chapter p2: assessment for pip · chapter p2: assessment for pip . daily living and mobility...

Chapter P2: Assessment for PIP

Contents

Daily Living and mobility components ................................................... P2001

Limited and severely limited ability .............................................................. P2002

Information requirements............................................................................. P2026

Assessment consultations........................................................................... P2046

Failure to comply....................................................................................... P2056

Good reason................................................................................................ P2058

Duration of award ...................................................................................... P2061

Re-determination ....................................................................................... P2064

Terminal illness ......................................................................................... P2076

Third party claims ........................................................................................ P2080

Appendices

Personal Independence Payment Assessment.................................. Appendix 1

Daily living and mobility activities ....................................................... Appendix 2

Chapter P2: Assessment for PIP

Daily living and mobility components

P2001 The activities to satisfy the Daily Living and/or Mobility components are prescribed1.

These can be found in the Appendices to this Chapter.

1 SS (PIP) Regs, Sch 1

Limited and severely limited ability

P2002 Entitlement to PIP is based on whether a claimant has limited or severely limited

ability to carry out daily living and/or mobility activities1. This will be determined by a

DM using the information gathered during the PIP assessment (see P2004 –

P2006).

1 SS (PIP) Regs, reg 4

P2003 In addition the required period condition, consisting of

1. the qualifying period of 3 months and

2. the prospective test of 9 months

has to be satisfied1. The HP will advise the DM if these conditions are likely to have

been met (see P1031).

1 SS (PIP) Reg, reg 12 & 13

P2004 The PIP assessment is used to determine a claimant’s ability to carry out

1. daily living activities or

2. mobility activities or

3. a mixture of both.

P2005 The assessment will determine whether a claimant’s ability is limited or severely

limited by their physical or mental condition, and if the claimant meets the required

period condition1 (see ADM Chapter P1 - Conditions of Entitlement).

1 SS (PIP) Regs, reg 4 & reg 12 to 15

P2006 The assessment will be in the form of either1

1. a face-to-face consultation or

2. a telephone consultation or

3. a paper based assessment or

4. fast track if under the special rules for terminally ill persons or

5. a combination of any of 1. – 4.

Once all the evidence is gathered the DM will also assess the claimant using the

same criteria as the HP. The DM at this point may also ask the HP for additional

information if required, to help the DM make their decision.

1 SS (PIP) Regs, reg 9(1)

P2007 The HP is specially trained to assess and evaluate the impact of disability on a

claimant’s ability to carry out activities of daily living and mobility. This includes the

affects of variable conditions.

P2008 The HP has appropriate knowledge of clinical aspects of a wide range of medical

conditions and is skilled in assessing people with physical and mental health

conditions.

P2009 A HP will be one of the following

1. An occupational therapist

2. Nurse (level 1)

3. Physiotherapist

4. Paramedic

5. Doctor (GMC registered)

P2010 The HP provides advice to the DM on the limitation to carry out daily living and/or

mobility activities and advises on which descriptors are appropriate for the claimant.

The advice the HP provides is based on the daily living/mobility needs arising from a

condition or conditions and not the condition(s) itself.

P2011 The claimant will be assessed as having limited ability if the daily living activities or

mobility activities achieve a score of at least 8 points1 in each component. This will

then lead to an award of the relevant component or components at the standard rate

of PIP (see P2014).

1 SS (PIP) Regs, reg 5(3)(a); reg 6(3)(a)

P2012 The claimant will be assessed as having severely limited ability if the daily living

activities or mobility activities achieve a score of at least 12 points1 in each

component. This will then lead to an award of the relevant component or

components at the enhanced rate of PIP (see P2014).

1 SS (PIP) Regs, reg 5(3)(b ): reg 6(3)(b)

P2013 The score in relation to the daily living and mobility activities is determined1 by

adding together, in relation to each activity, the points awarded against the selected

descriptors.

1 SS (PIP) Regs, reg 5(1); reg 6(1)

P2014 The applicable descriptor for the claimant for each activity is

1. where one descriptor is satisfied for over 50% of the days, that descriptor1 or

2. where two or more descriptors are satisfied for over 50% of the days, the

descriptor which scores the highest number of points2 or

3. where no descriptor is satisfied for over 50% of the days but two or more

scoring descriptors are satisfied for periods of more than 50% of the days

when added together, the descriptor to be applied is the one which

3.1 is satisfied for the greatest proportion of the days or

3.2 scores the higher or highest number of points where both or all

descriptors are satisfied for the same period3.

1 PIP Regs, reg 7(1)(a)); 2 reg 7(1)(b); 3 reg 7(1)(c)

Example 1

Phil has long term problems with rheumatoid arthritis and has very limited walking

ability. He needs to use a wheelchair for more than 50% of the days when outdoors,

and can only walk a few metres before being in pain and discomfort. He is assessed

as

“Can stand and move more than 1 metre but no more than 20 metres, either

aided or unaided”

and scores 12 points on the assessment. He is therefore awarded the enhanced rate

of the PIP mobility component.

Example 2

Mary has learning difficulties and

“Needs supervision or assistance to either prepare or cook a simple meal”

scoring 4 points.

“Needs supervision, prompting or assistance to be able to manage therapy

that takes no more than 3.5 hours a week” - scoring 2 points.

“Needs supervision or prompting to be able to wash or bathe” – scoring 2

points.

“Cannot read or understand signs, symbols or words at all” – scoring 8 points.

“Cannot make any budgeting decisions at all – scoring 6 points.

“Cannot plan the route of a journey” – scoring 8 points.

Mary is therefore awarded the daily living component at the enhanced rate as she

has scored 22 points, and the mobility component at the standard rate as she has

scored 8 points.

Example 3

John has arthritis in his hands and for approximately 1 to 2 weeks a month he

cannot

“Cannot prepare and cook food” which would score 8 points.

He also has Multiple Sclerosis which is not controlled well and for about 16 weeks of

the year, which do not overlap with the arthritis, he

“Needs supervision or assistance to either prepare or cook a simple meal”

which would score 4 points.

Neither descriptor is satisfied for more than 50% of the time on their own, but in

aggregate cover more than 50% of the time. John is awarded the standard rate of

the daily living component as the descriptor awarding 8 points applies for the

greatest amount of the time.

