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Chapter G2: Limited capability for work

Contents
G2001:Introduction
G2010:Treated as having limited capability for work
G2012:Receiving certain treatments
G2015:Hospital patient
G2020:Medical or other treatment

Hospital or similar institution
G2023:Hospital
G2026:Similar institution
G2029:Examples of hospitals or similar institutions
G2039:Future admission to hospital
G2040:Planned admission postponed
G2041:Planned admission cancelled
G2050:Prevented from working by law
G2051:Meaning of relevant infection or contamination
G2052:Substantial risk
G2054:Meaning of substantial risk
G2058:Risk at work
G2070:Life threatening disease
G2072:Medical evidence
G2080:Disabled and over State Pension Credit age
Assessed as having limited capability for work
G2090:Introduction
G2100:Determining limited capability for work
Appendix - Regular treatment categories

Chapter G2: Limited capability for work

G2001 Introduction

A claimant has LCW where their capability for work is limited by their physical or
mental condition and it is not reasonable to require them to work (1).

1 WR Act 12, s 37(1)

G2002

A claimant has LCW where
1. it is determined that they have LCW on the basis of the WCA, whether for the
purposes of UC or ESA (1) (see G2055 et seq) or
2. they are treated as having LCW (2) (see G2010 et seq).
See ADM Chapter G1 for guidance on the WCA process.

1 UC Regs, reg 39(1)(a) & Sch 6; ESA Regs 13, Part 4; 2 UC Regs, reg 39(1)(b) & (4) & Sch 8

G2003

A determination on whether a claimant
1. has or does not have LCW or
2. is to be treated as having or not having LCW
for the purposes of UC is conclusive for other UC decisions (1).

1 UC, PIP, JSA & ESA (D&A) Regs, reg 40(2)

G2004

The question of whether a claimant has LCW is relevant in order to determine
1. if the LCW element can be included in the UC award (1) and
2. what work-related requirements group the claimant falls into (2) and
3. which income and work allowance deduction is applicable (3) and
4. where the claimant is also eligible for receipt of the carer element, which
element is payable (4).
See ADM Chapter F5 for guidance on work capability elements, Chapter J2 for
guidance on work-related requirements groups, Chapter E2 (Awards and maximum
amount of UC) for guidance on income and work allowance deductions, and Chapter
F6 for guidance on the carer element.
1 UC Regs, reg 27(1)(a) & (2); 2 WR Act 12, s 13(2) & 21; 3 UC Regs, reg 22; 4 reg 29(4)

[G2005-G2009]

G2010 Treated as having limited capability for work G2002 G2090

Certain claimants can be treated as having LCW and do not have to undergo the
WCA (1). This is where the claimant is
1. receiving certain treatments - see G2012 or
2. in hospital - see G2015 et seq or
3. prevented from working by law - see G2050 - G2051 or
4. disabled and over the age for SPC - see G2080.
Note: See ADM Chapter G1 for guidance on where a claimant is treated as having
LCW for the purposes of ESA.

1 UC Regs, reg 39(1)(b) & (6); Sch 8, paras 1 - 3

G2011 G2115

Certain claimants can be treated as having LCW when they have been found not to
have LCW following application of the WCA (1). This is where the claimant is
1. a substantial risk to themselves or to others - see G2052 et seq or
2. suffering from a life-threatening disease - see G2070 et seq.
1 UC Regs, reg 39(1)(b) & (7); Sch 8, paras 4 & 5

G2012 Receiving certain treatments G2010 G2013

Claimants are treated as having LCW when they
1. receive
1.1. regular weekly treatment by way of haemodialysis for chronic renal
failure (1) or
1.2. treatment by way of plasmapheresis (2) or
1.3. regular weekly treatment by way of total parenteral nutrition for gross
impairment of enteric function (3) or
2. are recovering from any treatment as in 1. and the DM is satisfied the claimant
should be treated as having LCW (4).

1 UC Regs, Sch 8, para 1(a); 2 para 1(b); 3 para 1(c); 4 para 1(d)

G2013

See the Appendix to this Chapter for an explanation of the treatments in G2012.

G2014

G2015 Hospital patient G2010 G2016 G2017

Claimants are treated as having LCW where they are
1. undergoing medical or other treatment as a patient in a hospital or similar
institution or
2. recovering from treatment as in 1. and the DM is satisfied that the claimant
should be treated as having LCW (1).

