The role of observation in the Personal Independence Payment assessment

An aspect of the Personal Independence Payment (PIP) assessment that is sometimes misunderstood is how informal observations are taken into account. The PIP Assessment Guide, produced by the Department for Work and Pensions (DWP), is very explicit about this (we have included the relevant extract at the end of this blog post).

Why do observations form part of the Personal Independence Payment assessment?

The role of observation in the Personal Independence Payment AssessmentInformal observations form part of the PIP assessment because they can add to the information that is available to the HP for them to be able to provide a report to the DWP. They may, for example, indicate that you have problems that you haven’t referred to elsewhere, or give a clearer indication of how you are affected by certain aspects of your disability or illness. It is important to remember that PIP is concerned with your needs as a result of your disability or illness, rather than the disability or illness itself.

Observations will only be made by the HP while they are with you during a face-to-face consultation. They won’t be made through things such as CCTV or observation of the car park through a window. They also won’t be done by anyone other than the HP, such as a receptionist.

How observations are used in the Personal Independence Payment assessment

If you are observed to do something by the HP it does not mean that they will assume that you can always do that. The PIP assessment takes into account that some conditions can fluctuate, and that whether you can do something reliably is important. We have covered on this blog previously both how fluctuating conditions are handled under PIP and how the reliability criteria are applied.

HPs will always consider informal observations in the context of fluctuations in someone’s condition. However, if the observations are inconsistent with what has been claimed in the ‘how your disability affect you’ form then the HP will have to use their judgement about what weight to apply to them.

We know that some people are advised by others to explain how they are affected by their illness or disability as if every day is like their worst. If you say in your ‘How your disability affects you’ form that you can never complete a particular task, but you are then seen doing so by the HP, this may be viewed as inconsistent. If your condition fluctuates you are always better explaining how it fluctuates in terms of things like good days vs bad days per week or per year.

Extract from the DWP PIP Assessment Guide, 27th May 2014

Informal observations

  • 2.6.24. Throughout the consultation, the HP should be making informal observations and evaluating any functional limitations described by the claimant. Informal observations start from “meeting and greeting” (where HPs may be able to observe the claimant’s appearance, manner, hearing ability, walking ability) and continue throughout history taking. The claimant’s mood, powers of concentration and ability to stand, sit, move around freely and use their hands should be observed. They may also be observed performing activities such as bending down to retrieve objects such as a handbag on the floor beside them, or reaching out for an object such as their medication.
  • 2.6.25. HPs may note how claimants stand and mobilise to any examination couch and observe the ease with which they get on and off the couch. How does the claimant remove their clothes or shoes? Informal observations should be recorded in the report, for example: “I observed the claimant… and they appeared to have no difficulty with…”; “I saw the claimant lean heavily on a walking stick to cover the distance to the consulting room”.
  • 2.6.26. The HP should note any aids or appliances in evidence, such as a walking aid, and the extent to which they are used during the consultation. Aids are devices that help a performance of a function, for example walking sticks or spectacles. Appliances are devices that provide or replace a missing function, for example artificial limbs, wheelchairs, or collecting devices for stomas.
  • 2.6.27. The HP’s informal observations will also help check the consistency of evidence on the claimant’s functional ability. For example, there is an inconsistency of evidence if a claimant bends down to retrieve a handbag from the floor but then later during formal assessment of the spine, declines to bend at all on the grounds of pain or if the claimant states that they have no mobility problems but they appear to struggle to walk to the consulting room. In deciding their advice, the HP will need to weigh this inconsistency, and decide, with full reasoning, which observation should apply.

 

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Atos Healthcare’s role in the delivery of Personal Independence Payment

Personal Independence Payment (PIP) has been designed by the Government to help with some of the extra costs associated with long-term ill health or a disability for those aged between 16 and 64. It has been introduced as a replacement for Disability Living Allowance (DLA). The Department for Work and Pensions (DWP) have overall responsibility for PIP, and directly manage the claim, decision making and payments part of it, as well as the overall policy that sets out how it works. The assessment part of the PIP process, which happens when you first claim PIP as well as periodically while you receive it, is managed by assessment providers, one of which is Atos Healthcare (we cover Scotland, the north of England and the south of England including London).

The role of the PIP assessment provider

As an assessment provider it is our job to provide an independent assessment of the impact that a claimant’s health condition or disability has on their daily life. The report we provide for DWP for any PIP claimant has to be objective and unbiased. Each assessment report is produced by a Health Professional qualified in disability assessment. They could be Nurses, Physiotherapists, Occupational Therapists, Doctors or Paramedics.

The information used to write the report could come from various places, such as:

  • your completed ‘How your disability affects you’ form
  • Any other relevant information you provided with your form
  • Information that we ask for and receive from people involved in your care,
  • A face-to-face consultation with you (if the other information isn’t enough).
  • Information provided by DWP

All this information is considered by the Health Professional so that they can provide a report to the DWP decision maker that explains what it all means in relation to the PIP criteria (also known as the descriptors). The decision maker uses the report along with the rest of the information to decide whether the PIP criteria are met and, if so, to what extent, so that they can make an award.

How do we fulfil our role?

