Employment and Support Allowance – the Limited Capacity to Work questionnaire

On this page you’ll find detailed information about completing the Limited Capability for Work questionnaire.

This information about completing the Limited Capability Work questionnaire is specifically for people with complex disabilities, including deafblindness, and their families or carers.

Once you have made a claim for Employment and Support Allowance (ESA) by completing an ESA1 form, you’ll be sent the Limited Capability for Work questionnaire. This form is known as ESA50.

What is the Limited Capability for Work Questionnaire (ESA50)?

You’ll receive the ESA50 form if you have made a claim for ESA. It is your signed statement of needs and it is important that you answer the questions in full.

Do I have to fill in all the questions?

The form is divided up into standard and specific questions about your disability. You should answer all of the standard questions.

Pages 1-6: Standard questions

Page 1: This page contains guidance for filling out the ESA50.

Page 2: Fill in all your basic details, such as name, address, date of birth and National Insurance number.

Page 3: You do not have to give a telephone number relating to ‘face to face assessments’. If you can't talk on the phone you can give a support worker or carer's number. Otherwise, you can state ‘in writing please’.

If you need to bring an interpreter with you, for example a British Sign Language (BSL) interpreter, state this on page. Write down whether you want to bring your own interpreter, which can be a family member or friend, or whether you want one arranged for you.

If you need to take somebody with you to an assessment, for example a family member, friend or support worker, you should state this at the bottom of page 3. The person you decide to bring with you can either come into the assessment or wait outside; it is up to you.

Page 4: It’s important that you fill in your GP’s details. If there are lots at your doctor's surgery, write the name of the person who understands your case the best.

You are also asked for your specialist’s details. If you see more than one specialist, write ‘see attached sheet’ and note down the details of all of your specialists on a separate piece of paper. Enclose this with your form, remembering to write your name and National Insurance number on each separate sheet you add.

Page 5: Use this page to list your illnesses or disabilities. Try to put an approximate date when the condition began and remember to include details of any medication you are taking.

You are asked how your condition varies. This is difficult to answer in such a small box, so it is fine to write ‘I will explain how my condition affects me day-to-day under each question in the rest of the form’. There is plenty of space later in the form to give more detail.

Page 6: You are asked about hospitals, clinics and special treatment. It is important to write down the details of any hospitals or clinics you attend. If you are not sure whether something is relevant write it down anyway, as it is better not to miss things out.

You are also asked about alcohol and substance misuse. If you think this section applies to you, remember to fill out details of any help you are getting. You can also contact the Sense Information and Advice team for advice on how to approach this answer.

Page 7 onwards: Numbered questions

From page 7 onwards, questions will be numbered. These headings are called descriptors. Points can be awarded under each descriptor that applies to you depending on how difficult you find that task.

You do not need to score points under each question and they may not all apply to you. You need to score a total of 15 points or more to be awarded ESA.

The questions on the ESA50 do not relate exactly to the legal test. It is helpful to read the ESA descriptors while filling out your answers.

Sometimes, the questions allow you to tick a box named ‘It varies’. Even if your conditions do change, don't rule out any of the options straight away. The only time you should tick ‘It varies’ is if none of the other boxes apply.

You will be asked if you ‘cannot’ do certain activities. It’s important to remember that ‘cannot do something’ means ‘cannot safely, reliably and repeatedly do it most of the time’.

If you can carry out the activity but it would be unsafe, or you can’t do it repeatedly or reliably, you should tick that you cannot do that particular activity.

Part 1: Physical functions

Part 1 covers questions 1 to 10. These questions relate to physical functions only. Mental health functions are dealt with in Part 2.

Remember to look at the ESA descriptors for every question. Decide which part of the ESA descriptor applies most to you and apply that to each of your answers.

Question 1: Moving around and using steps. You are asked to tick how far you can move without needing to stop. It’s important to ask yourself which of the options apply on most days, for example 50 metres, 100 metres or 200 metres.

Remember that, if it varies, you can explain this in the space below. It may vary from day-to-day, or from one time of the day to another. Explain how it varies in the space below the question.

If you walk with an aid, including wheelchairs and guide dogs, you should answer this question as if you were using that aid. If you have difficulty using the aid on your own you should write this in the space below the question.

Remember this question is about the act of moving 50 metres, 100 metres and 200 metres both indoors and outdoors. There is a separate question (question 8) about getting around safely regarding any sensory impairment you may have.

Question 2: Standing and sitting. You are asked how long you can sit or stand without pain or exhaustion: less than 30 minutes, 30 minutes to one hour, or more than one hour. Think realistically about how long you can sit or stand in one place. Do not count the time that you would be uncomfortable doing so.

Question 3: Reaching. You are asked about different methods of reaching. This question looks at both arms together. Points can only be scored if you can’t do these tasks with either arm.

If one arm is worse than the other, you need to think about whether you can do these tasks with your better arm.
Remember, if you cannot do it safely, reliably and repeatedly most days then you need to make this clear.

Question 4: Picking up and moving things. The same advice applies as in question 3 – the question looks at both hands.

Question 5: Manual dexterity. You are asked whether you can do any of the listed activities. If you tick ‘some of these things’, remember to explain which ones. Think about both hands – if you can do these tasks with one of your hands you will not qualify for any points for this question.

Question 6: Communicating with people. This is a question relevant to most disabled people with complex needs. When ticking ‘Yes’ or ‘No’ as to whether you have any difficulties, remember that communication has to be ‘consistent and reliable’.

You are asked if you can communicate a simple message to other people, such as explaining something dangerous. If you rely on another person to communicate you should tick ‘No’.

