new entrant wca learning journey introduction to lima module f

MED-NEHCPITL~001 September 2020

New Entrant WCA Learning Journey – Introduction to LiMA

Module F

Introduction to LiMA

MED-NEHCPITL~001 of 28

Foreword

This training has been produced as part of a training programme for Healthcare Professionals (HCPs) who conduct assessments for The Centre for Health and Disability Assessments on behalf of the Department for Work and Pensions.

All HCPs undertaking assessments must be registered practitioners who in addition, have undergone training in disability assessment medicine and specific training in the relevant benefit areas. The training includes theory training in a classroom setting, supervised practical training, and a demonstration of understanding as assessed by quality audit.

This training must be read with the understanding that, as experienced practitioners, the HCPs will have detailed knowledge of the principles and practice of relevant diagnostic techniques and therefore such information is not contained in this training module.

In addition, the training module is not a stand-alone document, and forms only a part of the training and written documentation that the HCP receives. As disability assessment is a practical occupation, much of the guidance also involves verbal information and coaching.

Thus, although the training module may be of interest to non-medical readers, it must be remembered that some of the information may not be readily understood without background medical knowledge and an awareness of the other training given to HCPs.



Document control

Superseded documents

Version history

Version Date Comments

1a draft July 2018 Initial draft

1b draft 7th August 2018 Comments from Clinical Training Team & Medical Solutions Advisor incorporated

1c draft 7th August 2018 Formatting

1 Final

2a draft

10th August 2018

23rd December 2019

Signed off by SH&S

Review and update

2 Final 3rd February 2020 Signed off by DWP

3 Final 22nd September 2020 Final document

Changes since last version

Applying LCWRA on LiMA added

Outstanding issues and omissions

Updates to Standards incorporated

Issue control

Author: Clinical Training Team

Owner and approver:



Contents

Overview of this Module 5

1. Introduction 7

2. Examination 14

3. Observed Behaviour 17

4. Medical Opinion - Activity Outcomes 19

5. Medical Opinion - Activity Outcome Justification 21

6. Medical Opinion – Non-Functional Descriptor and LCWRA 22

7. Medical Opinion - Assessment Summary 23

8. Medical Opinion - Prognosis and Harmful Information 25

9. Applying LCWRA on LiMA 26

10. Review and Confirm 27

Observation form 28



Overview of this Module

This module is intended for use by new HCPs alongside the LiMA training server and serves as a “walkthrough” to enable HCPs to begin to familiarise themselves with the structure of LiMA.

Background

Feedback from new HCPs indicated a desire to have the opportunity to have a “preview” of LiMA prior to commencing their learner journey to have some familiarity with navigation of the system and the IT aspects of the system.

In the learner journey, LiMA is introduced at a very early stage, however learners often felt they got “lost” in terms of the overall structure of the system. For example they will spend quite a lot of time entering examination findings etc and they lose sight of where this actually happens in the full end to end LiMA application.

Feedback from facilitators also suggested the IT skills of new HCPs varied widely and some HCPs will need more support as they lack knowledge of basic concepts such as radio buttons/drop down menus etc.

CHDA felt a module that was based on guiding new HCPs through the LiMA application may enhance confidence and allow greater familiarity to support the learner and demonstrate how LiMA assists in the production of a quality report for the Decision Maker in the WCA.

How this module should be used

This module is designed for use by newly employed HCPs.

The module can also be used by HCPs (both employed and those working for CHDA on a sessional basis during their initial training).

It must be borne in mind that at this stage, HCPs will have very limited knowledge of the WCA, so therefore this module really is there to support navigation through the system with some basic points on how the system relates to the 5 steps of Disability Analysis.

It is therefore not intended to explain any of the legislation, policy intent or procedural issues such as ESA 50 input. All of these are explained in detail later in the learner journey. This module is designed to allow new HCPs to be familiar with the structure of how phrases etc can be built up in LiMA and essentially allow a pre-amble of the system.



IT Practicalities

The learner will require to have their training account set up by IT prior to using this system

If being used in Induction, the TSM should supply the learner with a LiMA Training Server “log in” and training NINo for use while at base. It must be made clear to the New Entrant that they should only use this LiMA log in/NINo at base and in their facilitated blocks, they will be supplied with new log in details and NINos for use.

The TSM or CSL should support the learner in their initial log on to the main training server and then logging onto MSRS/LiMA and accessing a report.

