Request for Mandatory Reconsideration of decision to cease ESA award Background The client has been receiving benefits since 2005 when she gave up work on the advice of her doctor. She was asked to go for a work capability assessment, as a result of which her ESA has been stopped. The decision letter makes no mention at all of the main reason the client is unfit for work, which is her bowel control problems, despite the fact that the client explained these in detail at the assessment. We believe she should have been awarded 15 points for this, as at least once a week she suffers from a complete voiding of the bowel to such an extent that despite wearing a pad she has to change her clothes. The client requested a copy of the medical report form as she was surprised this was not mentioned. The report acknowledges the diagnosis of rectocele which her surgeon is unwilling to operate upon due to her other health conditions. She was advised to do pelvic floor exercises following surgery for a cystocele and although these caused some improvement to the urinary incontinence, they made no difference to the bowel incontinence. The report states that her GP has prescribed antidiarrhoeal medication. The client uses these if she needs to attend an appointment such as the work capability assessment in order to avoid any embarrassment, but she is unable to use them every day as they cause significant side effects and pain. This has previously resulted in her needing to visit A&E and being diagnosed with gastroparesis. For this reason she would be unable to attend any kind of work on a regular basis without incurring substantial risk to her health. The medical report states that her bowel leakage is in ‘slight amounts’ every few days. This is inaccurate as she suffers from complete voiding of the bowel such that a pad is not sufficient to contain it and she soils her clothes. The report further states that she keeps spare pads and clothes in the boot of her car. This is also misleading as the client does not have a car but often relies on her daughter to drive her. She keeps spare pads and a complete change of clothes with her at all times. She also holds a ‘Can’t Wait’ card. The client has some history of depression and anxiety, particularly relating to her condition, which is exacerbated by stress and she has now been referred for counselling.

Client has a range of diagnosed conditions including ADHD, Behavioural problems and Depression and Anxiety. He was diagnosed with ADHD at the age 9 and was under the care of the Community Paediatrician. He has a history of disruptive behaviour both at school and at home. He was excluded from school at the age of 13 and was placed in a school for children with behavioural problems. He has also been in trouble with the police for various incidents including aggressive behaviour towards his mother. After leaving school went to College and started doing a basic Engineering course, but subsequently left as he was having difficulty coping, despite being given extra help. He was referred to CAMHS Team who deal with young people with mental health and emotional difficulties. They started him on a programme of medication for his Depression (Fluoxetine) and this was being monitored by his Clinical Nurse Specialist who was visiting bi-weekly to monitor his condition. He was also prescribed Concerta and Strattera for his ADHD. Support from CAMHS has now ceased, Client’s mother is currently trying to obtain help from the adult mental health services. This is the reason why he currently has no specialist input. In addition he is currently refusing to take the medication prescribed for him, and has started self-harming. He is no longer living with mother since social services intervened because he was violent towards his sister and mother. Preparation of Food – Hasn’t the skills to prepare/cook a meal. He is easily distracted and has left the gas ring on. He would not be able to identify when things are cooked. He has problems operating the microwave and mother has to show him repeatedly how to operate it. He lacks the concentration to following instructions and gets frustrated very quickly if being supervised. If left to his own devices he would just snack. Eating and Drinking – Needs prompting to eat and is now refusing to eat food cooked by mother as he believes I am putting his medication into his food.. Monitoring his health condition – refuses to take his medication and/or will lie about having taken it. It is obvious when he hasn’t had his medication because his behaviour deteriorates. Does not recognise the deterioration and becomes verbally aggressive when family try to reason/persuade him to take his tablets. Washing/Bathing –Physically able to shower himself, however, he needs prompting/reminding to shower. He doesn’t take care of his personal hygiene and needs daily reminding to wash and clean his teeth. Dressing – Able to dress himself although his selection of clothing is not always suitable for the weather. He also need reminding to change his clothing and would wear the same/dirty clothes if not prompted to change them. Communicating –Finds it extremely difficult to engage with people for the majority of the time. He exhibits aggressive behaviour which has resulted in him being excluded from School, having to leave college, being in trouble with the police, and having to leave the family home. His behaviour around others is inappropriate as he can be rude and/or swear at them. Alternatively he will become introverted and will not engage with people at all. The PIP assessment lasted half an hour during which he managed to control his behaviour. He was however becoming very agitated towards the end, and had it lasted much longer, it is likely he would have snapped and displayed his aggressive behaviour. Making budgeting decisions – Has no sense where money is concerned. Although he is able to add up he will spend any money on inappropriate items. He has no idea of the cost of things or on how to budget/pay for things. Planning/Following a journey – Unable to do this. When he attended college and had to catch a train he was taken to the station by his grandparents as he would not be able to get there otherwise. He travelled on the train to college with a friend and was met by his grandparents from the station after college. If on arrival at the station his friend was not there it was unlikely that he would have been able to get on the train. He doesn’t go anywhere on his own outside the area he knows as he couldn’t cope with public transport, knowing where to get off, purchase a ticket or approach anyone to ask for directions.

