«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
Form DS1500 received without a claim form 2.4.29. The DS1500 should be sent to DWP not to providers. Any DS1500s received direct by providers should not be considered. Unsolicited DS1500s should be sent urgently to DWP, with an explanation as to the reason why the provider is sending the form.
Claimant questionnaire or further evidence suggests SRTI applies in standard claims 2.4.30. If evidence of a terminal illness meeting the prescribed conditions is uncovered following receipt of the claimant questionnaire or additional evidence in a non-SRTI claim, then advice should be given to DWP that the claimant fulfils the criteria for SRTI and the case should then be treated as an SRTI referral. The assessment report must be completed and returned to DWP using the work queue for SRTI within two working days from that point. The advice should fully justify why the claim is being treated as a SRTI case.
2.4.31. Should an HP identify that a claimant is likely to meet the SRTI conditions during a face-to-face consultation and the claimant is aware of their condition, the HP should treat the case as a SRTI referral. The HP should consider whether it would be more appropriate to complete clerical form PA2 or the relevant screens in the PIP Assessment Tool where in their opinion the claimant is terminally ill under the prescribed conditions. They should also provide advice for the mobility component based on the evidence received with the referral and/or gathered at the face-to-face consultation.
2.4.32. In a small number of cases, the individual may not be aware they are terminally ill. In these cases, providers and the Department must ensure the claimant is not inadvertently advised of their prognosis.
Before treating a standard claim as a SRTI claim, the HP should take steps to discreetly gain an understanding of the level of knowledge the claimant has about their own condition and prognosis. For example, if the evidence of terminal illness comes from the claimant’s GP, the HP should telephone the GP to confirm
Author has misunderstood the purpose of the DS1500 2.4.33. Very occasionally, the HP will encounter a case where the contents of the DS1500 reveal that the author has completely misunderstood its purpose; for example, where there is no implication that the claimant is suffering from a terminal illness. The HP should return the assessment report to DWP with any supporting evidence, if obtained, stating that the claimant is not terminally ill under the prescribed definition and that the author has misunderstood the purpose of the DS1500.
2.5. Paper-Based Review 2.5.1. It is critical that all advice offered by HPs in PIP assessments is fully evidence based and HPs should only choose to advise on an assessment without a face-to-face consultation where there is evidence to enable them to advise on all aspects of the case.
Suggested method for approaching cases 2.5.2. The following guidance provides a structured framework that HPs will want to consider when undertaking paper-based reviews
2.5.3. Consider obtaining FE if there is a significant gap in the available information, there is doubt about the level of function or if it is required in order to provide robust advice 2.5.4. There does not need to be independent corroborating evidence in every case. Where the available information is comprehensive, clearly outlines the extent and nature of any functional problems and, above all, is consistent with the claimed condition(s) without raising doubt in the HP’s mind on the level of function, then this should be sufficient.
2.5.5. When requesting FE:
Contacting the claimant 2.5.6. Claimants should be contacted if the HP considers that they need to clarify certain points, for example reliability or variability or to obtain additional information from them, or to ask for additional sources of information. The phone call should not be a telephone interview for example it should not be used if there are numerous inconsistencies in the claimant questionnaire. However, if there is information missing or the HP is considering a face-to-face consultation in order to clarify a small number of areas or activities, a phone call may provide the additional necessary facts and allow for paper-based advice.
Balance of probabilities
2.5.7. In some cases there may be sufficient information to advise on the majority of activities, but which leaves small gaps that it has not been possible to fill through obtaining FE or by contacting the claimant. In such cases, where the available information is consistent, the HP should consider whether they can use their own expert clinical knowledge of the condition(s), its severity and known impact in other areas to determine, on the balance of probabilities, the likely impact in the remaining areas. If they feel confident doing this and it would be in line with the consensus of medical opinion, then a paper-based review may still be possible, referring to such in the summary justification.
HPs advice 2.5.8. Apart from personal details and informal observations that can only be obtained at a face-to-face consultation, the HP must complete the paper-based review in line with the advice given in this guidance
from section 2.8 onwards. HPs are required to advise on:
2.5.9. The HP must - where appropriate - provide an overall summary justification or an individual justification for each descriptor choice to support the advice and provide the reasons for the advice.
