Ill health retirement: Some good news

I am posting this week’s blog on behalf of a member of the NHS Long Covid community. They wanted others to have hope in relation to applying for ill health retirement.

It’s a longer blog than normal so please take your time over reading it. I have added in some headings (see above) and coloured blocks to make the blog easier to navigate.

Additional information about applying for ill health retirement from NHS pensions can be found here.

Good news

Hi all

I have news, that I think you all need to know. I have been awarded Tier 1 and Tier 2 Ill health retirement. I’d forgotten I’d applied for it, given that I’m in my early 40’s and haven’t heard of anyone else being successful and I’m probably much less “ill” than many others. I’d started the fairly torturous process to apply for PIP. But, the letter plopped on my doormat a couple of weeks ago and here I am, waiting for my lump sum and pension to start.

The reason I’m so keen to share this with you all is obvious. If I can be awarded this, then maybe you can too. I’ll tell you what I did, you can have a copy of my letter, and then if you do get turned down, you’ve got a much firmer footing to appeal.

Don’t try to read this all-in-one go!

PLEASE bear in mind two important things-

1. In order to receive your benefits, you must have paid at least two years qualifying contributions to the scheme and your employment must be terminated on the grounds of ill health. So, don’t resign!
2. This isn’t a quick process. If you’re nearing the end of your employment/ pay then start the process for PIP/ ESA. That takes ages too but at least you’ll have some guaranteed income.

Okay, so the process:

After 2 years of sick leave from my job, two failed phased returns and a few dozen tests, investigations, treatments, rehab programmes etc, my employment with my NHS Trust ended in October 2022. HR suggested I apply for IHR. Thought, “can’t be bothered- won’t get it” but also “shy bairns get nowt”!

HR filled in their part of the form, then sent it to me. I attached copies of EVERY medical letter, physio treatment plans, appt details etc. I included a timeline of my illness from 2020 to date and a “summary” of my symptoms and how it affects me and my family. This took bloody ages, I won’t lie, but hubby helped and I did it in phases over a week.  

Top tip: if you want to explain about your symptoms, do it on a computer and save it- it’ll come in handy for when you do PIP applications etc. and make sure you talk about symptoms on a “bad day”. Also, if you’re able to, get all your letters scanned and saved on to your computer- then they’re ready to be emailed etc when needed.

Then you post the form off (signed for delivery) to Occ Health. A few weeks later I had a planned telephone consultation with the Occ Health Doc, which lasted about 10 minutes. Because he had all the information in front of him, he didn’t need to ask very much- Bonus!

Then it gets sent off to somewhere else and they get a specialist doctor to make a decision and they write to you.

The key bit of the letter is this:

In considering whether the applicant’s incapacity for the work in question is permanent, I would first consider whether, in the absence of future treatment, the incapacity is likely to be permanent and, if so, then go on to consider whether future treatment would be likely to alter this.

So, basically- if this person has engaged with all of the current (limited) treatment that we have available for Long Covid and none of its helped and she still remains a bit wonky and we have nowt else to offer…. Then what?

What the Tiers mean:

That the applicant is permanently incapable of the NHS employment (i.e. the job you are currently in); the tier 1 condition is met;

That the applicant, in addition to meeting the tier 1 condition, is permanently incapable of regular employment of like duration; the tier 2 condition is also met.

What you get money wise:

Ill health retirement tiers   Tier 1 Pension already earned without reduction   Tier 2 Tier 1 plus the ‘tier 2 addition’ which is pro rata enhancement based on ½ of the prospective pension to normal pension age (half of what you would have got, had you gone on to work until normal retirement age).   You also have the option of receiving a lump sum retiring allowance by giving up some of your pension (including any additional pensions you may have bought). So, in my case, I’m taking the maximum lump sum (it’s not taxable unless its over something mad like £268k) and I’m still left with a pension of over £20K pa. You can also still apply for PIP and ESA.

My letter telling me I had been awarded IHR:

Dear …. ….. …..