P2015 When assessing the claimant’s ability to carry out an activity, the claimant is to be

assessed as if wearing or using any aid or appliance1 which

1. the claimant normally wears or uses or

2. the claimant could reasonably be expected to wear or use.

1 SS (PIP) Regs, reg 4(2)(a) & (b)

P2016 The descriptor will only be regarded as being satisfied if the claimant can be

assessed as carrying out that activity, in the manner described in the descriptor

1. safely – which means in a manner unlikely to cause harm to themselves or to

another person, either during or after completion of the activity and

2. to an acceptable standard – given the nature of the activity and

3. repeatedly – which means as often as the activity being assessed is

reasonably required to be completed and

4. in a reasonable time period1- which means no more than twice as long as the

maximum period that a person without a physical or mental condition, which

limits that person’s ability to carry out the activity in question, would normally

take to complete that activity.

1 SS (PIP) Regs, reg 4(2A)(d)

P2017 In determining whether the activity can be carried out in this manner, consideration

should be given to

1. approach – what the individual needs to do; what assistance or aids are

required; how long it takes; and whether it is safe and

2. outcome – whether the activity can be successfully completed and the standard

that is achieved and

3. impact – the effects that reaching the outcome has on the individual and, where

relevant, other people; and whether the individual can repeat the activity within a

reasonable period of time and to the same standard (this includes consideration

of symptoms such as pain, discomfort, breathlessness, fatigue and anxiety) and

4. variability – how an individual’s approach and outcomes change over time and

the impact this has on them.

Example 1

Henry is able to stand and move unaided. He can comfortably walk up to 150 metres

at a normal pace. After 150 metres he starts to become breathless and to

experience some mild pain. He can continue to walk but his pace slows. The pain

and breathlessness gradually increases and after 250 metres he needs to stop and

rest for about 5 minutes before starting to walk again. Henry can repeatedly walk

250 metres, with short 5-minute rests in between for around an hour. After an hour

of this, he needs a longer rest of about an hour before walking again. It takes Henry

around four minutes to walk 200 metres. The DM considers whether Henry can

stand and then move more than 200 metres (descriptor 2a) safely, to an acceptable

standard, repeatedly and a in a timely manner. The DM decides there is no evidence

that this activity poses any risk to Henry’s safety; he has said he experiences some

pain and breathlessness and, while this may be uncomfortable, he knows when to

stop and rest and there is no indication that this causes him any harm. The DM

decides Henry can complete the activity more frequently than would reasonably be

expected and, although he takes a little longer than a non-disabled person, he can

complete the activity in a reasonable time period. As Henry can therefore stand and

then move more than 200 metres safely, repeatedly and in a timely manner (the

standard is not an issue in this instance), the DM selects descriptor 2a.

Example 2

Louise is able to stand and move with a walking stick. She can walk up to 50 metres

at a slightly slowed pace with some discomfort. After this distance she starts to

experience increasing hip pain. She can continue to walk, but her pace slows even

further and after 100 metres she needs to stop and rest. This takes a lot out of her

and for a few hours after Louise is unable to go more than a few steps without

experiencing further severe hip pain. The DM considers whether Louise can stand

and then move more than 50 metres but no more than 200 metres (descriptor 2b)

safely, to an acceptable standard, repeatedly, and in a timely manner. The DM

decides that there is no issue with the standard and that she can do so safely,

because, although she experiences pain, she knows when to stop and rest, and

there is no indication that this causes her any harm. However, after she has walked

100 metres, it is several hours before Louise can walk this distance again. The DM

decides this is less frequently than would be reasonably expected and therefore

concludes she cannot do so repeatedly. Louise can repeatedly manage a few

metres using her stick, which is less than 20 metres but more than 1 metre

(descriptor 2e). On this evidence the DM selects descriptor 2e.

Example 3

Julie can prepare and cook a simple meal. However she lacks a perception of

danger and occasionally cuts herself from mishandling knives or burns herself on

hot pans. She is also impatient and does not cook food for as long as it should be

cooked, as a result she prepares food that is lukewarm and meat that is not cooked

properly – for example, chicken that is pink in the middle. Her sister usually has to

be in the kitchen when she is cooking meals to make sure she does so safely and to

remind her to leave food to cook fully. The DM considers whether Julie can prepare

and cook a simple meal unaided (descriptor 1a), safely, to an acceptable standard,

repeatedly and in a timely manner. The DM decides Julie is able to do so repeatedly

and in a timely manner. Because she lacks a perception of danger, the DM decides

Julie needs supervision to be able to safely prepare or cook a simple meal

(descriptor 1e). Because she does not cook food for as long as she should, the DM

decides Julie needs prompting to prepare or cook a simple meal (descriptor 1d) to

an acceptable standard. In this case there are two possible descriptors – 1d and 1e,

but as descriptor 1d does not describe a manner in which Julie is able to carry out

the activity safely, the DM selects descriptor 1e.

P2018 Where the claimant is assessed as having severely limited ability to carry out the

daily living and/or mobility activities, they cannot also be assessed as having limited

ability in relation to that component1.


P2019 – P2025

Information requirements P2026 The claimant will be required to provide any information or evidence1 that may be

requested by the DM to determine their ability to undertake either the daily living or

mobility activities specified.


P2027 The information will take the form of

1. the claimant questionnaire, (How your disability affects you), if required

2. any other information as may be requested by the DM

3. any other additional information requested by a person approved by the

Secretary of State (e.g. a HP requesting further information by telephone).

P2028 Where information has been requested of the claimant, that information must be

provided within 1 month1 of the request, or any longer period as the DM may

consider reasonable.

Note: See P2056 for guidance where a claimant fails to comply with providing

information or evidence.

1 SS (PIP) Reg, reg 8(2)

P2029 – P2045

Assessment consultations

P2046 If it is decided that a consultation1 with the claimant is required to assess the

claimant’s ability to undertake daily living and/or mobility activities the consultation1

will take the form of participation in a face-to-face consultation (but see P2006, a

consultation by telephone may be used to gather further information).

Note: A paper based assessment may be available for some claimants, and may be

made where there is sufficient evidence for the HP to advise on all aspects of the

claim.


P2047 The claimant will be required to comply with the request to attend for a consultation.

Failure to comply will result in the DM giving a negative determination1, unless the

claimant shows good reason2 not to participate in the consultation (see P2058).

