an introduction to personal independence payment for support organisations

An introduction to Personal Independence Paymentfor support organisations

2Department for Work & Pensions

Aims and Objectives

• Introduction to Personal Independence Payment (PIP)

• Introduction to PIP Toolkit

• Assessment Criteria

• PIP Claim Form

PIP Toolkit – About PIP


• Personal Independence Payment (PIP) will replace Disability Living Allowance (DLA) for eligible claimants from 8 April 2013

• DLA was introduced in 1992 and has not been reviewed since

• Complex and confusing to claim

• Little independent evidence/involvement

• No systematic process to review whether an award remains correct

• Financially unsustainable in the long term

• Current benefit not in step with the needs of a 21st century welfare system

Introduction to Personal Independence Payment

PIP Toolkit - Quick Guide


Similarities Differences

• Extra-costs cash benefit

• Not means-tested or taxable

• Two components

• Payable both in and out of work

• Maintains links to passported benefits where

possible

• Special rules for terminally ill people

• 3 month qualifying period and 9 month prospective

test

• New assessment criteria

• Individual assessment and face-to-face consultation

• Planned interventions

• Reconsiderations process

Similarities and Differences between DLA and PIP

PIP Toolkit – Differences and Similarities


Components and Eligibility• PIP will be made up of two components – daily

living and mobility

• Each can be paid at standard rate, or enhanced rate for those with the greatest needs

• The PIP assessment criteria will consider the individuals’ ability to carry out a range of everyday activities

• Individuals will receive a point score for each activity, depending on how well they can carry them out and the help they need to do them

• The total scores for each component determine whether a component is payable, and if so, whether at the standard or enhanced rate

Enhanced

Standard

Enhanced

Standard

Daily Living Mobility

8 points

12 points

Not Entitled Not Entitled

PIP Toolkit – Conditions of Entitlement


Assessment Criteria

Activity1. Preparing food

2. Taking Nutrition

3. Managing therapy or monitoring a health condition

4. Washing and bathing

5. Managing toilet needs or incontinence

6. Dressing and undressing

7. Communicating Verbally

8. Reading and understanding signs, symbols and words,

9. Engaging with other people face to face

10. Making budgeting decisions

Standard0 - 8

0 - 10

0 - 8

0 - 8

0 - 8

0 - 8

0 - 12

0 - 8

0 - 8

0 - 6

Activity

11.Planning and following journeys

12 Moving around

Standard

0 - 12

0 - 12

Daily Living Components (activities 1-10) Mobility Components (activities 11-12)Standard rate = 8 pointsEnhanced rate = 12 points

Standard rate = 8 pointsEnhanced rate = 12 points

PIP Toolkit – Assessment Criteria


Personal Independence Rates

Daily Living Component:

Standard Rate £53.00

Enhanced Rate £79.15

Mobility Component:

Standard Rate £21.00

Enhanced Rate £55.25


Assessment principles

• Individual– Considers the impact of a condition, not the condition itself– Claimants with the same condition may get different outcomes

• Objective– Based on independent evidence

• Independent– Assessment providers are independent and provide impartial

advice

• Consistent– Criteria are more detailed and more clearly defined


WCA and PIP – they aren’t the same

Similarities with DLA Differences

– Points-based assessment

– Face-to-face consultation main means of gathering evidence

– Regular reviews

Method

– WCA tests capability to work, PIP is about ability to carry out everyday activities

– WCA is a functional assessment, PIP assessment focuses on support needed

Content and principle


Assessment criteria – the descriptors

• Multiple descriptors for each activity describing varying ability to carry out the activity

• Each descriptor has a point score

• Cumulative scores determine entitlement to the rates and components of the benefit

A Can take nutrition unaided. 0

B Needs – i. to use an aid or appliance to be able to take nutrition; or ii. supervision to be able to take nutrition; oriii. assistance to be able to cut up food.

2

C Needs a therapeutic source to be able to take nutrition. 2

D Needs prompting to be able to take nutrition. 4

E Needs assistance to be able to manage a therapeutic source to take nutrition. 6

F Cannot convey food and drink to their mouth and needs another person to do so. 10

Example: Activity 2 – Taking Nutrition


Reliably

• In order to satisfy a descriptor, the claimant must be able to carry out the activity as described in the descriptor reliably.

