Chapter P2: Assessment for PIP

Chapter P: Assessment for PIP Contents Daily Living and mobility components... P001 Limited and severely limited ability... P00 Information requirements... P06 Assessment consultations... P046 Failure to comply... P056 Good reason... P058 Duration of award... P061 Re-determination... P064 Terminal illness... P076 Third party claims... P080 Appendices Personal Independence Payment Assessment... Appendix 1 Daily living and mobility activities... Appendix

Chapter P: Assessment for PIP Daily living and mobility components P001 The activities to satisfy the Daily Living and/or Mobility components are prescribed 1. These can be found in the Appendices to this Chapter. Limited and severely limited ability 1 SS (PIP) Regs, Sch 1 P00 Entitlement to PIP is based on whether a claimant has limited or severely limited ability to carry out daily living and/or mobility activities 1. This will be determined by a DM using the information gathered during the PIP assessment (see P004 P006). 1 SS (PIP) Regs, reg 4 P003 In addition the required period condition, consisting of 1. the qualifying period of 3 months and. the prospective test of 9 months has to be satisfied 1. The HP will advise the DM if these conditions are likely to have been met (see P1031). 1 SS (PIP) Reg, reg 1 & 13 P004 The PIP assessment is used to determine a claimant s ability to carry out 1. daily living activities or. mobility activities or 3. a mixture of both. P005 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 condition 1 (see ADM Chapter P1 - Conditions of Entitlement). 1 SS (PIP) Regs, reg 4 & reg 1 to 15 P006 The assessment will be in the form of either 1 1. a face-to-face consultation or. 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.

Once all the evidence is gathered the DM will also assess the claimant using the same criteria as the HP. The DM at this point may also ask the HP for additional information if required, to help the DM make their decision. 1 SS (PIP) Regs, reg 9(1) P007 P008 P009 The HP is specially trained to assess and evaluate the impact of disability on a claimant s ability to carry out activities of daily living and mobility. This includes the affects of variable conditions. The HP has appropriate knowledge of clinical aspects of a wide range of medical conditions and is skilled in assessing people with physical and mental health conditions. A HP will be one of the following 1. An occupational therapist. Nurse (level 1) 3. Physiotherapist 4. Paramedic 5. Doctor (GMC registered) P010 P011 The HP provides advice to the DM on the limitation to carry out daily living and/or mobility activities and advises on which descriptors are appropriate for the claimant. The advice the HP provides is based on the daily living/mobility needs arising from a condition or conditions and not the condition(s) itself. The claimant will be assessed as having limited ability if the daily living activities or mobility activities achieve a score of at least 8 points 1 in each component. This will then lead to an award of the relevant component or components at the standard rate of PIP (see P014). 1 SS (PIP) Regs, reg 5(3)(a); reg 6(3)(a) P01 The claimant will be assessed as having severely limited ability if the daily living activities or mobility activities achieve a score of at least 1 points 1 in each component. This will then lead to an award of the relevant component or components at the enhanced rate of PIP (see P014). 1 SS (PIP) Regs, reg 5(3)(b ): reg 6(3)(b) P013 The score in relation to the daily living and mobility activities is determined 1 by adding together, in relation to each activity, the points awarded against the selected descriptors. 1 SS (PIP) Regs, reg 5(1); reg 6(1) P014 The applicable descriptor for the claimant for each activity is 1. where one descriptor is satisfied for over 50% of the days, that descriptor 1 or

. where two or more descriptors are satisfied for over 50% of the days, the descriptor which scores the highest number of points or 3. where no descriptor is satisfied for over 50% of the days but two or more scoring descriptors are satisfied for periods of more than 50% of the days when added together, the descriptor to be applied is the one which 3.1 is satisfied for the greatest proportion of the days or 3. scores the higher or highest number of points where both or all descriptors are satisfied for the same period 3. 1 PIP Regs, reg 7(1)(a)); reg 7(1)(b); 3 reg 7(1)(c) Example 1 Phil has long term problems with rheumatoid arthritis and has very limited walking ability. He needs to use a wheelchair for more than 50% of the days when outdoors, and can only walk a few metres before being in pain and discomfort. He is assessed as Can stand and move more than 1 metre but no more than 0 metres, either aided or unaided and scores 1 points on the assessment. He is therefore awarded the enhanced rate of the PIP mobility component. Example Mary has learning difficulties and Needs supervision or assistance to either prepare or cook a simple meal - scoring 4 points. Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week - scoring points. Needs supervision or prompting to be able to wash or bathe scoring points. Cannot read or understand signs, symbols or words at all scoring 8 points. Cannot make any budgeting decisions at all scoring 6 points. Cannot plan the route of a journey scoring 8 points. Mary is therefore awarded the daily living component at the enhanced rate as she has scored points, and the mobility component at the standard rate as she has scored 8 points. Example 3 John has arthritis in his hands and for approximately 1 to weeks a month he cannot

Cannot prepare and cook food which would score 8 points. He also has Multiple Sclerosis which is not controlled well and for about 16 weeks of the year, which do not overlap with the arthritis, he Needs supervision or assistance to either prepare or cook a simple meal which would score 4 points. Neither descriptor is satisfied for more than 50% of the time on their own, but in aggregate cover more than 50% of the time. John is awarded the standard rate of the daily living component as the descriptor awarding 8 points applies for the greatest amount of the time. P015 When assessing the claimant s ability to carry out an activity, the claimant is to be assessed as if wearing or using any aid or appliance 1 which 1. the claimant normally wears or uses or. the claimant could reasonably be expected to wear or use. 1 SS (PIP) Regs, reg 4()(a) & (b) P016 The descriptor will only be regarded as being satisfied if the claimant can be assessed as carrying out that activity, in the manner described in the descriptor 1. safely which means in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity and. to an acceptable standard given the nature of the activity and 3. repeatedly which means as often as the activity being assessed is reasonably required to be completed and 4. in a reasonable time period 1 - which means no more than twice as long as the maximum period that a person without a physical or mental condition, which limits that person s ability to carry out the activity in question, would normally take to complete that activity. 1 SS (PIP) Regs, reg 4(A)(d) P017 In determining whether the activity can be carried out in this manner, consideration should be given to 1. approach what the individual needs to do; what assistance or aids are required; how long it takes; and whether it is safe and. outcome whether the activity can be successfully completed and the standard that is achieved and 3. impact the effects that reaching the outcome has on the individual and, where relevant, other people; and whether the individual can repeat the activity within a reasonable period of time and to the same standard (this includes consideration of symptoms such as pain, discomfort, breathlessness, fatigue and anxiety) and

4. variability how an individual s approach and outcomes change over time and the impact this has on them. Example 1 Henry is able to stand and move unaided. He can comfortably walk up to 150 metres at a normal pace. After 150 metres he starts to become breathless and to experience some mild pain. He can continue to walk but his pace slows. The pain and breathlessness gradually increases and after 50 metres he needs to stop and rest for about 5 minutes before starting to walk again. Henry can repeatedly walk 50 metres, with short 5-minute rests in between for around an hour. After an hour of this, he needs a longer rest of about an hour before walking again. It takes Henry around four minutes to walk 00 metres. The DM considers whether Henry can stand and then move more than 00 metres (descriptor a) safely, to an acceptable standard, repeatedly and a in a timely manner. The DM decides there is no evidence that this activity poses any risk to Henry s safety; he has said he experiences some pain and breathlessness and, while this may be uncomfortable, he knows when to stop and rest and there is no indication that this causes him any harm. The DM decides Henry can complete the activity more frequently than would reasonably be expected and, although he takes a little longer than a non-disabled person, he can complete the activity in a reasonable time period. As Henry can therefore stand and then move more than 00 metres safely, repeatedly and in a timely manner (the standard is not an issue in this instance), the DM selects descriptor a. Example Louise is able to stand and move with a walking stick. She can walk up to 50 metres at a slightly slowed pace with some discomfort. After this distance she starts to experience increasing hip pain. She can continue to walk, but her pace slows even further and after 100 metres she needs to stop and rest. This takes a lot out of her and for a few hours after Louise is unable to go more than a few steps without experiencing further severe hip pain. The DM considers whether Louise can stand and then move more than 50 metres but no more than 00 metres (descriptor b) safely, to an acceptable standard, repeatedly, and in a timely manner. The DM decides that there is no issue with the standard and that she can do so safely, because, although she experiences pain, she knows when to stop and rest, and there is no indication that this causes her any harm. However, after she has walked 100 metres, it is several hours before Louise can walk this distance again. The DM decides this is less frequently than would be reasonably expected and therefore concludes she cannot do so repeatedly. Louise can repeatedly manage a few metres using her stick, which is less than 0 metres but more than 1 metre (descriptor e). On this evidence the DM selects descriptor e.