Note: See P2056 for guidance where a claimant fails to comply with a request to

attend a consultation and guidance at P2058 and ADM Chapter P6 for guidance on

good reason.

1 SS (PIP) Regs, reg 9(2); 2 reg 10

P2048 The claimant must be notified in writing1 of the

1. date and

2. time and

3. place

of the consultation at least 7 days in advance.

Note: The claimant can agree to accept a shorter period of notice, whether given in

writing or otherwise.


P2049 The written notice may be issued electronically1 where the claimant has agreed to

correspondence being sent in this manner.

Note This facility will not be available until a future date.


P2050 – P2055

Failure to comply

P2056 Failure to comply with the request

1. to provide information or

2. attend a consultation

without good reason shall result in a negative determination1 of the component(s) to

which the failure is related.

Note: For guidance on good reason see P2058 and ADM Chapter P6 – Good

Reason.

1 SS (PIP) Regs, reg8(3) & 9(2)

P2057 A negative determination1 means a determination that a person does not meet the

requirements of the daily living component or the mobility component.

1 WR Act 12, s 80(6)

Example

Amanda made a telephone claim to PIP and was sent out a part 2 questionnaire,

‘How does your disability affect you’. She was asked to return the form within one

month of the date of the request. After 19 days she had not returned the form so she

was sent a postal reminder but she also failed to respond to this. As she did not

comply with returning the information required, and she hadn't been identified as

needing additional support, a negative determination was made on her claim.

Good reason

P2058 Claimants will have had the opportunity to explain why they have not complied with

a request to

1. provide information or

2. attend a consultation.

It will remain the claimant’s responsibility to show good reason and provide any

evidence to justify their good reason. The DM will make a decision based on all the

individual facts and circumstance of the case and taking into account in particular

the claimant’s state of health at the relevant time and the nature of their disability.

Note: For further guidance on good reason see ADM Chapter P6 - Good reason.

P2058 – P2060

Duration of award

P2061 When deciding the duration of an award1 of PIP the DM should look at all the

evidence and facts of the case, including the advice from the HP. There will be three

types of awards

1. short fixed term awards, which will be for a minimum of 9 months and a

maximum of 2 years or

2. longer fixed term awards, where the DM will set an expiry date 12 months

after the date on which the claimant is due to be referred to the HP for a

review or

3. ongoing awards where it would be inappropriate to give a fixed term award

where any change is highly unlikely.

Note: DMs will also have a role in deciding the review date which will be detailed in

the DM’s procedural guidance.

1 WR Act 12, s 88(2) & (3)

P2062 When deciding the length of the award the DM will have regard to

1. the advice from the HP, within the PIP assessment report and

2. any further evidence gathered by the HP and

3. the evidence given by the claimant in the questionnaire (How your disability

affects you), and any additional information supplied by the claimant.

Note: DMs should refer to the procedural guidance on Award Periods and Reviews

(within the Decision Making Process Guidance), when deciding the length of the

award and setting review periods.

P2063 The advice on prognosis from the HP advising when they wish to see the claimant

again in accordance with P2064 – P2065, will have had consideration as to

1. whether there is likely to be an improvement or deterioration in the disability or

its functional effects and

2. whether further treatment is required and

3. the time any improvement or deterioration is likely to be expected and

4. the natural progress of the underlying condition and

5. any adjustments and adaptations.

Example 1

Joan sent in her questionnaire for her claim to PIP and attended for a consultation

with an HP. On the evidence before them the HP provided a report to the DM for

their consideration, with a recommendation that the claim should be reviewed in 3

years. This took into account the likely prognosis by the HP of improvement in

Joan’s disability condition and the daily living/mobility needs arising. The DM

considered all the evidence and made their decision on the length of the award,

decided on a review date of 3 years and an award for PIP of 4 years. This ensures

that the award does not run out before the new decision is made.

Example 2

Richard submitted his questionnaire in relation to his claim for PIP, and the HP

considered the information and called him for a consultation. At the consultation

Richard brought a letter from his GP and handed it to the HP. The HP looked at all

the evidence, including the consultation, and advised that Richard’s claim should be

reviewed after two years. The DM considered all the evidence and decided that a

formal review would not be appropriate, and made an award of PIP for two years, as

it is expected that he will have improved by the end of the award. Richard will receive

a letter before the end of his award to advise him about claiming again, should his

needs not have improved.

Example 3

Agnes has had a long term disability and made a claim for PIP. She submitted her

questionnaire, and the HP decided to seek further advice from her hospital

consultant. On this evidence the HP made an assessment and advised the DM that

Agnes’ prognosis was that her needs would be unlikely to change. On this evidence

from the HP the DM made a decision to make an ongoing award for PIP, with a

review date after 10 years, to check if the level of benefit is still appropriate.

Re-determination

P2064 Where a claimant has been determined to have a limited or severely limited ability to

carry out activities, the DM may re-determine1 whether a claimant still has limited or

severely limited ability to carry out the required activities.

1 SS(PIP) Regs, reg 11

P2065 The re-determination can be performed when

1. a period of award is coming to an end or

2. a claimant reports a change of circumstances or

3. the DM wishes to review the claimant’s award, at any time or for any reason.

Note 1: When the DM initiates a review this is referred to as a planned intervention

(except, for instance where information is received from a third party which initiates

an investigation).

Note 2: For more information on any time reviews please see ADM Chapter A3.

Example 1

Sarah has rheumatoid arthritis and is in receipt of the standard rate of mobility as her

walking had been affected after an exacerbation. She asks the DM to look at her

claim again as she has had a further flare up and it has left her in more pain and

swelling of her feet and more deformity of the joints in her arms and hands. After

more evidence being obtained, and consideration given to the qualifying period, the

HP advises that her needs have increased and refers to the DM for a decision. The

DM decides that Sarah:

Needs supervision or assistance to either prepare or cook a simple meal - 4

points

Needs – assistance to be able to cut up food – 2 points

Needs assistance to get in or out of the bath or shower – 3 points

Can stand and then move using an aid or appliance more than 20 metres but

no more than 50 metres – 10 points.

On these findings the DM makes an award for daily living activities at the standard

rate, and maintains the mobility component at the standard rate.

Example 2

Billy has been suffering with a heart problem and had been awarded the standard

rate of the daily living component and the enhanced rate of the mobility component.