1 UC Regs, Sch 8, para 2(1)

G2016

Where a claimant attends a residential programme of rehabilitation for the treatment
of drug or alcohol abuse, they are regarded as undergoing treatment as in G2015 1.

1 UC Regs, Sch 8, para 2(2)

G2017

A claimant is regarded as undergoing treatment as in G2015 1. only where they have
been advised by a registered medical practitioner to stay for a period of 24 hours or
longer following that treatment (1). This applies even if the claimant disregards that
advice and returns home.
1 UC Regs, Sch 8, para 2(3)

Example

Sarah is admitted to hospital for surgery involving a general anaesthetic. She was
told before the surgery that she should bring a night bag in case she has to stay
overnight. Sarah's surgery goes well, and she is discharged the same day. As Sarah
was not advised to stay overnight, she cannot be treated as having LCW. Sarah will
need to be assessed for LCW in the normal way by completing a questionnaire and
attending for medical examination if necessary.

[G2018-G2019]

G2020 Medical or other treatment

To be treated as receiving patient treatment a person must be receiving
1. medical treatment, for example
1.1 surgical treatments
1.2 administration of drugs and injections or
2. other treatment which includes nursing services by professionally trained staff
in the form of
2.1 observations
2.2 therapies
2.3 support appropriate to the person's needs
2.4 advice and training in domestic and social skills.
It does not include straightforward care and attention by unqualified staff.

G2021

Whether a person is receiving treatment is a question of fact. It cannot be assumed
that because one person is receiving treatment in a hospital or similar establishment,
another person in the same establishment can automatically be regarded as
receiving treatment. But the fact that a person is a patient in a hospital is strong
evidence that the person is receiving medical or other treatment (1).

1 R(S) 26/54

G2022

A person does not have to receive treatment throughout each day (midnight to
midnight) for the day to be included in a period of patient treatment. The condition is
satisfied if a person receives treatment at some time during the day (1).
1 R(S) 4/84
Hospital or similar institution

G2023 Hospital

A
hospital (1) is
1. an institution for
1.1 the reception and treatment of people suffering from illness
1.2 the reception and treatment of people during convalescence
1.3 people needing medical rehabilitation
2. a maternity home that provides obstetric services
3. in Scotland, any institution for dental treatment maintained in connection with
a dental school
4. a clinic, dispensary or out-patient department maintained in connection with
any of these homes or institutions.

1 NHS Act 77, s 128; NHS (Scot) Act 78, s 108

G2024

Illness
includes (1)
1. mental disorder
or
2. any injury or disability needing
2.1 medical treatment
or
2.2 dental treatment
or
2.3 nursing.

1 NHS Act 77, s 128; NHS (Scot) Act 78, s 108

G2025

Mental disorder means
1. in England and Wales (1)
1.1 mental illness
or
1.2 arrested or incomplete development of the mind or
1.3 psychopathic disorder
or
1.4 any other disorder or disability of the mind
2. in
Scotland (2), any form of
2.1 mental illness
or
2.2 personality disorder
or
2.3 learning disability.
1 MH Act 83, s 1(2); 2 Mental Health (Care and Treatment)(Scotland) Act 2003, s 328(1)

G2026 Similar institution

Similar institution is not defined. If an institution does not satisfy the definition of
hospital, the DM should decide as a question of fact whether it is similar to a hospital
taking into account
1. the purpose of the institution and
2. the type of treatment provided and
3. the level of care offered.

G2027

To help determine if the establishment is a similar institution to a hospital, DMs must
determine whether the claimant receives on the premises medical or other
1 treatment
1. provided by doctors, qualified nurses or other health care professionals
employed by the home or
2. under the direct supervision of a qualified doctor, nurse or nurses at the home.

1 SSWP v Slavin [2011] EWCA Civ 1515

G2028

A hospital or similar institution also includes those
1. maintained by or on behalf of the (1)
1.1 DH
1.2 Welsh
Assembly
1.3 Scottish Government Health and Social Care Directorate or
2. maintained or administered by the Defence Council, for example an army,
navy or air force hospital.
Note: These include special hospitals such as Broadmoor and Rampton and the
State Hospital in Scotland.
1 NHS Act 77, s 4; NHS (Scot) Act 78, s 102

G2029 Examples of hospitals or similar institutions

An institution caring for former psychiatric patients which provides a degree of
medical treatment or rehabilitation may be a similar institution to a hospital.

