October 2008, Employment and Support Allowance (ESA) was introduced to replace Incapacity Benefit and Incapacity-based Income Support as the primary income support benefit for people who are unable to work due to disability or illness.
NAT would like to thank the following organisations for their vital assistance in this research:
Citizens Advice Bureau (Camden)
George House Trust
Terrence Higgins Trust (Brighton and Hove)
The report is available to download at:
For further information please contact:
Charli Scouller
Communications Manager
020 7814 6733

NAT (National AIDS Trust) is the UK’s leading charity dedicated to transforming society’s response to HIV. We provide fresh thinking, expert advice and practical resources. We campaign for change.
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