Personal Independence Payment NAWRA Mar 2012
This Guide is split into 5 sections:
• A. The structure of PIP (p.1-2)
• B. DWP General Guidance (p. 2-3)
• C. Daily Living Component (p. 3-10) - the 9 activities and their descriptors - with specific DWP guidance and comment
• D. Mobility Component (p.10 -12) - as above for the 2 Mobility activities
• E. Comment and comparisons - (p. 12-15) - likely effects of points system, old v. new processes/structures, likely rates and knock on effects and the case to retain DLA.
As you look at PIP you may have your own thoughts and comments on how the change will impact on you or the people you work with. Please let us know through tom@nawra.org.uk
, so we can improve this guide and feed into consultation responses and campaigning activity.
•
The new Personal Independence Payment (PIP) is set to replace Disability Living
Allowance (DLA) for new claims for people of working age from after April 2013,
•
A form of migration for existing DLA claims to follow (currently April 2013 to 2016).
Unlike ESA no interim switch to ESA, (so ? no transitional protection) and no use of existing DLA records. Claimants will receive a letter telling them that DLA will stop unless they request a PIP claim form within 4 weeks. If they do then DLA will continue until PIP assessed (as if a completely fresh claim), if not DLA will stop.
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DLA will be retained for children and AA for those of pension age - not simplification!
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Government aim is to cut spending by 20%/ focus help on the most severely disabled while having a more robust and consistent assessment framework
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PIP, like DLA, will have two components: Mobility (replacing DLA Mobility) and
Daily Living (replacing DLA Care).
•
It remains a long term benefit - plans to extend the qualifying period to 6 months have been dropped, but the forward test of likely mobility/daily living needs will now be 9 months instead of 6 months under DLA
•
A mixture of self assessment, medical evidence and in most cases a face to face assessment by an approved health professional
•
There are two rates in each component: Standard and Enhanced. Amounts are not yet known. It is probably best not to think of PIP as DLA minus Lower Care - the rates and criteria are very different.
• Rates are not distinguished as now by whether day and/or night need for care or whether mobility problems are mainly physical or a need for monitoring and guidance.
• PIP assessment will be by an ESA style points system, with the highest scoring descriptor in each of 9 Daily Living activities being totalled to give a score for the
Daily Living Component and in the 2 Mobility activities for the Mobility Component.
•
8 to 11 points for Standard rate - where someone has ‘limited ability’ to carry out daily living/mobility activities as a result of their physical or mental condition
• 12 or more points for Enhanced rate - where someone has ‘severely limited ability’ to carry out daily living/mobility activities
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There are no provisions for PIP related premiums/ elements in current plans for
Universal Credit, so a major cut for people with disabilities on the lowest incomes.
DWP information
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The current stage of PIP consultation was published in January 2012 - see: www.dwp.gov.uk/docs/pip-assessment-thresholds-and-consultation.pdf
. This explaining current thinking and puts thresholds to the points that will achieve the required 20% cut and reduction of 500,000 in claimant numbers.
•
The responses to the first draft and the thinking behind the new draft of descriptors published in November 2011 - along with the new draft descriptors and the specific guidance reproduced below - can be found at www.dwp.gov.uk/docs/pip-second-draftassessment-criteria-note.pdf
• For the draft regs see: www.dwp.gov.uk/docs/pip-second-draft-assessmentregulations.pdf
Variable and fluctuating condition
Descriptor choice should be based on consideration of a 12 month period, where their impairment(s) affects their ability to complete an activity on more than 50 per cent of days in the 12 month period. The following rules apply:
• If one descriptor in an activity applies on more than 50 per cent of the days in the period – then that descriptor should be chosen.
• If more than one descriptor in an activity applies on more than 50 per cent of the days in the period, then choose the one that applies for the greatest proportion of the time.
• Where one single descriptor in an activity is not satisfied on more than 50 per cent of days, but a number of different descriptors in that activity together are satisfied on more than 50 per cent of days – for example, descriptor ‘B’ is satisfied on 40 per cent of days and descriptor ‘C’ on 30 per cent of days – the descriptor satisfied for th e highest proportion of the time should be selected.
Awaiting treatment
Descriptor choices should be based on the likely continuing impact of the health condition or impairment as if any treatment or further intervention has not occurred.
Reliably, in a timely fashion, repeatedly and safely
An individual must be able to complete an activity descriptor reliably, in a timely fashion, repeatedly and safely; and where indicated, using aids and appliances or with support from another person (or, for activity 10, a support dog).
Otherwise they should be considered unable to complete the activity described at that level
• Reliably means to a reasonable standard.
•
In a timely fashion means in less than twice the time it would take someone without that disability
• Repeatedly means completed as often during the day as the individual activity requires.