12 months before his award was due to come to an end the DM instigated a planned

intervention and asked Billy to provide new information. He was invited by the HP to

a face-to-face consultation and medical evidence was obtained from his consultant.

It was found that although Billy had recently received a heart by-pass operation and

his needs had decreased, he was still recovering. He told the DM that he was going

to write in once he had see his GP again and was given the all clear. The DM, on the

evidence gathered, reduced his award to standard rate mobility component and no

rate of the daily living component for the remaining period of his previous award.

P2066 – P2075

Terminal illness

P2076 There are exceptions to the normal rules when the person who claims

1. is terminally ill and

2. has made a claim for PIP expressly on the ground of terminal illness1.

Note: Evidence from or on behalf of the disabled person of terminal illness will

amend the claim to one based on the Special Rules (see P2079).

1 WR Act 12, s 82

P2077 A person is regarded as being terminally ill1 for the purposes of P2076 if

1. at any time the person suffers from a progressive disease and

2. the person’s death in consequence of that disease can reasonably be

expected within 6 months.

1 WR Act 12, s 82(4)

P2078 When a claim is made under the circumstances in P2076 the claimant will

1. not be required to satisfy the required period condition for either component1

and

2. not be required to satisfy the past presence condition2 and

3. be awarded the enhanced rate of the daily living component3 and

4. be required to provide information on the mobility activities before either rate

of that component can be awarded.

1 WR Act 12, s 82(2) & (3); 2 SS (PIP) Regs, reg 22; 3 WR Act 12, s 82(2)

P2079 Claims for terminally ill people will usually be awarded for and limited to 3 years. A

reminder will be issued before the award expires to remind the claimant to re-claim

PIP.

Third party claims

P2080 A claim may be accepted from a third party1 if the claim is made expressly on the

ground that this is on behalf of someone who is terminally ill. This has the effect that

the terminally ill person has made the claim (see ADM Chapter A2 - claims).

1 WR Act 12, s 82(5); SS (PIP) Regs, reg 21

P2081 – P2999

Appendix 1

PERSONAL INDEPENDENCE PAYMENT ASSESSMENT

Interpretation of terms

1 This Appendix gives guidance on the interpretation of terms1 used for daily living and

mobility activities.


Aided

2 Aided means with

1. the use of an aid or appliance or

2. supervision, prompting or assistance.

Assistance

3 Assistance means physical intervention by another person and does not include

speech.

Assistance Dog

4 Assistance dog means a dog trained to guide or assist a person with a sensory

impairment.

Basic verbal information

5 Basic verbal information means information in the claimant’s native language

conveyed in a simple sentence.

Basic written information

6 Basic written information means signs, symbols and dates written or printed in the

claimant’s native language.

Bathe

7 Bathe includes getting into or out of an unadapted bath or shower.

Communication support

8 Communication support means support from a person trained or experienced in

communicating with people with specific communication needs including interpreting

verbal information into a non-verbal form and vice versa.

Complex budgeting decisions

9 Complex budgeting decisions means decisions involving

1. calculating household and personal budgets and

2. managing and paying bills and

planning future purchases

Complex verbal information

10 Complex verbal information means information in the claimant’s native language

conveyed in either more than one sentence or one complicated sentence.

Complex written information

11 Complex written information means more than one sentence of written or printed

standard size text in the claimant’s native language.

Cook

12 Cook means to heat food at or above waist height.

Dress and undress

13 Dress and undress includes putting on and taking off socks and shoes.

Engage socially

14 Engage socially means

1. interact with others in a contextually and socially appropriate manner and

2. understand body language and

3. establish relationships.

Manage incontinence

15 Manage incontinence means manage involuntary evacuation of the bowel or bladder

including use of a collecting device or self-catheterisation and clean oneself

afterwards.

Manage medication or therapy

16 Manage medication or therapy means take medication or undertake therapy, where

a failure to do so is likely to result in a deterioration in the claimant’s health.

Medication

17 Medication means medication to be taken at home which is prescribed or

recommended by a registered

1. doctor

2. nurse or

3. pharmacist.

Monitor health

18 Monitor health means

1. detect significant changes in the claimant’s condition which are likely to lead to

a deterioration in their health and

2. take action advised by a

2.1 registered doctor

2.2 registered nurse or

2.3 health professional who is regulated by the Health Professions Council

without which the claimant’s health is likely to deteriorate.

Orientation aid

19 Orientation aid means a specialist aid designed to assist disabled people to follow a

route safely.

Prepare

20 In the context of food prepare means to make food ready for cooking or eating.

Prompting

21 Prompting means reminding, encouraging or explaining by another person.

Psychological distress

22 Psychological distress means distress related to an enduring mental health condition

or an intellectual or cognitive impairment.

Read

23 Read includes reading signs, symbols and words but does not include reading

Braille.

Simple budgeting decisions

24 Simple budgeting decisions means decisions involving

1. calculating the cost of goods and

2. calculating change required after a purchase.

Simple Meal

25 Simple meal means a cooked one-course meal for one using fresh ingredients.

Social Support

26 Social support means support from a person trained or experienced in assisting

people to engage in social situations.

Stand

27 Stand means stand upright with at least one biological foot on the ground.

Supervision

28 Supervision means the continuous presence of another person for the purpose of

ensuring the claimant’s safety.

Take nutrition

29 Take nutrition means

1. to cut food into pieces and

2. convey food or drink to one’s mouth and

3. chew and swallow food or drink or

4. take nutrition by using a therapeutic source.

Therapeutic source

30 Therapeutic source means parenteral or enteral tube feeding, using a rate limiting

device such as a delivery system or feed pump.

Therapy

31 Therapy means therapy to be undertaken at home which is prescribed or

recommended by a

1. registered

1.1 doctor

1.2 nurse or

1.3 pharmacist

2. health professional regulated by the Health Professions Council.

Toilet needs

32 Toilet needs means

1. getting on and off an unadapted toilet and

2. evacuating the bladder and bowel and

3. cleaning oneself afterwards.

Unaided

33 Unaided means without

1. the use of an aid or appliance or

2. supervision, prompting or assistance.