• ‘Reliably’ means whether they can do so:– Safely – in a fashion that is unlikely to cause harm to themselves

or to another person. – To a necessary and appropriate standard – given the nature of

the activity. – Repeatedly – as often as is reasonably required. – In a timely manner – in a reasonable time period.

• This is not covered in Regulations, but will form an important part of the assessment. It will be in guidance for assessment providers and Case Managers.


Reliably - example

• Using a walking stick a claimant can walk up to 50 metres. However after doing so they cannot repeat it again the same day.

• You would reasonably expect someone to walk 50 metres more than once a day. Therefore the claimant does not reliably satisfy descriptor D.

• The individual can walk shorter distances up to 20 metres and repeat them in the same day.

• The individual therefore satisfies descriptor E.

A Can stand and then move more than 200 metres.

0

B Can stand and then move more than 50 metres but no more than 200 metres.

4

C Can stand and then move unaided more than 20 metres but no more than 50 metres.

8

D Can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres.

10

E Can stand and then move more than 1 metres but no more than 20 metres.

12

F Cannot – i. stand; orii. move at all; oriii. move more than 1 metre.

12

Example – Activity 12 – Moving around


Fluctuating conditions

• For a descriptor to apply, it must be satisfied on the majority of days (over 50% of days) in a one year period

• If it is satisfied at any point on a given day, it is satisfied for that day

• If two or more descriptors are satisfied for over 50% of days, the highest scoring descriptor applies.

• E.g. if D applies on 100% of days and E on 70% of days, E is selected.

A Can wash and bathe. 0

B Needs to use an aid or appliance to be able to wash or bathe.

2

C Needs supervision or prompting to be able to wash or bathe.

2

D Needs assistance to be able to wash either their hair or their body below the waist.

2

E Needs assistance to be able to get in or out of a bath or shower.

3

F Needs assistance to be able to wash their body between the shoulders and waist.

4

G Cannot wash and bathe at all and needs another person to wash their entire body.

8

Example – Activity 4 – Washing and bathing


Fluctuating conditions – cont.

• If no scoring descriptors apply for the majority of the days, but, when taken together, two or more scoring descriptors are likely to be satisfied on more than 50% of days, the descriptor that applies for the highest proportion of time applies.

• E.g. if B applies on 20% of days, D on 30% of days and E on 5% of days, D is selected

A Can wash and bathe. 0

B Needs to use an aid or appliance to be able to wash or bathe.

2

C Needs supervision or prompting to be able to wash or bathe.

2

D Needs assistance to be able to wash either their hair or their body below the waist.

2

E Needs assistance to be able to get in or out of a bath or shower.

3

F Needs assistance to be able to wash their body between the shoulders and waist.

4

G Cannot wash and bathe at all and needs another person to wash their entire body.

8

Example – Activity 4 – Washing and bathing


Aids and appliances

• Assessment takes account of aids and appliances that individuals use, or could reasonably be expected to use

• Definition is no longer limited to specialist aids and appliances.

• Where individuals use aids and appliances that are not specially designed to assist disabled people, they must be out of necessity, not choice.

• E.g. – If a claimant is reliant on a food processor because they are

unable to chop food due to their disability, the points will be awarded.

– If a claimant could chop food but chooses to use a food processor, no points will be awarded.


Assessment process


Health Professional & Case Manager roles

• Assessment providers advise, DWP Decision Makers make the decisions

• Health professionals provide an assessment report which will– List the sources of evidence– Summarise the discussion (if a face-to-face consultation) covering history,

medication and treatment, social and occupational history, a typical day etc.– Detail examination findings, if appropriate– Advise on descriptors and prognosis– Justify the advice

• DM’s should– Consider the assessment report and all evidence

• Is the HP’s advice consistent with all the evidence?• Are all issues addressed?• Do they have the information they need to make and explain the decision?