Consideration needs to be given to the cumulative effects of symptoms such as pain and fatigue – i.e. whether completing the activity adversely affects the individual’s ability to subsequently complete other activities.
•
Safely means in a fashion that is unlikely to cause harm to the individual, either directly or through vulnerability to the actions of others; or to another person.
• Risk and Safety: When considering if an activity can be undertaken safely it is to consider the risk of a serious adverse event occurring. However, the risk that this may
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Personal Independence Payment NAWRA Mar 2012 occur due to impairments is insufficient – there has to be evidence that if the activity was undertaken, the adverse event is likely to occur.
Aids and appliances
The assessment will take some account of aids and appliances which are used in everyday life. In this context:
• Aids are devices that help a performance of a function, for example, walking sticks or spectacles.
• Appliances are devices that provide or replace a missing function, for example artificial limbs, collecting devices (stomas) and wheelchairs.
Assessment will take into account aids and appliances that individuals normally use and low cost, commonly available ones which someone with their impairment might reasonably be expected to use, even if they are not normally used.
Individuals who use or could reasonably be expected to use aids to carry out an activity will generally receive a higher scoring descriptor than those who can carry out the activity unaided.
Support dogs
Guide, hearing and dual sensory dogs are not ‘aids’ but the test has attempted to ensure that the descriptors capture the additional barriers and costs of needing such a dog where they are required to enable individuals to follow a journey safely. Descriptors ‘C’ and ‘E’ in activity
10 therefore explicitly refer to the use of a ‘support dog’.for an individual without any impairment.
Support from other people
The assessment will take into account where individuals need the support of another person or persons to carry out an activity – including where that person has to carry out the activity for them in its entirety. The criteria refer to three types of support:
•
Assistance is support that requires the presence and physical intervention of another person i.e. actually doing some or all of the task in question. This specifically excludes non-physical intervention such as prompting or supervision which are defined below.
To apply, this only needs to be required for part of the activity.
• Prompting is support provided by reminding or encouraging an individual to undertake or complete a task but not physically helping them. To apply, this only needs to be required for part of the activity.
• Supervision is a need for the continuous presence of another person to avoid a serious adverse event from occurring to the individual. There must be evidence that any risk would be likely to occur in the absence of such supervision. To apply, this must be required for the full duration of the activity.
Unaided
Within the assessment criteria, the ability to perform an activity ‘unaided’ means without either the use of aids or appliances or assistance/prompting/supervision from another person.
1.1 DWP Guidance
This activity considers an individual’s ability to prepare a simple meal. This is not a reflection of an individual’s cooking skills but instead a consideration of the impact of impairment on ability to perform the tasks required. It assesses ability to open packaging, serve food, pour a drink, peel and chop food and use a microwave oven or cooker hob to cook or heat food.
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Notes:
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Preparing food means the activities required to make food ready for cooking and eating, such as peeling and chopping.
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Cooking food means cooking or heating at 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.
• A simple meal is a cooked one-course meal for one from fresh ingredients.
• Packaging includes tins, which may require the use of a tin opener.
• In this activity aids and appliances could include, for example, prostheses, perching stool, lightweight pots and pans, easy grip handles on utensils and single lever arm taps.
1.2 The descriptors
A
B
Can prepare and cook a simple meal unaided.
Needs to use an aid or appliance to either prepare or cook a simple meal.
0
2
C Cannot cook a simple meal using a conventional cooker but can do so using a microwave. 2
For example: may apply to individuals who cannot safely use a cooker hob and hot pans.
D reminded date.
Needs prompting to either prepare or cook a simple meal.
For example: may apply to individuals who lack motivation, who need to be
2 how to prepare and cook food or who are unable to ascertain if food is within
E
F
Needs supervision to either prepare or cook a simple meal.
For example: may apply to individuals who need supervision to prepare and cannot safely use a microwave oven.
Needs assistance to either prepare or cook a simple meal.
For example: may apply to individuals who cannot prepare food because of reduced manual dexterity; or who cannot safely heat food
4
4
G Cannot prepare and cook food and drink at all
1.3 Comment
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This replaces the cooking test for DLA Lower Care with a variety of descriptors. A “main meal” is replaced with a simple meal, and bending to use an oven is specifically excluded.
Using a microwave is also introduced. Anything bar complete inability to prepare food and drink at all will not secure benefit by itself, so points will be needed elsewhere.
2.1 DWP Guidance
This activity considers an individual’s ability to be nourished, either by cutting food into pieces, conveying to the mouth, chewing and swallowing; or through the use of therapeutic sources.
Notes:
A therapeutic source means parenteral or enteral tube feeding using a rate limiting device such as a delivery system or feed pump.
2.2 The descriptors:
A
B
Can take nutrition unaided.