Example 3 Julie can prepare and cook a simple meal. However she lacks a perception of danger and occasionally cuts herself from mishandling knives or burns herself on hot pans. She is also impatient and does not cook food for as long as it should be cooked, as a result she prepares food that is lukewarm and meat that is not cooked properly for example, chicken that is pink in the middle. Her sister usually has to be in the kitchen when she is cooking meals to make sure she does so safely and to remind her to leave food to cook fully. The DM considers whether Julie can prepare and cook a simple meal unaided (descriptor 1a), safely, to an acceptable standard, repeatedly and in a timely manner. The DM decides Julie is able to do so repeatedly and in a timely manner. Because she lacks a perception of danger, the DM decides Julie needs supervision to be able to safely prepare or cook a simple meal (descriptor 1e). Because she does not cook food for as long as she should, the DM decides Julie needs prompting to prepare or cook a simple meal (descriptor 1d) to an acceptable standard. In this case there are two possible descriptors 1d and 1e, but as descriptor 1d does not describe a manner in which Julie is able to carry out the activity safely, the DM selects descriptor 1e. P018 Where the claimant is assessed as having severely limited ability to carry out the daily living and/or mobility activities, they cannot also be assessed as having limited ability in relation to that component 1. 1 SS (PIP) Regs, reg 4(3) P06 P019 P05 Information requirements The claimant will be required to provide any information or evidence 1 that may be requested by the DM to determine their ability to undertake either the daily living or mobility activities specified. 1 SS (PIP) Regs, reg 8(1) P07 The information will take the form of 1. the claimant questionnaire, (How your disability affects you), if required. any other information as may be requested by the DM 3. any other additional information requested by a person approved by the Secretary of State (e.g. a HP requesting further information by telephone). P08 Where information has been requested of the claimant, that information must be provided within 1 month 1 of the request, or any longer period as the DM may consider reasonable. Note: See P056 for guidance where a claimant fails to comply with providing information or evidence. 1 SS (PIP) Reg, reg 8()

P09 P045 Assessment consultations P046 If it is decided that a consultation 1 with the claimant is required to assess the claimant s ability to undertake daily living and/or mobility activities the consultation 1 will take the form of participation in a face-to-face consultation (but see P006, a consultation by telephone may be used to gather further information). Note: A paper based assessment may be available for some claimants, and may be made where there is sufficient evidence for the HP to advise on all aspects of the claim. 1 SS (PIP) Regs, reg 9(1) P047 The claimant will be required to comply with the request to attend for a consultation. Failure to comply will result in the DM giving a negative determination 1, unless the claimant shows good reason not to participate in the consultation (see P058). Note: See P056 for guidance where a claimant fails to comply with a request to attend a consultation and guidance at P058 and ADM Chapter P6 for guidance on good reason. 1 SS (PIP) Regs, reg 9(); reg 10 P048 The claimant must be notified in writing 1 of the 1. date and. time and 3. place of the consultation at least 7 days in advance. Note: The claimant can agree to accept a shorter period of notice, whether given in writing or otherwise. 1 SS (PIP) Regs, reg 9(3) P049 The written notice may be issued electronically 1 where the claimant has agreed to correspondence being sent in this manner. Note This facility will not be available until a future date. 1 SS (PIP) Regs, reg 9(4) P050 P055 Failure to comply P056 Failure to comply with the request 1. to provide information or

. attend a consultation without good reason shall result in a negative determination 1 of the component(s) to which the failure is related. Note: For guidance on good reason see P058 and ADM Chapter P6 Good Reason. 1 SS (PIP) Regs, reg8(3) & 9() P057 A negative determination 1 means a determination that a person does not meet the requirements of the daily living component or the mobility component. 1 WR Act 1, s 80(6) Example Amanda made a telephone claim to PIP and was sent out a part questionnaire, How does your disability affect you. She was asked to return the form within one month of the date of the request. After 19 days she had not returned the form so she was sent a postal reminder but she also failed to respond to this. As she did not comply with returning the information required, and she hadn't been identified as needing additional support, a negative determination was made on her claim. Good reason P058 Claimants will have had the opportunity to explain why they have not complied with a request to 1. provide information or. attend a consultation. It will remain the claimant s responsibility to show good reason and provide any evidence to justify their good reason. The DM will make a decision based on all the individual facts and circumstance of the case and taking into account in particular the claimant s state of health at the relevant time and the nature of their disability. Note: For further guidance on good reason see ADM Chapter P6 - Good reason. P059 P060 Duration of award P061 When deciding the duration of an award 1 of PIP the DM should look at all the evidence and facts of the case, including the advice from the HP. There will be three types of awards 1. short fixed term awards, which will be for a minimum of 9 months and a maximum of years or

. longer fixed term awards, where the DM will set an expiry date 1 months after the date on which the claimant is due to be referred to the HP for a review or 3. ongoing awards where it would be inappropriate to give a fixed term award where any change is highly unlikely. Note: DMs will also have a role in deciding the review date which will be detailed in the DM s procedural guidance. 1 WR Act 1, s 88() & (3) P06 When deciding the length of the award the DM will have regard to 1. the advice from the HP, within the PIP assessment report and. any further evidence gathered by the HP and 3. the evidence given by the claimant in the questionnaire (How your disability affects you), and any additional information supplied by the claimant. Note: DMs should refer to the procedural guidance on Award Periods and Reviews (within the Decision Making Process Guidance), when deciding the length of the award and setting review periods. P063 The advice on prognosis from the HP advising when they wish to see the claimant again in accordance with P064 P065, will have had consideration as to 1. whether there is likely to be an improvement or deterioration in the disability or its functional effects and. whether further treatment is required and 3. the time any improvement or deterioration is likely to be expected and 4. the natural progress of the underlying condition and 5. any adjustments and adaptations. Example 1 Joan sent in her questionnaire for her claim to PIP and attended for a consultation with an HP. On the evidence before them the HP provided a report to the DM for 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 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 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 review date after 10 years, to check if the level of benefit is still appropriate. Re-determination P064 Where a claimant has been determined to have a limited or severely limited ability to carry out activities, the DM may re-determine 1 whether a claimant still has limited or severely limited ability to carry out the required activities. 1 SS(PIP) Regs, reg 11 P065 The re-determination can be performed when 1. a period of award is coming to an end or. 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: When the DM initiates a review this is referred to as a planned intervention (except, for instance where information is received from a third party which initiates an investigation). Example 1 Sarah has rheumatoid arthritis and is in receipt of the standard rate of mobility as her walking had been affected after an exacerbation. She asks the DM to look at her claim again as she has had a further flare up and it has left her in more pain and swelling of her feet and more deformity of the joints in her arms and hands. After more evidence being obtained, and consideration given to the qualifying period, the HP advises that her needs have increased and refers to the DM for a decision. The DM decides that Sarah:-