PIP Mandatory Reconsideration request We enclose a copy of a letter sent by the client’s GP to a housing association confirming that she is unable to manage stairs and getting in and out of her bath. The client suffers from severe arthritis in the back and knees, and sciatica which cause her constant severe pain. The decision letter states that the client does not take the maximum dose of her medication, and draws the conclusion that her pain level is low to moderate. The client states that the reason she does not take the maximum dose is that it causes her severe constipation and her doctor has advised her to take as much as she needs to reduce her pain to a manageable level. The letter also states that she was observed to stand unaided and stand on one leg, and this is evidence that she can prepare food and manage washing and bathing unaided. The client states that throughout this part of the assessment she used a walking stick to enable her to stand up and then Preparation of Food – The client is unable to use her oven as it is below waist level and she cannot bend. The decision letter accepts that she has problems bending, but then says that the evidence does not support the level of restriction she has reported. She also has difficulty standing for long enough to prepare a meal – 2 points. Washing & Bathing - The client needs help to get into and out of the bath. This is confirmed by the GP’s letter attached. She told the assessor that she usually uses the wet room in her mother’s bungalow in order to wash herself – 3 points. Managing Toilet Needs – The client cannot reach behind far enough to wipe herself after opening her bowels as she cannot twist her body due to the sciatica. The assessor asked her to put both hands behind her back which she could do, but reached the conclusion that she could therefore manage her toilet needs, which is not the case – 4 points. Moving Around - Although client can move 200 metres, the criteria states that this should be without pain, breathlessness or fatigue. The assessor acknowledges that the client stated she would need to stop 3 or 4 times to rest over that distance because of the pain. The assessor stated that the client was observed to walk with a normal pace and gait, but the client states she did not walk during the assessment, which took place at her home, and the assessor had no opportunity to make such an observation. – 4 points