Needs either –
0
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Personal Independence Payment NAWRA Mar 2012
C
D i. to use an aid or appliance to take nutrition; or ii.assistance to cut up food. 2
Needs a therapeutic source to take nutrition. 2
For example: may apply to individuals who require enteral or parenteral feeding but can do so unaided.
4 Needs prompting to take nutrition.
For example: may apply to individuals who need to be reminded to eat.
Needs assistance to manage a therapeutic source to take nutrition. 6 E
For example: may apply to individuals who require enteral or parenteral feeding and require support to manage the equipment.
F Needs another person to convey food and drink to their mouth. 10
2.3 Comment:
Physical help or prompting with eating could sometimes be the main ‘frequent attention throughout the day’ for DLA Middle care (e.g. diet controlled diabetes, cancer, depression, anorexia) but this sort of help will only count partway to an award of PIP
3.1 DWP Guidance:
This activity considers an individual’s ability to;
(i) appropriately take medications that are prescribed or recommended by a registered doctor, nurse or pharmacist;
(ii) monitor and detect changes in a health condition; and
(iii) manage long-term home therapeutic activities that are prescribed or recommended by a registered doctor, nurse, pharmacist or healthcare professional regulated by the Health Professions Council; and without any of which their health is likely to deteriorate.
Examples of prescribed or recommended medication include tablets, inhalers and creams and therapies could include home oxygen, domiciliary dialysis, nebulisers and exercise regimes to prevent complications such as contractures.
Whilst medications and therapies do not necessarily have to be prescribed, there must be an evidence base that supports their use in treatment of the condition
Notes:
• Managing medication means the ability to take prescribed medication in the correct way and at the right time.
• Monitoring a health condition or recognise significant changes means the ability to detect changes in the condition and take corrective action as advised by a healthcare professional.
• This activity does not take into account medication and monitoring requiring administration by a healthcare professional.
• Supervision due to the risk of accidental or deliberate overdose or deliberate self- harm is captured in these descriptors as the person would require support from another person in order to prevent this.
3.2 The descriptors
A Either – i. Does not receive medication, therapy or need to monitor a health condition; or
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Personal Independence Payment NAWRA Mar 2012
B
C ii. Can manage medication, therapy and monitor a health condition unaided, or with the use of an aid or appliance. 0
Needs supervision, prompting or assistance to manage medication or monitor a health condition. 1
Needs supervision, prompting or assistance to manage therapy that takes up to 3.5 hours a week. 2
D
E
F
Needs supervision, prompting or assistance to manage therapy that takes between
3.5 and 7 hours a week. 4
Needs supervision, prompting or assistance to manage therapy that takes between
7 and 14 hours a week. 6
Needs supervision, prompting or assistance to manage therapy that takes at least 14 hours a week. 8
3.3 Comment:
This according to the guidance is the main replacement for supervision - for e.g.self harm, suicidal ideation or the effects of a medical condition such as diabetic coma, epileptic fit etc.
However only the 1 point descriptor applies to a need for another person to monitor medical conditions as all the others involve help with managing prescribed therapy.
DWP case studies give examples of people experiencing 3 fits a month (but her work colleagues know what to do) and a major or minor fit most days who do not qualify for PIP at all and who depend on points from other areas for any score at all.
Help from healthcare professionals (e.g district nurses, CPNs is specifically excluded and no mention of help to attend hospital for appointments and treatments which can be important parts of a DLA claim
C
4.1 DWP Guidance
This activity considers an individual’s ability to clean their face, hands, underarms and torso to clean their teeth and to comb/brush and wash their hair.
Notes:
• Bathing is the ability to clean one’s torso, face, hands and underarms.
• Grooming means the ability to clean teeth, comb/brush and wash hair.
4.2 The descriptors:
A
B
D
E
Can bathe and groom unaided. 0
Needs to use an aid or appliance to groom.
For example: suitable aids could include modified hair brushes, combs and mirrors.
1
Needs prompting to groom. 1
For example: may apply to individuals who lack motivation or need to be reminded to groom
2 Needs assistance to groom.
For example: may apply to individuals who are unable to make use of aids.
Needs supervision or prompting to bathe. 2
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F
For example: may apply to individuals who need to be reminded to bathe or require supervision for safety
Needs to use an aid or appliance to bathe. 2
For example: may apply to individuals who cannot either get into the bath or shower or remain standing without suitable aids or appliances, such as a walk in shower or bath/shower seat.
Needs assistance to bathe. 4
Cannot bathe and groom at all. 8
G
H
4.3 Comment:
Note that ‘bathe’ does not mean ‘bath’ - the ability to wash is considered suffice.
5.1 DWP Guidance:
This activity considers an individual’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.
C
D
Notes:
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Toilet needs means the ability to get on and off the toilet and clean oneself afterwards.
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Managing incontinence means the ability to manage evacuation of the bladder and/or bowel including using collecting devices but does not include changing clothes.
