Personal Independence Payment (PIP) - A Guide on how to complete the Medical Assessment Form.

Personal Independence

Payment (PIP)

- A Guide on how to complete the

Medical Assessment Form.

(See also the companion guide Personal

Independence Payment (PIP) A Guide to the

Rules)

An information factsheet produced by the Welfare Rights

(Mental Health) and Assertive Inreach Teams.

Leicestershire Partnership

NHS

April

2013

Completing the Medical Assessment Form

This form asks for details on how your illness or health problems affect your everyday care, supervision and mobility needs. It is important to describe the help that you actually need, rather than the help you receive. You may find that you are repeating yourself in different sections. This is fine, it is better to put in too much information than miss out any details on how the condition affects you.

Many of the questions may not be relevant to you. Remember the same form is used for all health conditions, however you may still be awarded PIP even where only a few pages are relevant to your condition.

At the end of this guide (see Appendix One) you will find the point scoring for each category that is used.

Remember you need to score 8-11 points for the standard rate and 12 or more points for the enhanced rate from questions 3-12 to get the Daily Living Component; and you need to score 8-11 points for the standard rate and 12 or more points for the enhanced rate from questions 13 and 14 to get the Mobility Component.

It is important to try and give answers to the questions, or examples of the help you require, which demonstrate how you meet the descriptors and therefore score certain points. The descriptors are not on the claim form but see Appendix One for a copy of them and the points attached to each descriptor.

How to decide which point scoring applies to your condition

• If one descriptor applies for at least 50% of the time that will apply

• If two or more descriptors apply for at least 50% of the time then the descriptor with the highest point score applies

• Where no descriptor is satisfied for 50% of the time BUT two or more apply and when they are added together they apply for more than 50% of the time then you will score for the descriptor that applies on the greatest proportion of time OR where they apply for the same proportion of time the one that scores highest will apply The test looks at whether you can do the activities in a “safely”, to an “acceptable standard”, “repeatedly” and within a “reasonable time period”. (See Appendix Two for a definition of terms used in PIP)

For each section we have tried to put statements or questions which act as a prompt to help you complete the form as successfully as possible.

Question 1 - Please tell us who are the professionals best placed to advise us on your circumstances

This gives space for up to three people who are involved with your care. This could be a support worker, Community Psychiatric Nurse (CPN), social worker, GP, Consultant Psychiatrist etc. If you have a number of people who know you it may be best to list them in the order of who knows most about your condition. The DWP may write to them for more information so make sure they are aware of how your condition affects you on a daily basis and what you can and cannot do because of your condition.

Question 2 - About your health conditions or disabilities

Any award of Personal Independence Payments will be based on your health problems and how these affect you. If you have been given a diagnosis by your doctor or consultant write this in here. If there is no specific diagnosis you can simply write mental health problems in this box. If there are physical health problems do not forget to give details of these. List all your medication and tablets and where possible how much and how often they are taken, you can attach a repeat prescription form if you have a spare one. Also list any other treatment or support you receive, e.g. seeing someone from the Community Mental Health Services on a regular basis or counselling and therapy.

Question 3 – Preparing Food (Activity 1)

3a – Do you use an aid or appliance to prepare or cook a simple meal?

Aids and appliances could include needing easy grip handles, lever arm taps, electric tin opener, a perching stool to sit on when cooking.

3b Do you need help from another person to prepare or cook a simple meal?

Do you need help in preparing a cooked meal? This does not mean you have

to prepare or cook the meal it is to find out, if given the ingredients and

equipment you would be able to prepare a healthy meal from fresh

ingredients. It considers things such as can you open packages, serve food,

peel and chop. Cooking in this test means using an oven, or hob or

microwave, but it does not consider issues around bending down for example

to get food out of an oven.

Examples of difficulties you may have:

Explain the help you need to prepare and cook a meal. Do you need

motivation and encouragement to begin the cooking process? Do you need

supervision to ensure your safety and security? Are you more likely to cook if

there is someone there to remind you? Are you able to work out sell-by dates

or read or understand cooking instructions? Give any examples of incidents or

occasions where accidents have happened because of your mental health

problems.