Atos Healthcare is responsible for the assessment phase. This includes all of the administrative tasks (such as receiving referrals from DWP, moving them along the different stages, issuing letters to claimants and requesting information) and the assessment itself (including the face-to-face consultations and paper based reviews and reports). We work closely with DWP to ensure that any changes that DWP make to the policy are reflected in the way we are carrying out the PIP assessments. DWP also set targets for us in areas such as quality of both service and reports and the time within which we should provide them with a report after they have sent a referral to us. However, we don’t have any targets relating to the type of advice we provide or the decisions that DWP ultimately make on claims.

You can find more detailed information about the different parts of the PIP assessment process for our areas on our website, as well as by looking at other blog posts here.  The infographic below might also help you to identify who you need to contact with any questions that you might have.

Atos-Healthcare-PIP-Contact

Personal Independence Payment: Who to contact with questions. Click to enlarge

A version of this infographic with audio description is available on our YouTube channel

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DWP announcement about the next Work Capability Assessment provider

The Department for Work and Pensions (DWP) has announced that Atos Healthcare will be handing over our contract to deliver the Work Capability Assessment (WCA) and other smaller volume benefits to Maximus Health and Human Services Ltd on the 1st of March 2015. At the moment there are no changes to the WCA process for those people already going through it. Please continue to follow any information you have already been given, such as to return the ESA50 questionnaire or attend an appointment for an assessment.

Whilst we can’t answer questions for you about the new contract that the DWP have signed with Maximus, we are still the people to contact for any questions or feedback you have if you are currently going through the assessment process. You can find our feedback process and contact details on our website, which will also continue to provide information about the WCA process until we have handed over to Maximus.

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What to have with you for a PIP consultation?

One of the key things people want to know before their Personal Independence Payment (PIP) consultation is what they should have with them.

It is important that you can prove your identity when you attend a PIP consultation, the Department for Work and Pensions (DWP) will not allow us to proceed with the consultation if you are unable to prove your identity. It is also important that you can explain to the Health Professional how your condition or disability affects you in daily life.

Why you should bring your appointment letter?

The appointment letter gives you exact details of where to go for your consultation and the phone number of the customer service centre should you need to contact us.

What is suitable for Proof of Identity?

We are required by DWP to carry out a proof of identity check when you have a consultation. Suitable proof is two types of identification from the list below.

  • PassportAtos-Healthcare- proof-of-identity
  • UK driving license
  • UK travel pass with photograph
  • Birth certificate
  • Marriage certificate
  • Debit/credit card
  • Council tax demand
  • UK utility bill
  • Council/housing association rent or tenancy agreement document
  • Foreign national ID card
  • Evidence of entitlement to state or local authority benefit

In some circumstances we will be able to verify your identity without these documents but it is far easier and quicker if you bring the appropriate documents.

Bringing a Companion

You are encouraged to bring a companion or support worker who knows your situation well with you to your consultation. They can also participate in the consultation itself (if you like) and are frequently helpful in ensuring that the HP gets a full understanding of your situation.

Bringing Additional Supporting Materials

You may have already provided evidence that you had when you completed and returned the ‘How Your Disability Affects You’ form to DWP. The Health Professional will have access to this information at the time of your consultation.

However, you can bring new or additional information with you to the consultation. Of particular value will be:

  • Tablets and other current medication, such as inhalersAtos-Healthcare-hearing-aid
  • Any medical aids, such as walking aids, hearing aids, glasses and contact lenses
    which you would normally use or take with you if going out. You don’t need to bring any aids or adaptations you only use at home however, but the HP will want to talk about these during the assessment
  • Any extra medical information, such as test results, or letters which you have from GPs or specialists about your disability or condition, which you’ve not already provided as part of your claim. Anything you have already sent to DWP will be on the system and the HP will be able to see them

You can also see more information on the additional evidence blog

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What to do with new information about your health during the WCA process

We have said before on this blog about the importance in the Work Capability Assessment (WCA) of up to date information about how your illness or disability affects you.  You can include information with the ESA50 questionnaire that you complete and send in as well as bringing in information to the face-to-face part of the assessment if you need to have one.  It is important to remember though that new information can be submitted at any stage in the assessment process.Atos-Healthcare-new information-folder

When a healthcare professional (HCP) reviews your referral to us from the Department of Work and Pensions (DWP) they take into account all of the information that is available to them at the time.  Depending on the stage in the process, this might be your completed questionnaire, information that you sent in with the questionnaire or information that we have obtained from a health professional involved in your care, such as your GP.  If the HCP has enough information to be able to provide a report to DWP without you needing to have a face-to-face assessment they will do so.

It is helpful to make us aware if you receive new information about your illness or disability or your condition changes at any stage during the assessment process.  The new information can then be taken into account. It might mean that you don’t need to be seen face-to-face or it might mean that you can be seen at home instead of an assessment centre.

Atos-Healthcare-new information-contact-usWhat you need to do with any new information will depend on the stage in the process you’re at and what the new info is.  To find out what to do in your case you can call us on 0800 2888 777 and speak to an advisor.  If we have already sent a report to DWP we can tell you this so that you can send the information to them.  The Decision Maker at the DWP who makes the decision on your ESA claim has access to all of the information that you have sent in or that we have obtained, and takes it into account along with the report that we write.

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