•
Individuals with catheters and collecting devices are considered incontinent for the purposes of this activity.
5.2 The descriptors
A Can manage toilet needs or incontinence unaided 0
B Needs to use an aid or appliance to manage toilet needs or incontinence. 2
For example: suitable aids could include commodes, raised toilet seats, bottom wipers or bidets.
Needs prompting to manage toilet needs. 2
For example: may apply to individuals who need to be reminded to go to the toilet.
Needs assistance to manage toilet needs. 4
E
F
Needs assistance to manage incontinence of either bladder or bowel.
Needs assistance to manage incontinence of both bladder and bowel.
G Cannot manage incontinence at all.
5.3 Comment
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8
8
Under DLA, toileting and continence difficulties alone could justify frequent attention throughout the day for Middle Care. Under PIP, people would need scores elsewhere, unless also needing help with bladder and bowel movements.
6.1 DWP Guidance:
This activity assesses an individual’s ability to appropriately select, put on and take off culturally appropriate and un-adapted clothing, which may include the need for fastening such as zips or buttons. This includes the ability to put on/take off socks and slip on shoes.
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Personal Independence Payment NAWRA Mar 2012
6.2 The descriptors:
A
B
C
Can dress and undress unaided 0
Needs to use an aid or appliance to dress or undress. 2
For example: suitable aids could include modified buttons, zips, front fastening bras, trouser, velcro fastenings and shoe aids.
Needs either – i. prompting to dress, undress or determine appropriate circumstances for remaining clothed; or ii. assistance or prompting to select appropriate clothing. 2
For example: may apply to individuals who need to be encouraged to dress. Includes a consideration of whether the individual can determine what is appropriate for the environment, such as time of day and the weather.
Needs assistance to dress or undress lower body.
Needs assistance to dress or undress upper body.
3
4
D
E
F Cannot dress or undress at all. 8
6.3 Comment
Some confusion - does someone struggling with buttons fastenings score 2 points for needing adapted clothing or 4 for needing assistance? Potential to score half points needed from this one activity. What about medical fittings - e.g. lymphoedema sleeves/ surgical corsets - are they clothes scoring high points or medical support? (low scoring).
7.1 DWP Guidance:
This activity considers an individual’s ability with regard to expressive (conveying) communication, receptive (understanding) communication and accessing written information.
Notes:
•
This activity considers the capability to convey information and understand other people in the person’s native language.
•
Communication support means support from another person trained to communicate with people with specific communication needs (for example, a sign language interpreter) or someone directly experienced in communicating with the individual themselves (for example, a family member).
•
Basic communication is conveying or understanding basic information, for example a basic need such as asking for help with an activity of daily living or understanding a simple safety instruction.
A
•
Complex communication is conveying or understanding complex information which is any communication that is more complicated than conveying a basic need.
7.2 The descriptors
Can communicate unaided and access written information unaided, or using spectacles or contact lenses. 0
B Needs to use an aid or appliance other than spectacles or contact lenses to access written information. 2
For example: may apply to individuals who require low vision aids.
C Needs to use an aid or appliance to express or understand verbal communication.
2
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Personal Independence Payment NAWRA Mar 2012
D
For example: may apply to individuals who require voice aids such as a voice synthesiser
Needs assistance to access written information.
For example: may apply to individuals who require another person to read the information to them.
4
Needs communication support to express or understand complex verbal information.
For example: may apply to individuals who require a sign language interpreter. 4
E
F Needs communication support to express or understand basic verbal information. 8
For example: may apply to individuals require a sign language interpreter.
G Cannot communicate at all. 12
7.3 Comment:
Is this just related to sensory impairment or learning difficulty? Or is there scope for caselaw to develop around confusion, memory, motivation e.g. in mental health or due to side effects of medication?
8.1 DWP Guidance:
This activity considers an individual’s ability to engage socially, which means to interact with others in a contextually and socially appropriate manner, understand body language and establish relationships.
A
B
C
Notes:
• An inability to engage socially must be due to the impact of impairment and not simply a matter of preference by the individual.
• Social support means support from a person trained or experienced in assisting people to engage in social situations, who can compensate for limited ability to understand and respond to body language, other social cues and assist social integration.
• For descriptor (d) (i), there must be evidence of an enduring mental health condition, intellectual impairment or cognitive impairment. There must be evidence that overwhelming distress has/would occur, not just that it might.
8.2 The descriptors:
D
Can engage socially unaided.
Needs prompting to engage socially.
For example: may apply to people who need encouragement to interact with others by the presence of a third party.
0
Needs social support to engage socially.
For example: may apply to people who are only able to interact with others by the
4 presence of a third party.