Question 4 Eating and Drinking (Activity 2)

Much of this section may not be applicable, but consider whether there are times when you need reminding or prompting to eat or drink.

4a - Do you use an aid or appliance to eat and drink?

4b - Do you use a feeding tube or similar device to eat or drink? 4c – Do you need help from another person to eat and drink?

Do you have problems at mealtimes? Do you only eat junk food/snacks? Do

you need to be encouraged, reminded or told to eat? If you have an eating

disorder you will need to explain how this affects you on a daily basis.

Examples of difficulties you may have:

• I feel so low I cannot start to cook

• I can only manage convenience things

• I cannot concentrate to get everything ready at the same time

• I cannot concentrate to follow a recipe

• I am easily confused or distracted and may leave pots and pans boil away

• I let things burn/burn myself

• I may forget what I am doing and start to do something else

• I forget to check the “sell by” date on food

• I suffer panic/anxiety attacks that stop me from cooking

• I worry that I will poison myself if food is not cooked properly

• My medication makes me sleepy/forgetful • My medication makes me shaky/unsteady

• I have little or no appetite

• I need encouragement to eat regularly

• I have an eating disorder

• I do not eat for days

• I think people are trying to poison me

• I have certain rituals concerning meals

• I do not have mealtimes

• I feel too depressed/tired/lethargic to eat

• I binge on food then make myself sick

• I take diuretics/laxatives after eating

• I constantly think about food and the effect it has on me

• I want to harm myself/I feel disgusted/depressed after eating

• I get upset by the mess – I want to clean up before I have eaten

• I get too anxious/excited to eat

Question 5 - Managing Treatments (Activity 3)

5a – Do you use an aid or appliance to monitor your health conditions, take medication or manage home treatments?

Aids and appliances could include a dosset box to put your medication in.

5b Do you need help from another person to monitor your health conditions, take medication or manage home treatments?

Taking the correct medication at the right time can often be crucial in ensuring

people’s conditions do not deteriorate and making sure that they do not need

to come into hospital. It is useful to explain if there have been times when you

have forgotten to take your medication, or have taken too much either

accidentally or deliberately, or if you self harm.

Examples of difficulties you may have:

Question 6 – Washing and Bathing (Activity 4)

6a – Do you use an aid or appliance to wash and bathe yourself, including using a bath or shower?

Aids or appliances could include bath seats, grab rails, or shower seats.

6b – Do you need help from another person to wash and bathe?

Do you have problems with washing and bathing and generally taking care of

your personal hygiene? These issues can be due to poor or lack of motivation

to deal with personal care or to stop any repetitive compulsive behaviour.

Examples of difficulties you may have:

• I forget if I have taken my medication

• I refuse to take my medication

• I am unaware when my condition deteriorates

• I have to have depot injections

• I over medicate myself

• If I do not take my medication my behaviour changes dramatically

• My medication makes me feel tired/lethargic/confused/disorientated

• My medication causes involuntary movements

• I have deliberately taken an overdose

• I feel better if I stop taking my medication

• I need someone to supervise my medication due to the risk of overdosing or self harm

• I need motivation/encouragement to get

washed/bathe/shower/shave/clean my teeth

• I forget to wash/bathe

• I hate (certain parts of) my body

• I do not wear /cannot get rid of tampons/towels

• I lack self esteem

• I am to low to care about my personal hygiene

• I feel the need to wash/bathe/shower very often

• I have to do things a certain way and a certain number of times

• I scrub my skin red raw/until it is sore

• My medication makes me sweat so I have to wash more often

• I need supervision in case I have fit or lose consciousness in the bath

Question 7 – Managing Toilet Needs (Activity 5)

7a – Do you use an aid or appliance to go to the toilet or manage incontinence

Aids or appliances could include commodes, raised toilet seats or incontinence pads.

7b – Do you need help from another person to go to the toilet or manage incontinence?

This section is often not relevant for people with mental health problems and

is more likely if people have problems such as incontinence. However, think if

you are sometimes so anxious that you may have had an accident, or if your

medication makes you so sleepy that you haven’t woken up and experienced

problems. Other issues could be where people don’t use the toilet properly

due to self-neglect or incomplete self-awareness.