Needs supervision or assistance to either prepare or cook a simple meal - 4 points Needs assistance to be able to cut up food points Needs assistance to get in or out of the bath or shower 3 points Can stand and then move using an aid or appliance more than 0 metres but no more than 50 metres 10 points. On these findings the DM makes an award for daily living activities at the standard rate, and maintains the mobility component at the standard rate. Example Billy has been suffering with a heart problem and had been awarded the standard rate of the daily living component and the enhanced rate of the mobility component. 1 months before his award was due to come to an end the DM instigated a planned intervention and asked Billy to provide new information. He was invited by the HP to a face-to-face consultation and medical evidence was obtained from his consultant. It was found that although Billy had recently received a heart by-pass operation and his needs had decreased, he was still recovering. He told the DM that he was going to write in once he had see his GP again and was given the all clear. The DM, on the evidence gathered, reduced his award to standard rate mobility component and no rate of the daily living component for the remaining period of his previous award. P066 P075 Terminal illness P076 There are exceptions to the normal rules when the person who claims 1. is terminally ill and. has made a claim for PIP expressly on the ground of terminal illness 1. Note: Evidence from or on behalf of the disabled person of terminal illness will amend the claim to one based on the Special Rules (see P079). 1 WR Act 1, s 8 P077 A person is regarded as being terminally ill 1 for the purposes of P076 if 1. at any time the person suffers from a progressive disease and. the person s death in consequence of that disease can reasonably be expected within 6 months. 1 WR Act 1, s 8(4) P078 When a claim is made under the circumstances in P076 the claimant will

1. not be required to satisfy the required period condition for either component 1 and. not be required to satisfy the past presence condition and 3. be awarded the enhanced rate of the daily living component 3 and 4. be required to provide information on the mobility activities before either rate of that component can be awarded. 1 WR Act 1, s 8() & (3); SS (PIP) Regs, reg ; 3 WR Act 1, s 8() P079 Claims for terminally ill people will usually be awarded for and limited to 3 years. A reminder will be issued before the award expires to remind the claimant to re-claim PIP. Third party claims P080 A claim may be accepted from a third party 1 if the claim is made expressly on the ground that this is on behalf of someone who is terminally ill. This has the effect that the terminally ill person has made the claim (see ADM Chapter A - claims). 1 WR Act 1, s 8(5); SS (PIP) Regs, reg 1 P081 P999

Appendix 1 PERSONAL INDEPENDENCE PAYMENT ASSESSMENT Interpretation of terms 1 This Appendix gives guidance on the interpretation of terms 1 used for daily living and mobility activities. Aided 1 SS (PIP) Regs, Sch 1 Aided means with 1. the use of an aid or appliance or. supervision, prompting or assistance. Assistance 3 Assistance means physical intervention by another person and does not include speech. Assistance Dog 4 Assistance dog means a dog trained to guide or assist a person with a sensory impairment. Basic verbal information 5 Basic verbal information means information in the claimant s native language conveyed in a simple sentence. Basic written information 6 Basic written information means signs, symbols and dates written or printed in the claimant s native language. Bathe 7 Bathe includes getting into or out of an unadapted bath or shower. Communication support 8 Communication support means 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 9 Complex budgeting decisions means decisions involving 1. calculating household and personal budgets and

. managing and paying bills and planning future purchases Complex verbal information 10 Complex verbal information means information in the claimant s native language conveyed in either more than one sentence or one complicated sentence. Complex written information 11 Complex written information means more than one sentence of written or printed standard size text in the claimant s native language. Cook 1 Cook means to heat food at or above waist height. Dress and undress 13 Dress and undress includes putting on and taking off socks and shoes. Engage socially 14 Engage socially means 1. interact with others in a contextually and socially appropriate manner and. understand body language and 3. establish relationships. Manage incontinence 15 Manage incontinence means manage involuntary evacuation of the bowel or bladder including use of a collecting device or self-catheterisation and clean oneself afterwards. Manage medication or therapy 16 Manage medication or therapy means take medication or undertake therapy, where a failure to do so is likely to result in a deterioration in the claimant s health. Medication 17 Medication means medication to be taken at home which is prescribed or recommended by a registered 1. doctor. nurse or 3. pharmacist. Monitor health

18 Monitor health means 1. detect significant changes in the claimant s condition which are likely to lead to a deterioration in their health and. take action advised by a.1 registered doctor. registered nurse or.3 health professional who is regulated by the Health Professions Council without which the claimant s health is likely to deteriorate. Orientation aid 19 Orientation aid means a specialist aid designed to assist disabled people to follow a route safely. Prepare 0 In the context of food prepare means to make food ready for cooking or eating. Prompting 1 Prompting means reminding, encouraging or explaining by another person. Psychological distress Psychological distress means distress related to an enduring mental health condition or an intellectual or cognitive impairment. Read 3 Read includes reading signs, symbols and words but does not include reading Braille. Simple budgeting decisions 4 Simple budgeting decisions means decisions involving 1. calculating the cost of goods and. calculating change required after a purchase. Simple Meal 5 Simple meal means a cooked one-course meal for one using fresh ingredients. Social Support 6 Social support means support from a person trained or experienced in assisting people to engage in social situations. Stand

7 Stand means stand upright with at least one biological foot on the ground. Supervision 8 Supervision means the continuous presence of another person for the purpose of ensuring the claimant s safety. Take nutrition 9 Take nutrition means 1. to cut food into pieces and. convey food or drink to one s mouth and 3. chew and swallow food or drink or 4. take nutrition by using a therapeutic source. Therapeutic source 30 Therapeutic source means parenteral or enteral tube feeding, using a rate limiting device such as a delivery system or feed pump. Therapy 31 Therapy means therapy to be undertaken at home which is prescribed or recommended by a 1. registered 1.1 doctor 1. nurse or 1.3 pharmacist. health professional regulated by the Health Professions Council. Toilet needs 3 Toilet needs means 1. getting on and off an unadapted toilet and. evacuating the bladder and bowel and 3. cleaning oneself afterwards. Unaided 33 Unaided means without 1. the use of an aid or appliance or. supervision, prompting or assistance.

Appendix PIP Descriptor log Daily living and mobility activities Note: See P011- P014 Daily Living Activities Column 1 Column Column 3 Activity Descriptors Points 1. Preparing food. a. Can prepare and cook a simple meal unaided. b. Needs to use an aid or appliance to be able to either prepare or cook a simple meal. c. Cannot cook a simple meal using a conventional cooker but is able to do so using a microwave. d. Needs prompting to be able to either prepare or cook a simple meal. e. Needs supervision or assistance to either prepare or cook a simple meal. f. Cannot prepare and cook food.. Taking nutrition. a. Can take nutrition unaided. b. Needs 0 4 8 0 (i) to use an aid or appliance to be able to take nutrition; or (ii) supervision to be able to take nutrition; or (ii) assistance to be able to cut up food. c. Needs a therapeutic source to be able to take nutrition. d. Needs prompting to be able to take nutrition. 4

e. Needs assistance to be able to manage a therapeutic source to take nutrition. f. Cannot convey food and drink to their mouth and needs another person to do so. 6 10 3. Managing therapy or monitoring a health condition. 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. b. Needs either 1 (i) to use an aid or appliance to be able to manage medication; or (ii) supervision, prompting or assistance to be able to manage medication or monitor a health condition. c. Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week. 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. 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. f. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week. 4 6 8 4.Washing and bathing a. Can wash and bathe unaided. 0 b. Needs to use an aid or appliance to be able to wash or bathe. c. Needs supervision or prompting to be able to wash or bathe. d. Needs assistance to be able to wash

either their hair or body below the waist. 5. Managing toilet needs or incontinence. e. Needs assistance to be able to get in or out of a bath or shower. f. Needs assistance to be able to wash their body between the shoulders and waist. g. Cannot wash and bathe at all and needs another person to wash their entire body. a. Can manage toilet needs or incontinence unaided. b. Needs to use an aid or appliance to be able to manage toilet needs or incontinence. c. Needs supervision or prompting to be able to manage toilet needs. d. Needs assistance to be able to manage toilet needs. e. Needs assistance to be able to manage incontinence of either bladder or bowel. f. Needs assistance to be able to manage incontinence of both bladder and bowel. 3 4 8 0 4 6 8 6. Dressing and undressing. a. Can dress and undress unaided. 0 b. Needs to use an aid or appliance to be able to dress or undress. c. Needs either - (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 or undress their lower body. e. Needs assistance to be able to dress or undress their upper body. 4

f. Cannot dress or undress at all. 8 7. Communicating verbally. 8. Reading and understanding signs, symbols and words a. Can express and understand verbal information unaided. b. Needs to use an aid or appliance to be able to speak or hear. c. Needs communication support to be able to express or understand complex verbal information. d. Needs communication support to be able to express or understand basic verbal information. e. Cannot express or understand verbal information at all even with communication support. a. Can read and understand basic and complex written information either unaided or using spectacles or contact lenses. 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. c. Needs prompting to be able to read or understand complex written information. d. Needs prompting to be able to read or understand basic written information. e. Cannot read or understand signs, symbols or words at all. 0 4 8 1 0 4 8 9. Engaging with other people faceto-face a. Can engage with other people unaided. 0 b. Needs prompting to be able to engage with other people. c. Needs social support to be able to engage with other people. d. Cannot engage with other people due to such engagement causing either 4 8