Cannot engage socially due to such engagement causing either – i. overwhelming psychological distress to the individual; or
2 ii. the individual to exhibit uncontrollable episodes of behaviour which would result in a substantial risk of harm to the individual or another person. 8
8.3 Comment:
T his seems to narrow the Fairey/Halliday widening of scope for help with social activities e.g. hobbies at home / social/community activities down to psychological support only
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Personal Independence Payment NAWRA Mar 2012
9.1 DWP Guidance
This activity considers the ability of an individual to make financial decisions.
Notes:
•
Complex financial decisions are those that are involved in calculating household and personal budgets, managing and paying bills and planning future purchases.
•
Simple financial decisions are those that are involved in activities such as calculating the cost of goods and change required following purchases.
9.2 The descriptors
A Can manage complex financial decisions unaided. 0
B Needs prompting to make complex financial decisions.
For example: may apply to individuals who need to be encouraged or reminded to
2 make complex financial decisions.
C
D
Needs prompting to make simple financial decisions. 4
For example: may apply to individuals who need to be encouraged or reminded to make simple financial decisions
Cannot make any financial decisions at all.
9.3 Comment:
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A new area compared to DLA which shies away from activities such as shopping, except in relation to help with a bodily function e.g. helping a blind person to shop for themselves as help with seeing. Particular scope for e.g. slowness or reliability for a number of limiting illnesses e.g. depression, effects of cancer treatment
General comment:
Only two activities which reflect current DLA Lower and Higher Mobility criteria but with the possibility that some on DLA Lower Mob could get more and some on DLA Higher Mob will get less, along with the possibility of combining difficulties from both. Individual descriptors score more than in Daily Living activities, but no go faster stripes for 15 points!
10.1 DWP Guidance:
This activity considers an individual’s ability to work out and follow a route.
Notes:
• A person should only be considered able to journey to an unfamiliar destination if they are capable of using public transport (bus or train).
• For those descriptors which refer to overwhelming psychological distress, there must be evidence of an enduring mental health condition, intellectual impairment or cognitive impairment. There must be evidence that overwhelming distress has/would occur, not just that it might.
• Safety and reliability are particularly important considerations here if there would be a substantial risk to the individual or others if they went out alone.
10.2 The descriptors
A Can plan and follow a journey unaided. 0
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Personal Independence Payment NAWRA Mar 2012
D
B Needs prompting for all journeys to avoid overwhelming psychological distress to the individual. 4
For example: may apply to individuals who are only able to leave the home when accompanied by another person.
C Needs either – i. supervision, prompting or a support dog to follow a journey to an unfamiliar destination; or ii. a journey to an unfamiliar destination to have been entirely planned by another person.
Cannot follow any journey because it would cause overwhelming psychological distress to the individual.
For example: may apply to individuals who are unable to leave the home at all
8
10
E Needs either – i. supervision, prompting or a support dog to follow a journey to a familiar destination; or ii. a journey to a familiar destination to have been planned entirely by another person. 15
10.3 Comment:
You may recognise this as reflecting current criteria for DLA Lower Mobility. It is suggested that this is really only about mental, cognitive and sensory impairment so it may be difficult for those with physical walking abilities to pick up many points here. It brings in the ability to use public transport so it’s not just walking from A to B
It is now possible for people with DLA Lower Mobility type needs to access the enhanced rate of DLA if for example they need support even in familiar places. The scoring for overwhelming psychological distress (in B and D) seems rather out of kilter with points for supervision and prompting, so you may want to pursue claims based on C and E, unless there is some intention to only allow people with mental health issues to score under B and D which would point to a very discriminatory approach.
11.1 DWP Guidance:
This activity considers an individual’s physical ability to move around. This includes ability to transfer unaided between two seated positions, to move up to 50 metres, up to 200 metres and over 200 metres.
Notes:
•
This activity should be judged in relation to a type of surface normally expected out of doors such as pavements and roads on the flat and includes the consideration of kerbs.
•
50 metres is considered to be the distance that an individual is required to be able to walk in order to achieve a basic level of independence such as the ability to get from a car park to the supermarket.
•
50 to 200 metres is considered to be the distance that an individual is required to be able to walk in order to achieve a higher level of independence such as the ability to get around a small supermarket.
•
Aids or appliances that a person uses to support their physical mobility may include walking sticks, crutches and prostheses but do not include manual wheelchairs or any motorised device.
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•
As with all activities, the person must be able to perform the activity safely and in a timely fashion - however, for this activity this only refers to the actual act of moving.
For example, danger awareness (such as traffic) is considered as part of activity 10.
11.2 The descriptors:
A Can move at least 200 metres either: i. unaided; or ii. using an aid or appliance, other than a wheelchair or a motorised device. 0
B Can move at least 50 metres but not more than 200 metres either – i. unaided; or ii. using an aid or appliance, other than a wheelchair or a motorised device 4
C Can move up to 50 metres unaided but no further. 8
For example: identifies individuals who can move up to 50 metres unaided but then require a wheelchair for anything further.