It would be prudent to have a CSL available to assist with any issues the learner has while using the training server and completing this module. (The CSL does not have to fully support the learner and can be engaged in other activities while the HCP completes this module).

The learner should also have access to the LiMA technical guide online and this guide will need to be printed off prior to working through this module as it cannot be accessed while on the training server.



1. Introduction

The Work Capability Assessment is used to determine a person’s capability for work in both Employment and Support Allowance (ESA) and Universal Credit (UC). In this module, we will be using the ESA application. Both systems are very similar, but there a few differences between ESA and UC that you will learn about later in your learner journey.

LiMA is an IT platform used to record details of the Work Capability Assessment (WCA) you conduct on claimants.

You will enter the details of the assessment into the system to generate a Work Capability Assessment report – also known as an ESA 85 report (or UC 85 report).

Once you have been assisted in logging into the system and accessing the LiMA report, you should read the following guidance notes on how you can progress through this module.

Do not worry about a lot of the terminology and technical terms; this is something you will become familiar with throughout your learner journey.

This guide will walk you through the system and is structured to reflect the way LiMA follows the 5 points of Disability Analysis. (You should have read about these in Module A).

The points in each section will give you hints and tips on how to progress through each screen and some very brief points on the type of data we capture in each section.

LiMA is a computer application which has logic built in to the system that may assist you in the advice you offer to the Decision Maker in the WCA.

LiMA also assists by having some pre-populated phrases that you can click on, and also phrases that have a start section that you can then free-text more detail into. For example when detailing the clinical history, a phrase may start with “The condition has been present for” – you will then have options to put in specific times such as 2 years, or less specific details such as many years. The advantage is that you do not have to free type the first part of the phrase.

LiMA also allows you to free text any required information.

In addition, LiMA has a section to allow you to detail the clinical examination findings in a consistent manner.



The system will also ensure you have completed all the relevant sections and will prompt you with certain issues medically – such as a diagnosis that may suggest that severe disability is likely.

You will see as you progress through the screens how LiMA will assist you in various ways when you are completing WCA reports.

When using LiMA, the program will “Time out” after about 30 minutes of remaining on the same screen (even if you are typing or selecting drop down options on that particular screen). Therefore, in order to prevent lost documentation, you must remember to change screens periodically during your use of LiMA, by using the forward or backward arrow.

The LiMA technical guide and this module provides an explanation on how to move around LiMA and how to enter information however below is an explanation of the common buttons used to help you to get started.

These arrows are at the bottom of every screen and allow you to move forward and backwards to the adjacent screen.

If you have not completed all of the required sections on the page, you will not be allowed to move on to the next screen and LiMA will highlight in red what you need to complete before moving on.

If a square box is present, multiple options can be entered into that part of a phrase.

If a radio button is present, only one option can be entered into that part of a phrase.

The scroll bar is on the right hand side of the screen or individual box; it is used to move up and down either the whole screen or the box with the scroll bar. Use the left mouse button to click on the arrow at the top to move up or the arrow at the bottom to move down.



1.1 Questionnaire Page (ESA 50)

On this page, initially a box will come up with “LiMA tip of the Day”. This is a useful prompt for HCPs and will remind you of any recent changes etc. For now, just click on the “close button”.

The screen you will now see is where you input details from the claimant questionnaire form. This form is where the person you are seeing will have completed details of their health problems and areas where they feel they have restriction.

Do not worry about all the technical detail of this for now.

To progress –click on the “problem” button for “Lower Limb” and “problem” button for “Understanding and focus”.

For all the other areas such as upper limb, continence etc, click on “No Problem”.

Then click on the little clock at the bottom of the screen (on the right hand side).

1.2 Medical Conditions

You will see a screen with 3 boxes. These are explained in the technical guide and will also be explained in your training.

“Common Conditions” is highlighted in the middle box. Find anxiety and depression, to enter this into the “Conditions medically identified box on the right of the screen, either double click on this or click on it and then use the arrow as shown in the technical guide.

Then click on “Leg Problem” and find “arthritis of hip”. Click on this diagnosis but before moving it across, click in “Right” tick box above the condition list and then repeat what you did for anxiety and depression.

Click back on common conditions and click on “Client states no other problems” which is at the top. You will not be able to move on with the report until this statement has been entered and you will be prompted to enter this statement if you have not done so.

Click on the arrow at the bottom to move onto the next page (the right hand arrow pointing to the right).



