A guide to the Personal Independence Payment

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Personal

Independence Payment NAWRA Mar 2012







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A guide to the Personal Independence Payment


About this guide

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
specif
ic 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 g
uide and feed into consultation responses and campaigning activity.


A. The structure of PIP



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 f
orm 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
un
less 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.



DLA will be retained for children and AA for those of pension age
-

not simplification!



Governme
nt aim is to cut spending by 20%/ focus help on the most severely disabled
while having a more robust and consistent assessment framework



PIP, like DLA, will have two components: Mobility (replacing DLA Mobility) and
Daily Living (replacing DLA Care).



It r
emains 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 a
nd 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 highe
st 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 S
tandard 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 E
nhanced rate

-

where someone has ‘
severely limited

ability’
to carry out daily living/mobility activities

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There are no provisions for PI
P related premiums/ elements in current plans for
Universal Credit, so a major cut for people with disabilities on the lowest incomes.

DWP information



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 50
0,000 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
-
draft
-
assessment
-
criteria
-
note.pdf




For the draft regs see:
www.
dwp.gov.uk/docs/pip
-
second
-
draft
-
assessment
-
regulations.pdf



B. General DWP Guidance on PIP

Variable and fluctuating condition

Descriptor choice should be based on consideration of a 12 month period, where their
impairment(s) affects their ability to com
plete 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 desc
riptor 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 fash
ion, 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 suppor
t 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
mea
ns 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 su
bsequently 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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occur due to impairments is insufficient


there has to be evidence that if the activity
was undertaken, the adverse event is likely to oc
cur.

Aids and appliance
s

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 devic
es 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 someon
e 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 in
dividuals 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 individual
s 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 an
d 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 p
art 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.


C: Daily Living Activities


1. Preparing foo
d and drink

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 requi
red. 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:



Preparing food means the activities required to make food ready for cooking and
eating, such as pee
ling and chopping.



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 me
al 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

Can prepare and cook a simple meal unaided.





0

B

Needs to use an aid or appliance to either prepare or cook a simple meal.


2

C

Cannot cook a simple meal using a conventional cooker but can do so using a

m
icrowave.









2


For example: may apply to individuals who cannot safely use a cooker hob and hot

pans.


D

Needs prompting to either prepare or cook a simple meal.



2


For example: may apply to individuals who lack motivation, who need to be remind
ed

how to prepare and cook food or who are unable to ascertain if food is within date.

E

Needs supervision to either prepare or cook a simple meal.



4


For example: may apply to individuals who need supervision to prepare and

cannot safely use a microw
ave oven
.





F

Needs assistance to either prepare or cook a simple meal.




4

For example: may apply to individuals who cannot prepare food because of

reduced manual dexterity; or who cannot safely heat food


G

Cannot prepare and cook food and drink at a
ll





8


1.3 Comment

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 com
plete inability to prepare food and
drink at all will not secure benefit by itself, so points will be needed elsewhere.



2. Taking nutrition

2.1 DWP Guidance

This activity considers an individual’s ability to be nourished, either by cutting food into
pi
eces, 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 descriptor
s:

A

Can take nutrition unaided.







0

B

Needs either


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i. to use an aid or appliance to take nutrition; or

ii.assistance to cut up food.






2

C

Needs a therapeutic source to take nutrition.





2

For example: may apply to individuals who require enter
al or parenteral feeding but
can do so unaided.







D

Needs prompting to take nutrition.






4

F
or example: may apply to individuals who need to be reminded to eat.


E

Needs assistance to manage a therapeutic source to take nutrition.


6

For exa
mple: 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 sometim
es 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. Managing therapy or monitoring a health conditio
n

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 deterior
ate.

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.



M
onitoring 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 requir
ing
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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ii. Can manage medication, therapy and monitor a health condition unaided, or with
the use of an aid or appliance.







0

B

Needs supervision,

prompting or assistance to manage medication or monitor a health
condition.









1

C

Needs supervision, prompting or assistance to manage therapy that takes up to 3.5
hours a week.









2


D

Needs supervision, prompting or assistance to manage thera
py that takes between


3.5 and 7 hours a week.








4


E

Needs supervision, prompting or assistance to manage therapy that takes between


7 and 14 hours a week.








6

F

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) a
nd 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 hosp
ital for appointments and treatments which can be important
parts of a DLA claim



4. Bathing and grooming

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/b
rush 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

Can bathe and groom unaided.







0

B

Needs to use an aid

or appliance to groom.





1

For example: suitable aids could include modified hair brushes, combs and

mirrors.

C

Needs prompting to groom.







1


For example: may apply to individuals who lack motivation or need to be reminded to
groom

D

Needs assis
tance to groom.







2


For example: may apply to individuals who are unable to make use of aids.





E

Needs supervision or prompting to bathe.





2

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For example: may apply to individuals who need to be reminded to bathe or require
supervision for saf
ety

F

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.






G

Needs
assistance to bathe.







4

H

Cannot bathe and groom at all.







8


4.3 Comment:

Note that ‘bathe’ does not mean ‘bath’
-

the ability to wash is considered suffice.


5. Managing toilet needs or incontinence

5.1 DWP Guidance:

This activity considers an i
ndividual’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.