G2030

A care home providing appropriate nursing care by professionally trained nurses is a
hospital. Medical or other treatment does not have to be the majority service
provided to patients or be the main reason for the stay in the care home. But if the
provision of nursing care is minimal, for example rarely expected, the care home
may not be a hospital.

[G2031-G2038]

G2039 Future admission to hospital G2040

Where
1. on consideration of all the evidence after application of the WCA, the DM is of
the opinion that the claimant would not have, or would not be treated as
having, LCW and
2. the HCP advises that the claimant is about to go into hospital for treatment
requiring an overnight stay within 21 days of the medical examination
the DM should defer making a determination as to whether the claimant has LCW
until it is confirmed that the claimant has become a hospital patient.

G2040 Planned admission postponed

If
1. the claimant is not admitted to hospital as planned and
2. a new date for admission is provided
the DM should continue to defer making a determination on LCW as in G2039.

G2041 Planned admission cancelled

Where a planned admission to hospital is cancelled and no new date is proposed,
the DM should determine whether the claimant has LCW as normal.

[G2042-G2049]

G2050 Prevented from working by law G2010

A claimant is treated as having LCW where the claimant is known or reasonably
suspected to be infected or contaminated by, or to have been in contact with a case,
of a relevant infection or contamination and
1. is excluded or abstains from work in accordance with a request or notice in
writing in accordance with legislation or
2. is otherwise prevented from working in accordance with legislation (see G2051)1.
1 UC Regs, Sch 8, para 3

G2051 Meaning of relevant infection or contamination G2010 G2050

The following definitions apply
1. in Scotland, the term "contamination" is the same as defined in legislation (1).
2. in England and Wales, the term "infection or contamination" shall be read in
accordance with legislation (2).
3. in Scotland, the term "infectious disease" is the same as defined in
legislation (3).
4. in England and Wales, the term "relevant infection or contamination" means
4.1 any incidence or spread of infection or contamination, in respect of
which certain legislation applies (4), for the purpose of preventing,
protecting against, controlling or providing a public health response
4.2 any disease, food poisoning, infection, infectious disease or notifiable
disease to which certain legislation applies (5).
5. in Scotland, the term "relevant infection or contamination" means
5.1 any infectious disease or exposure to an organism causing that
disease, or
5.2 contamination or exposure to a contaminant to which certain legislation
applies (6).
1 Public Health etc (Scotland) Act 2008, s 1(5);
2 Health and Social Care Act 2008, s 45A(3); 3 Public Health etc (Scotland) Act 2008, s 1(5);
4 Public Health (Control of Disease) Act 1984, Part 2A; 5 Public Health (Aircraft) Regulations 1979,
reg 9 & Public Health (Ships) Regulations 1979, reg 10; 6 Public Health etc (Scotland) Act 2008, s 56 to 58

G2052 Substantial risk G2011

A claimant is treated as having LCW (1) if
1. they are
suffering from some specific disease or bodily or mental disablement
and
2. as a result, there would be a substantial risk (see G2054) to the mental or
physical health of the claimant or anyone else if they were found not to have
LCW.
But see G2053 for where this does not apply.

1 UC Regs, Sch 8, para 4(1)

G2053 G2052

The claimant cannot be treated as having LCW if the risk could be significantly
reduced by
1. reasonable adjustments being made to the claimant's workplace or
2. the claimant taking medication prescribed by their GP to manage their
condition (1).
1 UC Regs, Sch 8, para 4(2)

Example 1

Khaled suffers from back pain, and claims UC. His previous employment was office
work. Khaled argues that he satisfies the substantial risk rules, as he cannot sit at a
desk for lengthy periods without exacerbating his condition. The DM determines that
the risk to his health could be alleviated by reasonable adjustments to his
workstation, such as a desk which can rise and fall to allow working in standing and
sitting positions, and taking breaks away from his workstation. The DM determines
that Khaled cannot be treated as having LCW.