Question 8 Dressing and Undressing (Activity 6)

8a – Do you use an aid or appliance to dress or undress?

Aids or appliances could include shoe horns, modified clothing e.g. front fastening bras, velcro fastenings etc

8b – Do you need help from another person to dress or undress?

Do you have problems getting dressed or undressed? Do you need motivation

or encouragement to get dressed/undressed? Do you need help choosing

appropriate clothing?

Examples of difficulties you may have:

• I forget to put on clean clothes

• I go to bed in my clothes

• I sit around all day in my nightclothes

• I lack motivation/am too low to get dressed

• I see no point in getting dressed

• I have difficulty choosing what to wear

• I wear inappropriate clothes

• I have to dress/undress in a certain way

• I find it too much of an effort to get dressed

• I lack self esteem

• I do not care what I look like

Question 9 – Communicating (Activity 7)

This activity looks at the ability to communicate in the persons own language it is not a test of the ability to speak English.

9a - Do you use an aid or appliance to communicate with others?

This could be a hearing aid.

9b – Do you need help from another person to communicate with others?

Do you need help from another person to help you communicate with other

people? This is more likely to apply to people who have problems such as

deafness and need help with sign language. But you may need help to

express or understand complicated material.

Question 10 – Reading (Activity 8)

10 a – Do you use an aid or appliance other than spectacles or contact lenses to read signs, symbols and words?

Aids and appliances here could include magnifying glasses but does not include normal glasses or contact lenses.

10b – Do you need help from another person to read or understand signs, symbols and words?

This activity looks at your ability to read and understand signs, symbols and words. For many people this section may not be relevant, but think about whether there are ever times when you are too ill to understand things and need support from another person to understand letters etc

Question 11 – Mixing with other People (Activity 9)

11a Do you need another person to help you mix with other people?

11b – Do you find it difficult to mix with other people because of severe anxiety or distress?

This looks at your ability to have contact with other people, not just people you

know well but also strangers. Try to explain the difficulties you experience and

any anxiety or stress these situations cause you, or if you avoid social

situations. Engaging in this means in a socially appropriate manner including

understanding body language and being able to establish relationships.

Examples of difficulties you may have:

Question 12 - Making Decisions about Money (Activity 10)

12a - Do you need someone else to help you understand how much things cost when you buy them or how much change you’ll receive?

12b – Do you need someone else to help you to manage your household budgets, pay bills or plan future purchases?

This looks at the ability to make everyday budgeting decisions including managing and paying bills, working out your household budget, and planning future purchases.

Examples of difficulties you may have:

• I am scared of meeting new people

• I have paranoid thoughts about other people

• The voices I hear make it difficult to concentrate on what people are saying to me

• I find it very difficult to trust anyone I don’t know well

• I get scared about meeting new people

• I get easily confused when talking to people I don’t know

• When I am stressed I can behave in a way that other people find strange, cannot understand, or upsetting

• I can appear aggressive towards other people

• I tend to become very withdrawn and don’t want to talk to people

• I can suffer panic attacks when meeting new people

• I get easily intimidated by people

• If I feel threatened or unsafe I can become verbally or physically aggressive towards others

• I wouldn’t go to appointments unless a family member or friend came with me

• I suffer from a Personality Disorder which makes it difficult for me to form any meaningful relationship with people and leads to trust issues.

• I do not manage my money and find I am always short at the end of the week

• I have lots of debts as I have not been able to manage my money

• I rely on my support worker to arrange my bill payments

• I lack the motivation to deal with letters and correspondence about money

• I am impulsive about what I spend my money and don’t plan to pay my essential bills

• When in manic phases I spend money and don’t realise what I am doing

• I get confused in shops about paying for things and how much change I need

• I bury my head in the sand about money

• I do not know what my income or outgoings are

Question 13 – Going Out (Activity 1)

This is an important section. If you only complete this section in the whole

pack this may lead to an entitlement to the Mobility Component.

13a – Do you need help from another person to plan a route to

somewhere you know well? Or do you need another person, guide dog

or specialist aid to help you get there?

