adm chapter p2: assessment for pip · chapter p2: assessment for pip ... reg 6(3)(a) p 2 0 1 2 t h...

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 ....................................................................................... P2066

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.

O n c e all t h e e vi d e n c e i s g at h er e d t h e D M will al s o a s s e s s t h e cl ai m a nt u si n g t h e

s a m e crit eri a a s t h e H P. T h e D M at t hi s p oi nt m a y al s o a s k t h e H P f or a d diti o n al

i nf or m ati o n if r e q uir e d, t o h elp t h e D M m a k e t h eir d e ci si o n.

1 S S ( PI P) R e gs, r e g 9( 1)

P 2 0 0 7 T h e H P i s s p e ci all y tr ai n e d t o a s s e s s a n d e v al u at e t h e i m p a ct of di s a bilit y o n a

cl ai m a nt’ s a bilit y t o c arr y o ut a cti viti e s of d ail y li vi n g a n d m o bilit y. T hi s i n cl u d e s t h e

aff e ct s of v ari a bl e c o n diti o n s.

P 2 0 0 8 T h e H P h a s a p pr o pri at e k n o wl e d g e of cli ni c al a s p e ct s of a wi d e r a n g e of m e di c al

c o n diti o n s a n d i s s kill e d i n a s s e s si n g p e o pl e wit h p h y si c al a n d m e nt al h e alt h

c o n diti o n s.

P 2 0 0 9 A H P will b e o n e of t h e f oll o wi n g

1. A n o c c u p ati o n al t h er a pi st

2. N ur s e (l e v el 1)

3. P h y si ot h er a pi st

4. P ar a m e di c

5. D o ct or ( G M C r e gi st er e d)

P 2 0 1 0 T h e H P pr o vi d e s a d vi c e t o t h e D M o n t h e li mit ati o n t o c arr y o ut d ail y li vi n g a n d/ or

m o bilit y a cti viti e s a n d a d vi s e s o n w hi c h d e s cri pt or s ar e a p pr o pri at e f or t h e cl ai m a nt.

T h e a d vi c e t h e H P pr o vi d e s i s b a s e d o n t h e d ail y li vi n g/ m o bilit y n e e d s ari si n g fr o m a

c o n diti o n or c o n diti o n s a n d n ot t h e c o n diti o n( s) it s elf.

P 2 0 1 1 T h e cl ai m a nt will b e a s s e s s e d a s h a vi n g li mit e d a bilit y if t h e d ail y li vi n g a cti viti e s or

m o bilit y a cti viti e s a c hi e v e a s c or e of at l e a st 8 p oi nt s1 i n e a c h c o m p o n e nt. T hi s will

t h e n l e a d t o a n a w ar d of t h e r el e v a nt c o m p o n e nt or c o m p o n e nt s at t h e st a n d ar d

r at e of PI P ( s e e P 2 0 1 4).

1 S S ( PI P) R e gs, r e g 5( 3)( a); r e g 6( 3)( a)

P 2 0 1 2 T h e cl ai m a nt will b e a s s e s s e d a s h a vi n g s e v er el y li mit e d a bilit y if t h e d ail y li vi n g

a cti viti e s or m o bilit y a cti viti e s a c hi e v e a s c or e of at l e a st 1 2 p oi nt s 1 i n e a c h

c o m p o n e nt. T hi s will t h e n l e a d t o a n a w ar d of t h e r el e v a nt c o m p o n e nt or

c o m p o n e nt s at t h e e n h a n c e d r at e of PI P ( s e e P 2 0 1 4).

1 S S ( PI P) R e gs, r e g 5( 3)( b ): r e g 6( 3)( b)

P 2 0 1 3 T h e s c or e i n r el ati o n t o t h e d ail y li vi n g a n d m o bilit y a cti viti e s i s d et er mi n e d 1 b y

a d di n g t o g et h er, i n r el ati o n t o e a c h a cti vi t y, t h e p oi nt s a w ar d e d a g ai n st t h e s el e ct e d

d e s cri pt or s.

1 S S ( PI P) R e gs, r e g 5( 1); r e g 6( 1)

P 2 0 1 4 T h e a p pli c a bl e d e s cri pt or f or t h e cl ai m a nt f or e a c h a cti vit y i s

1. w h er e o n e d e s cri pt or i s s ati sfi e d f or o v er 5 0 % of t h e d a y s, t h at d e s cri pt or 1 o r

2. w h er e t w o or m or e d e s cri pt or s ar e s ati sfi e d f or o v er 5 0 % of t h e d a y s, t h e

d e s cri pt or w hi c h s c or e s t h e hi g h e st n u m b er of p oi nt s 2 o r

3. w h er e n o d e s cri pt or i s s ati sfi e d f or o v er 5 0 % of t h e d a y s b ut t w o or m or e

s c ori n g d e s cri pt or s ar e s ati sfi e d f or p er i o d s of m or e t h a n 5 0 % of t h e d a y s

w h e n a d d e d t o g et h er, t h e d e s cri pt or t o b e a p pli e d i s t h e o n e w hi c h

3. 1 i s s ati sfi e d f or t h e gr e at e st pr o p orti o n of t h e d a y s or

3. 2 s c or e s t h e hi g h er or hi g h e st n u m b er of p oi nt s w h er e b ot h or all

d e s cri pt or s ar e s ati sfi e d f or t h e s a m e p eri o d 3 .

1 PI P R e gs, r e g 7( 1)( a)); 2 r e g 7( 1)( b); 3 r e g 7( 1)( c)

E x a m pl e 1

P hil h a s l o n g t er m pr o bl e m s wit h r h e u m at oi d art hriti s a n d h a s v er y li mit e d w al ki n g

a bilit y. H e n e e d s t o u s e a w h e el c h air f or m or e t h a n 5 0 % of t h e d a y s w h e n o ut d o or s,

a n d c a n o nl y w al k a f e w m etr e s b ef or e b ei n g i n p ai n a n d di s c o mf ort. H e i s a s s e s s e d

a s

“ C a n st a n d a n d m o v e m or e t h a n 1 m etr e b ut n o m or e t h a n 2 0 m etr e s, eit h er

ai d e d or u n ai d e d”

a n d s c or e s 1 2 p oi nt s o n t h e a s s e s s m e nt. H e i s t h er ef or e a w ar d e d t h e e n h a n c e d

r at e of t h e PI P m o bilit y c o m p o n e nt.

E x a m pl e 2

M ar y h a s l e ar ni n g diffi c ulti e s a n d

“ N e e d s s u p er vi si o n or a s si st a n c e t o eith er pr e p ar e or c o o k a si m pl e m e al” -

s c ori n g 4 p oi nt s.

“ N e e d s s u p er vi si o n, pr o m pti n g or a s si st a n c e t o b e a bl e t o m a n a g e t h er a p y

t h at t a k e s n o m or e t h a n 3. 5 h o urs a w e e k” - s c ori n g 2 p oi nt s.

“ N e e d s s u p er vi si o n or pr o m pti n g t o b e a bl e t o w a s h or b at h e” – s c ori n g 2

p oi nt s.

“ C a n n ot r e a d or u n d er st a n d si g n s, s y m b ol s or w or d s at all” – s c ori n g 8 p oi nt s.

“ C a n n ot m a k e a n y b u d g eti n g d e ci si o n s at all – s c ori n g 6 p oi nt s.

“ C a n n ot pl a n t h e r o ut e of a j o ur n e y” – s c ori n g 8 p oi nt s.

M ar y i s t h er ef or e a w ar d e d t h e d ail y li v i n g c o m p o n e nt at t h e e n h a n c e d r at e a s s h e

h a s s c or e d 2 2 p oi nt s, a n d t h e m o bilit y c o m p o n e nt at t h e st a n d ar d r at e a s s h e h a s

s c or e d 8 p oi nt s.

E x a m pl e 3

J o h n h a s art hriti s i n hi s h a n d s a n d f or a p pr o xi m at el y 1 t o 2 w e e k s a m o nt h h e

c a n n ot

“ C a n n ot pr e p ar e a n d c o o k f o o d” w hi c h w o ul d s c or e 8 p oi nt s.

H e al s o h a s M ulti pl e S cl er o si s w hi c h i s n ot c o ntr oll e d w ell a n d f or a b o ut 1 6 w e e k s

of t h e y e ar, w hi c h d o n ot o v erl a p wit h t h e art hriti s, h e

“ N e e d s s u p er vi si o n or a s si st a n c e t o eit h er pr e p ar e or c o o k a si m pl e m e al”

w hi c h w o ul d s c or e 4 p oi nt s.

N eit h er d e s cri pt or i s s ati sfi e d f or m or e t h a n 5 0 % of t h e ti m e o n t h eir o w n, b ut i n

a g gr e g at e c o v er m or e t h a n 5 0 % of t h e ti m e . J o h n i s a w ar d e d t h e st a n d ar d r at e of

t h e d ail y li vi n g c o m p o n e nt a s t h e d e s cri pt or a w ar di n g 8 p oi nt s a p pli e s f or t h e

gr e at e st a m o u nt of t h e ti m e.

P 2 0 1 5 W h e n a s s e s si n g t h e cl ai m a nt’ s a bilit y t o c a rr y o ut a n a cti vit y, t h e cl ai m a nt i s t o b e

a s s e s s e d a s if w e ari n g or u si n g a n y ai d or a p pli a n c e1 w hi c h

1. t h e cl ai m a nt n or m all y w e ar s or u s e s or

2. t h e cl ai m a nt c o ul d r e a s o n a bl y b e e x p e ct e d t o w e ar or u s e.

1 S S ( PI P) R e gs, r e g 4( 2)( a) & ( b)

P 2 0 1 6 T h e d e s cri pt or will o nl y b e r e g ar d e d a s b ei n g s ati sfi e d if t h e cl ai m a nt c a n b e

a s s e s s e d a s c arr yi n g o ut t h at a cti vit y, i n t h e m a n n er d e s cri b e d i n t h e d e s cri pt or

1. s af el y – w hi c h m e a n s i n a m a n n er u nli k el y t o c a u s e h ar m t o t h e m s el v e s or t o

a n ot h er p er s o n, eit h er d uri n g or a ft er c o m pl eti o n of t h e a cti vit y a n d

2. t o a n a c c e pt a bl e st a n d ar d – gi v e n t h e n at ur e of t h e a cti vit y a n d

3. r e p e at e dl y – w hi c h m e a n s a s oft e n a s t h e a cti vit y b ei n g a s s e s s e d i s

r e a s o n a bl y r e q uir e d t o b e c o m pl et e d a n d

4. i n a r e a s o n a bl e ti m e p eri o d1 - w hi c h m e a n s n o m or e t h a n t wi c e a s l o n g a s t h e

m a xi m u m p eri o d t h at a p er s o n wit h o ut a p h y si c al or m e nt al c o n diti o n, w hi c h

li mit s t h at p er s o n’ s a bilit y t o c arr y o ut t h e a cti vit y i n q u e sti o n, w o ul d n or m all y

t a k e t o c o m pl et e t h at a cti vit y.

1 S S ( PI P) R e gs, r e g 4( 2 A)( d)

P 2 0 1 7 I n d et er mi ni n g w h et h er t h e a cti vit y c a n b e c arri e d o ut i n t hi s m a n n er, c o n si d er ati o n

s h o ul d b e gi v e n t o

1. a p pr o a c h – w h at t h e i n di vi d u al n e e d s t o d o; w h at a s si st a n c e or ai d s ar e

r e q uir e d; h o w l o n g it t a k e s; a n d w h et h er it i s s af e a n d

2. o ut c o m e – w h et h er t h e a cti vit y c a n b e s u c c e s sf ull y c o m pl et e d a n d t h e st a n d ar d

t h at i s a c hi e v e d a n d

3. i m p a ct – t h e eff e ct s t h at r e a c hi n g t h e o ut c o m e h a s o n t h e i n di vi d u al a n d, w h er e

r el e v a nt, ot h er p e o pl e; a n d w h et h er t h e i n divi d u al c a n r e p e at t h e a cti vit y wit hi n

a r e a s o n a bl e p eri o d of ti m e a n d t o t h e s a m e st a n d ar d (t hi s i n cl u d e s

c o n si d er ati o n of s y m pt o m s s u c h a s p ai n, di s c o mf ort, br e at hl e s s n e s s, f ati g u e

a n d a n xi et y) a n d

4. v ari a bilit y – h o w a n i n di vi d u al’ s a p pr o a c h a n d o ut c o m e s c h a n g e o v er ti m e a n d

t h e i m p a ct t hi s h a s o n t h e m.

E x a m pl e 1

H e nr y i s a bl e t o st a n d a n d m o v e u n ai d e d. H e c a n c o mf ort a bl y w al k u p t o 1 5 0

m etr e s at a n or m al p a c e. Aft er 1 5 0 m etr e s h e st art s t o b e c o m e br e at hl e s s a n d t o

e x p eri e n c e s o m e mil d p ai n. H e c a n c o nti n u e t o w al k b ut hi s p a c e sl o w s. T h e p ai n

a n d br e at hl e s s n e s s gr a d u all y i n cr e a s e s a n d aft er 2 5 0 m etr e s h e n e e d s t o st o p a n d

r e st f or a b o ut 5 mi n ut e s b ef or e st arti n g t o w al k a g ai n. H e nr y c a n r e p e at e dl y w al k

2 5 0 m etr e s, wit h s h ort 5- mi n ut e r e st s i n b et w e e n f or ar o u n d a n h o ur. Aft er a n h o ur

of t hi s, h e n e e d s a l o n g er r e st of a b o ut a n h o ur b ef or e w al ki n g a g ai n. It t a k e s H e nr y

ar o u n d f o ur mi n ut e s t o w al k 2 0 0 m etr e s. T h e D M c o n si d er s w h et h er H e nr y c a n

st a n d a n d t h e n m o v e m or e t h a n 2 0 0 m etr e s ( d e s cri pt or 2 a) s af el y, t o a n a c c e pt a bl e

st a n d ar d, r e p e at e dl y a n d a i n a ti m el y m a n n er. T h e D M d e ci d e s t h er e i s n o

e vi d e n c e t h at t hi s a cti vit y p o s e s a n y ri s k t o H e nr y’ s s af et y; h e h a s s ai d h e

e x p eri e n c e s s o m e p ai n a n d br e at hl e s s n e s s a n d, w hil e t hi s m a y b e u n c o mf ort a bl e,

h e k n o w s w h e n t o st o p a n d r e st a n d t h er e i s n o i n di c ati o n t h at t hi s c a u s e s hi m a n y

h ar m. T h e D M d e ci d e s H e nr y c a n c o m pl et e t h e a cti vit y m or e fr e q u e ntl y t h a n w o ul d

r e a s o n a bl y b e e x p e ct e d a n d, alt h o u g h h e t a k e s a littl e l o n g er t h a n a n o n- di s a bl e d

p er s o n, h e c a n c o m pl et e t h e a cti vit y i n a r e a s o n a bl e ti m e p eri o d. A s H e nr y c a n

t h er ef or e st a n d a n d t h e n m o v e m or e t h a n 2 0 0 m etr e s s af el y, r e p e at e dl y a n d i n a

ti m el y m a n n er (t h e st a n d ar d i s n ot a n i s su e i n t hi s i n st a n c e), t h e D M s el e ct s

d e s cri pt or 2 a.

