«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
Cannot follow the route of a familiar journey without another person, an F assistance dog or an orientation aid.
This descriptor is most likely to apply to claimants with cognitive, sensory or developmental impairments, who cannot, due to their impairment, work out where to go, follow directions or deal with unexpected changes in their journey, even when the journey is familiar.
To ‘follow’ is the visual, cognitive and intellectual ability to reliably navigate a route. The ability to walk itself is assessed in activity 12.
Cognitive impairment encompasses orientation (understanding of where, when and who the person is), attention, concentration and memory.
Any accompanying person should be actively navigating for the descriptor to apply. If the accompanying person is present for any other purpose then this descriptor will not apply.
Small disruptions and unexpected changes, such as road works and changed bus-stops are commonplace when following journeys and consideration should be given to whether the claimant would be able to carry out the activity as described if such common place disruptions occur. Consideration should also be given to whether the claimant is likely to get lost. Clearly many people will get a little lost in unfamiliar locations and that is expected, but most are able to recover and eventually reach their target location. An individual who would get excessively lost, or be unable to recover from getting lost would be unable to complete the activity to an acceptable standard.
For example, a person with learning difficulties is out shopping in town. On their way home (a familiar journey), a road they would normally walk down has been closed off due to a police incident. If the person wouldn’t be able to successfully navigate an alternative route home then this descriptor would apply. If they can follow a familiar route even with minor diversions, move to descriptor D.
Safety should be considered in respect of risks that relate to the ability to navigate, for example visual impairment and substantial risk from traffic when crossing a road.
Activity 12 – Moving around This activity considers a claimant’s physical ability to move around without severe discomfort, such as breathlessness, pain or fatigue. This includes the ability to stand and then move up to 20 metres, up to 50 metres, up to 200 metres and over 200 metres.
As with all the other activities, a claimant is to be assessed as satisfying a descriptor only if the reliability criteria are also considered. The claimant must be
able to undertake the activity:
• safely (in a manner unlikely to cause harm to the claimant or to another, either during or after completion of the activity);
• to an acceptable standard;
• repeatedly (as often as the activity being assessed is reasonably required to be completed); and
• within a reasonable time period (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).
This activity should be judged in relation to a type of surface normally expected out of doors, such as pavements on the flat and includes the consideration of kerbs.
‘Standing’ means to stand upright with at least one biological foot on the ground with or without suitable aids and appliances (note – a prosthesis is considered an appliance, so a claimant with a unilateral prosthetic leg may be able to stand, whereas a bilateral lower limb amputee would be unable to stand under this definition).
“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.
Aids or appliances that a person uses to support their physical mobility may include walking sticks, crutches and prostheses.
When assessing whether the activity can be carried out reliably, consideration should be given to the manner in which the activity is completed. This includes but is not limited to, the claimant’s 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.
NB: in legislation this activity is referred to as Mobility Activity 2.
Can stand and then move more than 200 metres, either aided or A unaided.
Can stand and then move more than 50 metres but no more than 200 B metres, either aided or unaided.
For example, this would include people who can stand and move more than 50 metres but no further than 200 metres either by themselves, or using an aid or appliance such as a stick or crutch, or with support from another person.
Can stand and then move unaided more than 20 metres but no more C than 50 metres.
Within the assessment criteria, the ability to perform an activity ‘unaided’ means without either the use of aids or appliances; or help from another person.
For example, this would include people who can stand and move more than 20 metres but no further than 50 metres, without needing to rely on an aid or appliance such as a walking stick, or help from another person.
Can stand and then move using an aid or appliance more than 20 metres D but no more than 50 metres.
For example, this would include people who can stand and move more than 20 metres but no further than 50 metres, but need to use an aid or appliance, such as a stick or crutch to do so.
Can stand and then move more than 1 metre but no more than 20 E metres, either aided or unaided.
For example, a person who can stand and move more than 1 metre, but no further than 20 metres, either unaided or with the use of an aid or appliance such as a stick or crutch, or support from another person.
4. Health Professional Performance 4.0.1. This chapter sets out the processes to be followed by providers to ensure HPs carrying out PIP assessments meet the required performance standards, including the requirements around competencies, training, approval audit and complaint handling.