Notes:



Toilet needs means the ability to get on and off the toilet and clean oneself afterw
ards.



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
pu
rposes 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, b
ottom
wipers or bidets.

C

Needs prompting to manage toilet needs.





2


For example: may apply to individuals who need to be reminded to go to the toilet.

D

Needs assistance to manage toilet needs.






4

E

Needs assistance to manage incontinence of eith
er bladder or bowel.


6

F

Needs assistance to manage incontinence of both bladder and bowel.


8

G

Cannot manage incontinence at all.






8


5.3 Comment

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. Dressing and undressing

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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6.2 The descriptors:

A

Can dress and undress unaided







0

B

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.

C

Needs either


i. prompting to dress, undress or determine approp
riate 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 i
s appropriate for the
environment, such as time of day and the weather.

D

Needs assistance to dress or undress lower body.





3

E

Needs assistance to dress or undress upper body.





4

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 corset
s
-

are
they clothes scoring high points or medical support? (low scoring).


7. Communicating

7.1 DWP Guidance:

This activity considers an individual’s ability with regard to expressive (conveying)
communication, receptive (understanding) communication an
d 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 wit
h 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, f
or example a
basic need such as asking for help with an activity of daily living or understanding a
simple safety instruction.



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


A

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 info
rmation.








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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For example: may apply to individuals who require voice aids such as a voi
ce
synthesiser


D

Needs assistance to access written information.





4

For example: may apply to individuals who require another person to read the
information to them.







E

Needs communication support to express or understand complex verbal informatio
n.


For example: may apply to individuals who require a sign language interpreter.

4

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. Engag
ing socially

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.

Notes:



An inabil
ity 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:

A

Can engage socially unaided.







0

B

Needs prompting to engage socially.






2


For example: may apply to people who need encouragement to inter
act with

others by the presence of a third party.





C

Needs social support to engage socially.






4


For example: may apply to people who are only able to interact with others by the
presence of a third party.

D

Cannot engage socially due to such eng
agement causing either


i. overwhelming psychological distress to the individual; or

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



9. Making financial decisions

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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 tho
se 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.




2


For example: may apply to individuals who need to be encouraged or reminded to

make complex financial decisions.





C

Needs prompting to make simple financial decisions.




4


For example: may apply to individuals who need to be encouraged or reminded t
o

make simple financial decisions


D

Cannot make any financial decisions at all.





6

9.3 Comment:

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 per
son 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


D. Mobility Activities

General comment:

Only two activities which reflect cur
rent 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. Planning and following a journey

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 j
ourney 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 impairme
nt 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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B

Needs prompting for all journeys to avoid overwhelming psychological distress to

the individual.









4


For example: may apply to individuals who are only a
ble 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

a
nother person.









8

D

Cannot follow any journey because it would cause overwhelming


psychological distress to the individual.






10


For example: may apply to individuals who are unable to leave the home at all

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) s
eems 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 discri
minatory approach.


11. Moving around

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 ac
hieve 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 o
r 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 con
sidered 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 metr
es 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.






1
0


For example: identifies individuals who can use an aid or appliance to move up to 50

metr
es but then require a wheelchair for anything furthe
r

E

Cannot move up to 50 metres without using a wheelchair propelled by the

individual









12

F

Cannot move up to 50 metres without using a wheelchair propelled by another

person or a motorise
d device.







15


G

Cannot either



i. move around at all; or


ii. transfer unaided from one seated position to another adjacent seated position

15


1
1.3 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 w
ill 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?



E. Comments and comparisons


E.1. The PIP points system compared to DLA


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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a) Care v. Dail
y 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 C
are 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) h
ave 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 activit
ies 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 th
e 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 fa
ctors 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.

E.2.

PIP

structure and assessment process compared to DLA



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 te
st, 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 c
ould 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 ben
efit 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 s
aving 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:
expens
ive 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 unnece
ssary, 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 exag
geration 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, re
peatedly,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.



E. 3. Amounts for PIP and “knock on” effects under UC


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
-

th
is
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 stan
dard
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 t
he 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 disabilit
y 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 Assessm
ent. 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)
an
d
-

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 wil
l 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 clai
m 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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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 the
y 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” ?



E.5. Is there a case for abolishing DLA?


Stepping back from the complexiti
es 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 i
ncreases 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, encoura
gement 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 erro
r 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 assessmen
ts 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. Har
d 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 over
turned 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
principl
es 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,
bet
ter 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 thoughtf
ully compiled
-

list; and to exclude
possibly significant disabling effects that are not. DLA forms focus on main areas, but
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if appropriate other effects can be introduced (subject to establishing a link to attention
and supervision criteria)



Myth 7 PIP g
ives 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!)



M
yth 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
wil
l 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 a
nd 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.



PI
P
-

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 aft
er 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.

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Appendix 1: NAWRA condemns Government attacks
on personal independence



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 certain
ly 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 clai
ming of DLA



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 befo
re 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 s
implify
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
-

an
d 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 so
cial 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, p
eace of mind and health will be incalculable. PIP is based on a failed
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outdated model, while a modernised and more effective DLA could significantly contribute to
making the Government’s “Big Society” ideal a reality.