Example 2

Lucy is at risk of potentially fatal anaphylactic shock if she comes into contact with
products containing latex, which is a risk at work and in the journey to and from
work. There is no suggestion that she satisfies any of the descriptors. The DM
determines that the risk could be substantially reduced if Lucy carried an adrenaline
auto-injector which has been prescribed for her, and a medical alert bracelet.

G2054 Meaning of substantial risk G2052

`Substantial' is not defined and should be given its ordinary meaning. What amounts
to `substantial' is a question which must be determined using all the available
evidence and taking account of all the circumstances.

G2055 G2002

The substantial risk can be to the claimant or to any other person. For example, the
claimant's mental health may be such that they may self-harm or self-neglect or may
be violent to others.

G2056

A claimant's anxiety or concern about their ability to cope with the demands of work
or a return to work alone does not constitute a substantial risk.

G2057

Substantial risk must be determined, not only in the context of work undertaken or in
the workplace itself, but also the journey to and from work (1).
1 Charlton v Secretary of State for Work and Pensions [2009] EWCA Civ 42; R(IB) 2/09

G2058 Risk at work

The judgment states that the DM must consider whether a substantial risk arises in
the light of the work which the person might be expected to perform in the workplace
he might find himself in. In making this assessment, the DM need only identify a
broad range of duties that the person could be capable of, taking into account any
training given, the person's aptitude and their disease or disablement.

Example 1

Peter is 27 years old and suffers from alcohol dependency syndrome. He has never
worked and says that his condition prevents him from undertaking any kind of work.
The DM identifies that Peter could undertake straightforward and unstructured,
unskilled work without substantial risk to himself or any person. The DM need not
identify a particular type of work that Peter could be capable of.

Example 2

Phillip is 22 years old and has recently been diagnosed as suffering from epilepsy.
Since the age of 18 he has worked as a roofer and scaffolding erector. Phillip says
that if he were to return to this work, his health would be at substantial risk as he was
often expected to work at great height. The DM determines that Phillip could now
undertake closely supervised, indoor or outdoor work, at ground level without risk to
himself or any person. The DM need not identify a particular type of work that Phillip
could be capable of.

[G2059-G2069]

G2070 Life threatening disease G2011

A claimant is treated as having LCW (1) if they are suffering from a life threatening
disease for which
1. there is medical evidence (see G2072) that the disease is uncontrollable, or
uncontrolled by a recognised therapeutic procedure and
2. in the case of a disease that is uncontrolled, there is a reasonable cause for it
not to be controlled by a recognised therapeutic procedure.

1 UC Regs, Sch 8, para 5

G2071

There should be evidence that the disease is either uncontrolled or uncontrollable.
The DM should establish that there is a reasonable cause for it not being controlled
by medication or other recognised therapeutic procedure.

G2072 Medical evidence G2070

Medical evidence includes evidence
1. from a HCP approved by the Secretary of State or
2. from any HCP, hospital or similar institution or
3. that constitutes the most reliable evidence available in the circumstances.

[G2073-G2079]

G2080 Disabled and over State Pension Credit age G2010

A claimant is treated as having LCW where they
1. have reached the qualifying age for SPC and
2. are entitled to
2.1 DLA
or
2.2 PIP (1).
See DMG Chapter 77 for guidance on the qualifying age for SPC.
1 UC Regs, Sch 8, para 6

[G2081-G2089]

Assessed as having limited capability for work

G2090 Introduction

Where the claimant is not treated as having LCW as in G2010 et seq, the question
of whether
1. a claimant's capability for work is limited by their physical or mental condition
and
2. the limitation is such that it is not reasonable to require that claimant to work
is determined on the basis of a WCA (1).
Note: See ADM Chapter G1 for detailed guidance on the WCA process.

1 UC Regs, reg 39(1)(a)

G2091

The WCA assesses the claimant's ability to perform specified activities. The
performance of those activities is measured by descriptors, which score points
according to the level of the descriptor (1). If the required number of points is not
reached the claimant does not have LCW. The test is the ability to perform any work,
not a specific occupation.

1 UC Regs, reg 39(2) & Sch 6

G2092

The activities are in two parts. Part 1 is a physical assessment. Part 2 is an
assessment of mental, cognitive and intellectual functions. The extent to which a
claimant can or cannot carry out and activity is determined by one of a range of
descriptors applied to the claimant for that activity. Each descriptor within the range
attracts a score from 0-15.

