«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
Inconsistencies could result in claimants either over or under emphasising the impact of their conditions and efforts should be made to avoid both. For example, is the level of functional impairment claimed in one activity compatible with that claimed in another? If a claimant can handle a toothbrush, it is unlikely they cannot handle kitchen cutlery. If a claimant cannot bend to put on their shoes, it is unlikely that they are able to wash below the waist.
2.6.12. The HP should check the consistency of what is being said by using different approaches, asking questions in different ways or coming back to a previous point. When considering inconsistencies, HPs should bear in mind that some claimants may have no insight into their condition, for example claimant’s with cognitive or developmental impairments.
History of conditions
2.6.13. The HP should record a succinct and relevant history of all the health conditions or impairments that affect the claimant. The HP should record when the condition began and - if there are any changes, when the change occurred. If the diagnosis is unclear - for example the claimant has low back pain probably of mechanical origin but they are still being investigated to rule out prolapsed intervertebral disc or other specific diagnosis - the HP should record the condition as a symptom such as "low back pain of uncertain origin", rather than trying to guess at the underlying pathology.
2.6.14. The HP should record treatment given, and how effective it has been, and whether any further intervention, such as physiotherapy or a surgical procedure, has been carried out or is planned. The HP should also include what relevant investigations have been carried out or planned for the future.
2.6.15. The HP should also include details of fluctuating conditions, indicating how frequent the fluctuations are, how long exacerbations last and, on balance, how many "good" days or weeks and how many "bad" ones the claimant experiences over time.
2.6.16. Although the HP may consider that the claimant’s view of the impact of their condition is unrealistic or inconsistent with other evidence, the place to address this is later in the report, when justifying their advice.
2.6.17. Where the claimant’s clinical history is accurately detailed in either the claimant questionnaire or in supporting evidence, the HP may reference where it is recorded instead of reproducing this information in the assessment report.
2.6.18. All current medication should be recorded. Include “over-thecounter” medication as well as prescribed drugs. For each medication record the frequency, dosage and purpose (where known) in full. Any relevant drug side effects which affect the claimant’s functionality should be recorded here and an indication of the effectiveness of any treatment provided. The HP should also include any alterations to medication which may have occurred since the questionnaire or supporting evidence was supplied.
2.6.19. The HP should record any other prescribed therapies such as physiotherapy, making a note of who prescribed them, how often they are carried out, and how effective they are.
2.6.20. Where the claimant’s current medication is accurately recorded in either the claimant questionnaire or in supporting evidence, the HP may reference where it is recorded instead of reproducing this information in the assessment report.
Social and occupational history 2.6.21. The HP should record a concise and relevant social and occupational history. What type of dwelling does the claimant live in and do they live alone or with others? Can they access all areas of their home and have they made any modifications? Social and leisure activities undertaken by the claimant and any they have given
Employment 2.6.22. If the claimant is in employment, it is important that this information is explored and recorded as part of the evidence gathered in ‘social and occupational history’.
2.6.23. The HP should record the occupation and the nature of the job i.e.
their activities on a daily/weekly basis, including any adjustments made by their employer. They should also include information where the claimant has given up work or changed their job due to the functional limitations of their health condition or impairment.
2.6.24. The HP should be evaluating evidence and checking for inconsistencies. For example, the claimant questionnaire states that the claimant is unable to bend at the waist or raise their arms for washing and dressing, however they work 4 hours a day at their local supermarket and during their working day, they may bend and raise their arms while stacking shelves or operating a till without pain or discomfort. Here the claimant’s employment activities are not consistent with claimed assistance needed with washing and dressing.
Functional history including the ‘typical day’ 2.6.25. HPs should record the functional effects of the claimant’s health condition or impairment in relation to the daily living and mobility activities.
2.6.26. Evidence gathered in the functional history is an integral part of the assessment process as it should provide the Case Manager with a clear picture of the claimant’s day-to-day life.
2.6.27. The ‘typical day’ is a tool used to explore the claimant’s perception of how they manage their daily living, and the nature and extent of the functional limitations resulting from their health condition or impairment. The HP should invite the claimant to talk through all the activities they carry out on a normal day, from when they get up to when they go to bed.
2.6.28. The functional history is the claimant's own perspective on how they manage the daily living and mobility activities. What functional limitations do they have as a result of their health condition or impairment? It is not the HP’s opinion of what the claimant should be able to do. It should be recorded in the third person, and should make it clear that this is the claimant's story. For example, "He gets up at... and says he can wash and dress without any difficulty"; "She states that she finds it difficult to lift heavy saucepans". Wherever possible, the record should contain specific examples to illustrate difficulty with activities. For example, "He finds buttons difficult and tends to wear clothes that can be pulled over his head"; "She can manage to feed herself but needs to have meat cut up for her".