1.3 Condition History

Please note “Condition History” is now highlighted in the “Select History” box and that “Medical Conditions” has now turned blue from red which indicates information has been added in this required section.

Anxiety and depression is highlighted in the Select Condition box, so this is the condition history you will now be completing.

In the “History of condition” box, your training will cover what is needed for the condition history but for now spend some time looking at the different drop downs. To open these up, either double click on them or click and then click on “Add”. Please see the technical guide for how radio buttons and tick boxes work for these drop downs.

Free text is also used to provide further detailed evidence. To do this, click on the bottom box underneath where your drop downs have been added and free text a comment about their anxiety being triggered by going out of the house alone and meeting people they do not know. Press Enter for this free text to be added to the history.

Click on Arthritis of the hip. Spend some time entering some history for this condition using both drop downs and free text.

You will notice that there are some drop downs which are the same for both diagnoses such as “Duration” and “Progress” however there are also different and condition specific such as “Mental Symptoms” for anxiety and depression and “Skeletal Symptoms” for arthritis of the hip.

Click on the arrow at the bottom to move onto the next page.

1.4 Medication and Side Effects

Please note “Med & Side Effects” is now highlighted in the “Select History” box and “Condition History” has turned blue as information has been entered in this required section.

The first 4 sections in the medicine box are common to all diagnoses and cover things like “No Rx for Condition” and “Medication Brought”. Then the final section will list the medications associated with the specific and highlighted condition will be listed; these will be listed in alphabetical order.

If you do not know a trade name of a drug, please remember you have free access to the BNF online (you will be provided with details on how to access this) and you also have the use of a search engine such as Google to clarify any trade drug names.



Anxiety and depression is the first condition listed so is automatically highlighted in the “Select Condition” box so the medications listed are mental health related. Click on citalopram, then either click on “Add” or double click to open. Enter 20 mg once a day every day then click on “Add”.

Click onto arthritis of the hip and notice the medications listed have changed to be relevant for this condition. Enter Ibruprofen 200 mg three times every day and Tramadol 50 mg three times most days following the same process you did for citalopram.

Then move to the bottom box called “Side Effects”. Take some time to read the drop downs. To progress, double click on “None Reported” or click on this drop down and then click “Add”.


1.5 Social and Occupational History.

Please note that “Social and Occupational History” is now highlighted in the “Select History” box and the “Med & Side Effects” is now blue as evidence has been added into a required section.

In the Social History box, the top drop down is “Evidence Considered” and this is in red- this means that this must be completed otherwise you will not be allowed to move onto the next screen to continue with the report. In LiMA, anything in RED must be completed otherwise you will not be allowed to move on until you do.

Take some time to read the drop downs- all drop downs throughout LiMA open in the same way- either by double clicking on them or clicking on the drop down and then clicking add.

Double click on “Evidence Considered”, or click on it then click “Add”. Your training will explain the different options available to you. To progress – tick Questionnaire, Med 3 and POID and then click “Add”.

Again your training will cover these drop downs and what information is required in your report.

To progress- open “Travel Here Today” and record that they came by bus which took 10 minutes. Then add free text to provide some further detail- she walked from home to the bus stop which took 10 minutes and then walked from 5 minutes from the bus station to the assessment centre. The process of adding free text was mentioned in condition history.

Open “Accompanied By” and record she was accompanied by her friend who stayed in the waiting room. Then click “Add”.



Open “Lives With Who?” and record she lives with her husband and adult son. Click “Add”.

Open “House Type” and record she lives in a house with 1 flight of stairs. Then click “Add”.

In the Occupational History box, please take some time to read the drop downs available to you. The information needed in this section will be covered in your training.

To progress- open “Last Worked When” and record she last worked many years ago. Add some other information such as her previous job and why she left it either by using the drop downs or free text.


1.6 Typical Day

Please note that “Typical Day” is now highlighted in the “Select History” box and the “Social & Occ History” is now blue.

The typical day is the claimant’s account of how they spend their day. LiMA provides a list of some daily activities such as washing, dressing, shopping, housework and socialising. Your training will cover what is required in this section but please take as much time as you can to open up the drop downs to see what they say so you become familiar with them. The more time you spend now doing this will be of benefit to you both in your training and when you are doing face to face assessments with claimants.

In this section, you should use both drop downs and free text; the latter is crucial as it provides further details and makes the report individualised and personal to the claimant.

To progress- add some information into the typical day using both drop downs and free text.

