Employment Support Allowance (ESA) Medical Examinations

George Gardner made this Freedom of Information request to Department for Work and Pensions

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The request was successful.

George Gardner

Dear Sir or Madam,

1)Could you please provide with a copy of the legislation and delegated authority that gives effect to the handling, acceptance and rejection of applications for Employment Support Allowance by individuals.

2)Could you also provide details of how a medical examination and opinion of an individuals health, performed by a Doctor (or other medically qualified person) working on behalf of your department(or your agents)takes precedent over the medical examination and opinion of an applicants own General Practitioner or Consultant?

To assist you in locating and providing the correct information I am trying to understand the purpose of NHS General Practitioners 'MED 1' certificate when claiming a benefit such as ESA if the medical 'evidence' of that General Practitioner is discounted, ignored or contradicts the examination of the individual by your department's own medical examination staff or agents.

I look forward to your reply.

Yours faithfully,

George Gardner

DWP Adelphi Freedom-of-Information-Request, Department for Work and Pensions

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DWP Adelphi Freedom-of-Information-Request, Department for Work and Pensions

1 Attachment

Dear Mr Gardner

Please find attached response to your FoI request.

Kind regards

Central FoI Team
Department for Work & Pensions
Information and Devolution Policy - DP/FoI (part of Legal Group)
Freedom of Information Unit

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George Gardner left an annotation ()

This is the actual response:

DWP Central Freedom of Information Team

e-mail: xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx@xxx.xxx.xxx.xx

Our Ref: FoI 595/09

22 April 2009

Dear Mr Gardner

Freedom of Information Request – 595

I am writing in response to your request for information about Employment and Support Allowance (ESA) which you asked for on 2 April 2009.

You have asked for copies of the legislation which gives effect to the handling, acceptance and rejection of applications for ESA. I have attached copies of the Welfare Reform Act 2007, the Employment and Support Regulations, 2008, and the Social Security (Medical Evidence) Regulations, 1976 (as amended).

You have also requested details of how a medical examination and opinion of an individual’s health, performed by a Doctor (or other medically qualified person) working on behalf of the Department for Work and Pensions (or agents), takes precedence over the medical examination and opinion of an applicant’s own General Practitioner or Consultant.

The decision on whether or not someone has limited capability for work and is entitled to ESA is made by a decision maker on the basis of the available evidence. This evidence includes medical opinion, or advice resulting from a Work Capability Assessment (WCA) carried out by a healthcare professional employed by Atos Healthcare to carry out medical examinations for the DWP. It also includes information provided by the customer in a questionnaire before the WCA is carried out.

A decision maker may also consider evidence provided by an applicant’s General Practitioner or Consultant. Though the General Practitioner or Consultant may know their patient very well their primary role is to diagnose and treat a condition. This is not the same as advice provided by independent healthcare professionals designed to help decision makers decide whether or not someone has limited capability for work for benefit entitlement purposes.

The WCA has been designed as a positive assessment, focusing on what an individual is capable of as well as their limitations with regard to work. Healthcare professionals are trained in disability assessment which enables them to provide advice to decision makers.

For these reasons it is possible that a decision maker may give more weight to the evidence of the Healthcare Professional than to the evidence of the applicant’s GP or Consultant or to the evidence of the applicant. However each decision is made on the basis of the available evidence and it is also possible that a decision maker may give greater weight to the evidence of the GP, Consultant or customer.

If you are not satisfied with my handling of your request or reason for not giving you all the information you asked for please tell me why within two calendar months of the date of this letter. I will then arrange for someone to conduct an internal review of your request and my handling/decision. The review will be conducted by another officer, usually of a more senior grade to myself. This person will have taken no part in my original decision. You will be advised of their decision in writing.

If you are still not content with the outcome of the internal review you have the right to apply directly to the Information Commissioner to look into the way your request has been handled. Please note that generally the Commissioner cannot make a decision unless you have first exhausted DWP’s own complaints procedure. The Commissioner can be contacted at:

FoI Complaints Resolution
Information Commissioner’s Office
Wycliffe House
Water Lane
Fax: 01625 545 510


If you have any queries about this letter, please contact me. Please remember to quote the reference number above in any future communications.