10. Making budgeting decisions (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 budgeting decisions unaided. b. Needs prompting or assistance to be able to make complex budgeting decisions. c. Needs prompting or assistance to be able to make simple budgeting decisions. d. Cannot make any budgeting decisions at all. 0 4 6 1 SS (PIP) Regs, Sch 1

Mobility Activities Column 1 Column Column 3 Activity Descriptors Points 1. Planning and following journeys. 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 1 journey without another person, an assistance dog or an orientation aid.. Moving around. a. Can stand and then move more than 0 00 metres, either aided or unaided. b. Can stand and then move more than 4 50 metres but no more than 00 metres, either aided or unaided. c. Can stand and then move unaided 8 more than 0 metres but no more than 50 metres. d. Can stand and then move using an 10 aid or appliance more than 0 metres but no more than 50 metres. e. Can stand and then move more than 1 1 metre but no more than 0 metres, either aided or unaided.

f. Cannot, either aided or unaided, 1 (i) stand; or (ii) move more than 1 metre. 1 SS (PIP) Regs, Sch 1 The content of the examples in this document (including use of imagery) is for illustrative purposes only

PIP Descriptior Log Question What is the best method to score descriptors? General Principles Answer Start at the highest scoring descriptor and work up to the lowest scoring descriptor. Working from the lowest to the highest scoring descriptor can result in application of the incorrect descriptor - 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 which limits that

person s ability to carry out the activity in question would normally take to complete that activity). How should we treat fluctuating conditions (Regulation 7)? PIP should support those individuals who have a longterm 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 1 month period. The PIP assessment allows descriptors (that score) to be combined to meet the 50 per cent rule. The following rules apply: What if the Assessment Guide and Descriptor Log contain contradictory or conflicting information? Reasonably required principle - UT decision CPIP/1534/015 If one descriptor in an activity is likely to apply on more than 50 per cent of the days in the 1 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 the days 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 per cent 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 Follow the Log version. The Assessment Guide can only be updated at certain times within the year. The Log is updated as often as necessary. As PIP develops parts of the Guide may become out of date. The Log should be as up to date as possible. This decision held that the reasonably required principle is not applicable to the can/cannot descriptors. However, it is applicable to needs descriptors e.g. needs to use an aid or needs assistance. The Judge has stated that the need envisaged is a reasonable need as opposed to a medical one. So for example if a claimant needs to use an aid to prepare or cook a simple meal the need to use that aid must be reasonable in the claimant s circumstances

Question What is the best method to score descriptors? What should be considered when we propose the use of aids? Answer Start at the highest scoring descriptor and work up to the lowest scoring descriptor. Working from the lowest to the highest scoring descriptor can result in application of the incorrect descriptor - for example in relation to Activity 1 if someone needs prompting and supervision to prepare food, descriptor 1d may be incorrectly chosen. 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 which limits that person s ability to carry out the activity in question would normally take 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 1 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 1 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 the days 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 per cent 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. What if the Assessment Guide and Descriptor Log contain contradictory or conflicting information? Follow the Log version. The Assessment Guide can only be updated at certain times within the year. The Log is updated as often as necessary. As PIP develops parts of the Guide may become out of date. The Log should be as up to date as possible.

Activity 1 Preparing food This activity considers a claimant s ability to prepare a simple, cooked meal for one from fresh ingredients. It is not designed to assess a claimant s culinary skills, but to assess the impact of any impairment on their ability to perform the tasks required to prepare and cook a simple meal. 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. Carrying items around the kitchen is not included in this activity. Notes: 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. Preparing food means the activities required to make food ready for cooking and eating, such as peeling and chopping. Cooking food means heating food at or above waist height for example, using a microwave oven or on a cooker hob. It does not consider the ability to bend down for example, to access an oven. Serving food means transferring food to a plate or bowl. It does not include presentation, or involve carrying food to where it will be eaten. Where the claimant is reliant on pre-chopped vegetables, you should consider whether the claimant could peel and chop. If a person could peel and chop then, in the absence of any other relevant functional restrictions, they can prepare a simple meal unaided. 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 need assistance to prepare a simple meal. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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. A Can prepare and cook a simple meal unaided. 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. 0 B Needs to use an aid or appliance to be able to either prepare or cook a simple meal.

In this activity, aids and appliances could include, for example, prostheses, perching stool, lightweight pots and pans, easy grip handles on utensils, single lever arm taps and spiked chopping boards. C Cannot cook a simple meal using a conventional cooker but is able to do so using a microwave. 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. Please note that this descriptor only refers to the cooking of a meal using a microwave, not the preparation of it. Ensure the claimant s ability to prepare a meal is also taken in to account when considering if this descriptor applies. D Needs prompting to be able to either prepare or cook a simple meal. 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. 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. In cases of a risk of self-harm, there should be good evidence of the risk to the individual through, for example, high level involvement of community mental health services, care plan etc. 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. 4 Supervision due to significant risk of self-harm or suicide intent is also captured by descriptor E. F Cannot prepare and cook food. 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 but their functional ability indicates they could undertake tasks involved in preparing and cooking food then this descriptor would not apply. 8

Question What descriptor should apply to someone who relies on ready meals? What if reduced mobility means the person cannot move about the kitchen area? Does the claimant need to be able to make a variety of food, or make meals that are of nutritional value? How should we treat someone who needs supervision to use a conventional cooker? What is the difference between 1e and 1f? What considerations should be given to a claimant who for example suffers seizures or blackouts? Are different cultural cooking practices relevant? Is hygiene a consideration? UT DECISION: CSPIP/690/014 Is the ability to bend down to use an oven a relevant consideration? UT DECISION: CSPIP/40/015 Answer If someone only eats ready meals then you 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 meals out of choice 1a would apply. 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 Activity 1e will apply. Mobility is not considered as part of this activity but, as with any task, the reliability criteria must be considered. A claimant who has difficulty standing for more than a few minutes may, for example, require a perching stool. Carrying food from the kitchen to the eating area is not included in this activity. 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. 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. 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 assistance or supervision). If they cannot do one of these, even with assistance or supervision, but can do the other then one of the other descriptors will apply. Someone with very infrequent/ predictable episodes should be able to use a conventional cooker. Those with unpredictable episodes may need to use a microwave due to the risk of burning themselves with a conventional cooker. 1e should rarely apply and only to those where there is strong evidence that the seizures/ blackouts are extremely frequent and unpredictable in nature. No. The test should be a standard benchmark one of functional ability and broadly the same whoever is being assessed, see CDLA/3008/014, also applicable to PIP. Hygiene is a consideration when assessing whether a claimant can prepare food to an acceptable standard. Confirmed that bending down issues are irrelevant as to cook is defined as being "waist high or above".

Activity 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 type of food and drink for nourishment is not a consideration for this activity, but rather the claimant s ability to nourish themselves. The frequency of taking nutrition should only be considered if the claimant has a mental health condition, supported by further medical evidence. Notes: A therapeutic source means parenteral or enteral tube feeding using a rate limiting device, such as a delivery system or feed pump. Spilling food can be considered, regular spillage requiring a change of clothes after meals is not an acceptable standard of taking nutrition. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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. A Can take nutrition unaided. 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. 0 B Needs i. to use an aid or appliance to be able to take nutrition; or ii. supervision to be able to take nutrition; or iii. assistance to be able to cut up food. A key consideration when assessing whether supervision is required should be whether the claimant has a real risk of choking when taking nutrition. Please note it is not necessary for an individual to be able to cut up tough meats, e.g. steak, in order to be able to take nutrition to an acceptable standard.