E x a m pl e 2

L o ui s e i s a bl e t o st a n d a n d m o v e wit h a w al ki n g sti c k. S h e c a n w al k u p t o 5 0 m etr e s

at a sli g htl y sl o w e d p a c e wit h s o m e di s c o mf ort. Aft er t hi s di st a n c e s h e st art s t o

e x p eri e n c e i n cr e a si n g hi p p ai n. S h e c a n c o nti n u e t o w al k, b ut h er p a c e sl o w s e v e n

f urt h er a n d aft er 1 0 0 m etr e s s h e n e e d s t o sto p a n d r e st. T hi s t a k e s a l ot o ut of h er

a n d f or a f e w h o ur s aft er L o ui s e i s u n a bl e t o g o m or e t h a n a f e w st e p s wit h o ut

e x p eri e n ci n g f urt h er s e v er e hi p p ai n. T h e D M c o n si d er s w h et h er L o ui s e c a n st a n d

a n d t h e n m o v e m or e t h a n 5 0 m etr e s b ut n o m or e t h a n 2 0 0 m etr e s ( d e s cri pt or 2 b)

s af el y, t o a n a c c e pt a bl e st a n d ar d, r e p e at e dl y, a n d i n a ti m el y m a n n er. T h e D M

d e ci d e s t h at t h er e i s n o i s s u e wit h t h e st a n d ar d a n d t h at s h e c a n d o s o s af el y,

b e c a u s e, alt h o u g h s h e e x p eri e n c e s p ai n, s h e k n o w s w h e n t o st o p a n d r e st, a n d

t h er e i s n o i n di c ati o n t h at t hi s c a u s e s h er a n y h ar m. H o w e v er, aft er s h e h a s w al k e d

1 0 0 m etr e s, it i s s e v er al h o ur s b ef or e L o ui s e c a n w al k t hi s di st a n c e a g ai n. T h e D M

d e ci d e s t hi s i s l e s s fr e q u e ntl y t h a n w o ul d b e r e a s o n a bl y e x p e ct e d a n d t h er ef or e

c o n cl u d e s s h e c a n n ot d o s o r e p e at e dl y. L o ui s e c a n r e p e at e dl y m a n a g e a f e w

m etr e s u si n g h er sti c k, w hi c h i s l e s s t h a n 2 0 m etr e s b ut m or e t h a n 1 m etr e

( d e s cri pt or 2 e). O n t hi s e vi d e n c e t h e D M s el e ct s d e s cri pt or 2 e.

E x a m pl e 3

J uli e c a n pr e p ar e a n d c o o k a si m pl e m e al. H o w e v er s h e l a c k s a p er c e pti o n of

d a n g er a n d o c c a si o n all y c ut s h er s elf fr o m mi s h a n dli n g k ni v e s or b ur n s h er s elf o n

h ot p a n s. S h e i s al s o i m p ati e nt a n d d o e s n ot c o o k f o o d f or a s l o n g a s it s h o ul d b e

c o o k e d, a s a r e s ult s h e pr e p ar e s f o o d t h at i s l u k e w ar m a n d m e at t h at i s n ot c o o k e d

pr o p erl y – f or e x a m pl e, c hi c k e n t h at i s pi n k i n t h e mi d dl e. H er si st er u s u all y h a s t o

b e i n t h e kit c h e n w h e n s h e i s c o o ki n g m e al s t o m a k e s ur e s h e d o e s s o s af el y a n d t o

r e mi n d h er t o l e a v e f o o d t o c o o k f ull y. Th e D M c o n si d er s w h et h er J uli e c a n pr e p ar e

a n d c o o k a si m pl e m e al u n ai d e d ( d e s cri pt or 1 a), s af el y, t o a n a c c e pt a bl e st a n d ar d,

r e p e at e dl y a n d i n a ti m el y m a n n er. T h e D M d e ci d e s J uli e i s a bl e t o d o s o r e p e at e dl y

a n d i n a ti m el y m a n n er. B e c a u s e s h e l a c k s a p er c e pti o n of d a n g er, t h e D M d e ci d e s

J uli e n e e d s s u p er vi si o n t o b e a bl e t o s af e l y pr e p ar e or c o o k a si m pl e m e al

( d e s cri pt or 1 e). B e c a u s e s h e d o e s n ot c o o k f o o d f or a s l o n g a s s h e s h o ul d, t h e D M

d e ci d e s J uli e n e e d s pr o m pti n g t o pr e p ar e or c o o k a si m pl e m e al ( d e s cri pt or 1 d) t o

a n a c c e pt a bl e st a n d ar d. I n t hi s c a s e t h er e ar e t w o p o s si bl e d e s cri pt or s – 1 d a n d 1 e,

b ut a s d e s cri pt or 1 d d o e s n ot d e s cri b e a m a n n er i n w hi c h J uli e i s a bl e t o c arr y o ut

t h e a cti vit y s af el y, t h e D M s el e ct s d e s cri pt or 1 e.

P 2 0 1 8 W h er e t h e cl ai m a nt i s a s s e s s e d a s h a vi n g s e v er el y li mit e d a bilit y t o c arr y o ut t h e

d ail y li vi n g a n d/ or m o bilit y a cti viti e s, t h e y c a n n ot al s o b e a s s e s s e d a s h a vi n g li mit e d

a bilit y i n r el ati o n t o t h at c o m p o n e nt1 .

1 S S ( PI P) R e gs, r e g 4( 3)

P 2 0 1 9 – P 2 0 2 5

I nf or m ati o n r e q uir e m e nt s

P 2 0 2 6 T h e cl ai m a nt will b e r e q uir e d t o pr o vi d e a n y i nf or m ati o n or e vi d e n c e 1 t h at m a y b e

r e q u e st e d b y t h e D M t o d et er mi n e t h eir a bility t o u n d ert a k e eit h er t h e d ail y li vi n g or

m o bilit y a cti viti e s s p e cifi e d.

1 S S ( PI P) R e gs, r e g 8( 1)

P 2 0 2 7 T h e i nf or m ati o n will t a k e t h e f or m of

1. t h e cl ai m a nt q u e sti o n n air e, ( H o w y o ur di s a bilit y aff e ct s y o u), if r e q uir e d

2. a n y ot h er i nf or m ati o n a s m a y b e r e q u e st e d b y t h e D M

3. a n y ot h er a d diti o n al i nf or m ati o n r e q u e st e d b y a p er s o n a p pr o v e d b y t h e

S e cr et ar y of St at e ( e. g. a H P r e q u e sti n g f urt h er i nf or m ati o n b y t el e p h o n e).

P 2 0 2 8 W h er e i nf or m ati o n h a s b e e n r e q u e st e d of t h e cl ai m a nt, t h at i nf or m ati o n m u st b e

pr o vi d e d wit hi n 1 m o nt h 1 of t h e r e q u e st, or a n y l o n g er p eri o d a s t h e D M m a y

c o n si d er r e a s o n a bl e.

N ot e: S e e P 2 0 5 6 f or g ui d a n c e w h er e a cl ai m a nt f ail s t o c o m pl y wit h pr o vi di n g

i nf or m ati o n or e vi d e n c e.

1 S S ( PI P) R e g, r e g 8( 2)

P 2 0 2 9 – P 2 0 4 5

A s s e s s m e nt c o n s ult ati o n s

P 2 0 4 6 If it i s d e ci d e d t h at a c o n s ult ati o n1 wit h t h e cl ai m a nt i s r e q uir e d t o a s s e s s t h e

cl ai m a nt’ s a bilit y t o u n d ert a k e d ail y li vi n g a n d/ or m o bilit y a cti viti e s t h e c o n s ult ati o n 1

will t a k e t h e f or m of p arti ci p ati o n i n a f a c e-t o-f a c e c o n s ult ati o n ( b ut s e e P 2 0 0 6, a

c o n s ult ati o n b y t el e p h o n e m a y b e u s e d t o g at h er f urt h er i nf or m ati o n).

N ot e: A p a p er b a s e d a s s e s s m e nt m a y b e a v ail a bl e f or s o m e cl ai m a nt s, a n d m a y b e

m a d e w h er e t h er e i s s uffi ci e nt e vi d e n c e f or t h e H P t o a d vi s e o n all a s p e ct s of t h e

cl ai m.

1 S S ( PI P) R e gs, r e g 9( 1)

P 2 0 4 7 T h e cl ai m a nt will b e r e q uir e d t o c o m pl y wi t h t h e r e q u e st t o att e n d f or a c o n s ult ati o n.

F ail ur e t o c o m pl y will r e s ult i n t h e D M gi vi n g a n e g ati v e d et er mi n ati o n 1 , u nl e s s t h e

cl ai m a nt s h o w s g o o d r e a s o n 2 n ot t o p arti ci p at e i n t h e c o n s ult ati o n ( s e e P 2 0 5 8).

N ot e: S e e P 2 0 5 6 f or g ui d a n c e w h er e a cl ai m a nt f ail s t o c o m pl y wit h a r e q u e st t o

att e n d a c o n s ult ati o n a n d g ui d a n c e at P 2 0 5 8 a n d A D M C h a pt er P 6 f or g ui d a n c e o n

g o o d r e a s o n.

1 S S ( PI P) R e gs, r e g 9( 2); 2 r e g 1 0

P 2 0 4 8 T h e cl ai m a nt m u st b e n otifi e d i n writi n g 1 of t h e

1. d at e a n d

2. ti m e a n d

3. pl a c e

of t h e c o n s ult ati o n at l e a st 7 d a y s i n a d v a n c e.

N ot e: T h e cl ai m a nt c a n a gr e e t o a c c e pt a s h or t er p eri o d of n oti c e, w h et h er gi v e n i n

writi n g or ot h er wi s e.

1 S S ( PI P) R e gs, r e g 9( 3)

P 2 0 4 9 T h e writt e n n oti c e m a y b e i s s u e d el e ctr o ni c all y 1 w h er e t h e cl ai m a nt h a s a gr e e d t o

c orr e s p o n d e n c e b ei n g s e nt i n t hi s m a n n er.

N ot e T hi s f a cilit y will n ot b e a v ail a bl e u ntil a f ut ur e d at e.

1 S S ( PI P) R e gs, r e g 9( 4)

P 2 0 5 0 – P 2 0 5 5

F ail ur e t o c o m pl y

P 2 0 5 6 F ail ur e t o c o m pl y wit h t h e r e q u e st

1. t o pr o vi d e i nf or m ati o n or

2. att e n d a c o n s ult ati o n

wit h o ut g o o d r e a s o n s h all r e s u lt i n a n e g ati v e d et er mi n ati o n1 of t h e c o m p o n e nt( s) t o

w hi c h t h e f ail ur e i s r el at e d.

N ot e : F or g ui d a n c e o n g o o d r e a s o n s e e P 2 0 5 8 a n d A D M C h a pt er P 6 – G o o d

R e a s o n.

1 S S ( PI P) R e gs, r e g 8( 3) & 9( 2)

P 2 0 5 7 A n e g ati v e d et er mi n ati o n 1 m e a n s a d et er mi n ati o n t h at a p er s o n d o e s n ot m e et t h e

r e q uir e m e nt s of t h e d ail y li vi n g c o m p o n e nt or t h e m o bilit y c o m p o n e nt.

1 W R A ct 1 2, s 8 0( 6)

E x a m pl e

A m a n d a m a d e a t el e p h o n e cl ai m t o PI P a n d w a s s e nt o ut a p art 2 q u e sti o n n air e,

‘ H o w d o e s y o ur di s a bilit y aff e ct y o u’. S h e w a s a s k e d t o r et ur n t h e f or m wit hi n o n e

m o nt h of t h e d at e of t h e r e q u e st. Aft er 1 9 d a y s s h e h a d n ot r et ur n e d t h e f or m s o

s h e w a s s e nt a p o st al r e mi n d er b ut s h e al s o f ail e d t o r e s p o n d t o t hi s. A s s h e di d n ot

c o m pl y wit h r et ur ni n g t h e i nf or m ati o n r e q uir e d, a n d s h e h a d n't b e e n i d e ntifi e d a s

n e e di n g a d diti o n al s u p p ort, a n e g ati v e d et er mi n ati o n w a s m a d e o n h er cl ai m.

G o o d r e a s o n

P 2 0 5 8 Cl ai m a nt s will h a v e h a d t h e o p p ort u nit y t o e x pl ai n w h y t h e y h a v e n ot c o m pli e d wit h

a r e q u e st t o

1. pr o vi d e i nf or m ati o n or

2. att e n d a c o n s ult ati o n.