To have practice at moving around in the report, the claimant tells you in the typical day that she uses paracetamol every day for her hip pain that she buys over the counter. This must be recorded in the report so click on Meds & Side Effects in the “Select History” box to return to this section, click on “Arthritis of Hip” under “Select Condition” and click on paracetamol and record that she uses this as required, 2 tablets (1000mg) 4 times per day. Then click “Add”, it would also be useful to clarify how often as required is, so add some free text stating she takes the paracetamol 1-2 days per month.



To get back to the typical day, you can either click on “Typical Day” in the “Select History” box or click on the “Goto” tab in the top left hand corner- a list of the sections of the report that you have completed will appear; place your cursor over “History” and a further list will appear- click on Typical Day and you will be taken back to Typical Day.




2. Examination

2.1 General

You will now see 4 boxes on the screen. The box on the left lists the examination areas and you will see lower limb, mental state and observed behaviour are in red- as previously stated, this means information must be added into these sections otherwise you will not be able to move on.

Your training will cover all of these examination areas including what examinations you are required to do, how to do them and how to record your findings.

In the main box on the right of the screen, add “Exam Consent” by double clicking on it or clicking on it and clicking “Add”. Consent must always be obtained and recorded if a physical examination is carried out.

An offer of a chaperone/attendant is also made- click on “Attendant Refused”.

The box above the main screen on the left is self-explanatory as what is entered here; the box on the right above the main screen is greyed out and the BMI will appear here if both height and weight are entered. Again these will be covered in your training.


2.2 Lower Limb

You will see a box on the left of the screen called “Select Examination”- this works in the same way as the “Select History” box – the section you are in is highlighted and the required sections remain red until information has been added.

Underneath this box there is a “Set all to normal” button- do not click on this button.

The technical guide explains about the 3 tabs on the right hand side and the options available. Your training will cover how to use these tabs, how to do these examinations and how to record them. Free text is also used with examination findings to provide more detailed evidence- this is added in the same way as previously indicated.



The “Lower Back” tab is highlighted so click on “Findings”- a list of findings is shown. To progress- click on the drop down findings for “Forward Flexion” and select mid shin. You will now note that lower back has now changed from red to blue as findings have been entered.

Click on the left leg tab and again a list of findings will appear. Click on all of the left hand side findings and record these were all normal, on the right hand side just click on power and indicate this was normal.

Click on the right leg tab – the list of findings are obviously the same as those for the left leg. Click on the following findings:

Straight leg raising - select “Reduced by hip pain”;

Hip flexion – select “Reduced to 110o”;

Hip rotation – select “Less than 30o – stiffness”;

All the remaining findings on the left hand side and power – select “normal”.

You will notice when you have recorded abnormal findings, LiMA provides tick boxes to allow you to explain why – tick the appropriate box or boxes. An alternative way of doing this is to free text the reason why. The latter is more useful if there are a number of abnormal findings for different reasons- in this instance right straight leg raising and right hip flexion were reduced by pain and right hip rotation was reduced due to stiffness. To free text these findings, scroll down the screen until you can see the “Other Significant Findings” box and click in the greyed out lower box- this will now turn white and your cursor will be in the box ready for free text.

Please remember when free texting in this section, it is important to specifically state which finding is abnormal – for example, right hip and not just hip. The reason for this is that the “Other Significant Findings” box does not appear under the specific section in the final layout of the report, in this instance the Right Leg.

In the “Other Significant Findings” box, you will see more drop downs. Please take some time to open these and read them.

Open “Muscle Wasting Absent” and tick “legs”, then click “Add”.

2.3 Mental State Examination

Click on “Mental State” in the “Select Examination” box. You will notice Lower Limb is now blue as information has been entered.

There are 11 tabs for the Mental State Examination. You will cover all of



these in your training. As with the lower limb tabs, there are 3 radio buttons for each of the tabs.

Click on “Findings” for “Appearance” and enter findings which suggest normal for example, for “General Health – Well”, “Tremulous – Absent”.

Again free text is useful as it can provide more detail than the drop downs; please add some free text such as “She initially appeared very anxious but this reduced as the assessment progressed- her shaking reduced, she was able to answer questions appropriately”.

Please take some time to look at all of the tabs and the associated findings.

Click on the arrow at the bottom to move onto the next page or click on “Observed Behaviour”.



3. Observed Behaviour

You will notice that Mental State is now blue in the “Select Examination” box.

