How are fluctuating medical conditions handled under Personal Independence Payment (PIP)?

We know that many people have conditions or disabilities that may vary over time. They may have good and bad days, good and bad months, or good and bad times within a day. If you have a fluctuating condition, you will want to be sure that it will be fully considered during your assessment.

Atos-Healthcare-pip-fluctuating conditions-calenderHealth professionals are asked to establish how your condition affects you over a 12 month period. If your condition means you are unable to undertake a certain activity for the majority of days in the year, you will be considered unable to undertake the activity. Someone who is unable to perform an activity four days a week will be considered as effectively unable to complete the activity. Conversely if you are unable to perform an activity only two days a week you would be seen as able to perform the activity for the majority of days.

Where an activity cannot be performed for part of a day it is deemed that it cannot be done at all on that day.

In addition to the health professional establishing how your condition affects you over a period of time, he or she will also consider reliability – i.e. whether an activity can be completed safely, to an acceptable standard, repeatedly and in a reasonable time period.

Atos-Healthcare-pip-fluctuating conditions-diaryIf your condition varies, it’s a good idea to keep a diary to provide a picture of how your health condition impacts on your ability over time. In a diary over a typical period, you could note down that you need help doing certain activities; perhaps preparing meals may have been difficult for 5 days one week but OK on the other two days. This will help you answer any questions you might be asked about managing these activities. Longer-term diaries can be useful to record any difficulties lasting several days or weeks. The health professional will ask you specifically about variability of your conditions during your assessment, and will want to know if your ability in any of the PIP activities differs from time to time.

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What are the ‘reliability’ criteria that are used during the PIP Assessment?

Personal Independence Payment (PIP) is a benefit aimed at helping people to live an independent life. PIP assesses your ability to perform 12 daily living and mobility activities, such as preparing food, communicating verbally, and planning and following journeys. It is not sufficient to be able to complete these activities once, or occasionally; PIP assesses your ability to undertake tasks “reliably”.Atos-Healthcare-PIP-reliability-criteria-crossing

Reliability has four components each of which must be satisfied in order for an activity to be undertaken ‘reliably’. The
four components are:

  • Safely
  • To an acceptable standard
  • Repeatedly
  • In a reasonable time

Activities must be performed safely. This means you must be able to undertake them in a way that is unlikely to cause harm to you or anyone else. This could be either during or after you have done the activity. For the purpose of PIP, something is unsafe only if harm is likely to occur; it is not sufficient for you to feel harm may occur.

They must be performed to an acceptable standard. This means that the task must be done to a standard that would reasonably be acceptable to most people.

Atos-Healthcare-PIP-reliability-criteria-clock-faceIt should be possible to undertake the activity repeatedly. This means as often as reasonably required. For example if you are able to prepare a meal once without help, but the exhaustion from doing this means that you could not prepare another meal that day, you would be treated as being unable to prepare a meal unaided. This is because it is reasonable to expect someone to be able to prepare more than one meal a day.

The activities can be completed in a reasonable time. This means not more than twice as long as the maximum amount of time that a person without your health condition or impairment would normally take to complete that activity.

The ‘reliability’ criteria must be considered for each activity and will be considered as an integral part of the information-gathering process whether at a face-to-face consultation or during a paper-based review.

 

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Mental function champions: their role in the WCA

We know that people with mental health problems who are going through the Work Capability Assessment (WCA) are often concerned about whether their illness will be properly taken into account.

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The WCA is carried out by fully-qualified, experienced health professionals who are trained to assess people with a variety of conditions, including mental health.

As part of ongoing improvements to Work Capability Assessments, we have mental function champions to assist our health care professionals when carrying out an assessment of a person with a mental health condition.

The role of the mental function champions is to spread best practice and provide advice and coaching to health care professionals at any stage in a referral to us from the Department for Work and Pensions (DWP). They do this in a variety of ways. They can provide specific advice to health care professionals by phone and in person at both the initial scrutiny stage of a referral and in relation to a face-to-face assessment. They provide ad hoc skills transfer depending on the needs in their area. They also see people face-to-face like any other health care professional.

What are their qualifications?

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The mental function champions are all qualified clinicians who have at least three years post-registration experience. In addition, they have postgraduate clinical qualifications and/or experience in psychiatric practice as well as an ongoing interest in this area of medicine.

All health care professionals undergo a regular random audit of their work to ensure it meets the required standard.

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Arrangement of a PIP consultation

Most people making a claim for Personal Independence Payment (PIP) will be asked to attend a consultation either in a consultation centre or in the home.

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The initial appointment letter will contain:

  • The time, date and location of your consultation
  • Maps and directions to the consultation centre
  • An information leaflet that will answer some common questions about the consultation process
  • The phone number of the Customer Services Centre should you need to change the appointment

If you are unable to attend on the date you are given

If you are unable to attend your appointment please let us know as soon as possible so that we can rearrange it to a suitably convenient date and time. You can rearrange your appointment by calling our Customer Service Centre; the telephone number is written on your appointment letter.

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It is important that you try to attend your appointment. However, if you have to rearrange it we can usually offer you an alternative appointment on one occasion. If you do not attend your re-scheduled appointment, we may refer your claim back to the DWP.

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The Personal Independence Payment (PIP) consultation: a simulation video

Most people claiming Personal Independence Payment (PIP) will be asked to attend a consultation. Our aim is to make your experience with us as comfortable and stress-free as possible. To help you get an idea of what to expect, this video shows a simulation of a PIP consultation. Actors represent a health professional, by training a physiotherapist, and a man who suffers from joint problems and depression.
Other key facts about the PIP consultation:

  • They will take place in a variety of community settings, such as local clinic. For some people, home consultations will be carried out instead.
  • The health professional will have reviewed any supporting evidence you sent, including your ‘How your disability affects you’ form. You can also bring additional relevant evidence to your consultation.
  • The consultation is not designed to make a diagnosis but as a conversation between you and the health professional to describe how your disability affects your ability to live independently
  • You are encouraged to bring a companion into the consultation with you if you like.

For more information about the PIP consultation process, see also: Will a face-to-face consultation always be required if I claim PIP?

Additional evidence for Personal Independence Payment

Where will your Personal Independence Payment consultation take place?

And other videos on our YouTube channel

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