Appendix 2 See PIP Descriptor Log

Daily living and mobility activities

Note: See P2011- P2014

Daily Living Activities

Column 1 Column 2

Activity Descriptors

1. Preparing food. a. Can prepare and cook a simple meal

unaided.

b. Needs to use an aid or appliance to be

able to either prepare or cook a simple

meal.

c. Cannot cook a simple meal using a

conventional cooker but is able to do so

using a microwave.

d. Needs prompting to be able to either

prepare or cook a simple meal.

e. Needs supervision or assistance to

either prepare or cook a simple meal.

f. Cannot prepare and cook food.

2. Taking nutrition. a. Can take nutrition unaided.

b. Needs –

(i) to use an aid or appliance to be able to

take nutrition; or

(ii) supervision to be able to take nutrition;

or

(ii) assistance to be able to cut up food.

c. Needs a therapeutic source to be able to

take nutrition.

d. Needs prompting to be able to take

nutrition.

Column 3

Points

0

2

2

2

4

8

0

2

2

4

3. Managing

therapy or

monitoring a health

condition.

4.Washing and

bathing

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

a. Either – 0

(i) does not receive medication or therapy

or need to monitor a health condition; or

(ii) can manage medication or therapy or

monitor a health condition unaided.

b. Needs either – 1

(i) to use an aid or appliance to be able to

manage medication; or

(ii) supervision, prompting or assistance to

be able to manage medication or monitor a

health condition.

c. Needs supervision, prompting or

assistance to be able to manage therapy

that takes no more than 3.5 hours a week.

2

d. Needs supervision, prompting or


that takes more than 3.5 but no more than

7 hours a week.

4

e. Needs supervision, prompting or


that takes more than 7 but no more than 14

hours a week.

6

f. Needs supervision, prompting or


that takes more than 14 hours a week.

8

a. Can wash and bathe unaided. 0


able to wash or bathe.

2

c. Needs supervision or prompting to be

able to wash or bathe.

2

5. Managing toilet

needs or

incontinence.

6. Dressing and

undressing.

d. Needs assistance to be able to wash

either their hair or 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

a. Can manage toilet needs or

incontinence unaided.

0


able to manage toilet needs or

incontinence.

2

c. Needs supervision or prompting to be

able to manage toilet needs.

2

d. Needs assistance to be able to manage

toilet needs.

4

e. Needs assistance to be able to manage

incontinence of either bladder or bowel.

6

f. Needs assistance to be able to manage

incontinence of both bladder and bowel.

8

a. Can dress and undress unaided. 0


able to dress or undress.

2

c. Needs either 2

(i) prompting to be able to dress, undress

or determine appropriate circumstances

for remaining clothed; or

(ii) prompting or assistance to be able to

select appropriate clothing.

d. Needs assistance to be able to dress or

undress their lower body.

2

e. Needs assistance to be able to dress or 4

7. Communicating

verbally.

8. Reading and

understanding

signs, symbols and

words

9. Engaging with

other people face

to-face

undress their upper body.

f. Cannot dress or undress at all. 8

a. Can express and understand verbal

information unaided.

0


able to speak or hear.

2

c. Needs communication support to be

able to express or understand complex

verbal information.

4

d. Needs communication support to be

able to express or understand basic verbal

information.

8

e. Cannot express or understand verbal

information at all even with

communication support.

12

a. Can read and understand basic and

complex written information either unaided

or using spectacles or contact lenses.

0

b. Needs to use an aid or appliance, other

than spectacles or contact lenses, to be

able to read or understand either basic or

complex written information.

2

c. Needs prompting to be able to read or

understand complex written information.

2

d. Needs prompting to be able to read or

understand basic written information.

4

e. Cannot read or understand signs,

symbols or words at all.

8

a. Can engage with other people unaided. 0

b. Needs prompting to be able to engage

with other people.

2

c. Needs social support to be able to

engage with other people.

4

d. Cannot engage with other people due to

such engagement causing either –

8

10. Making

budgeting

decisions

(i) overwhelming psychological distress to

the claimant; or

(ii) the claimant to exhibit behaviour which

would result in a substantial risk of harm

to the claimant or another person.

a. Can manage complex budgeting

decisions unaided.

0

b. Needs prompting or assistance to be

able to make complex budgeting

decisions.

2

c. Needs prompting or assistance to be

able to make simple budgeting decisions.

4

d. Cannot make any budgeting decisions

at all.

6


Mobility Activities

Column 1

Activity

1. Planning and

following journeys.

2. Moving around.

Column 2 Column 3

Descriptors Points

a. Can plan and follow the route of a 0

journey unaided.

b. Needs prompting to be able to 4

undertake any journey to avoid

overwhelming psychological distress

to the claimant.

c. Cannot plan the route of a journey. 8

d. Cannot follow the route of an 10

unfamiliar journey without another

person, assistance dog or orientation

aid.

e. Cannot undertake any journey 10

because it would cause overwhelming

psychological distress to the claimant.

f. Cannot follow the route of a familiar 12

journey without another person, an

assistance dog or an orientation aid.

a. Can stand and then move more than 0

200 metres, either aided or unaided.

b. Can stand and then move more than 4

50 metres but no more than 200

metres, either aided or unaided.

c. Can stand and then move unaided 8

more than 20 metres but no more than

50 metres.

d. Can stand and then move using an 10

aid or appliance more than 20 metres

but no more than 50 metres.

e. Can stand and then move more than 12

1 metre but no more than 20 metres,

either aided or unaided.

f. Cannot, either aided or unaided,– 12

(i) stand; or

(ii) move more than 1 metre.


Descriptor Query Line to take

Activity 1

All What is the best method to score descriptors?

Start at the highest scoring descriptor and work up to the lowest scoring descriptor. Working from the lowest to the highest scoring descriptor can result in application of the incorrect descriptor - for example in relation to Activity 1 if someone needs prompting and supervision to prepare food, descriptor 1d may be incorrectly chosen.

All What should be considered when we propose the use of aids?

The aid must be necessary to help the Claimant overcome their disability. Everyone uses aids to some extent. For example, many people use dosette boxes as they are useful to manage a pill regimen, but this does not necessarily mean they are overcoming a disability by using it. You must consider if the aid (or appliance) is affordable to the Claimant. You must consider if the aid (or appliance) is readily available or acquirable. You must consider whether the aid is practical for the Claimant to use, based both on their on their disability and domestic circumstances

1b Are prechopped vegetables an aid or appliance?