It will r e m ai n t h e cl ai m a nt’ s r e s p o n si bilit y t o s h o w g o o d r e a s o n a n d pr o vi d e a n y

e vi d e n c e t o j u stif y t h eir g o o d r e a s o n. T h e D M will m a k e a d e ci si o n b a s e d o n all t h e

i n di vi d u al f a ct s a n d cir c u m st a n c e of t h e c a s e a n d t a ki n g i nt o a c c o u nt i n p arti c ul ar

t h e cl ai m a nt’ s st at e of h e alt h at t h e r el e v a nt ti m e a n d t h e n at ur e of t h eir di s a bilit y.

N ot e: F or f urt h er g ui d a n c e o n g o o d r e a s o n s e e A D M C h a pt er P 6 - G o o d r e a s o n.

P 2 0 5 9 – P 2 0 6 0

D u r ati o n of a w ar d

P 2 0 6 1 A w ar d s f or PI P ar e b y d ef a ult t o b e f or a fi x e d t er m 1 . T h er e ar e e x c e pti o n s t o t hi s,

w h er e it i s c o n si d er e d t h at s u c h a p eri o d w o ul d b e i n a p pr o pri at e.

1 W R A ct 1 2, s 8 8( 2)

P 2 0 6 2 W h er e f oll o wi n g a n a s s e s s m e nt c o n s ult ati o n, it i s c o n si d er e d t h at t h e cl ai m a nt h a s

1. a l e v el of f u n cti o n al a bilit y w hi c h i s n ot li k el y t o c h a n g e i n t h e l o n g-t er m or

2. hi g h l e v el s of f u n cti o n al i m p air m e nt w hi c h ar e o nl y li k el y t o i n cr e a s e

a fi x e d t er m a w ar d will b e i n a p pr o pri at e a n d a n o n- g oi n g a w ar d wit h a PI P A w ar d

R e vi e w d at e aft er 1 0 y e ar s will b e a p pli c a bl e.

N ot e: T hi s i s t h e g ui d a n c e i s s u e d b y t h e S ecr et ar y of St at e i n a c c or d a n c e wit h

l e gi sl ati o n1 .

1 W R A ct 1 2, s 8 8( 3)

P 2 0 6 3 W h e n d e ci di n g t h e d ur ati o n of a fi x e d t er m a w ar d 1 of PI P t h e D M s h o ul d l o o k at all

t h e e vi d e n c e a n d f a ct s of t h e c a s e, i n cl u din g t h e a d vi c e fr o m t h e H P. T h er e will b e

t w o t y p e s of fi x e d t er m a w ar d s

1. s h ort fi x e d t er m a w ar d s, w hi c h w ill b e f or a mi ni m u m of 9 m o nt h s a n d a

m a xi m u m of 2 y e ar s or

2. l o n g er fi x e d t er m a w ar d s, w h er e t h e D M will s et a n e x pir y d at e 1 2 m o nt h s

aft er t h e d at e o n w hi c h t h e cl ai m a nt i s d u e t o b e r ef err e d t o t h e H P f or a

r e vi e w

N ot e: D M s will al s o h a v e a r ol e i n d e ci di n g t h e PI P A w ar d R e vi e w d at e w hi c h will

b e d et ail e d i n t h e D M’ s pr o c e d ur al g ui d a n c e.

1 W R A ct 1 2, s 8 8( 2)

P 2 0 6 4 W h e n d e ci di n g t h e l e n gt h of t h e a w ar d t h e D M will h a v e r e g ar d t o

1. t h e a d vi c e fr o m t h e H P, wit hi n t h e PI P a s s e s s m e nt r e p ort a n d

2. a n y f urt h er e vi d e n c e g at h er e d b y t h e H P a n d

3. t h e e vi d e n c e gi v e n b y t h e cl ai m a nt i n t h e q u e sti o n n air e ( H o w y o ur di s a bilit y

aff e ct s y o u), a n d a n y a d diti o n al i nf or m ati o n s u p pli e d b y t h e cl ai m a nt.

N ot e: D M s s h o ul d r ef er t o t h e pr o c e d ur al g ui d a n c e o n A w ar d P eri o d s a n d R e vi e w s

( wit hi n t h e D e ci si o n M a ki n g Pr o c e s s G uid a n c e), w h e n d e ci di n g t h e l e n gt h of t h e

a w ar d a n d s etti n g r e vi e w p eri o d s.

P 2 0 6 5 T h e a d vi c e o n pr o g n o si s fr o m t h e H P a d vi s i n g w h e n t h e y wi s h t o s e e t h e cl ai m a nt

a g ai n i n a c c or d a n c e wit h P 2 0 6 6 – P 2 0 6 7, will h a v e h a d c o n si d er ati o n a s t o

1. w h et h er t h er e i s li k el y t o b e a n i m pr o v e m e nt or d et eri or ati o n i n t h e di s a bilit y

or it s f u n cti o n al eff e ct s a n d

2. w h et h er f urt h er tr e at m e nt i s r e q uir e d a n d

3. t h e ti m e a n y i m pr o v e m e nt or d et eri or ati o n i s li k el y t o b e e x p e ct e d a n d

4. t h e n at ur al pr o gr e s s of t h e u n d erl yi n g c o n diti o n a n d

5. a n y a dj u st m e nt s a n d a d a pt ati o n s.

E x a m pl e 1

J o a n s e nt i n h er q u e sti o n n air e f or h er cl ai m t o PI P a n d att e n d e d f or a c o n s ult ati o n

wit h a n H P. O n t h e e vi d e n c e b ef or e t h e m t h e H P pr o vi d e d a r e p ort t o t h e D M f or

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 PIP Award 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 PIP

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

Re-determination P2066 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

P2067 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: This provision does not enable the award to be changed. In order to change

the award a supersession decision is required, see ADM Chapter A4.

P2068 – P2075

T e r mi n al ill n e s s

P 2 0 7 6 T h er e ar e e x c e pti o n s t o t h e n or m a l r ul e s w h e n t h e p er s o n w h o cl ai m s

1. i s t er mi n all y ill a n d

2. h a s m a d e a cl ai m f or PI P e x pr e s sl y o n t h e gr o u n d of t er mi n al ill n e s s 1 .

N ot e: E vi d e n c e fr o m or o n b e h alf of t h e di s a bl e d p er s o n of t er mi n al ill n e s s will

a m e n d t h e cl ai m t o o n e b a s e d o n t h e S p e ci al R ul e s ( s e e P 2 0 7 9).

1 W R A ct 1 2, s 8 2

P 2 0 7 7 A p er s o n i s r e g ar d e d a s b ei n g t er mi n all y ill 1 f or t h e p ur p o s e s of P 2 0 7 6 if

1. at a n y ti m e t h e p er s o n s uff er s fr o m a pr o gr e s si v e di s e a s e a n d

2. t h e p er s o n’ s d e at h i n c o n s e q u e n c e of t h at di s e a s e c a n r e a s o n a bl y b e

e x p e ct e d wit hi n 6 m o nt h s.

1 W R A ct 1 2, s 8 2( 4)

P 2 0 7 8 W h e n a cl ai m i s m a d e u n d er t h e cir c u m st a n c e s i n P 2 0 7 6 t h e cl ai m a nt will

1. n ot b e r e q uir e d t o s ati sf y t h e r e q uir e d p eri o d c o n diti o n f or eit h er c o m p o n e nt 1

a n d

2. n ot b e r e q uir e d t o s ati sf y t h e p a st pr e s e n c e c o n diti o n 2 a n d

3. b e a w ar d e d t h e e n h a n c e d r at e of t h e d ail y li vi n g c o m p o n e nt 3 a n d

4. b e r e q uir e d t o pr o vi d e i nf or m ati o n o n t h e m o bilit y a cti viti e s b ef or e eit h er r at e

of t h at c o m p o n e nt c a n b e a w ar d e d.

1 W R A ct 1 2, s 8 2( 2) & ( 3); 2 S S ( PI P) R e gs, r e g 2 2; 3 W R A ct 1 2, s 8 2( 2)

P 2 0 7 9 Cl ai m s f or t er mi n all y ill p e o pl e will u s u a ll y b e a w ar d e d f or a n d li mit e d t o 3 y e ar s. A

r e mi n d er will b e i s s u e d b ef or e t h e a w ar d e x pir es t o r e mi n d t h e cl ai m a nt t o r e- cl ai m

PI P.

T hi r d p art y cl ai m s

P 2 0 8 0 A cl ai m m a y b e a c c e pt e d fr o m a t hir d p art y 1 if t h e cl ai m i s m a d e e x pr e s sl y o n t h e

gr o u n d t h at t hi s i s o n b e h alf of s o m e o n e w h o i s t er mi n all y ill. T hi s h a s t h e eff e ct t h at

t h e t er mi n all y ill p er s o n h a s m a d e t h e cl ai m ( s e e A D M C h a pt er A 2 - cl ai m s).

1 W R A ct 1 2, s 8 2( 5); S S ( PI P) R e gs, r e g 2 1

P 2 0 8 1 – P 2 9 9 9

A p p e n di x 1[ S e e A D M M e m o 3/ 1 7]

P E R S O N A L I N D E P E N D E N C E P A Y M E N T A S S E S S M E N T

I nt er pr et ati o n of t er m s

1 T hi s A p p e n di x gi v e s g ui d a n c e o n t h e i nt er pr et ati o n of t er m s 1 u s e d f or d ail y li vi n g

a n d m o bilit y a cti viti e s.

1 S S ( PI P) R e gs, S c h 1

Ai d e d

2 Ai d e d m e a n s wit h

1. t h e u s e of a n ai d or a p pli a n c e or

2. s u p er vi si o n, pr o m pti n g or a s si st a n c e.

A s si st a n c e

3 A s si st a n c e m e a n s p h y si c al i nt er v e nti o n b y a n ot h er p er s o n a n d d o e s n ot i n cl u d e

s p e e c h.

A s si st a n c e D o g

4 A s si st a n c e d o g m e a n s a d o g tr ai n e d t o g ui d e or a s si st a p er s o n wit h a s e n s or y

i m p air m e nt.

B a si c v er b al i nf or m ati o n

5 B a si c v er b al i nf or m ati o n m e a n s i nf o r m ati o n i n t h e cl ai m a nt’ s n ati v e l a n g u a g e

c o n v e y e d i n a si m pl e s e nt e n c e.

B a si c w ritt e n i nf or m ati o n

6 B a si c writt e n i nf or m ati o n m e a n s si g n s, s y m b ol s a n d d at e s writt e n or pri nt e d i n t h e

cl ai m a nt’ s n ati v e l a n g u a g e.

B at h e

7 B at h e i n cl u d e s g etti n g i nt o or o ut of a n u n a d a pt e d b at h or s h o w er.

C o m m u ni c ati o n s u p p ort

8 C o m m u ni c ati o n s u p p ort m e a n s s u p p ort fr o m a p er s o n tr ai n e d or e x p eri e n c e d i n

c o m m u ni c ati n g wit h p e o pl e wit h s p e cifi c c o m m u ni c ati o n n e e d s i n cl u di n g

i nt er pr eti n g v er b al i nf or m ati o n i nt o a n o n- v er b al f or m a n d vi c e v er s a.

C o m pl e x b u d g eti n g d e ci si o n s

9 C o m pl e x b u d g eti n g d e ci si o n s m e a n s d e ci si o n s i n v ol vi n g

1. c al c ul ati n g h o u s e h ol d a n d p er s o n al b u d g et s a n d

2. m a n a gi n g a n d p a yi n g bill s a n d

pl a n ni n g f ut ur e p ur c h a s e s

C o m pl e x v er b al i nf or m ati o n

1 0 C o m pl e x v er b al i nf or m ati o n m e a n s i nf o r m ati o n i n t h e cl ai m a nt’ s n ati v e l a n g u a g e

c o n v e y e d i n eit h er m or e t h a n o n e s e nt e n c e or o n e c o m pli c at e d s e nt e n c e.

C o m pl e x w ritt e n i nf or m ati o n

1 1 C o m pl e x writt e n i nf or m ati o n m e a n s m or e t h a n o n e s e nt e n c e of writt e n or pri nt e d

st a n d ar d si z e t e xt i n t h e cl ai m a nt’ s n ati v e l a n g u a g e.

C o o k

1 2 C o o k m e a n s t o h e at f o o d at or a b o v e w ai st h ei g ht.

D r e s s a n d u n dr e s s

1 3 Dr e s s a n d u n dr e s s i n cl u d e s p utti n g o n a n d t a ki n g off s o c k s a n d s h o e s.

E n g a g e s o ci all y

1 4 E n g a g e s o ci all y m e a n s

1. i nt er a ct wit h ot h er s i n a c o nt e xtu all y a n d s o ci all y a p pr o pri at e m a n n er a n d

2. u n d er st a n d b o d y l a n g u a g e a n d

3. e st a bli s h r el ati o n s hi p s.

M a n a g e i n c o nti n e n c e

1 5 M a n a g e i n c o nti n e n c e m e a n s m a n a g e i n v ol u nt ar y e v a c u ati o n of t h e b o w el or

bl a d d er i n cl u di n g u s e of a c oll e cti n g d e vi c e or s elf- c at h et eri s ati o n a n d cl e a n o n e s elf

aft er w ar d s.

M a n a g e m e di c ati o n or t h er a p y

1 6 M a n a g e m e di c ati o n or t h er a p y m e a n s t a k e m e di c ati o n or u n d ert a k e t h er a p y, w h er e

a f ail ur e t o d o s o i s li k el y t o r e s ult i n a d et eri or ati o n i n t h e cl ai m a nt’ s h e alt h.

M e di c ati o n

1 7 M e di c ati o n m e a n s m e di c ati o n t o b e t a k e n at h o m e w hi c h i s pr e s cri b e d or

r e c o m m e n d e d b y a r e gi st er e d

1. d o ct or

2. n ur s e or

3. p h ar m a ci st.