Appeal against refusal of ESA Moving Around – 0 points awarded I believe I should be awarded 9 points for this descriptor as I cannot mobilise more than 100 metres on level ground within a reasonable timescale because of significant discomfort or exhaustion. I am enclosing a letter from my GP to support this. As acknowledged by the HCP I suffer from heart failure, angina and asthma. The HCP states that I can walk to the local shop which is approx. 160 metres away, but does not mention that I need to stop up to 3 times during the journey to recover my breath. S/he then states that I ‘walk back OK after’, but this is not true as I would again have to stop at least once, and often 2 or 3 times due to breathlessness. On page 8 the HCP acknowledges this stating that I will stand and wait for my shortness of breath to go away. S/he states that my use of my angina relieving spray is infrequent, but this is because my asthma usually causes me to stop before my angina starts. The HCP also states my breathing was normal at the assessment even though on page 6 s/he states that my peak flow test could not be interpreted. Reaching – 0 points awarded I believe I should be awarded 6 points for this descriptor. I suffer from tennis elbow in both arms and cannot straighten either arm, or lift them above my head, so could not reach for something. On page 9 the HCP states that I can reach to wash my hair and the top of my head, but I have to bend my back and neck in order to do this. On page 7 the HCP states my arms were normal on examination. S/he did not ask me to straighten them or raise my arms above my head during the assessment. I was only asked to put my hands on my hips, which I can do. Getting around safely – 0 points awarded I believe I should be awarded 15 points as I cannot safely cross a road without being accompanied by another person due to sensory impairment. I am completely blind in one eye, following an air gun accident, and the vision in my other eye is severely restricted. I make short local journeys which do not entail crossing busy roads, but otherwise I can only cross roads where there is a light-controlled crossing, or when accompanied by another person. I could not find my way around an unfamiliar place. On page 7 the HCP acknowledges my visual difficulties but then states I am ‘able to cross roads okay’. S/he gives no reason for having reached this conclusion or why s/he considered my distant vision to be reasonable.

Appeal against decision to refuse PIP daily living component and only standard rate of mobility component Dressing and Undressing – I have been awarded no points for this, but believe I should have been awarded 2 points. I stated in my request for mandatory reconsideration that I need an aid to be able to dress and undress. I use a shoe horn and a leg lifter for this activity, and I only ever buy slip-on shoes, or shoes fastened with Velcro. In this context the assessor, who visited me at home, stated that I was observed to be able to stand unaided and that the musculoskeletal examination indicated no restrictions in my upper limbs or with bending. I did not stand unaided as my chair was next to a radiator which I used to assist me, and I can only stand for short periods. I do not have restrictions in my upper limbs and I can bend to some extent, but not sufficiently far to enable me to put on shoes, trousers etc. Moving Around – I have been awarded 8 points but I believe I should be awarded 12 points on the grounds that I cannot move more than 20 metres unaided. The assessor gave no reason why he believed I could move more than 20 metres. When he visited me he did not ask me to walk outside and I barely walked at all during the assessment. I need to be accompanied at all times as I am extremely anxious about the possibility of falling. I have been diagnosed with osteoporosis and have had 2 serious falls resulting in bone fractures. The first was my left ankle, and a year later I fractured my right femur. As a result of this fall I was cared for in a nursing home for 5 months before I could weight-bear. These experiences have caused extreme anxiety about going out, and I would not be able to use public transport even if I could get to the bus stop or train station.

Appeal against decision to place client in the Work Related Activity rather than the Support Group for ESA Mobilising (moving around) In the mandatory reconsideration letter you state that the HCP at the assessment reported that I attended the assessment centre by bus and walked to the centre from the bus stop, which took about 15 metres (assume that should read minutes) at a slow pace. It is true that I travelled by bus, but walking to the centre took about 30 minutes with numerous stops because of my severe back pain and dizziness. According to Google maps, the distance is approx. 500 m. The criteria for this descriptor are that the claimant cannot repeatedly mobilise 50 metres within a reasonable timescale or significant discomfort. This includes dizziness and balance problems, as well as pain. If the activity causes too much pain or discomfort, which it does, I should be treated as not being able to do it. I would not normally attempt such a journey. Because of my balance problems, my doctor has advised that I should not go out alone as I have a tendency to stumble. I am no longer able to drive due to my balance problems, and my doctor advised that I must inform the DVLA. I originally requested a home visit for my assessment but I was told I would need a letter from my doctor. As this would have cost £25 which I am unable to afford, I had no alternative but to attempt the journey to the assessment centre, as I feared I would otherwise lose my benefit. The letter states that on a typical day I go to the shops and use public transport, but this is not true. I need to spend most of every day lying flat with a cloth over my eyes to control the dizziness. I am unable to watch TV because of the dizziness so can only listen to the radio. I live in a 1-bedroom bungalow, but have my bed in the living room. On my better days I go by taxi to the supermarket a mile away to buy food and walk slowly round the store. The taxi driver helps load the shopping into the car and unload it on our return home. I use private hospital transport to get to hospital appointments. Transferring from one seated position to another The mandatory reconsideration letter states that I was able to sit on a chair with a back for 51 minutes and rose without assistance from another person. This is somewhat misleading. I was in so much pain on arrival that the HCP said she would not ask me to do the test of moving from one seat to another, so she was not able to assess me for that descriptor. I was in severe pain for the whole of the assessment and the HCP asked if I would like to get up and stretch, but I declined to do so as I knew that could make the pain worse. When I did get up, I used a nearby table to push against, otherwise I would have needed assistance from another person. I therefore believe I satisfy the Support Group Criteria for this activity.

