NI PIP Handbook - Assessment criteria

Within each activity there are a number of descriptors, each representing a varying level of ability to carry out the activity.

Individuals will receive a point score for each activity, depending on how well they can carry them out and the help they need to do so.

The total scores will determine whether a component is payable, and if so, whether at the standard or enhanced rate. The entitlement threshold for each component is eight points for the standard rate and 12 points for enhanced.

The activities

There are a total of 12 activities:

Daily Living activities:

1. Preparing food unaided
2. Eating and drinking / taking nutrition
3. Managing therapy or monitoring a health condition
4. Washing and bathing
5. Managing toilet needs or incontinence
6. Dressing and undressing unaided or with use of aids/appliances
7. Talking, Listening and Understanding
8. Reading and understanding signs, symbols, and words
9. Mixing with other people
10. Managing money

Mobility activities:

11. Going out
12. Moving around

Guidance on applying the criteria

As the assessment will consider a claimant’s ability to carry out the activities, inability to carry out activities must be due to the effects of a health condition or disability and not simply a matter of preference by the claimant.

Health conditions or disabilities may be physical, sensory, mental, intellectual or cognitive, or any combination of these.

The impact of all impairment types can be taken into account across the activities, where they affect a claimant’s ability to complete the activity and achieve the stated outcome.

For example, a claimant with a severe depressive illness may physically be able to prepare food and feed himself, but may lack the motivation to do so, to the extent of needing prompting from another person to carry out the task.

However, some activities focus on specific elements of function. For example, moving around relates to the physical aspects of walking, whilst mixing with other people relates to the mental, cognitive or intellectual aspects of interacting with other people.

As the assessment principles consider the impact of a claimant’s condition on their ability to live independently and not the condition itself, claimants with the same condition may get different outcomes. The outcome is based on an independent assessment and all available evidence.

Evidence may come from a variety of sources including:

• the form – ‘How your disability affects you’
• a factual report from the claimant’s General Practitioner
• evidence from other healthcare professionals involved in the claimant’s care
• any other evidence from other professionals involved in supporting the claimant, for example social worker or support worker
• the claimant can ask for their assessment to be recorded
• the claimant can request a copy of their assessment report. Some assessments are face to face and some are by phone.
• information about Help and Support with PIP is available

Sometimes we can make a decision by using just the written information a claimant has given us, but some people may be asked to attend a meeting with a Health Professional.

The most appropriate descriptor for each activity will be selected, based on the assessment and any available evidence.

Regular reviews will take place during the lifecycle of a PIP award to ensure that the award still meets the claimant’s support needs.

Reliability

For a descriptor to apply to a claimant they must be able to reliably complete the activity as described in the descriptor. Reliably means whether they can do so:

• safely – in a manner unlikely to cause harm to themselves or to another person, either during or after completion of the activity
• to an acceptable standard
• repeatedly – as often as is reasonably required, and
• in a reasonable time period – no more than twice as long as the maximum period that a non-disabled person would normally take to complete that activity
• We recognise that the reliability criteria are a key protection for claimants. Also, as a result of feedback received during the consultation on the PIP ‘moving around’ criteria (held between 24 June and 5 August 2013), measures are in place to ensure the reliability criteria are properly and consistently applied as part of the assessment

Time periods, fluctuations, and descriptor choices

The impact of most health conditions and disabilities can fluctuate. Taking a view of ability over a longer period of time helps to iron out fluctuations and presents a more coherent picture of disabling effects. The descriptor choice should be based on consideration of a 12-month period. This should correlate with the Qualifying Period and Prospective Test for the benefit – so in the three months before the assessment and in the nine months after.

A scoring descriptor can apply to claimants in an activity where their impairment(s) affect(s) their ability to complete an activity, at some stage of the day, on more than 50% of days in the 12-month period. The following rules apply:

• if one descriptor in an activity is likely to apply on more than 50% of the days in the 12-month period – the activity can be completed in the way described on more than 50% of days – then that descriptor should be chosen.
• if more than one descriptor in an activity is likely to apply on more than 50% of the days in the period, then the descriptor chosen should be the one that is the highest scoring. For example, if D is worth four points and applies on 100% of days, whilst E is worth six points and applies on 70% of days, then E is selected.
• where one single descriptor in an activity is likely to not be satisfied on more than 50% of days, but a number of different scoring descriptors in that activity together are likely to be satisfied on more than 50% of days, the descriptor likely to be satisfied for the highest proportion of the time should be selected. For example, if B applies on 20% of days, D on 30% of days and E on 5% of days, D is selected.

If someone is awaiting treatment or further intervention, it can be difficult to accurately predict its level of success or whether it will even occur. Descriptor choices should therefore be based on the likely continuing impact of the health condition or disability as if any treatment or further intervention has not occurred.