M o nit or h e alt h

1 8 M o nit or h e alt h m e a n s

1. d et e ct si g nifi c a nt c h a n g e s i n t h e cl ai m a nt’ s c o n diti o n w hi c h ar e li k el y t o l e a d

t o a d et eri or ati o n i n t h eir h e alt h a n d

2. t a k e a cti o n a d vi s e d b y a

2. 1 r e gi st er e d d o ct or

2. 2 r e gi st er e d n ur s e or

2. 3 h e alt h pr of e s si o n al w h o i s r e g ul at e d b y t h e H e alt h Pr of e s si o n s C o u n cil

wit h o ut w hi c h t h e cl ai m a nt’ s h e alt h i s li k el y t o d et eri or at e.

O ri e nt ati o n ai d

1 9 Ori e nt ati o n ai d m e a n s a s p e ci ali st ai d d e si g n e d t o a s si st di s a bl e d p e o pl e t o f oll o w a

r o ut e s af el y.

P r e p ar e

2 0 I n t h e c o nt e xt of f o o d pr e p ar e m e a n s t o m a k e f o o d r e a d y f or c o o ki n g or e ati n g.

P r o m pti n g

2 1 Pr o m pti n g m e a n s r e mi n di n g, e n c o ur a gi n g or e x pl ai ni n g b y a n ot h er p er s o n.

P s y c h ol o gi c al di str e s s

2 2 P s y c h ol o gi c al di str e s s m e a n s di str e s s r el at e d t o a n e n d uri n g m e nt al h e alt h

c o n diti o n or a n i nt ell e ct u al or c o g niti v e i m p air m e nt.

R e a d

2 3 R e a d i n cl u d e s r e a di n g si g n s, s y m b ol s a n d w or d s b ut d o e s n ot i n cl u d e r e a di n g

Br aill e.

Si m pl e b u d g eti n g d e ci si o n s

2 4 Si m pl e b u d g eti n g d e ci si o n s m e a n s d e ci si o n s i n v ol vi n g

1. c al c ul ati n g t h e c o st of g o o d s a n d

2. c al c ul ati n g c h a n g e r e q uir e d aft er a p ur c h a s e.

Si m pl e M e al

2 5 Si m pl e m e al m e a n s a c o o k e d o n e- c o ur s e m e al f or o n e u si n g fr e s h i n gr e di e nt s.

S o ci al S u p p ort

2 6 S o ci al s u p p ort m e a n s s u p p ort fr o m a p er s o n tr ai n e d or e x p eri e n c e d i n a s si sti n g

p e o pl e t o e n g a g e i n s o ci al sit u ati o n s.

St a n d

2 7 St a n d m e a n s st a n d u pri g ht wit h at l e a st o n e bi ol o gi c al f o ot o n t h e gr o u n d.

S u p er vi si o n

2 8 S u p er vi si o n m e a n s t h e c o nti n u o u s pr e s e n c e of a n ot h er p er s o n f or t h e p ur p o s e of

e n s uri n g t h e cl ai m a nt’ s s af et y.

T a k e n utriti o n

2 9 T a k e n utriti o n m e a n s

1. t o c ut f o o d i nt o pi e c e s a n d

2. c o n v e y f o o d or dri n k t o o n e’ s m o ut h a n d

3. c h e w a n d s w all o w f o o d or dri n k or

4. t a k e n utriti o n b y u si n g a t h er a p e uti c s o ur c e.

T h er a p e uti c s o ur c e

3 0 T h er a p e uti c s o ur c e m e a n s p ar e nt er al or e nt er al t u b e f e e di n g, u si n g a r at e li miti n g

d e vi c e s u c h a s a d eli v er y s y st e m or f e e d p u m p.

T h er a p y

3 1 T h er a p y m e a n s t h er a p y t o b e u n d ert a k e n at h o m e w hi c h i s pr e s cri b e d or

r e c o m m e n d e d b y a

1. r e gi st er e d

1. 1 d o ct or

1. 2 n ur s e or

1. 3 p h ar m a ci st

2. h e alt h pr of e s si o n al r e g ul at e d b y t h e H e alt h Pr of e s si o n s C o u n cil.

T oil et n e e d s

3 2 T oil et n e e d s m e a n s

1. g etti n g o n a n d off a n u n a d a pt e d t oil et a n d

2. e v a c u ati n g t h e bl a d d er a n d b o w el a n d

3. cl e a ni n g o n e s elf aft er w ar d s.

U n ai d e d

3 3 U n ai d e d m e a n s wit h o ut

1. t h e u s e of a n ai d or a p pli a n c e or

2. s u p er vi si o n, pr o m pti n g or a s si st a n c e.

A p p e n di x 2 PI P D e s cri pt or l o g

D ail y li vi n g a n d m o bilit y a cti viti e s

N ot e: S e e P 2 0 1 1- P 2 0 1 4

D ail y Li vi n g A cti viti e s

C ol u m n 1 C ol u m n 2

A cti vit y D e s cri pt or s

1. Pr e p ari n g f o o d. a. C a n pr e p ar e a n d c o o k a si m pl e m e al

u n ai d e d.

b. N e e d s t o u s e a n ai d or a p pli a n c e t o b e

a bl e t o eit h er pr e p ar e or c o o k a si m pl e

m e al.

c. C a n n ot c o o k a si m pl e m e al u si n g a

c o n v e nti o n al c o o k er b ut i s a bl e t o d o s o

u si n g a mi cr o w a v e.

d. N e e d s pr o m pti n g t o b e a bl e t o eit h er

pr e p ar e or c o o k a si m pl e m e al.

e. N e e d s s u p er vi si o n or a s si st a n c e t o

eit h er pr e p ar e or c o o k a si m pl e m e al.

f. C a n n ot pr e p ar e a n d c o o k f o o d.

2. T a ki n g n utriti o n. a. C a n t a k e n utriti o n u n ai d e d.

b. N e e d s –

(i) t o u s e a n ai d or a p pli a n c e t o b e a bl e t o

t a k e n utriti o n; or

(ii) s u p er vi si o n t o b e a bl e t o t a k e n utriti o n;

or

(ii) a s si st a n c e t o b e a bl e t o c ut u p f o o d.

c. N e e d s a t h er a p e uti c s o ur c e t o b e a bl e t o

t a k e n utriti o n.

C ol u m n 3

P oi nt s

0

2

2

2

4

8

0

2

2

d. N e e d s pr o m pti n g t o b e a bl e t o t a k e 4

n utriti o n.

3. Managing therapy or monitoring a health condition.

4.Washing and bathing

e. Needs assistance to be able to manage 6 a therapeutic source to take nutrition.

f. Cannot convey food and drink to their 10 mouth and needs another person to do so.

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.

3(b) Needs any one or more of the 1 following —

(i) to use an aid or appliance to be able to manage medication;

(ii) supervision, prompting or assistance to be able to manage medication;

(iii) supervision, prompting or assistance to be able to monitor a health condition

c. Needs supervision, prompting or 2 assistance to be able to manage therapy that takes no more than 3.5 hours a week.

d. Needs supervision, prompting or 4 assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week.

e. Needs supervision, prompting or 6 assistance to be able to manage therapy that takes more than 7 but no more than 14 hours a week.

f. Needs supervision, prompting or 8 assistance to be able to manage therapy that takes more than 14 hours a week.

a. Can wash and bathe unaided. 0

b. Needs to use an aid or appliance to be 2 able to wash or bathe.

c. Needs supervision or prompting to be 2

5. Managing toiletneeds or incontinence.

6. Dressing andundressing.

able to wash or bathe.

d. Needs assistance to be able to washeither their hair or body below the waist.

2

e. Needs assistance to be able to get in orout of a bath or shower.

3

f. Needs assistance to be able to washtheir body between the shoulders and waist.

4

g. Cannot wash and bathe at all and needsanother person to wash their entire body.

8

a. Can manage toilet needs orincontinence unaided.

0

b. Needs to use an aid or appliance to beable to manage toilet needs or incontinence.

2

c. Needs supervision or prompting to beable to manage toilet needs.

2

d. Needs assistance to be able to managetoilet needs.

4

e. Needs assistance to be able to manageincontinence of either bladder or bowel.

6

f. Needs assistance to be able to manageincontinence of both bladder and bowel.

8

a. Can dress and undress unaided. 0

b. Needs to use an aid or appliance to beable 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 orundress their lower body.

2

7. Communicatingverbally.

8. Reading andunderstanding signs, symbols and words

9. Engaging withother people face-to-face

e. Needs assistance to be able to dress orundress their upper body.

4

f. Cannot dress or undress at all. 8

a. Can express and understand verbalinformation unaided.

0

b. Needs to use an aid or appliance to beable to speak or hear.

2

c. Needs communication support to beable to express or understand complex verbal information.

4

d. Needs communication support to beable to express or understand basic verbal information.

8

e. Cannot express or understand verbalinformation at all even with communication support.

12

a. Can read and understand basic andcomplex written information either unaided or using spectacles or contact lenses.

0

b. Needs to use an aid or appliance, otherthan 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 orunderstand complex written information.

2

d. Needs prompting to be able to read orunderstand 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 engagewith other people.

2

c. Needs social support to be able toengage with other people.

4

10. Makingbudgeting decisions

d. Cannot engage with other people due tosuch engagement causing either –

8

(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 budgetingdecisions unaided.

0

b. Needs prompting or assistance to beable to make complex budgeting decisions.

2

c. Needs prompting or assistance to beable to make simple budgeting decisions.

4

d. Cannot make any budgeting decisionsat all.

6


Mobility Activities

Column 1

Activity

1. Planning andfollowing 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 12journey without another person, an assistance dog or an orientation aid.

a. Can stand and then move more than 0200 metres, either aided or unaided.

b. Can stand and then move more than 450 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 10aid or appliance more than 20 metres but no more than 50 metres.

e. Can stand and then move more than 121 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.


The content of the examples in this document (including use of imagery) is for illustrative purposes only

3

General principles

Q & A

Question Answer What is the best method to score descriptors?

All descriptors for a given activity should be considered in order to determine which is the best fit for the claimant (and applying Regulation 7, if necessary).

Working from lowest to highest scoring descriptor (or the reverse), and stopping as soon as a descriptor seems to fit the claimant’s circumstances, may result in errors (for example in relation to Activity 1 if someone needs prompting and supervision to prepare food, descriptor 1d may be incorrectly chosen).

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

The aid must be necessary to help the Claimant perform an activity. 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 improving or repairing a functional impairment by using it.

You must consider: • Affordability• Availability• Practicality, based on their disability and domestic circumstances.

DMs should distinguish between: • an aid or appliance that a claimant must use or could reasonably be expected

to use in order to help overcome the claimant’s functional loss; and • an aid or appliance that a claimant may be using or wish to use because it

makes it easier to carry out the activity but is not reasonably required to overcome a functional loss

Descriptor awards for using an aid or appliance should only be given in the former case. An aid or appliance is not reasonably required in the latter.

Where a claimant chooses not to use an aid or appliance that he or she could reasonably be expected to use and would enable them to carry out the activity without assistance, they should be assessed as needing an aid or appliance rather than a higher level of support.

What is the reliability criteria (Regulation 4)?

With all of the 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 whichlimits that person’s ability to carry out the activity in question would normallytake to complete that activity).

How should we treat fluctuating conditions (Regulation 7)?

PIP should support those individuals who have a long-term health condition or impairment that affects them most of the time.

A descriptor will apply if the impact of a health condition or impairment is experienced on the ‘majority of days’ over a 12 month period.

The PIP assessment allows descriptors (that score) to be combined to meet the 50 per cent rule. The following rules apply:

• If one descriptor in an activity is likely to apply on more than 50 per cent of the days in the

4

12 month period – i.e. the activity can be completed in the way described on more than 50 per cent of days – then that descriptor should be chosen • If two or more descriptors in an activity are likely to apply on more than 50 per cent of thedays in the period, then the descriptor chosen should be the one which is the highest scoring • Where one single descriptor in an activity is likely to not be satisfied on more than 50 percent of days, but a number of different scoring descriptors in that activity cumulatively are likely to be satisfied on more than 50 per cent of days, the descriptor likely to be satisfied for the highest proportion of the time should be selected. For example, if descriptor ‘B’ is likely to be satisfied on 40 per cent of days and descriptor ‘C’ on 30 per cent of days, descriptor ‘B’ should be chosen. Where two or more descriptors are satisfied for the same proportion of days, the descriptor which is the highest scoring should be chosen.

How should a CM assess whether a claimant can manage a task “safely” in accordance with Regulation 4?

The CM should follow the recent decision of RJ, GMcL and CS V SSWP [2017] UKUT 0105 (AAC). Guidance on how to do this can be found in ADM memo 15/18.

Should items that are surgically implanted in the body be treated as aids?

In accordance with regulation 4 a claimant should be assessed as wearing or using an aid or appliance which they normally wear or use or could be reasonably expected to wear or use. A surgical implant is not ‘worn’. The term ‘use’ indicates a level of control over the device. However, an operation such as a knee replacement or lens implant has the effect of surgically implanting something into the body that the recipient has no control over. Also, in most cases they will ‘correct’ the impairment that the claimant suffers to the extent that they can carry out activities without difficulty. In these cases the joint replacement/ implant should not be treated as an aid.

5

Activity 1: Preparing Food

Activity 1 – Preparing food

This activity considers a claimant’s ability to prepare a simple, cooked meal for one from fresh ingredients. It assesses ability to open packaging, peel and chop, serve food on to a plate and use a microwave oven or cooker hob to cook or heat food. Serving food means transferring food to a plate or bowl, it does not include presentation.

Carrying items around the kitchen or carrying food to where it will be eaten is not included in this activity.

This activity considers the claimant’s functional limitations in their ability to prepare food and not the claimant’s lack of skill or the opportunity to learn. If an individual cannot cook at all because they have never needed to learn, consider their ability to carry out activities at or above waist height and their cognitive ability to use a stove or microwave if shown how.

Cooking food at waist height does not consider the ability to bend down to access an oven.

If an individual cannot reliably complete an activity in the way described in a descriptor then they should be considered unable to complete it at that level and an alternative descriptor selected.

