Understanding criteria systems in Health, Care & Benefits

Some of the things I regularly hear in my advocasy work on benefits, NHS & PHB care packages, are that I can't manage; I'm disabled and I must be entitled to support/help. Having met these people and spending a time discussing their problems or issues, it would seem so.

The most difficult thing to try and explain and get over, is that yes you may be disabled medically or even according to the legal definition (under the Equality Act), but unfortunately our convoluted systems in the UK, mean that for each benefit not only is there a different definition of what is and what isn't a disability, but more difficult to comprehend is that each type of benefit, care package is based on a scoring or criteria system.

Starting with Employment Support allowance, which is/was (as people are encouraged to take up universal credit these days). This is the benefit for you if you are ill or too disabled to work instead of job seekers. This benefit is a points based system that you need to get 15 points for in one or more categories. Even if you achieve this, you then have another criteria which is on a similar points system but decides, whether you can do some work or no work. Again split depending on criteria. There are different criteria for mental health issues again based on the same points system.

Personal independence payment (PIP), which replaced DLA (disability living allowance), is the benefit that allows you some extra money to cope and pay for some disability needs (extra costs incurred). This again is based on a point system maximum of 12 points are required over a number of different criteria. Some very similar to ESA. PIP is further split into two parts, both requiring 12 points for living; the other is for getting around (transport). This benefit even when you get the fully enhanced allowance will barely cover your disability costs. A charity has calculated the average costs of disability is in the region of £600 a month. Please note that this is an average, which means there are many whose expenses will be much higher.

In both of the above points, make pounds. The more you can do, the less you get. As an example for personal hygiene, if you can't shower/wash (remember, this is just the act of washing not getting there, whether you can turn taps or push buttons just showering). You will get the max points, however if you can wash say your chest and hair you'll get two thirds of the points. If you if you can just wash your chest then you will get 3/4 of the points.

This is the issue people don't realise. Your illness and disability benefits depend on a sliding scale based on activities and how much of those activities you can or can't do. Some of the activities in certain circumstances seem ridiculous. Others are pointless as they don't really relate to actual living or how things fit together in real life, but are judged as individual exercises.

When it comes to help with care, you have a social care budget and health budget; again, there is much overlap. The organisations officers will spend a lot of time arguing between themselves, whether it's care or health it depends on which pocket the budget come out of. Again, people who need the services often left waiting along time whilst they sort themselves out.

There are again criteria in both these areas that you have to meet or be able to do or not do. Some wether you like it or not are the same as above for ESA and PIP. They are managed completely separately and by different departments. These two systems are not based on points but on severity.

Both have a very similar process, yet they can be seen and are thought of as two very different systems, based on wether it’s a care issue or a health issue. Somone needs to tell them that care and health are often interchangeable!

The differences between them all are subtle and regular checking (especially for those who aren't going to change or get better seems ridiculous). Personally, I believe that there is potential for one system. That covers both medical and social needs and benefits. If you work in this area and work with these criteria systems, you'll see a lot of repetition in all of them. The cost for government and departments must run into millions to administer and track all the different systems involved.

Whatever your requirements don't forget to reach out for help, if you have difficulties. Though increasingly harder to find, there are advocacy services to help you, particularly in social care and health. There is also talk of introducing advocasy for the benefits systems as well.