Mobilising- reasonable to use wheelchair?

Has anyone had any luck in persuading a FTT that it is not reasonable for a client with no upper limb impairment to use a manual wheelchair? (eg: cost, possible detrimental effect on client’s long term health, etc). I’ve yet to have an appeal where the outcome hangs on this but may have one now.

A GP tribunal member has expressed the view that it may not usually be reasonable to expect a person to use a wheelchair because it is important for them maintain what walking ability they retain for as long as possible as walking is generally a good thing for health and well being. In otherwords use of a wheelchair could actually be considered detrimental to health. Therefore that GP considers that part of the provision effectively meaningless / irrelevant in most cases!

It would be good to have that opinion in writing substantiated with appropriate medical research evidence etc!

It does suggest that running the argument may have merit.

Has no one already got a case on this point on its way to the UtT yet?

That’s what I was hoping.

I obtained a very useful response from a local specialist OT on the issue of the potential detrimental effect on health of using wheelchair which I’ve tended to use as standard when preparing subs where mobiising is an issue and there is no convenient upper body impairment. However, I’ve yet to encounter a FTT that’s gone along with it (they’ve invariably awarded points from other applicable descriptors in order to allow the appeals). With the case in question, it’s looking like there’s little possibility of client attracting more than 9 points on sitting/standing unless we can persuade FTT to award at least 6 on mobilising.

If they have problems sitting - due to pain or severe discomfort - then would it be reasonable to expect them to sit in a wheelchair for long periods?

This article “Wheelchair propulsion: a straining form of ambulation” in an Indian Medical Journal looks useful:

http://www.highbeam.com/doc/1P3-876919461.html

I’ve not looked at the full thing because I’m wary of these 7 day free trial things

I thought it was fairly well established in IB/ESA law that you should not be treated as able to carry out an action if, among other reasons, you have been advised against it by a health care professional who is responsible for your care.

I came across a man once who had Charcot’s foot: sever damage to the foot caused by nerve damage in diabetes. It’s one of the very nastiest complications of diabetes. You lose sensation and are unaware of injuring the foot, eg breaking bones and having them set crooked. This is then likely to lead to ulceration, and hence to gangrene and amputation.

The effect of the damage can be helped by foot surgery, but the underlying neuropathy doesn’t go away. It is therefore crucial in such cases to rest the foot and use it a little as possible to avoid further damage, until it is properly healed. This can take at least 6 months as diebetics have terrible healing.

The upshot of this was that the mere fact that my man could walk without pain or limping on his recently-operated foot didn’t mean he could do it. It was downright dangerous for him to do so and he had been told not to by his surgeon. The doctor on the Tribunal was horrified and a complaint to ATOS made, which we learnt had led to the assessor in question being sent for extra training.

OK, that was extreme; but the point is the same.

I see your point. I suppose the difficulty is that in many cases, no one has specifically advised the client not to use a wheelchair because the issue just hasn’t arisen. It’s sort of obvious that clients with (for instance) degenerative spinal diseases should keep as active as possible but it’s unlikely there will be a record of said client being told a wheelchair is not a good option (it’s just common sense). However, in the case of the client I am thinking of (who has a permanent injury to one leg following an accident and who can walk only using crutches) it may be possible for his GP or consultant to confirm a wheelchair would be a bad idea.

Thanks all!

CSIB/12/1996 mentioned at http://www.rightsnet.org.uk/forums/viewthread/3623/ might be helpful?

CE/1217/2011 concerns when it’s reasonable to use aids in all the circumstances. We’ve cited that in the following case, are awaiting the hearing.

IB to ESA transition, early 60s, poor mobility, walks with a stick never used a wheelchair, has asbestosis and COPD. On the ESA50 he reported being able to walk 7-9 metres. In the ESA assessment, observed behaviour of walking 16 metres to the exam room was found to be “consistent” (... with the medical conditions, I assume?). DM says no reported problems with upper limbs, should be able to use a wheelchair, zero points.

We have provided an occ health report (basis for client’s Blue Badge) which puts his mobility in the 0-20 metre range, and against the pro forma question “Does the applicant regularly need to use: wheelchair” the assessor has put :No, “due to asbestosis”.

The DM has looked at this and found no new evidence to change the decision. Is it ever worth replying directly to this sort of thing, to ask for reasons?
eg “Please explain why it would be reasonable to use a wheelchair in these circs, what evidence are you relying on”.

Craven CAB welfare benefits - 13 September 2012 12:11 PM

The DM has looked at this and found no new evidence to change the decision. Is it ever worth replying directly to this sort of thing, to ask for reasons?
eg “Please explain why it would be reasonable to use a wheelchair in these circs, what evidence are you relying on”.

We have raised this issue through local MPs with the DWP. We are still awaiting a full response from the dept. including our request for a meeting with the manager of local BDC about the quality of ESA decision making. We have also sighted this issue in our response to Harrington.

Only today we received the following (as an additional sub. to tribunal) in response to a formal request for a revision submitted with medical evidence:

“Having considered this new evidence I have decided that there are no grounds to revise the decision under appeal.

Ms X’s representative have forwarded a letter to the department requesting a revision of our decision of Y quoting SSAs9(6). They have also given their opinion as to the descriptors of ESA Sch 2 that should have been applied to Ms X as well as ESA Reg 29(2)(b). However. I respectfully submit that the descriptors have been fully justified by the healthcare proffessional by clinical findings, observations made at the assessment and referral to the typical day history given by Ms X. The Medical Report was appropriate, complete and covered all the incapacity detailed.

The above mentioned letter also refers to additional evidence they supplied, being a detailed letter to Ms X’s GP dated ... and the GP detailed reply dated…

I respectfully advise that the crux of the letter to the GP and the subsequent responding letter from the GP is the argument for Ms X having limited capability for work related activity. However, I respectfully submit that Ms X’s appeal and the depts subsequent response is for Ms X scoring 0 points in the physical and 0 points in the mental descriptors and a determination by a decision maker that Ms X does not have limited capability for work”

Thus demonstrating an understanding of SSAs9(6), how to weigh evidence, how Harrington has put DMs back at the heart of decision making etc etc!

Also received today from the manager of BDC appeals section in response to a complaint about the failure of a DM to question the advice provided by Atos where the ESA85 states at various places that the claimant had had his hand amputated and at other described his use of both hands:

“As you are aware interpretation of evidence can be subjective”

Incidently Atos response to the same complaint about the ESA85 was:

“Admittedly, there is a level of ambiguity over whether or not Mr Z had had an amputation of the right hand”.

(you couldn’t make it up!)

So I suggest the answer to your question is no!

Whilst we would not expect a DM to change the decision based on the new evidence we would expect them to demonstrate why that evidence did not allow the decision to be changed. The standard response it just another example of DM’s ‘rubber stamping’ Atos advice. DWP - ‘we have made our decision and we will not (don’t know how to) considier any additional evidence however compelling’.

Whilst the answer may be no - given the introduction of compulsory revision before appeal and introduction of WCA style assessmnts for PIP I would suggest this issue needs to be pursued vigorously with DWP.

Perhaps if MPs were inundated with requests to raise this issue in individual cases with DWP (shades of CSA) some action might eventually result given the issue is also getting some significant media attention at present (i.e. BBC’s One Show on PIP last night)