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Employment and Support Allowance

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Employment and Support Allowance (ESA) is a new benefit, introduced from 27 October 2008, that is paid to people who are incapable of working because of illness and disability.

ESA replaces Incapacity Benefit (including Incapacity Benefit in Youth) and Income Support paid on the basis of incapacity. However, people who currently receive these existing benefits will be entitled to stay in receipt of them when the new benefit comes into effect, at least initially. Only people who make a new claim after the 27 October 2008 will claim ESA.

An important difference between ESA and Incapacity Benefit is that ESA has both an "income-related" strand and a "contributory" strand. Anyone who has paid enough National Insurance contributions through work can claim ESA through the contributory strand, but those who haven't paid enough can still claim ESA through the income-related strand. However, the income-related strand of ESA is means-tested, so your income and savings will be looked at before you can qualify for it. This is similar to the way Income Support paid on the basis of incapacity is currently calculated.

People aged under 20 (and in some cases 25) can qualify for the contributory-based ESA without having paid National Insurance contributions, in a similar way to Incapacity Benefit in Youth.

Another major difference between ESA and Incapacity Benefit is that the medical assessment for ESA has been significantly overhauled. The existing assessment for Incapacity Benefit - the "Personal Capabilities Assessment" - has been replaced by a new "Work Capability Assessment" which is far more in-depth. This assessment looks initially into whether someone has "limited capability to work" but then looks at the work that people can do, rather than what they cannot. The National Autistic Society was heavily involved in the consultation process when the new assessment was being drawn up and as a result there are parts of the assessment that relate specifically to difficulties with communication and social interaction, which are common to people on the autism spectrum.

How does ESA work?

All claims to ESA go through an initial "assessment phase" of 13 weeks, before entering the "main phase" of the benefit. The amount of money paid is less within these 13 weeks and increases in the main phase. The only exception to this is for people who are terminally ill, whose claims will be fast-tracked.

The first stage of the assessment phase is that a claim form needs to be completed and returned, although, like Incapacity Benefit, this is completed over the telephone and a statement is then sent out in the post for you to sign and return.

Secondly, medical evidence to support your claim is required, in a similar way to Incapacity Benefit. This will require you to obtain a medical certificate from a GP to confirm incapacity from work.

There is a requirement to attend a "Work-Focused Interview" within the assessment phase as well. This interview is explained in more detail below.

After submitting your claim you will be asked to take part in the "Work Capability Assessment", which is the test that replaces the existing "Personal Capabilities Assessment for Incapacity Benefit. This test consists of three parts; the "limited capability for work" test, the "limited capability for work-related activity" test and the "work-focused health-related assessment". However, the first two parts are completed at the same time. Let's look at these three parts in turn.

1. The limited capability for work test

This test assesses whether you are classed as having "limited capability for work".

The initial stage is that a questionnaire (ESA50) regarding your health is issued. This is followed, in most cases, by a medical assessment by a Department of Works and Pensions-approved doctor.

The test uses a point-scoring system based on assessment of a variety of physical and mental health functions (referred to as "descriptors"). These descriptors include physical tasks such as walking, flexing joints and carrying objects and mental health functions such as memory, concentration and coping with social situations. There are 21 of these descriptors in total.

For each of these descriptors, different points are awarded according to the level of difficulty experienced in completing them. For example, one of the descriptors in the mental health assessment is called "Getting about". If it is considered that you experience the following difficulties you would score 9 points:

Is unable to get to a specified place with which the claimant is familiar, without being accompanied by another person on each occasion.

However, if within the same descriptor the doctor concludes that you experience a higher degree of difficulty, as described below, you would score 15 points:

Cannot get to any specified place with which the claimant is, or would be, familiar.

To qualify as having "limited capability for work" you need to score 15 points in total on either the physical health descriptors alone, the mental health descriptors alone, or a combination of the two. As you can see from the above example, it is actually possible to pass the test based on just one descriptor. However, the higher scores within each descriptor relate to people who experience the most severe physical and mental health difficulties, so it is likely that if the test is passed it will be based on a combination of the descriptors. The test has been significantly changed from the "Personal Capabilities Assessment" used for Incapacity Benefit, which tended to concentrate primarily on physical functions. As a result, it should now be possible for more people on the autism spectrum to meet the points threshold.

If you score less than 15 points then you are not found to have "limited capability for work" and will not be entitled to continue to receive ESA, though you have the right to appeal against this decision. If you do not pass the "limited capability for work test" you can claim Jobseeker's Allowance instead. However, as mentioned above, some of the questions asked in this new test relate more specifically to autism spectrum disorders than the existing test within Incapacity Benefit.