No, but it may demonstrate an inability to prepare vegetables. If someone has difficulty chopping or peeling and uses pre-chopped vegetables as a proxy for an aid or appliance, then 1b may apply if they could prepare food using an aid/appliance. If their health condition/impairment prevents the claimant from preparing vegetables at all (even with an aid) then descriptor 1e may apply (if with assistance or supervision they could manage it). 1f may apply if even with assistance or supervision they could not prepare food.

1c Does activity 1C automatically apply to someone who says they use a microwave oven to cook?

No. Activity 1C should only apply to someone with a condition that means that they cannot safely use a conventional cooker but could use a microwave oven instead - For example this may apply to a cognitively impaired person who might leave a gas cooker on

1a, 1c, 1e What descriptor should apply to someone with epilepsy?

1a, 1c or 1e. Someone with infrequent/ predictable fits should be able to use a conventional cooker. Somebody with unpredictable epilepsy might need to use a microwave due to the risk of burning themselves with a conventional cooker. Descriptor 1e should rarely apply and only in those people where there is good evidence that their fits are extremely frequent, (i.e. several times a day) and unpredictable.

1e What descriptor should apply to someone who can't chop and peel vegetables,

1e. Preparation of a simple meal includes the ability to peel and chop food. If someone can't do this then activity 1e will apply because it wouldn’t be

even with the use of aids, but can use a microwave to prepare a 'ready' meal?

reasonable for someone to live on microwave 'ready' meals. Note, however, that a microwave can be used to cook vegetables and other fresh produce and therefore a whole simple meal can be cooked using one.

1 Can someone who is at risk of self harm meet descriptors under activity 1?

Yes, depending on the evidence. Somebody who is at high risk of suicide or self harm may need supervision to prepare a meal in which case 1e may apply. There should be evidence that the person is at high risk of harm, for example high level involvement of community mental health services, care plan approach... etc

1 What if reduced mobility means the person cannot move about the kitchen area?

Mobility is not part of the activity but, as with any task, it must be completed 'safely' (in a manner unlikely to cause harm to themselves or another person, either during or after the completion of it). A perching stool may be a reasonable aid to reduce risk in these circumstances. Carrying food from kitchen to eating area is not included in this activity.

1f If a person never makes meals or never cooks do they meet descriptor 1f?

If the lack of making meals is through choice, lack of knowledge of cooking or because someone else always does it, 1a would apply. If it stems from their health condition then they may satisfy 1f.

1 Does the Claimant need to be able to make a variety of food, or make meals that are of nutritional value?

They must gain an adequate level of nourishment from their diet. However, if someone chooses to eat poorly or have a repetitive diet, but had the capacity to cook a variety of food such as to give them this adequate level of nourishment, then they would not score any points.

1 DECISION: CSPIP 690 2014

Hygiene is a consideration when assessing whether a Claimant can prepare food “to an acceptable standard”.

Activity 2

2b(i) If someone needs an aid or appliance to peel and chop food for Activity 1 can you automatically asssume that they will need to use an aid or appliance to take nutrition for Activity 2 ?

No. Somebody who has problems with manual dexterity or grip strength to the extent that they have problems chopping and peeling raw vegetables may have difficulties cutting cooked food into pieces but this is not inevitable as it may be easier to cut cooked food than raw vegetables.

2 Should someone with epilepsy require supervision to avoid the risk of choking when eating?

In rare circumstances 2b may be appropriate but there must be evidence that the fits are without warning and are poorly controlled, e.g. the person is likely to be on multiple antiepileptic medication, under the care of a neurologist and will not be able to drive. The vast majority of people with epilepsy do not require another person to supervise them when eating

2 What if the person conveys some food and drink to their mouth but also spills a great deal

All individuals spill some food and drink at times but regularly spilling food as a result of a medical condition to the extent, say, that an individual has to change their clothes after eating is not acceptable.

Activity 3

3b Is a needle an aid or appliance?

No - An injecting needle is not an aid or appliance (there is no impaired function that is improved or replaced by the use of the needle).

3c-f The hours - Is it the therapy or is it the supervision/ prompting/assistance that must last this long?

It is the duration of the assistance/prompting/supervision. So for example somebody who needs supervision with haemodialysis that takes 5 hours 3 times a week - 3f would apply. However, if someone only needs assistance for 30 minutes with a therapy that lasts 5 hours, then that should only count as 30 minutes towards the weekly hourly total.

3b Is a blood sugar monitor for a diabetic an aid/appliance?

No - It is not an aid or appliance (there is no impaired function that is improved or replaced by the use of the monitor). However, if supervision, assistance or prompting is required in its use then descriptor 3b(ii) might apply.

3 Therapy is defined as being administered at 'home'. What if they are in a nursing home?

Home' means their domestic setting. If they reside in some form of nursing home, this is their domestic setting

3b Would someone at risk of suicide need supervision to manage medication?

Potentially – 3b(ii) could apply if the medication they take is of a type that an overdose could lead to harm and there is good evidence that the person is at high risk; for example high level involvement of community mental health services, care plan approach... etc.

3b Is an asthma inhaler an aid/appliance?

No - it's medication. An individual who uses an inhaler without aids or assistance would meet descriptor 3a(ii).

3 Is a dosette box an aid or appliance?

Yes - As long as the person uses one because of their mental/physical impairment or health condition. for example, the box could replace/improve the memory function .

3 Does 'keeping an eye' on how a person is count as monitoring?

Only if there is a medically advised intervention that the person doing the monitoring must implement in order to prevent deterioration in the claimant. Asking relatives or friends how they are or checking on their feelings or wellbeing as part of normal social interaction would not meet this criteria unless there was a medical reason for expecting a change, a defined sign of deterioration and an advised action plan.

3a-b If a person with learning difficulties or cognitive impairment, for example Alzheimer's disease, is not on medication, could 3b be scored as they might need help or monitoring to assess if they need some medication in the future?

No. If a person is not on long term medication only 3a can be chosen. The descriptors reflect their current needs as assessed as being present for the 12 month period. Any short term medications would not meet the scope of 3b and we are not being asked to predict possible future changes. If the claimant did develop a condition requiring long term medications they could apply for a change of circumstances in the usual manner.

3

What descriptor should apply to people who use support stockings / compression bandaging?