Yours sincerely

DWP Central FoI Team

Brooke Steve JCP PTD,

5 Attachments

<<FOI-595 response.doc>> <<FoI 595.txt>> <<Medical Evidence
Regulations.pdf>> <<WR Act 2007.pdf>> <<ESA Regulations.pdf>>

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David Cartwright left an annotation ()

To whom it may concern.

I, David Cartwright confirm the following to be true:

I attended a medical examinination by Dr Madhuri Khurana at Albert bridge House, Manchester on 03 June 2009. My friend Mr. Howard Woolley came with me as a witness.

The examination was brief and consisted mainly of computer generated questions which were highly irrelevant to my medical condition. I was sat to the side of the Doctor and little eye contact was made between us.

I blew in to a cardboard tube which was supposed to demonstrate my lung capacity which is extremely poor as my left lung does not function very well after it collapsed. This was the only part of the examination that was physical.

I received a letter 11 July from Job Centre Plus explaining that i was no longer entitled to Employment Support Allowance and National Insurance credits. I felt overwhelmed with stress as I am struggling financially and I am fearful of returning to work in case I suffer a reoccurence of spontaneous Pneumathorax which first occured in February 2009.

I asked for a copy of the medical report and the following is my response to the itemised points within it:

1. My condition - spontaneous pneumathorax - is not named

4. I was not in hospital for three months. Breathlessness is not bearable. I do not attend a respiratory clinic. Did not attend out-patient clinic or receive any treatment from any such place. I find dealing with bills and letters to be stressful. It is difficult for me to go shopping and to do housework. I am not planning a trip to Southport soon.

8. when walking, standing, sitting, bending or kneeling I have a problem with the lung capacity required.

12. when reaching and lifting I have a problem with the lung capacity required.

28. I do have a problem in getting about.

33. Yes my condition is life threatening and there is medical evidence to support that it is uncontrollable. I am suffering from mental and physical disablement. I have limited capability for work.

34. death is likely due to my respiratory problem causing cardiac arrest. There is substantial physical and mental risk if I were found capable of work related activity.

35. I have contrary advice from my GP. that a return to work should be considered within one year and not within three months.

It is clear to me from the report that I was not listened to when I described the difficulties I have experienced with my health condition.

David Cartwright left an annotation ()

When dealing with the Department for work and pensions you will find the managers and staff are very good at being economical with the truth.

Howard Woolley

Bandit Queen left an annotation ()

ATOS and the Medical Assessment Team who make the decisions on ESA are not only economical with the truth but with information, action and facts. My husband was meant to attend a medical on 29th December, a day that Mann Island was actually closed, in thick snow, a few days after Christmas, when he was still recovering from prostate cancer.

He is also urinially incontinent and could not stand the embarrassment of sitting around for three hours at Mann Island. He was not well enough to leave the house and both of us had recently had surgery and were not allowed to drive at the time. These facts had been informed to the DWP and they were more than aware of his condition.

I tried to get them to at least send a doctor out to the house. The latest appointment they had on their books was 7th January. The DWP and the doctor were closed until 4th January and my doctor came out to see my husband but she said that the DWP would have to write for the medical information that they now said they needed to arrange a medical visit at home. They would not get it back in time for the 7th.

I could get no answer from either ATOS or the DWP for the next three weeks and tried to make an appointment after 11th January as he had to go for more treatment all that week. We got to the managerial people at ATOS and they were meant to be sorting it out. Also we got ignored by the DWP.

We got four appointments made for 6th January, four more made for the 7th January, and a letter on 23rd January telling us that all of the medical appointments were cancelled and another on 24th telling me that the appointment on 22nd was cancelled. What appointment on 22nd? We never had any notification of such an appointment. Then on 26th January we got a letter, dated 15th January telling is that we did not need to have a medical at this time and that our benefits would be unaffected. This was as Stephen was still having and recovering from extenside medical treatment. He was in the Support Group and the DWP confirmed he would remain in this and a medical was not needed. He should never have been sent for one to begin with!

Now, on Monday I got another letter, a standard change to payments letter, dated 15th February, but received eight days later and this was showing a change in the money, it had gone down by 20 a week, and reason; he has moved from the Support Group to the Work Activity Group. No explanation, no nothing.