Now you see a screen with 2 boxes- the one on the left is the “Select Examination” box and the one on the right has 3 tabs and the “Lower Limb & Back” tab is in red. The other 2 tabs are in black type.

These 3 areas of observed behaviour will be covered in your training. Observed behaviour are not clinical examination findings and are in relation to physical health problems; anything related to their mental health must be recorded in the mental state examination.

Please take time to open the drop downs under all 3 areas to familiarise yourself with them.

Free text is also used in this section to provide more detail.

In this case, the claimant had some difficulty sitting for 30 minutes as she was constantly repositioning herself in the chair and then after 30 minutes rose from her chair with some difficulty, however she did not walk around; she remained standing in the same place for about 5 minutes, with slight difficulty, and then sat down again for a further 30 minutes. She continued to have some difficulty sitting for these 30 minutes but did not rise again.

The use of drop downs only here may not make it clear what the lady actually did during the assessment. So the use of both free text and drop downs would be useful here.

Open “Sitting Coped” and record she had some difficulty sitting for 30 minutes due to Arthritis of hip; click “Add”. Please note the drop down states did not need to get up from the chair so you cannot say she sat for 60 minutes (the 2 periods of 30 minutes) as this would be incorrect.

Now add some free text stating she was constantly repositioning herself in the chair during these 30 minutes.

Open “Rose Coped” and record she has some difficulty rising from a chair with no arms.

Open “Standing Coped” and record she stood for 5 minutes.

Add free text stating she did not move around while standing and remained in the same place before sitting down again for a further 30 minutes.



You can now either add further free text stating she continued to have some difficulty sitting for these further 30 minutes or you could open “Sitting Coped” drop down and record these details however you need to make it clear this is a second period of sitting for 30 minutes with difficulty.

Open “Abnormal Gait” and record she had a limping gait which is consistent.

The distance she has walked from the waiting room to the assessment room also needs to be recorded so free text in that she walked 15 metres at a normal pace.

You will notice a double head icon in the bottom left hand corner – click on this icon. You will see a box with 7 tabs, for now stay on the first tab “Questionnaire” which is already showing. You will see “Examination Duration”- this is self explanatory as it shows how long the examination has lasted. This can be clicked on during an assessment to see how long the claimant had sat before rising from the chair, how long they walked around the room and so on. Also, it is useful to know the duration of the assessment so when you are recording observed behaviour for lower limb & back, the combined time the claimant is standing and sitting does not exceed the duration. In this case the duration was around 65 minutes but if it was recorded she sat for 90 minutes and stood for 5 minutes, this would be incorrect.

Click on the arrow to move on to the next page “Medical Opinion – Activity Outcomes”. You will notice that the Open Door icon at the bottom of the screen now becomes greyed out; ideally this icon should be clicked when the claimant leaves the assessment room which is after the physical examination is completed as you enter the examination findings after the claimant has left.



4. Medical Opinion - Activity Outcomes

You will now see a screen with a box on the left called “Select Activity Sub Group” where the activity outcomes are listed. Again you will notice these are all in red so they must all be reviewed and an outcome recorded.

In every report you will have to select an activity outcome for each functional area irrespective of the conditions stated and the problems indicated in the ESA 50.

Your training will cover all of these activity outcomes. Also please refer to your WCA Handbook.

You will notice that LiMA highlights in blue, one or a number of potential outcomes for each activity outcome. This is based on the drop downs that you have used throughout the assessment.

If there is one outcome highlighted, you will note that the radio button will be ticked for the default outcome i.e. “None of the above”. If there are more than one potential outcomes highlighted in blue, you will note that there are no radio buttons ticked.

It is always your responsibility to select the appropriate activity outcome.

Below the “Select Activity Sub Group” box, there is another box which will have the particular activity sub group as it’s heading with a tick box for “Justify Anyway”. This will be explained in your training. Do not click it now.

4.1 Physical Activity Outcomes.

The first 5 activity sub groups are physical functional areas.

The “Lower Limb” functional area is highlighted and you will notice there are 2 activity outcomes- “Mobilising” and “Standing and Sitting”.

Click “None of the above” for both of these activity outcomes.

To move on the next activity outcomes, either click in the “Select Activity Sub Group” box to the next heading in red or click on the right hand arrow at the bottom on the screen.

As you work your way through all of the activity subgroups, you will notice there are varying number of activity outcomes for each, for example “Upper Limb” has 3 activity outcomes while “Continence” has one.