4.1. Health Professional Competencies 4.1.1. All HPs recruited for the delivery of PIP assessments (or any parts of
these) must meet the following requirements:
• Are able to critically evaluate evidence and use logical reasoning to provide accurate evidence based advice
• Have excellent interpersonal and written communication skills
that include the ability to:
o Interact sensitively and appropriately, with particular regard for an individual’s cultural background and issues specific to disabled people o Take a comprehensive, appropriately focused and clear history o Accurately record observations and formal clinical findings o Produce succinct, accurate reports in plain English, fully justifying conclusions from evidence gathered, and dealing appropriately with apparent conflicts of evidence and fluctuating conditions.
4.2. Training of Health Professionals Initial training 4.2.1. Assessment providers are required to put in place suitable training programmes to ensure that HPs carrying out assessments meet the competency requirements set out in section 4.1.. They should involve the Department in the quality assurance process for the development and on going refinement of these programmes and the quality standards associated with them. Where relevant, training programmes should be based on this guidance.
4.2.2. The training programmes should include, but not be limited to,
ensuring HPs have:
4.2.3. Training programmes should involve both theoretical and simulated practical elements, with relevant examinations. Following training, HPs should undergo a written and practical assessment to ensure that the required level of competence has been achieved and that they can demonstrate this to the Department (see section 4.3 below).
Refresher Training and on going Continuing Professional Development 4.2.4. Providers are required to develop, deliver and evaluate a programme of refresher training and Continuing Professional Development (CPD) on an annual basis for all HPs involved in delivering PIP assessments.
4.2.5. Each HP should be given a personal training plan on an annual basis, containing details of the modules to be delivered to the individual and the timescales in which they will be delivered.
4.2.6. The Department may require that topics be included in the CPD programme.
Training Plans 4.2.7. Providers are required to undertake a Training Needs Analysis at organisational level to identify areas of training needs together with priorities for implementation. The scope, objectives and methodology of the analysis will be subject to prior approval by the Department.
4.2.8. Providers are also required to supply the Department with a Training Plan setting out in detail the manner in which their training programme, both initial training and refresher training / CPD, will be delivered. This plan should be developed in co-operation with the Department and will be subject to Departmental approval.
4.2.9. Any subsequent changes to the Training Plan must be submitted to the Department for approval.
4.2.10. Providers must evaluate the effectiveness of their training and CPD programmes. The format and timescales of the evaluation should be agreed with the Department.
4.3 Approval / Revocation of Health Professionals 4.3.1. Before an HP can carry out PIP assessments they must go through a formal Approval Process to ensure they meet the Department’s requirements in relation to experience, skills and competence. Failure to demonstrate that HPs have reached or maintained the necessary standards or co-operate with feedback and/or retraining will result in Approval being refused/revoked.
4.3.2. Approval for an HP must be conferred by the DWP Chief Medical Officer (CMO) on behalf of the Secretary of State for Work and Pensions. This will, in turn, be based on the recommendation of providers who must provide evidence that the HP has demonstrated that they meet the required standards.
4.3.3. This section describes processes to be followed during the live-running of PIP assessment contracts.
Initial Approval 4.3.4.
The Initial Approval process must be undertaken:
Provisional Approval 4.3.6. Once HPs have successfully completed Stage 2 (Assessment of Competence) they will have Provisional Approval to carry out assessments. Providers do not need to inform the Department at this stage.
4.3.7. At this point the provider should keep evidence to demonstrate that the HP meets the required competence standards.
4.3.8. HPs with Provisional Approval should initially be supervised but once the provider is satisfied that they meet the required standards, they will be able to carry out assessments without supervision but subject to 100% audit until Full Approval is given by the Department.
Full Approval 4.3.9. Providers will be able to seek Full Approval from DWP for an HP once that HP has shown an ability to consistently apply the competence standards by achieving the following number of
consecutive Grade A audit results at Stage 4:
If the provider wishes to submit a HP for approval to carry out SRTI referrals only, they may do so when the HP has achieved 5 consecutive Grade A audit results for terminal illness cases. If the provider subsequently wishes to submit the same HP for approval to carry out paper-based reviews, the HP must achieve a further 5 consecutive Grade A results following paper-based reviews on nonSRTI referrals.
All cases which contribute to approval must be cases where advice is given either on a PA2, PA3 or PA4.