«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
2.14.26. In TI cases, a telephone call to a different health professional should be considered. If there is no suitable alternative the HP should provide proof of consent. Once this has been provided, the HP should call the healthcare professional involved in the claimant’s care again. If the healthcare professional involved in the claimant’s care remains unwilling to provide the information in TI cases, an appropriate alternative person - e.g. their consultant - should be telephoned.
Consent in third party claims 2.14.27. The PIP Terminal Illness legislation creates special provision for a third party to make a claim on behalf of a disabled person without their knowledge.
2.14.28. Further information relating to the TI claim may be required and, due to the tight timescales involved in TI claims, contact with the claimant’s own health professionals may be required. When making contact with that professional by telephone the HP must make it clear if they do not hold consent from the disabled person to permit disclosure of information about their condition and explain the provision for third party claims under the Terminal Illness rules.
2.14.29. The HP should also ensure that the claimant’s health professional understands that a written record will be made of any information given during the telephone conversation and that this will be available to the patient at a later date unless there is “Harmful Information”.
2.14.30. It will be for the individual professional to determine whether they wish to release information about the claimant to the HP. The HP should not apply pressure to the professional to supply this information.
Confidentiality 2.14.31. Personal information held by DWP is regarded as confidential.
Confidentiality is breeched when one person discloses information to another in circumstances where it is reasonable to expect that the information will be held in confidence. The duty of confidentiality continues after the death of an individual to whom that duty is owed.
2.14.32. DWP takes confidentiality very seriously and all confidential information should be held securely and in accordance with legislation. With regard to requests for personal information,
Telephone conversations 2.14.33. It is important that in all telephone contact with claimants or their representatives, the correct person is being spoken to. For all incoming calls the caller’s identity must be verified. If there is any doubt, the telephone call should be terminated and, if necessary, the claimant or their representative be contacted using the telephone contact number on file.
2.14.34. Personal information should never be left on answering machines or voice-mail facilities.
Confidential information 2.14.35. Any written information that is marked by a claimant or a third party as “confidential” or “in confidence” cannot be used in a claim for PIP as it cannot be further disclosed to a Case Manager.
2.14.36. If the claimant states that they want to tell the HP something “in confidence” and that they do not want recorded in the HP’s advice, the HP should explain to them that they are unable to take such information into account, as the Case Manager would have no access to it.
Releasing information to the claimant 2.14.37. Other than information about their appointments with the HP or an update on their current position in the assessment process, it is not the role of the provider to release information to the claimant; and/or their representative, Appointee or person who has Power of Attorney/Deputy. Anyone making a request must be advised that requests for information should be made to the DWP.
Solicitors & representatives and Third Party Requests
2.14.38. Solicitors and/or claimant representatives such as support agencies may approach a provider with requests for copies of all information held – e.g. in personal injury compensation cases. Providers have no role to play in releasing information to a third party, and the person making the requests must be advised to contact the DWP.
Release of information to the claimant’s MP 2.14.39. It is usually accepted that if a claimant has authorised their MP to write on their behalf they have consented to the MP seeing information relating to their claim. This authorisation does not extend to the claimant’s spouse or relatives so in these circumstances consent from the claimant to communicate with the MP should be sought by the MP themselves.
3. The Assessment Criteria 3.0.1. This section outlines the assessment criteria for Personal Independence Payment. It explains how the assessment is structured, including how the activities and descriptors fit together to determine entitlement to each of the two components. It also includes the assessment criteria themselves and guidance for HPs on how to apply them.
3.1. The assessment approach 3.1.1. Personal Independence Payment will provide a cash contribution towards the additional costs faced by disabled people as a result of needs arising from a health condition or impairment. The Department considered whether it would be possible for the Personal Independence Payment assessment to assess the actual extra costs incurred by an individual. However, it was felt that doing so would create a very complicated and lengthy assessment, which would be both subjective and inconsistent, going against the aims of the new benefit. The Department instead decided that the most effective means of determining entitlement would be to consider a proxy for the impact and additional costs arising from disability.
3.1.2. The PIP assessment therefore focuses on assessing an individual’s ability to participate, defining ‘participation’ as ‘involvement in life situations’. The criteria are focused on outcomes and the impact of a health condition or impairment on an individual’s ability to carry out a range of activities which are fundamental to everyday life. It would not be practical for the assessment to take account of the impact of a health condition or impairment on all everyday activities, nor to seek to include all possible areas where extra costs may be generated. This would lead to over-complexity and be challenging for consistency, administration and the time needed for assessments. Instead the assessment considers a series of key activities that cumulatively act as a proxy and so seeks to identify those individuals who are likely to have the highest level of need.