2. The limited capability for work-related activity test

If you pass the "limited capability for work" test, you will move to the second test to determine whether you should be placed in a "support" group or "work-related activity" group. Like the "limited capability for work" test, this second test assesses a number of physical and mental health tasks, though these are not based on a point-scoring system as such. You only need to satisfy one of the descriptors in this test to pass it. The descriptors in this test relate only to people who experience the most severe forms of physical or mental health problem and if the test is satisfied they will be placed in the "support" group. If none of the descriptors are met they will be placed in the "work-related activity" group.

The support group

If you are placed in the "support" group you are not required to take part in "work-related activity" (though you can choose to do so if you like). You will also receive a higher amount of ESA. However, the criteria for entering the support group is very restrictive and it is expected that only a minority of people will be placed in this group.

The Work-Related Activity Group

If you do not pass the "limited capability for work-related activity test" then you will be placed in the work-related activity group. This is expected to be the case for the majority of ESA claimants.

The amount of benefit is lower for the work-related activity group than for the support group and you will be required to attend a series of six "work-focused interviews", probably every month, in order to continue receiving ESA. Failure to take part in these interviews can result in the benefit being "sanctioned". This means that the benefit is reduced for a period of time.

Your work-focused interview will take place with a personal adviser who will try to help you into work by drawing up an "action plan". After you are placed in the work-related activity group, a final assessment of your ESA entitlement called the "work-focused health-related assessment" - will be made.

3. Work-Focused Health-Related Assessment (WFHRA)

A WFHRA will be carried out if you are placed in the "work-related activity" group. This test looks at your "functional capacity" or, in other words, the work you are capable of doing, taking into account your medical difficulties, rather than the work you cannot do. This assessment also establishes if any action should be taken in regard to your condition to help you back into work. The WFHRA does not play a part in determining the level of benefit you receive, as this is calculated from the tests described above. It is designed to inform your personal adviser about your condition and to assist them during work-focused interviews and when drawing up an action plan.

Is anyone exempt from the medical assessments?

There are fewer exemptions from medical assessment in Employment and Support Allowance than there were with Incapacity Benefit. Usually, the only groups of people who are automatically treated as having "limited capability for work" without a medical assessment are the terminally ill, people receiving chemotherapy and pregnant women who are due to give birth shortly.

What if I already receive Incapacity Benefit?

People who currently receive Incapacity Benefit and Income Support will stay in receipt of these benefits when ESA is introduced. This is known as "transitional protection". However, the Government eventually plans to transfer everyone who is receiving these benefits over to ESA. The first stage of this process will require existing Incapacity Benefit/Income Support claimants to take part in the Work Capability Assessment rather than the old Personal Capability Assessment from April 2010.

When existing Incapacity Benefit/Income Support claims are transferred over to ESA, there should be provisions in place to ensure there is no drop in the amount of benefit you receive.

If you come off long-term Incapacity Benefit to start work but then seek to re-claim benefits later, you can claim Incapacity Benefit rather than ESA, even up to 104 weeks later. This is known as the "linking rule".

Working and claiming ESA

Although ESA is paid to people who have "limited capability for work" it is possible to receive the benefit and still work. This is known as "permitted work" and it follows rules that are similar to the existing rules for Incapacity Benefit (see the NAS information sheet "Incapacity Benefit: a guide"). One major difference, however, is that people receiving income-related ESA can do permitted work for up to 16 hours a week, earning £88.50 or less for 52 weeks, and keep their full entitlement to ESA. This is different to the current system, in which people who earn a wage while receiving Income Support on the grounds of incapacity must have their Income Support reduced by the equivalent amount.

Claiming ESA under the age of 25

As with Incapacity Benefit, people under the age of 20 can claim contributory-based ESA without having paid the relevant National Insurance contributions through work. In certain cases, this can be extended to the age of 25 if the person has been in education or training.

How much is ESA?

The calculation of ESA is complex. The basic rate for both contributory and income-based ESA is expected to be £60.50 per week when it is introduced, and this will be paid during the 13-week assessment phase of the benefit. This figure will be lower for people under 25 and can also be reduced in income-related ESA if, for example, the claimant has other income and savings.

However, this amount can also be increased by "premiums". These are extra amounts payable to people in certain situations for example, carers can receive the "carers' premium" and the severely disabled can receive the "severe disability premium". There is, however, no "disability premium within ESA as there is within Income Support.

At the end of the assessment phase, and assuming the "limited capability for work" test has been passed, an additional amount of money is added to the basic rate and any premium you qualify for. The additional amount varies depending on which of the two groups you are placed in. You will get an extra £24 per week if you are in the Work-Related Activity group and an extra £29 per week if you are in the Support group.