Changes in both Incapacity Benefit and Disability Living Allowance were announced in July 2001 by the Secretary of State for Social Security, Alistair Darling. Both will affect renal patients currently in receipt of these benefits and future claimants.

In respect of Incapacity Benefit, claimants will be subject to a three-yearly review as a maximum to ensure that they are still eligible to claim the benefit. This will mean that awards will be made for fixed periods and people will be required to re-apply after the allocated period.

This change is directly in response to benefit fraud and to help meet the Government's aim of achieving full employment.

Final details of these proposals are yet to be announced but the implications for renal patients are that if you claim Incapacity Benefit you will have to re-apply at least every three years.

As regards Disability Living Allowance the Government is undertaking Welfare Reform with the aim of a: "simpler, clearer, and fairer system of determining entitlement to disability benefits."

A Social Security Select Committee has recommended to the Government that they should consider using a functional assessment (ie, what you can or cannot physically do) similar to that used for Incapacity Benefit. A Disability Living Allowance working party is currently looking at alternative assessments for DLA and Attendance Allowance.

Along with this, the Department of Social Security Medical Policy Group is developing a point-scoring system and has used this on test cases. A further test will take place on "live" cases later this year.

The points system is based on the "activities of managing life" (AML). The current AML allocates scores within several functional categories including:

		feeding and drinking;
		dressing and undressing;
		washing and bathing;
		toileting;
		getting in and out of and turning in bed;
		rising and sitting;
		fits and supervision;
		awareness of danger/antisocial behaviour;
		taking medication/complying with therapy;
		reliance on machines or equipment; and
		communication.

This has good and bad points for the renal patient.

If the category for reliance on machines/equipment covers dialysis in all its forms, claims may be more successful. But, on the negative side, the categories are designed to be more computer friendly and judgements may become less individual and more crude.

It is hard to see how a number-crunching system can provide anything other than a less-responsive approach to individual circumstances.

Simpler perhaps, and clearer to those who understand the rules, but fairness is not easily measured by numbers alone and of the Government's stated aims this is deemed the most important.

Another major implication for Disability Living Allowance claimants is that GPs will no longer be asked to sign the form in Part One of the DLA/AA form. From early 2002, factual reports from the GP will only be requested as a last resort and will be based only on clinical facts rather than subjective information like: "How far can Mr Z walk without severe discomfort?"

This is a very positive step for renal patients who rarely see their GP, as they often know their consultant better.

Time after time, GPs and hospital generalists have said that they have no idea how far a patient can walk because they only see them walk into their clinic and out of the door. Yet, in the many cases I have dealt with at appeal and tribunal, the GP's word has been taken as correct although this may conflict with what the claimant and other professionals are saying about their abilities. As a result, patients are often disappointed with how their doctor sees their condition and this can cause friction in the doctor/patient relationship.

Advice can be sought on claiming Incapacity Benefit, Disability Living Allowance and Attendance Allowance from the Benefits Agency and support can be given by Welfare Rights Departments or Renal Social workers (if available).