There are ten daily living activities and two mobility activities.
3.1.3. Underpinning each activity are a number of descriptors, each describing a varying level of ability to carry out the activity – for example, ranging from being able to carry out an activity unaided to not being able to carry it out at all. Some activities have more descriptors than others.
3.1.4. When assessing an individual, the descriptor most appropriate to the individual within each activity will be chosen.
3.1.5. Each descriptor in the assessment criteria has a numeric point score attached to it, reflecting both the level of ability it represents and the overall importance of the activity. The total scores for all of the activities related to each component are added together to determine entitlement for that component. The entitlement threshold for each component is 8 points for the standard rate and 12 points for the enhanced rate.
3.2. Applying the criteria 3.2.1. The assessment will consider a claimant’s ability to undertake the activities detailed below. Inability to undertake activities must be due to the effects of a health condition or impairment and not simply a matter of preference by the claimant.
3.2.2. A health condition or impairment may be physical, sensory, mental, intellectual or cognitive, or any combination of these. The impact of all impairment types can be taken into account across the activities, where they affect a claimant’s ability to complete the activity and achieve the stated outcome. For example, a claimant with a severe depressive illness may physically be able to prepare food and feed himself, but may lack the motivation to do so, to the extent of needing prompting from another person to carry out the task.
However, some activities focus on specific elements of function. For example, Moving around relates to the physical aspects of walking, whilst Engaging with other people face to face relates to the mental, cognitive or intellectual aspects of interacting with other people.
3.2.3. When assessing a claimant, the HP should consider all the evidence of the case and the likely ability of the claimant over a year-long period (see 3.2.9) before selecting the most appropriate descriptor to the claimant relating to each of the assessment activities, taking into account their level of ability, whether they need to use aids or appliances and whether they need help from another person or an assistance dog.
3.2.4. In choosing descriptors, the HP should use their knowledge of the health condition or impairment as a measure of the level of disability that would be expected from the claimant's condition. For example, it is unlikely that mechanical low back pain is unremitting day after day, because the natural history is of pain that varies from day to day, and it would be appropriate to make this observation in the report. However, it is insufficient for the HP to argue just from the general principle when justifying descriptor choices; the evidence has to relate to the specific claimant.
3.2.5. The fact that an individual can complete an activity is not sufficient
evidence of ability. HPs may find it helpful to consider:
3.2.6. People are influenced by their perceptions and beliefs about their condition; and this can affect the level of disability they experience.
Some individuals are able to cope to a large extent and may perceive a much lower level of disability, while others may be far more disabled than might be expected from their condition. The key to choosing descriptors is to evaluate whether the history and the claimant's behaviour are consistent, not just with the nature of the disabling condition but also with the claimant's lifestyle.
3.2.7. HPs should not consider the point scores associated with descriptors or whether these will confer entitlement to the benefit if chosen by Case Managers. HPs should only consider whether the descriptor is appropriate to the claimant’s circumstances.
Reliability 3.2.8. For a descriptor to be able to apply to a claimant, the claimant must be able to reliably complete the activity as described in the descriptor. More information on this can be found in section 3.3.
Time periods, fluctuations and descriptor choices 3.2.9. The impact of most health conditions and impairments can fluctuate over time. Taking a view of ability over a longer period of time helps to iron out fluctuations and presents a more coherent picture of disabling effects. Therefore the descriptor choice should be based on consideration of a 12 month period. This should correlate with the Qualifying Period and Prospective Test for the benefit – so the HP should broadly consider the claimant’s likely ability in the three months before the assessment and in the nine months after.
3.2.10. A scoring descriptor can apply to claimants in an activity where their impairment(s) affects their ability to complete an activity, at some stage of the day, on more than 50 per cent of days in the 12 month
period. The following rules apply:
3.2.11. If someone is awaiting treatment or further intervention it can be difficult to accurately predict its level of success or whether it will even occur. Descriptor choices should therefore be based on the likely continuing impact of the health condition or impairment as if any treatment or further intervention has not occurred.
3.2.12. The timing of the activity should be considered, and whether the claimant can carry out the activity when they need to do it. For example if taking medication in the morning (such as painkillers) allows the individual to carry out activities reliably when they need to throughout the day, although they would be unable to carry out the activity for part of the day (i.e. before they take the painkillers), the individual can still complete the activity reliably when required and therefore should receive the appropriate descriptor.