I had to email and they phone the Medical Referral Team and they could not give me an answer. They did not know why the benefits had changed, on what basis it had changed, who the decision maker was, who had made the decision and what information had been used. All the records showed that this was the advice given to them from ATOS. This, turns out from my investigations to be lies and rubbish.

Diane Foley, the Medical Referral Team Leader in Liverpool said that she did not know why the decision was made. She asked me what information ATOS had, as if I was going to know that and told me to find our what information they had used, to send it to them and asked me questions about the information and the letter. What could I tell her but that we had the letter that said we did not have a medical and did not need one? This was bad enough, but she did not know any information and did not know what basis the decision maker had made the decision. The decision maker did not know either. I had to find out the information and send it to them.

I have had to contact ATOS who tell a totally different story to the DWP, they wanted to defer any medical for the time and that no decision should be made to change anything and told the DWP this. No change should have been made to the benefits. They have confirmed what our letter says.

But they do not know what information they had and saidI have to contact the DWP and ask to see the file as they cannot help me. They did not have any medical information as they did not ask my doctor for it. They decided that as he is having treatment still to accept that he still has a prognosis of several months and that the decision should be deferred. I am still unsure as to what they mean, but it sounds that the DWP have made a fatal error.

I have spent the last three days, writing to doctors, copying medical information, sending emails to DWP and ATOS and making calls everywhere and getting more up to date information. I have also asked on what basis the decision was made: ATOS do not know. The DWP do not know on what basis it was made and refuse to give me the information that they or ATOS have. I have now asked to see the file. I have a right to know why my husband's benefits have been changed and for a review and we are doing this. But I just feel that these bl**** ba****ds, swines, have caused me a lot of upset for no reason.

We cannot live on what we have and already have two appeal tribunals on 15th March; another one would kill us!

But these people do not provide information; they only lie and cause chaos and hell in peoples lives. I would also like to know the direct mobile number of this woman and the name of the decision maker. That would be fun; to put them through the hell that they have caused me and thousands of others.

To everyone on this site trying to get information; good luck and I hope you use it to bring these bastards down!

Ian Talbot left an annotation ()

Thanks to George Gardner for starting this link

My appeal was won as all previous appeals
My opinion is ATOS is unprofessional and out to make money....

This is my appeal letter to those at ESA

Help for the disabled on ESA and DLA can be found at http://www.moopoo.org.uk

ESA APPEAL in summary -

Dear Sir/Madam

I am writing to you to address my appeal against Dr Youngs (ATOS) interview and what I truly believe to be a biased and wholly inaccurate report about my health issues and capability to work as fully as I am able to help you on the panel understand my life as it is.

First paragraph:

There is no reference to chronic pain which dominates my life.

Second Paragraph:

“These conditions are managed by his GP”?
What does that mean? Of cause all of these conditions are managed by my GP as they affect my life severely.

Third Paragraph:

I strongly dispute these clinical findings which indicate all were normal. How can they be when I can’t walk far without severe pain and now I’m forced to take Tramadol 100mg before I can even go outside away from the house? There is also an assumption that I walk around a supermarket quite happily. This is untrue as to do so would involve me holding onto a shopping trolley for support. And yes, I do park my car away from the disabled areas. This forces me to walk with my walking stick until I can find a suitable trolley. I do this because disabled parking spaces are often full and many are unfortunately used by non-disabled persons. Of those who are disabled and twenty years my senior and using a walking stick, they mostly seem to walk off with a spring in their step compared to myself as they boldly go a damn lot faster than I can manage. As a consequence for walking across a car park, I am forcing myself to endure crippling pain from my lower spine, hips, calf’s and down to my toes when attempting to walk through the small Sainsbury’s car park as I must keep myself going.

I have recently purchased a wheelchair. Not because I’m lazy, but because I simply can’t walk any real distance or go into town anymore without help. I can’t even push the thing along very far either because of the severe fatigue I get in both arms.

Fourth Paragraph:

Clinical findings on this report are certainly not accurate and I challenge this most strongly. I suffer mainly from Myalgic Encephalopathy, Chronic Ulcerative Colitis and Peripheral Vascular Disease, not some other problem which restricts movement although my joints are stiff and fatigued. In addition, all movement for me is exhaustive and painful. I am sorry to report, but squeezing the hands of your Dr Youngs is no way conducive of evidence to make a judgment on my ability to handle things physically.