– If not – refer back to the AP


The new assessment

• The PIP assessment will involve health professionals who consider the evidence provided by the claimant, along with any further evidence they think is needed

• The health professionals will be employed by independent providers

• People will be assessed as individuals, and the focus is on the impact their condition has on their daily lives and over a range of different activities

• Most people will be asked to a face-to-face consultation with a health professional as part of the assessment process - claimants will be encouraged to take somebody with them to the consultation

• Home visits will be available when necessary

• Face-to-face consultations may not be necessary for everyone – for example, those who are terminally ill may not have to have them

• The assessment provider will send a report back to the DWP Case Manager to make a decision

PIP Toolkit – Assessment Process and Providers


The Assessment Providers



Passporting to other benefits and services

• Many DLA claimants are receiving other benefits, such as ESA

– Most DLA claimants receiving Incapacity Benefit will have already been reassessed for Employment and Support Allowance by the time they need to make a claim to PIP

– Claimants receiving DLA or PIP won’t be migrated to Universal Credit until later in the UC rollout

– Households where someone is in receipt of DLA/PIP are exempt from the new Benefit Cap

• Most existing passporting arrangements have been maintained for PIP

– receipt of the Daily Living component (either rate) means that their carer may be entitled to Carer’s Allowance

– Motability scheme will work with PIP in the same way as it does with DLA

• Changes in entitlement may affect other benefits or support that the claimant or carer receives PIP Toolkit – Passporting


Implementing PIP

• Introducing PIP for new claimants from April 2013

• Reassessing existing DLA claimants from October 2013

PIP Checker:

www.gov.uk/pip-checker

• Use this tool to check:• if PIP affects you • when your Disability Living Allowance may be affected • when you can make a new claim for PIP

PIP Toolkit – Implementing PIP


Starting a Claim for PIP

• To start a claim for PIP telephone DWP on:

– 0800 917 2222

– Textphone – 0800 917 7777

– These numbers will be available from 8th April 2013. Lines will be open fro 8am to 6pm, Monday to Friday

– The phone call can also be made by someone supporting the claimant – the claimant will need to be present and give consent

– DWP will provide interpreters through Big Word – Language Line - for those whose first language is not English


New Claims start in April 2013

June

2013

April

2013

New claims to PIP will be taken including from people living in Cheshire, Cumbria, Merseyside, North East England and North West England

New claims national rollout

PIP Toolkit – Introducing PIP for new claimants


Reassessment starts in October 2013

October

2013

October 2015

• From this date, DWP will start to invite some existing DLA recipients to claim PIP. DWP will write to those individuals who

– are reaching the end of a fixed period DLA award– are about to turn 16

inviting them to claim PIP• Those existing DLA claimants who report a change in their condition will

be invited to claim PIP• DLA recipients who contact DWP wishing to claim PIP will be able to do

so (self selectors)

• From this date, DWP will start to reassess remaining DLA claimants who were aged between 16 and 64 on the day that PIP was introduced (8 April 2013)

• Once selected for reassessment, claimants will be asked to claim PIP. – If they do, then their DLA award will normally continue until a

decision on the PIP claim is made.– If they don’t claim PIP then their DLA claim will end.

PIP Toolkit – Reassessing existing DLA claimants


Making a claimClaimants (or those supporting them) phone DWP to make a claim to PIP. Paper claims won’t normally be used, and online claims will not be available before 2014.

DWP will send claimants a form where they can explain how their disability affects them.2

AssessmentClaim details, form and supporting evidence are passed to the health professional.

Most people will be asked to attend a face to face consultation The health professional reviews the claim against a set of clear descriptors to assess the challenges faced by the individual.

4

Thinking about claimingInformation about PIP will be available from a range of sources, including online, via leaflets and through support organisations.

Existing DLA claimants will be contacted individually to ask if they want to claim PIP.

1

DecisionA DWP Case Manager will use all the information in the claim form, from the health professional and anything else that has been provided. They will make a reasoned decision on entitlement, including the level and length of award.

5

The claimant journey There are five key stages to claiming

How your disability affects youClaimant completes the ‘How your disability affects you’ form to explain how their condition affects their daily life, both on good and bad days and over a range of activities.

