“ The client was found to have a significant level of disability due to arthritis at the previous examination, suggesting they had limited capability for work. The ESA50 and previous report does not indicate that there has been a substantial improvement……... The available evidence does not suggest that the client has severely restricted musculo-skeletal or cardio-respiratory function, such that they would be unable to mobilise more than 50 metres, or transfer between two seats without assistance from another person… ”
“ Having considered the available evidence, I have determined that [RD] (has scored at least 15 points from the appropriate descriptors and is treated [1] as having limited capability for work). I have also determined that by reason of his (physical and/or mental) condition none of the descriptors set out in Schedule 3 to the ESA Regulations apply. He does not have limited capability for work-related activity. He will be placed in the Work Related Activity Group. His existing award(s) will be converted to an award of [ESA] from and including20/12/2011 . ”
“ The client was found to have a significant level of disability due to stroke at the previous examination, suggesting they had limited capability for work. The Med3 and previous report does not indicate that there has been a substantial improvement……... The available evidence does not suggest that the client has severely restricted musculo-skeletal or cardio-respiratory function, such that they would be unable to mobilise more than 50 metres, or transfer between two seats without assistance from another person… ”
“ Having considered the available evidence, I have determined that [RW] has scored 15 points from the appropriate descriptors and has limited capability for work). [RW] continues to be accepted as having Limited Capability for Work and is still entitled to [ESA]. The Decision Maker has also considered limited capability for work-related activity. Having considered the available evidence the Decision Maker has decided that by reason of his (physical) condition none of the descriptors set out in schedule 3 of the ESA Regs apply to [RW]. [RW]…….does not have limited capability for work-related activity. He continues to be entitled to ESA and will be placed in the Work Related Activity Group. ”
“ Limited capability for work 8(1) For the purposes of this Part, whether a person’s capability for work is limited by his physical or mental condition and, if it is, whether the limitation is such that it is not reasonable to require him to work shall be determined in accordance with regulations. (2) Regulations under subsection (1) shall— (a) provide for determination on the basis of an assessment of the person concerned; (b) define the assessment by reference to the extent to which a person who has some specific disease or bodily or mental disablement is capable or incapable of performing such activities as may be prescribed; (c) make provision as to the manner of carrying out the assessment. (3) Regulations under subsection (1) may, in particular, make provision— (a) as to the information or evidence required for the purpose of determining the matters mentioned in that subsection; (b) as to the manner in which that information or evidence is to be provided; (c) for a person in relation to whom it falls to be determined whether he has limited capability for work to be called to attend for such medical examination as the regulations may require. ”
“ Determination of limited capability for work 19. —(1) For the purposes of Part 1 of the Act, whether a claimant’s capability for work is limited by the claimant’s physical or mental condition and, if it is, whether the limitation is such that it is not reasonable to require the claimant to work is to be determined on the basis of a limited capability for work assessment of the claimant in accordance with this Part. (2) The limited capability for work assessment is an assessment of the extent to which a claimant who has some specific disease or bodily or mental disablement is capable of performing the activities prescribed in Schedule 2 or is incapable by reason of such disease or bodily or mental disablement of performing those activities. (3) Subject to paragraph (6), for the purposes of Part 1 of the Act a claimant has limited capability for work if, by adding the points listed in column (3) of Schedule 2 against any descriptor listed in that Schedule, the claimant obtains a total score of at least— (a) 15 points whether singly or by a combination of descriptors specified in Part 1 of that Schedule; (b) 15 points whether singly or by a combination of descriptors specified in Part 2 of that Schedule; or (c) 15 points by a combination of descriptors specified in Parts 1 and 2 of that Schedule. (4) In assessing the extent of a claimant’s capability to perform any activity listed in Part 1 of Schedule 2, the claimant is to be assessed as if wearing any prosthesis with which the claimant is fitted or, as the case may be, wearing or using any aid or appliance