13b - Do you need help from another person, guide dog or specialist aid

to get to a location that is unfamiliar to you?

13c – Are you unable to get out because of severe anxiety or distress?

In this page you need to describe the problems that you have with walking in

places that are unfamiliar. The person may be able to go to lots of places near

their home, like the post office or shops, but how would they cope if they had

to go to somewhere like Birmingham and get about without someone’s help or

assistance.

Examples of difficulties you may have:

Leaving the House

Coping with being Outdoors

Describe in your own words the help you need whether it is someone to make

sure you or members of the public are kept safe or that you need

encouragement to go outdoors. Explain if you need someone to keep you

calm if you feel anxious, panicky or aggressive. You may need help if you

become lost, confused or distracted.

You may also wish to add examples of particular dangerous or distressing

situations you have found yourself in as a result of you mental health

problems. Explain if you are unable to use public transport, such as a bus or

train, due to stress or anxiety.

• I have to be encouraged to go

• I feel too tired and lethargic to leave the house

• I worry for days if I know I have to go somewhere

• I get panicky/anxious before I go

• I do not sleep the night before

• I feel/I am sick beforehand

• I have to prepare myself/things in a certain order

• If I do it wrong I have to start again

• I have to check and recheck things

• I get panic/anxiety attacks

• I get breathless/tearful/angry/ill

• I am not safe

• I hear voices/have disruptive thoughts that effect my concentration

• I think people are looking/talking about/laughing at me

• I have shouted at people

• I have to get to a place of safety

• I have to have company

• I get confused/disorientated in unfamiliar places

Question 14 – Moving Around (Activity 2)

These questions only apply if you have physical problems with walking.

Question 15 – Additional Information

Use this box to include any information that you have not been able to include

anywhere else on the form and you think will be relevant. Detail any hospital

admissions and times that you have been taken to hospital for your own

safety. If you have had any other treatments that you have not been able to

include may be added. If there are any particular incidents or situations that

demonstrate the problems you have, then write about them here.

There may be groups or organisations that give you help and support not in

connection with particular activities that might have a bearing on your claim.

They may talk to you, listen to you and encourage you. If you did not have this

support your condition may deteriorate and you may put your well being in

danger or have to be admitted to hospital. Give as much information about the

support you receive and what would happen without it.

You can also send in additional supporting evidence with the completed form,

such as care plans, information or letters from health professionals or support

workers. Before you do this though think about whether these really help to

support your case, if they have not be written specifically with a PIP claim in

mind the evidence may not give a full picture about how your condition affects

you.

What Happens Next

You may be asked to attend a medical as part of the application process. Capita the company who undertakes the assessment have said they will deal with the majority of these assessments in the person’s own home. If you are required to attend elsewhere and need any special help to attend a medical assessment explain your difficulties here. If you

physically need someone to accompany you, if you need help to use stairs or if you cannot go alone because you suffer panic/anxiety attacks or you suffer intrusive paranoid thoughts and do not feel safe on your own you need to explain this here. You may not be able to use public transport because of the above reasons.

Declaration

You will need to sign the form. The declaration states that you understand and will comply with the rules. You should sign and date the form and return it to the DWP in the envelope provided.

You have one month from the date the form was sent to you to return it. If you cannot return it in time then contact the DWP to explain why, e.g. because you need help and your support worker can’t see you before a certain date, and ask them to extend the time limit. If you state that you have a mental health condition you will usually be given an extra two weeks to return the form.

It is a good idea if possible to keep a copy of the form and any supporting evidence you send in with it.