My pip assessment was handeld very well. Unfortunately my brain disease idiopathic intracranial hypertension, depression and anxiety also incontinence due to a lumbar puncture to remove fluid from my head causing damage and the extra care and mobility I need on a daily basis was not enough for full points. I was also turned down at MR With more evidence and my neurological symptoms where diagnosed as fatigue by the person who went over my MR and spike to me like crap. My condition has since worsened and I don't have the confidence to apply again as it was very disheartening, demeaning and took the self worth I had left away from me.

Having applied on 2 separate occasions for PIP, I have to say I found the whole process to say the least demeaning and discriminatory. I have what is best described as a lifelong mental health condition caused by bullying and harassment in my former workplace. I first applied for pip in the first half of 2015 and was turned down principally on the grounds that I turned up for my interview well dressed, clean, and able to communicate clearly. Add to this my astonishing ability to subtract 39 pence from a pound giving the correct answer and being asked to repeat the names of 3 household animals after 20 seconds, I was effectively told by the DWP there was nothing wrong with me. I requested a mandatory reassessment and again was refused. I then appealed and went in front of a tribunal who listened empathetically but ultimately came down on the side of the DWP simply because I did not tick the right boxes on the application! So much for an impartial hearing! Subsequent to this I had to retire from my chosen profession on ill health grounds and earlier this year I was advised that I would have to take medication for the rest of my life to control my condition. Realising this fundamental change in my life circumstances I reapplied for pip only again to be declined. This time I decided against requesting a mandatory reconsideration or taking to appeal for the sake of my health and wellbeing! The problem as I see it is that the application process as it stands is biased very strongly towards physical disability but is being used as a "catch-all" for other disabilities and quite simply is not fit for purpose in relation to the latter. In summary, from my experience there has to be a different approach taken for those suffering from mental illness, with more relevant questions being asked of the applicant. Furthermore the points system for making awards needs a complete overhaul. We are told when attending our appointment that we will be assessed by a trained health professional. Surely with the mass of experience(?) behind them they can award points say on a scale of one to ten?