G2093

When assessing the extent of the claimant's LCW, it is a condition that the
claimant's inability to perform (1)
1. physical
descriptors (2) arises
1.1 from a specific bodily (i.e. physical) disease or disablement or
1.2 as a direct result of treatment by a registered medical practitioner for
such a condition and
2. mental
descriptors (3) arises
2.1 from a specific mental illness or disablement or
2.2 as a direct result of treatment by a registered medical practitioner for
such a condition.
1 UC Regs, reg 39(4); 2 Sch 6, Part 1; 3 Sch 6, Part 2

Example 1

Brian suffers from rheumatoid arthritis in his hands and knees, and claims UC. In the
questionnaire Brian states that due to cognitive and mental impairment he has
difficulty with learning tasks, awareness of hazards and completing personal actions.
At the medical examination, Brian explains that the high level of painkillers he takes
for his arthritis makes him too tired to concentrate. The HCP advises that Brian is
mentally disabled by the medication, but not sufficiently to satisfy any mental health
descriptors. Brian scores 6 points for mobility problems.

Example 2

Rita is injured in an accident which leaves her with significant mobility problems and
facial scarring. Rita also suffers from depression and social anxiety disorder as a
result of the accident. Meeting people outside her immediate family brings on a
panic attack, so she avoids this. She scores 6 points for mobility problems arising
from her physical health condition, and 9 points for coping with social engagement
arising from her mental health condition.

Example 3

Ailsa suffers from mechanical back pain. She states that she has difficulties with
mobilising as well as getting about unless she has someone with her. The HCP
advises that Ailsa's need for assistance with getting about is only due to her physical
problems. The DM determines that Ailsa does not score any points for mental health
descriptors.

G2094

A claimant has LCW if, on application of the WCA, they score a total of at least 15
points (1).

1 UC Regs, reg 39(3)

G2095

As part of the WCA, claimants may be required to complete a questionnaire, and if
necessary to attend a medical examination. If they fail without a good reason to do
either, they can be treated as not having LCW (1). See ADM Chapter G1 (WCA) for
detailed guidance.
1 UC Regs, reg 43(3) & 44(2)

[G2096-G2099]

G2100 Determining limited capability for work

Where the WCA applies, the DM must determine in relation to each activity which of
the descriptors apply to the claimant due to a specific bodily or mental disease,
illness or disablement (1).
Note: See ADM Chapter G1 for detailed guidance on the WCA process.

1 UC Regs, reg 39(3)

G2101

Where a claimant meets a descriptor, points will be awarded corresponding to that
descriptor (1).

1 UC Regs, reg 39(3)

G2102 G2104

Where more than one descriptor specified for an activity applies to a claimant, only
the descriptor with the highest score in respect of each activity which applies can be
counted (1).

1 UC Regs, reg 39(5)

G2103

The total number of points scored on the WCA is the aggregate of the number
scored in relation to each descriptor (1).

1 UC Regs, reg 39(3)

G2104

Other than as in G2102, there is no scoring limitation based on the claimant's
specific disease or bodily disablement. So, for example, a claimant who has a
sensory impairment can score points both for the activity of understanding
communication and that of navigation (1).

1 R(IB) 3/98

G2105

The DM determines whether the assessment is satisfied from
1. the questionnaire (UC (50)) if one is available (see ADM Chapter G1) and
2. a statement from the GP (1) if one is available and
3. the medical report of the claimant's ability to perform the specified functions
(UC (85)) and
4. the personalised summary statement and
5. any other relevant evidence.

1 SS (Med Ev) Regs, reg 2(1)

G2106

The normal principles apply to considering the evidence - see ADM Chapter A1
(Principles of decision making and evidence).

G2107

The WCA does not have to be satisfied in respect of each day (1). A claimant should
satisfy the test throughout a period. A claimant whose condition varies from day to
day and who would easily satisfy the WCA on three days a week and would nearly
satisfy it on the other four days might have LCW for the whole week.

1 R(IB) 2/99

G2108

A claimant may have long periods of illness separated by periods of remission
lasting some weeks, during which he or she suffers no significant disablement; such
a claimant might have LCW during the periods of illness but not have LCW during
the periods of remission. This is so even if the periods of illness are longer than the
periods of remission (1).