Supporting evidence can be sent with this form, which they return to DWP by post.

3

PIP Toolkit – Claimant Journey


Thinking about claiming1

New Claims

Existing DLA claimants

Information is available that explains the eligibility criteria and helps the claimant decide if they want to make a claim. GPs and

Healthcare Professionals

Family & Friends

SupportOrganisations

Online

Leaflets DWP

From October 2015 all the remaining claimants in receipt of a DLA award will be invited to make a claim to PIP. We will select those recipients of DLA in receipt of an indefinite award or fixed term award, and notify them about what they need to do to claim PIP.If they choose not to claim PIP then their DLA would end.

Existing DLA claimants will be asked at some point after October 2013 if they want to claim PIP.

From October 2013 there will be reassessment to PIP of fixed period DLA awards coming up for renewal, young people turning 16 or where DLA claimants with indefinite awards report a change in their condition


Making a claim2

Claims are made via a telephone call (0800) to DWP

• The claimant’s personal and contact details

• Residency details (known as residency and presence)

• Relevant periods spent in hospital, residential care

• Claims under special rules for terminally ill people, and

• Payment (bank account) details

DWP will identify communication needs (such as alternative formats) and consider if the claimant needs additional support

DWP will explain what happens next

A form is posted to the claimant. It is individually addressed and barcoded to speed up processing

DWP checks basic eligibility conditions – if not met then a disallowance letter will be issued

The initial information required to make a claim to PIP will be basic information covering:

PIP Toolkit – How to Claim


How your disability affects you3

Claimants may ask someone, such as a family member or support organisation to help them complete the form

The form allows the claimant to explain how their condition affects them in their own words

Some disabled people have fluctuating conditions, that affect them in different ways on ‘good and bad’ days, so they can use the form to explain this

The form and any supporting evidence is returned to DWP in a freepost envelope

Any additional evidence that may help support the claim can be returned with this form

PIP Toolkit – Completing the form


Assessment 4

The claim information, completed form and any additional evidence is passed over to the health professional

Some assessments may be completed at this stage– such as if someone is claiming under the special rules for the terminally ill or where the written evidence is sufficient

Most will be asked to attend a face-to-face consultation

They will decide if there is a need for any further evidence and will make all the arrangements to get this



Assessment 4

Face-to-face consultation not requiredClaimant will be contacted to invite them to a face-

to-face consultation

Claimants can contact the health professional to ask questions about the consultation or rearrange appointments

The health professional will ask the claimant to explain how their condition affects them on a day to day basis. The claimant may also be able to provide additional evidence

The health professional sends a report back to the DWP to help inform their decision

The health professional reviews all the evidence against a set of everyday activities and clear descriptors to assess the challenges faced by the individual

Face-to-face consultation required

Claimant attends face-to-face consultation with health professional


Decision 5

The DWP Case Manager reviews the evidence they’ve received – including the report from the health professional

They make a reasoned decision on entitlement, level of award and the length of any award

Claimants can call DWP to ask for more information about the decision

A decision letter is posted to the claimant

If a claim has been disallowed, or an existing award reduced, then the Case Manager will try to call the claimant to explain the decision

PIP Toolkit – Decision and Payment


Additional Information

• Special Rules for Terminally Ill People

• Reviewing Awards

• Disputes

• Where to find more information about PIP

• PIP Toolkit list of contents


Special Rules for Terminally Ill People

• Claims for those who are found to meet the Special Rules for terminally ill people criteria

– will be dealt with more quickly than normal claims

– are guaranteed an award of the enhanced rate of the daily living component of PIP without having to wait until they satisfy the qualifying period or prospective test

– Both the daily living component and, providing the conditions are met, the mobility component will be paid straight away

• The claimant will not be sent the form ‘How your disability affects you’

– they will be asked some extra questions whilst they are on the phone about their condition and how it affects their ability to get around

PIP Toolkit – Special Rules


• Awards of PIP will be based upon the claimant’s circumstances and will look at the impact of their disability or health condition on their daily lives

• If someone is awarded PIP we will tell them how long the award is for

• We will write to them to tell them how and when they need to tell us about any change in circumstances

• Claimants will have their award regularly reviewed

• When someone’s award comes to an end, they can decide to make a further claim to PIP, if they still have needs arising from their health condition or disability.