C Needs a therapeutic source to be able to take nutrition. For example: may apply to claimants who require enteral or parenteral feeding but can carry it out unaided. D Needs prompting to be able to take nutrition. Prompting means reminding, encouraging or explaining by another person. May apply 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 through the claimant s lifestyle choices then this descriptor would not apply. 4 E Needs assistance to be able to manage a therapeutic source to take nutrition. For example: may apply to claimants who require enteral or parenteral feeding and require support to manage the equipment. 6 F Cannot convey food and drink to their mouth and needs another person to do so. 10 Q & A Question If someone needs an aid or appliance to peel and chop food for Activity 1 can you automatically assume that they will need to use an aid or appliance to take nutrition for Activity? Answer No. Somebody who has problems with manual dexterity or grip strength to the extent that they have 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 than raw vegetables.

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. The outcome of this activity is taking the medication or completing the recommended therapy as prescribed / recommended, without which the claimant s health is likely to deteriorate. Notes: Managing medication means the ability to take prescribed medication in the correct way and at the right time. Monitoring a health condition or recognising significant changes means the ability to detect changes in the condition and take corrective action, as advised by a healthcare professional. Note that keeping an eye on how a person is doing does not count as monitoring, unless the person is monitoring a specific parameterunder medical advice and is implementing treatment modifications to prevent deterioration. Asking someone how they are will not meet the criteria unless there is a medical reason for expecting a change, a defined sign of deterioration and an advised action plan. This activity takes into account the administration of medication or therapy irrespective of who delivers it, and includes delivery by healthcare professionals, such as district or community psychiatric nurses. It only applies to medication/therapy delivered in the home environment i.e. where the claimant lives (and may include care homes), that has been prescribed/recommended by a registered healthcare professional or pharmacist. Examples of prescribed or recommended medication include tablets, inhalers, creams, suppositories and enemas. Therapies could include domiciliary dialysis and exercise regimes to prevent complications, such as contractures. Whilst 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 by a registered healthcare professional or pharmacist. Descriptors C F needs 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. For example if compression bandaging is worn 4 hours a day for venous insufficiency, the time spent by another person applying the bandaging is counted, not the time the bandages are worn. For the purpose of this activity, 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 a majority of days i.e. on a majority of days the statement about how much support an individual needs a week must be true. For example, if a claimant needs assistance to undergo home dialysis for three hours on Monday and Friday, 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 in a week. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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. Either A 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. 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 either i. to use an aid or appliance to be able to manage medication; or ii. supervision, prompting or assistance to be able to manage medication or monitor a health condition. This descriptor captures the supervision required by the claimant taking their own medication in the home. Supervision due to the risk of accidental or deliberate overdose is also captured here. For example: the claimant needs physical help opening bottles or taking pills out of blister packs; help interpreting or reading blood sugar for the correct dose of medication; supervision to ensure the medication is taken properly; prompting to remind the claimant to take medication at the appropriate time(s). Pill boxes, dosette boxes, blister packs, alarms and reminders only apply to descriptor B if the claimant is unable to manage their medication due to their health condition or impairment and there is evidence to explain their use; or if they are unable to read and an aid would help them to manage medication independently. Note that needles, glucose meters and inhalers are not aids. 1 C Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week. Prompting means reminding, encouraging or explaining by another person. For example, a claimant needs 15 minutes of assistance with therapy each day Monday to Friday, or reminding to manage therapy. 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 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 F Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week. 8

Question Is a nebuliser classed as medication or therapy? Answer A nebuliser could be considered both therapy and medication depending on its use. A nebuliser usually gives medication via aerosol delivery such as salbutamol for COPD/asthma; adrenaline for croup or in rare cases diamorphine for pain relief in very little children. However, it can also be used to deliver saline water to patients with chronic end stage COPD, cystic fibrosis or any chronic lung condition where it is used as a therapy to help dislodge some of the mucus build up; and is often used by physiotherapists as part of the chest physiotherapy to help the patient breathe better. The hours measured - Is it the therapy or is it the supervision/ prompting/ assistance that must last this long? Thus, although sometimes confused as being the same as an inhaler, it is in fact used for multiple purposes and - depending on its clinical indication - would either fall under medication (if used in an acute situation to deliver aerosol drugs) or therapy ( if used as part of a physiotherapy regime or to prevent build-up of mucus). It is the duration of the assistance/prompting/supervision. For example, someone who needs assistance for 30 minutes during a therapy that lasts 5 hours, would only accrue 30 minutes towards the weekly hourly total. UT Decision: CSPIP/40/015 confirmed this is the correct approach. This decision also stated that the assistance can be to "manage" therapy, not just assist with the therapy itself. So in this case, a person who didn t need help to use a TENS machine themselves, but did need help to set up the TENS machine, was deemed to be receiving assistance to manage therapy UT Decision: CPIP/1679/015 further confirms that it is the hours spent assisting, supervising or prompting that count towards the time periods in descriptors 3c 3f, and not the total duration of the therapy If a person with learning difficulties or cognitive impairment, for example Alzheimer's disease, is not on medication, could 3b be scored as they might need help or monitoring to assess if they need some medication in the future? Is an asthma inhaler an aid to manage medication? UT DECISION: CPIP/106/015 No. If a person is not on long term medication only 3a can be chosen. The descriptors reflect their current needs as assessed as being present for the qualifying 1 month period. Any short term medications would not meet the scope of 3b and we are not being asked to predict possible future changes. If the claimant did develop a condition requiring long term medications they could apply for a change of circumstances in the usual manner. This decision confirms that an asthma inhaler is not an aid. Instead the UT Judge confirms that it is the medication which improves the claimant s physical function of breathing. The fact that the medication is administered using a device is irrelevant

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 either a standard bath or shower. Shower can include shower attachments for a bath. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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. A Can wash and bathe unaided. Applies to claimants who can wash and bath unaided, including getting in to and out of a standard bath or shower. 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. 0 B Needs to use an aid or appliance to be able to wash or bathe. For example: a long-handled sponge, shower seat or bath rail. If a claimant uses a shower attachment on a bath, this should be considered as a standard bath or shower. A wet-room is not considered an aid for this activity the assessment is hypothetical and should apply to the context of a standard bathroom. C Needs supervision or prompting to be able to wash or bathe. 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 HP should assess the likelihood of a risk to the claimant occurring. 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. 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. F This descriptor relates to physical assistance by another person and should be applied as a hypothetical test to consider where the claimant needs assistance to get in to and out of either a bath or shower. Needs assistance to be able to wash their body between the shoulders and waist. 3 4 G Cannot wash and bathe at all and needs another person to wash their entire body. 8 QA Question Does the claimant need to be able to touch every part of their body, front and back, when looking at descriptor 4f? Answer The vast majority of people cannot touch every single part of their back. Most people 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. Can drying oneself be considered in this descriptor? No, not only is it not mentioned in the descriptors but it is difficult to see why someone who could wash a particular area of their body could not then dry that same area. Is the ability to shave a consideration for this activity? Is a wet room considered an aid or appliance? What is an unadapted shower How should a claimant who uses a wet room shower be assessed? No. Shaving is not part of cleaning oneself with water, including removing dirt and sweat, or getting into and out of either a standard bath or shower. A wet room should only be considered an aid or appliance if the claimant is physically unable to access either a standard bath or shower. If a claimant has a wet room at home then it is expected that the same criteria applies that an aid or appliance should only be considered in this regard if the wet room is necessary. A shower over a bath is considered to be an unadapted shower. A shower cubicle (i.e. a partitioned area with a threshold/ ledge to step over) is considered to be an unadapted shower. Shower attachments to bath taps are considered to be an unadapted shower. A wet room shower is distinct from a cubicle shower by not being partitioned and not having a threshold/ledge to step over. If its use is reasonably required, (i.e. if the claimant cannot step over the threshold/ ledge of a standard shower cubicle), it is evidence that a person cannot get into and out of an unadapted shower. To decide what score the claimant would receive the CM would need to look at the claimant s functional restrictions to see if they: could reasonably use an aid such as a grab rail to get into or out of an unadapted shower (4b) or whether they require assistance (4e) to get in and out of an unadapted shower