SCHEME: Application for III Health Retirement Benefits under the NHS Pension Scheme

You will be pleased to know that your application for Ill Health Retirement Benefits has been accepted.

The Scheme’s Medical Adviser, Dr ***GMC***: has advised that:

This is an initial application for ill health retirement benefits under the NHS Pension Scheme.

Consideration of this application requires a determination of whether for;

TIER 1-: there is a physical or mental infirmity which gives rise to permanent incapacity for the efficient discharge of the

TIER 2 – there is a physical or mental infirmity which gives rise to permanent incapacity for regular employment of like duration (regard being had to the number of hours, half days and sessions the applicant worked in the NHS employment) in addition to meeting the tier 1 condition.

Permanent incapacity is assessed by reference to the normal benefit age of 68 years.

THE APPLICANT:

The applicant, ***, is a *** year old full time {Band 7 senior nurse}.  

This role involves being responsible and accountable for ensuring the delivery of safe, effective and efficient care to service users as allocated within the designated pathway.

MEDICAL EVIDENCE

The medical evidence considered:   – The referral documents – Report dated 29 September 2022 from Dr *** occupational health physician (this is Part C of the AW33E form) – Report dated 1 September 2022 and July 2020 summary of health and symptoms from scheme member – Report dated 15 August 2022 from physiotherapist – Reports dated 25 July 2022, 9 August 2022 and 23 August 2022 from occupational therapist – Report dated 18 May 2022 from Professor Louise Cummings – Report dated 23 March 2022 from consultant respiratory physician – Reports dated 12 January 2022 and 10 November 2021 from arrhythmia nurse specialist – Report dated 29 November 2021 from Dr  *** Community Mental Health Team – A number of occupational health reports from OH dated from 27 May 2020 through to 19 October

Cases are considered on an individual basis and decisions are made on the balance of probabilities.

In considering whether the applicant’s incapacity for the work in question is permanent, I would first consider whether, in the absence of future treatment, the incapacity is likely to be permanent and, if so, then go on to consider whether future treatment would be likely to alter this. In considering this application I have taken into account the requirements of the relevant scheme regulations.

I consider that the relevant medical evidence indicates that, on the balance of probabilities, the applicant is permanently incapable of the NHS employment. The tier 1 condition is met. In addition, the applicant is permanently incapable of regular employment of like duration. The tier 2 condition is met.

The rationale for this is as follows: Having considered the application and evidence there is, in my opinion, reasonable medical evidence that the applicant has a physical or mental infirmity as a result of which the applicant is currently incapable of efficiently discharging the duties of their NHS employment and also currently incapable of regular employment of like duration. The key issue in relation to the application is whether the applicant’s current incapacity is likely to be permanent.

From the medical evidence submitted, I understand that the primary cause of *** incapacity relates to her long-COVID symptoms following COVID-19 illness in April 2020. Dr *** report provides a good summary of her health conditions. I understand that she has had ongoing symptoms despite evidence-based interventions for her long-COVID symptoms. He adds that she has had a progressive deterioration in her symptoms since the diagnosis and this has a significant impact on her functional disability. This is despite specialist input, therapy interventions, treatment and additional support. She has not been able to successfully return to work and I understand that she has been on long term sickness absence from her work role due to this condition. An attempt at return to work was made with a phased return and adjustments but this was unsuccessful and, unfortunately, resulted in a further period of sickness absence over her long-term sickness absence period. I understand that there is no significant past medical history of note.

She has multisystem involvement and widespread debilitating symptoms. She developed pneumonia subsequent to her COVID-19 infection and continues to have symptoms impacting her functional ability. She reports ongoing fatigue and post-exertional malaise with reduced exercise tolerance. She also has shortness of breath, productive cough and wheeze and arrythmia. She suffers from vestibular migraines with reports of vertigo and episodes of dizziness and migraines which occur in cycles and cause debility. She has cognitive impairment symptoms with brain fog and memory difficulties and struggles recalling information and concentrating and focussing. She also struggles with speech and word finding.