Click “None of the above” for the remaining 4 physical functional areas.



4.2 Mental Health Activity Outcomes.

The remaining 3 activity sub groups are mental health functional areas and again as you work through them, you will notice there are either 2 or 3 activity outcomes.

Click “None of the above” for all 3 activity sub groups.

After recording your outcome for Social Interaction, click on the arrow to move on to the next page.



5. Medical Opinion - Activity Outcome Justification

You will notice a box on the left called “Select Activity Sub Group”. All of the functional areas are listed but you will note that only 2 are in red and the others are greyed out. Again the red areas require information entering and you will not be able to enter information in the greyed out functional areas.

This is the part of the report where you will use information you have obtained from the condition history and typical day to support and justify your advice to the decision maker as to why you have advised “None Apply”. For example, in the typical day, if the claimant has told you that they sit to watch films for about 2 hours this would support your advice that they can sit for over 1 hour; if they tell you they get washed and dressed every day without prompting and they drive, this would support advising no significant problems with initiating and completing personal action.

The right hand box is divided into 2 parts – the left hand side is the “History of the typical day” and this is where the relevant information from the condition history, social and occupational history and typical day will be listed. Some phrases or information will be highlighted in different colours to suggest ability or disability. Please see the technical guide for an explanation of this.

The right hand side is “Prominent features of daily living”. This will be blank until you add information from the left hand side.

Underneath the right hand box, the selected activity outcomes are stated; It is useful to check that these outcomes are the ones you want to advise, if not you will need to go back to the “Activity Outcomes section by going to the “Goto” tab and placing your cursor over “Activity Outcomes” and then clicking on the appropriate activity group. Then select the appropriate outcome before returning to the activity outcome justification by going to the “Goto” tab again and clicking on “Goto latest”.

In this case, “Lower Limb” and “Understanding and Focus” are highlighted in red and the former is already selected. You need to choose information from the histories side of the box that is relevant to the particular activity outcomes so in this instance, mobilising, using stairs, standing and sitting. To do this, either double click on the sentence which you want to add or click on the sentence and then click add. Please remember, prominent features are needed here so there is no need to put every last piece of information in.

To move on to the next activity outcome justification, either click on it in the “Select Activity Sub Group” box or click on the arrow to move on.

Repeat for “Understanding and Focus”.

Click on the arrow to move to the next page.



6. Medical Opinion – Non-Functional Descriptor and LCWRA

You will now see a screen with a box on the left hand side called “Select Opinion Screens”- a number will be highlighted in red. On the right hand side there is a list of multiple options with a box underneath this list called “CSD Practitioner Consulted:”

All of these will be covered in your training. Also please see the technical guide and your WCA handbook.

To move on now, please click on the top option of “NFD’s and LCWRA Do Not Apply”. You will notice that this turns blue and the NFD and Not LCWRA now turns red.

So click on this heading and a screen with 2 boxes appears. The left hand box is “Select Justification” and the right hand box is “Justification”. There are multiple headings in red so these must be completed.

“Uncontrolled/ Uncontrollable” is highlighted in the “Select Justification” box and the related justifications are in the “Justification” box. Click on “Uncontrol Not Apply”.

Click on the arrow to move on and you will see “Terminally Ill justification must be recorded” written in red underneath the Justification box. So click on “Terminally Unlikely”.

Then click on “Chemo/Radio” and “No Chemo Radio”.

Click on “Pregnancy Risk” and “Not Pregnant”. If the claimant was male, this would be greyed out so you would not have to justify.

Click on “Mental/Phys Risk LCWRA” and “Justify Not Risk”. Then tick both diagnoses, condition history, physical examination, mental state examination. In the “JustifyNoRisk” box at the bottom, free text “Has no thoughts of deliberate self harm”, then click “Add”. Your training will cover in more detail what needs to be written here, this was just to be able to move on.

Click “Eating and Drinking” and “Eat/Drink No Problem”.

Free text can also be used to provide further justification for each of these areas if you feel this was necessary.

Click the arrow to move on to the next page.



7. Medical Opinion - Assessment Summary

You will see that Assessment Summary is highlighted in the “Select Opinion Screens” box. This is another key area of justification. You must justify your opinion of the person’s likely functional capabilities and restrictions. This must be consistent with both the Prominent Features section of justification (section 5) and the descriptors you are advising to the decision maker.