Yes, I can look after my affairs and keep my house clean and drive a car, but all are at a price. Pain, stiff joints and muscle fatigue which are constant. But I am a fighter and have been all of my life. I will not sit back and let my conditions worsen intentionally or read biased and rubbish reports without first challenging them with the truth.

Fifth paragraph:

Am I being treated as an idiot here? Please explain to me as I am lost as to where this is leading. How dare this man or anybody else interpret how I feel inside or how my guts constantly fall through the floor with anxiety and thoughts of ending my life so to stop the pain forever. Dr Youngs has no idea and made no attempt to even find out either except to ask how I feel in the morning? Of which I replied I wish I didn’t. But nothing followed from that remark. This to me shows that your health professional has little or no training on mental health issues and if he has, he should be ashamed of himself.

Sixth paragraph:

I sort of agree, but I feel this matter concerning my chronic ulcerative colitis is understated as is everything else of any relevance in this rotten report.

My appeal against the decision made now follows on to the work capability assessment findings.

Work Capability Assessment:

Learning how to do tasks:

What a patronising and stupid requirement on your forms for somebody with some intelligence. This requirement is only relevant to those suffering a certain criteria. I resent this question being on the form if there is no sign of dementia, learning disabilities or maybe drug abuse.

Being aware of danger:

Am I? Nobody can make the assumption that I keep myself safe and especially as I feel living simply isn’t worth the bother anymore. What a stupid thing to assess on people such as myself who do not thankfully have learning disabilities.

Starting a task and finishing it:

How does this man know? Is Dr Youngs a fly on the wall and with me 24/7? I don’t think so. Even writing to you with my complaints and appeal has taken me over two weeks so far to write. Because of this intrusion, I have suffered more anxieties, frustration and anger than is usually normal for me which incidentally is in the upper reaches and nearly exploding inside my head.

Coping with changes:

Life is full of changes and full of lies as well. Of cause I cope with it.

Coping with getting about on your own:

If I didn’t I would surely die as nobody is going to get my shopping for food in for me with the probable exception of my very close and dear friend who has put up with me almost daily popping in to see how I am and also hand write forms on my behalf if needed and other such things.
My grown up children don’t help anymore as they say they are busy. I think it is the money I have given them over the years from my life savings which has mostly run out now, so they keep out of the way. This is what the world has turned into in my opinion. Well, the tit is now dry!! And I seem to be the biggest tit of them all for letting this happen. But please, will somebody tell me what I am supposed to live on now? Not even ESA is that much help on its own as it can’t cover the bills, but I guess I am fit in the eyes of the government as I am still breathing. It seems to me that only those poor wretches in a coma or from overseas get any help from this lousy government.

ESA complaint in full including my medical conditions and medication

Dear Sir/Madam

Thank you for your letter dated 18th May and setting out a deadline of four weeks from that date to appeal. I received it well over a week after that date.

I am totally disgusted and once again feel humiliated by your so called medical professional, Dr Youngs report and its miserable outcome. This man who supposedly conducted my assessment spent 95% of his time typing with one finger whilst looking up my previous notes of which I presume he made his judgement and report from the previous rubbish and disregarded chronic pain or length of time doing simple things such as walking as far as I am able or reaching up for any length of time. During this interview, I was asked just six questions whilst the rest of the time was spent in virtual silence while he attempted to type.

The questions I was asked were:

Did I drive here and where did I park
Do I live in Ipswich or Cornwall
How do I feel when I wake up in the morning
Hold his hands and squeeze
Remove my shoes and socks and get on the couch
Put them back on following a brief attempt to find a pulse in my legs

Did this man report what a struggle it was for me to get up on the highly raised couch or the length of time it takes me to take off or put on footwear as it exasperates my ability to breathe or the effort put in due to fatigue or the amount of pain which is involved? No he didn’t. All is green in the garden as far as this man is concerned and to get as many disabled people off the ESA list as possible. This is barbaric and I shall be making my complaints to my local MP Ben Gummer to take these issues to parliament and challenge this disgusting discrimination against those who have disabilities. I wonder if it is the intention of this government to disinherit disabled people altogether and have them sell matches in the streets? I have no income and I am forced to live off my life savings which will soon all be gone. Am I to starve I wonder? I am a realist and let’s face it, which employer is ever going to offer me as a 54 year old cripple with incontinence problems, depression, verbal aggression, being smarter than they are, in constant pain, can’t write intelligibly by hand and a whole host of other problems! The answer is nobody.