D Cannot move up to 50 metres without using an aid or appliance, other than a wheelchair or a motorised device. metres but then require a wheelchair for anything further
E Cannot move up to 50 metres without using a wheelchair propelled by the individual
10
For example: identifies individuals who can use an aid or appliance to move up to 50
12
F Cannot move up to 50 metres without using a wheelchair propelled by another person or a motorised device. 15
G Cannot either – i. move around at all; or ii. transfer unaided from one seated position to another adjacent seated position 15
11.3 Comment:
The focus here is distance people can walk with no specific reference to time, speed and manner of walking or ability to walk without severe discomfort. However there is the clear general guidance running throughout PIP concerning the ability to do a task - in this case walking- reasonably, regularly, safely and in a timely fashion. to bring these factors back in.
Clearly though virtual inability to walk is tightening up
• someone for whom B applies could currently get DLAHigher Mobility if there were additional other factors, but again it may be possible to argue a case for C
• C is the current typical distance for many current DLA Higher Mobility claims. A pass here will secure 8 points, but this in itself will only secure standard PIP Mobility, which is likely to be less than Higher Mobility and possibly insufficient for Motability cars. They will pass but only with the 8 points for standard rate PIP Mobility.
• It is really only those who have to use a wheel chair within 50 metres or who are unable to walk at all who score the 12 points for enhanced PIP Mobility?
It is not easy to generalise on winners (yes there may be some!) and losers, when looking at how the new points system would impact on current DLA claimants. But some initial general observations:
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Personal Independence Payment NAWRA Mar 2012 a) Care v. Daily Living
• the equality between verbal help and physical help is lost - where these are distinguished in descriptors verbal help tends to score less
•
The cooking test will not in itself create entitlement to any PIP - so claimants who were getting DLA Lower Care will need to evidence other difficulties to reach 8 points.
Some will be unable to do so and lose benefit, while others may see an increase from
DLA Lower Car to PIP Standard Daily Living.
• Some specific areas of difficulty (e.g. washing and grooming) have a bigger impact on the PIP score than they currently play in establishing the pattern of care needs for DLA
Care - more key proxies for disability rather than the personalised asessment of individual patterns of need that DLA is capable of
• Some activities can be the main reason for a pattern of frequent attention throughout the day (e.g. toilet, and diet). These won’t score the full 8 points in themselves.
• There is very little scope for claims only on supervision grounds - see the DWP case studies in the Jan 2012 consultation document b) Mobility
• It is possible to add scores from the two areas, but it is likely that the Planning and following a journey activity will be restricted to mental, cognitive and sensory impairment, rather than physical factors restricting the journey
• Current recipients of DLA Lower Mobility could go up to enhanced PIP Mobility (if for example they have difficulties even in familiar places)
• However many more DLA Higher Mobility “virtually unable to walk” claimants may just make the 8 points but see their payment fall to standard rate, which is likely to be lower than DLA Higher Mobility and so end the option of Motability cars for many.
• Benefits simplification cannot be argued - PIP brings its own cost, complexity and confusion, while DLA will be retained for children and AA for those over working age, and possibly some interesting better off calculations for people at pension age
• Still subjective A very different test, using an ESA style points system is claimed to bring objectivity and consistency to PIP decisions, but the experience of ESA suggests there will be huge subjectivity in the application of these criteria and a failure to fully apply the guidance which could help address the realities of living with a disability
• DLA can do personalised asessments: DLA may look messy to the tidy administrative eye with limited statute law and regulations, but the wealth of caselaw means that this has now matured into a benefit that can help a DM or Tribunal to apply reasonableness and common sense to the particular circumstances of a claimant.
•
PIP probably cannot: assessments may discount severe disabling effects that do not fit into the descriptors and unlike ESA has no saving provision to allow benefit in exceptional circumstances, where although insufficient points are scored it is obvious to all that a person has in the case of ESA, limited capability.
• Medical “snap shot” assessments for everyone are problematic: expensive to run -£600 million, poor at dealing with less immediately apparent or less clear cut disabling effects and poor at considering variability, fatigue, repeatability of tasks. It also means dragging people through an assessment process that my be unnecessary, distressing or difficult to attend.
•
Other evidence from claimants, carers or professionals can be far more informative for a proper assessment and far cheaper to obtain. There is little evidence that DLA claims without EMP reports are prone to exaggeration or fraud.
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•
Reasonable requirement? The reasonable requirement for attention and supervision is enshrouded in DLA case law. PIP does have an important principle in the guidance that the ability to perform descriptors must be to to do so reliably, repeatedly,safely and in a timely fashion. As with ESA, the danger is this may be forgotten in the assessments, in rubber stamping by Decision Makers and so only really be considered at appeal.
a) How much will PIP be?