A Can prepare and cook a simple meal unaided.

0

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.

As well as claimants who can prepare and cook a simple meal unaided, this descriptor also applies to claimants who do not prepare or cook through choice; or due to a lack of cooking skills; or who have some one else prepare their meals through choice rather than necessity.

If someone only eats ready meals then the HP must look at their functional ability to see what they could do. If there is nothing that would prevent them from cooking and preparing a simple meal but they use microwave ready means out of choice, 1a would apply.

B Needs to use an aid or appliance to be able to either prepare or cook a simple meal.

2 In this activity, aids and appliances could include, for example, prostheses, perching stool, and spiked chopping boards..

Where the claimant is reliant on pre-chopped vegetables, you should consider whether the claimant could peel and chop. If they could peel and chop with the use of an aid, they carry out preparation with aids. If the person uses pre-chopped vegetables because they couldn’t peel and chop even with an aid, they may need assistance to prepare a simple meal.

C Cannot cook a simple meal using a conventional cooker but is able to do so using a microwave.

2 May apply to someone with a condition that means they cannot safely use a cooker hob, but could use a microwave oven instead - for example, a cognitively impaired person who would be likely to leave a gas cooker on.

6

A claimant can only satisfy this descriptor if they can prepare a meal unaided.

D Needs prompting to be able to either prepare or cook a simple meal.

2 ‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who lack motivation to prepare and cook a simple meal on the majority of days due to a mental health condition, or who need to be reminded how to prepare and cook food on the majority of days.

E Needs supervision or assistance to either prepare or cook a simple meal.

4

For example: may apply to claimants who need supervision to safely heat or cook food using a microwave oven; or to claimants who cannot safely prepare vegetables, even with an aid or appliance. This descriptor also applies to claimants who are unable to determine whether food is safe to eat – for example, that meat is properly cooked – due to sensory or cognitive impairment.

Preparation of a simple meal includes the ability to peel and chop fresh ingredients. If someone can’t do this without supervision or assistance then 1e will apply.

F Cannot prepare and cook food.

8

This descriptor refers to the person’s functional ability in relation to any impairment and their cooking skills should not be taken in to consideration for this descriptor. If a claimant cannot cook because they have never learned but their functional ability indicates they could undertake tasks involved in preparing and cooking food then this descriptor would not apply.

Descriptor 1f measures the ability to prepare and cook food. A claimant can only satisfy 1f if they can neither prepare nor cook food (even with aids, assistance, supervision or prompting). Claimants who can prepare food but cannot cook it (or vice versa) would not satisfy this descriptor.

Q & A

Question Answer Does the claimant need to be able to make a variety of food, or make meals that are of nutritional value?

If someone chooses to eat an unhealthy or repetitive diet, but has the capacity to prepare and cook a simple meal, then they would not score any points.

How should we treat someone who needs supervision to use a conventional cooker?

If a person needs such supervision one must consider whether they could satisfy 1c (i.e. could cook using a microwave) rather than automatically awarding 1e. If the person still needs supervision to cook using a microwave then 1e would apply.

Are different cultural cooking practices relevant?

No. The test should be a standard benchmark one of functional ability and broadly the same whoever is being assessed, see CPIP/1532/2015.

If the claimant has an adapted kitchen with lowered work surfaces should this be taken into account?

A claimant should be assessed against standard height work surfaces. Therefore a claimant who has had their work surfaces lowered, for example due to being in a wheelchair, should still be assessed against a standard kitchen.

7

Does it matter if the claimant can only use an electric hob as opposed to a gas one?

To cook means to heat food at or above waist height. This can be by any method e.g. by gas or electric. If someone can cook by gas but not electric or vice versa then they should not score as they are able to heat food in a normal manner. It doesn’t matter what the claimant has in their kitchen; it is a hypothetical test.

For example – a claimant with an oxygen cylinder only has a gas cooker and claims not to be able to use it due to the risk presented by the naked flame. If that claimant could use an electric hob instead then they would not score despite the fact they do not have an electric hob in their home.

If a claimant cannot use a conventional cooker and instead uses a slow cooker should this be considered an aid under descriptor B?

A slow cooker takes several hours for a simple meal to cook therefore the slow cooker should not be considered as an aid, as in order to do so it must enable a claimant to cook a simple meal within a reasonable time period. Consideration should be given as to the reasons why a claimant may be using a slow cooker instead of a conventional cooker that may lead to entitlement to higher scoring descriptors, for example they require assistance or supervision to cook using a conventional cooker. It should however be noted that using a slow cooker as a preference, rather than it being needed due to a physical or mental condition, would not result in points being awarded.

UT Decision CSPIP/288/16: Guidance on how to apply each of the descriptors under activity 1:

This decision helpfully includes the following table at the annex to the decision:

Descriptors Explanation a. Can prepare and cook asimple meal unaided.

This descriptor applies to a person who can make ready for heating, and heat (at or above waist height), a one-course meal for one using fresh ingredients. No additional support is required. The person can do so even without an aid or appliance or supervision, prompting or assistance.

(see in particular definitions for “prepare”, “cook”, “simple meal” and “unaided”)

b. Needs to use an aid orappliance to be able to either prepare or cook a simple meal.

Additional support is required. A person needs to use a device which improves, provides or replaces their impaired physical or mental function, to be able to either make ready for heating, or to heat (at or above waist height), a one-course meal for one using fresh ingredients.

The means of cooking food is not relevant. What is relevant is the need for a device which improves, provides or replaces the person’s impaired physical or mental function to enable a person to either make or heat food. A cooker and microwave is not a device within the meaning of this statutory definition. It “merely provides one means of cooking” (see paragraph 10 of AI v SSWP (PIP) [CPIP/190/2016]).

(see in particular definitions for “aid or appliance”, “prepare”, “cook” and “simple meal”)

c. Cannot cook a simple mealusing a conventional cooker but is able to so using a microwave.

This descriptor requires two conditions to be met. Firstly the person cannot heat (at or above waist height) a one-course meal for one (using fresh ingredients) using a conventional cooker. Secondly the person is able to do so unaided using a microwave, so is able to do so without use of an aid or appliance, prompting, supervision or assistance.

This is the only descriptor in which the means of cooking is relevant and preparation is not expressly mentioned. However preparation is relevant to the higher scoring descriptors, so even if a claimant falls within the language of descriptor c., looked at in isolation, a higher scoring descriptor could apply

8

because the claimant cannot prepare food unaided.

(see in particular definitions for “cook” and “simple meal”)

d. Needs prompting to be ableto either prepare or cook a simple meal.

Additional support is required. A person needs someone else to remind, encourage or explain to be able to either make ready for heating, or to heat (at or above waist height), a one-course meal for one using fresh ingredients.

The means of cooking food is not relevant. What is relevant is whether the claimant needs prompting to be able to either make or heat (at or above waist height) a one-course meal for one using fresh ingredients.

(see in particular definitions for “prompting”, “prepare”, “cook” and “simple meal”).

e. Needs supervision orassistance to either prepare or cook a simple meal.

Again additional support is required. A person needs either the continuous presence of another for their own safety or physical intervention by another to be able to either make ready for heating, or heat (at or above waist height), a one-course meal for one using fresh ingredients.

The means of cooking food is not relevant. What is relevant is whether the claimant needs supervision or assistance to be able to either make or heat (at or above waist height) a one-course meal for one using fresh ingredients.

(see in particular definitions for “supervision”, “prepare”, “cook” and “simple meal”).

f. Cannot prepare and cookfood.

This descriptor applies to a person who cannot prepare and cook food, even with additional support because of that person’s physical or mental condition.

(see in particular definitions for “prepare” and “cook” and also section 80(1) of the Welfare Reform Act 2012).

9

Activity 2: Taking nutrition

Activity 2 – Taking nutrition

This activity considers a person’s ability to be nourished, either by cutting food into pieces, conveying it to the mouth and chewing and swallowing; or through the use of therapeutic sources.

The defined term ‘taking nutrition’ refers solely to the act of eating and drinking and so the quality of what is being consumed is irrelevant for the purposes of daily living activity 2. Therefore, if for any reason a claimant elects to have a bad or restricted diet, makes dietary choices or chooses to avoid certain foods as part of dietary requirements, they are nevertheless ‘taking nutrition’ to an acceptable standard and therefore will not score under activity 2.

Cases where what is being consumed is so beyond any reasonable or rational view of what constitutes food or drink that it does not amount to ‘taking nutrition’ are possible but will be very rare. However, if a claimant needs prompting to eat because they have a physical or mental condition that makes their ability to make active choices about the food they consume (for example, claimants with a learning disability or an eating disorder who because of that disorder need prompting to undertake the physical act of eating) they will qualify under descriptor d.

The frequency of taking nutrition should only be considered if the claimant has an underlying condition which affects their ability to remember to eat, or their motivation to eat, e.g. dementia, severe clinical depression or an eating disorder.

A therapeutic source means parenteral or enteral tube feeding using a device such as a delivery system or feed pump.


A Can take nutrition unaided.

0 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.

B Needs –

i. to use an aid or appliance to be able to take nutrition; orii. supervision to be able to take nutrition; oriii. assistance to be able to cut up food.

2

Applies to claimants who need to use specially adapted cutlery, claimants who are at significant risk of choking when taking nutrition; claimants who regularly spill food due to tremors or other factors and claimants who have difficulty cutting up food which is ready to be eaten (not raw ingredients as these are considered in activity 1).

If someone needs an aid to peel and chop food (activity 1) you cannot automatically assume that they will need to use an aid or appliance to take nutrition. Somebody who has problems with manual dexterity or grip strength to the extent that they 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 that raw vegetables.

C Needs a therapeutic source to be able to take nutrition.

2 For example: may apply to claimants who require enteral or parenteral feeding but can carry it out unaided.

D 4

10

Needs prompting to be able to take nutrition.

‘Prompting’ means reminding, encouraging or explaining by another person.

Applies to claimants who need to be reminded to eat (for example, due to a cognitive impairment or severe depression), or who need prompting about portion size. Prompting regarding portion size should be directly linked to a diagnosed condition such as Prader Willi Syndrome or Anorexia. In cases where obesity is a factor and where there is no impaired condition which would suggest a lack of choice of control through the claimant’s lifestyle choices then this descriptor would not apply.

E Needs assistance to be able to manage a therapeutic source to take nutrition.

6 For example: may apply to claimants who require enteral or parenteral feeding and require support to manage the equipment.

F Cannot convey food and drink to their mouth and needs another person to do so. 10

Q & A

Question Answer

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Activity 3: Managing therapy or monitoring a health condition

Activity 3 – Managing therapy or monitoring a health condition

This activity considers a claimant’s ability to:

(i) appropriately take medications in a domestic setting that are prescribed or recommended by a registered doctor, nurse or pharmacist;

(ii) monitor and detect changes in a health condition; and (iii) manage therapeutic activities that are carried out in a domestic setting that are prescribed or recommended by

a registered doctor, nurse, pharmacist or healthcare professional regulated by the Health Professions Council;

Without any of which their health is likely to deteriorate.

This activity only applies to medication or therapy delivered in the home environment, i.e. where the claimant lives (which may include care homes).

Medication is pharmaceutical treatment, i.e. treatment which involves the use of medicinal drugs. Drugs a re substances which have a physiological effect when ingested or introduced into or onto the body. Examples of medication include tablets, injections, inhaled medications and creams.

Therapy is non-pharmaceutical treatment, i.e. treatments which do not involve the use of medicinal drugs. Examples of therapy include physiotherapy and home dialysis. Whist medications and therapies do not necessarily have to be prescribed, there must be a consensus of medical opinion that supports their use in treatment of the condition, hence the necessity for it at least to be recommended for the claimant by a registered healthcare professional or pharmacist. Therapy does not include taking or applying, or otherwise receiving or administering medicarion (whether orally, topically or by any other means), or any action which, in the claimant’s case, falls within the definition of “monitor a health condition”.

For the purpose of descriptor 3c-f, the ‘majority of days’ test does not require the individual to actually be receiving therapy on the majority of days in a year. However, the descriptor would still need to accurately describe the claimant’s circumstances on the majority of weeks in the required period. For example, if a claimant needs assistance to undergo home dialysis for three hours on Monday and Friday every week, they would not actually be receiving therapy on the majority of days in a year. However, the statement that they need ‘assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week’ would still apply, as it accurately describes the level of support needed on the majority of weeks in the required period.

Monitoring a health condition means the ability to recognise significant adverse changes in a claimant’s health condition and take corrective action to implement treatment plans or modifications, as advised by a healthcare professional. The HP should expect to see evidence demonstrating recognition of the role the person is playing in actively monitoring the claimant’s health condition, for example a diabetic claimant whose blood sugar levels change and where the third party would be able to take action as a result, without which the claimant’s short or long-term health would be at risk.

Descriptors C – F: the need for supervision, prompting or assistance to be able to manage therapy apply to the duration of the supervision, prompting or assistance and not the duration of the therapy. See the descriptors for illustrative examples of how to consider any intervention the claimant requires.

A nebuliser could be considered to be delivering either medication or therapy depending on the clinical indication and use. In some cases it will be used to deliver medications such as salbutamol in asthma. However it can also be used in a therapeutic role to deliver nebulised saline water in chronic chest conditions to help loosen mucous secretions and aid chest physiotherapy. In most cases the process of delivering nebulised liquids encompasses both medication and non-pharmaceutical treatment (i.e. therapy) so the higher descriptor would apply.

A claimant who requires a therapeutic source to take nutrition would not score under this activity but may be considered under activity 2.


A Either – 0

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i. Does not receive medication or therapy or need to monitor ahealth condition; or

ii. Can manage medication or therapy or monitor a health conditionunaided.


The potential future needs of a person cannot be considered. If a person with a cognitive impairment or learning disability takes no medications, this descriptor should be chosen.