which is normally worn or used. (5) In assessing the extent of a claimant’s capability to perform any activity listed in Schedule 2, it is a condition that the claimant’s incapability to perform the activity arises from— (a) a specific bodily disease or disablement; (b) a specific mental illness or disablement; or (c) as a direct result of treatment provided by a registered medical practitioner, for such a disease, illness or disablement. (6) Where more than one descriptor specified for an activity apply to a claimant, only the descriptor with the highest score in respect of each activity which applies is to be counted. (7) Where a claimant— (a) has been determined to have limited capability for work; or (b) is to be treated as having limited capability for work under regulations 20, 25, 26, 29 or 33(2), the Secretary of State may, if paragraph (8) applies, determine afresh whether the claimant has or is to be treated as having limited capability for work. (8) This paragraph applies where— (a) the Secretary of State wishes to determine whether there has been a relevant change of circumstances in relation to the claimant’s physical or mental condition; (b) the Secretary of State wishes to determine whether the previous determination of limited capability for work or that the claimant is to be treated as having limited capability for work, was made in ignorance of , or was based on a mistake as to, some material fact; or (c) at least 3 months have passed since the date on which the claimant was determined to have limited capability for work or to be treated as having limited capability for work. ”
“ The end of the assessment phase 4. —(1) Subject to paragraph (2) and regulations 5 and 6, the assessment phase in relation to a claimant ends on the last day of a period of 13 weeks beginning on the first day of the assessment phase as determined under section 24(2)(a) of the Act. (2) If at the end of the period of 13 weeks referred to in paragraph (1), it has not yet been determined whether the claimant has limited capability for work— (a) the claimant having been assessed in accordance with a limited capability for work assessment; or (b) as a result of the claimant being treated as having limited capability for work in accordance with regulation 20, 25, 26, 29 or regulation 33(2) (persons to be treated as having limited capability for work), the assessment phase will end when the limited capability for work determination is made. ”
“ 12. -(1)This section applies to any decision of the Secretary of State under section 8 or 10 above (whether as originally made or as revised under section 9 above) which— (a)is made on a claim for, or on an award of, a relevant benefit, and does not fall within Schedule 2 to this Act; (b)is made otherwise than on such a claim or award, and falls within Schedule 3 to this Act. (2)In the case of a decision to which this section applies, the claimant and such other person as may be prescribed shall have a right to appeal to a First-tier Tribunal…. (6)A person with a right of appeal under this section shall be given such notice of a decision to which this section applies and of that right as may be prescribed….. (8)In deciding an appeal under this section, an appeal tribunal— (a)need not consider any issue that is not raised by the appeal; and (b)shall not take into account any circumstances not obtaining at the time when the decision appealed against was made. ”
“ Notice of decision against which appeal lies 28.—(1) A person with a right of appeal under the Act or these Regulations against any decision of the Secretary of State…. shall— (a)be given written notice of the decision against which the appeal lies; (b)be informed that, in a case where that written notice does not include a statement of the reasons for that decision, he may, within one month of the date of notification of that decision, request that the Secretary of State…. provide him with a written statement of the reasons for that decision; and (c)be given written notice of his right of appeal against that decision. (2) Where a written statement of the reasons for the decision is not included in the written notice of the decision and is requested under paragraph (1)(b), the Secretary of State….. shall provide that statement within 14 days of receipt of the request or as soon as practicable afterwards. ”
“ 24.-(4)(a) a copy of any written record of the decision under challenge, and any statement of reasons for that decision, if they were not sent with the notice of appeal [and] (b) copies of all documents relevant to the case in the decision maker’s possession, unless a practice direction or direction states otherwise… ”
“ That duty [under section 8 SSA] is to give an “outcome decision” which, broadly speaking, is one which decides whether the claimant is entitled to benefit and, if so, how much and for what period. There is no obligation under Section 8 to explain the reasoning behind the decision. ”