Compression hosiery and compression bandaging can count as therapy as long as its use is to actually treat an existing condition (that is to improve, alleviate or prevent deterioration) rather than to prevent a condition arising. If there is assistance/prompting needed to use the compression stockings/bandaging then this could score under 3c-3f but note that it is the time spent on the asssistance/prompting that should be considered, not the time spent actually undertaking the therapy. For example, if someone needs 15 minutes of assistance to put on their compression hosiery, which they keep on for 6 hours a day, it is the 15 minutes of time which goes towards the weekly totals in 3c-3f, not the 6 hours

3b

Can an alarm be an aid/appliance?

Yes, it could replace/improve the memory function. However, everyone uses alarms to some extent. It would have to be shown that there was a medical condition that meant the use of the alarm was necessary.

Activity 4

4 Which descriptor should apply to someone with epilepsy for washing and bathing?

4a could apply if they have a shower in the house or 4b could apply if they need a shower attachment for the bath. Even if they don’t have a shower they can use a shower attachment for their bath taps. A shower attachment can be as effective as a conventional shower so there is no question that use of this would not be to the same standard as a bath / ordinary shower.

44ff Does between shoulders and waist mean whole torso?

Yes - Read 4f as if to say "Needs assistance to wash any part of their body between shoulders and waist".

44 Is there a definition of 'wash'?

There is no legal definition. The ordinary meaning, to clean oneself to an acceptable standard with water, should be used

4444 Can drying oneself be considered in this descriptor?

No, not only is it not mentioned in the descriptors but it is difficult to see why someone who could wash a particular area of their body could not then dry that same area

44

Activity 5

5b Is a bidet an aid or appliance?

Potentially, but the vast majority of people use one out of choice. If someone claims to need a bidet to clean themselves after using the toilet, 5b may apply if there is evidence that they cannot clean themselves by conventional means and that this is consistent with their medical condition.

5b Does activity 5b apply to someone who has to use a commode/bottle because they are unable to get to the toilet quickly enough?

If the Claimant is not incontinent then no. This Activity only refers to the ability to get on and off the toilet, to clean afterwards and to manage evacuation of the bladder and bowel - it does not include problems with mobilising or the ability to climb stairs. However, if the Claimant is incontinent then a commode or water bottle could be an aid. Their ability to get to the toilet is hampered not by their inability to mobilise but rather by their inability to properly control evacuation.

5 Is the ability to manage clothing considered in this Activity?

No. This is considered in Activity 6 – Dressing and Undressing

Activity 6 6 If someone must sit down to

dress/undress, are they carrying out that activity to “an acceptable standard”?

Yes. It is an acceptable method of completing this

activity. Many people choose to dress in such a manner.

6B If a Claimant must sit to dress/undress, and they use a chair, or the edge of a bed,

for this purpose, can the chair/bed be considered as

an aid?

No. A bed or chair is not a ‘device’ expressly made for the purpose of improving, providing or replacing the

impaired ability to dress/undress. In contrast a shoe horn, say, is expressly made for this purpose, and

could be considered an aid (if its use is medically required).

Activity 7

77 Does writing things down count as communication?

No. This activity relates to verbal communication. If a person has a hearing problem such that they need to communicate by writing then 7d would likely apply.

7b How should I score someone who has been prescribed a hearing aid but choses not to use it?

If someone claims that they can't use a hearing aid that they have been prescribed, the reason given must be checked to ensure that it is reasonable. So for example if someone says they don’t like using it for cosmetic reasons, this wouldn’t be reasonable. However if it was because of a chronic ear infection, this is likely to be reasonable

Activity 8

8 Is dyslexia considered under activity 8?

Potentially they could satisfy a descriptor but it depends on the severity of their dyslexia; there should be good supporting evidence to support your choice of descriptor

8 How should illiteracy be addressed?

In order to be taken into account illiteracy must be as a direct result of a health condition or impairment and not due to a lack of education.

8 If someone can only "read" using braille what descriptor should be used?

8e. The use of braille does not count. As per the PIP guide, the person must be able to physically see the "written or printed information".

Activity 9

9 Is vulnerability to the actions of others considered in activity 9?

Yes. If someone is unable to engage with others safely as a result of vulnerability because of a defined medical condition and to the extent that they need social support (9c) this should be taken into account. So, for example, someone with Downs Syndrome or autism may be less risk aware and vulnerable to manipulation or abuse.

9 What is the difference between "prompting" in descriptor 9b and "social support" in 9c?

9b "prompting" applies to people who need someone present for part of the time to help them socially engage, for example somebody with depression who might need intermittent encouragement; 9C "social support" applies to someone who can only engage with another person in the presence of a third party, so in effect they need someone with them all of the time, for example someone with a severe behavioural disorder or autism

9 Can a violent person satisfy 9d(ii)?

Yes, but the violent behaviour must be due to an inability to control their behaviour and as a result of an underlying health condition. Violence relating to alcohol would not meet descriptors unless that person had alcohol dependency, and for the majority of time they were under the influence and a risk to others which is supported by a documented past history of violent behaviour . Violence relating to being provoked would only be considered if the low threshold for reacting was related to an underlying medical condition.

9 'Social Support' is defined as support from a person trained or experienced in assisting people to engage in social situations. What does a person 'experienced' in assisting people mean?

This can mean a family member or friend - just someone who is experienced in supporting the person and can compensate for their limited ability to engage socially.

9 Which descriptor would apply to a blind person under activity 9?

It is unlikely that a blind person would require either prompting or social support to engage with other people in which case descriptor 9a would apply. However, there may be individual cases where the person does require additional support for reasons unrelated to their visual impairment and the relevant descriptor should apply.

9 If a person is deaf and needs a sign language translator, would this meet descriptors under activity 9?

No, communication is covered by Activity 7. In Activity 9 the presence of another person as social support must be due to their inability to understand and respond to body language, other social cues and to assist in social integration.

9 The person can engage fully with people they know well, but cannot engage at all with strangers? Do they satisfy any of the descriptors?

Consideration should be given to whether the Claimant can engage with people generally, not just people they know well.

Activity 10

10 Does financial knowledge come into 'complex budgeting decisions'? When calculating household and personal budgets, or planning future purchases, does one not need to understand mortgage rates, interest rates, or similar financial instruments? What if they need to take on debt?

No, The activity does not include the sort of decisions which require financial knowledge, such as calculating interest rates or comparing mortgages. This is well beyond what is considered as complex. Complex budgeting involves making choices about what to spend money on, when to save, how to plan future purchases etc.