PIP then is not DLA with Lower Care chopped off. The amounts for standard and enhanced rates - or even indicative levels - have not yet been announced, but:
•
There is a general policy trend to focus more resources on the most disabled - this could well mean a larger gap between standard and enhanced rates, than say between
Middle and Higher Care - see for example the two tiers proposed within Universal
Credit.
•
The two lower rates of DLA are lined up, but that may be seen as too low for standard
Mobility.
•
The desire to harmonise and align rates across the system may take over. This could mean similar rates in each component (especially as enhanced PIP Mobility would be for the few) perhaps masking effects of a standard rate that might be less for the many on DLA Middle Care or DLA Higher Mobility. It could mean rates lined up with the two tiers in Universal Credit.
But the reality is we just don’t know yet and Government may be reluctant to put figures on it until the last moment for fear of the reactions. b) Knock on effects under Universal Credit
At present, these can be worth as much as or more than the DLA itself to those on the lowest incomes. But it seems that the poorest are targeted for extra cuts under Universal Credit:
• No disability elements for adults: There are no disability elements for working age adults within Universal Credit - only elements for “limited capability for work” and
“limited capability for work related activity” for those assessed under the Work
Capability Assessment. Earlier policy briefings spoke of disability elements aligned to these rates but it seems as if someone has read this as just having the “limited capability element”.
• Amounts: The rates for these elements will be around current WRAC rates (c. £32) and
- eventually - a new enhanced Support Component (c. £73)
• Children will retain child disability element (linked to receipt of any rate of DLA) and severe disability element (linked to DLA Higher Care), but the amounts will change significantly as they will be alined to adult “limited capability” elements so that the main disability element will fall to ESA WRAC rates while children with severe disabilities may see a small increase.
• Sickness v disability benefits: While some DLA/PIP claimants will also claim ESA and so would access the ‘limited capability for work” elements under UC, many do not.
They may be in full time work, actively seeking work or otherwise busy as lone parents or carers. they may not need a sickness benefit to replace lost earnings, but they do
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Personal Independence Payment NAWRA Mar 2012 need the disability benefits to help with extra costs and the vital top-ups of disability related premiums/elements which can be worth £100 a week.
•
A double assessment? Will they now have to go through a WCA just to access the elements? Would they necessarily pass it anyway? And what of a disabled worker possibly in a full time work needing to prove that they may have even “limited capability for work related activity” ?
Stepping back from the complexities of the new proposals - both on PIP and Universal Credit
- the Government’s case for change is largely based on assertions and raising myths about the current situation around DLA:
• Myth 1: DLA is out of control - budgets have grown ahead of inflation increases and claimant numbers have grow. But this may largely be due to the success of DLA in helping with significant legal, social and economic changes for people with disabilities: the moves out of expensive institutional care to community care, encouragement and support of personal independence including a move into paid work where possible.
DLA is a vital resource to give effect to legal rights of equality and a more general social acceptance of people’s rights to participate in society. Fraud and error estimates for DLA are very low, while the DWP’s own research suggests significant under claiming remains a problem.
• Myth 2: That DLA is not subject to robust assessment: Decision Makers can use their own judgement as to how much supporting evidence they require. This includes DWP medical assessment in 53 % of cases, but DMs are not required to waste resources where they feel that other evidence is sufficient - or often more reliable - to safely make an award.
•
Myth 3: DLA awards are made for life and not reviewed: Most DLA awards are for limited periods and must be renewed and re-assessed. Even indefinite awards - where medical opinion and common sense suggest improvement is unlikely - are subject to a periodic review process
•
Myth 4: DWP medical assessments are more robust and objective: the experience of
IB or ESA since 1995 suggests otherwise. Significant subjectivity creeps in especially for conditions which are less obvious on a “snapshot” examination or are medically controversial/ misunderstood. Hard pressed health professionals or Decision Makers may forget to adequately consider whether people can perform tasks “reliably, repeatedly, safely and in a timely fashion”. There is a reason why 40% of ESA disallowances based mainly on these tests are overturned at appeal.
•
Myth 5: A points based system is more objective and standardised: such a “Napoleonic code” system is certainly tidier to look at than messy “common law” approach of DLA where case law has informed the boundaries of discretion and principles of reasonableness and common sense. DWP Pilots of a similar Activities for Managing
Life points system in 2002/4 concluded little real advantage in such a system as regards consistency and objectivity and considerable increased administrative costs, better spent on improvements to DLA decision making.