Does a claimant need to require assistance to get into or out of both a bath and shower to score under 4e? The following decision matrix has been devised to help CMs 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 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. Activity 5 Managing toilet needs or incontinence This activity considers a claimant s ability to get on and off the toilet, to clean afterwards and to manage evacuation of the bladder and/or bowel, including the use of collecting devices. This activity does not consider the ability to manage clothing, climb stairs or mobilise to the toilet. Notes: 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. If a claimant can manage a collecting device or catheter independently, without assistance or the use of an aid, they are able to manage incontinence unaided and they would not score under this activity. Note that a collecting device includes a stoma bag and incontinence pads. 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. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or

appliance is not 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. A Can manage toilet needs or incontinence unaided. 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. Descriptor A may be appropriate for claimants who use a commode due to limited mobility (to the toilet) but can manage their toilet needs or incontinence. 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, for example, a bladder problem and the claimant will be incontinent before they reach the toilet, then the commode is being used as 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. 0 B Needs to use an aid or appliance to be able to manage toilet needs or incontinence. 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 and bottom wipers. C Needs supervision or prompting to be able to manage toilet needs. 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 get on and off the toilet safely. D Needs assistance to be able to manage toilet needs. This descriptor only refers to claimants who require assistance to get on and off the toilet and/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. 4 E Needs assistance to be able to manage incontinence of either bladder or bowel. 6 F Needs assistance to be able to manage incontinence of both bladder and bowel. 8 QA Question Is a bidet an aid or appliance? Answer The vast majority of people who use one do so out of choice. Potentially, if someone claims to need a bidet to clean themselves after using the toilet, 5b may apply if there is evidence that they cannot clean themselves by conventional means and that this is consistent with their medical condition

Is dressing before and after going to the toilet a relevant consideration under activity 5? UT DECISION: CSPIP/666/014 The UT Judge agreed that activity 5 concerns activities such as getting on and off an unadapted toilet, evacuating the bowel and/or bladder and cleaning oneself afterwards. It does not concern the ability to undress/dress before or after any of these activities Activity 6 Dressing and undressing This activity assesses a claimant s ability to put on and take off un-adapted clothing that is suitable for the situation. This may include the need for fastenings, such as zips or buttons and considers the ability to put on/take off socks and shoes. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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. A Can dress and undress unaided. 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. 0 B Needs to use an aid or appliance to be able to dress or undress. For example: modified buttons, zips, front fastening bras, Velcro fastenings and shoe aids. C Needs either 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. 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.

Applies to claimants who cannot dress or undress their lower body, even with the use of aids. E Needs assistance to be able to dress or undress their upper body. Applies to claimants who cannot dress or undress their upper body, even with the use of aids. 4 F Cannot dress or undress at all. 8

Question Answer If someone chooses to UT Decision CPIP/168/015 The question is not whether claimants might sit down to choose to sit down to carry out the activity, but whether they are unable to dress/undress, are they carry out the activity without sitting down. Therefore, if a claimant is unable, carrying out that activity because of their medical condition, to dress or undress without sitting down to an acceptable then they should score points under 6b. standard? Are types of clothing an important consideration? - UT Decision: CPIP/5338/014 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 for convenience 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. The clothing 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 of preference 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 the defeats 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 of alternatives 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.

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. Notes: 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 viceversa 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. Lip reading is not considered an acceptable way to interpret verbal communication. Note: 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. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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.

A Can express and understand verbal information unaided. 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. 0 B Needs to use an aid or appliance to be able to speak or hear. For example: may apply to claimants who require a hearing aid or an electro larynx. If the claimant is not using a prescribed hearing aid, ask why. If there is a good medical reason such as chronic ear infection, function without the aid should be assessed. If there is not a good reason, expected function with the aid should be assessed. C Needs communication support to be able to express or understand complex verbal information. For example: may apply to claimants who require a sign language interpreter. 4 D Needs communication support to be able to express or understand basic verbal information. For example: may apply to claimants who require a sign language interpreter. 8 Cannot express or understand verbal information at all even with communication E 1 support. QA Question Does writing things down count as communication If the claimant uses a hearing aid in 1 ear when the other ear has normal hearing, would they satisfy 7a or 7b? How should activity 7 be approached? Answer 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, e.g. a text to speech phone. 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 4b. A person who cannot either speak or hear even with communication support (even if all communication could be written down) would score 7e 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 The following process may be helpful when considering this activity: Is there any functional impairment to the claimant s ability to speak or hear? If yes, does the claimant need to use an aid or appliance in order to communicate, for example a hearing aid or voicebox? If the claimant is still unable to either speak or hear to an acceptable standard, even with an aid or appliance, for example because they are profoundly deaf or due to their speech being

very difficult to understand due to a stroke, then they may need communication support 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 difficulties. Illiteracy or lack of familiarity with written English are not health conditions and should not be considered. Notes: Basic information is signs, symbols or dates, e.g. a green exit sign on a door. Complex information is more than one sentence of written or printed standard size text e.g. Your home may be at risk if you do not keep up repayments on your mortgage or any other debt secured on it. Subject to terms and conditions. The ability to remember and retain information is not within the scope of this activity. 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 a blue screen to read text when indoors and a portable magnifying glass to do so when outdoors. If despite aids the claimant cannot read both indoors and outdoors, another descriptor may apply. When considering whether a claimant requires an aid or appliance, HPs should distinguish between: an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; 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 safely, reliably, repeatedly and in a timely manner. Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not 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. A Can read and understand basic and complex written information either unaided or using spectacles or contact lenses. 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. 0 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. For example: may apply to claimants who require vision aids.

C Needs prompting to be able to read or understand complex written information. 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. 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 information due to a cognitive impairment. 4 E Cannot read or understand signs, symbols or words at all. For example: may apply to claimants who require another person to read everything for them due to a learning disability or severe visual impairment. 8 Question What is printed standard size text? Answer Standard size text should be considered as point 1. 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-toface in a contextually and socially appropriate manner, understand body language and establish relationships. Notes: 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 a 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 integration. 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. Vulnerability to the actions of others is considered in this activity. For example, someone with Downs Syndrome or Autism may be less risk aware and vulnerable to manipulation or abuse. A 0

Can engage with other people unaided. 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 engage with other people. Prompting means reminding, encouraging or explaining by another person. For example: may apply to people who need encouragement to engage with others in the presence of a third party. C Needs social support to be able to engage with other people. For example: may apply 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. 4 D Cannot engage with other people due to such engagement causing either 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. 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 occur in conditions such as generalised anxiety disorder, panic disorder, dementia or agoraphobia. 8 QA Question What is the difference between "prompting" in descriptor 9b and "social support" in 9c? Which descriptor would apply to a blind or partially sighted person under Activity 9? If a person is deaf or has a hearing loss and needs a sign language translator, would this meet any descriptor under Activity 9? Answer 9b "prompting" 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. 9c "social support" applies to someone who can only engage with another person with the active support of a third party, so in effect they need someone with them all of the time, for example someone with a severe behavioural disorder or autism. It is unlikely that a blind or partially sighted person would require either prompting or social support to engage with other people in which case descriptor 9a would apply. However, there may be individual cases where the person does require additional support for reasons unrelated to their visual impairment and the relevant descriptor could apply No, communication is covered by Activity 7. In Activity 9 the presence of another person as social support must be due to their inability to understand and respond to body language, other social cues and to assist in social integration.