• If someone is given a longer award we will contact them occasionally to see if their needs have changed over time.

Reviewing Awards

PIP Toolkit – Reviewing Awards


Disputes

• The change to the appeals process for DWP consists of the following key elements

– mandatory reconsideration of decisions prior to appeal

– direct lodgement of appeals with HMCTS

– time limits for DWP to return appeal responses to HMCTS.

• DWP will introduce mandatory reconsideration and direct lodgement for PIP from April 2013.

PIP Toolkit – Disputes


Where to find more information

• Information for support organisations and advisers is online at www.dwp.gov.uk/pip. The site includes a quick guide to PIP for advisers, an overview of the claimant journey and frequently asked questions.

• We’ll also include the latest news in the monthly Touchbase bulletin – sign up at the DWP website

• Information aimed at claimants is available at www.gov.uk/pip. Please signpost to these pages from your own sites or materials.

• Updated leaflets will be available too – generic information in existing leaflets from the Autumn, and PIP specific leaflet from early next year.

• Talk to your local DWP Partner Manager


PIP Toolkit list of contents

Core Products Fact sheets

• Introduction to PIP Toolkit

• Quick Guide

• PIP Timeline

• Claimant Journey

• External PIP white brand presentation and speaker notes

• Sample forms and notifications

• Leaflets

• PIP Communications Products and Timeline

• Sample Assessment Provider notifications

• Conditions of Entitlement • Assessment Criteria • The difference between PIP and DLA • Introducing PIP for new claimants (from April 2013)• Reassessing existing DLA claimants for PIP (from

Oct 2013)• How to Claim PIP• Completing the How your disability affects you

form • Assessment Process • Decision and Payment • Reviewing Awards • Special Rules for Terminally Ill People • Young People approaching age 16• People approaching age 65 and over • Passporting to other benefits • Vulnerable Claimants (includes signposting) • Disputes Process

Key Black – Version 1 January 13Red – Version 2 post January 13 Green – currently available on line


Toolkit for support organisations and advisers


All about Personal Independence Payment

[intro]

Content>> Quick guide to PIP (pdf)>> Conditions of Entitlement (pdf)>> Assessment Criteria (pdf)>> Differences and Similarities between PIP and DLA (pdf)>> Passporting (pdf)




Implementing Personal Independence Payment

[intro]

Content>> PIP Timetable (pdf)>> Introducing PIP for new claimants from April 2013 (pdf)>> Reassessing existing DLA claimants for PIP from October 2013 (pdf)>> PIP calculator (pdf)>> When DWP forms and leaflets will be available




Personal Independence Payment Claimant Journey

[intro]

Content>> Claimant journey outline (pdf)>> How to Claim PIP (pdf)>> How to fill in the form ‘How your disability affects you’ (pdf)>>Assessment Process and Providers (pdf)>> Decision and Payment (pdf)>> Reviewing PIP awards (pdf)




Personal Independence Payment Specific Circumstances

[intro]

Content>> Special Rules for Terminally Ill People (pdf)

>> Supporting young people (pdf)>> People approaching 65 (pdf)

>> Supporting people in vulnerable situations (pdf)

>> Disputes (pdf)




Personal Independence Payment tools for you to use

[Intro text]

Editorial[Intro text]>> Introduction text – under 100 words (on page content)>> Short text – under 250 words (on page content)>> Medium text – about 600 words (on page content)>> Long text – about 1000 words (on page content)

Presentations[Intro text]>> An introduction to PIP for support organisations and advisers (PowerPoint)

Printable material[Intro text]>> Information posters (PowerPoint)>> A quick guide to PIP for support organisations and advisers (pdf)>> A quick guide to PIP for Local Authorities (pdf)

an introduction to personal independence payment for support organisations

Documents

work pensionsaims

work pensionssimilarities

work pensionscomponents

work pensionswca

pointsenhanced rate

pointsstandard rate

components daily living

standard rate53