1 R(IB) 2/99

G2109

The test of whether a claimant cannot perform an activity is not purely based on
whether they are physically incapable of performing it. Matters such as pain,
discomfort and repeatability are taken into account. A claimant is not capable of
carrying out an activity if they can only do so with severe pain or, if having done it
once, they are unable to repeat it for hours or days. The extent of a claimant's ability
to repeat the activity in a single stretch and of the intervals at which the claimant
would be able to repeat the performance should be identified. A decision can then be
made on whether the claimant can perform the relevant descriptor with reasonable
regularity.

G2110

There is no specific requirement that a claimant must be able to perform the activity
in question with "reasonable regularity". Even so regard should be had to some such
concept. The real issue is whether, taking an overall view of the claimant's limited
capability to perform the activity in question, they should reasonably be considered to
be incapable of performing it. The fact that they might occasionally manage to
accomplish it, would be of no consequence if, for most of the time, and in most
circumstances, they could not do so (1).

1 R(IB) 2/99

G2111

Where relevant descriptors are expressed in terms that the claimant "cannot"
perform the activity, the DM should not stray too far from an arithmetical approach
that considers what the claimant's abilities are most of the time (1).

1 R(IB) 2/99

G2112

Descriptors which state that "none of the above apply" to their ability to carry out the
activity or where they do not apply mean that the claimant has no problem
performing the activity or has less of a problem than would satisfy any of the other
descriptors for that activity.

Example

Activity 1 descriptor (e) is "none of the above applies". Descriptor (b) is "cannot,
unaided by another person, mount or descend 2 steps even with the support of a
handrail". "None of the above apply" means the claimant has no problem going up
and down steps, or less of a problem than would satisfy the penultimate descriptor
1(d), and would score no points for that activity.

G2113

Where a descriptor refers to a claimant being able to use a tool or implement, the
use referred to is the use to which the tool or implement is normally put. For
example, Activity 5 relates to hand function and is intended to reflect the ability to
manipulate objects in order to carry out work-related tasks.

Example

Ability to use a pen or pencil is intended to reflect the physical use of the object, not
a claimant's level of literacy. The same concept applies to the use of a computer
keyboard or mouse.

G2114

The DM should decide which descriptor applies to each activity. Provided the
determination is sufficiently supported by evidence, for each activity the DM can
select the descriptor from the medical report, the evidence provided by the claimant
(including the questionnaire), or a different descriptor.

G2115

The DM must record the final scores for each descriptor and the reasons for the
determination. Guidance on burden of proof is in ADM Chapter A1 (Principles of
decision making and evidence).

[G2116-G2999]

Appendix
Regular treatment categories (see G2011 et seq)
Explanation of treatments
Plasmapheresis
Plasmapheresis is a process by which harmful substances can be removed from the
bloodstream. Blood is taken from the person's vein, and the fluid part (plasma)
containing the harmful substance is separated from the blood cells and removed.
The blood cells are then mixed with an appropriate substitute fluid and returned to
the person.
Renal dialysis
Renal dialysis is used in the treatment of kidney (renal) failure. It is the process
whereby waste products, which would usually be excreted in the main by the
kidneys, are artificially removed from the body. There are two forms of dialysis:
haemodialysis and peritoneal dialysis.
In haemodialysis, blood is circulated from the person's arm into a machine which
removes the waste substances; the cleansed blood is then returned to the person.
Haemodialysis is usually carried out two or three times a week.
In peritoneal dialysis the process involves introducing fluid into the abdomen through
a permanently-positioned tube (an indwelling catheter). Harmful waste products are
removed from the blood into this fluid through the inner lining of the abdomen (the
peritoneum). After some hours, the fluid is drained from the abdomen and replaced
with a fresh volume, and the cycle is repeated on a continuous basis.
Total parenteral nutrition
Total parenteral nutrition is a recent development in the treatment of serious
intestinal conditions such as Crohn's disease. It is a way of ensuring adequate
nutrition when normal absorption of food and fluid from the gut is impossible as a
result of severe disease.
A fine tube (catheter) is inserted into a major vein in the neck, and is held in
permanent position; its end is capped when not in use. A special feeding solution,
three to five litres in all, is pumped through the catheter using a special pump
mounted on a stand. The process takes eight to fourteen hours, and is usually
carried out overnight.
For most people, the need for total parenteral nutrition will be life-long.