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. Notes: Complex budgeting decisions are those that are involved in calculating household and personal budgets, managing and paying 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. A Can manage complex budgeting decisions unaided. 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. 0 B Needs prompting or assistance to be able to make complex budgeting decisions. This descriptor applies to people who need assistance with managing their household bills or planning future purchases. A level of vulnerability due to 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. C Needs prompting or assistance to be able to make simple budgeting decisions. 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 independently. 4 D Cannot make any budgeting decisions at all. 6

Question Does financial knowledge come into 'complex budgeting decisions'? When calculating household and personal budgets, or planning future purchases, does one not need to understand mortgage rates, interest rates, or similar financial instruments? What if they need to take on debt? If the person is, say, 16 years old, should this be factored into their ability to manage a budget? Should the ability to go out and physically pay bills be taken into account? Would someone s mental health affect their ability to make a budgeting decision? Answer No, The 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 as 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 purchases (e.g. knowing that saving is required when necessary). The age of the person or whether they have ever done any household budgeting is irrelevant - it is their ability to make budgeting decisions, for example their level of cognitive function, that is relevant. The focus of this activity is on the decisions themselves, not any of the physical activity that goes on around them; for example, the ability to use a computer, make a phone call, write a letter, or leave the house to go and pay a bill. A mental health condition may affect a person s ability to make complex budgeting decisions. Complex budgeting decisions are not just a string of simple sums, but the ability to respond appropriately to changing circumstances and events, as income and outgoings change, new demands are made, new things become priorities etc. This ability to respond to events makes this descriptor quite different. 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. You should look at the decision making process itself. Does the claimant understand that the bill must be paid and how that will affect their other finances, if they need to make adjustments to their spending elsewhere, or need to ask for extra time to pay? Do they understand that money must last a period of time, and be parcelled out over that period in order that it lasts until the next piece of income arrives, and do they have the ability to do that? So, an example of someone who needs prompting/assistance 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 in to 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 in order to score points. Is reduced vision a This decision confirms that reduced vision does not impact on making consideration in activity budgeting decisions. The fact that a person s limited sight might make it difficult 10? UT Decision: for them to see price tags in shops or count change may mean that they CPIP/1650/015 require someone else to provide them with the information necessary to make the decision but it does not itself give rise to difficulty in making the decisions based on the necessary information.

Activity 11 Planning and following journeys This activity considers a claimant s ability to plan and follow the route of a journey. As with all the other 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 which limits that person s ability to carry out the activity in question would normally take to complete that activity). Notes: This activity was designed to assess the barriers claimants may face that are associated with mental, cognitive or sensory ability. Journey means a local journey, whether familiar or unfamiliar. Environmental factors may be considered if they prevent the claimant from reliably completing a journey, for example being unable to cope with crowds or loud noises. NB: in legislation, this activity is referred to as Mobility Activity 1. A Can plan and follow the route of a journey unaided. 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. Can the claimant go out to make any single journey, without prompting most days? If so, mobility 1A is likely to apply. 0 For example, consider a claimant who manages to walk 5 minutes by herself to collect her child from school each weekday, despite her anxiety. She doesn t need any support or assistance to do this, but does not leave the house on any other occasion without someone else with her. She is able to make a single journey 5 days a week without prompting, so would satisfy mobility 1a. Needs prompting to be able to undertake any journey to avoid overwhelming B psychological distress to the claimant. 4

This descriptor applies to claimants where leaving the home and undertaking any journey causes overwhelming psychological distress and where they need prompting on the majority of days to be able to go out. Prompting means reminding, encouraging or explaining by another person. Prompting can take place either before or during a journey. Any journey means any single journey on the majority of days. 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 occur in conditions such as generalised anxiety disorder, panic disorder, dementia or agoraphobia. In cases of agoraphobia, going out provokes anxiety but may still be possible with prompting. If agoraphobia is severe and the claimant is unable to go out even with support on the majority of days, descriptor E may be more appropriate. A claimant who is actively suicidal or who is at substantial risk of exhibiting violent behaviour and who needs prompting not to harm themselves or others when undertaking a journey would meet this descriptor. In cases such as this, there must be good evidence that the person is a high suicide risk by, for example, a high level involvement of community mental health services, care plan approach etc. In cases of violent behaviour there must be good evidence that they are unable to control their behaviour and that being prompted by another person reduces a substantial risk of the person committing a violent act. Does the claimant need prompting to be able to make any single journey on most days? In other words, if they get support from someone else, can they successfully make a journey on most days? If so, descriptor B is likely to apply. For example, a claimant who goes out to his local shop four days each week but needs to have his wife with him to be able to cope with this journey. He will sometimes try to go to his weekly physiotherapy appointment alone if his wife is working, but this causes him significant anxiety and he has only managed to cope with this once in the last month; he cancelled the other appointments rather than make the trip alone. He can go out on most days but requires prompting / support to be able to do so. He is only able to go out alone on occasion and very infrequently. He 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 undertake other journeys without prompting during the required period. The HP should ask clarifying questions of claimants who state they can undertake some journeys but not others without prompting to ascertain the reasons why and to obtain corroborating evidence where necessary. The HP should also explore what the claimant is able to do rather than what they do do. For example, a claimant who goes out twice a week is this through choice, or because they need prompting due to overwhelming psychological distress? If it is the former then this descriptor will not apply. C Cannot plan the route of a journey. Applies to claimants with cognitive or developmental impairments, who cannot formulate a plan for their journey using simple materials, such as bus route maps, phone apps or timetables, but who can follow a journey planned by someone else for example take a bus journey on their own. Such a person is likely to be able to ask for help with their route if the bus is diverted. 8

D Cannot follow the route of an unfamiliar journey without another person, assistance dog or orientation aid. This descriptor is most likely to Apply to claimants with cognitive, sensory or developmental impairments who cannot, due to their impairment, work out where to go, follow directions or deal with unexpected changes in their journey when it is unfamiliar. To follow is the visual, cognitive and intellectual ability to reliably navigate a route. The ability to walk itself is assessed in activity 1. Cognitive impairment encompasses orientation (understanding of where, when and who the person is), attention, concentration and memory. 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. Any accompanying person should be actively navigating for the descriptor to apply. If the accompanying person is present for any other purpose then this descriptor will not apply. 10 Small disruptions and unexpected changes, such as road works and changed busstops are commonplace when following journeys and consideration should be given to whether the claimant would be able to carry out the activity if such commonplace disruptions were to occur. Consideration should also be given to whether the claimant is likely to get lost. Clearly many people will get a little lost in unfamiliar locations and that is expected, but most are able to recover and eventually reach their target location. An individual who would get excessively lost, or be unable to recover from getting lost would be unable to complete the activity to an acceptable standard. Safety should be considered in respect of risks that relate to the ability to navigate, for example, visual impairment and substantial risk from traffic when crossing a road. If the risk identified is due to something else, such as behaviour, this descriptor is unlikely to apply. E Cannot undertake any journey because it would cause overwhelming psychological distress to the claimant. Applies to claimants who cannot undertake any journey on the majority of days, even with prompting or assistance, owing to overwhelming psychological distress. Prompting means reminding, encouraging or explaining by another person. Prompting can take place either before or during a journey. Any journey means any single journey on the majority of days. 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. 10 This descriptor is likely to apply to claimants with severe mental health conditions (typically severe agoraphobia or panic disorder) or cognitive impairments (typically 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). If the claimant cannot go out even with prompting on most days so despite

encouragement or support, they still fail to make any journey on most days then this descriptor will apply. For example, a claimant who only manages to go out once a week to the 4hour supermarket at am. They choose this time because it is quiet and they do not usually see anyone they know there. The rest of the week they remain at home due to their agoraphobia and anxiety. They have friends and family visit them at home, but even with encouragement and offers of support, the claimant is too anxious to go out at any other time during the week. Therefore, on the majority of days, they cannot make any journey even with prompting. F Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid. This descriptor is most likely to apply to claimants with cognitive, sensory or developmental impairments, who cannot, due to their impairment, work out where to go, follow directions or deal with unexpected changes in their journey, even when the journey is familiar. To follow is the visual, cognitive and intellectual ability to reliably navigate a route. The ability to walk itself is assessed in activity 1. Cognitive impairment encompasses orientation (understanding of where, when and who the person is), attention, concentration and memory. Any accompanying person should be actively navigating for the descriptor to apply. If the accompanying person is present for any other purpose then this descriptor will not apply. Small disruptions and unexpected changes, such as road works and changed busstops are commonplace when following journeys and consideration should be given to whether the claimant would be able to carry out the activity as described if such common place disruptions occur. Consideration should also be given to whether the claimant is likely to get lost. Clearly many people will get a little lost in unfamiliar locations and that is expected, but most are able to recover and eventually reach their target location. An individual who would get excessively lost, or be unable to recover from getting lost would be unable to complete the activity to an acceptable standard. 1 For example, a person with learning difficulties is out shopping in town. On their way home (a familiar journey), a road they would normally walk down has been closed off due to a police incident. If the person wouldn t be able to successfully navigate an alternative route home then this descriptor would apply. If they can follow a familiar route even with minor diversions, move to descriptor D. Safety should be considered in respect of risks that relate to the ability to navigate, for example visual impairment and substantial risk from traffic when crossing a road.