A society can be judged on how it cares for its most vulnerable members. Based on our family's experience, thousands on this forum & those who aren't aware of this forum, the evidence isn't looking good. I came across this forum by chance - today. Why hasn't access to it been publicised? I have 2 children with disabilities. One, 25 with Asperger Syndrome/ADHD, diagnosed in 2004,went through a rigorous diagnostic criteria, including Speech & Lang, O.T, Psychology & Educational Psychology assessments.He attended a special school from Year 8. Was awarded DLA. Daughter was born with brain damage. Right & left hemispheres not joined & right side atrophied. Has Autistic Spectrum Disorder, Hydrocephalus, Visual impairment, Mild Scoliosis, Cerebral Palsy,Left Hemiplegia (wears special boots & has hardly any use in left arm/hand), Epilepsy, Severe Learning Difficulties, Challenging Behaviour,the cognitive & emotional understanding of a 4 to 5 year old. She's received DLA from early date allowed. Every 3 years each re-claim would include evidence from Special School, all professionals involved. NOTE: DLA RARELY WRITE TO ALL THE PROFESSIONALS ON CLAIMANTS LIST. If they'd been more proactive over the years, contacting at least one professional in ALL claim forms, they would've weeded out the false claims at very little cost - an email or a phone call. Didn't need a multi million pound contract to be more efficient. Even our assessor said as much. At 16 my daughter transferred to Adult DLA & was awarded it indefinitely - because she isn't going to get better! This year,20 years after our original award we were invited to apply for PIP. Have you noticed DLA gave you plenty of time to fill in the form - even as a single mum with 2 special needs kids I managed to complete the detailed form. (Friends've always been staggered why I have to regurgitate same info to prove their disabilities.) Quite! Both known to the Special Education system, the Health Care system & Social Care system - an integrated system. Bizarrely there is no such thing in Adult Services. So, by the time the PIP form has moved about the DWP internal system (call centre's comment) we barely have 2 to 3 weeks to complete & return with all relevant information. YOU ARE entitled to a full month from date YOU receive it but are also entitled to ask for more time. I have had to do that for both PIP forms & strongly justify why. Impossible to give it full attention as a full time carer over a few weeks. It has to be fitted around our very difficult life. DWP do not look back at previous DLA evidence. Daughter's assessor stated this.He stated that PIP is nothing to do with disabilities. He said DWP aren't interested in your diagnosis - it's not a measure of your disability but how much you can function & a small measure of function is enough to indicate you can do something. Our assessor asked if I knew why we'd been called for a F2F. I said No, given my daughter's disabilities will increase as she gets older. He scanned my form on screen, & indicatd that they don't receive each claimants info much before they meet you. Begs the question do they have time to read/understand it fully? At the end of the document he pointed out that DWP had written "insufficient medical evidence" (clearly they DON'T look at existing info they HOLD IN THEIR SYSTEM.) He scrolled down & looked at what I had sent & clearly thought there was evidence enough but was also dismayed that she had been called at all. DID YOU KNOW DWP HAVE TRIAGE SYSTEM? His opinion was the triage system failed (fails) in our case as they possibly hadn't read all descriptions (there was a lot) nor bothered to email/phone one of the 8 professionals I'd listed with full contact details. He was a Physio so had knowledge of Hemiplegia but not about ASD, Visual problems, Cognitive Impairment. Tried to engage with her but she was anxious,rigid & became non-verbal. He stated he hoped she wouldn't have to go through this again but stressed he would write the report but the decision was always the DWP's. He advised that when the decision was received one should ALWAYS request a copy of report from DWP. Also, that if we didn't receive Enhanced Payment that I should go to the end of the report & examine signatures. His should there, his status & the date he wrote report.BUT if there was another signature below, that would indicate that the DWP had "added" to the report. In which case, he said, you should ring & ask for the "original" report ie, his. His final words were if you don't receive Enhanced Payment, if I were I would appeal. CLEARLY THIS PROVOKES MANY QUESTIONS ABOUT THE DWP'S METHODS. It was difficult for him to ask my daughter questions, many she didn't understand but he seemed to accept from our statements & OT's that she couldn't plan, prepare, cook a meal, nor manage even a simple budget, communication, socialising also difficult. She needs 1 to 1 all day & someone at nighttime (sleeping.)

Reassessment started Aug 2016. After 3 interviews cancelled because I wanted them recorded, I was cut off for saying I could not continue after being told to travel over 10 miles for the assessment, something I told them on the first form that I could not do. Still waiting for my appeal to be heard. The mandatory reassessment or whatever is a pathetic joke, inserted to waste time, and deter appeals. Not even remotely "claimant friendly". The only way to improve it is to scrap the whole process and understand that my doctor is not "on my side", nor do I, or anyone else want them to be. A doctor's job is to make an objective assessment of the patient, and second guessing them is stupid.