• Myth 6 The range of descriptors in PIP covers wider scope than DLA. There may be a lot of descriptors, but the effect of the PIP proposal is to narrow down consideration to what is on the - however thoughtfully compiled - list; and to exclude possibly significant disabling effects that are not. DLA forms focus on main areas, but if
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Personal Independence Payment NAWRA Mar 2012 appropriate other effects can be introduced (subject to establishing a link to attention and supervision criteria)
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Myth 7 PIP gives a more personal assessment: Being forced through a production line process and to have an individual face to face asessment may feel personal but that is not the same as a better or more personalised asessment of individual difficulties (see above!)
• Myth 8 PIP will better targets help on those who need it most: Significant numbers of severely ill/disabled with e.g supervision needs or severely limited walking ability may well lose out under PIP, while those on the lowest incomes, including children will be targetted for cuts under Universal Credit.
• Myth 9 DLA can mean people get double provision for their needs from benefit and other help: Practical support from social services and the NHS is under huge pressure.
Where available it covers very different things - some Home Care, a grant for adaptions rather than help with additional daily living costs. Adaptions are already taken into account under DLA while the benefit can be vital part of the funding for Home Care and supported living or to make up for services such as home helps that are being withdrawn.
• Myth 10 DLA cannot support people into work: It can and it does.There is more that could be done to tackle barriers of perception amongst claimants and some of the barriers put up by DWP procedures to making DLA an effective welfare to work benefit for those than can. PIP does nothing in itself to address this, while confusion remains on how Universal Credit wil deal with disabled workers.
• Myth 11 DLA is incapable of reform: DLA is by no means perfect and is capable of improvement to better meet its objectives of promoting independence. It does however provide a far better starting point than one built on the failed arbitrary medical models of Activities for Managing Life, ESA and IB points systems.
PIP - taken together withUniversal Credit - by contrast merely offers additional cost, complexity and confusion, and is unlikely to yield any improvements in consistency and correctness in benefits. These were all reasons for not adopting a points system after the
AML pilots. However it may be that these same properties are seen as useful when the main aim is to mange a 20% cut in budget and get 500,000 people off benefit.
NAWRA believes that a flexible and mature benefit such as DLA, that has been tested over time through case law, offers a better basis for reform and improvement than adopting an outdated, discredited, hugely expensive to administer and inflexible PIP.
There are certainly of course ways in which DLA could more effectively support those living with disabilities;
• better communication of DLA’s “welfare to work” potential and removal of perverse systemic barriers within other benefits and DWP processes
• a genuinely flexible Mobility Component could allow those with greater needs for monitoring and guidance to access the higher rate and those with significant mobilising difficulties - but not quite severe enough for Higher rate to access the Lower Rate..
• make DLA better able to deal with periods of significant disabling effects and recovery during treatment (e.g after a cancer diagnosis, a stroke) by adopting a similar passporting provision as operates under ESA.
• positive action to tackle the significant problems of under claiming of DLA
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Personal Independence Payment NAWRA Mar 2012
• simplify the benefits system and end age discrimination by having a single disability benefit for all claimants rather than the three different ones that will obtain after PIP.
• to reduce the number of mistaken decisions subsequently overturned at appeal by
“getting it right first time”, through: better forms, better training and guidance, use of specialist Decision Makers in complex cases and allowing DMs to seek appropriate medical evidence and apply skilled judgements to all the evidence before them.
• reduced income and higher costs means that long term limiting illness and disability create major risks of poverty according to DWP research. The positive impact of DLA is sharpened by related additions in means tested benefit. There is scope to simplify these but no justification for doing away with them altogether.
• In particular these benefits are vital to support carers. Benefits for carers could be simplified considerably as part of a fairer settlement that recognises the huge contribution - and savings - carers make. But there is no justification for singling out carers with health problems or disabilities for particular cuts in Universal Credit.
Such changes might help DLA to better achieve its core purpose of supporting personal independence, saving costs from institutional/residential care,reducing poverty, supporting work where possible and reaching people that need it most.
We accept that these are unlikely to help with a 20% cut, but NAWRA questions:
• whether targeting cuts at the disabled in general and the sick and disabled poorest in particular - especially children, carers and those in and seeking work - makes any sense in moral or policy terms
• even if moral compasses can be sufficiently reset, whether these benefit cuts would actually yield any net savings.
Cuts to disability and related benefits will come at a cost elsewhere: the breakdown of many supported living arrangements and as a result increased/ earlier/ more frequent needs for expensive hospital or residential care or other social services support. Civil society - big or otherwise - offers huge amounts of practical, family and community support, but DLA and related benefits provide a vital resource to such social support networks.
These are difficult financial times indeed. But aside from what it says about our priorities as a society, NAWRA believes cuts in disability and related benefits will not yield the savings anticipated. There will be significant costs elsewhere in the system , while the costs to peoples’ independence, peace of mind and health will be incalculable. PIP is based on a failed outdated model, while a modernised and more effective DLA could significantly contribute to making the Government’s “Big Society” ideal a reality.
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