Appendix One: Daily Living and Mobility Activities

and Descriptors

The entitlement thresholds (pass mark) for the rates and

components of the PIP are:

Daily Living component (activities 1 to 10)

Standard rate: 8-11 points

Enhanced rate: 12 points or more

Mobility component (activities 11 to12)

Standard rate: 8-11 points

Enhanced rate: 12 points or more

Daily living activities and descriptors

Activity 1 - Preparing Food Score

a. Can prepare and cook a simple meal unaided 0 b. Needs to use an aid or appliance to be able to either

prepare or cook a simple meal 2 c. Cannot cook a simple meal using a conventional cooker but is able to do so using a microwave 2 d. Needs prompting to be able to either prepare or cook a

simple meal 2

e. Needs supervision or assistance to either prepare or cook a

simple meal 4

f. Cannot prepare and cook food 8

Activity 2 – Taking Nutrition Score

a. Can take nutrition unaided 0 b. Needs either (i) to use an aid or appliance to be able to

take nutrition; or

(ii) supervision to be able to take nutrition; or (iii) assistance to be able to cut up food

2

c. Needs a therapeutic source to be able to take nutrition 2 d. Needs prompting to be able to take nutrition 4 e. Needs assistance to be able to manage a therapeutic

source to take nutrition 6 f. Cannot convey food and drink to their mouth and needs

Activity 3 – Managing Therapy or Monitoring a Health

Condition Score

a. Either (i) does not receive medication or therapy or need to monitor a health condition; or (ii) can manage medication or therapy or monitor a health condition unaided

0 b. Needs either (i) to use an aid or appliance to be able to

manage medication; or (ii) supervision, prompting or assistance to be able to manage medication or monitor a health condition

1

c. Needs supervision, prompting or assistance to be able to

manage therapy that takes no more than 3.5 hours a week 2 d. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week

4 e. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 7 but no more than 14 hours a week

6 f. Needs supervision, prompting or assistance to be able to

manage therapy that takes more than 14 hours a week 8

Activity 4 – Washing and Bathing Score

a. Can wash and bathe unaided 0 b. Needs to use an aid or appliance to be able to wash or

bathe 2

c. Needs supervision or prompting to be able to wash or

bathe 2

d. Needs assistance to be able to wash either their hair or

body below the waist 2

e. Needs assistance to be able to get in or out of a bath or

shower 3

f. Needs assistance to be able to wash their body between

the shoulders and waist 4 g. Cannot wash and bathe at all and needs another person to wash their entire body 8

Activity 5 – Managing Toilet Needs or Incontinence Score

a. Can manage toilet needs or incontinence unaided 0 b. Needs to use an aid or appliance to be able to manage

toilet needs or incontinence 2 c. Needs supervision or prompting to be able to manage toilet

needs 2

d. Needs assistance to be able to manage toilet needs 4 e. Needs assistance to be able to manage incontinence of

either bladder or bowel 6 f. Needs assistance to be able to manage incontinence of both

Activity 6 – Dressing and Undressing Score

a. Can dress and undress unaided 0 b. Needs to use an aid or appliance to be able to dress or

undress 2

c. Needs either (i) prompting to be able to dress, undress or determine appropriate circumstances for remaining clothed; or (ii) prompting or assistance to be able to select

appropriate clothing

2

d. Needs assistance to be able to dress or undress their lower

body 2

e. Needs assistance to be able to dress or undress their upper

body 4

f. Cannot dress or undress at all 8

Activity 7 – Communicating Verbally Score

a. Can express and understand verbal information unaided 0 b. Needs to use an aid or appliance to be able to speak or

hear 2

c. Needs communication support to be able to express or

understand complex verbal information 4 d. Needs communication support to be able to express or

understand basic verbal information 8 e. Cannot express or understand verbal information at all

even with communication support 12

Activity 8 – Reading and Understanding Signs, Symbols

and Words Score

a. Can read and understand basic and complex written information either unaided or using spectacles or contact lenses

0 b. Needs to use an aid or appliance, other than spectacles or contact lenses, to be able to read or understand either basic or complex written information

2 c. Needs prompting to be able to read or understand complex

written information 2

d. Needs prompting to be able to read or understand basic

written information 4

e. Cannot read or understand signs, symbols or words at all 8

Activity 9 – Engaging with People Face to Face Score

a. Can engage with other people unaided 0 b. Needs prompting to be able to engage with other people 2 c. Needs social support to be able to engage with other

people 4

d. Cannot engage with other people due to such engagement causing either (i) overwhelming psychological distress to the claimant; or (ii) the claimant to exhibit behaviour which would result in a substantial risk of harm to the claimant or another person

