We received an enquiry from an employer regarding whether long COVID can be considered a permanent condition under ill-health criteria.

On contacting the LGPS they shared communication received from their contact at ALAMA (Association for Local Authority Medical Advisers) in 2023 for his view on whether long covid would be classed as a permanent condition in relation to the ill-health criteria. An extract of his response is set out below:

'When assessing individuals for ill health retirement IRMPs take two different approaches to assessing illness, the biomedical approach and the biopsychosocial approach. The biomedical approach identifies physiological and pathological evidence and looks for treatment interventions that alter physiology or pathology.

In practice, in many cases there is either no physiological or pathological evidence, or the evidence doesn’t explain or support the degree of symptomatology. Some doctors and patients simply ignore the fact that there is no evidence to explain the symptoms, call it a disease and try treating it anyway, and get frustrated when there is no improvement. The best practice approach is to consider biopsychosocial issues, looking at other factors, patient beliefs, behaviours and circumstances.

The concept of Long-Covid or Post-Covid Syndrome is not particularly helpful, as it has been driven by patients and not doctors. The syndrome is very broad and includes patients who have profound severe pathology and patients with absolutely no pathology at all.

Where doctors identify pathology, they can generally come up with a treatment plan and a prognosis, and in some circumstances, it is reasonable to state that on balance of probabilities, the patient will not recover sufficiently to return to work.

Where no pathology has been identified, they confirmed it would be inappropriate to consider the condition permanent. There is a long history of equivalent conditions over the decades, including ‘railway spine’, ‘miner’s nystagmus’, ‘Royal Free syndrome’, ‘whiplash’, ‘repetitive strain injury’ and ‘gulf war syndrome’. In all cases there was a view at the time that these were extremely disabling and permanent but after thorough investigation all were attributed to belief and behaviour rather than disease and none are considered permanent now.

In my view the only reasonable approach is to identify the key symptoms and features for an individual patient, and find an equivalent condition that is already understood, for example post-viral myocarditis, post-viral encephalomyelitis, post-viral fatigue etc. and apply the same prognosis.

It is also important to acknowledge that any prognosis in relation to LGPS regulations is ‘on balance of probabilities’, so if more than 50% of patients are expected to be capable of working again, none will be considered eligible, if fewer than 50% are expected to be capable of working again, all will be considered eligible.

Currently the evidence base does not support ill health retirement in those who don’t have clearly identifiable pathology that would be expected to permanently incapacitate them, and there is no emerging evidence that is likely to change this.'