Below this box, there is a list of the activity outcomes that needs to be justified and the outcome you have advised. Again if one of these is not correct, you must return to the appropriate section to enter the appropriate outcome using the process explained earlier.

The box to the right is called “Personalised Summary Statement” (PSS) and this is where you bring together all of the information/evidence from the condition history, typical day, physical and mental state examinations (as appropriate) and observed behaviour to justify the claimant’s likely functional capability.

Your training will cover what evidence must be included and how to structure your PSS. The PSS is free text only and the claimant’s correct title and surname must be used. You need to cover the likely functional impact for each diagnosis mentioned as well every required activity outcome. Please see the technical guide

Click on the double head icon in the bottom left hand corner. You have already seen the “Questionnaire” screen, so click on the “Condition” tab and you will see all of the condition histories that you have entered. Click on the other tabs to see what is covered.

This icon can be used when writing your PSS to ensure you do not include new information in the PSS that was not in the body of the report. It usually opens in the top left corner and if you want to move it so you can write in the PSS box, click on the box and then keeping the left mouse button pressed, drag the box to where you want it and then release the left mouse button. It is also useful to check if you have entered all the evidence you have gathered, for example you might spot in the typical day that despite asking about how they manage talking to unexpected callers at their home that you have not written this in, so you could return to this section and enter this information.

For the purposes of this case, please enter the following in the PSS box- Mrs Bloggs has arthritis of the hip. Then add some information from the typical day that you have added to show how long she is walking for, how she is managing stairs, how long she is sitting to watch TV etc (this will obviously depend on what you have included in your typical day). This will allow you to move on.



YOU MUST NOT COPY AND PASTE ANYTHING WITHIN YOUR REPORT.

THIS MUST ALL BE FREE TEXT.

Click to move onto the next page.



8. Medical Opinion - Prognosis and Harmful Information

You will again see the “Select Opinion Screens” box on the left with the “Prognosis & Harmful Info” heading selected.

On the right hand side you will see 3 tabs – “Functional”, “NFD/LCWRA” and “Harmful Info”.

These will be covered in your training and please also see the technical guide.

In this case, the first 2 tabs will be greyed out and this is because you have advised no significant functional problems and LiMA will automatically apply the default prognosis.

The third tab is “Harmful Info” and an explanation of this is provided at the top of the “Harmful Information” box. This is not a required section and if there is harmful information, it must be entered by using free text.

Click on the arrow to move on.

You then have to complete the spell check. LiMA will highlight in red the potentially incorrectly spelt words and provide suggestions for these; you need to either click ignore or change to move on. Please read the suggested change carefully and do not just click change without checking.

Then you have to complete the grammar check. LiMA will highlight sentences/phrases/punctuation which may be incorrect. Again you need to click either change of ignore, and again please remember to check carefully before you change or ignore so the meaning is not changed.



9. Applying LCWRA on LiMA

The WCA assessment can be stopped at any point when sufficient information has been obtained to enable the HCP to advise that the claimant meets the criteria for LCWRA. Hover the mouse pointer over the ‘Exam’ title at the top left of the screen.

A short list will drop down. Click on ‘LCWRA’ to select it.

Note: This LCWRA button should only be selected if the claimant meets criteria for LCWRA in:

• Severe Functional Disability

• Chemotherapy/Radiotherapy

• Terminally Ill

• Serious Risk in Pregnancy

This does not apply to Substantial Risk to Mental/Physical Health LCW and LCWRA. The process for this will be covered in Part 5 of your learning journey.



10. Review and Confirm

Following completion of the spell and grammar check the final page is the review and confirm screen.

LiMA will automatically check the report and direct you to any areas which have not been completed.

It is good practice to review the entire report before submitting it and this will be covered in your new entrant training course. Clicking on the final tab of the drop down menu on the left opens the ‘Authorise and Accept’ page where the report can be ‘signed off’ as completed.


MED-NEHCPITL~001 Page 28 of 28

Observation form

Please photocopy this page and use it for any comments and observations on this document, its contents, or layout, or your experience of using it. If you are aware of other standards to which this document should refer, or a better standard, you are requested to indicate this on the form. Your comments will be taken into account at the next scheduled review.

Name of sender: ________________________ Date: _____________

Location and telephone number:______________________________

Please return this form to : Centre for Health and Disability Assessments

Clinical Training Team

Room 236 2nd Floor

Five Ways House

Islington Row Middleway

Birmingham

B15 1SL

new entrant wca learning journey introduction to lima module f

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