Her sleep is disturbed, and she suffers from widespread muscle and joint pain and has gastrointestinal disturbance and continence issues. She has difficulty with mobility and walking and becomes fatigued with prolonged recovery following exertion. She struggles to complete tasks and household chores and has struggles to tend to her personal care. I understand that this is despite energy management and pacing strategies. I understand that she has been managed and supported through long-COVID services with physiotherapy, occupational therapy and pacing strategies but there has been no significant improvement with her symptoms over the last 2 years, as per Dr *** report.

I understand that she is taking antidepressant medication but has had no reported overall benefit from her current medication regime.

In summary Dr *** states that the prognosis for her condition remains uncertain and that she has had symptoms for over 2 years causing significant functional restrictions and impairment. Given the chronic nature of her conditions, he states that it is unlikely that her situation will change significantly, and he does not foresee any significant improvement in the longer term. Given the chronicity of her symptoms, I would agree with his opinion. Overall, in his opinion, in cases when incapacity is prolonged and work rehabilitation is unsuccessful, the prognosis is poor.

The key consideration is whether *** current incapacity is likely to be permanent. When considering if a medical condition would be likely to give rise to permanent incapacity I would first consider whether, in the absence of future treatment, the incapacity would be likely to be permanent and. if so. then go on to consider whether future treatment would be likely to alter this.

The natural history of *** ongoing long-COVID symptoms is such that significant improvement is unlikely to occur spontaneously. In my opinion, on the balance of probability, in the absence of future treatment, *** incapacity for the efficient discharge of her NHS employment duties as a {Nurse in health services} working full time is likely to be permanent. Her symptoms remain significant and functionally debilitating despite interventions and support from appropriate specialist teams. It is possible that there will be some improvement, in my opinion, in the next few years with her symptoms but, it is unlikely that she will improve enough to regain capacity to return to her challenging and stressful role as a full-time *** Hence, in my opinion, on the balance of probability, it is unlikely that future treatment will improve her enough to allow her to return to her NHS employment role and she meets tier 1 of the pension scheme criteria, in my opinion.

Given her significant functional limitations, I am of the opinion that her incapacity is also likely to be permanent for regular employment of like duration.

In my opinion, the applicant does have physical or mental infirmity as a result of which the applicant is currently incapable of efficiently discharging the duties of their NHS employment and also currently incapable of regular employment of like duration. This incapacity is likely to be permanent.  The tier 1 condition and the tier 2 condition are therefore both likely to be met for the reasons given above.

CONCLUDING ADVICE

It is my opinion that relevant medical evidence has been considered in this case and, on the balance of probabilities, indicates:

That the applicant is permanently incapable of the NHS employment; the tier 1 condition is met;

That the applicant, in addition to meeting the tier 1 condition, is permanently incapable of regular employment of like duration; the tier 2 condition is also met.

THE HMRC SEVERE ILL HEALTH TEST

The conditions to be considered are any paid work should be insignificant, for example it should be infrequent or only for a few days during the year and the payment must be small in amount, not just as a proportion of previous pay or salary.” The applicant’s State Pension age is 68.

Although unfit for regular employment of like duration, the applicant is, on the balance of probabilities, likely to be capable of more than such minimal work before State Pension age.

Although, in my opinion she is unlikely to regain capacity to return to full time employment before she reaches scheme pension age, I think it is likely that she will improve with her symptoms enough to enable her to return to the employment field likely in a less challenging and stressful role and with a reduced hours commitment.

HMRC’s Severe III Health Condition (SIC) test is not met.”

In order to receive your benefits you must have paid at least two years qualifying contributions to the scheme and your employment must be terminated on the grounds of ill health.

We have written to your Pensions Officer today informing them of this decision. On receipt of our letter, they will contact you about the next steps for obtaining your pension and lump sum. However, if you need to contact them for any reason, please allow three days from receipt of this letter before doing so.

Please note: we are unable to answer queries regarding the amount of your pension and lump sum. If you have not heard anything within the next 6 weeks, you should contact NHS Pensions Customer Contact Centre on 0300 330 1346. They will answer your queries regarding your pension benefits.

Yours sincerely