QA Question Does Activity 11 apply to people with physical conditions What does follow the route mean? Answer Only if the condition results in either sensory or cognitive impairment or overwhelming psychological distress. Activity 11 relates to the cognitive and sensory ability to plan and follow a journey, but not the physical ability to move - this is covered under Activity 1. To follow the route is the visual, cognitive and intellectual ability to reliably navigate a route. The ability to walk itself is assessed in activity 1. The accompanying person should be actively navigating for the descriptor to apply. If the accompanying person is present for any other purpose, for example reassurance, this descriptor does not apply. Cognitive impairment encompasses orientation (understanding of where, when and who the person is), attention, concentration and memory. Conditions that may impair cognitive function include physical conditions (such as stroke, head injury, dementia), learning disabilities, and mental health conditions such as bipolar disorder or psychotic illnesses (e.g. schizophrenia). Mental health conditions involving anxiety, panic attacks and psychological distress are only relevant for consideration for the purposes of descriptors 1d or 1f if at the time of the attack they cause the claimant specifically to lose the faculty of navigation. If not, descriptors 1b or 1e are instead relevant for consideration See UT Decision: DC v Secretary of State, [015] UKUT 0344 (AAC) (UK/6/015). Judge Jacobs provides a good summary of what follow the route means 1. I accept the Secretary of State s argument that descriptor 1d deals with navigation and excludes dealing with other difficulties that may be encountered along the way. 13.. The natural meaning of follow the route of an unfamiliar journey is that it is concerned with navigation rather than coping with obstacles of whatever sort that may be encountered on the route. Activity 1 covers both planning and following a journey. Descriptor 1d, like descriptors 1a and 1f, deals with following the route of the journey. That assumes that the journey involves a route that has been planned. Difficulties that may arise during the journey, such as getting lost and asking directions or encountering crowds, are not difficulties with following the route. They may prevent the claimant getting back onto the route if lost or finding an alternative route to avoid some obstacle, but those are different matters. 14. This reading is consistent with and reinforced by the contrasts within the descriptors for Activity 1. The descriptors contrast the route of a journey (descriptors 1a, 1c, 1d and 1f) with the journey itself (descriptors 1b and 1e). And following the route of the journey (descriptors 1a, 1d and 1f) with undertaking the journey (descriptors 1b and 1e). The latter is used when the claimant could not embark on or complete a journey either without prompting or at all. The impediment in either case must be overwhelming psychological distress. That could be distress from going on a journey (such as might occur if a claimant has agoraphobia) or from contemplating or coping with difficulties that might arise on the route (such as might occur if a claimant has a fear of crowds). In contrast, the other descriptors are limited to one aspect of the journey, following its route. It would be inappropriate to interpret this more widely than its natural meaning. Doing so, would disrupt the structure of the Activity by incorporating issues that are properly covered, if at all, by other

descriptors. This navigational interpretation has also been followed by the Upper Tribunal in HL v SSWP [015] UKUT 694 (AAC) (UK/313/015): 3. On my view, what then does it entail to follow the route? I agree with the Secretary of State that the words follow the route must be taken to have been adopted advisedly; that route refers to (in the broad sense) the pathway to somewhere and that to follow has connotations of keeping to such a pathway. I accept the submission that the deliberate use of the words follow and route focuses us upon the claimant s ability to navigate along pathways and is not concerned with other possible problems that a claimant may have when being in the natural environment. And further echoed in CSPIP/55/015: 4 It is abundantly clear in my view that the terms of the mobility descriptor 1(d) are related to the ability to orientate to follow a route. It seems to me that the activity covers both orientation in Activities 1d and 1f and the effects of psychological distress in Activities 1b and 1e.I agree with what was said by Upper Tribunal Judge (Jacobs) in DA v SSWP [015] UKUT 344 (AAC) (UK/6/015). I consider that the Upper Tribunal Judge (Sir Crispin Agnew of Lochnaw) in CSPIP/109/015 is attempting to stretch the meaning of the descriptor beyond a definition which it can reasonably bear. It follows that I do not accept the claimant s submission. Can activity 11 apply to someone with a seizure or blackout disorder? The vast majority of people with a seizure or blackout disorder will not require another person to accompany them, in order to navigate out of doors. Those with well controlled seizure disorders or blackouts should be able to safely go out alone, in which case 11a should apply. A small minority of people might be so anxious about having a seizure or blackout that they will not go out alone or might feel the need for reassurance when out - in which case 11b might apply. 11d or 11f may apply, where a claimant is experiencing uncontrolled or unpredictable seizures which result in prolonged confusion and disorientation and which occur on the majority of days. There should be evidence that the seizures/ blackouts are poorly controlled, e.g. the person is likely to be under the care of a neurologist and will not be able to drive. Is a satellite navigation system an orientation aid? Is a symbol cane an orientation aid? UT decision CSPIP/196/015 Specialist satellite navigation systems may be considered orientation aids i.e. if they have specialist software for the purpose of helping those with a disability. The definition of orientation aid is a specialist aid designed to assist disabled people to follow a route safely. For the purpose of orientation aid, one should not take into account similar aids that are non-specialist, such as generically available satellite navigation systems because many people rely on these, whether or not they have a health condition or impairment This decision confirmed that a symbol cane is not an orientation aid as it is not concerned with navigation but gives other road users an awareness of a person s sight loss and acts as a prompt to them to offer assistance.

Activity 1 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 0 metres, up to 50 metres, up to 00 metres and over 00 metres. As with all the other 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 which limits that person s ability to carry out the activity in question would normally take to complete that activity). Notes: 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. 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. NB: in legislation this activity is referred to as Mobility Activity. A Can stand and then move more than 00 metres, either aided or unaided. 0 B C Can stand and then move more than 50 metres but no more than 00 metres, either aided or unaided. For example, this would include people who can stand and move more than 50 metres but no further than 00 metres either by themselves, or using an aid or appliance such as a stick or crutch, or with support from another person. Can stand and then move unaided more than 0 metres but no more than 50 metres. 4 8 Within the assessment criteria, the ability to perform an activity unaided means

D E F without either the use of aids or appliances; or help from another person. For example, this would include people who can stand and move more than 0 metres but no further than 50 metres, without needing to rely on an aid or appliance such as a walking stick, or help from another person. Can stand and then move using an aid or appliance more than 0 metres but no more than 50 metres. For example, this would include people who can stand and move more than 0 metres but no further than 50 metres, but need to use an aid or appliance, such as a stick or crutch to do so. Can stand and then move more than 1 metre but no more than 0 metres, either aided or unaided. For example, a person who can stand and move more than 1 metre, but no further than 0 metres, either unaided or with the use of an aid or appliance such as a stick or crutch, or support from another person. Cannot, either aided or unaided i. stand; or ii. move more than 1 metre. 10 1 1

QA Question 'Stand' is defined as being 'upright' - what if the Claimant can only move in a stooped position? Answer Posture should only be taken into account if it affects the person's ability to mobilise safely and to an acceptable standard (e.g. without severe discomfort).