Supplementary evidence from the Chronic Illness Inclusion (HAB0129)


We are grateful to the Work and Pensions Committee for the opportunity to give evidence to the inquiry into health and disability assessments on 16th March 2022. We would like to add additional evidence in answer to the question Do assessments adequately measure functional impairment or ability to work? which was not fully explored in the session.

Problems with the current assessment systems for people with energy-limiting conditions (ELCs)

  1. PIP 20 metre rule. We concur with the evidence given by MS Society that the 20m rule for PIP results in many people with significant mobility impairment being denied the support they need. People with ELCs often have very limited mobility due to energy impairment and pain, and rely on cars and taxis to leave their homes. Restoring the 50-metre rule under DLA for enhanced mobility support would more accurately reflect support needs and help with the significant extra costs of relying on cars and taxis.
  2. Guidance on the scope of descriptors.  ELCs limit both cognitive and physical activity in relation to work and daily living activities. But the descriptors for mental, cognitive and intellectual function in the WCA, like the activities of communication in PIP, can only be applied to certain diagnoses, according to the published guidance for assessors. This means assessments are effectively based on a person’s diagnosis, not on how their condition affects them, which is contrary to the stated aim of a functional assessment. This leads to inaccurate assessments and unfair decision making. CII calls for revised guidance to assessors on the scope of descriptors to properly reflect the principles of a functional assessment. Descriptors should be applied according to the difficulties reported by claimants, not according to their medical diagnosis.


CII believes that a fundamental overhaul of assessment methods and principles is necessary to create a fairer system that accurately measures functional ability. We would welcome the opportunity to design a more holistic assessment model in collaboration with other Deaf and Disabled People’s Organisations. We believe a fairer system must be grounded in the social model of disability.


What are implications of assessments informed by the social model of disability?

For people with ELC, as for all Deaf and Disabled People, capacity for work is determined by the interaction between their health condition or impairment and external factors such as social attitudes, barriers in physical environment, and the organisation of work.

Fit for work/not fit for work is a false binary. In reality, many external factors determine someone’s employability, such as the availability of support, the attitude of employers and the design of jobs.

The WCA takes no account of these external factors and therefore cannot measure distance from the labour market.

For example, a Deaf BSL may be able to work full time if their communication support needs are met. But if Access to Work decides it is too expensive to fund this support, they are effectively incapable of most forms of work.

Similarly, someone with an ELC may be able to work for 10 hours per week, on the condition that they have full flexibility over their hours of work to accommodate fluctuating symptoms and can work from home to avoid energy lost to commuting. But unless more roles are designed and made available in the jobs market with low hours and maximum flexibility, that person is effectively unable to work. 

These external factors should be accounted for in assessments of work capability. Not only would this lead to fairer and more accurate decisions on benefit eligibility, it would also help to address some of the societal barriers to employment that maintain the very large gap between the percentage of disabled people in work and the percentage of non-disabled people in work.

Incorporating the social model of disability into assessments is the only way to move beyond the false binary of fitness for work’ and would be a key factor in closing the disability employment gap.


March 2022