“ An issue the Upper Tribunal may need to address is the rationality/ transparency of the Schedule 2 ESA decision-making structure where seemingly it is contended that the decision-maker is obliged to award points to a claimant against the Schedule 2 descriptors but, it would seem, never make any record of that scoring. How then is, say, another decision maker able to recite the points scored when the decision was in fact made if requested to provide this information pursuant to regulation 28(2) of theDecision and Appeals Regulations 1999 if there is no record of those points? Further, is it the case that such a scoring exercise was carried out on these two appeals when the limited capability for work decision was made but not recorded or that the record has since been lost: see paragraph 41 of the Secretary of State’s submissions? Paragraph 49 of those submissions seems to indicate that no such record is ever kept initially and that any Schedule 2 descriptor scoring is only (ever) done when such a request is made by the First-tier Tribunal. Is that the case? And it that is the case what is the evidential basis for such a scoring exercise having been conducted by the decision maker (and the precise score made by him/her) when the limited capability for work decision was made? ”
“ ……. Memo ADM 8/14 , dated April 2014,….seems relevant to the issues arising on these appeals….. In terms, what that Memo indicates is that from the end of 2013 HCPs were required on the ESA85A form to record the likely Schedule 2 scoring descriptors. The Memo says “ This change enables the DM to record the points scored on form UC/ESA56 when determining that the claimant has LCW, where the HCP’s advice is accepted ”
“ Until December 2013, the practice was that although the HCP would assess the claimant against the individual descriptors in order to determine whether the threshold of 15 points was met…., he or she was not required to specify or set out the particular activities and descriptors which applied to re-referral claimants. ”
“ many Decision Maker lack the confidence to make a decision that deviates from the Atos advice….It is clear that a culture has developed amongst Decision Makers that sees the advice from Atos as forming the decision, and that they are there simply to ratify that decision ” (paragraphs 7 and 8 on pages 49 and 50 of the report). Professor Harrington went on in that report: “ Conversely, Atos HCPs see their reports from the WCA as forming solely advice….Atos correctly see their role as offering advice, and providing information that should be considered as part of the final decision. These two viewpoints mean that effectively, both parties expect that the other has responsibility for making the decisions. There is what can be termed a decision gap, which can leave no-one actually claiming responsibility for the benefit decision.” (page 50, paragraphs 9 and 10) Professor Harrington therefore recommended that Decision Makers “ are put back at the heart of the system and empowered to make an independent and considered decision ”
“ Whilst the practice described is not in accordance with the guidance, it is clear that the DM’s did reach determinations based on material provided by appropriately qualified HCP’s who had, as described above, gone through the descriptors for the purpose of producing the ESA85A form. ”
“ whilst the Decision Maker did not usually actively score the claimant against each descriptor, he or she reached a decision based on a consideration of the advice supplied by the Atos HCP who will themselves have gone through the descriptors and the point scoring exercise. ”
“ The ESA85A and the Med3 form completed by [RW’s] GP did not indicate that there had been a substantial improvement, so there was nothing to suggest that his score would have dropped below the 15 point threshold for ESA . ” (my underlining added for emphasis). This leaves wholly out of account the change in the descriptors which had occurred in March 2011. He went on: “ There was also nothing to suggest the claimant’s condition had significantly worsened. [RW] previously scored 15 points for vision, but even had his vision deteriorated further, there is no corresponding Schedule 3 descriptor for vision…. ”
“ Against this background of the decision-making process, it is possible to see how regulation 19(2) fits in. An assessment is, to summarise, an assessment of the extent to which a claimant’s physical and mental condition restricts or prevents performance of the activities in Schedule 2. That is something that requires findings of fact and they can only be made by the decision-maker. This leads to the conclusion that the assessment is undertaken, or at least completed, by the decision-maker, not the health care professional. It therefore follows that the determination on the basis of a limited capability for work assessment, to which regulation 19(1) refers, does not involve two separate stages. ”
“ there may be some decisions made by the Secretary of State which have so little coherence or connection to legal powers that they do not amount to decisions …….at all”