B

Needs any one or more of the following—

i. to use an aid or appliance to be able to manage medication;ii. supervision, prompting or assistance to be able to managemedication iii. supervision, prompting or assistance to be able to monitor ahealth condition.

1

Examples of aids to help manage medication include dosette boxes, alarms and reminders. Consideration of their use for the purpose of this activity should be directly linked with the reliability criteria – in other words the claimant is unable to reliability manage their medication independently and the use of aids and appliances is required.

Supervision may be required to ensure that medication is taken properly, or to minimise the risk of accidental or deliberate overdose (there must be strong evidence to indicate that such a risk is likely i.e. previous incidents of self harm or recent psychiatric intervention).

Prompting may be necessary to remind the claimant to take medication at certain times, for example due to problems with short-term memory, or to repeatedly explain why it is necessary for the claimant to take medication where there are issues with their own capacity to understand.

Assistance may be required for example, where the claimant needs physical help opening bottles or taking pills out of blister packs, or help interpreting blood sugar levels for the correct dose of medication.

Inhalers, needles, glucose meters and nebulisers are not aids or appliances for managing medication, but are devices for delivering the medication or monitoring the health condition. However, if a claimant requires assistance to use such devices to take medication or monitor their health condition they would score under this descriptor.

C Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week.

2

Therapies could include domiciliary dialysis, talking therapies and exercise regimes undertaken in the home. For example, a claimant needs 15 minutes of assistance with applying compression bandages every day. The assistance required each week totals 1 hour and 45 minutes, even though the claimant wears the bandages (i.e. undertakes the therapy), all day every day. If the claimant is visited by a therapist for an hour per week, but undertakes the therapy independently for an hour on the other 6 days, only the hour where they are assisted to manage the therapy should be considered rather than the independent therapy.

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D Needs supervision, prompting or assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week.

4 For example: a claimant who undergoes home dialysis for 3 hours on Monday and 3 hours on Friday each week and who requires supervision throughout the duration of the dialysis.

E Needs supervision, prompting or assistance to be able to manage therapy that takes more than 7 but no more than 14 hours a week.

6 For example: a claimant who requires assistance to perform exercises which have been recommended by a physiotherapist for the purpose of improving a health condition for 1.5 hours a day.

F Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week.

8

For example: a claimant who is undergoing intensive and prolonged therapeutic treatment which requires the presence of another person to prompt, supervise or assist, and without which the claimant would be undertake the therapy safely, to an acceptable standard or as often as required.

Q & A

Question Answer

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Activity 4: Washing and bathing

Activity 4 – Washing and bathing

This activity considers a claimant’s ability to wash and bathe.

‘Washing’ means cleaning ones whole body, including removing dirt and sweat.

‘Bathing’ means getting into and out of both an unadapted bath and an unadapted shower.


A wet room is not an unadapted shower. If a claimant reasonably requires use of a wet room it could be evidence that the claimant cannot access an unadapted bath and shower. Consideration should be given to the claimant’s ability to use an unadapted bath and shower and ascertain what help, if any, they need in relation to using these. Consideration should be given to the claimant’s functional restrictions to see if they:

• Could reasonably use an aid such as a grab rail to get in or out of an unadapted bath or shower (4b)• Or whether they require assistance (4e) to get in and out of an unadapted bath or shower.

The same principles will also apply when determining whether a claimant requires an aid (4b) or prompting or supervision (4c) to get into or out of an unadapted bath or shower.

Shaving or the ability to dry oneself is not considered in this activity.

A Can wash and bathe unaided.

0

Applies to claimants who can wash and bath unaided, including getting in to and out of both an unadapted bath and unadapted shower.


The majority of people cannot touch every single part of their back. Most people without a disability cannot access their upper spinal region. If someone needs an aid or appliance or requires assistance simply to reach their upper spinal region this is insufficient in itself to score points as the majority of people experience the same restriction.

B Needs to use an aid or appliance to be able to wash or bathe.

2 For example: a long-handled sponge to wash parts of the body that people without a disability could access independently, shower seat where the claimant has difficulty standing for the time taken to shower, or bath rail where there are issues with balance, stability or upper body strength. If a claimant uses a shower attachment on a bath, this should be considered as an unadapted shower.

C Needs supervision or prompting to be able to wash or bathe.

2 ‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who lack motivation or need to be reminded to wash, or require supervision for safety reasons. When considering safety, the likelihood of a risk to the claimant occurring in both a bath and shower should be

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considered. If the claimant can wash or bathe the majority of the time without risk of injury, for example because their health condition is under control through medication, then this descriptor would not apply.

D Needs assistance to be able to wash either their hair, or body below the waist.

2 For example: may apply to claimants who are unable to make use of aids and who cannot reach their lower limbs, or their hair.

E Needs assistance to be able to get in or out of a bath or shower.

3

This descriptor relates to physical assistance by another person and should be applied as a hypothetical test to consider whether the claimant needs assistance to get in to and out of either one of an unadapted bath, or an unadapted shower.

Unadapted baths and showers include a shower over a bath, a shower cubicle (i.e. a partitioned area with a threshold/ledge to step over) and shower attachments to bath taps. Those who cannot access either one of an unadapted bath or shower without assistance from another will qualify for descriptor 4e. A wet room shower, if its use is reasonably required, is evidence that the claimant cannot get into an unadapted shower.

The following decision matrix has been devised to help determine whether a claimant can satisfy 4e:

Does the claimant need assistance to get in or out of a BATH?

Does the claimant need assistance to get in or out of a SHOWER?

Does the claimant score points under descriptor 4(e)?

YES YES YES

YES NO YES

NO YES YES

NO NO NO

F Needs assistance to be able to wash their body between the shoulders and waist.

4

For the purposes of this descriptor, the ability to wash ones upper spinal region is not considered.

G Cannot wash and bathe at all and needs another person to wash their entire body. 8

Q & A

Question Answer

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Activity 5: Managing toilet needs or incontinence

Activity 5 – Managing toilet needs or incontinence

This activity considers toileting and incontinence. Toileting includes the claimant’s ability to (i)get on and off the toilet, (ii)to manage evacuation of the bladder and/or bowel and (iii)to clean oneself afterwards. If help is needed with any of these three actions the appropriate descriptor is satisfied.

Managing incontinence means the ability to manage involuntary evacuation of the bladder and/or bowel, including the use of a collecting device or self catheterisation and cleaning oneself afterwards.

This activity does not consider the ability to manage clothing, climb stairs or mobilise to the toilet.

Claimants with indwelling (permanent) catheters or stoma are considered incontinent for the purposes of this activity.

If the urinary tract is normal there will be little risk of incontinence no matter how long it takes to mobilise to the toilet. If there is, however, a bladder problem and the claimant will be incontinent before they reach the toilet, then a commode could be considered as an aid for the bladder condition (toilet needs) not the mobility problem (mobility needs). Urinary tract conditions that cause urgency of micturition will be relevant, other urinary tract conditions may not be relevant.


A Can manage toilet needs or incontinence unaided.


Descriptor A should be appropriate for claimants who use a commode due to limited mobility (and therefore have difficulty mobilising to the toilet) but otherwise can manage their toilet needs or incontinence.

B Needs to use an aid or appliance to be able to manage toilet needs or incontinence.

2 For example: the claimant is unable to use a standard toilet due to their health condition or impairment. Suitable aids could include commodes, raised toilet seats, bottom wipers, incontinence pads or a stoma bag.

C Needs supervision or prompting to be able to manage toilet needs.

2 ‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who need to be reminded to go to the toilet or need supervision to ensure they cleanse properly.

D Needs assistance to be able to manage toilet needs.

4 This descriptor refers to claimants who require assistance to get on and off the toilet, or evacuate the bladder and bowel, or to clean themselves afterwards, but not to claimants who require assistance due to incontinence. Claimants requiring assistance who are also incontinent are covered by descriptors 5e and 5f.

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E Needs assistance to be able to manage incontinence of either bladder or bowel. 6

For example may apply to a claimant who requires assistance to change a stoma bag.

F Needs assistance to be able to manage incontinence of both bladder and bowel. 8

Q & A

Question Answer

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Activity 6: Dressing and undressing

Activity 6 – Dressing and undressing

This activity assesses a claimant’s ability to put on and take off appropriate, un-adapted clothing that is suitable for the situation. This may include the need to use aids, or where the claimant requires prompting supervision or assistance to dress.

If an individual cannot reliably complete an activity in the way described in a descriptor then they should be considered unable to complete it at that level and an alternative descriptor should be selected.

All claimant’s should be measured by their level of functional ability rather than by how they choose to dress . The key consideration should be the functions that are involved in dressing and undressing and the claimant’s condition that is said to limit their ability to perform those functions.

Dressing and undressing may involve stretching, reaching, bending, gripping and other such movements.

A Can dress and undress unaided.


B Needs to use an aid or appliance to be able to dress or undress.

2

For example: button hooks and sock aids.

Consider whether the way in which the claimant uses an item is a regular way of performing the activity, in the sense that someone without any relevant impairment might also carry out the activity in that way. For example, both standing up and sitting down are usual or normal ways of performing the activity of dressing and undressing. If a claimant cannot stand for all or part of the activity of dressing/undressing (for example due to balance or back problems) the fact that they must sit down does not mean they are not performing the activity to an acceptable standard (as dressing whilst seated is a usual or normal way of carrying out the activity).Therefore, when the claimant is seated instead of standing and a chair or bed is used to sit on, then the chair/bed is NOT an aid. However, there may be circumstances where a chair/bed is used not because the claimant has a problem standing, but for some other reason and it may be an aid depending on the circumstances.

C Needs either –

i. prompting to be able to dress, undress or determine appropriatecircumstances for remaining clothed; or

ii. prompting or assistance to be able to select appropriate clothing.

‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who need to be encouraged to dress at appropriate times, e.g. when leaving the house or receiving visitors. Includes a consideration of whether the claimant can determine what is appropriate for the environment, such as time of day and the weather.

D Needs assistance to be able to dress or undress their lower body. 2

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Applies to claimants who cannot dress or undress their lower body, even with the use of aids or appliances and require the physical assistance of another person.

E Needs assistance to be able to dress or undress their upper body.

4 Applies to claimants who cannot dress or undress their upper body, even with the use of aids or appliances and require the physical assistance of another person.

F Cannot dress or undress at all. 8

Q & A

Question Answer Are types of clothing an important consideration? - UT Decision: CPIP/5338/2014

All claimants should be measured by their level of functional loss rather than by how they dress. The Judge confirmed that the key consideration should be the functions that are involved in dressing and undressing and the claimant’s condition that is said to limit their ability to perform those functions. Without intending to be comprehensive dressing and undressing may involve stretching, reaching, bending, and gripping and other such movements.

A useful quote from this decision is as follows:

“19. This is a convenient point to consider the sort clothing to which the claimant’s limitations must be applied. This will only arise if the claimant is able to cope with some sorts of clothing but not others. The tribunal must always consider socks and shoes, because this is what paragraph 1 of Part 1 of Schedule 1 requires. Beyond that, tribunals must apply a uniform standard for all claimants. I accept the Secretary of State’s submission to that effect and that this involves an element of judgment. It is, though, possible to give some guidance on how a tribunal should make its assessment. • The test is the general one whether the claimant can dress – I focus on this forconvenience and because it will usually present more difficulty than undressing – not whether they can dress in any particular types of clothing. • But dressing is not an abstract activity. We dress for a particular purpose or occasion. Theclothing we wear depends on whether we are going to be inside or out as it will on the temperature and weather. The tribunal should not limit itself to the minimum clothing necessary for warmth and decency. • This does not mean that the claimant is entitled to specify the type of clothing by way ofpreference or requirement, for example, in a particular job. That would defeat the uniform nature of the test. • The tribunal must not identify the clothing to which the test is applied in a way that thedefeats the purpose of the test by defining away the limiting effects of the claimant’s disability. • But the tribunal is entitled to consider reasonable and practical alternatives. For example:claimants who cannot raise their arms to put on a pullover, may be able to put on a cardigan. • The balance between not defining away the claimant’s disability and taking account ofalternatives can be struck by concentrating on the functions that underlie the activity. The legislation imposes a test of the claimant’s ability to perform the functions involved in the activity. It may be appropriate in an overall assessment of the claimant’s ability to dress to disregard a limitation with a particular function. But it would not be appropriate to disregard a limitation with so many functions that the claimant could only wear loose, elasticated clothes with no fastenings. The test would then no longer be a test of the activity, but of only a limited part of the activity.”

Are slip on shoes an aid or a reasonable practical alternative?

Slip on shoes should be considered a reasonable and practical alternative to shoes with fastenings and therefore if a claimant relies on slip on shoes only then they should not score under activity 6. See UT decision CPIP/772/2016:

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“28 In my judgment slip-on shoes do constitute the kind of reasonable and practical alternative clothing envisaged by the Upper Tribunal Judge in PE [CPIP/5338/2014). In so finding, I am of the view that the balance is struck in the appropriate place. It is right to disregard the limitation of function that would be caused by putting on shoes that required to be fastened due to the claimant’s dizziness. By using the slip-on shoes the claimant bypasses the impaired function. As in the example of the cardigan and pullover, slip-on shoes perform a similar clothing role to other shoes, in that they cover and protect the feet; and they are a commonly available, non-specialist item of clothing….

29 Furthermore, I do not consider the lack of specific reference to types of shoes in the definition of “dress and undress” to be a significant omission, and it certainly does not lead the conclusion that a claimant who is able, unaided and without assistance, to put on slip-on shoes but not other types will score points under daily living activity 6.”

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Activity 7: Communicating verbally

Activity 7 – Communicating verbally

This activity considers a claimant’s ability to communicate verbally with regard to expressive (conveying) communication and receptive (receiving and understanding) communication in ones native language.

Clarity of the claimant’s speech should be considered. In some cases the other participant in the conversation may have to concentrate slightly harder than normal, for example after a certain type of stroke it can be hard to articulate some sounds in speech. The speech sounds different to normal but is understandable. This is to an acceptable standard in the meaning of the descriptor. If the claimant couldn’t make themselves understood and had to resort to hand gestures and writing notes this would not be to an acceptable standard.