2.6.29. The HP should explore all the PIP activity areas for daily living and mobility, focusing on the activities most likely to be affected by the claimant's condition. The HP should do this by using open-ended questions to begin with (such as "tell me about..."), and not just by asking a series of closed questions (such as "can you wash yourself without help?"). The HP should encourage the claimant to expand their answer to explore how easy or difficult they find a task. Do they need help to carry it out or are they completely unable to do it and need someone else to do it for them? The HP should explore how long it takes the claimant to carry out a task and whether they experience any symptoms or side-effects such as pain, fatigue or anxiety, either during or after the activity. If help is given from another person, the HP should record the type of help, who gives it, how often and for how long.
2.6.30. The HP should explore any variability or fluctuation in the claimant's condition and functional ability by asking the claimant what they can do on "good" days and "bad" days. How many "good" and "bad" days do they have over a period of time? For some conditions different time periods will need to be considered, such as the potential impact of different times of the day. If a claimant is unable to complete an activity or needs support to do so at a point in the day when you would reasonably expect them to complete it, the need should be treated as existing for the whole of the day, even if it does not exist at other points in the day.
2.6.31. In general, HPs should record function over an average year for conditions that fluctuate over months, per week for conditions that fluctuate by the day, and by the day for conditions that vary over a day. Information about variability is important in assessing the functional effects of the claimant’s condition that apply on the majority of days (bearing in mind that advice will need to consider the impact of conditions over a year-long period). A "snapshot" view of the claimant's condition on a particular day at a particular time is not an adequate assessment.
Other relevant functional information 2.6.32. As well as covering all the PIP activity areas, the typical day should also cover other activities such as housework, shopping and caring responsibilities for adults, children and pets. Although these are not specifically considered in determining entitlement to benefit, they give additional supporting information about functional ability. For example, doing housework provides information about mobility, manual dexterity and fatigability. A claimant who provides information that they take the dog out for a walk every day would not be compatible with the claimant questionnaire which says their mobility is limited to house and garden. Shopping habits may provide information about mobility and cognitive functioning. The claimant’s ability to drive and whether they drive in their current day-to-day life, may also demonstrate the claimant’s cognitive ability and manual dexterity.
2.6.33. Similarly, asking about hobbies and pastimes provides useful additional information. For example, doing crossword puzzles requires visual acuity, manual dexterity, concentration and cognitive ability. Asking about hobbies and pastimes allows the HP to check the consistency of what the claimant is saying.
Informal observations 2.6.34. Informal observations are part of the suite of evidence used by Case Managers to help them determine entitlement to benefit.
2.6.35. Informal observations are of paramount importance to the consultation, as they can reveal abilities and limitations not mentioned in the claimant questionnaire, supporting evidence or during the history taking for the face-to-face consultation. They may also show the discrepancies between the reported need and the actual needs of the claimant.
2.6.36. The HP should be making informal observations and evaluating any functional limitations described by the claimant from the start of the consultation (where HPs may be able to observe the claimant's appearance, manner, hearing ability, walking ability), during the history taking, through to the conclusion of the consultation. The claimant's mood, powers of concentration and ability to stand, sit, move around freely and use their hands should be observed. They may also be observed performing activities such as bending down to retrieve objects such as a handbag on the floor beside them, or reaching out for an object such as their medication. How does the claimant remove their coat or shoes? Informal observations should be recorded in the report, for example: "I observed the claimant...
and they appeared to have no difficulty with..."; "I saw the claimant lean heavily on a walking stick to cover the distance to the consulting room".
2.6.37. The HP should note any aids or appliances in evidence, such as a walking aid, and the extent to which they are used during the consultation. Aids are devices that help a performance of a function, for example walking sticks or spectacles. Appliances are devices that provide or replace a missing function, for example artificial limbs, wheelchairs, or collecting devices for stomas.
2.6.38. The HP’s informal observations will also help check the consistency of evidence on the claimant's functional ability. For example, there is an inconsistency of evidence if a claimant bends down to retrieve a handbag from the floor but then later during formal assessment of the spine, declines to bend at all on the grounds of pain, or if the claimant states that they have no mobility problems but they appear to struggle to walk to the consulting room. In deciding their advice, the HP will need to weigh this inconsistency, and decide, with full reasoning, which observation should apply.