Cases that should not require a face-to-face consultation 2.5.10. In certain circumstances it should be possible to provide advice at a paper based review. Although each case should be determined individually, The following types of cases should not normally require
a face-to-face consultation:
• The claimant questionnaire indicates a high level of disability, the information is consistent, medically reasonable and there is nothing to suggest over-reporting
• The health condition(s) is severe and associated with a high level of functional impairment which is consistently claimed. Examples
• Any case where there is sufficient detailed, consistent and medically reasonable information on function.
Cases that are more than likely to require a face-to-face consultation 2.5.11. For cases where there is marked inconsistency, the claimed level of disability is unexpected based on the available evidence, or it has not been possible to gain sufficient FE or to advise based on the balance of probability, face-to-face consultation may be required.
Although each case should be determined individually, the following types of cases are examples which may require a face-to-face
• No claimant questionnaire has been provided and no other information is available
• There are numerous inconsistencies in the claimant questionnaire that are unlikely to be clarified by additional evidence or a phone call to the claimant
• Formal examination findings and informal observations are required to provide robust advice
• High level of functional impairment is claimed and the health condition is usually associated with mild disability.
• Low level functional impairment is claimed and the health condition is usually associated with high disability
• The claimant has a health condition that is known to run a variable course over time but claims continual problems, for example low back pain
• There is insufficient evidence to provide advice despite trying all appropriate avenues.
2.6. Face-to-Face Consultation 2.6.1. During the application process, a suite of evidence is gathered in order to build a clear picture about the functional effects of the claimant’s health condition or impairment on their day-to-day lives, including information gathered from face-to-face consultations. This enables the HP to complete a clear, fully reasoned and justified report for the Case Manager. History taking during the face-to-face consultation, whether through the clinical, functional, social or occupational history is important to PIP as this will help towards building a clear picture of the claimant’s day-to-day life.
2.6.2. The consultation process involves interviewing the claimant and, where appropriate, any companion; making informal observations throughout the interview and carrying out a focused examination where relevant. The information gathered from this process will enable the most appropriate activity descriptors to be chosen and will provide the HP with the material required for factual justifications of descriptor choices and other advice.
2.6.3. Face-to-face consultations may be carried out at a range of locations, including an assessment centre, local healthcare centre or at the claimant's own home.
2.6.4. This section contains guidance for HPs on how to carry out face-toface consultations, including giving a standard structure to consultations. However, HPs should be prepared to adapt their approach to the needs of the particular claimant, not taking a prescriptive approach and ensuring that claimants are able to put across the impact of their health condition or impairment in their own words. It is important that claimants feel they have been listened to and that the consultation feels like a genuinely two-way conversation.
2.6.5. The relevant information required when offering advice on a face-toface consultation is set out in the clerical form PA4 or the relevant screens in the PIP Assessment Tool. See section 2.8 regarding completing assessment reports.
Before starting the consultation 2.6.6. Before starting the consultation, the HP should read the claimant questionnaire and all other evidence on file which may include, but
may not be limited to:
• Supporting information supplied by the claimant
• Any further medical or other evidence supplied by the claimant
• Information from the claimant's GP or other relevant supporting professional gathered by the provider
• Information from earlier claims and assessments, if the claimant is being reassessed for an existing entitlement to PIP.
2.6.7. When meeting the claimant, the HP should:
Interview skills 2.6.8. Throughout consultations, the HP should use clear language that the claimant will readily understand. For sighted claimants, body language should be positive – for example, sitting to face the claimant, maintaining good eye contact, nodding to indicate understanding of what is being said and leaning forward toward the claimant from time to time. Where the HP decides to record information on any computer systems, the HP should ensure that they look up frequently from the screen and continued to maintain eye contact, thereby demonstrating that they are focusing on the claimant and what they are saying. For blind and partially sighted claimants, the HP should explain what they are doing at each stage of the assessment.
2.6.9. The approach should be relaxed and unhurried, allowing the claimant time and encouraging them to talk about themselves and put across the impact of their health condition or disability in their own words. The claimant and any companion should feel fully involved in the process and feel that the consultation is a genuine two-way process. Summarising back to the claimant what has been said is useful to show active listening and to ensure that key pieces of information have been correctly heard.
2.6.10. Different types of questions should be used where appropriate:
Inconsistencies in the level of functional limitations 2.6.11. Throughout the consultation, HPs should be evaluating what they are being told and checking whether the evidence is consistent.