Basic verbal information is information conveyed in a simple sentence. Examples of a simple sentence: “Can I help you?”; “I would like tea please”; “I came home today”; “The time is 3 o’clock.”

Complex verbal information is information conveyed in either more than one sentence or one complicated sentence,for example: “I would like tea please, just a splash of milk and no sugar, as I always have sweeteners with me for when I go out.”

Verbal information can include information that is interpreted from verbal into non-verbal form or vice-versa – for example, speech interpreted through sign language.

Communication support means support from another person trained or experienced in communicating with people with specific communication needs (for example, a sign language interpreter); or someone directly experienced in communicating with the claimant themselves (for example, a family member).

Individuals who cannot express or understand verbal information and would need communication support to do so should receive the appropriate descriptor even if they do not have access to this support. For example , a deaf person who cannot communicate verbally and does not use sign language might need another person to support them in another way even if they do not routinely have such help.

Lip reading is not considered an acceptable way to interpret verbal communication.

The ability to remember and retain information is not within the scope of this activity e.g. relevant to those with dementia or learning disabilities.

A Can express and understand verbal information unaided.


B Needs to use an aid or appliance to be able to speak or hear.

2 Applies to claimants who require a hearing aid in order to hear to an acceptable standard, or an electro larynx in order to speak. If the claimant is not using a prescribed hearing aid, there should be exploration of whether there is a medical reason such as chronic ear infection. If so, function without the aid should be assessed. If there is not a good reason, expected function with the aid should be assessed. If a claimant cannot speak or her to an acceptable standard even with the use of aids then an alternative descriptor should be selected.

C Needs communication support to be able to express or understand complex verbal information. 4

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This descriptor applies to claimants who can express and understand basic verbal information, but who need support to be able to express or understand complex verbal information. If a claimant cannot express or understand even basic verbal information then Descriptor D or Descriptor E would be appropriate.

D Needs communication support to be able to express or understand basic verbal information.

8 For example: may apply to claimants who require a sign language interpreter for all verbal communication.

E Cannot express or understand verbal information at all even with communication support. 12

A claimant who cannot communicate verbally, even with communication support, would score under this descriptor.

Q & A

Question Answer Does writing things down count as communication?

No, writing things down is not verbally communicating to an acceptable standard. Verbal communication can be interpreted from verbal into certain non-verbal forms e.g. speech interpreted through sign language or vice versa. A person who needs a sign language interpreter to communicate with others would score as requiring communication support. A person who uses an aid or appliance in order to communicate e.g. a voice box should score under descriptor 7b. A person who cannot either express or understand verbal information even with communication support (even if all communication could be written down) would score 7e.

See also UT decision CPIP/2306/2015:

“44. The baseline descriptor for activity 7, a “can express and understand verbal information unaided” refers to the spoken word and does not include written communication. The wording of descriptor b, meriting 2 points, “needs to use an aid or appliance to be able to speak or hear” is not assessing the ability to communicate in writing. Under my analysis a text to speech machine, or even a mobile phone used for a similar purpose, which communicated information at least in part in written words to another person does not satisfy the concept of two way communication by way of the spoken word.”

If the claimant uses a hearing aid in one ear when the other ear has normal hearing, would they satisfy 7a or 7b?

If the claimant has good hearing in one ear, but uses a hearing aid in the other, then normally they would not score any points. They already hear to a satisfactory standard, and require neither an aid nor communication support. However, if the claimant has hearing loss in both ears to a level at which they would struggle to hear without a hearing aid then 7b would likely apply.

Should a cochlear implant be treated as an aid (bearing in mind that internal implants are not aids?

A cochlear implant has two parts; one part that is inserted surgically and cannot be removed, and the second part, the transmitter, which is worn on the ear much like a hearing aid. The internal part is reliant on the external part in order to function and enable hearing of sound. Whilst the implant alone would not be considered an aid the fact that it will not work without the external part means that we can classify the device as a whole as an aid.

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Activity 8: Reading and understanding signs, symbols and words

Activity 8 – Reading and understanding signs, symbols and words

This activity considers the claimant’s capability to read and understand written or printed information in the person’s native language. To be considered able to read, claimants must be able to see the information - accessing information via Braille is not considered as reading for this activity.

If the claimant cannot read, this must be as a direct result of their health condition or impairment e.g. visual impairment, cognitive impairment or learning disability. Illiteracy or lack of familiarity with written English are not health conditions and should not be considered except where they arise as a consequence of a sensory or cognitive impairment.

The ability to remember and retain information is not within the scope of this activity.

If an individual cannot reliably complete an activity in the way described in a descriptor then they should be considered unable to complete it at that level and an alternative descriptor chosen.

A Can read and understand basic and complex written information either unaided or using spectacles or contact lenses.


The distance between the eyes and written material is not relevant. Some people hold text closer to their eyes than others, but if it can be read without aids then this descriptor will apply.

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

For example: may apply to claimants who require vision aids.

Some people have prims in their glasses prescription to correct their vision. In such cases the prism should not be considered an aid as it would be part of the normal spectacles prescription.

If a larger prism has to be held in front of the person’s usual glasses, then the prism lenses should be considered an aid.

Basic written information is signs, symbols or dates written or printed in standard sized text in claimant’s native language.

Complex written information is more than one sentence of written or printed standard size text in claimant’s native language.

Consideration must be given to whether the claimant can read and understand information both indoors and outdoors. In doing so consideration should also be given to whether the claimant uses or could reasonably be expected to use aids or appliances, such as screen magnification to read text when indoors and a portable magnifying glass to do when outdoors. If despite the use of aids the claimant cannot read basic or complex information both indoors and outdoors, another descriptor may apply.

C Needs prompting to be able to read or understand complex written information. 2

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‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who require another person to explain complex written information due to a cognitive impairment.

D Needs prompting to be able to read or understand basic written information.

4 ‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who require another person to remind them of the meaning of basic written information due to a cognitive impairment.

E Cannot read or understand signs, symbols or words at all.

8 For example: may apply to claimants who require another person to read everything for them due to a learning disability or severe visual impairment.

Q & A

Question Answer

What is printed standard size text? Standard size text should be considered as point 12.

If a claimant with dyslexia wears tinted spectacles to help them read could they be classed as an aid?

Yes, if the claimant requires the spectacles to assist with a cognitive impairment (i.e. dyslexia) then this does not fall within the ordinary meaning of spectacles as the spectacles are not being used to correct defective eyesight; therefore, they can be treated as an aid.

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Activity 9: Engaging with other people face to face

Activity 9 – Engaging with other people face to face

This activity considers a claimant’s ability to engage with other people, which means to interact face-to-face in a contextually and socially appropriate manner, understand body language and establish relationships.

Activities 7 and 9 are not mutually exclusive. If claimants require support to engage with others under activity 9, as well as communication support under activity 7, then their needs must be considered under both activities.

An inability to engage face-to-face must be due to the impact of impairment and not simply a matter of preference by the claimant.

Social support means support from another person trained or experienced in assisting people to engage in social situations, or someone directly experienced in supporting the claimant themselves (for example a family member), who can compensate for limited ability to understand and respond to body language, other social cues and assist social intregration. Most claimants with sensory impairments will be able to fully engage with others independently, however they may score on both activities 7 and 9 if, for example, anxiety arising from their impairment means they reasonably require social support to engage with people generally.

Behaviour which would result in a substantial risk of harm to the claimant or another person must be as a result of an underlying health condition and the claimant’s inability to control their behaviour.

When considering whether claimants can engage with others, consideration should be given to whether they can engage with people generally, not just those people they know well.


A Can engage with other people unaided.


B Needs prompting to be able to engage with other people.

2

‘Prompting’ means reminding, encouraging or explaining by another person. This could take the form of a person acting in a reassuring capacity, e.g. calming someone who is anxious about interacting with others.

Descriptor 9b 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.

C Needs social support to be able to engage with other people.

4

Social support is something over and above prompting such as active intervention and not mere reassurance by presence.

Descriptor 9c is about needing social support to engage in order to reduce anxiety (note the legislation does not refer to overwhelming psychological distress and so the bar is much lower) or to assist with social interaction, or to minimise harm to the claimant or others.

Social support means support from another person trained or experienced in assisting people to engage in social situations or someone directly experienced in supporting the claimant themselves (for example a family member), who can compensate for limited ability to understand and respond to body language, other

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social cues and assist social integration.

Applies to people who can only engage with others with active and skilled support on the majority of days, or who are left vulnerable due to their level of risk-awareness as a result of their condition.

Vulnerability to the actions of others is considered in this activity. For example someone with cognitive or learning impairment may be less risk aware and vulnerable to manipulation or abuse.

D Cannot engage with other people due to such engagement causing either –

i. overwhelming psychological distress to the claimant; orii. the claimant to exhibit behaviour which would result in a substantial riskof harm to the claimant or another person.

8 ‘Overwhelming psychological distress’ means distress related to an enduring mental health condition or intellectual or cognitive impairment which results in a severe anxiety state in which the symptoms are so severe that the person is unable to function. This may be as a direct result of a mental health impairment, or as a result of another disability such as cognitive or developmental impairment.

Q & A

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

See UT decisions CSPIP/203/2015 and CSPIP/210/2015:

“8…. I agree, therefore, with the analysis by the Secretary of State that “there should be a definition of ‘social support’ which is qualitatively differently from mere ‘prompting’……..In my judgement, what is required is that, on account of a person’s physical or mental condition, she reasonably requires action from a person trained or experienced in assisting people to engage in social situations, in order to be able to engage with other people face to face; ‘support’ is about helping a person, who would otherwise be unable to do so, carry out a task. As it has to involve more than ‘reminding, encouraging or explaining’ then it connotes active intervention and not mere reassurance by presence. It must be help, more substantial than prompting, reasonably necessary if the claimant is to participate in society.”

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Activity 10: Making budgeting decisions

Activity 10 – Making budgeting decisions

The aim of this activity is to assess whether the claimant is able to make budgeting decisions, either simple or complex.

Complex budgeting decisions are those that are involved in calculating household and personal budgets, managing bills and planning future purchases.

Simple budgeting decisions are those that are involved in activities such as calculating the cost of goods and change required following purchases.

Assistance in this activity refers to another person carrying out elements, although not all, of the decision making process for the claimant.


This 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 complex. Complex budgeting involves calculating household and personal budgets (e.g. knowing how much money is left to spend once bills and rent is paid), managing and paying bills (e.g. setting aside money from income for gas and electricity bills) and planning future purchses (e.g. knowing that saving is required when necessary).

The age of the person and whether they have ever done any household budgeting is irrelevant –it is their ability to make budgeting decisions and their level of cognitive function that is relevant.

Reduced vision or mobility does not impact on making budgeting decisions. The fact that a person’s limited sight or mobility make it difficult to them to see price tags in shops or get about may mean they require someone else to read or help with travel, but it does not in itself give rise to difficulty in making the decisions.

A Can manage complex budgeting decisions unaided.

0 Within this activity, the ability to perform an activity ‘unaided’ means without prompting from another person.

B Needs prompting or assistance to be able to make complex budgeting decisions.

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This descriptor applies to people who need assistance with managing their household bills or planning future purchases. A cognitive or developmental impairment which leaves the person vulnerable as a result of not understanding everyday financial matters should also be considered.

This activity also applies to people who need prompting, e.g. those who need to be encouraged or reminded to make complex budgeting decisions.

Where bad budgeting decisions are made, consideration must be given to whether this is as a result of a health condition or impairment.

Similarly, some individuals may lack motivation to carry out this activity and consideration must be given to whether this is as a result of a health condition or impairment and whether the individual would carry out the activity if they really had to, for example if they were to receive a final notice to pay a bill.

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A mental health condition may affect a person’s ability to make complex budgeting decisions. Complex budgeting decisions are the ability to respond appropriately to changing circumstances and events, as income and outgoings change, new demands are made, new things become priorities. Because of this, conditions such as depression can have an impact if they mean that the person is unable to respond to these changing circumstances and demands.

An example of someone who needs prompting to manage complex budgeting decisions may be where a claimant can manage day to day simple budgeting decisions e.g. when food shopping, buying clothes..etc, but not longer term finances. This activity does not take into account a person’s choices around budgeting, but simply their functional ability. So if a person spends all their money at the start of the month and cannot prioritise spending, this must be due to a health condition to satisfy the descriptor.

C Needs prompting or assistance to be able to make simple budgeting decisions.

4 ‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who need to be encouraged or reminded to make simple financial decisions or who need assistance to manage simple budgeting decisions independently.

D Cannot make any budgeting decisions at all. 6

Q & A

Question Answer

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Mobility Activity 1: Planning and following journeys

Mobility Activity 1 – Planning and following journeys

This activity considers a claimant’s ability to plan and follow the route of a journey. It is useful separately to consider:

• ability to plan the route of a journey in advance

• ability to leave the home and embark on a journey and

• ability to follow the intended route once they leave the home.

This activity is designed for limitations on mobility deriving from mental health, cognitive and sensory impairments, whereas activity 12 is generally designed for limitations from physical problems. Cognitive impairment includes orientation (understanding of where, when and who the person is), attention, concentration and memory. Any issues with the ability to stand and then move are not applicable under activity 11, but under activity 12.

Regarding falls, consideration must be given to how the risk of falling manifests itself. Ordinarily the risk to a claimant’s safety arising from a physical inability to move safely would be applicable under activity 12. However, where the fall arises as a result of a sensory or cognitive impairment (for example, seizures associated with loss of consciousness) the risk of the fall to a claimant’s safety would be applicable under activity 11. When assessing which descriptor might apply, consideration also needs to be given to any risks to an individual arising during the “recovery” period (for example, any post ictal confusion).

11d or 11f only apply where a claimant could not reliably make their way along a route without an accompanying person, assistance dog or orientation aid. The presence of another person out of preference is not sufficient.

Examples provided in this guidance are for illustrative purposes only and are not designed to be exhaustive.