10 If someone has a physical condition that affects their ability to make everyday budgeting conditions, which descriptor should apply?

10a because the activity only relates to the cognitive ability to make budgeting decisions

10

If the person is, say, 16 should this be factored into their ability to manage a budget?

The age of the person or whether they have ever done any household budgeting is irrelevant - it is their ability to make budget decisions, for example their level of cognitive function, that is relevant

Activity 11

11 Does Activity 11 apply to people with physical conditions?

Only if the condition results in either sensory or cognitive impairment or severe anxiety. Activity 11 relates to the ability to plan and follow a journey but not the physical ability to move - this is covered under Activity 12. For example, someone with Crohn's Disease which leads to a severe anxiety about walking outdoors, which may lead to a score under Activity 11.

11 Does activity 11 apply to people who are violent?

In rare circumstances Activity 11 may apply but the violent behaviour must be due to an inability to control their behaviour and as a result of an underlying mental health condition; Also there must be good evidence that being accompanied by another person actually reduces the risk of the person committing a violent act.

11 What is 'overwhelming psychological distress'?

A severe anxiety state in which the symptoms are so severe that the person is unable to function. This may occur in conditions such as generalised anxiety disorder, panic disorder and agoraphobia

11 Under which activity is awareness of danger considered?

Activity 11. If someone cannot safely follow a journey because of a condition affecting sensory or mental health/intellectual/cognitive function then descriptors 11d or 11f should be considered

11 What descriptor applies if someone is actively suicidal?

if someone is actively suicidal they may require another person to accompany them out of doors in which case 11b would apply. There must be good evidence that the person is a high suicide risk by for example high level involvement of community mental health services, care plan approach etc

11b When would descriptor 11b apply?

This descriptor would most likely to apply to a person with agoraphobia or panic disorder who is able to leave their home but requires someone else to be with them in order to do so. It may apply if someone has anxiety in relation to a physical condition - they don't have to have a formal mental health diagnosis but there must be good evidence to support the stated level of functional impairment. For example: may apply to claimants who are able to follow the route of their journey themselves, for example they can work out where they need to go, follow directions and deal with unexpected changes in their journey. However, due to their mental health condition or impairment, they become overwhelmed with distress, unless they are prompted by another person. This means they are able to leave the home but are unable to complete any journey, including a short familiar journey, without prompting from another person.

11e When would 11e apply?

This descriptor would most likely to apply to a person with agoraphobia or panic disorder who is unable to leave their home at all.

11c When would 11c apply

Applies to claimants with cognitive or sensory impairments, who cannot formulate a plan for their journey using simple materials, such as bus route map and timetable, but who can follow a journey planned by someone else for example take a bus journey on their own. Such a person is likely to be able to ask for help with their route if the bus is diverted. This descriptor is unlikely to apply to mental or behavioural disorders.

11d and f When would 11d and 11f apply?

Applies to claimants with cognitive or sensory impairments who cannot, due to their impairment, work out where to go, follow directions or deal with unexpected changes in their journey when it is unfamiliar. ‘Follow’ does not include the physical act of moving, it is the visual, cognitive and intellectual ability to reliably navigate a route that should be considered. The accompanying person should be actively navigating for the descriptor to apply. If the accompanying person is present for any other purpose, this descriptor does not apply. Cognitive impairment encompasses orientation (understanding of where, when and who the person is), attention, concentration and memory. Conditions that may impair cognitive function include physical conditions (such as stroke, head injury, dementia), learning disabilities, and mental health conditions such bipolar disorder or psychotic illnesses (e.g. schizophrenia). Consider this example: a person with learning difficulties is left alone to walk home. If left in a familiar area can they safely and reliably get home, if not then 11f applies. If they can get home from a familiar location, move on to the next relevant descriptor in this category 11d. If they were left in an unfamiliar area for example a new shopping area in town, could they do this? If no 11d may be satisfied. Small disruptions and unexpected changes, such as roadworks and changed bus stops, are commonplace and should be taken into account when considering if individuals can follow routes reliably

11 Should the use of public transport be considered?

A person should only be considered able to follow an unfamiliar journey (11d) if they are capable of using public transport. The reason for not being able to use it must be because of their cognitive/sensory impairment. A physical reason for not being able to use public transport, such as being unable to negotiate a high step, or an inability to speak English does not count.

11f Can activity 11f apply to someone with epilepsy?

Rarely. Only if there is evidence of cognitive impairment in that the person has uncontrolled epilepsy which results in fits on the majority of days and prolonged episodes of post fit confusion. There should be evidence that the fits are poorly controlled, e.g. the person is likely to be on multiple antiepileptic medication, under the care of a neurologist and will not be able to drive. The vast majority of people with epilepsy do not require another person to accompany them to navigate out of doors.

11 Where might epilepsy be relevant?

Those with well controlled epilepsy might safely go out alone in which case 11a should apply. A small minority of people with epilepsy might be so anxious about having a fit that they will not go out alone or might feel the need for reassurance when out - in which case 11b might apply. 11c, 11d and 11e are unlikely to apply.

Activity 12

12 On what surface should the walking be judged?

It should be judged in relation to a flat surface normally expected out of doors such as pavement and includes the consideration of kerbs

12 Can moving in a wheelchair be considered?

“Stand and then move” requires an individual to stand and then move independently while remaining standing. It does not include a claimant who stands and then transfers into a wheelchair or similar device. Individuals who require a wheelchair or similar device to move a distance should not be considered able to stand and move that distance. .

12 'Stand' is defined as being 'upright' - what if the Claimant can only move in a stooped position?

Posture should be taken into account if it affects the person's ability to mobilise safely and to an acceptable standard (e.g. without severe discomfort).

12 What factors should be assessed when considering whether a Claimant can walk to a ‘reasonable standard’?

When assessing whether the activity can be carried out reliably, consideration should be given to the manner in which they do so. This includes but is not limited to, their gait, their speed, the risk of falls and symptoms or side effects that could affect their ability to complete the activity, such as pain, breathlessness and fatigue. However, for this activity, this only refers to the physical act of moving. For example, danger awareness is considered as part of activity 11.

chapter p2: assessment for pip · chapter p2: assessment for pip . daily living and mobility...

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