If you rely on others knowing your method of communication, for example BSL, you can tick ‘No’. It’s worth explaining this in the box.

Question 7: Other people communicating with you. Your ability to understand has to be consistent and reliable, so always consider this when you are asked whether you have any difficulty.

Sight and/or hearing problems count. You do not need to have a problem with both to score points for this question. If you rely on lipreading, remember to think about any limitations or problems with that and mention them. Does your ability to lipread depend on whether it is with someone you know well? Does it rely on lighting?

Question 8: Getting around safely. This question is misleading as it only asks about eyesight. The question in the legal test is about ‘sensory problems’ with getting around safely. This means that hearing problems count too.

Remember that the activity should be able to be done safely, reliably and repeatedly. If you can cross a road but it is unsafe because you can't always hear or see oncoming traffic, you should tick that you cannot cross the road on your own.

Question 9: Controlling your bladder and bowels and using a collecting device. If the problem is variable think about whether it is weekly (most of the time) or monthly (most of the time). This is important because it can determine what level of ESA you are awarded. You can explain any variability in the space below.

If you are at risk of incontinence and need to stay close to a toilet for this reason, you can still get points. You will need to explain this in the box.

Question 10: Staying conscious while awake. You should include instances where you do not know or feel confused about what is going on around you.

It is misleading just to ask about ‘fits, faints and blackouts’. For example, if you are diabetic and your sugar levels are too high or low you may still be conscious. However, this can still be unsafe due to confusion or reduced awareness. Think about whether anything like this applies to you.

Part two: Mental, cognitive and intellectual functions

Remember to look at the ESA descriptors for every question. Decide which part of the ESA descriptor applies most to you and apply that to each of your answers.

Question 11: Learning how to do tasks. If you frequently have to be reminded to do simple tasks, you should tick ‘No’ and explain in the box below.
The test in this question uses a washing machine as an example of a moderately complex task, as learning to use one includes understanding appropriate settings for different clothes, without prompting every time.

Question 12: Awareness of hazards or danger. You are asked if you can stay safe when doing everyday tasks. If you can stay safe sometimes, but not all of the time, do not tick that you can complete tasks safely.

You are also asked if you need supervision to stay safe. Even if you do not have somebody who supervises you, you should still put down why you are at risk.

The question focuses on your awareness of risk, and not whether you already receive help.

The question also addresses whether you can keep yourself safe. The legal test includes damage to property or injury to other people, so if your awareness of hazards or danger could lead to this, you should also write this on the form.

Question 13: Starting and finishing tasks. If you cannot do things in a logical order due to distraction, confusion or lack of concentration, make this clear.

You are asked if you can manage to plan, start and finish daily tasks. If you cannot most of the time, then ‘never’ is the closest option.

If you normally need help or prompting then you should tick ‘never’ and explain the problem in the box. Tasks to think about include washing, dressing, housework or making and attending appointments.

Question 14: Coping with change. You are asked to tick the box if you can cope with changes to your daily routine. If you have some problems with this, do not tick this box and look further into the question.

You are asked whether you can cope with small changes to your routine if you know about them before they happen. You should tick ‘No’ if you cannot deal with change on any level, even if you are warned about it. Try and explain how you react to change, and how long it takes you to adapt to small changes.

The second question is about small, unexpected change. You might have problems with small, unexpected changes if it takes a lot of planning and mental preparation to get ready for something, and you find it hard to cope when it is cancelled. This is just an example. Try to explain by giving examples of what happens to you.

Question 15: Going out. This question is about your ability to cope mentally or emotionally with going out. If you have physical problems with going out, address this in Part 1 of the form.

Remember the above guidance on ticking the ‘It varies’ box.

Tick ‘No’ if you cannot leave home and go to places you do not know. Talk about any difficulties you can get into, for example panic attacks, getting lost or the risk of road accidents.

Question 16: Coping with social situations. If you have difficulty talking to or spending time with people, even if you know them well, make this clear.

Coping with social situations means more than managing to be in the same room as people. If you can do this but can't talk with anyone in the room, or you can only do it if someone you know is with you, explain why and give examples.

If you need someone you know to be with you to cope with these situations then the answer is ‘No’.

Question 17: Behaving appropriately. The DWP need to know whether you behave aggressively or in an uncontrolled way, or whether you behave inappropriately in front of other people.

Part three

Question 18: Eating and drinking. Part 3 relates only to question 18. It’s important that you fill this in accurately if it applies to you, as it is a determining factor in being placed into the ‘support group’.

Remember that, if your ability to eat and drink varies, you can explain this in the space below.
Both of the questions include physical problems. They also include issues like forgetting to eat and drink or refusing to eat without prompting.

Including other information

Page 17: If you have letters from consultants or specialists about your diagnosis or condition you should attach copies to the form. This also applies to other types of information, like a GP's letter or an occupational health assessment. If you do include any of these reports, list what you have included on page 17.

You can also add any additional information you want to tell the DWP about. Remember that if you want to add further information to any of the questions, you can use a separate sheet of paper and attach it to your form. Remember to write your name and National Insurance number on each piece of paper attached to the form.

Page 18: It’s important that the form is signed and dated. If either of the boxes is not filled in your application will be sent back to you.

We recommend photocopying your completed ESA50, as well as any supporting evidence that you send, for your records.
If you are filling in the form for somebody else, page 18 asks for your details.

Page 19: Tick the box if you are including any medical evidence. You are also asked if you would like somebody else to be informed of your assessment instead of you.

You may want to nominate somebody to be told about your assessment if you think they are in a better position to receive information and avoid delays.

Page 20: If you are waiting for, having or recovering from cancer treatment, this page should be filled out by your GP.

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