A Can plan and follow the route of a journey unaided.

0 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.

B Needs prompting to be able to undertake any journey to avoid overwhelming psychological distress to the claimant.

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This descriptor applies to claimants where undertaking any journey causes overwhelming psychological distress (OPD) and where they need prompting (‘prompting’ means reminding, encouraging or explaining by another person) on the majority of days to be able to undertake the journey. In practice, this is only likely to apply in the circumstances where someone needs prompting to set off on the journey, but would not need another person whilst on the journey itself.

‘Any journey’ means that in order to satisfy the descriptor on a day the person must require prompting when undertaking every single journey on that day to avoid OPD. If the person can manage to leave the home to make a journey once without prompting then on that day the descriptor is not satisfied. For example, a claimant who can make visits to the local shop or collect their children from school without prompting on most days will not satisfy this descriptor, even if they are unable to undertake other journeys without prompting during the same day. However, being able to start a journey at night time only is not considered to be undertaking a journey to an acceptable standard. Therefore, in these instances, descriptor E may be more appropriate.

OPD means distress related to a mental health condition or intellectual or cognitive impairment resulting in a severe anxiety state in which the symptoms are so severe that the person cannot undertake a journey without being overwhelmed.

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The threshold is a very high one - a claimant who, without prompting, would be left feeling anxious, worried or emotional does not meet it. OPD may occur in conditions such as generalised anxiety disorder, panic disorder, dementia or agoraphobia.

Illustrative examples:

The claimant becomes panicked before any journey and they are only able to get out of the door if someone provides encouragement and reassurance that there are no dangers or threats as a result of going outside. However, once they are out they are able to follow a route independently without help. They would therefore satisfy mobility 1B.

If, however, a claimant can undertake any single journey on the majority of days in the required period without prompting, for example, regular visits to the local shop to collect the daily paper, or regularly collect their children from school without support then they will not satisfy this descriptor, even if they are unable to set off on other journeys without prompting during the required period.

C Cannot plan the route of a journey.

8 This descriptor is most likely to apply to claimants with cognitive or developmental impairments who cannot formulate a plan for their journey in advance using simple materials, such as bus route maps, phone apps or timetables. The route that is being planned is unfamiliar – one does not need to plan a familiar route.

D Cannot follow the route of an unfamiliar journey without another person, assistance dog or orientation aid.

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“Follow the route” means make one’s way along a route to a destination. This involves more than just navigation of the route; it also includes making your way along the route reliably. Safety should be considered in respect of risks that relate to making ones’ way along a route (for example, tendency to wander into the road, inability to safely cross a road or risk of self-harm due to overwhelming psychological distress caused). For example, a claimant with a severe visual or profound hearing impairment may be at a substantial risk from traffic when crossing a road.

This descriptor is most likely to apply to claimants with cognitive, sensory or developmental impairments, or a mental health condition that results in overwhelming psychological distress, who cannot, due to their impairment, work out where to go, follow directions, follow a journey safely or deal with minor unexpected changes in their journey when it is unfamiliar. A claimant who suffers overwhelming psychological distress whilst on the unfamiliar journey and who needs to be accompanied to overcome the overwhelming psychological distress may satisfy descriptor 1d.

A person should only be considered able to follow an unfamiliar journey if they would be capable of using public transport – the assessment of which should focus on ability rather than choice.

The route has already been planned. Any significant diversions from that route are therefore irrelevant – it is no longer the planned route. However, making one’s way around road works, or a change of train platform (i.e. minor diversions) are part of being able to follow the route of a journey. For example a profoundly deaf person may need a person to accompany them to relay information, such as changes to a journey, due to minor disruptions.

The descriptor refers to “an unfamiliar journey” rather than “any unfamiliar

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journey”. Accordingly, claimants can satisfy the descriptor by showing that they typically need to be accompanied by another person or an assistance dog or to use an orientation aid on the majority of days when undertaking unfamiliar journeys (it’s not necessary to show that they need such support for every possible unfamiliar journey on most days).

Orientation aids are specialist aids. Ordinary satellite navigation systems such as those found in mobile phones do not count as specialist. Maps or lists of directions do not count as specialist. A long cane (as used by person with sight impairment) is an example of a specialist orientation aid (NB – a symbol cane, which is used to signal to others the person has some sight impairment, is not an orientation aid as it does not actually help the person orient themselves).

E Cannot undertake any journey because it would cause overwhelming psychological distress to the claimant.

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This descriptor applies to claimants where undertaking any journey on the majority of days causes overwhelming psychological distress (OPD) despite being aided.

‘Any journey’ means that in order to satisfy the descriptor on any particular day the person must not be able to manage to undertake a single journey. If the person can manage to leave the home to undertake a journey once then on that day the descriptor is not satisfied, even if they are unable to undertake other journeys during the same day. Being able to complete a journey at night time only however, is not considered to be completing a journey to an acceptable standard. Therefore, in these instances, this descriptor may be appropriate.

OPD means distress related to a mental health condition or intellectual or cognitive impairment resulting in a severe anxiety state in which the symptoms are so severe that the person cannot undertake a journey without being overwhelmed. The threshold is a very high one - a claimant who is anxious, worried or emotional does not meet it.

This descriptor is likely to apply to claimants with severe mental health conditions (for example severe agoraphobia, panic disorder or psychotic illness associated with severe paranoia) or cognitive impairments (for example a person with dementia who may become very agitated and distressed when leaving home, to the extent that journeys outside the home can no longer be made either at all, or on the majority of days, even with the support of another person).

A claimant who satisfies 1e cannot also satisfy 1f. If they cannot undertake a single journey on the majority of days due to overwhelming psychological distress, then 1e will be the applicable descriptor, even if there are occasions when they could follow a familiar route, if accompanied.

F Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid.

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“Follow the route” means make one’s way along a route to a destination. This involves more than just navigation of the route. Safety should be considered in respect of risks that relate to making ones’ way along a route (for example, tendency to wander into the road, inability to safely cross a road or risk of self-harm due to overwhelming psychological distress caused). For example, a claimant with a severe visual or profound hearing impairment may be at a substantial risk from traffic when crossing a road.

The familiar route does not need to be planned – it is familiar. Any significant diversions from that route are therefore irrelevant – it is no longer the familiar route. However, making one’s way around road works, or a change of train platform (i.e. minor diversions) are part of being able to follow the route of a journey.

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The descriptor refers to “a familiar journey” rather than “any familiar journey”. Accordingly, claimants can satisfy the descriptor by showing that they typically need to be accompanied by another person or an assistance dog or to use an orientation aid on the majority of days when undertaking familiar journeys (it’s not necessary to show that they need such support for every possible familiar journey on most days).

This descriptor is most likely to apply to claimants with cognitive, sensory or developmental impairments, or a mental health condition that results in overwhelming psychological distress, who cannot, due to their impairment, work out where to go, follow directions, follow a journey safely or deal with unexpected changes in their journey, even when the journey is familiar. A claimant who suffers overwhelming psychological distress whilst on the familiar journey and who needs to be accompanied to overcome the overwhelming psychological distress may satisfy descriptor 1f.

A claimant who is actively suicidal or who is at substantial risk of exhibiting violent behaviour and who needs to be accompanied by another person to prevent them harming themselves or others when undertaking a journey would meet this descriptor. In cases such as this, the HP should look for evidence of suicidal thoughts and/or behaviour. In cases of violent behaviour there must be evidence that they are unable to control their behaviour and that being accompanied by another person, who can intervene if necessary, reduces a substantial risk of the person committing a violent act.

Orientation aids are specialist aids. Ordinary satellite navigation systems such as those found in mobile phones do not count as specialist. Maps or lists of directions do not count as specialist. A long cane (as used by person with sight impairment) is an example of a specialist orientation aid (NB – a symbol cane, which is used to signal to others the person has some sight impairment, is not an orientation aid as it does not actually help the person orient themselves).

Q & A

Question Answer

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Mobility Activity 2: Moving around

Mobility Activity 2 – 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.


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.

Limited pauses do not necessarily mean the bout of moving has come to an end. For example, a claimant who has some difficulty with balance may pause before avoiding a small obstacle or stepping up onto a kerb – the claimant should not be viewed as completely stopping at this point. The reliability criteria should be applied when assessing what distances the claimant can achieve.

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.

Posture should only be taken into account if it affects the person’s ability to mobilise and to an acceptable standard (e.g. without severe discomfort). Physical symptoms arising from overwhelming psychological distress which have been considered for mobility activity 1 should be disregarded for the purposes of mobility activity 2.

NB: in legislation this activity is referred to as Mobility Activity 2.

A Can stand and then move more than 200 metres, either aided or unaided. 0

B Can stand and then move more than 50 metres but no more than 200 metres, either aided or unaided. 4

C Can stand and then move unaided more than 20 metres 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, without needing to rely on an aid or

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appliance such as a walking stick, or help from another person.

This descriptor would only apply to someone who was limited to 50 metres and no further. If the claimant can stand and move further than 50 metres safely and reliably with an aid then a lower scoring descriptor must apply.

D Can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres. 10

E Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided. 12

F Cannot, either aided or unaided –

i. stand; orii. move more than 1 metre.

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Q & A

Question Answer Is there any guidance to the walking speed which is “not within a reasonable time period”?

As a guide, an average person can walk 60 metres per minute. Therefore, taking into account “reasonable time period” in regulation 4(2A)(d) (i.e. no more than twice as long as the maximum period that a non disabled person would take), the walking speed which is deemed within a reasonable time period is 30 metres per minute. This equates to 1 metre every 2 seconds.

If someone can walk faster than that speed then they can perform the activity in a reasonable time period. If someone walks slower than that speed for whatever descriptor distance bracket you are measuring then you will have to investigate the next higher scoring descriptor until you reach a distance that they are able to walk at this speed.

For example, a claimant who can only walk up to 51 metres and it takes them 1 and a half minutes. In accordance with the above guidance a reasonable time period in which to walk 51 metres is one minute 42 seconds; therefore the claimant can walk the distance in a reasonable time period and will score descriptor 2(b). If the claimant ,more often than not(over 50% of days), would take longer than one minute 42 seconds to walk up to 51 metres, then you would need to consider the next descriptor with a shorter distance - 2(c) or (d) - and see whether the claimant can walk more than 20 metres in a reasonable time period.

Is “swinging through” considered to be moving to an acceptable standard?

Yes, “swinging through” is an acceptable way to stand and move. It is a way of mobilising when using an aid or appliance.

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Definitions

PHRASE LEGAL DEFINITION (AS PER SOCIAL SECURITY (PIP) REGULATIONS 2013)

Aid or Appliance

(a) any device which improves, provides or replaces C's impaired physical or mental function (b) includes a prosthesis.

Aided With (a) the use of an aid or appliance, or (b) supervision, prompting or assistance.

Assistance Physical intervention by another person and does not include speech.

Assistance Dog A dog trained to guide or assist a person with sensory impairment.

Basic Verbal Information

Information in C's native language conveyed verbally in a simple sentence.

Basic Written Information

Signs, symbols and dates written or printed in standard size text in C's native language.

Bathe Includes to get into or out of an unadapted bath or shower.

Communication Support

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

Decisions involving (a) calculating household and personal budgets; (b) managing and paying bills and (c) planning future purchases.

Complex Verbal Information

Information in C's native language conveyed verbally in either more than one sentence or one complicated sentence.

Complex Written Information

More than one sentence of written of printed standard size text in C's native language.

Cook Heat food at or above waist height.

Dress and Undress

Includes to put on and take off socks and shoes.

Engage Socially

(a)Interact with others in a contextually and socially appropriate manner (b) Understand body language and (c) establish relationships.

Manage Incontinence

Manage involuntary evacuation of the bowel or bladder, including use a collecting device or self-catheterisation, and clean oneself afterwards.

Manage Medication or therapy

Take medication, or undertake therapy, where a failure to do so is likely to result in a deterioration in C’s health

Medication Medication to be taken at home which is prescribed by a registered (a) doctor (b) nurse or (c) pharmacist.

Monitor a (a)Detect changes in C's health condition which are likely to lead to a

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health condition

deterioration in C's health; and (b) take action advised by a (i) registered doctor (ii)registered nurse or (iii) health professional who is regulated by the Health Professional Council, without which C's health is likely to deteriorate.

Orientation Aid A specialist aid designed to assist disabled people to follow a route safely.

Prepare In the context of food, means make food ready for cooking or eating.

Prompting Reminding, Encouraging or explaining by another person.

Psychological Distress

Psychological Distress related to an enduring mental health condition or an intellectual or cognitive impairment.

Read Includes reading signs, symbols and words but does not include reading Braille.

Simple Budgeting Decisions

Decisions involving (a) calculating the costs of goods; and (b) calculating change required after a purchase.

Simple Meal A cooked one-course meal for one using fresh ingredients.

Social Support Support from a person trained or experienced in assisting people to engage in social situations.

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

Supervision The continuous presence of another person for the purpose of ensuring C's safety.

Take Nutrition (a)Cut food into pieces, convey food and drink to one's mouth and chew and swallow food or drink; or (b) take nutrition by using a therapeutic source.

Therapeutic Source

Parenteral or enteral tube feeding, using a rate-limiting device such as a delivery system or feed pump.

Therapy Therapy to be undertaken at home which is prescribed or recommended by a - (a) registered–

(i) doctor; (ii) nurse; or (iii) pharmacist; or

(b) health professional regulated by the Health Professions Council, but does not include taking or applying, or otherwise receiving or administering, medication (whether orally, topically or by any other means), or any action which, in C’s case, falls within the definition of “monitor a health condition”.

Toilet Needs (a)Getting on and off an unadapted toilet (b) evacuating the bladder and bowel and (c) cleaning oneself afterwards.

Unaided Without (a) the use of an aid or appliance or (b) supervision, prompting or assistance.

adm chapter p2: assessment for pip · chapter p2: assessment for pip ... reg 6(3)(a) p 2 0 1 2 t h...

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