Because of the previous assessment and awful interrogation which I found most distressing, I brought a close friend along with me for support and to act as my witness. This close friend has helped look after me for many years and fully understands what I go through daily and how debilitating and miserable my life has become. Without her attendance that day, I would not even have been able to walk the distance from the car park to the medical waiting room unaided. This was not asked, nor anything else of any relevance except a presumption of walking around a supermarket.
It is sad to say that your medical professional knows nothing about me or long term Myalgic Encephalopathy and the terrible affects it has on people or how normal life is destroyed by pain, bouts of feeling like you have flu and chronic fatigue. These I suffer daily and suffer I do. May I remind you that I successfully appealed against the last judgement made against me from a report which made a mockery of my condition and illness’ and I believe this last report was based mostly upon those notes which were laid out on the desk in front of this inept medical person. Sadly for me, the Myalgic Encephalopathy which was reported in my last failed medical has not simply gone away or will get better in time as previously reported and I can tell you now that Cornwall NHS actually spends money on patients such as myself to try to understand and manage this disease. Dr Gardner working under Professor Pinching was appointed to me when I was living there last year. If you wish to see his reports, then I can supply you with all the contact details you require. In addition, this is a truly devastating disease with a potential to kill. I invite you to look it up and try to understand this disease and how it causes inflammation in the dorsal root ganglia within the spinal cord. This is why I take large doses of Pregabalin. This drug in large doses helps to block the pain caused by damaged nerve endings in my spine. Maybe you could look up the case of Sophia Mirza, the first official death in the UK caused by Myalgic Encephalopathy. People like your medical professional have no idea about this terrible disease. Maybe he thinks it is a lazy persons excuse not to get up and walk around or go to work or maybe he “doesn’t believe in it”, as one ill-informed and ignorant pig of a GP once said to me.

Since my last medical assessment for ESA, my health has seriously declined further with the additional diagnosis following an MRI scan of severe peripheral vascular disease which is additionally very painful. How can I be judged to be fit and healthy by a refusal to recognise or understand certain diseases and the severe restrictions they cause? And to conduct an assessment with just six questions and an unfair written report which is wholly inaccurate and biased against me because I performed mentally sound during interview as I can present myself very well. But I am afraid your man didn’t even pick up when he asked how I felt when I wake up each day. I told him, I wish I didn’t wake up, but he didn’t even bother to ask any further questions and missed an important opportunity to find out why. I invite you to contact my GP, Dr Donepudi at the Chesterfield Road practice in Ipswich as he has put me on a high alert for depression with suicidal tendencies together with my refusal to be treated with medication as my opinion is tablets won’t make me better.

As for scoring points for this medical assessment and the method used for scoring fitness, it is a shambolic nonsense and I’m sorry to say that one size fits all to gain points has no relevance in my case and I suspect several others. I may be stubborn and refuse to give up my daily struggles, but I am not Lazarus and I am neither able to miraculously walk away pain free or simply be healed. Furthermore, I will not be treated in such a manner that makes me feel that I am a sponger on society or worse. I have worked hard and paid in full my contribution of national insurance and now I am treated like muck on a boot. In addition to this, Doctor Youngs is an absolute disgrace to the medical profession for his insensitive so called interview style and his biased outcome.

Peripheral Vascular Disease
After suffering Reynaud’s syndrome during December to March last year, incredible pain was experienced when my toes went purple/black and my feet and lower legs swelled up like balloons. I have no pulse in either leg. I had pain on top of existing pain due to M.E. and especially when walking or lying in bed at night with accompanied even worse night twitching. My GP saw this condition and immediately sent me off for an MRI scan at the Ipswich hospital which confirmed and diagnosed Chronic Peripheral Vascular disease. My main arteries are blocked from just below my heart and right down into both legs. I have been told stents are not an option as the disease is too advanced and would require a dangerous no guarantee five hour operation with two surgeons working simultaneously to by-pass the diseased arteries. For now, I have declined the operation as I asked the surgeons what they would do if they were in my shoes. The answer was to wait and hold on for as long as possible.