Activity 10 – Making Budgeting Decisions Score

a. Can manage complex budgeting decisions unaided 0 b. Needs prompting or assistance to be able to make complex

budgeting decisions 2

c. Needs prompting or assistance to be able to make simple

budgeting decisions 4

d. Cannot make any budgeting decisions at all 6

Mobility activities and descriptors

Activity 1 – Planning and Following Journeys Score

a. Can plan and follow the route of a journey unaided 0 b. Needs prompting to be able to undertake any journey to

avoid overwhelming psychological distress to the claimant 4 c. Cannot plan the route of a journey 8 d. Cannot follow the route of an unfamiliar journey without

another person, assistance dog or orientation aid 10 e. Cannot undertake any journey because it would cause

overwhelming psychological distress to the claimant 10 f. Cannot follow the route of a familiar journey without

another person, an assistance dog or an orientation aid 12

Activity 2 – Moving Around Score

a. Can stand and then move more than 200 metres, either

aided or unaided 0

b. Can stand and then move more than 50 metres but no

more than 200 metres, either aided or unaided 4 c. Can stand and then move unaided more than 20 metres

but no more than 50 metres 8 d. Can stand and then move using an aid or appliance more

than 20 metres but no more than 50 metres 10 e. Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided 12 f. Cannot, either aided or unaided, (i) stand; or (ii) move

Appendix Two – Definitions of Terms

The definitions below are from the PIP Regulations and may assist to explain some of the terms used in assessing PIP.

Acceptable standard – means that you may be able to actually complete

the activity, but not to a good standard. For example, where someone can wash themselves but does not realise they have done so badly and are still not clean after they have finished

Assistance – means physical assistance by another person

Cook – means heating food at or above waist height (i.e. not bending

down to use a low oven)

Prompting – means reminding, encouraging or explaining by another

person

Psychological distress – means distress related to an enduring mental

health problem or an intellectual or cognitive impairment

Repeatedly – means being able to repeat the activity as often as is

required. Consideration should be given to the collective effects of

symptoms such as pain and fatigue. For example, if the effort it takes for you to complete a task then makes you tired and/or in pain so much so that you would not be able to do it again or take on another activity, you should not say you can do the activity repeatedly. For example, if you are able to prepare a meal unaided, but the exhaustion caused to you by doing this would mean that you could not prepare another meal that day, you should be treated as being unable to prepare a meal unaided.

Reasonable time period – means no more than twice as long as the

maximum period that a person without a physical or mental health condition would normally take to complete that activity

Safely – means in a manner unlikely to cause harm to you or to another

person, either during or after completion of the activity

Simple meal – means a cooked one-course meal for one person using

fresh ingredients

Supervision – means the continuous presence of another person for the

Appendix Three – Useful Addresses and Telephone

Numbers

PIP Telephone Claim Line: 0800 917 2222 (Textphone: 0800 917 7777)

Open Mon-Fri 8am-6pm PIP Postal Address:

FREEPOST RTBS-CBYC-SCZS

DWP Personal Independence Payment (4) Warbreck House

Blackpool FY2 0UZ

Appendix Four – Where can I get more information?

If you are a mental health service user or carer or a member of staff working

in mental health, advice and information is available from the:-

Benefit Advice Support Line

on 0116 2256222 Tuesday – Friday 9.30-12.30am.

For people living in the City, information and advice is available from the:-

Benefits Campaign

on 0116 2543399 Monday – Wednesday 1.00-4.00pm.

There are a number of other advice agencies within Leicester. Please see the

link below for an Advice Services Guide:

http://www.leicester.gov.uk/your-council-services/housing/housing-and-council-tax-benefits/big-benefit-changes/

If you have any comments or suggestions on this factsheet then please send them to:-

Senior Welfare Rights Officer Brandon Mental Health Unit Leicester General Hospital Gwendolen Road

Leicester LE5 4PW

WARNING

The information in this guide is as accurate as possible at the time of production. However, it is only a guide, and therefore cannot be completely accurate and cover every possible situation.

We recommend that you always seek advice from a competent person in cases of doubt.