The timing of the activity should be considered, and whether the claimant can carry out the activity when they need to do it. For example, if taking medication in the morning (such as painkillers) allows the individual to carry out activities reliably when they need to throughout the day, although they would be unable to carry out the activity for part of the day (before they take the painkillers), the individual can still complete the activity reliably when required and therefore should receive the appropriate descriptor.

Risk and safety

When considering whether an activity can be carried out safely it is important to consider both the likelihood of the harm occurring and the severity of the consequences.

For example, an activity could be deemed unsafe if the harm caused would be very severe, even though the likelihood of the harm occurring is low

If the harm caused would be less severe, then the likelihood of that harm occurring would need to be higher for the activity to be deemed unsafe.

Support from other people

The assessment takes into account where claimants 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 various types of support:

• supervision is a need for the continuous presence of another person to ensure the claimant’s safety to avoid harm occurring to the claimant or another person. We will consider the likelihood of the harm occurring and the severity of the harm were it to occur in the absence of such supervision. For example, an activity without supervision could be deemed unsafe if the harm caused would be very severe, even though the likelihood of the harm occurring is low. If the harm caused would be less severe, then the likelihood of that harm occurring would need to be higher for the activity to be deemed unsafe without supervision. To apply, supervision must be required for the full duration of the activity.
• prompting is support provided by another person by reminding or encouraging a claimant to carry out or complete a task, or explaining it to them, but not physically helping them. To apply, this only needs to be required for part of the activity.
• assistance is support that requires the presence and physical intervention of another person to help the claimant complete the activity - including doing some but not all of the activity in question. To apply, assistance only needs to be required for part of the activity.

A number of descriptors also refer to another person being required to complete the activity in its entirety. These descriptors would apply where the claimant is unable to reliably carry out any of the activity for themselves, even with help.

Activities 7 Talking, Listening and Understanding) and 9 (mixing with other people) refer to communication support and social support.

The assessment does not look at the availability of help from another person but rather at the underlying need. As such claimants may be awarded descriptors for needing help even if it is not currently available to them – for example, if they currently manage in a way that is not reliable, but could do so with some help.

Aids and appliances

The assessment takes into account where individuals need aids and appliances to complete activities. In this context:

• aids are devices that help a performance of a function, for example, walking sticks or magnifying glasses.
• appliances are devices that provide or replace a missing function, for example artificial limbs, collecting devices (stomas) and wheelchairs.

The 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.

This may include mainstream items used by people without an impairment, where the claimant is completely reliant on them to complete the activity. For example, this would include an electric can-opener where the claimant could not open a can without one, not simply where they prefer to use one.

Activity 11 (going out) refers specifically to ‘orientation aids’, which are defined as specialist aids designed to assist disabled people in following a route.

Claimants 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.

When considering whether it is reasonable to expect a claimant to use an aid or appliance that they do not usually use, the health professional will consider whether:

• the claimant possesses the aid or appliance.
• the aid or appliance is widely available.
• the aid or appliance is available at no or low cost.
• it is medically reasonable for them to use an aid or appliance.
• the claimant was given specific medical advice about managing their condition, and it is reasonable for them to continue following that advice.
• the claimant would be advised to use an aid or appliance if they sought advice from a professional such as a General Practitioner or occupational therapist.
• the claimant is able to use and store the aid or appliance.
• the claimant is unable to use an aid or appliance due to their physical or mental health condition – for example, they are unable to use a walking stick or manual wheelchair due to a cardiac, respiratory, upper body or mental health condition.

Assistance dogs

We recognise that guide, hearing and dual sensory dogs are not ‘aids’ but have attempted to ensure that the descriptors capture the additional barriers and costs of needing such a dog where they are required to enable claimants to follow a route safely. Activity 11 (going out) therefore explicitly refers to the use of an ‘assistance dog’. Assistance dogs are defined as dogs trained to help people with sensory impairments.

‘Unaided’

Within the assessment criteria, the ability to perform an activity ‘unaided’ means without the use of aids or appliances and without help from another person.

Moving around

Activity 12 (moving around) considers a claimant’s physical ability to move around without severe discomfort such as breathlessness, pain or fatigue. This includes the ability to stand and then move up to 20 metres, up to 50 metres, up to 200 metres and over 200 metres.

This activity should be judged in relation to a type of surface normally expected out of doors such as pavements and includes the consideration of kerbs.

Standing means to stand upright with at least one biological foot on the ground with or without suitable aids and appliances (note – a prosthesis is considered an appliance so a claimant with a unilateral prosthetic leg may be able to stand whereas a bilateral lower limb amputee would be unable to stand under this definition).