I walk then waddle the best I can which is very slowly after just a few yards. I use a walking stick for any distance of around 10 metres or more for support. When walking I endure severe pain in my lower back, hips, legs and feet. More recently I have purchased a wheelchair for longer journeys such as town. However, my arms can’t wheel myself along very far due to the chronic fatigue in both arms, so I must rely on somebody to push me. I feel very embarrassed and my head tells me to get up and walk. I try my utmost to be as active as I can, but I’m dogged by the exhaustion suffered by Myalgic Encephalopathy and such chronic pain in my lower spine and both hips reaching right down to my feet. I can’t wheel myself along very far as I have severely reduced energy in my arms. The pain I get from walking, which unfortunately is rather slowly to help reduce pain and after just 20-30 metres, my pain rate is hitting a 9-10 on the scale and I am forced to stop. My whole life is pain, stop, go, depressed mood and frustration. I stop to relieve the pain then go on as far as I can because I will not give up my battle with chronic and continual pain, frustration with stiffening of joints, fatigue, daily sadness or depression, colitis or anything else which blights my pathetic life.

Myalgic Encephalopathy
The possible trigger of M.E. started when I was working as a registered nurse for the NHS 16 or 17 years ago and following compulsory Hepatitis B immunisation which wouldn’t take causing severe health problems. I started feeling very unwell shortly afterwards followed by two bouts of long term sick leave of three months each. Initially I was treated for viral infections, exhaustion and depression although I stated I was never depressed at that time. Eventually I was forced to refrain from work for 14 months. Dr Deacon from NHS staff health eventually diagnosed M.E. and the probable origin through history charting. The chronic viral like symptoms have somewhat subsided over the years but I am still experiencing restrictions to normal activity due to continual lethargy, joint, bone and muscular pains/stiffness, the inability to regulate body temperature, a depressed immune system, irritability and bad temper, temporary memory problems, loss of voice and a disturbed and erratic sleep disorder with night twitching, chronic pins and needles and aching of muscles and bones.

Ulcerative Colitis
I was diagnosed seven years ago following heavy bleeding from my anus. I had initially been treated to remove several ulcers in all three sections of my colon which is now distended due to bloating and internal irritation. I suffer from a continual sore and painful stomach, nausea and frequent bouts of chronic diarrhoea. This disease also leaves me physically drained, fatigued and not always able to leave home.

A bone spur in my upper spine sometimes causes significant pressure to the nerve in my neck. It was once treated with analgesics to little effect and I was told by Ipswich hospital that operating to remove the growth would be a last resort and instructed my GP to continue to prescribe pain care. This was discontinued following effective long term treatment under a private Chiropractor Dr. K Correll at the Ipswich Chiropractor Clinic on Norwich Road, Ipswich.

Gastro-oesophageal reflux disease
I suffer frequent bouts of chronic heartburn and often vomit during sleep, coughing or brushing my teeth. I am treated long term with drugs which mostly reduce the heartburn.

Familial Tremor
This is an inherited neurological disorder causing me to experience involuntary shaking or tremor of my hands, head, arms and legs. It may also be exasperated or associated to M.E or stress related issues but is more noticeable when conducting kinetic movement with my hands such as writing. I am treated with beta blockers which tend to have side effects of chronic pins and needles in both my hands, feet and lower arms.


Tramadol Hydrochloride 100mg capsules x 2 x 8 caps daily
Pregabalin 200mg capsules x 1 cap morning
Lansoprazole 30mg gastro-restraint capsules x 1 cap morning
Propranalol 80mg modified-release capsules x 1 cap morning
Mesalazine tablets 400mg x 4 tabs morning x 4 tabs evening
Colecalciferol 400unit 1.25g tablets x 2 tabs midday
Pregabalin 200mg capsules x 1 cap evening
Simvastatin 40mg tabs x 1 tab evening
Salbutamol 100 micrograms/dose inhaler cfc free x when required
Prednisolone 5mg tabs x up to 8 tabs

Yours sincerely



To add, I am now faced with a similar situation with DLA for mobility. I am appealing this disgraceful nonsense. Without DLA mobility, there is no Blue Badge in future as this forms part of the renewal or application process.

http://moopoo.org.uk is being set up to help those wrongly assessed by ATOS for ESA and DLA for the Department of Work and Pensions