A Transformed PCA Simon Osborne The context Current
A Transformed PCA Simon Osborne
The context • Current PCA is, ‘viewed simply as a hurdle that must be cleared…focuses on incapacity rather than capability’ (A new deal for welfare, January 2006) • Changes in, ‘the prevalence of disabling conditions; in advances in medical science…and in the workplace environment’ (Report of PCA Technical Working Groups, September 2006) • Various problems with current test, including mental health test overall, and physical health descriptors for ‘minimal levels of disability’ (Report of Technical Working Groups) • Employment and Support Allowance to be based on ‘limited capability for work’ (Welfare Reform Act 2007)
What will the new PCA do? • Test for ‘limited capability for work’ • Test for ‘limited capability for work-related activity’ (ie, for the Support Group of ESA) • Apply the ‘Work-focused Health-Related Assessment’ (for use in work-focused interviews) • Apply to Employment and Support Allowance only? – not confirmed
New test of ‘limited capability for work’ • Basic structure similar to current PCA – ie activities, descriptors, points • Main changes: - much reduced list of exemptions - removal of lower scoring descriptors in physical health - extensively revised mental health test - simplified scoring – 15 point threshold for both tests, similar points system in both tests, straightforward combining of scores
Exemptions • • Current list of exemptions abolished Terminally ill Certain chemotherapy ‘substantial risk’ to health Not working due to a relevant disease Pregnant women In-patients in hospital Receiving certain treatment (haemodialysis, radiotherapy, etc, but only on days of treatment) • Severe life threatening disease which is uncontrolled or uncontrollable (exceptional circumstance) • ? Support Group members – not specifically mentioned
Physical health test – key changes • Removal of lower scoring (3 point) lowerlimb/back function descriptors • 3 grades of severity only – 6, 9 or 15 points • ‘sitting’, ‘rising from sitting’ and ‘standing’ activities merged into one • ‘walking up and down stairs’ activity removed • 3 sets of descriptors for continence • Various new/revised wording in descriptors
Mental health test – key changes • Scrapping of 1 or 2 point scoring system – replacement with 6, 9 or 15 points • Replacement of 4 activities with 10 • Wording extensively revised • New concepts, eg ‘initiating and sustaining personal action’, ‘disproportionate’ reactions to events or criticism, ability to visit new places or engage in social contact
Mental health descriptors • • • Completion of tasks Memory and concentration Getting about Coping with change Execution of tasks Initiating and sustaining personal action Inappropriate behaviour Dealing with other people Coping with social situations Awareness of hazard
Scoring • Mental and physical health scoring systems now aligned – 15 point threshold • Rule providing allocation of 9 points to physical health score for 6 -9 points in mental health score removed • But mental health and physical health scores may be combined, ie 15 points can be scored from a simple combination
Manual Dexterity Current descriptors • Cannot turn the pages of a book with either hand (15) • Cannot turn a sink tap or the control knobs on a cooker with either hand (15) • Cannot pick up a coin which is 2. 5 centimetres or less in diameter with either hand (15) • Cannot use a pen or pencil (15) • Cannot tie a bow in laces or string (10) • Cannot turn a sink tap or the control knobs on a cooker with one hand but can with the other (6) • Cannot pick up a coin which is 2. 5 centimetres or less in diameter with one hand but can with the other (6) • No problem with manual dexterity (0) Revised descriptors • Cannot turn a ‘star headed’ sink tap with either hand (15) • Cannot pick up a £ 1 coin or equivalent with either hand (15) • Cannot turn the pages of a book with either hand (9) • Cannot physically use a pen or pencil (9) • Cannot physically use a conventional keyboard or mouse (9) • Cannot do up/undo small buttons such as shirt or blouse buttons (9) • Cannot turn a ‘star headed’ sink tap with one hand but can with the other (6) • Cannot pick up a £ 1 coin or equivalent with one hand but can with the other (6) • Cannot pour from an open 0. 5 litre carton full of liquid (6) • None of the above apply (0)
Vision Current descriptors • Cannot tell light from dark (15) • Cannot see the shape of furniture in the room (15) • Cannot see well enough to read 16 point print at a distance greater than 20 centimetres (15) • Cannot see well enough to recognise a friend across the room at a distance of at least 5 metres (12) • Cannot see well enough to recognise a friend across the room at a distance of at least 15 metres (8) • No problem with vision (0) Revised descriptors • Cannot see at all (15) • Cannot see well enough to read 16 point print at the distance of greater than 20 cm (15) • Has 50% or greater reduction of visual fields (15) • Cannot see well enough to recognise a friend at a distance of at least 5 metres (9) • Has 25% or more but less than 50% reduction of visual fields (6) • Cannot see well enough to recognise a friend at a distance of at least 15 metres (6) • None of the above apply (0)
Coping With Change (a) Cannot cope with very minor expected changes in routine, to the extent that overall day to day life cannot be managed 15 (b) Cannot cope with expected changes of routine (such as pre-arranged permanent change to the routine time scheduled for a lunch break), to the extent that overall day to day life is made significantly more difficult 9 (c) Cannot cope with minor, unforeseen changes in routine (such as an unexpected change of the timing of an appointment on the day it is due to occur), to the extent that overall day to day life is made significantly more difficult 6 (d) None of the above apply 0
Evaluations • • First evaluation – February 2007 More failed physical health test More passed mental health test Modifications made Second evaluation – expected September 2007 Will more people fail overall? Further modifications ? Regulations not yet finalised
- Slides: 13